Private drug shops can effectively provide contraceptive methods, especially injectables, complementing government services. Most drug shop clients in 4 peri-urban areas of Uganda were continuing users of DMPA; had switched from other providers, mainly government clinics, because the drug shops had fewer stock-outs and were more convenient (closer location, shorter waiting time, more flexible hours); and were satisfied with the quality of services. The drug shops provided a substantial part of the total market share for family planning services in their areas.

This project in Zambia contributes to our understanding of the impact of community-based provision of injectables on method choice and uptake and of the costs of adding DMPA to an established community-based family planning program. The project also illustrates the importance of involving stakeholders from the outset, analyzing costs relevant to scale up, and engaging in policy change dialogue not at the end, but rather throughout project implementation.

BackgroundTask shifting from higher cadre providers to CHWs has been widely adopted to address healthcare provider shortages, but the addition of any service can potentially add to an already considerable workload for CHWs. Objective measures of workload alone, such as work-related time and travel may not reflect howCHWs actually perceive and react to their circumstances. This study combined perception and objectivemeasures of workload to examine their effect on quality of services, worker performance, and job and clientsatisfaction.MethodsThree hundred eighty-three CHWs from control and intervention districts, where the intervention group was trained to provide contraceptive resupply, completed diaries of work-related activities for one month. Interviews were also conducted with a subset of CHWs and their clients.ResultsCHW diaries did not reveal significant differences between intervention and control groups in time spent on service provision or travel. Over 90 % of CHWs reported workload manageability, job satisfaction, and motivation to perform their jobs. Clients were highly satisfied with CHW services and most stated preference for future services from CHWs.ConclusionThe study demonstrated that adding resupply of hormonal contraceptives to CHWs’ tasks would not place undue burden on them. Accordingly, the initiative was scaled up in all 30 districts in the country.

Background and methods Emergency contraceptive pills (ECPs) are becoming more popular, yet little is known about the contraceptive preferences of women who take ECPs. Women purchasing ECPs were recruited from pharmacies in Accra, Ghana. A total of 24 semi-structured, qualitative interviews were conducted in May 2008. Results Nearly all participants preferred ECPs to other contraceptive methods. Although fear of side effects from oral contraceptive pills (OCPs), intrauterine devices and injectables were deterrents to use of those methods, side effects from ECPs were acceptable to this small and highly self-selected group of ECP users. Participants had little knowledge about how other contraceptive methods work and expressed a strong distrust and dislike of condoms. Discussion and conclusion Study participants loved their ECPs, despite minor discomforts like bleeding, and most had no concerns about repeated use, though these fi ndings may not apply to women outside Accra or women who obtain ECPs from non-pharmacy settings. Future interventions should work to dispel myths about OCPs, condoms and other modern methods, and focus on basic contraception education.Emergency contraceptive pills (ECPs) represent a small but growing segment of the contraceptive market. Recent availability of emergency contraception (EC) products in the private sector has fuelled interest in ECPs as an important contraceptive option for women. ECPs are currently underutilised, 1 2 but private sector promotion in pharmacy settings, coupled with preliminary data indicating increased demand, suggest that ECPs will become increasingly important as an alternative contraceptive option for women and couples. [3][4][5] ECPs are recommended to avoid unwanted pregnancy when no contraceptive has Article effects than other hormonal contraceptive methods, and frequent use of ECPs is likely to lead to a higher incidence of side effects and a higher total hormone intake than other hormonal contraceptive methods. 11Furthermore, most contraceptive options cost less than ECPs (Research International/Ghana, personal communication, May 2008).Given the drawbacks of ECPs and the availability of other options, it may be beneficial for some ECP users to switch to contraceptive methods that are more effective and possibly safer for long-term use -a transition known as 'bridging'.12 Successful bridging of ECP users to more effective contraception, however, is dependent on understanding the reasons women choose ECPs beyond use in emergency situations, and women's acceptance of a longer-term contraceptive method. The goal of this formative research study was to investigate the potential for bridging ECP users who purchase the product in pharmacies to longer-term contraception. MethodsData for the current study were collected in May 2008 in Accra, Ghana during the formative research phase of a larger intervention study. The intervention was designed to target ECP users in pharmacies, and transition them to OCPs through the provision of two free cycles of OCPs a...

Teacher ratings of social competence and academic achievement were obtained from a sample of 127 Bermudian children at ages 5, 6, 7 and 8 years. The children were studied first during their pre-school years, when they had been exposed to various amounts and qualities of day care. Quality of care was found to be important to the children's intellectual and social development while they were in the day care settings but not after 1-4 years of primary schooling.In hierarchical and simultaneous regressions, family background characteristics, not child care amounts or qualities, were found to be predictive of social competence and academic achievement in the primary grades. By school age, the effects of infant and preschool child care experiences were no longer influential in childmm's development, but family background continued to be important. These findings and their implications for child care are discussed.Keywords: Day care, social development, academic achievement, longitudinal study, follow-up study.research has generated a spirited debate, stimulated by the timeliness of the social issues surrounding child care. This phenomenon has been catapulted into prominence by the ever-growing number of mothers who choose to work or are obliged to do so. In this century, child care was sanctioned in the United States during periods of national emergency (World War II and the Great Depression), but in the absence of such circumstances, non-maternal care was provided only for "the poor, the immigrant, and the Scarr and Eisenberg, 1993;Scarr et al., 1989;Vandell and Powers, 1983). Studies that do not take the variable quality of care into account are unable to draw firm conclusions about the effects of home care or day care on children (Scarr and Eisenberg, 1993).Current research has gone beyond simple comparisons between home-reared and substitute care children to examine the effects of day care quality (Goossens et af., Howes, 1988;Vandell et al., 1988).Indeed, a number of studies have indicated that there are several indices of day care quality: staffchild ratios, group size, staff stability and caregiver training in early education or child development have repeatedly been found to describe quality (Phillips, 1989;Phillips and Howes, 1987; Ruopp et aZ., 1979). In addition, because most of these indicators tend to co-occur, a more global assessment of quality has generally been obtained via measures such as the Early Childhood Environment Rating Scale (ECERS) developed by Harms and Clifford (1980). Research programmes that employ both specific and global assessments provide more valid measures of quality (McCartney, 1984;Phillips et al., 1987a;Vandell and Powers, 1983).Studies guided by this focus on quality have reported positive effects of pre-school child care on a number of dimensions. For example, children in goodquality centres scored better on measures of language development (McCartney et al., 1985) than their peers in lower-quality centres. Caregivers at high-quality centres rated their children as more con...