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Craig LS, Cunningham-Myrie CA, Theall KP, Gustat J, Hernandez JH, Hotchkiss DR. Multimorbidity patterns and health-related quality of life in Jamaican adults: a cross sectional study exploring potential pathways. Front Med (Lausanne) 2023; 10:1094280. [PMID: 37332764 PMCID: PMC10272613 DOI: 10.3389/fmed.2023.1094280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/09/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Multimorbidity and health-related quality of life (HRQoL) are intimately linked. Multiple chronic conditions may adversely affect physical and mental functioning, while poorer HRQoL may contribute to the worsening course of diseases. Understanding mechanisms through which specific combinations of diseases affect HRQoL outcomes can facilitate identification of factors which are amenable to intervention. Jamaica, a middle-income country with high multimorbidity prevalence, has a health service delivery system dominated by public sector provision via a broad healthcare network. This study aims to examine whether multimorbidity classes differentially impact physical and mental dimensions of HRQoL in Jamaicans and quantify indirect effects on the multimorbidity-HRQoL relationship that are mediated by health system factors pertaining to financial healthcare access and service use. Materials and methods Latent class analysis (LCA) was used to estimate associations between multimorbidity classes and HRQoL outcomes, using latest available data from the nationally representative Jamaica Health and Lifestyle Survey 2007/2008 (N = 2,551). Multimorbidity measurement was based on self-reported presence/absence of 11 non-communicable diseases (NCDs). HRQoL was measured using the 12-item short-form (SF-12) Health Survey. Mediation analyses guided by the counterfactual approach explored indirect effects of insurance coverage and service use on the multimorbidity-HRQoL relationship. Results LCA revealed four profiles, including a Relatively Healthy class (52.7%) characterized by little to no morbidity and three multimorbidity classes characterized by specific patterns of NCDs and labelled Metabolic (30.9%), Vascular-Inflammatory (12.2%), and Respiratory (4.2%). Compared to the Relatively Healthy class, Vascular-Inflammatory class membership was associated with lower physical functioning (β = -5.5; p < 0.001); membership in Vascular-Inflammatory (β = -1.7; p < 0.05), and Respiratory (β = -2.5; p < 0.05) classes was associated with lower mental functioning. Significant mediated effects of health service use, on mental functioning, were observed for Vascular-Inflammatory (p < 0.05) and Respiratory (p < 0.05) classes. Conclusion Specific combinations of diseases differentially impacted HRQoL outcomes in Jamaicans, demonstrating the clinical and epidemiological value of multimorbidity classes for this population, and providing insights that may also be relevant to other settings. To better tailor interventions to support multimorbidity management, additional research is needed to elaborate personal experiences with healthcare and examine how health system factors reinforce or mitigate positive health-seeking behaviours, including timely use of services.
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Affiliation(s)
- Leslie S. Craig
- Department of Medicine, School of Medicine, Tulane University, New Orleans, LA, United States
| | | | - Katherine P. Theall
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Jeanette Gustat
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Julie H. Hernandez
- Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - David R. Hotchkiss
- Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
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Hernandez JH, LaNasa KH, Koba T. Task-shifting and family planning continuation: contraceptive trajectories of women who received their method at a community-based event in Kinshasa, DRC. Reprod Health 2023; 20:24. [PMID: 36717937 PMCID: PMC9887934 DOI: 10.1186/s12978-023-01571-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 01/20/2023] [Indexed: 01/31/2023] Open
Abstract
While community-based interventions are a proven high-impact strategy to increase contraceptive uptake in low-income countries, their capacity to support women's contraceptive choices (including continued use, switching and discontinuation) in the long run remains insufficiently discussed. This cohort study follows 883 women 3 and 6 months after they received a modern method during community campaigns organized in Kinshasa (D.R. Congo), to analyze their contraceptive trajectories and the factors associated with ever discontinuing contraceptive use in the first 6 months following a campaign. In the community-based distribution (CBD) model currently institutionalized in DRC, campaign clients are not provided with additional doses or support, besides baseline counseling, to (dis-)continue using the method they received, but must rely on Family Planning resources within the existing local health system. Almost a third (28.9%) of all women discontinued modern contraception during the study period, with much higher discontinuation rates for short-acting methods (38.7% for pills and up to 68.9% for DMPA-SC). Variables previously associated with high discontinuation (marital status, fertility intentions and side-effects) led to higher odds of "ever discontinuing". However, these variables became non-significant when controlling for resupply issues. Women's self-reported reasons for discontinuation confirmed the multivariate regression results. Detailed sub-analysis of resupply issues for pills, injectables and Cyclebeads pointed to the role of cost, unreliable campaign schedules and weak integration of community-based strategies into the formal health system. Extremely low rates of implants removal suggest similar access to FP services issues. The study highlights the need to identify CBD strategies best suited to support women's choices and preferences towards successful contraceptive trajectories in fragile health systems.
