Intervention In Pakistan Research Articles

Evaluating the Efficacy of Covid-19 Intervention in Pakistan

Since the last two decades, public policy around the world, specifically in first-world countries has been guided by behavioral insights to nudge people to increase the efficacy of government interventions and policies. In this context, this study analyzes the effectiveness of government interventions and policies regarding the COVID-19 pandemic by finding if any of these were behaviorally informed and whether any behavioral insights were considered. For this purpose, focus group discussions, and episodic and semi-structured interviews were conducted with the representatives of government institutions, medical experts, and recovered patients of COVID-19. Consequently, the results depicted that only interventions and policies regarding precautionary measures, risk communication, and vaccination were behaviorally informed while none of the behavioral insights were intentionally taken into consideration but some aspects of progressive, regressive, educative, and architectural behavioral insights were identified in the COVID-19 interventions of government and the educative one performed most effectively. Moreover, emotional nudges and national and group reinforcement bias were also identified in the government interventions. Based on the results, this study emphasizes the need for the government to develop its behavioral insight team to conduct surveys and experimental-based studies to develop its behavioral insights based on its regional environmental characteristics.

Financial impact of low pathogenic avian influenza virus subtype H9N2 on commercial broiler chicken and egg layer production systems in Pakistan

Low Pathogenic Avian Influenza (LPAI) subtype H9N2 is endemic in Pakistan and impacts poultry farming through disease related mortality, poor weight gain and reduced egg production. This study aims to estimate the farm-level financial impact of LPAI H9N2 infection on commercial broiler and layer production systems in Pakistan.A questionnaire based cross-sectional survey of 138 broiler farms and 136 layer farms in Pakistan was conducted in 2019. Primary data collected by cross-sectional survey along with expert opinion and published literature were used to parameterize five stochastic production and gross margin models for three broiler and two layer production systems: fully integrated production (FIP), partially integrated production (PIP) and independent farming production (IP) systems. Partial budget analysis were then carried out to estimate the financial impact of LPAI H9N2.Results indicate that in broiler production systems, starting with 35,000 day old chicks (DOC) per batch, the net cost of disease (million PKR/production cycle) was estimated at 4.10 (14,862 USD), 4.62 (16,747 USD) and 2.46 (8917 USD) for IP, PIP and FIP systems, respectively. The disease produced a negative gross margin (defined here as revenue minus replacement and variable costs) in IP (-53 PKR (-0.19 USD)/DOC bought) and PI (-25 PKR (-0.091 USD)/DOC bought) systems, while remained positive for FIP systems (87 PKR (0.32 USD)/DOC bought). For layer production systems, (mean flock size as 48,000 DOCs) the net cost (million PKR/production cycle) was 29.75 (107,095.21 USD) and 29.51 (106,223.45 USD) IP and PIP systems, respectively, and produced negative gross margin in both systems.The outcomes of the study highlight the vulnerability of independent and partially integrated production systems to the disease. These findings also offer a decision-making tool to the farmers and policy makers to evaluate avian influenza surveillance systems and control interventions in Pakistan.

Strengthening contraceptive counselling services to empower clients and meet their needs: protocol for a two-stage, multiphase complex intervention in Pakistan and Nigeria

BackgroundHigh-quality contraceptive counselling can accelerate global efforts to reduce the unmet need for and suboptimal use of modern contraceptives. This study aims to identify a package of interventions designed to...

Preventing Self-Harm Among Adolescents Through Culturally Adapted Psychological Intervention in Pakistan: A Multicenter RCT

Preventing Self-Harm Among Adolescents Through Culturally Adapted Psychological Intervention in Pakistan: A Multicenter RCT

Perceptions and Practices of Herbal Remedy Usage during the COVID-19 Pandemic: A Call for Evidence-Based Healthcare in Pakistan

