The influence of social and cultural practices on maternal mortality: a qualitative study from South Punjab, Pakistan

Background: A disproportionately high rate of maternal deaths is reported in developing and underdeveloped regions of the world. Much of this is associated with social and cultural factors, which form barriers to women utilizing appropriate maternal healthcare. A huge body of research is available on maternal mortality in developing countries. Nevertheless, there is a lack of literature on the socio-cultural factors leading to maternal mortality within the context of the Three Delays Model. The current study aims to explore socio-cultural factors leading to a delay in seeking care in maternal healthcare in South Punjab, Pakistan. Methods: We used a qualitative method and performed three types of data collection with different target groups: (1) 60 key informant interviews with gynaecologists, (2) four focus group discussions with Lady Health Workers (LHWs), and (3) ten case studies among family members of deceased mothers. The study was conducted in Dera Ghazi Khan, situated in South Punjab, Pakistan. The data was analysed with the help of thematic analysis. Results: The study identified that delay in seeking care-and the potentially resulting maternal mortality-is more likely to occur in Pakistan due to certain social and cultural factors. Poor socioeconomic status, limited knowledge about maternal care, and financial constraints among rural people were the main barriers to seeking care. The low status of women and male domination keeps women less empowered. The preference for traditional birth attendants results in maternal deaths. In addition, early marriages and lack of family planning, which are deeply entrenched in cultural values, religion and traditions-e.g., the influence of traditional or spiritual healers-prevented young girls from obtaining maternal healthcare. Conclusion The prevalence of high maternal mortality is deeply alarming in Pakistan. The uphill struggle to reduce deaths among pregnant women is firmly rooted in addressing certain socio-cultural practices, which create constraints for women seeking maternal care. The focus on poverty reduction and enhancing decision-making power is essential for supporting women's right to medical care.Plain language summary Round the world, many women are dying because of complications during pregnancy or in childbirth. These deaths are more frequent in developing and underdeveloped countries. Some reasons for this are related to social and cultural factors, which form barriers to women using appropriate maternal healthcare. Therefore, this study aims to explore socio-cultural factors leading to a delay in seeking maternal healthcare in South Punjab, Pakistan. We interviewed a variety of people to get an overview of this topic: (1) 60 interviews were conducted with gynaecologists, (2) we performed four focus group discussions with eight to ten Lady Health Workers providing maternal healthcare, and (3) we talked with family members of mothers who had died. The study shows that delays in seeking care are related to poor socioeconomic status, limited knowledge about maternal care, and low incomes of rural people. The low status of women and male domination keeps women less empowered. In addition, early marriages and lack of family planning due to cultural values, religion and traditions stopped young girls from getting maternal healthcare. The number of new mothers who die is very worrying in Pakistan. One of the important tasks for reducing deaths among pregnant women is to address certain socio-cultural practices. It is very important to reduce poverty and improve decision-making power to make sure women can use their right to medical care

Consanguineous marriages and their association with women’s reproductive health and fertility behavior in Pakistan: secondary data analysis from Demographic and Health Surveys, 1990–2018

Background: Pakistan has been showing consistently the highest prevalence of consanguinity. The popularity of consanguineous marriages is not declining in the country, because of social, cultural, and religious beliefs as well as economic advantages. However, couples also face various health-related implications, such as poor pregnancy outcomes or multiple reproductive and fertility consequences, having adverse effects on mothers and their children. This research investigated the trend of consanguineous marriages and their association with women's reproductive health and fertility behavior in Pakistan from 1990 to 2018. Methods: This study is based on secondary data analysis, using all four waves of the Pakistan Demographic Health Surveys carried out from 1990 to 2018. The analysis is limited to women aged 15-49 years, who had given birth in the previous five years preceding each survey. Sampling weights were calculated and subsequently weighted analysis was conducted. Descriptive statistics, bivariable and multivariable logistic regression analysis were performed to determine the association of consanguinity with multiple characteristics related to socio-demographics, co-variates, and women's reproductive health and fertility behaviors. Results: The findings revealed a high but overall stable trend of consanguinity prevalence of about 63% during the last three decades. Consanguineous marriages were more prevalent amongst young and uneducated women, living in rural areas, with poorer wealth status and having less exposure to mass media to access information. A strong association of consanguinity was observed with women's reproductive health and fertility behavior, particularly for women who gave first birth at a younger age, had multi-gravida pregnancies, multi-parity, pregnancy termination, ANC visits, and higher fertility. Conclusion: Consanguineous marriages are predominant in the patriarchal society of Pakistan. Findings revealed that consanguinity contributes significantly to women's reproductive health and fertility behaviors. Appropriate counseling, educational, and health promotional programs related to consanguinity should be designed and launched at the community level to raise awareness about risks towards women's reproductive health and fertility

