Optimizing the delivery of contraceptives in low- and middle-income countries through task shifting: a systematic review of effectiveness and safety

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• 作者：Stephanie Polus (1) (2)
  Simon Lewin (3) (4)
  Claire Glenton (3)
  Priya M Lerberg (5)
  Eva Rehfuess (1)
  A Metin G眉lmezoglu (2)
  
  1. Institute for Medical Informatics ; Biometry and Epidemiology ; University of Munich ; Munich ; Germany
  2. Department of Reproductive Health and Research ; UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research ; Development and Research Training in Human Reproduction (HRP) ; World Health Organization ; Geneva ; Switzerland
  3. Global Health Unit ; Norwegian Knowledge Centre for the Health Services ; Oslo ; Norway
  4. Health Systems Research Unit ; Medical Research Council of South Africa ; Cape Town ; South Africa
  5. Department of Community Medicine ; University of Oslo ; Oslo ; Norway
  
• 关键词：Systematic review ; Contraception ; Task shifting ; Low income countries ; Middle income countries ; Effectiveness ; Safety ; IUD ; Tubal ligation ; Vasectomy ; Injectables
• 刊名：Reproductive Health
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：12
• 期：1
• 全文大小：1,094 KB
• 参考文献：1. Cleland, J, Bernstein, S, Ezeh, A, Faundes, A, Glasier, A, Innis, J (2006) Family planning: the unfinished agenda. Lancet 368: pp. 1810-27 CrossRef
  2. Sedgh, G, Singh, S, Shah, IH, Ahman, E, Henshaw, SK, Bankole, A (2012) Induced abortion: incidence and trends worldwide from 1995 to 2008. Lancet 379: pp. 625-32 CrossRef
  2013 update for the MDG database: unmet need for family planning (POP/DB/CP/B/MDG2013).
  3. Singh, S, Sedgh, G, Hussain, R (2010) Unintended pregnancy: worldwide levels, trends, and outcomes. Stud Fam Plann 41: pp. 241-50 CrossRef
  4. Nabudere, H, Asiimwe, D, Mijumbi, R (2011) Task shifting in maternal and child health care: an evidence brief for Uganda. Int J Technol Assess Health Care 27: pp. 173-9 CrossRef
  5. Lehmann, U, Damme, W, Barten, F, Sanders, D (2009) Task shifting: the answer to the human resources crisis in Africa?. Hum Resour Health 7: pp. 49 CrossRef
  Optimizing health worker roles to improve access to key maternal and newborn health interventions through task shifting. World Health Organization, Geneva
  6. Janowitz, B, Stanback, J, Boyer, B (2012) Task sharing in family planning. Stud Fam Plann 43: pp. 57-62 CrossRef
  7. Laurant M, Reeves D, Hermens R, Braspenning J, Grol R, Sibbald B. Substitution of doctors by nurses in primary care. Cochrane Database Syst Rev. 2005: Issue 2. Art. No.: CD001271.
  8. Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, et al. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database Syst Rev. 2012:CD004015. Update in Progress.
  9. Lassi Z, Bhutta Z. Mid-level health workers for improving the delivery of health services (Protocol). Cochrane Database Syst Rev. 2012: Issue 2. Art. No.: CD009649.
  10. Gogia, S, Sachdev, HS (2010) Home visits by community health workers to prevent neonatal deaths in developing countries: a systematic review. Bull World Health Organ 88: pp. 658-666B CrossRef
  11. Malarcher, S, Meirik, O, Lebetkin, E, Shah, I, Spieler, J, Stanback, J (2011) Provision of DMPA by community health workers: what the evidence shows. Contraception 83: pp. 495-503 CrossRef
  12. Ballini, L, Bero, L, Eccles, M, Grimshaw, J, Gruen, R, Lewin, S (2011) About the Cochrane Collaboration (Cochrane Review Groups (CRGs)). Cochrane Effective Practice and Organisation of Care Group.
  13. Higgins, JPT, Green, S (2011) Cochrane handbook for Systematic Reviews of Interventions. Cochrane handbook for Systematic Reviews of Interventions version 5.0.2., 2009, The Cochrane Collaboration.
  14. Gopinathan, U, Lewin, S, Glenton, C (2014) Implementing large-scale programmes to optimise the health workforce in low- and middle-income settings: a multicountry case study synthesis. Trop Med Int Health 19: pp. 1437-56 CrossRef
  15. Oladapo F, Khanna R, Lewin S, G眉lmezoglu M. LHWs for delivery of injectable contraceptives. in press.
  16. Norwegian Satellite of the Cochrane Effective Practice and Organisation of Care Group. Suggested risk of bias criteria for EPOC reviews. http://epoc.cochrane.org/epoc-specific-resources-review-authors.
  17. Guyatt, GH, Oxman, AD, Kunz, R, Vist, GE, Falck-ytter, Y, Schunemann, HJ (2008) What is 鈥?of evidence鈥?and why is it important to clinicians?. BMJ 337: pp. 995-8 CrossRef
  The Cochrane Collaboration. Review Manager (RevMan) [Computer program].
  18. Eren, N, Ramos, R, Gray, RH (1983) Physicians vs. auxiliary nurse-midwives as providers of IUD services: a study in Turkey and the Philippines. Stud Fam Plann 14: pp. 43-7 CrossRef
  19. Lassner, KJ, Chen, CH, Kropsch, LA, Oberle, MW, Lopes, IM, Morris, L (1995) Comparative study of safety and efficacy of IUD insertions by physicians and nursing personnel in Brazil. Bull Pan Am Health Organ 29: pp. 206-15
  20. Dusitsin, N, Chalapati, S, Varakamin, S, Boonsiri, B, Ningsanon, P, Gray, RH (1980) Post-partum tubal ligation by nurse-midwives and doctors in Thailand. Lancet 1: pp. 638-9 CrossRef
  21. Einhorn, RF, Sear, AM, Perez, E, Cabrera, E (1977) Contraceptive method continuation according to type of provider. Am J Public Health 67: pp. 1157-64 CrossRef
  22. Bunyaratavej, P, Rajatapiti, B, Dhitavat, V, Kichanantha, B, Tangchai, W, Sukonthaman, Y (1981) Comparison of vasectomy performed by medical students and surgeons in Thailand. Stud Fam Plann 12: pp. 316-8 CrossRef
  23. Oxman, AD, Lavis, JN, Lewin, S, Fretheim, A (2009) SUPPORT tools for evidence-informed health Policymaking (STP) 1: what is evidence-informed policymaking?. Health Res Policy Syst 7 Suppl 1: pp. S1 CrossRef
  Making decisions about contraceptive introduction: a guide for conducting assessments to broaden contraceptive choice and improve quality of care. World Health Organization, Geneva
  24. Pacqu茅-Margolis, A, Cox, C, Puckett, A, Schaefer, L (2013) Exploring contraceptive use differentials in Sub-Saharan Africa through a health workforce lens. Capacity Plus Technical Brief.
  25. Harper, R, Lewin, S, Glenton, C, Pena-Rosas, JP (2013) Completeness of reporting of setting and health worker cadre among trials on antenatal iron and folic acid supplementation in pregnancy: an assessment based on two Cochrane reviews. Syst Rev 2: pp. 42 CrossRef
  26. Glenton, C, Scheel, IB, Lewin, S, Swingler, GH (2011) Can lay health workers increase the uptake of childhood immunisation? Systematic review and typology. Trop Med Int Health 16: pp. 1044-53 CrossRef
  27. Christopher, JB, May, A, Lewin, S, Ross, DA (2011) Thirty years after Alma-Ata: a systematic review of the impact of community health workers delivering curative interventions against malaria, pneumonia and diarrhoea on child mortality and morbidity in sub-Saharan Africa. Hum Resour Health 9: pp. 27 CrossRef
  28. Glenton, C, Lewin, S, Mayhew, A, Scheel, I, Odgaard-Jensen, J (2013) Nonrandomized studies are not always found even when selection criteria for health systems intervention reviews include them: a methodological study. J Clin Epidemiol 66: pp. 367-70 CrossRef
  29. B-e, K, Kane, TT, Phillips, JF, Viguerie, KE (1997) Improving the Bangladesh health and family planning programme. Lessons learned through operations research. Dhaka, International Centre for Diarrhoeal Disease Research, Bangladesh
  30. Bang, S, Song, SW, Choi, CH (1968) Improving access to the IUD: experiments in Koyang, Korea. Stud Fam Plann 1: pp. 4-11 CrossRef
  31. Bhatia, S, Mosley, WH, Faruque, AS, Chakraborty, J (1980) The Matlab family planning-health services project. Stud Fam Plann 11: pp. 202-12 CrossRef
  32. Loghmani, M, Mitra, M (1976) Evaluation of trained midwives in a copper-T IUD insertion Program in Isfahan. Iran Int J Gynaecol Obstet 14: pp. 205-7
  33. Ramos, R, Apelo, RA (1978) A program of IUD insertions by paraprofessionals and physicians in the Philippines. Int J Gynaecol Obstet 16: pp. 321-3
  34. Ronaghy, HA, Zeighami, B, Zeighami, E, Nayeri, F (1975) Insertion of IUDs by rural midwives in Iran. Public Health Rep 90: pp. 498-501
  35. Fretheim, A, Munabi-Babigumira, S, Oxman, AD, Lavis, JN, Lewin, S (2009) SUPPORT tools for evidence-informed policymaking in health 6: using research evidence to address how an option will be implemented. Health Res Policy Syst 7 Suppl 1: pp. S6 CrossRef
  