Objective: To determine the prevalence, perception and practices towards the use of herbal remedies by Pakistani population during the era of covid 19 pandemic. Methodology: This cross-sectional explorative study was conducted at Department of medicine Sir Syed Medical College Karachi 2021 from the month of August 2021 to December 2021. An online google form well written by primary investigator was distributed generally to various what’s up forum throughout Pakistan with no specific inclusion or exclusion criteria. First section of the questionnaire included demographics of participants, second section include about the use of herbal remedy types, perception, beliefs of their use, source of getting them and the remedies used for the prevention of covid virus Results: This study, was conducted from August to December 2021 spread through google online forms, included 332 respondents, 52.1% of participants utilized herbal remedies for COVID-19 prevention, with 55.5% belonging to the 25-45 age group with 81.3% of them were educated females. A significant association (p<0.05) was observed between herbal remedy usage and age group, gender, education, and occupation. Senna Makki (38.8%), ginger (17.7%), and kalonji (10.2%) were commonly used herbs. While 37.7% reported health benefits, 15.1% believed these herbs had no side effects, and 22.3% used them for virus prevention. Attitudes toward herbal remedy usage revealed that 47.4% agreed these herbs could prevent disease, and 36% believed no additional preventive measures were necessary while using them. Family tradition (19.3%), health professionals (14.5%), and internet/media (14.2%) were key sources of information, while Hakeem stores (16.6%) and family members (7.8%) were common herbal remedy providers. Conclusion: This study highlights an urgent need for evidence-based healthcare interventions in Pakistan regarding the utilization of herbal remedies during the virus pandemic especially when there are risks associated with the improper use and potential influence from media. Key words: Covid 19 pandemic, Herbal remedies, Perception, Practices

The Emerging Role of Endovascular Portal Interventions in Pakistan

To outline new modalities and techniques offered by Interventional Radiology (IR) in diagnosing and treating patients with complications related to portal hypertension and techniques to induce remnant liver hypertrophy to enable hemi hepatectomy in Pakistan. Known portal hypertensive patients were selected retrospectively including those for portal vein embolisation. Selected cases are presented to outline the treatment modality technique and its effectiveness using minimally invasive IR-based treatment options. Different techniques used by interventional radiologists are now also available in Pakistan and are paramount in managing the complications of portal hypertension and inducing remnant liver hypertrophy. Minimally invasive procedures offered by IR continue to evolve with technological innovations and are now available to manage complications related to portal hypertension hitherto not thought of and which profoundly improve patient care.

GIS Environment Based Study of Acute Myocardial Infarction Incidence and Associated Risk Factors at a Major Referral Cardiac Center in Twin City of Rawalpindi and Islamabad, Pakistan

Background: Acute Myocardial Infarction (AMI) is a critical cardiac condition characterized by sudden blood flow blockage to the heart. Previous research indicates associations between AMI risk and factors such as age, gender, lifestyle habits, and preexisting medical conditions. Methods: This cross-sectional spatial analysis study aims to explore the geographically diverse incidence of AMI and associated risk factors in the twin cities of Islamabad and Rawalpindi. Data from 500 AMI patients, collected in April 2022 from a major cardiac center, were analyzed using the Chi-square test to assess associations between AMI risk factors. Results: Significant associations were identified between the lifestyle of AMI patients and diabetes (p = 0.002), and a highly significant association of age was found with diabetes, hypertension, and smoking (p = 0.000). This pioneering spatial analysis of AMI incidence provides valuable insights for developing national health interventions in Pakistan. Conclusion: This study addresses the significant concern of AMI incidence and associated risk factors in data-sparse Pakistan. Utilizing Geographical Information System (GIS), it offers a spatial understanding of AMI distribution and patterns, paving the way for future cardiovascular health research in the country.

Encouraging Female Graduates to Enter the Labor Force: Evidence from a Role Model Intervention in Pakistan

Encouraging Female Graduates to Enter the Labor Force: Evidence from a Role Model Intervention in Pakistan

Sociodemographic determinants of gender disparity in primary percutaneous coronary intervention in Pakistan

