A Nested Case-control Study On IUD's Failure About Service Quality For Women In Rural Areas In Yunnan Province

OBJECTIVE:This study aimed to explore the potential relevant risk factors of IUD's Failure about Service quality for Women in Rural Areas in Yunnan Province,thus promoting the effectiveness of IUD and quality of family planning services.METHODS:The study is part of a national tenth five-year IUD project.Theories of management epidemiology and quality of family planning services are used in research design.We designed a nested case-control study within the complete cohort of IUD users to determine whether the factors about the practitioner affect the IUD's Failure.the cases and the control populations all come from Rural Areas in Yunnan Province.cases(failure of IUD)and matched controls(1:1)were included.Matching criteria were region,age,type of IUD and the result of last pregnancy.Statistical methods included Chi-square tests,univariate and multivariate condition Logistic regression model.Data were analyzed by conditional logistic regression modeling that considered matching factors as potential confounders.Odds ratios(OR)were estimated from the models and 95%confidence intervals were calculated.Trend test for an ordinal variable was performed introducing in the model.We expect to look for the risk factor of IUD's Failure about Practitioner for Women in Rural Areas in Yunnan Province.RESULTS:Univariate analysis show that the possible reasons(P＜0.05)responsible for Failsure related expulsion and IUD downward dislocation include type of organ, the number of Operation in 2004,surgery certification of family planning,training in five years,proficiency of Operation,knowing operating contraindications,kind of working,Methods of diagnosis judgement.Multivariate-adjusted odds ratios(OR)and 95%confidence intervals(CI)were used to measure the strength of the association between Practitioner and IUD's Failure risk.Factors of entering multivariate Logistic regression model of Failsure related expulsion are as follows:no surgery certification offamily planning OR=4.261,P=0.000,95.0%CI(1.931,9.404);once trainingin five years OR=0.378,P=0.000,95.0%CI(0.219,0.652);twice training in five years OR=0.313,P =0.004,95.0%CI(0.142,0.688);kind of working OR=2.408,P =0.000, 95.0%CI(1.874,3.095);incomplete model of MLCu375 OR=2.791,P =0.028,95.0% CI(1.120,9.960)。Factors of entering multivariate Logistic regression model of IUD downward dislocation are as follows:once training in five years OR=0.345,P =0.001,95.0%CI(0.182,0.656);kind of working OR=2.460,P =0.000,95.0%CI (1.894,3.196);Methods of diagnosis judgement OR=0.503,P=0.001,95.0%CI (0.331,0.765)。RECOMMENDATIONS:The findings suggest that by strenghening training and assessment,the technical level of IUD's operation should be further improved.follow-up work should meet the needs of the women,nationnal family planning policy should be put into effect to ensure the effectiveness of IUD and quality of family planning services.