Bivariate mapping of intimate partner violence prevalence and its correlates in Liberia by county: Results from the 2019-2020 Demographic and Health Survey.

Intimate partner violence (IPV) is a global public health concern and requires nuanced health policy response for effective addressal at the subnational level. Using the nationally and county level representative data from the 2019-20 Demographic and Health Survey of Liberia, the prevalence of IPV was computed for each of the sixteen Liberian counties in 15 - 49-year-old women. Additionally, prevalence of IPV acceptance and having parental IPV were also computed. Prevalence of each of the three metrics were mapped by county, in addition to bivariate mapping of the three attributes. Results demonstrate wide chasms in prevalence at the county level. Several countries with high prevalence of one metric were correlated with the high prevalence of the other two metrics, and vice versa. Albeit nuanced differences in associations at the county level were also observed. Findings auger for nuanced health policy measures to address IPV more effectively in Liberia.

Spatial Distribution And Clustering Of The Proportion Of Disabled Individuals By Districts In Punjab.

Disabilities are globally endemic and will increase with population ageing and ubiquitous prevalence of non- communicable diseases. The Pakistan Social and Living Standards Measurement survey conducted in 2019-20 is the only district-level representative survey that provides proportion of disabled individuals. The survey used a standardized and validated six-questions from the 'Washington Group Questions' that identify functional disabilities pertaining to difficulty in the domains of sight, hearing, walking/climbing steps, remembering/ concentrating, self-care (washing/dressing), and communicating/being understood. Disabilities were more common in men in both urban and rural areas of districts. Clustering of highest percentage of disabled persons were found in the north-western districts, while lower percentages were seen on the north-eastern districts. Test for the spatial autocorrelation of cumulative disability in the entire study area of Punjab province was found to be statistically significant. Findings underscore the need for better targetted health and social services for the disabled individuals in the Punjab province.

Intimate partner violence among ever-married Afghan women: patterns, associations and attitudinal acceptance.

Intimate partner violence (IPV) is one of the most prevalent forms of violence that women suffer globally. Women in Afghanistan have been exposed to high levels of IPV which coincided with high levels of conflict during more than four decades. We cross-sectionally examined the Afghanistan Demographic and Health Survey responses of 21,234 ever-married Afghan women. We first performed the frequency distribution analysis to determine the prevalence of IPV and the basic socio-demographic characteristics of the participants. Subsequently we examined the relationship between the independent and dependent variables followed by the bivariate and survey versions of logistic regression analyses. We report odds ratios in order to depict the strength and direction of the associations between the IPV and selected independent variables. P-values less than 0.05 were considered statistically significant. The analyses showed that 55.54% of Afghan women experienced some form of physical, emotional, or sexual violence by their intimate partners during the recall period partners. The most common form of IPV found was physical violence (50.52%). Factors such as being exposed to inter-parental violence (respondent woman's father physically abused her mother) (adjusted OR= 3.69, CI= 3.31-4.10) and respondent's acceptance of IPV (aOR= 1.85, 1.51-2.26) were associated with increased exposure to IPV. Having a spouse with at least a primary education (aOR= 0.76, CI= 0.64-0.91) or a respondent with at least a primary education (aOR= 0.82, CI= 0.68-0.98) was associated with lower exposure to reported IPV. The lifetime experience of IPV occurs to a high extent among Afghan women, and several socio-demographic factors have predisposing attributes. IPV policy formulation and strategizing may benefit from considering these factors.

Cross-national examination of adolescent suicidal behavior: a pooled and multi-level analysis of 193,484 students from 53 LMIC countries.

