Knowledge and Awareness Regarding Cervical Cancer and Uptake of Pap Smear among Women in Karachi, Pakistan

Objective: To determine the knowledge regarding cervical cancer, its symptoms and risk factors among women of 18 years and above attending the gynecology OPD in two public hospitals Karachi, Pakistan.Methodology: A cross-sectional survey was held from February to June 2013 in Karachi, Pakistan. 384 females aged 18 years and above attending gynecology clinics in two public sector hospitals were taken through non-probability sampling method. The knowledge was assessed using a point scale method which had binary response i.e. correct and incorrect. A score of 50% (≥ 11 correct responses) was considered as optimum knowledge.Results: Overall knowledge of cervical cancer was 23% based on scoring. Multiparity (29.1%) and unsafe sexual practice (21.8%) were mostly reported risk factors. Vaginal discharge (23.1%) were commonly reported presenting features of cervical cancer. Uptake of pap smear was 11% among all women. Women with younger had much less knowledge (AOR: 0.56, 95% CI: 0.14 - 0.71) as compare to middle age. Women with no education and 3 or more children were less likely to have sufficient knowledge (AOR: 0.79, 95% CI: 0.51 - 0.89) as compared to the educated. Women with 6 or more children were less likely to have sufficient knowledge (AOR: 0.44, 95% CI: 0.2 - 0.68) as compared to the women with less than 3 children. Married women were more likely to have enough knowledge (AOR: 1.2, 95% CI: 1.01 - 3.11) as compare to unmarried women.Conclusion: Insufficient knowledge of cervical cancer and about its screening services was found among general population. Establishing strategies for spreading awareness and provision of preventive services is essential through health care providers and media advocacy. Hence to improve health seeking behaviour and enhance early screening rates

Evaluation of EMR Implementation in a Private Hospital from User’s Perspective

Implementation of an electronic medical recordsystem increases efficiency of health services, quality of careand patient satisfaction. Successful implementation dependson multiple factors; one of which is users’ response to EMR.This study aimed to assess physicians and nurses’ views on theuse, quality and user satisfaction with EMR at a tertiarycare center in Karachi, Pakistan. Since its inception theHospital is accredited for being Pakistan’s first paperlesshospital. A cross-sectional survey was conducted using aself-administered questionnaire to evaluate use, quality and usersatisfaction with EMR. The questionnaire assessed: 1) computerrelated experience; 2) perceptions regarding EMR use; 3)quality of EMR system and 4) level of satisfaction with EMRsystem. The response rate was 75% nurses and 61% physicians.It was found that 80% of the respondents used EMR to obtainresults of patients’ investigations and test reports.81.6% respondents were of the opinion that the EMR Systemprovides the needed information about patients andreported their satisfaction with the accuracy of the system.Concerning user satisfaction with EMR, 94.6% of EMR usersbelieved that EMR is a useful system and 90.8% agreed on itssignificance for the better care of the patients. Type ofrespondents emerged as a significant correlate with overallusers’ satisfaction (p < 0.05). 90% respondents emphasized ona user-friendly EMR system and adequate training on its usage.Besides respondents, gender and computer relatedexperience have also significantly correlated with variousaspects of use, quality and user satisfaction with EMR (p <0.05). We were unable to correlate age with satisfaction with anEMR. EMR implementation positively effects workflow andpractice efficiency in a hospital. This study provides asystematic evaluation of various d imens ions of EMR andits correlates which is essential to understand reasons andbarriers for success, and methods to increase success inEMR implementation. Hospital management should ensure theavailability of technical expertise along with adequate trainingof HMIS staff

Analyzing Physician and Patient factors in optimizing Cervical Cancer Screening in Alberta: Progress, Barriers, and Enablers

