|Year : 2014 | Volume
| Issue : 2 | Page : 99-103
Contraceptive trend in a tertiary facility in North Western Nigeria: A 10-year review
Z Muhammad, DG Maimuna
Department of Obstetrics and Gynaecology, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
|Date of Web Publication||6-Sep-2014|
Dr. Z Muhammad
Department of Obstetrics and Gynaecology, Bayero University, Aminu Kano Teaching Hospital, Kano
Source of Support: None, Conflict of Interest: None
Background: Of all the direct influences on fertility, contraceptive use is the single most important factor for reproductive health policy makers and program managers. Increase in its use accounted for the largest proportion of fertility decline worldwide including the sub-Saharan region. Objective: To determine the trends of contraceptive use and the preferred method of contraception among the clients visiting the family planning clinic of Aminu Kano Teaching Hospital, Kano. Study Design: This is a retrospective descriptive study, involving all acceptors of contraceptive methods from January 1999 and December 2008 in the family planning unit of Aminu Kano Teaching Hospital Kano, Nigeria. Results: A total of 35,792 clients booked for antenatal care at Aminu Kano Teaching Hospital over the study period. Acceptors of contraceptive methods were 11,346 clients, giving contraceptive prevalence of 31.6%. The acceptors of modern contraceptive methods increased steadily from a total of 1009 in the year 1999/2000 to 3014 the year 2007/2008. Approximately 65% of the clients used the Injectables; implant was the least used, by 2% of the clients. Female sterilization contributed about 3.4%, intrauterine contraceptive device (CUT 380A) 16.6%, male condom 2.8%, and oral contraceptive pills 10.4%. There was a significant increase in the trend of use of modern hormonal contraceptive methods as compared to the non hormonal methods. χ2trend = 87.21, P = 0.00000. No man had vasectomy over the 10-year period. Conclusion: There is an increase in the trend of contraceptive use over the study period. Injectable contraceptives are the most commonly used method in this study.
Keywords: Aminu Kano teaching hospital, contraceptive, Kano, Nigeria, trends
|How to cite this article:|
Muhammad Z, Maimuna D G. Contraceptive trend in a tertiary facility in North Western Nigeria: A 10-year review. Niger J Basic Clin Sci 2014;11:99-103
|How to cite this URL:|
Muhammad Z, Maimuna D G. Contraceptive trend in a tertiary facility in North Western Nigeria: A 10-year review. Niger J Basic Clin Sci [serial online] 2014 [cited 2019 Oct 13];11:99-103. Available from: http://www.njbcs.net/text.asp?2014/11/2/99/140358
| Introduction|| |
To sustain higher living standards, world population size must stabilise. This can be brought about by reduction in the fertility rate that is compatible with the attainment of economic social goals. , Of all the direct influences on fertility, contraceptive use is the single most important factor for reproductive health policy makers and program managers, and increase in its prevalence accounted for the largest proportion of fertility declines worldwide including the Sub-Saharan region. 
Contraceptive use and fertility rates vary substantially among regions. Fertility levels are inversely proportional to the contraceptive prevalence. In countries where contraceptive use is uncommon, the fertility rate is high. , In few countries of Asia and Latin America, at least three-fourths of married women use a contraceptive method. In contrast, in some sub-Saharan African countries fewer than 10% of married women use contraception.
Fertility rates range from just 2.3 children per woman in Vietnam to 7.2 in Niger.  The low prevalence of contraceptive use in Nigeria and indeed in the Sub-Saharan region is due to interplay of many factors: Socio-cultural, economic, political, religious, and demographic. Continued strong cultural preference for large families, large rural populations relying on subsistence farming and low levels of economic development are contributory. 
Based on statistics about contraceptive prevalence, developing countries as groups are about halfway through the demographic transition from high to low fertility. Levels of contraceptive use of 75% to 84%, as found in North America and Northern Europe, reflected the completion of the transition. The highest contraceptive prevalence rate found in any country with a population over 3 million is 87% in Hong Kong and 86% in the United Kingdom. Among 30 countries, surveyed in sub-Saharan Africa since 1990, contraceptive prevalence varied substantially up-to-date. In five countries - Cape Verde, Kenya, Mauritius, South Africa, and Zimbabwe - over one-third of married women used contraception. In seven other countries - Chad, Eritrea, Guinea, Mali, Mozambique, Niger, and Nigeria - contraceptive prevalence was 6% or lower. 
Surveys suggest that parts of Africa have started down the path already taken in other regions. , Zimbabwe has perhaps the most articulate family planning programme in Africa,  while significant positive progress in recent fertility transition has been made in Botswana, Swaziland, South Africa and Kenya.  Fertility rate decreased, by more than 1% per year in more than 51% of sub-Saharan countries with more than one survey since 1990. 
