From their own perspective - constraints in the Polio Eradication Initiative: perceptions of health workers and managers in a district of Pakistan's Punjab province

<p>Abstract</p> <p>Background</p> <p>The success of the Global Polio Eradication Initiative was remarkable, but four countries - Afghanistan, Pakistan, India and Nigeria - never interrupted polio transmission. Pakistan reportedly achieved all milestones except interrupting virus transmission. This paper describes the perceptions of health workers and managers regarding constraints in the Polio Eradication Initiative (PEI) to ultimately provide evidence for designing future interventions.</p> <p>Methods</p> <p>A qualitative cross-sectional study using focus group discussions and in-depth interviews was conducted in the Nankana Sahib District of Pakistan's Punjab province. Study subjects included staff at all levels in the PEI at district headquarters, in all 4 tehsils (sub-districts) and at 20 randomly selected primary health centers. In total, 4 FGD and 7 interview sessions were conducted and individual session summary notes were prepared and later synthesized, consolidated and subjected to conceptual analysis.</p> <p>Results</p> <p>The main constraints identified in the study were the poor condition of the cold chain in all aspects, poor skills and a lack of authority in resource allocation and human resource management, limited advocacy and communication resources, a lack of skills and training among staff at all levels in the PEI/EPI in almost all aspects of the program, a deficiency of public health professionals, poor health services structure, administrative issues (including ineffective means of performance evaluation, bureaucratic and political influences, problems in vaccination areas and field programs, no birth records at health facilities, and poor linkage between different preventive programs), unreliable reporting and poor monitoring and supervision systems, limited use of local data for interventions, and unclear roles and responsibilities after decentralization.</p> <p>Conclusion</p> <p>The study highlights various shortcomings and bottlenecks in the PEI, and the barriers identified should be considered in prioritizing future strategies.</p

Knowledge on uterine prolapse among married women of reproductive age in Nepal

Binjwala Shrestha,1,2 Bhimsen Devkota,3,4 Badri Bahadur Khadka,5 Bishnu Choulagai,1,2 Durga Prasad Pahari,1 Sharad Onta,1 Max Petzold,6 Alexandra Krettek2,7 1Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal; 2Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden; 3Development Resource Centre, Kathmandu, Nepal; 4Institute of Education, Tribhuvan University, Kathmandu, Nepal; 5National Health Education Information and Communication Centre, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal; 6Akademistatistik &ndash; Centre for Applied Biostatistics, Occupational and Environmental Medicine, University of Gothenburg, Sweden; 7Nordic School of Public Health NHV, Gothenburg, Sweden Background: Uterine prolapse (UP), which affects about 10% of women of reproductive age in Nepal, is the most frequently reported cause of poor health in women of reproductive age and postmenopausal women. Currently, women&#39;s awareness of UP is unknown, and attempts to unravel the UP problem are inadequate. This study aims to assess UP knowledge among married reproductive women, and determine the association between UP knowledge and socioeconomic characteristics. Methods: Our cross-sectional descriptive study investigated 25 districts representing all five administrative regions, three ecological zones, and urban and rural settings. We used structured questionnaires to interview 4,693 married women aged 15&ndash;49 years. We assessed UP knowledge by asking women whether they had ever heard about UP, followed by specific questions about symptoms and preventive measures. Descriptive statistics characterized the study population regarding socioeconomic status, assessed how many participants had ever heard about UP, and determined UP knowledge level among participants who had heard about the condition. Simple regression analysis identified a possible association between socioeconomic characteristics, ever heard about UP, and level of UP knowledge. Results: Mean age of participants was 30 years (SD [standard deviation] 7.4), 67.5% were educated, 48% belonged to the advantaged Brahmin and Chhetri groups, and 22.2% were Janajati from the hill and terai zones. Fifty-three percent had never heard about UP. Among women who had heard about UP, 37.5% had satisfactory knowledge. Any knowledge about UP was associated with both urban and rural settings, age group, and education level. However, satisfactory knowledge about UP was associated with administrative region, ecological zones, caste/ethnic group, and age group of women. Conclusion: Fifty-three percent of participants had never heard about UP, and UP knowledge level was satisfactory in 37.% of those who had ever heard about UP. Any knowledge was associated with urban/rural setting, age group, and education level, whereas satisfactory knowledge was associated with geography, caste/ethnic group, and age group. UP-related health promotion programs should target women from all caste/ethnic groups, age groups, and education levels, including urban and rural communities. Keyword: associated factors, knowledge, uterine prolapse, associated factors, Nepa

Simultaneous identities: ethnicity and nationalism in mother tongue education in Nepal *

The scholarly works on ethnicity and nationalism have been highly dominated by binary frameworks. In addition, the normative preference for civic consciousness and the concerns of national disintegration often separate the notions of ethnicity and nationalism. This article suggests that the notions of ethnicity and nationalism cannot be understood exclusively as a choice between maintaining the integrity of the nation and completely rejecting it. Drawing on fieldwork in mother tongue schools in Nepal, the article draws attention to the ways in which school actors discursively positioned ethnic identity as imperative to national identity, the one that bolsters the notion of Nepali nationhood. By paying close attention to the everyday context within which discourses of nationalism are situated, this article argues for an analytical necessity to approach ethnicity and nationalism in relation to each other to appreciate the process of symbolic negotiations in public spaces

Heterogeneity in the validity of administrative-based estimates of immunization coverage across health districts in Burkina Faso: implications for measurement, monitoring and planning

Background Data aggregation in national information systems begins at the district level. Decentralization has given districts a lead role in health planning and management, therefore validity of administrative-based estimates at that level is important to improve the performance of immunization information systems