Tran Nguyen Toan, Yameogo Wambi Maurice E, Langwana Félicité, Gaffield Mary Eluned, Seuc Armando, Cuzin-Kihl Asa, Kouanda Seni, Mashinda Désiré, Thieba Blandine, Yodi Rachel, Nyandwe Kyloka Jean, Millogo Tieba, Coulibaly Abou, Bolangala Basele, Zan Souleymane, Kini Brigitte, Ouedraogo Bibata, Puludisi Fifi, Landoulsi Sihem, 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), University of Geneva, Boulevard du Pont d'Arve 40, 1211, Geneva, Switzerland.
BMC Womens Health. 2018 Jul 5;18(1):122. doi: 10.1186/s12905-018-0573-5.
The YAM DAABO study ("your choice" in Mooré) takes place in Burkina Faso and the Democratic Republic of Congo. It has the objective to identify a package of postpartum family planning (PPFP) interventions to strengthen primary healthcare services and determine its effectiveness on contraceptive uptake during the first year postpartum. This article presents the process of identifying the PPFP interventions and its detailed contents.
Based on participatory action research principles, we adopted an inclusive process with two complementary approaches: a bottom-up formative approach and a circular reflective approach, both of which involved a wide range of stakeholders. For the bottom-up component, we worked in each country in three formative sites and used qualitative methods to identify barriers and catalysts to PPFP uptake. The results informed the package design which occurred during the circular reflective approach - a research workshop gathering service providers, members of both country research teams, and the WHO coordination team.
As barriers and catalysts were found to be similar in both countries and with the view to scaling up our strategy to other comparable settings, we identified a common package of six low-cost, low-technology, and easily-scalable interventions that addressed the main service delivery obstacles related to PPFP: (1) refresher training of service providers, (2) regularly scheduled and strengthened supportive supervision of service providers, (3) enhanced availability of services 7 days a week, (4) a counseling tool, (5) appointment cards for women, and (6) invitation letters for partners.
Our research strategy assumes that postpartum contraceptive uptake can be increased by supporting providers, enhancing the availability of services, and engaging women and their partners. The package does not promote any modern contraceptive method over another but prioritizes the importance of women's right to information and choice regarding postpartum fertility options. The effectiveness of the package will be studied in the experimental phase. If found to be effective, this intervention package may be relevant to and scalable in other parts of Burkina Faso and the DRC, and possibly other Sub-Saharan countries.
Retrospectively registered in the Pan African Clinical Trials Registry ( PACTR201609001784334 , 27 September 2016).
“YAM DAABO研究”（在莫雷语中意为“你的选择”）在布基纳法索和刚果民主共和国开展。其目的是确定一套产后计划生育（PPFP）干预措施，以加强初级卫生保健服务，并确定其对产后第一年避孕措施采用情况的有效性。本文介绍了确定PPFP干预措施的过程及其详细内容。
基于参与式行动研究原则，我们采用了一种包容性过程，包含两种互补方法：自下而上的形成性方法和循环反思方法，这两种方法都涉及广泛的利益相关者。对于自下而上的部分，我们在每个国家的三个形成性地点开展工作，并使用定性方法确定采用PPFP的障碍和促进因素。这些结果为在循环反思方法过程中进行的方案设计提供了依据，循环反思方法是一个研究研讨会，召集了服务提供者、两个国家研究团队的成员以及世卫组织协调团队。
由于发现两国的障碍和促进因素相似，并且为了将我们的战略扩大到其他类似环境，我们确定了一套包含六项低成本、低技术且易于扩展的干预措施的通用方案，这些措施解决了与PPFP相关的主要服务提供障碍：（1）对服务提供者进行进修培训；（2）定期安排并加强对服务提供者的支持性监督；（3）每周7天提高服务可及性；（4）一种咨询工具；（5）为女性提供预约卡；（6）为伴侣提供邀请函。
我们的研究策略假定，通过支持提供者、提高服务可及性以及让女性及其伴侣参与，可以增加产后避孕措施的采用率。该方案并不偏袒任何一种现代避孕方法，而是优先考虑女性在产后生育选择方面获得信息和做出选择的权利的重要性。该方案的有效性将在实验阶段进行研究。如果被证明有效，这个干预方案可能适用于布基纳法索和刚果民主共和国的其他地区，并可能扩大到其他撒哈拉以南国家。
追溯注册于泛非临床试验注册中心（PACTR201609001784334，2016年9月27日）。
