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Drouard SHP, Brenner S, Antwisi D, Toure NK, Madhavan S, Fink G, Shapira G. Effects of Performance-Based Financing on Availability, Quality, and Use of Family Planning Services in the Democratic Republic of Congo: An Impact Evaluation. Stud Fam Plann 2024; 55:127-149. [PMID: 38627906 DOI: 10.1111/sifp.12264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
Access to high-quality family planning services remains limited in many low- and middle-income countries, resulting in a high burden of unintended pregnancies and adverse health outcomes. We used data from a large randomized controlled trial in the Democratic Republic of Congo to test whether performance-based financing (PBF) can increase the availability, quality, and use of family planning services. Starting at the end of 2016, 30 health zones were randomly assigned to a PBF program, in which health facilities received financing conditional on the quantity and quality of offered services. Twenty-eight health zones were assigned to a control group in which health facilities received unconditional financing of a similar magnitude. Follow-up data collection took place in 2021-2022 and included 346 health facility assessments, 476 direct clinical observations of family planning consultations, and 9,585 household surveys. Findings from multivariable regression models show that the PBF program had strong positive impacts on the availability and quality of family planning services. Specifically, the program increased the likelihood that health facilities offered any family planning services by 20 percentage points and increased the likelihood that health facilities had contraceptive pills, injectables, and implants available by 23, 24, and 20 percentage points, respectively. The program also improved the process quality of family planning consultations by 0.59 standard deviations. Despite these improvements, and in addition to reductions in service fees, the program had a modest impact on contraceptive use, increasing the modern method use among sexually active women of reproductive age by 4 percentage points (equivalent to a 37 percent increase), with no significant impact on adolescent contraceptive use. These results suggest that although PBF can be an effective approach for improving the supply of family planning services, complementary demand-side interventions are likely needed in a setting with very low baseline utilization.
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Ibikunle OO, Ipinnimo TM, Bakare CA, Ibirongbe DO, Akinwumi AF, Ibikunle AI, Ajidagba EB, Olowoselu OO, Abioye OO, Alabi AK, Seluwa GA, Alabi OO, Filani O, Adelekan B. Community perceptions, beliefs and factors determining family planning uptake among men and women in Ekiti State, Nigeria: finding from a descriptive exploratory study. BMJ Open 2024; 14:e077932. [PMID: 38604631 PMCID: PMC11015261 DOI: 10.1136/bmjopen-2023-077932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 03/27/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVES To examine family planning through the community's perception, belief system and cultural impact; in addition to identifying the determining factors for family planning uptake. DESIGN A descriptive exploratory study. SETTING Three communities were selected from three local government areas, each in the three senatorial districts in Ekiti State. PARTICIPANTS The study was conducted among young unmarried women in the reproductive age group who were sexually active as well as married men and women in the reproductive age group who are currently living with their partners and were sexually active. MAIN OUTCOME MEASURES Eight focus group discussions were conducted in the community in 2019 with 28 male and 50 female participants. The audio recordings were transcribed, triangulated with notes and analysed using QSR NVivo V.8 software. Community perception, beliefs and perceptions of the utility of family planning, as well as cultural, religious and other factors determining family planning uptake were analysed. RESULTS The majority of the participants had the perception that family planning helps married couple only. There were diverse beliefs about family planning and mixed reactions with respect to the impact of culture and religion on family planning uptake. Furthermore, a number of factors were identified in determining family planning uptake-intrapersonal, interpersonal and health system factors. CONCLUSION The study concluded that there are varied reactions to family planning uptake due to varied perception, cultural and religious beliefs and determining factors. It was recommended that more targeted male partner engagement in campaign would boost family planning uptake.
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Affiliation(s)
| | - Tope Michael Ipinnimo
- Department of Community Medicine, Federal Teaching Hospital Ido-Ekiti, Ido Ekiti, Nigeria
| | - Caroline Ajoke Bakare
- Ekiti State Primary Health Care Development Agency, Ekiti State of Nigeria Government, Ado Ekiti, Nigeria
| | | | - Adebowale Femi Akinwumi
- Department of Community Medicine, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria
| | - Austine Idowu Ibikunle
- Department of Community Medicine, Federal Teaching Hospital Ido-Ekiti, Ido Ekiti, Nigeria
| | | | | | | | - Ayodele Kamal Alabi
- Department of Community Medicine, Federal Teaching Hospital Ido-Ekiti, Ido Ekiti, Nigeria
| | - Gilbert Ayodele Seluwa
- Ekiti State Primary Health Care Development Agency, Ekiti State of Nigeria Government, Ado Ekiti, Nigeria
| | | | - Oyebanji Filani
- Ekiti State Ministry of Health and Human Services, Ekiti State of Nigeria Government, Ado Ekiti, Nigeria
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Glover AL, Mulunda JC, Akilimali P, Kayembe D, Bertrand JT. Expanding access to safe abortion in DRC: charting the path from decriminalisation to accessible care. Sex Reprod Health Matters 2023; 31:2273893. [PMID: 37955526 PMCID: PMC10653615 DOI: 10.1080/26410397.2023.2273893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Abstract
Access to safe and comprehensive abortion care has the potential to save thousands of lives and prevent significant injury in a vast and populous country such as the Democratic Republic of the Congo (DRC). While the signing of the Maputo Protocol in 2003 strengthened the case for accessible abortion care across the African continent, the DRC has grappled with de jure ambiguity resulting in de facto confusion about women's ability to access safe, legal abortion care for the past two decades. Conflicting laws and the legacy of the colonial penal code created ambiguity and uncertainty that has just recently been resolved through medical and legal advocacy oriented towards facilitating an enabling policy environment that supports reproductive healthcare. A study of the complex - and frequently contradictory - pathway from criminalised abortion to legalisation that DRC has taken from ratification of the protocol in 2008 to passage of the 2018 Public Health Law and subsequent Ministry of Health guidelines for abortion care, is an instructive case study for the international sexual health and reproductive rights community. Through this analysis, health and legal advocates can better understand the interdependence of law and public health and how a comprehensive approach to advocacy that includes legal, systems, and clinical accessibility can transform a country's system of care and the protection of women's rights. In DRC, new legislation and service delivery guidelines demonstrate a path forward towards concrete improvements for safe abortion care.
