Providing free pregnancy test kits to community health workers increases distribution of contraceptives: results from an impact evaluation in Madagascar
Providing free pregnancy test kits to community health workers increases distribution of contraceptives: results from an impact evaluation in Madagascar
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DOI：
10.1016/j.contraception.2015.09.011
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发表时间：
2016-01-01
期刊：
影响因子：
2.9
通讯作者：
Hathi, Payal
中科院分区：
文献类型：
--
作者：
Comfort, Alison B.;Chankova, Slavea;Hathi, Payal
目的：为了改善偏远和农村地区获得避孕药具的机会，撒哈拉以南非洲国家允许社区卫生工作者分发激素避孕药具。在提供激素避孕药之前，社区卫生工作者必须确定怀孕状况，但往往缺乏可靠的方法。没有研究评估为社区卫生工作者提供尿妊娠试验试剂盒的影响。我们评估的影响，让CHWs免费怀孕测试试剂盒上的新客户购买激素避孕药从CHWs.Study design的数量：我们实施了一项随机实验，在马达加斯加东部的CHWs谁出售注射和口服激素避孕药。共有622名社区卫生工作者按地区分层，并在个人层面上随机分配。治疗组CHW接受免费妊娠试验分发（分析n =272），对照组CHW未接受试验（分析n =263）。我们估计了一个普通的最小二乘回归模型，每月新的激素避孕药的客户每CHW作为我们的主要outcome.Results的数量：我们发现，提供免费的妊娠测试试剂盒CHW增加了新的激素避孕药的客户数量。治疗组的社区保健工作者每月向3.1名新客户提供激素避孕药，而对照组为2.5名。这种差异0.7客户每月（95%置信区间0.13-1.18; p= 0.014）代表了26%的increases.Conclusions：给予CHW免费妊娠试验是一种有效的方式来增加激素避孕药的分布。作为怀孕测试越来越负担得起的卫生保健系统在发展中国家，以社区为基础的分配方案应考虑包括测试作为一个低成本的除了CHWs'service.Implications：没有研究评估的影响，让CHWs免费尿液妊娠测试试剂盒的分配，以改善提供激素避孕药。向社区卫生工作者提供免费的怀孕测试包，大大增加了他们向其出售激素避孕药的客户数量。以社区为基础的分发方案应考虑将这些测试纳入社区卫生工作者的服务。(C)2016 Elsevier Inc. All rights reserved.
Objectives: To improve access to contraceptives in remote and rural areas, sub-Saharan African countries are allowing community health workers (CHWs) to distribute hormonal contraceptives. Before offering hormonal contraceptives, CHWs must determine pregnancy status but often lack a reliable way to do so. No studies have evaluated the impact of providing CHWs with urine pregnancy test kits. We assessed the impact of giving CHWs free pregnancy test kits on the number of new clients purchasing hormonal contraceptives from CHWs.Study design: We implemented a randomized experiment in Eastern Madagascar among CHWs who sell injectable and oral hormonal contraceptives. A total of 622 CHWs were stratified by region and randomly assigned at the individual level. Treatment-group CHWs were given free pregnancy tests to distribute (n analyzed=272) and control-group CHWs did not receive the tests (n analyzed=263). We estimated an ordinary least-squares regression model, with the monthly number of new hormonal contraceptive clients per CHW as our primary outcome.Results: We find that providing CHWs with free pregnancy test kits increases the number of new hormonal contraceptive clients. Treatment-group CHWs provide hormonal contraceptives to 3.1 new clients per month, compared to 2.5 in the control group. This difference of 0.7 clients per month (95% confidence interval 0.13-1.18; p=.014) represents a 26% increase.Conclusions: Giving CHWs free pregnancy tests is an effective way to increase distribution of hormonal contraceptives. As pregnancy tests become increasingly affordable for health-care systems in developing countries, community-based distribution programs should consider including the tests as a low-cost addition to CHWs' services.Implications: No study has evaluated the impact of giving CHWs free urine pregnancy test kits for distribution to improve provision of hormonal contraceptives. Giving CHWs free pregnancy test kits significantly increases the number of clients to whom they sell hormonal contraceptives. Community-based distribution programs should consider including these tests among CHWs' services. (C) 2016 Elsevier Inc. All rights reserved.