29 results on '"Kabra, Rita"'
Search Results
2. Intersectional analysis of the experiences of women who fail to conceive in low and middle income neighbourhoods of Delhi, India: Findings from a qualitative study.
- Author
-
Adhikary P, Mburu G, Kabra R, Habib NA, Kiarie J, Dhabhai N, Chowdhury R, and Mazumder S
- Subjects
- Humans, India, Female, Adult, Poverty, Focus Groups, Socioeconomic Factors, Income, Male, Masculinity, Residence Characteristics, Young Adult, Social Class, Fertilization, Qualitative Research
- Abstract
Background: Experiences of delayed conception and infertility have been reported among women. However, the concept of intersectionality is rarely utilised in studies of infertility, and it is particularly uncommon in research from low- and middle- income countries., Research Question: What are the lived experiences of women with delayed conception in low to -middle income neighbourhoods of Delhi, India?, Methods: This was a qualitative study (n = 35) that recruited women who had failed to conceive after 18 months of regular unprotected sexual intercourse. Data were collected between February and July 2021. Data were collected through focus group discussions in low income to middle income neighbourhoods of Delhi, India. Analysis identified themes related to intersecting axes of inequality., Results: The results showed that gender intersected with economics, masculinity, patriarchal norms and class to influence the experiences of women. The intersection of gender, economics and patriarchal norms compromised women's agency to be active generators of family income, and this dynamic was exacerbated by patrilocal residence. In addition, masculinity contributed to stigmatisation and blaming of women, due to the inaccurate perception that men did not contribute to a couple's infertility. The intersection of gender and social class in medical settings created barriers to women's access to medical information., Conclusion: Findings from this study provide representative examples of the variety of axes of inequality that shape women's experiences in the study setting. Although these findings may not be generalisable to all women who are experiencing delayed conception, they highlight a need for improved awareness and education on infertility, as well as a need to ensure the availability and accessibility of fertility care for couples in need., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Adhikary et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
- Published
- 2024
- Full Text
- View/download PDF
3. Scaling postpartum family planning services in the Democratic Republic of Congo: outcomes and lessons learned.
- Author
-
Kabra R, Allagh KP, Kini BN, Kanke RM, and Kiarie J
- Subjects
- Female, Humans, Democratic Republic of the Congo, Postpartum Period, Family Planning Services, Contraception
- Abstract
Competing Interests: Competing interests: None declared.
- Published
- 2024
- Full Text
- View/download PDF
4. Strengths and weaknesses of the South-South Learning Exchange: a qualitative analysis of experts' perspectives.
- Author
-
Triulzi I, Kabra R, Allagh KP, and Kiarie J
- Subjects
- Humans, Female, Peer Group, Male, Interviews as Topic, Learning, Qualitative Research
- Abstract
Background: South-South learning exchange (SSLE) refers to an interactive learning process where peers exchange knowledge and experience to work towards a beneficial change. Despite organizations having recently increased the opportunity to run SSLEs, the SSLE support mechanisms and processes are not well documented in the scientific literature. This study explored experts' perspectives on SSLEs, strengths, weaknesses and mechanisms leading to sustainable outcomes., Methods: We conducted a qualitative study using semi-structured interviews on experiences of participants and organizers of SSLEs. Data were collected between 1st September 2021 to 26th November 2021. All data were digitally recorded, transcribed verbatim, and analysed. In the analysis, we adopted an inductive approach derived from thematic analysis., Results: Sixteen experts, who have participated in or facilitated one or more SSLE, were interviewed. The experts' accounts demonstrated an appreciation of participants' empowerment, positive peer-to-peer "mind change" and convincing and powerful hands-on learning of this approach as strengths in the implementation of the SSLE. Being resource heavy, participant and donor reluctance and absence of a validated methodology emerged as main weaknesses of the South-South learning approach, which could impair the effectiveness of this scheme., Conclusions: The strengths of SSLEs are anchored in the theories of experiential and social learning, highlighting SSLE's potential to create an environment that enhances knowledge exchange. the study highlights the challenges SSLE initiatives face. In particular, these include limited commitment and funds, limited evidence of impact, disparate approaches, and the absence of standardized guidelines and evaluation practices., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Triulzi I et al.)
- Published
- 2024
- Full Text
- View/download PDF
5. Description of the methodology for developing and validating the WHO's family planning and comprehensive abortion care competencies for the primary health care workforce.
- Author
-
Loi UR, Sorhaindo A, Embo M, Kabra R, Kiarie J, and Ganatra B
- Subjects
- Pregnancy, Female, Humans, Workforce, World Health Organization, Primary Health Care, Family Planning Services, Abortion, Induced
- Abstract
A qualified health workforce is essential to receiving effective, timely, affordable, equitable and respectful family planning and comprehensive abortion care. However, in many countries, health workers lack the competencies required to deliver quality family planning and comprehensive abortion care services. Competency-based education and learning aims to train and assess competencies. The theory-supported approach focuses on outcomes, emphasizes the learner's ability to perform, promotes learner-centeredness and links the health needs of the population to the competencies required of health workers. In 2011, the World Health Organization published a guidance document, Sexual and reproductive health - Core competencies in primary care, defining the competencies that primary care providers need to safely deliver sexual and reproductive health services at the community level and included family planning and comprehensive abortion care. In this article, we describe the methodology and process undertaken in 2020, by the World Health Organization to produce the family planning and comprehensive abortion care competencies guidance, filling gaps identified in the previous guidance document. The World Health Organization's Family Planning and Comprehensive Abortion Care toolkit for the primary health care workforce was published in 2022 and defines the key competencies for health workers in primary health care providing quality family planning and comprehensive abortion care services, as well as support for developing programmes and curricula for education and lifelong learning. The Toolkit is useful for practitioners, managers/supervisors and employers, educators, regulatory bodies, and policymakers. It is an important advance toward strengthening family planning and comprehensive abortion care services in primary health care., (Copyright © 2024 World Health Organization. Published by Elsevier B.V. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
6. The impact of cascade training-A FIGO and WHO Department of Sexual and Reproductive Health and Research collaboration to improve access to quality family planning globally.
