Academic journal article Bulletin of the World Health Organization

Contraceptive Injections by Community Health Workers in Uganda: A Nonrandomized Community trial/Injections Contraceptives Par Des Agents De Sante Communautaires En Ouganda : Essai En Communaute Non randomise/Administracion De Anticonceptivos Inyectables Por Agentes De Salud Comunitarios En Uganda: Ensayo Comunitario No Aleatorizado

Academic journal article Bulletin of the World Health Organization

Contraceptive Injections by Community Health Workers in Uganda: A Nonrandomized Community trial/Injections Contraceptives Par Des Agents De Sante Communautaires En Ouganda : Essai En Communaute Non randomise/Administracion De Anticonceptivos Inyectables Por Agentes De Salud Comunitarios En Uganda: Ensayo Comunitario No Aleatorizado

Article excerpt

Introduction

Africa is home to dozens of programmes for community-based distribution (CBD) of contraceptives. However, the popularity and impact of programmes that use paramedical workers to distribute condoms and oral contraceptive pills may be limited by the fact that none supply the most popular family planning method in sub-Saharan Africa: injectable progestin-only contraceptives such as depot medroxyprogesterone acetate (DMPA, Depo Provera). Though practically unknown on the continent before the 1990s, injectable contraceptives have rapidly become the region's method of choice due to their effectiveness, their simple re-injection schedule (every three months for DMPA) and their suitability for discreet use.

Community health workers routinely provide vaccinations in Africa and give contraceptive injections in some developing regions. Bangladesh, for example, began a programme to provide Depo Provera and other methods in clients' homes in 1976. The programme was credited with reducing fertility rates by 25% compared with areas where use of DMPA was rare. (1) More recently, community-based family planning programmes in Bolivia, Guatemala, Mexico and Peru successfully added injectable contraceptives to the method mix offered to many of their rural clients. (2-5) Solid evidence exists that community-based health workers can safely screen for medical contraindications to DMPA, (6) and checklists using WHO eligibility criteria have been created to facilitate CBD provision of injectable contraceptives. (7)

In spite of this evidence base, paramedical provision of injectable contraception remains rare around the world and is unknown in Africa, where clinic access is often poor and the need is greatest. Critics of the practice contend that it is unsafe for women to receive contraceptive injections from nonclinically trained personnel. Other concerns include the possibility that poorly supervised paramedicals will provide other, perhaps unnecessary, injections or pose as medical personnel. Finally, some health personnel may feel that task shifting to nonclinicians will infringe on their status (or their income), and some policy-makers and managers may dislike the prospect of responsibility for yet another cadre of health workers.

The purpose of this study was to test the hypothesis that the safety and quality of contraceptive injections by community-based reproductive health workers in a rural African setting was not significantly inferior to injections given by local clinic-based workers.

Participants and intervention

The research took place in Uganda, which has a modern method contraceptive prevalence rate of 18%. Injectables are the most popular contraceptive method in Uganda, accounting for about 57% of all modern methods used. (8)

Planning for the study began in 2003, after interest was expressed by Uganda's Ministry of Health and Save the Children/USA, a nongovernmental organization that sponsors Uganda's most active CBD programme in its main focus district, Nakasongola. This large rural district two hours north of Kampala has a population of about 140 000 which subsists mainly on agriculture, cattle grazing and fishing. The district's total fertility rate is about 7, while its contraceptive prevalence is estimated at 9%. There are no sterilization services in the district, nor are implants routinely available. Intrauterine devices (IUDs) are available in theory, though in practice they are almost never provided due to provider concerns about STI risks. For most women, oral contraceptive pills and Depo Provera are the only realistic options for family planning, and reviews of clinic records suggest that Depo Provera is by far the preferred method available.

Although Nakasongola's health needs are served by a subdistrict hospital, five health centres and eight health posts, only 6% of the population live within 5 km of a health services unit. (9) Save the Children/ USA sponsors health and education efforts throughout the district, including a community based reproductive health and family planning programme that complements existing clinic-based services, particularly for those for whom clinic access is problematic. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.