ザンビアにおける自己管理型中絶ケアへのアクセスに対する標的介入の影響評価

This study evaluates the effectiveness of targeted interventions implemented in Zambia from June 2023 to May 2024 in improving access to self-managed medical abortion (SMA) care, following the identification of barriers among providers and community through a baseline assessment and subsequent endline survey.

A pre- and post-survey using quantitative method focused on barriers for healthcare providers and community, including Access and Physical Environment; Guidelines and Documents; Equipment and Supplies; Provision and Staff Training; and Financial Aspects. Interventions included improving access, provider training, commodity strengthening, and community sensitization. Participants included healthcare providers, community members, and peer educators across 30 health facilities. STATA was used for descriptive analysis and McNemar's test.

Our study revealed notable improvements in the provision of SMA services across the 30 participating facilities. Facilities offering SMA services increased from 25.3% at baseline to 44% at endline, while the proportion of facilities with adequate sticks of combipacks and misoprostol increased significantly. There was also a documented rise in hospital leadership support and a reduction in charges for SMA services. Access to telemedicine services also improved, increasing from 5.3% to 20.9%. Among community health volunteers, social acceptance of SMA care increased from 54.7% to 79.3%. There was also a greater preference for home administration of SMA medication and self-assessment of effectiveness. Facilities with trained community health volunteers delivering SMA education rose markedly from 25.3% to 93.1%.

The findings demonstrated significant improvements from baseline to endline, highlighting that SMA interventions were effective in improving access to safe abortion care in Zambia.