- Author
-
Makins A, Hearing F, Taghinejadi N, Kiarie J, Kabra R, Arulkumaran SS, and Steyn P
- Subjects
- Humans, Contraception methods, Sexual Behavior, World Health Organization, Family Planning Services education, Reproductive Health
- Abstract
Globally, there are considerable barriers to accessing safe and effective contraceptive methods. Increased awareness and utilization among obstetricians and gynecologists (OB/GYNs) and allied health professionals of the WHO's tools and guidelines on contraception is a possible avenue to changing this. A cascade-training model, based on regional training-of-trainer workshops followed by national workshops, was used to share key WHO global family planning tools and guidelines among OB/GYNs in 29 countries across three regions-Anglophone Africa, Middle East and Mediterraean, and Francophone West Africa. Monitoring and evaluation was performed through pre- and post-knowledge questionnaires as well as in-depth interviews of key informants before and after the training was instituted. The training increased both participants' knowledge and understanding of the relevant guidelines, as well as their confidence in using them. Qualitative data suggested that this improved in-country clinical practice and influenced national policy through dissemination and engagement with country leadership. The cascade-training model was a practical, locally adaptable means of disseminating up-to-date WHO family planning guidelines and tools. It resulted in sustainable changes in many participating countries, including training curriculum updates, policy changes, and increased government engagement with family planning. Future iterations of the initiative would benefit from additional support for multidisciplinary training., (© 2023 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)
- Published
- 2024
- Full Text
- View/download PDF
7. Implementation strategies, facilitators, and barriers to scaling up and sustaining demand generation in family planning, a mixed-methods systematic review.
- Author
-
Nabhan A, Kabra R, Ashraf A, Elghamry F, and Kiarie J
- Subjects
- Humans, Contraceptive Agents, Health Services, Research Design, Family Planning Services methods, Contraception methods
- Abstract
Background: Demand generation aims to increase clients' desire to use family planning. The aim of this work was to systematically summarize strategies, facilitators, and barriers to scaling up and sustaining demand generation in family planning., Methods: We searched electronic bibliographic databases from inception to October 2022. We included quantitative, qualitative, and mixed methods reports on demand generation strategies in family planning, regardless of country, language, publication status, or methodological limitations. We assessed abstracts, titles and full-text papers according to the inclusion criteria, extracted data, and assessed methodological quality of included reports. We used the convergent integrated approach and a deductive thematic synthesis to summarize demand generation themes and subthemes. We used the health system building blocks to synthesize the factors affecting implementation (barriers and facilitators). We used GRADE-CERQual to assess our confidence in the findings., Results: Forty-six studies (published 1990-2022) were included: forty-one quantitative, one qualitative, and four mixed methods). Three were from one high-income country, and forty three from LMIC settings. Half of reports were judged to be of unclear risk of bias. There were unique yet interrelated strategies of scaling-up demand generation for family planning. Interpersonal communication strategies increase adoption and coverage of modern contraceptive methods, but the effect on sustainability is uncertain. Mass media exposure increases knowledge and positive attitudes and may increase the intention to use modern contraceptive methods. Demand-side financing approaches probably increase awareness of contraceptives and the use of modern contraceptive methods among poor clients. Multifaceted Demand generation approaches probably improve adoption, coverage and sustainability of modern methods use. Factors that influence the success of implementing these strategies include users knowledge about family planning methods, the availability of modern methods, and the accessibility to services., Conclusions: Demand generation strategies may function independently or supplement each other. The myriad of techniques of the different demand generation strategies, the complexities of family planning services, and human interactions defy simplistic conclusions on how a specific strategy or a bundle of strategies may succeed in increasing and sustaining family planning utilization., Trial Registration: Systematic review registration: Center for Open Science, osf.io/286j5., (© 2023. The Author(s).)
- Published
- 2023
- Full Text
- View/download PDF
8. Implementation strategies, facilitators, and barriers to scaling up and sustaining task-sharing in family planning: a protocol for a mixed-methods systematic review.
