Impact and Performance of Institutionalizing Immediate Post-partum IUD Services

NCT ID: NCT02718222

Last Updated: 2019-08-08

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

140258 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-09-30

Study Completion Date

2018-12-31

Brief Summary

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Studying the impact and performance of institutionalizing immediate post-partum IUD services as a routine part of antenatal counselling and delivery room services in Sri Lanka, Tanzania, and Nepal.

Detailed Description

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The International Federation of Gynaecology and Obstetrics (FIGO) has designed and is planning to implement, through its nationally-affiliated Associations of Gynaecologists and Obstetricians, an intervention program on post-partum IUD (PPIUD) services. As part of this Program, FIGO is responsible for information material, training providers, improving facilities, quality of service, and monitoring the program. Independent of the implementation, this study will measure the impact and performance of this intervention in three (Sri Lanka, Nepal and Tanzania) of the six countries participating in the FIGO project entitled: "Institutionalization of immediate post-partum IUD (PPIUD) services as a routine part of antenatal counselling and delivery room services in Sri Lanka, Kenya, India, Tanzania, Nepal and Bangladesh." The FIGO intervention will take place over a nine-month period in Tanzania (nine months in the first group of three hospitals and three months in the second group of three hospitals), and over a fifteen-month period in Nepal and Sri Lanka (fifteen months in the first group of three hospitals and nine months in the second group of three hospitals). Investigators will study both the impact of the intervention on the uptake and subsequent continued use of PPIUD and the extent to which the intervention leads to the institutionalization of postpartum IUD services in the hospitals during and after the FIGO intervention and to what extent the service diffuses to other hospitals or providers. The institutionalization and diffusion of the intervention will be measured by interviewing and following up trained providers, review of hospital records and baseline, during intervention and post-intervention facility surveys.

Conditions

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Contraception

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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3-9 months PPIUD intervention

Tanzania: Baseline (no intervention) period is 9 months. Post-partum IUD intervention begins after 9 months and continues for 3 months.

Nepal and Sri Lanka: Baseline (no intervention) period is 9 months. Post-partum IUD intervention begins after 9 months and continues for 9 months.

Group Type EXPERIMENTAL

Post-partum IUD

Intervention Type DEVICE

The PPIUD intervention aims to address the postpartum contraceptive needs of women by training community midwives, health workers, doctors and delivery unit staff in postpartum IUD counselling and insertion.

9-15 months PPIUD intervention

Tanzania: Baseline (no intervention) period is 3 months. Post-partum IUD intervention begins after 3 months and continues for 9 months.

Nepal and Sri Lanka: Baseline (no intervention) period is 3 months. Post-partum IUD intervention begins after 3 months and continues for 15 months.

Group Type EXPERIMENTAL

Post-partum IUD

Intervention Type DEVICE

The PPIUD intervention aims to address the postpartum contraceptive needs of women by training community midwives, health workers, doctors and delivery unit staff in postpartum IUD counselling and insertion.

Interventions

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Post-partum IUD

The PPIUD intervention aims to address the postpartum contraceptive needs of women by training community midwives, health workers, doctors and delivery unit staff in postpartum IUD counselling and insertion.

Intervention Type DEVICE

Other Intervention Names

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PPIUD

Eligibility Criteria

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Inclusion Criteria

* Delivered in intervention hospital during 12-month enrollment period (Tanzania)/18-month enrollment period (Nepal and Sri Lanka)

Exclusion Criteria

* Does not live in the country where delivered
* Tanzania only: Under age 18
Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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International Federation of Gynaecology and Obstetrics

OTHER

Sponsor Role collaborator

Harvard School of Public Health (HSPH)

OTHER

Sponsor Role lead

Responsible Party

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Iqbal Shah

Principal Research Scientist

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Iqbal H Shah, PhD

Role: PRINCIPAL_INVESTIGATOR

Harvard School of Public Health (HSPH)

David Canning, PhD

Role: PRINCIPAL_INVESTIGATOR

Harvard School of Public Health (HSPH)

Locations

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Center for Research on Enviornment Health and Population Activities

Kathmandu, , Nepal

Site Status

Sri Lanka College of Obstetricians and Gynecologists

Colombo, , Sri Lanka

Site Status

Management and Development for Health

Dar es Salaam, , Tanzania

Site Status

Countries

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Nepal Sri Lanka Tanzania

References

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Murray E, Treweek S, Pope C, MacFarlane A, Ballini L, Dowrick C, Finch T, Kennedy A, Mair F, O'Donnell C, Ong BN, Rapley T, Rogers A, May C. Normalisation process theory: a framework for developing, evaluating and implementing complex interventions. BMC Med. 2010 Oct 20;8:63. doi: 10.1186/1741-7015-8-63.

