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Accuracy of Assessment of Eligibility for Early Medical Abortion by Community Health Workers in Ethiopia, India and South Africa
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...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Public Library of Science
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4701452/ https://www.ncbi.nlm.nih.gov/pubmed/26731176 http://dx.doi.org/10.1371/journal.pone.0146305 |
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author | Johnston, Heidi Bart Ganatra, Bela Nguyen, My Huong Habib, Ndema Afework, Mesganaw Fantahun Harries, Jane Iyengar, Kirti Moodley, Jennifer Lema, Hailu Yeneneh Constant, Deborah Sen, Swapnaleen |
author_facet | Johnston, Heidi Bart Ganatra, Bela Nguyen, My Huong Habib, Ndema Afework, Mesganaw Fantahun Harries, Jane Iyengar, Kirti Moodley, Jennifer Lema, Hailu Yeneneh Constant, Deborah Sen, Swapnaleen |
author_sort | Johnston, Heidi Bart |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-4701452 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-47014522016-01-15 Accuracy of Assessment of Eligibility for Early Medical Abortion by Community Health Workers in Ethiopia, India and South Africa Johnston, Heidi Bart Ganatra, Bela Nguyen, My Huong Habib, Ndema Afework, Mesganaw Fantahun Harries, Jane Iyengar, Kirti Moodley, Jennifer Lema, Hailu Yeneneh Constant, Deborah Sen, Swapnaleen PLoS One Research Article 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. Public Library of Science 2016-01-05 /pmc/articles/PMC4701452/ /pubmed/26731176 http://dx.doi.org/10.1371/journal.pone.0146305 Text en © 2016 Johnston et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited |
spellingShingle | Research Article Johnston, Heidi Bart Ganatra, Bela Nguyen, My Huong Habib, Ndema Afework, Mesganaw Fantahun Harries, Jane Iyengar, Kirti Moodley, Jennifer Lema, Hailu Yeneneh Constant, Deborah Sen, Swapnaleen Accuracy of Assessment of Eligibility for Early Medical Abortion by Community Health Workers in Ethiopia, India and South Africa |
title | Accuracy of Assessment of Eligibility for Early Medical Abortion by Community Health Workers in Ethiopia, India and South Africa |
title_full | Accuracy of Assessment of Eligibility for Early Medical Abortion by Community Health Workers in Ethiopia, India and South Africa |
title_fullStr | Accuracy of Assessment of Eligibility for Early Medical Abortion by Community Health Workers in Ethiopia, India and South Africa |
title_full_unstemmed | Accuracy of Assessment of Eligibility for Early Medical Abortion by Community Health Workers in Ethiopia, India and South Africa |
title_short | Accuracy of Assessment of Eligibility for Early Medical Abortion by Community Health Workers in Ethiopia, India and South Africa |
title_sort | accuracy of assessment of eligibility for early medical abortion by community health workers in ethiopia, india and south africa |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4701452/ https://www.ncbi.nlm.nih.gov/pubmed/26731176 http://dx.doi.org/10.1371/journal.pone.0146305 |
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