Scoping review on the use of South-South learning exchange to scale up evidence-based practices in family planning

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

Scoping review protocol to map evidence on South-South learning exchange in family planning

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

Disabled People's Organisations increase access to services and improve well-being: evidence from a cluster randomized trial in North India.

BACKGROUND: Disabled People's Organisations (DPOs) are the mainstay of disability responses worldwide. Yet there is no quantitative data assessing their effectiveness in low-and middle-income countries (LMICs). The aim of this study was to measure the effectiveness of DPOs as a low-cost intervention to improve well-being and access to services and facilities for people with disabilities. METHODS: We undertook a cluster randomised intervention control trial across 39 distinct rural villages in Uttarakhand State, North India. A total of 527 participants were included from 39 villages: 302 people from 20 villages were assigned to the intervention arm and 225 from 19 villages were assigned to the control group. Over a 2-year period, people with disabilities were facilitated to form DPOs with regular home visits. Participants were also given financial support for public events and exposure visits to other DPOs. Seven domains were used to measure access and participation. RESULTS: DPO formation had improved participation in community consultations (OR 2.57, 95% CI 1.4 to 4.72), social activities (OR 2.46, 95% CI 1.38 to 4.38), DPOs (OR 14.78, 95% CI 1.43 to 152.43), access to toilet facilities (OR 3.89, 95% CI 1.31 to 11.57), rehabilitation (OR 6.83, 95% CI 2.4 to 19.42) and Government social welfare services (OR 4.82, 95% CI 2.35 to 9.91) in intervention when compared to the control. People who were part of a DPO had an improvement in having their opinion heard (OR 1.94, 95% CI 1.16 to 3.24) and being able to make friends (OR 1.63, 95% CI 1 to 2.65) compared to those who were not part of a DPO. All other well-being variables had little evidence despite greater improvement in the DPO intervention group. CONCLUSIONS: This is the first randomised control trial to demonstrate that DPOs in LMICs are effective at improving participation, access and well-being. This study supports the ongoing role of DPOs in activities related to disability inclusion and disability services. This study also suggests that supporting the establishment, facilitation and strengthening of DPOs is a cost-effective intervention and role that non-governmental organisations (NGOs) can play. TRIAL REGISTRATION: ISRCTN36867362, 9th Oct 2019 (retrospectively registered)

Birth prevalence of neural tube defects and orofacial clefts in India: a systematic review and meta-analysis.

BACKGROUND: In the last two decades, India has witnessed a substantial decrease in infant mortality attributed to infectious disease and malnutrition. However, the mortality attributed to birth defects remains constant. Studies on the prevalence of birth defects such as neural tube defects and orofacial clefts in India have reported inconsistent results. Therefore, we conducted a systematic review of observational studies to document the birth prevalence of neural tube defects and orofacial clefts. METHODS: A comprehensive literature search for observational studies was conducted in MEDLINE and EMBASE databases using key MeSH terms (neural tube defects OR cleft lip OR cleft palate AND Prevalence AND India). Two reviewers independently reviewed the retrieved studies, and studies satisfying the eligibility were included. The quality of included studies was assessed using selected criteria from STROBE statement. RESULTS: The overall pooled birth prevalence (random effect) of neural tube defects in India is 4.5 per 1000 total births (95% CI 4.2 to 4.9). The overall pooled birth prevalence (random effect) of orofacial clefts is 1.3 per 1000 total births (95% CI 1.1 to 1.5). Subgroup analyses were performed by region, time period, consanguinity, and gender of newborn. CONCLUSION: The overall prevalence of neural tube defects from India is high compared to other regions of the world, while that of orofacial clefts is similar to other countries. The majority of studies included in the review were hospital based. The quality of these studies ranged from low to moderate. Further well-designed, high quality community-based observational studies are needed to accurately estimate the burden of neural tube defects and orofacial clefts in India

Access to health care and employment status of people with disabilities in South India, the SIDE (South India Disability Evidence) study.

