Health systems approach to ensure quality and safety amid COVID-19 pandemic in Pakistan

Ensuring quality and safe care during the coronavirus disease 2019 (COVID-19) pandemic offers a challenge to already strained health systems in low and middle-income countries (LMICs), such as Pakistan with less shock-absorbing capacities. There is a dearth of evidence on mechanisms to provide optimum quality care to COVID-19 patients in the resource-constrained healthcare environment. The lessons learned from the Ebola virus outbreak for the deficient health systems and quality improvement are considered to propose strengthening the health systems response to deliver quality-assured care to patients during the current pandemic. In this regard, the World Health Organization (WHO) health systems framework can serve as a guiding principle towards providing quality-assured and safe healthcare services during the ongoing pandemic in Pakistan by ensuring the availability of an adequate workforce, medical supplies and equipment, strong governance, active information system, and adequate health financing to effectively manage COVID-19. Research evidence is needed to be better prepared for an effective and coordinated health systems response to offer quality and safe care to patients

Behavioral change communication tool kit to promote hygiene among school children

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Out-of-school children: Examining the reasons in semi- urban setting in Pakistan

Globally, 57 million primary age children remain out-of-school. In South Asia, Pakistan has the highest (34%) out-of-primary school age children. This paper highlights the proportion of out-of-school children with reasons and children’s educational attainment in the semi-urban community of Pakistan. A cross-sectional survey was conducted by using systematic sampling in a semi-urban town in Karachi, Pakistan. Chi-square was used to describe the difference in the educational achievements with age and gender of the children with p-value \u3c 0.05, considered as significant. Among 254 surveyed households, 22.9% of the children (age 3-15 years) were found out-of-school, with no significant gender difference among boys (11.6%) and girls (11.1 %). A large group of young children (3-6 years of age) were found out-of-school with boys 71.6% (n=68) and girls 67.03% (n=61). Children’s lack of interest in education was the major (42%) reason, followed by high school expenses (23%). Children’s educational attainment was significantly (p\u3c0.000) related to age and gender. At the local community level, teachers and Taluka Education Officers have a pivotal role to play towards increasing primary school enrollment and mobilizing the resources to overcome financial hardships faced by the parents for their children’s education in early years. Nousheen Akber Pradhan is a Senior Instructor at the Department of Community Health Sciences, Aga Khan University, Karachi, Pakista

Determinants of contraceptives use amongst youth: an exploratory study with family planning service providers in Karachi Pakistan

Introduction: In Pakistan, Contraceptive Prevalence Rate (CPR) among married female youth is 17.4% and even lower in rural and slum areas leading to rapid population growth on one hand and poor health consequences on the other. The study was conducted to explore family planning service providers\u27 perceptions regarding use of different contraceptive methods and to identify factors that are influencing their use amongst currently married youth aged 18-24 years in slum areas of Karachi.METHOD: Qualitative exploratory study design was adopted and a total of ten in-depth interviews were conducted with family planning service providers of the area. For content analysis coding of transcribed interviews was done and then categories were made and furthermore themes were derived.Results: Our findings revealed that family planning service providers perceived that there is low use of contraceptive methods amongst youth of study area and low usage could be due to side effects; myths and misconceptions; lack of proper knowledge about different contraceptives; unmet needs of contraceptives; socio-cultural and religious factors about different contraceptive methods and family planning service providers own biases against or for use of contraceptive methods amongst youth in the study area. However better education of youth and family planning service providers\u27 improved knowledge about counseling and use of contraceptive methods was perceived to be associated with improved use of family planning methods amongst youth of the study area.CONCLUSION: Exaggerated side effects and socio-cultural factors could be important influences leading to low use of family planning methods amongst youth of Karachi. Some policy initiatives are the training of lady health Workers, lady health visitors, physicians and staff of the pharmacies for counseling youth in the correct use of family planning methods

School-based interventions to promote personal and environmental hygiene practices among children in Pakistan: Protocol for a mixed methods study