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Affiliation(s)
- Annie L. Glover
- Adjunct Assistant Professor, Department of International Health & Sustainable Development, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, USA; Fellow, University of North Carolina at Chapel Hill Institute for Global Health & Infectious Diseases, National Institutes of Health Fogarty Global Health Center
| | | | - Pierre Akilimali
- Professor, Kinshasa School of Public Health & Kinshasa School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Dynah Kayembe
- Field Coordinator, Kinshasa School of Public Health & Kinshasa School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jane T. Bertrand
- Professor, School of Public Health & Tropical Medicine Department of Health Policy & Management, Tulane University, New Orleans, LA, USA
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Abeid RA, Sumari EI, Qin C, Lyimo AA, Luttaay GA. Uptake of modern contraceptive methods among women of reproductive age in Chake District-Pemba Tanzania: a descriptive crossectional study. Contracept Reprod Med 2023; 8:35. [PMID: 37461065 PMCID: PMC10351188 DOI: 10.1186/s40834-023-00234-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/21/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The uptake of the modern contraceptive method provides chances for women and couples to reach optimal child spacing, achieve the desired family size and prevent unsafe abortions and maternal deaths. Despite the efforts in the health sector still, the contraceptive prevalence rate in Zanzibar remains low (9.1%). In Pemba, few studies have been done on modern contraceptive uptake and little is known about factors that hinder the uptake of modern contraceptives among women of reproductive age. This study investigated the uptake of modern contraceptive methods among women of reproductive age (18-45 years) and its associated factors. METHODS This was a quantitative cross-sectional study conducted in Chake District Hospital, Pemba Tanzania. A stratified random sampling technique was used to recruit 214 eligible participants for the study. After we informed the participants, data were collected using a structured English questionnaire. The collected data was analyzed using SPSS version 25, descriptive analysis was done to determine frequencies. A chi-square test was done to determine the association between the study variables and multivariate logistic regression to check the nature and strength of the association. The p<0.05 was considered statistically significant. RESULTS This study included 214 women of with majority 79(36.9%) at the age group of 21-30 years, 100(46.7%) had secondary education and 187(87.4%) married. Most of the participants 212(99.1%) have heard about modern contraceptives, with health facilities being the common source of information191(45.3). More than half 120(56.1%) of the participants were not using any modern contraceptive method and injectable 38(40.4%) was the commonly reported method among users. Among the users of modern contraceptives, lack of power to decide 180(84.1%), fear of divorce 141(65.9%), and social perception of users as the cause of reduced workforce in the future 161(75.2%) were common barriers. Participants provided suggestions to improve modern contraceptive uptake including male involvement 203(94.9%) and community awareness 182(85%). Further analysis revealed women with college/university education were 2 times more likely to use modern contraceptives method compared to those with primary or not attended school(p=0.023, OR=2.437, 95% CI: 1.129-5.259). Moreover employed women were 2 times more likely to use modern contraceptives compared to unemployed/housewives (p=0.028, OR=1.844, CI=1.068-3.185). CONCLUSION This study assesses the uptake of modern contraceptives among women of reproductive age. Results showed a low uptake of modern contraceptives in this population. Although the observation in this study is similar to those reported in other countries, the updated information is still important to the policymakers and the Ministry of Health in the studied district.
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Affiliation(s)
- Rehema Abdalla Abeid
- Department of Preventive Services, Integrated Reproductive and Child Health Program, Ministry Health, Pemba, Tanzania
| | - Emmanuel Izack Sumari
- Department of Nursing Management Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Chunxiang Qin
- Department of Nursing, The Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Ally Abdul Lyimo
- Department of Community Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Godrian Aron Luttaay
- Department of Nursing, Kibosho Institute of Health and Allied Sciences, Moshi, Tanzania
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Bapolisi WA, Bisimwa G, Merten S. Barriers to family planning use in the Eastern Democratic Republic of the Congo: an application of the theory of planned behaviour using a longitudinal survey. BMJ Open 2023; 13:e061564. [PMID: 36764708 PMCID: PMC9923293 DOI: 10.1136/bmjopen-2022-061564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
OBJECTIVE In the Democratic Republic of the Congo, there is a low adherence of the population to the use of family planning (FP) due to various social barriers. This study aimed to understand the drives from social barriers to the use of FP in women in the Kivu, a region particularly affected by poverty and many years of conflicts. A theory of planned behaviour (TPB) using a generalised structural equation modelling has been applied to understand the complex sociocultural drivers to the intention and the ultimate decision to use FP. DESIGN Longitudinal study. SETTING A community-based approach was used to investigate FP use in the North and South-Kivu regions. PARTICIPANTS Overall, 1812 women 15 years and older were enrolled in the baseline study and 1055 were retrieved during the follow-up. PRIMARY AND SECONDARY OUTCOMES FP use and intention to use FP. RESULTS The mean age was 36±12.9 years, with a minimum of 15 years old and a maximum of 94 years old. Among sexually active participants, more than 40% used a modern contraceptive method at the last sexual intercourse. Education was positively and significantly associated with intention to use FP (β=0.367; p=0.008). Being married was positively and marginally significantly associated with intention to use FP (β=0.524: p=0.050). Subjective norms were negatively and significantly associated with intention to use FP (β=-0.572; p=0.003) while perceived control was positively associated with intention to use FP (β=0.578; p<0.0001). Education and perceived control were positively and significantly associated with the use of FP (respectively, β=0.422, p=0.017; and β=0.374; p=0.017), while Intention to use FP was positively and marginally significantly associated with the use of FP (β=0.583; p=0.052). CONCLUSION TPB helped understand sociocultural barriers to FP use and it can be useful to define adapted strategies in different contexts.