ABSTRACTObjectivesThis study aims to contribute to the body of literature on gender disparities after acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PPCI).MethodsWe identified all adult patients who had AMI between January 2017, and December 2022 and were in follow-up at our institute. We collected data on PPCI, revascularization strategy, sociodemographic characteristics, and in-hospital complications in the years following the procedure.ResultsA total of 5,872 patients who underwent PCI for AMI were included in the study, out of which 2,058 (35%) were women and 3,814 (65%) were men. Regarding the timing of PCI, female patients had a significantly longer median door-to-balloon time compared to male patients (136 minutes vs 108 minutes, P-value = 0.006). Female patients had a significantly higher rate of in-hospital mortality compared to male patients (5.5% vs 1.2%, P-value = 0.011). Multivariate logistic regression analysis showed that female gender, older age, and lower household income were independent predictors of longer door-to-balloon time.ConclusionThis study highlights gender disparities in PPCI in Pakistan, with female patients facing longer door-to-balloon times and higher in-hospital mortality rates. The findings suggest the need for targeted interventions to improve the access and quality of care for female patients with AMI.

Agency, aspirations and citizenship: Non‐formal education from the perspective of children in street situations in Pakistan

AbstractThis paper explores an NGO‐based non‐formal education (NFE) intervention in Pakistan from the perspective of its recipients, children in street situations. Recognizing children as agential beings, we draw on participant observation and in‐depth semi‐structured interviews with 20 children, aged 10–19 years. Young people discussed the impact of the intervention on their self‐worth and future aspirations. They also reflected on their growing awareness of civic issues and citizenship rights. The study emphasizes the importance of NFE in providing opportunities to the most marginalized and those without adequate documentation, particularly in a context when state support can be lacking.

Barriers and Strategies for Hepatitis B and C Elimination in Pakistan.

Pakistan has a high hepatitis burden for both hepatitis C virus (HCV) and hepatitis B virus (HBV). To achieve World Health Organization (WHO) 2030 targets for hepatitis elimination, there is a need to constitute progress in the country, find the barriers and strategies for HCV elimination, and take actions to address the gaps. We collected data from (1) WHO estimates in 2020, (2) midterm review questionnaire of the WHO regional action plan, and (3) WHO estimates on immunization. We analyzed these data to inform (1) the burden defined as prevalence and mortality and (2) response in 3 thematic areas: governance, policy, and finance; strategic information; and service delivery. The prevalence of hepatitis B in the general population is 1.6% with 12 000 deaths/year. The prevalence of hepatitis C in the general population is 7.5% with 19 000 deaths and 545 000 new cases (incidence)/year. The selected indicators to monitor progress on viral hepatitis in Pakistan were governance and financing, policies and guidelines, and strategic information. The overall governance indicators are good with a focal point, a national hepatitis strategy, an operational plan, strategy for price reduction, and involvement of civil society but the costed action plan and the advocacy strategy are missing. The indicators on policies and guidelines are also adequately addressed. The hepatitis B and C testing and treatment guidelines are available, there is a policy to screen all blood donations, and there is an injection safety policy, but the policy for timely hepatitis B vaccine birth dose and hepatitis B vaccination for the vulnerable is missing. Both indicators regarding strategic information, that is measures of key hepatitis indicators and regular data review, are missing. The status of 5 key interventions in Pakistan show that the hepatitis B vaccination coverage is 74% and only 3% of newborn children are given the hepatitis B vaccine birth dose. Only 22% of HCV cases have been diagnosed and 2% have received treatment. Treatment response is 96%. Same-day testing and treatment of hepatitis C reduced the overall dropout rate and improved the cascade of care. Decentralization and task shifting are important tools to improve service delivery and reach communities. Finances to implement hepatitis elimination is a major barrier. Pakistan has the highest hepatitis disease burden. With the current pace, hepatitis elimination appears impossible. Introduction of the birth dose of hepatitis B vaccine and improving access and affordability of testing can improve the testing and treatment numbers. Finances need to be mobilized from within the country and outside to support disease elimination.

The prevalence, angiographic profile and clinical features, management, and outcomes of coronary artery perforation secondary to percutaneous coronary interventions in Pakistan: a retrospective cohort study.

