Department of Obstetrics and Gynaecology, Jimma University, Jimma, Ethiopia.
Population and Family Health, Jimma University, Jimma, Ethiopia.
BMJ Open Qual. 2023 Feb;12(1). doi: 10.1136/bmjoq-2022-002051.
Even though the immediate postpartum period is a golden time and a great opportunity to provide long-acting reversible contraceptives to prevent unintended pregnancy, its utilisation is very low in Ethiopia. Quality of care in postpartum long-acting reversible contraceptive provision is thought to be an issue for this low utilisation. Thus, continuous quality improvement intervention is necessary to increase the use of postpartum long-acting reversible contraceptives at Jimma University Medical Center.
A quality improvement intervention to offer long-acting reversible contraceptive methods to immediate postpartum women at Jimma University Medical Center was initiated in June 2019. To study the baseline prevalence of long-acting reversible contraceptive use at Jimma Medical Centre over 8 weeks, we reviewed postpartum family planning registration logbooks and patients' charts. Based on the baseline data, the quality gaps were identified, prioritised and change ideas were generated and tested over another 8 weeks towards achieving the immediate postpartum long-acting reversible contraceptive prevalence target set.
This new intervention resulted in an average increase in immediate postpartum long-acting reversible contraceptive methods use from 6.9% to 25.4% by the end of the project intervention. The major barriers to low long-acting reversible contraceptive use were lack of attention from hospital administrative staff and quality improvement teams on the provision of long-acting reversible contraceptives, lack of training of healthcare providers on postpartum contraception and unavailability of contraception commodities at each postpartum service delivery points.
The immediate postpartum long-acting reversible contraceptive use at Jimma Medical Centre was increased by training of healthcare providers, availing contraception commodities through administrative staff involvement, weekly audit and feedback on contraception use. Thus, training of the newly hired healthcare providers on postpartum contraception, involvement of hospital administrative staff, regular audits and feedback on contraception use is necessary to increase postpartum long-acting reversible contraception uptake.
尽管产后即刻时期是提供长效可逆避孕措施以防止意外怀孕的黄金时期和绝佳机会，但在埃塞俄比亚，其利用率非常低。人们认为，产后长效可逆避孕措施提供方面的护理质量是造成这种低利用率的一个问题。因此，为了增加吉马大学医学中心产后长效可逆避孕措施的使用，有必要进行持续质量改进干预。
2019 年 6 月，在吉马大学医学中心启动了一项质量改进干预措施，为产后即刻的妇女提供长效可逆避孕措施。为了在 8 周内研究吉马医疗中心产后长效可逆避孕措施使用的基线流行率，我们查阅了产后计划生育登记日志和患者病历。根据基线数据，确定了质量差距，对其进行了优先排序，并提出了改进想法，然后在接下来的 8 周内进行测试，以实现设定的产后即刻长效可逆避孕措施流行率目标。
这项新干预措施使产后即刻长效可逆避孕措施的使用平均从项目干预开始时的 6.9%增加到项目结束时的 25.4%。长效可逆避孕措施使用率低的主要障碍是医院行政人员和质量改进团队对长效可逆避孕措施提供的重视不够，医护人员缺乏产后避孕方面的培训，以及每个产后服务提供点缺乏避孕用品。
通过培训医护人员、通过行政人员参与提供避孕用品、每周对避孕措施使用情况进行审计和反馈，提高了吉马医疗中心产后即刻长效可逆避孕措施的使用率。因此，有必要对新雇用的医护人员进行产后避孕方面的培训，让医院行政人员参与进来，定期对避孕措施使用情况进行审计和反馈，以提高产后长效可逆避孕措施的使用率。