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Affiliation(s)
- Julie H. Hernandez
- grid.265219.b0000 0001 2217 8588Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Suite 2200, New Orleans, LA 70112 USA
| | - Katherine H. LaNasa
- grid.265219.b0000 0001 2217 8588Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Suite 1900, New Orleans, LA 70112 USA
| | - Tesky Koba
- grid.9783.50000 0000 9927 0991Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Hernandez JH, Babazadeh S, Anglewicz PA, Akilimali PZ. As long as (I think) my husband agrees…: role of perceived partner approval in contraceptive use among couples living in military camps in Kinshasa, DRC. Reprod Health 2022; 19:6. [PMID: 35022043 PMCID: PMC8756630 DOI: 10.1186/s12978-021-01256-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Male partner's approval is a key determinant of contraceptive use for women living in Sub-Saharan Africa and improving men's support and couple communication is a cornerstone of family planning programs. However, approval is often only measured through the women's perception of their partner's opinion. METHODS This study conducted in Kinshasa compares contraceptive approval variables from matched male and female partners (n = 252 couples) to establish the frequency of (in)accurate perceptions by the woman, then test their association with modern contraceptive use. Additional regressions estimate individual and couple variables associated with (in)correct perceptions. RESULTS Results confirm women are poorly aware of their partner's opinion but indicate that perceived approval or disapproval by the woman is a much stronger determinant of modern contraceptive use than her partner's actual opinion. Higher educational achievement from the woman is the strongest driver of misunderstanding her partner's approval. CONCLUSIONS Women's perceptions of partner's approval are much stronger determinant of contraceptive use than the latter's actual opinion, and stereotyping men's opinion of family planning is a common error of appreciation. However, findings also suggest these misunderstandings might serve women's capacity to negotiate contraceptive use.
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Affiliation(s)
- Julie H Hernandez
- Department of International Health and Sustainable Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, New Orleans, LA, 70112, USA.
| | - Saleh Babazadeh
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Philip A Anglewicz
- Department of Population, Family, and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Pierre Z Akilimali
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
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Rosenberg RE, Akilimali PZ, Hernandez JH, Bertrand JT. Factors influencing client recall of contraceptive counseling at community-based distribution events in Kinshasa, Democratic Republic of the Congo. BMC Health Serv Res 2021; 21:784. [PMID: 34372830 PMCID: PMC8351144 DOI: 10.1186/s12913-021-06796-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clients must recall information from contraceptive counseling sessions to properly use their chosen method. Client recall in community-based settings is challenging given the public nature of these events and the presence of many potential distractions. Understanding the factors that influence client recall during community-based distribution events can guide future training of providers to improve proper use of contraceptive methods and client satisfaction. METHODS This cross-sectional study employed a convenience sample of 957 women ages 15-49 old who sought contraceptive services from community-based contraceptive distribution events in Kinshasa, Democratic Republic of the Congo, known as Lelo PF. Recall scores were developed by matching direct observations with client exit interviews. The association between recall and client characteristics, provider characteristics and an index for the quality of the provider-client interaction were tested using multivariate linear regression. RESULTS The average recall score was 67.6%. Recall scores were higher among clients who accepted methods with simpler administration procedures, such as CycleBeads (81.3%), compared to methods requiring more medically advanced administration procedures, such as DMPA-SC (56.6%) and Implanon-NXT (62.1%). This relationship held even after controlling for amount of information each client received. Status as a first-time user was associated with a 5.8 percentage point decrease in recall score (p = 0.002). Time since the provider's initial family planning training and clients' perception of the provider-client interaction were associated with higher client recall scores. CONCLUSION Results of this study suggest that to improve client recall at Lelo PF events, future provider training should focus on how to deliver clear, specific information to clients, making sure clients feel at ease during the counseling session, and treating clients with respect. First-time family planning users and clients who select methods with more medically advanced administration procedures may require extra attention during the consultation to ensure they are able understand and remember the information. Results suggest that providers who have been offering services longer may be more effective in conveying information in a way that clients can remember. Program managers should consider requesting input from experienced providers to improve training sessions.
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Affiliation(s)
- Rebecca E Rosenberg
- Avenir Health, 655 Winding Brook Dr., 4th Floor, Glastonbury, CT, 06033, USA.
| | - Pierre Z Akilimali
- Kinshasa School of Public Health, Universite de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Julie H Hernandez
- Tulane School of Public Health and Tropical Medicine, 1440 Canal St., Suite 1900, New Orleans, LA, 70112, USA
| | - Jane T Bertrand
- Tulane School of Public Health and Tropical Medicine, 1440 Canal St., Suite 1900, New Orleans, LA, 70112, USA
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Craig LS, Cunningham-Myrie CA, Hotchkiss DR, Hernandez JH, Gustat J, Theall KP. Social determinants of multimorbidity in Jamaica: application of latent class analysis in a cross-sectional study. BMC Public Health 2021; 21:1197. [PMID: 34162349 PMCID: PMC8220124 DOI: 10.1186/s12889-021-11225-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Non-communicable disease (NCD) multimorbidity is associated with impaired functioning, lower quality of life and higher mortality. Susceptibility to accumulation of multiple NCDs is rooted in social, economic and cultural contexts, with important differences in the burden, patterns, and determinants of multimorbidity across settings. Despite high prevalence of individual NCDs within the Caribbean region, exploration of the social epidemiology of multimorbidity remains sparse. This study aimed to examine the social determinants of NCD multimorbidity in Jamaica, to better inform prevention and intervention strategies. Methods Latent class analysis (LCA) was used to examine social determinants of identified multimorbidity patterns in a sample of 2551 respondents aged 15–74 years, from the nationally representative Jamaica Health and Lifestyle Survey 2007/2008. Multimorbidity measurement was based on self-reported presence/absence of 11 chronic conditions. Selection of social determinants of health (SDH) was informed by the World Health Organization’s Commission on SDH framework. Multinomial logistic regression models were used to estimate the association between individual-level SDH and class membership. Results Approximately one-quarter of the sample (24.05%) were multimorbid. LCA revealed four distinct profiles: a Relatively Healthy class (52.70%), with a single or no morbidity; and three additional classes, characterized by varying degrees and patterns of multimorbidity, labelled Metabolic (30.88%), Vascular-Inflammatory (12.21%), and Respiratory (4.20%). Upon controlling for all SDH (Model 3), advancing age and recent healthcare visits remained significant predictors of all three multimorbidity patterns (p < 0.001). Private insurance coverage (relative risk ratio, RRR = 0.63; p < 0.01) and higher educational attainment (RRR = 0.73; p < 0.05) were associated with lower relative risk of belonging to the Metabolic class while being female was a significant independent predictor of Vascular-Inflammatory class membership (RRR = 2.54; p < 0.001). Material circumstances, namely housing conditions and features of the physical and neighbourhood environment, were not significant predictors of any multimorbidity class. Conclusion This study provides a nuanced understanding of the social patterning of multimorbidity in Jamaica, identifying biological, health system, and structural determinants as key factors associated with specific multimorbidity profiles. Future research using longitudinal designs would aid understanding of disease trajectories and clarify the role of SDH in mitigating risk of accumulation of diseases.
