Settings In Pakistan Research Articles

Preliminary Evaluation of Culturally Adapted CBT for Psychosis (CA-CBTp): Findings from Developing Culturally-Sensitive CBT Project (DCCP)

Cognitive Behaviour Therapy for Psychosis (CBTp) has a strong evidence base and is practised widely in the Western World. Psycho-social interventions, on the other hand, including Cognitive Behaviour Therapy (CBT) are hardly used in the low and middle income countries for psychosis. It has been suggested that adaptations in content, format and delivery are needed before CBT can be used outside the Western cultures. We describe preliminary evaluation of Culturally Adapted Cognitive Behaviour Therapy for Psychosis (CaCBTp) in in-patient settings in Lahore, Pakistan. We aimed to evaluate the efficacy of culturally adapted CBT for psychosis (CaCBTp) in Pakistan in a pilot project. In a randomized controlled trial we tested CaCBTp against treatment as usual (TAU) in in-patient settings in Pakistan. Those diagnosed with schizophrenia according to the DSM-IV-TR, and who fulfilled the inclusion criteria, were recruited into the study. Patients (n = 42) were randomized into two equal groups, i.e. CaCBTp and TAU. Assessments were carried out both at the baseline and then at the end of the therapy by raters blind to the groupings. Psychopathology was measured using PANSS (Positive and Negative Syndrome Scale of Schizophrenia), PSYRATS (Psychotic Symptom Rating Scales), and the Insight Scale. Patients receiving CaCBTp showed statistically significant improvement on measures of positive symptoms (p = .000), negative symptoms (p = .000), overall psychotic symptoms (p = .000), hallucinations (p = .000), delusions (p = .000) and insight (p = .000) at the end of the therapy. The CaCBTp was effective in reducing symptoms of psychosis and in improving insight in in-inpatient settings in Pakistan.

Measuring Coverage in MNCH: A Prospective Validation Study in Pakistan and Bangladesh on Measuring Correct Treatment of Childhood Pneumonia

BackgroundAntibiotic treatment for pneumonia as measured by Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) is a key indicator for tracking progress in achieving Millennium Development Goal 4. Concerns about the validity of this indicator led us to perform an evaluation in urban and rural settings in Pakistan and Bangladesh.Methods and FindingsCaregivers of 950 children under 5 y with pneumonia and 980 with “no pneumonia” were identified in urban and rural settings and allocated for DHS/MICS questions 2 or 4 wk later. Study physicians assigned a diagnosis of pneumonia as reference standard; the predictive ability of DHS/MICS questions and additional measurement tools to identify pneumonia versus non-pneumonia cases was evaluated.Results at both sites showed suboptimal discriminative power, with no difference between 2- or 4-wk recall. Individual patterns of sensitivity and specificity varied substantially across study sites (sensitivity 66.9% and 45.5%, and specificity 68.8% and 69.5%, for DHS in Pakistan and Bangladesh, respectively). Prescribed antibiotics for pneumonia were correctly recalled by about two-thirds of caregivers using DHS questions, increasing to 72% and 82% in Pakistan and Bangladesh, respectively, using a drug chart and detailed enquiry.ConclusionsMonitoring antibiotic treatment of pneumonia is essential for national and global programs. Current (DHS/MICS questions) and proposed new (video and pneumonia score) methods of identifying pneumonia based on maternal recall discriminate poorly between pneumonia and children with cough. Furthermore, these methods have a low yield to identify children who have true pneumonia. Reported antibiotic treatment rates among these children are therefore not a valid proxy indicator of pneumonia treatment rates. These results have important implications for program monitoring and suggest that data in its current format from DHS/MICS surveys should not be used for the purpose of monitoring antibiotic treatment rates in children with pneumonia at the present time. Please see later in the article for the Editors' Summary

Labour in Global Value Chains: Work Conditions in Football Manufacturing in China, India and Pakistan

ABSTRACTA critical challenge facing developing country producers is to meet international labour standards and codes of conduct in order to engage in global value chains. Evidence of gains for workers from compliance with such standards and codes remains limited and patchy. This article focuses on the global football industry, a sector dominated by leading global brands that manage dispersed global value chains. It assesses the working conditions for football stitchers engaged in different forms of work organization, factories, stitching centres and home‐based settings in Pakistan, India and China. It draws on detailed qualitative primary field research with football‐stitching workers and producers in these three countries. The article explains how and why work conditions of football stitchers differ across these locations through an analytical framework that interweaves both global and local production contexts that influence work conditions. In doing so, it argues that current debates on the role of labour in global value chains have to go beyond a narrow focus on labour standards and corporate social responsibility compliance and engage with economic, technological and social upgrading as factors that could generate sustained improvements in real wages and workers’ conditions.

