This study investigated the wife experience of verbal and physical violence from their husbands, ... more This study investigated the wife experience of verbal and physical violence from their husbands, aimed to estimate the prevalence of interpersonal violence and to identify the reasons among women in squatter settlements of Karachi, Pakistan. The data was collected using a cross-sectional study design, by structured interviewing 400 currently married women. Seventy percent (283) of the study subjects reported verbal violence while 25% (100) women reported for physical violence. Women felt mental pressure due to verbal violence as 89% (253/283). The main reasons for physical violence were: in-laws (26%), wife arguing 24%, stopping husband for smoking 17%, taunting the children by the husbands/ in-laws 14%, financial constraints 13%, house-hold chores 7%, stopping the husbands for any thing by wife 6%, women had abortion 5%, followed by others. The qualitative phase of study emerged the themes that husbands violence is the part of normal life of women, Health professionals should be he...
Background: Improved complementary feeding is cited as a critical factor for reducing stunting. C... more Background: Improved complementary feeding is cited as a critical factor for reducing stunting. Consumption of meats has been advocated, but its efficacy in low-resource settings has not been tested. Objective: The objective was to test the hypothesis that daily intake of 30 to 45 g meat from 6 to 18 mo of age would result in greater linear growth velocity and improved micronutrient status in comparison with an equicaloric multimicronutrient-fortified cereal. Design: This was a cluster randomized efficacy trial conducted in the Democratic Republic of Congo, Zambia, Guatemala, and Pakistan. Individual daily portions of study foods and education messages to enhance complementary feeding were delivered to participants. Blood tests were obtained at trial completion. Results: A total of 532 (86.1%) and 530 (85.8%) participants from the meat and cereal arms, respectively, completed the study. Linear growth velocity did not differ between treatment groups: 1.00 (95% CI: 0.99, 1.02) and 1.02 (95% CI: 1.00, 1.04) cm/mo for the meat and cereal groups, respectively (P = 0.39). From baseline to 18 mo, stunting [length-forage z score (LAZ) ,22.0] rates increased from w33% to nearly 50%. Years of maternal education and maternal height were positively associated with linear growth velocity (P = 0.0006 and 0.003, respectively); LAZ at 6 mo was negatively associated (P , 0.0001). Anemia rates did not differ by group; iron deficiency was significantly lower in the cereal group. Conclusion: The high rate of stunting at baseline and the lack of effect of either the meat or multiple micronutrient-fortified cereal intervention to reverse its progression argue for multifaceted interventions beginning in the pre-and early postnatal periods. This trial was registered at clinicaltrials.gov as NCT01084109.
Background The prevalence of chronic malnutrition and its associated morbid outcomes has been a s... more Background The prevalence of chronic malnutrition and its associated morbid outcomes has been a significant cause of health loss globally, affecting millions of children hampering their mental, physical, social, and immune system development. World Health Organization's (WHO) recommendations presenting infant feeding guidelines have largely controlled this burden. However, developing countries including Pakistan have failed to promote these guidelines and still succumb to a huge burden of morbidity and mortality secondary to malnourishment among infants.
Geographic access to working family planning centers and unintended pregnancies among married wom... more Geographic access to working family planning centers and unintended pregnancies among married women: a community based nested case control study..
This is an open access artic e under the terms of the Creative Commons Attribution License which ... more This is an open access artic e under the terms of the Creative Commons Attribution License which permits use distribution and reproduction in any medium provided the original work is properly cited. The Authors Nursing Open pub ished by John Wi ey Sons Ltd
OBJECTIVE To explore the perceptions and experiences of couples with secondary infertility regard... more OBJECTIVE To explore the perceptions and experiences of couples with secondary infertility regarding adoption practices; to estimate the prevalence of adoption among couples with secondary infertility, and to study the adopted child preference pattern. METHODS To fulfill the objectives of the study both qualitative and quantitative study designs were utilized. In qualitative explorative study design, three Focus Group discussions were conducted with married fertile women to explore their perceptions for adoption practices. Moreover, eight in-depth interviews were conducted with women with secondary infertility to explore their experiences. For quantitative methodology, a case series of 400 secondary infertile couples was conducted. RESULTS Qualitative methodology result suggests that adoption is the last option for infertile couples. Couples often take this as a "Totka", that when they adopt a child, they could end up having their own baby. The husband's family is usua...