BACKGROUND: Data shows that people with disability are more disadvantaged in accessing health, education and employment opportunities compared to people without a disability. There is a lack of credible documented evidence on health care access and barriers to access from India. The South India Disability Evidence (SIDE) Study was undertaken to understand the health needs of people with disabilities, and barriers to accessing health services. METHODS: The study was conducted in one district each in two States (Andhra Pradesh and Karnataka) in 2012. Appropriate age and sex-matched people without a disability were recruited to compare with people with disability who were identified through a population-based survey and available government disability records by trained key informants. These people were then examined by a medical team to confirm the diagnosis. Investigators administered questionnaire schedules to people with and without a disability to harness information on employment and health service access, utilization and barriers. RESULTS: A total of 839 people with disabilities and 1153 age and sex matched people without a disability, aged 18 years or more were included. People with disability had significantly lower employment rates. On univariate analysis, people with disability (18.4%) needed to visit a hospital significantly more often in the preceding year compared to people without a disability (8.8%) (X2- 40.0562; P < =0.001). However adjusted odds ratios did not show a statistically significant difference. Significant differences were also observed with respect to past hospitalization. People with disabilities had 4.6 times higher risk of suffering from diabetes and 5.8 times higher risk of suffering from depression compared to people without a disability and the risk was significantly higher in males compared to females with disability. People with disability faced significantly more barriers to accessing health services compared to people without a disability. Barriers included ignorance regarding availability of services, costs of services and transportation. CONCLUSIONS: This study highlights the challenges that people with disability face in accessing health-care and employment opportunities. The study findings have public health implications and should be used for planning need-based appropriate strategies to improve health care access for people with disabilities

A Mixed-Method Study to Determine the Benefits of Periconceptional Folic Acid Supplementation and Effects of Folic Acid Deficiency in Mothers on Birth Outcomes.

BACKGROUND: Evidence from high income countries shows mothers who are supplemented with folic acid in their periconceptional period and early pregnancy have significantly reduced adverse outcomes like birth defects. However, in India there is a paucity of data on association of birth defects and folic acid supplementation. We identified a few important questions to be answered using separate scientific methods and then planned to triangulate the information. OBJECTIVE: In this paper, we describe the protocol of our study that aims to determine the association of folic acid and pregnancy outcomes like neural tube defects (NTDs) and orofacial clefts (OFCs). We decided to fill the gaps in knowledge from India to determine public health consequences of folic acid deficiency and factors influencing dietary and periconceptional consumption of folic acid. METHODS: The proposed study will be carried out in five stages and will examine the questions related to folic acid deficiency across selected locations in South and North India. The study will be carried out over a period of 4 years through the hierarchical evidence-based approach. At first a systematic review was conducted to pool the current birth prevalence of NTDs and orofacial clefts OFCs in India. To investigate the population prevalence, we plan to use the key informant method to determine prevalence of NTDs and OFCs. To determine the normal serum estimates of folic acid, iron, and vitamin B12 among Indian women (15-35 years), we will conduct a population-based, cross-sectional study. We will further strengthen the evidence of association between OFCs and folic acid by conducting a hospital-based, case-control study across three locations of India. Lastly, using qualitative methods we will understand community and health workers perspective on factors that decide the intake of folic acid supplements. RESULTS: This study will provide evidence on the community prevalence of birth defects and prevalence folic acid and vitamin B12 deficiency in the community. The case-control study will help understand the association of folic acid deficiency with OFCs. CONCLUSIONS: The results from this study are intended to strengthen the evidence base in childhood disability for planning and policy initiatives

Untersuchungen ueber die strukturmechanischen und aeroelastischen Einfluesse von Winglets

TIB: DP 9278 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Prevalence, Awareness, Treatment, and Control of Hypertension and Its Associated Risk Factors: Results from Baseline Survey of SWADES Family Cohort Study

Introduction. Hypertension is one of the most important modifiable risk factors for cardiovascular diseases. The objective of this study is to estimate the prevalence, awareness, treatment, and control of hypertension and its associated risk factors in Ernakulam district, Kerala. Methods. In this prospective family-based cohort study, 573 families were included with a total of 997 participants aged 30 years and above. Baseline interviews were conducted in participant’s homes using a combination of self-structured and standardized questionnaire. Blood pressure and plasma glucose were assessed for each participant. Results. The prevalence of hypertension was 43%. It was slightly higher in women than men (43.7% vs. 41.4%). The mean systolic blood pressure in the hypertensive population was 141.9 mmHg and mean diastolic blood pressure was 85.3 mmHg. In total, 78% (86.2% in women, 62.9% in men) of the participants were aware of their hypertension. Among those aware, 60.4% (63.5% in women, 52.6% in men) of the participants were on treatment, and hypertension was controlled in 75.1% (77.5% women, 68% in men) of the participants on treatment. The prevalence of hypertension was higher among persons with comorbidities (diabetes 64.5%, transient ischemic attack 54.7%, and heart disease 64.4%). Prevalence was lower among persons who did regular vigorous intensity exercise versus those who did moderate intensity exercise (32% vs. 45.7%) and among nonsmokers versus smokers (42.2% vs. 46.6%). Conclusion. The prevalence of hypertension in Kerala is high. Although awareness is quite high, there is a need to improve the number of persons with hypertension taking treatment

Improving access to quality family planning services in Nepal and Sri Lanka: insights from a South-South learning exchange

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