title: Integrating family planning messages into immunization services: a cluster-randomized trial in Ghana and Zambia.
abstract: OBJECTIVE
  To determine whether integrating family planning (FP) messages and referrals into facility-based, child immunization services increase contraceptive uptake in the 9- to 12-month post-partum period.
  
  
  METHODS
  A cluster-randomized trial was used to test an intervention where vaccinators were trained to provide individualized FP messages and referrals to women presenting their child for immunization services. In each of 2 countries, Ghana and Zambia, 10 public sector health facilities were randomized to control or intervention groups. Shortly after the introduction of the intervention, exit interviews were conducted with women 9-12 months postpartum to assess contraceptive use and related factors before and after the introduction of the intervention. In total, there were 8892 participants (Control Group Ghana, 1634; Intervention Group Ghana, 1129; Control Group Zambia, 3751; Intervention Group Zambia, 2468). Intervention effects were evaluated using logistic mixed models that accounted for clustering in data. In addition, in-depth interviews were conducted with vaccinators, and a process assessment was completed mid-way through the implementation of the intervention.
  
  
  RESULTS
  In both countries, there was no significant effect on non-condom FP method use (Zambia, P = 0.56 and Ghana, P = 0.86). Reported referrals to FP services did not improve nor did women's knowledge of factors related to return of fecundity. Some providers reported having made modifications to the intervention; they generally provided FP information in group talks and not individually as they had been trained to do.
  
  
  CONCLUSIONS
  Rigorous evidence of the success of integrated immunization services in resource poor settings remains weak.
authors.affiliation: Gwyneth Vance, 2224, E. HWY 54 Durham, NC 27713, USA. E-mail: gvance@fhi360.org.
authors.forename: Gwyneth
authors.initials: G
authors.lastname: Vance
authors.forename: Barbara
authors.initials: B
authors.lastname: Janowitz
authors.forename: Mario
authors.initials: M
authors.lastname: Chen
authors.forename: Brooke
authors.initials: B
authors.lastname: Boyer
authors.forename: Prisca
authors.initials: P
authors.lastname: Kasonde
authors.forename: Gloria
authors.initials: G
authors.lastname: Asare
authors.forename: Beatrice
authors.initials: B
authors.lastname: Kafulubiti
authors.forename: John
authors.initials: J
authors.lastname: Stanback
mesh_terms: D000328:Adult; D005260:Female; D005869:Ghana; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017589:Immunization Programs / Q000379:methods* / Q000458:organization & administration; D007223:Infant; D011181:Postnatal Care / Q000379:methods / Q000458:organization & administration; D012736:Sex Education / Q000379:methods* / Q000458:organization & administration; D055815:Young Adult; D015024:Zambia
keywords: Family planning; immunization; integration; referrals; vaccinators