Accuracy of assessment of eligibility for early medical abortion by community health workers in Ethiopia, India and South Africa

 

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dc.contributor.author Johnston, Heidi Bart en_ZA
dc.contributor.author Ganatra, Bela en_ZA
dc.contributor.author Nguyen, My Huong en_ZA
dc.contributor.author Habib, Ndema en_ZA
dc.contributor.author Afework, Mesganaw Fantahun en_ZA
dc.contributor.author Harries, Jane en_ZA
dc.contributor.author Iyengar, Kirti en_ZA
dc.contributor.author Moodley, Jennifer en_ZA
dc.contributor.author Lema, Hailu Yeneneh en_ZA
dc.contributor.author Constant, Deborah en_ZA
dc.contributor.author Sen, Swapnaleen en_ZA
dc.date.accessioned 2016-03-08T10:53:24Z
dc.date.available 2016-03-08T10:53:24Z
dc.date.issued 2016 en_ZA
dc.identifier.citation Johnston, H. B., Ganatra, B., Nguyen, M. H., Habib, N., Afework, M. F., Harries, J., ... & Sen, S. (2016). Accuracy of assessment of eligibility for early medical abortion by community health workers in Ethiopia, India and South Africa. PloS one, 11(1). doi:10.1371/journal.pone.0146305 en_ZA
dc.identifier.uri http://dx.doi.org/10.1371/journal.pone.0146305 en_ZA
dc.identifier.uri http://hdl.handle.net/11427/17568
dc.description.abstract Objective To assess the accuracy of assessment of eligibility for early medical abortion by community health workers using a simple checklist toolkit. Design Diagnostic accuracy study. Setting Ethiopia, India and South Africa. METHODS: Two hundred seventeen women in Ethiopia, 258 in India and 236 in South Africa were enrolled into the study. A checklist toolkit to determine eligibility for early medical abortion was validated by comparing results of clinician and community health worker assessment of eligibility using the checklist toolkit with the reference standard exam. RESULTS: Accuracy was over 90% and the negative likelihood ratio <0.1 at all three sites when used by clinician assessors. Positive likelihood ratios were 4.3 in Ethiopia, 5.8 in India and 6.3 in South Africa. When used by community health workers the overall accuracy of the toolkit was 92% in Ethiopia, 80% in India and 77% in South Africa negative likelihood ratios were 0.08 in Ethiopia, 0.25 in India and 0.22 in South Africa and positive likelihood ratios were 5.9 in Ethiopia and 2.0 in India and South Africa. CONCLUSION: The checklist toolkit, as used by clinicians, was excellent at ruling out participants who were not eligible, and moderately effective at ruling in participants who were eligible for medical abortion. Results were promising when used by community health workers particularly in Ethiopia where they had more prior experience with use of diagnostic aids and longer professional training. The checklist toolkit assessments resulted in some participants being wrongly assessed as eligible for medical abortion which is an area of concern. Further research is needed to streamline the components of the tool, explore optimal duration and content of training for community health workers, and test feasibility and acceptability. en_ZA
dc.language.iso eng en_ZA
dc.publisher Public Library of Science en_ZA
dc.rights This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. en_ZA
dc.rights.uri http://creativecommons.org/licenses/by/4.0 en_ZA
dc.source PLoS One en_ZA
dc.source.uri http://journals.plos.org/plosone en_ZA
dc.subject.other Termination of pregnancy en_ZA
dc.subject.other India en_ZA
dc.subject.other Ethiopia en_ZA
dc.subject.other South Africa en_ZA
dc.subject.other Pregnancy en_ZA
dc.subject.other Obstetrics and gynecology en_ZA
dc.subject.other Public and occupational health en_ZA
dc.title Accuracy of assessment of eligibility for early medical abortion by community health workers in Ethiopia, India and South Africa en_ZA
dc.type Journal Article en_ZA
dc.rights.holder © 2016 Johnston et al en_ZA
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Women's Health Research Unit en_ZA
uct.type.filetype Text
uct.type.filetype Image


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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Except where otherwise noted, this item's license is described as This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.