Best Free Communication
Results from a randomised controlled trial of an mHealth intervention to increase post-menstrual regulation contraceptive use in Bangladesh
Kate Reiss, London School of Hygiene & Tropical Medicine and Marie Stopes International, United Kingdom; Kathryn Andersen, Ipas, United States; Manuela Colombini, London School of Hygiene & Tropical Medicine, United Kingdom; Loraine Bacchus, London School of Hygiene & Tropical Medicine, United Kingdom; Erin Pearson, Ipas, United States; Caroline Free, London School of Hygiene & Tropical Medicine, United Kingdom; Tanzila Tabassum, Marie Stopes Bangladesh, Bangladesh; Katharine Footman, Marie Stopes International, United Kingdom; Kamal Biswas, Ipas Bangladesh, Bangladesh; Mobarak Hossain, Marie Stopes Bangladesh, Bangladesh; Jamie Menzel, Ipas, Bangladesh;
Presenter: Kathryn Church, Marie Stopes International, United Kingdom
Objectives: In Bangladesh, women undergoing menstrual regulation (MR) (an approved procedure to regulate menstruation in women at risk of pregnancy) are a key group to target with contraceptive services. We used a randomised controlled trial to evaluate an intervention delivered by mobile phone which was designed to promote contraceptive use among MR clients in Bangladesh.
Methods: In 2015/2016, we recruited 972 women after their MR procedure from 41 facilities, and randomised them to intervention or control groups. The intervention group were sent 11 automated, interactive voice messages with optional call centre counselling over 4-months post-MR. The primary outcome was self-reported LARC (long acting reversible contraceptive) use at four months post-MR; secondary outcomes were use of any effective modern method, subsequent pregnancy or MR and intimate partner violence (IPV).
We used Logistic regression modelling to calculate odds ratios, allowing adjustment for baseline differences between the groups among pre-defined variables. In 2017, we conducted in-depth interviews (IDIs) with 30 trial participants to explore the intervention effects/non-effects.
Results: We interviewed 773 participants (80%) at 4-months. Full details of the results from the trial and IDIs will be presented at the conference. Many IDI participants reported that they learnt more about contraception from the intervention however some women faced barriers to accessing the automated content due to low phone literacy. IDIs indicated a high frequency of phone sharing and that women’s phone use is sometimes monitored or controlled by others in the home. The majority of IDI participants had told their husbands about the study and their MR.
Conclusions: These findings highlight the importance of considering familial contexts when designing interventions that reach into homes. The results of this trial will help us to understand whether this type of intervention can be successfully translated to the Bangladesh context.
Extending medical home abortion up to 70 days’ gestational age in a Swedish setting- an interim analysis
Volodymyr Podolskyi, Karolinska Institutet, Sweden; Lena Maltzman, Södersjukhuset, Sweden; Kristina Gemzell-Danielsson, Karolinska Institute, Sweden; Lena Marions, Karolinska Institutet, Sweden
Objectives To evaluate the efficacy and acceptability of home administration of misoprostol up to 70 days’ gestational age
Methods Women seeking medical home abortion up to 70 days were invited to participate in the study. They were stratified in two groups due to gestational length, up to 63 days or 64-70 days. In both groups Mifepristone was administered at the clinic and Misoprostol was administered by the woman at home 24-48 hours later. Primary outcome was success of treatment, defined as complete abortion without the need for further intervention. Secondary outcomes were adverse events, reported pain and level of satisfaction. Required sample size was calculated to be 500 participants.
Results This is an interim report after inclusion of 112 subjects,77 in the early group and 55 in the late group. Primary outcome was assessed for 62 women in the early group and 50 women from the late group. Mean age of the participants was similar 27.5 years (18-46) and 29 years (18-44) for early and late groups respectively. Success rate was 95.2% for the early group and 96% for the late group. In the late group one ongoing pregnancy was found and the pregnancy was terminated medically. Surgical intervention was performed in one woman in the early group and two in the late group. Medical interventions were performed in three cases in the early group and in two cases in the late group. Total days of bleeding were 13.7 + 5.6 in the early group and 16 + 7.2 in the late group. Most women in both groups found the abortion method acceptable regardless of gestational length.
Conclusions The preliminary results support that home use of misoprostol in medical abortion is safe and well accepted up to 70 days of gestation.
Best Young Researcher
Increase of manual vacuum aspiration in the treatment of incomplete abortions in Malawi
Maria Lisa Odland, Norwegian University of Science and Technology, Norway; Gladys Membe-Gadama, Queen Elizabeth Central Hospital, Malawi; Ursula Kafulafula Kamuzu College of Nursing, Malawi; Elisabeth Darj, Norwegian University of Science and Technology; Norway
Objectives: The overall main objective of this study is to improve post abortion care in Malawi by increasing the use of manual vacuum aspiration (MVA) in the treatment of incomplete abortions. More specifically our aim is to investigate if an intervention of training health personnel could increase the safer and cheaper method of MVA by 15%.
Methods: A prospective cross-sectional assessment of the pre/post use of MVA was performed at three public hospitals in Malawi. Health personnel at these hospitals were trained in MVA using theory and practice in April 2016. Two hospitals served as controls. Ethical approval was obtained from Malawian and Norwegian Ethics Committees.
Results: The intervention was successful with an overall increase of 21.3% in the use of MVA after one year. The control hospitals only had 3.0% increase during the same time period.
Conclusion: Training health personnel in using MVA is an efficient way of increasing a safer and cheaper method of treating incomplete abortions in Malawi. However, other factors, such as equipment, is crucial as well.