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2006
OBJECTIVE To determine the factors affecting the health-seeking behavior of couples with secondar... more OBJECTIVE To determine the factors affecting the health-seeking behavior of couples with secondary infertility in Karachi. DESIGN A descriptive case series. PLACE AND DURATION OF STUDY The data was collected from women attending infertility clinics in five tertiary care hospitals in Karachi from March to June 2003. PATIENTS AND METHODS All currently married women, between the age of 15-35 years, with at least one previous conception, irrespective of outcome, attending an infertility clinic and consenting to participate in the study, were included. Women with corrective surgery on vagina and uterus, and cases of primary infertility, were excluded. Multiple logistic regression models were used to determine the association of various factors, affecting the health-seeking behavior, with statistical significance set at p < 0.05 for the covariates and the interaction terms between various factors. RESULTS The women consulted multiple health care providers for treatment of secondary inf...
This study investigates the prevalence of physical and psychological violence against infertile w... more This study investigates the prevalence of physical and psychological violence against infertile women in Karachi, Pakistan. A total of 400 infertile women attending the selected infertility clinics in Karachi, Pakistan were interviewed using the to investigate their experiences of physical and psychological violence. Out of 400 infertile women, 278 (64%) reported to be the victims of violence during the last 12 months before they were interviewed. Nearly one quarter (23.1%) reported facing physical violence. All women reported their husbands and their family members to be the perpetrators. It is concluded that Clinicians should identify the abused women and provide them with medical care and supportive counseling.
Introduction Discontinuation of a contraceptive method soon after its initiation is becoming a pu... more Introduction Discontinuation of a contraceptive method soon after its initiation is becoming a public health problem in Low middle income countries and may result in unintended pregnancy and related unwanted consequences. A better understanding of factors behind discontinuation of a modern method would help in designing interventions to continue its use till desired spacing goals are achieved. Objective To determine factors associated with the discontinuation of modern contraceptive methods within six months of its use compared to continued use of modern method for at least six months in low-income areas of Karachi, Pakistan. Methods A community-based case-control study was conducted in low-income areas of Karachi. Cases were 137 users who discontinued a modern contraceptive method within 6 months of initiation and were not using any method at the time of interview, while controls were 276 continuous users of modern method for at least last six months from the time of interview. Information was collected by using a structured questionnaire. Applied logistic regression was used to identify the associated factors for discontinuation. Results The mean ages of discontinued and continued users were 29.3±5.3 years and 29.2±5.4 years respectively. A larger proportion of the discontinued users had no formal education (43.8%) as compared to the continued users (27.9%). The factors associated with discontinuation of a modern method of contraception were belonging to Sindhi ethnicity [
Background. Early growth faltering is common but is difficult to reverse after the first 2 years ... more Background. Early growth faltering is common but is difficult to reverse after the first 2 years oflife.
Background: Integrated management of childhood illnesses (IMCI) strategy has been proven to impro... more Background: Integrated management of childhood illnesses (IMCI) strategy has been proven to improve health outcomes in children under 5 years of age. Pakistan, despite being in the late implementation phase of the strategy, continues to report high under-five mortality due to pneumonia, diarrhea, measles, and malnutrition Á the main targets of the strategy. Objective: The study determines the factors influencing IMCI implementation at public-sector primary health care (PHC) facilities in Matiari district, Sindh, Pakistan. Design: An exploratory qualitative study with an embedded quantitative strand was conducted. The qualitative part included 16 in-depth interviews (IDIs) with stakeholders which included planners and policy makers at a provincial level (n 05), implementers and managers at a district level (n 03), and IMCI-trained physicians posted at PHC facilities (n 08). Quantitative part included PHC facility survey (n 016) utilizing WHO health facility assessment tool to assess availability of IMCI essential drugs, supplies, and equipments. Qualitative content analysis was used to interpret the textual information, whereas descriptive frequencies were calculated for health facility survey data. Results: The major factors reported to enhance IMCI implementation were knowledge and perception about the strategy and need for separate clinic for children aged under 5 years as potential support factors. The latter can facilitate in strategy implementation through allocated workforce and required equipments and supplies. Constraint factors mainly included lack of clear understanding of the strategy, poor planning for IMCI implementation, ambiguity in defined roles and responsibilities among stakeholders, and insufficient essential supplies and drugs at PHC centers. The latter was further substantiated through health facilities' survey findings, which indicated that none of the facilities had 100% stock of essential supplies and drugs. Only one out of all 16 surveyed facilities had 75% of the total supplies, while 4 out of 16 facilities had 56% of the required IMCI drug stock. The mean availability of supplies ranged from 36.6 to 66%, while the mean availability of drugs ranged from 45.8 to 56.7%. Conclusion: Our findings indicate that the Matiari district has sound implementation potential; however, bottlenecks at health care facility and at health care management level have badly constrained the implementation process. An interdependency exists among the constraining factors, such as lack of sound planning resulting in unclear understanding of the strategy; leading to ambiguous roles and responsibilities among stakeholders which manifest as inadequate availability of supplies and drugs at PHC facilities. Addressing these barriers is likely to have a cumulative effect on facilitating IMCI implementation. On the basis of these findings, we recommend that the provincial Ministry of Health (MoH) and provincial Maternal Neonatal and Child Health (MNCH) program jointly assess the situation and streamline IMCI implementation in the district through sound planning, training, supervision, and logistic support.
