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Tytuł:
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Continuation rates and reasons for discontinuation of intra-uterine device in three provinces of Pakistan: results of a 24-month prospective client follow-up.
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Autorzy:
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Hameed W; Marie Stopes Society, Research, Monitoring and Evaluation Department, Technical Services, Karachi, Sindh, Pakistan. .
Azmat SK; Marie Stopes Society, Research, Monitoring and Evaluation Department, Technical Services, Karachi, Sindh, Pakistan. .; Department of Urogynecology, University of Ghent, Ghent, Belgium. .
Ishaque M; Marie Stopes Society, Research, Monitoring and Evaluation Department, Technical Services, Karachi, Sindh, Pakistan. .
Hussain W; Marie Stopes Society, Research, Monitoring and Evaluation Department, Technical Services, Karachi, Sindh, Pakistan. .
Munroe E; Research, Monitoring and Evaluation Department, Marie Stopes International, London, UK. .
Mustafa G; Marie Stopes Society, Research, Monitoring and Evaluation Department, Technical Services, Karachi, Sindh, Pakistan. .
Khan OF; Marie Stopes Society, Research, Monitoring and Evaluation Department, Technical Services, Karachi, Sindh, Pakistan. .
Abbas G; Marie Stopes Society, Research, Monitoring and Evaluation Department, Technical Services, Karachi, Sindh, Pakistan. .
Ali S; Marie Stopes Society, Research, Monitoring and Evaluation Department, Technical Services, Karachi, Sindh, Pakistan. .
Asghar QJ; Marie Stopes Society, Research, Monitoring and Evaluation Department, Technical Services, Karachi, Sindh, Pakistan. .
Ali S; Marie Stopes Society, Research, Monitoring and Evaluation Department, Technical Services, Karachi, Sindh, Pakistan. .
Ahmed A; Marie Stopes Society, Research, Monitoring and Evaluation Department, Technical Services, Karachi, Sindh, Pakistan. .
Hamza HB; Freelance Public Health Consultant, Adelaide, Australia. .
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Źródło:
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Health research policy and systems [Health Res Policy Syst] 2015 Nov 25; Vol. 13 Suppl 1, pp. 53. Date of Electronic Publication: 2015 Nov 25.
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Typ publikacji:
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Comparative Study; Journal Article
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Język:
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English
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Imprint Name(s):
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Original Publication: [London] : BioMed Central, 2003-
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MeSH Terms:
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Contraception Behavior*
Family Planning Services*
Health Personnel*
Motivation*
Intrauterine Devices/*statistics & numerical data
Adolescent ; Adult ; Community Health Workers ; Female ; Follow-Up Studies ; Government Programs ; Humans ; Life Tables ; Pakistan ; Pregnancy ; Proportional Hazards Models ; Prospective Studies ; Young Adult
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References:
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PLoS One. 2013 Sep 12;8(9):e74260. (PMID: 24069287)
Eur J Epidemiol. 2004;19(8):751-60. (PMID: 15469032)
J Pak Med Assoc. 2013 Apr;63(4 Suppl 3):S21-6. (PMID: 24386726)
BMC Womens Health. 2012 Mar 29;12:8. (PMID: 22458444)
Obstet Gynecol. 2011 May;117(5):1105-13. (PMID: 21508749)
N Engl J Med. 2012 May 24;366(21):1998-2007. (PMID: 22621627)
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Entry Date(s):
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Date Created: 20160122 Date Completed: 20161019 Latest Revision: 20220330
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Update Code:
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20240104
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PubMed Central ID:
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PMC4895309
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DOI:
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10.1186/s12961-015-0040-9
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PMID:
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26792610
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Background: Long-acting reversible contraceptives, such as the intrauterine device (IUD), remain underutilised in Pakistan with high discontinuation rates. Based on a 24-month prospective client follow-up (nested within a larger quasi-experimental study), this paper presents the comparison of two intervention models, one using private mid-level providers branded as "Suraj" and the other using community midwives (CMWs) of Maternal Newborn and Child Health Programme, for method continuation among IUD users. Moreover, determinants of IUD continuation and the reasons for discontinuation, and switching behaviour were studied within each arm.
Methods: A total of 1,163 IUD users, 824 from Suraj and 339 from the CMW model, were enrolled in this 24-month prospective client follow-up. Participants were followed-up by female community mobilisers physically every second month to ascertain continued IUD usage and to collect information on associated factors, switching behaviour, reasons for discontinuation, and pregnancy occurrence. The probabilities of IUD continuation and the risk factors for discontinuation were estimated by life table analysis and Cox proportional-hazard techniques, respectively.
Results: The cumulative probabilities of IUD continuation at 24 months in Suraj and CMW models were 82% and 80%, respectively. The difference between the two intervention areas was not significant. The probability distributions of IUD continuation were also similar in both interventions (Log rank test: χ(2) = 0.06, df = 1, P = 0.81; Breslow test: χ(2) = 0.6, df = 1, P = 0.44). Health concerns (Suraj = 57.1%, CMW = 38.7%) and pregnancy desire (Suraj = 29.3%, CMW = 40.3%) were reported as the most prominent reasons for IUD discontinuation in both intervention arms. IUD discontinuation was significantly associated with place of residence in Suraj and with age (15-25 years) in the CMW model.
Conclusion: CMWs and private providers are equally capable of providing quality IUD services and ensuring higher method continuation. Pakistan's National Maternal Newborn and Child Health programme should consider training CMWs and providing IUDs through them. Moreover, private sector mid-level providers could be engaged in promoting the use of IUDs.
