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ORIGINAL ARTICLE
Open Access

Factors Associated With Delayed Contraceptive Implant Removal in Ethiopia

Elizabeth Costenbader, Alice F. Cartwright, Misti McDowell, Berhane Assefa, Meza Yirga Tejeji and Eskindir Tenaw
Global Health: Science and Practice September 2020, 8(3):000; https://doi.org/10.9745/GHSP-D-20-00135
Elizabeth Costenbader
aFHI 360, Durham, NC, USA.
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  • For correspondence: bcostenbader@fhi360.org
Alice F. Cartwright
bDepartment of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Misti McDowell
cFHI 360-Ethiopia, Addis Ababa, Ethiopia.
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Berhane Assefa
dFederal Ministry of Health, Addis Ababa, Ethiopia.
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Meza Yirga Tejeji
cFHI 360-Ethiopia, Addis Ababa, Ethiopia.
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Eskindir Tenaw
cFHI 360-Ethiopia, Addis Ababa, Ethiopia.
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Figures & Tables

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  • FIGURE 1.
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    FIGURE 1.

    Number of Implanon Users Surveyed in Ethiopia, by Region

    Abbreviation: SNNPR, Southern Nations, Nationalities, and Peoples’ Region.

Tables

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    • View popup
    TABLE 1.

    Demographic Characteristics of Study Participants by Provider That Inserted Implanona

    HEW
    (n=1,346)
    Other Health Provider
    (n=514)
    Total
    (N=1,860)
    P-value
    Ageb.0017
    18–24166 (12.3)86 (18.0)252 (14.4)
    25–34704 (57.3)283 (50.7)987 (54.8)
    35–44397 (27.2)133 (30.5)530 (28.5)
    45–4976 (3.2)12 (0.8)88 (2.3)
    Level of education.0012
    No education807 (60.3)214 (46.0)1,021 (55.0)
    Read and write82 (6.2)25 (4.7)107 (5.6)
    Primary374 (28.2)187 (38.9)561 (32.2)
    Secondary80 (5.0)71 (8.6)151 (6.4)
    Tertiary3 (0.3)17 (1.8)20 (0.8)
    Religionc.84
    Orthodox712 (42.0)244 (36.2)956 (39.8)
    Protestant328 (37.7)123 (36.8)451 (37.4)
    Muslim276 (18.5)136 (23.7)412 (20.5)
    Catholic/other30 (1.8)11 (3.3)41 (2.4)
    Marital status<.001
    Married1,219 (93.1)443 (85.7)1,662 (90.3)
    Divorced/widowed/separated110 (5.5)59 (10.3)169 (7.3)
    Never married17 (1.4)12 (4.0)29 (2.4)
    Employment statusd.42
    Farm work844 (54.7)225 (67.3)1,069 (59.4)
    Housewife266 (27.1)109 (14.0)375 (22.2)
    Merchant162 (10.9)100 (10.9)262 (10.9)
    Public servant/other/student/not employed74 (7.3)80 (7.9)154 (7.5)
    Region.0059
    Tigray379 (10.5)101 (12.7)480 (11.3)
    Oromia274 (24.8)235 (63.7)509 (39.4)
    Amhara304 (18.4)96 (5.5)400 (13.5)
    SNNPR389 (46.4)82 (18.1)471 (35.8)
    Contraceptive method(s) currently usinge
    None511 (39.7)152 (20.1)663 (32.3)<.001
    Implanon332 (25.0)176 (49.1)508 (34.0)<.001
    Other implant15 (2.0)7 (1.8)22 (1.9).94
    Injectable432 (28.8)145 (24.3)577 (27.1).53
    Pills24 (1.9)23 (3.4)47 (2.5).35
    IUD26 (2.1)9 (1.1)35 (1.8).36
    Condom/calendar/other7 (0.6)4 (0.2)11 (0.4).13
    • Abbreviations: HEW, health extension worker; IUD, intrauterine device; SNNPR, Southern Nations, Nationalities, and Peoples’ Region.

    • ↵a Frequencies and weighted percentages reported.

    • ↵b Three people missing age (all in HEW group).

    • ↵c Other religion includes Traditional religion (“Wakefeta”) and “Jesus only” (“Hawariyat”).

    • ↵d Other employment includes day laborer, construction worker, maid/janitor, and self-employed.

    • ↵e Respondents could choose more than one method of family planning. Other methods include Sino-implant and female sterilization.

    • View popup
    TABLE 2.

    Characteristics of Implanon Insertion Experience and Use by Provider That Inserted Implanona

    HEW
    (n=1,346)
    Other Health Provider
    (n=514)
    Total
    (N=1,860)
    P-value
    Informed about possible side effects of Implanon.61
    Yes1,026 (76.8)404 (77.3)1,430 (77.0)
    No300 (21.9)105 (22.2)405 (22.0)
    Can’t remember/no response20 (1.3)5 (0.5)25 (1.0)
    Told when Implanon should be removed.46
    Yes1,276 (95.0)490 (96.5)1,766 (95.6)
    No61 (4.1)21 (3.2)82 (3.7)
    Can’t remember/no response9 (0.9)3 (0.3)12 (0.7)
    Advised where they could get Implanon removed.021
    Yes1,230 (93.0)482 (93.1)1,712 (93.1)
    No105 (6.2)31 (6.9)136 (6.5)
    Can’t remember/no response11 (0.7)1 (0.0)12 (0.4)
    Duration of Implanon useb.0010
    <1 year30 (1.7)19 (2.0)49 (1.8)
    1 year to <3 years251 (16.7)100 (14.7)351 (16.0)
    3 years781 (55.3)311 (70.9)1092 (61.1)
    >3 yearsc284 (26.3)84 (12.4)368 (21.1)
    • Abbreviation: HEW, health extension worker.

