title: Feasibility of training Zambian nurse-midwives to perform postplacental and postpartum insertions of intrauterine devices.
abstract: OBJECTIVE
  To explore the feasibility of competency-based training of Zambian nurse-midwives in postplacental and postpartum intrauterine device (PPIUD) insertion and to estimate learning curves for this procedure.
  
  
  METHODS
  A pilot service-delivery project was conducted, involving 9 nurse-midwives who participated in a 10-day PPIUD insertion training course at the University Teaching Hospital, Lusaka, Zambia. US and Zambian clinicians taught the didactic and practical curriculum. Checklists were used for standardization and a pelvic model was developed to achieve PPIUD insertion competency in the classroom before moving to clinical practice. Patients were recruited during prenatal visits, in early labor, and postpartum. Informed, voluntary consent was obtained. All clinical PPIUD insertions were supervised or performed by experienced trainers.
  
  
  RESULTS
  All 9 nurse-midwives achieved competency on the pelvic model after 3 attempts. During the training period, 38 PPIUDs were inserted in postpartum women; no complications occurred. By the end of training, 4 of the nurse-midwives were deemed competent to independently insert PPIUDs. On average, 4 PPIUD insertions were needed to achieve clinical competency.
  
  
  CONCLUSIONS
  Concentrated, competency-based training in PPIUD insertion is feasible in an African setting. Replication of such training could increase the popularity and prevalence of PPIUD use among African women.
authors.affiliation: University of Washington School of Medicine, Seattle, USA. pragers@u.washington.edu
authors.forename: Sarah
authors.initials: S
authors.lastname: Prager
authors.forename: Pratima
authors.initials: P
authors.lastname: Gupta
authors.forename: Jully
authors.initials: J
authors.lastname: Chilambwe
authors.forename: Bellington
authors.initials: B
authors.lastname: Vwalika
authors.forename: Josselyn
authors.initials: J
authors.lastname: Neukom
authors.forename: Nomsa
authors.initials: N
authors.lastname: Siamwanza
authors.forename: Maxine
authors.initials: M
authors.lastname: Eber
authors.forename: Paul D
authors.initials: PD
authors.lastname: Blumenthal
mesh_terms: D057189:Checklist; D002983:Clinical Competence; D004506:Education, Nursing / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007434:Intrauterine Devices; D059032:Learning Curve; D009721:Nurse Midwives / Q000193:education*; D010865:Pilot Projects; D011181:Postnatal Care; D015024:Zambia