Search

Background: Endemic polio in Pakistan is threatening the Global Polio Eradication Initiative (PEI). In recent years, vaccine refusals have surged, spiking polio cases. The current study was conducted to understand the ethnic, religious and cultural roots of vaccine refusals in Charsadda District and explore the remedial options. Methods We conducted 43 in-depth interviews with parents who had refused polio vaccines for their children and the PEI staff. Interviews were audio-recorded, written in verbatim and analysed with Atlis.ti. We conducted a thematic analysis of our data. Results The fear of American and Jewish conspiracies was the primary cause of vaccine refusals. Militant groups like Tehrek-i-Taliban Pakistan capitalised on this fear, through social media. The Pashtun ethnic group considers itself at the centre of conspiracies. They are suspicious of mass investment and mobilisation behind the polio campaign. Our respondents feared that polio vaccines were making children vulgar. They also feared a reduction in the male to female ratio in childbirth. In Pashtun communities, the iconic conventional community gatherings ["Hujras"] are being replaced by provocative digital Hujra [social media], which the PEI and the Government of Pakistan (GOP) are failing to influence or regulate. The PEI uses the misleading term 'religious refusal'. Some factions in the clergy are maligning people from vaccinations, but not through religious dictum. The anti-state elements have stirred sentiments to weaken the state initiative. Fear of adverse effects, attitudinal barriers of health care providers, unmet basic needs and alleged haram composition of the vaccine were among the reasons for vaccine refusals. The PEI needs to revise its misleading nomenclature and ensue open discussion to dispel the myths of infertility, vulgarity and gender ratio related to the vaccines. Simultaneously, the GOP should stop disinformation on social media and rebrand polio vaccination with popular initiatives like the government-sponsored health insurance schemes. Conclusions The ethnic, cultural and religious dispositions of community members shape polio vaccine refusals in Charsadda District, in different ways. In synch with existing conspiracy theories and medical misconceptions, these three factors make refusals harder to counter. Awareness campaigns with content addressing these three dimensions can improve the situation. [ABSTRACT FROM AUTHOR]

Background: Heart failure is a leading cardiac morbidity prevalent across the globe. Its incidence is rising in direct proportion to increasing longevity all over the world. Demographic variables are important predictors of quality of life, morbidity, rehospitalization, and mortality due to systolic heart failure. The objective of our study was to assess the association of demographic variables with quality of life of systolic heart failure in patients presenting at Cardiology Out Patient Department, Hayatabad Medical Complex, Peshawar. Our study aims to inform policy making as it highlights some important demographics factors associated with quality of life. Methods: A cross sectional method was employed in the study to examine systolic heart failure and its prevalence across various demographic variables such as age, gender, marital status, activity, number of children, education, employment status, and BMI at cardiology OPD of a medical teaching institution in Peshawar. Consecutive sampling was used and data were collected through a structured questionnaire from 368 Systolic Heart Failure patients. Data were analyzed using SPSS version 22. Results: We had 368 participants, a majority of whom (n=290; 78.8%), were in NYHA class III. The rest (n=78; 21.2%) were in class IV. Minnesota Living with Heart Failure Questionnaire (MLHFQ) was used to categorize quality of life into 'Good', 'Moderate' and 'Poor'. Most participants were in the 'poor' category with MLHFQ scores >45 (n=193; 52.4%). Those who had scores between 25 -45 were categorized as 'moderate' (n=116; 31.5%), and participants who scored < 24 were categorized as having a 'good' quality of life (n=59; 16%). Reliability of tools was checked by Cronbach alpha which was 0.86 Conclusion: It was concluded that demographic variables have a significant effect on the overall morbidity of heart failure patients and heart failure related quality of life. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess the knowledge, attitude and practice regarding hepatitis B virus (HBV) infection among nurses working in a public hospital of Peshawar, Pakistan. METHODS: This descriptive, cross sectional was conducted on 100 (96 females, 4 males) staff nurses of Haytabad Medical Complex, Peshawar, Pakistan, from 15th November 2010 to 15th January 2011. The sampling technique was simple random sampling. Qualitative variables were analyzed by calculating means and standard deviations. Quantitative variables were analyzed by calculating frequencies and percentages. RESULTS: The mean age of the respondents was 34.8±9.5 years. Sixty one percent had job duration >4 years. Previous source of knowledge about HBV, during nursing training school was 91% through workshops. Knowledge about HBV infection was 94%. 95% responded that it spread through blood transfusions. Ninety-six percent responded that they do not have separate dressing sets for hepatitis B patient. The practice of vaccination against HBV in nurses was 66% and use of disposable gloves while handling hepatitis B patient was 45%. Increase in duration of job was significantly associated with knowledge about hepatitis B virus and its spread (p-value <0.001). Intravenous cannulas and syringes were properly discarded with increasing job experience (p-value <0.001). Nurses with job duration of more than four years used gloves while handling hepatitis B patient (p-value <0.001). CONCLUSION: Knowledge of hospital staff nurses regarding HBV infection was adequate. The attitude of the hospital staff nurses regarding HBV infection was good. The practices of the hospital staff nurse regarding HBV infection were very poor. [ABSTRACT FROM AUTHOR]

