Unintended pregnancy and the associated factors among pregnant females: Sukh survey-Karachi, Pakistan

Objective: Unintended pregnancy has become a substantially growing reproductive health concern in South Asian region. The objective of this survey was to assess the magnitude of unintended pregnancy along with its correlates among currently pregnant women residing in Karachi.Methods: A community based, multistage, cross-sectional study was carried out among 612 currently pregnant women from squatter settlements of Karachi, inquiring for unintended pregnancy , outcome of interest. Multivariable logistic analysis was done using SPSS v.19 to determine associated factors.Results: Of 612 pregnant women interviewed, 168(27.4%) reported their pregnancies as unintended. The multivariable regression identified a high likelihood of unintended pregnancy among females aged ≥ 35 years (adjusted odds ratio =3.0, 95% Confidence Interval =1.2 to 4.9)], having: ideal family structure perceived as ≤ two children (Adj. OR=2.3, CI=1.3 - 4.5), no media exposure (Adj. OR=2.9, CI=1.7 to 5.0), no inter-spousal communication about planning a family (Adj. OR=1.5, CI=1.1 - 2.3), ≥5 children (Adj. OR=7.2, CI: 3.4 to 15.1), more sons than daughters (Adj. OR=4.0, CI=1.7 to 6.7), and positive attitude towards using family planning method (Adj. OR=1.8, CI=1.2 to 2.8). Unintended pregnancy decreased with increased age at marriage (Adj. OR= 0.8, CI=0.8, 0.7 - 0.9) and with use of contraceptive methods ever in life (Adj. OR=0.7, CI=0.5 - 0.9).Conclusions: We found important predictors which suggest policy measures for enhancing media exposure, promoting effective family planning usage, and incorporating behaviour change models in reproductive health clinics to modify fertility intentions of couples

The quest for small family size among Pakistani women--is voluntary termination of pregnancy a matter of choice or necessity?

Objective: To present the socio-biologic predictors of induced abortion among married women residing in low income squatter settlements of Karachi, Pakistan.Methods: A cross-sectional survey was conducted in three squatter settlements of Karachi from June to August 1997. Interviews were conducted on 1,214 married women assessing past pregnancy history, literacy and employment status of self and spouse and specifically probing for past history of seeking an induced abortion.Results: Fifty women reported an induced abortion during last three years prior to survey. Of these, forty percent (20/50) of abortion seekers were using some method of family planning before conceiving the index pregnancy. Post abortion family planning method use was adopted by 50% (25/50) of the abortion seekers. The most parsimonious multivariate logistic regression model included grand-multigravidity (OR 2.6 CI, 1.3 - 5.2), literate status of the woman (OR 1.9 CI, 1.0 - 3.4) and the 26-35 age group (OR 3.0 CI, 1.4 - 6.6).CONCLUSIONS: Unplanned/mistimed pregnancies generally result from high unmet need and ineffective use of contraceptives and culminate through induced abortions. We propose that improvement in the quality of family planning counseling should be targeted to effective use of a method, back-up support in case of method failure and the health consequences of unsafe abortions

Strategic Human Resource Management and Employee Creativity: The Role of Leadership Style and Knowledge Management Capacity

In this study we explored the relationship between strategic human resource management practices and creativity of the employees. Using multisource data gathering technique, we collected data from 382 employees and their respective 68 supervisors working at ministry of migration and displacement Baghdad-Iraq. We built on the theoretical framework based on employee–organizational relationship theories, specifically, organizational support theory, and leadership theory. We found that strategic human resource management practices affect the employees’ potential to produce creative ideas at organizations directly or indirectly through knowledge acquisition, knowledge sharing, and knowledge application. We also found that leadership styles affect the relationship between strategic human resource management practices and creativity of the employees. The results of this study provided new insight among strategic human resource management practice, knowledge management capacity, knowledge application, creativity of employees, transactional leadership, transformational leadership style, and the interaction of leadership styles with human resource management practices for creativity of employees. Research implications and future research directions are also discussed in this research. Keywords: Strategic human resource practices, knowledge management capacity, employee creativity, transactional leadership, transformational leadershi

Desire to limiting child birth and the associated determinants among married females: Sukh survey-Karachi, Pakistan

Objective: High rates of population growth negatively influence the social and economic development of a country. This study aimed to determine the women\u27s desire to limiting child birth in future (fertility intention) and its determinants among Pakistani women of reproductive age resident of Karachi.Methods: A community-based, multistage cross-sectional study was carried out among residents of the squatter settlements in Karachi. The were 4,485 married residents, and currently non-pregnant females of 18 to 49 years old. Framework adapted has been based on Pullum 1980 to operationalize the outcome of determining the desire to limiting childbearing and the factors related with controlling the family size. Multivariable logistic regression using SPSS 13.0 was used.Results: The survey comprised of a total sample of 4485 females who participated and acquiring a median (interquartile range) age of 30 (25 to 35) years. Whereas, the living children count was found to be [median: 3 children; (IQR: 2 to 4)]. From the total, 2109 (47%) wanted to limit the future child birth. Multivariable logistic analysis showed that women who did not want to limit child birth significantly (p-value 37 years (referent category), who belonged to poor wealth category (aOR=0.41), were ever contraceptive users (aOR=0.49), were currently not a contraceptive user (aOR=0.53), not educated (aOR=0.34), and having sons less than the daughters (aOR=0.74). Conversely, females with perceived family structure of ≤two children ideally (aOR=2.62), were autonomous (aOR=1.25) and who had equal daughters and sons (aOR=1.13) rather than more number of sons, had more probability to limiting child birth at a statistically significance (p-value) of less than 0.05.Conclusions: The survey highlights the strategic independent determinants and there is a need of devising behaviour modification modalities accordingly to expedite the use of contraceptive methods and to encourage fertility decline among women

