Efficacy of Fractional Co2 Laser with PRP for Cutaneous Leishmaniasis Scar

Abstract

Background: Family-planning use in underserved communities is influenced not only by service availability but also by social norms, myths about contraception, gendered decision-making, privacy concerns, and trust in frontline workers. Community-based models such as the Marvi Markaz/BiB approach may improve access and acceptability, but routine monitoring alone cannot explain how such interventions are experienced or under which conditions they are perceived as workable and sustainable. Objective: To explore perceptions of the Marvi Markaz/BiB family-planning model, identify barriers and facilitators affecting communication and access, and assess its perceived acceptability and sustainability among community and district stakeholders. Methods: An interpretative qualitative endline evaluation was conducted from 18 to 22 November 2024 using in-depth interviews and focus group discussions with married women of reproductive age, men, Marvi workers, and district-level stakeholders. Participants were purposively selected based on their direct experience of the intervention or its service pathways. Data were audio-recorded, transcribed, anonymized, and analyzed thematically. Results: The findings indicated that trust in local female workers, nearby safe access, respectful counselling, repeated follow-up, and community familiarity were central to perceived acceptability. Persistent barriers included myths and fear of side effects, male-dominated decision-making, elder-family influence, privacy-related constraints, and interruptions in commodity continuity. Participants linked the model to improved awareness, greater comfort in discussing family planning, better perceived service acceptability, and, in some accounts, improved couple communication. Perceived sustainability was tied mainly to reliable supplies, worker support, and district-level supervision. Conclusion: The Marvi Markaz/BiB model was perceived as acceptable primarily when trusted community relationships were supported by accessible services and implementation reliability. Strengthening male engagement, refresher training, supervision, monitoring, and commodity continuity may improve the sustainability of similar community-based family-planning interventions.