INTRODUCTION: Suicide is a leading cause of adolescent mortality worldwide. We aimed to estimate the prevalence and identify individual-level and country-level factors which might explain the variability in suicidal behavior among students in 53 low to middle income countries. METHODS: We used data on adolescents aged 12-16 years from the Global School-based Student Health Surveys from 2009-2016. The suicidal behaviors investigated included suicide ideation, suicidal planning and suicide attempt. The prevalence was estimated for 53 countries, while a multilevel logistic regression analysis (33 countries) was used to investigate the associations of these behaviors with individual and country-level contextual risk factors. The contextual variables included the Gini Coefficient, Gross Domestic Product per capita, pupil-to-teacher ratios, population density, homicide rates, law criminalizing suicide and the night light index. RESULTS: The overall prevalence of suicide ideation, making a plan and suicide attempt were 10.4%, 10.3% and 11.0%, respectively. The highest prevalence rates reported were from the Americas. The strongest risk factors associated with suicidal behavior included anxiety, loneliness, no close friends and the substance abuse. Among the country level variables, the night light index was associated with making a suicide plan and attempting suicide. CONCLUSION: The non-significant country level findings were not entirely surprising given the mixed results from prior studies. Additional knowledge is thus achieved with regard to country level factors associated with suicidal behavior across adolescent populations.

Gender differentials in spatial distribution of immunisation status in children aged 12-23 months by district in Punjab - Results from Pakistan Social and Living Standards Measurements Survey 2014-15.

In Pakistan routine immunisation for children is offered free of cost in the public sector and several studies have been conducted analysing coverage at the village, city, district, and provincial levels that show wide variation in immunisation coverage rates. Using the district level Pakistan Bureau of Statistics 'Pakistan Social and Living Standards Measurements' survey data for 2014-15, various immunisation indices were analysed and mapped for Punjab province. The mapping of gender disaggregated, three immunisation indices at the district level illustrate that immunisation of 12-to-23-month children is wide spread in the Punjab province. In the southern and central districts, immunisation coverage was not at par with the northern districts. Gender-based immunisation coverage proportions does show differentials that is a cause of concern. Disease mapping brings out these immunisation coverage and differences in an easily understandable format that could help better plan, target, and deliver childhood routine immunisations in the province.

Spousal violence against women in Afghanistan: Bivariate mapping of correlates.

Spousal violence against women is endemic and owes its genesis to deeply entrenched socio-cultural norms. In this study 2015 Demographic and Health Survey data for Afghanistan was used to calculate the provincial prevalence and two correlates of spousal violence, and their bivariate mapping. Large differences were present in the provincial prevalence of spousal violence, having witnessed their father ever beat their mother, and acceptance of spousal violence by the currently or ever married women aged 15-49 years. In general, bivariate maps showed strong associations between spousal violence against women, its acceptance by women, and having witnessed their father beat their mother by ever married women. In an easily comprehensible manner, these maps underscore ensuring better quality of life in marital settings, higher and more equal social stature of women, and protecting their basic human rights would entail legal, social, and cultural paradigm shift.

Spatiotemporal analysis of having been sick or injured and having sought health consultation by district in Punjab province of Pakistan - 2010-2015.

Objectives: To analyse the geospatial and temporal distribution of disease and injury burden and factors that influence health care seeking behaviour in thirty-six districts of Punjab in Pakistan. METHODS: Utilizing the district level-Pakistan Social and Living Standards Measurement survey data for 2010-2015 from the Pakistan Bureau of Statistics and Human Development Index (HDI) data for the years 2011-2015 from the United Nations Development Programme; choropleth maps were created based on the district level proportions of population reporting having been sick or injured and having sought health consultations for all three waves of PSLM surveys and based on HDI for the years 2011, 2013 and 2015 for the Punjab districts. Spatial cluster analysis of having been sick or injured and having sought health consultations for three waves of PSLM was conducted. RESULTS: For the years (2010-11), (2012-13) and (2014-15) respectively; the mean proportions of population that reported being sick or injured were (7.36±2.23), (6.99±2.33), and (5.70±1.72). The corresponding mean proportions that sought health consultation were (96.11±2.92), (96.05±2.26) and (96.82±2.15) respectively. Having sought health consultation in years (2010-11) and (2012-13), having been sick/injured in (2010-11), and human development index of 2013 as well as 2015 were statistically significant determinants of having sought consultation in the last wave of (2014-15) (p<0.05). CONCLUSIONS: Findings show a decline in the reported disease and injury burden between 2010 and 2015 but constant rates of seeking health care. HDI and having sought care previously are the major determinants of subsequent health consultation in Punjab. Future studies need to focus on how these results can be utilized to health inequalities in Pakistan.

Spatial analysis of 'Couple Years of Protection' by district in Punjab: Percent change from 2015-2016 to 2016-2017.

