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Jeeva IK, Masud S, Ali TS, Siddiqui MAR, Waheed AA, Awan A. Evaluation of visual outcomes with toric intraocular lens implantation using digital marker during cataract surgery. J PAK MED ASSOC 2024; 74:450-455. [PMID: 38591276 DOI: 10.47391/jpma.8008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Objectives To assess the visual improvement and mean residual astigmatism in patients who underwent cataract surgery with toric intraocular lens. METHODS The retrospective, observational study was conducted at the Department of Ophthalmology, Aga Khan University Hospital, Karachi, and comprised data from January 1, 2018, to December 31, 2020, related to adult patients who had regular astigmatism of at least 0.75D and underwent cataract surgery with toric intraocular lens implantation using a digital marker. The patients were followed up on post-operative days 1, 7, 30, 90 and 180. Along with age, the degree of astigmatism was noted. The visual acuity was calculated pre- and post-operatively. The mean residual astigmatism was then noted for all patients post-operatively. Data was analysed using SPSS 22. RESULTS The sample comprised 240 eyes of 177 patients; 99(55.9%) males and 78(44.1%) females. The mean age of the sample was 62.5±10.6 years. The mean unaided visual acuity improved post-operatively from 0.57±0.38 to 0.07±0.22 at 90 days. At the 30-day follow-up, mean residual astigmatism had reduced from 1.52±0.84 to 0.01±0.09 (p<0.001). The mean intraocular lens rotation from the intended axis was 0.73°±0.92° on day 30. CONCLUSIONS Toric intraocular lens implantation using a digital marker could effectively reduce the post-operative cylinder, and improve the unaided visual acuity following cataract surgery.
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Affiliation(s)
- Irfan Kabiruddin Jeeva
- Department of Ophthalmology and Visual Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - Sidra Masud
- Department of Ophthalmology and Visual Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - Tazeen Saeed Ali
- Department of Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | | | | | - Amna Awan
- 4th Year MBBS Student, Ziauddin Medical University, Karachi, Pakistan
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Rehman R, Ali TS, Khalid S, Ali R. The ongoing evolution of mentorship: Advancing the formal mentorship program at AKU-SONAM. Pak J Med Sci 2024; 40:514-519. [PMID: 38356814 PMCID: PMC10862465 DOI: 10.12669/pjms.40.3.8212] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/30/2023] [Accepted: 11/28/2023] [Indexed: 02/16/2024] Open
Abstract
Objective To investigate the perceptions of mentors, mentees, administrators (including chairs, co-chairs, and coordinators of the mentoring program), and leadership regarding the Faculty Mentorship Program at AKU School of Nursing and Midwifery (AKU-SONAM). Additionally, the study aimed to explore the strengths and challenges faced by the program. Methods A qualitative exploratory study on mentorship was carried out in AKU-SONAM from February till December 2021. In this study we conducted purposive criterion sampling. The study participants included mentors, mentees, administrators, and the dean of AKU-SONAM. An interview guide was developed, validated, and reviewed by experts. After piloting, two focused group discussions and three in-depth interviews were conducted. Results Thematic analysis of the data revealed the following themes: "Nurturing growth and development in mentoring relationships," "Establishing a strong foundation for effective mentoring," and "Opportunities for growth and development through overcoming challenges." Conclusion The participants expressed confidence in the existing support system, leadership, and mentorship program at the institution. They highlighted the significance of regular monitoring to recognize areas of improvement uphold high standards and ensure excellence.
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Affiliation(s)
- Rehana Rehman
- Rehana Rehman Professor, Department of Biological & Biomedical sciences, Aga Khan University, Karachi. Pakistan
| | - Tazeen Saeed Ali
- Tazeen Saeed Ali Interim Dean, School of nursing and Midwifery Aga Khan University, Karachi. Pakistan
| | - Saira Khalid
- Saira Khalid Nursing Instructor, College of Nursing Armed Forces Postgraduate, Medical Institute (AFPGMI), Rawalpindi. Pakistan
| | - Rahila Ali
- Rahila Ali Senior Instructor, Department for Educational Development, Aga Khan University, Karachi. Pakistan
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Ali AM, Alameri RA, Brooks T, Ali TS, Ibrahim N, Khatatbeh H, Pakai A, Alkhamees AA, Al-Dossary SA. Cut-off scores of the Depression Anxiety Stress Scale-8: Implications for improving the management of chronic pain. J Clin Nurs 2023; 32:8054-8062. [PMID: 37674274 DOI: 10.1111/jocn.16878] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/13/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023]
Abstract
AIM Mental distress, non-specific symptoms of depression and anxiety, is common in chronic pelvic pain (CPP). It contributes to poor recovery. Women's health nurses operate in multidisciplinary teams to facilitate the assessment and treatment of CPP. However, valid cut-off points for identifying highly distressed patients are lacking, entailing a gap in CPP management. DESIGN This instrumental cross-sectional study identified a statistically derived cut-off score for the Depression Anxiety Stress Scale-8 (DASS-8) among 214 Australian women with CPP (mean age = 33.3, SD = 12.4, range = 13-71 years). METHODS Receiver operator characteristic curve, decision trees and K-means clustering techniques were used to examine the predictive capacity of the DASS-8 for psychiatric comorbidity, pain severity, any medication intake, analgesic intake and sexual abuse. The study is prepared according to the STROBE checklist. RESULTS Cut-off points resulting from the analysis were ordered ascendingly. The median (13.0) was chosen as an optimal cut-off score for predicting key outcomes. Women with DASS-8 scores below 15.5 had higher analgesic intake. CONCLUSION CPP women with a DASS-8 score above 13.0 express greater pain severity, psychiatric comorbidity and polypharmacy. Thus, they may be a specific target for nursing interventions dedicated to alleviating pain through the management of associated co-morbidities. IMPLICATIONS FOR PATIENT CARE At a cut-off point of 13.0, the DASS-8 may be a practical instrument for recommending a thorough clinician-based examination for psychiatric comorbidity to facilitate adequate CPP management. It may be useful for evaluating patients' response to nursing pain management efforts. Replications of the study in different populations/countries are warranted.
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Affiliation(s)
- Amira Mohammed Ali
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Rana Ali Alameri
- Fundamentals of Nursing Department, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Tiffany Brooks
- University of Adelaide and Aware Women's Health, North Adelaide, South Australia, Australia
| | - Tazeen Saeed Ali
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | - Nashwa Ibrahim
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | | | - Annamaria Pakai
- Institute of Nursing Sciences, Basic Health Sciences and Health Visiting, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Abdulmajeed A Alkhamees
- Department of Medicine, Unayzah College of Medicine and Medical Sciences, Qassim University, Unayzah, Saudi Arabia
| | - Saeed A Al-Dossary
- Psychology Department, College of Education, University of Ha'il, Ha'il, Saudi Arabia
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Tharani A, Van Hecke A, Ali TS, Duprez V. Perspectives on self-management of individuals living with chronic illnesses: A qualitative study in the Asian context. Res Nurs Health 2023; 46:591-602. [PMID: 37704572 DOI: 10.1002/nur.22339] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 08/17/2023] [Accepted: 08/31/2023] [Indexed: 09/15/2023]
Abstract
Living with a chronic illness requires individuals to perform a critical role in self-managing their illness to improve their quality of life and prevent disease-related complications. To our knowledge, no studies have explored how individuals perceive managing their illness in daily living within the Asian context. This exploratory-descriptive qualitative study aimed to explore the individuals' perspectives regarding self-managing their life with a chronic illness within the Asian context. Individual interviews were conducted with 15 adults living with chronic illness, from three teaching hospitals in Pakistan. An iterative process was followed for data collection and analysis. The analysis identified self-management as complex and situation-driven with variable roles for individuals, namely follower, selective follower, self-permitting role, and active role. Three interrelated elements were found to be influencing these roles: the components of self-management; individuals' relationship with agencies (significant people and power); and their inner drives. Individuals keep moving between these four self-management roles to avoid disharmony and reciprocate the efforts of their significant others. The interdependent community structure, which is a reality in Asian society, was reflected in our data. With this in view, a great deal of authority was given to family relationships and healthcare professionals (HCPs). This study found a lack of collaborative partnership role between individuals and HCPs. The findings and a suggested conceptual figure can facilitate redefining the individuals' and professionals' roles in the healthcare system to promote collaborative partnership and improve individuals' experience of living with a chronic illness within the Asian context. Members of the research team have extensive experience in research around chronic illness management, and self-management (support) from the Western context. The researcher did not need the patient or public contribution in this preliminary exploratory study from the Asian context.
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Affiliation(s)
- Ambreen Tharani
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- School of Nursing and Midwifery, The Aga Khan University, Karachi, Pakistan
| | - Ann Van Hecke
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Department of Nursing, Ghent University Hospital, Ghent, Belgium
| | - Tazeen Saeed Ali
- School of Nursing and Midwifery, The Aga Khan University, Karachi, Pakistan
| | - Veerle Duprez
- Department of Nursing, Ghent University Hospital, Ghent, Belgium
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Kumar P, Khan UR, Soomar SM, Jetha Z, Ali TS. Workplace Violence and Bullying Faced by Health Care Personnel at the Emergency Department of a Tertiary Care Hospital of Karachi, Pakistan: A Cross-Sectional Study. J Emerg Nurs 2023; 49:785-795. [PMID: 37178090 DOI: 10.1016/j.jen.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION The emergency department is the most affected by physical and verbal abuse and bullying in health care. Violence against health care workers not only affects their safety, but also their performance and motivation. This study aimed to determine the prevalence and associated determinants of violence against health care personnel. METHODS A cross-sectional study design was used with 182 health care personnel at the emergency department tertiary care hospital of Karachi, Pakistan. Data were collected through a questionnaire comprised of 2 sections: (1) demographic questions and (2) statements to identify the prevalence of workplace violence and bullying among health care personnel. Nonprobability purposive sampling was used for recruitment. Binary logistic regression was used to identify the prevalence and determinants of violence and bullying. RESULTS Most participants were younger than 40 years of age (n = 106, 58.2%). Participants were mainly nurses (n = 105, 57.7%) and physicians (n = 31, 17.0%). Participants reported experiencing sexual abuse (n = 5, 2.7%), physical violence (n = 30, 16.50%), verbal abuse (n = 107, 58.8%), and bullying (n = 49, 26.9%). The odds of experiencing physical violence were 3.7 times greater (confidence interval = 1.6-9.2) when there was not a procedure for reporting workplace violence compared to when there was a procedure. DISCUSSION Attention is required to identify the prevalence of workplace violence. Creating effective policies and procedures for a reporting system would potentially lead to lowering violence rates and positively impacting health care workers' well-being.
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Rehman R, Ali R, Khalid S, Ali TS. Seeds of trust ripe as luscious fruits: Faculty mentorship forum at Aga Khan University Medical College. Pak J Med Sci 2023; 39:1268-1274. [PMID: 37680801 PMCID: PMC10480750 DOI: 10.12669/pjms.39.5.7175] [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: 09/24/2022] [Revised: 01/24/2023] [Accepted: 05/08/2023] [Indexed: 09/09/2023] Open
Abstract
Background & Objective Faculty members require mentoring in all stages of their professional development. Aga Khan University (AKU) has initiated mentorship programs for students and faculty at AKU Medical College (AKU- MC) and AKU School of Nursing and Midwifery (AKU-SONAM). This study aimed to explore perceptions of mentors, mentees, administrators (chairs, co-chairs, founder members and coordinators of the mentoring program) and leadership and further investigate the strengths and challenges faced by 'Faculty Mentorship Program' at AKU- MC. Methods We conducted a qualitative exploratory study from February till December 2021 after approval from AKU using purposive criterion sampling. Mentors, mentees, administrators and dean of AKU- MC were included in the study. The interview guide was developed, validated and reviewed by experts. After piloting, four focused group discussions and 8 in-depth interviews were conducted in AKU- MC. Results The findings described the transition from informal to formal mentorship, identified challenges faced by mentors and mentees and suggested the role of leadership / administrators. The themes identified were "Continuous improvement of mentoring practices", "Building strong foundations for mentoring relationships", and "Growth and development through challenging experiences". Conclusion The faculty mentorship program at AKU-MC was in line with the goals and vision of the institution. All participants identified the need of additional resources, administrative support, rewards, incentives and recognition of mentors for sustainability of the program.