Workplace violence towards nurses: A reality from the Pakistani context

Workplace violence is a devastating issue worldwide. Incidents of workplace violence towards nurses are common in every healthcare setting. Nurses are more prone to workplace violence due to the nature of the tasks performed by them at healthcare settings. Lack of respect towards the nursing profession in the Pakistani society is a significant contributing factor in workplace violence towards nurses. Workplace violence towards nurses is categorized in two types, psychological and physical violence and both these types of violence exist equally in different health care settings of Pakistan. There are many reported and unreported cases in which nurses experience rape, unwanted sexual deeds, workplace bullying, and physical violence from patients, their family members and other paramedical staff. Limited work has been done to manage workplace violence at the health care settings in Pakistan. Incidents of violence towards nurses are yet under reported because of fear and more disrespect in the Pakistani society if reported formally. This is extremely important to design more effective strategies to assist nurses in dealing with workplace violence proficiently and competently. A Safe work environment will automatically attract nurses to remain in the nursing profession.

Safe and Healthy Work Environments: An Assessment of Physiciansʼ Level of Satisfaction in Pakistan

PP-30-204 Background/Aims: The safety and well-being of healthcare providers is rarely prioritized in developing countries. In resource-poor environments, safety may be compromised, which can expose workers to greater risks like communicable diseases. Poor health provider safety can also increase stress and decrease motivation. Unfortunately, little is known about unsafe working environments, particularly in conflict areas. In this study, we explored physicians' satisfaction regarding safety and occupational health in busy hospital settings in Pakistan. Methods: A stratified random sample of 360 physicians was selected from public primary, public secondary, and public and private tertiary health facilities in the Lahore district, Pakistan. An equal number of male and female respondents were chosen from each setup. Pretested, semi-structured, self-administered questionnaires were used. The physicians were asked to rate their satisfaction regarding occupational health and safety in their current jobs. Results: Overall, more than half of the physicians (58%) reported that they were less satisfied or dissatisfied with the amount of workplace, personal safety, and security available. A much higher percentage of females reported being dissatisfied (82%). Fewer physicians in private setups (11%) were dissatisfied compared with those in public setups (74%). Concerning general occupational health satisfaction, 70% of physicians reported being less satisfied or dissatisfied. Additionally, 79% of physicians in the study were less satisfied or dissatisfied regarding workplace health safety measures against diseases. Conclusion: Satisfaction with safety measures was generally low, particularly among women and physicians in public setups. Recent security issues in the region and the absence of adequate responses from mangers and policymakers may also be compounding the issue. These findings suggest that issues related to personal health and safety should be addressed, especially in conflict areas. Failure to do so may result in illnesses, burnout, or the immigration of physicians, particularly women, from already overburdened health systems.

Prevalent genotypes of meticillin-resistant Staphylococcus aureus: report from Pakistan

Meticillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen in Pakistan and is emerging in the community. This is one of the first reports of the prevalent genotypes of MRSA in both hospital and community settings in Pakistan. Isolates collected in 2006-2007 were characterized by PFGE, staphylococcal cassette chromosome mec (SCCmec) typing and multilocus sequence typing (MLST). PFGE identified nine pulsotypes, the majority of isolates belonging to pulsotypes A (n=70) and B (n=38), which were predominant among hospital-onset MRSA (HO-MRSA) and community-onset MRSA (CO-MRSA) isolates, respectively. Among the HO-MRSA isolates, variants of SCCmec type III were prevalent, whilst SCCmec type IV or variants were predominant in the CO-MRSA isolates. MLST identified two principal sequence types, ST8 and ST239. An association was observed between ST8, PFGE pulsotype B and SCCmec type IV in the CO-MRSA (ST8-MRSA-IV). Similarly, ST239, PFGE pulsotype A and SCCmec type III were associated with HO-MRSA (ST239-MRSA-III). Therefore, the prevalent genotypes circulating in Pakistan at the time of study were ST8-MRSA-IV and ST239-MRSA-III in the community and hospital settings, respectively. A set of HO-MRSA isolates collected in 1997 were characterized by PFGE and SCCmec typing for comparison. The isolates belonged to two PFGE pulsotypes (A, n=28; B, n=11) and contained just two SCCmec types. These results suggest that an increase in genetic diversity occurred over the period 1997-2007 as a result of either microevolution or the importation of strains from surrounding areas.

