Insight into COVID-19 responses and initiatives from Pakistan

The coronavirus pandemic is a rapidly evolving outbreak that has tremendously distressed people worldwide. The paper aims to present some key rapid responses and initiatives to COVID-19 undertaken in Pakistan. The information has been gathered by reviewing material and documents pertinent to COVID-19 in the context of Pakistan. The incidences of COVID-19 cases are gradually increasing; however, the case fatality rate is relatively lower in Pakistan as compared to developed countries. The government has taken massive actions, in terms of lockdowns, quarantine homes, testing facilities, closure of schools, and mass gatherings at places, to combat COVID-19. However, the measures seem to be insufficient due to the fear and stigma attached to it and the low socio-economic conditions. The government has launched initiatives, like Ehsaas cash dissemination programme, for the underprivileged families to address their basic needs; and philanthropic organisations are also coming forward to support these families. The spread of the pandemic is gradually increasing in Pakistan and we recommend strategies like increasing public awareness campaigns, improving screening capacity, and contact tracing to augment the efficiency of the current responses and initiatives

Mental health challenges and psycho-social interventions amid COVID-19 pandemic: A call to action for Pakistan

The increase in death and spread-related coronavirus (COVID-19) has shifted the world focus to the containment of the disease by emphasising measures to prevent spread in the general population. Such a complex, threatening, and unprecedented situation has left the psycho-social wellbeing needs of general public unaddressed. This paper aims to review the current COVID-19 scenario and its effects on the psycho-social wellbeing of people; and an attempt to shed some light on the aforementioned questions. Furthermore, the review will propose some recommendations for overcoming the mental illness issues, during and after the COVID-19 outbreak. We extracted information from reliable published international and national literature and reviewed anecdotes from media content from January to June 2020. The mental health implications of this outbreak will be long-lasting; however, by prioritising, investing diligently, and taking a collective approach, this challenge can be dealt with in a promising manner

Association of depression and resilience with fertility quality of life among patients presenting to the infertility centre for treatment in Karachi, Pakistan

Background: In Pakistan there is a dire need to explore the quality of life in infertile males and females and its undesirable psychological outcomes. This, study aimed to compare the quality of life (QoL) of males and females visiting an infertility centre for treatment and to assess its association with resilience, depression, and other socio-demographic factors.Methods: An Analytical Cross-Sectional study was conducted amongst infertile males and females at the Australian Concept Infertility Medical Centre (ACIMC), Karachi, Pakistan. The non-probability (purposive) sampling strategy was used to recruit the participants. The sample size was 668. Data was analysed using STATA version 12. FertiQoL tool, Beck II Depression Inventory Tool and Resilience Scale 14 (RS-14) were used for assessing the quality of life, depression and resilience respectively of infertile patients.Results: Total 668 infertile patients, 334 males and 334 females participated in the study. The mean age was 35.53 ± 6.72, among males, and 30.87 ± 6.12 among females. The mean resilience scores were significantly higher among males, (77.64 ± 8.56), as compared to females (76.19 ± 8.69) (95% CI; - 2.757, - 0.1347). However, a significantly higher proportion of females were depressed (13.8%) as compared to males (6%). The mean QoL scores for the general health domain, emotional domain, mind and body domain, and relational domain, and the total QoL were significantly higher in males as compared to females (p value\u3c 0.001); however, QoL for the social domain was not significantly different in both the groups. On multivariable linear regression resilience and depression among males had a significant association with QoL, after adjusting for the covariates educational status, monthly income, and number of friends. Similar association was observed among females after adjusting for the covariate monthly income only.Conclusion: Fertility related QoL of men and women has a significant association with no formal education, number of friends, income, depression and resilience. Therefore, health care professionals in the field of infertility must be adequately trained to respond to the needs of individuals going through these psychological problems

Association between breast feeding and childhood obesity among school-going children (5-16 years of age) in Karachi, Pakistan

Background: Overweight and obesity in children are major risk factors for adult obesity, associated chronic diseases, and premature deaths worldwide. According to the International Obesity Taskforce (2010) estimates, globally 200 million school aged children are overweight. Out which 40-50 million school aged children are obese. Effects of rapid globalization in the developing countries, have resulted in profound implications for poorly resourced countries like Pakistan where the rate of overweight and obesity among children is on rapid rise. Early identification of protective factors is the key to prevention in this vulnerable group that accounts for 45 percent of the total population in Pakistan. A substantial body of evidences has suggested breast feeding, asbeing protective against childhood obesity. However, such an association is neither conclusive in literature nor has it been explored in the Pakistani context. Objective: This study aimed to investigate the association between breast feeding and childhood obesity in school going children (5-16 years of age) in Karachi. Pakistan. Methodology: A matched-case control study was conducted during April 2012 to July 2012.In this study, 528 school going children, aged 5-14 years of age (132 cases and 396 controls) matched on age and gender, were recruited from public and private schools. Data was collected face to face using a pre-tested structured questionnaire on socio-demographic profile, and lifestyle domains (dietary patterns, physical activity, sedentarism, and breast feeding) from children and their mothers at the schools. Anthropometric measurements were done using standardized procedures and BMI was calculated using the Centre of Disease Control growth charts. Analysis was done using the Statistical Package for Social Sciences (SPSS version 19.0), and Statistical Analysis System (SAS version 9.2). Findings: Conditional logistic regression results showed that having a history of not being exclusively breast fed [mORadj= 5.5; 95% CI (2.3-12.9)], exclusively breast fed for less than 3 months [mORadj= 4, 95% CI (2.0-7.8)], and exclusively breast fed for 4-5 months in school going children was [mORadj= 2.6; 95% CI (1.5-4.7)] associated with a higher obesity risk. However, in this study being moderately active [mORadj=0.5; 95% CI (0.3-0.8)], as well as lower extent of participation [mORadj=0.3; 95% CI (0.15-0.7)] in moderate to vigorous physical activity was protective against childhood obesity. Conclusion: Longer duration of exclusive breast feeding have a protective effect against childhood obesity in a dose-response manner. In Pakistan, future longitudinal studies are urged to confirm this association because of its implications for public health. Further studies are also needed to better understand the independent link between physical activity and sedentarism in children