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Affiliation(s)
- Leslie S Craig
- Department of Medicine, School of Medicine, Tulane University, New Orleans, LA, USA.
| | | | - David R Hotchkiss
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Julie H Hernandez
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Jeanette Gustat
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Katherine P Theall
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
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Hernandez JH, Karletsos D, Avegno J, Reed CH. Is Covid-19 community level testing effective in reaching at-risk populations? Evidence from spatial analysis of New Orleans patient data at walk-up sites. BMC Public Health 2021; 21:632. [PMID: 33789647 PMCID: PMC8012072 DOI: 10.1186/s12889-021-10717-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper evaluates the increase in coverage and use of Covid-19 testing services for vulnerable and hard-to-reach populations through the introduction of community-based walk-up sites in New Orleans, LA. While most GIS work on Covid-19 testing coverage and access has used census tract or ZIP code aggregated data, this manuscript is unique in that it uses individual level demographics and exact addresses to calculate distances actually traveled by patients. METHODS We used testing data recorded for 9721 patients at 20 sites operating in May-June 2020. The dataset includes detailed age, race and ethnicity, and testing results as well as the exact address of each individual. Using GIS, we estimated changes in testing coverage for minority neighborhoods and calculated the actual distance covered by individuals. Logistic regression and multivariate linear regression were used to identify socio-demographic variables associated with distance travelled to and used of nearest testing site. We used a secondary dataset from drive-through sites to evaluate change in coverage at the census tract level for the metropolitan area. RESULTS Walk-up sites significantly increased testing availability in New Orleans, and specifically in minority neighborhoods. Both African Americans and Asians were more likely (14.7 and 53.0%) to be tested at the nearest walk-up site. They also covered shorter distances to get tested. Being elderly was also significantly and positively associated with testing at the nearest site. Hispanics, however, were not associated with increased proximity to and use of nearest sites, and they traveled an additional 0.745 km to get tested. Individuals who tested positive also travelled significantly longer distances to obtain a test. CONCLUSIONS Walk-up sites increased testing availability for some vulnerable populations who took advantage of the sites' proximity, although inequalities appear at the metropolitan scale. As cities are planning community vaccination campaigns, mobile, walk-up sites appear to improve both coverage and accessibility for hard-to-reach populations. With adequate technical (vaccine dose refrigeration) and messaging (addressing reticence to immunization) adaptations, they could constitute a key complementary approach to health facility points of delivery.
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Affiliation(s)
- Julie H Hernandez
- Department of Health Policy and Management, Tulane University School of Public health and Tropical Medicine, New Orleans, LA, USA.
| | - Dimitris Karletsos
- Department of Health Policy and Management, Tulane University School of Public health and Tropical Medicine, New Orleans, LA, USA
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Craig LS, Hotchkiss DR, Theall KP, Cunningham-Myrie C, Hernandez JH, Gustat J. Prevalence and patterns of multimorbidity in the Jamaican population: A comparative analysis of latent variable models. PLoS One 2020; 15:e0236034. [PMID: 32702046 PMCID: PMC7377400 DOI: 10.1371/journal.pone.0236034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 06/26/2020] [Indexed: 01/15/2023] Open
Abstract
Background Evidence suggests that the single-disease paradigm does not accurately reflect the individual experience, with increasing prevalence of chronic disease multimorbidity, and subtle yet important differences in types of co-occurring diseases. Knowledge of multimorbidity patterns can aid clarification of individual-level burden and needs, to inform prevention and treatment strategies. This study aimed to estimate the prevalence of multimorbidity in Jamaica, identify population subgroups with similar and distinct disease profiles, and examine consistency in patterns identified across statistical techniques. Methods Latent class analysis (LCA) was used to examine multimorbidity patterns in a sample of 2,551 respondents aged 15–74 years, based on data from the nationally representative Jamaica Health and Lifestyle Survey 2007/2008 and self-reported presence/absence of 11 chronic conditions. Secondary analyses compared results with patterns identified using exploratory factor analysis (EFA). Results Nearly one-quarter of the sample (24.1%) were multimorbid (i.e. had ≥2 diseases), with significantly higher burden in females compared to males (31.6% vs. 16.1%; p<0.001). LCA revealed four distinct classes, including a predominant Relatively Healthy class, comprising 52.7% of the sample, with little to no morbidity. The remaining three classes were characterized by varying degrees and patterns of multimorbidity and labelled Metabolic (30.9%), Vascular-Inflammatory (12.2%), and Respiratory (4.2%). Four diseases determined using physical assessments (obesity, hypertension, diabetes, hypercholesterolemia) were primary contributors to multimorbidity patterns overall. EFA identified three patterns described as “Vascular” (hypertension, obesity, hypercholesterolemia, diabetes, stroke); “Respiratory” (asthma, COPD); and “Cardio-Mental-Articular” (cardiovascular disease, arthritis, mental disorders). Conclusion This first study of multimorbidity in the Caribbean has revealed a high burden of co-existing conditions in the Jamaican population, that is predominantly borne by females. Consistency across methods supports the validity of patterns identified. Future research into the causes and consequences of multimorbidity patterns can guide development of clinical and public health strategies that allow for targeted prevention and intervention.
