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Athena SWAN Silver has been awarded to the Nuffield Department of Obstetrics & Gynaecology (NDOG) in recognition of their commitment to advancing women's careers in science and medicine in academia.
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Gillman & Soame 2015
Impact of the FIGO 2023 Staging System on the Adjuvant Treatment of Endometrial Cancer: A Comparative Analysis with FIGO 2009.
Background: ProMisE (Proactive Molecular Risk Classifier for Endometrial Cancer) has brought about the publication of the FIGO 2023 staging system with a significant impact in practice for endometrial cancer (EC). Methods: In this comparative study, we investigated the need for adjuvant treatment according to FIGO 2023, for each FIGO 2009 stage. We prospectively enrolled EC patients from June 2021 to June 2024, collected classical risk factors and classified according to FIGO 2009. Afterwards, we reclassified the same women according to FIGO 2023 and grouped them according to ESMO/ESTRO/ESGO risk factors. Results: We collected 211 eligible patients. We found 176 patients with FIGO 2009 I-II and 35 women with FIGO 2009 III-IV. Based on classic anatomopathological risk factors and FIGO 2009, adjuvant treatment was indicated in 124 (70.5%) patients with FIGO 2009 I-II (vaginal brachytherapy = 48; external beam radiotherapy with or without vaginal brachytherapy = 63; chemotherapy with external beam radiotherapy with or without vaginal brachytherapy = 13) and in 35 (100%) women with FIGO 2009 III-IV (all underwent chemotherapy). After FIGO 2023 re-staging, the women with early-stage EC, were more frequently candidates for no treatment, with a decreased relative risk (RR) for adjuvant treatment (RR 0.84; CI95% 0.74-0.95; p < 0.01) when compared to the previous FIGO classification. No significant risk (RR 1.01; CI95% 0.76-1.3; p = 0.08) for a more aggressive adjuvant treatment was noted after FIGO 2023 re-staging. In FIGO stage III-IV, no changes in the treatment modalities were observed. Conclusions: The re-staging according to FIGO 2023 of women previously staged to FIGO 2009 I-II, yields an RR of 0.84 to spare any type of adjuvant treatment.
Blood pressure-lowering and risk of cancer: an individual participant-level data meta-analysis and Mendelian randomisation studies
BACKGROUND Pharmacological blood pressure (BP)-lowering is typically a lifelong treatment, and both clinicians and patients may have concerns about the long-term use of antihypertensives and the risk of cancer. However, evidence from randomised controlled trials (RCTs) regarding the effect of long-term pharmacological BP-lowering on the risk of new-onset cancer is limited, with most knowledge derived from observational studies. OBJECTIVES This study aimed to assess whether long-term BP-lowering affects the risk of new-onset cancer, cause-specific cancer death, and selected site-specific cancers. METHODS Individual-level data from 42 RCTs were pooled using a one-stage individual participant data (IPD) meta-analysis. The primary outcome was incident cancer of all types, and secondary outcomes were cause-specific cancer death and selected site-specific cancers. Pre-specified subgroup analyses were conducted to assess the heterogeneity of the BP-lowering effect by baseline variables and also over follow-up time. Cox proportional hazards regression, stratified by trial, was used for the statistical analysis. For site-specific cancers, analyses were complemented with Mendelian randomisation, using naturally randomised genetic variants associated with BP-lowering to mimic the design of a long-term RCT. RESULTS Data from 314,016 randomly allocated participants without known cancer at baseline were analysed. Over a median follow-up of four years (25th-75th percentiles 3–5), 17,954 participants (5.7%) developed cancer, and 4,878 (1.5%) died from cancer. In the IPD meta-analysis, no associations were found between reductions in systolic or diastolic BP and cancer risk (hazard ratio [HR] per 5 mmHg reduction in systolic BP: 1.03 [95% CI 0.99-1.06]; per 3 mmHg reduction in diastolic BP: 1.03 [95% CI 0.98-1.07]). No changes in relative risk for incident cancer was observed over follow-up time, nor was there evidence of heterogeneity in treatment effects across baseline subgroups. No effect on cause-specific cancer death was found. For site-specific cancers, no evidence of effect was observed, except a possible link with lung cancer risk (HR for systolic BP reduction: 1.17 [99.5% CI 1.02-1.32]). Mendelian randomisation studies showed no association between systolic or diastolic BP reduction and site-specific cancers, including overall lung cancer and its subtypes. CONCLUSIONS Randomised data analysis provided no evidence to indicate that pharmacological BP-lowering has a substantial impact—either increasing or decreasing—on the risk of incident cancer, cause-specific cancer death, or selected site-specific cancers.
