Tran Nguyen Toan, Gaffield Mary Eluned, Seuc Armando, Landoulsi Sihem, Yamaego Wambi Maurice E, Cuzin-Kihl Asa, Kouanda Seni, Thieba Blandine, Mashinda Désiré, Yodi Rachel, Kiarie James, Reier Suzanne
Department of Reproductive Health Research, World Health Organization, Avenue Appia 20, 1211, Genève 27, Switzerland.
Institute of Demography and Socioeconomics (IDESO), Geneva University, Boulevard du Pont d'Arve 40, 1211, Geneva, Switzerland.
BMC Health Serv Res. 2018 Jun 11;18(1):439. doi: 10.1186/s12913-018-3199-2.
Postpartum family planning (PPFP) information and services can prevent maternal and child morbidity and mortality in low-resource countries, where high unmet need for PPFP remains despite opportunities offered by routine postnatal care visits. This study aims to identify a package of PPFP interventions and determine its effectiveness on the uptake of contraceptive methods during the first year postpartum. We hypothesize that implementing a PPFP intervention package that is designed to strengthen existing antenatal and postnatal care services will result in an increase in contraceptive use.
This is an operational research project using a complex intervention design with three interacting phases. The pre-formative phase aims to map study sites to establish a sampling frame. The formative phase employs a participatory approach using qualitative methodology to identify barriers and catalysts to PPFP uptake to inform the design of a PPFP intervention package. The intervention phase applies a cluster randomized-controlled trial design based at the primary healthcare level, with the experimental group implementing the PPFP package, and the control group implementing usual care. The primary outcome is modern contraceptive method uptake at twelve months postpartum. Qualitative research is embedded in the intervention phase to understand the operational reasons for success or failure of PPFP services.
Designing, testing, and scaling-up effective, affordable, and sustainable health interventions in low-resource countries is critical to address the high unmet need for PPFP. Due to socio-cultural complexities surrounding contraceptive use, this research assumes that this is more effectively accomplished by engaging key stakeholders, including adolescents, women, men, key community members, service providers, and policy-makers. At the individual level, knowledge, attitudes, and behaviors of women and couples toward PPFP will likely be influenced by a set of low-cost interventions. At the health service delivery level, the implementation of this trial will probably require a shift in behavior and accountability of providers regarding the systematic integration of PPFP into their clinical practice, as well as the optimization of health service organization to ensure the availability of competent staff and contraceptive supplies.
Retrospectively registered in the Pan African Clinical Trials Registry ( PACTR201609001784334 , 27 September 2016).
产后计划生育（PPFP）信息和服务可预防资源匮乏国家的孕产妇和儿童发病及死亡，尽管常规产后护理访视提供了机会，但这些国家对产后计划生育的未满足需求仍然很高。本研究旨在确定一套产后计划生育干预措施，并确定其对产后第一年避孕方法采用情况的有效性。我们假设实施一套旨在加强现有产前和产后护理服务的产后计划生育干预措施将导致避孕措施使用的增加。
这是一个采用复杂干预设计的行动研究项目，包括三个相互作用的阶段。形成前阶段旨在绘制研究地点以建立抽样框架。形成阶段采用参与式方法，运用定性方法确定影响产后计划生育采用的障碍和促进因素，以为产后计划生育干预措施的设计提供信息。干预阶段采用基于初级卫生保健层面的整群随机对照试验设计，实验组实施产后计划生育套餐，对照组实施常规护理。主要结局是产后12个月现代避孕方法的采用情况。定性研究嵌入干预阶段，以了解产后计划生育服务成败的操作原因。
在资源匮乏国家设计、测试和扩大有效、可负担且可持续的卫生干预措施对于满足产后计划生育的高未满足需求至关重要。由于围绕避孕使用的社会文化复杂性，本研究认为通过让关键利益相关者参与，包括青少年、妇女、男子、关键社区成员、服务提供者和政策制定者，能更有效地实现这一目标。在个体层面，妇女和夫妇对产后计划生育的知识、态度和行为可能会受到一系列低成本干预措施的影响。在卫生服务提供层面，本试验的实施可能需要提供者在将产后计划生育系统纳入其临床实践方面改变行为并承担责任，以及优化卫生服务组织以确保有称职的工作人员和避孕用品。
在泛非临床试验注册中心进行回顾性注册（PACTR201609001784334，2016年9月27日）。
