{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:54:56Z","timestamp":1753890896982,"version":"3.41.2"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T00:00:00Z","timestamp":1666656000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill \/ Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-010614"],"award-info":[{"award-number":["INV-010614"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Glob. Womens Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Ensuring adequate access to contraceptive implant removal services requires an understanding of potential clinical, logistical, and geographic challenges.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a cross-sectional survey of 39 public health facilities in two districts of Senegal. To assess facility readiness, we reported the proportion of facilities meeting all minimum conditions for regular and difficult implant removals. We then describe characteristics of referral networks. Geographic access modeling was conducted in a geographic information system to estimate the proportion of women of reproductive age living within specific travel times of facilities ready for regular and difficult removals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>72% of facilities met all conditions for regular removals, and 8% for difficult removals. In both cases, the main gaps related to equipment availability (79% of facilities had the minimum equipment for regular removals and 8% for difficult removals). 72% of facilities organized in three referral networks sent clients to other facilities for cases they could not manage. Of 11 receiving or single-network facilities, seven were ready for regular removals and one for difficult removals. Altogether, 36% of women in Dakar Centre and 99% of women in Kolda lived within two hours of a facility that was equipped to handle regular removals, compared to 15% and 69%, respectively, for difficult removals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Data such as those provided in this assessment are important to provide a realistic picture of the state of readiness of the health system and its ability to meet the inevitable demand for implant removals. Referral networks should be considered as an emerging strategy to avail sufficient capacity at the systems level, including for managing difficult removals. However, careful thought should be given to the location of facilities that are ready to receive cases in order to target upgrades.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fgwh.2022.899543","type":"journal-article","created":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T05:34:32Z","timestamp":1666676072000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical, logistic, and geographic factors in ensuring adequate access to implant removals: A cross-sectional survey of public facilities and GIS modeling of geographic access in two districts of Senegal"],"prefix":"10.3389","volume":"3","author":[{"given":"Aur\u00e9lie","family":"Brunie","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caleb","family":"Parker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salif","family":"Ndiaye","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fatou Ndiat\u00e9 Rachel","family":"Sarr Aw","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily B.","family":"Keyes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Lebetkin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Etienne","family":"Dioh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"MacCarthy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00e8me Mady Dia","family":"Ndiaye","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,10,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"17","DOI":"10.9745\/GHSP-D-17-00396","article-title":"Liftoff: the blossoming of contraceptive implant use in Africa","volume":"6","author":"Jacobstein","year":"2018","journal-title":"Glob Health Sci Pract"},{"year":"","key":"B2"},{"year":"","key":"B3"},{"volume-title":"S\u00e9n\u00e9gal: Enqu\u00eate d\u00e9mographique et de sant\u00e9 continue - EDS-continue 2019","year":"2019","key":"B4"},{"volume-title":"Enqu\u00eate d\u00e9mographique et de sant\u00e9 \u00e0 indicateurs multiples s\u00e9n\u00e9gal (EDS-MICS) 2010\u20132011","year":"2012","key":"B5"},{"key":"B6","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1783\/147118906777888459","article-title":"The challenges of location and removal of Implanon\u00ae contraceptive implants","volume":"32","author":"Fraser","year":"2006","journal-title":"J Fam Plann Reprod Health Care"},{"key":"B7","doi-asserted-by":"publisher","first-page":"220","DOI":"10.9745\/GHSP-D-20-00013","article-title":"What goes in must come out: a mixed-method study of access to contraceptive implant removal services in Ghana","volume":"8","author":"Callahan","year":"2020","journal-title":"Glob Health Sci Pract"},{"key":"B8","doi-asserted-by":"publisher","first-page":"366","DOI":"10.9745\/GHSP-D-16-00096","article-title":"Accessible contraceptive implant removal services: an essential element of quality service delivery and