We conducted a retrospective study of the patients who have undergone PCI at our institution from January 2015 to December 2021. During this duration, all the patients who had developed CAP based on angiographic review during the PCI were selected. The demographic, clinical, angiographic, procedure-related features, management of the CAP, and in-hospital and follow-up outcomes were gathered. Thirty-five thousand fifty-nine patients underwent PCI among which, only 93 (0.26%) patients were complicated with (CAP. Fifty-eight (62.4%) patients were in the 50-70 years age range. The most common vessel involved was the left anterior descending (36.5%) followed by the right coronary artery (32.3%). The angiographic calcification was present in 51.6% of patients, significant tortuosity greater than 90° was seen in 48.4% of patients, chronic total occlusion was observed in 42% of patients and In-stent restenosis was found in 8.6% patients. The highest mortality of four patients was seen in the CAP involving the right coronary artery. Mostly the CAP involves large vessel perforations however both, the distal and large vessel perforations are related to the increased incidence of adverse clinical results which indicates the significance of the prevention and early identification and treatment of the perforation.

Evaluation of the FAST-M maternal sepsis intervention in Pakistan: A qualitative exploratory study.

The World Health Organization and partners developed and evaluated a maternity-specific sepsis care bundle called 'FAST-M' for low-resource settings. However, this bundle has not yet been studied in Asia. Our study sought to evaluate the perceptions of healthcare providers about the implementation of the FAST-M intervention in Pakistan. The study was conducted at a public sector hospital in Hyderabad. We conducted three focus group discussions with healthcare providers including doctors, nurses, and healthcare administrators (n = 22) who implemented the FAST-M intervention. The Consolidated Framework for Implementation Research was used as a guiding framework for data collection and analysis. The data were analyzed using a thematic analysis approach and deductive methods. Five overarching themes emerged: (I) FAST-M intervention and its significance including HCPs believing in the advantages of using the intervention to improve clinical practices; (II) Influence of outer and inner settings including non-availability of resources in the facility for sepsis care; (III) HCPs perceptions about sustainability, which were positive (IV) Integration into the clinical setting including HCPs views on the existing gaps, for example, shortage of HCPs and communication gaps, and their recommendations to improve these; and (V) Outcomes of the intervention including improved clinical processes and outcomes using the FAST-M intervention. Significant improvement in patient monitoring and FAST-M bundle completion within an hour of diagnosis of sepsis was reported by the HCPs. The healthcare providers' views were positive about the intervention, its outcomes, and long-term sustainability. The qualitative data provided findings on the acceptability of the overall implementation processes to support subsequent scaling up of the intervention.

Internal migration and utilization of reproductive and maternity care among women in Pakistan: evidence from a recent National Survey.

During the last decades, migratory behavior has had a key role in population growth and redistribution in Pakistan. Migration has far-reaching socioeconomic implications for individuals and society at large that could influence the health integrity of Pakistani women. This study aimed to describe the migration patterns and drivers as well as their association with adequate access to reproductive and maternal care among married Pakistani women aged 15-49. The data from the 2017-18 Pakistan Demographic Health Survey (PDHS) was used to extract the information on the explanatory (sociodemographic and migration backgrounds) and outcome variables (unmet needs for family planning, adequate antenatal care, and delivery at health facilities). Bivariate and multivariate logistic regression analyses were employed to examine the relationship between these explanatory and outcome variables before and after adjustment for sociodemographic inequalities. In unadjusted models, the odds of having adequate ANC and delivery at health facilities were approximately 2 to 4 times higher in those living (urban non-migrant), moving to (urban to urban, rural to urban), or leaving the urban areas (rural to urban) as compared to rural non-migrants; likewise, the odds of the unmet needs for family planning was about 20-50% lower in the same migration streams compared to rural non-migrant. However, after adjustment for sociodemographic inequalities, most of these associations attenuated and only the association of urban to urban migration with unmet needs for family planning and the association of urban non-migrant with delivery at health facilities remained significant. Although the findings suggest that Internal migration flows, particularly those to urban areas (urban to urban and rural to urban), could be associated with better access to reproductive and maternity care among married Pakistani women aged 15-49 years; adjustment for sociodemographic inequalities, particularly education and wealth, nullified this association to a great extent. This has important implications for current policies and interventions in Pakistan and calls for policy reform and women's rights advocacy to enhance the literacy level of young Pakistani girls through well-tailored interventions, maintaining them at school.

