Incidence, patterns and associated factors for occupational injuries among agricultural workers in a developing country

Background: Injuries are common among agricultural workers, and a large section of the population is employed in agriculture worldwide. We aimed to determine the incidence, patterns and associated risk factors of occupational injuries among the agricultural workers in a developing country. Methods: A cross-sectional study in Hyderabad, Pakistan was conducted from December 2012 to February 2013. Information was collected about incidence, pattern and associated risk factors of occupational injuries from 472 agricultural workers. Injury incidence and patterns for place, severity, type, agent, parts of body affected and work activity were calculated. Analysis was performed using SPSS version 19.0. Multivariate logistic regression was performed to calculate the adjusted odds ratio (OR) with 95% confidence interval, to identify the putative risk factors for occupational injuries. Results: Incidence of occupational injuries was 35.0 per 100 per year (95% CI: 28.9 - 42.7). Cuts (70%) and hand tools (71%) were the most common type and agent for injury, respectively. Majority of injuries occurred during harvesting (55%). Increasing age [AOR 1.03 (95% CI: 1.01 - 1.05)], income \u3c6000PKR/month [AOR 2.27 (95% CI: 1.08 - 4.76)] and driving tractor [AOR 2.58 (95% CI: 1.25 -5.33)] increase the risk for injuries. Conclusion: There was a high burden of injuries among the agricultural workers in Pakistan. Large-scale studies are required to further characterize the risk of injuries and develop preventive strategies to protect agricultural workers

Prevalence and Risk Factors of Musculoskeletal Pain among Construction Industry Workers in a Low-Income Country

Musculoskeletal pain (MSP) is one of the major causes of disability around the world. We ought to determine the prevalence and risk factors of MSP among construction workers in Karachi, Pakistan. We carried out a cross-sectional study among 321 construction workers from five registered construction companies in Karachi, Pakistan. We administered an Extended Nordic Musculoskeletal Questionnaire (NMQ-E) to determine the frequency of MSP and inquired about socio-demographic characteristics, occupational and ergonomic risk factors, knowledge and practices regarding MSP. Age-adjusted logistic regression analysis was carried out to identify factors that were associated with MSP. The mean age of participants was 29.6 (±10.6) years. Low back pain was the most common (27.8%) complaint. The MSP risk was higher in the poorest strata [OR= 1.85, 95% CI:1.10-3.12], and those exposed to vibrations [OR=1.63, 95%CI: 1.05-2.54] during their work activities. Moreover, the unmarried [OR= 0.56, 95%CI: 0.35-0.91] and the workers of Punjabi ethnicity [OR=0.46, 95% CI: 0.27-0.76] were at a lower risk of MSP compared to married men and Sindhi workers. Of the 319 workers, the majority [202 (62.9%)] had low knowledge about occupational hazards, and [194 (60.4%)] health hazards, [131(40.8%)] MSP prevention strategies. More than one third [124(38.6)] workers, were not using personal protective equipment (PPEs) during work. The construction workers in Pakistan suffer from a very high prevalence of MSP. The study reports MSP from five major registered construction companies in Pakistan. The young group of workers reported difficulty working due to MSP. There is a dire need to design contextualized occupational health and safety policies and interventions with a focus on workers at higher risk of MSP

A comparison of \u27cough and cold\u27 and pneumonia: risk factors for pneumonia in children under 5 years revisited

Objectives: The aim of this study was to identify and measure the risk factors differentiating upper respiratory infection from pneumonia.Methods: The World Health Organization\u27s acute respiratory infection case management criteria were used. We studied 259 cases of pneumonia (cases) and 187 cases of \u27cough and cold\u27 (controls) among children under 5 years of age at a large tertiary-care hospital in Gilgit, Pakistan. While previous studies used healthy controls, in this study we used controls who had mild infection (\u27cough and cold\u27).Results: In the multivariate logistic regression analysis, lack of immunization (adjusted odds ratio (AOR)=1.54, 95% CI 1.0, 2.3), previous history of pneumonia (AOR=1.77, 95% CI 1.16, 2.7), younger age (AOR for each preceding month in children aged up to 59 months=1.01, 95% CI 0.99, 1.03) and malnutrition (wasting) (AOR=2.2, 95% CI 1.0, 5.23) were revealed as important risk factors for pneumonia.CONCLUSIONS: Some of the factors reported in previous studies that used healthy controls were not found to be significant when \u27cough and cold\u27 children were used as controls. Nonetheless, malnutrition, younger age, low coverage of immunization and also early childhood mismanagement and respiratory damage were found to be significant factors for development of pneumonia

