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Pervez A, Bukhari MM, Chhapra R, Baig MI, Martins RS, Pirzada S, Rizvi NA, Aamdani SS, Ayub B, Rehman AA, Mustafa MA, Nadeem S, Asad N, Haider AH, Nadeem T. Adolopment of clinical practice guidelines and creation of referral pathways for psychiatric conditions in Pakistan. Lancet Reg Health Southeast Asia 2024; 23:100387. [PMID: 38486880 PMCID: PMC10938165 DOI: 10.1016/j.lansea.2024.100387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/07/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024]
Abstract
Psychiatric disorders are highly prevalent in Pakistan and burdens the scarce number of psychiatrists present in the country. The establishment of evidence-based clinical practice guidelines (EBCPGs) and primary-care referral pathways within the local context is imperative to make the process efficient. In this Health Policy, we aimed to develop EBCPGs and primary-care referral pathways that are specific to Pakistan's primary-care setting, with the aim of facilitating the management of psychiatric conditions. Ten EBCPGs were created through the GRADE-ADOLOPMENT process; two recommendations were adopted with minor changes, 43 were excluded, and all others were adopted without any changes. Ten primary-care referral pathways for managing ten psychiatric disorders were created and 23 recommendations were added which will help to bridge the gap in care provision. These psychiatric referral pathways and EBCPGs will bring Pakistan's healthcare system a step closer to achieving optimal health outcomes for patients.
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Affiliation(s)
- Alina Pervez
- Center for Clinical Best Practices, Clinical and Translational Research Incubator, Aga Khan University, Karachi, Pakistan
| | | | | | | | - Russell Seth Martins
- Center for Clinical Best Practices, Clinical and Translational Research Incubator, Aga Khan University, Karachi, Pakistan
| | - Sonia Pirzada
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Nashia Ali Rizvi
- Center for Clinical Best Practices, Clinical and Translational Research Incubator, Aga Khan University, Karachi, Pakistan
| | | | - Bushra Ayub
- Learning Research Centre, Patel Hospital, Karachi, Pakistan
| | - Alina Abdul Rehman
- Center for Clinical Best Practices, Clinical and Translational Research Incubator, Aga Khan University, Karachi, Pakistan
| | - Mohsin Ali Mustafa
- Center for Clinical Best Practices, Clinical and Translational Research Incubator, Aga Khan University, Karachi, Pakistan
| | - Sarah Nadeem
- Section of Endocrinology, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Nargis Asad
- Department of Psychiatry, Aga Khan University, Karachi, Pakistan
| | | | - Tania Nadeem
- Department of Psychiatry, Aga Khan University, Karachi, Pakistan
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Shafiq Y, Rubini E, Fazal ZZ, Bukhari MM, Zakaria M, Zeeshan NUH, Muhammad A, Ragazzoni L, Barone-Adesi F, Valente M. Correction: Impact of Ebola and COVID‑19 on maternal, neonatal, and child health care among populations affected by conflicts: a scoping review exploring demand and supply‑side barriers and solutions. Confl Health 2024; 18:18. [PMID: 38429840 PMCID: PMC10908184 DOI: 10.1186/s13031-024-00576-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024] Open
Affiliation(s)
- Yasir Shafiq
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy.
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
- Centre of Excellence for Trauma and Emergencies (CETE) & Community Health Science, The Aga Khan University, Karachi, Pakistan.
- Harvard Humanitarian Initiative, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Bostan, USA.
- Department of Pediatrics, Brigham and Women's Hospital, Global Advancement of Infants and Mothers, Boston, USA.
| | - Elena Rubini
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
| | | | | | | | | | | | - Luca Ragazzoni
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
| | - Francesco Barone-Adesi
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Martina Valente
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
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Shafiq Y, Rubini E, Fazal ZZ, Bukhari MM, Zakaria M, Zeeshan NUH, Muhammad A, Ragazzoni L, Barone-Adesi F, Valente M. Impact of Ebola and COVID-19 on maternal, neonatal, and child health care among populations affected by conflicts: a scoping review exploring demand and supply-side barriers and solutions. Confl Health 2024; 18:12. [PMID: 38291492 PMCID: PMC10829480 DOI: 10.1186/s13031-024-00572-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024] Open
Abstract
INTRODUCTION Armed conflicts have a severe impact on the health of women and children. Global health emergencies such as pandemics and disease outbreaks further exacerbate the challenges faced by vulnerable populations in accessing maternal, neonatal, and child healthcare (MNCH). There is a lack of evidence that summarizes the challenges faced by conflict-affected pregnant women, mothers, and children in accessing MNCH services during global health emergencies, mainly the Ebola and COVID-19 pandemics. This scoping review aimed to analyze studies evaluating and addressing barriers to accessing comprehensive MNCH services during Ebola and COVID-19 emergencies in populations affected by conflict. METHODS The search was conducted on PubMed, Scopus, and Web of Science databases using terms related to Ebola and COVID-19, conflicts, and MNCH. Original studies published between 1990 and 2022 were retrieved. Articles addressing the challenges in accessing MNCH-related services during pandemics in conflict-affected settings were included. Thematic analysis was performed to categorize the findings and identify barriers and solutions. RESULTS Twenty-nine studies met the inclusion criteria. Challenges were identified in various MNCH domains, including antenatal care, intrapartum care, postnatal care, vaccination, family planning, and the management of childhood illnesses. Ebola-related supply-side challenges mainly concerned accessibility issues, health workforce constraints, and the adoption of stringent protocols. COVID-19 has resulted in barriers related to access to care, challenges pertaining to the health workforce, and new service adoption. On the demand-side, Ebola- and COVID-19-related risks and apprehensions were the leading barriers in accessing MNCH care. Community constraints on utilizing services during Ebola were caused by a lack of trust and awareness. Demand-side challenges of COVID-19 included fear of disease, language barriers, and communication difficulties. Strategies such as partnerships, strengthening of health systems, service innovation, and community-based initiatives have been employed to overcome these barriers. CONCLUSION Global health emergencies amplify the barriers to accessing MNCH services faced by conflict-affected populations. Cultural, linguistic, and supply-side factors are key challenges affecting various MNCH domains. Community-sensitive initiatives enhancing primary health care (PHC), mobile clinics, or outreach programs, and the integration of MNCH into PHC delivery should be implemented. Efforts should prioritize the well-being and empowerment of vulnerable populations. Addressing these barriers is crucial for achieving universal health coverage and the Sustainable Development Goals.
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Affiliation(s)
- Yasir Shafiq
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy.
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
- Centre of Excellence for Trauma and Emergencies (CETE) & Community Health Science, The Aga Khan University, Karachi, Pakistan.
- Harvard Humanitarian Initiative, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Bostan, USA.
- Department of Pediatrics, Brigham and Women's Hospital, Global Advancement of Infants and Mothers, Boston, USA.
| | - Elena Rubini
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
| | | | | | | | | | | | - Luca Ragazzoni
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
| | - Francesco Barone-Adesi
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Martina Valente
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health, Università del Piemonte Orientale, Novara, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, Italy
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