|Year : 2016 | Volume
| Issue : 2 | Page : 138-143
Intrauterine contraceptive device use in Abakaliki, southeast Nigeria: A 5-year review
Nwali Matthew Igwe
Department of Obstetrics and Gynecology, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
|Date of Web Publication||5-Jul-2016|
Nwali Matthew Igwe
Federal Teaching Hospital, PMB 102, Abakaliki - 480001, Ebonyi State
Objective: To evaluate intrauterine contraceptive device (IUCD) use in Abakaliki for acceptance rate, efficacy, and complications. Materials and Methods: A descriptive retrospective study was done in the family planning unit of the Federal Teaching Hospital, Abakaliki, between 1 January 2009 and 31 December 2013. The records of the clients from the family planning and their case files from the medical records units were studied. Data on sociodemographic characteristics, side effects, discontinuation, and reasons for discontinuation were extracted and fed into the computer using Epi Info program (2008) of Centers for Disease Control and Prevention (CDC) (Atlanta, GA) version 3.5.1 and were analyzed. Results: Out of 1,737 contraceptive acceptors, 230 clients accepted IUCD giving a rate of 13.2%. The mean age and parity were 33.6 ± 6.5 years and 4.6 ± 2.4, respectively. Only 3 (1.3%) out of the 230 acceptors were nulliparous, the rest were parous. Sixty eight clients discontinued the method giving a discontinuation rate of 29.6%. Young, married clients with low parity discontinued the method commonly desiring further conception hence used the method as spacer. The commonest reason for discontinuation was pregnancy desire (54.4%) followed by presence of side effect (19.1%). Eighteen clients (7.8%) had side effects or complications resulted from the use of this device. The commonest side effect was abdominal pain 8/18 (44.4%). Others were menorrhagia 4/18 (22.2%), missing IUCD 3/18 (16.7%), and pelvic inflammatory disease (PID) 3/18 (16.7%). The presence of side effect (P = 0.0156) and occupation (P = 0.0218) are the variables with significant correlation with the duration of usage of the method while young age (P = 0.0009), low parity (P = 0.0001), and marital status (P = 0.0001) had statistically significant relationship with the discontinuation of the method. Conclusion: IUCD is very effective but with the acceptance rate of 13.2% among the methods offered and discontinuation rate of 29.6% in Abakaliki.
Keywords: Abakaliki, contraception, intrauterine contraceptive device, Nigeria
|How to cite this article:|
Igwe NM. Intrauterine contraceptive device use in Abakaliki, southeast Nigeria: A 5-year review. Trop J Med Res 2016;19:138-43
| Introduction|| |
The intrauterine contraceptive device (IUCD) is one of the commonly used contraceptive methods. Worldwide it is a commonly used long-acting reversible method of contraception with estimated 128 million users.  The IUCD has undergone several modifications from the old inert devices to the modern devices that has either copper or levonorgestrel attached to their frame. It now comes in different shapes and sizes with improved efficacy and reduced side effect, and also with increased rate of acceptance and prolonged usage period. , This method is very popular among the women in sub-Saharan Africa, especially in Nigeria, as it is coitus independent, cost-effective, and long acting. , Reports from different family planning units in Nigeria had shown the prevalence rates of 34.5-66% among contraceptive acceptors. ,, The reported discontinuation rates in Nigeria ranged 2.8-42.9% with a major reason for discontinuation as desire for pregnancy. ,,
The IUCD work by marked inflammatory reaction in the uterus leading to increased concentration of macrophages and leukocytes, prostaglandin and various enzymes in both uterine and tubal fluids that interfere with the transport of spermatozoa, ova, and prevent implantation.  Time and route of insertion was considered important as this may increase the risk of complications. For instance, insertion in the postpartum period was found to increase adverse events such as perforation, pain, and expulsion but a poor to fair quality evidence from a review article demonstrated no increase in the risk of complications,  especially when inserted within 48 h or after 4 weeks of delivery. Copper T 380A has been the major device offered to clients in the unit. The usage has not been evaluated since the inception of the unit, thus this review is necessary to provide update on the use of IUCDs in the Federal Teaching Hospital, Abakaliki, southeast Nigeria.
| Materials and Methods|| |
The family planning unit of the Federal Teaching Hospital, Abakaliki in Ebonyi State, Nigeria, was established in 2012 following the merger between Ebonyi State University Teaching Hospital and Federal Medical Center both located in Abakaliki. Prior to the merger, both hospitals were running their family planning clinics separately. The hospital is a tertiary institution that also offers secondary care to women within Ebonyi and its environs. The family planning clinic obtains its clients from the postnatal clinic, the general outpatient department, specialist clinics, and referrals from the primary, secondary, and private health centers in the state.
This is a retrospective descriptive study that was carried out in the family planning clinic of the Federal Teaching Hospital, Abakaliki. Data were collected from the records in the family planning unit as well as from folders of users from 1 January 2009 to 31 December 2013. Information extracted includes age, parity, religion, educational status, marital status, occupation, duration of usage, side effects, and reason for discontinuation. The Research and Ethics Committee of the Federal Teaching Hospital approved the study protocol. The information obtained was recorded and the coded data were fed into the computer using Epi info program (2008) of Centers for Disease Control and Prevention (CDC) (Atlanta, GA) 3.5.1 version, and were analyzed. A P value less than 0.05 was considered statistically significant.
| Results|| |
During the study period, a total of 1,737 clients were using one contraceptive or the other out of which 230 clients accepted IUCD. This gives an uptake rate of 13.2%. Acceptance of contraception however remained low compared to the number of deliveries during the period under review with no particular trend [Figure 1]. During the period under review, only one Mirena was used and one Lippes Loop was removed from a postmenopausal woman, for the rest copper T380A model was employed.
|Figure 1: Yearly acceptance of contraception and IUCD bar chart. IUCD=Intrauterine contraceptive device|
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The age of the clients ranged 20-55 years with a mean age of 33.6 ± 6.5 years. Majority of the clients were aged 30-39 years (51.3%). Parity ranged 0-12 with a mean parity of 4.6 ± 2.4. Only three clients (1.3%) were nulliparous while 43.5% were grand multiparous. Most of the clients had tertiary education (79.1%), were married (90.4%), and were Christians (74.3%). More than half (51.3%) of the clients were civil servants [Table 1].