Background: Poor personal hygiene and inadequate sanitation practices among young children leads to communicable diseases. There remains a gap in the holistic assessment of school children\u27s hygiene literacy, practices and effectiveness of school-based hygiene interventions in Pakistan. Therefore, a school-based intervention protocol has been designed to promote personal and environmental hygiene practices for primary school children. Towards improving children\u27s hygiene behaviors, the study will also focus on enhancing mothers\u27 hygiene knowledge and practices.Methods: Using quasi-experimental design with mixed methods data collection approaches, this study will be conducted in schools located in an urban squatter settlements in Pakistan. To assess primary grade children and their mothers\u27 hygiene status, a survey will be held in the pre-intervention phase. This phase also includes qualitative exploration of key stakeholders (mothers, teachers, health & education authorities representatives\u27) perceptions about the factors facilitating and impeding the adaption of hygiene behaviors among school children. In-depth guides and focus group discussion tools will be used for this purpose. This will be followed by multi-component intervention phase with behavior change strategies to improve children\u27s and mothers\u27 hygiene literacy and behaviors. The post-intervention phase will assess the intervention effectiveness in terms of enhancing hygiene knowledge and practices among school children and mothers, alongside exploration of mothers and teachers\u27 insights into whether or not the intervention has been effective in improving hygiene practices among children. Paired t-test will be applied pre and post-intervention to measure the differences between the mothers and children\u27s hygiene literacy and knowledge scores. Similar test will be performed to assess the differences in children\u27s hygiene knowledge and practice scores, pre and post-intervention (\u3c 50 = poor, 50-75 = good and \u3e 75 = excellent). Thematic analysis will be carried out for qualitative data.Discussion: Multi-component intervention aimed at improving personal and environmental hygiene among primary school children offers an opportunity to design and test various behavioral change strategies at school and in home settings. The study findings will be significant in assessing the intervention\u27s effectiveness in improving children\u27s overall hygiene

Perceptions of stakeholders about the role of health system in suicide prevention in Ghizer, Gilgit-Baltistan, Pakistan

Background: Suicide is a serious global public health problem, with more than 800,000 people dying by suicide worldwide every year. 79% of suicides happen in Low and Middle-Income Countries (LMICs), where lack of national suicide prevention programs coupled with inadequate MH facilities for early identification and treatment of mental disorders add to seriousness of the problems. Although there is paucity of research, studies suggest that the rate of suicide in district Ghizer, Gilgit-Baltistan (GB), in northern Pakistan may be higher compared to rest of the country.Methods: This study aimed to explore the perceptions of stakeholders about the role of the health system at District Ghizer, GB using a qualitative descriptive exploratory research design. A total of 12 face to face in-depth interviews were conducted from the stakeholders using purposive sampling technique.Results: The study results led to three broad themes, 1) Suicide as A Social Issue, 2) Role of Health System in Suicide Prevention, and 3) Challenges for Health System in Suicide Prevention. Theme one was sub-categorized into; a) Perceived situations contributing to suicide, b) Environmental factors. Theme two was subdivided into; a) Major hurdles for Health system, b) Lack of MH services in the available health system. Theme three was subdivided into; a) Lack of collaboration across-sectors, b) Unavailability of MH professionals, and c) Financial issues. The study findings reveal that there are multiple challenges for health system including, lack of awareness on mental issues, shortage of resources and lack of collaboration in the community. Moreover, existing policies or strategies need to be modified to overcome the existing challenges for the effective prevention.Conclusion: This study emphasized creating awareness about MH issues, introduction of school health programs, parental counseling session and strengthening of the health system by allocating suitable budget for MH issues and suicide prevention strategies

Measuring socio-economic status of an urban squatter settlement in Pakistan using WAMI index

Objective: To determine the socio-economic status of a peri-urban community.Methods: The cross-sectional study was conducted at Deh Chuhar village, Gaddap Town, Karachi from December 2015 to February 2016. The Water/Sanitation, Assets, Maternal Education and Income Index was used. All variables were given a score on the scale of 0-8. The resulting index was illustrated in the form of quintiles.Results: : A total of 254 households were surveyed. Total population was 2117 with mean number of household members being 8±4. Mean index score was 0.39±0.14 and the median score was 0.375. Percentile distribution of the score indicated that 152(60%) households scored below 0.40 whereas, 51 (20%) were in the highest quintile with a score above 0.50.Conclusions: Water/Sanitation, Assets, Maternal Education and Income index suggested poor socio-economic status of the community studied