- Author
-
Aderoba AK, Kabra R, and Kiarie JN
- Subjects
- Humans, Systematic Reviews as Topic, Meta-Analysis as Topic, Research Design, Family Planning Services, Contraception
- Abstract
Background: Ensuring access to quality family planning (FP) services is fundamental to achieving the Sustainable Development Goals (SDG) targets 3.1, 3.7, and 5.6, including universal access to reproductive health services. However, barriers such as health workforce shortages and restrictive policies on the role of mid and lower-level health workforce cadres limit access to contraceptives and FP in many settings. Workforce reorganization makes more efficient use of human resources. Consequently, the World Health Organization (WHO) recommends task-sharing for FP by different cadres. Evidence on the implementation strategies, facilitators, and barriers to scaling up and sustaining task-sharing could inform financing, implementation approaches, and technical assistance of national and global FP task-sharing programs. Therefore, this study aims to describe and assess the quality of the evidence on implementation strategies, facilitators, and barriers to scaling up and sustaining task-sharing in FP and the outcome of the scale-up/sustainability interventions., Methods: This systematic review protocol was developed using relevant guidelines, including the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Protocols (PRISMA-P). A search of five databases, namely CINAHL (EBSCOhost), EMBASE (OvidSP), Global Health (OvidSP), MEDLINE (OvidSP), and Scopus ( www.scopus.com ), and gray literature resources will be conducted. Two independent reviewers will screen and select studies, assess their quality using the "Mixed Methods Appraisal Tool," and extract data from eligible studies. Publications or articles are eligible if they report implementation strategies, facilitators, or barriers to scaling up/sustainability of task-sharing in FP/contraception or the outcomes of the scale-up/sustainability interventions. A convergent synthesis that integrates qualitative, quantitative, descriptive, and mixed-methods data into one dataset will be used for analysis based on an a priori framework-the Cochrane Effective Practice and Organization of Care (EPOC) taxonomy of the health system framework. Two independent reviewers will assess the quality of evidence using the GRADE-CERQual guideline., Discussion: To our knowledge, this systematic review of implementation strategies, facilitators, and barriers to scaling up and sustaining task-sharing in family planning is the first in this area. Our rigorous methodology based on up-to-date guidelines can help generate relevant recommendations to support interventions to scale up and sustain task-sharing in family planning., Systematic Review Registration: PROSPERO CRD42022339885., (© 2023. BioMed Central Ltd., part of Springer Nature.)
- Published
- 2023
- Full Text
- View/download PDF
9. Aligning health worker education and learning approaches with population health needs: WHO's Family Planning and Comprehensive Abortion Care Toolkit for the primary healthcare workforce.
- Author
-
Rehnström Loi U, Sorhaindo A, Embo M, Kabra R, Kiarie J, and Ganatra B
- Subjects
- Humans, Female, Pregnancy, Health Education, Primary Health Care, World Health Organization, Family Planning Services, Abortion, Induced
- Abstract
Competing Interests: Competing interests: None declared.
- Published
- 2023
- Full Text
- View/download PDF
10. Implementation strategies, facilitators, and barriers to scaling up and sustaining post pregnancy family planning, a mixed-methods systematic review.
- Author
-
Nabhan A, Kabra R, Allam N, Ibrahim E, Abd-Elmonem N, Wagih N, Mostafa N, and Kiarie J
- Subjects
- Pregnancy, Female, Humans, Postpartum Period, Sex Education, Family Planning Services, Contraception
- Abstract
Background: Post pregnancy family planning includes both postpartum and post-abortion periods. Post pregnancy women remain one of the most vulnerable groups with high unmet need for family planning. This review aimed to describe and assess the quality of the evidence on implementation strategies, facilitators, and barriers to scaling up and sustaining post pregnancy family planning., Methods: Electronic bibliographic databases (MEDLINE, PubMed, Scopus, the Cochrane Library, and Global Index Medicus) were searched from inception to October 2022 for primary quantitative, qualitative, and mixed method reports on scaling up post pregnancy family planning. Abstracts, titles, and full-text papers were assessed according to the inclusion criteria to select studies regardless of country, language, publication status, or methodological limitations. Data were extracted and methodological quality assessed using the Mixed Methods Appraisal Tool. The convergent integrated approach and a deductive thematic synthesis were used to identify themes and sub-themes of strategies to scale up post pregnancy family planning. The health system building blocks were used to summarize barriers and facilitators. GRADE-CERQual was used to assess our confidence in the findings., Results: Twenty-nine reports (published 2005-2022) were included: 19 quantitative, 7 qualitative, and 3 mixed methods. Seven were from high-income countries, and twenty-two from LMIC settings. Sixty percent of studies had an unclear risk of bias. The included reports used either separate or bundled strategies for scaling-up post pregnancy family planning. These included strategies for healthcare infrastructure, policy and regulation, financing, human resource, and people at the point of care. Strategies that target the point of care (women and / or their partners) contributed to 89.66% (26/29) of the reports either independently or as part of a bundle. Point of care strategies increase adoption and coverage of post pregnancy contraceptive methods., Conclusion: Post pregnancy family planning scaling up strategies, representing a range of styles and settings, were associated with improved post pregnancy contraceptive use. Factors that influence the success of implementing these strategies include issues related to counselling, integration in postnatal or post-abortion care, and religious and social norms., Trial Registration: Center for Open Science, OSF.IO/EDAKM., (© 2023. The Author(s).)
- Published
- 2023
- Full Text
- View/download PDF
11. Scaling-up post-pregnancy family planning services: experiences and challenges from Afghanistan.
- Author
-
Kabra R, Chikvaidze P, Mubasher A, Allagh KP, Gholbzouri K, and Kiarie J
- Subjects
- Pregnancy, Female, Humans, Afghanistan, Postpartum Period, Family Planning Services, Contraception
- Abstract
Competing Interests: Competing interests: None declared.