Perceptions and experiences of men and women towards acceptability and use of contraceptives in underserved areas of Karachi, Pakistan: A midline qualitative assessment of sukh initiative, Karachi Pakistan

Background: Family planning (FP) is an essential component of Sustainable Development Goals (SDG) and contributes directly to SDG targets 3.7 and 5.6. In Pakistan, contraceptive use has remained stagnant over the past 5 years. This change has been very slow when compared to the FP2020 pledge. The Sukh initiative project was conceived and implemented to alleviate these challenges by providing access to quality contraceptive methods in some underserved areas of Karachi, Pakistan. A qualitative study was conducted to understand the perceptions and experiences of men and women towards acceptability and contraceptive use.Methods: A qualitative study was conducted at ten Sukh stations located in four towns of Karachi. Focus group discussions (FGDs) were conducted with married women of reproductive age (MWRA) and married men who received FP services through the Sukh initiative. Study participants were purposively sampled for focus group discussions (FGDs). Interview data was manually transcribed and analyzed using thematic analysis.Results: A total of 20 FDGs (Men = 10 FGDs; MWRA = 10 FGDs) were conducted. Three overarching themes were identified: (I) Appropriateness and means to promote contraceptive use; (II) Equity and Accessibility to contraceptives; and (III) Perspective on available FP services. Generally, both men and women were informed about FP methods but women were more cognizant of FP information. The door to door services by community health workers in Sukh initiative areas was largely appreciated both by women and men as it has made the accessibility and availability of the information and services easy. Women suggested that the Sukh initiative should bring some strategies that can help men broaden their perspective towards FP. The study informed that the men feel left out from the FP programs. Therefore, male participants expressed keen interest in initiatives for men in their communities that would cater to their FP needs.Conclusions: This qualitative study provided a unique opportunity to understand the perceptions of men and women towards the phenomena of contraceptive use. The study identified the need for trained and qualified female and male healthcare providers and well-established health facilities alongside door-to-door services

Using mobile phones to improve community health workers performance in low-and-middle-income countries

Background: In low-and-middle-income countries community health workers are the core component of the PHC system as they act as a liaison between the communities and the healthcare facilities. Evidence suggests that the services offered by these workers have helped in the decline of maternal and child morbidity and mortality rates and the burden of communicable and non-communicable diseases. However, the coverage and the overall progress towards achieving the SDG targets is very sluggish. The recent consensus concerning this current pace of progress, is that it relates to financial and human resources constraints. CHWs are overburdened as they are expected to accomplish more although they may not obtain the required support to perform their duties. The health systems of LMICs, have given very little attention to the work environment of CHWs; which has negatively affected CHWs productivity, and quality of services. This debate is intended to explore the potential of mobile phone technology in LMICs for improving CHWs performance and effectiveness.Discussion: To improve CHWs productivity, some studies involved the use of mobile phones for data collection and reporting, while other studies used mobile technology for patient to provider communication, patient education, CHWs supervision, and monitoring and evaluation. A wide range of benefits exists for using mobile phones including reduction in CHWs workload, improvement in data collection, reporting and monitoring, provision of quality healthcare services, supportive supervision, better organization of CHWs tasks and improvement in community health outcomes. However, a number of studies suggests that CHWs encounter unique challenges when adopting and using mobile health solutions for health service delivery such as, lack of CHWs training on new mHealth solutions, weak technical support, issues of internet connectivity and other administrative challenges. Future research efforts should be directed to explore health system readiness for adopting sustainable mHealth solutions to improve CHWs workflows in LMICs.Conclusion: Future research efforts and policy dialogue should be directed to explore health system readiness for adopting sustainable mHealth solutions to improve CHWs workflows in LMICs

Equipping community health workers with digital tools for pandemic response in LMICs

