Safety, Quality, and Acceptability of Contraceptive Implant Provision by Community Health Extension Workers versus Nurses and Midwives in Two States in Nigeria.

Task sharing is a strategy with potential to increase access to effective modern contraceptive methods. This study examines whether community health extension workers (CHEWs) can insert contraceptive implants to the same safety and quality standards as nurse/midwives. We analyze data from 7,691 clients of CHEWs and nurse/midwives who participated in a noninferiority study conducted in Kaduna and Ondo States, Nigeria. Adverse events (AEs) following implant insertions were compared. On the day of insertion AEs were similar among CHEW and nurse/midwife clients-0.5 percent and 0.4 percent, adjusted odds ratio (aOR) 0.92 (95 percent CI 0.38-2.23)-but noninferiority could not be established. At follow-up 6.6 percent of CHEW clients and 2.1 percent of nurse/midwife clients experienced AEs. There was strong evidence of effect modification by State. In the final adjusted model, odds of AEs for CHEW clients in Kaduna was 3.34 (95 percent CI 1.53-7.33) compared to nurse/midwife clients, and 0.72 (95 percent CI 0.19-2.72]) in Ondo. Noninferiority could not be established in either State. Implant expulsions were higher among CHEW clients (142/2987) compared to nurse/midwives (40/3517). Results show the feasibility of training CHEWs to deliver implants in remote rural settings but attention must be given to provider selection, training, supervision, and follow-up to ensure safety and quality of provision.

Factors influencing the use of modern contraceptive in Nigeria: a multilevel logistic analysis using linked data from performance monitoring and accountability 2020.

BACKGROUND: The population of Nigeria is estimated at over 190 million and it is projected to increase by 44% between 2015 and 2030. However, less than one-quarter of women within reproductive age in Nigeria uses modern contraceptive methods despite its importance. Hence, this study aims at examining the influence of individual and community level factors on the use of modern contraceptive method. METHODS: The study is a secondary analysis of linked household and Service Delivery Point datasets from a 2018 survey conducted by Performance, Monitoring and Accountability in Nigeria. Data was abstracted for a total of 9126 sexually active women within the ages of 15-49 years across 295 enumeration areas in seven States. A 2-level binary logistic regression was used to examine the association between study variables and the use of modern contraceptives while adjusting for the clustering effect. RESULTS: There was significant influence of educational level, marital status, parity, socio-economic status, fertility intention, and awareness of family planning methods on the use of modern contraceptives. Also, women who perceived support from someone in the community on family planning were more likely to use modern contraceptive unlike those without such support. Those who believed that contraceptive methods are used by almost all and some of their friends or relatives were more likely to use modern contraceptive compared to those who think otherwise. CONCLUSIONS: The study shows the need to reduce inequalities between FP utilization across women with different socio-economic status as well as increasing the awareness for modern contraceptive methods.