Community Health Commons^™

Low Self-Esteem Leads To Depression Among Elderly: Case Study Of Nursing Home, Savera Aziz Ali, Nadir Suhail, Sumera Aziz Ali

School of Nursing & Midwifery

Background: Self-esteem is defined as “how we value our self”; it affects our trust and relationships in every part of life. Person with low self-esteem may feel powerless and incompetent about himself/herself. Moreover, low self-esteem operates as a risk factor for depression, which is most common disorder among elderly people both in developed and developing countries, causing multiple behavioral changes as well as may increase the chances of depression and suicide among the elderly people. Objective: The objective of this case study was to understand the problems faced by elderly people in the nursing home and to relate the self-esteem …

Frequency Of Birth Defects And Its Relationship To Parents Having Interfamily Marriages At A Tertiary Care Hospital, Tufail Soomro, Shiyam Sunder Tikmani

Community Health Sciences

Background: Inter family cousin marriages carries a risk of increased birth defects. The exact contribution of interfamily to birth defects risk is controversial. The aims of this study were to determine the frequency of birth defects in in relation to interfamily or outside family marriages.
Methods: This cross sectional study was conducted in the Civil hospital Sukkur from 9th November 2013 to 13th December 2015. Mothers giving birth to babies married in interfamily or outside family with their consent obtained were included in the study. Mothers not giving consent for study and having any known major illnesses were excluded from …

794 Evaluating Disability In Adult Burn Injury Patients Treated At A Tertiary-Care Burn Unit In Karachi, Pakistan: A Longitudinal Study Using Who Disability Assessment Schedule Ii, Nukhba Zia, Asim Durrani, Safia Awan, Madiha Hashmi, Mazhar Nizam, Asad Latif

Department of Anaesthesia

Background: Disability after burn injury is not assessed in the context of Pakistan. This study assesses disability among adult burn injury patients presenting to a burn unit in Karachi, Pakistan.
Methods: This longitudinal study was conducted at a burn centre is Karachi, Pakistan. Adult patients(>18 years) who were discharge after 24-hour admission were enrolled from August 2014–March 2015. Baseline assessment before discharge and follow-up at 2,6 and 12 weeks after discharge via telephone was done using 12-item WHODAS 2.0 (5 -point likert-scale; 1 = none; 2 = mild; 3 = moderate; 4 = severe; and 5 = extreme) related …

A Step By Step Methodological Approach To Appraise The Quality Of Written Feedback Using Comment Analysis, Lubna Ghazal, Raisa B. Gul, Amina Aijaz Khowaja

School of Nursing & Midwifery

Several studies have been conducted to analyze the quality of written feedback given by teachers on students’ written assignments. However, it has been observed that there is no clear existing method or tool to facilitate the analysis of teachers’ written feedback. This paper aims to document a step by step methodological approach to analyze teachers’ comments and appraise the quality of feedback on students’ written assignments. A self-initiated tool was developed from the comment analysis process which revealed the use of various formats and modes employed to provide written feedback to the students. In addition, this tool helped to determine …

Perceived Barriers To Utilizing Maternal And Neonatal Health Services In Contracted-Out Versus Government-Managed Health Facilities In The Rural Districts Of Pakistan, Atif Riaz, Shehla Zaidi, Asif Raza Khowaja

Community Health Sciences

Background: A number of developing countries have contracted out public health facilities to the Non-Government Organizations (NGOs) in order to improve service utilization. However, there is a paucity of in-depth qualitative information on barriers to access services as a result of contracting from service users’ perspective. The objective of this study was to explore perceived barriers to utilizing Maternal and Neonatal Health (MNH) services, in health facilities contracted out by government to NGO for service provision versus in those which are managed by government (non-contracted).