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Affiliation(s)
- Wyvine Ansima Bapolisi
- Epidemiology, University of Basel Faculty of Science, Basel, Switzerland
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Ghislain Bisimwa
- Ecole Régionale de Santé Publique, Catholic University of Bukavu, Bukavu, South-Kivu, Congo (the Democratic Republic of the)
| | - Sonja Merten
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
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Pattnaik A, Mohan D, Zeger S, Kanyuka M, Kachale F, Marx MA. From raw data to a score: comparing quantitative methods that construct multi-level composite implementation strength scores of family planning programs in Malawi. Popul Health Metr 2022; 20:18. [PMID: 36050721 PMCID: PMC9438221 DOI: 10.1186/s12963-022-00295-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 03/27/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Data that capture implementation strength can be combined in multiple ways across content and health system levels to create a summary measure that can help us to explore and compare program implementation across facility catchment areas. Summary indices can make it easier for national policymakers to understand and address variation in strength of program implementation across jurisdictions. In this paper, we describe the development of an index that we used to describe the district-level strength of implementation of Malawi's national family planning program. METHODS To develop the index, we used data collected during a 2017 national, health facility and community health worker Implementation Strength Assessment survey in Malawi to test different methods to combine indicators within and then across domains (4 methods-simple additive, weighted additive, principal components analysis, exploratory factor analysis) and combine scores across health facility and community health worker levels (2 methods-simple average and mixed effects model) to create a catchment area-level summary score for each health facility in Malawi. We explored how well each model captures variation and predicts couple-years protection and how feasible it is to conduct each type of analysis and the resulting interpretability. RESULTS We found little difference in how the four methods combined indicator data at the individual and combined levels of the health system. However, there were major differences when combining scores across health system levels to obtain a score at the health facility catchment area level. The scores resulting from the mixed effects model were able to better discriminate differences between catchment area scores compared to the simple average method. The scores using the mixed effects combination method also demonstrated more of a dose-response relationship with couple-years protection. CONCLUSIONS The summary measure that was calculated from the mixed effects combination method captured the variation of strength of implementation of Malawi's national family planning program at the health facility catchment area level. However, the best method for creating an index should be based on the pros and cons listed, not least, analyst capacity and ease of interpretability of findings. Ultimately, the resulting summary measure can aid decision-makers in understanding the combined effect of multiple aspects of programs being implemented in their health system and comparing the strengths of programs across geographies.
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Affiliation(s)
- Anooj Pattnaik
- grid.21107.350000 0001 2171 9311Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, E5541, Baltimore, MD 21205 USA
| | - Diwakar Mohan
- grid.21107.350000 0001 2171 9311Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, E5541, Baltimore, MD 21205 USA
| | - Scott Zeger
- grid.21107.350000 0001 2171 9311Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, E5541, Baltimore, MD 21205 USA
| | | | - Fannie Kachale
- grid.415722.70000 0004 0598 3405Reproductive Health Directorate, Ministry of Health, Lilongwe, Malawi
| | - Melissa A. Marx
- grid.21107.350000 0001 2171 9311Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, E5541, Baltimore, MD 21205 USA
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Memon ZA, Reale S, Ahmed W, Spencer R, Lashari TH, Bhutta Z, Soltani H. Effects of Integrating Family Planning With Maternal, Newborn, and Child Health Services on Uptake of Voluntary Modern Contraceptive Methods in Rural Pakistan: Protocol for a Quasi-experimental Study. JMIR Res Protoc 2022; 11:e35291. [PMID: 35258461 PMCID: PMC8941439 DOI: 10.2196/35291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 12/03/2022] Open
Abstract
Background The uptake of modern contraceptive methods (MCMs) remains low, with 25% of women reporting their use in Pakistan. The overarching interventions covering service delivery platforms at facility and community levels necessitate the integration of family planning (FP) with maternal, newborn, and child health (MNCH) services. Objective The main aim of this study is to evaluate the impact of an integrated FP-MNCH service delivery model to increase coverage of MCMs in rural Pakistan. Moreover, we aim to measure the level of effectiveness of interventions regarding the uptake of MCMs. Methods A quasi-experimental, sequential, mixed methods study design with pre- and postevaluation will be adopted to evaluate the impact of integration of FP with MNCH services. The interventions include the following: (1) capacity strengthening of health care providers, including technical trainings; training in counseling of women who attend immunization centers, antenatal care (ANC) clinics, and postnatal care (PNC) clinics; and provision of job aids; (2) counseling of women and girls attending ANC, PNC, and pediatric clinics; (3) ensuring sustained provision of supplies and commodities; (4) community engagement, including establishing adolescent-friendly spaces; and (5) use of District Health Information System data in decision-making. Descriptive statistics will be used to estimate prevalence (ie, proportions) and frequencies of outcome indicators. A univariate difference-in-difference analytical approach will be used to estimate the effect of the interventions. In addition, a Blinder-Oaxaca decomposition analysis will be conducted to identify and quantify determinants of the modern contraceptive prevalence rate. Results The intervention phase began in July 2021 and will run until June 2022. The impact assessment will be conducted from July to September 2022. Conclusions This project will evaluate the impact of integrating FP with MNCH services. Furthermore, this study will identify the drivers and barriers in uptake of MCMs and will simultaneously help in modifying the interventional strategies that can be scaled up through existing service delivery platforms within the public and private sectors, according to the local sociocultural and health system context. Trial Registration ClinicalTrials.gov NCT05045599; https://clinicaltrials.gov/ct2/show/NCT05045599 International Registered Report Identifier (IRRID) DERR1-10.2196/35291
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Affiliation(s)
- Zahid Ali Memon
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.,Health Research Institute, Sheffield Hallam University, Sheffield, United Kingdom
| | - Sophie Reale
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, United Kingdom
| | - Wardah Ahmed
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Rachael Spencer
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, United Kingdom
| | | | - Zulfiqar Bhutta
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Hora Soltani
- Health Research Institute, Sheffield Hallam University, Sheffield, United Kingdom
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Sanni F, Onoja A, Onoja S, Abu A. A comparative assessment of the level of stockouts of modern family planning services in private and public health facilities in Nigeria. MGM JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4103/mgmj.mgmj_87_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Buowari D, Esievoadje E, Odimegwu C, Agoyi M, Jimoh A, Emeagui O, Emeribe N, Ogbonna V, Oseji M. Accessibility and utilization of family planning services in Nigeria during the coronavirus disease-2019 pandemic. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_8_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Readiness of health facilities and determinants to manage diabetes mellitus: evidence from the nationwide Service Provision Assessment survey of Afghanistan, Bangladesh and Nepal. BMJ Open 2021. [PMCID: PMC8719183 DOI: 10.1136/bmjopen-2021-054031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives Using nationally representative surveys, the study’s aims were to: (1) evaluate healthcare facilities’ readiness to provide diabetes mellitus (DM) services and (2) identify the factors that affect DM service readiness. Data source Data from Service Provision Assessment surveys conducted in three low-resource South Asian (SA) countries: Afghanistan, Bangladesh and Nepal, were used in this study. Design Cross-sectional nationally representative survey Participants A total of 117, 317 and 397 public and private health facilities in Afghanistan, Bangladesh and Nepal, respectively were analysed. Primary outcome A total of 12 items/indicators were used to measure a health facility’s readiness to provide DM services across four domains. Results For DM management, about 39.3%, 58.4% and 58.2% of health facilities in Afghanistan, Bangladesh and Nepal centred around 7–8, 3–6 and 4–6 items. Only 12.8%, 5.0% and 4.8% of healthcare facilities in Afghanistan, Bangladesh and Nepal reported having at least % (9/12) of the necessary items for DM management, and no one reported having all 12 important items for DM management. According to the negative binomial regression models, the factors associated with higher readiness scores vary among the three countries analysed. Regression models also showed that increases in the number of DM care providers and facility types are similar factors linked to increased readiness scores in all three countries. Conclusions In order to increase a health facility’s readiness to offer DM care, country-specific factors must be addressed in addition to common factors found in all three countries. Further research is required to determine the cause of country-level differences in tracer item availability in order to develop targeted and effective country-specific strategies to improve care quality in the SA region.