[Table 2] showed that 18 clients (7.8%) had side effects or complications that include abdominal pain (44.4%), menorrhagia (22.2%), missing IUCD (16.7%), and pelvic inflammatory disease (PID) (16.7%). Two out of the 3 missing IUCD were recovered from the uterine cavity while 1 was recovered from the pelvic cavity by laparotomy. No accidental pregnancy (method failure) occurred during the period under review.
Sixty eight clients (29.6%) discontinued the method during the period under review. [Figure 2] showed that the commonest reason for discontinuation was desire for another pregnancy (54.4%) while the least was method change (1.5%). Most of the clients (79.1%) used the method for 2 or more years while 20.9% used the method for less than 2 years. [Table 3] showed occupation (P = 0.0218) and side effect or complication (P = 0.0156) as the variables with significant correlation with the duration of usage of the method during the period under review. [Table 4] shows the influence of sociodemographic characteristics on the reason for discontinuation of the method. Age (P = 0.0009), parity (P = 0.0001), and marital status (P = 0.0001) had statistically significant relationship with the discontinuation of the method.
|Figure 2: Pie chart of reasons for discontinuation of IUCD. PD=Pregnancy desire, CMP=Complications, MNP=Menopause, UNS=Unspecified, DUE=Due for removal, MC=Method change|
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|Table 3: Effect of sociodemographic characteristics and other variables on duration of usage of IUCD |
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|Table 4: Effect of sociodemographic characteristics on the reason for discontinuation of IUCD |
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| Discussion|| |
The IUCD acceptance rate of 13.2% was recorded in this study, which is lower than the previously reported rates from different centers in Nigeria that ranged 16.2-64.12%. ,,, This may be due to the fact that the majority of reproductive age women in this locality are uneducated farmers, they have no knowledge of contraceptives, hence require repeated counseling to accept a method. Majority of them also believe in large family size for easy and cheap labor in their farms. The rate of acceptance is higher than 7.6% as reported in developed countries.  A newer study at Nnewi reported the acceptance rate of 50.91% for IUCD.  This problem is however getting resolved as a result of increased community awareness spread by the hospitals and the state government's Mother and Child Care Initiative (MCCI). This was reflected in the increased acceptance of family planning methods in 2012 and 2013, but it is still far from the contraception need. Copper T380A is the most commonly used IUCD because it is cheap, effective, and readily available in our center.
Women aged between 30 years and 39 years make up 51.3% of IUCD users. This is similar to other reports from Enugu and Nnewi. ,, This may be due to early marriage and child bearing, such that at third decade of life the desired family size is completed. Majority of the users are students in the tertiary institution who require long-acting and effective method that is independent of coitus. It is also relatively contraindicated in much younger than this due to higher bleeding and expulsion rates.  There was no teenager in this study. Another study conducted in Port Harcourt also had no teenager subjects using IUCD,  but there are other studies however that showed limited number of teenager users.  This may be due to the fact that teenagers are more likely to be unmarried and have multiple sexual partners that might increase the risk of PID among IUCD users.
Ninety eight percent of the acceptors are multiparous. This is similar to previous studies. , This may be related to fear of negative effect on future conception, though studies had shown similar fertility rates at 6-12 months after discontinuation of the method to that of nonusers.  Majority of the clients are civil servants with tertiary education, married, and Christians. This may be because educated women are more likely to be aware and accept contraception. The study was done in a Christian-dominated part of southeastern Nigeria. A previous study done in the Muslim dominated northern part of the country also showed majority of Muslims using this method. 
Only 7.8% had side effects or complications during the period under review. Most of the people that had side effects however discontinued the method. The duration of usage of the method was negatively affected by the presence of side effects or complications as majority with side effects used the method for less than 2 years. This was not the same with the study conducted in Nnewi, Nigeria.  There was no accidental pregnancy (method failure) among the IUCD users during the period under review demonstrating the efficacy of the method. The studies conducted in Nnewi also did not record any unintended pregnancy or method failure. , Other studies recorded one case of pregnancy with pearl index ranged 0.007-0.27 per 100 women per year. ,,
The discontinuation rate was 29.6%. This is similar to the Port Harcourt study  but less than 55.1% reported in the Nnewi study.  Desire for another pregnancy was the commonest reason for discontinuation followed by the presence of side effects or complications. This is similar to other studies. , Univariate analysis showed age, parity, and marital status as the variables significantly related to discontinuation. This is understandable as young married women with low parity are more likely to discontinue the method for further conception.
| Conclusion|| |
IUCD is an effective method of contraception in Abakaliki with 13.2% acceptance rate and 29.6% discontinuation rate. Intensive health education and awareness rallies in the rural areas among the nonliterate population will improve its acceptance and usage as well as the health of women in Abakaliki.
I wish to express my profound gratitude to the staff of the family planning and medical records units of the Federal Teaching Hospital, Abakaliki, for their assistance in providing the materials for this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]