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Affiliation(s)
- Leslie S. Craig
- Department of Medicine, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - David R. Hotchkiss
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Katherine P. Theall
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Colette Cunningham-Myrie
- Department of Community Health and Psychiatry, University of the West Indies, Mona, Jamaica
- * E-mail:
| | - Julie H. Hernandez
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Jeanette Gustat
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
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Hernandez JH, Akilimali P, Glover A, Bertrand JT. Feasibility and acceptability of using medical and nursing students to provide Implanon NXT at the community level in Kinshasa, Democratic Republic of Congo. BMC Womens Health 2020; 20:133. [PMID: 32580766 PMCID: PMC7315479 DOI: 10.1186/s12905-020-00993-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 06/16/2020] [Indexed: 11/10/2022]
Abstract
Background The use of implants has steadily increased in Kinshasa since 2013 but clinic-based access to this family planning method is limited due to distance and costs barriers. The objective of this study was to examine the feasibility and acceptability of providing Implanon NXT at the community level using medical and nursing students (M/N) as distributors, as part of a strategy to improve contraceptive uptake in the Democratic Republic of Congo. Methods A cohort of 531 women who chose to receive Implanon NXT from a M/N student during community-based campaign days participated in three rounds of a quantitative survey administered at the time of insertion of the method, and at 6 and 12 months later. We conducted descriptive analysis to assess the feasibility and acceptability of providing the method through M/N students in terms of method choice, user profiles, contraceptive history, experience with insertion and side effects, continuation / discontinuation of the method, and overall satisfaction with FP services as well as students’ preparedness and capacity to safely offer the method, and their satisfaction with the experience.. Results The study demonstrated the feasibility of training students for community-based provision of Implanon NXT and 95% of them were satisfied with their experience. Acceptability of both the method and the service delivery strategy was high among participants, including among young and first-time contraceptive users. Out of the 441 women with a known outcome at 12 months, 92% still had Implanon NXT inserted, despite some of them reporting experiencing side effects. The vast majority (79%) would “strongly recommend” obtaining NXT from a M/N student if a friend wanted to avoid pregnancies. Conclusions The provision of Implanon NXT at the community-level is a promising solution to address some of the barriers to accessing this method for women living in Kinshasa. However, strengthening pre-insertion counseling, particularly on expected side-effects and the possibility of early removal, is necessary to increase informed choice for the women and potentially limit method discontinuation.
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Affiliation(s)
- Julie H Hernandez
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, 1440 Canalt St, Suite 1900, New Orleans, LA, 70112, USA.
| | - Pierre Akilimali
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Annie Glover
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, 1440 Canalt St, Suite 1900, New Orleans, LA, 70112, USA
| | - Jane T Bertrand
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, 1440 Canalt St, Suite 1900, New Orleans, LA, 70112, USA
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Hernandez JH, Akilimalib P, Mbadu MF. Provision of Emergency Contraceptive Pills in Kinshasa's Informal Drug Shops: Results from a Mystery Client Study. Int Perspect Sex Reprod Health 2020; 46:89-97. [PMID: 32538791 DOI: 10.1363/46e9120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
CONTEXT Despite the prominence of informal drug shops as sources of contraceptives in Kinshasa, Democratic Republic of the Congo, evidence on the quality of services they provide is scant. Given efforts to leverage the private sector to increase contraceptive access, evaluating the contraceptive knowledge, attitudes and practices of these providers is warranted. METHODS In April-May 2018, a mystery client study on the provision of emergency contraception (EC) was conducted in 854 informal drug shops in Kinshasa. Twelve mystery clients, presenting as younger or older than 18 and married or unmarried, visited the outlets to request something to "avoid getting pregnant" after unprotected sex, and to purchase the recommended medicine. Frequencies of key outcomes were calculated, and chi-square testing assessed associations between client age and marital status and the methods and counseling received. RESULTS Overall, providers recommended EC in 77% of visits, and in 54% of visits, clients left with the method. In 62% of the visits in which providers recommended EC, they specified a time frame for taking the pill; the correct window of efficacy was indicated in 75% of these visits. In 18% of visits, other (noncontraceptive) drugs were provided, and in 7% of visits, providers did not help the client. Regardless of the visit outcome, providers were nearly always deemed respectful (96%). CONCLUSIONS Leveraging informal outlets to increase contraceptive provision will require identifying quality outlets, strengthening supply chains and advocating for policy changes that recognize them as effective contraceptive providers without decreasing their perceived advantages for women.