Management of maternal depression: Qualitative exploration of perceptions of healthcare professionals from a public tertiary care hospital, Karachi, Pakistan

The lack of implementation and routine screening of management techniques at tertiary care hospitals leads to an increased burden of maternal depression. The consequences are borne emotionally, physically, and mentally by the mother, the child, the overall family, and society. Hence, it is vital to contextualize this mental disorder to design and implement effective healthcare interventions. The study is aimed to assess the knowledge and practices of healthcare professionals, in a tertiary care setting, who deal with depressive symptoms amongst mothers. It gauges whether a psychological screening criterion is being implemented by the clinical staff during prenatal and postnatal visits to recommend steps that can help develop a service framework. A qualitative, exploratory study design was implemented for this research. With purposive sampling, eight in-depth interviews (three nurses and five doctors) at a single tertiary care hospital were conducted categorically using a semi-structured (open and close-ended questions) interview toolkit. Content Analysis was carried out using information gathered from the unit of analysis. The study provided evidence of the existing gaps in one particular tertiary healthcare system, within Pakistan, concerning diagnosis and management of maternal depression. Results highlighted that providers were well-versed with explanations of maternal depression, the aftermath of it, and the current status of healthcare; however, they were minimally educated about the specifics and levels of treatment. The gathered information assisted in recommending steps to develop a service framework

Factors affecting Maternal-care during labour at maternity centres of Karachi, Pakistan: Exploratory study

Globally 529,000 women die every year due to harmful consequences of childbirth. This study aimed to explore the barriers and facilitators that influence the provision of quality care during labour at maternity centres in Karachi, Pakistan. The qualitative exploratory study design was used to study such factors from public and private maternity health facilities of Karachi, Pakistan. A total of 12 in-depth interviews were conducted through purposive sampling by using validated semi-structured interview guide. Data was analysed using content analysis manually. Among major barriers, unhygienic environment, lack of basic equipment, supplies and medicine, unprofessional attitude of staff, physical infrastructre and shotrage of staff were explored. Among facilitators, caring and supportive attitude of healthcare personnel during labour were identified. These identified determinants would guide policy-makers, Maternal, Newborn and Child Health (MNCH) planners and health managers to take appropriate actions to enhance the quality of maternal care which will subsequently result in considerable reduction in maternal mortalities

Quality of inpatient care of small and sick newborns in Pakistan: Perceptions of key stakeholders

Background: In LMICs including Pakistan, neonatal health and survival is a critical challenge, and therefore improving the quality of facility-based newborn care services is instrumental in averting newborn mortality. This paper presents the perceptions of the key stakeholders in the public sector to explore factors influencing the care of small and sick newborns and young infants in inpatient care settings across Pakistan.Methods: This exploratory study was part of a larger study assessing the situation of newborn and young infant in-patient care provided across all four provinces and administrative regions of Pakistan. We conducted 43 interviews. Thirty interviews were conducted with the public sector health care providers involved in newborn and young infant care and 13 interviews were carried out with health planners and managers working at the provincial level. A semi-structured interview guide was used to explore participants\u27 perspectives on enablers and barriers to the quality of care provided to small and sick newborns at the facility level. The interviews were manually analyzed using thematic content analysis.Findings: The study respondents identified multiple barriers contributing to the poor quality of small and sick newborn care at inpatient care settings. This includes an absence of neonatal care standards, inadequate infrastructure and equipment for the care of small and sick newborns, deficient workforce for neonatal case management, inadequate thermal care management for newborns, inadequate referral system, absence of multidisciplinary approach in neonatal case management and need to institute strong monitoring system to prevent neonatal deaths and stillbirths. The only potential enabling factor was the improved federal and provincial oversight for reproductive, maternal, and newborn care.Conclusion: This qualitative study was insightful in identifying the challenges that influence the quality of inpatient care for small and sick newborns and the resources needed to fix these. There is a need to equip Sick Newborn Care Units with needed supplies, equipment and medicines, deployment of specialist staff, strengthening of in-service training and staff supervision, liaison with the neonatal experts in customizing neonatal care guidelines for inpatient care settings and to inculcate the culture for inter-disciplinary team meetings at inpatient care settings across the country