Quality of Family Planning services in Malawi: what
can we learn by observing consultations with clients?

IntroductionWomen and men are influenced in theirchoice of health provider by many factors,including cost and accessibility. Quality ofprovision has also been identified as animportant driver of service utilisation, andwhere deficient can represent a barrier toutilisation. Observation of consultationsallows direct assessment of service quality.
The aim of the present study was to collect information about the interactions between clients and providers during family planning (central and southern regions) or Tumbuka languages (northern region). The commonest government run facilities from a nationally contraceptive supplies. 4/5 of the consultationsobserved were with a female provider, and three quarters of clients were seen by a nurse. The majority of consultations took place between 9 am and midday. New consultations (9/42) had a mean duration of 43 minutes (range 15-85) while southern regions, and of service provider.
for existing clients the mean duration was 15 minutes (range 2-80). The longest consultations were recorded when pelvic examination was government health centres, private health carried out without provision of Depo Provera, centres and clinics of Banja la Mtsogolo.
reflecting longer discussion time in those notalready seeking a specific method.
With the consent of clients, consultationswere observed and notes made of the duration and content of consultations.
For new clients, information elicited regarding age,marital status, number of children, pregnancyhistory, husband’s attitude and STI history was Fact Sheet 12 Reproductive Health Research funded by DFID patchy. There was little or no enquiry about usually the same individual who had conducted desire for more children or preferred timing the consultation, who was usually a nurse.
Other staff involved were medical assistants and Consultations included responding to questions,encouraging clients to ask questions, and The client’s name was confirmed prior to the assurance of confidentiality in more than half injection in less that one fifth of cases.The correct those episodes observed. Clients were asked date of administration for the client was usually about concerns with methods, shown respect, checked. Verification that the client was not afforded privacy and offered a return visit in a pregnant occurred in only half the cases. There high proportion of consultations (88-98%).
was almost universal application of safe sharpsdisposal practice.
Method choice and informationAmong the new clients all but one received the Hand washing was observed for just under half method of choice.These were the pill (3), Depo before the injection procedures, as was also the Provera (5) and female sterilization (1). Because of suspected infection one client was given condoms.
examination was usually conducted without Including existing users, the method mix was asking clients to take slow deep breaths and in Depo Provera (71%), the pill (21%), female the few instances of speculum examination sterilization (2.4% ) and the condom (2.4%).
observed, the procedure was almost neverexplained to the client.
The range of potential methods was discussed indetail in one third or fewer consultations, whereas injectables were discussed with 74% of clients.
The observations demonstrate adherence tosome aspects of good practice in communication, For pill users, the blood pressure was checked in especially demonstrating respect and affording 8/9 cases, 8 clients were weighed, pregnancy was privacy to clients. There is some evidence for excluded in all clients, breastfeeding was discussed provider bias towards injectables.The main flaws with 4/9 and menstrual cycle disturbance was in relation to administration of injectables were failing to exclude pregnancy and hand washing.
For Depo Provera users, blood pressure was Priorities for attention are consultations that
checked in all cases, 20/25 were weighed, explore fertility intentions and that
smoking history was obtained in 4/25, pregnancy support wide method choice, and good
was positively excluded in 18/25, the medical clinical practice during intimate
menstrual irregularity was discussed in 20/25consultations.
Health’s Department for Population Services and the University of Malawi’s Demographic administration of Depo Provera (71% of clients).
The person administering the injection was For details about this report contact: Rosemary Lawrence, Opportunities and ChoicesProgramme, Department of Social Statistics, University of Southampton, Southampton, SO171BJ, UK.Tel: +44 (0)23 8059 5763, Fax: +44 (0)23 8059 3846, E-mail: Fact Sheet 12 Reproductive Health Research funded by DFID


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IngentaConnect Post-dexamethasone cortisol correlateswith severity of depression. during carbamazepine treatment in women Authors: Osuch, Elizabeth A.1; Cora-Locatelli, Gabriela2; Frye, Mark A.3; Huggins, Teresa2; Kimbrell, Timothy A.4; Ketter, Terence A.5; Callahan, Ann M.2; Post, Robert M.2 Source: Acta Psychiatrica Scandinavica, Volume 104, Number 5, November 2001 , p

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