title: Accuracy of Assessment of Eligibility for Early Medical Abortion by Community Health Workers in Ethiopia, India and South Africa.
abstract: OBJECTIVE
  To assess the accuracy of assessment of eligibility for early medical abortion by community health workers using a simple checklist toolkit.
  
  
  METHODS
  Diagnostic accuracy study.
  
  
  METHODS
  Ethiopia, India and South Africa.
  
  
  METHODS
  Two hundred seventeen women in Ethiopia, 258 in India and 236 in South Africa were enrolled into the study. A checklist toolkit to determine eligibility for early medical abortion was validated by comparing results of clinician and community health worker assessment of eligibility using the checklist toolkit with the reference standard exam.
  
  
  RESULTS
  Accuracy was over 90% and the negative likelihood ratio <0.1 at all three sites when used by clinician assessors. Positive likelihood ratios were 4.3 in Ethiopia, 5.8 in India and 6.3 in South Africa. When used by community health workers the overall accuracy of the toolkit was 92% in Ethiopia, 80% in India and 77% in South Africa negative likelihood ratios were 0.08 in Ethiopia, 0.25 in India and 0.22 in South Africa and positive likelihood ratios were 5.9 in Ethiopia and 2.0 in India and South Africa.
  
  
  CONCLUSIONS
  The checklist toolkit, as used by clinicians, was excellent at ruling out participants who were not eligible, and moderately effective at ruling in participants who were eligible for medical abortion. Results were promising when used by community health workers particularly in Ethiopia where they had more prior experience with use of diagnostic aids and longer professional training. The checklist toolkit assessments resulted in some participants being wrongly assessed as eligible for medical abortion which is an area of concern. Further research is needed to streamline the components of the tool, explore optimal duration and content of training for community health workers, and test feasibility and acceptability.
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.|Swiss Tropical and Public Health Institute, Basel, Switzerland.
authors.forename: Heidi Bart
authors.initials: HB
authors.lastname: Johnston
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Bela
authors.initials: B
authors.lastname: Ganatra
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: My Huong
authors.initials: MH
authors.lastname: Nguyen
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Ndema
authors.initials: N
authors.lastname: Habib
authors.affiliation: School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Mesganaw Fantahun
authors.initials: MF
authors.lastname: Afework
authors.affiliation: Women's Health Research Unit, School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, Cape Town, South Africa.
authors.forename: Jane
authors.initials: J
authors.lastname: Harries
authors.affiliation: Action Research & Training for Health, Udaipur, Rajasthan, India.
authors.forename: Kirti
authors.initials: K
authors.lastname: Iyengar
authors.affiliation: Women's Health Research Unit, School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, Cape Town, South Africa.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Moodley
authors.affiliation: Independent consultant, Addis Ababa, Ethiopia.
authors.forename: Hailu Yeneneh
authors.initials: HY
authors.lastname: Lema
authors.affiliation: Women's Health Research Unit, School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, Cape Town, South Africa.
authors.forename: Deborah
authors.initials: D
authors.lastname: Constant
authors.affiliation: Action Research & Training for Health, Udaipur, Rajasthan, India.
authors.forename: Swapnaleen
authors.initials: S
authors.lastname: Sen
mesh_terms: D000028:Abortion, Induced; D000328:Adult; D057189:Checklist; D003150:Community Health Workers; D004608:Eligibility Determination / Q000592:standards*; D005002:Ethiopia; D005260:Female; D006801:Humans; D007194:India; D011247:Pregnancy; D013019:South Africa