Pathfinder International, Maputo, Mozambique.
Pathfinder International, Washington, DC, USA.
Glob Health Sci Pract. 2022 Feb 28;10(1). doi: 10.9745/GHSP-D-21-00252.
The recent increase in the use of long-acting reversible contraceptives (LARCs) will result in an equal increase in the need for removals. Few countries monitor the number of LARC removals and even fewer track reasons for removal, discontinuation, and method switching. We conducted a mixed-method study to pilot the introduction of 5 LARC removal indicators in Mozambique: (1) reason for seeking removal, (2) duration of use, (3) removal outcome, (4) reason for referral, and (5) family planning (FP) outcome. We assessed providers' perceptions about the feasibility and utility of tracking these indicators and reviewed the findings to ascertain the quality-of-care concerns.
We used a purposive, multistage sampling technique to select 19 intervention facilities in Nampula and Sofala provinces. Over 6 months, we abstracted data on the 5 indicators from an FP register addendum to determine when and why clients seek LARC removals and identify service quality issues that need to be addressed in the FP program. We used a supportive supervision checklist to assess the time taken to record data on the indicators and perceived benefits and challenges encountered by providers during record keeping.
Of the 795 clients who sought a LARC removal, 112 women (14.1%) opted not to have the removal after counseling. The most frequently reported reasons for seeking a removal were: the method was on-schedule for removal or past its expiration date (29.5%), complaints of side effects (25.8%), and desire to be pregnant (22.9%). Health care providers reported no major challenges in recording information in the addendum. Reasons for and timing of removal pointed to the need for strengthening FP counseling.
Collecting, synthesizing, and interpreting data from the LARC removal indicators was feasible and provided valuable insights to improve the quality of care to enhance clients' reproductive health care and contraceptive choices.
长效可逆避孕措施（LARC）的使用最近有所增加，这将导致对移除服务的需求同样增加。很少有国家监测 LARC 移除的数量，更少的国家跟踪移除、停用和方法转换的原因。我们开展了一项混合方法研究，在莫桑比克试行引入 5 项 LARC 移除指标：（1）寻求移除的原因，（2）使用期限，（3）移除结果，（4）转诊原因，以及（5）计划生育（FP）结局。我们评估了提供者对跟踪这些指标的可行性和实用性的看法，并审查了调查结果，以确定护理质量问题。
我们采用了一种有目的的多阶段抽样技术，在楠普拉和索法拉省选择了 19 家干预机构。在 6 个月的时间里，我们从 FP 登记附加表中提取了 5 项指标的数据，以确定客户何时以及为何寻求 LARC 移除，并确定 FP 项目中需要解决的服务质量问题。我们使用支持性监督检查表来评估记录指标数据所需的时间，以及提供者在记录过程中遇到的益处和挑战。
在寻求 LARC 移除的 795 名患者中，有 112 名女性（14.1%）在咨询后选择不进行移除。寻求移除的最常见原因是：方法已到预约移除时间或已过期（29.5%）、抱怨副作用（25.8%）以及想要怀孕（22.9%）。医疗保健提供者报告在附加表中记录信息没有遇到重大挑战。移除的原因和时间表明，需要加强 FP 咨询。
收集、综合和解释 LARC 移除指标的数据是可行的，并提供了有价值的见解，以改善护理质量，增强客户的生殖健康护理和避孕选择。
