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Background
Depo medroxyprogesterone acetate (DMPA) injectable contraceptive is a reversible and
effective hormonal contraceptive method many women in East Africa use. However, various
studies suggest it might increase cardiometabolic disease risk due to its influence on
cardiometabolic risk factors and call for a thorough evaluation of its effects on cardiometabolic
risk profile to design proper prevention strategies. There is a need for further research to fully
characterize the effects and make an informed decision on establishing measures for regular
follow-up with users. This study responds to that need and explores the impact of DMPA use
on lipid profile, waist circumference, blood pressure, glycated haemoglobin, and inflammatory
markers among women of reproductive age in Rwanda. Three main objectives guided the study:
(i) to explore the prevalence of central obesity and its association with other cardiometabolic
risk factors in women of reproductive age in Kigali, Rwanda; (ii) to evaluate the effects of
DMPA on lipid profile, waist circumference, blood pressure, glycated haemoglobin, and
inflammatory markers among women of reproductive age in Kigali, Rwanda; and (iii) to analyse
changes in cardiometabolic risk markers among abdominally obese women of reproductive age
in Kigali, Rwanda during the use of DMPA.
Methods
The study used a cross-sectional design to explore the prevalence of central obesity and its
correlates (objective 1). It also used a prospective cohort design to evaluate the effects of DMPA
on cardiometabolic risk profile among the users (objective 2) and a pre-post design to analyse
the changes in cardiometabolic risk markers among abdominally obese women.
The target population was women of reproductive age in Kigali city. To explore the prevalence
of central obesity and its correlates, we conveniently selected 138 participants and analysed data
by chi-square and logistic regression analyses. To evaluate the effects of DMPA on
cardiometabolic risk profile, we randomly selected 45 DMPA users and 45 non-hormonal
methods users and analysed data by the Manny Whitney test. To assess the changes in
cardiometabolic risk markers among abdominally obese women during DMPA use, we selected
a sample of 65 participants and analysed data using Wilcoxon signed-rank test.
Results
The thesis report is presented as a compilation of three complementary manuscripts, each
responding to one of the objectives earlier described.
Study 1: The first study explored the prevalence of central obesity and its correlates using a
cross-sectional design. Results indicate that the prevalence of central obesity was 48.5% and
was significantly associated with age (OR=3.25, 95% CI: 1.11-9.47), alcohol use (OR=5.57,
95% CI: 1.91-16.20), meat consumption (OR=4.33, 95% CI: 1.49-12.59), hypertriglyceridemia
(OR= 4.12, 1.01-14.76), and elevated diastolic blood pressure (OR=4.87, 95% CI: 1.47-16.13).
Study 2: The second study evaluates the effects of DMPA on cardiometabolic risk profiles
among the users using a prospective design. Results indicate that DMPA users experienced a
significant increase in waist circumference, TG, LDL, TC, hs-CRP, and glycated haemoglobin
at twelve months of follow-up. In contrast, they experienced a significantly lower HDL than
controls (p= <0.05). However, the study did not indicate a significant difference in blood
pressure changes between DMPA users and the control group (p> 0.05).
Study 3: The third study analysed the changes in cardiometabolic risk markers among
abdominally obese women during the use of DMPA. Results indicate that after twelve months,
all cardiometabolic risk markers showed significant changes; there was a gradual decrease in
HDL and an increase in TG, LDL, TC, hs-CRP, waist circumference, SBP, DBP, and glycated
haemoglobin (p= <0.05).
Conclusions
The prevalence of central obesity was relatively high among women of reproductive age, and it
was associated with older age, elevated diastolic blood pressure, high triglycerides levels, and
meat and alcohol consumption. The study recommends an intensive awareness of health risks
associated with central obesity and its associated factors to address the rising risk of
cardiovascular diseases in this population. DMPA induces alteration in the cardiometabolic risk
profile, where this alteration worsens when the user is abdominally obese. Considering the
cardiometabolic health of individual users before initiating the method and providing a follow up to the users of increased risk sounds essential |
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