Study setting
The study was conducted at the family planning clinic, Kawempe NRH in Kampala district. It is found in Kawempe Division in the northwestern corner of Kampala City. Kawempe NRH is located alongside Bwaise- Kawempe road in Kawempe division, 4.2 km away from Kampala town. It was established by the government of Uganda to offer Maternal and Child health services to the public. According to secondary data collected from the family planning clinic at Kawempe NRH showed that 235 out of 625 women who were using implants between 22/10/2018 and 6/02/19 opted to discontinue before the recommended period.
Study Design
A facility-based cross-sectional study was conducted among women above 18 to 49 years who had used contraceptive implants and requested for removal at Kawempe National Referral Hospital. Data were collected for almost 2 months from 2nd -January to 4th -March 2020. Every woman was interviewed on the same day she discontinued the implant and the date on which she inserted the implant was recorded from the client card that had been given to her after insertion, this minimized recall bias.
Study Population
The study was composed of women 18 years and above who had come to discontinued implants at family planning clinic, Kawempe NRH during the study period.
Data collection
Data were collected once from each participant using the quantitative-descriptive method of data collection. Data were collected using face-to-face questionnaires that included open-end and closed-end questions on socio-demographic (age, marital status, religion, occupation, and education), obstetric (number of children, counseling, past contraception utilization), method related (side effects, follow-up, conception, past contraception utilization) and social (pattern opposition and involvement, peer influence) factors.
Sample Size Determination
The sample size was determined by using the desired precision e= 0.05 for the prevalence of early discontinuation at Kawempe NRH, a confidence level of 95% and z- statistic for the level of confidence Z = 1.96. Using an equation developed by Cochran (1963:75) (Glenn, 1992) for calculating the sample size in research studies, a sample size of 207 respondents was used in the study with a 100% response.
Using equation developed by Cochran (1963:75) (Glenn, 1992), no=Z2pq/e2, where no is the sample size, Z2 is the abscissa of the normal curve that cuts off an area alpha at tails (1-alpha equals the desired confidence level, e.g., 95%), P is the estimated proportion of an attribute that is present in the population, e is the desired level of precision and q is (1-p). The value for Z is found in statistical tables that contain the area under the normal curve. Therefore, if the estimated prevalence of early implants removal, p= 16% [19]. The sample size will equal to 207 women.
Sampling procedure
According to data collected for three and a half months, reported 235 women opted to discontinue implants. The study participants were selected using a systematic random sampling method with kth value 2. The first participant who arrived at the health facility was selected to be the first and the other third-person was included in the study.
Inclusion Criteria
I. All women who requested implant removal at the family planning clinic, Kawempe NRH were eligible to participate during the study period.
II. Women of reproductive age (18-49) years who came for removal of the contraceptive implant at family planning clinic, Kawempe NRH.
III. For a respondent to be included in the study they must have been a visible record of the date of insertion of the contraceptive implant, either as a client card.
Data Collection Instruments and definition of variables
Data were collected using a semi-structured face-to-face questionnaire having three parts. The first part contained the socio-demographic characteristics of a woman. The second part of the questionnaire consisted of obstetric characteristics of a woman while the third part consisted of method-related characteristics.
Dependent variable; Early implants removal was the dependent variable, defined as discontinuation at 18 months or less after implant insertion [20]. It was measured as a binary variable coded as ‘Yes’ if an implant was discontinued before 18 months from the time of insertion and ‘No’ if 18 or more months.
Independent variables; these included; socio-demographic factors (age, marital status, religion, occupation, and education), obstetric factors (number of children and number of induced abortion), social factors (husband perception and peer group influence) and method related factors (type and duration of usage, side effects, follow up, conception, counseling, past contraception utilization).
Data Collection Procedure
Participants were recruited at the family planning clinic, Kawempe NRH, every Monday to Friday, between 8.00 am and 4.00 pm. Data were collected from 2nd January to 4th March using a face-to-face questionnaire. Questionnaires were given to eligible participants after systematic sampling taking the first and the third person in the line, among women who came for removal of implants.
There was one research assistant who was trained for one day before data collection on the contents of the study, contents of the questionnaires, and interview skills. The research assistant was a midwife and a staff at the study site.
Data Management
The raw data from the filled questionnaires were entered into Statistical Package for Social Services (SPSS), cleaned, coded, and analyzed. The main author was the only person to access files that were protected using a personalized password. Raw data was kept safely in my room where nobody else could access it without my permission.
Quality assurance was accomplished through data checking that involves; double-checking coding of the responses, checking data completeness, statistical analyses to detect errors, and anomalous values.
Transformation was performed on variables such as age, marital status, religion, level of education, occupation of the woman, and spouse.
Data analysis
Descriptive statistics including proportion, percentage, mean, median, and standard deviation were presented in text and tables. Results of Bivariate and multivariate analysis are presented in tables. For inclusion into a multivariate model, only variables with a p-value of 0.20 or less after bivariate analysis were considered while establishing determinants of early discontinuation of implants. Multivariate analysis was performed to control for confounders and the variables were jointly analyzed to attain adjusted odds ratios. The significance level was set at 5% for all tests of significance.