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

Abstract

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

Provision of injectable contraceptives by community health workers in sub-Saharan Africa: a systematic review of safety, acceptability and effectiveness

“…A wide variety of study designs have been used to examine CHW performances in SSA based on the present evidence base. Of the 13 eligible studies, 4 were non-randomized community trials (non-RCTs) [ 19 – 22 ], 3 descriptive cross-sectional studies [ 4 , 15 , 18 ], 2 descriptive longitudinal studies [ 23 , 24 ], 1 pilot intervention [ 14 ], 1 randomized control trial [ 17 ] and 2 case study [ 10 , 25 ]. Most of the studies had a study period of 12–13 months [ 15 , 21 , 23 , 25 ] and 1 had a study period of 3 years [ 20 ].…”

“…The Eastern African region included 3 studies in Uganda [ 19 , 20 , 25 ], 2 in Ethiopia [ 10 , 21 ], 1 in Kenya [ 23 ], 1 in Zambia [ 15 ], 1 in Mozambique [ 22 ] and 2 in Madagascar [ 17 , 18 ]. The Central African region included 1 study in the Democratic Republic of the Congo [ 14 ].…”

Evolution of a Large-Scale Community-Based Contraceptive Distribution Program in Kinshasa, DRC Based on Process Evaluation

“…This change should be complemented by the expansion of the method mix offered by CBDs, which in AcQual 3 will include DMPA-SC (Sayana Press) and emergency contraceptive pills, both in high demand and retailed at higher prices than other community-level methods. The addition of these 2 methods to the CBDs' method mix stems from separate Tulane-led research outlining the opportunities for community-based provision of these methods, 16 , 17 and illustrate how pilot studies and operational research (such as this process evaluation) can be leveraged to improve program design and implementation 18 …”

DMPA-SC: an emerging option to increase women's contraceptive choices

“…In the same study, Mwembo and colleagues assessed the acceptability and feasibility of DMPA-SC among 252 women on the initial injection date and 3 months later. Of the 239 women interviewed at follow-up, 92% would recommend DMPA-SC to a friend or family member, and 95% would choose to continue receiving DMPA-SC from a CHW rather than in a health facility [9]. Bertrand and colleagues assessed the acceptability and feasibility of self-injection in two urban and one rural areas of Kinshasa, DRC; three quarters of women opted for self-injection over being injected by the CHW for reasons of convenience and personal agency.…”