Exploring the value of a well-established conditioned pain modulation paradigm in women: a Translational Research in Pelvic Pain (TRiPP) study
Background: Conditioned pain modulation (CPM) is considered a human proxy for descending inhibitory pain pathways. However, there is wide variation in the CPM response described in the literature and ongoing debate about its utility. Methods: Here we explored CPM in women with (n = 59) and without (n = 26) chronic pelvic pain (CPP), aiming to determine the magnitude of effect and factors influencing variability in the CPM response. Results: Using a pressure pain threshold test stimulus and ischaemic pressure cuff conditioning stimulus (CS), we found no significant difference in the mean CPM effect between CPP and control participants. Using a robust statistical method (+/−2 standard error of measurement) to further investigate CPM, there was no significant difference in the proportion exhibiting inhibition between controls and CPP participants (X2 = 0.003, p = 0.96). Notably, only 23.1% of our healthy controls demonstrated a “true” CPM effect (n = 4 inhibitory, n = 2 facilitatory). Despite a rich data set, we were unable to identify any single questionnaire, clinical or psychophysical covariate correlating with the CPM effect. Conclusions: Despite using one of the recommended CPM paradigms we were only able to demonstrate “true” CPM in 23.1% of control participants. Thus, the absence of differences between women with and without chronic pelvic pain must be interpreted with caution. Future studies using different CPM paradigms or larger sample sizes may find different results. Although CPM in chronic pain populations is of major theoretical mechanistic interest, the lack of an established assessment standard led us to question its added value in current clinical research.
Low to Moderate Prenatal Alcohol Exposure and Facial Shape of Children at Age 6 to 8 Years.
IMPORTANCE: In addition to confirmed prenatal alcohol exposure and severe neurodevelopmental deficits, three cardinal facial features are included in the diagnostic criteria for fetal alcohol spectrum disorder. It is not understood whether subtle facial characteristics occur in children without a diagnosis but who were exposed to a range of common pregnancy drinking patterns and, if so, whether these persist throughout childhood. OBJECTIVE: To determine whether subtle changes in facial shape with prenatal alcohol exposure found in 12-month-old children were evident at age 6 to 8 years using extended phenotyping methods and, if so, whether facial characteristics were similar to those seen in fetal alcohol spectrum disorder. DESIGN, SETTING, AND PARTICIPANTS: In a prospective cohort study in Melbourne, Victoria, Australia, commencing in July 2011 with follow-up through April 2021, pregnant women were recruited in the first trimester from low-risk, metropolitan, public maternity clinics over a period of 12 months. Three-dimensional craniofacial images from 549 children of European descent taken at age 12 months (n = 421 images) and 6 to 8 years (n = 363) were included. Data analysis was performed from May 2021 to October 2024. EXPOSURES: Predominantly low to moderate prenatal alcohol exposure in the first trimester or throughout pregnancy compared with controls without prenatal alcohol exposure. MAIN OUTCOMES AND MEASURES: Following hierarchical facial segmentation, phenotype descriptors were computed. Hypothesis testing was performed for 63 facial modules to analyze different facial parts independently using principal component analysis and response-based imputed predictor (RIP) scores. Comparison was made with a clinical discovery sample of facial images of children with a confirmed diagnosis of partial or full fetal alcohol syndrome. RESULTS: A total of 549 children took part in the 3-dimensional craniofacial image analysis, of whom 235 (42.8%) contributed an image at both time points. Time 1 included 421 children, comprising 336 children (159 [47.3%] female) with any prenatal alcohol exposure and 85 control children (45 [52.9%] female); time 2 included 363 children, comprising 260 children with any prenatal alcohol exposure (125 [48.1%] female; mean [SD] age, 6.9 [0.7] years) and 103 control children (53 [51.5%] female; mean [SD] age, 6.8 [0.7] years). At both time points, there was consistent evidence for an association between prenatal alcohol exposure and the shape of the eyes (eg, module 15: RIP partial Spearman ρ, 0.19 [95% CI, 0.10-0.29; P
Dysregulation of lipid metabolism, energy production, and oxidative stress in myalgic encephalomyelitis/chronic fatigue syndrome, Gulf War Syndrome and fibromyalgia