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Affiliation(s)
- Julie H Hernandez
- Assistant Professor, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA,
| | - Pierre Akilimalib
- Assistant Professor, Kinshasa School of Public Health, University of Kinshasa, Democratic Republic of the Congo
| | - Muanda Fidèle Mbadu
- Director, Programme National de Santé des Adolescents, Kinshasa, Democratic Republic of the Congo
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Xiong X, Carter R, Lusamba-Dikassa PS, Kuburhanwa EC, Kimanuka F, Salumu F, Clarysse G, Tutu BK, Yuma S, Iyeti AM, Hernandez JH, Shaffer JG, Villeneuve S, Prual A, Pyne-Mercier L, Nigussie A, Buekens P. Improving the quality of maternal and newborn health outcomes through a clinical mentorship program in the Democratic Republic of the Congo: study protocol. Reprod Health 2019; 16:147. [PMID: 31601228 PMCID: PMC6785870 DOI: 10.1186/s12978-019-0796-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 08/26/2019] [Indexed: 11/10/2022] Open
Abstract
Background The Democratic Republic of the Congo (DRC) boasts one of the highest rates of institutional deliveries in sub-Saharan Africa (80%), with eight out of every ten births also assisted by a skilled provider. However, the maternal and neonatal mortality are still among the highest in the world, which demonstrates the poor in-facility quality of maternal and newborn care. The objective of this ongoing project is to design, implement, and evaluate a clinical mentorship program in 72 health facilities in two rural provinces of Kwango and Kwilu, DRC. Methods This is an ongoing quasi-experimental study. In the 72 facilities, 48 facilities were assigned to the group where the clinical mentorship program is being implemented (intervention group), and 24 facilities were assigned to the group where the clinical mentorship program is not being implemented (control group). The groups were selected and assigned based on administrative criteria, taking into account the number of deliveries in each facility, the coverage of health zones, accessibility, and ease of implementation of a clinical mentorship program. The main activities are organizing and training a national team of mentors (including senior midwives, obstetricians, and pediatricians) in clinical mentoring, deploying them to mentor all health providers (mentees) performing maternal and newborn health (MNH) services, and providing in-service training in routine and Emergency Obstetrical and Newborn Care (EmONC) to the mentees in health facilities over an 18-month period. Baseline and endline assessments are carried out to evaluate the effectiveness of the clinical mentorship program on the quality of MNH care and the effective coverage of key interventions to reduce maternal and neonatal mortality. Findings will be disseminated nationwide and internationally, as scientific evidence is scarce. A national strategy, guidelines, and tools for clinical mentorship in MNH will be developed for replication in other provinces, thus benefitting the entire country. Discussion This is the largest project on clinical mentorship aimed to improving the quality of MNH care in Africa. This program is expected to generate one of the first pieces of scientific evidence on the effectiveness of a clinical mentorship program in MNH on a scientifically designed and sustainable model.
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Affiliation(s)
- Xu Xiong
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Ste. 2000, New Orleans, LA, 70112, USA.
| | - Rebecca Carter
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Ste. 2000, New Orleans, LA, 70112, USA
| | - Paul-Samson Lusamba-Dikassa
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Ste. 2000, New Orleans, LA, 70112, USA.,Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Elvis C Kuburhanwa
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Ste. 2000, New Orleans, LA, 70112, USA.,Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Francine Kimanuka
- UNICEF, 372, avenue Colonel Mondjiba, Kinshasa-Ngaliema, Democratic Republic of the Congo
| | - Freddy Salumu
- UNICEF, 372, avenue Colonel Mondjiba, Kinshasa-Ngaliema, Democratic Republic of the Congo
| | - Guy Clarysse
- UNICEF, 372, avenue Colonel Mondjiba, Kinshasa-Ngaliema, Democratic Republic of the Congo
| | - Baudouin Kalume Tutu
- Ministère de la Santé, Secrétariat général, 36 Avenue de la Justice, Kinshasa - Gombe, Democratic Republic of the Congo
| | - Sylvain Yuma
- Ministère de la Santé, Secrétariat général, 36 Avenue de la Justice, Kinshasa - Gombe, Democratic Republic of the Congo
| | - Alain Mboko Iyeti
- Ministère de la Santé, Secrétariat général, 36 Avenue de la Justice, Kinshasa - Gombe, Democratic Republic of the Congo
| | - Julie H Hernandez
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Ste. 2000, New Orleans, LA, 70112, USA
| | - Jeffrey G Shaffer
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Ste. 2000, New Orleans, LA, 70112, USA
| | - Susie Villeneuve
- UNICEF Western & Central Africa Regional Office, PO Box 29720, Dakar-Yoff, Senegal
| | - Alain Prual
- UNICEF Western & Central Africa Regional Office, PO Box 29720, Dakar-Yoff, Senegal
| | | | - Assaye Nigussie
- Bill & Melinda Gates Foundation, PO Box 23350, Seattle, WA, USA
| | - Pierre Buekens
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Ste. 2000, New Orleans, LA, 70112, USA
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11
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Carter R, Xiong X, Lusamba-Dikassa PS, Kuburhanwa EC, Kimanuka F, Salumu F, Clarysse G, Tutu BK, Yuma S, Iyeti AM, Hernandez JH, Shaffer JG, Bertrand JT, Villeneuve S, Prual A, Pyne-Mercier L, Nigussie A, Buekens P. Facility conditions, obstetric and neonatal care practices, and availability of emergency obstetric and neonatal care in 72 rural health facilities in the Democratic Republic of the Congo: A cross-sectional study. Gates Open Res 2019; 3:13. [PMID: 31410393 PMCID: PMC6676177 DOI: 10.12688/gatesopenres.12905.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Current facility conditions, obstetric and neonatal care practices, and availability of emergency obstetric and neonatal care (EmONC) were assessed in the Kwango and Kwilu provinces of the Democratic Republic of the Congo (DRC). Methods: This is an analysis of the baseline survey data from an ongoing clinical mentoring program among 72 rural health facilities in the DRC. Data collectors visited each of the facilities and collected data through a pre-programmed smartphone. Frequencies of selected indicators were calculated by province and facility type-general referral hospital (GRH) and primary health centers (HC). Results: Facility conditions varied across province and facility type. Maternity wards and delivery rooms were available in the highest frequency of rooms assessed (>95% of all facilities). Drinking water was available in 25.0% of all facilities; electricity was available in 49.2% of labor rooms and 67.6% of delivery rooms in all facilities. Antenatal, delivery, and postnatal care services were available but varied across facilities. While the proportion of blood pressure measured during antenatal care was high (94.9%), the antenatal screening rate for proteinuria was low (14.7%). The use of uterotonics immediately after birth was observed in high numbers across both provinces (94.4% in Kwango and 75.6% in Kwilu) and facility type (91.3% in GRH and 81.4% in HC). The provision of immediate postnatal care to mothers every 15 minutes was provided in less than 50% of all facilities. GRH facilities generally had higher frequencies of available equipment and more services available than HC. GRH facilities provided an average of 6 EmONC signal functions (range: 2-9). Conclusions: Despite poor facility conditions and a lack of supplies, GRH and HC facilities were able to provide EmONC care in rural DRC. These findings could guide the provision of essential needs to the health facilities for better delivery of maternal and neonatal care.
