ABSTRACT
This was a comparative study of users of Norplant contraceptive, Subdermal implants and LA Minilap, in rural, urban and peri-urban sites in Kenya during 1991-1993. Both methods are very well accepted by well counselled women seeking long-term, continuous, convenient, highly effective contraception. Norplant users had a mean age of 27.3 years, an average of 2.6 living children and 25.3 per cent were unmarried, while 32.9 percent had completed their families. This compares with 31.3 years, 6.2 living children, 0.6 percent unmarried and 100 percent completed families respectively for LA Minilap. Norplant acceptance rates have continued to rise over the few years since programme inception, and now stand at 5.4 percent of all new acceptors. LA Minilap acceptance trends shows a plateau or moderate down-turn at 21.6 percent of new acceptors. The possible reasons and implications of these observations, along with user characteristics are discussed.
Subject(s)
Levonorgestrel/administration & dosage , Patient Acceptance of Health Care , Sterilization, Tubal/statistics & numerical data , Adolescent , Adult , Female , Humans , Kenya , Laparoscopy/statistics & numerical data , Marital Status , Middle Aged , Parity , Prospective Studies , Rural Population , Suburban Population , Urban PopulationABSTRACT
Norplant contraceptive implants are a relatively new acquisition onto the Kenyan family planning scene. The method seems highly acceptable to a wide cross-section of Kenyan women in government and non-governmental organisations (NGO) clinics. One thousand, six hundred and fifty four clients were recruited into the programme of the largest family planning NGO between 1991 and 1994. Most of the acceptors were young with an average number of 2.6 living children. Half-yearly acceptance rates have been rising. There were minimal serious side effects reported, but 72.0% of the clients complained of some menstrual disruption. Site infection rates were 0.2%, the same as capsule expulsion rates and benign ovarian cyst. Continuation rates were good at 91.0% over the first year and 80.0% over the second year. Client profile and user characteristics are presented. Norplant seems to be a well accepted contraceptive method by young low-parity Kenyan women seeking long-term, continuous yet reversible contraceptive options.
Subject(s)
Levonorgestrel , Patient Acceptance of Health Care , Adolescent , Adult , Age Distribution , Cross-Sectional Studies , Female , Humans , Kenya , Levonorgestrel/administration & dosage , Levonorgestrel/adverse effects , Middle Aged , Parity , Prospective StudiesABSTRACT
OBJECTIVE: To determine the efficacy of the nonoxynol 9 contraceptive sponge in preventing sexual acquisition of the human immunodeficiency virus (HIV). DESIGN: Prospective, randomized placebo-controlled trial. SETTING: Research clinic for prostitutes in Nairobi, Kenya. PATIENTS AND INTERVENTIONS: One hundred thirty-eight HIV-seronegative women were enrolled, of whom 74 were assigned to nonoxynol 9 sponge use and 64 to placebo use. These two groups did not significantly differ with respect to demographic characteristics, sexual practices, or prevalence of genital infections at enrollment, except for a lower number of sex partners per week and a higher initial prevalence of genital ulcers among women assigned to nonoxynol 9 sponge use. Among the 116 women who returned for follow-up, the mean durations of follow-up were 14 and 17 months for the two groups, respectively. MAIN OUTCOME MEASURE: HIV seroconversion. RESULTS: Nonoxynol 9 sponge use was associated with an increased frequency of genital ulcers (relative risk [RR], 3.3; P less than .0001) and vulvitis (RR, 3.3; P less than .0001) and a reduced risk of gonococcal cervicitis (RR, 0.4; P less than .0001). Twenty-seven (45%) of 60 women in the nonoxynol 9 sponge group and 20 (36%) of 56 women in the placebo group developed HIV antibodies. The hazard ratio for the association between nonoxynol 9 sponge use and HIV seroconversion was 1.7 (95% confidence interval [CI], 0.9 to 3.0). Using multivariate analysis to control for the presence of genital ulcers at enrollment, the adjusted hazard ratio for the association between nonoxynol 9 sponge use and seroconversion was 1.6 (95% CI, 0.8 to 2.8). CONCLUSIONS: Genital ulcers and vulvitis occurred with increased frequency in nonoxynol 9 sponge users. We were unable to demonstrate that nonoxynol 9 sponge use was effective in reducing the risk of HIV infection among highly exposed women.