Rational prescription & use: a snapshot of the evidence from Pakistan and emerging concerns

Introduction: Irrational drug use remains globally common and there is a lack of country level synthesis for strategizing policy actions in Pakistan. Methodology: We conducted a scoping review of available peer reviewed and grey literature on prescribing patterns and drug dispensing in Pakistan to identify emerging concerns. Results: There is excessive drug use in Pakistan compared to the average for LMICs with inappropriate prescribing, high use of injections and antibiotics, choice of more expensive drugs, inadequate dispensing and weak community pharmacy. Policy concerns include excessive drug registration, poor enforcement of essential drug lists and standard management protocols, open access of industry to health providers, and lack of private sector regulation. Conclusion and Policy Recommendations: Review of evidence demonstrates deviance from rational use in the areas of medicine prescription, dispensing and self-medication, and low impact of existing policy measures. Quality of research needs to be improved focusing on standardized national surveys, consumer related formative research, and interventional research. Rational drug use is a neglected area in Pakistan requiring policy measures at multiple levels of health system and continued and simultaneous investment in standardized researc

Parallel NGO networks for HIV control: risks and opportunities for NGO contracting.

Policy measures for preventive and promotive services are increasingly reliant on contracting of NGOs. Contracting is a neo-liberal response relying on open market competition for service delivery tenders. In contracting of health services a common assumption is a monolithic NGO market. A case study of HIV control in Pakistan shows that in reality the NGO market comprises of parallel NGO networks having widely different service packages, approaches and agendas. These parallel networks had evolved over time due to vertical policy agendas. Contracting of NGOs for provision of HIV services was faced with uneven capacities and turf rivalries across both NGO networks. At the same time contracting helped NGO providers belonging to different clusters to move towards standardized service delivery for HIV prevention. Market based measures such as contracting need to be accompanied with wider policy measures that facilitate in bringing NGOs groups to a shared understanding of health issues and responses

Determinants of contraceptives use amongst youth: an exploratory study with family planning service providers in Karachi Pakistan

Introduction: In Pakistan, Contraceptive Prevalence Rate (CPR) among married female youth is 17.4% and even lower in rural and slum areas leading to rapid population growth on one hand and poor health consequences on the other. The study was conducted to explore family planning service providers\u27 perceptions regarding use of different contraceptive methods and to identify factors that are influencing their use amongst currently married youth aged 18-24 years in slum areas of Karachi.METHOD: Qualitative exploratory study design was adopted and a total of ten in-depth interviews were conducted with family planning service providers of the area. For content analysis coding of transcribed interviews was done and then categories were made and furthermore themes were derived.Results: Our findings revealed that family planning service providers perceived that there is low use of contraceptive methods amongst youth of study area and low usage could be due to side effects; myths and misconceptions; lack of proper knowledge about different contraceptives; unmet needs of contraceptives; socio-cultural and religious factors about different contraceptive methods and family planning service providers own biases against or for use of contraceptive methods amongst youth in the study area. However better education of youth and family planning service providers\u27 improved knowledge about counseling and use of contraceptive methods was perceived to be associated with improved use of family planning methods amongst youth of the study area.CONCLUSION: Exaggerated side effects and socio-cultural factors could be important influences leading to low use of family planning methods amongst youth of Karachi. Some policy initiatives are the training of lady health Workers, lady health visitors, physicians and staff of the pharmacies for counseling youth in the correct use of family planning methods

Myths and fallacies about male contraceptive methods: a qualitative study amongst married youth in slums of Karachi, Pakistan

Pakistan presently has one of the largest cohorts of young people in its history, with around 36 million people between the ages of 15 and 24 years. One of the main reasons for high population growth in Pakistan is almost stagnant contraceptive prevalence rate of 30% nationallyand 17.4% amongst youth. The study was conducted to explore the perceptions regarding myths and fallacies related to male contraceptive methods among married youth aged 18-24 year in Karachi, Pakistan. Qualitative exploratory study design was adopted and a total of eight Focus Group Discussions (FGDs) were conducted. Study was conducted in two Union Councils of Korangi Town in the squatter settlement of Karachi, Pakistan from July to September 2010. Thematic analysis was done manually. General, physical, sexual, psychological, socio-cultural and religious were the common categories which lead to myths and fallacies related to condoms use and vasectomy among the married youth. The foremost myth amongst male and female youth was that use of both condoms and vasectomy cause impotence in males. Additionally, condoms were thought to cause infections, backache and headache in males. Some youth of the area think that vasectomy is meant for prisoners only. In conclusion our findings suggest that the potential reasons behind low use of male contraceptive methods among youth of squatter settlement of Karachi were myths and fallacies about male contraceptive methods. There are some important policy implications like counseling of the couple through peers and well trained family planning service providers to address these myths and misconceptions from the minds of youth

Understanding the complexities of prevalence of trans fat and its control in food supply in Pakistan