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Nkole T, Silumbwe A, Munakampe MN, Cordero JP, Milford C, Zulu JM, Steyn PS. Community and health provider perspectives on the quality of family planning and contraceptive services in Kabwe District, Zambia. Sex Reprod Health Matters 2021; 29:1985945. [PMID: 34747352 PMCID: PMC8583990 DOI: 10.1080/26410397.2021.1985945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Quality family planning and contraceptive (FP/C) services result in positive outcomes such as client satisfaction and sustained use of contraceptives. While most assessments of quality in FP/C services are based on measurable reproductive health outcomes, there is limited consideration of the perspectives and experiences of health providers and community members. This study aimed to address this knowledge gap, by exploring health providers’ and community perspectives on the elements of quality FP/C services in Kabwe district, Zambia. Fourteen focus group discussions and 10 in-depth interviews were conducted in October–December 2016, involving community members, key community stakeholders such as religious and political leaders, health committee members and frontline and managerial healthcare providers. Data were analysed using a thematic approach. According to study participants, quality FP/C services would include provision by skilled personnel with positive attitudes towards clients, availability of preferred methods and affordable products. Additional factors included appropriate infrastructure, especially counselling services spaces and adequate consultation time. Participants stressed the need for reduced waiting time and opportunity for self-expression. The efficiency and effectiveness of service delivery factors, such as information dissemination and community engagement, were also considered important elements of quality FP/C. This study underscores the value of considering both community and health provider perspectives in efforts to improve the quality of FP/C services, with the overall aim of increasing client satisfaction and sustained utilisation. However, service delivery processes must also be addressed in addition to providing for community participation, if quality is to be achieved in FP/C services.
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Affiliation(s)
- Theresa Nkole
- UPTAKE Local Principal Investigator, Gynaecologist, Department of Obstetrics and Gynaecology, Levy Mwanawasa Medical University (LMMU), Lusaka, Zambia
| | - Adam Silumbwe
- UPTAKE Data Associate, Lecturer/Researcher, Department of Health Policy and Management, School of Public Health, University of Zambia, P.O Box 50110, Lusaka, Zambia. Correspondence:
| | - Margarate N Munakampe
- UPTAKE Data Associate, Department of Health Policy and Management, School of Public Health, University of Zambia, P.O Box 50110, Lusaka, Zambia
| | - Joanna Paula Cordero
- UPTAKE Coordinator, Researcher, UNDP-UNFPA-UNICEF-WHO-World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research (SRH), World Health Organization, Geneva, Switzerland
| | - Cecilia Milford
- UPTAKE Qualitative Lead, Researcher, MRU (MatCH Research Unit), Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Joseph Mumba Zulu
- UPTAKE Data Associate, Department of Health Policy and Management, School of Public Health, University of Zambia, P.O Box 50110, Lusaka, Zambia
| | - Petrus S Steyn
- UPTAKE Coordinator, Researcher, UNDP-UNFPA-UNICEF-WHO-World Bank Special Program of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research (SRH), World Health Organization, Geneva, Switzerland
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Guo F, Qi X, Xiong H, He Q, Zhang T, Zou S, Wang H, Takesue R, Tang K. Trends of maternal health service coverage in the Democratic Republic of the Congo: a pooled cross-sectional study of MICS 2010 to 2018. BMC Pregnancy Childbirth 2021; 21:748. [PMID: 34740321 PMCID: PMC8569966 DOI: 10.1186/s12884-021-04220-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 10/21/2021] [Indexed: 12/03/2022] Open
Abstract
Background Maternal health services are essential for reducing maternal and newborn mortality. However, maternal health service status in the Democratic Republic of the Congo (DRC) remains poorly understood. This study aims to explore the trends of antenatal care (ANC) and skilled birth attendance coverage in the past decade in the DRC. Methods The 13,361 participants were from two rounds of Multiple Indicators Cluster Survey (MICS) conducted by the National Institute of Statistics of the Ministry of Planning of the DRC, in collaboration with the United Nations Children’s Fund (UNICEF), in 2010 and 2017-2018. A regression-based method was adopted to calculate adjusted coverage of ANC and skilled birth attendance. Subgroup analysis based on different socioeconomic status (SES) was conducted to explore the impact of domestic conflicts. Results From 2010 to 2018, the overall weighted ANC coverage in the DRC declined from 87.3 % (95 % CI 86.1–88.0 %) to 82.4 % (95 % CI 81.1–84.0 %), while the overall weighted skilled birth attendance coverage increased from 74.2 % (95 % CI 72.5–76.0 %) to 85.2 % (95 % CI 84.1–86.0 %). Adjusted ANC coverage and adjusted skilled birth attendant coverage both declined in Kasai Oriental, but increased in Nord Kivu and Sud Kivu. In Kasai Occidental, ANC coverage declined, but skilled birth coverage increased. In the Kasai region, the largest decline in adjusted coverage of ANC was found among the poorest women. However, in the Kivu region, both the adjusted coverage of ANC and skilled birth attendance increased among the poorest women. Conclusions Due to ongoing conflicts, there has been a systemic deterioration of maternal healthcare coverage in some regions of the DRC, particularly among people with low SES. However, in other regions, maternal healthcare services were not severely disrupted possibly due to substantial international health assistance. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04220-7.