Cervical cancer screening (CCS) program effectiveness is well-accepted; however, inappropriate CCS results in either a woman being tested too often or not being tested at the recommended intervals. Widespread disparities in CCS uptake also exist, even when screening is offered without cost through a publicly funded and organized CCS in Alberta. This thesis has three main objectives: Study 1.To describe temporal trends in screening and outcomes for women, after changes in guidelines in Alberta, Canada, that raised the starting age for screening to 21, then to 25 years of age, and reduced frequency to 3-yearly Study 2. To identify family physicians’ (FP) characteristics that are associated with over- and under-screening for 25-69-year-old women in Calgary, Alberta. Study 3. To study spatial and temporal associations of CCS and sociodemographic variables in Calgary, Canada using Census Canada datasets (2006, 2011, 2016). Methods Study 1: Calgary Laboratory Information System data were used to examine CCS, follow-up procedures, and cancer among women 10 to 29 years from 2007 to 2016 in the whole population of Calgary. Interrupted time-series analyses were used to assess changes in screening and subsequent diagnostic procedures over the ten-year period. Study 2: A population-based retrospective observational study was performed by linking the College of Physicians and Surgeons Alberta physicians’ database of FPs practicing in Calgary with the Calgary Laboratory Services database. We matched physicians’ sex, country and year of medical school graduation, years since medical school graduation, city quadrant of practice, and their estimated patient panel size. Logistic regression models were applied to analyze the over-screening and under-screening patterns. Study 3: CCS rates were obtained from a population-wide laboratory administrative database for Calgary, Alberta for the years 2006, 2011, and 2016 for women 25-69 years of age. These years coincide with Census Canada years, allowing comparison with sociodemographic factors Ordinary Least Square regression (OLS) and geographically weighted regression models (GWR) were used to examine sociodemographic variables associated with CCS rates. Results Study 1: Annual Screening rates dropped by around 10% for all ages over 15 after the 2009 Alberta cervical cancer screening guidelines, followed by a steady decrease. The rates of abnormal test results and biopsies did not increase with decreased screening. Likewise, no increases in Cervical intra-epithelial neoplasias (CIN I, CIN II/III), or invasive cervical cancer rates were observed after reduced testing. Study 2: Among 807 physicians included in the over-screening analysis, 43% of physicians had over-screened their screen-eligible patients. Among the 317 physicians included in the underscreening analysis, 42% had under-screened during the three-year study period. Physician characteristics significantly associated with over-screening included more years of practice and having more female patients in the practice. Female physicians were less likely to under-screen their eligible female patients. Physicians practicing in the Northeast quadrant of the city also had lower odds of screening. Study 3: We analyzed approximately 200,000 cervical cancer screening tests for each year and noted a considerable decrease in screening rates between 2006 and 2011, consistent with changes in screening guidelines. The OLS results showed that a high median household income and university education were strongly associated with higher screening rates in all three census years. 2006 and 2011 OLS models showed negative associations with screening of Aboriginals, Blacks, and recent immigrant women. Conclusions Study 1: The largest decrease in screening and follow-up procedures occurred in the period immediately following the implementation of 2009 Alberta screening guidelines. The number of consequent procedures also decreased in proportion to decreased screening, but there was no increase in cancer rates. Starting screening at age 25 and reducing intervals appears to be safe. Study 2: Screening patterns of family physicians indicate both overuse and underuse, which indicates inconsistencies in adherence to screening guideline recommendations. Identifying strategies and addressing disparities to improve guideline adherence among different physician demographic groups is critical for the success of screening programs. More education and guideline publicity are required to encourage compliance with screening guidelines. Study 3: There were significant sociodemographic differences associated with cervical cancer screening in Calgary. Understanding these sociodemographic associations could form the basis of future education or outreach screening programs, targeting underserved populations, such as women with low income and education

Sociodemographic correlates of cervical cancer screening rates in Calgary, AB: Matched Trend analysis of 2006, 2011 and 2016

Introduction Cervical Cancer Screening (CCS) has reduced the incidence and mortality rates of cervical cancer (CC). However, the benefits are distributed unevenly since 30% of eligible women have not been screened within three years in Alberta. Women who have never been screened or are screened irregularly are most at risk for CC. Objectives and Approach The aim of this study was to understand who gets CCS and who does not, in Calgary, Alberta and analyze the CC policy implications since 2006-2016. CCS information of women aged 25-69 were obtained from Calgary Laboratory Services for the years 2006, 2011 and 2016 and matched with Canadian Census data. Negative binomial regression and Generalized Estimating Equations were used to test associations of CCS rates with socio-demographic variables for eligible women. CCS spatial trends over the years was studied using the GIS Hotspot analysis. Results Major age and geographical variations were observed in CCS rates in Calgary. CCS rates in the recommended age groups varied from 40.6 % to 23.6 %. For age groups between 25 and 54, CCS rates were above 33\%, which implies that many women are having tests more than once every three years. Use was positively associated with median household income, education, Chinese ethnicity and negatively associated with ‘Black’ visible minority status. Women living in lower socio-economic areas of Calgary are screened at lower rates. Hotspot analysis maps revealed heterogeneous testing patterns in the city with relatively higher testing in the downtown, Southeast and Northwest quadrants of the city and relatively decreased CCS in the Northeast quadrant of Calgary Conclusion/Implications Screening programs need to be strengthened with greater focus on including specific demographic groups and reducing overuse. Understanding current testing patterns are important in assessing the benefit to harm ratio of CCS and for monitoring and evaluation of CCS program

Does the family physicians’ characteristics affect Cervical Cancer Screening rates?

