Objectives:Due to the absence of necessary rules, poor coordination, and various challenges, the pharmacovigilance system of Pakistan is not optimally functional at all levels of the health system. The objective of the study was to assess... more
Objectives:Due to the absence of necessary rules, poor coordination, and various challenges, the pharmacovigilance system of Pakistan is not optimally functional at all levels of the health system. The objective of the study was to assess the stakeholders’ perceptions of the current ADR reporting system and to identify the pharmacovigilance policy issues and problems of effective coordination.Methodology:Stakeholders from a broad range of disciplines, academia, regulatory authorities, the pharmaceutical industry, international health organizations, as well as pharmacovigilance experts, and healthcare professionals were included in the study. A total of 25 stakeholders throughout Pakistan were interviewed during exploratory semi-structured interviews. The interviews were recorded digitally, transcribed, coded, compared, and grouped according to their similarity of themes. Participants provided insights into gaps, limitations, and challenges of Pakistan’s current ADR reporting system,...
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<p>Interview respondent characteristics.</p
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☯ These authors contributed equally to this work.
Introduction Despite evidence from recent Demographic Health Surveys that show 98% of the adult Pakistani population have an awareness of at least one modern contraceptive method, only 25% of married couples in Pakistan used a modern... more
Introduction Despite evidence from recent Demographic Health Surveys that show 98% of the adult Pakistani population have an awareness of at least one modern contraceptive method, only 25% of married couples in Pakistan used a modern method of contraception. Of the modern contraceptive methods, LARC usage has increased only from 2.1 to 3%. This low uptake is puzzling in the context of high awareness of LARC methods and its availability through public sector facilities at subsidized costs. This study aimed to understand the social influences in initiating and continuing use of an LARC methods for contraception in a rural setting in Pakistan. Methods In-depth interviews were conducted with 27 women who were using a LARC method for contraception. Data was managed using NVivo 12 and themes were identified using a content analysis approach to analyze the transcripts. Results Four key themes, supported by sub-themes relating to a temporal model, were identified to explain women’s experien...
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The health status of pregnant women depends largely on the quality of the antenatal and delivery services available to them. Maternal mortality remains a major public health problem with antenatal and delivery care utilization remaining... more
The health status of pregnant women depends largely on the quality of the antenatal and delivery services available to them. Maternal mortality remains a major public health problem with antenatal and delivery care utilization remaining low in Pakistan. This study explores the perspectives of rural community members about the antenatal and delivery care services' utilization by the community. A qualitative study was undertaken in the rural community of District Attock. Focus Group Discussions (FGD) were conducted with husbands, married women of child-bearing age with young children and mothers-in-law. Data was analysed manually using content analysis techniques. Majority of the respondents sought antenatal care (ANC) after 3-4 months. They further reported that home was the preferred place of delivery followed by the local "rural health centre". The preferred attendant for delivery was the local Dai (traditional birth attendant). Major limitations to accessing ANC and ...
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Research Interests: Nursing, Focus Groups, Adult Continuing and Professional Education, Pakistan, Developing Countries, and 15 moreQualitative Research, Midwifery, Medicine, Community Health Workers, Humans, Millennium Development Goals, Developing Country, Attitude, Economic Competition, Adult, Public health systems and services research, Rural Health Services, Health Resources, Community health services, and Paediatrics and reproductive medicine
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This paper explores the perceptions and attitudes of married couples which prevent them from using modern contraceptive for purpose of family planning, based on semi-structured interviews with 16 married couples from rural Pakistan. This... more
This paper explores the perceptions and attitudes of married couples which prevent them from using modern contraceptive for purpose of family planning, based on semi-structured interviews with 16 married couples from rural Pakistan. This study, with married couples, not using any modern contraceptives, discussed issues of spousal communication and religious norms using qualitative methods. Despite near universal knowledge of modern contraceptives among married Pakistani women, the use continues to be low, with high unmet need. Understanding the couple context about reproductive decision making, pregnancy and family planning intentions is imperative to helping individuals fulfil their reproductive desires. Married couples may have varying intentions and desires about family size; a lack of alignment between partners may lead to unintended pregnancies and affect uptake and use of contraception. This study specifically explored the factors which prevent married couples from using LARCs...