• 刊物主题：Reproductive Medicine; Public Health;
• 出版者：BioMed Central
• ISSN：1742-4755

文摘

Objective To assess the effectiveness and safety of task shifting for the delivery of injectable contraceptives, contraceptive implants, intrauterine devices (IUDs), tubal ligation and vasectomy in low- and middle-income countries. Methods Multiple electronic databases were searched up to 25 May 2012 for studies which had assessed the delivery of contraceptives by health workers with lower levels of training, compared to delivery by health workers usually assigned this role, or compared to no organized provision of contraceptives. We included randomized controlled trials, non-randomized controlled trials, controlled before-after studies, and interrupted time series. Data were extracted using a standard form and the certainty of the evidence found was assessed using GRADE. Results We identified six randomized controlled trials published between 1977 and 1995 that assessed the safety and effectiveness of task shifting for the delivery of long-term contraceptives. Two studies assessed IUD insertion by nurses compared to doctors, two assessed IUD insertion by auxiliary nurse-midwives compared to doctors, one assessed tubal ligation by midwives compared to doctors, and one assessed the delivery of vasectomy by medical students compared to doctors. In general, little or no difference was found in contraceptive outcomes between cadres. Study design limitations and the low number of eligible studies, however, allow only limited conclusions to be drawn. Conclusions The findings indicate that task shifting for the delivery of long-term contraceptives may be a safe and effective approach to increasing access to contraception. Further research is needed because the certainty of the evidence identified is variable.