Adequate human resources are the most vital requirement for running a health services and ensuring quality health care delivery. However, numerical strength of health personnel alone cannot lead to the desired change in health status and good health outcome. Commensurate levels of knowledge, attitude and behavior among the health care personnel especially among the Nurses are essential. A review is used to evaluate and interpret all available information related to our research topic from 1990 to 2011. Cochrane style literature review was used for the purpose. For systematic review, the scheme is adopted from Aveyard 2007 and Biggam 2011).This review shows that in many countries pressure ulcers remain a common problem in health care centers. Many countries around the world are placing their steps forward towards to prevent the development of pressure ulcers having effective policies and guideline. Pressure ulcers policies (using a broader definition) should therefore, come out from the pressure ulcers prevention policies and framework. [ABSTRACT FROM AUTHOR]

Health human resources play a vital role in the economy of a country however imbalance in the health workforce is emerging challenge for the policy makers. Mostly policies neglect the importance of human resource development and regional disparities. Migration of health workforce from developing country to industrialized country has picked up the pace, and act as threat to developing countries to meet their health care needs (1, 2). Apart from such transitions, there is regional disparity of health workforce in developing country. Significant disparities of health workforce at regional and national level are seen due to varying push and pull factors. These regional disparities could be overcome by competent and knowledge spillovers of a country but unfortunately the developing country experienced lower returns to skill attainment and hence have reduced the health expenditure which in turn caused in poor health indicators(3). As a result of migration, and giving emphasis to work in urban areas; human capital levels are increasingly deviate across the region. The political commitment and policy assistance at country and regional level can enhance the human resource development and reduce disparity (2, 3). This paper will address the economic and political perspective of health workforce development; highlight the reasons of imbalance human resource at country and regional level due to brain drain, and at last after assessing all factors provide a way forward for sustainable health workforce. [ABSTRACT FROM AUTHOR]

Background: Pakistan is a federal state with three tiers of government. Following contentious general elections in 2013, ever first democratic transition took place in Pakistan. Subsequently, two social health protection schemes were launched. Current paper's objective is to understand the political context in which these schemes were launched and to explore the constitutional position of access to healthcare in Pakistan. This paper also explores the legal protection/ sustainability with regards to these schemes., Methods: We used qualitative research techniques with interpretivist paradigm and case-study approach. In-depth interviews were conducted, followed by content analysis. Triangulation and data saturation were observed to guide our sample size. Officials involved with these schemes at policy and implementation level were interviewed. Ethical approval was taken from ethics board of Khyber Medical University. Based on purposive sampling, in-depth interviews were conducted and thematic analysis was performed., Results: We identified two themes in response to question-1 of our interview, asking about the cause of action behind starting these schemes and their legal protection. These themes were: (i) [initiation of] Social Health Protection as democratization of healthcare, and (ii) [initiation of] Social health protection in legal void. Implicitly, these schemes are a product of grass root political activism and health found berth in election manifestos recently. Also, we deduce that health is not a constitutional right in Pakistan. These schemes lack constitutional guarantee and ensued in absence of overarching legal framework., Conclusions: These social health protection schemes are high on political agenda but lack constitutional and legal protection.

