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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 24  |  Issue : 3  |  Page : 178-181

Progestogen-only injectable contraceptive: Acceptor prevalence and client experience at Sagamu, Nigeria


1 Department of Obstetrics and Gynecology, Babcock University, Sagamu, Ogun, Nigeria
2 Department of Obstetrics and Gynecology, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun, Nigeria

Date of Web Publication30-Oct-2017

Correspondence Address:
Adebayo Adekunle Akadri
Department of Obstetrics and Gynaecology, Babcock University, Ilishan-Remo, Ogun
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/npmj.npmj_99_17

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  Abstract 

Context: Progestogen-only injectable contraceptive is a long-lasting contraceptive given at interval of two or 3 months. It is effective, safe and convenient. Menstrual irregularity is a recognised side effect. Aims: This study aims to determine the acceptor prevalence and clinical experience of women using progestogen-only injectable contraceptive at Olabisi Onabanjo University Teaching Hospital, Sagamu. Methods: This was a retrospective study of new acceptors of progestogen-only injectable contraceptives between 1 January, 2010, and 31 December, 2014. Relevant information was retrieved from the family planning clinic records using a purpose-designed data capture sheet. Data analysis was done using IBM-SPSS windows version 21. Results: Out of a total of 623 new acceptors of contraceptives during the study period, 162 opted for progestogen-only injectable contraceptives giving an acceptor prevalence of 26%. The mean age of new acceptors was 32.69 ± 5.94 years. Majority 108 (66.7%) used depot medroxyprogesterone acetate. Child spacing was the most common indication for use. Ninety-seven clients (59.9%) had not used any previous contraceptive method. Menstrual irregularity was the most common side effect, occurring in 73 (45.1%) of the clients. Continuation rate after the fifth dose was 27.1%. No pregnancy complication was reported. Conclusions: Acceptor prevalence and continuation rate of progestogen-only injectable contraceptive are low. There is need for more enlightenment campaigns to encourage women to use this effective method of contraception.

Keywords: Acceptor prevalence, continuation rate, injectable contraceptive, side effects


How to cite this article:
Akadri AA, Odelola OI. Progestogen-only injectable contraceptive: Acceptor prevalence and client experience at Sagamu, Nigeria. Niger Postgrad Med J 2017;24:178-81

How to cite this URL:
Akadri AA, Odelola OI. Progestogen-only injectable contraceptive: Acceptor prevalence and client experience at Sagamu, Nigeria. Niger Postgrad Med J [serial online] 2017 [cited 2019 Jul 18];24:178-81. Available from: http://www.npmj.org/text.asp?2017/24/3/178/217408


  Introduction Top


Contraception is the intentional prevention of conception or impregnation through the use of various devices, agents, drugs, sexual practices or surgical procedures.[1] About 50% of all couples in the world are now using modern methods of contraception.[2],[3] In Nigeria, the contraceptive prevalence rate among women in the reproductive age group is 15%.[4] About 16 million women worldwide rely on injectable steroids for contraception making it the third most prevalent form of reversible contraception worldwide.[3],[5]

Progestogen-only injectable contraceptives are long-acting contraceptives that provide protection for 2 months (norethisterone enanthate) or 3 months (depot medroxyprogesterone acetate). They are usually administered by intramuscular injections, and the effective doses are 200 mg for norethisterone enanthate and 150 mg for depot medroxyprogesterone acetate. Progestogens act primarily by inhibition of gonadotrophin secretion thereby inhibiting follicular maturation and ovulation. They also thicken cervical mucus thus preventing ascent of spermatozoa into the uterine cavity. Progesterone causes morphological changes in the endometrium leading to endometrial atrophy thus rendering implantation of fertilised ovum difficult.[6] Progestogen-only injectable contraceptives have an advantage of drastically reducing the compliance difficulties encountered with daily use of oral contraceptives and coital-dependent barrier methods such as condoms and spermicides.[5] They are also useful in lactating mothers since they do not affect the quality, quantity and composition of breast milk. Injectable contraceptives offer women a convenient, safe, reversible and effective birth control method with failure rates ranging from 0.1 to 2/100 woman-years.[5],[7]

The common side effects associated with use of progesterone-only contraceptives are menstrual disorders including secondary amenorrhoea, irregular vaginal bleeding, menorrhagia and metrorrhagia.[2],[8],[9] Episodes of unpredictable, irregular vaginal bleeding are common during the first few months of use. With increasing duration of use, the frequency and duration of these episodes decrease. Other reported complications include accidental pregnancies, weight changes, decreased libido, abdominal and chest pains.[2],[10],[11] Less reported side effects are psychological and vasomotor disturbances. The return of fertility following use of progestogen-only injectable contraceptives may be delayed although they do not have any permanent impact on endocrine function.[12] About half of women who discontinue depot medroxyprogesterone acetate to become pregnant will conceive within 10 months of the last injection. In a small proportion of women, however, fertility is not re-established until 18 months after the last injection.[12] Although progestogen-only injectable contraceptives are highly effective, some adverse effects associated with them may be unacceptable to the some women and thus result in discontinuation.[5],[8],[13] It is therefore imperative to assess the pattern of use of progestogen-only injectable contraceptive in our centre. The aim of this study is to determine the acceptor prevalence, side effects and the continuation rate of progestogen-only injectable contraceptive at Olabisi Onabanjo University Teaching Hospital, Sagamu.