Couple Years of Protection (CYP) is a proxy indicator for birth control protection. Using data from Pakistan Bureau of Statistics, spatial distribution of CYP percent change from 2015-2016 with 2016-2017 was compared by district for Population Welfare Departments, Health departments, and Lady Health Workers in the Punjab province. Spatial profile of CYP showed discernable differences by the three service providers. Local indicators of spatial autocorrelation showed significant districts by type of spatial autocorrelation including high-high, low-low, spatial clusters, as well as spatial outliers. The three service providers had different profile of clusters for percentage change from 2016 to 2017. Cluster and significance maps depict districts where CYP percent change is statistically significantly different or same from the neighbouring districts, and as such underscoring districts where additional focus on service delivery in terms of contraceptives provision could yield improved outcomes.

Knowledge and perceptions about the health effects of environmental hazards among students from Hamdard University, Karachi: A cross sectional study.

Environmental hazards increase the health morbidity and mortality burden. This study compared the knowledge and perceptions about the health effects of environmental hazards among medical and engineering students of Hamdard University Karachi. A total of 263 (44.1%) engineering students, and 333 (55.9%) medical students participated in the study. Cumulatively, the three most commonly identified environmental hazards included tobacco smoking 561 (94.1%), global climate change 518 (86.9%), and solar ultraviolet radiation 511 (85.7%). The study results suggest the need for better quantifying the magnitude of understanding environmental hazards, and for health education and promotion programmes at the graduate level for medical and engineering students in Karachi.

Comparison of medical and allied health students' attitudes on organ donation: Case study from a private university in Karachi - Short Report.

Organ transplantation is often the only hope for patients with end-stage organ failure. Organ transplant surgeries are increasingly becoming available in Pakistan. From May-July 2017, using convenience sampling and statistical programme R 3.4.1, we assessed and compared the organ donation attitudes among medical and allied health undergraduate students of the Hamdard University in Karachi. Compared to non-medical students, medical students were more likely to be concerned that family members of brain-dead patients would be upset if approached for organ donation, and felt that appropriate time for bringing up organ donation would be after the declaration of brain death has taken place. Medical students also considered prolonging life by using human organ transplants more appropriate, and considered organ donation desirable when a patient has been declared brain dead. As demand of human organs for transplantation far exceeds the supply, there is need to better understand the dynamics underpinning positive attitudes towards organ donation, and to improve educational activities by encouraging debate and acceptance of organ donation for saving lives.

Daughters witnessing domestic violence perpetrated by fathers on mothers: Case study from a private University of Karachi.

Violence against women is a human rights issue and a major public health problem. The objectives of this study were to determine the magnitude and type of emotional and physical domestic violence perpetrated by fathers on mothers of female students of a private university. A total of 564 questionnaires were duly filled and returned with a response rate of 94.0%. The most common form of violence was reported by 93 (16.5%) of the respondents who witnessed their fathers either saying or doing something to humiliate the respondents' mothers. While the most common physical violence witnessed was fathers slapping their mothers as reported by 39 (6.9%) of the respondents. Empowerment of women, and effective endeavours in education of both sexes are important steps towards addressing and preventing domestic violence.

Spatial distribution of contraceptive usage by district in Pakistan: Percent change in couple years of protection in 2015-16 compared to 2014-15.

Pakistan's population will cross the 200 million-mark in 2017. 'Couple Years of Protection' (CYP) is a proxy indicator for various contraceptive methods used. The Pakistan 'Contraceptive Performance Report 2015-2016' (CPR) in Pakistan, provides comparison with the previous year i.e. 2014-2015 in terms of CYP percent change at the district level in the country. In this study, CPR percent change data were mapped and cluster analysis was conducted, using GIS programmes to visualize spatial distribution in the country by district. No statistical evidence of clustering at the global/country level was found. The percent change in CYP 2015-16, compared to 2014-15 at the district level ranged from -90.4% to 316.9% in the 113 districts for which data was available. Sixty-five districts reported negative CYP percent change, while 48 reported positive CYP change. With the exception of Balochistan province, all provinces and FATA had districts with percent change in CYP ranging from -90.4% to -50.0%.

