Factors associated with the acceptability of self-injection training by clients receiving DMPA-SC services from community pharmacies and patent and proprietary medicine vendors in Nigeria.

backgroundThe self-administration of the subcutaneous depot medroxyprogesterone acetate (DMPA-SC) has the potential to empower women and improve contraceptive use. Several studies have demonstrated the acceptability of the provider-administered DMPA-SC, for private, public, or community-based health providers, but less is known about self-injection training from community pharmacists (CPs) and Patent and Proprietary medicine Vendors (PPMVs) (also known as drug shops). The purpose of this study was to examine the factors associated with the acceptance of DMPA-SC self-injection training when provided by trained CPs and PPMVs in Lagos and Kaduna states.

methodsA cross-sectional study was conducted among 186 women of reproductive age (18-49 years) who received self-injection training on DMPA-SC from trained CPs and PPMVs between August and September 2019, and between May 2022 and June 2023. Women who selected DMPA-SC, opted for self-injection, and were trained by a CP or a PPMV were invited to participate in the study. Quantitative telephone interviews were conducted with eligible clients within six (6) weeks of obtaining DMPA-SC commodities for self-injection from a trained CP or PPMV. Bivariate chi-square test and multivariate logistic regression were used to examine factors associated with acceptability and continued self-injection of DMPA-SC at home. The results were considered significant at a p value < 0.05.

resultsMore than half of the women had used a contraceptive in the past (55%), and 73% received information on DMPA-SC from a CP or PPMV. Using a family planning method prior to visiting the provider (Odds ratio (OR) = 4.31; 95% Confidence Intervals (CIs): 1.05, 17.69; p = 0.04), receiving information on DMPA-SC from friends/relative (OR = 5.08; 95% CI: 1.01, 25.62; p = 0.05), perceived high-quality care (OR = 7.72; 95% CI: 2.52, 23.61; p = 0.00) and middle-quality care (OR = 3.35; 95% CI: 1.16, 9.69; p = 0.03) were significantly associated with the likelihood of continued DMPA-SC self-injection at home. A high level of acceptance of training in DMPA-SC self-injection was significantly associated with service from PPMVs (OR = 4.94; 95% CI = 1.46, 16.75; p = 0.01) and perceived high-quality care (OR = 4.23; 95% CI = 1.62, 11.05; p = 0.00).

conclusionsThe results are promising for expanding DMPA-SC self-injection service delivery in Nigeria through increased method choice, and empowered users. The provision of counseling and DMPA-SC self-injection training by CPs and PPMVs is acceptable among women in Lagos and Kaduna states.