Ayiasi Richard Mangwi, Muhumuza Christine, Bukenya Justine, Orach Christopher Garimoi
Makerere University College of Health Sciences, School of Public Health Department of Community Health and Behavioural Sciences, Uganda.
Makerere University College of Health Sciences, School of Public Health Department of Epidemiology and Biostatistics.
Pan Afr Med J. 2015 Jun 22;21:138. doi: 10.11604/pamj.2015.21.138.7026. eCollection 2015.
Globally, most postpartum pregnancies are unplanned, mainly as a result of low level of knowledge and fear of contraceptive use especially in low-income settings. The aim of this study was to evaluate the effect of prenatal contraceptive counselling on postpartum contraceptive use and pregnancy outcomes after one year.
Sixteen health centres were equally and randomly allocated to control and intervention arms. Mothers were consecutively recruited during their first antenatal clinic consultations. In the intervention arm Village Health Team members made home visits and provided prenatal contraceptive advice and made telephone consultations with health workers for advice while in the control arm mothers received routine antenatal care offered in the health centres. Data were collected in 2014 in the two districts of Kiryandongo and Masindi. This data was collected 12-14 months postpartum. Mothers were asked about their family planning intentions, contraceptive use and screened for pregnancy using human Chorionic Gonadotropin (hCG) levels. Socio-demographic and obstetric indices were recorded. Our primary outcomes of interests were current use of modern contraceptive, decision to use a modern contraceptive method and pregnancy status. Multilevel analysis using the xtmelogit stata command was used to determine differences between intervention and control groups.
A total of 1,385 women, 748 (control) and 627 (intervention) were recruited. About 80% initiated breastfeeding within six hours of delivery 78.4% (control) and 80.4% (intervention). About half of the mothers in each arm had considered to delay the next pregnancy 47.1% (control) and 49% (intervention). Of these 71.4% in the control and 87% in the intervention had considered to use a modern contraceptive method, only 28.2% of the control and 31.6% in the intervention were current modern contraceptive users signifying unmet contraceptive needs among immediate postpartum mothers. Regarding pregnancy, 3.3% and 5.7% of the women were found to be pregnant in the control and intervention arms respectively. There were no statistical differences between the control and intervention arms for all primary outcomes of interests.
Prenatal contraceptive counseling did not affect postpartum contraceptive use among immediate postpartum mothers in Masindi and Kiryandongo districts. Interventions aiming at improving postpartum contraceptive use should focus on addressing unmet contraceptive needs.
在全球范围内，大多数产后妊娠都是意外怀孕，主要原因是知识水平低以及对使用避孕药具存在恐惧，尤其是在低收入地区。本研究的目的是评估产前避孕咨询对产后一年避孕措施使用情况和妊娠结局的影响。
16个健康中心被平均随机分配到对照组和干预组。母亲们在首次产前门诊咨询时被连续招募。在干预组，村卫生团队成员进行家访并提供产前避孕建议，同时与卫生工作者进行电话咨询以获取建议；而在对照组，母亲们接受健康中心提供的常规产前护理。2014年在基里扬东戈和马辛迪两个地区收集数据。这些数据在产后12 - 14个月收集。询问母亲们的计划生育意愿、避孕措施使用情况，并使用人绒毛膜促性腺激素（hCG）水平筛查是否怀孕。记录社会人口统计学和产科指标。我们感兴趣的主要结局是现代避孕方法的当前使用情况、决定使用现代避孕方法以及妊娠状态。使用xtmelogit stata命令进行多水平分析以确定干预组和对照组之间的差异。
共招募了1385名女性，其中748名（对照组）和627名（干预组）。约80%的女性在分娩后6小时内开始母乳喂养，对照组为78.4%，干预组为80.4%。每组中约一半的母亲考虑推迟下一胎妊娠，对照组为47.1%，干预组为49%。在这些母亲中，对照组有71.4%、干预组有87%考虑使用现代避孕方法，但对照组中只有28.2%、干预组中只有31.6%是当前现代避孕方法使用者，这表明产后即刻母亲中存在未满足的避孕需求。关于妊娠情况，对照组和干预组分别有3.3%和5.7%的女性怀孕。在所有感兴趣的主要结局方面，对照组和干预组之间没有统计学差异。
在马辛迪和基里扬东戈地区，产前避孕咨询对产后即刻母亲的产后避孕措施使用情况没有影响。旨在改善产后避孕措施使用的干预措施应侧重于满足未满足的避孕需求。