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), Gulf War Syndrome (GWS), and Fibromyalgia (FM) are complex, chronic illnesses with overlapping clinical features. Symptoms that are reported across these conditions include post-exertional malaise (PEM), fatigue, and pain, yet the etiology of these illnesses remains largely unknown. Diagnosis is challenging in patients with these conditions as definitive biomarkers are lacking; patients are required to meet clinical criteria and often undergo lengthy testing to exclude other conditions, a process that is often prolonged, costly, and burdensome for patients. The identification of reliable validated biomarkers could facilitate earlier and more accurate diagnosis and drive the development of targeted pharmacological therapies that might address the underlying pathophysiology of these diseases. Major driving forces for biomarker identification are the advancing fields of metabolomics and proteomics that allow for comprehensive characterization of metabolites and proteins in biological specimens. Recent technological developments in these areas enable high-throughput analysis of thousands of metabolites and proteins from a variety of biological samples and model systems, that provides a powerful approach to unraveling the metabolic phenotypes associated with these complex diseases. Emerging evidence suggests that ME/CFS, GWS, and FM are all characterized by disturbances in metabolic pathways, particularly those related to energy production, lipid metabolism, and oxidative stress. Altered levels of key metabolites in these pathways have been reported in studies highlighting potential common biochemical abnormalities. The precise mechanisms driving altered metabolic pathways in ME/CFS, GWS, and FM remain to be elucidated; however, the elevated oxidative stress observed across these illnesses may contribute to symptoms and offer a potential target for therapeutic intervention. Investigating the mechanisms, and their role in the disease process, could provide insights into disease pathogenesis and reveal novel treatment targets. As such, comprehensive metabolomic and proteomic analyses are crucial for advancing the understanding of these conditions in-order to identify both common, and unique, metabolic alterations that could serve as diagnostic markers or therapeutic targets.
What is the safest mode of birth for extremely preterm breech singleton infants who are actively resuscitated? A systematic review and meta-analyses
Background: The safest delivery mode of extremely preterm breech singletons is unknown. Objectives: To determine safest delivery mode of actively resuscitated extremely preterm breech singletons. Search strategy: We searched Cochrane CENTRAL, MEDLINE, EMBASE, CINAHL and ClinicalTrials.gov from January 1994 to May 2017. Selection criteria: We included studies comparing outcomes by delivery mode in actively resuscitated breech infants between 23 +0 and 27 +6 weeks. Data collection and analysis: We synthesised data using random effects, generated odds ratios, 95% confidence intervals and number-needed-to-treat (NNT). Our primary outcomes were death (neonatal, before discharge, or by 6 months) and severe intraventricular haemorrhage (grades III/IV), stratified by gestational age (23 +0 –24 +6 , 25 +0 –26 +6 , 27 +0 –27 +6 weeks). Main results: We included 15 studies with 12 335 infants. We found that caesarean section was associated with a 41% decrease in odds of death between 23 +0 and 27 +6 weeks [odds ratio (OR) 0.59, 95% CI 0.36–0.95, NNT 8], with the greatest decrease at 23 +0 –24 +6 weeks (OR 0.58, 95% CI 0.44–0.75, NNT 7). The OR at 25 +0 –26 +6 and 27 +0 –27 +6 weeks were 0.72 (95% CI 0.34–1.52) and 2.04 (95% CI 0.20–20.62), respectively. We found that caesarean section was associated with 49% decrease in odds of severe intraventricular haemorrhage between 23 +0 and 27 +6 weeks (OR 0.51, 95% CI 0.29–0.91, NNT 12), whereas the OR at 25 +0 –26 +6 and 27 +0 –27 +6 was 0.29 (95% CI 0.07–1.12) and 0.91 (95% CI 0.27–3.05), respectively. Conclusions: Caesarean section was associated with reductions in the odds of death by 41% and of severe intraventricular haemorrhage by 49% in actively resuscitated breech singletons < 28 weeks of gestation. The data are mostly observational, which may be inherently biased, and scarce on other morbidities, necessitating thorough discussion between parents and clinicians. Tweetable abstract: Caesarean section associated with lower odds of death and severe intraventricular haemorrhage in actively resuscitated breech singletons <28 weeks.
