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.authorJohnston, Heidi Barten_ZA
dc.contributor.authorGanatra, Belaen_ZA
dc.contributor.authorNguyen, My Huongen_ZA
dc.contributor.authorHabib, Ndemaen_ZA
dc.contributor.authorAfework, Mesganaw Fantahunen_ZA
dc.contributor.authorHarries, Janeen_ZA
dc.contributor.authorIyengar, Kirtien_ZA
dc.contributor.authorMoodley, Jenniferen_ZA
dc.contributor.authorLema, Hailu Yenenehen_ZA
dc.contributor.authorConstant, Deborahen_ZA
dc.contributor.authorSen, Swapnaleenen_ZA
dc.date.accessioned2016-03-08T10:53:24Z
dc.date.available2016-03-08T10:53:24Z
dc.date.issued2016en_ZA
dc.description.abstractObjective 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.identifier.apacitationJohnston, 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. <i>PLoS One</i>, http://hdl.handle.net/11427/17568en_ZA
dc.identifier.chicagocitationJohnston, Heidi Bart, Bela Ganatra, My Huong Nguyen, Ndema Habib, Mesganaw Fantahun Afework, Jane Harries, Kirti Iyengar, et al "Accuracy of assessment of eligibility for early medical abortion by community health workers in Ethiopia, India and South Africa." <i>PLoS One</i> (2016) http://hdl.handle.net/11427/17568en_ZA
dc.identifier.citationJohnston, 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.0146305en_ZA
dc.identifier.ris TY - Journal Article AU - Johnston, Heidi Bart AU - Ganatra, Bela AU - Nguyen, My Huong AU - Habib, Ndema AU - Afework, Mesganaw Fantahun AU - Harries, Jane AU - Iyengar, Kirti AU - Moodley, Jennifer AU - Lema, Hailu Yeneneh AU - Constant, Deborah AU - Sen, Swapnaleen AB - 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. DA - 2016 DB - OpenUCT DO - 10.1371/journal.pone.0146305 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2016 T1 - Accuracy of assessment of eligibility for early medical abortion by community health workers in Ethiopia, India and South Africa TI - Accuracy of assessment of eligibility for early medical abortion by community health workers in Ethiopia, India and South Africa UR - http://hdl.handle.net/11427/17568 ER - en_ZA
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0146305en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/17568
dc.identifier.vancouvercitationJohnston HB, Ganatra B, Nguyen MH, Habib N, Afework MF, Harries J, et al. Accuracy of assessment of eligibility for early medical abortion by community health workers in Ethiopia, India and South Africa. PLoS One. 2016; http://hdl.handle.net/11427/17568.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentWomen's Health Research Uniten_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis 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.holder© 2016 Johnston et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherTermination of pregnancyen_ZA
dc.subject.otherIndiaen_ZA
dc.subject.otherEthiopiaen_ZA
dc.subject.otherSouth Africaen_ZA
dc.subject.otherPregnancyen_ZA
dc.subject.otherObstetrics and gynecologyen_ZA
dc.subject.otherPublic and occupational healthen_ZA
dc.titleAccuracy of assessment of eligibility for early medical abortion by community health workers in Ethiopia, India and South Africaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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