Public Health Commons^™

Comparing The Effectiveness Of Mother-Focused Interventions To That Of Mother-Child Focused Interventions In Improving Maternal Postpartum Depression Outcomes: A Systematic Review, Divya Kumar, Waqas Hameed, Bilal Iqbal Avan

Community Health Sciences

Background: Most empirically researched interventions for postpartum depression (PPD) tend to target mothers' depression alone. Harmful effects of PPD on physical and mental health of both mother and child has led researchers to investigate the impact of interventions on PPD and child outcomes together. So far, the evidence is limited regarding how these interventions compare with those focusing only on mothers' depression. This review compares the effectiveness of PPD-improving interventions focusing only on mothers with those focusing on mother and child together.
Methods: Nine electronic databases were searched. Thirty-seven studies evaluating mother-focused (n = 30) and mother-child focused interventions (n …

Building On The Health Policy Analysis Triangle: Elucidation Of The Elements, Aysha Zahidie, Saima Asif, Meesha Iqbal

Community Health Sciences

The health policy triangle first presented in the 20th century by Walt and Gilson has been extensively used at local, national, regional, and international levels to assess health policies related to communicable and non-communicable diseases, physical and mental health, antenatal and postnatal care, and human resources, services, and systems. However, the framework lacks intricate details for the four pillars in the triangle viz: 'content,' 'context', 'actors', and 'processes. We propose a checklist of elements to be considered for each pillar; to ease and enhance the process of policy analyses for researchers and policymakers across the globe, including low- and middle-income …

Understanding The Mental Health Impact And Needs Of Public Healthcare Professionals During Covid-19 In Pakistan : A Qualitative Study, Waqas Hameed, Anam Shahil Feroz, Bilal Iqbal Avan, Bushra Khan, Zafar Fatmi, Noreen Afzal, Hussain Jafri, Mansoor Ali Wassan, Sameen Siddiqi

Community Health Sciences

Objectives: A dearth of qualitative studies constrains in-depth understanding of health service providers' perspectives and experiences regarding the impact of COVID-19 on their mental health. This study explored the mental health impact and needs of of public sector healthcare workers during COVID-19 who working in secondary-level and tertiary-level healthcare settings of Pakistan.
Design: An exploratory qualitative study.
Setting: Twenty-five secondary-level and eight tertiary-level public hospitals of Sindh and Punjab provinces of Pakistan.
Participants: In-depth interviews were conducted with 16 health service providers and 40 administrative personnel. Study data were analysed on NVivo V.11 using the conventional content analysis technique.
Results: …

Narrative Synthesis Systematic Review Of Pakistani Women's Health Outcomes From Primary Care Interventions, Sara Rizvi Jafree, Qaisar Khalid Mahmood, Sohail Mujahid, Muhammad Asim, Jane Barlow

Community Health Sciences

Objective: Women living in Pakistan have complex health problems including infectious and non-communicable diseases, accident and injuries, and mental health problems. While a majority of these women rely on primary healthcare services for all of their healthcare needs, there has to date been no overview of the extent of their effectiveness. The objective of this review was to (1) synthesise the available evidence regarding the effectiveness of primary care based interventions aimed at improving women's mental and physical health and (2) identify the factors that promote effectiveness for women's health outcomes.
Methods: Five academic databases were searched, including PubMed, BMC …

Inclusive, Supportive And Dignified Maternity Care (Sdmc)-Development And Feasibility Assessment Of An Intervention Package For Public Health Systems: A Study Protocol, Bilal Iqbal Avan, Waqas Hameed, Bushra Khan, Muhammad Asim, Sarah Saleem, Sameen Siddiqi

Community Health Sciences

Introduction: Mistreatment, discrimination, and poor psycho-social support during childbirth at health facilities are common in lower- and middle-income countries. Despite a policy directive from the World Health Organisation (WHO), no operational model exists that effectively demonstrates incorporation of these guidelines in routine facility-based maternity services. This early-phase implementation research aims to develop, implement, and test the feasibility of a service-delivery strategy to promote the culture of supportive and dignified maternity care (SDMC) at public health facilities.
Methods: Guided by human-centred design approach, the implementation of this study will be divided into two phases: development of intervention, and implementing and testing …

