Format

Send to

Choose Destination
Contraception. 2018 Nov;98(5):411-417. doi: 10.1016/j.contraception.2018.08.002. Epub 2018 Aug 16.

An observational study to test the acceptability and feasibility of using medical and nursing students to instruct clients in DMPA-SC self-injection at the community level in Kinshasa.

Author information

1
Tulane School of Public Health and Tropical Medicine, Department of Global Health Management and Policy, 1440 Canal St, Suite 1900, New Orleans, LA 70112, USA. Electronic address: bertrand@tulane.edu.
2
Tulane School of Public Health and Tropical Medicine, Department of Global Health Management and Policy, 1440 Canal St, Suite 1900, New Orleans, LA 70112, USA.
3
Institut Supérieur de Statistiques, Kinshasa, Democratic Republic of Congo.
4
University of Kinshasa, School of Public Health, Kinshasa, Democratic Republic of Congo.
5
Tulane International LLC, Kinshasa, Democratic Republic of Congo.

Abstract

OBJECTIVES:

Given the promise of DMPA-SC to increase community-level access to modern contraception in developing countries, we conducted an observational study to assess the acceptability and feasibility of DMPA-SC self-injection among women in Kinshasa, Democratic Republic of the Congo, and of medical/nursing (M/N) students as instructors for self-injection.

STUDY DESIGN:

Women who selected DMPA-SC at a community outreach event adjacent to a health center were interviewed upon acceptance (baseline) and then 3, 6 and 12 months later.

RESULTS:

Of 850 clients selecting DMPA-SC at baseline, 640 (75.3%) opted for self-injection over being injected by the M/N students for reasons of convenience and personal agency. Among these 640 self-injectors, 47.5% were anxious at baseline (for fear of needles or injecting incorrectly). Over 80% reported feeling very ready after training, confident that they knew how to self-inject and confident that they would remember the next injection date. By 3 months, 97% described it as easy. Half (54%) experienced side effects, mainly menstrual irregularities, the main reason for discontinuation. At 6-month follow-up, self-injectors cited effectiveness and ease of use as positive elements, though one quarter reported side effects. Their impressions of M/N students as instructors were highly positive.

CONCLUSIONS:

Where DMPA-SC was free and easily accessible, the majority of women interested in DMPA-SC opted to learn self-injection. The M/N students performed well in instructing women to self-inject. Clients were highly satisfied with the services received, yet many did not recognize their student status, possibly because outreach occurred near a health facility. Once told, clients remained very favorable, suggesting strong motivation to receive their preferred contraceptive free, whoever the provider.

IMPLICATION STATEMENT:

This study provides additional evidence on the acceptability and the feasibility of the self-injection of DMPA-SC by users from a resource-limited setting.

KEYWORDS:

Auto-injection; DMPA-SC; Injectable; Self-injection; Task-shifting

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center