Background: Reproductive Tract Infections (RTIs) is a major public health problem. In Pakistan, t... more Background: Reproductive Tract Infections (RTIs) is a major public health problem. In Pakistan, there is dearth of information about the prevalence of RTIs among women and their health seeking behavior. A study was conducted to determine the prevalence, number and types of RTIs among women residing in squatter settlements in Karachi and their health seeking behavior.
Background. The prevalence of infertility in Pakistan is 22% with primary infertility at 4% and s... more 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.
Journal of the Pakistan Medical Association, Sep 1, 2005
To assess knowledge regarding availability, affordability, appropriate use and efficacy for five ... more To assess knowledge regarding availability, affordability, appropriate use and efficacy for five non-permanent contraceptive methods. Married Muslim women and men (500 each) were randomly selected from two low socioeconomic settlements in Karachi, Pakistan. Interviews to assess their knowledge on a range of contraceptive and abortion themes were conducted. Four hundred men and 357 women were selected from this larger sample based on their knowledge of condoms, withdrawal, oral pills, injectables and IUDs. Nearly half of the sampled men (56%) and women (48%) were contraceptive users. Knowledge regarding contraception, a specific method, its availability and affordability was high. Appropriate use knowledge for condoms was 73% among men (users 78%, non-users 60%; p-value &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 0.001 ) and 5% among women. Efficacy knowledge was generally poor. Low knowledge levels regarding appropriate use and efficacy even among contraceptive users suggests, that quality of family planning services should not be limited to service delivery issues but extend to appropriate use and efficacy knowledge levels among clients.
Journal of the College of Physicians and Surgeons--Pakistan: JCPSP
To determine the factors affecting the health-seeking behavior of couples with secondary infertil... more To determine the factors affecting the health-seeking behavior of couples with secondary infertility in Karachi. Design: A descriptive case series. Place and Duration of Study: The data was collected from women attending infertility clinics in five tertiary care hospitals in Karachi from March to June 2003. Patients and Methods: All currently married women, between the age of 15-35 years, with at least one previous conception, irrespective of outcome, attending an infertility clinic and consenting to participate in the study, were included. Women with corrective surgery on vagina and uterus, and cases of primary infertility, were excluded. Multiple logistic regression models were used to determine the association of various factors, affecting the health-seeking behavior, with statistical significance set at p < 0.05 for the covariates and the interaction terms between various factors. Results: The women consulted multiple health care providers for treatment of secondary infertility. The main reasons for seeking treatment were couple's wish (54.2%), family pressure (22.6%) and want of a son by husbands or in-laws (20.4%). The most commonly sought providers were physicians (74.7%), Traditional Birth Attendants (TBA, 39.5%), Spiritual healers (26%), Hakeems (23%) and Homeopaths (17.2%). Most of the women who consulted non-physicians were illiterate (69.4%) as compared to those who consulted a physician (37.8%, p-value = 0.00). The non-physicians were more commonly consulted by women belonging to low socioeconomic group. The posttreatment complications were more common among women who consulted non-physicians. Conclusion: Pressure from husbands and in-laws compels women for consulting multiple providers. Health seeking behavior for infertility is affected by the literacy and socioeconomic status of the women.
