Pillay D, Morroni C, Pleaner M, Adeogba O, Chersich M, Naidoo N, Mullick S, Rees H
Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Women’s Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
S Afr Med J. 2017 Oct 1;107(10):827-831. doi: 10.7196/SAMJ.2017.v107i10.12822.
Background. Implanon NXT, a long-acting subdermal contraceptive implant, was introduced in South Africa (SA) in early 2014 as part of an expanded contraceptive method mix. After initial high levels of uptake, reports emerged of frequent early removals and declines in use. Monitoring of progress and challenges in implant service delivery could identify aspects of the programme that require strengthening. Objectives. To assess data management and record keeping within implant services at primary care facilities. Methods. We developed a checklist to assess the tools used for monitoring implant services and data reporting to district offices. The checklist was piloted in seven facilities. An additional six high-volume and six low-volume implant insertion clinics in the City of Johannesburg (CoJ), Gauteng Province, and the Dr Kenneth Kaunda District, North West Province, were selected for assessment. Results. All 12 facilities completed a Daily Head Count Register, which tallied the number of clients attending the clinic, but not information about implant use. A more detailed Tick Register recorded services that clinic attendees received, with nine documenting number of implant insertions and six implant removals. A more specific tool, an Insertion Checklist, collected data on insertion procedures and client characteristics, but was only used in CoJ (five of six facilities). Other registers, which were developed de novo by staff at individual facilities, captured more detailed information about insertions and removals, including reasons. Five of six low-volume insertion facilities used these registers, but only three of six high-volume facilities. No facilities used the form specifically developed by the National Department of Health for implant pharmacovigilance. Nine of 12 clinics reported data on numbers of insertions to the district office, six reported removals and none provided data on reasons for removals. Conclusion. For data to inform effective decision-making and quality improvement in implant services in SA, standardised reporting guidelines and data collection tools are needed, reinforced by staff training and quality assessment of data collection. Staff often took the initiative to fill gaps in reporting systems. Current systems are unable to accurately monitor uptake or discontinuation, or identify aspects of services requiring strengthening. Lack of pharmacovigilance data is especially concerning. Deficiencies noted in these monitoring systems may be common to family planning services more broadly, which warrants investigation.
背景。依伴侬NXT（Implanon NXT）是一种长效皮下避孕植入剂，于2014年初在南非引入，作为扩大的避孕方法组合的一部分。在最初的高接受率之后，出现了关于频繁早期取出和使用量下降的报告。监测植入剂服务提供过程中的进展和挑战可以确定该项目中需要加强的方面。目标。评估初级保健机构植入剂服务中的数据管理和记录保存情况。方法。我们制定了一份清单，以评估用于监测植入剂服务和向地区办公室报告数据的工具。该清单在七个机构进行了试点。另外在豪登省约翰内斯堡市（CoJ）以及西北省肯尼斯·卡翁达博士区选择了六个高使用量和六个低使用量的植入剂插入诊所进行评估。结果。所有12个机构都完成了每日点名登记，该登记记录了到诊所就诊的客户数量，但没有关于植入剂使用的信息。一份更详细的打勾登记记录了诊所就诊者接受的服务，其中9个记录了植入剂插入的数量，6个记录了植入剂取出的数量。一个更具体的工具，即插入清单，收集了关于插入程序和客户特征的数据，但仅在约翰内斯堡市（六个机构中的五个）使用。其他登记册是由各机构的工作人员重新编制的，记录了关于插入和取出的更详细信息，包括原因。六个低使用量插入机构中有五个使用了这些登记册，但六个高使用量机构中只有三个使用。没有机构使用国家卫生部专门为植入剂药物警戒制定的表格。12个诊所中有9个向地区办公室报告了插入数量的数据，6个报告了取出数量，没有一个提供取出原因的数据。结论。为了使数据为南非植入剂服务中的有效决策和质量改进提供依据，需要标准化的报告指南和数据收集工具，并通过工作人员培训和数据收集质量评估加以强化。工作人员经常主动填补报告系统中的空白。当前的系统无法准确监测接受率或停用率，也无法确定需要加强的服务方面。缺乏药物警戒数据尤其令人担忧。这些监测系统中发现的缺陷可能在更广泛的计划生育服务中普遍存在，值得进行调查。
