ORIGINAL ARTICLE
Open Access

Factors Affecting Continued Use of Subcutaneous Depot Medroxyprogesterone Acetate (DMPA-SC): A Secondary Analysis of a 1-Year Randomized Trial in Malawi

Holly M. Burke, Mario Chen, Mercy Buluzi, Rachael Fuchs, Silver Wevill, Lalitha Venkatasubramanian, Leila Dal Santo and Bagrey Ngwira
Global Health: Science and Practice March 2019, 7(1):54-65; https://doi.org/10.9745/GHSP-D-18-00433

Figures & Tables

Tables

  • TABLE 1.

    Baseline Sociodemographic Characteristics of Participants, September 2015 to February 2017, Mangochi District, Malawi (N=731)

    CharacteristicValue
    Provider type at enrollment, No. (%)
    Clinic-based205 (28.0)
    Community health worker526 (72.0)
    Age group, years, No. (%)
    18–24264 (36.1)
    25–29238 (32.6)
    30–35184 (25.2)
    >3545 (6.2)
    Age, years, mean (SD)26.9 (5.2)
    Education, No. (%)
    No school/less than primary school545 (74.6)
    Completed primary school or higher185 (25.3)
    No response1 (0.1)
    Religion, No. (%)
    Christian310 (42.4)
    Muslim418 (57.2)
    None1 (0.1)
    No response2 (0.3)
    Married or has regular sexual partner, No. (%)
    Not married and no regular sexual partner25 (3.4)
    Married or regular sexual partner705 (96.4)
    No response1 (0.1)
    Husband/partner knows respondent receiving family planning today, among those with partner,a No. (%)
    No137 (20.1)
    Yes522 (76.8)
    Don't know13 (1.9)
    No response8 (1.2)
    Ever given birth, No. (%)
    No5 (0.7)
    Yes725 (99.2)
    No response1 (0.1)
    Number of living children, among those who gave birth, No. (%)
    Less than 3 living children321 (44.3)
    3 or more living children404 (55.7)
    Number of living children, among those who gave birth, mean (SD)3.0 (1.64)
    Would like to have a/another child, No. (%)
    No182 (24.9)
    Yes529 (72.4)
    Don't know17 (2.3)
    No response3 (0.4)
    Ever used contraception, No. (%)
    No47 (6.4)
    Yes679 (92.9)
    No response5 (0.7)
    Ever used injectables, among those who ever used contraception, No. (%)
    No21 (3.1)
    Yes657 (96.8)
    No response1 (0.1)

    • Abbreviations: No., number; SD, standard deviation.

    • ↵a This question purposefully excludes 25 women who were married but were not living with their husband and had no other regular sexual partner.

  • TABLE 2.

    Cumulative Probability of Continuation Among Self-Administered and Provider-Administered Clients, Stratified by Type of Provider at Enrollment

    MonthClinic-Based ProviderCommunity Health Worker
    Number at RiskProbability (95% CI)Number at RiskProbability (95% CI)
    Self-administered
    First quarter970.992671.00
    Second quarter960.88 (0.79, 0.93)2670.86 (0.81, 0.90)
    Third quarter830.81 (0.72, 0.88)2260.77 (0.71, 0.82)
    Fourth quarter760.79 (0.70, 0.86)2020.70 (0.64, 0.75)
    Provider-administered
    First quarter1081.002591.00
    Second quarter1080.69 (0.60, 0.77)2580.67 (0.61, 0.73)
    Third quarter740.58 (0.48, 0.67)1710.53 (0.47, 0.59)
    Fourth quarter590.48 (0.39, 0.57)1350.44 (0.38, 0.50)

    • Abbreviation: CI, confidence interval.

  • TABLE 3.

    Experience With Side Effects in Last 3 Months Among Self-Administered Participants, Stratified by Type of Provider at Enrollment, No. (%)

