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. 2024 Apr 5;16(4):e57649.
doi: 10.7759/cureus.57649. eCollection 2024 Apr.

Trends in Utilization of Emergency Contraceptives in Tanzania: A Retrospective Longitudinal Study From 2018 to 2023

Auleria W Kadinde  1 , Raphael Z Sangeda  1 , Lucy Mwenda  1 , Khadija I Yahya-Malima  2 , Cassian F Masatu  3 , Yonah H Mwalwisi  3 , Adam M Fimbo  3
Affiliations

Trends in Utilization of Emergency Contraceptives in Tanzania: A Retrospective Longitudinal Study From 2018 to 2023

Auleria W Kadinde et al. Cureus. .

Abstract

Introduction Emergency contraceptives (ECs) are a critical method for preventing unwanted pregnancies following unprotected sexual intercourse. However, Tanzania is experiencing an alarming surge in the misuse of ECs among reproductive-aged females, particularly younger girls and women. Reports of their use as regular contraceptives are a rising concern. Deviations from their intended use in emergencies may not only increase the risk of contraceptive failure but also increase the risk of adverse health events. This study aims to delineate and evaluate the utilization patterns of ECs over six consecutive years using importation data obtained from the Tanzania Medicines and Medical Devices Authority (TMDA). Materials and methods We analyzed the EC data collected by TMDA over six consecutive years using a retrospective longitudinal design. Microsoft Power BI (Microsoft® Corp., Redmond, WA) was used to clean, organize, and aggregate the data. IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States) was used to analyze annual trend utilization using linear regression. Results We analyzed 114 importation consignments for ECs, identifying 95.6% (109 records) as oral ECs and 4.4% (five records) as intrauterine devices (IUDs) between 2018 and 2023. This data revealed a significant increase in the volume of EC imports, with its contribution increasing from 1.9% in 2018 to 60.1% in 2023. This highlights the marked increase in EC consumption in Tanzania. In 2023, the defined daily dose per 1000 inhabitants per year (DID) peaked at 3.917826, indicating an unprecedented increase of 4,983.06% compared to the lowest DID observed in 2019 at 0.0873552. The year 2023 alone accounted for 41.63% of the total DID (9.43) over the entire study period. In 2019 and 2020, there was a decrease in EC consumption, followed by a rapid increase from 2021 to 2023. The reduction in EC consumption from 2019 to 2020 was 36.9% compared to that between 2021 and 2022. Conclusions The significant rise in EC importation and utilization in Tanzania between 2018 and 2023, marked by fluctuating consumption trends and a notable surge, highlights the urgent need for targeted educational and policy intervention. This will guide the rational and informed use of ECs, ensuring access aligns with best practices for reproductive health.

Keywords: emergency contraceptives (ecs); ethinyloestradiol; levonorgestrel; p2; pharmacoepidemiology; tanzania.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Annual consumption trends of ECs expressed by DDD per 1000 inhabitants per day in Tanzania from 2018 to 2023
ECs: emergency contraceptives; DDD: defined daily dose
Figure 2
Figure 2. Countries supplying ECs to Tanzania expressed by DDD per 1000 inhabitants per day between 2018 and 2023. The size of the bubble in the map corresponds to the quantity of DIDs
ECs: emergency contraceptives; DDD: defined daily dose; DID: DDD per 1000 inhabitants per day The figure was created using Microsoft Power BI Desktop software.
Figure 3
Figure 3. Brands of ECs consumed in Tanzania expressed by DDD per 1000 inhabitants per day between 2018 and 2023. Panel A shows products with a total DDI above 0.005 and panel B shows those with totals above 0.005
ECs: emergency contraceptives; DDD: defined daily dose; DID: DDD per 1000 inhabitants per day
Figure 4
Figure 4. Trends of dosage forms of ECs consumed in Tanzania expressed by DDD per 1000 inhabitants per day (DID) in Tanzania from 2018 to 2023
ECs: emergency contraceptives; DDD: defined daily dose; DID: DDD per 1000 inhabitants per day
Figure 5
Figure 5. Trends in total consumed ECs from 2018 to 2023. The linear curve estimation for (A) the overall EC consumption shows an increasing trend. (B) The Holt model with autoregressive integrated moving average (ARIMA) shows an upward forecast until 2026
ECs: emergency contraceptives; DDD: defined daily dose
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