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Contraception. 2018 Nov;98(5):454-459. doi: 10.1016/j.contraception.2018.08.004. Epub 2018 Aug 14.

Acceptability of the distribution of DMPA-SC by community health workers among acceptors in the rural province of Lualaba in the Democratic Republic of the Congo: a pilot study.

Author information

1
École de Santé Publique de Lubumbashi, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo.
2
Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Suite 1900, New Orleans, LA 70112, USA. Electronic address: remel@tulane.edu.
3
l'Univers Santé Plus, Democratic Republic of the Congo.
4
Pathfinder International-Democratic Republic of the Congo.
5
Pathfinder International-Democratic Republic of the Congo (at the time of the study).
6
Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, Suite 1900, New Orleans, LA 70112, USA.

Abstract

OBJECTIVES:

The objective of this research is to assess the acceptability of the provision of subcutaneously administered depo medroxyprogesterone acetate (DMPA-SC) by nonclinically trained community health workers (CHWs) among acceptors in the rural province of Lualaba in the Democratic Republic of the Congo (DRC).

STUDY DESIGN:

In 2017, 34 CHWs received training in provision of DMPA-SC. Among other methods, DMPA-SC by CHWs was offered during household visits and at community outreach events. The initial survey included questions on acceptors' demographic characteristics, contraceptive use history and experience with provision of DMPA-SC by a CHW. The follow-up included questions about side effects experienced and continuation of DMPA-SC by a CHW.

RESULTS:

Seventy-four percent of initial acceptors of DMPA-SC (N=252) were first-time contraception users. Almost all (96.0%) felt very comfortable with a CHW performing the injection rather than a physician or nurse, and 97.6% perceived that the CHW was very comfortable performing the injection. A total of 239 women were interviewed at follow-up. Most expressed satisfaction with the method despite some side effects experienced. Almost all acceptors (97.9%) were satisfied with the information provided by CHWs, and 93.8% were satisfied with the overall service. Most (96.4%) would choose to continue receiving DMPA-SC by a CHW rather than in a health clinic, and 95.2% would recommend DMPA-SC by a CHW to a friend.

CONCLUSIONS:

Overall, administration of DMPA-SC by CHWs is acceptable to users in Lualaba. DMPA-SC can be safely provided within the community after proper training.

IMPLICATIONS:

This study validates the use of CHWs (without clinical training) to provide DMPA-SC in a rural sub-Saharan African setting. It also represents an important step in obtaining official MOH authorization for the scale-up of this mechanism of distribution to other underserved regions in the DRC.

KEYWORDS:

Acceptability; Community health workers (CHWs); DMPA-SC; Rural Africa; Sayana® press

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