Provision of a postpartum intrauterine device (PPIUD) within 48 hours of delivery was highly cost-effective compared with standard practice in 2 lower middle-income countries. Policy makers should consider expansion of postpartum family planning counseling and introduction of immediate PPIUD services as an added tool to address the unmet need for contraception.

Introduction This is a one-year post-intervention study following an initiative to provide orientation to female community health volunteers (FCHVs) on postpartum family planning in Nepal. In light of positive results in the earlier post-intervention study, this study was designed to provide a more long-term perspective on sustainability by assessing the effect at one-year post-intervention. Methods This mixed-methods study was conducted in January 2020 in Morang district, Nepal. We collected quantitative data from a knowledge assessment of FCHVs who had participated in the intervention on postpartum family planning, data on their community-based counseling coverage and through interviews with postpartum mothers in two selected hospitals. Qualitative data were collected through six key informant interviews with health providers and four focus group discussions with FCHVs involved in the intervention. We performed descriptive and multivariate analyses for quantitative data and thematic analysis for qualitative data. Results In total, 206 FCHVs participated in the one-year post-intervention study with significant improvement in knowledge of postpartum family planning as compared to pre-intervention period. The adjusted odds ratios (AOR) for knowledge of the 5 key messages on postpartum family planning as compared to the pre-intervention period included 1) knowledge on postpartum family planning can be used immediately after birth (AOR = 18.1, P<0.001), 2) postpartum intra-uterine device (PPIUD) can provide protection up to 12 years (AOR = 2.9, P = 0.011), 3) mothers who undergo cesarean section can use PPIUD (AOR = 2.3, P<0.001), 4) PPIUD can be inserted immediately after birth (AOR = 6.2, P <0.001), and 5) women should go for follow-up immediately if the IUD strings are seen outside vulva (AOR = 2.0, P = 0.08). The FCHVs answering 4 or more questions correctly was 10 times higher (AOR = 10.1, P<0.001) at one-year post-intervention, whereas it was 25 times higher at immediate-post-test (AOR = 25.1, p<0.001) as compared to pre-intervention phase. The FCHVs had counseled 71% of the pregnant women (n = 538) within their communities at one-year post-intervention. The postpartum mothers in hospitals had a 2 times higher odds of being counseled by FCHVs during their pregnancy at one-year post-intervention (AOR = 1.8, P = 0.039) than in pre-intervention phase. The qualitative findings suggested a positive impression regarding the FCHV’s involvement in postpartum family planning counseling in the communities, however, supervision and monitoring over a longer term was identified as a key challenge and that may influence sustainability of community-based and hospital-based postpartum family planning services. Conclusion The FCHVs’ knowledge and community-based activities on postpartum family planning remained higher than in the pre-intervention. However, it declined when compared to the immediate post-intervention period. We propose regular supervision and monitoring of the work of the FCHVs to sustain progress.

Functional approaches to disability measurement in Zambia reveals an overall disability prevalence rate of 13.4%, 4% of whom are recorded as having “speech impairment” (Zambia Federation of the Disabled [ZAFOD], 2006). Further, multidimensional poverty assessments indicate that 48.6% of Zambia's approximately 16 million citizens are impoverished. Currently, there are three internationally qualified speech-language pathologists (SLPs) providing services within Zambia's capital city, Lusaka. Given these statistics, it follows that a significant number of Zambian's, experiencing communication disability, are unable to access specialist assessment and support. Over the past decade, Zambia has seen two very different approaches to address this service gap—firstly, a larger scale top-down approach through the implementation of a formal master's degree program and more recently a smaller scale, bottom-up approach, building the capacity of existing professionals working in the field of communication disability. This article provides an overview of both programs and the context, unique to Zambia, in which they have developed. Authors describe the implementation challenges encountered and program successes leading to a discussion of the weakness and merits to both programs, in an attempt to draw lessons from which future efforts to support communication disability and SLP service development in Majority World contexts may benefit.

Objective The objective of this study was to compare postpartum hemoglobin (Hb) between postpartum intrauterine device (PPIUD) and non‐PPIUD users. Methods A sample of 3697 postpartum women (475 PPIUD users, 3222 non‐PPIUD users) from 5 tertiary referral hospitals in Bangladesh were assessed at multiple time points between 6 weeks and 12 months postpartum. Non‐inferiority linear regression analysis compared changes in Hb levels at 29–52 weeks postpartum between the two groups. Non‐inferiority was declared if the lower 95% confidence interval of the estimated difference in Hb change since delivery between PPIUD and non‐PPIUD users was greater than −0.05 g/dl. Results At approximately 9 months postpartum, 276 women in the PPIUD group (58.1%) and 1086 women in the comparison group (33.7%) attended follow‐up. In total, 57.9% of PPIUD users and 61.0% of non‐PPIUD users had taken iron supplementation. Change in Hb was 0.02 g/dl (95% CI: −0.16, 0.19) higher in the PPIUD users than the comparison group. The lower limit of the 95% CI was greater than −0.05 g/dl, providing good evidence that PPIUD users were non‐inferior to the comparison group in their Hb levels. Conclusion In the presence of offering iron supplementation, and an uptake of just over 60%, no difference in anemia was observed between the PPIUD and control group.

Background This is a 1-year post-intervention study following an initiative to provide orientation to female community health volunteers (FCHVs) on postpartum family planning (PPFP) in Nepal implemented in December 2018. Despite positive results in the earlier post-intervention study, this study was designed to provide a more long-term perspective on sustainability by assessing the effect at 1-year post-intervention. Methods This mixed-methods study was conducted in January 2020 in Morang district, Nepal. We collected quantitative data from a knowledge assessment of FCHVs who had participated in the intervention on PPFP; data on their community-based counseling coverage and through interviews with postpartum mothers in two selected hospitals. Qualitative data was collected through six key informant interviews with health providers working on PPFP and four focus group discussions with FCHVs involved in the intervention. We performed descriptive and multivariable analyses for quantitative data and thematic analysis for qualitative data. Results of 1-year post-intervention were compared with pre-intervention and earlier evaluation study results. Results In total, 206 FCHVs participated in the 1-year post-intervention knowledge assessment with a 15-fold [adjusted odds ratio (AOR) = 14.9, p < 0.001] increase in knowledge when compared with the pre-intervention phase. A 20-fold increase in knowledge (AOR = 20.4, P < 0.001) had been reported in the post-test conducted immediately after the orientation. The FCHVs counseled 71% of the pregnant women within their communities at 1-year post-intervention. The postpartum mothers in hospitals had 2 times higher odds than in pre-intervention phase of being counseled by FCHVs during their pregnancy at 1-year post-intervention (AOR = 1.9, P = 0.036) as compared to a 3-fold higher odds of being counseled at 2-months post-intervention (AOR = 2.9, P < 0.001). The qualitative findings suggested a positive impression regarding the FCHV's involvement in PPFP counseling in the communities, however, supervision and monitoring over the longer term was identified as a key challenge and may influence sustainability of community-based and hospital-based PPFP services. Conclusion The FCHVs’ knowledge and community-based activities on PPFP remained higher than in the pre-intervention phase. They had however declined when compared to the 2-months post-intervention period. We propose regular supervision and monitoring of the work of the FCHVs in order to sustain progress.