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Affiliation(s)
- Rebecca Carter
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, 70112, USA
| | - Xu Xiong
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, 70112, USA
| | - Paul-Samson Lusamba-Dikassa
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, 70112, USA
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Elvis C. Kuburhanwa
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, 70112, USA
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Freddy Salumu
- UNICEF-DRC, Kinshasa-Ngaliema, Democratic Republic of the Congo
| | - Guy Clarysse
- UNICEF-DRC, Kinshasa-Ngaliema, Democratic Republic of the Congo
| | - Baudouin Kalume Tutu
- Ministère de la Santé, Secrétariat général, Kinshasa – Gombe, Democratic Republic of the Congo
| | - Sylvain Yuma
- Ministère de la Santé, Secrétariat général, Kinshasa – Gombe, Democratic Republic of the Congo
| | - Alain Mboko Iyeti
- Ministère de la Santé, Secrétariat général, Kinshasa – Gombe, Democratic Republic of the Congo
| | - Julie H. Hernandez
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, 70112, USA
| | - Jeffrey G. Shaffer
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, 70112, USA
| | - Jane T. Bertrand
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, 70112, USA
| | - Susie Villeneuve
- UNICEF Western & Central Africa Regional Office, Dakar-Yoff, Senegal
| | - Alain Prual
- UNICEF Western & Central Africa Regional Office, Dakar-Yoff, Senegal
| | | | | | - Pierre Buekens
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, 70112, USA
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12
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Carter R, Xiong X, Lusamba-Dikassa PS, Kuburhanwa EC, Kimanuka F, Salumu F, Clarysse G, Tutu BK, Yuma S, Iyeti AM, Hernandez JH, Shaffer JG, Bertrand JT, Villeneuve S, Prual A, Pyne-Mercier L, Nigussie A, Buekens P. Facility conditions, obstetric and neonatal care practices, and availability of emergency obstetric and neonatal care in 72 rural health facilities in the Democratic Republic of the Congo: A cross-sectional study. Gates Open Res 2019. [DOI: 10.12688/gatesopenres.12905.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Current facility conditions, obstetric and neonatal care practices, and availability of emergency obstetric and neonatal care (EmONC) were assessed in the Kwango and Kwilu provinces of the Democratic Republic of the Congo (DRC). Methods: This is an analysis of the baseline survey data from an ongoing clinical mentoring program among 72 rural health facilities in the DRC. Data collectors visited each of the facilities and collected data through a pre-programmed smartphone. Frequencies of selected indicators were calculated by province and facility type—general referral hospital (GRH) and primary health centers (HC). Results: Facility conditions varied across province and facility type. Maternity wards and delivery rooms were available in the highest frequency of rooms assessed (>95% of all facilities). Drinking water was available in 25.0% of all facilities; electricity was available in 49.2% of labor rooms and 67.6% of delivery rooms in all facilities. Antenatal, delivery, and postnatal care services were available but varied across facilities. While the proportion of blood pressure measured during antenatal care was high (94.9%), the antenatal screening rate for proteinuria was low (14.7%). The use of uterotonics immediately after birth was observed in high numbers across both provinces (94.4% in Kwango and 75.6% in Kwilu) and facility type (91.3% in GRH and 81.4% in HC). The provision of immediate postnatal care to mothers every 15 minutes was provided in less than 50% of all facilities. GRH facilities generally had higher frequencies of available equipment and more services available than HC. GRH facilities provided an average of 6 EmONC signal functions (range: 2-9). Conclusions: Despite poor facility conditions and a lack of supplies, GRH and HC facilities were able to provide EmONC care in rural DRC. These findings could guide the provision of essential needs to the health facilities for better delivery of maternal and neonatal care.
