***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To determine whether community-based health workers in a rural region of Ethiopia can provide  injectable contraceptives  to women with similar levels of safety , effectiveness and acceptability as health extension workers ( HEWs ) . METHODS This was a prospect i ve non-r and omized community intervention trial design ed to test the provision of injectable contraceptives by community-based reproductive health agents ( CBRHAs ) . Effectiveness , safety , acceptability and continuation rates were the outcomes of interest . The outcomes observed when injectable contraceptives were administered by HEWs in health posts and when they were administered by CBRHAs were compared by means of χ(2 ) tests for association among categorical variables and t-tests for independent sample s to determine differences between group means . FINDINGS A total of 1062 women participated in the study . Compared with health post clients , the clients of CBRHAs were , on average , slightly older , less likely to be married and less educated , and they had significantly more living children . Women seeking services from CBRHAs were also significantly more likely to be using injectable contraceptives for the first time ; health post clients were more likely to have used them in the past . In addition , clients of CBRHAs were less likely to discontinue using injectable contraceptives over three injection cycles than health post clients . CONCLUSION Receiving injectable contraceptives from CBRHAs proved as safe and acceptable to this sample of Ethiopian women as receiving them in health posts from HEWs . These findings add to the growing body of evidence supporting the development , introduction and scale up of programmes to train community-based health workers such as CBRHAs to safely administer injectable contraceptives OBJECTIVE To compare the safety and quality of contraceptive injections  by community-based health workers with those of clinic-based nurses in a rural African setting . METHODS A nonr and omized community trial tested provision of injectable Depo Provera ( DMPA ) by community reproductive health workers and compared it with routine DPMA provision at health units in Nakasongola District , Ug and a. The primary outcome measures were safety , acceptability and continuation rates . FINDINGS A total of 945 new DMPA users were recruited by community workers , clinic-based nurses and midwives . Research ers successfully followed 777 ( 82 % follow-up ) : 449 community worker clients and 328 clinic-based clients . Ninety-five percent of community-worker clients were " satisfied " or " highly satisfied " with services , and 85 % reported receiving information on side-effects . There were no serious injection site problems in either group . Similarly , there was no significant difference between continuation to second injection ( 88 % among clients of community-based workers , 85 % among clinic-going clients ) , nor were there significant differences in other measures of safety , acceptability and quality . CONCLUSION Community-based distribution ( CBD ) of injectable contraceptives is now routine in some countries in Asia and Latin America , but is practically unknown in Africa , where arguably the need for this practice is greatest . This research reinforces experience from other regions suggesting that well-trained community health workers can safely provide contraceptive injections CONTEXT Contraceptive use among young couples in India is low , and early childbearing and short birth intervals are common . The PRACHAR Project , an ongoing intervention in Bihar , seeks to increase contraceptive use for delaying and spacing births through communication interventions . METHODS R and om sample s of married women younger than 25 with no more than one child were surveyed in 2002 - 2003 , before PRACHAR was implemented ( N=1,995 ) , and in 2004 , 21 - 27 months after implementation ( N=2,080 ) .  Contraceptive dem and and use , and related attitudes and knowledge , were assessed in the two surveys in both intervention areas and comparison areas . Logistic regression was used to assess the effect of the interventions on these indicators . RESULTS Contraceptive use was very low ( 2 - 6 % ) at baseline in both comparison and intervention areas . Dem and for contraception increased from 25 % at baseline to 40 % at follow-up in intervention areas , but remained virtually unchanged in comparison areas . At follow-up , contraceptive use had risen in both areas , but the adjusted odds of use in intervention areas were 3.8 times those in comparison areas . Women in intervention areas had elevated odds of knowing that fertility varies during the menstrual cycle , and of agreeing that early childbirth can be harmful and that contraceptive use is necessary and safe for delaying first births ( odds ratios , 1.6 - 3.0 ) . CONCLUSION Culturally appropriate , community-based communication programs that target youth and those who influence their decisions can create dem and for contraception among young couples and lead to increased contraceptive use A r and omized community trial of a family planning outreach program  was conducted in Rakai District , Ug and a. Five communities received st and ard services ; six intervention communities  received additional family planning information , counseling , and contraceptive methods from government service providers and community-based volunteer agents using social marketing and other strategies . Condom use was promoted in all of the communities . The community-based family planning outreach program was implemented in two phases--1999 - 2000 ( early ) and 2001(late)-- and its impact was evaluated by means of population surveys in 2002 - 03 . At follow-up , hormonal contraceptive prevalence was 23 percent in the intervention communities , compared with 20 percent in the control communities . The differential was greater in the early-intervention communities than the late-intervention communities . Pregnancy rates at follow-up were 15 percent in the control and 13 percent in the intervention communities . No differentials in condom use were found between study arms . Family planning outreach via social marketing can significantly increase hormonal contraceptive use and decrease pregnancy rates , but the impact of this outreach program was modest The impact of community-based family planning programs and access to credit on contraceptive use , fertility , and family size preferences has not been established conclusively in the literature . We provide additional evidence on the possible effect of such programs by describing the results of a r and omized field experiment whose main purpose was to increase the use of contraceptive methods in rural areas of Ethiopia . In the experiment , administrative areas were r and omly allocated to one of three intervention groups or to a fourth control group . In the first intervention group , both credit and family planning services were provided and the credit officers also provided information on family planning . Only credit or family planning services , but not both , were provided in the other two intervention groups , while areas in the control group received neither type of service . Using pre- and post-intervention surveys , we find that neither type of program , combined or in isolation , led to an increase in contraceptive use that is significantly greater than that observed in the control group . We conjecture that the lack of impact has much to do with the mismatch between women ’s preferred contraceptive method ( injectibles ) and the contraceptives provided by community-based agents ( pills and condoms ) Objective Despite the availability of free contraception from family planning clinics , the rate of unwanted pregnancy in Iran is still high . The effectiveness of other methods for contraceptive supply should , therefore , be evaluated . The aim of this study was to determine the effects of community-based distribution ( CBD ) on contraceptive usage in Iran . Methods This controlled field trial study involved 297 individuals ( 100 subjects in the CBD group and 197 subjects in the control group ) from four major remote areas of Hamedan , Iran . Stratified r and om sampling was used . Results Data analysis suggested that using CBD has four major effects : ( 1 ) it increases the level of contraceptive knowledge ( p<0.0001 ) , ( 2 ) it enhances correct contraceptive choice by couples ( p<0.0001 ) , ( 3 ) it improves contraceptive usage ( p<0.0001 ) and ( 4 ) it improves contraceptive continuation rates ( p<0.0001 ) . Conclusions CBD facilitates better knowledge , proper choice , and correct and continuous usage of contraception . This method should , therefore , be adopted for family planning services in remote areas of Iran 
    Output:
    
Based on these findings , strong evidence exists for promoting CHW programs to improve access to FP services .