Reference Type BACKGROUND
PMID: 20961442 (View on PubMed)

Hernan MA, Brumback B, Robins JM. Marginal structural models to estimate the causal effect of zidovudine on the survival of HIV-positive men. Epidemiology. 2000 Sep;11(5):561-70. doi: 10.1097/00001648-200009000-00012.

Reference Type BACKGROUND
PMID: 10955409 (View on PubMed)

Gong Q, Schaubel DE. Partly conditional estimation of the effect of a time-dependent factor in the presence of dependent censoring. Biometrics. 2013 Jun;69(2):338-47. doi: 10.1111/biom.12023. Epub 2013 May 2.

Reference Type BACKGROUND
PMID: 23635094 (View on PubMed)

Eroglu K, Akkuzu G, Vural G, Dilbaz B, Akin A, Taskin L, Haberal A. Comparison of efficacy and complications of IUD insertion in immediate postplacental/early postpartum period with interval period: 1 year follow-up. Contraception. 2006 Nov;74(5):376-81. doi: 10.1016/j.contraception.2006.07.003. Epub 2006 Sep 15.

Reference Type BACKGROUND
PMID: 17046378 (View on PubMed)

Govindarajulu US, Spiegelman D, Thurston SW, Ganguli B, Eisen EA. Comparing smoothing techniques in Cox models for exposure-response relationships. Stat Med. 2007 Sep 10;26(20):3735-52. doi: 10.1002/sim.2848.

Reference Type BACKGROUND
PMID: 17538974 (View on PubMed)

Ross John A. and Winfrey William L. Contraceptive use, intention to use and unmet need during the extended postpartum period. International Family Planning Perspectives, 2001, 27(1): 20-27.

Reference Type BACKGROUND

Rotnitzky A, Robins JM. Semiparametric regression estimation in the presence of dependent censoring. Biometrika. 1995 Dec;82(4):805-20.

Reference Type BACKGROUND

Winfrey, William and Rakesh Kshitiz. Use of Family Planning in Postpartum Period. DHS Comparative Report No. 36. 2014. Rockville, Maryland, USA: ICF International.

Reference Type BACKGROUND

Medical Eligibility Criteria for Contraceptive Use: A WHO Family Planning Cornerstone. 4th edition. Geneva: World Health Organization; 2010. Available from http://www.ncbi.nlm.nih.gov/books/NBK138639/

Reference Type BACKGROUND
PMID: 23741782 (View on PubMed)

Chen BA, Reeves MF, Hayes JL, Hohmann HL, Perriera LK, Creinin MD. Postplacental or delayed insertion of the levonorgestrel intrauterine device after vaginal delivery: a randomized controlled trial. Obstet Gynecol. 2010 Nov;116(5):1079-87. doi: 10.1097/AOG.0b013e3181f73fac.

Reference Type BACKGROUND
PMID: 20966692 (View on PubMed)

Kapp N, Curtis KM. Intrauterine device insertion during the postpartum period: a systematic review. Contraception. 2009 Oct;80(4):327-36. doi: 10.1016/j.contraception.2009.03.024. Epub 2009 Aug 29.

Reference Type BACKGROUND
PMID: 19751855 (View on PubMed)

Grimes DA, Lopez LM, Schulz KF, Stanwood NL. Immediate postabortal insertion of intrauterine devices. Cochrane Database Syst Rev. 2010 Jun 16;(6):CD001777. doi: 10.1002/14651858.CD001777.pub3.

Reference Type BACKGROUND
PMID: 20556754 (View on PubMed)

McKaig, Catherine and Blanchard, Holly. The IUD: A contraceptive option for postpartum and postabortion women. Access/USAID.

Reference Type BACKGROUND

Mohamed SA, Kamel MA, Shaaban OM, Salem HT. Acceptability for the use of postpartum intrauterine contraceptive devices: Assiut experience. Med Princ Pract. 2003 Jul-Sep;12(3):170-5. doi: 10.1159/000070754.

Reference Type BACKGROUND
PMID: 12766335 (View on PubMed)

Bryant AG, Kamanga G, Stuart GS, Haddad LB, Meguid T, Mhango C. Immediate postpartum versus 6-week postpartum intrauterine device insertion: a feasibility study of a randomized controlled trial. Afr J Reprod Health. 2013 Jun;17(2):72-9.

