Evaluation of efficacy of self breast examination for breast cancer prevention: a cost effective screening tool

Breast cancer is the most prevalent neoplasm among females and every year the number of associated deaths increases so that there is a dire need for implementation of cancer screening and early detection. A survey conducted by various locally organised cancer registries indicated breast cancer to be the most prevalent cancer among females and the second most common cause of cancer deaths among Pakistani women. Since Pakistani females do not generally engage in screening practices we argue that nurses and lady health workers should team up to educate women for the possible early detection of cancer using Self Breast Examination as a screening tool. In this paper, we attempt to evaluate the primary efficacy of self breast examination as an early and cost effective cancer screening measure, and to discuss the relation of community health nurses as well as the lady health workers to education of females of low income countries such as Pakistan to possibly lower the cancer burden

Evaluation of a cancer awareness campaign: experience with a selected population in Karachi

The incidence and prevalence of cancer is rapidly increasing in both developed and developing countries. The most common cancers reported in Pakistan are breast and cervical cancers in females, and lung and oral cancers in males. Public awareness of cancer can play a vital role in its prevention, early diagnosis and treatment. A pilot survey conducted by the Cancer Support Group (CSG) of Aga Khan University Hospital from 2001 till 2004 to gauge the public awareness of cancer in Pakistan revealed that people were afraid of cancer and had little knowledge about its prevention and early detection. The survey also identified several social, religious and cultural misconceptions which hinder cancer screening and treatment. In order to create awareness amongst the general public, especially the young generation, members of the CSG also organized fifteen health education sessions in schools, colleges, hospitals and communities in Karachi which were attended by more than 1,500 people. With the help of the results generated in the pilot project, education material was designed and developed for these health education sessions. Ten percent of the participants contacted CSG members for some unusual finding after administering a self screening tests taught in these sessions. This indicates the importance of holding cancer awareness sessions and the positive feedback obtained suggests that people would like to have cancer awareness sessions continued. Key Words

Health seeking behavior of couples with secondary infertility

OBJECTIVE: To determine the factors affecting the health-seeking behavior of couples with secondary infertility in Karachi. DESIGN: A descriptive case series. PLACE AND DURATION OF STUDY: The data was collected from women attending infertility clinics in five tertiary care hospitals in Karachi from March to June 2003. PATIENTS AND METHODS: All currently married women, between the age of 15-35 years, with at least one previous conception, irrespective of outcome, attending an infertility clinic and consenting to participate in the study, were included. Women with corrective surgery on vagina and uterus, and cases of primary infertility, were excluded. Multiple logistic regression models were used to determine the association of various factors, affecting the health-seeking behavior, with statistical significance set at p \u3c 0.05 for the covariates and the interaction terms between various factors. RESULTS: The women consulted multiple health care providers for treatment of secondary infertility. The main reasons for seeking treatment were couple s wish (54.2%), family pressure (22.6%) and want of a son by husbands or in-laws (20.4%). The most commonly sought providers were physicians (74.7%), Traditional Birth Attendants (TBA, 39.5%), Spiritual healers (26%), Hakeems (23%) and Homeopaths (17.2%). Most of the women who consulted non-physicians were illiterate (69.4%) as compared to those who consulted a physician (37.8%, p-value = 0.00). The non-physicians were more commonly consulted by women belonging to low socioeconomic group. The posttreatment complications were more common among women who consulted non-physicians. CONCLUSION: Pressure from husbands and in-laws compels women for consulting multiple providers. Health seeking behavior for infertility is affected by the literacy and socioeconomic status of the women

Prevalence and factors associated with maternal postpartum haemorrhage in Khyber agency, Pakistan

Background: Postpartum haemorrhage (PPH) is one of the main causes of maternal mortality globally. The objective of this study was to estimate the prevalence of PPH and identify factors associated with PPH in Khyber Agency, Pakistan. Methodology: A quantitative, cross-sectional study design was selected to estimate the prevalence and associated factors for PPH among married women aged 15–49 years, residing in the Khyber Agency, FATA, Pakistan. A pre-tested structured questionnaire was adapted with some modifications to interview 1,000 women. Results: Prevalence of PPH was 21.3% in the study population. Factors associated with PPH were age, number of pregnancies, duration of labour, avoidance of milk, insertion of homemade remedies in vagina, retained placenta, and rest during postpartum period. Conclusion: Poor infrastructure, lack of appropriate training for healthcare providers, economic conditions, and negative cultural practices are some amongst the multiple factors that have a perilous impact on women’s health, particularly women of reproductive age. The morbidities were the result of malpractices ingrained in the communit

Domestic violence against infertile women in Karachi, Pakistan

This study investigates the prevalence of physical and psychological violence against infertile women in Karachi, Pakistan. A total of 400 infertile women attending the selected infertility clinics in Karachi, Pakistan were interviewed using the to investigate their experiences of physical and psychological violence. Out of 400 infertile women, 278 (64%) reported to be the victims of violence during the last 12 months before they were interviewed. Nearly one quarter (23.1%) reported facing physical violence. All women reported their husbands and their family members to be the perpetrators. It is concluded that Clinicians should identify the abused women and provide them with medical care and supportive counseling

Prevalence of perceived heavy postpartum hemorrhage and its associated factors among married mothers in squatter settlements of Karachi