    3-Month Follow-Up6-Month Follow-Up9-Month Follow-Up
    CBPCHWOverallCBPCHWOverallCBPCHWOverall
    Experienced any side effects or problems over last 3 months?
    No74 (79.6)190 (72.5)264 (74.4)72 (84.7)197 (82.4)269 (83.0)68 (88.3)197 (86.0)265 (86.6)
    Yes19 (20.4)72 (27.5)91 (25.6)13 (15.3)42 (17.6)55 (17.0)9 (11.7)32 (14.0)41 (13.4)
    Type of side effects (among women reporting side effects)
    Irregular bleeding/spotting5 (26.3)14 (19.4)19 (20.9)1 (7.7)4 (9.5)5 (9.1)2 (22.2)5 (15.6)7 (17.1)
    Amenorrhea10 (52.6)22 (30.6)32 (35.2)7 (53.8)21 (50.0)28 (50.9)5 (55.6)19 (59.4)24 (58.5)
    Heavy bleeding3 (15.8)17 (23.6)20 (22.0)1 (7.7)3 (7.1)4 (7.3)0 (0.0)0 (0.0)0 (0.0)
    Weight gain1 (5.3)1 (1.4)2 (2.2)0 (0.0)4 (9.5)4 (7.3)0 (0.0)1 (3.1)1 (2.4)
    Weight loss1 (5.3)2 (2.8)3 (3.3)1 (7.7)2 (4.8)3 (5.5)0 (0.0)0 (0.0)0 (0.0)
    Backaches8 (42.1)19 (26.4)27 (29.7)3 (23.1)17 (40.5)20 (36.4)1 (11.1)15 (46.9)16 (39.0)
    Headaches8 (42.1)21 (29.2)29 (31.9)3 (23.1)14 (33.3)17 (30.9)3 (33.3)10 (31.3)13 (31.7)
    Abdominal pain7 (36.8)27 (37.5)34 (37.4)4 (30.8)20 (47.6)24 (43.6)3 (33.3)14 (43.8)17 (41.5)
    Nausea/vomiting6 (31.6)12 (16.7)18 (19.8)2 (15.4)4 (9.5)6 (10.9)2 (22.2)5 (15.6)7 (17.1)
    Decreased libido6 (31.6)9 (12.5)15 (16.5)3 (23.1)6 (14.3)9 (16.4)2 (22.2)3 (9.4)5 (12.2)
    Soreness at injection site3 (15.8)12 (16.7)15 (16.5)2 (15.4)7 (16.7)9 (16.4)1 (11.1)4 (12.5)5 (12.2)
    Skin irritation at injection site4 (21.1)3 (4.2)7 (7.7)1 (7.7)7 (16.7)8 (14.5)2 (22.2)9 (28.1)11 (26.8)
    Pain at injection site7 (36.8)21 (29.2)28 (30.8)1 (7.7)7 (16.7)8 (14.5)1 (11.1)5 (15.6)6 (14.6)
    Other4 (21.1)15 (20.8)19 (20.9)3 (23.1)4 (9.5)7 (12.7)3 (33.3)5 (15.6)8 (19.5)
    How much did these side effects interfere with daily activities?
    Not at all11 (57.9)46 (63.9)57 (62.6)9 (69.2)37 (88.1)46 (83.6)8 (88.9)30 (93.8)38 (92.7)
    Very little0 (0.0)5 (6.9)5 (5.5)0 (0.0)2 (4.8)2 (3.6)0 (0.0)0 (0.0)0 (0.0)
    Little2 (10.5)7 (9.7)9 (9.9)0 (0.0)1 (2.4)1 (1.8)0 (0.0)2 (6.3)2 (4.9)
    Moderate1 (5.3)4 (5.6)5 (5.5)1 (7.7)1 (2.4)2 (3.6)0 (0.0)0 (0.0)0 (0.0)
    Very much5 (26.3)9 (12.5)14 (15.4)3 (23.1)1 (2.4)4 (7.3)1 (11.1)0 (0.0)1 (2.4)
    Don't know0 (0.0)1 (1.4)1 (1.1)0 (0.0)0 (0.0)0 (0.0)0 (0.0)0 (0.0)0 (0.0)

    • Abbreviations: CBP, clinic-based provider; CHW, community health worker; No., number.

  • TABLE 4.

    Experience With Side Effects in Last 3 Months Among Provider-Administered Participants, Stratified by Type of Provider at Enrollment, No.(%)

