Gehani Manish, Pal Manoj, Arya Anupama, Singh Shobhana, S Kaushik, O'Connell Kathryn A, Cagatay Levent, Sengupta Sumon, Singal Sunita
EngenderHealth Inc., Ahmedabad, Gujrat, India.
EngenderHealth Inc., New Delhi, Delhi, India.
Gates Open Res. 2020 Mar 4;3:1473. doi: 10.12688/gatesopenres.12997.3. eCollection 2019.
To accelerate progress toward Family Planning 2020 (FP2020) goals, the government of India focused on improving the quality of intrauterine device (IUD) services. EngenderHealth, an international sexual and reproductive health and rights organization, has been supporting the governments of Gujarat and Rajasthan since 2014 through the Expanding Access to IUD Services in India (EAISI) project by building the capacity of service providers, monitoring compliance with standard practices, and strengthening health systems. This study sought to assess whether EAISI-trained providers offer higher quality IUD services than non-EAISI-trained providers, as indicated by a reduction in confirmed IUD complications. The study team conducted an analytical cross-sectional study of secondary data collected from follow-up registers at 176 intervention facilities (38 in Gujarat and 138 in Rajasthan) during Phase I of the EAISI project. The analysis included follow-up clients who returned to the same facility between April 2018 and March 2019. We performed a multivariate logistic regression to determine factors associated with IUD complications. During the period of assessment, 56,733 clients received IUD insertions, and 10,747 (18.9%) clients returned for follow-up services. Of the returning clients, 49.4% (N=5,305) had received IUDs from EAISI-trained providers, while 50.6% (N=5,442) had received IUDs from non-EAISI-trained providers. A total of 4.0% (N=432) of all returning clients experienced complications (expulsion: 1.3%, missing strings: 1.7%, infection: 1.1%). Clients who received IUDs from non-EAISI-trained providers were 55.5% more likely (95% CI [26.2%, 91.5%], p<0.0005) to have experienced complications than clients who received insertions from EAISI-trained providers. The type of IUD, the timing of the insertion, and the timing of the follow-up visit also affected complication prevalence. Our findings indicate that intensive, practical clinical skills training for IUD insertion can reduce the prevalence of complications.
为加快实现计划生育2020（FP2020）目标，印度政府着重提高宫内节育器（IUD）服务质量。自2014年以来，国际性健康和生殖健康及权利组织“促进健康组织”（EngenderHealth）通过“扩大印度宫内节育器服务可及性”（EAISI）项目，支持古吉拉特邦和拉贾斯坦邦政府，具体措施包括提高服务提供者的能力、监测标准操作的合规情况以及加强卫生系统。本研究旨在评估接受EAISI培训的提供者提供的宫内节育器服务质量是否高于未接受EAISI培训的提供者，评估依据是确诊的宫内节育器并发症是否减少。研究团队对EAISI项目第一阶段从176个干预设施（古吉拉特邦38个，拉贾斯坦邦138个）的随访登记册收集的二手数据进行了分析性横断面研究。分析纳入了2018年4月至2019年3月期间返回同一设施的随访客户。我们进行了多因素逻辑回归分析，以确定与宫内节育器并发症相关的因素。在评估期间，56,733名客户接受了宫内节育器植入，10,747名（18.9%）客户返回接受随访服务。在返回的客户中，49.4%（N = 5,305）从接受EAISI培训的提供者处接受了宫内节育器，而50.6%（N = 5,442）从未接受EAISI培训的提供者处接受了宫内节育器。所有返回客户中共有4.0%（N = 432）出现并发症（排出：1.3%，尾丝缺失：1.7%，感染：1.1%）。从未接受EAISI培训的提供者处接受宫内节育器的客户出现并发症的可能性比从接受EAISI培训的提供者处接受植入的客户高55.5%（95%可信区间[26.2%，91.5%]，p<0.0005）。宫内节育器的类型、植入时间和随访时间也影响并发症发生率。我们的研究结果表明，针对宫内节育器植入的强化实用临床技能培训可降低并发症发生率。