  Methods Top


Olabisi Onabanjo University Teaching Hospital is a tertiary hospital located in Sagamu, a semi-urban town in Ogun State Southwestern Nigeria. This is a retrospective review of all new clients who had progestogen-only injectable contraceptive between 1 January, 2010, and 31 December, 2014. Relevant information was retrieved from the family planning clinic records using a purpose designed pro forma. The information extracted included age, parity, occupation, educational status, type of injectable contraceptive (medroxyprogesterone acetate or norethisterone enanthate), number of doses taken, side effects and previously used contraceptives. Data analysis was done using IBM-SPSS Statistics for Windows version 21.0 (Armonk, NY: IBM Corp). Categorical variables were summarised using frequencies and percentages while mean and standard deviation were used for continuous variables.


  Results Top


There were 623 new contraceptive acceptors at the institution family planning clinic during the period of review. Out of these, 162 had progestogen-only injectable contraceptive giving an acceptor prevalence of 26%. The acceptor prevalence of other contraceptive methods used by women in Olabisi Onabanjo University Teaching Hospital (OOUTH) during the study period is presented in [Table 1]. The sociodemographic characteristics of women who accepted progestogen-only injectable contraceptive are depicted in [Table 2]. The age of women ranged between 20 and 48 years with a mean of 32.69 ± 5.94 years. The modal age group was 30–39 years. The parity ranged between 1 and 7, majority 82 (50.6%) were within parity group of 3–4. Majority 133 (82.1%) were Christians, 28 (17.3%) were Muslims while there was only 1 (0.6%) client who engaged in traditional religion worship. The educational status of the study population revealed that 1 (0.6%) client did not have any formal education, 12 (7.4%) completed primary school, 84 (51.9%) completed secondary school while 65 (40.1%) had tertiary education. Sixty clients (37.0%) were traders while 54 (33.3%), 23 (14.2%) and 18 (11.1%) clients were civil servants, artisans and full-time homemakers, respectively. Majority 120 (74.1%) were of Yoruba ethnicity, 31 (19.1%) clients were Igbos and 11 (6.8%) were Hausas.
Table 1: Acceptor prevalence of various contraceptive methods

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Table 2: Sociodemographic characteristics of the clients

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Out of the 162 clients that had progestogen-only injectable contraceptive, 108 (66.7%) had depot medroxyprogesterone acetate while 54 (33.3%) had norethisterone enanthate. Majority 121 (74.6%) of the clients learnt of family planning services from OOUTH post-natal clinic, 12 (7.4%) clients learnt about the services through other clinics in the hospital, 21 (13.0%) clients were informed through the media houses, 4 (2.5%) were informed through religious houses and 4 (2.5%) were uncertain about their source of information about family planning. Majority 107 (66.1%) of the clients used the contraceptive method for child spacing, 48 (29.6%) for terminal contraception while 7 (4.3%) were uncertain. Ninety-seven (59.9%) of the clients had never used any form of contraceptives before present use of progestogen-only injectable contraceptive, 37 (22.8%) clients had previously used progestogen-only injectable contraceptives, 11 (6.8%) had used oral pills, 8 (4.9%) had used condoms and 9 (5.6%) had used intrauterine contraceptive device. The side effects associated with the use of progesterone-only contraceptives are depicted in [Table 3]. Seventy-nine clients (48.8%) had no complaint, 57 (35.2%) had amenorrhoea while 16 (9.9%) had other menstrual irregularities (such as hypomenorrhea, oligomenorrhoea and menstrual cycle irregularity) associated with the use of the method. [Table 4] shows the continuation rate of clients on progestogen-only injectable contraceptive. Out of 162 clients that took the 1st dose of the progestogen-only injectable contraceptive, 117 (72.2%) returned for 2nd dose, 89 (54.9%) returned for the 3rd dose, 62 (38.3%) returned for the 4th dose and 44 (27.1%) returned for the 5th doses. At the time of review, only 8 (6.8%) of the clients were still on regular follow-up.
Table 3: Side effects of progestogen-only injectable contraceptive

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Table 4: Client discontinuity rate of progestogen-only injectable contraceptive