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Hernandez JH, Akilimali PZ, Muanda MF, Glover AL, Bertrand JT. Evolution of a Large-Scale Community-Based Contraceptive Distribution Program in Kinshasa, DRC Based on Process Evaluation. Glob Health Sci Pract 2018; 6:657-667. [PMID: 30591574 PMCID: PMC6370360 DOI: 10.9745/ghsp-d-18-00205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 11/24/2018] [Indexed: 11/23/2022]
Abstract
Midterm process evaluation results indicated that design and implementation failures hindered the program's success, notably: (1) the short-acting methods provided by community-based distributors (CBDs) offered limited choice; (2) the nominal revenue retained from selling the methods provided limited motivation for the volunteer CBDs; and (3) the model was poorly coordinated with the existing clinical service system, partly because of challenging systems issues. In the revised model, the CBDs will also provide subcutaneous injectables and emergency contraceptive pills, retain more revenue from contraceptive sales, and have better interaction with the existing system including conducting monthly mini-campaigns to increase visibility and attract more clients. In a context where distance, user fees, and health staff shortages constitute significant barriers to accessing facility-based family planning services, the use of community-based distributors (CBDs) as counseling and contraceptive providers has been tested in several resource-constrained environments to increase family planning uptake. In the capital city of the Democratic Republic of the Congo (DRC), Kinshasa, a massive CBD program (AcQual) has been implemented since 2014, with lackluster results measured in terms of the low volume of contraceptives provided. A process evaluation conducted in 2017 assessed the fidelity of implementation of the program compared with the original AcQual design and analyzed gaps in provider training and motivation, contraceptive supplies, and reporting and monitoring processes. Its objective was to identify both theory and implementation failures in order to propose midcourse corrections for the program. The mixed-method data collection focused on the CBDs as a pivotal component of the AcQual program with 700 active CBDs interviewed. In addition, 10 in-depth interviews were conducted with clinical personnel, local health program managers, and project partners to identify gaps in the AcQual implementation environment. Issues with CBDs' performance, knowledge retention, and commitment to program activities, as well as gaps in contraceptive supply chains and insufficient monitoring and supervision processes, were the main implementation failures identified. Inappropriate method mix offered by the CBDs (condoms, pills, and CycleBeads only) and chronic overburdening of health care staff at the local level compounded these issues and explained the low volume of contraceptives provided through AcQual. Midcourse corrections included a more structured schedule of activities, stronger integration of CBDs with clinical providers and health zone managers, expansion of the mix of contraceptives offered to include subcutaneous injectables and emergency contraceptive pills, and clarifying reporting and monitoring responsibilities among all partners. Findings from this process evaluation contribute to the limited knowledge base regarding “unwelcome results” by examining all the intervention components and their relationships to highlight areas of potential failures, both in design and implementation, for similar CBD programs.
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Affiliation(s)
- Julie H Hernandez
- Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
| | - Pierre Z Akilimali
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Mbadu Fidèle Muanda
- Programme National de Santé des Adolescents (PNSA), Kinshasa, Democratic Republic of the Congo
| | - Annie L Glover
- Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Jane T Bertrand
- Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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14
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Hernandez JH, Akilimali P, Glover A, Emel R, Mwembo A, Bertrand J. Task-shifting the provision of DMPA-SC in the DR Congo: Perspectives from two different groups of providers. Contraception 2018; 98:449-453. [PMID: 30031000 PMCID: PMC6197837 DOI: 10.1016/j.contraception.2018.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 07/02/2018] [Accepted: 07/04/2018] [Indexed: 11/14/2022]
Abstract
Objectives To document the experience of three groups of Family Planning service providers participating in task-shifting for the provision of subcutaneous depot-medroxyprogesterone acetate (DMPA-SC) at the community level in the DRC. Study design This article compares results from interviews with DMPA-SC providers in two separate pilot studies: 1) 53 medical and nursing school students teaching women how to self-inject (2016–2017); and 2) 34 lay community health workers providing DMPA-SC in rural areas of Lualaba (2017). All providers gave information on socio-demographic characteristics, recruitment,) training, supervision, experience and satisfaction with the provision of DMPA-SC. The paper examines variations in responses from the different provider cadres. Results Despite substantive variations in provider profiles in terms of age, educational and marital status, reported levels of satisfaction with offering DMPA-SC in the community were consistently high. Over 90% of all providers declared being comfortable or very comfortable interacting with FP clients, and more than three quarters of them were very comfortable performing an injection. Over 90% of Lualaba providers and over 80% of student providers gave correct responses to DMPA-SC protocol questions regarding referral of clients to facilities and side-effects management. The vast majority declared being (very) satisfied with their experience providing DMPA-SC. Conclusions Providers with and without a clinical background, when properly trained and supervised, can provide DMPA-SC at the community level in both urban and rural settings of the DRC. Support strategies from the Family Planning environment (continuous contraceptive supplies and adequate referral system to fixed facilities) are key to engaging community health workers and sustainably leveraging task-shifting opportunities. Implication statement This study provides additional evidence on the acceptability and feasibility of task-shifting in relation to DMCP-SC and supports further scale-up efforts.
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Affiliation(s)
- Julie H Hernandez
- Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Suite 1900, New Orleans, LA 70112, USA.
| | - Pierre Akilimali
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Annie Glover
- Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Suite 1900, New Orleans, LA 70112, USA
| | - Rebecca Emel
- Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Suite 1900, New Orleans, LA 70112, USA
| | - Albert Mwembo
- École de Santé Publique de Lubumbashi, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Jane Bertrand
- Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Suite 1900, New Orleans, LA 70112, USA
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15
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Hernandez JH, Muanda M, Garcia M, Matawa G. Awareness and Perceptions of Emergency Contraceptive Pills Among Women in Kinshasa, Democratic Republic of the Congo. Int Perspect Sex Reprod Health 2017; 43:121-130. [PMID: 29553473 DOI: 10.1363/43e4417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
CONTEXT Despite the commitment of the Democratic Republic of the Congo (DRC) to expand the family planning method mix and increase access to services, awareness of emergency contraception is low among women, and the method remains underused and poorly integrated in family planning programming. METHODS Data from 15 focus group discussions conducted in 2016 among women aged 15-35 were used to examine awareness and perceptions of, and attitudes toward, emergency contraceptives. After facilitators explained emergency contraceptive pills' mechanism of action and other characteristics, participants were asked about the potential benefits and risks of making the method more widely available. Transcripts were analyzed using an iterative approach. RESULTS Women reported employing a wide range of postcoital contraceptive behaviors, albeit often using inappropriate products, and generally agreed that emergency contraceptive pills seemed to be a potentially effective solution to their family planning needs. Perceived benefits and limitations of the method were almost always framed in reference to other, better-known contraceptives, and women expressed strong preferences for pharmacy-based provision that aligned with their usual behaviors for obtaining contraceptives. Participants were reluctant to see the method available for free. CONCLUSIONS Emergency contraceptive pills have the potential to address gaps in the family planning method mix in the DRC. Assessing whether women have incomplete or erroneous information about family planning methods can provide better understanding of women's contraceptive choices in low-income countries.
