Households’ Non-leisure Time Allocation for Children and Determinants of Child Labour in Punjab, Pakistan

Pakistan is one of those countries in Asia where incidence of child labour is very high. Children should not have to work, but the estimates of the Child Labour Survey 1996 show that there are 3.3 million working children between the ages of 5–14 years in Pakistan. Due to political, social and economic pressures, developing countries like Pakistan tend to react by enacting legislation which bans child labour. Countries which are now developed did the same thing when they successfully completed their industrialisation. Child labour is often harmful for the children, but there are situations where the alternatives to child labour may offer only deeper poverty both for the children and their families. Therefore, mishandling of this issue can make matters from bad to worse, for example, if legislation pushes children into even worse situations. The Government of Pakistan has enacted the Employment of Children Act of 1991 which has banned employment of children below the age of 14 years and their employment is now a cognisable offence under the Act punishable by imprisonment and fine.1 Such interventions can lead to reductions in the already limited choices available to the child. For example, this legislation may mean that the child can neither work nor go to school. To put it differently, this ban does not address market failures, for example, in the education market. Hence, to tackle this complex problem different policy instruments are required which address not only the aspects of market failures, but also distributional and efficiency considerations of such services. In handling the issue of child labour, the supply side factors which motivate households to allocate non-leisure time of their children can provide useful insights to address this complex problem.

Measurable Predictors of Birth Outcomes: Community Health Needs Assessment Objectives

Purpose: The purpose of this study was to identify measurable predictors of birth weight in the four zip codes of Montgomery County, Ohio with the poorest health outcomes. Previous literature has shown that birth weight is strongly correlated with risk of infant mortality. Methods: Multiple linear regression was used to assess the relationship between multiple predictor variables and the outcome of interest, birth weight. Separate models were fit for each zip code (45402, 45405, 45406, and 45414). Maternal and infant characteristics were analyzed to assess which variables served as the best predictors of birth weight in order to better allocate hospital community health funding to decrease disparities in birth outcomes. Results: Maternal education was a significant predictor of infant birth weight for all four zip codes. Mothers with higher education on average had children with greater birth weight. Maternal race was significant across three zip codes as a predictor of infant birth weight. White mothers on average had children with greater birth weight. Conclusion: Maternal education, maternal race, and the mean number of cigarettes smoked during pregnancy were found to be strong predictors of infant birth weight. A higher Apgar score at five minutes was found to be associated with a heavier infant birth weight. However, limited sample sizes in some zip codes may have resulted in certain associations being non-significant and others being significant that were not consistent with previous research

Living with violence in the home: Exposure and experiences among married women, residing in urban Karachi, Pakistan

AIM: A study was conducted in urban Karachi, Pakistan to investigate prevalence, frequency, risk factors, and mental health effects of husbands’ violence against their wife. It also explores current gender roles in urban Karachi, Pakistan, how these are reproduced and maintained, and their influence on life circumstances for both men and women. Further, it explores the women’s perceptions of situations which create conflicts and potentially lead to different forms of violence and the immediate consequences of violence exposure. METHOD: The research collected quantitative and qualitative data. The quantitative part used a questionnaire developed by the World Health Organization (WHO) for violence research for data collection among 759 married women living in lower and middle income areas of Karachi city. For the qualitative part, five focus group discussions were carried through, in which 28 women were included, representing employed, unemployed, educated and uneducated women from different socioeconomic strata. Analysis of the focus group discussions was conducted by applying manifest and latent content analyses. FINDINGS: The quantitative studies indicate that violence against women is a common phenomenon within family life among low and middle income groups in Karachi, whether it is exercised as physical, sexual or psychological violence. Further, overlapping between the different forms of violence was huge and most women were exposed to two or all three forms of violence. Risk factors for physical violence related mainly to the husband, his low educational attainment and his being an unskilled worker, as well as there being five or more family members living in one household. For sexual violence, the risk factors were the respondent's low education, low socio-economic status of the family and there being five or more family members living in one household. For psychological violence, the risk factors were the husband's being an unskilled worker and the low socio-economic status of the family. The mental health effects as an outcome of the violence were serious. Suicidal thoughts showed associations with all three forms of violence. Through qualitative studies with manifest and latent content analysis, three major themes emerged: 1) ‘Reiteration of gender roles’, 2) ‘Agents of change’ and 3) ‘Family violence through the eyes of females’. The first theme included perceptions of traditional gender roles and how these preserve women’s subordination. The power gradient, where men given a superior position in relation to women, distinctive features in the culture and the role of the extended family were considered to interact to suppress women. The second theme included agents of change, where the role of education was prominent, as well as the role of mass media. It was further emphasised that the younger generation was more positive to modernisation of gender roles than the elder generation. The third theme describes the circumstances that provoke and sustain violence, situations evoking suicidal thoughts and actions, and how violence can be avoided through women’s awareness and actions. CONCLUSION: This study reveals serious gender inequalities and human rights violations against women within marriage, in her extended family and within Pakistani society. The unequal gender roles were perceived as static and enforced by structures imbedded in society. The female victims of abuse are trapped in a society where violence, from a partner or other family members, is viewed as acceptable, where divorce is a largely unavailable option for the majority, and where societal support directed at women is sparse. Women routinely face serious restrictions and limitations of autonomy, which contribute to the development of multiple forms of psychological stress and serious mental health problems. However, attainment of higher levels of education, especially for women but also for men, was viewed as an agent towards change. Further, mass media was perceived as having a positive role to play in supporting women’s empowerment. Reliable health surveillance system and healthcare services are needed to serve abused women

