Background. Pakistan’s contraceptive prevalence rate (CPR) has remained static (less than 1% annu... more Background. Pakistan’s contraceptive prevalence rate (CPR) has remained static (less than 1% annual increase since 2006) due to several demand and supply issues. The Akhter Hameed Khan Foundation implemented a community-driven, demand-generation intervention with complementary supply side family planning (FP) services in a large urban informal settlement in Rawalpindi, Pakistan. Methods. The intervention recruited local women as outreach workers called Aapis (sisters), who conducted household outreach and provided counseling, contraceptives, and referrals. Program data were used to guide in-program corrections, identify the most willing to use married women of reproductive age (MWRA), and target specific geographic locations. The evaluation compared results from two surveys. The baseline survey included 1485 MWRA while the endline included 1560 MWRA that were sampled using the same methodology. A logit model was used with survey weights and clustered standard errors, to estimate the...
ABSTRACTObjectivesThe COVID-19 pandemic showed distinct waves where cases ebbed and flowed. While... more ABSTRACTObjectivesThe COVID-19 pandemic showed distinct waves where cases ebbed and flowed. While each country had slight, nuanced differences, lessons from each wave with country-specific details provides important lessons for prevention, understanding medical outcomes and the role of vaccines. This paper compares key characteristics from the five different COVID-19 waves in Pakistan.MethodsWe used specific criteria to define COVID-19 waves, and key variables such as COVID-19 tests, cases, and deaths with their rates of change to the peak and then to the trough were used to draw descriptive comparisons. Additionally, a linear regression model estimated daily new COVID-19 deaths in Pakistan.ResultsPakistan saw five distinct waves, each of which displayed the typical topology of a complete infectious disease epidemic. The time from wave-start to peak became progressively shorter, and from wave-peak to trough, progressively longer. Each wave appears to also be getting shorter, except ...
Background. Pakistan's contraceptive prevalence rate (CPR) has remained static (less than 1% annu... more Background. Pakistan's contraceptive prevalence rate (CPR) has remained static (less than 1% annual increase since 2006) due to several demand and supply issues. The Akhter Hameed Khan Foundation implemented a community-driven, demand-generation intervention with complementary supply side family planning (FP) services in a large urban informal settlement in Rawalpindi, Pakistan. Methods. The intervention recruited local women as outreach workers called Aapis (sisters), who conducted household outreach and provided counseling, contraceptives, and referrals. Program data were used to guide in-program corrections, identify the most willing to use married women of reproductive age (MWRA), and target specific geographic locations. The evaluation compared results from two surveys. The baseline survey included 1485 MWRA while the endline included 1560 MWRA that were sampled using the same methodology. A logit model was used with survey weights and clustered standard errors, to estimate the odds of using a contraceptive method. Results. CPR in Dhok Hassu increased from 33% at the baseline to 44% at endline. Long-acting reversible contraceptives (LARCs) usage increased from 1% at baseline to 4% at endline. Increase in CPR is correlated with increasing number of children and education of MWRA and is the highest between the ages of 25 and 39 and for working women. Qualitative evaluation of the intervention provided lessons about in-program corrections using data and empowerment of the female outreach workers and MWRA. Conclusion. The Aapis Initiative is a unique community-based demand-supply side intervention that successfully increased modern contraceptive prevalence rate (mCPR) by economically engaging the women from within the community as outreach workers and enabling healthcare providers to establish a sustainable ecosystem for increasing knowledge and access to family planning services.
Developing countries have been facing difficulties in reaching out to low-income and underserved ... more Developing countries have been facing difficulties in reaching out to low-income and underserved communities for COVID-19 vaccination coverage. The rapidity of vaccine development caused a mistrust among certain subgroups of the population, and hence innovative approaches were taken to reach out to such populations. Using a sample of 1760 respondents in five low-income, informal localities of Islamabad and Rawalpindi, Pakistan, we evaluated a set of interventions involving community engagement by addressing demand and access barriers. We used multi-level mixed effects models to estimate average treatment effects across treatment areas. We found that our interventions increased COVID-19 vaccine willingness in two treatment areas that are furthest from city centers by 7.6% and 6.6% respectively, while vaccine uptake increased in one of the treatment areas by 17.1%, compared to the control area. Our results suggest that personalized information campaigns such as community mobilization help to increase COVID-19 vaccine willingness. Increasing uptake however, requires improving access to the vaccination services. Both information and access may be different for various communities and therefore a "one-size-fits-all" approach may need to be better localized. Such underserved and marginalized communities are better served if vaccination efforts are contextualized.
