Реферат
ABSTRACT Objective: The prevalence of sub-dermal contraceptive implant use in Jamaica is low, despite growing international acceptance of long-acting reversible contraception. This study assessed the availability, effectiveness, side-effects and utilization of sub-dermal contraceptive implants and described the characteristics of users over a one-year period. Methods: We reviewed the medical records of women aged 15-45 years who utilized contraceptive implant-related services at any of the six included public health centres in Jamaica during 2013, and surveyed 20 available reproductive healthcare providers. Results: In 2013, 738 women attended a Jamaican public health centre for contraceptive implant services: 493 (66.8%) for insertion, 202 (27.4%) for removal and 53 (7.2%) for follow-up visits (10 women had the same implant inserted and removed in 2013). The women's median age was 26.0 years, 24.3% were ≤ 18 years, and 85.9% had ≥ 1 child. Most women (68.5%) did not have documented side-effects; irregular bleeding, the most commonly documented side-effect, was recorded for 24%. Of the 493 women who had implants inserted, three (0.6%) were identified to be pregnant within three months of insertion. Among the 202 women who had implants removed, 11 (5.4%) experienced complications with removal. Reproductive healthcare providers highlighted the need for an expansion of contraceptive implant availability and provider training. Conclusion: Sub-dermal implants have few insertion complications and side-effects and are effective, but were underutilized in Jamaica. Increased implant availability and enhanced reproductive healthcare provider training may improve implant utilization and reduce unintended pregnancy rates in Jamaica.
RESUMEN Objetivo: La prevalencia del uso de implantes anticonceptivos subdérmicos en Jamaica es baja, a pesar de la creciente aceptación internacional de la anticoncepción reversible de acción prolongada. El presente estudio evalúa la disponibilidad, efectividad, efectos secundarios y utilización de los implantes anticonceptivos subdérmicos, y describe las características de los usuarios durante el período de un año. Métodos: Se revisaron las historias clínicas de mujeres de 15 a 45 años de edad, que utilizaron servicios relacionados con los implantes anticonceptivos en cualquiera de los seis centros de salud pública de Jamaica durante 2013, y se encuestaron 20 profesionales de salud reproductiva disponibles. Resultados: En 2013, 738 mujeres asistieron a un centro de salud pública de Jamaica para recibir servicios de implantes anticonceptivos: 493 (66.8%) para inserción, 202 (27.4%) para eliminación, y 53 (7.2%) para visitas de seguimiento (a 10 mujeres se les insertó y se les quitó el mismo implante en 2013). La edad promedio de las mujeres fue 26.0 años, 24.3% tenían ≤ 18 años, y el 85.9% tenían ≥ 1 niño. La mayoría de las mujeres (68.5%) no presentaban efectos secundarios documentados. El sangramiento irregular - el efecto secundario más comúnmente documentado - se registró en un 24%. De las 493 mujeres que tenían implantes insertados, se halló que tres (0.6%) resultaron embarazadas en el plazo de tres meses tras la inserción. De las 202 mujeres a las que se les había retirado el implante, 11 (5.4%) tuvieron complicaciones en el proceso de la eliminación. Los profesionales de la salud reproductiva destacaron la necesidad de expandir la disponibilidad de implantes anticonceptivos y la capacitación de proveedores. Conclusión: Los implantes subdérmicos presentan pocas complicaciones a la hora de su inserción, y tienen pocos efectos secundarios. Sin embargo, son subutilizados en Jamaica, a pesar de ser efectivos. Una mayor disponibilidad de implantes y una mejor capacitación de los profesionales de la salud reproductiva pueden mejorar la utilización de implantes y reducir las tasas de embarazos no intencionados en Jamaica.
Тема - темы
Humans , Female , Adolescent , Adult , Middle Aged , Long-Acting Reversible Contraception/statistics & numerical data , Health Services Accessibility/statistics & numerical data , Socioeconomic Factors , Retrospective Studies , Long-Acting Reversible Contraception/adverse effects , JamaicaРеферат
Abstract Unwanted pregnancy is a major public health problem both in developed and developing countries. Although the reduction in the rates of these pregnancies requires multifactorial approaches, increasing access to long-acting contraceptive methods can contribute significantly to change this scenario. In Brazil, gynecologists and obstetricians play a key role in contraceptive counseling, being decisive in the choice of long-acting reversible methods, characterized by intrauterine devices (IUDs) and the contraceptive implant. The vast scope due to the reduced number of situations to indicate long-acting methods should be emphasized in routine contraceptive counseling. On the other hand, gynecologists and obstetricians should adapt the techniques of insertion of long-acting methods, and engage in facilitating conditions to access these contraceptives through public and private health systems in Brazil. This study is part of a project called Diretrizes e Recomendações FEBRASGO (Guidelines and Recommendations of the FEBRASGO - Brazilian Federation of Gynecology and Obstetrics Associations from the Portuguese acronym). It aims to review the main characteristics of long-acting contraceptives and critically consider the current situation and future prospects to improve access to these methods, proposing practical recommendations of interest in the routine of gynecologists and obstetricians.
Resumo A gravidez não planejada representa importante problema de saúde pública tanto em países desenvolvidos quanto naqueles em desenvolvimento. Embora a redução das taxas dessas gestações requeira abordagens multifatoriais, o aumento no acesso aos métodos contraceptivos de longa ação pode contribuir de forma expressiva na mudança desse cenário. No Brasil, os ginecologistas e obstetras têm papel fundamental no aconselhamento contraceptivo, sendo decisivos na escolha dos métodos reversíveis de longa ação, caracterizados pelos dispositivos intrauterinos (DIUs) e pelo implante anticoncepcional. A grande abrangência decorrente do pequeno número de situações que contraindicam os métodos de longa ação deve ser enfatizada no aconselhamento contraceptivo de rotina. Por outro lado, os ginecologistas e obstetras devem se adaptar às técnicas de inserção dos métodos de longa ação, bem como se engajar na facilitação de condições para o acesso a esses contraceptivos por meio do sistema de saúde pública e privada no Brasil. Este estudo, parte do projeto denominado "Diretrizes e Recomendações FEBRASGO", tem por objetivo revisar as principais características dos contraceptivos de longa ação, além de considerar de forma crítica o panorama atual e as perspectivas futuras, visando melhorar o acesso a esses métodos, com recomendações práticas de interesse na rotina do ginecologista e obstetra.
Тема - темы
Humans , Female , Long-Acting Reversible Contraception/adverse effects , Long-Acting Reversible Contraception/methods , Practice Guidelines as TopicРеферат
Apesar do crescente número de usuárias de métodos contraceptivos, 41% das gestações mundiais não foram planejadas. Os métodos de longa duração são uma alternativa eficaz de reduzir o número de gestações não planejadas diminuindo, assim, taxas de mortalidade materna e infantil. O implante é um método reversível de longa duração, com alta eficácia e taxa de continuidade. Este estudo tem como proposta fazer uma revisão sobre o implante liberador de etonogestrel, seus efeitos adversos e benefícios contraceptivos e não contraceptivos.(AU)
Despite the growing number of users of contraceptive methods, 41% of worldwide pregnancies were unplanned. Long acting reversible contraceptives (LARCS) are an effective alternative to reduce the number of unplanned pregnancies thereby reducing maternal and child mortality. The implant is a LARC, with high efficacy and continuation rate. This study has the objective to review the use of the etonogestrel-releasing implant, its adverse effects and contraceptive and non-contraceptive benefits.(AU)