Inequities in Antenatal Care, and Individual and Environmental Determinants of Utilization at National and Sub-national Level in Pakistan: A Multilevel Analysis

Background: Nationally representative surveys are vital for gauging progress in health and planning health services. However, often marred with inadequate analysis to provide any guidance to health policy and planning. Most recent Pakistan Demographic and Health Survey (PDHS) 2012-2013 is an inclusive nationally representative investigation. Nonetheless, its published report offers limited evidence regarding antenatal care (ANC). Furthermore, after 18th constitutional amendment, policies are principally made at provincial level in Pakistan; therefore, it is imperative to have contextual evidence at sub-national level to feed programs and policies.Methods: We analysed 7142 women with a recent birth, to assess the individual and environmental determinants of ANC, adapting Andersen\u27s model of healthcare utilization, by multilevel analysis. Separate models of determinants were developed for the national level and five provinces using survey command in Stata version 12.1.Results: Besides that the recommended ANC coverage (≥4 visits) is low in Pakistan (36%), gross inequities exist predominantly across provinces (12% to 82%). Small differences exist between urban and rural localities. Education, health literacy and socio-economic status of women were strong predictors, while communities with high concentration of literate women very strongly predict ANC use (odds ratio [OR] = 12). Determinants of ANC vary at national and at sub-national level. For example, women\u27s education had no influence on ANC utilization in Khyber Pakhtunkhwa (KPK) and Baluchistan (BC) provinces. Notably, husband\u27s education was significantly associated with ANC utilization in KPK only. Significant positive interaction exists between urban areas and larger provinces (Punjab, Sindh, and KPK). Also, very strong positive interaction occurs when women have secondary or particularly higher level of education and living in urban areas or larger provinces.Conclusion: This study highlights conspicuous contextual differences which determine maternal care at national and sub-national level. It identified contextual factors which are important for planning maternal health services between and within provinces. High positive interaction for ANC utilization between women education, urban areas and larger provinces highlights the inequities which need to be addressed. It also identified factors at the community level (cluster) which relates to overall context and influence individual behavior and highlights the diminishing urban-rural gap in service utilization in Pakistan

Strategies for prevention of road traffic injuries (RTIs) in Pakistan: situational analysis.

Road traffic injuries (RTIs) are one of the leading causes of death among productive age group. Using systems approach framework (SAF), current preventive strategies for RTI control were reviewed in Pakistan. A review of the literature was done using four international search engines. Only ten studies on preventive strategies for RTI stemming from Pakistan were found. The first Road Traffic Injuries Research Network (RTIRN) surveillance system for road traffic injuries was established in urban city (Karachi) in Pakistan has shown promise for injury control and should be scaled up to other cities. Enforcement of traffic laws on seat-belt and helmet wearing is poor. National Highway and Motorway Police Ordinance (2000) was one of the few legislative measure so far taken in Pakistan. Using SAF, efforts are required to implement interventions targeting human, vehicle design and also making environment safer for road users

Predictors of Modern Contraceptive Usage among Women in Rural Pakistan: Physical Access to Services Stills a Major Barrier

Background: The predictors of contraceptive use may vary in urban and rural areas. Studies have largely focused on the factors predicting contraceptive usage in urban areas. We studied the predictors of contraceptives in one of the rural districts of Pakistan.Methods: A nested case-control design was used on The Global Network’s Maternal Newborn Health Registry (MNHR) in district Thatta Pakistan between June 2011 to July 2012. Pregnant women before their index pregnancy, who did not use (n = 200 cases) and those used any modern contraceptive method (n = 600 controls), were compared. Logistic regression was used to as certain independent factors associated with non-use of modern contraceptives.Results: Increasing maternal age (AOR = 1.1, 95 % CI = 1.03 - 1.11 per year increase in age), women’s educational level (AOR for secondary education = 2.8, 95 % CI = 1.58 - 5.01 and AOR for higher education = 2.0, 95% CI = 1.04 - 3.95), high socioeconomic status (AOR = 1.9, 95 % CI = 1.05 - 3.56) and unintended pregnancy (AOR   1.9, 95 % CI = 1.29 - 3.02) were significantly associated with the utilization of modern contraceptive methods. While distance from the family planning centers was inversely related (AOR = 0.9, 95% CI = 0.87 - 0.98 per kilometers).Conclusion: Maternal age, women’s education, socioeconomic status, the intention of a woman for pregnancy and distance were independent predictors for contraceptive use in district Thatta. Besides addressing known socio-demographic differential, access to family planning services to the women of reproductive age, particularly for younger age, poor and less educated women is essential to improve contraceptive prevalence. Furthermore, intention of pregnancy affect the use of contraceptive which has not been studied previously