Schools were closed all over Pakistan on November 26, 2020 to reduce community transmission of CO... more Schools were closed all over Pakistan on November 26, 2020 to reduce community transmission of COVID-19 and reopened between January 18 and February 1, 2021. However, these closures were associated with significant economic and social costs, prompting a review of effectiveness of school closures to reduce the spread of COVID-19 infections in a developing country like Pakistan. A single-group interrupted time series analysis (ITSA) was used to measure the impact of school closures, as well as reopening schools, on daily new COVID-19 cases in 6 major cities across Pakistan: Lahore, Karachi, Islamabad, Quetta, Peshawar, and Muzaffarabad. However, any benefits were contingent on continued closure of schools, as cases bounced back once schools reopened. School closures are associated with a clear and statistically significant reduction in COVID-19 cases by 0.07 to 0.63 cases per 100,000 population, while reopening schools is associated with a statistically significant increase. Lahore is an exception to the effect of school closures, but it too saw an increase in COVID-19 cases after schools reopened in early 2021. We show that closing schools was a viable policy option, especially before vaccines became available. However, its social and economic costs must also be considered.
Objectives The COVID-19 pandemic showed distinct waves where cases ebbed and flowed. While each c... more Objectives The COVID-19 pandemic showed distinct waves where cases ebbed and flowed. While each country had slight, nuanced differences, lessons from each wave with country-specific details provides important lessons for prevention, understanding medical outcomes and the role of vaccines. This paper compares key characteristics from the five different COVID-19 waves in Pakistan.
Methods We used specific criteria to define COVID-19 waves, and key variables such as COVID-19 tests, cases, and deaths with their rates of change to the peak and then to the trough were used to draw descriptive comparisons. Additionally, a linear regression model estimated daily new COVID-19 deaths in Pakistan.
Results Pakistan saw five distinct waves, each of which displayed the typical topology of a complete infectious disease epidemic. The time from wave-start to peak became progressively shorter, and from wave-peak to trough, progressively longer. Each wave appears to also be getting shorter, except for wave 4, which lasted longer than wave 3. A one percent increase in vaccinations increased daily new COVID-19 deaths by 0.10% (95% CI: 0.01, 0.20) in wave 4 and decreased deaths by 0.38% (95% CI: -0.67, -0.08) in wave 5.
Conclusion Each wave displayed distinct characteristics that must be interpreted in the context of the level of response and the variant driving the epidemic. Key indicators suggest that COVID-19 preventive measures kept pace with the disease. Waves 1 and 2 were mainly about prevention and learning how to clinically manage patients. Vaccination started late during Wave 3 and its impact became apparent on hospitalizations and deaths in Wave 5. The impact of highly virulent strains Alpha/B1.1.7 and Delta/B.1.617.2 variants during Wave 3 and milder but more infectious Omicron/BA.5.2.1.7 are apparent.
Background. Pakistan’s contraceptive prevalence rate (CPR) has remained static (less than 1% annu... more Background. Pakistan’s contraceptive prevalence rate (CPR) has remained static (less than 1% annual increase since 2006) due to several demand and supply issues. The Akhter Hameed Khan Foundation implemented a community-driven, demand-generation intervention with complementary supply side family planning (FP) services in a large urban informal settlement in Rawalpindi, Pakistan. Methods. The intervention recruited local women as outreach workers called Aapis (sisters), who conducted household outreach and provided counseling, contraceptives, and referrals. Program data were used to guide in-program corrections, identify the most willing to use married women of reproductive age (MWRA), and target specific geographic locations. The evaluation compared results from two surveys. The baseline survey included 1485 MWRA while the endline included 1560 MWRA that were sampled using the same methodology. A logit model was used with survey weights and clustered standard errors, to estimate the...