scale-up","volume":"4","author":"Christofield","year":"2016","journal-title":"Glob Health Sci Pract"},{"key":"B9","doi-asserted-by":"publisher","first-page":"684694","DOI":"10.3389\/fgwh.2021.684694","article-title":"Experiences of accessing and providing contraceptive implant removal services in Gaborone, Botswana: a qualitative study among implant users and healthcare providers","volume":"2","author":"Howett","year":"2021","journal-title":"Front Glob Women\u2019s Health"},{"key":"B10","doi-asserted-by":"publisher","first-page":"19","DOI":"10.29063\/ajrh2019\/v23i4.3","article-title":"Closing the gap: ensuring access to and quality of contraceptive implant removal services is essential to rights-based contraceptive care","volume":"23","author":"Howett","year":"2019","journal-title":"Afr J Reprod Health"},{"key":"B11","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1097\/AOG.0000000000003457","article-title":"Referral center experience with nonpalpable contraceptive implant removals","volume":"134","author":"Matulich","year":"2019","journal-title":"Obstet Gynecol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"101","DOI":"10.7196\/sajog.1229","article-title":"Non-palpable and difficult contraceptive implant removals: the new somerset hospital referral-clinic experience","volume":"23","author":"Petro","year":"2017","journal-title":"S Afr J Obstet Gynaecol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.contraception.2019.03.052","article-title":"Real world data on Nexplanon\u00ae procedure-related events: final results from the nexplanon observational risk assessment study (NORA)","volume":"100","author":"Reed","year":"2019","journal-title":"Contraception"},{"key":"B14","doi-asserted-by":"publisher","first-page":"90","DOI":"10.2307\/3583202","article-title":"Access to norplant removal: an issue of informed choice","volume":"5","author":"Tolley","year":"2001","journal-title":"Afr J Reprod Health"},{"year":"","key":"B15"},{"key":"B16","doi-asserted-by":"publisher","first-page":"46","DOI":"10.12688\/gatesopenres.13600.1","article-title":"Ensuring sufficient service capacity for removals of long-acting reversible contraceptives: a mixed-method study of provider experiences in Senegal [version 1; peer review: 3 approved]","volume":"6","author":"Brunie","year":"2022","journal-title":"Gates Open Res"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e2200123","DOI":"10.9745\/ghsp-d-22-00123","article-title":"Making removals part of informed choice: a mixed-method study of client experiences with removal of long-acting reversible contraceptives in Senegal","volume":"10","author":"Brunie","year":"2022","journal-title":"Glob Health Sci Pract"},{"volume-title":"Service availability and readiness assessment (SARA): An annual monitoring system for service delivery: reference manual. No. WHO\/HIS\/HSI\/RME\/2013\/1","year":"2013","key":"B18"},{"key":"B19","doi-asserted-by":"publisher","first-page":"473","DOI":"10.9745\/GHSP-D-18-00041","article-title":"Assessment of family planning service availability and readiness in 10 african countries","volume":"6","author":"Ali","year":"2018","journal-title":"Glob Health: Sci Pract"},{"year":"2016","key":"B20"},{"key":"B21","doi-asserted-by":"publisher","first-page":"2061239","DOI":"10.1080\/16549716.2022.2061239","article-title":"The role of non-governmental organizations in strengthening healthcare systems in low- and middle-income countries: lessons from Sant\u00e9 Diab\u00e8te in Mali","volume":"15","author":"Besan\u00e7on","year":"2022","journal-title":"Glob Health Action"},{"key":"B22","doi-asserted-by":"publisher","first-page":"18","DOI":"10.21037\/jphe-2020-gs-07","article-title":"The role of non-governmental organizations in advancing the global surgery and anesthesia goals","volume":"4","author":"Jumbam","year":"2020","journal-title":"J Pub Health Emerg"},{"year":"","key":"B23"},{"year":"","key":"B24"},{"year":"","key":"B25"},{"year":"","key":"B26"},{"year":"","key":"B27"},{"key":"B28","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1097\/GCO.0000000000000416","article-title":"Difficult implant removals","volume":"29","author":"Voedisch","year":"2017","journal-title":"Curr Opin Obstet Gynecol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1016\/j.ijgo.2011.09.004","article-title":"Using a GIS to model interventions to strengthen the emergency referral system for maternal and newborn health in Ethiopia","volume":"115","author":"Bailey","year":"2011","journal-title":"Int J Gynaecol Obstet"}],"container-title":["Frontiers in Global Women's Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fgwh.2022.899543\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T05:34:37Z","timestamp":1666676077000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fgwh.2022.899543\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,25]]},"references-count":29,"alternative-id":["10.3389\/fgwh.2022.899543"],"URL":"https:\/\/doi.org\/10.3389\/fgwh.2022.899543","relation":{},"ISSN":["2673-5059"],"issn-type":[{"type":"electronic","value":"2673-5059"}],"subject":[],"published":{"date-parts":[[2022,10,25]]},"article-number":"899543"}}