An analysis of the gender and social determinants of health in urban poor areas of the most populated cities of Pakistan

Background: Recent surveys, studies and reviews in urban areas of Pakistan have highlighted the impacts of social inequities on access of women and children to health services for women and children in Pakistan. Objectives: The Urban Slum Profiles and coverage surveys were conducted between 2017 and 2019. The objective of the profiles was to obtain an updated listing of slums and other underserved areas, and to better understand current vaccination and health service coverage in these areas. Utilising findings from these studies, this paper aims to better understand the gender and social determinants of health that are giving rise to health inequalities in the slums. Methods: The Urban Slum Profiles adopted a mixed methods approach combining both qualitative and quantitative methods. The study was comprised of two main survey approaches of Urban Slum Profiles and Immunisation Coverage Survey in 4431 urban poor areas of the 10 most highly populated cities of Pakistan. Results: Findings are classified into six analytic categories of (1) access to health services, (2) female workforce participation, (3) gender-friendly health services, (4) access to schools and literacy, (5) social connections, and (6) autonomy of decision making. Out of a national sample of 14,531 children in urban poor areas of 10 cities, the studies found that just over half of the children are fully immunised (54%) and 14% of children had received zero doses of vaccine. There are large shortages of health facilities and female health workforce in the slums, with significant gaps in the quality of health infrastructure, which all serve to limit both demand for, and supply of, health services for women and children. Results demonstrate low availability of schools, low levels of female literacy and autonomy over decision making, limited knowledge of the benefits of vaccination, and few social connections outside the home. All these factors interact and reinforce existing gender norms and low levels of health literacy and service access. Conclusion: The Urban Slum profiles and coverage studies provide an opportunity to introduce gender transformative strategies that include expansion of a female health workforce, development of costed urban health action plans, and an enabling policy environment to support community organisation and more equitable health service delivery access

An embedded implementation research initiative to tackle service delivery bottlenecks in the expanded programme on immunisation in Pakistan: Overview and reflections.

BACKGROUND: Embedded implementation research (IR) can play a critical role in health systems strengthening by tackling systems and implementation bottlenecks of a program. To achieve this aim, with the financial support of GAVI, the Vaccine Alliance, in 2016, the Government of Pakistan, UNICEF and the Alliance for Health Policy and Systems Research (AHPSR) launched an Embedded IR for Immunisation Initiative (the Initiative) to explore health systems and implementation bottlenecks, and potential strategies to tackle such bottlenecks in the Expanded Programme on Immunisation (EPI) in Pakistan. In total, 10 research teams were involved in the Initiative, which was the first of its kind in the country. In this paper, we provided a brief overview of the Initiative's approach as well as the key learnings including challenges and successes of the research teams which could inform future embedded IR Initiatives. METHODS: Data were collected from members of the IR teams through an online survey. In addition, in-depth interviews were conducted via phone and in-person from IR team members to explore further the challenges they faced while conducting IR in Pakistan and recommendations for future IR initiatives. The qualitative information obtained from these sources was collated and categorized into themes reflecting some of the challenges, successes, and lessons learned, as well as teams' recommendations for future initiatives. RESULTS: The embedded IR Initiative in Pakistan followed several steps starting with a desk review to compile information on key implementation challenges of EPI and ended with a dissemination workshop where all the research teams shared their IR results with policymakers and implementers. Key factors that facilitated the successful and timely completion of the studies included appreciation by and leadership of implementers in generation and use of local knowledge, identification of research priorities jointly by EPI managers and researchers and provision of continuous and high-quality support from in-country research partners. Participants in the Initiative indicated that challenges included a lack of clarity on the role and responsibilities of each partner involved and need for further support to facilitate use and dissemination of research findings. CONCLUSIONS: The Initiative established that an immunisation programme in a lower middle-income country can use small and time-bound embedded IR, based on partnerships between programme managers and local researchers, to generate information and evidence that can inform decision-making. Future embedded IR initiatives should strive to ensure effective coordination and active participation of all key stakeholders, a clear research utilisation plan from the outset, and efforts to strengthen research teams' capacity to foster utilisation of research findings

Awareness of Mainstream Elementary Level Teachers About Learning Difficulties Among Their Students in Mainstream Classrooms

Awareness of mainstream elementary level teacher regarding learning difficulty (LD) is very crucial to identify and deal with students having LD at an early stage. Subsequently, there are insufficient studies that investigate the mainstream teacher’s awareness of LD in Pakistan. Therefore, the focus of the current study is to measure the level of awareness of mainstream elementary school teachers about learning difficulty, and the influence of variables i.e. gender, age, educational qualification, working experience of teachers, private and public sector schools on the awareness of LD. The design of the study was descriptive in nature. The population comprised of two hundred mainstream teachers of public and private elementary level schools (6th grade, 7th grade, and 8th grade) of Rawalpindi and Islamabad, Pakistan. Selection of sample for the study was based on the stratified random sampling technique and data was collected by self-developed questionnaires. After statistical analysis, it was established that majority of respondents (73.5%) have a low level of awareness about LD. Appropriate professional training, at different levels and durations, can be provided to teachers in the direction of building capacity of teachers’ instructional practices to deal with and facilitate students having a learning difficulty

Knowledge and attitude about covid-19 Vaccination in pregnant women at Baqai Medical University

Objective: The objective of this study was to explore the knowledge and attitude of pregnant women about Covid 19 vaccination. Methodology: A cross-sectional survey was conducted between 1st May 2022 to 30th November 2022 at OPD of Gynecology &Obstetric, Fatima Hospital, Baqai Medical University. This survey included women age 18-40 years seeking antenatal care through OPD and all pregnant women who were coming in emergency in active labour were excluded. A Pre-validated questionnaire was used in this study. Data was entered and statistical analysis was done using SPSS version 25.0 (IBM Corp., Armonk, NY, USA). Categorical variables were described using frequencies and percentages. Cross tabulation was done by using Chi-square test to assess the association between the respondents’ socio-demographic characteristics and their willingness to accept  the COVID-19 vaccine. A p-value of <0.05 was considered statistically significant. Result: Frequency of participants response to knowledge questions’56% had history of Covid 19 infection prior to pregnancy and conception.62% were vaccinated with vaccine other than Covid vaccine.65.8% did not receive Covid vaccine and upon asking if they are willing to receive ,only 27% answered positively. Conclusion: The study found that more than half of pregnant women were unable to receive Covid 19 vaccination more likely due to lack of awareness regarding the safety of vaccination during pregnancy