Tags

Type your tag names separated by a space and hit enter

Comparison of outcomes at 6 weeks following postpartum intrauterine contraceptive device insertions by doctors and nurses in India: a case-control study.
Contraception 2016; 93(4):347-355C

Abstract

OBJECTIVE

As part of a strategy to revitalize postpartum family planning services, Government of India revised its policy in 2013 to permit trained nurses and midwives to insert postpartum intrauterine contraceptive devices (PPIUCDs). This study compares two key outcomes of PPIUCD insertions--expulsion and infection--for physicians and nurses/midwives to generate evidence for task sharing.

STUDY DESIGN

We analyzed secondary data from the PPIUCD program in seven states using a case-control study design. We included facilities where both doctors and nurses/midwives performed PPIUCD insertions and where five or more cases of expulsion and/or infection were reported during the study period (January-December 2013). For each case of expulsion and infection, we identified a time-matched control who received a PPIUCD at the same facility and had no complaints. We performed a multiple logistic regression analysis focusing on provider cadre while controlling for potential confounding factors.

RESULTS

In 137 facilities, 792 expulsion and 382 infection cases were matched with 1041 controls. Provider type was not significantly associated with either expulsion [odds ratio (OR) 1.84; 95% confidence interval (CI): 0.82-4.12] or infection (OR 0.73; 95% CI: 0.39-1.37). Compared with centralized training, odds of expulsion were higher for onsite (OR 2.32, 95% CI: 1.86-2.89) and on-the-job training (OR 1.23, 95% CI: 1.11-1.36), but odds of infection were lower for onsite (OR 0.45, 95% CI: 0.27-0.75) and on-the-job training (OR 0.31, 95% CI: 0.25-0.37).

CONCLUSION

Trained nurses and midwives who conduct deliveries at public health facilities can perform PPIUCD insertions as safely as physicians.

IMPLICATIONS

Institutional deliveries are increasing in India, but most normal vaginal deliveries at public health facilities are attended by nurses and midwives due to a shortage of physicians. Task sharing with nurses and midwives can increase women's access to and the acceptability of quality PPIUCD services.

Authors+Show Affiliations

Jhpiego - an affiliate of Johns Hopkins University, 221, Okhla Phase III, New Delhi 110020, India.Jhpiego - an affiliate of Johns Hopkins University, 221, Okhla Phase III, New Delhi 110020, India.Jhpiego - an affiliate of Johns Hopkins University, 221, Okhla Phase III, New Delhi 110020, India. Electronic address: drssinha@gmail.com.Jhpiego - an affiliate of Johns Hopkins University, 270, 1st Floor, Patliputra Colony, Patna, Bihar 800013, India.Jhpiego - an affiliate of Johns Hopkins University, 221, Okhla Phase III, New Delhi 110020, India.Jhpiego - an affiliate of Johns Hopkins University, 221, Okhla Phase III, New Delhi 110020, India.Jhpiego - an affiliate of Johns Hopkins University, 221, Okhla Phase III, New Delhi 110020, India.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26738620

Citation

Yadav, Vivek, et al. "Comparison of Outcomes at 6 Weeks Following Postpartum Intrauterine Contraceptive Device Insertions By Doctors and Nurses in India: a Case-control Study." Contraception, vol. 93, no. 4, 2016, pp. 347-355.
Yadav V, Balasubramaniam S, Das S, et al. Comparison of outcomes at 6 weeks following postpartum intrauterine contraceptive device insertions by doctors and nurses in India: a case-control study. Contraception. 2016;93(4):347-355.
Yadav, V., Balasubramaniam, S., Das, S., Srivastava, A., Srivastava, A., Kumar, S., & Sood, B. (2016). Comparison of outcomes at 6 weeks following postpartum intrauterine contraceptive device insertions by doctors and nurses in India: a case-control study. Contraception, 93(4), pp. 347-355. doi:10.1016/j.contraception.2015.12.012.
Yadav V, et al. Comparison of Outcomes at 6 Weeks Following Postpartum Intrauterine Contraceptive Device Insertions By Doctors and Nurses in India: a Case-control Study. Contraception. 2016;93(4):347-355. PubMed PMID: 26738620.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of outcomes at 6 weeks following postpartum intrauterine contraceptive device insertions by doctors and nurses in India: a case-control study. AU - Yadav,Vivek, AU - Balasubramaniam,Sudharsanam, AU - Das,Saswati, AU - Srivastava,Ashish, AU - Srivastava,Ashish, AU - Kumar,Somesh, AU - Sood,Bulbul, Y1 - 2015/12/29/ PY - 2015/09/14/received PY - 2015/12/21/revised PY - 2015/12/22/accepted PY - 2016/1/8/entrez PY - 2016/1/8/pubmed PY - 2016/12/15/medline KW - Midwives KW - Nurses KW - Postpartum family planning KW - Postpartum intrauterine contraceptive device KW - Task sharing SP - 347 EP - 355 JF - Contraception JO - Contraception VL - 93 IS - 4 N2 - OBJECTIVE: As part of a strategy to revitalize postpartum family planning services, Government of India revised its policy in 2013 to permit trained nurses and midwives to insert postpartum intrauterine contraceptive devices (PPIUCDs). This study compares two key outcomes of PPIUCD insertions--expulsion and infection--for physicians and nurses/midwives to generate evidence for task sharing. STUDY DESIGN: We analyzed secondary data from the PPIUCD program in seven states using a case-control study design. We included facilities where both doctors and nurses/midwives performed PPIUCD insertions and where five or more cases of expulsion and/or infection were reported during the study period (January-December 2013). For each case of expulsion and infection, we identified a time-matched control who received a PPIUCD at the same facility and had no complaints. We performed a multiple logistic regression analysis focusing on provider cadre while controlling for potential confounding factors. RESULTS: In 137 facilities, 792 expulsion and 382 infection cases were matched with 1041 controls. Provider type was not significantly associated with either expulsion [odds ratio (OR) 1.84; 95% confidence interval (CI): 0.82-4.12] or infection (OR 0.73; 95% CI: 0.39-1.37). Compared with centralized training, odds of expulsion were higher for onsite (OR 2.32, 95% CI: 1.86-2.89) and on-the-job training (OR 1.23, 95% CI: 1.11-1.36), but odds of infection were lower for onsite (OR 0.45, 95% CI: 0.27-0.75) and on-the-job training (OR 0.31, 95% CI: 0.25-0.37). CONCLUSION: Trained nurses and midwives who conduct deliveries at public health facilities can perform PPIUCD insertions as safely as physicians. IMPLICATIONS: Institutional deliveries are increasing in India, but most normal vaginal deliveries at public health facilities are attended by nurses and midwives due to a shortage of physicians. Task sharing with nurses and midwives can increase women's access to and the acceptability of quality PPIUCD services. SN - 1879-0518 UR - https://www.unboundmedicine.com/medline/citation/26738620/Comparison_of_outcomes_at_6_weeks_following_postpartum_intrauterine_contraceptive_device_insertions_by_doctors_and_nurses_in_India:_a_case_control_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0010-7824(15)30117-7 DB - PRIME DP - Unbound Medicine ER -