    • ↵a Frequencies and weighted percentages reported.

    • ↵b Includes 2 respondents who said their implant was missing.

    • ↵c Includes 92 respondents who still had their implant inserted at the time of interview.

    • View popup
    TABLE 3.

    Multivariate Logistic Regression Model for the Association Between Health Provider Who Inserted Implant and Keeping Implant for Longer Than 3 Yearsa (N=1,860)

    OR (95% CI)
    Health extension worker (ref: other health worker)2.50c (1.19, 5.24)
    Client Age, years (ref: 25–34)
    18–241.46 (0.58, 3.68)
    35–441.20 (0.83, 1.72)
    45–491.16 (0.58, 2.31)
    Literate/any education (ref: illiterate/no education)0.73b (0.54, 1.00)
    Married (ref: unmarried)0.55b (0.39, 0.79)
    Orthodox (ref: any other religion)1.07 (0.54, 2.12)
    Region (ref: Tigray)
    SNNPR2.74c (1.40, 5.35)
    Oromia2.25 (0.86, 5.90)
    Amhara1.68 (0.64, 4.44)
    Reported distance to facility/transportation as a barrier3.31c (1.61, 6.78)
    • Abbreviations: CI, confidence interval; OR, odds ratio; SNNPR, Southern Nations, Nationalities, and Peoples’ Region.

    • ↵a This model does not include any interaction terms.

    • ↵b P<.05

    • ↵c P<.001

    • View popup
    TABLE 4.

    Adjusteda Odds Ratios Comparing Health Extension Workers and Other Health Workers for the Association Between Exposure Variable and Keeping Implant for 3 Years or Longer (N=1,860)

    ExposureAdjusted ORb,c(95% CI)
    Age
    18–240.65 (0.17, 2.53)
    25–342.45 (0.82, 7.36)
    35–446.17d (2.31, 16.48)
    45–490.74 (0.10, 5.97)
    Religion
    Orthodox religion0.87 (0.43, 1.78)
    Any other religion3.08e (1.07, 8.82)
    • Abbreviations: CI, confidence interval; OR, odds ratio.

    • ↵a Odds ratio adjusted for age, education, marital status, religion, region, and facility/transport barriers.

    • ↵b Odds ratios shown for each subgroup to interpret significant interaction effects.

    • ↵c Only covariates with significant interactions shown.

    • ↵d P<.001.

    • ↵e P<.05.

    • View popup
    TABLE 5.

    Barriers to Removal by Timing of Removal and by Provider That Inserted Implanona

    HEWOther Health ProviderTotalP-value
    Removal at or before 3 yearsn=1,062n=430n=1,492
    No barriers868 (83.9)368 (90.0)1,236 (86.4).029
    Service provider unavailable day of visit47 (3.9)16 (3.7)63 (3.8).88
    Service provider unable to provide removalb15 (1.8)4 (0.2)19 (1.1)<.001
    Service provider refused to provide removal59 (5.7)21 (2.4)80 (4.3).015
    Distance to facility/transportation72 (4.8)12 (2.1)84 (3.6).020
    Other barriersc20 (1.9)13 (0.9)33 (2.0).90
    Removal more than 3 years after insertion/still insertedn=284n=84n=368
    No barriers110 (38.7)38 (34.6)148 (37.8).61
    Forgot or did not know removal date89 (32.6)29 (31.4)118 (32.3).88
    Service provider unavailable day of visit80 (28.1)15 (25.6)95 (27.6).67
    Service provider unable to provide removalb18 (5.8)5 (4.6)23 (5.6).76
    Service provider refused to provide removal16 (3.8)7 (6.2)23 (4.3).39
    Distance to facility/transportation43 (11.8)2 (9.9)45 (11.4).83
    Other barriersc61 (26.7)23 (32.9)84 (28.1).50
    • Abbreviation: HEW, health extension worker.

    • ↵a Frequencies and weighted percentages reported. Respondents could select more than one barrier.

    • ↵b Includes lack of materials to provide removal.

    • ↵c Other barriers include lack of time to go to facility, fear, and cost.

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Global Health: Science and Practice: 8 (3)
Global Health: Science and Practice
Vol. 8, No. 3
September 30, 2020
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Factors Associated With Delayed Contraceptive Implant Removal in Ethiopia
Elizabeth Costenbader, Alice F. Cartwright, Misti McDowell, Berhane Assefa, Meza Yirga Tejeji, Eskindir Tenaw
Global Health: Science and Practice Sep 2020, 8 (3) 000; DOI: 10.9745/GHSP-D-20-00135

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Factors Associated With Delayed Contraceptive Implant Removal in Ethiopia
Elizabeth Costenbader, Alice F. Cartwright, Misti McDowell, Berhane Assefa, Meza Yirga Tejeji, Eskindir Tenaw
Global Health: Science and Practice Sep 2020, 8 (3) 000; DOI: 10.9745/GHSP-D-20-00135
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