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Background Pregnant women are more likely to develop antenatal depression due to multiple factors including sickness and death of close family member, unwanted pregnancy, unplanned pregnancy, economic and relationship difficulties. Food... more
Background Pregnant women are more likely to develop antenatal depression due to multiple factors including sickness and death of close family member, unwanted pregnancy, unplanned pregnancy, economic and relationship difficulties. Food insecurity is a major issue in low resource settings, especially in developing countries. Malnourishment in pregnant women along with antenatal depression can lead to adverse effect on growth of foetus and can lead to adverse pregnancy outcomes. The aim of this study was to determine an association between food insecurity and antenatal depression among pregnant women living in slum settlements of Lahore. Methods A community based, crosssectional study was conducted in slum settlements of district Lahore, with a sample of 367 pregnant women. Antenatal depression and household food insecurity was measured using Edinburgh Postnatal Depression Scale (EPDS) and Household food insecurity access scale (HFIAS). Data was entered and analysed in SPSS-20.0. Chi...
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Background Pakistan’s Maternal, Newborn and Child Health (MNCH) Program is faced with multiple challenges in service delivery, financial and logistic management, training and deployment of human resources, and integration within the... more
Background
Pakistan’s Maternal, Newborn and Child Health (MNCH) Program is faced with multiple challenges in service delivery, financial and logistic management, training and deployment of human resources, and integration within the existing health system. There is a lack of evidence on managerial aspects of the MNCH program management and implementation.
Methods and Findings
This study used qualitative methods to explore the challenges national, provincial and district program managers have faced in implementing a community midwifery program in province of Punjab while also exploring future directions for the program under a devolved health system. While the program had been designed in earnest, the planning lacked critical elements of involving relevant stakeholders in design and implementation, socio-demographic context and capacity of the existing health system. Financial limitations, weak leadership and lack of a political commitment to the problem of maternal health have also had an impact on program implementation.
Conclusions
Our study results suggest that there is a need to re-structure the program while ensuring sustainability and collaboration within the health sector to increase uptake of skilled birth attendance and improve maternal health care in Pakistan.
Pakistan’s Maternal, Newborn and Child Health (MNCH) Program is faced with multiple challenges in service delivery, financial and logistic management, training and deployment of human resources, and integration within the existing health system. There is a lack of evidence on managerial aspects of the MNCH program management and implementation.
Methods and Findings
This study used qualitative methods to explore the challenges national, provincial and district program managers have faced in implementing a community midwifery program in province of Punjab while also exploring future directions for the program under a devolved health system. While the program had been designed in earnest, the planning lacked critical elements of involving relevant stakeholders in design and implementation, socio-demographic context and capacity of the existing health system. Financial limitations, weak leadership and lack of a political commitment to the problem of maternal health have also had an impact on program implementation.
Conclusions
Our study results suggest that there is a need to re-structure the program while ensuring sustainability and collaboration within the health sector to increase uptake of skilled birth attendance and improve maternal health care in Pakistan.
Background: Maternal mortality ratio in Pakistan remains high at 276 per 100000 live births (175 in the urban areas and 319 in rural) with a mother dying as a result of giving birth every 20 minutes. Despite the intervening years since... more
Background: Maternal mortality ratio in Pakistan remains high at 276 per 100000 live births (175 in the urban areas
and 319 in rural) with a mother dying as a result of giving birth every 20 minutes. Despite the intervening years
since the Safe Motherhood Initiative launch and the Millennium Development Goals (MDGs), there have been few
improvements in MDGs 4 and 5 in Pakistan. A key underlying reason is that only 39% of the births are attended by
skilled birth attendants. Pakistan, like many other developing countries has been struggling to make improvements
in maternal and neonatal health, amongst other measures, which include a nationwide health infrastructure
network. Recently, government of Pakistan revised its maternal and newborn health program and introduced a new
cadre of community based birth attendants, called community midwives (CMW), trained to conduct home-based
deliveries. There is limited research available on field experiences of community midwives as maternal health care
providers. Formative research was designed and conducted in a rural district of Pakistan with the objective of
exploring role of CMWs as home based skilled service providers and the challenges they face in provision of skilled
maternal care.
Methods: A qualitative research using content analysis was conducted in one rural district (Attock) of Pakistan.
Focus group discussions were conducted with CMWs and other community based health workers as LHWs and
LHSs, focusing on the role of CMWs in the existing primary health care infrastructure.
Results: Results of this study reveal that the community midwives are struggling for survival in rural areas as
maternal care providers as they are inadequately trained, lack sufficient resources to deliver services in their
catchment areas and lack facilitation for integration in district health system.
Conclusions: CMWs face many challenges in the field related to the communities' attitude and the health system.