Pakistan is among the nations with a high intake of trans‐fatty acids (TFAs), a major dietary risk factor of noncommunicable diseases (NCDs). Efforts are underway in the country to eliminate industrially produced TFAs from the food supply in keeping with the priority targets of the World Health Organization (WHO) for 2019‐2023. We reviewed the TFA content reported in industrially produced foods and discuss the regulatory landscape for TFAs, to facilitate the required policy changes in Pakistan and ultimately eliminate the TFA burden from industrial food products. The study components include review of published research and product labels as well as review of prevailing food regulations for TFA‐related information. A set of recommendations was also prepared to eliminate TFAs from Pakistan after national consultation workshops conducted in year 2019. Vanaspati ghee (partially hydrogenated vegetable oil), bakery shortening, hard margarines, and fat spreads are identified as the major sources of TFAs. Federal and provincial food authorities have recently established the limits for TFAs in few products; however, the TFA regulations are insufficient and not in line with global best practices. This study informs a comprehensive national strategy for TFA elimination based on knowledge of TFA prevalence associated regulatory control. We recommend to (1) promote actions toward replacement of traditional vanaspati ghee/bakery fats with healthier alternatives; (2) develop and implement best regulatory practices in line with WHO recommendations; and (3) amend food labeling laws so that clear information will be provided to inform consumers healthy food choices

Myths and misconceptions about contraceptive methods: an exploratory qualitative study amongst married youth of Karachi

Introduction Youth is emphasized as an important phase of life because it makes up the personality forming years of an individual. According to UNFPA, the age between 15-24 years is considered as youth. Pakistan presently has one of the largest cohorts of young people in its history, with around 36 million people between the ages of 15 and 24 years which has grown rapidly parallel to the total population of the country over the last few decades Currently, the rapid population growth of the country is a major concern as it is leading to increased pressure on social and economic resources. One of the main reasons for high population growth is almost stagnant contraceptive prevalence rate (CPR) of 30% which country is struggling for at least two decades. More worryingly, the CPR among youth is only 17.4 percent. The low CPR amongst youth could be due to myths and misconceptions about family planning methods, which may raise concerns about the side effects and effectiveness of different methods. There are many examples of myths and misconceptions about contraceptives such as injections being responsible for causing cessation of menstruation and cancer of ovaries. The actual fact is that cessation of menstruation is due to high level of the hormones in the blood caused by contraceptive injections and as soon as the levels come down, menstruation resumes. In addition, the injection rather pi otects the women from the cancers of ovaries and uterus. Another aspect of low use of contraceptives is its relation with unwanted pregnancies ending up in unsafe abortions, morbidities and mortality. Though there is not much data about female youth, the overall maternal mortality ratio in Pakistan is 276 per 100000 live births with around 700,000 women per year facing one or more morbidity during pregnancy, childbirth and postpartum period. Many of these women are in the age group of 15-24 years as the mean age of marriage for girls in Pakistan is 17.9 years. Family planning could be one of the interventions helping in saving women\u27s lives through proper spacing between the children. Many of these women are youth. Study Objectives To explore the perceptions regarding myths and misconceptions of contraceptive methods and to understand the effect of these myths and misconceptions on use of contraceptive methods among married youth aged 18-24 years in Karachi. Methodology The study was conducted in the city of Karachi, Pakistan from July to September 2010 in two Union Councils (UC2 and UC3) of Korangi Town. Qualitative exploratory study design was adopted and focus group discussions (FGDs) with the youth and in-depth interviews with FP service providers were conducted to know about perceptions and experiences about low use of family planning methods amongst married youth. Purposive sampling was done for the selection of males and females as participants for FGDs who were 18-24 years old having at least one live child. For the in-depth interviews, family planning service providers were selected in consultation with local Lady Health Workers and those suggested by participants of FGDs. Analysis For analysis purpose, FGDs and in depth interviews were transcribed and translated into English. Content analysis was conducted manually. Coding of data into nodes, sub nodes was done and themes were derived around individual contraceptive methods. Triangulation was done with the responses from the male and female youth and FP service providers. Results The study demonstrated that use of family planning methods amongst married youth was quite low. In addition to the misperceptions about family planning in general, main reasons identified behind it was myths and misconceptions about FP methods among youth. A main misperception among male youth was that family planning is meant for females only. In addition, both males and females misperceived that youth should not use any contraceptive until they have two or three children. The foremost myth was that most of the contraceptive methods cause sterility in both males and females. There were misconceptions against the individual methods of contraception. Some of the myths about condoms were that it causes infections, backache and headache in males. IUCD was perceived to result in putrefaction, perforation and cancer of the uterus and it could also move up in the abdomen and heart. Most of the men and women expressed that injections and OCPs cause excessive weight gain and swelling of body and in breastfeeding women, milk secretion decreases. Similar findings were also validated by vu family planning service providers, that youth of the area are having these perceptions. The myths were more prevalent among FGDs participants with low educational status. Conclusion Our finding suggests that though married youth resident of squatter settlement of Karachi appear to be inclined towards family planning, the actual use of contraceptives is low. The potential reasons behind this are the myths and misconceptions about different contraceptive methods. Major factors contributing to these myths and misconception could be poor education, certain cultural and religious beliefs and apprehensions about the use and side effects of family planning methods. There are some important policy implications like counseling of the couple through peers and well trained family planning service providers to remove these myths and misconceptions from the minds of youth. Moreover friend, families and mothers in law could play a substantial role in removing the misconception