Case report : discontented life versus peaceful death

In today’s healthcare system, health professionals deal with many challenging dilemmas and controversies that are difficult to resolve. Among several issues, the issue of refusal of blood transfusion by the patient in an emergency situation has been debated a lot in the literature. It is a crucial issue that puts health care professional in a state of confusion, and creates ethical and legal dilemma to deal with. The health professional engage in ethical inquiry to identify the best possible option, based on ethical grounds and discover morally-justifiable solution while prioritizing a patient’s interest. The pioneers in ethical theories and principles provide us a framework to ethical decision making. The widely used ethical theories include Utilitarian, and Kantism

Community health nursing clinical teaching models practiced in undergraduate nursing programme at a private university in Pakistan

Objective: To explore the perceptions and experiences of students and faculty about the modified community clinical model.Methods: The descriptive qualitative study was conducted at a nationally-accredited Baccalaureate School of Nursing and Midwifery in Pakistan in November 2016, and comprised final year students enrolled in Advanced Concepts in Community Health Nursing course, and experienced community health nursing faculty members. Individual interviews were conducted with students while faculty members were requested to write out their reflections. On the basis of this data, codes and categories were identified which led to two broader themes; window of opportunities, and challenges in practice.Results: Of the 17 subjects, 12 (70.6%) were students and 5(29.4%) were faculty members. All subjects were females. The window of opportunities theme had three categories: perceived comfort and safety; stakeholder\u27s involvement and support; and open door for personal recognition and self-image. The challenges in practice theme had two categories: time consuming, and home visits. Faculty reflections highlighted the need for sustaining student-related activities within the communities.Conclusions: The findings are suggestive of a wide range of application of the modified clinical model at undergraduate nursing education level

Influence of gender roles and responsibilities on family planning decisions in adults, in Karachi, Pakistan: A qualitative analysis of open-ended interviews

Background: In Pakistan, the slow pace of declining fertility rate accounts for troubling consequences like multiple pregnancies, induced abortions, the low 34% contraceptive prevalence rate, and overpopulation. This coupled with the lack of literature on this topic in the country makes it pivotal to explore the gender roles and responsibilities of adults in marital life and within the family and their influence on Family Planning decisions in adults, in Karachi, Pakistan.Methods: The study design involved purposive selection of 12 consenting married adults belonging to Gulberg Town, from whom detailed qualitative data was collected using open-ended, semi-structured interviews, supported by field notes. For the sake of anonymity, participants were assigned codes. Furthermore, all discussions were conducted in English or Urdu language by the female investigator herself and were audio recorded after obtaining participants’ consent. Thereafter, a rigorous thematic analysis of the interviews was carried out, with the results being double-checked before being securely stored in soft or hard copy.Results: The study observations identified that gender roles and responsibilities do affect Family Planning decisions in Pakistan. The results were broadly categorized into two themes: superficial reasons and deeper reasons affecting FP decisions. The first theme has three main categories; interpretation of FP, awareness about FP, and couple as representative of FP decision making whereas the second theme has five categories; roles and responsibilities of men in the family, roles and responsibilities of women in the family, women autonomy, mind the gap or taming the women, and way forward.Conclusions: Our study findings suggest that while superficial reasons must be resolved, it is primarily crucial to eliminate the subtler, tap root factors influencing FP decisions by strongly addressing school curricula, nurses and other Health Care Workers (HCWs) to positively impact the society. Further qualitative and quantitative research is ultimately necessary for assessing the viewpoint of important stakeholders and how, using a multiprong approach, the stringent perceptions pertaining to Family Planning can be altered to benefit the society

Association between breastfeeding and childhood obesity among school-going children, 5-16 years of age in Karachi, Pakistan

Background: Overweight and obesity in children are major risk factors for adult obesity, associated chronic diseases, and premature deaths worldwide. In Pakistan, the rate of overweight and obesity among children is on rapid rise. A substantial body of evidences has suggested breast feeding, as being protective against childhood obesity. However, such an association is neither conclusive in literature nor has it been explored in the Pakistani context. Objective: This study aimed to investigate the association between breast feeding and childhood obesity in school going children, 5–16 years of age in Karachi. Pakistan. Methodology: In this study, 528 school going children, aged 5–14 years of age (132 cases and 396 controls) matched on age and gender, were recruited from public and private schools of Karachi. Findings: Conditional logistic regression results showed that being breast fed for less than 12 months [mORadj= 1.96; 95% CI (1.0–3.7)],having a history of not being exclusively breast fed [mORadj= 5.5; 95% CI (2.3–12.9)], exclusively breast fed for less than 3 months [mORadj= 4, 95% CI (2.0–7.8)], and exclusively breast fed for 4–5 months in school going children was [mORadj= 2.6; 95% CI (1.5–4.7)] associated with a higher obesity risk. Conclusion: Longer duration of breast feeding, and exclusive breast feeds have a protective effect against childhood obesity in a dose-response manner. In Pakistan, future longitudinal studies are urged to confirm this association because of its implications for public health