Human Resource Department, Ministry of Public Health, Yaoundé, Cameroon.
University of Nigeria, Nsukka, Nigeria.
Hum Resour Health. 2022 Sep 5;20(1):66. doi: 10.1186/s12960-022-00763-8.
Injectable contraceptives are the most popular method of contraception in sub-Saharan Africa (SSA), but their availability in clinical settings has been severely limited, despite the scarcity of health care providers and limited access to health facilities. WHO and USAID have endorsed the community-based distribution of injectable contraceptives as a promising option for improving access to family planning services and expanding the method mix for women who want to limit the number of births. Studies have shown that community health workers (CHWs) can provide women with injectable contraceptives that meet acceptable quality standards. The goal of this study is to identify, evaluate and synthesize evidence supporting the use of community-based administration of injectable contraceptives in SSA.
This review's guidance was based on a previously developed protocol. Nine international electronic databases and the websites of organizations known to support community-based reproductive health initiatives in SSA were searched systemically. Experts in this area were also contacted for the identification of unpublished literature and ongoing studies. The reference lists of eligible studies were reviewed. The Effective Public Practice Project tool was used to assess the quality and risk of bias in eligible studies. Data were extracted and analysed using a custom data extraction form and a narrative synthesis.
The search strategy identified a total of 1358 studies with 12 studies meeting the inclusion criteria. One unpublished study was provided by an expert making a total of 13 studies. The results showed that irrespective of the study designs, well-trained CHWs can competently administer injectable contraceptives safely and community-based delivery of injectable contraceptives is acceptable in SSA. Also, the use of community health workers in the provision of depot-medroxyprogesterone acetate expanded access to inhabitants of hard-to-reach areas and led to an overall uptake of injectable contraceptives as well as family planning. Studies that compared CHWs to clinic-based providers revealed equivalent or higher levels of performance in favour of CHWs.
The CHWs can competently provide injectable contraceptives within SSA communities if appropriately trained and supervised. Hence, SSA policymakers should give this initiative due consideration as a way of improving access to family planning services.
在撒哈拉以南非洲（SSA），注射型避孕药具是最受欢迎的避孕方法，但由于医疗保健提供者稀缺，以及获得卫生设施的机会有限，这些避孕药具在临床环境中的供应严重受限。世界卫生组织和美国国际开发署已认可在社区层面分发注射型避孕药具，这是改善计划生育服务获取机会和扩大希望控制生育数量的妇女避孕方法选择的一项有前景的选择。研究表明，社区卫生工作者（CHWs）可以为妇女提供符合可接受质量标准的注射型避孕药具。本研究的目的是确定、评估和综合支持在 SSA 社区层面管理注射型避孕药具使用的证据。
本综述的指导依据是之前制定的方案。系统检索了 9 个国际电子数据库和已知支持 SSA 社区生殖健康倡议的组织网站。还联系了该领域的专家，以确定未发表的文献和正在进行的研究。对合格研究的参考文献进行了回顾。使用有效公共实践项目工具评估合格研究的质量和偏倚风险。使用自定义数据提取表和叙述性综合方法提取和分析数据。
搜索策略共确定了 1358 项研究，其中 12 项研究符合纳入标准。一名专家提供了一项未发表的研究，使总共 13 项研究符合纳入标准。结果表明，无论研究设计如何，经过良好培训的 CHWs 都可以安全地管理注射型避孕药具，并且在 SSA 社区层面提供注射型避孕药具是可以接受的。此外，在提供 depot-medroxyprogesterone acetate 时使用社区卫生工作者扩大了难以到达地区居民的获取途径，并导致整体接受了注射型避孕药具和计划生育。将 CHWs 与诊所提供者进行比较的研究显示，CHWs 的表现相当于或优于诊所提供者。
如果经过适当的培训和监督，CHWs 可以在 SSA 社区中熟练地提供注射型避孕药具。因此，SSA 政策制定者应认真考虑这一举措，以此作为改善计划生育服务获取机会的一种方式。
