Evaluation of a multi-level intervention to improve post-partum intrauterine device services in Rwanda

Background. The copper intrauterine device is one of the most safe, effective, and cost-effective methods for preventing unintended pregnancy. It can be used post-partum irrespective of breastfeeding to improve birth spacing and reduce unintended pregnancy and maternal-child mortality. However, this method remains highly underutilized. Methods. We developed a multi-level intervention targeting supply, demand, and sustainability to increase uptake of the post-partum intrauterine device (PPIUD, defined as insertion up to six weeks post-delivery) in Kigali, Rwanda. High-volume hospitals and health centers were selected for implementation of promotions and service delivery. Formative work informed development of a PPIUD promotional flipchart delivered in-clinic (during antenatal care, labor and delivery, or infant vaccination visits) or in the community. Two-day PPIUD didactic counseling, insertion/removal, and follow-up trainings were provided to labor and delivery and family planning nurses followed by a mentored practicum certification process. Stakeholders were involved from intervention development through dissemination of results. Results. Two hospitals (and their two associated health centers) and two health centers were selected. In the 6-months prior to our intervention, only one nurse and one midwife from each hospital were providing PPIUD services, and just 46 PPIUDs had been placed at the selected health facilities. From August 2017-July 2018, we trained 83 promotional agents and 39 providers to provide PPIUD services. N=9,073 women received PPIUD promotions who later delivered at a selected health facility, and of those n=2,633 had PPIUDs inserted (29% uptake). Most PPIUDs (60%) were inserted within 10 minutes of delivery of the placenta, with an additional 13% intra-cesarean, 17% between 10 minutes and 48 hours after delivery, and 8% between 4 and 6 weeks after delivery. Conclusions. This successful, comprehensive intervention has the potential to make a significant impact on PPIUD uptake in Rwanda. The intervention is scalable and adaptable to other sub-Saharan African countries.

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Evaluation of a multi-level intervention to improve postpartum intrauterine device services in Rwanda

Gates Open Research ◽

10.12688/gatesopenres.12854.3 ◽

2019 ◽

Vol 2 ◽

pp. 38

Author(s):

Rosine Ingabire ◽

Julien Nyombayire ◽

Alexandra Hoagland ◽

Vanessa Da Costa ◽

Amelia Mazzei ◽

...

Keyword(s):

Family Planning ◽

Unintended Pregnancy ◽

Intrauterine Device ◽

Intervention Development ◽

Health Centers ◽

Labor And Delivery ◽

African Countries ◽

Government Clinic ◽

Multi Level

Background. The copper intrauterine device is one of the most safe, effective, and cost-effective methods for preventing unintended pregnancy. It can be used postpartum irrespective of breastfeeding to improve birth spacing and reduce unintended pregnancy and maternal-child mortality. However, this method remains highly underutilized. Methods. We developed a multi-level intervention to increase uptake of the postpartum intrauterine device (PPIUD, defined as insertion up to six weeks post-delivery) in Kigali, Rwanda. High-volume hospitals and health centers were selected for implementation of PPIUD counseling and service delivery. Formative work informed development of a PPIUD counseling flipchart to be delivered during antenatal care, labor and delivery, infant vaccination visits, or in the community. Two-day didactic counseling, insertion/removal, and follow-up trainings were provided to labor and delivery and family planning nurses followed by a mentored practicum certification process. Counseling data were collected in government clinic logbooks. Insertions and follow-up data were collected in logbooks created for the implementation. Data were collected by trained government clinic staff and abstracted/managed by study staff. Stakeholders were involved from intervention development through dissemination of results. Results. Two hospitals (and their two associated health centers) and two additional health centers were selected. In 6-months prior to our intervention, 7.7 PPIUDs/month were inserted on average at the selected facilities. From August 2017-July 2018, we trained 83 counselors and 39 providers to provide PPIUD services. N=9,020 women received one-on-one PPIUD counseling after expressing interest in family planning who later delivered at a selected health facility. Of those, n=2,575 had PPIUDs inserted (average of 214.6 insertions/month), a 29% uptake. Most PPIUDs (62%) were inserted within 10 minutes of delivery of the placenta. Conclusions. This successful, comprehensive intervention has the potential to make a significant impact on PPIUD uptake in Rwanda. The intervention is scalable and adaptable to other sub-Saharan African countries.

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Evaluation of a multi-level intervention to improve postpartum intrauterine device services in Rwanda

Gates Open Research ◽

10.12688/gatesopenres.12854.2 ◽

2018 ◽

Vol 2 ◽

pp. 38 ◽

Cited By ~ 4

Author(s):

Rosine Ingabire ◽

Julien Nyombayire ◽

Alexandra Hoagland ◽

Vanessa Da Costa ◽

Amelia Mazzei ◽

...