- Published
- 2023
- Full Text
- View/download PDF
12. Scoping review on the use of South-South learning exchange to scale up evidence-based practices in family planning.
- Author
-
Allagh KP, Triulzi I, Kiarie J, and Kabra R
- Subjects
- Humans, Capacity Building, Databases, Factual, Evidence-Based Practice, Family Planning Services, Contraceptive Agents
- Abstract
Background: South-South learning exchange (SSLE) is an interactive learning process where teams from low-income and middle-income countries exchange knowledge and experience to support one or both team's work towards a change in policies, programmes or practices. SSLE has been used by countries to improve family planning (FP) outcomes such as increased contraceptive prevalence rate and reduced unmet need for FP, but at present, there are no reviews that summarise its use. We conducted a scoping review with stakeholder consultations to summarise the use of SSLE to change FP outcomes., Objective: To systematically identify and map the purposes, approaches, outputs, outcomes, enablers and barriers to using SSLE in FP., Methods: A search was conducted on electronic databases, grey literature sources, websites and the reference list of included studies. The scoping review is based on an adapted version of Arksey and O'Malley's scoping review framework suggested by Levac et al . Experts were interviewed on their experiences in SSLE., Results: The initial search yielded 1483 articles; however, only 29 were selected in the final analysis. The articles were published between 2008 and 2022. Most of the articles were reports, case studies or press releases, only two were peer-reviewed publications. Capacity building of FP providers, policy-makers and community was the most commonly reported purpose of SSLE, with study tours (57%) being the most common approach. Policy dialogue was the most common (45%) output and improved contraceptive prevalence was the most frequently reported outcome. The experiences of the 16 interviewed experts aligned with the scoping review findings., Conclusion: The evidence on the effectiveness of SSLE for addressing FP outcomes is very limited and of very low quality. We call on stakeholders conducting SSLE to document their experiences in detail, including the outcomes achieved., Competing Interests: Competing interests: None declared., (© World Health Organization 2023. Licensee BMJ.)
- Published
- 2023
- Full Text
- View/download PDF
13. Determining the Impact of the COVID-19 Pandemic on Availability, Use, and Readiness of Family Planning and Contraceptive Services at Selected Primary Health Care Facilities in Africa and Asia: Protocol for a Mixed Methods Study.
- Author
-
Kabra R, Joshi B, Elisaria E, Akande TM, Allagh KP, Olumide A, Tandon D, Prusty RK, Ramesh M, Shamba D, and Kiarie J
- Abstract
Background: The COVID-19 pandemic and the associated social restrictions may have disrupted the provision of essential services, including family planning (FP) and contraceptive services. This protocol is adapted from a generic study protocol titled "Health systems analysis and evaluations of the barriers to availability and readiness of sexual and reproductive health services in COVID-19 affected areas," conducted by the World Health Organization (WHO) Department of Reproductive Health and Research., Objective: This study aims to assess the availability and use of FP and contraceptive services in primary health facilities during and after the COVID-19 pandemic; assess the risk perceptions of COVID-19 stigma, barriers to access, and quality of services from clients' and providers' perspectives in the COVID-19-affected areas; and assess the postpandemic recovery of the facilities in the provision of FP and contraceptive services., Methods: In-depth interviews will be conducted with clients-women in the reproductive age group and their male partners who visit the selected health facilities for FP and contraceptive services-and health providers (the most knowledgeable person on FP and contraceptive service provision) at the selected health facilities. Focus group discussions will be conducted with clients at the selected health facilities and in the community. The in-depth interviews and focus group discussions will help to understand clients' and health service providers' perspectives of FP and contraceptive service availability and readiness in COVID-19-affected areas. A cross-sectional health facility assessment will be conducted in all the selected health facilities to determine the health facility infrastructure's ability and readiness to provide FP and contraceptive services and to capture the trends in FP and contraceptive services available during the COVID-19 pandemic. Scientific approval for this study is obtained from the WHO Research Project Review Panel, and the WHO Ethics Review Committee has given ethical approval in the 3 countries., Results: Using a standardized research protocol will ensure that the results from this study can be compared across regions and countries. The study was funded in March 2021. It received ethics approval from the WHO Ethics Review Committee in February 2022. We completed data collection in September 2022. We plan to complete the data analysis by March 2023. We plan to publish the study results by Summer 2023., Conclusions: The findings from this study will provide a better understanding of the impact of the COVID-19 pandemic on FP and contraceptive services at the facility level, which will help policy makers and health managers develop and strengthen FP policies and services in health facilities to be more responsive to community needs., International Registered Report Identifier (irrid): DERR1-10.2196/43329., (©Rita Kabra, Beena Joshi, Ester Elisaria, Tanimola Makanjuola Akande, Komal Preet Allagh, Adesola Olumide, Deepti Tandon, Ranjan Kumar Prusty, Mary Ramesh, Donat Shamba, James Kiarie. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 10.05.2023.)
- Published
- 2023
- Full Text
- View/download PDF
14. Fulfilment of fertility desires for the attainment of Global Sustainable Development Goals.
- Author
-
Mburu G, Kamuyango A, Kidula N, Kabra R, Thatte N, Kiarie J, and Allotey P
- Subjects
- Humans, Goals, Health Services, Sustainable Development, Fertility
- Abstract
Competing Interests: Competing interests: None declared.
