A 15-YEAR REVIEW OF FEMALE STERILIZATION BY MINILAPAROTOMY UNDER LOCAL-ANESTHESIA IN KENYA

This paper is a comprehensive review of literature concerning the Keny an experience with female sterilization through minilaparotomy under l ocal anesthesia (ML/LA). A composite picture from analysis of several studies that include some 12,000 clients since 1979 reveals an average Kenyan user to be 31-34 years old (SD 4.9) with 5.9-6.8 children (SD 1.7-1.8). In up to 96% of cases, the indication for choosing steriliza tion is personal socio-economic considerations. The majority of client s (97%-99%) report satisfaction with their choice of sterilization at the first follow-up visit, and 96-99% state that they would recommend the method to others. The operation takes an average of 14 min (SD 4.5 -5.3) ''skin-to-skin'' through a 2.5-2.8 cm incision (SD 0.5). A mean of 18 cm(3) of 1% lignocaine is used (SD 2.7). Most clients (76.4%) ha ve no post-operative complaints; those who do have any complaints repo rt minor transitory problems. Similarly, most clients (96%) have moder ate, little, or no peri-operative pain, but 1.9%-5% report much pain. The intra-operative and early complication rate is 0.9%. Some 3.3% of clients suffer at least one complication, some multiple, and the compl ication rate at 6 weeks is 4.1%, with major complications occurring in 0.7% of cases, and minor complications in 3.4%. The crude failure rat e is 0.4% in the first year and 0.1% in the second year; when correcte d for luteal phase pregnancies, which account for 50% of all ''failure s,'' the actual failure rate is 0.2% in the first year and 0.1% in the second year both for interval and postpartum procedures. This literat ure review finds outpatient ML/LA to be a relatively safe, simple, eff ective, and well-accepted option for most Kenyan couples seeking contr aception that is intended to be permanent. Counseling, adequate client assessment, and voluntarism have been shown to be essential elements, not only for client satisfaction and avoidance of possible future reg ret, but also for technical case of the operative procedure. Recommend ations that derive from the Kenya experience are made. (C) 1997 Elsevi er Science.