Co-designing the implementation of a rural health systems-strengthening rheumatic heart disease program with remote First Nations Australian communities using Theory of Change.
BACKGROUND: Rheumatic heart disease (RHD) is highly prevalent and under-detected in remote First Nations Australian communities. Rural communities face severe health workforce shortages that impact negatively on health outcomes. Task-sharing using local healthcare workers, trained to screen for active RHD cases (using handheld ultrasound with remote support from experts), has been proposed as a means of improving early detection whilst also strengthening referral pathways. Implementing new models of care within remote communities, however, requires local knowledge, cultural and operational adaptation, whilst ensuring consistency and quality assurance across multiple sites. This study aimed to co-design local implementation strategies for an RHD active case finding program with five remote communities and explain how and why the task-sharing program might lead to improved health outcomes. METHODS: A qualitative study using a Theory of Change approach and 'yarning' methods, was conducted with five remote First Nations Australian communities. We used a combination of participant observation, extensive field notes over sequential visits to each site, supplemented with document analysis to inform co-design of Theories of Change for each community. Data were curated using NVivo software and analysed using Powell's refined compilation of implementation strategies framework. RESULTS: Through the co-design process, a total of 24 locally tailored implementation strategies were identified. All sites identified the need for a positive implementation environment, including recognition of local healthcare workers through positive messaging and celebratory events for achieving key training milestones. Other key themes included the importance of opportunistic RHD screening, and the integration of local languages during both training and screening. Five locally adapted versions of the Theory of Change were co-designed to include planned outcomes, assumptions, causal mechanisms, and indicators for the program at each community. CONCLUSIONS: Our study identified implementation strategies and Theories of Change for the training and screening aspects of a new model of care for RHD screening in five remote First Nation Australian communities. These findings will be used to support future program evaluation and exploration the mechanisms by which the RHD screening program achieves its outcomes.
Identification of heart failure subtypes using transformer-based deep learning modelling: a population-based study of 379,108 individuals.
BACKGROUND: Heart failure (HF) is a complex syndrome with varied presentations and progression patterns. Traditional classification systems based on left ventricular ejection fraction (LVEF) have limitations in capturing the heterogeneity of HF. We aimed to explore the application of deep learning, specifically a Transformer-based approach, to analyse electronic health records (EHR) for a refined subtyping of patients with HF. METHODS: We utilised linked EHR from primary and secondary care, sourced from the Clinical Practice Research Datalink (CPRD) Aurum, which encompassed health data of over 30 million individuals in the UK. Individuals aged 35 and above with incident reports of HF between January 1, 2005, and January 1, 2018, were included. We proposed a Transformer-based approach to cluster patients based on all clinical diagnoses, procedures, and medication records in EHR. Statistical machine learning (ML) methods were used for comparative benchmarking. The models were trained on a derivation cohort and assessed for their ability to delineate distinct clusters and prognostic value by comparing one-year all-cause mortality and HF hospitalisation rates among the identified subgroups in a separate validation cohort. Association analyses were conducted to elucidate the clinical characteristics of the derived clusters. FINDINGS: A total of 379,108 patients were included in the HF subtyping analysis. The Transformer-based approach outperformed alternative methods, delineating more distinct and prognostically valuable clusters. This approach identified seven unique HF patient clusters characterised by differing patterns of mortality, hospitalisation, and comorbidities. These clusters were labelled based on the dominant clinical features present at the initial diagnosis of HF: early-onset, hypertension, ischaemic heart disease, metabolic problems, chronic obstructive pulmonary disease (COPD), thyroid dysfunction, and late-onset clusters. The Transformer-based subtyping approach successfully captured the multifaceted nature of HF. INTERPRETATION: This study identified seven distinct subtypes, including COPD-related and thyroid dysfunction-related subgroups, which are two high-risk subgroups not recognised in previous subtyping analyses. These insights lay the groundwork for further investigations into tailored and effective management strategies for HF. FUNDING: British Heart Foundation, European Union - Horizon Europe, and Novo Nordisk Research Centre Oxford.