Reference Type BACKGROUND
PMID: 24069753 (View on PubMed)

Arrowsmith ME, Aicken CR, Saxena S, Majeed A. Strategies for improving the acceptability and acceptance of the copper intrauterine device. Cochrane Database Syst Rev. 2012 Mar 14;2012(3):CD008896. doi: 10.1002/14651858.CD008896.pub2.

Reference Type BACKGROUND
PMID: 22419340 (View on PubMed)

Hussey MA, Hughes JP. Design and analysis of stepped wedge cluster randomized trials. Contemp Clin Trials. 2007 Feb;28(2):182-91. doi: 10.1016/j.cct.2006.05.007. Epub 2006 Jul 7.

Reference Type BACKGROUND
PMID: 16829207 (View on PubMed)

Pagel C, Prost A, Lewycka S, Das S, Colbourn T, Mahapatra R, Azad K, Costello A, Osrin D. Intracluster correlation coefficients and coefficients of variation for perinatal outcomes from five cluster-randomised controlled trials in low and middle-income countries: results and methodological implications. Trials. 2011 Jun 14;12:151. doi: 10.1186/1745-6215-12-151.

Reference Type BACKGROUND
PMID: 21672223 (View on PubMed)

Ali MMS, Rachael K, Cleland John, Ngo Thoai D, and Shah Iqbal H. Long-term contraceptive protection, discontinuation and switching behaviour: intrauterine device (IUD) use dynamics in 14 developing countries. London: World Health Organization and Marie Stopes International, 2011.

Reference Type BACKGROUND

Family Health Bureau MoH, Sri Lanka. Annual Report on Family Health 2012. Colombo, Sri Lanka: Ministry of Health, Sri Lanka, 2012.

Reference Type BACKGROUND

Ministry of Health and Population (MOHP) [Nepal], New ERA, and ICF International Inc. Nepal Demographic and Health Survey 2011. Kathmandu, Nepal: Ministry of Health and Population, New ERA, and ICF International, Calverton, Maryland, 2012.

Reference Type BACKGROUND

Pearson E, Senderowicz L, Pradhan E, Francis J, Muganyizi P, Shah I, Canning D, Karra M, Ulenga N, Barnighausen T. Effect of a postpartum family planning intervention on postpartum intrauterine device counseling and choice: evidence from a cluster-randomized trial in Tanzania. BMC Womens Health. 2020 May 12;20(1):102. doi: 10.1186/s12905-020-00956-0.

Reference Type DERIVED
PMID: 32398077 (View on PubMed)

Karra M, Pearson E, Pradhan E, de Silva R, Samarasekera A, Canning D, Shah I, Weerasekera D, Senanayake H. The effect of a postpartum IUD intervention on counseling and choice: Evidence from a cluster-randomized stepped-wedge trial in Sri Lanka. Trials. 2019 Jul 8;20(1):407. doi: 10.1186/s13063-019-3473-6.

Reference Type DERIVED
PMID: 31287021 (View on PubMed)

Pradhan E, Canning D, Shah IH, Puri M, Pearson E, Thapa K, Bajracharya L, Maharjan M, Maharjan DC, Bajracharya L, Shakya G, Chaudhary P. Integrating postpartum contraceptive counseling and IUD insertion services into maternity care in Nepal: results from stepped-wedge randomized controlled trial. Reprod Health. 2019 May 29;16(1):69. doi: 10.1186/s12978-019-0738-1.

Reference Type DERIVED
PMID: 31142344 (View on PubMed)

Pradhan E, Pearson E, Puri M, Maharjan M, Maharjan DC, Shah I. Determinants of imbalanced sex ratio at birth in Nepal: evidence from secondary analysis of a large hospital-based study and nationally-representative survey data. BMJ Open. 2019 Jan 30;9(1):e023021. doi: 10.1136/bmjopen-2018-023021.

Reference Type DERIVED
PMID: 30705238 (View on PubMed)

Canning D, Shah IH, Pearson E, Pradhan E, Karra M, Senderowicz L, Barnighausen T, Spiegelman D, Langer A. Institutionalizing postpartum intrauterine device (IUD) services in Sri Lanka, Tanzania, and Nepal: study protocol for a cluster-randomized stepped-wedge trial. BMC Pregnancy Childbirth. 2016 Nov 21;16(1):362. doi: 10.1186/s12884-016-1160-0.

Reference Type DERIVED
PMID: 27871269 (View on PubMed)

Other Identifiers

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6904190-01

Identifier Type: -

Identifier Source: org_study_id

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