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Affiliation(s)
- Fuyu Guo
- Vanke School of Public Health, Tsinghua University, No. 30 Shuangqing Road, 100084, Beijing, China
| | - Xinran Qi
- Vanke School of Public Health, Tsinghua University, No. 30 Shuangqing Road, 100084, Beijing, China
| | - Huayi Xiong
- Vanke School of Public Health, Tsinghua University, No. 30 Shuangqing Road, 100084, Beijing, China
| | - Qiwei He
- Vanke School of Public Health, Tsinghua University, No. 30 Shuangqing Road, 100084, Beijing, China
| | - Tingkai Zhang
- Vanke School of Public Health, Tsinghua University, No. 30 Shuangqing Road, 100084, Beijing, China
| | - Siyu Zou
- Vanke School of Public Health, Tsinghua University, No. 30 Shuangqing Road, 100084, Beijing, China
| | - Hanyu Wang
- Vanke School of Public Health, Tsinghua University, No. 30 Shuangqing Road, 100084, Beijing, China
| | - Rie Takesue
- Health Section Programme Division, UNICEF Headquarters, 3 United Nations Plaza, New York, NY, 10017, USA
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, No. 30 Shuangqing Road, 100084, Beijing, China.
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Coulibaly A, Millogo T, Baguiya A, Tran NT, Thieba B, Seuc A, Cuzin-Kihl A, Landoulsi S, Kiarie J, Yodi R, Mashinda D, Kouanda S. Time to Long-Acting Reversible Contraceptive Uptake Over Twelve Months Postpartum: Findings of the Yam Daabo Cluster Randomized-Controlled Trial in Burkina Faso and the Democratic Republic of the Congo. Open Access J Contracept 2021; 12:73-82. [PMID: 33727868 PMCID: PMC7955758 DOI: 10.2147/oajc.s287770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/11/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose An earlier adoption of contraceptive methods during the postpartum period could help women to extend the inter-pregnancy interval. This article aimed to determine and compare the timing of long-acting reversible contraceptives (LARC) use (ie, intrauterine device and implant) in Burkina Faso (BF) and DR Congo (DRC) between the intervention and control groups. Patients and Methods A total of 1120 postpartum women were enrolled and followed up to 12 months postpartum. We used Yam-Daabo trial data which was a multi-intervention, single-blinded, cluster-randomised controlled trial done in primary health-care centres (clusters) in both countries. Centres were randomly allocated to receive the six-component intervention or standard antenatal and postnatal care in matched pairs (1:1). We did a secondary analysis using Royston-Parmar’s semi-parametric model to estimate the effect of the interventions on the median time of LARC uptake. Results Our analysis included 567 postpartum women in BF (284 in the intervention group and 283 in the control group) and 553 in the DRC (274 in the intervention group and 279 in the control group). After showing an increase in family planning use in these two African countries, Yam Daabo’s interventions showed a reduction of the median time of LARCs adoption in the intervention group compared to the control group in both countries (difference of 39 days in Burkina Faso; difference of 86 days in the DR Congo). Conclusion The Yam Daabo intervention package resulted in increased and earlier adoption of LARC in rural settings in Burkina Faso and urban settings in DR Congo. Such an intervention could be relevant in similar contexts in Sub-Saharan Africa with very high fertility rates and high unmet needs for contraception.
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Affiliation(s)
- Abou Coulibaly
- Institut de Recherche en Sciences de la Santé (IRSS), Département Biomédical et Santé Publique, Ouagadougou, Burkina Faso
| | - Tieba Millogo
- Institut Africain de Santé Publique, Ouagadougou, Burkina Faso
| | - Adama Baguiya
- Institut de Recherche en Sciences de la Santé (IRSS), Département Biomédical et Santé Publique, Ouagadougou, Burkina Faso
| | - Nguyen Toan Tran
- University of Technology, Faculty of Health, Australian Centre for Public and Population Health Research, Sydney, Australia
| | - Blandine Thieba
- Université Joseph KI-ZERBO, Unité de Formation et de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Armando Seuc
- World Health Organization, Department of Reproductive Health Research, Geneva, Switzerland
| | - Asa Cuzin-Kihl
- World Health Organization, Department of Reproductive Health Research, Geneva, Switzerland
| | - Sihem Landoulsi
- World Health Organization, Department of Reproductive Health Research, Geneva, Switzerland
| | - James Kiarie
- World Health Organization, Department of Reproductive Health Research, Geneva, Switzerland
| | - Rachel Yodi
- Université de Kinshasa, Ecole de Santé Publique, Kinshasa, République Démocratique du Congo
| | - Désiré Mashinda
- Université de Kinshasa, Ecole de Santé Publique, Kinshasa, République Démocratique du Congo
| | - Séni Kouanda
- Institut de Recherche en Sciences de la Santé (IRSS), Département Biomédical et Santé Publique, Ouagadougou, Burkina Faso
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Onoja A, Sanni F, Akogu S, Onoja S, Abubakar A. Comparative analysis of family planning services in urban and rural health facilities in Nigeria. INTERNATIONAL ARCHIVES OF HEALTH SCIENCES 2021. [DOI: 10.4103/iahs.iahs_60_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Onoja J, Sanni O, Ogedengge C, Onoja S, Abiodun P, Abubakar A. Regional variation of family planning services in Nigerian health facilities. MGM JOURNAL OF MEDICAL SCIENCES 2021. [DOI: 10.4103/mgmj.mgmj_21_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Tessema GA, Mahmood MA, Gomersall JS, Assefa Y, Zemedu TG, Kifle M, Laurence CO. Structural Quality of Services and Use of Family Planning Services in Primary Health Care Facilities in Ethiopia. How Do Public and Private Facilities Compare? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124201. [PMID: 32545564 PMCID: PMC7345433 DOI: 10.3390/ijerph17124201] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/01/2020] [Accepted: 06/08/2020] [Indexed: 11/16/2022]
Abstract
Background: Family planning (FP) is among the important interventions that reduce maternal mortality. Poor quality FP service is associated with lower services utilisation, in turn undermining the efforts to address maternal mortality. There is currently little research on the quality of FP services in the private sector in Ethiopia, and how it compares to FP services in public facilities. Methods: A secondary data analysis of two national surveys, Ethiopia Services Provision Assessment Plus Survey 2014 and Ethiopian Demographic and Health Survey 2016, was conducted. Data from 1094 (139 private, 955 public) health facilities were analysed. In total, 3696 women were included in the comparison of users’ characteristics. Logistic regression was conducted. Facility type (public vs. private) was the key exposure of interest. Results: The private facilities were less likely to have implants (Adjusted Odds Ratio (AOR) = 0.06; 95% Confidence Interval (CI): 0.03, 0.12), trained FP providers (AOR = 0.23; 95% CI: 0.14, 0.41) and FP guidelines/protocols (AOR = 0.33; 95% CI: 0.19, 0.54) than public facilities but were more likely to have functional cell phones (AOR = 8.20; 95% CI: 4.95, 13.59) and water supply (AOR = 3.37; 95% CI: 1.72, 6.59). Conclusion: This study highlights the need for strengthening both private and public facilities for public–private partnerships to contribute to increased FP use and better health outcomes.
