Contraceptive injections by community health workers in Uganda: a nonrandomized community trial

Abstract

Objective To compare the safety and quality of contraceptive injections by community-based health workers with those of clinicbased nurses in a rural African setting.Methods A nonrandomized community trial tested provision of injectable Depo Provera (DMPA) by community reproductive health workers and compared it with routine DPMA provision at health units in Nakasongola District, Uganda. The primary outcome measures were safety, acceptability and continuation rates. Findings A total of 945 new DMPA users were recruited by community workers, clinic-based nurses and midwives. Researchers successfully followed 777 (82% follow-up): 449 community worker clients and 328 clinic-based clients. Ninety-five percent of community-worker clients were "satisfied" or "highly satisfied" with services, and 85% reported receiving information on side-effects. There were no serious injection site problems in either group. Similarly, there was no significant difference between continuation to second injection (88% among clients of community-based workers, 85% among clinic-going clients), nor were there significant differences in other measures of safety, acceptability and quality. Conclusion Community-based distribution (CBD) of injectable contraceptives is now routine in some countries in Asia and Latin America, but is practically unknown in Africa, where arguably the need for this practice is greatest. This research reinforces experience from other regions suggesting that well-trained community health workers can safely provide contraceptive injections.

Provision of injectable contraceptives in Ethiopia through community-based reproductive health agents

“…2,9 While several countries have experimented with shifting the distribution of short-term methods of family planning to community-based distributors or health volunteers, [10][11][12] much unmet need for contraceptives remains. 13 Shifting the task of providing longer-acting injectable contraceptives, such as depot medroxyprogesterone acetate (DPMA), to community workers can provide access to these methods to a larger number of women.…”

“…Most recently, studies conducted in Madagascar, Malawi and Uganda have demonstrated that community health workers who receive proper training in screening, injection technique and counselling can administer DMPA injections to women in rural areas just as safely as clinic-based providers and with comparable rates of acceptability and continuation. 11,12,[16][17][18] In numerous settings, DMPA has emerged as the preferred method of contraception primarily because it is effective, can be used privately, has a longer period of action than oral contraceptives or condoms and requires less frequent supply. 19 In Ethiopia, DMPA is now the method of choice for over 70% of women using modern methods of contraception, compared with almost no utilization as recently as 1990.…”

Use of injectable hormonal contraceptives: diverging perspectives of women and men, service providers and policymakers in Uganda

“…2,4 In low-income countries, injectables have several advantages: they require minimal provider training and do not require patient follow-up beyond the woman returning regularly for repeat injections. 5,6 Furthermore, injections can be more easily concealed from partners than pills and other methods. Lastly, injectables are effective: less than 1% of women become pregnant within a year with consistent use; 3% with inconsistent use.…”

Achieving success with family planning in rural Afghanistan

“…11,12 Recent community trials in Uganda show that CHWs compare favourably with clinics in standards of care for providing injectables. 13 Study limitations include lack of a formal control group. However, having no competing inputs, changes can be attributed to the ACU Project.…”