Methods: A community-based qualitative exploratory study was conducted between April to September 2012 at two …

Cost Of Primary Health Care In Pakistan, Muhammad Ashar Malik, Wahid Gul, Saleem Per Waiz Iqbal, Farina Abrejo

Community Health Sciences

Background: Detailed cost analysis is an important tool for review of health policy and reforms. We provide an estimate of cost of service and its detailed breakup on out-door patient visits (OPV) to basic health units (BHU) in Pakistan.

Method: Six BHUs were randomly selected from each of the five districts in Khyber Pukhtonkhawa (KPK) and two agencies in Federally Administered Tribal Areas (FATA) of Pakistan for this study. Actual expenditure data and utilization data in the year 2005 –06 of 42 BHUs was collected from selected district health offices in KPK and FATA. Costs were estimated for outpatient visits …

Factors That Affect Attachment Between The Employed Mother And The Child, Infancy To Two Years, Naureen Kassamali, Salma Amin Rattani

School of Nursing & Midwifery

To explore a mother's feeling of attachment and the affects her working status on the attachment relationship with her child, upon ethical clearance from the institutional ethics committee, in-depth interviews of nine participants were conducted. Mothers enrolled were those who resumed the employment within the first year of post-delivery and were having a child up to two years of age. Results revealed that maternal employment itself does not enhance or deteriorate attachment with the child. It is combinations of factors that revolve around it impact on their bond. Overall, maternal integration or the balance of the dual roles of employment …

Tackling The Existing Burden Of Infectious Diseases In The Developing World: Existing Gaps And The Way Forward, Zulfiqar Ahmed Bhutta, Rehana A. Salam, Jai K. Das, Zohra S. Lassi

Department of Paediatrics and Child Health

This series evaluates the effectiveness of community-based interventions (CBIs) to prevent and control infectious diseases of poverty (IDoP). Evidence from our reviews suggests that CBIs and school-based delivery platforms are effective in averting risk behaviors and reducing the disease burden. Co-implementation of interventions through existing community-based programs including immunization campaigns, antenatal care and maternal and child health programs have the potential to scale-up interventions for IDoP. Future research should focus on the process of developing and implementing efficient community-based programs through a comprehensive approach, and to gauge the effectiveness of various existing delivery models in order to improve morbidity and …

Gender: Shaping Personality, Lives And Health Of Women In Pakistan, Narjis Rizvi, Kausar S. Khan, Babar T. Shaikh

Community Health Sciences

Background: Gender norms determine the status of Pakistani women that influence their life including health. In Pakistan, the relationship between gender norms and health of women is crucial yet complex demanding further analysis. This paper: determines the reasons for reiteration of gender roles; describes the societal processes and mechanisms that reproduce and reinforce them; and identifies their repercussions on women's personality, lives and health especially reproductive health.
Methods: As part of a six-country study titled 'Women's Empowerment in Muslim Contexts', semi-structured group discussions (n = 30) were conducted with women (n = 250) who were selected through snowballing from different …

Gender: Shaping Personality, Lives And Health Of Women In Pakistan, Narjis Rizvi, Kausar S. Khan, Babar T. Shaikh

Community Health Sciences

Background: Gender norms determine the status of Pakistani women that influence their life including health. In Pakistan, the relationship between gender norms and health of women is crucial yet complex demanding further analysis. This paper: determines the reasons for reiteration of gender roles; describes the societal processes and mechanisms that reproduce and reinforce them; and identifies their repercussions on women's personality, lives and health especially reproductive health.
Methods: As part of a six-country study titled 'Women's Empowerment in Muslim Contexts', semi-structured group discussions (n = 30) were conducted with women (n = 250) who were selected through snowballing from different …

Patient Attitudes Towards Physician Nonverbal Behaviors During Consultancy: Result From A Developing Country, Fahad Hanif Khan, Raheela Hanif, Rumina Tabassum, Waris Qidwai Dr, Kashmira Nanji