An increase in modern methods use, in particular, injectables, female sterilisation, oral contraceptives and the intrauterine contraceptive device (IUCD) account for half or more of the increase in total contraceptive use among married women in all countries and account for almost three-fourths of all contraceptive use,  On the average worldwide, nearly 9 in every 10 contraceptive user rely on modern methods while only about 1 in every 10 rely on traditional methods of withdrawal and periodic abstinence.
The specific contraceptive methods that women use vary substantially from country to country and from region to region within the country. The method mix in a country reflect many factors, including the availability of various contraceptive methods and people's awareness of them, their cost, and where they can be obtained. In addition, personal preferences, social norms, gender preferences, women's education, rural or urban residence, and perceived acceptability of family planning-use affect contraceptive choices. ,
Decisions about childbearing and contraceptive use are most likely to meet a person's needs when they reflect individual desires and values, that are based on accurate, relevant information and are medically appropriate - that is when they have informed choices. To make informed choices, people need to know about family planning, to have access to a range of methods, and to have support for individual choice from social policies and community norms. Informed choice offers many benefits because people use family planning longer if they choose methods for themselves. Also, access to a range of methods makes it easier for people to choose a method they like and to switch methods when they want. People's ability to make informed choices invites a trusting partnership between clients and providers and encourages people to take more responsibility for their own health. Enabling clients to make informed choices is a key to good-quality family planning services. ,
| Objectives|| |
To determine the trend of contraceptive use and the preferred method of contraception amongst the clients visiting the family planning clinic in Aminu Kano Teaching Hospital (AKTH), Kano.
| Materials and Methods|| |
Aminu Kano Teaching Hospital, Kano is one of the tertiary/referral health facilities for Kano and its environs. It is a 500-bed hospital established in 1988. Located in the state of Kano, the city Kano is the largest commercial centre of Northern Nigeria. This hospital receives clients from the Kano and neighboring states of in the northern Nigeria. The hospital has sixteen (16) departments. The clinical departments are obstetrics and gynaecology, surgery, internal medicine, paediatrics, ophthalmology, orthorhinolaryngology, anaesthesia and family medicine. The paraclinical departments include; haematology and blood bank, microbiology, histopathology, chemical pathology, radiology, physiotherapy, community medicine and pharmacy. The hospital operates family planning clinics, five days a week (Mondays to Fridays) consulting an average of 60 clients per clinic per day.
Study design/study population
This was a 10-year retrospective study at the Aminu Kano Teaching Hospital, Kano Nigeria, from 1999 to 2008. The total number of each of the method used by the clients for each year was retrieved from the record department of the Family Planning Unit of the hospital.
Data obtained was analysed using Epi info version 3.01 statistical software (CDC Atlanta, Georgia, USA). Absolute numbers and simple percentages were used to describe categorical variables. Similarly, quantitative variables were described using measures of central tendency (mean, median) and measures of dispersion (range, standard deviation) as appropriate. The Chi-square test was used for assessing the significance of associations between categorical groups. A P value of 0.05 or less was considered statistically significant.
| Results|| |
A total of 35,792 clients booked for antenatal care at Aminu Kano Teaching Hospital, over the study period. Acceptors of contraceptive methods were 11,346 clients, giving contraceptive prevalence of 31.6%.
The methods used were oral contraceptives, male condom, female sterilisation, implants, injectables (noristerat and depo-provera) and intrauterine contraceptive device (IUCD).
The acceptors of modern contraceptive methods increased steadily from a total of 1009 in the year 1999-2000 to 3014 during the year 2007-2008 [Figure 1].
Approximately 65% of the clients used the injectables. This was the method used by the highest number of clients; and implant, was the least, used by 2% of the clients. Female sterilisation contributed about 3.4%, intrauterine contraceptive device (CUT 380A) 16.6%, male condom 2.8%, and oral contraceptive pills 10.4% [Table 1].
Oral contraceptive had 18.8% in the first two years (1999-2000). The use of this method decreased to 7.5% during the last two years of the study.
Male condom at the outset made its maximal contribution of 6.9% to the total contraceptive mix. This sharply dropped to 2.5% during the subsequent 2 years and made very insignificant contributions thereafter.
The injectable contraceptives contributed 52.4% at the beginning of the study, and then increased to 54.4% and its use then increased over time through 63.9% to 72.1%, during the year 2007-2008.
The intrauterine contraceptive device made its maximum contribution of 24% to the contraceptive mix during the year 2003-2004. This gradually decreased to11%, during the year 2007-2008.
The contribution of implants to the contraceptive mix started at 3.5% and decreased to 0.5%, 1.7%, 3.1%, and finally 2% during the year 2007-2008.
