Management of maternal depression: Qualitative exploration of perceptions of healthcare professionals from a public tertiary care hospital, Karachi, Pakistan.

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.

Civil society organizations, the implementing partners of the Global Vaccine Action Plan.

The authors illustrate by way of civil society (CS) experiences in Pakistan, India, and Ghana how the guiding principles of CS and civil society organizations (CSOs) align with those of the Global Vaccine Action Plan (GVAP); (i.e., country ownership, shared responsibility and partnership, equity, integration, sustainability, and innovation). These experiences show how CS is contributing to GVAP goals such as global polio eradication and improving vaccination coverage by removing barriers and ultimately working toward achieving Millennium Development Goal (MDG) 4-reducing child mortality. A number of CSOs working in the field of child health share some of the objectives enlisted in GVAP: that immunization becomes a national health priority; individuals, families, communities understand the importance of immunization; benefits of immunization are equitably extended to all people; and vaccination systems are part of an integrated health system.

Potential benefits and perceived need for health promoting hospitals in Pakistan: a healthcare stakeholder's perspective.

OBJECTIVES: To explore perceptions of healthcare stakeholders' about health promoting hospitals, potential benefits and need in Pakistan. METHODOLOGY: A qualitative exploratory study was conducted between July-August 2007. The data was collected through key-informant (KI) interviews and focus group discussions (FGD) with purposively selected hospital administrators, healthcare providers, health policy makers, and UN-donor agency representatives. The thematic analysis was done using QSR NVivo 2.0; and nodes representing themes were generated. RESULTS: The study participants perceived health promotion, a concept synonymous to health education. Those participants with public health background were better able to relate their perceptions to a more holistic view of health promotion; than those without public health background. Participants largely revealed HPH to benefit not only patients, but also community, hospital staff and hospitals at large. HPH transition was also perceived as 'opportunistic step' for controlling triple burden of diseases, curtailing morbidity and mortality toll, and 'sole answer' to promote population health, and wellbeing. Given the view, HPH was strongly recommended as "Need of the hour" for Pakistan. CONCLUSION: The HPH settings would bring positive change in the healthcare delivery system, by empowering patients and local community. Technical trainings on health promotion for healthcare providers, constant policy dialogue, political will and support from community stakeholders will further strengthen the scope of health promoting hospitals in Pakistan.

High incidence of childhood pneumonia at high altitudes in Pakistan: a longitudinal cohort study.

OBJECTIVE: To determine the incidence of pneumonia and severe pneumonia among children living at high altitudes in Pakistan. METHODS: A longitudinal cohort study was conducted in which 99 female government health workers in Punial and Ishkoman valleys (Ghizer district, Northern Areas of Pakistan) enrolled children at home, conducted home visits every 2 weeks and actively referred sick children to 15 health centres. Health centre staff used Integrated Management of Childhood Illness criteria to screen all sick children aged 2-35 months and identify those with pneumonia or severe pneumonia. FINDINGS: Community health workers enrolled 5204 eligible children at home and followed them over a 14-month period, ending on 31 December 2002. Health centre staff identified 1397 cases of pneumonia and 377 of severe pneumonia in enrolled children aged 2-35 months. Among children reported with pneumonia, 28% had multiple episodes. Incidence rates per 100 child-years of observation were 29.9 for pneumonia and 8.1 for severe pneumonia. Factors associated with a high incidence of pneumonia were younger age, male gender and living at high altitude. CONCLUSION: Pneumonia incidence rates in the Northern Areas of Pakistan are much higher than rates reported at lower altitudes in the country and are similar to those in high-altitude settings in other developing countries. More studies are needed to determine the causes of pneumonia in these high-mountain communities. However, early introduction of the vaccines that are known to prevent pneumonia should be considered.

The cost of treatment for child pneumonias and meningitis in the Northern Areas of Pakistan.

Pneumonia, meningitis, and sepsis place a significant economic burden on health care systems, particularly in developing countries. This study estimates treatment costs for these diseases in health facilities in the Northern Areas of Pakistan. Health facility resources are organized by categories--including salaries, capital costs, utilities, overhead, maintenance and supplies--and quantified using activity-based costing (ABC) techniques. The average cost of treatment for an outpatient case of child pneumonia is dollar 13.44. For hospitalized care, the health system spent an average of dollar 71 per episode for pneumonia, dollar 235 for severe pneumonia, and dollar 2,043 for meningitis. These costs provide important background information for the potential introduction of the conjugate Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae vaccines in Pakistan.

Prevalence and awareness of risk factors and behaviours of coronary heart disease in an urban population of Karachi, the largest city of Pakistan: a community survey.

OBJECTIVES: To estimate the prevalence and awareness of risk factors and risk behaviours of coronary heart disease (CHD) in the lower middle class residing in urban localities of Karachi, a mega city of Pakistan. METHODS: The design consisted of a cross-sectional community based survey in the lower middle class urban localities of Karimabad, Garden and Kharardar in Karachi, Pakistan. One thousand four hundred adults (18 years and above) registered with the Aga Khan Development Network (AKDN) participated in the survey. Life style, self-reported risk variables, blood pressure and anthropometric measurements were recorded. RESULTS: Prevalence of hypertension, high cholesterol and diabetes were 38.5, 10.7 and 9.1 per cent, respectively. 52.2 per cent of the sample was overweight or obese; 64.8 per cent never exercised; 11.9 per cent had two or more major risk factors of CHD. CONCLUSION: The communities studied showed a very high prevalence of hypertension, obesity and a sedentary life style. Despite a high literacy rate, awareness regarding CHD risk factors was low. This underlines the need for measures to increase awareness regarding CHD and its risk factors and a healthy lifestyle in the developing countries.