Effect of integrating maternal and child health services, nutrition and family planning services on postpartum family planning uptake at 6 months post-partum in Burkina Faso, Cote d’Ivoire and Niger: a quasi-experimental study protocol

Reproductive Health, Volume 19, No. 1, Year 2022

Interpretation

Background: Although several interventions integrating maternal, neonatal, child health and nutrition with family planning have been implemented and tested, there is still limited evidence on their effectiveness to guide program efforts and policy action on health services integration. This study aims to assess the effectiveness of a service delivery model integrating maternal and child health services, nutrition and family planning services, compared with the general standard of care in Burkina Faso, Cote d’Ivoire, and Niger. Methods: This is a quasi experimental study with one intervention group and one control group of 3 to 4 health facilities in each country. Each facility was matched to a control facility of the same level of care that had similar coverage on selected reproductive health indicators such as family planning and post-partum family planning. The study participants are pregnant women (up to 28 weeks of gestational age) coming for their first antenatal care visit. They will be followed up to 6 months after childbirth, and will be interviewed at each antenatal visit and also during visits for infant vaccines. The analyzes will be carried out by intention to treat, using generalized linear models (binomial log or log Poisson) to assess the effect of the intervention on the ratio of contraceptive use prevalence between the two groups of the study at a significance level of 5%, while taking into account the cluster effect and adjusting for potential confounding factors (socio-demographic characteristics of women unevenly distributed at inclusion). Discussion: This longitudinal study, with the provision of family planning services integrated into the whole maternal care continuum, a sufficiently long observation time and repeated measurements, will make it possible to better understand the timeline and the factors influencing women’s decision-making on the use of post-partum family planning services. The results will help to increase the body of knowledge regarding the impact of maternal and child health services integration on the utilization of post-partum family planning taking into account the specific context of sub-Saharan Africa French speaking countries where such information is very needed. Burkina Faso, Cote d’Ivoire, and Niger are 3 West african French speaking countries with poor level of maternal and child health indicators. Some information related to relevant reproductive health and health service utilization indicators based on demographic and health survey data from theses countries, Burkina Faso (2010), Cote d’Ivoire (2011–2012) and Niger (2012) are presented in Table Table11. Selected indicators on reproductive health and utilization of maternal and child health services Burkina Faso (2010), Cote d’Ivoire (2011–2012) and Niger (2012) aAmong women in union We will conduct a quasi experimental study in the selected countries health facilities. In each country, we will have one intervention group of facilities and one control group of facilities. Participants of the intervention group, meaning women attending the intervention facilities, will receive the full package of integrated PPFP/MNCH/Nutrition services, while participants in the control group will receive standard care. In each country, 3 to 4 health facilities have been identified as the intervention sites including a district hospital, an urban health center, and a rural health center. Each facility was matched to a control facility of the same level of care and that had similar coverage on selected reproductive health indicators such as family planning and post-partum family planning (Table (Table2).2). For each country, the selection of the intervention districts and health facilities was purposively made by a working group on Maternal, Neonatal and Child Health (MNCH) from the Ministry of Health. Sites of study • CMA of Po • CSPS niché at the CMA • CSPS of Tiébélé • CMA of Kombissiri • CSPS niche at the CMA • CSPS de Toécé • HG district of Agnibilekro • CSU of Damé • CSR of Assuamé • HG of Adzopé • CSU Assikoi • CSR Ananguié • HD of Aguié • CSI urban of Aguié • CSI rural of Débi • CS of Zabon Moussou • HD Guidanroumji • CSU urban of Guidanroumji • CSI rural of Karazome • CS of Tabouka HD, CMA, and HG: General Hospital or Health District Hospital; CSPS, CSU, CSR, CSI: Primary Health care facilities (CSU = urban, CSR = rural) As part of the Ouagadougou partnership, the conferences held in Ouagadougou, Burkina Faso (2011) and London (2012) and the creation of FP2020 drew attention to FP in Francophone West African countries, which are lagging far behind other regions in terms of use of modern contraceptive methods [15]. Since then, notable progress has been made in these countries, including a 40% increase in the number of new FP users between 2011 and 2015 [15]. However, additional efforts are still needed for these countries to accelerate the use of essential quality FP and MNCH care [15]. The INSPiRE initiative is a project that aims to support the nine countries of the Ouagadougou Partnership to intensify their efforts by investing in the integration of FP and MNCH services. The vision of the INSPiRE Initiative is that all nine countries of the Ouagadougou Partnership achieve their national objectives in terms of increasing the modern contraceptive prevalence rate (mCPR); preventing maternal and child deaths and preventable diseases; improving maternal nutrition and infant and young child feeding practices, and improving the health, nutrition and well-being of newborns and infants. INSPiRE is based on the development and testing of models of excellence in the delivery of integrated MNH, PPFP and Nutrition services. For the pilot phase of this project implementation, three countries have been selected: Burkina Faso, Cote d’Ivoire and Niger. The model of integrated health service delivery includes the community level (community contacts with community health workers), the intermediate level (rural and urban basic health centers), and the central level with the district hospital. The standard model of integrated PPFP/MNCH/Nutrition service delivery has four points of contact where integrated services should be offered in the health facility: antenatal care, childbirth, postnatal care, and infant wellness visits (Fig. 1). In the model, these services are delivered during the same client visit based on client needs and standards of care. For instance, a pregnant woman would be offered PPFP counseling at each contact with the health system, along with counseling on other services such as maternal and infant nutrition. The intervention