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  • Title: Experience with NORPLANT in Egypt.
    Author: Shaaban MM.
    Journal: Ann Med; 1993 Apr; 25(2):167-9. PubMed ID: 8489755.
    Abstract:
    Experience with the contraceptive NORPLANT in Egypt dates back to early 1980 when the first multicentre trial was initiated. To date, more than 3000 women have received this contraceptive at the Assiut University Family Clinic alone. Analysis of the overall experience in this clinic has indicated a 5-year cumulative continuation rate of 51 and a pregnancy rate of 1.8 per 100 women. Clinical pharmacology studies pertaining to the safety of NORPLANT in our community have indicated no deleterious effect on the lipid profile, liver functions and blood coagulation system. Two studies conducted in Egypt have indicated that the initiation of NORPLANT use shortly after delivery does not have any unfavourable effect on lactational performance, or on physical or psychomotor development of the breast-fed infants. This is particularly important in Arab and Moslem cultures where prolonged breast-feeding is emphasized. A study utilizing focus-group discussion to assess users' attitudes to NORPLANT has indicated the need to improve the informational/educational package given in the service by emphasizing certain cultural considerations. On the whole, this first implant method has proven to be safe and acceptable in Egypt, where there is a special need for long-term methods for contraception, particularly as sterilization is not socially acceptable. Egyptian women first experienced the contraceptive implant, Norplant, in early 1980, but Egypt still has not registered Norplant for public use. The 1980 preintroductory trial Norplant took place in 4 centers. 84% of the women accepting Norplant continued to accept it for more than 12 months. The net cumulative continuation rates at the center in Assiut in southern Egypt were 86.6% at 1 year, 69.2% at 3 years, and 50.9% at 5 years. The 5-year pregnancy rate was 1.4%. The Assiut clinic still provides Norplant (as of early 1993, 3130 Norplant acceptors and more than 10,000 woman-years of Norplant use). Most Norplant acceptors at Assiut (85%) have at least 4 children. Researchers at Assiut University found no changes in serum lipids and a slight, but significant, increase in serum high-density lipoprotein cholesterol after 12 months of using Norplant. They also did not find Norplant to have a significant effect on several liver function tests. This finding is especially important in Egypt where schistosomiasis and acute viral hepatitis are endemic. After 6 months of Norplant use, the Assiut researchers reported a significant increase in factor VII activity and a significant decrease in antithrombin III. Yet these changes were considerably smaller than those in oral contraceptive (OC) users. Besides, OC users experienced changes in other factors which increase blood coagulability. Also in Assiut, 50 lactating mothers used Norplant beginning at the 2nd month postpartum. Norplant did not affect lactational performance or infant health. Further, it did not prevent breastfed infants from reaching the various milestones of psychomental development. Assiut university conducted focus groups to learn about Norplant acceptability. The focus groups emphasized the need for service to improve the information and education they provide clients. A physician at Assiut University calls for facilities to remove Norplant on demand to increase acceptability.
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