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Affiliation(s)
- Rehana Rehman
- Rehana Rehman, Professor, Department of Biological & Biomedical Sciences, Aga Khan University, Karachi. Pakistan
| | - Rahila Ali
- Rahila Ali, Senior Instructor, Department for Educational Development, Aga Khan University, Karachi. Pakistan
| | - Saira Khalid
- Saira Khalid, Nursing Instructor, College of Nursing Armed Forces Postgraduate, Medical Institute (AFPGMI), Rawalpindi. Pakistan
| | - Tazeen Saeed Ali
- Tazeen Saeed Ali Interim Dean, School of nursing and Midwifery, Aga Khan University, Karachi. Pakistan
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Ejaz M, Ekström AM, Ali TS, Salazar M, Ahmed A, Ali D, Haroon A, Siddiqi S. Integration of human papillomavirus associated anal cancer screening into HIV care and treatment program in Pakistan: perceptions of policymakers, managers, and care providers. BMC Public Health 2023; 23:1034. [PMID: 37259085 DOI: 10.1186/s12889-023-15896-1] [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: 04/09/2022] [Accepted: 05/15/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND The incidence of anal cancer, largely associated with anal human papillomavirus (HPV) infection, is increasing among men who have sex with men (MSM), and transgender women living with or without HIV. Screening for anal cancer to detect anal precancerous lesions in high-risk groups is an important opportunity for prevention but still lacking in many low-and-middle-income countries. The aim of this study was to explore the readiness of Pakistan's healthcare system to integrate anal cancer and HPV screening into a national HIV program, as perceived by policymakers, health managers, and healthcare providers. DESIGN This qualitative study using key-informant interviews with participants influence in policy making, implementation and advocacy from public and private sector were conducted between March 2021 to August 2021 in Karachi Pakistan. METHODS Key informants were purposely selected from different domains of the healthcare system responsible for the target group of interest, MSM and transgender-women in general and people living with HIV in particular. A total of 18 key informants, at different levels of seniority were recruited from governmental and non-governmental organizations, high-level infectious disease healthcare managers, and United Nations Program representatives. Qualitative content analysis was used to identify the manifest and latent themes, based on socioecological framework. RESULTS The results were grouped into five major themes; (1) The policy context and priorities, (2) Health systems factors, (3) Community environment, (4) Healthcare setting & providers and (5) Individual-level obstacles. The policy actors expressed their concerns about their limited voice in country's health and health related priority setting. Informants reported a lack of political will and suggested that government should bring a change in the paradigm of healthcare service delivery from reactive to proactive approach. Although, participants unanimously favored integration of HPV preventive services into existing HIV program, they also identified several service delivery barriers including trained workforce shortage, limited capacity of information technology, lack of supplies needed for screening, lack of financing, and lack of services that could meet key-populations needs. Participants also predicted other implementation challenges such as stigma, social victimization, and systemic discrimination against at-risk groups at healthcare facilities. CONCLUSION Although policy makers and health providers in Pakistan saw a clear need to scale-up and integrate anal cancer screening for key populations, the feasibility of this is dependent on political will, financing, anti-stigma and discrimination interventions and health system efficiency.
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Affiliation(s)
- Muslima Ejaz
- Department of Global Public Health, Karolinska Institutet Stockholm, Widerströmska Huset 18 A 171 77, Stockholm, Sweden.
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan.
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet Stockholm, Widerströmska Huset 18 A 171 77, Stockholm, Sweden
- Department of Infectious Diseases, South Central Hospital, Stockholm, Sweden
| | | | - Mariano Salazar
- Department of Global Public Health, Karolinska Institutet Stockholm, Widerströmska Huset 18 A 171 77, Stockholm, Sweden
| | - Alyan Ahmed
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Dania Ali
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Ayman Haroon
- Department of Biostatistics and Epidemiology, School of Public Health, Boston University, Boston, MA, USA
| | - Sameen Siddiqi
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
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Ali SS, Ali TS, Adnan F, Asif N, Memon Z, Barkat S, Soofi S, Hussaini AS, Karmaliani R. Safe motherhood: A hidden reality in Pakistan. Midwifery 2023; 119:103624. [PMID: 36804831 DOI: 10.1016/j.midw.2023.103624] [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: 03/31/2022] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To explore the perceptions and experiences of healthcare professionals, including female health visitors, female health workers, community midwives, and heads of departments of healthcare facilities, regarding the importance of the Safe Motherhood Initiative (SMI), its pillars, and its foundational principles. DESIGN Qualitative descriptive exploratory study. SETTING This study was conducted in healthcare centres in 10 districts in Pakistan: six in Gilgit Baltistan, two in Chitral, and two in Sindh. PARTICIPANTS Healthcare professionals were recruited using a purposive sampling technique. In total, 14 in-depth interviews were conducted. FINDINGS The following themes emerged through thematic analysis: (1) health and well-being of mothers and newborns; (2) strengthening the SMI pillars; (3) equity of health services; and (4) effective strategies for behaviour modification. Each theme had two categories. KEY CONCLUSIONS The health and well-being of mothers and newborns are key indicators; as such, interventions should be made to promote their quality of life. Capacity building and refresher training on antenatal care, childbirth, postnatal care, postabortion care, and family planning can be considered effective to enhance the competencies of healthcare professionals. IMPLICATIONS FOR PRACTICE The findings of this study suggest that healthcare professionals should receive training to enhance their competencies and provide safe care.
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Affiliation(s)
- Shahnaz Shahid Ali
- School of Nursing and Midwifery/Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
| | - Tazeen Saeed Ali
- School of Nursing and Midwifery/Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Farzana Adnan
- School of Nursing and Midwifery/Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Nimira Asif
- School of Nursing and Midwifery/Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Zahid Memon
- Centre of Excellence for Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Samina Barkat
- Centre of Excellence for Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sajid Soofi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Anum S Hussaini
- School of Nursing and Midwifery/Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Rozina Karmaliani
- School of Nursing and Midwifery/Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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Shahid Ali S, Letourneau N, Rajan A, Jaffer S, Adnan F, Asif N, Ali TS. Midwives' perspectives on perinatal mental health: A qualitative exploratory study in a maternity setting in Karachi, Pakistan. Asian J Psychiatr 2023; 80:103356. [PMID: 36470193 DOI: 10.1016/j.ajp.2022.103356] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 10/29/2022] [Accepted: 11/25/2022] [Indexed: 11/27/2022]
Abstract
Women experience perinatal mental health problems (PMHP), such as anxiety and depression antenatally and/or postnatally. Among Asian countries, Pakistan has the highest prevalence of postnatal depression ranging from 28% to 63%. This study aimed to explore midwives' perceptions, understanding, thoughts, and feelings regarding perinatal mental health (PMH), as well as experiences and roles in identifying and managing perinatal women cases suffering from PMHP. A qualitative, descriptive, exploratory design was used. The study was conducted at Koohi Goth Hospital. Purposive sampling was used to recruit practicing midwives holding diplomas in midwifery and public health, and with at least two years of experience. Ten participants were recruited. Data were collected by conducting in-depth interviews using a semi-structured interview guide, translated into Urdu. Interviews were audio recorded. Ethics approval was attained by the institutional Ethical Review Committee. Data analysis was done manually by using the content analysis steps described by Creswell. From the analysis, three themes emerged: 1) Dearth of PMH competencies; 2) Importance of PMH; and 3) Myths related to PMH. PMHP undermine mothers' and infants outcomes, thus, midwives should be competent in assessing and managing symptoms in perinatal women to reduce suffering.
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Affiliation(s)
- Shahnaz Shahid Ali
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan.
| | | | | | | | - Farzana Adnan
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | - Nimira Asif
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | - Tazeen Saeed Ali
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
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Ali TS, Ali SS, Nadeem S, Memon Z, Soofi S, Madhani F, Karim Y, Mohammad S, Bhutta ZA. Perpetuation of gender discrimination in Pakistani society: results from a scoping review and qualitative study conducted in three provinces of Pakistan. BMC Womens Health 2022; 22:540. [PMID: 36550528 PMCID: PMC9772583 DOI: 10.1186/s12905-022-02011-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 10/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Gender discrimination is any unequal treatment of a person based on their sex. Women and girls are most likely to experience the negative impact of gender discrimination. The aim of this study is to assess the factors that influence gender discrimination in Pakistan, and its impact on women's life. METHODS A mixed method approach was used in the study in which a systematic review was done in phase one to explore the themes on gender discrimination, and qualitative interviews were conducted in phase two to explore the perception of people regarding gender discrimination. The qualitative interviews (in-depth interviews and focus group discussions) were conducted from married men and women, adolescent boys and girls, Healthcare Professionals (HCPs), Lady Health Visitors (LHVs) and Community Midwives (CMWs). The qualitative interviews were analyzed both manually and electronically through QSR NVivo 10. The triangulation of data from the systematic review and qualitative interviews were done to explore the gender discrimination related issues in Pakistan. RESULTS The six major themes have emerged from the systematic review and qualitative interviews. It includes (1) Status of a woman in the society (2) Gender inequality in health (3) Gender inequality in education (4) Gender inequality in employment (5) Gender biased social norms and cultural practices and (6) Micro and macro level recommendations. In addition, a woman is often viewed as a sexual object and dependent being who lacks self identity unless being married. Furthermore, women are restricted to household and child rearing responsibilities and are often neglected and forced to suppress self-expression. Likewise, men are viewed as dominant figures in lives of women who usually makes all family decisions. They are considered as financial providers and source of protection. Moreover, women face gender discrimination in many aspects of life including education and access to health care. CONCLUSION Gender discrimination is deeply rooted in the Pakistani society. To prevent gender discrimination, the entire society, especially women should be educated and gendered sensitized to improve the status of women in Pakistan.
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Affiliation(s)
- Tazeen Saeed Ali
- grid.7147.50000 0001 0633 6224School of Nursing and Midwifery, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan ,grid.7147.50000 0001 0633 6224Department of Community Health Sciences, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan
| | - Shahnaz Shahid Ali
- grid.7147.50000 0001 0633 6224School of Nursing and Midwifery, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan
| | - Sanober Nadeem
- grid.492602.b0000 0000 9892 3591Aga Khan Health Services, Karachi, Pakistan
| | - Zahid Memon
- grid.7147.50000 0001 0633 6224Center of Excellence Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Sajid Soofi
- grid.7147.50000 0001 0633 6224Center of Excellence Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Falak Madhani
- grid.492602.b0000 0000 9892 3591Aga Khan Health Services, Karachi, Pakistan
| | - Yasmin Karim
- Aga Khan Rural Service Pakistan, Gilgit, Pakistan
| | - Shah Mohammad
- grid.7147.50000 0001 0633 6224Center of Excellence Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar Ahmed Bhutta
- Institute for Global Health, Karachi, Pakistan ,grid.7147.50000 0001 0633 6224Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
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Saadaat R, Abdul-Ghafar J, Haidary AM, Atta N, Ali TS. Esophageal Carcinoma and Associated Risk Factors: A Case-control Study in Two Tertiary Care Hospitals of Kabul, Afghanistan. Cancer Manag Res 2022; 14:2445-2456. [PMID: 35975105 PMCID: PMC9375978 DOI: 10.2147/cmar.s372883] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/03/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose Esophageal cancer (EC) is the most common cancer among males in Afghanistan, thus we aimed to conduct a case-control study to determine the associated risk factors with EC in two tertiary care hospitals of Kabul, Afghanistan. Patients and Methods We enrolled 132 EC cases and 132 controls and used conditional logistic regression to estimate the odds ratio (OR) with consideration of 95% confidence interval (CI). Results The results of our study revealed that esophageal squamous cell carcinoma (ESCC) was the predominant type of EC constituting 75.8% of the cases. The results of the multivariate logistic analysis showed that males and older ages were at increased risk of developing EC (OR: 4.62, 95%CI, p-value=0.026) and (OR: 1.070, 95%CI, p-value <0.001), respectively. In addition, living in rural areas (OR: 46.64, 95%CI, p-value <0.001), being uneducated (OR: 13.94, 95%CI, p-value=0.042), using oral snuff (OR: 6.10, 95%CI, p-value=0.029), drinking hot tea (OR: 5.719, 95%CI, p-value=0.005), lack of physical exercise (OR: 32.548, 95%CI, p-value=0.001), less fresh fruit consumption (OR: 93.18, 95%CI, p-value<0.001) and family history of cancer (OR: 14.50, 95%CI, p-value=0.003) were significantly associated with the development of EC, while body mass index (BMI), smoking, alcohol drinking, consumption of spicy food and pickled vegetables did not have a significant association with EC. Moreover, the majority of the cases (83.3%) in our study were from to low-income families and the majority were unemployed (93.9%), of whom (50%) were farmers, who did not show statistically significant association. Conclusion Our study concluded that EC risk was higher in older ages, males, rural residents, uneducated people, oral-snuff users, hot tea drinkers, fewer fresh fruit consumers, lack of physical exercise, and family history of cancer. Further detailed studies and screening policies of the affected groups are suggested to further elaborate on the subject.