of integrated health services delivery Inclusion criteria The study participants are pregnant women who meet the following criteria: Exclusion criteria The study participants will be excluded from the analysis if: Participants will be recruited at the ANC unit. All women coming for their first ANC visit will be invited to participate in the study. Women who accept will be screened according to the inclusion criteria. Those meeting the study criteria will be included in the study. In addition, each woman will have a unique identification number which will be entered in the registers to allow follow up throughout the duration of the study. Women with a pregnancy up to 28 weeks of gestational age will be followed up to 6 months after childbirth, and will be interviewed at each antenatal visit and also during visits for infant vaccination, as detailed in the Table Table33. Participants follow-up schedule The primary outcome is the uptake of modern contraceptive methods at 6 months postpartum (proportion of women using modern contraceptives at 6 months in the experimental vs. control group). Secondary outcomes are related to health indicators, services delivered and service utilization, as detailed in the Table Table4,4, along with their definition and/or measurement process. Maternal infections will be considered for clinical signs of postpartum infection in mothers before discharge from hospital. Early neonatal infections will be considered as reported by health care providers in the patient file or based on obvious clinical signs of neonatal infection (fever, hypothermia, jaundice). Secondary outcomes of interest According to the Population Division of the United Nations Department of Economic and Social Affairs, the modern contraceptive prevalence among married or in union women in 2020 was estimated at 22.4% Cote d’Ivoire, 28.1% for Burkina Faso and 15.1% for Niger [26]. Considering an improvement of 15% in this proportion, attributable to the intervention, with a power of 80%, a significance level of 5%, and finally an intraclass correlation coefficient of 0.015, Cote d’Ivoire will have the largest sample size, about 88 women per cluster. By increasing the size by 15% to take into account any lost to follow-up related to travel, we’ll have a size of 102 women per health facility, meaning a total of 306 women per group in Cote d’Ivoire, and 268, and 172 per group in Burkina Faso and Niger, respectively. It is important to mention that the project health centers in each country were considered as clusters.And since the number of clusters is known in each country, we calculated the number of participants to be included so that the study have a good power. Details for each country are provided in the Table Table55. Parameters used for sample size calculation Data will be collected through direct interview with health facility clients and extraction of data from health facility registers. Direct interview with health facility clients: They will be carried out with the study participants at the various follow-up points. Data will be collected from a standardized questionnaire integrated into electronic tablets.Interviews will be carried out in health centers on the day of the woman’s consultation at her convenience. Otherwise, the interviewer will get in touch with the participant to agree on a day and place for the interview. In addition, these interviews will comply to barrier measures against Covid-19 (wearing a mask and a maintaining a distance of at least one meter between the investigator and the respondent). Data extraction: Data will be extracted from health facilities registers (ANC, Childbirth, post-natal care, Immunization). Data will be collected by six females interviewers per country who speak the local languages. They will be trained for 1 week on the study procedures and the content of the questionnaire. Data quality control procedures will be put in place to ensure that accurate data are recorded in the registers and entered into the database. Guidelines for data collection and the establishment of a registration register will be produced. In order to ensure that data will be collected in a standardized way in all participating health facilities, a pilot test of data collection and data management will be carried out before the beginning of baseline data collection. Data quality reports will be produced regularly for each health facility. Site control supervisions in the participating health facilities will be carried out regularly and a verification of the source data will be carried out to ensure that the data collected is accurate, complete, precise and reliable. The supervisions will be carried out by the principal investigator and the country co-investigators. A statistical analysis plan will be developed. Descriptive statistics will be reported by calculating frequencies and percentages for categorical variables and means, standard deviations, and minimum and maximum values for the continuous variables if they are normally distributed. Since the main outcome is contraceptive use, we will use generalized linear models (binomial log or log Poisson) to assess the effect of interventions on the ratio of contraceptive use prevalence between the two groups of the study at a significance level of 5%, while taking into account the cluster effect and adjusting for potential confounding factors (socio-demographic characteristics of women unevenly distributed at inclusion). All bi and multivariate analyzes will be carried out by intention to treat, including all women, whether or not they continued to visit health centers after inclusion. The unit of analysis will therefore be the woman. The analyzes will be carried out with Stata. This protocol has been approved by the Institutional Review Committee of Intrahealth International as well as the respective ethical committees of the selected countries. To ensure the safety and well-being of participants (healthcare providers and pregnant women) and to ensure no harm to them for this study, the team will take the following measures: There will be no risk to women who decide not to participate in the study. Women who will not consent to participate in the study will receive the same care and access to services as those who have consented to participate in the study. If a condition warranting referral (including domestic violence, substance abuse, HIV counseling and testing, or any other relevant condition) is detected during the provision of antenatal care services (as part of this research), the study team will ensure that the woman is correctly referred and that the appropriate standard referral procedures are followed. The published data will be depersonalized, described in a comprehensive manner, if possible and the anonymity of the participants will be preserved at all times. This study will last 18 months, from July 2021 to December 2022 as follows:

AI Digest

Study Justification:

– Limited evidence on the effectiveness of integrating maternal and child health services, nutrition, and family planning services
– Need for guidance on program efforts and policy action regarding health services integration
– Poor maternal and child health indicators in Burkina Faso, Cote d’Ivoire, and Niger
– Lagging use of modern contraceptive methods in Francophone West African countries

Study Highlights:

– Quasi-experimental study with one intervention group and one control group in each country
– Intervention group receives integrated maternal and child health services, nutrition, and family planning services
– Control group receives standard care
– Follow-up of pregnant women up to 6 months postpartum
– Interviews conducted at antenatal visits and infant vaccine visits
– Analyzes carried out using generalized linear models to assess the effect of the intervention on contraceptive use prevalence

Study Recommendations:

– Assess the effectiveness of integrating maternal and child health services, nutrition, and family planning services
– Increase the body of knowledge regarding the impact of integration on postpartum family planning uptake
– Provide evidence to guide program efforts and policy action on health services integration

Key Role Players:

– Ministry of Health in Burkina Faso, Cote d’Ivoire, and Niger
– Working group on Maternal, Neonatal and Child Health (MNCH)
– Health facility staff
– Community health workers
– Research team

Cost Items for Planning Recommendations:

– Training of interviewers and health facility staff
– Data collection tools and equipment (electronic tablets)
– Travel expenses for supervision and data collection
– Data management and analysis software (Stata)
– Ethical review and approval processes
– Publication costs
Please note that the provided information is a summary of the study protocol and does not include actual cost estimates.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is relatively strong, but there are some areas for improvement. The study design is described as quasi-experimental, which may limit the strength of the evidence compared to a randomized controlled trial. However, the study does include an intervention group and a control group, which is a strength. The study aims to assess the effectiveness of a service delivery model integrating maternal and child health services, nutrition, and family planning services, which is a relevant and important topic. The study will use intention-to-treat analysis and generalized linear models to assess the effect of the intervention. The study also mentions adjusting for potential confounding factors, which is another strength. To improve the strength of the evidence, it would be helpful to provide more details on the sample size calculation, including the rationale for the chosen parameters. Additionally, providing information on the specific reproductive health indicators that will be measured and how they will be assessed would enhance the clarity of the study. Finally, including information on the potential limitations of the study, such as any potential biases or challenges in data collection, would further strengthen the evidence.