Spatiotemporal Variation And Socioeconomic Factors Of Financial Hardships Of Out-Of-Pocket Health Expenditure In Pakistan, Muhammad Ashar Malik, Iqbal Azam Syed, Amir Khan, Faisal Rifaq, Kinza Chaudhary

Community Health Sciences

Background: Financial hardships of out-of-pocket health expenditure (OPHE) is a growing concern for health policy makers in many low and middle-income countries. Spatiotemporal variation between Pakistan's four provinces over 2001-2015 is discussed, which would help comparing existing health services delivery and financial risk protection plans.
Aims: In this paper, we estimate financial hardship of OPHE in Pakistan.
Methods: We use the data sets of the household integrated economic surveys 2001-02, 2005-06, 2010-11 and 2015-16. We estimate OPHE share in household total and non-subsistence expenditure, catastrophic headcount at the threshold of OPHE ≥ 10% of total expenditure or OPHE ≥ 25% …

The Influence Of The Urban Food Environment On Diet, Nutrition And Health Outcomes In Low-Income And Middle-Income Countries: A Systematic Review, Susannah Westbury, Iman Ghosh, Helen Margaret Jones, Daniel Mensah, Folake Samuel, Ana Irache, Nida Azhar, Lena Al-Khudairy, Romaina Iqbal, Oyinlola Oyebode

Community Health Sciences

Introduction: Diet and nutrition are leading causes of global morbidity and mortality. Our study aimed to identify and synthesise evidence on the association between food environment characteristics and diet, nutrition and health outcomes in low-income and middle-income countries (LMICs), relevant to urban settings, to support development and implementation of appropriate interventions.
Methods: We conducted a comprehensive search of 9 databases from 1 January 2000 to 16 September 2020 with no language restrictions. We included original peer-reviewed observational studies, intervention studies or natural experiments conducted in at least one urban LMIC setting and reporting a quantitative association between a characteristic of …

Conflicts Of Interest: An Invisible Force Shaping Health Systems And Policies, Afifah Rahman-Shepherd, Priya Balasubramaniam, Meenakshi Gautham, Eleanor Hutchinson, Freddy E. Kitutu, Robert Marten, Mishal S. Khan

Community Health Sciences

No abstract provided.

Violence And Abuse Among Working Children In Urban And Suburban Areas Of Lower Sindh, Pakistan, Meesha Iqbal, Zafar Fatmi, Kausar S. Khan, Asaad Ahmed Nafees

Community Health Sciences

Background: Child labourers are exposed to an insecure environment and higher risk of violence. Violence among child labourers is an under-studied phenomenon which requires contextual assessment.
Aims: We applied Bronfenbrenner's ecological model (micro-, exo- and macro-system) to understand the interplay of individual, community, societal and policy context fuelling violence.
Methods: Focus group discussions and family ethnographies of child-labourers working in common occupational sectors of suburban areas of Sindh were carried out to gain in-depth understanding of their immediate environment and abuse (micro-system). Frequency of emotional, physical and sexual violence (5-14 years; n = 634) was also determined. Indepth interviews with …

Cost Estimation Alongside A Multi-Regional, Multi-Country Randomized Trial Of Antenatal Ultrasound In Five Low-And-Middle-Income Countries, B W. Bresnahan, E Vodicka, J B. Babigumira, Ashar Muhammad Malik, F Yego, A Lokangaka, B M. Chitah, Z Bauer, H Chavez, Sarah Saleem

Community Health Sciences

Background: Improving maternal health has been a primary goal of international health agencies for many years, with the aim of reducing maternal and child deaths and improving access to antenatal care (ANC) services, particularly in low-and-middle-income countries (LMICs). Health interventions with these aims have received more attention from a clinical effectiveness perspective than for cost impact and economic efficiency.
Methods: We collected data on resource use and costs as part of a large, multi-country study assessing the use of routine antenatal screening ultrasound (US) with the aim of considering the implications for economic efficiency. We assessed typical antenatal outpatient and …