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Affiliation(s)
- Ramin Saadaat
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
| | - Jamshid Abdul-Ghafar
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
| | - Ahmed Maseh Haidary
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
| | - Nooria Atta
- Department of Gynecology and Obstetrics, Kabul University of Medical Science (KUMS), Kabul, Afghanistan
| | - Tazeen Saeed Ali
- School of Nursing and Midwifery and Department of Community Health Sciences, Aga Khan University (AKU), Karachi, Pakistan
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Rehman R, Khan F, Kayani N, Ali TS. Reflection of mentors and mentees at initiation of Faculty Mentorship Program at Aga Khan University: A perspective. Pak J Med Sci 2022; 38:1691-1695. [PMID: 35991259 PMCID: PMC9378395 DOI: 10.12669/pjms.38.6.5454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 04/09/2022] [Accepted: 04/25/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives: To explore perception of mentors and mentees about ‘Mentorship Program at Aga Khan University Medical College (AKU-MC) from a structured feedback form Methods: A retrospective study was conducted for evaluation of mentorship program at AKU-MC during the period from Jan 2019 to March, 2021. Responses on validated “Pre-intervention Probe Forms”, from forty-seven mentors and fourteen mentees inducted in the program were reviewed. Confidentiality and anonymity of data were deliberated. All replies to each question were entered in a separate worksheet to determine the frequency and percentage of answers. Responses conveying same message, but worded differently were then grouped. Results: All the mentees (n=14) responded positively to the question on the “understanding of the mentoring program. The mentees (n=12, 86%) recognized the potential of the program to transfer knowledge and skills, (n=11, 79%) supported its role for achievement of goals, (n=7, 50%), acknowledged its role in faculty relationships. The mentors expressed their enthusiasm to help the mentee’s in their professional development. They (n=20, 43%) offered support to set career goals, (n=29, 62%) proposed transfer of knowledge, skills, and experiences to achieve goals, (n=15, 32%) decided to be “role models”. Some (n=10, 21%) forecasted improved communication skills, (n=14, 30%) boosted leadership capabilities, (n=13, 28%) expected improved work performance, (n=15, 32%) opinioned that networking and leadership qualities will impact the growth of the mentee to meet the university’s expectations. Conclusion: Both mentors and mentees recognized the importance of the faculty mentorship program at AKU-MC for professional guidance, development and improvement in work performance.
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Affiliation(s)
- Rehana Rehman
- Dr. Rehana Rehman, MBBS, M. Phil, Ph.D., FHEA (UK) Associate Professor, Department of Biological & Biomedical Sciences Aga Khan University, Karachi, Pakistan
| | - Fauzia Khan
- Dr. Naila Kayani, Prfessor of Pathology & Medicine Aga Khan University, Karachi, Pakistan
- Correspondence: Dr. Fauzia Khan, Department of Anesthesiology, Faculty of Health Sciences, Medical College, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.
| | - Naila Kayani
- Dr. Fauzia Khan, MBBS, FRCA Professor, Department of Anesthesiology Aga Khan University, Karachi, Pakistan
| | - Tazeen Saeed Ali
- Dr. Tazeen Saeed Ali, Professor & Assistant Dean School of Nursing & Midwifery Aga Khan University, Karachi, Pakistan
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Ali AM, Al-Amer R, Atout M, Ali TS, Mansour AMH, Khatatbeh H, Alkhamees AA, Hendawy AO. The Nine-Item Internet Gaming Disorder Scale (IGDS9-SF): Its Psychometric Properties among Sri Lankan Students and Measurement Invariance across Sri Lanka, Turkey, Australia, and the USA. Healthcare (Basel) 2022; 10:healthcare10030490. [PMID: 35326968 PMCID: PMC8953588 DOI: 10.3390/healthcare10030490] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/04/2022] [Accepted: 03/05/2022] [Indexed: 12/24/2022] Open
Abstract
The prevalence of internet gaming disorders (IGD) is considerably high among youth, especially with the social isolation imposed by the ongoing COVID-19 pandemic. IGD adversely affects mental health, quality of life, and academic performance. The Internet Gaming Disorder Scale (IGDS9-SF) is designed to detect IGD according to DSM-IV diagnostic criteria. However, inconsistent results are reported on its capacity to diagnose IGD evenly across different cultures. To ensure the suitability of the IGDS9-SF as a global measure of IGD, this study examined the psychometric properties of the IGDS9-SF in a sample of Sri Lankan university students (N = 322, mean age = 17.2 ± 0.6, range = 16–18 years, 56.5% males) and evaluated its measurement invariance across samples from Sri Lanka, Turkey, Australia, and the USA. Among Sri Lankan students, a unidimensional structure expressed good fit, invariance across different groups (e.g., gender, ethnicity, and income), adequate criterion validity (strong correlation with motives of internet gaming, daily gaming duration, and sleep quality), and good reliability (alpha = 0.81). Males and online multiplayers expressed higher IGD levels, greater time spent gaming, and more endorsement of gaming motives (e.g., Social and Coping) than females and offline players. Across countries, the IGDS9-SF was invariant at the configural, metric, and scalar levels, although strict invariance was not maintained. The lowest and highest IGD levels were reported among Turkish and American respondents, respectively. In conclusion, the IGDS9-SF can be reliably used to measure IGD among Sri Lankan youth. Because the scale holds scalar invariance across countries, its scores can be used to compare IGD levels in the studied countries.
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Affiliation(s)
- Amira Mohammed Ali
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Smouha, Alexandria 21527, Egypt;
| | - Rasmieh Al-Amer
- Faculty of Nursing, Isra University, Amman 11953, Jordan;
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW 2751, Australia
| | - Maha Atout
- School of Nursing, Philadelphia University, Amman 19392, Jordan;
| | - Tazeen Saeed Ali
- School of Nursing and Midwifery, Aga Khan University, Karachi 3500, Pakistan;
| | - Ayman M. Hamdan Mansour
- Department of Psychiatric and Mental Health Nursing, School of Nursing, The University of Jordan, Amman 11942, Jordan;
| | - Haitham Khatatbeh
- Faculty of Health Sciences, Doctoral School of Health Sciences, University of Pécs, 7621 Pécs, Hungary;
| | - Abdulmajeed A. Alkhamees
- Department of Medicine, Unayzah College of Medicine and Medical Sciences, Qassim University, Unayzah, Al Qassim 52571, Saudi Arabia
- Correspondence: ; Tel.: +966-06-3800916
| | - Amin Omar Hendawy
- Department of Biological Production, Tokyo University of Agriculture and Technology, Tokyo 183-8509, Japan;
- Department of Animal and Poultry Production, Faculty of Agriculture, Damanhour University, Damanhour 22516, Egypt
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14
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Ejaz M, Ekström AM, Ahmed A, Haroon A, Ali D, Ali TS, Salazar M. Human Papillomavirus associated prevention: knowledge, attitudes, and perceived risks among men who have sex with men and transgender women in Pakistan: a qualitative study. BMC Public Health 2022; 22:378. [PMID: 35193544 PMCID: PMC8864907 DOI: 10.1186/s12889-022-12775-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/14/2022] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Men who have sex with men (MSM) and transgender individuals are at higher risk of genital warts and anal cancer due to sexually transmitted human papillomavirus infection. This study explores MSM and transgender women's perceptions of Human papillomavirus (HPV) infection and HPV prevention strategies (screening and vaccination) in Pakistan. DESIGN A qualitative study using focus group discussions (FGD) with self-identified MSM, male sex workers and transgender women were conducted between March 2019 to August 2019 in Karachi, Pakistan. METHODS Participants were recruited from community-based organization (CBO) working for MSM and transgender women. A total of 38 men and 10 transgender women took part in 6 FGDs. Discussions were recorded, translated, transcribed verbatim and analyzed using content analysis. RESULTS Three themes were identified from the emerging analysis. These are, 1) Knowledge and risk perceptions about STIs and HPV, 2) Beliefs and attitudes towards HPV prevention, 3) Participant's recommendations for HPV vaccination and anal Pap screening. Participants described lack of knowledge of HPV and its health consequences as HIV is the only focus of attention of the government and the local CBOs. None of participants had heard about HPV prevention including vaccination and anal Pap screening for men but expressed a positive attitude towards prevention. Genital warts and anal cancer were perceived as severe potential consequences of a known risk behaviors. All participants stated they would be interested in taking an HPV vaccine but acknowledged that the provision of services for sexually transmitted infections (STI) are inadequate to meet the needs of key populations and are not prioritized by the government. The main perceived barriers to access HPV prevention included cost and challenges to access public health care services or openly discussing one's sexual orientation with health care providers. Participants generally preferred the CBO for more professional, unbiased staff attitudes that respect patients' integrity, confidentiality and privacy. Most participants thought that in case the government is non-cooperative, CBOs should work in the interest of HPV eradication and generate funds through international funding. CONCLUSIONS The findings from this study can help public health policy and researchers to understand this minority's perspective on HPV prevention. Given the low level of knowledge about HPV infection and its negative health consequences there is a need of HPV education combined with STI education and awareness through HPV brochures to educate the target population effectively.
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Affiliation(s)
- Muslima Ejaz
- Department of Global Public Health Karolinska Institutet, Stockholm, Sweden. .,Department of Community Health Sciences, the Aga Khan University, Karachi, Pakistan.
| | - Anna Mia Ekström
- Department of Global Public Health Karolinska Institutet, Stockholm, Sweden
| | - Alyan Ahmed
- Department of Community Health Sciences, the Aga Khan University, Karachi, Pakistan
| | - Aymen Haroon
- Department of Biostatistics and Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, United States
| | - Dania Ali
- Department of Community Health Sciences, the Aga Khan University, Karachi, Pakistan
| | - Tazeen Saeed Ali
- Department of Community Health Sciences, the Aga Khan University, Karachi, Pakistan.,School of Nursing, the Aga Khan University, Karachi, Pakistan
| | - Mariano Salazar
- Department of Global Public Health Karolinska Institutet, Stockholm, Sweden
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15
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Siddiqui D, Ali TS. The importance of community midwives in Pakistan: Looking at existing evidence and their need during the COVID-19 pandemic. Midwifery 2021; 106:103242. [PMID: 34990996 PMCID: PMC8701767 DOI: 10.1016/j.midw.2021.103242] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/13/2021] [Accepted: 12/20/2021] [Indexed: 11/23/2022]
Abstract
Concerns over the soaring number of COVID-19 cases has taken precedence within the healthcare community and overshadows the jarringly high rates of maternal mortality in developing countries. Pakistan is suffering from high maternal mortality, surges of COVID-19 cases, lack of integrated healthcare system, and rural poverty. Amidst fear and uncertainty, Community Midwives are stepping up as maternal healthcare leaders who are reaching out to neglected pregnant women in rural communities of Pakistan. They are responsible for rebuilding trust, delivering comprehensive and respectful maternal care and providing family planning counseling. To accomplish Sustainable Development Goal #3.1, Pakistan must support community midwives and diminish the barriers they face.
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Affiliation(s)
| | - Tazeen Saeed Ali
- Associate Professor, Assistant Dean of Research and Graduate studies, School of Nursing and Midwifery, Department of Community Health Sciences, Aga Khan University, Pakistan.
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16
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Le Quesne WJF, Fernand L, Ali TS, Andres O, Antonpoulou M, Burt JA, Dougherty WW, Edson PJ, El Kharraz J, Glavan J, Mamiit RJ, Reid KD, Sajwani A, Sheahan D. Is the development of desalination compatible with sustainable development of the Arabian Gulf? Mar Pollut Bull 2021; 173:112940. [PMID: 34537571 DOI: 10.1016/j.marpolbul.2021.112940] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 06/13/2023]
Abstract
The development of desalination has been essential to the rapid economic development of the countries bordering the Arabian Gulf. The current production capacity of sea water desalination plants drawing water from Gulf is over 20 million m3 day-1, which may rise to 80 million m3 day-1 by 2050. Whilst supporting aspects of sustainable development related to water and sanitation, desalination impacts the marine environment through impingement and entrainment of organisms in intakes, and through thermal, brine and chemical discharges. This may compromise other objectives for sustainable development related to sustainable use of the oceans. Under business as usual scenarios, by 2050, the impact of individual desalination plants will combine causing a regional scale impact. Without mitigating actions to avoid the business as usual scenario, by 2050, desalination in combination with climate change, will elevate coastal water temperatures across more than 50% of the Gulf by at least 3 °C, and a volume of water equivalent to more than a third of the total volume of water between 0 and 10 m deep will pass through desalination plants each year. This will adversely impact the coastal ecosystem of the Gulf, with impacts on biodiversity, fisheries and coastal communities and may cause potential loss of species and habitats from the Gulf. Given the significant implications of these preliminary findings, and in light of the precautionary approach to management, it is recommended that mitigating options addressing behavioural, regulatory and technological change are rapidly evaluated and implemented to avoid the development of desalination in the region along a business as usual pathway, and multidisciplinary research studies should be conducted to reduce uncertainty in predictions of future impacts.