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Affiliation(s)
- Gizachew Assefa Tessema
- School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia; (M.A.M.); (J.S.G.); (C.O.L.)
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar 196, Ethiopia
- School of Public Health, Curtin University, Perth, WA 6201, Australia
- Correspondence: ; Tel.: +61-470-118399; Fax: +61-8-8313-3339
| | - Mohammad Afzal Mahmood
- School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia; (M.A.M.); (J.S.G.); (C.O.L.)
| | - Judith Streak Gomersall
- School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia; (M.A.M.); (J.S.G.); (C.O.L.)
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, QLD 4072, Australia;
| | - Theodros Getachew Zemedu
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa 1242, Ethiopia;
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar 196, Ethiopia
| | - Mengistu Kifle
- Federal Ministry of Health, Addis Ababa, 1234, Ethiopia;
| | - Caroline O. Laurence
- School of Public Health, The University of Adelaide, Adelaide, SA 5005, Australia; (M.A.M.); (J.S.G.); (C.O.L.)
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Mukendi DM, Musalu EM, Muanda FM, Lutumba GO, Mukalenge FC, Mapatano MA, Utshudienyema GW. Assessment of Policies, Laws, and Regulations Affecting the Contraceptive Needs of Adolescents in the Democratic Republic of the Congo. Health (London) 2020. [DOI: 10.4236/health.2020.129090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hsiao A, Vogt V, Quentin W. Effect of corruption on perceived difficulties in healthcare access in sub-Saharan Africa. PLoS One 2019; 14:e0220583. [PMID: 31433821 PMCID: PMC6703670 DOI: 10.1371/journal.pone.0220583] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/18/2019] [Indexed: 12/01/2022] Open
Abstract
Background Achieving Universal Health Coverage (UHC) by improving financial protection and effective service coverage is target 3.8 of the Sustainable Development Goals. Little is known, however, about the extent to which paying bribes within healthcare acts as a financial barrier to access and, thus, UHC. Methods Using survey data in adults from 32 sub-Saharan African countries in 2014–2015, we constructed a multilevel model to evaluate the relationship between paying bribes and reported difficulties of obtaining medical care. We controlled for individual-, region-, and country-level variables. Results Having paid bribes for medical care significantly increased the odds of reporting difficulties in obtaining care by 4.11 (CI: 3.70–4.57) compared to those who never paid bribes, and more than doubled for those who paid bribes often (OR = 9.52; 95% CI: 7.77–11.67). Respondents with higher levels of education and more lived poverty also had increased odds. Those who lived in rural areas or within walking distance to a health clinic had reduced odds of reporting difficulties. Sex, age, living in a capital region, healthcare expenditures per capita, and country Corruption Perception Index were not significant predictors. Conclusions We found that bribery in healthcare is a significant barrier to healthcare access, negatively affecting the potential of African countries to make progress toward UHC. Future increases in health expenditures—which are needed in many countries to achieve UHC—should be accompanied by greater efforts to fight corruption in order to avoid wasting money. Measuring and tracking health sector-specific corruption is critical for progress toward UHC.
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Affiliation(s)
- Amber Hsiao
- Technische Universität Berlin, Department of Health Care Management, Berlin, Germany
- * E-mail:
| | - Verena Vogt
- Technische Universität Berlin, Department of Health Care Management, Berlin, Germany
| | - Wilm Quentin
- Technische Universität Berlin, Department of Health Care Management, Berlin, Germany
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Nkamba DM, Ditekemena J, Wembodinga G, Bernard P, Tshefu A, Robert A. Proportion of pregnant women screened for hypertensive disorders in pregnancy and its associated factors within antenatal clinics of Kinshasa, Democratic Republic of Congo. BMC Pregnancy Childbirth 2019; 19:297. [PMID: 31416427 PMCID: PMC6694649 DOI: 10.1186/s12884-019-2435-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/29/2019] [Indexed: 11/25/2022] Open
Abstract
Background Screening for hypertensive disorders in pregnancy (HDP) is clinically important for identifying women at high risk, and planning early preventative interventions to improve pregnancy outcomes. Several studies in developing countries show that pregnant women are seldom screened for HDP. We conducted a study in Kinshasa, DR Congo, in order to assess the proportion of pregnant women screened for HDP, and to identify factors associated with the screening. Methods We conducted a facility-based cross-sectional study in a random sample of 580 pregnant women attending the first antenatal visit. Data collection consisted of a review of antenatal records, observations at the antenatal care services, and interviews. A pregnant woman was considered as screened for HDP if she had received the tree following services: blood pressure measurement, urine testing for proteinuria, and HDP risk assessment. Multivariable logistic regression, with generalized estimating equations, was used to identify factors associated with the screening for HDP. Results Of the 580 pregnant women, 155 (26.7%) were screened for HDP, 555 (95.7%) had their blood pressure checked, 347(59.8%) were assessed for risk factors of HDP, and 156 (26.9%) were tested for proteinuria. After multivariable analysis, screening for HDP was significantly higher in parous women (AOR = 2.09; 95% CI, 1.11–3.99; P = 0.023), in women with a gestational age of at least 20 weeks (AOR = 5.50; 95% CI, 2.86–10.89; P = 0.002), in women attending in a private clinic (AOR = 3.49; 95% CI, 1.07–11.34; P = 0.038), or in a hospital (AOR = 3.24; 95% CI, 1.24–8.47; P = 0.017), and when no additional payment was required for proteinuria testing at the clinic (AOR = 2.39; 95% CI, 1.14–5.02; P = 0.021). Conclusion Our results show that screening for HDP during the first antenatal visit in Kinshasa is not universal. The factors associated with screening included maternal as well as clinics’ characteristics. More effort should be made both at maternal and clinic levels to improve the screening for HDP in Kinshasa.