THE INFLUENCE OF FAMILY AND KINSHIP-BASED PRACTICES ON SOCIAL INTERVENTIONS: AN ANALYSIS OF BARADARI SYSTEM IN PAKISTAN

The ways of Pakistan's society can be difficult to explain from a Western perspective. There are certain cultural influences that have implications on the society and it is pertinent to understand them. One of such cultural concepts is the Biradari system that is based on family and kinship-based practices. This paper discusses the significance of this system in social process and how it influences the Pakistani society. Why it is vital to examine family and kinships-based practices such as Baradari and how it is different from other concepts such wasta and guanxi. Finally, this paper discusses the implications of Baradari system on social interventions in Pakistan. This paper concludes that it fundamental for us to examine concepts such as Baradari for success of any social intervention. As this system is probably robust enough to prevent any attempt to change the society even if it is a positive development or reform. Keywords: Culture, Biradari, Wasta, Guanxi, Social interventions

Overcoming illiteracy through game-based learning in refugee camps and urban slums

Today 3.7 million refugee children are out of school. The ones forcibly displaced across borders are likely to remain there much of their childhoods and go through an entire school cycle in exile. Without access to quality education, these children have diminished likelihood of breaking free from circular dependency, scarcity, and marginalization. At the same time education sectors globally are adapting to the inevitable increase of digital learning. This study was motivated by the potential availability of digital education, and it argues for non-formal digital game-based learning in refugee and low-resource environments, with a special focus on early literacy.The participants (N = 359) consisted of marginalized, most vulnerable, and out-of-school children aged between 5 and 8. They participated in interventions in Pakistan and Bangladesh for 90 days, two hours a day. The children played digital learning games at their own pace following the learning goals of their national curriculums. The learning outcomes were measured using the EGRA framework.The study found that the intervention children achieved or surpassed the learning gains of a control group studying through formal education. These results suggest that digital learning games show promise for improving early grade literacy, even in low-resource contexts.

Evaluation of the feasibility of the FAST-M maternal sepsis intervention in Pakistan: a protocol

BackgroundMaternal sepsis is a life-threatening condition, defined by organ dysfunction caused by infection during pregnancy, childbirth, and the postpartum period. It is estimated to account for between one-tenth and half (4.7% to 13.7%) of all maternal deaths globally. An international stakeholder group, including the World Health Organization, developed a maternal sepsis management bundle called “FAST-M” for resource-limited settings through a synthesis of evidence and international consensus. The FAST-M treatment bundle consists of five components: Fluids, Antibiotics, Source identification and control, assessment of the need to Transport or Transfer to a higher level of care and ongoing Monitoring (of the mother and neonate). This study aims to adapt the FAST-M intervention and evaluate its feasibility in Pakistan.MethodsThe proposed study is a mixed method, with a before and after design. The study will be conducted in two phases at the Liaquat University of Medical and Health Sciences, Hyderabad. In the first phase (formative assessment), we will adapt the bundle care tools for the local context and assess in what circumstances different components of the intervention are likely to be effective, by conducting interviews and a focus group discussion. Qualitative data will be analyzed considering a framework method approach using NVivo version 10 (QSR International, Pty Ltd.) software. The qualitative results will guide the adaptation of FAST-M intervention in local context. In the second phase, we will evaluate the feasibility of the FAST-M intervention. Quantitative analyses will be done to assess numerous outcomes: process, organizational, clinical, structural, and adverse events with quantitative comparisons made before and after implementation of the bundle. Qualitative analysis will be done to evaluate the outcomes of intervention by conducting FGDs with HCPs involved during the implementation process. This will provide an understanding and validation of quantitative findings.DiscussionThe utilization of care bundles can facilitate recognition and timely management of maternal sepsis. There is a need to adapt, integrate, and optimize a bundled care approach in low-resource settings in Pakistan to minimize the burden of maternal morbidities and mortalities due to sepsis.