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Affiliation(s)
- W J F Le Quesne
- Centre for Environment, Fisheries and Aquaculture Sciences (Cefas), Lowestoft, NR33 0HT, UK.
| | - L Fernand
- Centre for Environment, Fisheries and Aquaculture Sciences (Cefas), Lowestoft, NR33 0HT, UK
| | - T S Ali
- Department of Natural Resources and Environment, Arabian Gulf University, Bahrain
| | - O Andres
- Centre for Environment, Fisheries and Aquaculture Sciences (Cefas), Lowestoft, NR33 0HT, UK
| | - M Antonpoulou
- Emirates Nature - WWF, Sustainable City, Dubai, United Arab Emirates
| | - J A Burt
- Water Research Center & Center for Genomics and Systems Biology, New York University Abu Dhabi, PO Box 129188, Abu Dhabi, United Arab Emirates
| | - W W Dougherty
- Climate Change Research Group, United States of America
| | - P J Edson
- Oceanographic Institute, University of Sao Paulo (IOUSP), Sao Paulo, Brazil
| | - J El Kharraz
- Middle East Desalination Research Center (MEDRC), P.O. Box 21, P.C. 133 Al Khuwair, Oman
| | - J Glavan
- Abu Dhabi Global Environmental Data Initiative (AGEDI), Environment Agency - Abu Dhabi, Al Moura Building, Abu Dhabi, United Arab Emirates
| | - R J Mamiit
- Global Green Growth Institute (GGGI), Masdar City, Abu Dhabi 135075, United Arab Emirates
| | - K D Reid
- Department of Urban Planning and Municipalities, Abu Dhabi, United Arab Emirates
| | - A Sajwani
- Department of Urban Planning and Municipalities, Abu Dhabi, United Arab Emirates
| | - D Sheahan
- Centre for Environment, Fisheries and Aquaculture Sciences (Cefas), Lowestoft, NR33 0HT, UK
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Ejaz M, Mubarak M, Ali TS, Andersson S, Ekström AM. Human papillomavirus-associated anal squamous intraepithelial lesions in men who have sex with men and transgender women living with and without HIV in Karachi Pakistan: implications for screening and prevention. BMC Infect Dis 2021; 21:1163. [PMID: 34789177 PMCID: PMC8597180 DOI: 10.1186/s12879-021-06850-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/01/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Anal squamous intraepithelial lesions (ASIL), strongly related to human papilloma virus (HPV) infection, is more prevalent among men who have sex with men (MSM). However, no such data are available for Pakistan yet, and neither HPV vaccination nor anal-cytology screening is implemented in Pakistan. The purpose of this first ever study was to assess the prevalence of HPV-related anal cytological abnormalities among MSM and transgender women living with and without HIV infection in Pakistan. METHODS We conducted a cross-sectional study from March 2016 to November 2017 at sexual health centers run by the Perwaaz Trust and the National AIDS Control Program in Karachi. The study enrolled MSM and transgender women aged greater-than-and-equal-to-18-years who reported anal sex in the preceding 6 months. We collected two anal samples for liquid-based cytology and HPV type testing by PCR, and socio-demographic and behavioral data were collected through face-to face interviews. ASIL and its associations with biological and behavioral risk factors were analyzed through Cox regression for prevalence ratios (PR) and corresponding 95% confidence intervals (CIs). RESULTS Out of 271 qualifying participants, 79% were MSM and 21% transgender women. The mean age was 28.8 (± 8) years. Almost 35% (93/271) of the study population had ASIL detected, ASIL was significantly more common among participants living with HIV than in HIV negative ((50/118) 42.4%; vs. (43/153) 28.1%) (p ≤ 0.001). Among ASIL, 66% (61/93) had low-grade squamous intraepithelial lesions (LSIL), and 3.6% (3/93) had high-grade squamous intraepithelial lesions (HSIL). The overall, HPV16 positivity was 35.5% (33/93) among all abnormal anal lesions and all 3 HSIL were HPV16 positive, however, HPV16 positivity could show its association with ASIL detection in univariate model only (PRcrude: 2.11(1.39-3.18)). Moreover, any HR-HPV type (PR 3.04; 95% CI 1.75-5.26), concurrent sexually transmitted infection (STI) (2.13; (1.28-3.55)) and HIV + /HPV + coinfection (1.75; (1.07-2.88)) remained independently associated with ASIL in the multivariate model. CONCLUSIONS Abnormal anal cytology among MSM and transgender is prevalent enough to consider optimal screening regimens. Further studies are required to see if periodic anal cytology can be made part of HIV care and treatment programs among MSM in Pakistan.
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Affiliation(s)
- Muslima Ejaz
- Department of Global Public Health, Global and Sexual Health Research Group, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18A, 171 77, Stockholm, Sweden. .,Department of Community Health Sciences, Aga Khan University (AKU), Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan.
| | - Muhammad Mubarak
- Department of Cytology and Histopathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | | | - Sören Andersson
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Global and Sexual Health Research Group, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
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Shahzaib N, Ali TS, Pradhan NA, Abrejo F, Shahid S, Samnani AA. Factors affecting Maternal-care during labour at maternity centres of Karachi, Pakistan: Exploratory study. J PAK MED ASSOC 2021; 71:2061-2064. [PMID: 34418030 DOI: 10.47391/jpma.575] [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] [Indexed: 12/01/2022]
Abstract
Globally 529,000 women die every year due to harmful consequences of childbirth. This study aimed to explore the barriers and facilitators that influence the provision of quality care during labour at maternity centres in Karachi, Pakistan. The qualitative exploratory study design was used to study such factors from public and private maternity health facilities of Karachi, Pakistan. A total of 12 in-depth interviews were conducted through purposive sampling by using validated semi-structured interview guide. Data was analysed using content analysis manually. Among major barriers, unhygienic environment, lack of basic equipment, supplies and medicine, unprofessional attitude of staff, physical infrastructre and shotrage of staff were explored. Among facilitators, caring and supportive attitude of healthcare personnel during labour were identified. These identified determinants would guide policy-makers, Maternal, Newborn and Child Health (MNCH) planners and health managers to take appropriate actions to enhance the quality of maternal care which will subsequently result in considerable reduction in maternal mortalities.
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Affiliation(s)
| | - Tazeen Saeed Ali
- Department of Midwifery and Community Health Sciences, School of Nursing, Aga Khan University, Karachi, Pakistan
| | | | - Farina Abrejo
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Shahnaz Shahid
- Department of Nursing, Aga Khan University, Karachi, Pakistan
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Jawed M, Pradhan NA, Mistry R, Nazir A, Shekhani S, Ali TS. Management of maternal depression: Qualitative exploration of perceptions of healthcare professionals from a public tertiary care hospital, Karachi, Pakistan. PLoS One 2021; 16:e0254212. [PMID: 34234364 PMCID: PMC8263250 DOI: 10.1371/journal.pone.0254212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 06/22/2021] [Indexed: 11/18/2022] Open
Abstract
The lack of implementation and routine screening of management techniques at tertiary care hospitals leads to an increased burden of maternal depression. The consequences are borne emotionally, physically, and mentally by the mother, the child, the overall family, and society. Hence, it is vital to contextualize this mental disorder to design and implement effective healthcare interventions. The study is aimed to assess the knowledge and practices of healthcare professionals, in a tertiary care setting, who deal with depressive symptoms amongst mothers. It gauges whether a psychological screening criterion is being implemented by the clinical staff during prenatal and postnatal visits to recommend steps that can help develop a service framework. A qualitative, exploratory study design was implemented for this research. With purposive sampling, eight in-depth interviews (three nurses and five doctors) at a single tertiary care hospital were conducted categorically using a semi-structured (open and close-ended questions) interview toolkit. Content Analysis was carried out using information gathered from the unit of analysis. The study provided evidence of the existing gaps in one particular tertiary healthcare system, within Pakistan, concerning diagnosis and management of maternal depression. Results highlighted that providers were well-versed with explanations of maternal depression, the aftermath of it, and the current status of healthcare; however, they were minimally educated about the specifics and levels of treatment. The gathered information assisted in recommending steps to develop a service framework.
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Affiliation(s)
- Makkiya Jawed
- Sehat Kahani Community Innovation Hub, Karachi, Sindh, Pakistan
- Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan
| | | | - Rozina Mistry
- Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan
- School of Nursing and Midwifery, Aga Khan University, Karachi, Sindh, Pakistan
| | - Amirah Nazir
- International Internship Programme, Aga Khan University, Karachi, Sindh, Pakistan
| | - Sualeha Shekhani
- Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan
- Center of Biomedical Ethics and Culture, Sindh Institute of Urology & Transplantation, Karachi, Sindh, Pakistan
| | - Tazeen Saeed Ali
- Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan
- School of Nursing and Midwifery, Aga Khan University, Karachi, Sindh, Pakistan
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Tharani A, Van Hecke A, Ali TS, Duprez V. Factors influencing nurses' provision of self-management support for patients with chronic illnesses: A systematic mixed studies review. Int J Nurs Stud 2021; 120:103983. [PMID: 34147728 DOI: 10.1016/j.ijnurstu.2021.103983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/03/2020] [Revised: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Self-management support is considered an important task for nurses working in chronic care provision. The complex nature of self-management support makes it necessary to clarify the factors affecting the behaviour of nurses in supporting patients living with chronic illnesses. OBJECTIVE The aim of this review is to synthesize the factors influencing the provision of self-management support as perceived by nurses in the care for patients living with a chronic illness. DESIGN A systematic mixed studies review. DATA SOURCE Studies published in English from 1999 to April 2020 were extracted from five databases: CINAHL, PubMed, Cochrane library, EMBASE, and Web of Science. REVIEW METHOD The selection process was guided by PICo (Population, phenomenon of Interest, and Context). Studies that highlighted factors associated with the provision of self-management support among nurses, within the context of the top four non-communicable chronic diseases, were included. The risk of bias was carefully assessed. Using data-based convergent synthesis, the identified factors were synthesized and tabulated. The clusters of factors organized under each theme were approved by all researchers in discussion meetings. RESULTS In total, sixteen studies met the inclusion criteria; out of these, seven were qualitative, seven quantitative, and two mixed methods studies. The review identified nurses' perspectives regarding factors influencing self-management support at the patient, nurse, care relationship, education and training, organization and healthcare system, and intra- and inter-professional levels. The review provided evidence that these factors are interdependent in nature. CONCLUSION This review proposed considering a framework of interdependent factors influencing self-management support. It highlighted the need to come up with a comprehensive definition of self-management support that takes into account the emotional aspect as well as patient-as-partner approach. The proposed framework can be useful in tailoring multi-faceted interventions to strengthen nurses' supportive role in self-management of chronic care. Future studies should focus on exploring contextually relevant factors impacting nurses' supportive role in self-management.
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Affiliation(s)
- Ambreen Tharani
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Aga Khan University School of Nursing and Midwifery, Stadium Road, P.O Box 3500, Karachi, Pakistan.
| | - Ann Van Hecke
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Nursing Department, Ghent University Hospital, Ghent, Belgium.
| | - Tazeen Saeed Ali
- Aga Khan University School of Nursing and Midwifery, Stadium Road, P.O Box 3500, Karachi, Pakistan.
| | - Veerle Duprez
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
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Abstract
Compliance with standard precautions is very important for healthcare workers because studies have shown that it helps in minimising the transmission of infectious diseases and healthcare-associated infections which is directly proportional to the patient cost and stay of the patient in hospitals. As healthcare associated infections increase, the cost and the stay of the patient will increase. Researchers suggest that all healthcare workers need to follow the standard precautions guideline and it can be possible with the help of health education, training, provision of equipment and supervision by the management. Barriers to the compliance identified are lack of education, heavy workload, unavailability of equipment, lack of resources and lack of access to supplies. The lack of education and heavy workload are the major factors faced by the nurses.