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  Discussion Top


Progestogen-only injectable contraceptive is the second most frequently accepted contraceptive method among women attending the family planning unit in OOUTH. The acceptor prevalence of progestogen-only injectable contraceptive was 26% which is similar to reported prevalence values of 22.1% and 21.9% from studies done in Osogbo and Ilorin, respectively.[8],[9] Several factors may affect the contraceptive prevalence in any health facility. These include the range of methods available, clients' choice, clients' religious and cultural beliefs, spouse influence, bias of the health personnel, side effects of contraceptive method and perception of method effectiveness.[14],[15] A national survey had suggested that injectable contraceptives were the most popular and most commonly accepted contraceptive method among Nigerian women.[4] This could be attributed to the ease of administration, making it particularly popular in primary health care centres where majority of women attend. Intrauterine contraceptive devices (IUCDs) were however more popular than progestogen-only injectable contraceptives among Sagamu women. This is likely due to the long-term coverage of IUCDs (up to 5 years), unlike progestogen-only injectable contraceptives which require two- or three-monthly injections. The availability of more contraceptive options and skilled personnel in a tertiary hospital may also be responsible for the low acceptor prevalence of progestogen-only injectable contraceptive in this study, similar to findings in other tertiary centres.[8],[9] The clients preferred the three-monthly depot medroxyprogesterone acetate injections to the two-monthly norethisterone enanthate injections. This is also consistent with previous reports from Osogbo and Port Harcourt.[2],[8] The reduced frequency of clinic appointments associated with the use of depot medroxyprogesterone acetate is likely responsible for this preference.

Majority (54.3%) of the clients were within the age of 30–39 years which is consistent with findings from other studies done in the country.[8],[9] This could suggest the use of contraception in older Nigeria women who may be of higher parity. In this study, young women (i.e. age 20 years and below) did not use progestogen-only injectable contraceptive. Young women are generally not advised to use progestogen-only injectable contraceptives due to deleterious effect on bone mineral density which may lead to osteoporosis.[7] Such young women are also likely to be unmarried and would benefit more from barrier methods which protect against sexually transmitted infections in addition to their contraceptive effects. Most of the clients were multiparous; this is consistent with findings from a study done in Ilorin.[9]

The most common source of information about contraception was from health workers at the post-natal clinics. This is similar to findings from a previous study.[16] Sustained efforts geared towards encouraging hospital deliveries, and post-natal clinic attendance will likely increase the uptake of contraceptives by women. It can be inferred from this study that progestogen-only injectable contraceptive is particularly popular among multiparous women who use the method mainly for child spacing and terminal contraception. Approximately 30% of the clients accepted progestogen-only injectable contraceptive for terminal contraception. The strong fear and aversion for surgical procedure common in our environment discourage the acceptance of surgical contraception for terminal contraception. The delayed return to fertility associated with progestogen-only injectable contraceptive also makes this method acceptable for terminal contraception among our women.[17]

It is important to state that almost half of the clients had no side effects; this indicates good safety profile. Menstrual abnormality was the most common complication experienced by women in the study. This is in keeping with result from previous studies.[2],[18] Clients who accept injectable contraceptive are usually adequately counselled on this predominant side effect before and during the period of use. It is important to note that some menstrual abnormalities such as amenorrhoea, oligomenorrhoea and hypomenorrhea may be beneficial to some women especially those that require reduced menstrual flow and those with sickle cell anaemia. This study shows poor continuation rate of the contraceptive as only about a quarter of the clients received up to the fifth dose of the injectable contraceptive. Factors such as desire for conception, side effects or relocation from place of abode may have contributed to the poor continuation rate. There was no report of accidental pregnancy while on the method among women that came for follow-up. This supports previous reports of the effectiveness of the contraceptive method and its association with low failure rate.[2],[9]


  Conclusions Top


The acceptor prevalence of progestogen-only injectable contraceptive is low. Menstrual irregularity was the most common side effect. There is need for effective counselling and education of women about this contraceptive method so as to increase the acceptance and continuation rates. Further studies will be necessary to further elucidate the reasons for the poor continuation rate despite good safety profile of the contraceptive.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Adeyemi AS, Adekanle DA. Progestogen-only injectable contraceptive: Experience of women in Osogbo, Southwestern Nigeria. Ann Afr Med 2012;11:27-31.  Back to cited text no. 8
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Balogun OR, Raji HO. Clinical experience with injectable progesterone-only contraceptive at the university of Ilorin teaching hospital: A five year review. Niger Postgrad Med J 2009;16:260-3.  Back to cited text no. 9
    
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Emuveyan EE. Advances in contraception. In: Kwawukwume EY, Emuveyan EE, editors. Comprehensive Gynaecology in the Tropics. Accra: Graphic Packaging LTD; 2005. p. 233-40.  Back to cited text no. 10
    
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Chigbu B, Onwere S, Aluka C, Kamanu C, Okoro O, Feyi-Waboso P, et al. Contraceptive choices of women in rural Southeastern Nigeria. Niger J Clin Pract 2010;13:195-9.  Back to cited text no. 14
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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