ABSTRACTObjectivesThe COVID-19 pandemic showed distinct waves where cases ebbed and flowed. While... more ABSTRACTObjectivesThe COVID-19 pandemic showed distinct waves where cases ebbed and flowed. While each country had slight, nuanced differences, lessons from each wave with country-specific details provides important lessons for prevention, understanding medical outcomes and the role of vaccines. This paper compares key characteristics from the five different COVID-19 waves in Pakistan.MethodsWe used specific criteria to define COVID-19 waves, and key variables such as COVID-19 tests, cases, and deaths with their rates of change to the peak and then to the trough were used to draw descriptive comparisons. Additionally, a linear regression model estimated daily new COVID-19 deaths in Pakistan.ResultsPakistan saw five distinct waves, each of which displayed the typical topology of a complete infectious disease epidemic. The time from wave-start to peak became progressively shorter, and from wave-peak to trough, progressively longer. Each wave appears to also be getting shorter, except ...
Background. Pakistan's contraceptive prevalence rate (CPR) has remained static (less than 1% annu... more Background. Pakistan's contraceptive prevalence rate (CPR) has remained static (less than 1% annual increase since 2006) due to several demand and supply issues. The Akhter Hameed Khan Foundation implemented a community-driven, demand-generation intervention with complementary supply side family planning (FP) services in a large urban informal settlement in Rawalpindi, Pakistan. Methods. The intervention recruited local women as outreach workers called Aapis (sisters), who conducted household outreach and provided counseling, contraceptives, and referrals. Program data were used to guide in-program corrections, identify the most willing to use married women of reproductive age (MWRA), and target specific geographic locations. The evaluation compared results from two surveys. The baseline survey included 1485 MWRA while the endline included 1560 MWRA that were sampled using the same methodology. A logit model was used with survey weights and clustered standard errors, to estimate the odds of using a contraceptive method. Results. CPR in Dhok Hassu increased from 33% at the baseline to 44% at endline. Long-acting reversible contraceptives (LARCs) usage increased from 1% at baseline to 4% at endline. Increase in CPR is correlated with increasing number of children and education of MWRA and is the highest between the ages of 25 and 39 and for working women. Qualitative evaluation of the intervention provided lessons about in-program corrections using data and empowerment of the female outreach workers and MWRA. Conclusion. The Aapis Initiative is a unique community-based demand-supply side intervention that successfully increased modern contraceptive prevalence rate (mCPR) by economically engaging the women from within the community as outreach workers and enabling healthcare providers to establish a sustainable ecosystem for increasing knowledge and access to family planning services.
Developing countries have been facing difficulties in reaching out to low-income and underserved ... more Developing countries have been facing difficulties in reaching out to low-income and underserved communities for COVID-19 vaccination coverage. The rapidity of vaccine development caused a mistrust among certain subgroups of the population, and hence innovative approaches were taken to reach out to such populations. Using a sample of 1760 respondents in five low-income, informal localities of Islamabad and Rawalpindi, Pakistan, we evaluated a set of interventions involving community engagement by addressing demand and access barriers. We used multi-level mixed effects models to estimate average treatment effects across treatment areas. We found that our interventions increased COVID-19 vaccine willingness in two treatment areas that are furthest from city centers by 7.6% and 6.6% respectively, while vaccine uptake increased in one of the treatment areas by 17.1%, compared to the control area. Our results suggest that personalized information campaigns such as community mobilization help to increase COVID-19 vaccine willingness. Increasing uptake however, requires improving access to the vaccination services. Both information and access may be different for various communities and therefore a "one-size-fits-all" approach may need to be better localized. Such underserved and marginalized communities are better served if vaccination efforts are contextualized.
Schools were closed all over Pakistan on November 26, 2020 to reduce community transmission of CO... more Schools were closed all over Pakistan on November 26, 2020 to reduce community transmission of COVID-19 and reopened between January 18 and February 1, 2021. However, these closures were associated with significant economic and social costs, prompting a review of effectiveness of school closures to reduce the spread of COVID-19 infections in a developing country like Pakistan. A single-group interrupted time series analysis (ITSA) was used to measure the impact of school closures, as well as reopening schools, on daily new COVID-19 cases in 6 major cities across Pakistan: Lahore, Karachi, Islamabad, Quetta, Peshawar, and Muzaffarabad. However, any benefits were contingent on continued closure of schools, as cases bounced back once schools reopened. School closures are associated with a clear and statistically significant reduction in COVID-19 cases by 0.07 to 0.63 cases per 100,000 population, while reopening schools is associated with a statistically significant increase. Lahore is an exception to the effect of school closures, but it too saw an increase in COVID-19 cases after schools reopened in early 2021. We show that closing schools was a viable policy option, especially before vaccines became available. However, its social and economic costs must also be considered.