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Affiliation(s)
- Shah Zeb
- Jinnah Medical College Hospital, Karachi, Pakistan
| | - Tazeen Saeed Ali
- School of Nursing, Department of Community Health Sciences, The Aga Khan University, Karachi
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Karmaliani R, McFarlane J, Khuwaja HMA, Somani Y, Shehzad S, Saeed Ali T, Asad N, Chirwa ED, Jewkes R. Right To Play's intervention to reduce peer violence among children in public schools in Pakistan: a cluster-randomized controlled trial. Glob Health Action 2021; 13:1836604. [PMID: 33138740 PMCID: PMC7646585 DOI: 10.1080/16549716.2020.1836604] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Peer violence is common globally, but a little researched topic in low-and middle-income countries. This study presents the evaluation of a two-year randomized controlled trial of a structured play-based life-skills intervention implemented in schools in Hyderabad, Pakistan. OBJECTIVE To determine the impact of the intervention on school-based peer violence (victimization and perpetration) and depression among school children. METHODS 40 single-sex public schools were randomized into two study arms (20 per arm 10 of each sex). A total of 1752 grade 6 students (929 from intervention and 823 from control schools) were enrolled in the trial. The two-year intervention was a biweekly structured game led by a coach followed by critical reflection and discussion for 30 minutes. Primary outcomes (exposure to peer violence exhibited through victimization and perpetration and depression) were evaluated using generalized linear-mixed models. RESULTS Of the enrolled children (N = 1752) 91% provided data for analysis. There were significant decreases in self-reported peer violence victimization, perpetration and depression. For peer violence victimization, the reductions in the intervention and control arms were: 33.3% versus 27.8% for boys and 58.5% versus 21.3% for girls. For peer violence perpetration, the reductions were: 25.3% versus 11.1% for boys and 55.6% versus 27.6% for girls in the intervention and control arms, respectively. There were significant drops in mean depression scores (boys 7.2% versus 4.8% intervention and control and girls 9.5% versus 5.6% intervention and control). CONCLUSION A well-designed and implemented play-based life-skills intervention delivered in public schools in Pakistan is able to effect a significant reduction in peer violence.
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Affiliation(s)
- Rozina Karmaliani
- School of Nursing and Midwifery, Aga Khan University , Karachi City, Pakistan
| | | | | | - Yasmeen Somani
- School of Nursing and Midwifery, Aga Khan University , Karachi City, Pakistan
| | - Shireen Shehzad
- School of Nursing and Midwifery, Aga Khan University , Karachi City, Pakistan
| | - Tazeen Saeed Ali
- School of Nursing and Midwifery, Aga Khan University , Karachi City, Pakistan
| | - Nargis Asad
- Department of Psychiatry, Aga Khan University , Karachi City, Pakistan
| | - Esnat D Chirwa
- Gender & Health Research Unit, South Africa Medical Research Council , Pretoria, South Africa.,School of Public Health, University of Witwatersrand , Johannesburg, South Africa
| | - Rachel Jewkes
- Gender & Health Research Unit, South Africa Medical Research Council , Pretoria, South Africa
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Ali TS, Sami N, Saeed AA, Ali P. Gynaecological morbidities among married women and husband's behaviour: Evidence from a community-based study. Nurs Open 2021; 8:553-561. [PMID: 33570305 PMCID: PMC7877143 DOI: 10.1002/nop2.660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 08/21/2020] [Accepted: 09/25/2020] [Indexed: 12/13/2022] Open
Abstract
AIM To determine the association between gynaecological morbidities and IPV among married women specifically, with attention to the attitudes of the husband and the degree of satisfaction in a marital relationship. DESIGN Cross-sectional study design. METHODS Data were collected using face-to-face interviews with married women aged 15-49 years, living in selected communities. Information was collected on demographic characteristics, gynaecological morbidities and IPV using a self-developed tool. Descriptive and inferential statistics were used to analyse the data. RESULTS Logistic Regression showed a significant association between physical violence and burning micturition, increased urinary frequency, constant dribbling of urine, genital ulcers, lower abdominal pain, vaginal discharge and painful coitus (OR: 1.41-1.84). A significant association between sexual and psychological abuse was also found with burning micturition (OR: 1.41) and dribbling of urine (OR: 0.12). Since gynaecological morbidities can have a serious effect on the psychological, physical well-being, and the social status of women in Pakistan; effective interventions are imperative in dealing with their symptoms and decreasing their emergence.
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Affiliation(s)
- Tazeen Saeed Ali
- School of Nursing and MidwiferyAga Khan UniversityKarachiPakistan
- Department of Community Health SciencesAga Khan UniversityKarachiPakistan
| | - Neelofar Sami
- Department of Community Health SciencesAga Khan UniversityKarachiPakistan
| | - Adil Ali Saeed
- Intern of School of Nursing and MidwiferyAga Khan UniversityKarachiPakistan
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24
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Ali TS, Karmaliani R, Shah NZ, Bhamani SS, Khuwaja HMA, McFarlane J, Wadani ZH, Kulane A. Community stakeholders' perspectives regarding acceptability of a life skills building intervention to empower women in Pakistan. Res Nurs Health 2020; 43:579-589. [PMID: 32905625 DOI: 10.1002/nur.22072] [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: 02/21/2020] [Accepted: 08/17/2020] [Indexed: 11/07/2022]
Abstract
Violence against women (VAW) is a major determinant in the assessment of a women's mental health. Many interventions have addressed strategies to reduce VAW, however, little information is available regarding effectiveness in the local context, particularly the role of men in women's empowerment. In Pakistan, a qualitative approach was undertaken in all four of its provinces to describe the community residents', both men and women, perceptions regarding the acceptability of a proposed life skills building (LSB) intervention involving men's engagement with regards to women's empowerment and VAW. Eighteen focus group discussions were conducted with men and women from locales within each province of Pakistan, averaging 6-10 participants per group. Fourteen key informant interviews were conducted with community stakeholders. The analysis identified three major themes: family life and male engagement, LSB training as an empowerment tool, and operationalization of the proposed LSB intervention. The proposed LSB intervention was well accepted by the participants with a strong urge to engage men in receiving the LSB training sessions. Men's engagement has been identified as an important element to facilitate women's empowerment. Participants suggested that these sessions should be held for two and a half hours per week within the community public spaces. In addition, these sessions should be based on an interactive approach. The focus of these sessions should include ideas surrounding positive relationships and economic skills building. Moreover, men's engagement will help to reduce VAW and improve the mental health of women in a patriarchal country like Pakistan.
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Affiliation(s)
- Tazeen Saeed Ali
- Nursing Division, School of Nursing & Midwifery, Aga Khan University, Karachi, Pakistan
| | - Rozina Karmaliani
- Nursing Division, School of Nursing & Midwifery, Aga Khan University, Karachi, Pakistan
| | - Nasim Zahid Shah
- Nursing Division, School of Nursing & Midwifery, Aga Khan University, Karachi, Pakistan.,Department of Center of Excellence, Women and Child Health Division, Aga Khan University, Karachi, Pakistan
| | | | | | | | - Zahid Hyder Wadani
- Nursing Division, School of Nursing & Midwifery, Aga Khan University, Karachi, Pakistan.,Department of Center of Excellence, Women and Child Health Division, Aga Khan University, Karachi, Pakistan
| | - Asli Kulane
- Department of Public Health, Karolinska Institutet, Solna, Sweden
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25
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Anwar N, Pervez S, Chundriger Q, Awan S, Moatter T, Ali TS. Oral cancer: Clinicopathological features and associated risk factors in a high risk population presenting to a major tertiary care center in Pakistan. PLoS One 2020; 15:e0236359. [PMID: 32760151 PMCID: PMC7410283 DOI: 10.1371/journal.pone.0236359] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/03/2020] [Indexed: 12/19/2022] Open
Abstract
Oral squamous cell carcinoma (OSCC) has the highest prevalence in head and neck cancers and is the first and second most common cancer in males and females of Pakistan respectively. Major risk factors include peculiar chewing habits like areca nut, betel quid, and tobacco. The majority of OSCC presents at an advanced stage with poor prognosis. On the face of such a high burden of this preventable cancer, there is a relative lack of recent robust data and its association with known risk factors from Pakistan. The aim of this study was to identify the socioeconomic factors and clinicopathological features that may contribute to the development of OSCC. A total of 186 patients diagnosed and treated at a tertiary care hospital, Karachi Pakistan were recruited. Clinicopathological and socioeconomic information was obtained on a structured questionnaire. Descriptive analysis was done for demographics and socioeconomic status (SES) while regression analysis was performed to evaluate the association between SES and chewing habits, tumor site, and tumor stage. The majority of patients were males and the mean age of OSCC patients was 47.62±12.18 years. Most of the patients belonged to low SES (68.3%) and 77.4% were habitual of chewing. Gender (male) and SES were significantly associated with chewing habits (p<0.05). Odds of developing buccal mucosa tumors in chewers (of any type of substance) and gutka users were 2 and 4 times higher than non-chewers respectively. Middle age, chewing habits, and occupation were significantly associated with late stage presentation of OSCC (p<0.05). In conclusion, male patients belonging to low SES in their forties who had chewing habits for years constituted the bulk of OSCC. Buccal mucosa was the most common site in chewers and the majority presented with late stage tumors.
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Affiliation(s)
- Namrah Anwar
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Shahid Pervez
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Qurratulain Chundriger
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Sohail Awan
- Department of Otolaryngology, Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Tariq Moatter
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Tazeen Saeed Ali
- School of Nursing and Midwifery, Aga Khan University Hospital, Karachi, Pakistan
- * E-mail:
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26
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Anjum A, Saeed Ali T, Akber Pradhan N, Khan M, Karmaliani R. Perceptions of stakeholders about the role of health system in suicide prevention in Ghizer, Gilgit-Baltistan, Pakistan. BMC Public Health 2020; 20:991. [PMID: 32576170 PMCID: PMC7313136 DOI: 10.1186/s12889-020-09081-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 06/10/2020] [Indexed: 12/11/2022] Open
Abstract
Background Suicide is a serious global public health problem, with more than 800,000 people dying by suicide worldwide every year. 79% of suicides happen in Low and Middle-Income Countries (LMICs), where lack of national suicide prevention programs coupled with inadequate MH facilities for early identification and treatment of mental disorders add to seriousness of the problems. Although there is paucity of research, studies suggest that the rate of suicide in district Ghizer, Gilgit-Baltistan (GB), in northern Pakistan may be higher compared to rest of the country. Methods This study aimed to explore the perceptions of stakeholders about the role of the health system at District Ghizer, GB using a qualitative descriptive exploratory research design. A total of 12 face to face in-depth interviews were conducted from the stakeholders using purposive sampling technique. Results The study results led to three broad themes, 1) Suicide as A Social Issue, 2) Role of Health System in Suicide Prevention, and 3) Challenges for Health System in Suicide Prevention. Theme one was sub-categorized into; a) Perceived situations contributing to suicide, b) Environmental factors. Theme two was subdivided into; a) Major hurdles for Health system, b) Lack of MH services in the available health system. Theme three was subdivided into; a) Lack of collaboration across-sectors, b) Unavailability of MH professionals, and c) Financial issues. The study findings reveal that there are multiple challenges for health system including, lack of awareness on mental issues, shortage of resources and lack of collaboration in the community. Moreover, existing policies or strategies need to be modified to overcome the existing challenges for the effective prevention. Conclusion This study emphasized creating awareness about MH issues, introduction of school health programs, parental counseling session and strengthening of the health system by allocating suitable budget for MH issues and suicide prevention strategies.
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Affiliation(s)
- Anila Anjum
- Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan.
| | - Tazeen Saeed Ali
- School of Nursing & Midwifery, The Aga Khan University, Karachi, Pakistan
| | | | - Murad Khan
- Department of Psychiatry at The Aga Khan University, Karachi, Pakistan
| | - Rozina Karmaliani
- School of Nursing & Midwifery & Community Health Sciences, The Aga Khan University, Karachi, Pakistan
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27
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Abstract
OBJECTIVE To consolidate research data and provide an insight into areas that need further research regarding intimate partner violence. METHODS The review targeted qualitative research-based studies done in the English language and conducted in Pakistan from 2008 to 2018 regarding intimate partner violence against women. A thorough search of Google Scholar and PubMed databases was done. Data from each selected article was extracted using a data-extraction template. RESULTS Of the 2,479 results, 21(0.8%) articles were selected along with 4(0.16%) texts from grey literature. An in-depth analysis led to six broad categories: experiences/perspectives of married women facing intimate partner violence; perspectives of married men towards intimate partner violence; perspectives of religious leaders who support the idea of men controlling their wives; societal norms, such as dowry, patriarchy and daughters being considered a burden; impact on women and family as damage to the women's physical and mental health affects not only her but also the society as a whole; and coping strategies used by most women. CONCLUSIONS The review helps in understanding the common trends and situation of Pakistani women who are exposed to violence, the common limitations faced by researches, and areas which require further research to prevent intimate partner violence.
