Awareness about reproductive health and rights among students of a public university in Karachi, Pakistan: a cross sectional study

Objective: To determine the knowledge, attitude and practices of Karachi University students about reproductive health and rights. Design: Cross sectional study Methods: A survey was conducted from February to May 2005 to determine the understanding and knowledge related to reproductive health and rights among the students of the department of Biochemistry, University of Karachi, Pakistan. A pre-coded questionnaire was developed and pre-tested. The questionnaire was introduced to those students, who agreed to participate in the study. Data collected was double entered and analyzed on SPSS and Epi-info latest version. Results: Fifty five percent (55%) of participants believed the reproductive rights to be as important as other human rights. About 80% of participants thought that proper birth spacing can improve maternal and child health but very few Pakistani women have birth spacing rights. Quality of life of women and men can be improved by knowing their reproductive rights in view of 71 % and 63 % of respondents respectively. Conclusion: Although one third of participants claimed to be aware of their reproductive rights but majority were unable to identify what exactly comes under the domain of reproductive rights. Majority knew that appropriate use of contraception and birth spacing can have positive impact on maternal and child health. The study recommends that awareness sessions should be conducted at all levels of society and more efforts should be made to improve reproductive health and increase awareness and the implementation of reproductive rights

Understanding the context of balanced scorecard implementation: a hospital-based case study in pakistan

Background: As a response to a changing operating environment, healthcare administrators are implementing modern management tools in their organizations. The balanced scorecard (BSC) is considered a viable tool in high-income countries to improve hospital performance. The BSC has not been applied to hospital settings in low-income countries nor has the context for implementation been examined. This study explored contextual perspectives in relation to BSC implementation in a Pakistani hospital. Methods: Four clinical units of this hospital were involved in the BSC implementation based on their willingness to participate. Implementation included sensitization of units towards the BSC, developing specialty specific BSCs and reporting of performance based on the BSC during administrative meetings. Pettigrew and Whipp\u27s context (why), process (how) and content (what) framework of strategic change was used to guide data collection and analysis. Data collection methods included quantitative tools (a validated culture assessment questionnaire) and qualitative approaches including key informant interviews and participant observation.Results: Method triangulation provided common and contrasting results between the four units. A participatory culture, supportive leadership, financial and non-financial incentives, the presentation of clear direction by integrating support for the BSC in policies, resources, and routine activities emerged as desirable attributes for BSC implementation. The two units that lagged behind were more involved in direct inpatient care and carried a considerable clinical workload. Role clarification and consensus about the purpose and benefits of the BSC were noted as key strategies for overcoming implementation challenges in two clinical units that were relatively ahead in BSC implementation. It was noted that, rather than seeking to replace existing information systems, initiatives such as the BSC could be readily adopted if they are built on existing infrastructures and data networks. Conclusion: Variable levels of the BSC implementation were observed in this study. Those intending to apply the BSC in other hospital settings need to ensure a participatory culture, clear institutional mandate, appropriate leadership support, proper reward and recognition system, and sensitization to BSC benefits

Therapeutic injections in Pakistan: from the patients\u27 perspective

Objective: To investigate the behaviour, knowledge of risks, and attitudes towards injections among patients at a clinic in Karachi.Methods: In March 1995, trained staff administered a structured questionnaire to 198 consecutive new adult patients attending a university clinic in Karachi, Pakistan.Results: Half (97:49%) of the patients received injections at their last visit to a health care provider. 3.5% had received 10 or more injections in the last year. 64% felt that injections were more powerful and were willing to pay more for them than for pills. 84% preferred pills or advice over injections if told they were equally effective, 83% believed that a used needle could transmit a fatal disease, and 86% believed that it is usually possible to get better without an injection. 91% reported that the doctor always recommends an injection; few patients (9%) ever asked for one. Injections were given without much regard for the chief complaint of the patient. Sonic needles (n = 21) for the injection came from bowls of water: of those from closed packets (n = 116), 68 were \u27cleaned\u27 by wiping ot placing them in water. 91% of patients (180) knew at least one risk of reuse of needles. Patients who knew three or more risks of using unclean needles were 0.14 times as likely to have had more than five injections per year in the last 5 years hut only if the patients had s or more years of education.CONCLUSION: Patients receive injections from doctors in Pakistan frequently, indiscriminately and often without proper safety precautions. They are aware of both positive and negative aspects of injections but are likely to do what the doctor suggests. Interventions to reduce risky overuse of injections should focus on patients\u27 general education and knowledge of the risks of injections to empower them to choose healthier therapies