- Published
- 2023
- Full Text
- View/download PDF
15. Scoping review protocol to map evidence on South-South learning exchange in family planning.
- Author
-
Allagh KP, Kiarie J, Triulzi I, and Kabra R
- Subjects
- Humans, Policy, Learning, Research Design, Family Planning Services, Sex Education
- Abstract
Introduction: South-South learning exchange (SSLE) is an interactive learning process where stakeholder teams exchange knowledge and experience to help one, or both to work towards change, by identifying, adopting and/or strengthening implementation of a best practice. SSLE has been conducted between countries to share knowledge on best practices and policies in family planning. To the best of our knowledge, no scoping review has been conducted to synthesise evidence on SSLE in family planning. In this paper, we outline the protocol to conduct scoping review on SSLE in family planning., Methods and Analysis: Arksey and O'Malley's scoping review framework with adaptions from Levac et al will be used to guide this scoping review. We will search electronic databases (Medline, Embase, CINAHL, Hinari, ProQuest DB, PUBMED, Web of Science and WorldCat), grey literature sources and reference lists of included studies. We will focus on literature published till August 2022. The abstract and title screening, full-text screening and data charting will be conducted by two independent reviewers. The findings will be summarised into a narrative based on thematic analysis. Stakeholder interviews will be conducted to understand their perception and experiences in applying SSLE in family planning., Ethics and Dissemination: The ethics review committee at WHO, Geneva, has exempted this study from ethical approval (ERC.0003752). The findings from the study will provide useful insights into effective approaches, barriers, facilitators to conduct SSLE in family planning. This knowledge will be of significant public health relevance and will help in designing future learning exchanges between countries in the south to accelerate access to quality family planning services. The findings will be disseminated via peer-reviewed journals, conference proceedings, newsletters and workshops., Competing Interests: Competing interests: None declared., (© World Health Organization 2023. Licensee BMJ.)
- Published
- 2023
- Full Text
- View/download PDF
16. Strengthening contraceptive counselling: gaps in knowledge and implementation research.
- Author
-
Ali M, Tran NT, Kabra R, and Kiare J
- Subjects
- Contraceptive Agents, Counseling, Humans, Contraception, Family Planning Services
- Abstract
Competing Interests: Competing interests: None declared.
- Published
- 2022
- Full Text
- View/download PDF
17. Improving access to quality family planning services in Nepal and Sri Lanka: insights from a South-South learning exchange.
- Author
-
Kabra R, Danansuriya M, Moonesinghe L, de Silva C, Jayathilaka CA, Allagh KP, Pradhan P, Triulzi I, and Kiarie J
- Subjects
- Female, Humans, Nepal, Sri Lanka, Family Planning Services
- Abstract
Nepal and Sri Lanka ministries of health shared best practices and learnings, in a South-South learning exchange (SSLE) to improve access to quality and rights-based family planning services. The SSLE between the two countries followed a five-step methodology designed by the WHO, under the Family Planning Accelerator project. SSLE between the two countries started in January 2020 and is still continuing. Both countries started implementation of the learnings (step 4) at the time of preparing this manuscript (December 2021). An independent consultant from Sri Lanka carried out an evaluation, to inform future SSLEs. The evaluation included a desk review on SSLE and family planning in both countries and key informant interviews with Sri Lanka Ministries Health, WHO CO, external partners. A final evaluation of the outcomes/impact is planned in December 2022. The SSLE resulted in a systematic cross-country transfer of knowledge and implementation of the learnings. Sri Lanka implemented a web-based system for logistics management of family planning commodities and Nepal commenced implementing integrated family planning services in a decentralised environment using a lifecycle approach to improve postpartum family planning uptake. The success of this SSLE is attributed to the rigorous methodology, country-led designing of the learning agenda and process, extensive communication amongst the teams, a focus on outcomes, commitment and leadership by ministries of health in both countries. Learning and technical assistance needs of countries can be met by SSLE if national contexts, availability of resources are considered., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2022
- Full Text
- View/download PDF
18. Prevalence of reproductive tract infections including sexually transmitted infections among married women in urban and peri-urban mid to low socioeconomic neighbourhoods of Delhi, North India: an observational study protocol.
- Author
-
Dhabhai N, Chaudhary R, Wi T, Mburu G, Chowdhury R, More D, Chatterjee L, De D, Kabra R, Kiarie J, Habib N, Dang A, Dang M, and Mazumder S
- Subjects
- Chlamydia trachomatis, Cross-Sectional Studies, Female, Humans, India epidemiology, Marriage, Observational Studies as Topic, Prevalence, Chlamydia Infections diagnosis, Chlamydia Infections epidemiology, Gonorrhea diagnosis, Gonorrhea epidemiology, Reproductive Tract Infections epidemiology, Sexually Transmitted Diseases diagnosis, Sexually Transmitted Diseases epidemiology
- Abstract
Introduction: The Global Health Sector Strategy on sexually transmitted infections (STIs), endorsed by the World Health Assembly in 2016 aims to end STIs as public health threat by 2030. WHO conducts global estimates of prevalence to monitor progress towards achieving the same. However, limited laboratory confirmed data exist of STIs and reproductive tract infections (RTIs) apart from few prevalence surveys among key populations and clinic-based reports, including in India. Syndromic approach is the cornerstone of RTI/STI management and to maximise the diagnostic accuracy, there is a need to determine the main aetiologies of vaginal discharge. This study aims to estimate the prevalence of common STIs and RTIs and their aetiological organisms in symptomatic and asymptomatic women living in the urban and peri-urban, mid to low socioeconomic neighbourhoods of Delhi, North India., Methods and Analysis: A cross-sectional study will be conducted among 440 married women who participated in the 'Women and Infants Integrated Interventions for Growth Study (WINGS)'. Information on sociodemographic profile, sexual and reproductive health will be collected, followed by examination and collection of vaginal swabs for nucleic acid amplification tests to diagnose Neisseria gonorrhoeae , Chlamydia trachomatis and Trichomonas vaginalis and microscopy to identify bacterial vaginosis and Candida albicans . Treatment will be as per the syndromic approach recommendations in the Indian National Guidelines. Data will be analysed to estimate prevalence, presence of symptoms and signs associated with laboratory confirmed RTIs/STIs using STATA V.16.0 (StataCorp)., Ethics and Dissemination: This study protocol has been approved by the ethics review committees of the WHO and Society for Applied Studies (SAS/ERC/RHR-RTI/STI/2020). Approval has been obtained by the WINGS investigators from SAS ethics research committee to share the contact details of the participants with the investigators. The findings will be published in peer-reviewed journals and disseminated through scientific conferences., Trial Registration Number: CTRI/2020/03/023954., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)
- Published
- 2022
- Full Text
- View/download PDF
19. Characteristics, experiences and actions taken by women to address delayed conception: A mixed-methods cross-sectional study protocol.
