Knowledge and communication needs assessment of community health workers in a developing country: a qualitative study

<p>Abstract</p> <p>Background</p> <p>Primary health care is a set of health services that can meet the needs of the developing world. Community health workers act as a bridge between health system and community in providing this care. Appropriate knowledge and communication skills of the workers are key to their confidence and elementary for the success of the system. We conducted this study to document the perceptions of these workers on their knowledge and communication needs, image building through mass media and mechanisms for continued education.</p> <p>Methods</p> <p>Focus group discussions were held with health workers and their supervisors belonging to all the four provinces of the country and the Azad Jammu & Kashmir region. Self-response questionnaires were also used to obtain information on questions regarding their continued education.</p> <p>Results</p> <p>About four fifths of the respondents described their communication skills as moderately sufficient and wanted improvement. Knowledge on emerging health issues was insufficient and the respondents showed willingness to participate in their continued education. Media campaigns were successful in building the image of health workers as a credible source of health information.</p> <p>Conclusion</p> <p>A continued process should be ensured to provide opportunities to health workers to update their knowledge, sharpen communication skills and bring credibility to their persona as health educators.</p

What can Pakistan do to address maternal and child health over the next decade?

Pakistan faces huge challenges in meeting its international obligations and agreed Millennium Development Goal targets for reducing maternal and child mortality. While there have been reductions in maternal and under-5 child mortality, overall rates are barely above secular trends and neonatal mortality has not reduced much. Progress in addressing basic determinants, such as poverty, undernutrition, safe water, and sound sanitary conditions as well as female education, is unsatisfactory and, not surprisingly, population growth hampers economic growth and development across the country. The devolution of health to the provinces has created challenges as well as opportunities for action. This paper presents a range of actions needed for change within the health and social sectors, including primary care, social determinants, strategies to reach the unreached, and accountability

Balancing science and public policy in Pakistan\u27s COVID-19 response

Background: Coronavirus disease 2019 (COVID-19) has affected the world in an unprecedented manner and South Asian countries were among the first to experience imported cases. Pakistan\u27s response to COVID-19 has been under scrutiny for its granularity, reach and impact.Aims: to evaluate objectively the chronology and depth of the response to COVID-19 in Pakistan.Methods: We evaluated available national and subnational epidemiological and burden information on COVID-19 cases and deaths in Pakistan, including projection models available to the Government at an early stage of the pandemic.Results: Pakistan, with a population of 215 million and considerable geographic diversity, experienced case introduction from pilgrims returning from the Islamic Republic of Iran, followed by widespread community transmission. The National Command and Operations Centre, established through civilian and military partnership, was critical in fast tracking logistics, information gathering, real-time reporting and smart lockdowns, coupled with a massive cash support programme targeting the poorest sections of society. Cases peaked in June 2020 but the health system was able to cope with the excess workload. Since then, although testing rates remain low (\u3e 300 000 cases confirmed to date), case fatality rates have stabilized, and with 6300 deaths, Pakistan seems to have flattened the COVID-19 curve.Conclusion: Despite notable successes in controlling the pandemic, several weaknesses remain and there are risks of rebound as the economy and educational systems reopen. There is continued need for strong technical and programmatic oversight, linked to civic society engagement and working with religious scholars to ensure nonpharmacological intervention compliance

Lady health workers programme in Pakistan: Challenges, achievements and the way forward

Objectives: To review the Lady Health Workers programme and critically explore various aspects of the process to extract tangible implications for other similar situations.Methods: A descriptive study was carried out over a period of one year (2007-08). A detailed desk review of project documents, interaction with relevant stakeholders, performance validation and extensive feedback from the community were collected. The data so obtained was analyzed and evaluated against predetermined benchmarks.Results: Each LHW serves a population of 1,000 people in the community and extends her services in the catchment population through monthly home visits. The scope of work includes over 20 tasks covering all aspects of maternal, newborn and child care. Total cost incurred on each worker is averaged at PKR 44,000 (US $ 570) per anum.Almost 60% of the total population of Pakistan, mostly rural, is covered by the programme with more than 90,000 LHWs allover the country. The health indicators are significantly better than the national average, in the areas served by the LHWs.Conclusions: The LHW programme has led to a development of a very well placed cader that links first level care facilities to the community thus improving the delivery of primary health care services. However, despite its success and the trust it has earned from the community, there are certain areas which need special attention which include poor support from sub-optimal functional health facilities, financial constraints and political interference leading to management issues. The future carries a number of challenges for management of the programme which have been highlighted

Balancing science and public policy in Pakistan\u27s COVID-19 response

Background: Coronavirus disease 2019 (COVID-19) has affected the world in an unprecedented manner and South Asian countries were among the first to experience imported cases. Pakistan\u27s response to COVID-19 has been under scrutiny for its granularity, reach and impact.Aims: to evaluate objectively the chronology and depth of the response to COVID-19 in Pakistan.Methods: We evaluated available national and subnational epidemiological and burden information on COVID-19 cases and deaths in Pakistan, including projection models available to the Government at an early stage of the pandemic.Results: Pakistan, with a population of 215 million and considerable geographic diversity, experienced case introduction from pilgrims returning from the Islamic Republic of Iran, followed by widespread community transmission. The National Command and Operations Centre, established through civilian and military partnership, was critical in fast tracking logistics, information gathering, real-time reporting and smart lockdowns, coupled with a massive cash support programme targeting the poorest sections of society. Cases peaked in June 2020 but the health system was able to cope with the excess workload. Since then, although testing rates remain low (\u3e 300 000 cases confirmed to date), case fatality rates have stabilized, and with 6300 deaths, Pakistan seems to have flattened the COVID-19 curve.Conclusion: Despite notable successes in controlling the pandemic, several weaknesses remain and there are risks of rebound as the economy and educational systems reopen. There is continued need for strong technical and programmatic oversight, linked to civic society engagement and working with religious scholars to ensure nonpharmacological intervention compliance

