<div class="section">
<a class="named-anchor" id="d930097e256">
<!--
named anchor
-->
</a>
<h5 class="title" id="d930097e257">Background</h5>
<p id="d930097e259">In rural Burkina Faso, a package of six low-technology, post-partum
contraceptive
interventions (ie, refresher training for providers, a counselling tool, supportive
supervision, daily availability of contraceptive services, client appointment cards,
and invitation letters to attend appointments for partners), aimed at strengthening
existing primary health-care services and enhancing demand for them, doubled the use
of modern contraceptives at 12 months post partum (ie, 55% uptake in intervention
recipients
<i>vs</i> 29% in routine-care users). This study assessed the effect of a similar
package but
in urban settings of Kinshasa province, Democratic Republic of the Congo, in an effort
to reduce the unmet need for post-partum family planning.
</p>
</div><div class="section">
<a class="named-anchor" id="d930097e264">
<!--
named anchor
-->
</a>
<h5 class="title" id="d930097e265">Methods</h5>
<p id="d930097e267">Yam Daabo was a multi-intervention, single-blinded, cluster-randomised
controlled
trial done in six primary health-care centres (clusters) in Kinshasa. Centres were
randomly allocated to receive the six-component intervention or standard antenatal
and postnatal care in matched pairs (1:1) on the basis of number of monthly births,
the ratio of health workers per population in the health zone, and the urban and suburban
settings. Only data analysts could be masked to cluster allocation. Health-care facilities
were eligible if they provided a continuum of antenatal, delivery, and postnatal care,
were well stocked with contraceptives, and were situated close to the main study centre.
All pregnant women presenting to the six centres were eligible if they were in their
third pregnancy trimester and had no counterindications to deliver in the facility.
The main outcome was prevalence of use of modern contraceptives at 12 months after
delivery. Analysis was by modified intention-to-treat using generalised linear mixed
models or Fisher's exact test for small groups. Prevalence ratios were adjusted for
cluster effects and baseline characteristics. This study was registered with the Pan-African
Clinical Trials Registry (PACTR201609001784334).
</p>
</div><div class="section">
<a class="named-anchor" id="d930097e269">
<!--
named anchor
-->
</a>
<h5 class="title" id="d930097e270">Findings</h5>
<p id="d930097e272">From July 1, 2016, to Feb 2, 2017, eight of 52 clinics assessed
for eligibility met
the criteria and were randomised. Of 690 women approached, 576 (83%) women were enrolled:
286 in the four intervention clusters and 290 in the four control clusters. Of them,
519 (90%) completed the 12-month study exit interview (252 in the intervention group
and 267 in the control group) and were included in the intention-to-treat analysis.
At 12 months, 115 (46%) of 252 women in the intervention group and 94 (35%) of 267
in the control group were using modern contraceptives (adjusted prevalence ratio [PR]
1·58, 95% CI 0·74–3·38), with significant differences in the use of contraceptive
implants (22%
<i>vs</i> 6%; adjusted PR 4·36, 95% CI 1·96–9·70), but without difference in the use
of short-acting
contraceptives (23%
<i>vs</i> 28%; 0·92, 0·29–2·98) and non-modern or inappropriate methods (7%
<i>vs</i> 18%; 0·45, 0·13–1·54). There were no serious adverse events or maternal
deaths related
to the study.
</p>
</div><div class="section">
<a class="named-anchor" id="d930097e283">
<!--
named anchor
-->
</a>
<h5 class="title" id="d930097e284">Interpretation</h5>
<p id="d930097e286">The Yam Daabo intervention package did not have a significant
effect on the overall
use of effective modern contraceptives but significantly increased implant use in
women post partum who live in urban settings in Kinshasa up to a year after childbirth.
However, interferences from external family planning initiatives in the control group
might have diminished differences between the services received. Such an intervention
could be potentially relevant in similar contexts in DR Congo and other countries.
</p>
</div><div class="section">
<a class="named-anchor" id="d930097e288">
<!--
named anchor
-->
</a>
<h5 class="title" id="d930097e289">Funding</h5>
<p id="d930097e291">Government of France; UNDP/UNFPA/UNICEF/WHO/World Bank Special
Programme of Research,
Development and Research Training in Human Reproduction.
</p>
</div>