- Author
-
Adhikary P, Roy N, Mburu G, Kabra R, Habib NA, Kiarie J, Dhabhai N, Chowdhury R, and Mazumder S
- Subjects
- Adaptation, Psychological, Cross-Sectional Studies, Female, Fertility Clinics, Humans, Infant, Pregnancy, Infertility, Quality of Life
- Abstract
Background: The impact of infertility on mental, emotional, physical and sexual health is grave, particularly in a pronatalist society. Literature is replete with evidence of wide ranging psychosocial consequences of infertility in women, indicating the need for identifying the gaps and designing appropriate context specific interventions to improve access and utilization of services. Data that are accessible, primarily from infertility clinics and women visiting hospitals for infertility treatment; information from community settings is rare. This is a protocol paper for a study to understand women's experiences and actions taken by them to cope with delayed conception., Methods: Mixed-methods cross-sectional design is used to obtain deep insights into the experiences of delayed conception, coping mechanisms, medical assistance and other help sought. Information is also being obtained on socio-demographic profile, fertility intentions, fertility quality of life, general medical history, obstetric, gynecological and sexual history, substance use and mental health status. A sample of 1530 women will be administered 4 modules of a quantitative survey. Focus group discussions, about four or till saturation point, will be conducted using purposive sampling. The study is recruiting from a population of women who previously participated in the 'Women and Infants Integrated Interventions for Growth Study (WINGS) and failed to conceive during 18 months follow up period. Data collected through questionnaire will be assembled, cleaned, analyzed and reported. The findings will be disseminated through reports with the ethics review committee, government entities, academic and research publications., Discussion: This study will provide insights on the experiences and coping strategies of women with delayed conception in the study community. Results will assist in designing appropriate interventions to meet the holistic health and psychosocial needs of women with delayed conception and promote sexual and reproductive health within the broader framework of Sustainable Development Goals and Universal health coverage., Trial Registration: Trial registration number: CTRI/2020/03/023955., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2022
- Full Text
- View/download PDF
20. Postpartum contraceptive practices among urban and peri-urban women in North India: a mixed-methods cohort study protocol.
- Author
-
Roy N, Adhikary P, Kabra R, Kiarie J, Mburu G, Dhabhai N, Chowdhury R, and Mazumder S
- Subjects
- Adolescent, Adult, Birth Intervals ethnology, Child Development, Child, Preschool, Cohort Studies, Female, Humans, India, Urban Population, Young Adult, Clinical Studies as Topic, Contraception methods, Contraception Behavior ethnology, Family Planning Services methods, Postpartum Period ethnology
- Abstract
Background: Postpartum family planning (PPFP) helps women space childbirths, increase exclusive breastfeeding and prevent unintended pregnancies, leading to reduction in maternal, infant and child morbidities and mortality. Unmet need of family planning is highest among women in the postpartum period due to lack of knowledge, cultural and religious barriers, access barriers and low antenatal care service utilization. However, in spite of low prevalence of postpartum family planning practices, birth-to-birth interval is reportedly high in Delhi, India. This study explores the postpartum contraception practices and the relationship between use of postpartum contraception and subsequent child linear growth., Methods: This is a mixed method cohort study on PPFP and is nested within an ongoing "Women and Infants Integrated Interventions for Growth Study" (WINGS). Married women aged 18-30 years who have delivered a live baby are recruited for quantitative interviews at 6 weeks, 6, 12, and 24 months postpartum. In-depth interviews are conducted with a randomly selected sub-sample of women at each of the four time points, 35 husbands and 20 local service providers to understand their perspectives on PPFP practices., Discussion: The findings from the study will provide useful insights into couples' contraception preferences and choice of contraception, modern and traditional, initiation time and the effect of birth spacing and contraception use on subsequent linear growth of the child. This knowledge will be of significant public health relevance and will help in designing appropriate interventions for appropriate postpartum contraception use and delivery strategies. The study aims to work address the Sexual and Reproductive Health and Rights goal of promoting reproductive health, voluntary and safe sexual and reproductive choices for women., Trial Registration: Trial registration number: CTRI/2020/03/023954 ., (© 2021. The Author(s).)
- Published
- 2021
- Full Text
- View/download PDF
21. Self-administered subcutaneous medroxyprogesterone acetate for improving contraceptive outcomes: a systematic review and meta-analysis.