With adequate training and facilitation by health department, CMWs have potential to play a vital role in reducing
burden of maternal morbidity and in achieving significant gains in improving maternal and child health.
and 319 in rural) with a mother dying as a result of giving birth every 20 minutes. Despite the intervening years
since the Safe Motherhood Initiative launch and the Millennium Development Goals (MDGs), there have been few
improvements in MDGs 4 and 5 in Pakistan. A key underlying reason is that only 39% of the births are attended by
skilled birth attendants. Pakistan, like many other developing countries has been struggling to make improvements
in maternal and neonatal health, amongst other measures, which include a nationwide health infrastructure
network. Recently, government of Pakistan revised its maternal and newborn health program and introduced a new
cadre of community based birth attendants, called community midwives (CMW), trained to conduct home-based
deliveries. There is limited research available on field experiences of community midwives as maternal health care
providers. Formative research was designed and conducted in a rural district of Pakistan with the objective of
exploring role of CMWs as home based skilled service providers and the challenges they face in provision of skilled
maternal care.
Methods: A qualitative research using content analysis was conducted in one rural district (Attock) of Pakistan.
Focus group discussions were conducted with CMWs and other community based health workers as LHWs and
LHSs, focusing on the role of CMWs in the existing primary health care infrastructure.
Results: Results of this study reveal that the community midwives are struggling for survival in rural areas as
maternal care providers as they are inadequately trained, lack sufficient resources to deliver services in their
catchment areas and lack facilitation for integration in district health system.
Conclusions: CMWs face many challenges in the field related to the communities' attitude and the health system.
With adequate training and facilitation by health department, CMWs have potential to play a vital role in reducing
burden of maternal morbidity and in achieving significant gains in improving maternal and child health.
Background: Despite initiation of family planning programs in 1960s, contraceptive uptake is very low in Pakistan because it is associated with various markers of socio-demographic status. Objective: To identify demographic and... more
Background: Despite initiation of family planning programs in 1960s, contraceptive uptake is very low in Pakistan
because it is associated with various markers of socio-demographic status.
Objective: To identify demographic and socioeconomic determinants of contraceptive uptake in Pakistan and see trends in
contraceptive utilization from 1990-2013.
Subjects and Methods: Using Pakistan Demographic and Health Survey (PDHS) 2006–07 data, descriptive secondary
analysis was performed to inspect frequency of number of socio-demographic variables including age, education, place of
residence, working status of women, number of living children and behavioral change factors. Bi-variate analysis was done
to show relationships between current contraceptive use and all outcome variables mentioned before and multivariate
logistic regression was employed to predict factors influencing contraceptive uptake. Projection of Contraceptive
Prevalence Rate (CPR) was done for the year 2025 and trends in contraceptive use was analyzed using data from PDHS
1990-91, 2006-07 and 2012-13.
Results: Secondary analysis of data on 9556 women was done. Sixty seven percent of the respondents were not using any
method of contraception, 66.5% were illiterate, 62% resided in rural areas and only 25% of the women were employed.
Bivariate analysis showed that contraceptive use was higher among older age women and those residing in urban areas. The
results of multivariate regression showed married women in older age groups (35-44 years), those residing in rural areas
and in Baluchistan Province were more likely not using contraceptives.
Conclusion: An appropriate national family planning and population policy is required, particularly to increase
contraceptive utilization among rural and newly married women. Provincial population departments should develop their
own policies according to their regional and socio cultural requirement. Access to family planning should be increased
through free availability of broad range of family planning commodities both at public and private health facilities
especially in hard to reach areas.
because it is associated with various markers of socio-demographic status.
Objective: To identify demographic and socioeconomic determinants of contraceptive uptake in Pakistan and see trends in
contraceptive utilization from 1990-2013.
Subjects and Methods: Using Pakistan Demographic and Health Survey (PDHS) 2006–07 data, descriptive secondary
analysis was performed to inspect frequency of number of socio-demographic variables including age, education, place of
residence, working status of women, number of living children and behavioral change factors. Bi-variate analysis was done
to show relationships between current contraceptive use and all outcome variables mentioned before and multivariate
logistic regression was employed to predict factors influencing contraceptive uptake. Projection of Contraceptive
Prevalence Rate (CPR) was done for the year 2025 and trends in contraceptive use was analyzed using data from PDHS
1990-91, 2006-07 and 2012-13.
Results: Secondary analysis of data on 9556 women was done. Sixty seven percent of the respondents were not using any
method of contraception, 66.5% were illiterate, 62% resided in rural areas and only 25% of the women were employed.
Bivariate analysis showed that contraceptive use was higher among older age women and those residing in urban areas. The
results of multivariate regression showed married women in older age groups (35-44 years), those residing in rural areas
and in Baluchistan Province were more likely not using contraceptives.
Conclusion: An appropriate national family planning and population policy is required, particularly to increase
contraceptive utilization among rural and newly married women. Provincial population departments should develop their
own policies according to their regional and socio cultural requirement. Access to family planning should be increased
through free availability of broad range of family planning commodities both at public and private health facilities
especially in hard to reach areas.