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Background: In Pakistan, only 59-73% of children 12-23 months of age are fully immunized. This randomized, controlled trial was conducted to assess the impact of a low-literacy immunization promotion educational intervention for mothers living in low-income communities of Karachi on infant immunization completion rates., Methods: Three hundred and sixty-six mother-infant pairs, with infants aged ≤ 6 weeks, were enrolled and randomized into either the intervention or control arm between August - November 2008. The intervention, administered by trained community health workers, consisted of three targeted pictorial messages regarding vaccines. The control group received general health promotion messages based on Pakistan's Lady Health Worker program curriculum. Assessment of DPT/Hepatitis B vaccine completion (3 doses) was conducted 4-months after enrollment. A Poisson regression model was used to estimate effect of the intervention. The multivariable Poisson regression model included maternal education, paternal occupation, ownership of home, cooking fuel used at home, place of residence, the child's immunization status at enrollment, and mother's perception about the impact of immunization on child's health., Results: Baseline characteristics among the two groups were similar. At 4 month assessment, among 179 mother-infant pairs in the intervention group, 129 (72.1%) had received all 3 doses of DPT/Hepatitis B vaccine, whereas in the control group 92/178 (51.7%) had received all 3 doses. Multivariable analysis revealed a significant improvement of 39% (adjusted RR = 1.39; 95% CI: 1.06-1.81) in DPT-3/Hepatitis B completion rates in the intervention group., Conclusion: A simple educational intervention designed for low-literate populations, improved DPT-3/Hepatitis B vaccine completion rates by 39%. These findings have important implications for improving routine immunization rates in Pakistan.

Objective: To assess the knowledge, attitudes and practices regarding sexuality, high risk sexual behaviors and methods of contraception, among college/university students of Karachi, Pakistan., Study Design: Cross-sectional observational study., Place and Duration of Study: Higher Education Commission-recognized government and private colleges/universities in Karachi from 2005-2006., Methodology: Two colleges/universities were randomly selected from each category i.e. government medical, government non-medical and private medical and non-medical colleges/universities. Three stage cluster sampling was employed to draw a representative sample of students. A self administered questionnaire was used to elicit information on knowledge, attitudes and practices regarding high risk sexual behaviors, methods of contraception and sources to obtain information about sexual issues., Results: A total of 957 students were interviewed. They comprised 542 (56.6%) males and 415 (43.4%) females with mean age of 21 ± 1.8 years. Bivariate analysis showed that students enrolled in medical colleges/universities were less likely to watch adult films (O.R. 0.7, CI; 0.5-0.9) to acquire sex related knowledge and go out on dates (O.R. 0.6, CI; 0.4- 0.8). Similarly, medical students were less likely to consider contraception as being against Islamic teachings (O.R. 0.7, CI; 0.5-0.9)., Conclusion: The curricula of non-medical studies at undergraduate level should include education regarding sexual health and contraception.

Objective: To determine Knowledge, Attitudes and Practices (KAP) regarding eight key integrated management of childhood illness (IMCI) suggested practices and the association of these key practices with stunting as outcome., Methods: Sampling proportionate to sub-population sizes was employed to ensure representation from all the Union Councils of taluka Gambat-Sindh., Results: Low female education and mobility show the status of child's first care provider in a typical rural community. Few women knew about giving more food to a child suffering from diarrhoea. Moreover, very few exclusively breastfed their children for first 4-6 months, got their children completely immunized, washed hands before cooking and serving meals and boiled water before utilizing it for drinking purpose. Multiple logistic regression analysis showed that children of mothers, who knew the importance of vaccination, obtained antenatal checkups, exclusively breastfed the last child, washed hands before serving and cooking meals were less likely to be stunted. Similarly, children from households where mothers received husband support in child rearing, and where no child less than five years suffered from diarrhoea in the past one year, were less likely to be stunted., Conclusions: Without improving education level of females in rural communities, it would be difficult to educate and empower the first care provider of child. However, as an interim strategy, educational messages regarding a limited number of key practices should be disseminated).