Evaluating the efficacy of tuberculosis advocacy, communication and social mobilization (ACSM) activities in Pakistan : a cross-sectional study

BACKGROUND: Tuberculosis (TB) continues to be a major public health and development problem within many low- and middle-income countries. Although Advocacy, Communication and Social Mobilization (ACSM) activities have been undertaken in high TB burden countries to remediate these issues, there is little empirical evidence of the efficacy of these approaches. The purpose of this study was therefore to examine the efficacy of an ACSM program undertaken within Pakistan. Pakistan was chosen because it has received considerable funding for ACSM related activities and is one of 22 high-burden TB countries. METHODS: The program was evaluated by surveying a stratified random sample of 2,400 participants across 57 districts of Pakistan. Participants were categorized into one of three groups: aware of both media and community ACSM activities (Aware(Media)&(Community)), aware of ACSM media activities only (Aware(Media)), or unaware of any ACSM activities (Unaware(Media)&(Community)). RESULTS: Independent measures ANCOVA revealed complex differences in knowledge, attitudes, and intended behaviors towards TB between the three groups. In general, Unaware(Media)&(Community) cases had a poorer understanding of TB and its treatment, whilst awareness of ACSM activities was highest among literate and urban dwelling Pakistanis. Preferred sources of TB information were also found to vary by gender, geographic location, and literacy. CONCLUSIONS: Whilst highlighting improvements in knowledge and attitudes toward TB, the results also provide invaluable insights into areas where further work needs to be done to address deficits in TB understanding, particularly among rural and illiterate Pakistanis. Equally important, the findings have implications for future TB ACSM initiatives in Pakistan in terms of leveraging the preferred media channels of key demographic segments and exploring the degree to which exposure to multiple channels of communication may have an additive effect on health knowledge

Tidal induced variation in the distribution, abundance and diversity of mesozooplankton along the Karachi coast, Pakistan

Temporal variations in biomass, abundance, diversity and species composition of mesozooplankton in relation to the tidal state were studied. Mesozooplankton sampling was carried out twice at the ebb and flood tides at fixed stations closed to Phitti creek (P) and Manora channel (M) near the Karachi coast during February 1999. The average percent abundance of mesozooplankton was high at ebb tide i.e., 66% and 63% whereas, low on flood tide i.e.,34% and 37%, at both stations respectively. However, there were no differences in species composition with tidal fluctuations at both sites. The mesozooplankton community was typically composed of 22 groups, out of which copepod was the most abundant group (comprising % of the total zooplankton) at both sites. During the flood tide high diversity 0.11 ± 0.021 was observed in Phitti creek, but no difference was observed at Manora channel. The species richness was high (2.30 ± 0.01273 and 2.38 ± 0.502) in the Manora channel at both ebb and flood tides, respectively, whereas the dominance values were high at Phitti creek. Complete randomized design ANOVA showed that there was no significant difference in abundance of mesozooplankton between stations and tides nested in stations, but the difference was significant for the diversity and equitability. On the short temporal scale the tidal cycle additionally determines changes in the zooplankton composition

Outcome of inadvertent high dose BCG administration in newborns at a tertiary care hospital, Karachi- Case series

Bacillus Calmette-Guérin (BCG) vaccine is given to newborns soon after birth. BCG vaccine overdose has been rarely reported. Here we report the outcome of newborns who accidently received high dose BCG at a tertiary care hospital, Karachi. We reviewed records of 26 newborns, who accidentally received intradermal high dose BCG, used for the treatment of urinary bladder cancers and 80 times higher dose than the BCG used for routine vaccination. The incident happened from 14-16th April, 2016 at Aga Khan University Hospital, Karachi. Analysis was carried out using SPSS. A total of 23/26(88.5%) newborns were followed for atleast 3 months and 11/26 (42.3%) were followed for atleast one year. 13/26 (50%) were male. All 26 patients were prescribed isoniazid and rifampicin for 3 months. 3/26 (11.5%) were lost to follow-up before completion of anti-tuberculous drugs (ATT). Lesions at the BCG site were observed in 16/26 (61.5%) infants, of which 15 (93.8%) had a papule, 3 (18.8%) developed a pustule, 3 (18.8%) had skin induration and 2 (12.5%) had skin erythema. Axillary lymphadenopathy was observed in 1/26 (3.8%) patient. Coagulation was deranged in 3/26 (11.5%) of babies. Intracranial bleeding was observed in 1/26 (3.8%) case. Localized skin lesions were the most common adverse events. None of them developed clinical tuberculosis. Chemoprophylaxis for inadvertent high dose BCG administration should be given for atleast 3 months. Furthermore, vigilant follow-up, transparency and disclosure are the vital steps in the management of any medical error

What can motivate Lady Health Workers in Pakistan to engage more actively in tuberculosis case-finding?