Keyword(s):

Family Planning ◽

Unintended Pregnancy ◽

Intrauterine Device ◽

Intervention Development ◽

Health Centers ◽

Labor And Delivery ◽

African Countries ◽

Government Clinic ◽

Multi Level

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Cost per insertion and couple year of protection for post-partum intrauterine devices and implants provided during service scale-up in Kigali, Rwanda

Gates Open Research ◽

10.12688/gatesopenres.12858.1 ◽

2018 ◽

Vol 2 ◽

pp. 39 ◽

Cited By ~ 1

Author(s):

Kristin M. Wall ◽

Rosine Ingabire ◽

Susan Allen ◽

Etienne Karita

Keyword(s):

Post Partum ◽

Low Cost ◽

Intrauterine Device ◽

Scale Up ◽

High Volume ◽

Health Facilities ◽

Doctoral Level ◽

Implementation Costs ◽

The Government ◽

The Cost

Introduction: In two high-volume government hospitals, their two affiliated health facilities, and two additional health facilities, we developed and implemented post-partum intrauterine device (PPIUD) and post-partum (PP) implant promotions and service delivery procedures between May and July 2017 in Kigali, Rwanda. Between August 2017 and July 2018, 9,073 pregnant women received PPIUD/PP implant promotions who later delivered in one of our selected facilities. Of those, 2,633 had PPIUDs inserted, and 955 had PP implants inserted. Methods: Here, we detail the expenditures during the implementation from the payer perspective (including both the implementation costs and the cost of contraceptive methods) and estimate the cost per PPIUD insertion, PP implant insertion, and couple years of protection (CYP) for PPIUD and PP implant users. Research costs for formative work were excluded. Results: A total of $74,147 USD was spent on the implementation between August 2017 and July 2018. The largest expense (34% of total expenses) went toward personnel, including doctoral-level, administrative, data management and nurse counseling staff. Training for PPIUD and implant providers and promoters comprised 8% of total expenses. Recruitment and reimbursements comprised 6% of expenses. Costs of implants to the government comprised 12% of the expenses, much higher than the cost of IUDs (1%). Costs per insertion were $25/PPIUDs and $77/PP implant. Costs per CYP were $5/PPIUDs and $20/PP implant. Conclusion: The PPIUD/PP implant service implementation provided services at a low cost per insertion and CYP. Understanding the cost per PPIUD/PP implant inserted and CYP can help to inform the cost of scaling up PPIUD/PP implant service implementation activities and resource allocation decision-making by the Rwandan Ministry of Health.

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An Exploratory Analysis of Factors Associated With Interest in Postpartum Intrauterine Device Uptake Among Pregnant Women and Couples in Kigali, Rwanda

Clinical Medicine Insights Reproductive Health ◽

10.1177/1179558119886843 ◽

2019 ◽

Vol 13 ◽

pp. 117955811988684 ◽

Cited By ~ 1

Author(s):

Vanessa Da Costa ◽

Rosine Ingabire ◽

Robertine Sinabamenye ◽

Etienne Karita ◽

Victoria Umutoni ◽

...

Keyword(s):

Pregnant Women ◽

Unintended Pregnancy ◽

Intrauterine Device ◽

Unmet Need ◽

Male Involvement ◽

Cost Effective ◽

Cross Sectional Study ◽

Cross Sectional ◽

Factors Associated ◽

Contraception Use

Background: The desire to space or prevent future pregnancies is high among postpartum women in Rwanda. However, the use of long-acting reversible contraception (LARC), especially the highly effective and cost-effective copper intrauterine device (IUD), is very low, whereas the rates of unintended pregnancy are high. This study aims to identify factors associated with pregnant women’s and couple’s interest in receiving a postpartum intrauterine device (PPIUD) within 6 weeks after delivery. Methods: A total of 150 pregnant women or couples attending antenatal care (ANC) in Kigali, Rwanda participated in this cross-sectional study. After participating in a postpartum LARC counseling session, surveys assessed participants’ demographics, pregnancy experiences and desires, and PPIUD knowledge, attitudes, practices, and interest. Multivariable logistic regression was used to model factors associated PPIUD interest within 6 weeks postpartum. Results: Although only 3% of women had ever used an IUD previously, 124 (83%) women were interested in receiving a PPIUD after counseling. Self-reporting physical side effects (adjusted odds ratio [aOR], 0.21; 95% confidence interval [CI], 0.06-0.75) and infection (aOR, 0.19; 95% CI, 0.04-0.85) as disadvantages to the IUD were significantly associated with no interest in receiving a PPIUD. Interest did not differ by male involvement. Conclusion: Recommendations to increase PPIUD uptake include educating pregnant women and couples about the method during ANC and addressing client myths and misconceptions about the IUD. This strategy allows pregnant women and couples to make informed decisions about their future contraception use, reduce unmet need for family planning, and reduce unintended pregnancy.