- Author
-
Nabhan A, Elshafeey F, Mehrain LM, Kabra R, and Elshabrawy A
- Subjects
- Community Health Workers, Female, Humans, Injections, Self Administration, Contraceptive Agents, Female, Medroxyprogesterone Acetate
- Abstract
Background: Subcutaneous depot medroxyprogesterone acetate is an easy-to-use injectable contraceptive. A trained person can administer it, including women through self-injection. The objective of this systematic review and meta-analysis was to assess the effectiveness and safety of self-injection versus provider-administered subcutaneous depot medroxyprogesterone acetate for improving continuation of contraceptive use., Methods: We searched for randomized controlled trials on November 1, 2020 in Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, Embase, Web of Science, Scopus, Open Grey, clinical trials registries, and reference lists of relevant studies. We did not impose any search restrictions. We included randomized trials comparing self- versus provider-administered subcutaneous depot medroxyprogesterone acetate. Two authors independently screened trials, extracted data, and assessed the risk of bias in the included studies. We used risk ratio and 95% confidence intervals for dichotomous outcomes., Results: We identified 3 randomized trials (9 reports; 1264 participants). The risk of bias in the included studies was low except for performance bias and detection bias of participant-reported outcomes in unmasked trials. Self-administration, compared to provider-administration, increased continuation of contraceptive use (risk ratio 1.35; 95% confidence intervals 1.10-1.66); moderate-certainty evidence). Self-injection appears to be making more of an impact on continuation for younger women compared to women 25 years and older and on women living in low and middle income compared to high income countries. There was no subgroup difference by the type of care provider (community health worker vs. clinic-based provider)., Conclusions: Self-injection of subcutaneous depot medroxyprogesterone acetate probably improves continuation of contraceptive use. The effects on other outcomes remain uncertain because of the very low certainty of evidence., (© 2021. The Author(s).)
- Published
- 2021
- Full Text
- View/download PDF
22. Scoping review to map evidence on mechanism of action, pharmacokinetics, effectiveness and side effects of centchroman as a contraceptive pill.
- Author
-
Kabra R, Allagh KP, Ali M, Jayathilaka CA, Mwinga K, and Kiarie J
- Subjects
- Contraceptives, Oral pharmacology, Contraceptives, Oral standards, Estrogen Antagonists pharmacology, Female, Humans, Product Surveillance, Postmarketing statistics & numerical data, Treatment Outcome, Centchroman pharmacology, Pharmacovigilance
- Abstract
Objective: To systematically identify and map the available evidence on effectiveness, side effects, pharmacokinetics and mechanism of action of centchroman as a contraceptive pill., Introduction: Centchroman was introduced in the Indian national family planning programme in 2016 as a once-a-week short-term contraceptive pill/oral contraceptive. At present there are no WHO recommendations on this method of contraception. We examined the available evidence through a scoping review., Methods: A search was conducted inclusive to the years 1970-2019 on electronic databases, grey literature sources and reference lists of included studies to identify studies. The five stages of Arksey and O'Malley's scoping review framework were applied in undertaking this scoping review., Results: The review identified 33 studies conducted between 1976 and 2017. Two studies reported mechanism of action of centchroman. Pharmacokinetics was reported by five studies among non-breastfeeding women and four studies among breastfeeding women. Eight studies reported on effectiveness ranging from 93% to 100%. Pregnancies due to user failure ranged from 2.6% to 10.2%. Although side effects were reported in 13 studies, the incidence varied greatly between the studies. Continuous bleeding and prolonged cycles >45 days were the most commonly reported side effects. All studies conducted had a small sample size and the duration of follow-up of women was 12 months or less. Fifty-five per cent of studies were by the developers of the pill (Central Drug Research Institute) and results of the phase IV clinical trial were unavailable., Conclusions: The scoping review shows that studies with robust designs and conducted in international context are lacking. Insufficient evidence exists on centchroman use as a postcoital contraceptive pill. The broad uncertainty in range of side effects and effectiveness in the studies implies insufficient evidence to make global recommendations on centchroman that is currently licensed as a contraceptive in India., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2019
- Full Text
- View/download PDF
23. Research gaps and emerging priorities in sexual and reproductive health in Africa and the eastern Mediterranean regions.
- Author
-
Ali M, Farron M, Ouedraogo L, Mahaini RK, Miller K, and Kabra R
- Subjects
- Adolescent, Adolescent Health, Adult, Africa, Contraception methods, Family Planning Services, Female, Humans, Male, Mediterranean Region, Pregnancy, Sexual Behavior, World Health Organization, National Health Programs, Reproductive Health, Sexual Health
- Abstract
Background: In-country research capacity is key to creating improvements in local implementation of health programs and can help prioritize health issues in a landscape of limited funding. Research prioritization has shown to be particularly useful to help answer strategic and programmatic issues in health care, including sexual and reproductive health (SRH). The purpose of this paper is to present the results of a priority setting exercise that brought together researchers and program managers from the WHO Africa and Eastern Mediterranean regions to identify key SRH issues., Methods: In June 2015, researchers and program managers from the WHO Africa and Eastern Mediterranean regions met for a three-day meeting to discuss strategies to strengthen research capacity in the regions. A prioritization exercise was carried out to identify key priority areas for research in SRH. The process included five criteria: answerability, effectiveness, deliverability and acceptability, potential impact of the intervention/program to improve reproductive, maternal and newborn health substantially, and equity., Results: The six main priorities identified include: creation and investment in multipurpose prevention technologies, addressing adolescent violence and early pregnancy (especially in the context of early marriage), improved maternal and newborn emergency care, increased evaluation and improvement of adolescent health interventions including contraception, further focus on family planning uptake and barriers, and improving care for mothers and children during childbirth., Conclusion: The setting of priorities is the first step in a dynamic process to identify where research funding should be focused to maximize health benefits. The key elements identified in this exercise provides guidance for decision makers to focus action on identified research priorities and goals. Prioritization and identifying/acting on research gaps can have great impact across multiple sectors in the regions for improved reproductive, maternal and children health.