BACKGROUND: Many interventions to motivate community health workers to perform better rely on financial incentives, even though it is not clear that monetary gain is the main motivational driver. In Pakistan, Lady Health Workers (LHW) are responsible for delivering community level primary healthcare, focusing on rural and urban slum populations. There is interest in introducing large-scale interventions to motivate LHW to be more actively involved in improving tuberculosis case-finding, which is low in Pakistan. METHODS: Our study investigated how to most effectively motivate LHW to engage more actively in tuberculosis case-finding. The study was embedded within a pilot intervention that provided financial and other incentives to LHW who refer the highest number of tuberculosis cases in three districts in Sindh province. We conducted semi-structured interviews with 20 LHW and 12 health programme managers and analysed these using a framework categorising internal and external sources of motivation. RESULTS: Internal drivers of motivation, such as religious rewards and social recognition, were salient in our study setting. While monetary gain was identified as a motivator by all interviewees, programme managers expressed concerns about financial sustainability, and LHW indicated that financial incentives were less important than other sources of motivation. LHW emphasised that they typically used financial incentives provided to cover patient transport costs to health facilities, and therefore financial incentives were usually not perceived as rewards for their performance. CONCLUSIONS: This study indicated that interventions in addition to, or instead of, financial incentives could be used to increase LHW engagement in tuberculosis case-finding. Our finding about the strong role of internal motivation (intrinsic, religious) in Pakistan suggests that developing context-specific strategies that tap into internal motivation could allow infectious disease control programmes to improve engagement of community health workers without being dependent on funding for financial incentives

Loss-to-follow-up and delay to treatment initiation in Pakistan's national tuberculosis control programme

BACKGROUND: Researchers and policy-makers have identified loss to follow-up as a major programmatic problem. Therefore, the objective of this study is to quantify TB related pre-treatment loss to follow up and treatment delay in private sector health care facilities in Pakistan. METHODS: This was a retrospective, descriptive cohort study using routinely collected programmatic data from TB referral, diagnosis and treatment registers. Data from 48 private healthcare facilities were collected using an online questionnaire prepared in ODK Collect, for the period October 2015 to March 2016. Data were analysed using SPSS. We calculated the: (1) number and proportion of patients who were lost to follow-up during the diagnostic period, (2) number and proportion of patients with pre-treatment loss to follow-up, and (3) the number of days between diagnosis and initiation of treatment. RESULTS: One thousand five hundred ninety-six persons with presumptive TB were referred to the laboratory. Of these, 96% (n = 1538) submitted an on-the-spot sputum sample. Of the 1538 people, 1462 (95%) people subsequently visited the laboratory to submit the early morning (i.e. the second) sample. Hence, loss to follow-up during the diagnostic process was 8% overall (n = 134). Of the 1462 people who submitted both sputum samples, 243 (17%) were diagnosed with sputum smear-positive pulmonary TB and 231 were registered for anti-TB treatment, hence, loss in the pre-treatment phase was 4.9% (n = 12). 152 persons with TB (66%) initiated TB treatment either on the day of TB diagnosis or the next day. A further 79 persons with TB (34%) commenced TB treatment within a mean time of 7 days (range 2 to 64 days). CONCLUSION: Concentrated efforts should be made by the National TB Control Programme to retain TB patients and innovative methods such as text reminders and behavior change communication may need to be used and tested

Temporal and spatial variations in the species composition, distribution, and abundance of Copepods in mangrove creek area along the Karachi coast, Pakistan

61-69Among different groups of zooplankton collected from Korangi-Phitti mangrove creek area, copepods contributed maximum numerical abundance up to 68% and 75% at S1 and S2, respectively. Twenty one species of copepod, pertaining to fourteen genera and thirteen families were identified from the sample, Difference in diversity of copepod species among seasons with highest density in post monsoon at both stations was recorded. Acrocalanus longicornis, Paracalanus sp., Acartia sp., Temora sp., Oncea sp. and Coryceaus sp. were observed as the dominant and abundantly found copepod species throughout the study period. The highest diversity and equitability was observed in pre monsoon at both stations followed by north east monsoon and south west monsoon. Biomass and species diversity are in inverse relationship

Learners with Special Needs: Problems faced by Students and Teachers at University Level

Purpose: Every person in this world has the right to be educated and by every person means every single person, yes, the persons of special needs as well. About 15 percent of the world’s population has suffered various forms of disabilities such as visual and hearing impairment, physically handicapped, or mental retardation. The 1st purpose of this research was to find out the problems that a teacher faced while teaching a special learner at a higher education level. 2nd to find out the student’s perspective of studying in an inclusive setting at the university level. Design/Methodology/Approach: A phenomenological design was used and both teachers and their students took interviews. Qualitative theme analysis method was used in this study to analyze the teachers and students’ perceptions. Findings: The study’s findings provide an understanding of the experiences of teachers as well as perspectives regarding disabilities of learners in the regular classroom. They both recognized four zones that obstruct their capability to efficiently teach in a mixed ability classroom and the regular classroom. (a) Insufficient knowledge of teachers and lack of awareness about inclusion in the classroom. (b) Lack of training employed in inclusive or regular classrooms with differently-abled students; (c) Lack of examination to choose the most suitable aids which helpful for the teaching in the inclusive regular classroom. (d). Learning difficulty and psychological issues in the classroom. Implications/Originality/Value: From This research everyone will be benefited: students, as per their learning will be improved by it; educators as it will improve their teaching and efficiency in the classroom and parents, as their children will more likely to have a positive environment in the university. It will provide them an opportunity to learn from each other at the university level