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Comparative study of IUCD inserted intracesarean and after vaginal delivery

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20181947 ◽

2018 ◽

Vol 7 (5) ◽

pp. 2007

Author(s):

Archana Goyal ◽

Rekha Wadhwani

Keyword(s):

Removal Rate ◽

Post Partum ◽

Intrauterine Device ◽

Uterine Cavity ◽

Cost Effective ◽

High Rate ◽

Contraceptive Device ◽

Expulsion Rate ◽

Intrauterine Contraceptive

Background: In view of high rate of unintended pregnancy in our country, particularly in post-partum women, there is a need for reliable, effective, long-term contraception such as intrauterine device (IUD) in post-partum women. The present study was planned to evaluate the safety and efficacy of immediate post-partum IUD insertion in women delivering vaginally or by caesarean section.Methods: The women recruited had CuT 380A insertion immediately after delivery of placenta in vaginal or caesarean delivery. Women having post-partum haemorrhage (PPH), anaemia, pre-labour rupture of membranes >18 h, obstructed labour and distorted uterine cavity by fibroid or by congenital malformation were excluded from the study. The women were followed up at 6 weeks after delivery.Results: A total of 500 women were included in the study. The present study shows that expulsion rate was more in postplacental insertion group i.e. 13.2% while among intracaesarean group it was 6.8% and this difference was statistically significant. Removal rate of PPIUCD (Post-partum Intrauterine Contraceptive device) was higher in postplacental insertion i.e.43 (17.2%) cases whereas in intracaesarean insertion removal rate was 8.4%. Most common cause of removal of PPIUCD in our study was pelvic pain and menstrual disturbances.Conclusions: Thus, from our study it is concluded that PPIUCD is safe, convenient, cost effective, reversible and long-term birth spacing method. It should be part of a maternal/newborn/reproductive health package.

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AlCu Pattern Generation on 3D StructuredWafer Using Multi Level Exposure Method on Electrodeposited Polymer Material

MRS Proceedings ◽

10.1557/proc-766-e5.4 ◽

2003 ◽

Vol 766 ◽

Cited By ~ 1

Author(s):

Vineet Sharma ◽

Arief B. Suriadi ◽

Frank Berauer ◽

Laurie S. Mittelstadt

Keyword(s):

Line Width ◽

Metal Film ◽

Focal Depth ◽

Cost Effective ◽

Pattern Generation ◽

Promising Technique ◽

Critical Dimensions ◽

Exposure Method ◽

Multi Level ◽

3D Surfaces

AbstractNormal photolithography tools have focal depth limitations and are unable to meet the expectations of high resolution photolithography on highly topographic structures. This paper shows a cost effective and promising technique of combining two different approaches to achieve critical dimensions of traces on slope pattern continuity on highly topographic structures. Electrophoretically deposited photoresist is used on 3-D structured wafers. This photoresist coating technique is fairly known in the MEMS industries to achieve uniform and conformal photoresist films on 3D surfaces. Multi step exposures are used to expose electrophoretically deposited photoresist. AlCu (Cu-0.5%), 0.47-0.53 μm thick metal film is deposited on 3D structured silicon substrate to plate photoresist. By combining these two novel methods, metal (AlCu) traces of 75 μm line width and 150 μm pitch (from top flat to down the slope) have been demonstrated on isotropically etched 350 μm deep trenches with 5-10% line width loss.

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Cost-effective, high-volume molecular beam epitaxy using a multi 6-in wafer reactor

Journal of Crystal Growth ◽

10.1016/s0022-0248(01)00653-4 ◽

2001 ◽

Vol 227-228 ◽

pp. 143-149

Author(s):

Larry Leung ◽

Damian Davison ◽

Arthur Cornfeld ◽

Frederick Towner ◽

Dave Hartzell

Keyword(s):

Molecular Beam Epitaxy ◽

Molecular Beam ◽

Cost Effective ◽

High Volume

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Safety, Efficacy, and Patient Acceptability of the Copper T-380A Intrauterine Contraceptive Device

Clinical Medicine Insights Women s Health ◽

10.4137/cmwh.s5332 ◽

2011 ◽

Vol 4 ◽

pp. CMWH.S5332

Author(s):

Anita L. Nelson

Keyword(s):

Intrauterine Device ◽

Cost Effective ◽

Mechanisms Of Action ◽

Contraceptive Device ◽

Menstrual Blood Loss ◽

First Line ◽

Medical Problems ◽

Patient Acceptability ◽

Cost Effective Method ◽

Intrauterine Contraceptive

The ParaGard Copper T 380A intrauterine device (CuT380A) provides reversible contraception that is as effective as sterilization for up to 20 years. The CuT380A is a mainstream, first-line contraceptive option for most healthy women, including nulligravid women, as well as many women who have serious medical problems. Because it is the most cost-effective method of birth control, the CuT380A is the preferred IUD, except for women who desire lighter or no menstrual blood loss. Surveys reveal that 95% of US CuT380A users are “very” or “somewhat” satisfied with their method. This article describes current candidates for IUD use, discusses the mechanisms of action of the CuT380A, provides guidance to reduce barriers to IUD access, suggests counseling points for patients, and outlines techniques to reduce the risks and side effects that can be associated with use of the CuT380A.