The contribution of female sterilisation to the study was an abysmal 1.6% in the first two years of the study. The use of the method then increased steadily over time to peak at 5.3% during the year 2005-2006. No man had vasectomy [Table 2] and [Table 3].
|Table 2: Number of clients that used the various methods of contraceptives|
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There was a significant increase in the trend of use of modern hormonal contraceptive methods as compared to the non-hormonal methods. ϰ 2trend = 87.21, P = 0.00000. [Table 4].
| Discussion|| |
The Aminu Kano Teaching Hospital (AKTH) provided all the range of family planning methods. This study looked at the trend of the contraceptive mix over the 10-year period.
The contraceptive prevalence in this study was 31.6%. This is higher than 13.8% reported by Idowu  and his co-workers from Ilorin, north central Nigeria and 11-13% reported by Emmanuel et al.,  in Calabar. The contraceptive prevalence in this study, was however similar to 29% reported by Odusina et al., in Ikeji Arakeji in Osun state south western Nigeria. 
Injectable contraceptive was the most widely used contraceptive method by our clients (64.6%). This may be due to subsidy provided for this method and ease of administration (i.e. does not required expertise of the doctors). The predominant choice of injectable contraceptives in this study is similar to the findings in Warri and Orlu in southern part of Nigeria and Zaria in Northern Nigeria. ,,,
It is however in contrast to the findings in a similar study in Jos, north-central Nigeria where ICD was the most widely used contraceptive method.  Female sterilisation is the most popular method worldwide. However, it contributed the least quota (3.5%) to the contraceptive mix in this study. This was due to a number of factors including cost, socio-cultural believes and premium given to childbirth in our environment, and because it is a permanent method of family planning. In Jos, however, female sterilisation contributed 21.7% to the contraceptive mix. 
The male condom was the 4 th most popular contraceptive method in the first 2 years of this study with a 6.9% contribution to the contraceptive mix. However, it subsequently became one of the least popular amongst the various methods contributing about 2.6% in the year 2007-2008. The enthusiasm that greeted the introduction of this method probably explained why the great number of acceptors opted for this method at the beginning of the study, especially with the prevailing 'suspicion' of the longer-acting and permanent methods as it pertained to return to fertility. This suspicion explained why female sterilisation and implants made their least contributions to the contraceptive mix at the beginning of the study, 1.6% and 3.5%, respectively. The average contribution of male condom to the total contraceptive mix was 3%. This finding is similar to the findings by other authors.  In the developing countries, the prevalence of condom usage among married women of reproductive age is between 2-6% in about half of the countries surveyed and below 2% in the other half.  However, globally the percentage of married couples using condoms for family planning appears to have declined slightly during the past decade  and condoms rank near the bottom among contraceptive methods used by married couples.  These two facts are reflected by the result of this study with the least total contribution at 2.9%. A number of factors are adduced for this decreased. While the family planning unit is open to all regardless of marital status or sex, its greatest clientele was made up of married women especially those referred from the postnatal clinic after the puerperium. However, few couples that practice family planning use condoms as their contraceptive of choice. Most of the need for condoms is among sexually active unmarried youth,  who did not constitute a sizeable percentage in our clinic. Also because the condom is the only contraceptive method that clearly prevents transmission of sexually transmitted infections (STIs), the AIDS epidemic has brought urgency and new attention to issues of condom use involving trust, negotiation and communication between sex partners.  For many people, especially married women, asking an intimate partner to use a condom suggest a lack of trust , and particularly in a long-term relationship, requesting to use condoms could imply distrust rather than caring. , Hence, the condom has suffered from an image problem and is associated with illicit sex, infidelity and immoral behavior.  In West Africa, many men believe that condom use is appropriate with their girl friends or casual partners, but not with their wives.  Finally, because much of the need for use of condoms is to prevent HIV/AIDS, and others STIs among unmarried people, particularly the youth.
Oral contraceptive in this study contributed 11.5% of the total contraceptive mix trailing injectables and the intrauterine device, which contributed 64.6% and 16.6%, respectively. This was similar to the findings by other authors. 
The intrauterine contraceptive device made a debut at its maximum contribution of 24% and gradually diminished. The initial 'rush' was associated with the subsidy provided for this method at the outset. With the introduction of a token fee, however, the number of clients waned.
Of the other modern methods, implants were the only one that made insignificant contribution at an overall 2.0%. It commenced at a modest 3.5% decreasing gradually to reach 1.7% during the third phase of the study. This could be due to the need to make an incision before its removal.
No man had vasectomy in this study. Male sterilisation is virtually non-existent in surveyed countries of sub-Saharan Africa. Less than 1% of women in developing countries rely on it for contraceptive protection.  This is due to inadequate information, cultural barriers, fears, misconceptions, and male dominance. 
In conclusion, majority of the clients in this study used the injectable contraceptive methods. Public awareness on other methods of contraception should be promoted.
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[Table 1], [Table 2], [Table 3], [Table 4]