Peace Perceptions Of Prospective Teachers For Promoting Peace Activities For School Settings In Pakistan

Peace has been recognized as a matter of education and to be promoted at the initial level. The present study attempts to generate a profile of activities toward peace education among prospective teachers. The Nominal Group Technique (NGT) was used by selecting fifteen prospective teachers as a Nominal Group (NG). NGT was applied under a sequence of stages (idea generating, selection, listing, clarification, ranking and consensus stages). Results generated from the NGT were organized into three categories of student-related activities, teacher-focused activities, and administration and community- related activities. Participants’ preferences were higher for activities that included individual practical participation. Participation in the Action Research process was ranked at the bottom. Tentative conclusions are drawn with regard to teacher education and peace studies.

Concordance between Hopkins Symptom Checklist (HSCL-10) and Pakistan Anxiety and Depression Questionnaire (PADQ), in a rural self-motivated population in Pakistan

BackgroundThere have been no previous studies conducted in Pakistan comparing the concordance of any well established Western anxiety/depression screening instrument with an indigenous scale, in a community based setting.MethodsParticipants (n = 1040) in the present study were recruited from the six villages of our interest from the district Gujarat of Pakistan, using a convenient sampling technique. Interview versions of the Hopkins Symptom Checklist 10-item version (HSCL-10) and the Pakistani Anxiety and Depression Questionnaire (PADQ) were used to observe the pattern of anxiety and depression among the participants.ResultsThe internal consistency of HSCL-10 and PADQ were 0.86 and 0.84 respectively. Exploratory factor analysis found evidence for both a one-dimensional (distress) and a two-dimensional (anxiety and depression) solution for the HSCL-10, but only a one-dimensional (distress) solution for the PADQ. The HSCL-10 and PADQ found to be moderately to highly correlated (r = 0.62, p < 0.0001, 0.73 after correction for attenuation).ConclusionHSCL-10 has shown good screening abilities in a rural setting in Pakistan, and moderate to good concordance with an indigenous instrument measuring psychological distress. The HSCL-10 can therefore be used as a screening instrument, both in clinical and epidemiological settings in Pakistan, and for Pakistani immigrants living in Western societies.

Responding to HIV in Afghanistan

Impoverished and war-torn Afghanistan is now facing an epidemic of HIV infection owing to its increasing numbers of injecting drug users, many of whom have returned from refugee settings in Pakistan and Iran. Other vulnerable groups are also at high risk of HIV infection. As a low-prevalence but high-risk country, Afghanistan's national authorities recognise HIV control as a major priority. The country is adopting a public-health approach that includes harm reduction to reduce the spread of HIV among injecting drug users.