Department of Family Medicine

Background. Nonverbal behaviors have a significant impact on patients during consultations. This study was undertaken to find out the attitudes and preferences of the patients regarding nonverbal communication during consultations with physicians, in a tertiary care hospital.
Methods. A questionnaire based cross-sectional study was carried out at the Aga Khan University Hospital, Karachi, Pakistan, during the months of January to March 2012. All patients (>18 years of age) coming for consultancy in the family medicine clinics were approached; out of 133, 120 agreed to participate. The subjects were asked questions regarding physician’s comforting touch and eye contact and …

Emerging Challenges And Health System Capacity: The Case Of Non- Communicable Diseases In Pakistan; A Review, Mubashir Zafar, Muhammad Ashar Malik

Community Health Sciences

Background: Pakistan is facing double burden of disease and the contribution of mortality by non-communicable diseases has over numbered the communicable diseases. The focus of health system of Pakistan is inclined more towards communicable disease and maternal & child health. Therefore, there is a need to review health policy, health sector budgeting and health setup in order to meet the needs of healthcare in context of non-communicable disease.

Objective: To review the health system capacity to manage the emerging challenge of non-communicable diseases in Pakistan.

Methodology: A thorough literature search on PubMed and Google Scholar was done. Reports from W.H.O, …

Resolving Ethical Dilemma: An Application Of A Theoretical Model, Lubna Ghazal, Zulekha Saleem, Gulzar Amlani

School of Nursing & Midwifery

Human error can occur in any profession. Medical errors most commonly occur in a health care system, which may delay patient’s recovery and produce harm to patients. However, when a medical error occurs, it is challenging to inform the incident to patients and their family. Health care professionals follow a professional code of ethics to do well and not harm patients. Historically, many of these errors were not disclosed to patients but the trend for more open disclosure of medical errors to patients and their families is a mutually beneficial and welcomed change.

Self-Reported Attitudes And Behaviours Of Medical Students In Pakistan Regarding Academic Misconduct: A Cross-Sectional Study, Kulsoom Ghias, Ghulam Rehmani Lakho, Hamna Asim, Iqbal Syed Azam, Sheikh Abdul Saeed

Department of Biological & Biomedical Sciences

Background: Honesty and integrity are key attributes of an ethically competent physician. However, academic misconduct, which includes but is not limited to plagiarism, cheating, and falsifying documentation, is common in medical colleges across the world. The purpose of this study is to describe differences in the self-reported attitudes and behaviours of medical students regarding academic misconduct depending on gender, year of study and type of medical institution in Pakistan.
Methods: A cross sectional study was conducted with medical students from one private and one public sector medical college. A pre-coded questionnaire about attitudes and behaviours regarding plagiarism, lying, cheating and …

Illuminating The Dark Side-Vitamin D Status In Different Localities Of Karachi, Romaina Iqbal, Lena Jafri, Ali Haroon, Aysha Habib Khan

Department of Pathology and Laboratory Medicine

This study was conducted to determine the association between place of residence (grouped into neighbourhoods), and 25-hydroxy D (25[OH]D) levels of individuals of Karachi. Addresses of 4788 individuals tested for 25[OH]D at the clinical laboratory of the Aga Khan University (AKU), Karachi, from January 2007 to June 2008 were reviewed. The neighbourhoods were categorized into ten, based on locality attributes. A high overall prevalence (74%) of vitamin D deficiency (VDD) was observed. There was a significant difference (p-value < 0.01) between mean log 25[OH]D levels amongst neighbourhoods grouped according to distinct housing structure attributes and localities. A high frequency of VDD in all the studied localities of an urban city warrant dietary vitamin D supplementation and food fortification.

Nutrition Political Economy, Pakistan. Province Report:Sindh, Shehla Zaidi, Zulfiqar Ahmed Bhutta, Rozina Mistry, Gul Nawaz, Noorya Hayat, Shandana Khan Mohmand, Andres Mejia Acosta

Community Health Sciences

No abstract provided.