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Affiliation(s)
| | - Mbadu Muanda
- Ministry of Health, Democratic Republic of the Congo, Kinshasa
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16
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Hernandez JH, Mbadu MF, Garcia M, Glover A. The provision of emergency contraception in Kinshasa's private sector pharmacies: experiences of mystery clients. Contraception 2017; 97:57-61. [PMID: 28803883 PMCID: PMC5745145 DOI: 10.1016/j.contraception.2017.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 08/01/2017] [Accepted: 08/01/2017] [Indexed: 11/24/2022]
Abstract
Objectives Recent programmatic and research efforts on addressing gaps in health systems of low-income countries increasingly see task shifting, i.e. the provision of healthcare by non-medically trained personnel, as a possible solution to increase the availability of specific services and commodities. In Kinshasa, private-sector pharmacies are the primary and preferred provider of family planning (FP) methods, and thus constitute a potential resource for expanding access to specific contraceptives. The objective of this study is to explore selected pharmacies' readiness to serve women seeking emergency contraception (EC). Study design This study used a mystery client (MC) methodology to visit 73 pharmacies in Kinshasa, Democratic Republic of Congo (DRC). Trained interviewers posed as novice EC users and asked specific questions to evaluate the pharmacy staff's technical knowledge of EC and their attitudes towards EC clients. The results of the MC visit were recorded immediately after the MC left the pharmacy. Results Findings indicate that more than two-thirds of EC providers were knowledgeable about EC dosage, timeframe, and side effects, and 90% were deemed helpful towards novice EC users. Rare but glaring misconceptions about EC timeframe (20% of providers) and long-term side effects (4% of providers), as well as frequent stock-out (22%) and cost issues highlight priorities for programmatic improvements. Conclusions As new service delivery strategies are explored to complement the uneven network of health structures in DRC, this study suggests that, given proper training and integration in FP programming, private-sector pharmacies have the potential to meet specific contraceptive needs for women living in Kinshasa. Implication statement Private pharmacies included in study sample in Kinshasa (DRC) have adequate family planning (FP) service skills to provide clients with emergency contraceptive pills. These higher-end outlets constitute an opportunity for expanding access to FP, although, under total market approaches, a more diverse range of drugs shops should be investigated.
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Affiliation(s)
- Julie H Hernandez
- Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Suite 1900, New Orleans, LA 70112, USA.
| | - Muanda Fidèle Mbadu
- Programme National de Santé de l'Adolescent (National Program for Adolescent Health), Ministry of Health, Avenue des Cliniques n° 43/Commune de la Gombe, Kinshasa, Democratic Republic of Congo
| | - Mélissa Garcia
- International Consortium for Emergency Contraception, Management Sciences for Health, 45 Broadway #320, New York, NY 10006, USA
| | - Annie Glover
- Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Suite 1900, New Orleans, LA 70112, USA
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Hernandez JH, Akilimali P, Kayembe P, Dikamba N, Bertrand J. The value of spatial analysis for tracking supply for family planning: the case of Kinshasa, DRC. Health Policy Plan 2016; 31:1058-68. [PMID: 27084735 DOI: 10.1093/heapol/czw036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2016] [Indexed: 11/12/2022] Open
Abstract
While geographic information systems (GIS) are frequently used to research accessibility issues for healthcare services around the world, sophisticated spatial analysis protocols and outputs often prove inappropriate and unsustainable to support evidence-based programme strategies in resource-constrained environments. This article examines how simple, open-source and interactive GIS tools have been used to locate family planning (FP) services delivery points in Kinshasa (Democratic Republic of Congo) and to identify underserved areas, determining the potential location of new service points, and to support advocacy for FP programmes. Using smartphone-based data collection applications (OpenDataKit), we conducted two surveys of FP facilities supported by partner organizations in 2012 and 2013 and used the results to assess gaps in FP services coverage, using both ratio of facilities per population and distance-based accessibility criteria. The cartographic outputs included both static analysis maps and interactive Google Earth displays, and sought to support advocacy and evidence-based planning for the placement of new service points. These maps, at the scale of Kinshasa or for each of the 35 health zones that cover the city, garnered a wide interest from the operational level of the health zones' Chief Medical Officers, who were consulted to contribute field knowledge on potential new service delivery points, to the FP programmes officers at the Ministry of Health, who could use the map to inform resources allocation decisions throughout the city.
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Affiliation(s)
- Julie H Hernandez
- Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Suite 1900, New Orleans, LA 70112, USA
| | - Pierre Akilimali
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Patrick Kayembe
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Nelly Dikamba
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Jane Bertrand
- Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Suite 1900, New Orleans, LA 70112, USA
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