Safety of the CBD of Injectables

Family Health Research, 2007, Vol. 1, Issue 2

Experience from sub-Saharan Africa, Asia, and Latin America shows that properly trained paramedical personnel can safely provide injectable contraceptives in community-based programs. Guidance based on this experience can help community-based family planning workers meet the basic requirements for safe administration of injectables such as depot-medroxyprogesterone acetate (DMPA), including proper client screening, counseling, injection technique, and waste disposal.
 
Screening. Medical conditions that contraindicate DMPA initiation are rare in potential users and were easily identified by community-based distribution (CBD) workers in a study conducted in Nepal. To help CBD workers screen potential DMPA users for such conditions, FHI has developed and extensively field-tested a checklist containing 13 simple "yes" or "no" questions. Another FHI checklist helps providers rule out pregnancy.

Counseling. Side effects, such as menstrual changes, headaches, and weight gain, are the primary reason that women stop using DMPA. Studies have shown that providing full and intensive counseling can significantly increase continuation rates for DMPA. CBD workers can be trained to counsel women on changes to expect when they begin using DMPA and to refer them to other levels of care when necessary.

Giving injections. CBD workers have demonstrated that they can safely give intramuscular injections. In a project in the Matlab subdistrict of Bangladesh, infections after injections by CBD workers were extremely rare – about three per 10,000 injections. No infections were reported after more than 1,000 injections in a similar program in Afghanistan. Meanwhile, scientists have developed a subcutaneous DMPA formulation, depo-subQ provera 104 or DMPA-SC, that is less painful to receive and easier to administer than the current intramuscular formulation because it can be injected under the skin with a shorter needle.

Disposing of needles and syringes. Concerns that needles and syringes be disposed of properly and not reused have been reduced by the availability of disposable injection devices that become automatically disabled after a single use. Such devices can be burned, but proper waste disposal requires careful planning and follow-up to ensure public safety. Training should emphasize safe use and disposal of needles and syringes to prevent the risk of infections such as HIV or hepatitis B through accidental needle sticks. The advent of nonresusable injection devices has greatly reduced the risk of such accidents.