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 …

Access To Essential Medicines In Pakistan: Policy And Health Systems Research Concerns., Shehla Zaidi, Maryam Bigdeli, Noureen Aleem, Arash Rashidian

Community Health Sciences

NTRODUCTION:

Inadequate access to essential medicines is a common issue within developing countries. Policy response is constrained, amongst other factors, by a dearth of in-depth country level evidence. We share here i) gaps related to access to essential medicine in Pakistan; and ii) prioritization of emerging policy and research concerns.

METHODS:

An exploratory research was carried out using a health systems perspective and applying the WHO Framework for Equitable Access to Essential Medicine. Methods involved key informant interviews with policy makers, providers, industry, NGOs, experts and development partners, review of published and grey literature, and consultative prioritization in stakeholder's Roundtable. …

Impact Of Water And Sanitation And Health Education Interventions On Health And Hygiene Behaviors: A Study From A Northern Pakistani Village, Aysha Zahidie, Fauziah Rabbani

Community Health Sciences

Introduction: Water and sanitation interventions were delivered in the northern areas of Pakistan as a joint venture of the Aga Khan University and the Aga Khan Health Systems Oshikhandass Diarrhea and Dysentery Project (1989-96) followed by the Aga Khan Water, Sanitation, Health and Hygiene Studies Program (WSHHSP). Through these interventions water treatment plants, new pit latrines along with a component of health education were introduced. Objectives: To explore perceptions, knowledge and practices of inhabitants of Oshikhandass village in Gilgit related to water quality, latrine use and hand washing following the intervention. Methods: Through a cross-sectional study during June-July 2012, six …

Meckel Gruber Syndrome: Second Trimester Diagnosis Of A Case In A Non-Consanguineous Marriage, Areej Alam, Mehreen Adhi, Raffat Bano, Aisha Zubair, Ammara Mushtaq

Department of Obstetrics & Gynaecology

Meckel-Gruber Syndrome (MKS) is a rare, autosomal recessive genetic disorder, incompatible with life. It is characterized by enlarged polycystic kidneys and post axial polydactyly. Foetal or neonatal death is caused by pulmonary hypoplasia. We report a case of a 35 year old woman who presented at 7 weeks of gestation of her sixth pregnancy. A transabdominal anomaly ultrasound performed for her current pregnancy at 18 weeks of gestation showed features consistent with MKS. The termination of pregnancy was declined and a live newborn female was delivered via an emergency caeserean section at 34 weeks of gestation due to previous history …

Situation Analysis Of Child Labour In Karachi, Pakistan: A Qualitative Study, Asaad Ahmed Nafees, Kausar S. Khan, Zafar Fatmi, Mubashir Aslam

Community Health Sciences

In Karachi, large employment opportunities, burgeoning population and the availability of cheap labour might be the contributing factors for the increasing prevalence of child labour. A literature review was conducted in 2007 that included published and unpublished literature since 2000. Various organizations working in the field were also covered, while the perception of the child labourers was covered through three focus group discussions. Common health issues among the child labourers in Karachi included respiratory illnesses, fever and generalised pains, as well as drug and sexual abuse. Organisations working for child labour could be broadly categorised into those working for legal …

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 …

Determinants Of Patient's Satisfaction With Health Care System In Pakistan: A Critical Review, Maliha Naseer, Aysha Zahidie, Babar Tasneem Shaikh

Community Health Sciences

Patient satisfaction with health care services is considered an important factor of quality health care. Although research on patient satisfaction has become standard in many developed country, in countries such as Pakistan the concept of patient satisfaction is still relatively neglected. This study aimed to find out the determinants of patient satisfaction from existing literature in Pakistan.The literature search was carried out by using the database of Medscape, Medline, PakMedinet and PubMed, without any language restriction using MeSH words as “patient satisfaction AND health care system in Pakistan” and “Determinants of patient satisfaction AND Pakistan”. Twenty-one articles were found which …

Malnutrition In Young Pakistani Children, Shela Akbar Ali Hirani

School of Nursing & Midwifery

Background: Pakistan is a developing country with the second highest infant and child mortality rate in South Asia. In this region, malnutrition underlies much of the high infant and under five child morbidity and mortality rates. Although struggle to tackle the issue of malnutrition among young Pakistani children has been going on since many decades, till yet a realistic solution for this growing problem has not been found.