Exploring Equity In Health And Poverty Impacts Of Control Measures For Sars-Cov-2 In Six Countries, Sedona Sweeney, Theo Prudencio Juhani Capeding, Rosalind Eggo, Maryam Huda, Mark Jit, Don Mudzengi, Nichola R. Naylor, Simon Procter, Matthew Quaife, Lela Serebryakova

Community Health Sciences

Background: Policy makers need to be rapidly informed about the potential equity consequences of different COVID-19 strategies, alongside their broader health and economic impacts. While there are complex models to inform both potential health and macro-economic impact, there are few tools available to rapidly assess potential equity impacts of interventions.
Methods: We created an economic model to simulate the impact of lockdown measures in Pakistan, Georgia, Chile, UK, the Philippines and South Africa. We consider impact of lockdown in terms of ability to socially distance, and income loss during lockdown, and tested the impact of assumptions on social protection coverage …

Are Underprivileged And Less Empowered Women Deprived Of Respectful Maternity Care: Inequities In Childbirth Experiences In Public Health Facilities In Pakistan, Waqas Hameed, Mudassir Uddin, Bilal Iqbal Avan

Community Health Sciences

Background: Attainment of healthcare in respectful and dignified manner is a fundamental right for every woman regardless of the individual status. However, social exclusion, poor psychosocial support, and demeaning care during childbirth at health facilities are common worldwide, particularly in low- and middle-income countries. We concurrently examined how women with varying socio-demographic characteristics are treated during childbirth, the effect of women's empowerment on mistreatment, and health services factors that contribute to mistreatment in secondary-level public health facilities in Pakistan.
Methods: A cross-sectional survey was conducted during August-November 2016 among 783 women who gave birth in six secondary-care public health facilities …

Global Strategies And Local Implementation Of Health And Health-Related Sdgs: Lessons From Consultation In Countries Across Five Regions, Sameen Siddiqi, Wafa Aftab, Fahad Javaid Siddiqui, Luis Huicho, Roman Mogilevskii, Peter Friberg, Johanna Lindgren-Garcia, Sara Causevic, Anil Khamis, Mashal Murad Shah, Zulfiqar Ahmed Bhutta

Community Health Sciences

Evidence on early achievements, challenges and opportunities would help low-income and middle-income countries (LMICs) accelerate implementation of health and health-related sustainable development goals (HHSDGs). A series of country-specific and multicountry consultative meetings were conducted during 2018-2019 that involved 15 countries across five regions to determine the status of implementation of HHSDGs. Almost 120 representatives from health and non-health sectors participated. The assessment relied on a multidomain analytical framework drawing on existing public health policy frameworks. During the first 5 years of the sustainable development goals (SDGs) era, participating LMICs from South and Central Asia, East Africa and Latin America demonstrated …

Do Recipients Of Cash Transfer Scheme Make The Right Decisions On Household Food Expenditure? A Study From A Rural District In Pakistan, Aminah Jahangir, Shehla Zaidi, Jai K. Das, Shifa Habib

Community Health Sciences

Objective: To assess spending by beneficiaries of Benazir Income Support Programme on monthly food commodities, and contribution of the cash grant programme on purchase of nutritious foods.
Methods: The descriptive cross-sectional survey of households enrolled in the Benazir Income Support Programme was conducted during July and August, 2013, in Matiari district of the Sindh province of Pakistan. Monthly household food expenditure on food commodities and use of the cash grant on type of food purchased was assessed through structured interviews of the beneficiaries. Results were computed in 2013 Pak rupees and converted to 2018 United States dollar. Women beneficiaries were …

Intimate Partner Violence Against Women In Pakistan: A Review Of Qualitative Research, Tazeen S. Ali, Rida Farhan, Michelle Ayub

Community Health Sciences

Objective: To consolidate research data and provide an insight into areas that need further research regarding intimate partner violence.
Methods: The review targeted qualitative research-based studies done in the English language and conducted in Pakistan from 2008 to 2018 regarding intimate partner violence against women. A thorough search of Google Scholar and PubMed databases was done. Data from each selected article was extracted using a data-extraction template.
Results: Of the 2,479 results, 21(0.8%) articles were selected along with 4(0.16%) texts from grey literature. An in-depth analysis led to six broad categories: experiences/perspectives of married women facing intimate partner violence; perspectives …