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Affiliation(s)
- Tazeen Saeed Ali
- Department of Community Health Sciences, Aga Khan University, Karachi
| | - Rida Farhan
- Student 3rd Year, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Michelle Ayub
- Student 3rd Year, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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28
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Ali TS, Karmaliani R, Khuwaja HMA, Shah NZ, Wadani ZH, Aijaz S, Kulane A. Community stakeholders' views on reducing violence against women in Pakistan. BMC Womens Health 2020; 20:98. [PMID: 32380986 PMCID: PMC7206774 DOI: 10.1186/s12905-020-00961-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 04/28/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Nearly half of the women experience violence across their lifespan in all the provinces of Pakistan at an alarming rate. Despite knowing the prevalence, there has been meager progress in developing strategies to combat violence at individual, family, or community level. Many interventions suggested in other countries have been pilot tested but the effects of those interventions had been limited. Therefore, the aim of this study is to understand the voices of stakeholders to reduce Violence Against Women (VAW) and to explore the possible community-based strategies that could be implemented in Pakistan. METHODS A total of 14 Key Informant Interviews (KIIs) and 18 Focus Group Discussions (FGDs) were held across all four provinces of Pakistan. Participants were purposefully recruited and all the interviews were audio-recorded. Transcriptions were open coded and content analysis was done to emerge codes, categories and themes. Ethical approval was obtained from Aga Khan University Ethics Review Committee. RESULTS Three major themes emerged on community members and stakeholders' views on VAW: a) community's perception of VAW b) the repercussions of VAW, and c) multiple voices regarding strategies to reduce VAW. Participants voiced the need of standing against the status quo, role of awareness and education: regarding capacity building skills, promotion of women rights and women empowerment through Life Skills Based Education (LSBE) through national health works program, has been proposed as an innovative strategy to reduce VAW. CONCLUSIONS The responsibility to bring about a substantial change in behavior and attitudes must begin with engaging men in all the interventions that aim to reduce violence. Since, VAW is very much linked with the cultural norms, so, without community stakeholder's involvement and participation it could never be reduced. Keeping the existing socio-cultural dynamics in mind, the need of time is to design and implement innovative interventions that are culturally and contextually appropriate and can be expanded across the country.
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Affiliation(s)
- Tazeen Saeed Ali
- School of Nursing and Midwifery, Aga Khan University (SONAM AKU), Stadium Road, Karachi, Sindh, Pakistan.
| | - Rozina Karmaliani
- School of Nursing and Midwifery, Aga Khan University (SONAM AKU), Stadium Road, Karachi, Sindh, Pakistan
| | | | - Nasim Zahid Shah
- Umeed-e-Nau Innovations Center of Excellence in Women and Child Health (COE), Aga Khan University (AKU), Karachi, Pakistan
| | - Zahid Hyder Wadani
- Umeed-e-Nau Innovations Center of Excellence in Women and Child Health (COE), Aga Khan University (AKU), Karachi, Pakistan
| | - Saher Aijaz
- School of Nursing and Midwifery, Aga Khan University (SONAM AKU), Stadium Road, Karachi, Sindh, Pakistan
| | - Asli Kulane
- Department of Equity and Policy Development at Karolinska Institutet, Stockholm, Sweden
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29
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Pradhan NA, Mughis W, Ali TS, Naseem M, Karmaliani R. School-based interventions to promote personal and environmental hygiene practices among children in Pakistan: protocol for a mixed methods study. BMC Public Health 2020; 20:481. [PMID: 32290822 PMCID: PMC7158119 DOI: 10.1186/s12889-020-08511-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 03/11/2020] [Indexed: 11/11/2023] Open
Abstract
Background Poor personal hygiene and inadequate sanitation practices among young children leads to communicable diseases. There remains a gap in the holistic assessment of school children’s hygiene literacy, practices and effectiveness of school-based hygiene interventions in Pakistan. Therefore, a school-based intervention protocol has been designed to promote personal and environmental hygiene practices for primary school children. Towards improving children’s hygiene behaviors, the study will also focus on enhancing mothers' hygiene knowledge and practices. Methods Using quasi-experimental design with mixed methods data collection approaches, this study will be conducted in schools located in an urban squatter settlements in Pakistan. To assess primary grade children and their mothers‘ hygiene status, a survey will be held in the pre-intervention phase. This phase also includes qualitative exploration of key stakeholders (mothers, teachers, health & education authorities representatives’) perceptions about the factors facilitating and impeding the adaption of hygiene behaviors among school children. In-depth guides and focus group discussion tools will be used for this purpose. This will be followed by multi-component intervention phase with behavior change strategies to improve children‘s and mothers’ hygiene literacy and behaviors. The post-intervention phase will assess the intervention effectiveness in terms of enhancing hygiene knowledge and practices among school children and mothers, alongside exploration of mothers and teachers’ insights into whether or not the intervention has been effective in improving hygiene practices among children. Paired t-test will be applied pre and post-intervention to measure the differences between the mothers and children's hygiene literacy and knowledge scores. Similar test will be performed to assess the differences in children’s hygiene knowledge and practice scores, pre and post-intervention (< 50 = poor, 50–75 = good and > 75 = excellent). Thematic analysis will be carried out for qualitative data. Discussion Multi-component intervention aimed at improving personal and environmental hygiene among primary school children offers an opportunity to design and test various behavioral change strategies at school and in home settings. The study findings will be significant in assessing the intervention’s effectiveness in improving children‘s overall hygiene. Trial registration Retrospectively registered with ClinicalTrials.gov (NCT03942523) on 5th May 2019.
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Affiliation(s)
- Nousheen Akber Pradhan
- Department of Community Health Sciences (CHS), Aga Khan University (AKU), Karachi, Pakistan.
| | - Waliyah Mughis
- Department of Pediatrics & Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Tazeen Saeed Ali
- School of Nursing & Midwifery, Aga Khan University, Karachi, Pakistan
| | - Maleeha Naseem
- Department of Community Health Sciences (CHS), Aga Khan University (AKU), Karachi, Pakistan
| | - Rozina Karmaliani
- Department of Community Health Sciences (CHS), Aga Khan University (AKU), Karachi, Pakistan.,School of Nursing & Midwifery, Aga Khan University, Karachi, Pakistan
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30
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Ali TS. Gender Based Violence and Health Effects. J Dow Univ Health Sci 2019. [DOI: 10.36570/jduhs.2019.3.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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31
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Khuwaja HMA, Karmaliani R, McFarlane J, Somani R, Gulzar S, Ali TS, Premani ZS, Chirwa ED, Jewkes R. The intersection of school corporal punishment and associated factors: Baseline results from a randomized controlled trial in Pakistan. PLoS One 2018; 13:e0206032. [PMID: 30356245 PMCID: PMC6200248 DOI: 10.1371/journal.pone.0206032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 10/07/2018] [Indexed: 11/19/2022] Open
Abstract
Violence against youth is a global issue; one form of youth victimization is school corporal punishment. We use baseline assessments from a cluster randomized controlled trial to examine the prevalence of school corporal punishment, by gender, and the relationship to levels of peer violence at school, parent corporal punishment, youth food security and youth academic performance and school attendance in Pakistan. Forty homogenous public schools in the urban city of Hyderabad, Pakistan were chosen for randomization into the trial evaluating a youth violence prevention intervention. 1752 6th graders, age 11-14 years, were selected as the target population. Since schools are segregated by gender in Pakistan, data are from interviews in 20 boys' schools and 20 girls' schools. Overall, 91.4% of boys and 60.9% of girls reported corporal punishment at school in the previous 4 weeks and 60.3% of boys had been physically punished at home in the past 4 weeks compared to 37.1% of girls. Structural equation modeling revealed one direct pathway for both boys and girls from food insecurity to corporal punishment at school while indirect pathways were mediated by depression, the number of days missed from school and school performance and for boys also by engagement in peer violence. Exposure to corporal punishment in school and from parents differs by gender, but in both boys and girls poverty in the form of food insecurity was an important risk factor, with the result that poorer children are victimized more by adults.
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Affiliation(s)
| | - Rozina Karmaliani
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | - Judith McFarlane
- Texas Woman’s University, Houston, Texas, United States of America
| | - Rozina Somani
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | - Saleema Gulzar
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | - Tazeen Saeed Ali
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | | | - Esnat D. Chirwa
- South African Medical Research Council, Pretoria, South Africa
| | - Rachel Jewkes
- South African Medical Research Council, Pretoria, South Africa
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Pradhan NA, Ali TS, Hasnani FB, Bhamani SS, Karmaliani R. Measuring socio-economic status of an urban squatter settlement in Pakistan using WAMI Index. J PAK MED ASSOC 2018; 68:709-714. [PMID: 29885167] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To determine the socio-economic status of a peri-urban community. METHODS The cross-sectional study was conducted at Deh Chuhar village, Gaddap Town, Karachi from December 2015 to February 2016. The Water/Sanitation, Assets, Maternal Education and Income Index was used. All variables were given a score on the scale of 0-8. The resulting index was illustrated in the form of quintiles. RESULTS : A total of 254 households were surveyed. Total population was 2117 with mean number of household members being 8±4. Mean index score was 0.39±0.14 and the median score was 0.375. Percentile distribution of the score indicated that 152(60%) households scored below 0.40 whereas, 51 (20%) were in the highest quintile with a score above 0.50. CONCLUSIONS Water/Sanitation, Assets, Maternal Education and Income index suggested poor socio-economic status of the community studied.
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Affiliation(s)
| | - Tazeen Saeed Ali
- School of Nursing and Midwifery and Department of Community Health Sciences
| | | | | | - Rozina Karmaliani
- School of Nursing and Midwifery and Department of Community Health Sciences
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Samnani AABA, Rizvi N, Ali TS, Abrejo F. Barriers or gaps in implementation of misoprostol use for post-abortion care and post-partum hemorrhage prevention in developing countries: a systematic review. Reprod Health 2017; 14:139. [PMID: 29078777 PMCID: PMC5659002 DOI: 10.1186/s12978-017-0383-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 09/11/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Around 303,000 maternal deaths occur every year; most of these are preventable (World Health Organization), ICD-10: International classification of diseases and related health problems, 10th revision. Volume 2: Instruction manual, 2010). Ninety-nine percent of these maternal deaths occur in developing countries. PPH contributed 35 % (35%) of total maternal. Several interventions being done to reduce the number of maternal deaths. It has been noted that a simple low cost intervention of providing misoprostol timely could prevent these deaths. OBJECTIVES The objectives of this systematic review was to identify barriers/gaps in the implementation of misoprostol use for prevention of postpartum hemorrhage and management of Post-abortion care services in developing countries. METHODS This study was a systematic review of published qualitative and quantitative literature on misoprostol in developing countries. Documents included were local and international peer reviewed articles and program reports on misoprostol implementation. PubMed, Google Scholars and Science direct databases were used along with Grey literature and manual search using terms "implementation gaps", "misoprostol use", "postpartum hemorrhage", "post-abortion care" and "developing countries". RESULTS Gaps or barriers in misoprostol use identified through systematic review can be categorized into six broader thematic areas including: inconsistency in supplies and its distribution; inadequate staffing; lack of knowledge of providers and end users, absence of the registration of drug and fear and apprehensions related to its use at provider and policy level. CONCLUSION It is concluded that barriers and gaps can be addressed through providing enabling environment through supportive policies, designing a formal plan for supplies, task shifting strategies and use of guidelines and protocols for successful implementation.