Objective: This paper aims at reviewing literature to analyse the biological, maternal, socio-cultural, environmental, and politico-economical determinants of malnutrition among young children in Pakistan so that need based interventions can …

Risk Factors For Depression Among Married Women Belonging To Higher And Lower Socioeconomic Status In Karachi, Pakistan, Saima Zainab, Zafar Fatmi, Ambreen Kazi

Community Health Sciences

OBJECTIVES: To determine the risk factors for depression among married women belonging to low and high socioeconomic status in Karachi.METHODS: The study design was cross-sectional. The data was collected from 128 adult married women during July to September 2005. The women were selected from different socioeconomic classes from five hospitals/institutes in Karachi. The Centre for Epidemiology Studies-Depression (CES-D) scale was used to screen the subjects for depression and a structured questionnaire was used to identify the factors for depression.RESULT: According to the CES-D scale, 65% of the study population was found to be depressed. Among the women from high socioeconomic …

Perceptions And Experiences Of Women In Karachi, Pakistan Regarding Secondary Infertility: Results From A Community-Based Qualitative Study, Neelofar Sami, Tazeen S. Ali

Community Health Sciences

Background: The prevalence of infertility in Pakistan is 22% with primary infertility at 4% and secondary infertility at 18%. This study explored perceptions and experiences of women in Karachi, Pakistan regarding the causes, treatment-seeking behavior for and consequences of secondary infertility.
Methods: Focus group discussions and in-depth interviews with married women explored their perceptions and experiences for issues related to secondary infertility.
Results: The knowledge of women about the causes and scientific treatment options for infertility was limited resulting in inclination for traditional unsafe health care. Infertility was stated to result in marital instability, stigmatization and abuse specially for women …

Teachers’ And Parents’ Perspective As How The Social Environment Of Immediate Vicinity Can Affect The Academic Learning Of A Child 4-6 Years Age Group, Salma Amin Rattani, Deedar Shah

School of Nursing & Midwifery

In the process of human development environment plays a pivotal role. At the age of 4 -6 years, children's immediate vicinity expands from home to school and in his social environment parents and teachers play a vital role. Therefore, in this study which was conducted in Phander district Ghizer, Northern areas; of Pakistan, employing descriptive research design five parents and five school teachers were enrolled. Participants shared their definition and understanding about social environment and immediate vicinity and its effects on academic learning. This research is part of Advanced Diploma in Human Development: Early Child Development Programme, Aga Khan University. …

Advances In Information And Communication Technology (Ict): Issues, Challenges And Opportunities For Health Care Professionals, Waris Qidwai

Department of Family Medicine

No abstract provided.

A Silent Storm: Hepatitis C In Pakistan, Noureen Jiwani, Raisa B. Gul

School of Nursing & Midwifery

No abstract provided.

Ngos And Government Partnership For Health Systems Strengthening: A Qualitative Study Presenting Viewpoints Of Government, Ngos And Donors In Pakistan, Iram Ejaz, Babar T. Shaikh, Narjis Rizvi

Community Health Sciences

Background: Health systems are expected to serve the population needs in an effective, efficient and equitable manner. Therefore, the importance of strengthening of public, private and community health systems has been emphasized time and again. In most of the developing countries, certain weaknesses and gaps in the government health systems have been hampering the achievement of improved health outcomes. Public sector in Pakistan has been deficient in the capacity to deliver equitable and quality health services and thus has been grossly underutilized.Methods: A qualitative study comprising in-depth interviews was conducted capturing the perceptions of the government functionaries, NGO representatives …