Background: Community health workers (CHWs) are well-positioned to play a pivotal role in fighting the pandemic at the community level. The Covid-19 outbreak has led to a lot of stress and anxiety among CHWs as they are expected to perform pandemic related tasks along with the delivery of essential healthcare services. In addition, movement restrictions, lockdowns, social distancing, and lack of protective gear have significantly affected CHWs\u27 routine workflow and performance. To optimize CHWs\u27 functioning, there is a renewed interest in supporting CHWs with digital technology to ensure an appropriate pandemic response.Discussion: The current situation has necessitated the use of digital tools for the delivery of Covid-19 related tasks and other essential healthcare services at the community level. Evidence suggests that there has been a significant digital transformation to support CHWs in these critical times such as remote data collection and health assessments, the use of short message service and voice message for health education, use of digital megaphones for encouraging behavior change, and digital contract tracing. A few LMICs such as Uganda and Ethiopia have been successful in operationalizing digital tools to optimize CHWs\u27 functioning for Covid-19 tasks and other essential health services.Conclusion: Yet, in most LMICs, there are some challenges concerning the feasibility and acceptability of using digital tools for CHWs during the Covid-19 pandemic. In most cases, CHWs find it difficult to adopt and use digital health solutions due to lack of training on new digital tools, weak technical support, issues of internet connectivity, and other administrative related challenges. To address these challenges, engaging governments would be essential for training CHWs on user-friendly digital health solutions to improve routine workflow of CHWs during the Covid-19 pandemic

The hidden figure: sexual intimate partner violence among Pakistani women

Background: The objectives of the present study were to determine the magnitude and factors associated with sexual intimate partner violence (SIPV) in women presenting to tertiary-care hospitals of Karachi, Pakistan. Methods: Five hundred women who presented to four tertiary-care hospitals to deliver were interviewed from September to December 2005. SIPV was assessed by using questions on sexual abuse in WHO Domestic Violence Module designed to determine intimate partner violence. Multiple logistic regression analysis was applied to determine factors associated with SIPV. Results: Twenty-one percent of women reported experiencing sexual violence in their married life. Gravida with five or more pregnancies [adjusted odds ratio (AOR) = 2.78, 95% confidence interval (CI) 1.12-6.96], index pregnancy as unwanted (AOR = 2.64, CI 1.16-6.02) and conflict with in-laws (AOR 1.9 CI 1.14-3.16) were independently associated with sexual abuse. Women who had social support were less likely to be abused by their intimate partners (AOR 0.76, CI 0.58-0.98). Conclusion: One in five women reported spousal sexual abuse in their married life. Women having more than five children, unwanted pregnancies or reporting differences with in-laws are more likely to be subjected to such abuse. Social support protects women from sexual abuse by intimate partner

Assessing mobile phone access, usage, and willingness among women to receive voice message-based mobile health intervention to improve antenatal care attendance in District Thatta, Sindh, Pakistan

Background: Pakistan has one of the highest maternal mortality ratios worldwide at 276/100,000 live births and only 51% percent of women receive four or more ANC visits. This means that there are missed opportunities for almost half of the women who were not able to seek the recommended antenatal visits. In Thatta district, the maternal mortality ratio is estimated at 313/100,000 live births. Various studies reported that mHealth interventions have proven to be effective to improve antenatal care and postnatal care services. However, the feasibility and effectiveness of mobile health interventions to increase uptake of preventive maternal healthcare services among pregnant women in different settings may be different due to differing patient demographics, cultural diversity, environmental and behavioral factors, availability and accessibility to mobile phones, and budgetary constraints. Prior to implementing a similar intervention in Thatta District, it is crucially important to assess the mobile phone access, usage and willingness among women to receive voice-message based mHealth intervention to improve antenatal care attendance.Methods: A cross-sectional quantitative study will be used to assess mobile phone access, usage and willingness among women to receive voice-message based mHealth intervention to improve antenatal care attendance in district Thatta. The study will be conducted in Thatta district of Sindh province. Married women of reproductive age (MWRA), who are residing in selected villages of Mirpur Sakro and willing to participate will be included in the study. Multistage sampling technique will be used to recruit the 415 study participants. A structured questionnaire has been designed on Epicollect to collect data from 415 women. Data will be analyzed using IBM SPSS Statistics version 23, with a level of significance as \u3c 0.05.Discussion: This research project will provide invaluable information on the current access, usage of mobile phones among women of district Thatta and their willingness to receive voice messages to improve the antenatal care services. The study will also highlight demographic, sociocultural and economic factors associated with women willingness and readiness to receive voice messages regarding antenatal care

Improving pregnancy outcomes in low- and middle-income countries

This paper reviews the very large discrepancies in pregnancy outcomes between high, low and middle-income countries and then presents the medical causes of maternal mortality, stillbirth and neonatal mortality in low-and middle-income countries. Next, we explore the medical interventions that were associated with the very rapid and very large declines in maternal, fetal and neonatal mortality rates in the last eight decades in high-income countries. The medical interventions likely to achieve similar declines in pregnancy-related mortality in low-income countries are considered. Finally, the quality of providers and the data to be collected necessary to achieve these reductions are discussed. It is emphasized that single interventions are unlikely to achieve important reductions in pregnancy-related mortality. Instead, improving the overall quality of pregnancy-related care across the health-care system will be necessary. The conditions that cause maternal mortality also cause stillbirths and neonatal deaths. Focusing on all three mortalities together is likely to have a larger impact than focusing on one of the mortalities alone