Abstract

Burkina Faso, Cote d’Ivoire, and Niger are 3 West african French speaking countries with poor level of maternal and child health indicators. Some information related to relevant reproductive health and health service utilization indicators based on demographic and health survey data from theses countries, Burkina Faso (2010), Cote d’Ivoire (2011–2012) and Niger (2012) are presented in Table Table11. Selected indicators on reproductive health and utilization of maternal and child health services Burkina Faso (2010), Cote d’Ivoire (2011–2012) and Niger (2012) aAmong women in union We will conduct a quasi experimental study in the selected countries health facilities. In each country, we will have one intervention group of facilities and one control group of facilities. Participants of the intervention group, meaning women attending the intervention facilities, will receive the full package of integrated PPFP/MNCH/Nutrition services, while participants in the control group will receive standard care. In each country, 3 to 4 health facilities have been identified as the intervention sites including a district hospital, an urban health center, and a rural health center. Each facility was matched to a control facility of the same level of care and that had similar coverage on selected reproductive health indicators such as family planning and post-partum family planning (Table (Table2).2). For each country, the selection of the intervention districts and health facilities was purposively made by a working group on Maternal, Neonatal and Child Health (MNCH) from the Ministry of Health. Sites of study • CMA of Po • CSPS niché at the CMA • CSPS of Tiébélé • CMA of Kombissiri • CSPS niche at the CMA • CSPS de Toécé • HG district of Agnibilekro • CSU of Damé • CSR of Assuamé • HG of Adzopé • CSU Assikoi • CSR Ananguié • HD of Aguié • CSI urban of Aguié • CSI rural of Débi • CS of Zabon Moussou • HD Guidanroumji • CSU urban of Guidanroumji • CSI rural of Karazome • CS of Tabouka HD, CMA, and HG: General Hospital or Health District Hospital; CSPS, CSU, CSR, CSI: Primary Health care facilities (CSU = urban, CSR = rural) As part of the Ouagadougou partnership, the conferences held in Ouagadougou, Burkina Faso (2011) and London (2012) and the creation of FP2020 drew attention to FP in Francophone West African countries, which are lagging far behind other regions in terms of use of modern contraceptive methods [15]. Since then, notable progress has been made in these countries, including a 40% increase in the number of new FP users between 2011 and 2015 [15]. However, additional efforts are still needed for these countries to accelerate the use of essential quality FP and MNCH care [15]. The INSPiRE initiative is a project that aims to support the nine countries of the Ouagadougou Partnership to intensify their efforts by investing in the integration of FP and MNCH services. The vision of the INSPiRE Initiative is that all nine countries of the Ouagadougou Partnership achieve their national objectives in terms of increasing the modern contraceptive prevalence rate (mCPR); preventing maternal and child deaths and preventable diseases; improving maternal nutrition and infant and young child feeding practices, and improving the health, nutrition and well-being of newborns and infants. INSPiRE is based on the development and testing of models of excellence in the delivery of integrated MNH, PPFP and Nutrition services. For the pilot phase of this project implementation, three countries have been selected: Burkina Faso, Cote d’Ivoire and Niger. The model of integrated health service delivery includes the community level (community contacts with community health workers), the intermediate level (rural and urban basic health centers), and the central level with the district hospital. The standard model of integrated PPFP/MNCH/Nutrition service delivery has four points of contact where integrated services should be offered in the health facility: antenatal care, childbirth, postnatal care, and infant wellness visits (Fig. 1). In the model, these services are delivered during the same client visit based on client needs and standards of care. For instance, a pregnant woman would be offered PPFP counseling at each contact with the health system, along with counseling on other services such as maternal and infant nutrition. The intervention of integrated health services delivery Inclusion criteria The study participants are pregnant women who meet the following criteria: Exclusion criteria The study participants will be excluded from the analysis if: Participants will be recruited at the ANC unit. All women coming for their first ANC visit will be invited to participate in the study. Women who accept will be screened according to the inclusion criteria. Those meeting the study criteria will be included in the study. In addition, each woman will have a unique identification number which will be entered in the registers to allow follow up throughout the duration of the study. Women with a pregnancy up to 28 weeks of gestational age will be followed up to 6 months after childbirth, and will be interviewed at each antenatal visit and also during visits for infant vaccination, as detailed in the Table Table33. Participants follow-up schedule The primary outcome is the uptake of modern contraceptive methods at 6 months postpartum (proportion of women using modern contraceptives at 6 months in the experimental vs. control group). Secondary outcomes are related to health indicators, services delivered and service utilization, as detailed in the Table Table4,4, along with their definition and/or