    3-Month Follow-Up6-Month Follow-Up9-Month Follow-Up
    CBPCHWOverallCBPCHWOverallCBPCHWOverall
    Experienced any side effects or problems over last 3 months?
    No63 (65.6)169 (68.7)232 (67.8)55 (77.5)143 (78.1)198 (78.0)50 (84.7)125 (81.2)175 (82.2)
    Yes33 (34.4)77 (31.3)110 (32.2)16 (22.5)40 (21.9)56 (22.0)9 (15.3)29 (18.8)38 (17.8)
    Type of side effects (among women reporting side effects)
    Irregular bleeding/spotting7 (21.2)20 (26.0)27 (24.5)1 (6.3)4 (10.0)5 (8.9)1 (11.1)6 (20.7)7 (18.4)
    Amenorrhea12 (36.4)20 (26.0)32 (29.1)8 (50.0)14 (35.0)22 (39.3)4 (44.4)10 (34.5)14 (36.8)
    Heavy bleeding11 (33.3)13 (16.9)24 (21.8)2 (12.5)8 (20.0)10 (17.9)1 (11.1)4 (13.8)5 (13.2)
    Weight gain1 (3.0)4 (5.2)5 (4.5)2 (12.5)4 (10.0)6 (10.7)5 (55.6)3 (10.3)8 (21.1)
    Weight loss1 (3.0)3 (3.9)4 (3.6)0 (0.0)2 (5.0)2 (3.6)0 (0.0)3 (10.3)3 (7.9)
    Backaches11 (33.3)22 (28.6)33 (30.0)5 (31.3)16 (40.0)21 (37.5)3 (33.3)14 (48.3)17 (44.7)
    Headaches18 (54.5)30 (39.0)48 (43.6)4 (25.0)15 (37.5)19 (33.9)3 (33.3)11 (37.9)14 (36.8)
    Abdominal pain17 (51.5)34 (44.2)51 (46.4)7 (43.8)13 (32.5)20 (35.7)2 (22.2)9 (31.0)11 (28.9)
    Nausea/vomiting6 (18.2)9 (11.7)15 (13.6)2 (12.5)7 (17.5)9 (16.1)2 (22.2)4 (13.8)6 (15.8)
    Decreased libido5 (15.2)10 (13.0)15 (13.6)5 (31.3)4 (10.0)9 (16.1)4 (44.4)7 (24.1)11 (28.9)
    Soreness at injection site2 (6.1)7 (9.1)9 (8.2)0 (0.0)2 (5.0)2 (3.6)1 (11.1)2 (6.9)3 (7.9)
    Skin irritation at injection site2 (6.1)6 (7.8)8 (7.3)0 (0.0)4 (10.0)4 (7.1)0 (0.0)1 (3.4)1 (2.6)
    Pain at injection site6 (18.2)16 (20.8)22 (20.0)3 (18.8)8 (20.0)11 (19.6)0 (0.0)3 (10.3)3 (7.9)
    Other6 (18.2)8 (10.4)14 (12.7)6 (37.5)7 (17.5)13 (23.2)2 (22.2)6 (20.7)8 (21.1)
    How much did these side effectsinterfere with daily activities?
    Not at all19 (57.6)52 (67.5)71 (64.5)11 (68.8)31 (77.5)42 (75.0)8 (88.9)22 (75.9)30 (78.9)
    Very little4 (12.1)9 (11.7)13 (11.8)1 (6.3)4 (10.0)5 (8.9)0 (0.0)2 (6.9)2 (5.3)
    Little3 (9.1)5 (6.5)8 (7.3)1 (6.3)1 (2.5)2 (3.6)0 (0.0)1 (3.4)1 (2.6)
    Moderate3 (9.1)4 (5.2)7 (6.4)0 (0.0)4 (10.0)4 (7.1)0 (0.0)2 (6.9)2 (5.3)
    Very much4 (12.1)7 (9.1)11 (10.0)3 (18.8)0 (0.0)3 (5.4)1 (11.1)2 (6.9)3 (7.9)
    Don't know0 (0.0)0 (0.0)0 (0.0)0 (0.0)0 (0.0)0 (0.0)0 (0.0)0 (0.0)0 (0.0)

    • Abbreviations: CBP, clinic-based provider; CHW, community health worker; No., number.

  • TABLE 5.

    Baseline Factors That May Influence DMPA-SC Discontinuation (N=731)

    FactorSample SizeaP ValueHazard Ratio (95% CI)
    Self-administered vs. provider-administered364 vs. 367<.0010.43 (0.33, 0.54)
    Age at enrollment731.180.98 (0.96, 1.01)
    Health facility catchment sitea731<.001—
    Site 1 vs. Site 6293 vs. 146—2.01 (1.39, 2.89)
    Site 2 vs. Site 667 vs. 146—1.78 (1.09, 2.91)
    Site 3 vs. Site 690 vs. 146—1.75 (1.11, 2.74)
    Site 4 vs. Site 675 vs. 146—2.90 (1.88, 4.47)
    Site 5 vs. Site 660 vs. 146—1.18 (0.66, 2.09)
    Married/regular sexual partner vs. none705 vs. 25.480.81 (0.45, 1.45)
    Worked outside home for pay in last 12 months vs. not96 vs. 634.181.25 (0.90, 1.72)
    Given birth vs. never given birth725 vs. 5.080.42 (0.15, 1.12)
    Completed primary school or higher vs. less or no school185 vs. 545.270.86 (0.65, 1.13)
    Christian, none, or other vs. Muslim418 vs. 311.101.24 (0.96, 1.61)
    Previous use of contraceptives vs. none or no response679 vs. 52.110.72 (0.48, 1.08)
    Previous use of injectables vs. none657 vs. 68.290.82 (0.56, 1.19)
    Community health worker vs. clinic-based provider526 vs. 205.450.90 (0.68, 1.19)

    • Abbreviations: CI, confidence interval; DMPA-SC, subcutaneous depot medroxyprogesterone acetate; vs., versus.

    • ↵a Sample size for each factor varied due to missing values.

    • b Except for site, the univariable models for all other factors were stratified by site.

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Factors Affecting Continued Use of Subcutaneous Depot Medroxyprogesterone Acetate (DMPA-SC): A Secondary Analysis of a 1-Year Randomized Trial in Malawi
Holly M. Burke, Mario Chen, Mercy Buluzi, Rachael Fuchs, Silver Wevill, Lalitha Venkatasubramanian, Leila Dal Santo, Bagrey Ngwira
Global Health: Science and Practice Mar 2019, 7 (1) 54-65; DOI: 10.9745/GHSP-D-18-00433
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