Improving Identification And Child-Focused Collaborative Care For Children Of Parents With A Mental Illness In Tyrol, Austria, Hanna Christiansen, Annette Bauer, Batool Fatima, Melinda Goodyear, Ingunn Olea Lund, Ingrid Zechmeister-Koss, Jean Lillian Paul

Community Health Sciences

Background: Children of parents with a mental illness (COPMI) are more likely to experience negative long-term adversities. However, interventions to support their needs early can significantly enhance adjustment and reduce negative outcomes. Approximately one in four children currently lives with a parent with mental illness worldwide. The lifelong impact for individuals, governments, and broader society is likely to be substantial. There are significant workforce barriers to the early identification of COPMI and addressing their needs, particularly within the adult mental health care system. The current study aims to reduce such barriers and to improve identification of COPMI in the current …

Measuring Socio-Economic Status Of An Urban Squatter Settlement In Pakistan Using Wami Index, Nousheen Pradhan, Tazeen Saeed Ali, Fauzia Basaria Hasnani, Shireen Shehzad Bhamani, Rozina Karmaliani

Community Health Sciences

Objective: To determine the socio-economic status of a peri-urban community.
Methods: The cross-sectional study was conducted at Deh Chuhar village, Gaddap Town, Karachi from December 2015 to February 2016. The Water/Sanitation, Assets, Maternal Education and Income Index was used. All variables were given a score on the scale of 0-8. The resulting index was illustrated in the form of quintiles.
Results: : A total of 254 households were surveyed. Total population was 2117 with mean number of household members being 8±4. Mean index score was 0.39±0.14 and the median score was 0.375. Percentile distribution of the score indicated that 152(60%) …

Health-Related Quality Of Life Variations By Sociodemographic Factors And Chronic Conditions In Three Metropolitan Cities Of South Asia: The Carrs Study, Kavita Singh, Dimple Kondal, Roopa Shivashankar, Mohammed K. Ali, Rajendra Pradeepa, Vamadevan S. Ajay, Viswanathan Mohan, Muhammad Masood Kadir, Mark Daniel Sullivan, Nikhil Tandon, K M Venkat Narayan, Dorairaj Prabhakaran

Community Health Sciences

Objectives: Health-related quality of life (HRQOL) is a key indicator of health. However, HRQOL data from representative populations in South Asia are lacking. This study aims to describe HRQOL overall, by age, gender and socioeconomic status, and examine the associations between selected chronic conditions and HRQOL in adults from three urban cities in South Asia.
Methods: We used data from 16 287 adults aged ≥20 years from the baseline survey of the Centre for Cardiometabolic Risk Reduction in South Asia cohort (2010-2011). HRQOL was measured using the European Quality of Life Five Dimension-Visual Analogue Scale (EQ5D-VAS), which measures health status …

Prevalence Of Hepatitis B Virus Infection Among Barbers And Their Knowledge, Attitude And Practices In The District Of Sukkur, Sindh ., Imran Naeem Abbasi, Zafar Fatmi, Muhammad Masood Kadir, Nalini Sathiakumar

Community Health Sciences

Abstract

OBJECTIVES:

Several occupations in developing countries lag behind in ensuring the safety of their workers in occupational settings. Lack of implementation of safety guidelines at workplaces can expose workers to health risks. In Pakistan, barbers are one of the un-regulated occupational groups. Low literacy, increased frequency of direct skin contact and blade/razors use can expose barbers to body fluids including blood of the customers. We conducted this study in order to determine hepatitis B virus (HBV) prevalence among barbers and their knowledge, attitude and practices in a peri-urban district of Sindh.

MATERIAL AND METHODS:

Three hundred eighty-five barbers from …

Knowledge, Attitude And Practices Regarding Hiv/Aids Among Adult Fishermen In Coastal Areas Of Karachi., Mubashir Zafar, Nighat Nisar, Masood Kadir, Zafar Fatmi, Zeeshan Ahmed, Kashif Shafique

Community Health Sciences

BACKGROUND:

Migrant populations are at high risk of Human Immuno Deficiency Virus infection (HIV) and Acquired Immunodeficiency Syndrome (AIDS). Studies of HIV/AIDS knowledge, attitudes and practices among fishermen in developing countries have shown gaps in knowledge and fear of contagion with ambivalent attitudes towards HIV/AIDS and inconsistent universal precautions adherence. The aim of this study was to determine the knowledge, attitude and practices regarding HIV/AIDS among adult fishermen in a coastal area of Karachi, Pakistan.

