Institutionalizing postpartum intrauterine device (IUD) services in Sri Lanka, Tanzania, and Nepal: study protocol for a cluster-randomized stepped-wedge trial
Institutionalizing postpartum intrauterine device (IUD) services in Sri Lanka, Tanzania, and Nepal: study protocol for a cluster-randomized stepped-wedge trial
复制标题
DOI：
10.1186/s12884-016-1160-0
复制
发表时间：
2016-11-21
影响因子：
3.1
通讯作者：
Langer, Ana
中科院分区：
文献类型：
--
作者：
Canning, David;Shah, Iqbal H.;Langer, Ana
背景：据估计，在孩子出生后的一年内，40% 的妇女的避孕需求未得到满足。带铜宫内节育器提供安全、有效、方便、长效的避孕保护，且不干扰产后母乳喂养。产后宫内节育器 (PPIUD) 放置应由经过培训的提供者在产后早期进行，以减少脱落率和并发症，但这些服务尚未广泛提供。国际妇产科医生联合会 (FIGO) 将实施一项干预措施，旨在将 PPIUD 培训制度化，作为妇产科培训计划的常规部分，并将其纳入干预医院分娩时标准实践的一部分。 方法：本试验采用整群随机阶梯楔形设计来评估 FIFAO 干预对 PPIUD 的摄取和持续使用的因果影响以及对随后妊娠和分娩的影响。该试验还旨在衡量研究医院中 PPIUD 服务的制度化以及这些服务向其他提供者和卫生机构的传播。这项研究还将包括嵌套混合方法绩效评估，以描述干预措施的实施情况。 讨论：这项研究将为三个低收入和中等收入国家的医院 PPIUD 提供对避孕选择和生殖健康结果的因果影响，以及可行性、可接受性和长期制度影响提供关键证据。
Background: During the year following the birth of a child, 40% of women are estimated to have an unmet need for contraception. The copper IUD provides safe, effective, convenient, and long-term contraceptive protection that does not interfere with breastfeeding during the postpartum period. Postpartum IUD (PPIUD) insertion should be performed by a trained provider in the early postpartum period to reduce expulsion rates and complications, but these services are not widely available. The International Federation of Obstetricians and Gynecologists (FIGO) will implement an intervention that aims to institutionalize PPIUD training as a regular part of the OB/GYN training program and to integrate it as part of the standard practice at the time of delivery in intervention hospitals.Methods: This trial uses a cluster-randomized stepped wedge design to assess the causal effect of the FIGO intervention on the uptake and continued use of PPIUD and of the effect on subsequent pregnancy and birth. This trial also seeks to measure institutionalization of PPIUD services in study hospitals and diffusion of these services to other providers and health facilities. This study will also include a nested mixed-methods performance evaluation to describe intervention implementation.Discussion: This study will provide critical evidence on the causal effects of hospital-based PPIUD provision on contraceptive choices and reproductive health outcomes, as well as on the feasibility, acceptability and longer run institutional impacts in three low-and middle-income countries.