To explore the perceptions and experiences of couples with secondary infertility regarding adopti... more To explore the perceptions and experiences of couples with secondary infertility regarding adoption practices; to estimate the prevalence of adoption among couples with secondary infertility, and to study the adopted child preference pattern. To fulfill the objectives of the study both qualitative and quantitative study designs were utilized. In qualitative explorative study design, three Focus Group discussions were conducted with married fertile women to explore their perceptions for adoption practices. Moreover, eight in-depth interviews were conducted with women with secondary infertility to explore their experiences. For quantitative methodology, a case series of 400 secondary infertile couples was conducted. Qualitative methodology result suggests that adoption is the last option for infertile couples. Couples often take this as a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Totka&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;, that when they adopt a child, they could end up having their own baby. The husband&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s family is usually preferred for adopting a child. The results of quantitative component suggest that the prevalence of adoption among 400 women is 7%. Less than half of the respondents (49.3%) reported to ever having thought of adopting a child to cope with the secondary infertility. The main decision maker for adoption of child is the husband (17%) and the mother-in-law (68%). Though majority of these women (72.5%) were supported by their husbands, however, in-laws and relatives were reluctant to pursue this option and less than one third (29%) of these women had a support from them. This study concludes that couples ever thought of or opted for adoption after prolonged duration of secondary infertility. In cases where the condition cannot be treated, it is necessary to counsel, not only the couple but also the in-laws.
Introduction: In Pakistan, Contraceptive Prevalence Rate (CPR) among married female youth is 17.4... more Introduction: In Pakistan, Contraceptive Prevalence Rate (CPR) among married female youth is 17.4% and even lower in rural and slum areas leading to rapid population growth on one hand and poor health consequences on the other. The study was conducted to explore family planning service providers’ perceptions regarding use of different contraceptive methods and to identify factors that are influencing their use amongst currently married youth aged 18-24 years in slum areas of Karachi. Method: Qualitative exploratory study design was adopted and a total of ten in-depth interviews were conducted with family planning service providers of the area. For content analysis coding of transcribed interviews was done and then categories were made and furthermore themes were derived. Results: Our findings revealed that family planning service providers perceived that there is low use of contraceptive methods amongst youth of study area and low usage could be due to side effects; myths and miscon...
This study investigated the wife experience of verbal and physical violence from their husbands, ... more This study investigated the wife experience of verbal and physical violence from their husbands, aimed to estimate the prevalence of interpersonal violence and to identify the reasons among women in squatter settlements of Karachi, Pakistan. The data was collected using a cross-sectional study design, by structured interviewing 400 currently married women. Seventy percent (283) of the study subjects reported verbal violence while 25% (100) women reported for physical violence. Women felt mental pressure due to verbal violence as 89% (253/283). The main reasons for physical violence were: in-laws (26%), wife arguing 24%, stopping husband for smoking 17%, taunting the children by the husbands/ in-laws 14%, financial constraints 13%, house-hold chores 7%, stopping the husbands for any thing by wife 6%, women had abortion 5%, followed by others. The qualitative phase of study emerged the themes that husbands violence is the part of normal life of women, Health professionals should be he...
Background: Improved complementary feeding is cited as a critical factor for reducing stunting. C... more Background: Improved complementary feeding is cited as a critical factor for reducing stunting. Consumption of meats has been advocated, but its efficacy in low-resource settings has not been tested. Objective: The objective was to test the hypothesis that daily intake of 30 to 45 g meat from 6 to 18 mo of age would result in greater linear growth velocity and improved micronutrient status in comparison with an equicaloric multimicronutrient-fortified cereal. Design: This was a cluster randomized efficacy trial conducted in the Democratic Republic of Congo, Zambia, Guatemala, and Pakistan. Individual daily portions of study foods and education messages to enhance complementary feeding were delivered to participants. Blood tests were obtained at trial completion. Results: A total of 532 (86.1%) and 530 (85.8%) participants from the meat and cereal arms, respectively, completed the study. Linear growth velocity did not differ between treatment groups: 1.00 (95% CI: 0.99, 1.02) and 1.02 (95% CI: 1.00, 1.04) cm/mo for the meat and cereal groups, respectively (P = 0.39). From baseline to 18 mo, stunting [length-forage z score (LAZ) ,22.0] rates increased from w33% to nearly 50%. Years of maternal education and maternal height were positively associated with linear growth velocity (P = 0.0006 and 0.003, respectively); LAZ at 6 mo was negatively associated (P , 0.0001). Anemia rates did not differ by group; iron deficiency was significantly lower in the cereal group. Conclusion: The high rate of stunting at baseline and the lack of effect of either the meat or multiple micronutrient-fortified cereal intervention to reverse its progression argue for multifaceted interventions beginning in the pre-and early postnatal periods. This trial was registered at clinicaltrials.gov as NCT01084109.
