Need for multilevel strategies and enhanced acceptance of contraceptive use in order to combat the spread of HIV/AIDS in a Muslim society: a qualitative study of young adults in urban Karachi, Pakistan

This qualitative study explored knowledge, attitudes, beliefs and perceptions of sexual and reproductive health, focusing specifically on contraceptive use and HIV prevention among young unmarried men and women, 17-21 years, in urban Karachi, Pakistan. The main theme, identified as underlying meaning in the focus group discussions was “Societal norms and perceptions create barriers to knowledge and awareness about sexual and reproductive health matters among young adults”. A knowledge gap was revealed concerning HIV/AIDS and contraceptive use among young males and females, who have to rely on media and peers for information seeking. Study participants perceived that HIV/AIDS is incurable and carries a social stigma. It was further revealed, that there is an opposition towards contraceptive use from religious leaders. Young adults in Pakistan are in need of improved knowledge about HIV/AIDS and contraceptive use. Youth clinics and schools/colleges may play a significant role in this regard. The religious leaders need to be informed about the beneficial effects of contraceptives and they should be part of any family planning/contraceptive use program to ensure better community acceptance. At the structural level there is an urgent need for policies targeting the issue of sexual and reproductive health, particularly HIV/AIDS information and contraceptive use to target the young population. The health care services should be able to respond by offering relevant services.

Knowledge, perceptions and myths regarding infertility among selected adult population in Pakistan: a cross-sectional study

BACKGROUND

The reported prevalence of infertility in Pakistan is approximately 22% with 4% primary and 18% secondary infertility. Infertility is not only a medical but also a social problem in our society as cultural customs and perceived religious dictums may equate infertility with failure on a personal, interpersonal, or social level. It is imperative that people have adequate knowledge about infertility so couples can seek timely medical care and misconceptions can be rectified. We aim to assess the knowledge, perception and myths regarding infertility and suggest ways to improve it.

METHODS

A cross-sectional survey was carried out by interviewing a sample of 447 adults who were accompanying the patients at two tertiary care hospitals in Karachi, Pakistan. They were interviewed one-on-one with the help of a pretested questionnaire drafted by the team after a thorough literature review and in consultation with infertility specialists.

RESULTS

The correct knowledge of infertility was found to be limited amongst the participants. Only 25% correctly identified when infertility is pathological and only 46% knew about the fertile period in women's cycle. People are misinformed that use of IUCD (53%) and OCPs (61%) may cause infertility. Beliefs in evil forces and supernatural powers as a cause of infertility are still prevalent especially amongst people with lower level of education. Seeking alternative treatment for infertility remains a popular option for 28% of the participant as a primary preference and 75% as a secondary preference. IVF remains an unfamiliar (78%) and an unacceptable option (55%).

CONCLUSIONS

Knowledge about infertility is limited in the population and a lot of misconceptions and myths are prevalent in the society. Alternative medicine is a popular option for seeking infertility treatment. The cultural and religious perspective about assisted reproductive technologies is unclear, which has resulted in its reduced acceptability.

Assessing reasons for school/college dropout among young adults and implications for awareness about STDs and HIV/AIDS: findings from a population-based study in Karachi, Pakistan

BACKGROUND

Dropping out of school/college not only impedes economic prosperity but may also result in poor knowledge and awareness about sexually transmitted diseases (STDs).

PURPOSE

This study investigated, among young adults in Karachi, Pakistan, the risk factors associated with involuntary school/college dropout and the implications for awareness about HIV/AIDS and STDs.

METHOD

A population-based, cross-sectional study of 1,650 young males and females, aged 17-21 years and living in Karachi, was conducted using a structured questionnaire. Bivariate and multivariate analyses were performed separately for males and females.

RESULTS

Females were twice as likely to drop out of school/college as males. Furthermore, migrant residential status, living in an extended family and lower socio-economic status were identified as risk factors for school/college dropout both for males and females. In the total sample, only 17% of males and 13% of females had heard of STDs (p = 0.020). Furthermore, 26.8% of males and 20.5% of females had not heard of HIV/AIDS (p = 0.003). The females exhibited a higher level of awareness on these matters than the males, irrespective of whether they had dropped out of school or not. While the males who dropped out were considerably less aware than those who remained at school, there was no such difference among females.

