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Self-administration of subcutaneous depot Medroxyprogesterone acetate by adolescent women

The intramuscular contraceptive depot medroxyprogesterone acetate (DMPA-IM) is now available in subcutaneous (SC) formulation, potentially allowing for home-based self-administration. We conducted the first examination of adolescent women’s interest in and proficiency at DMPA-SC self-administration.

Institutional Author(s): Indiana University School of Medicine
Individual Author(s): R. L. Williams, D. J. Hensel, D. Fortenberry
Publication date: August, 2010

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Global Experience of Community Health Workers for Delivery of Health Related Millennium Development Goals: A Systematic Review, Country Case Studies, and Recommendations for Integration into National Health Systems

Participation of community health workers (CHWs) in the provision of primary health care has been experienced all over the world for several decades, and there is an amount of evidence showing that they can add significantly to the efforts of improving the health of the population, particularly in those settings with the highest shortage of motivated and capable health professionals. With the overall aim of identifying CHWs programs with positive impact on Millennium Development Goals (MDGs) related to health or otherwise, a global systematic review was undertaken of such interventions, as well as eight in-depth country case studies in Sub-Saharan Africa (Ethiopia Mozambique and Uganda), South East Asia (Bangladesh, Pakistan and Thailand) and Latin America (Brazil and Haiti). The focus was on key aspects of these programs, encompassing typology of CHWs, selection, training, supervision, standards for evaluation and certification, deployment pat­terns, in-service training, performance, and impact assessment.

Institutional Author(s): Global Health Workforce Alliance, World Health Organization (WHO)
Publication date: 2010

The acceptability of self-administration of subcutaneous Depo-Provera

Depo-Provera (depot medroxyprogesterone acetate, or DMPA) is an important contraceptive option for women worldwide. Currently, it is only available in intramuscular form requiring regular quarterly routine attendance at a health facility. A new subcutaneous preparation has been developed. This is self-administrable and could potentially reduce need for routine attendance to an annual visit.
In a questionnaire survey of 176 women currently using DMPA, 67% would prefer to self-administer. Of the 33% who did not wish to self-administer, the most common reasons were a fear of needles (62%) and concern regarding incorrect administration (43%). In a second survey of 313 women not currently using DMPA, 64% of women said they would prefer to attend less often for contraceptive supplies. Twenty-six percent of women who had never used DMPA and 40% of ex-users would seriously consider DMPA if self-administration were possible.
Our findings would suggest that the advent of subcutaneous self-administrable Depo-Provera with appropriate training and reminder system is likely to be beneficial and popular with many women.

Institutional Author(s): University of Edinburgh, NHS Lothian Primary and Community Division
Individual Author(s): Fatim Lahka, Charlotte Henderson, Anna Glasier
Publication date: July, 2005

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Reproductive Health Supplies Coalition

The Reproductive Health Supplies Coalition (RHSC) is a global partnership of public, private, and non-governmental organizations dedicated to ensuring that all people in low- and middle-income countries can access and use affordable, high-quality supplies to ensure their better reproductive health. The Coalition brings together diverse agencies and groups with critical roles in providing contraceptives and other reproductive health supplies. These include multilateral and bilateral organizations, private foundations, governments, civil society, and private-sector representatives.

Institutional Author(s): Reproductive Health Supplies Coalition (RHSC)
Publication date: 2004

Website

Access to Medicines and Drug Regulation in Developing Countries: a Resource Guide for DFID

This 16-page paper provides an overview of the debate about how developing country drug regulation agencies are funded and the extent to which they should build local capacity or rely on regulators in developed countries.

Institutional Author(s): DFID Health Systems Resource Centre
Publication date: January, 2004

Report Web page

Self-administration with UniJect® of the once-a-month injectable contraceptive Cyclofem®

The objective of this study was to evaluate women’s acceptance of and ability to self-administrate the injectable contraceptive Cyclofem® using prefilled UniJect® devices. A total of 102 women were invited to participate in the study. Fourteen women (13.7%) refused to participate. Of the remaining 88 women, 32 women (31.4%) consented to participate and were trained using oranges but were still afraid of the procedure and ultimately refused to self-administer the injections. Only 56 women (55%) ultimately self-injected Cyclofem with UniJect. They performed a total of 144 injections, all of them on the ventral side of the thigh. When nurses evaluated women’s ability to activate the devices, they found that more than 80% were successful in both the group of women that later self-administered the injections and the group that did not. The evaluation of the self-administered injection technique showed that more than 90% of the women correctly self-administered the contraceptive using UniJect. With respect to the opinion of the women about the self-administration of the contraceptive, more than 50% (32 of 56) of women who self-injected preferred to self-administer the injection and said that they wished to continue with the self-administration, one-third (17) reported that they were afraid, and seven women (12.5%) expressed the opinion that the injection in the thigh was more painful than the administration in the buttocks or arm. In conclusion, our study showed that women can be trained to successfully self-administer the monthly injectable contraceptive Cyclofem and generally respond positively to UniJect.

Institutional Author(s): Universidade Estadual de Campinas (UNICAMP), Program for International Training in Health (INTRAH) Brazil, Hospital Regional Asa Sul, Centro de Assistencia Integral a Saude da Mulher
Individual Author(s): Luis Bahamondes, Nadia M. Marchi, Hitomi Miura Nakagava, Maria Lourdes R. de Melo, Maria de Lourdes Cristofoletti, Eliano Pellini, Regina H. Scozzafave, Carlos Petta
Publication date: November, 1997

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