Background The prevalence of chronic malnutrition and its associated morbid outcomes has been a s... more Background The prevalence of chronic malnutrition and its associated morbid outcomes has been a significant cause of health loss globally, affecting millions of children hampering their mental, physical, social, and immune system development. World Health Organization's (WHO) recommendations presenting infant feeding guidelines have largely controlled this burden. However, developing countries including Pakistan have failed to promote these guidelines and still succumb to a huge burden of morbidity and mortality secondary to malnourishment among infants.
Geographic access to working family planning centers and unintended pregnancies among married wom... more Geographic access to working family planning centers and unintended pregnancies among married women: a community based nested case control study..
This is an open access artic e under the terms of the Creative Commons Attribution License which ... more This is an open access artic e under the terms of the Creative Commons Attribution License which permits use distribution and reproduction in any medium provided the original work is properly cited. The Authors Nursing Open pub ished by John Wi ey Sons Ltd
OBJECTIVE To explore the perceptions and experiences of couples with secondary infertility regard... more OBJECTIVE To explore the perceptions and experiences of couples with secondary infertility regarding adoption practices; to estimate the prevalence of adoption among couples with secondary infertility, and to study the adopted child preference pattern. METHODS To fulfill the objectives of the study both qualitative and quantitative study designs were utilized. In qualitative explorative study design, three Focus Group discussions were conducted with married fertile women to explore their perceptions for adoption practices. Moreover, eight in-depth interviews were conducted with women with secondary infertility to explore their experiences. For quantitative methodology, a case series of 400 secondary infertile couples was conducted. RESULTS Qualitative methodology result suggests that adoption is the last option for infertile couples. Couples often take this as a "Totka", that when they adopt a child, they could end up having their own baby. The husband's family is usua...
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2006
OBJECTIVE To determine the factors affecting the health-seeking behavior of couples with secondar... more OBJECTIVE To determine the factors affecting the health-seeking behavior of couples with secondary infertility in Karachi. DESIGN A descriptive case series. PLACE AND DURATION OF STUDY The data was collected from women attending infertility clinics in five tertiary care hospitals in Karachi from March to June 2003. PATIENTS AND METHODS All currently married women, between the age of 15-35 years, with at least one previous conception, irrespective of outcome, attending an infertility clinic and consenting to participate in the study, were included. Women with corrective surgery on vagina and uterus, and cases of primary infertility, were excluded. Multiple logistic regression models were used to determine the association of various factors, affecting the health-seeking behavior, with statistical significance set at p < 0.05 for the covariates and the interaction terms between various factors. RESULTS The women consulted multiple health care providers for treatment of secondary inf...
This study investigates the prevalence of physical and psychological violence against infertile w... more This study investigates the prevalence of physical and psychological violence against infertile women in Karachi, Pakistan. A total of 400 infertile women attending the selected infertility clinics in Karachi, Pakistan were interviewed using the to investigate their experiences of physical and psychological violence. Out of 400 infertile women, 278 (64%) reported to be the victims of violence during the last 12 months before they were interviewed. Nearly one quarter (23.1%) reported facing physical violence. All women reported their husbands and their family members to be the perpetrators. It is concluded that Clinicians should identify the abused women and provide them with medical care and supportive counseling.
Introduction Discontinuation of a contraceptive method soon after its initiation is becoming a pu... more Introduction Discontinuation of a contraceptive method soon after its initiation is becoming a public health problem in Low middle income countries and may result in unintended pregnancy and related unwanted consequences. A better understanding of factors behind discontinuation of a modern method would help in designing interventions to continue its use till desired spacing goals are achieved. Objective To determine factors associated with the discontinuation of modern contraceptive methods within six months of its use compared to continued use of modern method for at least six months in low-income areas of Karachi, Pakistan. Methods A community-based case-control study was conducted in low-income areas of Karachi. Cases were 137 users who discontinued a modern contraceptive method within 6 months of initiation and were not using any method at the time of interview, while controls were 276 continuous users of modern method for at least last six months from the time of interview. Information was collected by using a structured questionnaire. Applied logistic regression was used to identify the associated factors for discontinuation. Results The mean ages of discontinued and continued users were 29.3±5.3 years and 29.2±5.4 years respectively. A larger proportion of the discontinued users had no formal education (43.8%) as compared to the continued users (27.9%). The factors associated with discontinuation of a modern method of contraception were belonging to Sindhi ethnicity [
Background. Early growth faltering is common but is difficult to reverse after the first 2 years ... more Background. Early growth faltering is common but is difficult to reverse after the first 2 years oflife.