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Manufacturing Metamaterials Using Synchrotron Lithography

Advances in Science and Technology ◽

10.4028/www.scientific.net/ast.75.230 ◽

2010 ◽

Vol 75 ◽

pp. 230-239

Author(s):

Herbert O. Moser ◽

Linke Jian ◽

Shenbaga M.P. Kalaiselvi ◽

Selven Virasawmy ◽

Sivakumar M. Maniam ◽

...

Keyword(s):

Electromagnetic Waves ◽

Cost Effective ◽

Pattern Generation ◽

Geometrical Parameters ◽

X Ray ◽

Spectral Bands ◽

Left Handed ◽

Aspect Ratios ◽

Multi Level ◽

Primary Pattern

The function of metamaterials relies on their resonant response to electromagnetic waves in characteristic spectral bands. To make metamaterials homogeneous, the size of the basic resonant element should be less than 10% of the wavelength. For the THz range up to the visible, structure details of 50 nm to 30 μm are required as are high aspect ratios, tall heights, and large areas. For such specifications, lithography, in particular, synchrotron radiation deep X-ray lithography, is the method of choice. X-ray masks are made via primary pattern generation by means of electron or laser writing. Several different X-ray masks and accurate mask-substrate alignment are necessary for architectures requiring multi-level lithography. Lithography is commonly followed by electroplating of metallic replica. The process can also yield mould inserts for cost-effective manufacture by plastic moulding. We made metamaterials based on rod-split-rings, split-cylinders, S-string bi-layer chips, and S-string meta-foils. Left-handed resonance bands range from 2.4 to 216 THz. Latest is the all-metal self-supported flexible meta-foil with pass-bands of 45% up to 70% transmission at 3.4 to 4.5 THz depending on geometrical parameters.

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Individual, community and societal correlates of insecticide treated net use among pregnant women in sub-Saharan Africa: a multi-level analysis

BMC Public Health ◽

10.1186/s12889-021-11635-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Edward Kwabena Ameyaw

Keyword(s):

Pregnant Women ◽

Sub Saharan Africa ◽

World Health ◽

Health Concern ◽

Maternal And Newborn Health ◽

African Countries ◽

The World ◽

Itn Use ◽

Multi Level ◽

Sub Saharan

Abstract Background Malaria in pregnancy is a crucial public health concern due to the enormous risk it poses to maternal and newborn health. The World Health Organisation therefore recommends insecticide-treated net (ITN) for pregnant women. The world over, sub-Saharan Africa bears the highest prevalence of malaria and its associated complications. This study investigated the individual, community and society level factors associated with ITN use among pregnant women in sub-Saharan Africa. Methods The study was conducted with Demographic and Health Survey data of 21 sub-Saharan African countries. A total of 17,731 pregnant women who possessed ITN participated in the study. Descriptive computation of ITN use by survey country and socio-demographic characteristics was conducted. Further, five multi-level binary logistic regression models were fitted with MLwiN 3.05 package in STATA. The Markov Chain Monte Carlo (MCMC) estimation procedure was used in estimating the parameters whilst the Bayesian Deviance Information Criterion was used for the model fitness test. Results On average, 74.2% pregnant women in SSA used ITN. The highest prevalence of ITN use occurred in Mali (83.7%) whilst the least usage occurred in Namibia (7%). Women aged 30–34 were more likely to use ITN compared with those aged 45–49 [aOR = 1.14; Crl = 1.07–1.50]. Poorest women were less probable to use ITN relative to richest women [aOR = 0.79; Crl = 0.70–0.89]. Compared to women who did not want their pregnancies at all, women who wanted their pregnancies [aOR = 1.06; Crl = 1.04–1.19] were more probable to use ITN. Women in male-headed households had higher likelihood of ITN use compared to those from female-headed households [aOR = 1.28; Crl = 1.19–1.39]. On the whole, 38.1% variation in ITN use was attributable to societal level factors whilst 20.9% variation was attributable to community level factors. Conclusion The study has revealed that in addition to individual level factors, community and society level factors affect ITN use in SSA. In as much as the study points towards the need to incorporate community and societal variations in ITN interventions, active involvement of men can yield better outcome for ITN utilisation interventions in SSA.

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