Four criteria to evaluate providers' service-delivery response to new contraceptive introduction.

This article presents an evaluation framework developed to assess the first-level effects of introducing the Standard Days Method (SDM) in Peru Ministry of Health clinics. Four questions are asked: 1) To what extent do providers routinely achieve SDM service delivery standards? 2) Is the time invested in SDM delivery consistent with program norms? 3) How does SDM delivery compare with delivery of established methods? and 4) How does SDM introduction affect delivery of established methods? A study at 62 clinics demonstrated the framework's usefulness. The Standard Days Method introduction had positive overall effects on the quality of care but provider training needed adjustments.

Challenging the courtesy bias interpretation of favorable clients' perceptions of family planning delivery.

Favorable client perceptions of provider's interpersonal behavior in contraceptive delivery, documented in clinic exit questionnaires, appear to contradict results from qualitative evaluations and are attributed to clients' courtesy bias. In this study, trained simulated clients requested services from Ministry of Health providers in three countries. Providers excelled in courteousness/respect in Peru and Rwanda; in India, providers were less courteous and respectful when the simulated clients chose the pill. Privacy and two-way communication were less prevalent in all three countries. The findings challenge the courtesy bias interpretation. Global results from qualitative studies may have expressed the views of the minority of clients who are not treated well by providers.

Quality of delivery of the Standard Days Method as compared with contraceptive pills in Rwanda.

BACKGROUND AND METHODOLOGY: Replicating a Peruvian study, this research introduced the Standard Days Method (SDM) into Rwanda Ministry of Health clinics and evaluated client counselling on the new method against that given for contraceptive pills. Providers received technical reinforcement concerning established methods in addition to SDM training. To evaluate their quality of care, simulated clients implemented a service test in visits to 20 clinics. RESULTS: As in Peru, providers exchanged significantly more relevant information with clients who chose SDM than with those who chose pills. Also, a minority of providers posed barriers to SDM access by refusing to give SDM tools to the client until she brought her partner for consultation. CONCLUSIONS: The findings of this study confirm that SDM counselling is generally satisfactory, although SDM training needs adjustment, and that the rigour of providers' pill counselling remains below capacity.

Oligofructose-supplemented infant cereal: 2 randomized, blinded, community-based trials in Peruvian infants.

BACKGROUND: Prebiotics are nondigestible food ingredients that stimulate the growth of Bifidobacterium and other bacteria in the gastrointestinal tract. Improved gastrointestinal and other health effects have been attributed to them. OBJECTIVE: The objective of this study was to evaluate the effects of dietary supplementation with the prebiotic oligofructose with and without zinc on the prevalence of diarrhea in a community with a high burden of gastrointestinal and other infections. DESIGN: Two consecutive randomized, blinded, controlled clinical trials were performed in a shantytown community near Lima, Peru. The first trial compared an infant cereal supplemented with oligofructose (0.55 g/15 g cereal) with nonsupplemented cereal. During the second trial, zinc (1 mg/15 g cereal) was added to both oligofructose-supplemented and control cereals. RESULTS: We enrolled 282 infants in the first trial and 349 in the second. In the first trial, mean (+/- SD) days of diarrhea were 10.3 +/- 9.6 in the nonsupplemented cereal group and 9.8 +/- 11.0 in the prebiotic-supplemented cereal group (P = 0.66). In the second trial, mean days of diarrhea were 10.3 +/- 8.9 in the group consuming cereal fortified only with zinc and 9.5 +/- 8.9 in the group consuming cereal containing both zinc and prebiotics (P = 0.35). Postimmunization titers of antibody to Haemophilus influenzae type B were similar in all groups, as were gains in height, visits to clinic, hospitalizations, and use of antibiotics. CONCLUSIONS: Cereal supplemented with prebiotics was not associated with any change in diarrhea prevalence, use of health care resources, or response to H. influenzae type B immunization. Infants and young children who continue to breast-feed may not benefit from prebiotic supplementation.