METHODS:

Community based cross sectional study was conducted among fishermen in coastal area of Karachi from June to September 2012. A total of 297 adult …

An Overview Of The Predictors Of Depression Among Adult Pakistani Women, Aysha Zahidie, Tanzil Jamali

Community Health Sciences

Diseases of women that are due to their gender specific roles and responsibilities result from cultural and social factors prevalent in the environs. World Health Organization has put special emphasis on research need regarding gender related factors for diseases disproportionately affecting women in developing countries. The objective of this write up was to determine the prevalence of depression and the associated risk factors among adult women in Pakistan. PubMed was searched using key words depression, risk factors, women and Pakistan. Out of 20 initially retrieved articles, 12 were directly related to depression and its risk factors among Pakistani women within …

Socio-Economic Determinants Of Out-Of-Pocket Payments On Healthcare In Pakistan, Ashar Muhammad Malik, Syed Iqbal Azam Shah

Community Health Sciences

BACKGROUND:

Out-of-pocket (OOP) payment on healthcare is dominant mode of financing in developing countries. In Pakistan it is 67% of total expenditure on healthcare. Analysis of determinants of OOP health expenditure is a key aspect of equity in healthcare financing. It helps to formulate an effective health policy. Evidence on OOP in Pakistan is sparse. This paper attempts to fill this research gap.

METHODS:

We estimated determinants of OOP payments on healthcare in Pakistan. We used data sets of Pakistan Household Integrated Economic Survey (HIES) and Pakistan Standard of Living Measurement (PSLM) Survey for the year 2004-05. We developed a …

Comparing Risk Factors Of Hiv Among Hijra Sex Workers In Larkana And Other Cities Of Pakistan: An Analytical Cross Sectional Study, Arshad Altaf, Aysha Zahidie, Ajmal Agha

Community Health Sciences

Background

In 2005, Pakistan was first labeled as a country with concentrated epidemic of Human Immunodeficiency Virus (HIV). This was revealed through second generation surveillance conducted by HIV/AIDS Surveillance Project (HASP). While injection drug users (IDUs) were driving the epidemic, subsequent surveys showed that Hijra (transgender) sex workers (HSWs) were emerging as the second most vulnerable group with an average national prevalence of 6.4%. An exceptionally high prevalence (27.6%) was found in Larkana, which is a small town on the right bank of river Indus near the ruins of Mohenjo-Daro in the province of Sindh. This paper presents the risk …

Stewardship In Health Policy And Its Relevance To Pakistan, Asaad Ahmed Nafees, Parvez Nayani

Community Health Sciences

Since the concept of stewardship in health care first appeared in World Health Report 2000 there has been very limited discussion in the academia about its implications. In the present paper we revisit this concept and review the literature that has been written about it. We have particularly focused on the role of stewardship in health policy of Pakistan. We also highlight the improvement that stewardship can bring about in the health policy of Pakistan and the possible constraints that might be faced during its implementation phase. The literature available is on the concept of stewardship in health policy. The …

Socio-Economic And Demographic Factors Associated With Injecting Drug Use Among Drug Users In Karachi, Pakistan, A. Agha, S. Parviz, M. Younus, Zafar Fatmi

Community Health Sciences

Objective: To identify the socio-economic and demographic factors associated with injecting drug users (IDUs) in Karachi.

Methods: We recruited 242 IDUs (taking drugs through sub-dermal routes) and 231 non-IDUs (taking drugs other than sub-dermal routes) from February through June 1996. IDUs were interviewed regarding sociodemographic factors, economic condition, and social network (marital status, living with spouse). In addition, information regarding location of drug users within the city (districts of Karachi) and current history of sexually transmitted diseases (STDs) were gathered. Moreover, blood samples were also obtained for HIV testing

.Results: Multivariate analysis showed that the income generation via illegal …