Gender based violence and health effects

Gender Based Violence (GBV) violates the basic human right of a person’s physical, sexual and emotional integrity and health ([i]) such that globally, one out of every three women is subject to some form of violence, ranging from verbal and physical abuse to emotional blackmailing and psychological torture eventually leading to futile despair and hopelessness. The ironical perception of gender equality in our society is the root cause of gender based violence, with women being more afflicted by such a form of gender discrimination than men. [i]. Ali TS, Krantz G, Gul R, Asad N, Johansson E, Mogren I. Gender roles and their influence on life prospects for women in urban Karachi, Pak0istan: a qualitative study. Global health action. 2011;4(1):7448

Hypertension and kidney disease in Asia

PURPOSE OF REVIEW: Communicable diseases were traditionally the major cause of public health concern in Asian countries, most of which were less developed. With industrialization and associated lifestyle changes during the past few decades, however, noncommunicable diseases similar to those that affect Western societies have emerged in Asian countries. The purpose of the review was to examine recent evidence about the burden and factors associated with hypertension and chronic kidney disease (CKD) in Asian countries.RECENT FINDINGS: Hypertension has become one of the leading causes of mortality in Asia. Although its prevalence continues to rise, it remains under-diagnosed and under-treated. CKD is becoming increasingly common mainly due to an increase in risk factors such as high blood pressure, diabetes, and obesity. Treatment of advanced CKD is overwhelmingly burdensome in a resource poor environment. Barriers to early detection of CKD in Asians include the fact that equations to estimate the glomerular filtration rate have not been validated in this population, and the uncertainty about appropriate glomerular filtration rate cutoff values to define CKD.SUMMARY: Concerted efforts are needed to develop and implement cost-effective strategies for prevention and treatment of hypertension and CKD in Asian countries. More research is needed on these conditions in these populations

Translational research in rheumatoid arthritis: Exploiting melanocortin receptors

The copyright of this thesis rests with the author and no quotation from it or information derived from it may be published without the prior written consent of the authorRheumatoid arthritis (RA) is a chronic inflammatory disease affecting 1% of the population. The aetiology of rheumatoid arthritis is unknown, although there are multiple postulated theories. In 1950, Philip Hench won the Nobel prize for treating patients with rheumatoid arthritis with cortisone. He also treated 6 patients with adrenocorticotropic hormone (ACTH) with good results. ACTH is a melanocortin. The melanocortin system describes the five melanocortin receptors, their ligands, agonists and antagonists and the accessory proteins. The aim of this study was to explore the melanocortin receptors in rheumatoid arthritis synovium. Methods HA-tagged stable cell lines were created for MC1R, MC3R and MC5R. Multiple antibodies were tested for their utility using Western Blot, immunohistochemistry and flow cytometry. Samples of synovium from 28 patients with RA were tested using RTPCR for the presence of MC1R and MC3R. Gene expression was correlated with clinical characteristics, cytokine (RTPCR) expression and immunohistochemical score. Results The stable cell lines expressed MC1R, MC3R and MC5R respectively. Of the antibodies tested none were found to be of utility in detecting MC1R or MC3R .The MC1R RQ values in rheumatoid synovium appear to split into two groups, high and low. The medians of the two groups are significantly different (p=0.0005). There is almost a 5 cycle, or 64 fold, difference in gene expression between the medians of the two groups (1.59 v 6.23). Of note no MC3R positive samples were CD138 high (i.e. no MC3R positive samples had a significant plasma cell infiltrate) (p=0.006). Categorical analysis using Fishers Exact test revealed an association between MC1R high samples and CD68 lining high scores, (i.e. MC1R high samples also had a high macrophage score in the lining of the sample) (p=0.02). MC1R low samples were associated with not being on combination therapy, 15 this did not quite reach significance (p=0.07). Linear regression analysis confirmed these associations for MC1R. PCA analysis did not show any grouping of samples according to any of the variables tested, likely due to sample size. Conclusion MC1R and MC3R are found in human synovium. Current commercial antibodies are not of utility in detecting MC1R or MC3R. Synovial samples can be split into high and low MC1R gene expression groups. MC3R was either present or absent. High expression of MC1R was associated with a high macrophage score and MC3R expression was associated with a low plasma cell score. MC1R and MC3R expression in RA synovium could be used as biomarkers of disease state or severity as well as a target for therapy