Predictors of parental mediation in teenagers’ internet use: a cross-sectional study of female caregivers in Lahore, Pakistan

Background: The internet has become the most widely used medium among teenagers, who spend much of their time online, which raises parental concerns. Notwithstanding teens' increased internet use and exposure to online risks, little is yet known about parental internet mediation in local settings. The present research aimed to assess the various dimensions of parental mediation to regulate teens' use of the internet and their predictors. Methods: A cross-sectional survey was conducted in the district of Lahore, Pakistan, among mothers/female caregivers of teens (aged 13-19 years). Only women were interviewed because they are more frequently engaged as primary caregivers than fathers or male caregivers. Furthermore, only qualified and working mothers from the top two professions among women, i.e. academia and medicine, were interviewed. A stratified random sampling technique was adopted, and 347 mothers were interviewed using face-to-face interviews at 11 universities and 11 hospitals/medical colleges. Data were entered and analysed using descriptive, bivariate and multivariate logistic regression analyses. Results: The findings highlighted that more than 65% of respondents applied highly active mediation of internet safety, around 60% used highly active co-use mediation and more than 56% applied restrictive mediation. In addition, 36% of respondents monitored and 15.3% technically mediated to regulate their teens' use of the internet. The results of the multivariate logistic regression revealed that the majority of respondents were more inclined to adopt active internet safety mediation if they had teens aged 16-19 years, with medium internet addiction, possessed good digital skills, felt confident about their teens' coping appraisal to perform online protection, and considered their teens to have high self-esteem and resilience. Conclusions: This research found that parental internet mediation is a multifaceted concept used to regulate teens' online activity and enhance a resilient approach to reduce the risks associated with use of the internet. The researchers recommend developing parental guidelines, e-safety resource material, local support networks and community programmes to educate parents, teachers and teens in order to raise awareness and promote resilient pathways amongst teens

Determinants of overall knowledge and health behaviours in relation to hepatitis B and C among ever-married women in Pakistan: evidence based on Demographic and Health Survey 2017–18

Background: In 2019, around 5 million and 10 million people were affected by hepatitis B virus (HBV) and hepatitis C virus (HCV) respectively in Pakistan. On World Hepatitis Day 2019, Pakistan's Government announced the Prime Minister's Plan to eliminate HBV and HCV from the country by 2030. In order to achieve this goal, adequate knowledge about HBV and HCV regarding mode of transmission, symptoms of the disease, and awareness about available treatments and vaccines is imperative. The present study aims to investigate the determinants related to overall knowledge about and behaviour in relation to HBV and HCV amongst married women in Pakistan. Methods: Secondary data analysis was carried out using the Pakistan Demographic and Health Survey (PDHS) 2017-18. A series of questions regarding women's knowledge about how to avoid HBV and HCV and their health behaviour in relation to HBV and HCV were posed to 12,364 ever-married women of reproductive age (15-49 years). Bivariate and multivariable logistic and linear regression was applied to examine the effects of sociodemographic characteristics and covariates on women's overall knowledge and health behaviour regarding HBV and HCV. Results: The findings highlight that the majority of women (88.3%) have heard of HBV and HCV. Nonetheless, only 34.8% had comprehensive knowledge about how to avoid HBV and HCV. Few women (11.3%) had been tested for HBV or HCV during the year preceding the survey. Furthermore, the results indicate that women living in urban areas, being older, and having more than 10 years of schooling, reported better knowledge and health behaviours regarding HBV and HCV. Conclusion: This study provides evidence that women's sociodemographic characteristics create differences in their overall knowledge about and attitudes towards HBV and HCV. This research emphasized that there is a need to create awareness about the causes and prevention of HBV and HCV in order to achieve the goal of eliminating these diseases in Pakistan by 2030

