Effectiveness of post-partum family planning interventions on contraceptive use and method mix at 1 year after childbirth in Kinshasa, DR Congo (Yam Daabo): a single-blind, cluster-randomised controlled trial

Abstract

Background In rural Burkina Faso, a package of six low-technology, post-partum contraceptive interventions (ie, refresher training for providers, a counselling tool, supportive supervision, daily availability of contraceptive services, client appointment cards, and invitation letters to attend appointments for partners), aimed at strengthening existing primary health-care services and enhancing demand for them, doubled the use of modern contraceptives at 12 months post partum (ie, 55% uptake in intervention recipients vs 29% in routine-care users). This study assessed the effect of a similar package but in urban settings of Kinshasa province, Democratic Republic of the Congo, in an effort to reduce the unmet need for post-partum family planning. Methods Yam Daabo was a multi-intervention, single-blinded, cluster-randomised controlled trial done in six primary health-care centres (clusters) in Kinshasa. Centres were randomly allocated to receive the six-component intervention or standard antenatal and postnatal care in matched pairs (1:1) on the basis of number of monthly births, the ratio of health workers per population in the health zone, and the urban and suburban settings. Only data analysts could be masked to cluster allocation. Health-care facilities were eligible if they provided a continuum of antenatal, delivery, and postnatal care, were well stocked with contraceptives, and were situated close to the main study centre. All pregnant women presenting to the six centres were eligible if they were in their third pregnancy trimester and had no counterindications to deliver in the facility. The main outcome was prevalence of use of modern contraceptives at 12 months after delivery. Analysis was by modified intention-to-treat using generalised linear mixed models or Fisher's exact test for small groups. Prevalence ratios were adjusted for cluster effects and baseline characteristics. This study was registered with the Pan-African Clinical Trials Registry (PACTR201609001784334). Findings From July 1, 2016, to Feb 2, 2017, eight of 52 clinics assessed for eligibility met the criteria and were randomised. Of 690 women approached, 576 (83%) women were enrolled: 286 in the four intervention clusters and 290 in the four control clusters. Of them, 519 (90%) completed the 12-month study exit interview (252 in the intervention group and 267 in the control group) and were included in the intention-to-treat analysis. At 12 months, 115 (46%) of 252 women in the intervention group and 94 (35%) of 267 in the control group were using modern contraceptives (adjusted prevalence ratio [PR] 1•58, 95% CI 0•74−3•38), with significant differences in the use of contraceptive implants (22% vs 6%; adjusted PR 4•36, 95% CI 1•96-9•70), but without difference in the use of shortacting contraceptives (23% vs 28%; 0•92, 0•29-2•98) and non-modern or inappropriate methods (7% vs 18%; 0•45, 0•13-1•54). There were no serious adverse events or maternal deaths related to the study. Interpretation The Yam Daabo intervention package did not have a...

Predictors of modern contraceptive use among women in Meru and Arusha districts in Northern Tanzania

“…CHWs may help to identify women who have unmet need i.e. need the contraceptive method but are not using and refer them to the nearest health facilities for counseling and services for implants and injectables as shown in Malawi, Democratic Republic of Congo and Burkina Faso [34,35]. CHWs may also help to address myths and misconceptions of using modern contraception [36].…”

Sustainability of Yam Daabo Interventions' Effects on Contraception use in Burkina Faso 12 Months after the end of Interventions

“…In BF, at 12 months, the modern contraceptive prevalence rate was 55% among women in the intervention group and 29% among women in the control group (adjusted prevalence ratio [PR]: 1.79, 95% CI = 1.30-2.47) [5]. In the DRC, at 12 months, 46% of the women in the intervention group and 35% of the women in the control group were using modern contraceptives (adjusted PR: 1.58, 95% CI = 0.74-3.38), with signi cant differences in the use of contraceptive implants (22% vs. 6%; adjusted PR: 4.36, 95% CI = 1.96-9.70) [6].…”

Discontinuation and switching of postpartum contraceptive methods over twelve months in Burkina Faso and the Democratic Republic of the Congo: a secondary analysis of the Yam Daabo trial

“…To improve the use of postpartum contraceptive methods, in 2015, we implemented a set of interventions in two African countries, Burkina Faso (BF) and the Democratic Republic of the Congo (DRC), and tested them in a cluster-randomized trial called Yam Daabo described previously [ 2 , 3 ]. The main results showed a significant increase in the use of contraceptive methods among women receiving interventions compared to women in the control group in both countries [ 4 , 5 ].…”