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  1. 1

    Clinical pre-introduction study of the subdermal contraceptive implant Norplant in Bolivia.

    Bolivia. Caja Nacional de Salud. Hospital Obrero No. 1. Servicio de Ginecologia; Population Council

    In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar. [2] p. (BOL-03)

    Longterm contraceptive methods, such as Norplant, are receiving broader acceptance, particularly among women who are not yet ready to consider sterilization. In countries such as Bolivia, where the availability of family planning (FP) methods remains limited, the introduction and diffusion of a culturally acceptable, safe, and effective method should contribute to an increase in contraceptive acceptance and prevalence. Therefore, in 1990, the Population Council allotted US $35,700 to a 3-year prospective clinical study of Norplant with the Hospital Obrero No. 1 of the Bolivian Caja Nacional de Salud (CNS). The project is intended to evaluate local experience in the use of Norplant to facilitate its introduction. Ultimately, it is hoped that a high quality FP clinic and training center will be established to facilitate expansion of Norplant. The project has 4 major objectives: 1) to assess the demand for Norplant; 2) to compare the sociocultural, health, and psychological characteristics of Norplant and IUD (CuT380A) acceptors; 3) to compare the clinical performance of Norplant with CuT380A; and 4) to compare the cost effectiveness of Norplant with CuT380A. The project entails 3 research components: 1) a preintroduction study to gather socioeconomic, medical, and previous contraceptive use data on all prospective and actual Norplant users (at periodic intervals, beginning when a sufficient number of volunteers have completed at least 6 months of use, statistical analysis of the method's performance will be undertaken); 2) a comparative study of Norplant and CuT380A performance; and 3) a comparison of the cost-effectiveness of the 2 methods. Results of this comparison are expected to provide the CNS with information to decide on the appropriateness of including Norplant within its FP service delivery program. It is hypothesized that the impact of this method on a FP program will be greater if Norplant does not replace other highly effective contraceptives and if acceptors are young and of low parity. Research to date indicates that the cost of Norplant insertion at CNS, including only materials and physician time, averages US $13.95, while the cost of an IUD insertion is estimated at $9.49. Adding product costs of US $22 for Norplant and $1.25 for the CuT380A yields a total insertion cost of $35.95 and $10.74, respectively. Based on these figures, the only point at which costs would approach parity is where IUD continuation averaged less than 2 years and Norplant continuation approached the maximum 5 years. Between the start-up of clinical activities in February and August 1991, 106 Norplant insertions had been performed by CNS (more than half the insertions projected for the project). The project will be expanded in 1992 to involve Servicios de Investigacion y Accion en Poblacion, a private program with extensive experience in social science research.
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  2. 2

    A diagnostic study to evaluate the prevalence of clinical and non-clinical delivery of Norplant in the Indonesian family planning program.

    Indonesia. National Family Planning Coordinating Board [BKKBN]; Population Council

    In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar. [1] p. (INS-14)

    Indonesia's national family planning (FP) program constituted the largest introduction of Norplant in the world; the first 5-year removals were scheduled for late 1991. The ANE operations research/technical assistance (OR/TA) project is conducting a use dynamics study to examine Norplant's use in the field. To prepare for that study and to get early information on program functioning, the National Family Planning Coordinating Board (BKKBN) and the Population Council, in conjunction with Andalas University in West Sumatra and BKS-PENFIN in West Java, undertook a diagnostic study in the fall of 1991 at a cost of US $6,250. Field teams investigated 6 clinics in each of the 2 provinces, interviewing service providers and examining records. 10 acceptors from each clinic (total 120) were visited in their homes to determine the feasibility of locating them and whether they were still using implants. About 70% of acceptors in each province had been served by nonclinical sources, either "safaris" or mobile teams. The 4-year life-table continuation rate was 78%. No written information specifically devoted to Norplant was available to providers or to clients. All physicians and nurse-midwives, as well as many nurses, had some training in Norplant insertion and removal. Contrary to expectation, clinical staff, records, and logistics all seemed generally adequate for 5-year removal. Results were used to address issues raised, and a final report has been completed. The feasibility of the use-dynamics study was confirmed. Available records generally matched official records, although significant gaps were found. The study allowed questionnaires and field procedures to be refined.
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