Skip to main content

Author: Uganda Ministry of Health


Continuation of injectable contraception when self-injected vs. administered by a facility-based health worker: a nonrandomized, prospective cohort study in Uganda

The purpose of this study was to compare 12-month continuation rates for subcutaneous depot medroxyprogesterone acetate (DMPA-SC) administered via self-injection and DMPA-IM administered by a health worker in Uganda. Women seeking injectable contraception at participating health facilities were offered the choice of self-injecting DMPA-SC or receiving an injection of DMPA-IM from a health worker. Those opting for self-injection were trained one-on-one. They self-injected under supervision and took home three units, a client instruction guide and a reinjection calendar. Those opting for DMPA-IM received an injection and an appointment card for the next facility visit in 3 months. We interviewed participants at baseline (first injection) and after 3 (second injection), 6 (third injection) and 9 (fourth injection) months, or upon discontinuation. We used Kaplan–Meier methods to estimate continuation probabilities, with a log-rank test to compare differences between groups. A multivariate Cox regression identified factors correlated with discontinuation.

Institutional Author(s): PATH, Uganda Ministry of Health
Individual Author(s): Jane Cover, Allen Namagembe, Justine Tumusiime, Damalie Nsangi, Jeanette Lim, Dinah Nakiganda-Busiku
Publication date: April, 2018

Journal Article Link to Journal Article

A prospective cohort study of the feasibility and acceptability of depot medroxyprogesterone acetate administered subcutaneously through self-injection

Evidence on contraceptive self-injection from the United States and similar settings is promising, and the practice may increase access. There are no published studies on the feasibility of contraceptive self-injection in sub-Saharan Africa to date. The purpose of this study was to assess feasibility of subcutaneous depot medroxyprogesterone acetate self-injection in Uganda, with specific objectives to (a) measure the proportion of participants who self-injected competently, (b) measure the proportion who self-injected on time 3 months after training (defined conservatively as within 7 days of their reinjection date) and (c) assess acceptability. In this prospective cohort study, 380 18–45-year-old participants completed self-injection training by licensed study nurses, guided by a client instruction booklet, and practiced injection on prosthetics until achieving competence. Nurses supervised participants’ self-injection and evaluated injection technique using an observation checklist. Those judged competent were given a Sayana® Press unit, instruction booklet and reinjection calendar for self-injection at home 3 months later. Participants completed an interview before and after self-injection. Nurses visited participants at home following reinjection dates; during the follow-up visit, participants demonstrated self-injection on a prosthetic, injection technique was reevaluated, and a post reinjection interview was completed.

Institutional Author(s): PATH, Uganda Ministry of Health
Individual Author(s): Jane Cover, Allen Namagembe, Justine Tumusiime, Jeanette Lim, Jennifer Kidwell Drake, Anthony K Mbonye
Publication date: October, 2016

Journal Article Link to Journal Article

Provider acceptability of Sayana® Press: results from community health workers and clinic-based providers in Uganda and Senegal.

Sayana® Press (SP), a subcutaneous formulation of depot medroxyprogesterone acetate (DMPA) in Uniject™, has potential to be a valuable innovation in family planning (FP) because it may overcome logistic and safety challenges in delivering intramuscular DMPA (DMPA IM). However, SP’s acceptability is unknown. We measured acceptability of SP among clinic-based providers (Senegal only) and community health workers. This open-label observational study was conducted in clinics in three districts in Senegal and community-based services in two districts in Uganda. Providers administered SP to clients seeking reinjection of DMPA IM. We conducted in-depth interviews with 86 providers (52 in Senegal, 34 in Uganda) to assess their experiences providing SP to clients.

Institutional Author(s): FHI 360, Centre de Formation et de Recherche en Santé de la Reproduction (CEFOREP), Senegal Ministry of Health and Social Action, Uganda Ministry of Health
Individual Author(s): Holly M Burke, Monique P. Mueller, Catherine Packer, Brian Perry, Leonard Bufumbo, Daouda Mbengue, Bocar Mamadou Daff, Anthony K Mbonye
Publication date: January, 2014

Journal Article Link to Journal Article