Contributions of side effects to contraceptive discontinuation and method switch among Kenyan women: a prospective cohort study.

OBJECTIVE: To determine the contribution of specific contraceptive side effects to method switch and modern-method discontinuation among Kenyan women. DESIGN: A prospective cohort study. SETTING: Five counties in Western Kenya. PARTICIPANTS: Women aged ≥18 years old and emancipated female minors ≥14 years old using modern, reversible contraception were recruited while attending 10 public health facilities. METHODS: Patient-reported adverse effect symptoms, method switch and discontinuation were reported through weekly text message-based surveys for 24 weeks. MAIN OUTCOME MEASUREMENTS: Prevalence, hazards ratio (HR). RESULTS: Among 825 women, 44% were using implants, 43% injectables, 7% an intrauterine device and 6% oral contraceptive pills at enrolment. Most (61%) women were continuing a method used in the previous month. During the 24-week follow up, incidence of contraceptive switch was 61.3 per 100 person-years (95% confidence interval [CI] 52.4-71.8) and incidence of discontinuation was 38.5 per 100 person-years (95% CI 31.6-47.0). On average, one-quarter (prevalence [Pr] 0.24, 95% CI 0.22-0.26) of participants reported side effects or method problems weekly, with sexual side effects the most prevalent symptom (Pr 0.15, 95% CI 0.13-0.16). Lack of expected bleeding was associated with higher risk of method switch (adjusted hazard ratio [aHR] 2.36, 95% CI 1.22-4.57). Risk of all-modern method discontinuation was higher among women experiencing irregular bleeding (aHR 2.39, 95% CI 1.20-4.77), weight changes (aHR 2.72, 95% CI 1.47-4.68) and sexual side effects (aHR 2.42, 95% CI 1.40-4.20). CONCLUSIONS: Addressing irregular bleeding, weight changes and sexual side effects through development of new products that minimise these specific side effects and anticipatory counseling may reduce method-related discontinuation. TWEETABLE ABSTRACT: Bleeding, weight changes, sexual problems associated with discontinuation of #contraception, but many continue despite side effects.

Seasonality and community's satisfaction with sources of domestic water in the Lake Victoria basin.

A cross-sectional study was conducted to describe the changes in, and the satisfaction with, sources of domestic water made by the community in response to seasons in Kisumu district in July 1990. Out of 15,324 household heads interviewed, 42.8% got their water from taps throughout the year and during the dry season the remaining 58.2% got their water from rivers, streams, boreholes, ponds, roof catchments and one or two other sources. In the wet season three times as many households use roof catchment and fewer households use rivers and streams and boreholes. Only 21.9% were dissatisfied with their supply in the dry season the main reason being dirty water and insufficient quantity. These findings indicate a need to expand the provision of piped water into the rural communities and promote roof water harvesting in the lake basin. Roof catchment would provide safe water in areas without piped water, and as reserve water in those with piped. The safety of water from roofs made of natural and traditional materials, such as grass and palm leaves (makuti) need to be assessed.