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Reiss K, Penfold S, Alabi O, et al. Safety, Quality, and Acceptability of Contraceptive Subdermal Implant Provision by Community Health Extension Workers Versus Nurses and Midwives in Nigeria: Protocol for a Quasi-Experimental, Noninferiority Study. JMIR Res Protoc. 2018;7(3):e67doi: 10.2196/resprot.8721.
Reiss, K., Penfold, S., Alabi, O., Ali, M., Hopkins, K., Ngo, T. D., Odogwu, K., Douthwaite, M., Ezire, O., Udoh, U., Effiom, E., & Munroe, E. S. (2018). Safety, Quality, and Acceptability of Contraceptive Subdermal Implant Provision by Community Health Extension Workers Versus Nurses and Midwives in Nigeria: Protocol for a Quasi-Experimental, Noninferiority Study. JMIR research protocols, 7(3), e67. https://doi.org/10.2196/resprot.8721
Reiss, Kate, et al. "Safety, Quality, and Acceptability of Contraceptive Subdermal Implant Provision by Community Health Extension Workers Versus Nurses and Midwives in Nigeria: Protocol for a Quasi-Experimental, Noninferiority Study." JMIR research protocols vol. 7,3 (2018): e67. doi: https://doi.org/10.2196/resprot.8721
Reiss K, Penfold S, Alabi O, Ali M, Hopkins K, Ngo TD, Odogwu K, Douthwaite M, Ezire O, Udoh U, Effiom E, Munroe ES. Safety, Quality, and Acceptability of Contraceptive Subdermal Implant Provision by Community Health Extension Workers Versus Nurses and Midwives in Nigeria: Protocol for a Quasi-Experimental, Noninferiority Study. JMIR Res Protoc. 2018 Mar 02;7(3):e67. doi: 10.2196/resprot.8721. PMID: 29500162; PMCID: PMC5856922.
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JMIR Res Protoc. 2018 Mar 02;7(3):e67. doi: 10.2196/resprot.8721.

Safety, Quality, and Acceptability of Contraceptive Subdermal Implant Provision by Community Health Extension Workers Versus Nurses and Midwives in Nigeria: Protocol for a Quasi-Experimental, Noninferiority Study.

JMIR research protocols

Kate Reiss, Suzanne Penfold, Olalere Alabi, Moazzam Ali, Kristen Hopkins, Thoai Dinh Ngo, Kingsley Odogwu, Megan Douthwaite, Onoriode Ezire, Uko Udoh, Effiom Effiom, Erik S Munroe

Affiliations

  1. Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
  2. Evidence to Action Team, Technical Services Department, Marie Stopes International, London, United Kingdom.
  3. Marie Stopes Nigeria, Abuja, Nigeria.
  4. Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
  5. Independent Consultant, London, United Kingdom.
  6. Poverty, Gender and Youth Programme, Population Council, New York, NY, United States.
  7. Palladium Group, Abuja, Nigeria.
  8. Department of Health Planning, Research and Statistics, Federal Ministry of Health, Abuja, Nigeria.

PMID: 29500162 PMCID: PMC5856922 DOI: 10.2196/resprot.8721

Abstract

BACKGROUND: As part of its Family Planning 2020 commitment, the Nigerian government is aiming for a contraceptive prevalence rate of 36% by 2018, and in 2014, approved a policy to allow community health extension workers (CHEWs), in addition to doctors, nurses, and midwives, to provide contraceptive subdermal implants. There is a lack of rigorous evidence on the safety of long-acting reversible contraceptive provision, such as implants, among lower cadres of health providers.

OBJECTIVE: This study aimed to compare implant provision by CHEWs versus nurses and midwives up to 14 days post insertion.

METHODS: The quasi-experimental, noninferiority study will take place in public sector facilities in Kaduna and Ondo States. In each state, we will select 60 facilities, and from these, we will select a total of 30 nurses and midwives and 30 CHEWs to participate. Selected providers will be trained to provide implant services. Once trained, providers will recruit a minimum of 8125 women aged between 18 and 49 years who request and are eligible for an implant, following comprehensive family planning counseling. During implant insertion, providers will record data about the process and any adverse events, and 14 days post insertion, providers will ask 4410 clients about adverse events arising from the implant. Supervisors will observe 792 implant insertions to assess service provision quality and ask clients about their satisfaction with the procedure. We will conclude noninferiority if the CI for the difference in the proportion of adverse events between CHEWs and nurses and midwives on the day of insertion or 14 days post insertion lies to the right of -2%.

RESULTS: In September and October 2015, we trained 60 CHEWs and a total of 60 nurses and midwives from 12 local government areas (LGAs) in Kaduna and 23 LGAs in Ondo. Recruitment took place between November 2015 and December 2016. Data analysis is being finalized, and results are expected in March 2018.

CONCLUSIONS: The strength of this study is having a standard care (nurse and midwife provision) group with which CHEW provision can be compared. The intervention builds on existing training and supervision procedures, which increases the sustainability and scalability of CHEW implant provision. Important limitations include the lack of randomization due to nurses and midwives in Nigeria working in separate types of health care facilities compared with CHEWs, and that providers self-assess their own practices. It is unfeasible to observe all procedures independently, and observation may change practice. Although providers will be trained to conduct implant removals, the study time will be too short to reach the sample size required to make noninferiority comparisons for removals.

TRIAL REGISTRATION: ClinicalTrials.gov NCT03088722; https://clinicaltrials.gov/ct2/show/NCT03088722 (Archived by WebCite at http://www.webcitation.org/6xIHImWvu).

©Kate Reiss, Suzanne Penfold, Olalere Alabi, Moazzam Ali, Kristen Hopkins, Thoai Dinh Ngo, Kingsley Odogwu, Megan Douthwaite, Onoriode Ezire, Uko Udoh, Effiom Effiom, Erik S Munroe. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 02.03.2018.

Keywords: community health workers; contraception; contraceptive prevalence; delivery of health care; drug implants; family planning services; long-acting reversible contraception; task shifting, Nigeria

References

  1. Reprod Health. 2015 Apr 01;12:27 - PubMed
  2. Contraception. 2013 Mar;87(3):259-63 - PubMed
  3. Contraception. 2013 Jan;87(1):113-20 - PubMed
  4. Glob Health Sci Pract. 2013 Mar 21;1(1):11-7 - PubMed
  5. Contraception. 2008 Sep;78(3):197-200 - PubMed
  6. Bull World Health Organ. 2014 Feb 1;92(2):93-8 - PubMed
  7. Contraception. 2011 Apr;83(4):291-4 - PubMed
  8. Glob Health Sci Pract. 2015 Sep 15;3(3):382-94 - PubMed

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