Introduction While the effectiveness of cervical cancer-screening (CCS) programs is well accepted, concern is growing regarding Family physicians (FP) poor adherence to CCS guidelines resulting in over and under screening. In Canada, it is a FP responsibility to ensure that the CCS is done as per guidelines and with appropriate follow-up. Objectives and Approach To identify primary care physicians’ characteristics that are associated with over and under CCS for eligible women in Calgary, Alberta. We accessed the Calgary Laboratory Services data for 1475 FPs practicing in Calgary and linked it with the Physicians database of College of Physicians and Surgeons Alberta database. We then matched FP’s gender, country and year of medical school graduation, years since medical school graduation, certification in family medicine and their clinic address with their CCS testing patterns. Using doctors as their own controls, we compared data from 2010-2016 to determine practice variations in CCS patterns subsequent to guideline changes. Results We analyzed approximately 2,400,000 Pap test requisitions (approx. 300,000 per year) to identify screening patterns from 2010-2016 of 1475 family practitioners practicing in Calgary. Our preliminary results identified significant variations in the test ordering patterns of FPs. Approx. half of the male FPs were not performing CCS tests on their eligible female patients. Female FPs ordered more CCS tests than their male counterparts. FP trained in North America, were ordering more pap tests than FPS trained elsewhere. Decreased CSS was also observed among FPs practicing in Northeast Calgary. Conclusion/Implications We detected three CCS patterns: FPs who never perform CSS on eligible female patients; FPs who followed recommended guidelines for performing CCS tests and FPs who performed CCS tests, not following the guidelines. To ensure appropriate use of CSS, identifying intention-behavior relationships and innovative educational interventions for FPs are required

Missed immunization opportunities among children under 5 years of age dwelling In Karachi city

Background: Immunization is the safest and effective measure for preventing and eradicating various communicable diseases. A glaring immunization gap exists between developing and industrialized countries towards immunization, because the developing countries including Pakistan are still striving to provide basic immunization to their children. The purpose of this study was to access the prevalence and factors of missing immunization among under 5-year children of Karachi.Methods: A cross sectional study was conducted from June 2015 to October 2015 among different outpatient clinics of Karachi. Parents who had child less than 5 year of age were approached by non-probability purposive sampling. Data was analysed by using Statistical Package of Social Sciences.Results: There were around 59.09% (n=156) and 64.43% (n=165) parents who have correctly responded regarding the number of essential immunization visit during the first and second year of their child life respectively. About 28.12% (n=108) parents responded that they do not know about the name and number of missed doses of vaccines. 31.78% (n=122) parents responded that their children have missed either one or more than one doses of routine immunization vaccines. Of which 34.42% (n=42) children have missed more than one vaccine. Lack of knowledge regarding immunization schedule 28.68% (n=34), concern about vaccine side effects 21.31%, (n=26), child sickness 17.21% (n=21), and lack of trust about government 10.65%, (n=13) were the major barriers identified by parents for missed immunization opportunities.Conclusion: Parents have inadequate knowledge regarding routine immunization visits, immunization schedule and vaccine doses. The practices of parents for routine childhood immunization are also poor. Parents refuse to immunize their child because of lack of immunization visit knowledge and also because of their doubts regarding vaccine potency and side effects. A proper system of immunization promotion, advocacy and reminder systems with proper follow-up mechanism need to be developed by all healthcare centres

Assessment of the level of knowledge and the perceived consequences of medical negligence among fresh medical graduates of a private medical university in Karachi, Pakistan