Background: Integrated management of childhood illnesses (IMCI) strategy has been proven to impro... more Background: Integrated management of childhood illnesses (IMCI) strategy has been proven to improve health outcomes in children under 5 years of age. Pakistan, despite being in the late implementation phase of the strategy, continues to report high under-five mortality due to pneumonia, diarrhea, measles, and malnutrition Á the main targets of the strategy. Objective: The study determines the factors influencing IMCI implementation at public-sector primary health care (PHC) facilities in Matiari district, Sindh, Pakistan. Design: An exploratory qualitative study with an embedded quantitative strand was conducted. The qualitative part included 16 in-depth interviews (IDIs) with stakeholders which included planners and policy makers at a provincial level (n 05), implementers and managers at a district level (n 03), and IMCI-trained physicians posted at PHC facilities (n 08). Quantitative part included PHC facility survey (n 016) utilizing WHO health facility assessment tool to assess availability of IMCI essential drugs, supplies, and equipments. Qualitative content analysis was used to interpret the textual information, whereas descriptive frequencies were calculated for health facility survey data. Results: The major factors reported to enhance IMCI implementation were knowledge and perception about the strategy and need for separate clinic for children aged under 5 years as potential support factors. The latter can facilitate in strategy implementation through allocated workforce and required equipments and supplies. Constraint factors mainly included lack of clear understanding of the strategy, poor planning for IMCI implementation, ambiguity in defined roles and responsibilities among stakeholders, and insufficient essential supplies and drugs at PHC centers. The latter was further substantiated through health facilities' survey findings, which indicated that none of the facilities had 100% stock of essential supplies and drugs. Only one out of all 16 surveyed facilities had 75% of the total supplies, while 4 out of 16 facilities had 56% of the required IMCI drug stock. The mean availability of supplies ranged from 36.6 to 66%, while the mean availability of drugs ranged from 45.8 to 56.7%. Conclusion: Our findings indicate that the Matiari district has sound implementation potential; however, bottlenecks at health care facility and at health care management level have badly constrained the implementation process. An interdependency exists among the constraining factors, such as lack of sound planning resulting in unclear understanding of the strategy; leading to ambiguous roles and responsibilities among stakeholders which manifest as inadequate availability of supplies and drugs at PHC facilities. Addressing these barriers is likely to have a cumulative effect on facilitating IMCI implementation. On the basis of these findings, we recommend that the provincial Ministry of Health (MoH) and provincial Maternal Neonatal and Child Health (MNCH) program jointly assess the situation and streamline IMCI implementation in the district through sound planning, training, supervision, and logistic support.
Background: Reproductive Tract Infections (RTIs) is a major public health problem. In Pakistan, t... more Background: Reproductive Tract Infections (RTIs) is a major public health problem. In Pakistan, there is dearth of information about the prevalence of RTIs among women and their health seeking behavior. A study was conducted to determine the prevalence, number and types of RTIs among women residing in squatter settlements in Karachi and their health seeking behavior.
Background. The prevalence of infertility in Pakistan is 22% with primary infertility at 4% and s... more 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.
Journal of the Pakistan Medical Association, Sep 1, 2005
To assess knowledge regarding availability, affordability, appropriate use and efficacy for five ... more To assess knowledge regarding availability, affordability, appropriate use and efficacy for five non-permanent contraceptive methods. Married Muslim women and men (500 each) were randomly selected from two low socioeconomic settlements in Karachi, Pakistan. Interviews to assess their knowledge on a range of contraceptive and abortion themes were conducted. Four hundred men and 357 women were selected from this larger sample based on their knowledge of condoms, withdrawal, oral pills, injectables and IUDs. Nearly half of the sampled men (56%) and women (48%) were contraceptive users. Knowledge regarding contraception, a specific method, its availability and affordability was high. Appropriate use knowledge for condoms was 73% among men (users 78%, non-users 60%; p-value &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 0.001 ) and 5% among women. Efficacy knowledge was generally poor. Low knowledge levels regarding appropriate use and efficacy even among contraceptive users suggests, that quality of family planning services should not be limited to service delivery issues but extend to appropriate use and efficacy knowledge levels among clients.