Contraceptive strategies for reducing the risk of reproductive cancers
Reproductive cancers, encompassing various malignancies like endometrial, ovarian, cervical cancer, and gestational trophoblastic neoplasia, pose a significant global health burden. Understanding their patterns is vital for effective prevention and management. Contraceptives show a protective effect against some of these cancers. This clinical guidance document aims to elucidate the disease burden of reproductive cancers and the evidence supporting contraceptive methods in prevention and management. Regional disparities in incidence and mortality highlight the urgent need for targeted interventions, particularly in low-resource settings. Healthcare providers must weigh individual risk profiles and medical eligibility criteria when discussing contraceptive options. Enhanced health literacy through direct patient education is essential for leveraging low-cost behavioral interventions to mitigate reproductive cancer risks.
A non‐inferiority analysis of hemoglobin levels in postpartum IUD users in Bangladesh
AbstractObjectiveThe objective of this study was to compare postpartum hemoglobin (Hb) between postpartum intrauterine device (PPIUD) and non‐PPIUD users.MethodsA sample of 3697 postpartum women (475 PPIUD users, 3222 non‐PPIUD users) from 5 tertiary referral hospitals in Bangladesh were assessed at multiple time points between 6 weeks and 12 months postpartum. Non‐inferiority linear regression analysis compared changes in Hb levels at 29–52 weeks postpartum between the two groups. Non‐inferiority was declared if the lower 95% confidence interval of the estimated difference in Hb change since delivery between PPIUD and non‐PPIUD users was greater than −0.05 g/dl.ResultsAt approximately 9 months postpartum, 276 women in the PPIUD group (58.1%) and 1086 women in the comparison group (33.7%) attended follow‐up. In total, 57.9% of PPIUD users and 61.0% of non‐PPIUD users had taken iron supplementation. Change in Hb was 0.02 g/dl (95% CI: −0.16, 0.19) higher in the PPIUD users than the comparison group. The lower limit of the 95% CI was greater than −0.05 g/dl, providing good evidence that PPIUD users were non‐inferior to the comparison group in their Hb levels.ConclusionIn the presence of offering iron supplementation, and an uptake of just over 60%, no difference in anemia was observed between the PPIUD and control group.
Impact of immediate postpartum insertion of TCu380A on the quantity and duration of lochia discharges in Tanzania
Abstract Background The insertion of Intrauterine Contraceptive Device (PPIUD) for the purpose of contraception immediately after delivery is becoming popular in countries where the use of IUD for contraception has been extremely low. Since 2015, Tanzania implemented the initiative by the International Federation of Gynecology and Obstetrics (FIGO) to institutionalize PPIUD. As a result of capacity building and information delivery under the initiative, there have been increased uptake of the method. Working in this context, the focus of the study was to generate evidence on the effect of TCu380A IUD on amount and duration of lochia and equip service providers with evidence-based knowledge which can help them in counselling their PPIUD clients. Objective Establish impact of postpartum TCu380A on amount and duration of lochia. Methods A prospective cohort study of delivered women in two teaching hospitals in Tanzania with immediate insertion of TCu380A or without use of postpartum contraception in 2018. TCu380A models; Optima (Injeflex Co. Brazil) and Pregna (Pregna International, Chakan, India) were used. Follow-up was done by weekly calls and examination at 6th week. Lochia was estimated by Likert Scale 0–4 relative to the amount of lochia on the delivery day. An estimated 250 women sample (125 each group) would give 80% power to detect a desired 20% difference in the proportion of women with prolonged lochia discharges among the Exposed and Unexposed groups. Data analysis was by SPSS. Results Two hundred sixty women were analysed, 127 Exposed and 133 Unexposed. Medical complaints were reported by 41 (28.9%) Exposed and 37 Unexposed (27.8%), p = 0.655. Lack of dryness by end of 6th week was to 31 (23.3%) Exposed and 9 (7.1%) Unexposed, p < 0.001. Exposed had higher weekly mean lochia scores throughout with the difference most marked in 5th week (3.556 Versus 2.039, p < 0.001) and 6th week (1.44 Versus 0.449, p<0.001). Conclusion PPIUD is associated with increased amount of lochia and slows progression to dryness within 6 weeks of delivery. The implications of PPIUD clients’ needs to be informed about the possibility of delayed dryness of lochia at time of counseling are discussed.