Background: Medical negligence is the one of the leading cause of death in developing countries and as well in developed countries. The incidence of medical negligence cannot be established in Pakistan mainly due to lack of data availability and no accredited system of reporting by the government and medical licensing body. Increasing number of cases of negligence enforced us to think about the revisions in medical curriculum. Methods: A cross sectional study was conducted during July-August 2011 in a private medical university of Karachi. A 30 itemed self-administered questionnaire was developed which was filled by a total of 200 medical graduates upon their consent. The collected data was analyzed using SPSS version 10.0. Results: Our results of the study showed that 62% of the participants blame doctors for the act of medical negligence and 87.5% reported that medical negligence affect their career, their image being a doctor and future scope in this profession. 82.5% participants had strongly recommended including medical ethics as a separate subject in the medical curriculum. Conclusions: Medical graduates are stressed due to the increased number of reported cases of medical negligence. This is high time for the government to enforce policy implementation to reduce medical negligence and for the implementing bodies and medical education departments of medical colleges to understand the need of revision of medical curricula. Continued follow-up of this study could provide information to inform further curriculum development and, if appropriate, aid in the design of training programs for the prevention of medical negligence. Key words: medical negligence, curriculum, medical graduates and medical ethic

Perspectives regarding antenatal care, delivery and breast feeding practices of women from Baluchistan, Pakistan.

Background: Antenatal Care is one of the fundamental rights for women to safeguard their health. Neonatal mortality rates have remained relatively static, compared to the decline in infant and under 5 mortality rates, adverse practices regarding breast feeding and pre-lacteal feeds being the important factors responsible. This study aimed to explore the Antenatal Care, delivery and breastfeeding practices in three districts of Baluchistan. Methods: It was a qualitative phenomenological design using Constructivist approach. The study was conducted in three districts of Baluchistan province, Gwadar, Quetta, Qila Saifullah. There were a total of 14 Focus Group Discussions with women regarding Antenatal Care, delivery and Breastfeeding practices, followed by audio taping, transcription as verbatim and analysis through Nvivo version 2. A process was deployed for identification and reporting of the components in order to ensure quality and validity of the qualitative findings. Results: Across the sites, women attended ANC at least once. However, their descriptions of ANC often varied. The women preferred Dais instead of doctors, due to the affordability, customs and availability. A lack of trained doctors and long distances to get a check-up lead to home deliveries in the study setting. Colostrum was discarded by majority of the mothers, while prelacteal feed was a common practice. Conclusion: This paper has explored factors affecting ANC attendance, delivery and breast feeding practices across three settings. Both the demand and supply side factors have an important influence on practices

Perceptions, barriers, and strategies regarding helmet use by female pillion riders in Pakistan: A qualitative study

Introduction: Despite the existence of a national motorcycle helmet law that applies to both riders and pillion riders, the use of helmets among female pillion riders is low in Pakistan. This study aimed to explore perceptions, barriers, and strategies related to helmet use by female pillion riders.Methods: Data was collected from nine focus group discussions held with female pillion riders and male riders working at the Aga Khan University. Focus group discussions were transcribed verbatim and checked for accuracy before being imported into NVivo2. Transcriptions were analyzed using a thematic analysis approach.Results: Four overarching themes emerged, including: (1) motorcycle as mode of transportation, (2) law on helmet use and its enforcement, (3) barriers to helmet use among female pillion riders, and (4) strategies to improve helmet use among female pillion riders. Female participants never wore a helmet or considered wearing it even though safety was the most important benefit of helmet usage expressed. The motorcycle is an economical mode of transportation for families, particularly those in the middle and lower socioeconomic groups. Helmet laws are not strictly enforced for pillion riders, including females. Possible barriers to helmet use among female pillion riders included discomfort in wearing a helmet, uninvited attention from others, concerns about physical appearance, and substandard quality and design of helmets. Suggested strategies for implementing helmet use among female pillion riders encompassed awareness generation through media, complementary distribution of helmets, strict law enforcement in the form of fines, and the influence of religious leaders regarding social norms and cultural barriers.Conclusion: Motorcycles are a risky mode of transport, and there are several social and cultural barriers regarding helmet use by female pillion riders. Enforcing helmet laws for female pillion riders, raising awareness about helmet laws, and making helmet use among pillion riders a norm are some essential steps to take to promote helmet use among female pillion riders in Pakistan

Experiences and Perceived Outcomes of Low-Income Adults During and After Participating in the British Columbia Farmers' Market Nutrition Coupon Program: A Longitudinal Qualitative Study

The British Columbia Farmers' Market Nutrition Coupon Program (FMNCP) is a farmers' market food subsidy program that provides low-income households with coupons valued at $21/wk for 16 weeks to purchase healthy foods at participating BC Association of Farmers' Markets members' markets