Available interventions for prevention of cotton dust-associated lung diseases among textile workers

The authors reviewed literature on interventions for cotton dust-associated lung diseases among textile workers. Internet sources (PubMed, Cochrane Library, Google and Google Scholar) were accessed and interventions were categorized into: Engineering or administrative controls, or personal protective equipment (PPE). Ten relevant articles were shortlisted, five related to engineering controls (pre-processing, bactericidal treatment of cotton, improved workplace design, machinery and dust control measures). Administrative controls may involve setting standards, environmental surveillance, periodic medical examinations, and workers training. Although specific guidelines are available regarding the use of PPEs, but there was little literature on their effectiveness. It was concluded that there is a dearth of literature regarding field-based assessment of interventions for control of cotton dust associated respiratory diseases and the available studies primarily focus on pre-processing of cotton. This review highlights the uncertainties that remain; and recommends several areas for future research on respiratory health of textile workers

Kangaroo mother care: Opportunities and implications for rural Pakistan

Neonatal mortality comprises 40% of total under-5 mortality, globally. Kangaroo mother care (KMC) is one of the most cost-effective interventions to reduce neonatal mortality. KMC does not require highend equipment, intensive care facilities or technical knowledge. A recent meta-analysis reported that KMC may reduce neonatal mortality in preterm and low birth weight neonates up to 36%. A review of enablers and barriers of KMC suggests that KMC can be integrated in maternal health care system by giving awareness, involving family and giving ownership of the intervention to the community. If supported with minimal incentives it would reduce the cost of health care substantially, reduce patient burden on hospitals by reducing hospital stay in postnatal period. It will reduce financial burden, time strain and help eliminate social taboos regarding preterm and low birth weight neonates. Hospital and community based KMC interventions should be tested in Pakistan

Resource allocation within the National AIDS Control Program of Pakistan: a qualitative assessment of decision maker\u27s opinions

Background: Limited resources, whether public or private, demand prioritisation among competing needs to maximise productivity. With a substantial increase in the number of reported HIV cases, little work has been done to understand how resources have been distributed and what factors may have influenced allocation within the newly introduced Enhanced National AIDS Control Program of Pakistan. The objective of this study was to identify perceptions of decision makers about the process of resource allocation within Pakistan\u27s Enhanced National AIDS Control Program. Methods: A qualitative study was undertaken and in-depth interviews of decision makers at provincial and federal levels responsible to allocate resources within the program were conducted. Results: HIV was not considered a priority issue by all study participants and external funding for the program was thought to have been accepted because of poor foreign currency reserves and donor agency influence rather than local need. Political influences from the federal government and donor agencies were thought to manipulate distribution of funds within the program. These influences were thought to occur despite the existence of a well-laid out procedure to determine allocation of public resources. Lack of collaboration among departments involved in decision making, a pervasive lack of technical expertise, paucity of information and an atmosphere of ad hoc decision making were thought to reduce resistance to external pressures. Conclusion: Development of a unified program vision through a consultative process and advocacy is necessary to understand goals to be achieved, to enhance program ownership and develop consensus about how money and effort should be directed. Enhancing public sector expertise in planning and budgeting is essential not just for the program, but also to reduce reliance on external agencies for technical support. Strengthening available databases for effective decision making is required to make financial allocations based on real, rather than perceived needs. With a large part of HIV program funding dedicated to public-private partnerships, it becomes imperative to develop public sector capacity to administer contracts, coordinate and monitor activities of the non-governmental sector