Evaluating the impact of female community health volunteer involvement in a postpartum family planning intervention in Nepal: A mixed-methods study at one-year post-intervention
Introduction This is a one-year post-intervention study following an initiative to provide orientation to female community health volunteers (FCHVs) on postpartum family planning in Nepal. In light of positive results in the earlier post-intervention study, this study was designed to provide a more long-term perspective on sustainability by assessing the effect at one-year post-intervention. Methods This mixed-methods study was conducted in January 2020 in Morang district, Nepal. We collected quantitative data from a knowledge assessment of FCHVs who had participated in the intervention on postpartum family planning, data on their community-based counseling coverage and through interviews with postpartum mothers in two selected hospitals. Qualitative data were collected through six key informant interviews with health providers and four focus group discussions with FCHVs involved in the intervention. We performed descriptive and multivariate analyses for quantitative data and thematic analysis for qualitative data. Results In total, 206 FCHVs participated in the one-year post-intervention study with significant improvement in knowledge of postpartum family planning as compared to pre-intervention period. The adjusted odds ratios (AOR) for knowledge of the 5 key messages on postpartum family planning as compared to the pre-intervention period included 1) knowledge on postpartum family planning can be used immediately after birth (AOR = 18.1, P<0.001), 2) postpartum intra-uterine device (PPIUD) can provide protection up to 12 years (AOR = 2.9, P = 0.011), 3) mothers who undergo cesarean section can use PPIUD (AOR = 2.3, P<0.001), 4) PPIUD can be inserted immediately after birth (AOR = 6.2, P <0.001), and 5) women should go for follow-up immediately if the IUD strings are seen outside vulva (AOR = 2.0, P = 0.08). The FCHVs answering 4 or more questions correctly was 10 times higher (AOR = 10.1, P<0.001) at one-year post-intervention, whereas it was 25 times higher at immediate-post-test (AOR = 25.1, p<0.001) as compared to pre-intervention phase. The FCHVs had counseled 71% of the pregnant women (n = 538) within their communities at one-year post-intervention. The postpartum mothers in hospitals had a 2 times higher odds of being counseled by FCHVs during their pregnancy at one-year post-intervention (AOR = 1.8, P = 0.039) than in pre-intervention phase. The qualitative findings suggested a positive impression regarding the FCHV’s involvement in postpartum family planning counseling in the communities, however, supervision and monitoring over a longer term was identified as a key challenge and that may influence sustainability of community-based and hospital-based postpartum family planning services. Conclusion The FCHVs’ knowledge and community-based activities on postpartum family planning remained higher than in the pre-intervention. However, it declined when compared to the immediate post-intervention period. We propose regular supervision and monitoring of the work of the FCHVs to sustain progress.
Improving post-partum family planning services provided by female community health volunteers in Nepal: a mixed methods study
Abstract Background Family planning services in the post-partum period, termed post-partum family planning (PPFP) is critical to cover the unmet need for contraception, especially when institutional delivery rates have increased. However, the intention to choose PPFP methods such as post-partum intrauterine devices (PPIUD) remains low in countries such as Nepal. Community health workers such as Female Community Health Volunteers (FCHVs) could play an important role in improving the service coverage of PPFP in Nepal. However, their knowledge of PPFP and community-based services related to PPFP remain unclear. This study aims to assess the effect on community-based PPFP services by improving FCHV’s knowledge through orientation on PPFP. Methods We conducted this mixed-methods study in Morang District in Nepal. The intervention involved orientation of FCHVs on PPFP methods. We collected quantitative data from three sources; via a survey of FCHVs that assessed their knowledge before and after the intervention, from their monthly reporting forms on counseling coverage of women at different stages of pregnancy from the communities, and by interviewing mothers in their immediate post-partum period in two selected hospitals. We also conducted six focus group discussions with the FCHVs to understand their perception of PPFP and the intervention. We performed descriptive and multivariable analyses for quantitative results and thematic analysis for qualitative data. Results In total, 230 FCHVs participated in the intervention and their knowledge of PPFP improved significantly after it. The intervention was the only factor significantly associated with their improved knowledge (adjusted odds ratio = 24, P < 0.001) in the multivariable analysis. FCHVs were able to counsel 83.3% of 1872 mothers at different stages of pregnancy in the communities. In the two hospitals, the proportion of mothers in their immediate post-partum period whom reported they were counseled by FCHVs during their pregnancy increased. It improved from 7% before the intervention to 18.1% (P < 0.001) after the intervention. The qualitative findings suggested that the intervention improved their knowledge in providing PPFP counseling. Conclusion The orientation improved the FCHV’s knowledge of PPFP and their community-based counseling. Follow-up studies are needed to assess the longer term effect of the FCHV’s role in improving community-based PPFP services.