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Affiliation(s)
- Dalau Mukadi Nkamba
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo. .,Institut de Recherche Expérimentale et Clinique (IREC), Pôle d'Epidémiologie et Biostatistique (EPID), Université catholique de Louvain (UCLouvain), Brussels, Belgium.
| | - John Ditekemena
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Gilbert Wembodinga
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Pierre Bernard
- Institut de Recherche Expérimentale et Clinique (IREC), Département d'obstétrique, Saint-Luc University Hospital, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Annie Robert
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle d'Epidémiologie et Biostatistique (EPID), Université catholique de Louvain (UCLouvain), Brussels, Belgium
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Casey SE, Gallagher MC, Dumas EF, Kakesa J, Katsongo JM, Muselemu JB. Meeting the demand of women affected by ongoing crisis: Increasing contraceptive prevalence in North and South Kivu, Democratic Republic of the Congo. PLoS One 2019; 14:e0219990. [PMID: 31323055 PMCID: PMC6641211 DOI: 10.1371/journal.pone.0219990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 07/04/2019] [Indexed: 12/04/2022] Open
Abstract
Context Over 20 years of conflict in the DRC, North and South Kivu have experienced cycles of stability and conflict, resulting in a compromised health system and poor sexual and reproductive health outcomes. Modern contraceptive use is low (7.5%) and maternal mortality is high (846 deaths per 100,000 live births). Program partners have supported the Ministry of Health (MOH) in North and South Kivu to provide good quality contraceptive services in public health facilities since 2011. Methods Cross-sectional population-based surveys were conducted in the program areas using a two-stage cluster sampling design to ensure representation in each of six rural health zones. Using MOH population estimates for villages in the catchment areas of supported health facilities, 25 clusters in each zone were selected using probability proportional to size. Within each cluster, 22 households were systematically selected, and one woman of reproductive age (15–49 years) was randomly selected from all eligible women in each household. Results Modern contraceptive prevalence among women in union ranged from 8.4% to 26.7% in the six health zones; current use of long-acting or permanent method (LAPM) ranged from 2.5% to 19.8%. The majority of women (58.9% to 90.2%) reported receiving their current method for the first time at a health facility supported by the program partners. Over half of women in four health zones reported wanting to continue their method for five years or longer. Conclusion Current modern contraceptive use and LAPM use were high in these six health zones compared to DRC Demographic and Health Survey data nationally and provincially. These results were accomplished across all six health zones despite their varied socio-demographic characteristics and different experiences of conflict and displacement. These findings demonstrate that women in these conflict-affected areas want contraception and will choose to use it when good quality services are available to them.
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Affiliation(s)
- Sara E. Casey
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, United States of America
- * E-mail:
| | | | | | - Jessica Kakesa
- International Rescue Committee, Kinshasa, Democratic Republic of the Congo
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Mpunga Mukendi D, Chenge F, Mapatano MA, Criel B, Wembodinga G. Distribution and quality of emergency obstetric care service delivery in the Democratic Republic of the Congo: it is time to improve regulatory mechanisms. Reprod Health 2019; 16:102. [PMID: 31307497 PMCID: PMC6631736 DOI: 10.1186/s12978-019-0772-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 07/08/2019] [Indexed: 11/09/2022] Open
Abstract
Background The Demographic and Health Survey 2013–14 indicated that the Democratic Republic of the Congo (DRC) is still challenged by high maternal and neonatal mortality. The aim of this study was to assess the availability, quality and equity of emergency obstetric care (EmOC) in the DRC. Methods A cross-sectional survey of 1,568 health facilities selected by multistage random sampling in 11 provinces of the DRC was conducted in 2014. Data were collected through interviews, document reviews, and direct observation of service delivery. Collected data included availability, quality, and equity of EmOC depending on the location (urban vs. rural), administrative identity, type of facility, and province. Associations between variables were tested by Pearson’s chi-squared test using an alpha significance level of 0.05. Results A total of 1,555 health facilities (99.2%) were surveyed. Of these, 9.1% provided basic EmOC and 2.9% provided comprehensive EmOC. The care was unequally distributed across the provinces and urban vs. rural areas; it was more available in urban areas, with the provinces of Kinshasa and Nord-Kivu being favored compared to other provinces. Caesarean section and blood transfusions were provided by health centers (6.5 and 9.0%, respectively) and health posts (2.3 and 2.3%, respectively), despite current guidelines disallowing the practice. None of the facilities provided quality EmOC, mainly due to the lack of proper standards and guidelines. Conclusions The distribution and quality of EmOC are problematic. The lack of regulation and monitoring appears to be a key contributing factor. We recommend the Ministry of Health go beyond merely granting funds, and also ensure the establishment and monitoring of appropriate standard operating procedures for providers.