Objectives The COVID-19 pandemic showed distinct waves where cases ebbed and flowed. While each c... more Objectives The COVID-19 pandemic showed distinct waves where cases ebbed and flowed. While each country had slight, nuanced differences, lessons from each wave with country-specific details provides important lessons for prevention, understanding medical outcomes and the role of vaccines. This paper compares key characteristics from the five different COVID-19 waves in Pakistan.
Methods We used specific criteria to define COVID-19 waves, and key variables such as COVID-19 tests, cases, and deaths with their rates of change to the peak and then to the trough were used to draw descriptive comparisons. Additionally, a linear regression model estimated daily new COVID-19 deaths in Pakistan.
Results Pakistan saw five distinct waves, each of which displayed the typical topology of a complete infectious disease epidemic. The time from wave-start to peak became progressively shorter, and from wave-peak to trough, progressively longer. Each wave appears to also be getting shorter, except for wave 4, which lasted longer than wave 3. A one percent increase in vaccinations increased daily new COVID-19 deaths by 0.10% (95% CI: 0.01, 0.20) in wave 4 and decreased deaths by 0.38% (95% CI: -0.67, -0.08) in wave 5.
Conclusion Each wave displayed distinct characteristics that must be interpreted in the context of the level of response and the variant driving the epidemic. Key indicators suggest that COVID-19 preventive measures kept pace with the disease. Waves 1 and 2 were mainly about prevention and learning how to clinically manage patients. Vaccination started late during Wave 3 and its impact became apparent on hospitalizations and deaths in Wave 5. The impact of highly virulent strains Alpha/B1.1.7 and Delta/B.1.617.2 variants during Wave 3 and milder but more infectious Omicron/BA.5.2.1.7 are apparent.
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Methods We used specific criteria to define COVID-19 waves, and key variables such as COVID-19 tests, cases, and deaths with their rates of change to the peak and then to the trough were used to draw descriptive comparisons. Additionally, a linear regression model estimated daily new COVID-19 deaths in Pakistan.
Results Pakistan saw five distinct waves, each of which displayed the typical topology of a complete infectious disease epidemic. The time from wave-start to peak became progressively shorter, and from wave-peak to trough, progressively longer. Each wave appears to also be getting shorter, except for wave 4, which lasted longer than wave 3. A one percent increase in vaccinations increased daily new COVID-19 deaths by 0.10% (95% CI: 0.01, 0.20) in wave 4 and decreased deaths by 0.38% (95% CI: -0.67, -0.08) in wave 5.
Conclusion Each wave displayed distinct characteristics that must be interpreted in the context of the level of response and the variant driving the epidemic. Key indicators suggest that COVID-19 preventive measures kept pace with the disease. Waves 1 and 2 were mainly about prevention and learning how to clinically manage patients. Vaccination started late during Wave 3 and its impact became apparent on hospitalizations and deaths in Wave 5. The impact of highly virulent strains Alpha/B1.1.7 and Delta/B.1.617.2 variants during Wave 3 and milder but more infectious Omicron/BA.5.2.1.7 are apparent.
Methods We used specific criteria to define COVID-19 waves, and key variables such as COVID-19 tests, cases, and deaths with their rates of change to the peak and then to the trough were used to draw descriptive comparisons. Additionally, a linear regression model estimated daily new COVID-19 deaths in Pakistan.
Results Pakistan saw five distinct waves, each of which displayed the typical topology of a complete infectious disease epidemic. The time from wave-start to peak became progressively shorter, and from wave-peak to trough, progressively longer. Each wave appears to also be getting shorter, except for wave 4, which lasted longer than wave 3. A one percent increase in vaccinations increased daily new COVID-19 deaths by 0.10% (95% CI: 0.01, 0.20) in wave 4 and decreased deaths by 0.38% (95% CI: -0.67, -0.08) in wave 5.
Conclusion Each wave displayed distinct characteristics that must be interpreted in the context of the level of response and the variant driving the epidemic. Key indicators suggest that COVID-19 preventive measures kept pace with the disease. Waves 1 and 2 were mainly about prevention and learning how to clinically manage patients. Vaccination started late during Wave 3 and its impact became apparent on hospitalizations and deaths in Wave 5. The impact of highly virulent strains Alpha/B1.1.7 and Delta/B.1.617.2 variants during Wave 3 and milder but more infectious Omicron/BA.5.2.1.7 are apparent.