Objectives; To estimate the prevalence of postpartum hemorrhage (PPH) and identify its associated factors among the married women of 15-49 years, residingin the Karachi, Pakistan. Methodology: This cross-sectional survey was carried out in five squatter settlements of Karachi during 2000-2001. Information was collected regarding age, gravida, education, antenatal, natal and postnatal care, with perceived puerperal morbidities from 525 mothers, who were in their 42nd to 56th post delivery day. Univariate and multivariate analyses were computed using multiple logistic regression method. Results: The estimated prevalence for perceived PPH was 7.24%. Three hundred and ninety six (75.4 %) women received ante-natal care with 273 (52%) consulting skilled health professionals and 268 (51%) gave birth to their babies at a health facility. Eighty nine (16.9%) women who delivered at a health facility were advised for the post partum routine care and only 127 (24.2%) women followed the instructions. Two hundred and seventy eight (53%) mothers reported at least one perceived puerperal morbidity and among them 38 (7.24%) women perceived PPH. On multivariate analysis, the factors associated with PPH were older age (aOR=1.10, 95% CI:1.04-1.1), longer duration of labor (aOR=1.08,95% CI :1.02-1.2) and restricted fluid intake (aOR=2.1, 95% CI :1.05-4.0).Conclusion: Older age group, longer duration of labor and restricted fluid in take were found to be the common factors associated with PPH. Women need to be educated regarding family planning program, safe and timely delivery by skilled medical personnel and intake of extra fluid during post partum period

Strategies and recommendations for prevention and control of domestic violence against women in Pakistan

Domestic violence is highly prevalent in Pakistan. This paper proposes the strategies based on literature review, for the prevention and control of domestic violence. The reported causes for domestic violence against women include women\u27s low educational levels, low empowerment, and least opportunities to indulge in political activities; wrong interpretations of religious, traditional and cultural norms in the society; poverty; dowry system; women\u27s suppressed autonomy and males\u27 addiction to alcohol. Through this article, we have attempted to highlight the need to recognize the domestic violence against women as an important issue and to enhance educational and health facilities for the prevention and control of violence with combined awareness programs including non governmental organizations through stake holders. Furthermore, comprehensive laws need to be developed and enforcement against dowry and alcohol abuse is required in low income countries like Pakistan

Adoption practices among couples with secondary infertility in Karachi: a triangulation study design

Objective: To explore the perceptions and experiences of couples with secondary infertility regarding adoption practices; to estimate the prevalence of adoption among couples with secondary infertility, and to study the adopted child preference pattern. Methods: To fulfill the objectives of the study both qualitative and quantitative study designs were utilized. In qualitative explorative study design, three Focus Group discussions were conducted with married fertile women to explore their perceptions for adoption practices. Moreover, eight in-depth interviews were conducted with women with secondary infertility to explore their experiences. For quantitative methodology, a case series of 400 secondary infertile couples was conducted. Results: Qualitative methodology result suggests that adoption is the last option for infertile couples. Couples often take this as a Totka , that when they adopt a child, they could end up having their own baby. The husband\u27s family is usually preferred for adopting a child. The results of quantitative component suggest that the prevalence of adoption among 400 women is 7%. Less than half of the respondents (49.3%) reported to ever having thought of adopting a child to cope with the secondary infertility. The main decision maker for adoption of child is the husband (17%) and the mother-in-law (68%). Though majority of these women (72.5%) were supported by their husbands, however, in-laws and relatives were reluctant to pursue this option and less than one third (29%) of these women had a support from them. Conclusions: This study concludes that couples ever thought of or opted for adoption after prolonged duration of secondary infertility. In cses where the condition cannot be treated, it is necessary to counsel, not only the couple but also the in-laws (JPMA 57:55;2007)

Women’s perception and attitude towards male dominancy and controlling behaviors

Introduction/Background: The study was conducted in urban Karachi, Pakistan to investigate women’s perceptions and attitudes towards male dominancy, female autonomy, and controlling behavior of husbands. Method: This was investigated in a population based study with a cross-sectional design, involving married women aged 25 to 60 years. A Structured questionnaire developed by World Health Organisation (WHO) on violence was used. Community midwives interviewed these married women living in pre-selected low, middle and upper socio-economic areas of urban Karachi, Pakistan.Findings: This study revealed women’s overall perception regarding male dominancy and controlling behavior and highlighted this attitude, as being acceptable to women. It was found that 96.7% (n=734) of females perceived their husband as authority figure in the family and 99.2% (n=753) consider themselves as good wives by being obedient to their husbands. Not only this, 88.9% (n=675) females perceived performing sex unwillingly with their husbands as an obligation. Conclusion: Perceptions of women regarding gender discrimination and male dominancy play a vital role in accepting gender discrimination. This study identified the declining status of women as compared to men in marital life due to various socio-cultural and religious beliefs, which promote controlling behaviour by the male partner. This is the result of learned behaviour and social norms in a patriarchal society adapted by women

Domestic violence among Pakistani women: an insight into literature

The objectives of this search were to estimate the burden of domestic violence, its contributing factors and strategies based on literature review for the prevention and control of domestic violence. Published literature about domestic violence in Pakistan during the years 1998 to 2008 was analyzed and scrutinized. This article is based on the searched result of 200 articles published in the English language from which finally 13 articles were selected. Search terms included “Violence”, “Domestic violence”, “Domestic violence in Pakistan” and “Strategies and Recommendations for Prevention of Domestic violence”. According to these studies, the intimate partners\u27 violence is reported as in the range of 30% to 79%. In Pakistan, there are some notable factors which make women prone to domestic violence like women\u27s low education, low empowerment, existing misconceptions about Islamic thoughts and traditional norms, misuse of women in the name of honor justifying honor killing, poverty and existence of unjust traditional dowry system in the society. The most common points made by researchers for prevention and control are 1) the need to recognize the domestic violence against women as an important issue 2) enhancement of educational and health facilities for the prevention and control of violence with combined awareness programs by governmental or nongovernmental organizations and 3) enactment and promulgation of comprehensive laws to combat this problem. Our work reveals that a significantly large proportion of women suffer with domestic violence and the factors identified are preventable and modifiable to a greater extent. Further research is also needed in this regar