Alice Olawo

There are some questions you may not ask in a clinic: Providing contraception information to young people in Kenya using SMS ☆

To evaluate the acceptability, information access, and potential behavioral impact of providing contraception information via text message on mobile phones to young people in Kenya.

Preventing unintended pregnancy among young women in Kenya: prospective cohort study to offer contraceptive implants.

BACKGROUND Subdermal contraceptive implants have low discontinuation rates but are underused among young women in Africa. This study aimed to isolate the role initial contraceptive method has on preventing unintended pregnancy. STUDY DESIGN We recruited 399 Kenyan women aged 18-24 years into a prospective cohort study if they wanted short-acting hormonal methods (injectable or oral contraceptives). We offered an implant and formed two study groups: implant and short-acting. For contraceptive discontinuation/pregnancy, we used log-rank tests and proportional hazards models. We applied intent-to-treat principles to evaluate the role of initial method choice on future pregnancy. RESULTS Twenty-four percent opted for an implant (n=97), and the remainder opted for a short-acting method (n=299). The 18-month discontinuation probability was 21 per 100 for implant users and 43 per 100 for the short-acting method group (p=.001). Twenty-two unintended pregnancies occurred; all were among the short-acting group. The adjusted relative risk of pregnancy among the short-acting group vs. implant group was 7.4 (95% confidence interval: 1.6-34.5). CONCLUSIONS Many young Kenyan women found implants to be a reasonable alternative to short-acting methods. Having choice is essential, and starting on implants provides substantial and clear protection from unintended pregnancy relative to short-acting methods.

Community-Based Distribution of Injectable Contraceptives: Introduction Strategies in Four Sub-Saharan African Countries

Improving access to family planning services and expanding method choice are two fundamental proven strategies for increasing contraceptive prevalence in resource-poor settings.[1-4] Community-based family planning programs are designed to improve access by bringing services to hard-to-reach communities.[56] Such services are typically delivered by community health workers who are trained in family planning but lack formal clinical credentials. Working outside the health facility community health workers provide health education to promote family planning distribute contraceptives and refer clients for clinic-based services. For decades community-based distribution programs have been credited with expanding access to family planning services in otherwise underserved communities in Africa Asia and Latin America.[5].

Factors associated with uptake of subdermal contraceptive implants in a young Kenyan population.

BACKGROUND Subdermal contraceptive implants may be a reasonable option for young women in sub-Saharan Africa; little is known about factors associated with method uptake in this subpopulation. STUDY DESIGN Four hundred women aged 18-24 years who sought short-acting hormonal contraception were offered an opportunity to use an implant instead. Cross-tabulations and logistic regression analysis were used to examine participant characteristics and other factors associated with choosing an implant. RESULTS Twenty-four percent of participants chose the implant. Participants with greater than 4 years of contraceptive need were over three times more likely to choose an implant [odds ratio (OR), 3.4; 95% confidence interval (CI), 1.6-6.9]. Women with health concerns over short-acting hormonal methods (OR, 2.2; 95% CI, 1.3-3.6) and those who expressed some difficulty returning to a clinic (OR, 1.9; 95% CI, 1.1-3.1) were about twice as likely to choose an implant. Product attributes such as long-acting protection and convenience were cited reasons for choosing an implant. CONCLUSIONS The implant appears to be an attractive option for a fairly large proportion of young women in Kenya. Within this age group of implant users, homogeneity of demographic characteristics relative to short-acting users suggests that the product has broad appeal.

The promise of affordable implants: is cost recovery possible in Kenya?

BACKGROUND Contraceptive implants are one of the most effective methods of family planning but remain underutilized due to their relatively high upfront cost. The increasing availability of a low-cost implant may reduce financial barriers and increase uptake of implants. The commodity cost of Sino-implant (II) is approximately 60% less than two other widely available implants, and a direct service delivery cost of approximately US

“A cup of tea with our CBD agent … ”: community provision of injectable contraceptives in Kenya is safe and feasible

12 makes it one of the most cost-effective methods available. This study was conducted to assess whether implant clients in Kenya are paying as much or more than the direct service delivery cost of Sino-implant (II). STUDY DESIGN A study was conducted in 22 facilities throughout Kenya, including public (n=8), private for-profit (n=6) and private not-for-profit facilities (n=8). Interviews were conducted with a convenience sample of 293 current and returning implant clients after at least 6 months of product use. RESULTS The median price for implant insertion paid by clients in the public, private for-profit and private not-for-profit sectors was US

Positioning Microbicides for HIV Prevention in Kenya A Case Study

1.30, US

Ensuring Health Care Providers Have Comprehensive Communication Tools for Future Microbicide Introduction in Kenya: A Formative Research Study

13.30 and US

I313 Implants: “Expanded opportunities with sino-implant (II)”

20.00, respectively. CONCLUSION Patient fees in both private sectors allow for 100% recovery of the direct cost of providing Sino-implant (II). Currently in Kenya, all sectors can receive donated commodities free of charge; Sino-implant (II) has the potential to reduce reliance on donor-supplied implants and thereby improve contraceptive security.

Reaching providers is not enough to increase IUD use: a factorial experiment of 'academic detailing' in Kenya.

Community health workers can safely provide the injectable DMPA when appropriately trained and supervised. We also found a fivefold increase in contraceptive uptake—a finding that builds on evidence from other countries for supportive policy change. Community health workers can safely provide the injectable DMPA when appropriately trained and supervised. We also found a fivefold increase in contraceptive uptake—a finding that builds on evidence from other countries for supportive policy change. ABSTRACT Background: In rural areas of Kenya, where the majority of Kenya′s population lives, contraceptive use remains low compared with that in urban areas (37% vs. 47%). Inadequate access to family planning services in rural areas is partly due to fewer health facilities and the shortage of health care workers. Community-based access to injectable contraceptives can improve access for rural populations and expand the range of contraceptive methods available. Our pilot project sought to generate local evidence on safety, feasibility, and acceptability of the provision of injectable depot medroxyprogesterone acetate (DMPA) by community health workers (CHWs). Design: We trained 31 CHWs in Tharaka District to provide injectable DMPA in addition to pills and condoms. Data were collected on family planning clients served by CHWs in Tharaka District as well as those who received services from health facilities from August 2009 to September 2010. Service statistics were collected from 3 pilot health facilities in the CHW service catchment area. Results: In the 12-month study period, CHWs reached 1,210 women with family planning services including referrals for long-acting and permanent methods. Family planning use in the pilot sites for all methods increased an estimated fivefold, from 9% in facilities to 46% when facilities and CHWs were combined (32% for CHWs and 14% for facilities). The majority (69%) of clients served by CHWs chose DMPA. No client reported any signs of infection at the injection site nor did any CHW report needlestick injuries or other adverse events. The re-injection rate was 68% at the third visit, which compares favorably with other DMPA continuation studies. Two main reasons given for discontinuing were change of residence and temporary separation from spouse. Conclusion: Community-based provision of DMPA along with other contraceptive methods increased the use of family planning and improved method choice during the study period. Injectable contraception provided by trained CHWs is a safe, acceptable, and feasible service delivery option in Kenya.