Background: Khyber Pakhtunkhwa (KP) launched its flagship Social health protection initiative (SHPI), named Sehat Sahulat Program (SSP). SSP envisions to improve access to healthcare for poorest of the poor and contribute towards achieving Universal Health Coverage (UHC). Current study was undertaken to analyze SSP in context of UHC framework i.e. to see as to (i) who is covered, (ii) what services are covered, and (iii) what extent of financial protection is conferred., Methods: We conducted thorough archival research. Official documents studied were concept paper(s), approved planning commission documents (PC-1 forms) and signed agreement(s) between government of KP and the insurance firm., Results: SSP enrolled poorest 51% of province' population i.e. 14.4 million people. It covers for all secondary and limited tertiary services. Maximum expenditure limit per family per year is Rs.540, 000/-. Government pays a premium of Rs.1549/- per year per household to 3rd party (insurance firm) which ensures services through a mix of public-private providers., Conclusions: The breadth, depth and height of SSP are significant. It is a phenomenal progress towards achieving UHC.

Background: The prevalence of complementary and alternative medicine (CAM) use in some developed countries is on the rise as surveys conducted on large scale vouch for. This study was conducted with the aim to determine the frequency of complementary and alternative medicine (CAM) use among asthmatic patients at outpatient department of tertiary care hospitals in Peshawar, Khyber Pakhtunkhwa, Pakistan., Methods: This cross-sectional study was conducted in outpatient department of two tertiary care hospitals. A face to face interview of 423 patients was conducted through a questionnaire. Non-probability consecutive sampling method was used to select the respondents. Stata version 12.1 (StataCorp), College Station, Texas) was used to carry out the statistical analysis., Results: Overall asthmatic patients in the study were 423, in which 232 (54.85%) patients reported as using CAM. There were 177 (41.84%) males and 246 (58.16%) females. The CAM use was significantly more in older age patients, suffering from asthma for more than 5 years, severe persistent type of asthma, married, unemployed, rural and current smokers., Conclusions: The use of CAM reflects a high CAM use among asthmatic patients in Pakistan. Clinicians should be aware about their patient's use of CAM.

Background: In several countries health related quality of life (HRQoL) scales have been used for adolescents, to assess the impact of disease. Health related quality of life scales are used on a range of different domains: physical, psychological, social and spiritual focusing on personal life including the concept of the World Health Organization definition of health., Methods: Health related quality of life in adolescent going to schools in the cantonment area of Peshawar garrison was assessed in a cross sectional descriptive study. Data was gathered by using a self-administered questionnaire (Kiddo-KINDL-R Questionnaire), previously tested to assess quality of life across six dimensions of health i.e. Physical and emotional well-being, self-esteem, family, social and school., Results: A total of 300 students of average age 13.41±1.34 years, with 145 (48.3%) females. Mean (SD) of total QoL score was 86.98 (12.86). The mean total scores were 86.28±12.34 and 87.64±13.34 for girls and boys, respectively., Conclusion: On the whole quality of life scores of the adolescent are good in the four dimensions. Special attention is needed towards the school environment, as majority of the participants are not satisfied with their schools. Similarly self-esteem scores are also low in the majority. However it is encouraging that most of the participants have scored highest scales in dimensions of family and physical health. Any effort to assess quality of life of the adolescents at the national level will give better view of quality of life of our youth.

Background: The magnitude of under nutrition among children below five years of age is high in Pakistan. Undernutrition and infections are the two most important factors that affect the growth of children. This study explains the extent of undernutrition and prevalence of wasting and stunting among preschool children., Methods: This cross sectional study with a sample size of 446 covered the age group 6-59 months in Jalozai Camp, District Nowshera. Height for age, weight for age and weight for height were measured as per WHO guidelines. Systematic random sampling technique was used for sample selection. Data was collected using a questionnaire., Results: According to height for age Z-score, out of 446 children studied, 8.5% were stunted and 4.0% were severely stunted. According to weight for age Z score, 11.4% were underweight and 3.6% were severely underweight. According to weight for height Z-score, 4.0% were wasted and 2.7% were severely wasted., Conclusion: The undernutrition in children is comparable to the national figures. Although our study found that absence of formal education, big family size, late and early weaning, absence of exclusive breast feeding and poverty were the factors associated with undernutrition in children, they could cause increase in under nutrition in future if not improved.