Date of Award

7-1-2010

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Evan Sequeira

Second Supervisor/Advisor

William Stones

Department

Obstetrics and Gynaecology (East Africa)

Abstract

Background: Contraceptive use is often a lifestyle choice that could impact on the quality of life. Depot medroxyprogesterone acetate (DMPA), like any other contraceptive method has other effects besides fertility control. Understanding how these impacts on the quality of life could assist in client counseling, eventually leading to informed choices.

Objective: To determine health related quality of life changes associated with the use of DMPA for contraception.

Methods: A longitudinal observational study was carried out between December 2008 and September 2009 at family planning clinics at the Aga Khan University Hospital and Family Health Options, Kenya (FHOK) after institutional and ethical clearance. The anglicized version of the short form (SF) - 36 quality of life questionnaire was administered to consecutive eligible clients before initiation of DMPA and then six months later. Socio-demographic characteristics of these clients were sought. A total of 105 women were needed to detect a 5 point difference in the mental summary score of the SF-36 questionnaire with 80% precision over a 6-month period. Sexual function was also sought.

Data analysis was done using SPSS version 15.0. Non-parametric data were analysed using the Wilcoxon-Rank test. The student t-test was used to compare means. A p-value of

Results: A total of 107 eligible participants were enrolled in the study of which 98(91.6%) completed the 6-month follow-up. The mean age of the participants was 30.7 years with predominantly a post secondary school education (80.4%). DMPA was mainly chosen because of the convenience it provided. After 6 months of use the participants had an improved physical summary score (PCS), mean change 5.64(95% CI 1.87 to 9.4) p=0.054. There was, however, no significant change in sexual function; 5.33(95%CI -2.15 to 12.81) p=0.0858 and mental summary score (MCS); -0.51 (CI -1.90 to 2.92) p=0.432. The socio-demographic characteristics of the participants did not influence the outcome of these scores. The main side effect of DMPA was menstrual irregularity (32.5%); however, 17.2% of the participants found amenorrhea desirable and 46.9% found DMPA to be convenient as anticipated.

Conclusions: Besides its contraceptive efficacy DMPA could also be associated with an improved physical health with no adverse effect on mental health and sexual function.

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