FACTORS ASSOCIATED WITH EARLY DISCONTINUATION OF CONTRACEPTIVE IMPLANTS AMONG WOMEN OF REPRODUCTIVE AGE IN WAKISO DISTRICT, A FACILITY BASED CROSS-SECTIONAL STUDY BY DDUNGU UMARU MB.Ch.B (Mak) A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE AWARD OF MASTERS OF PUBLIC HEALTH OF MAKERERE UNIVERSITY NOVEMBER 2019 APPROVAL i DECLARATION ii ACKNOWLEDGEMENT I extend my gratitude and sincere appreciation to all those that supported me in ensuring that this study is a success. My sincere thanks go to my supervisors Dr. Simon Peter Kibira and Mr. Ssenyonga for availing adequate time for engagements and support during the period of the study. I also thank the district health team especially health facility in-charges of Wakiso district for support and coordination during data collection in their respective facilities. Special recognition goes to Dr. Sseviri Mathias, Betty Nabuuma and Namulondo Edith sharing information about the district during literature review. Special thanks go to my research assistants who were committed and provided valuable time in data collection. They included Nabagesera Prever, Nakiyimba Viola, Tindimweebwa Ruth, Nakalembe Margaret Bateera Ann and all assistants from private health facilities who participated in data collection. On a similar note, I also thank all respondents who participated in the study for their time and efforts to respond to questions as honestly as possible. Lastly, appreciate the support from my work manager Dr. Kirima Andrew who provided a favorable studying environment for me during the period of this project iii TABLE OF CONTENTS APPROVAL ................................................................................................................................. i DECLARATION ........................................................................................................................ ii ACKNOWLEDGEMENT ........................................................................................................ iii LIST OF TABLES AND FIGURES ....................................................................................... vii ACRONYMS AND ABBREVIATIONS ............................................................................ viii DEFINITIONS ............................................................................................................................ 9 ABSTRACT .................................................................................................................................. x 1.0 INTRODUCTION AND BACKGROUND ..................................................................... 1 1.1 Introduction ....................................................................................................................................... 1 1.2 Background ........................................................................................................................................ 2 2.0 LITERATURE REVIEW ...................................................................................................... 5 2.1 Early Discontinuation of Contraceptive Implants ............................................................................. 5 2.2 Proportion of Early Discontinuation of implants............................................................................... 5 2.3 Determinants of Early Discontinuation of Implants .......................................................................... 6 2.4 Factors that influence the overall duration of use of implants. ........................................................ 8 3.0 STATEMENT OF THE PROBLEM, JUSTIFICATION, CONCEPTUAL FRAMEWORK AND RESEARCH QUESTIONS ................................................................ 9 3.1 Statement of the Problem ................................................................................................................. 9 3.2 Justification of the Study ................................................................................................................. 10 3.3 Conceptual Framework ................................................................................................................... 11 3.4 Research Questions ......................................................................................................................... 12 4.0 STUDY OBJECTIVES ........................................................................................................ 13 4.1 Aim .................................................................................................................................................. 13 4.2 General Objective ............................................................................................................................ 13 4.3 Specific Objectives ........................................................................................................................... 13 5.0 METHODOLOGY .............................................................................................................. 14 5.1 Study Area ....................................................................................................................................... 14 5.2 Study Population ............................................................................................................................. 14 5.3 Study Design .................................................................................................................................... 15 5.4 Sample Size ...................................................................................................................................... 15 iv 5.5 Sampling Procedure ........................................................................................................................ 15 5.6 Study Variables ................................................................................................................................ 15 5.6.1 Dependent variables. ................................................................................................................ 15 5.6.2 Independent variables ............................................................................................................... 16 5.7 Data Collection ................................................................................................................................ 17 5.7.1 Training of Research Assistants ............................................................................................... 17 5.7.2 Tools ......................................................................................................................................... 17 5.7.3 Pre-testing ................................................................................................................................. 17 5.7.4 Field editing of data .................................................................................................................. 17 5.7.5 Missing data ............................................................................................................................. 17 5.8 Data Management and Analysis ...................................................................................................... 18 5.8.1 Data Management..................................................................................................................... 18 5.8.2 Data Analysis ........................................................................................................................... 18 5.9 Ethical Considerations ..................................................................................................................... 18 6.0 RESULTS .............................................................................................................................. 20 6.1 Characteristics of the study population .......................................................................................... 20 6.2 Proportion of Early discontinuation ................................................................................................ 22 6.3 Determinants of early discontinuation ........................................................................................... 23 6.4 Factors that influence overall duration of use of implants. ............................................................ 27 7.0 DISCUSSION ...................................................................................................................... 32 8.0 CONCLUSIONS ................................................................................................................. 38 9.0 RECOMMENDATIONS ................................................................................................... 39 9.1 Recommendations for family planning programs ........................................................................... 39 9.2 Recommendations for further research .......................................................................................... 39 REFERENCES ............................................................................................................................ 40 APPENDICES ............................................................................................................................ 44 1. Number of Respondents per Health Facility ................................................................................. 44 2. Consent Forms for Respondents ......................................................................................................