Journal of the College of Physicians and Surgeons--Pakistan: JCPSP
To determine the factors affecting the health-seeking behavior of couples with secondary infertil... more To determine the factors affecting the health-seeking behavior of couples with secondary infertility in Karachi. Design: A descriptive case series. Place and Duration of Study: The data was collected from women attending infertility clinics in five tertiary care hospitals in Karachi from March to June 2003. Patients and Methods: All currently married women, between the age of 15-35 years, with at least one previous conception, irrespective of outcome, attending an infertility clinic and consenting to participate in the study, were included. Women with corrective surgery on vagina and uterus, and cases of primary infertility, were excluded. Multiple logistic regression models were used to determine the association of various factors, affecting the health-seeking behavior, with statistical significance set at p < 0.05 for the covariates and the interaction terms between various factors. Results: The women consulted multiple health care providers for treatment of secondary infertility. The main reasons for seeking treatment were couple's wish (54.2%), family pressure (22.6%) and want of a son by husbands or in-laws (20.4%). The most commonly sought providers were physicians (74.7%), Traditional Birth Attendants (TBA, 39.5%), Spiritual healers (26%), Hakeems (23%) and Homeopaths (17.2%). Most of the women who consulted non-physicians were illiterate (69.4%) as compared to those who consulted a physician (37.8%, p-value = 0.00). The non-physicians were more commonly consulted by women belonging to low socioeconomic group. The posttreatment complications were more common among women who consulted non-physicians. Conclusion: Pressure from husbands and in-laws compels women for consulting multiple providers. Health seeking behavior for infertility is affected by the literacy and socioeconomic status of the women.
To explore the perceptions and experiences of couples with secondary infertility regarding adopti... more To explore the perceptions and experiences of couples with secondary infertility regarding adoption practices; to estimate the prevalence of adoption among couples with secondary infertility, and to study the adopted child preference pattern. To fulfill the objectives of the study both qualitative and quantitative study designs were utilized. In qualitative explorative study design, three Focus Group discussions were conducted with married fertile women to explore their perceptions for adoption practices. Moreover, eight in-depth interviews were conducted with women with secondary infertility to explore their experiences. For quantitative methodology, a case series of 400 secondary infertile couples was conducted. Qualitative methodology result suggests that adoption is the last option for infertile couples. Couples often take this as a &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Totka&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;, that when they adopt a child, they could end up having their own baby. The husband&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s family is usually preferred for adopting a child. The results of quantitative component suggest that the prevalence of adoption among 400 women is 7%. Less than half of the respondents (49.3%) reported to ever having thought of adopting a child to cope with the secondary infertility. The main decision maker for adoption of child is the husband (17%) and the mother-in-law (68%). Though majority of these women (72.5%) were supported by their husbands, however, in-laws and relatives were reluctant to pursue this option and less than one third (29%) of these women had a support from them. This study concludes that couples ever thought of or opted for adoption after prolonged duration of secondary infertility. In cases where the condition cannot be treated, it is necessary to counsel, not only the couple but also the in-laws.
Introduction: In Pakistan, Contraceptive Prevalence Rate (CPR) among married female youth is 17.4... more Introduction: In Pakistan, Contraceptive Prevalence Rate (CPR) among married female youth is 17.4% and even lower in rural and slum areas leading to rapid population growth on one hand and poor health consequences on the other. The study was conducted to explore family planning service providers’ perceptions regarding use of different contraceptive methods and to identify factors that are influencing their use amongst currently married youth aged 18-24 years in slum areas of Karachi. Method: Qualitative exploratory study design was adopted and a total of ten in-depth interviews were conducted with family planning service providers of the area. For content analysis coding of transcribed interviews was done and then categories were made and furthermore themes were derived. Results: Our findings revealed that family planning service providers perceived that there is low use of contraceptive methods amongst youth of study area and low usage could be due to side effects; myths and miscon...
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