Protocol for a cross-sectional study on factors affecting health-related quality of life among Afghan refugees in Pakistan [version 1; peer review: awaiting peer review]

Background: Pakistan served as a host for more than 1.4 million Afghan refugees for more than 40 years. Access to health care is the most important issue faced by refugees, because they might be at a higher risk for certain diseases. This risk can be attributed to a lack of awareness of health care facilities, health beliefs, inadequate hygiene, cultural differences, and malnutrition. Health of individuals is closely associated with their quality of life. Quality of life over the whole lifespan is pivotal to overall life satisfaction. It includes physical wellbeing, mental health, education, occupation, income, personal safety, as well as (religious) freedom. Until now, the health status of Afghan refugees has never been comprehensively investigated in Pakistan. Therefore, an assessment in this regard is needed to explore their health-related quality of life, for securing their human right to health. Methods: A cross-sectional study has been designed to describe and explain the health-related quality of life of Afghan refugees in Pakistan. Multistage cluster sampling was applied for selection of study participants. The number of respondents from two regions in Pakistan was drawn through a proportionate sampling technique. A quantitative research method using pre-validated questionnaires was used for data collection. The questionnaire included items to assess well-being, mental health, health literacy, and factors affecting health and health care. Descriptive analysis was used, whereas inferential statistical tests (binary logistic regression model) was also performed. The study received ethically permission by the Advanced Studies and Research Board of the University of the Punjab, Lahore, Pakistan. Discussion: The assessment of Afghan refugee’s quality of life in Pakistan should lead to recommendations disseminated to public and health care officials. This evidence is needed for policymaking related to adequate measures for improving health conditions of Afghan refugees in Pakistan

Climate Change-Induced Water Scarcity: A Threat to Human Health*

Climate change might affect the development of water scarcity least in some areas of the world. Water scarcity means not only the availability but also the quality of water and sanitation. Climate change might reduce the capacity of the state to provide health care to the population. Thereby, climate change has direct and indirect impacts on human security and hence health effects may result from (climate change induced) water scarcity. Mainly developing countries will be affected by water scarcity due to their population increase. Water scarcity may lead to a reduction of institutional resources and thereby to a lack in the health care system. Therefore, climate change causes different factors which may promote local and/or transnational conflicts. This impacts the human security and health. Even though climate change is not the only reason for water scarcit

Political Insight of Youth Development: An Investigation Form Public Sector Colleges in Lahore

The current study intends to find out the role of political institution in the youth development. The study is based on mix method approach as it uses both qualitative and quantitative data. Quantitative study is based on the sample of 1335 college student‘s i.e. both male and female students. The qualitative phase of the study is based on focus group discussion with college students. The study concluded that political Action has greater importance for youth development along with civic engagement and political socialization for female political socialization is more important for their development. In this rank second comes Civic engagement and third comes political action. The qualitative findings complement the quantitative findings and show the similar trend of youth development. Political socialization, leadership qualities and political support are important factors in youth development

Challenges perceived by nursing professionals in physician‐centred organizations: An exploratory qualitative study