A comprehensive review of solar thermal desalination technologies for freshwater production

This review is inspired by the increasing shortage of fresh water in areas of the world, and is written in response to the expanding demand for sustainable technologies due to the prevailing crisis of depleting natural water resources. It focuses on comprehending different solar energy-based technologies. Since the increasing population has resulted in the rising demand for freshwater, desalination installation volume is rapidly increasing globally. Conventional ways of desalination technologies involve the use of fossil fuels to extract thermal energy which imparts adverse impacts on the environment. To lessen the carbon footprint left by energy-intensive desalination processes, the emphasis has shifted to using renewable energy sources to drive desalination systems. The growing interest in combining solar energy with desalination with an emphasis on increasing energy efficiency has been sparked by the rapid advancements in solar energy technology, particularly solar thermal. This review paper aims to reflect various developments in solar thermal desalination technologies and presents prospects of solar energy-based desalination techniques. This paper reviews direct and indirect desalination techniques coupled with solar energy, and goes on to explain recent trends in technologies. This review also summarizes the emerging trends in the field of solar thermal desalination technologies. The use of nanoparticles and photo-thermal materials for localized heating in solar desalination systems has decreased energy consumption and enhanced the efficiency of the system. Solar power combined with emerging processes like membrane distillation (MD) has also a recent resurgence

A scientometric analysis of birth cohorts in South Asia: Way forward for Pakistan

The present study aims to: a) systematically map the of birth cohort studies from the South Asian region b) examine the major research foci and landmark contributions from these cohorts using reproducible scientometric techniques and c) offer recommendations on establishing new birth cohorts in Pakistan, building upon the strengths, weaknesses and gaps of previous cohorts. Bibliographic records for a total of 260 articles, published during through December 2018, were retrieved from the Web of Science (core database). All data were analysed using Microsoft Excel (2013), Web of Science platform and CiteSpace. A series of network analysis were then run for each time-period using the link reduction method and pathfinder network scaling. The co-cited articles were clustered into their homogeneous research clusters. The clusters were named using the Latent Semantic Indexing (LSI) method that utilized author keywords as source of names for these clusters. The scientometric analyses of original research output from these birth cohorts also paint a pessimistic landscape in Pakistan- where Pakistani sites for birth cohorts contributed only 31 publications; a majority of these utilized the MAL-ED birth cohort data. A majority of original studies were published from birth cohorts in India (156), Bangladesh (63), and Nepal (15). Out of these contributions, 31 studies reported data from multiple countries. The three major birth cohorts include prospective and multi-country MAL-ED birth cohort and The Pakistan Early Childhood Development Scale Up Trial, and a retrospective Maternal and infant nutrition intervention cohort. In addition to these, a few small-scale birth cohorts reported findings pertaining to neonatal sepsis, intrauterine growth retardation and its effects on linear growth of children and environmental enteropathy

Co-producing the covid-19 response in Germany, Hong Kong, Lebanon, and Pakistan.

The covid-19 response is creating the opportunity for an accelerated and inclusive shift towards co-production for policy making It has brought a focus to three cross cutting issues: building on established structures; working together to co-produce research; and disseminating research and engaging communities. The covid-19 pandemic has forced policy makers to rethink the formal and informal structures of how, where, when, and with whom they collaborate, including with researchers as well as the broader public, patients, and communities. Unprecedented levels of public attention during the covid-19 pandemic have posed new challenges to evidence based policy making, particularly in terms of communicating sometimes complicated science and dealing with an overabundance of information

Post Discharge mHealth and Teach-Back Communication Effectiveness on Hospital Readmissions: A Systematic Review

Hospital readmissions pose a threat to the constrained health resources, especially in resource-poor low-and middle-income countries. In such scenarios, appropriate technologies to reduce avoidable readmissions in hospitals require innovative interventions. mHealth and teach-back communication are robust interventions, utilized for the reduction in preventable hospital readmissions. This review was conducted to highlight the effectiveness of mHealth and teach-back communication in hospital readmission reduction with a view to provide the best available evidence on such interventions. Two authors independently searched for appropriate MeSH terms in three databases (PubMed, Wiley, and Google Scholar). After screening the titles and abstracts, shortlisted manuscripts were subjected to quality assessment and analysis. Two authors checked the manuscripts for quality assessment and assigned scores utilizing the QualSyst tool. The average of the scores assigned by the reviewers was calculated to assign a summary quality score (SQS) to each study. Higher scores showed methodological vigor and robustness. Search strategies retrieved a total of 1932 articles after the removal of duplicates. After screening titles and abstracts, 54 articles were shortlisted. The complete reading resulted in the selection of 17 papers published between 2002 and 2019. Most of the studies were interventional and all the studies focused on hospital readmission reduction as the primary or secondary outcome. mHealth and teach-back communication were the two most common interventions that catered for the hospital readmissions. Among mHealth studies (11 out of 17), seven studies showed a significant reduction in hospital readmissions while four did not exhibit any significant reduction. Among the teach-back communication group (6 out of 17), the majority of the studies (5 out of 6) showed a significant reduction in hospital readmissions while one publication did not elicit a significant hospital readmission reduction. mHealth and teach-back communication methods showed positive effects on hospital readmission reduction. These interventions can be utilized in resource-constrained settings, especially low- and middle-income countries, to reduce preventable readmissions