Hyperendemic pulmonary tuberculosis in peri-urban areas of Karachi, Pakistan

BackgroundCurrently there are very limited empirical data available on the prevalence of pulmonary tuberculosis among residents of marginalized settings in Pakistan. This study assessed the prevalence of pulmonary tuberculosis through active case detection and evaluated predictors of pulmonary tuberculosis among residents of two peri-urban neighbourhoods of Karachi, Pakistan.MethodsA cross-sectional study was conducted in two peri-urban neighbourhoods from May 2002 to November 2002. Systematic sampling design was used to select households for inclusion in the study. Consenting subjects aged 15 years or more from selected households were interviewed and, whenever possible, sputum samples were obtained. Sputum samples were subjected to direct microscopy by Ziehl-Neelson method, bacterial culture and antibiotic sensitivity tests.ResultsThe prevalence (per 100,000) of pulmonary tuberculosis among the subjects aged 15 years or more, who participated in the study was 329 (95% confidence interval (CI): 195 – 519). The prevalence (per 100,000) of pulmonary tuberculosis adjusted for non-sampling was 438 (95% CI: 282 – 651). Other than cough, none of the other clinical variables was significantly associated with pulmonary tuberculosis status. Analysis of drug sensitivity pattern of 15 strains of Mycobacterium tuberculosis revealed that one strain was resistant to isoniazid alone, one to streptomycin alone and one was resistant to isoniazid and streptomycin. The remaining 12 strains were susceptible to all five drugs including streptomycin, isoniazid, rifampicin, ethambutol, and pyrazinamide.ConclusionThis study of previously undetected tuberculosis cases in an impoverished peri-urban setting reveals the poor operational performance of Pakistan's current approach to tuberculosis control; it also demonstrates a higher prevalence of pulmonary tuberculosis than current national estimates. Public health authorities may wish to augment health education efforts aimed at prompting health-seeking behaviour to facilitate more complete and earlier case detection. Such efforts to improve passive case-finding, if combined with more accessible DOTS infra-structure for treatment of detected cases, may help to diminish the high tuberculosis-related morbidity and mortality in marginalized populations. The economics of implementing a more active approach to case finding in resource-constrained setting also deserve further study.

Development and validation of a questionnaire for anxiety and depression in Pakistan

Background Currently clinicians and researchers in Pakistan have to use translated western instruments to screen for anxiety and depressive disorders. This study investigated the local idioms of emotional distress in Pakistan to develop a culturally valid and easy-to-use instrument to screen for common mental disorders in general clinical settings. Methods A systematic survey was conducted of psychiatric case notes of patients attending clinics in Peshawar and Lahore, diagnosed with anxiety or depressive disorders, to identify the range of common idioms of psychological distress. A pilot version of the questionnaire was refined and validated among a composite sample of 330 patients in inpatient, outpatient and rural community settings. ICD-10 Diagnostic Criteria for Research were used to define cases and patients' relatives acted as normal controls. Results The pilot version of the questionnaire was reduced to 42 items based on odds ratios between cases and controls. Anxiety symptoms were generally reported by depressed patients, but not vice versa. Finally 30 items were selected, in two sub-scales. This final version achieved sensitivity, specificity, and positive and negative predicted values of over 90% when comparing cases and controls. Limitations This questionnaire was based on what patients tell doctors and may not capture the entire repertoire of local idioms of distress. The validation study was conducted only in an Urdu/Punjabi speaking population, in Lahore and surrounding areas. Conclusions The Pakistan Anxiety and Depression Questionnaire consists of an anxiety/depression scale and a depression scale, each of 15 items. It demonstrates excellent validity as screening instrument for anxiety and depressive disorders in clinical settings in Pakistan.

Psychomotor Skills for the Undergraduate Medical Curriculum in a Developing Country - Pakistan

To identify essential psychomotor skills for all the medical graduates of an undergraduate programme in Pakistan. Twenty-five physicians practising in a tertiary care centre and ninety primary care physicians used a Likert's scale, ranging from "very essential" to"not required at all", to mark 99 psychomotor skills in the undergraduate medical curriculum in Pakistan. Overall the opinions of both the groups about the essential skills matched except for a few areas. This study provides baseline data about psychomotor skills that a medical graduate in developing countries should be able to perform. Further studies will be undertaken by involving other stakeholders to identify and incorporate these skills in the undergraduate medical curriculum, thereby enabling graduates to practice in all the settings in Pakistan.

A Time-Series Analysis of Self-Employment in the United States

In the early 1970s the proportion of the nonagricultural labor force self-employed in the United States ceased its downward trend and has been rising ever since. This study provides an analysis of the causes of this change. A general-equilibrium model of self- employment and wage employment is analyzed, and aggregate U.S. time- series data are used to test predictions derived from the model. The empirical analysis indicates that changes in technology, industrial structure, tax rates, and social-security retirement benefits have contributed to the reversal of the previous downward trend, which had persisted for over a century. Copyright 1987 by University of Chicago Press.