CONCLUSION

Young adults from poor families are at increased risk of dropping out of school/college. Among the dropouts, males were clearly at risk of ignorance about STDs while females were somewhat better informed.

Prevalence and risk factors for stunting among children under 5 years: a community based study from Jhangara town, Dadu Sindh

OBJECTIVE

To assess the prevalence and the associated risk factors for stunting in Jhangara Town, Dadu Sindh.

METHODS

A cross-sectional survey was conducted in Jhangara Town, located in district Dadu, rural Sindh. A total of 800 children less than 5 years of age were enrolled. A questionnaire was used to elicit required information and anthropometric measurements were made.

RESULTS

The overall prevalence for stunting was 61% in the study population, which was higher than the prevalence reported by Pakistan Demographic Health Survey (PDHS) 1990/91. In multivariate analysis various risk factors for stunting were ethnicity (OR = 2.1, 95% CI 1.27- 3.57) and birth interval < two years (OR = 1.5, 95% CI 1.09 - 1.99).

CONCLUSION

A large number of children below 5 years of age were stunted. Ethnicity and birth interval less than 2 years were the important risk factors.

What do young adults know about the HIV/AIDS epidemic? Findings from a population based study in Karachi, Pakistan

Background

HIVAIDS is spreading globally, hitting the younger generations. In Pakistan, the prevalence of HIV in high-risk subpopulations is five per cent or higher. This poses a serious threat of a generalised epidemic especially among the younger population. In the wake of HIVAIDS epidemic this is worrying as a well informed younger generation is crucial in restricting the spread of this epidemic. This study investigated Pakistani young adults' (male and female) knowledge and awareness of the HIV/AIDS disease.

Methods

A population-based, cross-sectional study of 1,650 male and female adults aged 17–21 years living in Karachi was conducted using a structured questionnaire. A multi-stage cluster sampling design was used to collect data representative of the general population in an urban area. Bivariate and multivariate analyses were performed separately for males and females.

Results

Of 1,650 subjects, 24 per cent (n = 390) reported that they had not heard of HIV/AIDS. Among the males, those with a poor knowledge were younger (AOR = 2.20; 95 per cent CI, 1.38, 3.49), with less than six years of schooling (AOR = 2.46; 1.29 4.68) and no computer at home (AOR = 1.88; 1.06 3.34). Among the females, the risk factors for poor knowledge were young age (AOR = 1.74; 1.22, 2.50), low socio-economic status (AOR = 1.54; 1.06, 2.22), lack of enrolment at school/college (AOR = 1.61; 1.09, 2.39) and being unmarried (AOR = 1.85; 1.05, 3.26).

Conclusion

Alarming gaps in knowledge relating to HIV/AIDS were detected. The study emphasises the need to educate young adults and equip them with the appropriate information and skills to enable them to protect themselves from HIV/AIDS. However, taboos surrounding public discussions of sexuality remain a key constraint to preventive activities.

Assessing the effects of training on knowledge and skills of health personnel: a case study from the family health project in Sindh, Pakistan

BACKGROUND

The Family Health Project (FHP) was implemented in the province of Sindh during 1992-99 with the assistance of the World Bank. The project was designed to bring substantial changes in health care system for achieving improvement in the health status by strengthening the quality and integration of primary health care services. One of the major components of the project was to develop the institutional capacity of Ministry of Health in Sindh. This is a comparative analysis to assess the knowledge and skills of health care providers in Area Focus Approach (AFA) health facilities with the ones in non-AFA health care facilities.

METHODS

In order to obtain a representative sample, 8 districts were selected which included, Larkana, Khairpur, Nawabshah, Dadu, Tharparkar, Thatta, Karachi South, and Karachi West. A structured questionnaire was designed with various sections to assess the knowledge and skills of various cadres of health facility staff.

RESULTS

This comparative assessment has come up with some interesting results; there is a difference between the scores of knowledge and skills between AFA and non-AFA health care providers. This assessment identified some important methodological issues such as the use of base-line information for comparing the results and the selection of a comparable study population for controlling the confounding factors.

CONCLUSIONS

These findings can be used as important lessons learned for producing better results of any post training assessment intervention.