Perspectives of depressed mothers on: Use of technology to deliver integrated parenting intervention in Pakistan

Perspectives of depressed mothers on: Use of technology to deliver integrated parenting intervention in Pakistan

Effectiveness of a school-based mental health intervention for school teachers in urban Pakistan: a randomized controlled trial

BackgroundSchools have a major role in promoting children’s physical and psychological health and well-being and the mental health literacy of all key stakeholders, especially teachers, is critical to achieving this goal. Teachers’ knowledge and beliefs about psychological problems influence the way they deal with their students’ mental health issues. This study is a preliminary investigation evaluating the effectiveness and feasibility of a School Mental Health Programme (SMHP) developed by the World Health Organization’s Eastern Mediterranean Regional Office (WHO-EMRO) in improving mental health literacy and self-efficacy among school teachers in an inner-city area of urban Lahore.MethodsTeachers were randomly assigned to 3 days standardized WHO-EMRO School Mental Health Manual based Intervention (n = 118) or to a wait list delayed intervention control group (n = 113). Teachers were assessed pre and post training and at 3 months follow up using measures for mental health literacy (Primary outcome) and self-efficacy. School Heads completed the WHO School Psychosocial Profile and students reported socioemotional skills and psychological problems using Strengths and Difficulties questionnaire at baseline and 3 months post intervention.ResultsCompared with waitlist group, teachers in intervention group presented a significant increase in mental health literacy (F2,181 = 8.92; P < 0.001), as well as better teacher’s self-efficacy in classroom management and student engagement (F2,181 = 16.45; P ≤ 0.000 and F2,181 = 4.65; P ≤ 0.011, respectively). Increase confidence in helping students with mental health problems was also noted in the intervention arm (F2,181 = 15.96 P ≤ 0.000). Improvement in overall school environment was also found. No statistical difference in the emotional and behavioural difficulties in students was noticed at 3 months.ConclusionThis study is one of the first preliminary investigation of WHO-EMRO school mental health intervention in Pakistan. The study showed that intervention led to significant improvement in mental health literacy and self-efficacy among teachers, which was largely sustained over time. Despite a major limitation of lack of clustering and likely contamination affecting follow up outcomes, the study showed promising results in the context of mental health promotion, prevention and early intervention in schools in Lahore, Pakistan. A larger cluster randomised trial is justified, given the level of participant engagement and acceptability by schools.Trail Registration: ClinicalTrials.gov registry (NCT02937714) Registered 13th October 2016, https://register.clinicaltrials.gov.

Effects of a maternal psychosocial intervention on hair derived biomarkers of HPA axis function in mothers and children in rural Pakistan

ObjectiveDisruptions in the hypothalamic-pituitary-adrenal (HPA) axis are thought to be key neuroendocrine mechanisms involved in psychopathology and may have intergenerational impacts. Hair-derived HPA hormones offer a measure of long-term HPA axis activity that may be useful in assessing maternal and infant health. Building on a community-based randomized control trial of a perinatal depression intervention in Pakistan, we examine intervention effects on HPA axis activity in a subsample of mothers and infants. MethodsHPA axis activity was assessed using hair-derived cortisol, cortisone, and dehydroepiandosterone (DHEA). Hair samples were collected from mother-child dyads at one year postpartum from prenatally depressed women randomized to a cognitive-behavioral intervention (n ​= ​35 dyads) or to enhanced usual care (n ​= ​37 dyads), and from a comparison sample of women who screened negative for depression in pregnancy (n ​= ​35 dyads). ResultsThe intervention group had 38 percent (p=0.01) lower maternal cortisol levels and 45 percent (p ​< ​0.01) lower maternal cortisone compared to the EUC group. Maternal DHEA levels were higher among women in the intervention group compared to the EUC group by 29 percent (p ​= ​0.02). Intergenerational intervention effects show higher DHEA levels in infants by 43% (p ​= ​0.03). Infant cortisol and cortisone did not differ across groups. ConclusionsResults suggest that the perinatal depression intervention has effects on HPA axis activity in both mothers and children, providing evidence that treating maternal depression may impact physiological stress system functioning intergenerationally. In addition, utilizing hair-derived biomarkers of HPA-axis activity is a potentially useful clinical indicator of intervention impacts on the neuroendocrine system.