Early Implanon Discontinuation and Associated Factors among Woman's of Implanon Users in Ethiopia: A Systematic Review and Meta-Analysis

Abstract

Background: Worldwide, large number of women becomes unprotected to the risk of pregnancy after contraceptive discontinuation. To ensure safe and consistent services addressing the factors that contribute to early Implanon discontinuation is necessary to women in the reproductive age group through appropriate use of contraceptive methods and method switching. Considerable studies have been done in Ethiopia about early implanon discontinuation among implanon users. But inconsistent findings were reported. Thus, this study was conducted to determine the pooled early discontinuation of implanon and to identify associated factors among implanon users in Ethiopia. Methods: Search of Pub Med, Scopus, Web of Science, Google Scholar, MEDLINE, CINAHL, Science Direct and Cochrane Library was conducted to identify relevant studies from November 1, 2022 to November 24, 2022. The Newcastle-Ottawa scale tool was used to measure the quality of included studies. The pooled estimate of early implanon discontinuation was performed using Random effect model. Data extracted independently by two reviewers with a standardized data extraction format and exported to STATA software version11 for meta-analysis. Heterogeneity among studies was checked by Cochrane Q and I2 test statistics. Results: After reviewing 19,002 studies, 8 studies involving 3,022 implanon users were included for this review and meta-analysis. The pooled estimate of early implanon discontinuation among implanon users in Ethiopia was 39.78% (95%CI: 23.03, 56.53). Identified factors associated with early implanon discontinuation were developed side effect (AOR = 1.96; 95%CI: 0.42, 3.35), services dissatisfaction (AOR = 1.27; 95%CI: 0.27, 5.96), having appointment after insertion (AOR = 0.66; 95%CI: 0.23, 1.92), and having pre-insertion counselling (0.75; 95%CI: 0.35, 1.60). Conclusion: The systematic review and meta-analysis of this study revealed that more than three-eighth of implanon user discontinues their implanon early. Experienced side effect, services dissatisfaction, lack of appointment after insertion and inadequate pre-insertion counselling were identified factors associated with early implanon discontinuation among implanon users in Ethiopia. Health care providers should give proper pre insertion counseling based on manual for the clients by giving highlight on side effects. Moreover, improving client service satisfaction and appointment follow-up also should be considered to accelerate the proper use of Implanon.