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Affiliation(s)
| | - Narjis Rizvi
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, Karachi, 74800 Pakistan
| | - Tazeen Saeed Ali
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, Karachi, 74800 Pakistan
| | - Farina Abrejo
- Department of Community Health Sciences, The Aga Khan University, Stadium Road, Karachi, 74800 Pakistan
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Karmaliani R, Mcfarlane J, Somani R, Khuwaja HMA, Bhamani SS, Ali TS, Gulzar S, Somani Y, Chirwa ED, Jewkes R. Peer violence perpetration and victimization: Prevalence, associated factors and pathways among 1752 sixth grade boys and girls in schools in Pakistan. PLoS One 2017; 12:e0180833. [PMID: 28817565 PMCID: PMC5560651 DOI: 10.1371/journal.pone.0180833] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 06/06/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Child peer violence is a global problem and seriously impacts health and education. There are few research studies available in Pakistan, or South Asia. We describe the prevalence of peer violence, associations, and pathways between socio-economic status, school performance, gender attitudes and violence at home. METHODS 1752 children were recruited into a cluster randomized controlled trial conducted on 40 fairly homogeneous public schools (20 for girls and 20 for boys), in Hyderabad, Pakistan. This was ranging from 20-65 children per school. All children were interviewed with questionnaires at baseline. RESULTS Few children had no experience of peer violence in the previous 4 weeks (21.7% of girls vs.7% of boys). Some were victims (28.6%, of girls vs. 17.9% of boys), some only perpetrated (3.3% of girls vs. 2.5%) but mostly they perpetrated and were victims (46.4%.of girls vs 72.6%. of boys). The girls' multivariable models showed that missing the last school day due to work, witnessing her father fight a man in the last month and having more patriarchal gender attitudes were associated with both experiencing violence and perpetration, while, hunger was associated with perpetration only. For boys, missing two or more days of school in the last month, poorer school performance and more patriarchal attitudes were associated with both victimization and perpetration. Witnessing father fight, was associated with peer violence perpetration for boys. These findings are additionally confirmed with structural models. DISCUSSION Peer violence in Pakistan is rooted in poverty and socialization of children, especially at home. A critical question is whether a school-based intervention can empower children to reduce their violence engagement in the context of poverty and social norms supportive of violence. In the political context of Pakistan, reducing all violence is essential and understanding the potential of schools as a platform for intervention is key.
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Affiliation(s)
- Rozina Karmaliani
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | - Judith Mcfarlane
- Texas Woman’s University, Denton, Texas, United States of America
| | - Rozina Somani
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | | | | | - Tazeen Saeed Ali
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | - Saleema Gulzar
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | - Yasmeen Somani
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | - Esnat D. Chirwa
- South African Medical Research Council, Pretoria, South Africa
| | - Rachel Jewkes
- South African Medical Research Council, Pretoria, South Africa
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McFarlane J, Karmaliani R, Maqbool Ahmed Khuwaja H, Gulzar S, Somani R, Saeed Ali T, Somani YH, Shehzad Bhamani S, Krone RD, Paulson RM, Muhammad A, Jewkes R. Preventing Peer Violence Against Children: Methods and Baseline Data of a Cluster Randomized Controlled Trial in Pakistan. Glob Health Sci Pract 2017; 5:115-137. [PMID: 28351880 PMCID: PMC5478222 DOI: 10.9745/ghsp-d-16-00215] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 09/28/2013] [Indexed: 11/24/2022]
Abstract
Peer violence was remarkably high at baseline. Among urban public school students, 94% of 6th-grade boys and 85% of girls reported being victimized by peers in the last 4 weeks. And 85% of boys and 66% of girls reported perpetrating such violence. Boys scored worse on a number of mental health measures. A cluster RCT is underway to evaluate a well-established school-based intervention using sports and games to reduce peer violence. Background: Violence against and among children is a global public health problem that annually affects 50% of youth worldwide with major impacts on child development, education, and health including increased probability of major causes of morbidity and mortality in adulthood. It is also associated with the experience of and perpetration of later violence against women. The aim of this article is to describe the intervention, study design, methods, and baseline findings of a cluster randomized controlled trial underway in Pakistan to evaluate a school-based play intervention aiming to reduce peer violence and enhance mental health. Methods: A cluster randomized controlled design is being conducted with boys and girls in grade 6 in 40 schools in Hyderabad, Pakistan, over a period of 2 years. The Multidimensional Peer-Victimization and Peer Perpetration Scales and the Children's Depression Inventory 2 (CDI 2) are being used to measure the primary outcomes while investigator-derived scales are being used to assess domestic violence within the family. Specifics of the intervention, field logistics, ethical, and fidelity management issues employed to test the program's impact on school age youth in a volatile and politically unstable country form this report. Baseline Results: A total of 1,752 school-age youth were enrolled and interviewed at baseline. Over the preceding 4 weeks, 94% of the boys and 85% of the girls reported 1 or more occurrences of victimization, and 85% of the boys and 66% of the girls reported 1 or more acts of perpetration. Boys reported more depression compared with girls, as well as higher negative mood and self-esteem scores and more interpersonal and emotional problems. Interpretation: Globally, prevalence of youth violence perpetration and victimization is high and associated with poor physical and emotional health. Applying a randomized controlled design to evaluate a peer violence prevention program built on a firm infrastructure and that is ready for scale-up and sustainability will make an important contribution to identifying evidence-informed interventions that can reduce youth victimization and perpetration.
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Affiliation(s)
- Judith McFarlane
- Texas Woman's University College of Nursing, Houston, Texas, USA.
| | - Rozina Karmaliani
- The Aga Khan University School of Nursing & Midwifery, Karachi, Pakistan
| | | | - Saleema Gulzar
- The Aga Khan University School of Nursing & Midwifery, Karachi, Pakistan
| | - Rozina Somani
- The Aga Khan University School of Nursing & Midwifery, Karachi, Pakistan
| | - Tazeen Saeed Ali
- The Aga Khan University School of Nursing & Midwifery, Karachi, Pakistan
| | - Yasmeen H Somani
- The Aga Khan University School of Nursing & Midwifery, Karachi, Pakistan
| | | | | | | | | | - Rachel Jewkes
- South African Medical Research Council, Pretoria, South Africa
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Saeed Ali T, Karmaliani R, Mcfarlane J, Khuwaja HMA, Somani Y, Chirwa ED, Jewkes R. Attitude towards gender roles and violence against women and girls (VAWG): baseline findings from an RCT of 1752 youths in Pakistan. Glob Health Action 2017; 10:1342454. [PMID: 28758882 PMCID: PMC5964875 DOI: 10.1080/16549716.2017.1342454] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/11/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Violence against women is driven by gender norms that normalize and justify gender inequality and violence. Gender norms are substantially shaped during adolescence. Programs offered through schools offer an opportunity to influence gender attitudes toward gender equity if we understand these to be partly shaped by peers and the school environment. OBJECTIVE We present an analysis of the baseline research conducted for a randomized controlled trial with 1752 grade 6 boys and girls and their attitudes toward gender roles, VAWG, and associated factors. METHODS We used baseline data from a cluster randomised control study. Interviews were conducted in 40 public schools in Hyderabad, with 25-65 children per school. Questions were asked about attitudes toward gender roles, peer-to-peer perpetration, and victimization experiences, and family life, including father- or in-law-to- mother violence and food security. Multiple regression models were built of factors associated with gender attitudes for boys and girls. RESULTS Our result have shown youth attitudes endorsing patriarchal gender beliefs were higher for boys, compared to girls. The multiple regression model showed that for boys, patriarchal gender attitudes were positively associated with hunger, depression, being promised already in marriage, and being a victim and/or perpetrator of peer violence. For girls gender attitudes were associated with hunger, experiencing corporal punishment at home, and being a perpetrator (for some, and victim) of peer violence. CONCLUSION Youth patriarchal attitudes are closely related to their experience of violence at school and for girl's physical punishment, at home and for boys being promised in early marriage. We suggest that these variables are indicators of gender norms among peers and in the family. The significance of peer norms is that it provides the possibility that school-based interventions which work with school peers have the potential to positively impact youth patriarchal gender attitudes and foster attitudes of gender equality and respect, and potentially to decrease youth victimization and perpetration.
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Affiliation(s)
- Tazeen Saeed Ali
- School of Nursing and Midwifery and Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Rozina Karmaliani
- Health Policy & Management, School of Nursing and Midwifery and Department of Community health sciences, Aga Khan University, Karachi, Pakistan
| | - Judith Mcfarlane
- College of Nursing, Office of Research and Sponsored Programs, Texas Women’s University, Houston, TX, USA
| | | | - Yasmeen Somani
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | - Esnat D. Chirwa
- Gender & Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Rachel Jewkes
- Gender & Health Research Unit, South African Medical Research Council, Pretoria, South Africa
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Khalid W, Rozi S, Ali TS, Azam I, Mullen MT, Illyas S, Un-Nisa Q, Soomro N, Kamal AK. Quality of life after stroke in Pakistan. BMC Neurol 2016; 16:250. [PMID: 27912744 PMCID: PMC5135839 DOI: 10.1186/s12883-016-0774-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 11/28/2016] [Indexed: 12/20/2022] Open
Abstract
Background There is very little information about the quality of life (QOL) of stroke survivors in LMIC countries with underdeveloped non communicable health infrastructures, who bear two thirds of the global stroke burden. Methodology We used a sequential mix methods approach. First, a quantitative analytical cross-sectional study was conducted on 700 participants, who constituted 350 stroke survivor and their caregiver dyads. QOL of stroke survivor was assessed via Stroke Specific Quality of Life Scale (SSQOLS) whereas QOL of caregivers was assessed through RAND-36. In addition; we assessed complications, psychosocial and functional disability of stroke survivors. Following this quantitative survey, caregivers were qualitatively interviewed to uncover contextually relevant themes that would evade quantitative surveys. Multiple linear regression technique was applied to report adjusted β-coefficients with 95% C.I. Results The QOL study was conducted from January 2014 till June 2014, in two large private and public centers. At each center, 175 dyads were interviewed to ensure representativeness. Median age of stroke survivors was 59(17) years, 68% were male, 60% reported depression and 70% suffered post-stroke complications. The mean SSQOLS score was 164.18 ± 32.30. In the final model severe functional disability [adjβ -33.77(-52.44, -15.22)], depression [adjβ-23.74(-30.61,-16.82)], hospital admissions [adjβ-5.51(-9.23,-1.92)] and severe neurologic pain [adjβ -12.41(-20.10,-4.77)] negatively impacted QOL of stroke survivors (P < 0.01). For caregivers, mean age was 39.18 ± 13.44 years, 51% were female and 34% reported high stress levels. Complementary qualitative study revealed that primary caregivers were depressed, frustrated, isolated and also disappointed by health services. Conclusion The QOL of Stroke survivors as reported by SSQOLS score was better than compared to those reported from other LMIC settings. However, Qualitative triangulation revealed that younger caregivers felt isolated, depressed, overwhelmed and were providing care at great personal cost. There is a need to develop cost effective holistic home support interventions to improve lives of the survivor dyad as a unit. Trial registration NCT02351778 (Registered as Observational Study). Electronic supplementary material The online version of this article (doi:10.1186/s12883-016-0774-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wardah Khalid
- Fogarty Cerebrovascular Research Fellow, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan
| | - Shafquat Rozi
- Department of Community Health Sciences, Epidemiology & Biostatistics, Director Clinical Research Track (CRT), Aga Khan University, Karachi, Pakistan
| | - Tazeen Saeed Ali
- School of Nursing and Midwifery (SONAM), Karachi, Pakistan.,Department of Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - Michael T Mullen
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Saleem Illyas
- Development Centre DOW University of Health Sciences, Karachi, Pakistan
| | - Qamar Un-Nisa
- Department of Neurology, DOW University of Health Sciences, Karachi, Pakistan.,Department of Medicine, Lecturer, Section of Neurology, Aga Khan University, Karachi, Pakistan
| | - Nabila Soomro
- Institute of Physical Medicine and Rehabilitation, DOW University of Health Sciences, Karachi, Pakistan
| | - Ayeesha Kamran Kamal
- The International Cerebrovascular Translational Clinical Research Training Program, Fogarty International Center and the National Institute of Neurologic Disorders and Stroke, Aga Khan University, Stadium Road, 74800, Karachi, Pakistan. .,Department of Medicine, Aga Khan University, Karachi, Pakistan.
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Sami N, Ali TS, Osama M. Quality of life among women with symptoms of gynecological morbidities: results of a cross-sectional study in Karachi, Pakistan. J Obstet Gynaecol Res 2014; 41:608-14. [PMID: 25492624 DOI: 10.1111/jog.12614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 04/02/2014] [Accepted: 09/01/2014] [Indexed: 11/30/2022]
Abstract
AIMS A population-based cross-sectional study design was used to study the effects of symptoms of various gynecological morbidities (GM) on health-related quality of life (HRQoL) of women, residents of squatter settlements of Karachi, Pakistan. MATERIAL AND METHODS This cross-sectional study was conducted in squatter settlements of Karachi from September 2012 to August 2013, with 1002 married, non-pregnant women. After obtaining written informed consent from every participant, a structured questionnaire was used to collect information about symptoms of GM and their effect on four domains of HRQoL (physical, social, functional and financial domains). RESULTS Of 1002 women who participated in the study, 578 reported suffering from one or more symptoms of GM. The most commonly reported symptoms were foul-smelling vaginal discharge, dysmenorrhea and uterovaginal prolapse while the least reported symptom was post-coital bleeding. Symptoms of GM were found to have a negative impact on HRQoL. Approximately one-third of women with the symptoms of GM reported having negative influences on the physical, financial and functional domains of HRQoL with social domain being comparatively less affected. Compared to other symptoms, dysmenorrhea and uterovaginal prolapse were reported to be mostly associated with poor HRQoL of women. CONCLUSION The concept of HRQoL has been kept marginal and inconspicuous by clinicians. In order to achieve the psychosocial satisfaction of the patient, the focus needs to be diverted to all domains of HRQoL.