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Affiliation(s)
- Dieudonné Mpunga Mukendi
- Kinshasa School of Public Health, University of Kinshasa, P.O. Box: 11850, Kinshasa I, Kinshasa, Democratic Republic of the Congo.
| | - Faustin Chenge
- Lubumbashi School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo.,Centre de connaissances santé en RDC (CCSC), Kinshasa, Democratic Republic of the Congo
| | - Mala A Mapatano
- Kinshasa School of Public Health, University of Kinshasa, P.O. Box: 11850, Kinshasa I, Kinshasa, Democratic Republic of the Congo
| | - Bart Criel
- Institute of Tropical Medicine, Antwerpern, Belgium
| | - Gilbert Wembodinga
- Kinshasa School of Public Health, University of Kinshasa, P.O. Box: 11850, Kinshasa I, Kinshasa, Democratic Republic of the Congo
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Jarvis L, Wickstrom J, Vance G, Gausman J. Quality and Cost Interventions During the Extended Perinatal Period to Increase Family Planning Use in Kinshasa, DRC: Results From an Initial Study. GLOBAL HEALTH: SCIENCE AND PRACTICE 2018; 6:456-472. [PMID: 30287528 PMCID: PMC6172126 DOI: 10.9745/ghsp-d-18-00075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 07/10/2018] [Indexed: 12/03/2022]
Abstract
The combined intervention of free contraceptives plus a set of quality inputs for family planning during the extended perinatal period, including provision of long-acting methods immediately postpartum, had the strongest effect on use of modern contraceptives, especially long-acting methods. Background: Most women worldwide do not desire another pregnancy within a year after giving birth, but uptake of modern contraception during this time period is low. We independently tested 2 approaches to increasing contraceptive uptake and the 2 approaches combined using a quasi-experimental study design in Kinshasa, the Democratic Republic of the Congo. Methods: The primary analytic data came from client exit interviews conducted post-intervention (N=563) from 4 study groups. The first arm (n=150) received free family planning, and the second arm (n=113) a quality inputs intervention involving systematic screening, referral, and immediate provision of long-acting reversible contraceptives (LARCs) after labor and delivery. The third arm (n=150) received a combination of the 2 interventions, and the fourth (n=150) no intervention. Family planning service statistics were also collected throughout the intervention period. Results: Women in the quality arm (odds ratio [OR]=4.5; 95% confidence interval [CI], 1.8 to 10.9) and free/quality arm (OR=6.7; 95% CI, 2.8 to 16.1) were more likely to be properly screened for family planning than women in the control group, but paper referral was seldom implemented in any group. Women in the free arm (OR=3.8; 95% CI, 1.6 to 9.0) and in the free/quality arm (OR=11.0; 95% CI, 4.3 to 27.9) were more likely than the control group to report being properly counseled on family planning. Clients were more likely to be modern contraceptive users (excluding condoms) in the free arm (OR=3.2; 95% CI, 1.4 to 7.2) and in the free/quality arm (OR=8.6; 95% CI, 3.9 to 19.0) than in the control group. Clients in all study arms were more likely to use a LARC compared with the control group (Quality arm: OR=2.9; 95% CI, 1.1 to 7.9. Free arm: OR=5.6; 95% CI, 2.3 to 13.7. Free/quality arm: OR=8.4; 95% CI, 3.4 to 20.6). Service statistics from the combined intervention arm showed that a significantly greater proportion of family planning adoption occurred within the immediate postpartum period (0 to 2 days) in the quality arm (P<.001) and free/quality arm (P<.001) than in the control arm. Quality inputs, free contraceptives, and the combined intervention had positive impacts on aspects of screening and contraceptive uptake. The combined intervention performed best by all measures. Conclusion: Providing family planning, including LARCs, in the immediate postpartum period, implementing a systematic screening and referral system, and providing free methods may improve family planning access and uptake in the extended perinatal period in this environment.
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Affiliation(s)
- Leah Jarvis
- EngenderHealth, New York, NY, USA. Now with Population Council, New York, NY, USA.
| | - Jane Wickstrom
- EngenderHealth, New York, NY, USA. Now with Bill & Melinda Gates Foundation, Seattle, WA, USA
| | | | - Jewel Gausman
- Harvard T. H. Chan School of Public Health, Amman, Jordan
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Kwete D, Binanga A, Mukaba T, Nemuandjare T, Mbadu MF, Kyungu MT, Sutton P, Bertrand JT. Family Planning in the Democratic Republic of the Congo: Encouraging Momentum, Formidable Challenges. GLOBAL HEALTH: SCIENCE AND PRACTICE 2018; 6:40-54. [PMID: 29602865 PMCID: PMC5878077 DOI: 10.9745/ghsp-d-17-00346] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 01/09/2018] [Indexed: 11/15/2022]
Abstract
Momentum for family planning in the Democratic Republic of the Congo (DRC) is evident in multiple ways: strong political will, increasing donor support, a growing number of implementing organizations, innovative family planning programming, and a cohesive family planning stakeholder group. Between 2013 and 2017, the modern contraceptive prevalence rate (mCPR) in the capital city of Kinshasa increased from 18.5% to 26.7% among married women, but as of 2013-14, it was only 7.8% at the national level. The National Multisectoral Strategic Plan for Family Planning: 2014-2020 calls for achieving an mCPR of 19.0% by 2020, an ambitious goal in light of formidable challenges to family planning in the DRC. Of the 16,465 health facilities reporting to the national health information system in 2017, only 40% offer family planning services. Key challenges include uncertainty over the political situation, difficulties of ensuring access to family planning services in a vast country with a weak transportation infrastructure, funding shortfalls for procuring adequate quantities of contraceptives, weak contraceptive logistics and supply chain management, strong cultural norms that favor large families, and low capacity of the population to pay for contraceptive services. This article describes promising initiatives designed to address these barriers, consistent with the World Health Organization's framework for health systems strengthening. For example, the national family planning coordinating mechanism is being replicated at the provincial level to oversee the expansion of family planning service delivery. Promising initiatives are being implemented to improve the supply and quality of services and generate demand for family planning, including social marketing of subsidized contraceptives at both traditional and non-traditional channels and strengthening of services in military health facilities. To expand contraceptive access, family planning is being institutionalized in nursing schools, allowing students to operate as community-based distributors. While major challenges remain, significant progress in family planning has been made in the DRC, which should be judged not in comparison with sub-Saharan African countries with high mCPR and mature programs, but rather with those starting from much further behind.
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Affiliation(s)
- Dieudonné Kwete
- Government of the Democratic Republic of the Congo (DRC), Advisor to the Prime Minister, Kinshasa, DRC
| | | | - Thibaut Mukaba
- United States Agency for International Development/DRC, Kinshasa, DRC
| | | | - Muanda Fidele Mbadu
- Programme National de Santé de l'Adolescent, Ministry of Health, Kinshasa, DRC
| | | | - Perri Sutton
- The Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Jane T Bertrand
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA.
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