Nepal Society of Obstetricians and Gynaecologists, Paropakar Maternity and Women's Hospital, Thapathali, Kathmandu, GPO: 23700, Nepal.
Koshi Zonal Hospital, Biratnagar, Morang District, Province One, Nepal.
BMC Health Serv Res. 2020 Feb 17;20(1):123. doi: 10.1186/s12913-020-4969-1.
Family planning services in the post-partum period, termed post-partum family planning (PPFP) is critical to cover the unmet need for contraception, especially when institutional delivery rates have increased. However, the intention to choose PPFP methods such as post-partum intrauterine devices (PPIUD) remains low in countries such as Nepal. Community health workers such as Female Community Health Volunteers (FCHVs) could play an important role in improving the service coverage of PPFP in Nepal. However, their knowledge of PPFP and community-based services related to PPFP remain unclear. This study aims to assess the effect on community-based PPFP services by improving FCHV's knowledge through orientation on PPFP.
We conducted this mixed-methods study in Morang District in Nepal. The intervention involved orientation of FCHVs on PPFP methods. We collected quantitative data from three sources; via a survey of FCHVs that assessed their knowledge before and after the intervention, from their monthly reporting forms on counseling coverage of women at different stages of pregnancy from the communities, and by interviewing mothers in their immediate post-partum period in two selected hospitals. We also conducted six focus group discussions with the FCHVs to understand their perception of PPFP and the intervention. We performed descriptive and multivariable analyses for quantitative results and thematic analysis for qualitative data.
In total, 230 FCHVs participated in the intervention and their knowledge of PPFP improved significantly after it. The intervention was the only factor significantly associated with their improved knowledge (adjusted odds ratio = 24, P < 0.001) in the multivariable analysis. FCHVs were able to counsel 83.3% of 1872 mothers at different stages of pregnancy in the communities. In the two hospitals, the proportion of mothers in their immediate post-partum period whom reported they were counseled by FCHVs during their pregnancy increased. It improved from 7% before the intervention to 18.1% (P < 0.001) after the intervention. The qualitative findings suggested that the intervention improved their knowledge in providing PPFP counseling.
The orientation improved the FCHV's knowledge of PPFP and their community-based counseling. Follow-up studies are needed to assess the longer term effect of the FCHV's role in improving community-based PPFP services.
产后计划生育服务（post-partum family planning，PPFP）是覆盖避孕未满足需求的关键，尤其是在机构分娩率增加的情况下。然而，在尼泊尔等国家，人们选择产后宫内节育器（post-partum intrauterine devices，PPIUD）等产后计划生育方法的意愿仍然较低。社区卫生工作者（如女性社区卫生志愿者，FCHVs）在提高尼泊尔产后计划生育服务的覆盖范围方面可以发挥重要作用。然而，他们对产后计划生育和与产后计划生育相关的社区服务的知识仍然不清楚。本研究旨在通过提高 FCHV 对产后计划生育的认识，评估以社区为基础的产后计划生育服务的效果。
我们在尼泊尔莫朗区进行了这项混合方法研究。干预措施包括对 FCHV 进行产后计划生育方法的定向培训。我们从三个来源收集了定量数据；通过对 FCHV 的调查，评估他们在干预前后的知识，从他们在社区中对不同阶段孕妇的咨询覆盖情况的每月报告表中，以及通过对两家选定医院的产妇在产后立即进行访谈。我们还与 FCHV 进行了六次焦点小组讨论，以了解他们对产后计划生育和干预的看法。我们对定量结果进行了描述性和多变量分析，对定性数据进行了主题分析。
共有 230 名 FCHV 参加了干预，他们的产后计划生育知识在干预后显著提高。在多变量分析中，干预是唯一与他们知识提高显著相关的因素（调整后的优势比=24，P<0.001）。FCHV 能够在社区中为 1872 名不同阶段妊娠的母亲提供 83.3%的咨询。在两家医院，报告在怀孕期间由 FCHV 咨询的产妇在产后立即的比例有所增加。从干预前的 7%增加到干预后的 18.1%（P<0.001）。定性研究结果表明，干预提高了 FCHV 提供产后计划生育咨询的知识。
定向培训提高了 FCHV 对产后计划生育的知识和他们以社区为基础的咨询能力。需要进行后续研究，以评估 FCHV 在改善以社区为基础的产后计划生育服务方面的长期作用。