Aim: To explore and analyse contextual challenges in nursing that have affected nurses' perceptions and role performance. Background: Health system hierarchy and patient/family-centred care has led to a high demand for skilled nurses. However, patriarchal organizations create challenges for nursing clinicians in Pakistan and elsewhere. Methods: A qualitative exploratory research (phenomenology) design was used. Twenty-five participants identified through purposive sampling contributed to the study. The data analysis was conducted using NVivo 12 Plus. We generated six major themes. Reporting was accomplished according to the consolidated criteria for reporting qualitative research checklist. Results: Gendered division of labour places nurses in a submissive position in clinical practice. Decreases in nurse-to-patient ratio and increase in patient-focused care adversely affect evidence-based practice. The gap between theory and practice in delivering quality care is increasing due to existing communication barriers among health-related professionals and an inadequate work environment. Comparatively inactive nursing leadership and directorate roles are not improving the social image of nursing, and are promoting role conflict and poor nursing self-concepts among nurses. In fact, cultural shock experienced by young nurses has produced inherent disorientation in their professionalism and fostered displays of horizontal violence towards them by senior nurses. Conclusion: These challenges are influencing nurses' decisions to remain in or to join nursing as a profession that is confronted by severe recruitment and retention shortages due to the social and cultural stigmatization of this female dominated profession. Implications for nursing, health and social policy: This study promotes the concept of evidence-based practice to deliver quality health services in public hospitals and to improve the social status of nursing in Pakistan. It provides influential evidence to policymakers who should urgently address nurses' workplace health and safety issues as a global right

Exploring parental perceptions and knowledge regarding breastfeeding practices in Rajanpur, Punjab Province, Pakistan

Zakar R, Zakar MZ, Zaheer L, Fischer F. Exploring parental perceptions and knowledge regarding breastfeeding practices in Rajanpur, Punjab Province, Pakistan. International Breastfeeding Journal. 2018;13(1): 24.Background Exclusive breastfeeding is significantly associated with strong infant immunity and optimal development. The importance of breastfeeding is underestimated. Parental lack of knowledge and unhealthy practices regarding breastfeeding deprive infants of their basic right to mother’s milk. In developing countries, including Pakistan, with high child mortality and malnutrition, healthy breastfeeding practices can bring positive changes in child health status. From this perspective, the present study aims to understand parents’ knowledge, attitudes and practical encounters with breastfeeding practices and the factors that prevent them from adopting such practices. Methods A qualitative study was carried out in both rural and urban settings in Rajanpur District of Punjab Province, Pakistan. We conducted 12 focus-group discussions (FGDs) that involved 38 mothers and 40 fathers with children aged under two years who were being breastfed. A thematic content analysis of data collected through FGDs was performed manually. The themes were both inductive and deductive in nature. Results The study found that a majority of participants believed that the first thing given to an infant after birth should not be breast milk but honey, rose flower, or goat’s milk from the hands of an elder in the family or a religious person. No cleanliness measures were practised in this regard. The participants had misconceptions about the benefits of colostrum, which frequently prevented it being given to newborns. Participants reported many factors, such as: insufficient milk syndrome (slow growth of infants due to insufficient daily breast milk intake), a mother’s high workload, lack of social support, the influence of culturally designated advisors, and the promotion and marketing strategies of infant formula companies, that undermined exclusive breastfeeding efforts and encouraged mothers to switch to infant formula. Conclusions Culturally acceptable and integrated public health interventions are needed to improve the breastfeeding-related health literacy and practices of parents, grandparents and communities. This will ultimately reduce the high infant mortality and malnutrition rates in Pakistan

COVID-19 Vaccination Hesitancy or Acceptance and Its Associated Factors: Findings from Post-Vaccination Cross-Sectional Survey from Punjab Pakistan.

COVID-19 has posed massive challenges related to health, economy, and the social fabric of the entire human population. To curb the spread of the virus, the Government of Pakistan initiated a vaccination campaign against COVID-19. The objective of this research was to assess the factors associated with COVID-19 vaccine acceptance or hesitancy. The data were collected telephonically using a cross-sectional survey design through a close-ended structured questionnaire from a sample of 1325 vaccinated and non-vaccinated individuals with a response rate of 38%. SPSS v. 26 was used to analyze the data. The study revealed that 73% of the respondents were male, half in the 40-49 age group, 78% living in urban areas, and 45% had a monthly income between 20,001-50,000 Pakistani rupees. People felt reluctant to get vaccinated because of myths and misinformation related to it. The socio-demographic factors including male, age 60-69, middle or higher level of education, marital status, currently employed, from middle socio-economic status, living in urban areas, high access to mass media, history of influenza vaccination, physical activity, and perceived good health status were significantly associated with COVID-19 vaccination uptake. Concerted efforts are needed to achieve vaccine targets for the broader population through understanding and identifying barriers to vaccination