- Published
- 2018
- Full Text
- View/download PDF
24. Correction to: Design and initial implementation of the WHO FP umbrella project- to strengthen contraceptive services in the sub Saharan Africa.
- Author
-
Kabra R, Ali M, and Kiarie J
- Abstract
Correction: After publication of the original article [1], it came to the authors' attention that the Acknowledgements section was not completed correctly. The Acknowledgements of the article should have been as follows.
- Published
- 2017
- Full Text
- View/download PDF
25. Design and initial implementation of the WHO FP umbrella project- to strengthen contraceptive services in the sub Saharan Africa.
- Author
-
Kabra R, Ali M, and Kiarie J
- Subjects
- Africa South of the Sahara, Contraception methods, Contraception Behavior, Delivery of Health Care, Female, Humans, Reproductive Health Services organization & administration, Family Planning Services organization & administration, Health Services Accessibility, World Health Organization
- Abstract
Background: Strengthening contraceptive services in sub Saharan Africa is critical to achieve the FP 2020 goal of enabling 120 million more women and girls to access and use contraceptives by 2020 and the Sustainable Development Goals (SDG) targets of universal access to sexual and reproductive health (SRH) services including family planning by 2030., Method: The World Health Organization (WHO) and partners have designed a multifaceted project to strengthen health systems to reduce the unmet need of contraceptive and family planning services in sub Saharan Africa. The plan leverages global, regional and national partnerships to facilitate and increase the use of evidence based WHO guidelines with a specific focus on postpartum family planning. The four key approaches undertaken are i) making WHO Guidelines adaptable & appropriate for country use ii) building capacity of WHO regional/country staff iii) providing technical support to countries and iv) strengthening partnerships for introduction and implementation of WHO guidelines. This paper describes the project design and elaborates the multifaceted approaches required in initial implementation to strengthen contraceptive services., Conclusion: The initial results from this project reflect that simultaneous application these approaches may strengthen contraceptive services in Sub Saharan Africa and ensure sustainability of the efforts. The lessons learned may be used to scale up and expand services in other countries.
- Published
- 2017
- Full Text
- View/download PDF
26. Research capacity strengthening for sexual and reproductive health: a case study from Latin America.
- Author
-
Kabra R, Castillo M, Melián M, Ali M, Say L, and Gulmezoglu AM
- Subjects
- Humans, Latin America, Biomedical Research standards, Health Promotion, Reproductive Health, Sexual Behavior
- Abstract
An essential, but often overlooked part of health promotion and development support to achieve self-sufficiency in developing countries is the concomitant need to build and strengthen research capacity. This is even more challenging and critical in the area of sexual and reproductive health because of diverse interplay of socio cultural, religious, economic factors in relation to reproductive health.This paper presents the case study of HRP's efforts to build research capacity in Latin America by studying and analyzing the 5-year history of institutional development support to an institution in Paraguay. In reviewing the efforts, we identify the strengths in the approaches used by HRP, the challenges and outcomes of the process and we present recommendations for future efforts to strengthen research capacity to improve sexual and reproductive health. The authors call for greater support from and collaborative efforts of developmental partners and governments to strengthen research capacity in low and middle-income countries to improve sexual and reproductive health.
- Published
- 2017
- Full Text
- View/download PDF
27. Men's behavior surrounding use of contraceptives in Guinea.
- Author
-
Baldé MD, Diallo BA, Compaoré R, Bah AK, Ali M, Kabra R, and Kouanda S
- Subjects
- Adult, Attitude to Health, Condoms statistics & numerical data, Contraception Behavior psychology, Family Characteristics, Female, Guinea, Humans, Male, Middle Aged, Sexual Partners, Young Adult, Contraception statistics & numerical data, Contraception Behavior statistics & numerical data, Social Perception
- Abstract
Objective: To analyze the sociocultural determinants that influence the attitude and practices of men toward contraceptive use in Guinea., Methods: A sequential, mixed methods, qualitative and quantitative study was carried out in two regions of Guinea with a low rate of contraceptive prevalence, and in the capital city of Conakry. A total of 1170 people (men and women) were interviewed., Results: Findings showed a positive perception of family planning overall, but reluctance to use modern contraception. The reasons for non-use of contraceptive methods were primarily the hope of having many children and religious prohibition associated with customs. Making decisions on contraceptive use within a couple represents a major cause of misunderstanding between spouses. Communication within a couple on the use of contraception is quickly declined by men., Conclusion: The findings demonstrate the need to develop communication strategies within a couple to improve the use of contraceptives., (Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
28. Maternal and neonatal health in Africa at MDG end: Availability of and access to maternal health services, and outcomes of intervention strategies.
- Author
-
Kouanda S, Kabra R, and Dumont A
- Subjects
- Africa epidemiology, Female, Healthcare Disparities statistics & numerical data, Humans, Infant, Newborn, Patient Acceptance of Health Care statistics & numerical data, Population Growth, Pregnancy, Socioeconomic Factors, Birth Rate trends, Health Services Accessibility trends, Infant Health trends, Maternal Health trends, Maternal Health Services trends
- Published
- 2016
- Full Text
- View/download PDF
29. Research capacity for sexual and reproductive health and rights.
- Author
-
Kabra R, Ali M, Gulmezoglu AM, and Say L
- Subjects
- Capacity Building, Developing Countries, Global Health, Health Services Accessibility, Humans, Universal Health Insurance organization & administration, Health Services Research organization & administration, Reproductive Health standards, Reproductive Rights standards, Sexual Health standards
- Published
- 2016
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.