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Allana S, Khowaja K, Ali TS, Moser DK, Khan AH. Gender differences in factors associated with prehospital delay among acute coronary syndrome patients in Pakistan. J Transcult Nurs 2014; 26:480-90. [PMID: 26541388 DOI: 10.1177/1043659614524787] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To identify gender differences in prehospital delay time (PDT) and its associated factors among acute coronary syndrome (ACS) patients. DESIGN Descriptive cross-sectional comparative study. METHODS This study was conducted among 249 ACS patients at two tertiary care hospitals of a large metropolitan city of Pakistan. Data were collected through the modified Response to Symptoms Questionnaire. RESULTS The median PDT of women was found to be 7 hours, compared to 3.5 hours among men (p = .001). Results of the regression analysis indicated that most women delayed because of social factors, such as attendants' responses to their symptoms (p = .002), and because they were worried about expenses required for the treatment (p = .002); yet, most men delayed owing to individual factors, such as waiting for symptoms to subside (p< .001), and not recognizing the symptoms as being cardiac related (p< .001). Having anxiety and lack of knowledge about symptoms was associated with extended PDT among both genders. CONCLUSION Women delayed longer than men in seeking treatment for their ACS symptoms. Different factors were associated with PDT in women and men. This study may provide important insights for designing interventional studies to reduce PDT in Pakistani ACS patients.
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Abstract
Use of complementary and alternative medicine (CAM) has increased globally, particularly among oncology patients. This study investigated the knowledge, experience and attitudes of oncology nurses towards CAM. A quantitative study was conducted in tertiary care hospitals in Karachi, Pakistan, where 132 oncology nurses were surveyed. The survey revealed that more than 50% of nurses had never heard about many of the CAM therapies used in Pakistan. Approximately 65% of the nurses had knowledge about prayer and less than 30% had experience of CAM education or training. In addition, the majority of nurses had seen patients using CAM and felt that their health status could be enhanced with the use of CAM. This study showed that oncology nurses had a positive experience of and attitude towards CAM, although they needed to enhance their knowledge of it to maximise patient satisfaction and quality of care.
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Affiliation(s)
- Salima Somani
- Resource Person for Nursing Education, University of Central Asia, Kyrgyz Republic
| | - Fauziya Ali
- Assistant Professor, School of Nursing and Midwifery, Aga Khan University
| | - Tazeen Saeed Ali
- Assistant Professor, School of Nursing and Midwifery & Community Health Sciences, Aga Khan University, Karachi, Pakistan
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Gani N, Ali TS. Prevalence and factors associated with maternal postpartum haemorrhage in Khyber Agency, Pakistan. J Ayub Med Coll Abbottabad 2013; 25:81-85. [PMID: 25098062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Postpartum haemorrhage (PPH) is one of the main causes of maternal mortality globally. The objective of this study was to estimate the prevalence of PPH and identify factors associated with PPH in Khyber Agency, Pakistan. METHODOLOGY A quantitative, cross-sectional study design was selected to estimate the prevalence and associated factors for PPH among married women aged 15-49 years, residing in the Khyber Agency, FATA, Pakistan. A pre-tested structured questionnaire was adapted with some modifications to interview 1,000 women. RESULTS Prevalence of PPH was 21.3% in the study population. Factors associated with PPH were age, number of pregnancies, duration of labour, avoidance of milk, insertion of homemade remedies in vagina. retained placenta, and rest during postpartum period. CONCLUSION Poor infrastructure, lack of appropriate training for healthcare providers, economic conditions, and negative cultural practices are some amongst the multiple factors that have a perilous impact on women's health, particularly women of reproductive age. The morbidities were the result of malpractices ingrained in the community.
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Ali TS, Árnadóttir G, Kulane A. Dowry practices and their negative consequences from a female perspective in Karachi, Pakistan <br>—A qualitative study. Health (London) 2013. [DOI: 10.4236/health.2013.57a4012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Parpio Y, Farooq S, Gulzar S, Tharani A, Javed F, Ali TS. Factors associated with stress among adolescents in the city of Nawabshah, Pakistan. J PAK MED ASSOC 2012; 62:1209-1213. [PMID: 23866413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To identify the risk factors of stress among school-going adolescents in rural Nawabshah, Pakistan. METHODS The cross-sectional study was conducted in 2005, comprising 800 school-going children of 10-16 years of age in Nawabshah, through simple random sampling. Data was collected using a structured questionnaire to assess the potential risk factors of stress. A modified version of Perceived stress scale was utilized to measure stress level. SPSS 12 was used for statistical analysis, while multiple linear regression analysis was run to identify the factors associated with stress in the study population. RESULTS Of the total, 529 (66%) children belonged to state-run schools while 271 (34%) were studying at private facilities. The mean age was 13.7+/-1.3 years. The level of stress was positively associated with the number of siblings, parental conflicts, the age of the mother and the number of rooms in the household. There was decreased level of stress among female adolescents (n=474; 59.3%) who had prior information about pubertal body changes than the boys (n=326; 40.8%). CONCLUSION The study showed that stress among adolescents can be reduced by modifying socio-economic and demographic factors.
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Affiliation(s)
- Yasmin Parpio
- School of Nursing, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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Abstract
Background Secondary infertility in developing countries is mostly attributable to blockage of the fallopian tubes due to adhesions caused by reproductive tract infections. There is a dearth of information on the prevalence and causes of secondary infertility from Pakistan. This paper presents results on factors associated with secondary infertility among married women in Karachi, Pakistan. Methods A matched case-control study was conducted. Cases were women aged 15–35 years with history of at least one previous conception and currently seeking treatment for secondary infertility. Controls were women residing in the neighborhood of cases with at least one live birth and not taking treatment for secondary infertility. The age of controls was matched by ±5 years to that of cases. Data was collected from June to August 2003. Conditional logistic regression was used to determine crude and adjusted odds ratios (OR) with corresponding 95% confidence intervals (CI) for factors associated with secondary infertility. Results The final multivariate logistic regression model revealed that after adjusting for age, cases were more likely to be the housewives (AOR = 2.6, 95% CI:1.5–4.4), had used inappropriate material to absorb blood during menstruation (AOR = 9.0, 95% CI: 5.0–16.4), and at their last delivery, had a birth attendant who did not wash hands with soap and water (AOR = 3.0, 95% CI: 1.4–5.7). Moreover, women with secondary infertility were more likely to report current or past history of having STI symptoms (AOR = 3.6, 95% CI: 2.4–5.6) and use of intra-vaginal indigenous medicines during their last post-partum period (AOR = 3.1, 95% CI: 1.6–5.7). Conclusion We recommend health education and awareness messages for safe practices during menstruation, delivery, and the postpartum period for women in general. Additionally, sanitary napkins should be made available at an affordable cost, and safe delivery kits should contain educational/pictorial brochures for appropriate hand washing skills.
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Affiliation(s)
- Neelofar Sami
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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Al-Hezaimi K, Javed F, Ali TS, Al-Askar M, Al-Rasheed A. Rapidly progressive periodontal disease associated with human immunodeficiency virus. J Coll Physicians Surg Pak 2012; 22:186-8. [PMID: 22414365 DOI: 02.2012/jcpsp.186188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 12/15/2011] [Indexed: 11/05/2022]
Abstract
Severe periodontal inflammation with generalized dental plaque accumulation, spontaneous and severe gingival bleeding, fungal infection, and interdental papillae necrosis are presented in a patient infected with human immunodeficiency virus (HIV). Bite-wing radiographs revealed a generalized horizontal alveolar bone loss of 7-8 millimetres in both arches. Erythematous patches were noted on the gingival mucosa in both jaws. DNA testing was performed to indentify the periodontopathogens. The patient had no signs or symptoms of acquired immunodeficiency syndrome. This case-report presents the massive periodontal destruction that occurred in a patient infected with HIV. Therefore, it is highly recommended that patients infected with HIV should be regularly monitored to aid in early detection and to provide proper management of periodontal inflammatory conditions to minimize its destruction.
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Sami N, Saeed Ali T. Perceptions and experiences of women in karachi, pakistan regarding secondary infertility: results from a community-based qualitative study. Obstet Gynecol Int 2012; 2012:108756. [PMID: 22474450 PMCID: PMC3306922 DOI: 10.1155/2012/108756] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 11/22/2011] [Accepted: 11/25/2011] [Indexed: 11/17/2022] Open
Abstract
Background. The prevalence of infertility in Pakistan is 22% with primary infertility at 4% and secondary infertility at 18%. This study explored perceptions and experiences of women in Karachi, Pakistan regarding the causes, treatment-seeking behavior for and consequences of secondary infertility. Methods. Focus group discussions and in-depth interviews with married women explored their perceptions and experiences for issues related to secondary infertility. Results. The knowledge of women about the causes and scientific treatment options for infertility was limited resulting in inclination for traditional unsafe health care. Infertility was stated to result in marital instability, stigmatization and abuse specially for women with no live child. Conclusions. Since infertility can have a serious effect on both the psychological well-being and the social status of women in Pakistan, effective interventions are the need of the day. There is a dire need for health education and counseling to be integrated into infertility management plans.
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Affiliation(s)
- Neelofar Sami
- Department of Community Health Sciences, Aga Khan University, Karachi 74800, Pakistan
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Khan N, Khowaja KZA, Ali TS. Assessment of knowledge, skill and attitude of oncology nurses in chemotherapy administration in tertiary hospital Pakistan. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ojn.2012.22015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Roshan Essani R, Ali TS. Knowledge and Practice Gaps among Pediatric Nurses at a Tertiary Care Hospital Karachi Pakistan. ISRN Pediatrics 2011; 2011:460818. [PMID: 22389778 PMCID: PMC3263578 DOI: 10.5402/2011/460818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 02/24/2011] [Indexed: 12/03/2022]
Abstract
The advancement in medical science has created health care environments that require nursing professionals who posses specialized clinical knowledge and skills to provide care and deal with critically and acutely ill children. This study explored gaps between knowledge and practice as perceived by the registered nurses of pediatric units by further recommending the changes suggested by them. A descriptive exploratory study design under the quantitative research methodology was utilized using universal sampling of all pediatric nurses working at a tertiary care hospital in Karachi, Pakistan. The gaps between knowledge and practice, as perceived by the participants, were categorized into five major categories: (1) medication (34%), (2) skills (28.3%), (3) knowledge (13.36%), (4) handling of code blue and intubations (12.6%), and (5) operating medical devices (11.58%). As a result, anxiety and incompetency were notably seen in the participants which had great amount of impact on the level of care provided to the patients. The implications of the findings for quality patient care were also analyzed.
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Affiliation(s)
- Rozina Roshan Essani
- School of Nursing, Aga Khan University, Karachi, Pakistan
- Nursing Practice, Division of Nursing Services, Aga Khan University Hospital, Karachi, Pakistan
| | - Tazeen Saeed Ali
- School of Nursing, Aga Khan University, Karachi, Pakistan
- Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Meherali SM, Parpio Y, Ali TS. Critical illness myopathy. J PAK MED ASSOC 2010; 60:961-963. [PMID: 21375205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Critical illness myopathy (CIM) is a syndrome of widespread muscle weakness and neurological dysfunction which can develop in critically ill patients receiving intensive care. CIM are often distinguished largely on the basis of specialized electrophysiologic testing or muscle and nerve biopsy and its causes are unknown, though they are thought to be a possible neurological manifestation of systemic inflammatory response syndrome usually developing in patients after a brief period of stay in the Intensive Care Unit (ICU). This case report aims to analyze the Clinical feature, diagnosis and treatment of CIM of 60-year-old male case with Chronic Obstructive Lung disease (COPD) admitted to the intensive care. Health professionals working at critical care unit should be aware that any ICU patient may develop CIM.
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Affiliation(s)
- Salima Moez Meherali
- School of Nursing, Department of Community Health Sciences, The Aga Khan University, Karachi
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