measurement process. Maternal infections will be considered for clinical signs of postpartum infection in mothers before discharge from hospital. Early neonatal infections will be considered as reported by health care providers in the patient file or based on obvious clinical signs of neonatal infection (fever, hypothermia, jaundice). Secondary outcomes of interest According to the Population Division of the United Nations Department of Economic and Social Affairs, the modern contraceptive prevalence among married or in union women in 2020 was estimated at 22.4% Cote d’Ivoire, 28.1% for Burkina Faso and 15.1% for Niger [26]. Considering an improvement of 15% in this proportion, attributable to the intervention, with a power of 80%, a significance level of 5%, and finally an intraclass correlation coefficient of 0.015, Cote d’Ivoire will have the largest sample size, about 88 women per cluster. By increasing the size by 15% to take into account any lost to follow-up related to travel, we’ll have a size of 102 women per health facility, meaning a total of 306 women per group in Cote d’Ivoire, and 268, and 172 per group in Burkina Faso and Niger, respectively. It is important to mention that the project health centers in each country were considered as clusters.And since the number of clusters is known in each country, we calculated the number of participants to be included so that the study have a good power. Details for each country are provided in the Table Table55. Parameters used for sample size calculation Data will be collected through direct interview with health facility clients and extraction of data from health facility registers. Direct interview with health facility clients: They will be carried out with the study participants at the various follow-up points. Data will be collected from a standardized questionnaire integrated into electronic tablets.Interviews will be carried out in health centers on the day of the woman’s consultation at her convenience. Otherwise, the interviewer will get in touch with the participant to agree on a day and place for the interview. In addition, these interviews will comply to barrier measures against Covid-19 (wearing a mask and a maintaining a distance of at least one meter between the investigator and the respondent). Data extraction: Data will be extracted from health facilities registers (ANC, Childbirth, post-natal care, Immunization). Data will be collected by six females interviewers per country who speak the local languages. They will be trained for 1 week on the study procedures and the content of the questionnaire. Data quality control procedures will be put in place to ensure that accurate data are recorded in the registers and entered into the database. Guidelines for data collection and the establishment of a registration register will be produced. In order to ensure that data will be collected in a standardized way in all participating health facilities, a pilot test of data collection and data management will be carried out before the beginning of baseline data collection. Data quality reports will be produced regularly for each health facility. Site control supervisions in the participating health facilities will be carried out regularly and a verification of the source data will be carried out to ensure that the data collected is accurate, complete, precise and reliable. The supervisions will be carried out by the principal investigator and the country co-investigators. A statistical analysis plan will be developed. Descriptive statistics will be reported by calculating frequencies and percentages for categorical variables and means, standard deviations, and minimum and maximum values for the continuous variables if they are normally distributed. Since the main outcome is contraceptive use, we will use generalized linear models (binomial log or log Poisson) to assess the effect of interventions on the ratio of contraceptive use prevalence between the two groups of the study at a significance level of 5%, while taking into account the cluster effect and adjusting for potential confounding factors (socio-demographic characteristics of women unevenly distributed at inclusion). All bi and multivariate analyzes will be carried out by intention to treat, including all women, whether or not they continued to visit health centers after inclusion. The unit of analysis will therefore be the woman. The analyzes will be carried out with Stata. This protocol has been approved by the Institutional Review Committee of Intrahealth International as well as the respective ethical committees of the selected countries. To ensure the safety and well-being of participants (healthcare providers and pregnant women) and to ensure no harm to them for this study, the team will take the following measures: There will be no risk to women who decide not to participate in the study. Women who will not consent to participate in the study will receive the same care and access to services as those who have consented to participate in the study. If a condition warranting referral (including domestic violence, substance abuse, HIV counseling and testing, or any other relevant condition) is detected during the provision of antenatal care services (as part of this research), the study team will ensure that the woman is correctly referred and that the appropriate standard referral procedures are followed. The published data will be depersonalized, described in a comprehensive manner, if possible and the anonymity of the participants will be preserved at all times. This study will last 18 months, from July 2021 to December 2022 as follows:

Materials

N/A

Innovations

Based on the provided information, the innovation being implemented to improve access to maternal health is the integration of maternal and child health services, nutrition, and family planning services. This service delivery model aims to provide a comprehensive package of care to pregnant women, including postpartum family planning (PPFP), maternal and child health (MCH) services, and nutrition services.

The key components of this innovation include:

1. Integration of services: The model integrates PPFP, MCH, and nutrition services into a single package of care. This means that pregnant women receive these services during the same client visit, based on their needs and the standards of care.
2. Multiple points of contact: The integrated services are offered at four points of contact in the health facility: antenatal care, childbirth, postnatal care, and infant wellness visits. This ensures that women have access to the necessary care throughout the continuum of maternal and child health.
3. Longitudinal follow-up: Women will be followed up to 6 months after childbirth, and they will be interviewed at each antenatal visit and during visits for infant vaccines. This allows for a better understanding of the factors influencing women’s decision-making on the use of PPFP services.
4. Quasi-experimental study design: The effectiveness of the service delivery model will be assessed through a quasi-experimental study with an intervention group and a control group. The intervention group will receive the integrated services, while the control group will receive standard care. The study will use generalized linear models to analyze the effect of the intervention on contraceptive use prevalence.

By integrating these services and providing comprehensive care, this innovation aims to improve access to maternal health services, including postpartum family planning, in Burkina Faso, Cote d’Ivoire, and Niger.

AI Innovations Description

The recommendation to improve access to maternal health in Burkina Faso, Cote d’Ivoire, and Niger is to implement a service delivery model that integrates maternal and child health services, nutrition, and family planning services. This model aims to address the limited evidence on the effectiveness of integrating these services and guide program efforts and policy action.

The study will be conducted as a quasi-experimental study with one intervention group and one control group of 3 to 4 health facilities in each country. The intervention group will receive the full package of integrated postpartum family planning (PPFP), maternal and child health (MCH), and nutrition services, while the control group will receive standard care.

Pregnant women up to 28 weeks of gestational age will be recruited at the antenatal care (ANC) unit and followed up to 6 months after childbirth. They will be interviewed at each ANC visit and during visits for infant vaccines. The primary outcome of the study is the uptake of modern contraceptive methods at 6 months postpartum.

The study will assess the effect of the intervention on the ratio of contraceptive use prevalence between the two groups, taking into account the cluster effect and adjusting for potential confounding factors. The data will be analyzed using generalized linear models.

The study aims to increase the body of knowledge regarding the impact of integrating maternal and child health services on the utilization of postpartum family planning in the specific context of sub-Saharan Africa French-speaking countries.

This recommendation is part of the INSPiRE initiative, which supports the nine countries of the Ouagadougou Partnership in intensifying their efforts to improve maternal and child health and family planning services. Burkina Faso, Cote d’Ivoire, and Niger have been selected as pilot countries for the implementation of the integrated health service delivery model.

The study protocol has been approved by the Institutional Review Committee of Intrahealth International and the respective ethical committees of the selected countries. Measures will be taken to ensure the safety and well-being of participants, and data will be collected and analyzed in a standardized and ethical manner.

The study is expected to contribute to the improvement of access to maternal health services and the utilization of postpartum family planning in Burkina Faso, Cote d’Ivoire, and Niger.

AI Innovations Methodology

Based on the provided description, the study aims to assess the effectiveness of a service delivery model that integrates maternal and child health services, nutrition, and family planning services in Burkina Faso, Cote d’Ivoire, and Niger. The goal is to improve access to postpartum family planning (PPFP) at 6 months postpartum.

To simulate the impact of these recommendations on improving access to maternal health, a quasi-experimental study design will be used. The study will have one intervention group and one control group in each country, with 3 to 4 health facilities in each group. The intervention group will receive the integrated package of PPFP/MNCH/Nutrition services, while the control group will receive standard care.

The study participants will be pregnant women attending their first antenatal care visit. They will be followed up to 6 months after childbirth, and data will be collected through interviews at each antenatal visit and during visits for infant vaccines. The primary outcome will be the uptake of modern contraceptive methods at 6 months postpartum.

The impact of the intervention will be assessed using intention-to-treat analysis, taking into account the cluster effect and adjusting for potential confounding factors. Generalized linear models, such as binomial log or log Poisson models, will be used to compare the prevalence of contraceptive use between the intervention and control groups.

The study will collect data through direct interviews with health facility clients and data extraction from health facility registers. Data quality control procedures will be implemented to ensure accurate and reliable data collection. Descriptive statistics will be reported, and statistical analyses will be conducted using software like Stata.

The study protocol has been approved by the Institutional Review Committee of Intrahealth International and the ethical committees of the selected countries to ensure the safety and well-being of participants. Measures will be taken to protect the privacy and confidentiality of participants, and no harm will come to those who choose not to participate.

The study is scheduled to last for 18 months, from July 2021 to December 2022.

Author

Dima Health

Identifiers:

DOI: 10.1186/s12978-022-01467-x

Research Areas:

Community Interventions, COVID, Food Security, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Substance Abuse, Violence and Injury, Workforce

Study Countries:

Burkina Faso, Ivory Coast, Multi-Countries, Niger

Study Design:

Cohort Study, Cross Sectional Study, Grounded Theory, Phenomenological Study, Quasi Experimental Study, randomised-control-trial

Study Approach:

Mixed-methods, Quantitative, Systematic Review

Participants Gender:

Female