Spatial distribution of under five year olds being sick or injured in the past two weeks by district in Pakistan.

Use of GIS to visualize the pattern and distribution of health indices in Pakistan would help in better choreographing of health policy and resource allocation decisions. In this study, district-wise spatial distribution of under five-year old children who got sick or injured in the past two weeks, and health consultation pattern was studied using the Pakistan Social and Living Standards Survey 2014-2015. Sex, urban/rural residency status, and province-based differences in the district-wise distribution of under-five year old children who fell sick/injured in the past two weeks and their having received health consultation for it, were observed. For male children, southwestern districts of Sindh, southeastern districts of Balochistan, central districts of KPK, and one southeastern of Punjab reported the highest percent of children who were sick or injured in the past two weeks. For females the pattern was similar with few exceptions.

Correlates of being sick or injured in under five-year old children by district in Pakistan: A spatial analysis case study.

This case study demonstrates the use of population based, spatial analysis of public health indices in Pakistan. The data for this study were obtained from the Pakistan Bureau of Statistics website. Using district level data, for the spatial analysis of having being sick or injured, and their correlates in the under-five year old children. Percent under 5 year children, who either fell sick or injured during the past two-weeks by district, was used as an outcome variable in the final spatial regression model. While district level population density, average household size, literacy ratios for females were used as explanatory variables. As opposed to the final Ordinary-Least-Squares model, only population density was statistically significant in the spatial model. Limitations in terms of availability of current and regularly updated, attribute as well as geographic data in the country are underscored by the results of this case study.

Descriptive epidemiology of Karachi road traffic crash mortality in 2015.

The Karachi city's Road Traffic Injury Research and Prevention Center (RTIRPC), collects Road Traffic Crash (RTC) data on injuries and fatalities from three major public and private hospitals' emergency departments. In the year 2015, 1021 deaths were recorded; with 871 (85.3%) deaths in males. Cumulatively, 286 (28.0%) deaths were recorded in the 21-30year age group, and for 198 (19.4%) RTC fatal victims, the primary vehicle involved was motorbike. Highest number of fatalities were recorded in the month of January i.e. 153 (15.0%), while the lowest number was recorded for June, with 47 (4.6%) fatalities. RTIRPC is a unique surveillance system in Pakistan providing RTC morbidity and mortality burden and trends in the city that needs to be expanded in Karachi, and extended throughout the country to better choreograph preventive measures including health promotion campaigns.

Influences on medical career choice and future medical practice plans among women: Perspective from final year students and house officers.

There is a growing perception in Pakistan that comparatively more women are gaining admissions and graduating from medical colleges; however these graduates are not practicing medicine. This pilot study provides perspectives on the influences on medical career choice and plans regarding future medical practice among female final-year students and house-officers in Karachi. Using convenience sampling, a study was conducted in August and September 2016, wherein out of 141 women, 95 (67.4%) were final-year medical students and 46 (32.6%) were house-officers. Most of the women (n=101; 71.6%) made their own choice to become doctors, while only 18 (12.8%) were compelled by their parents. An overwhelming majority (n=131; 92.9%) planned to do house job upon graduation or complete their ongoing one. Regarding post-graduation, 124 (87.9%) participants intended to acquire post-graduate qualification. Results indicate the need for representative studies to quantify the determinants and correlates of women's choice to study and practice medicine.

Spatial distribution of road traffic crash fatalities in Karachi: Perspective from 2008-2012.

Road Traffic Crash (RTC) mortality and morbidity is one of the major public health problems in Karachi. In this study we used geographic information systems (GIS) to visualize and quantify the spatial distribution of RTC mortality and yearly trend from 2008 to 2012, for all 24 administrative subdivisions of Karachi, using Road Traffic Injury Research and Prevention Center's (RTIRPC) data. Cumulatively, 6040 deaths were recorded by RTIRPC, out of which we were able to map 4657 (77.1%) deaths based on location information available in the database. During the 5-year period, highest number of cumulative RTC fatalities were recorded for Kemari, Bin Qasim, and Gushan-e-Iqbal; while lowest were recorded in Malir, Orangi, Korangi Cantonment, and Karachi Cantonment. Use of GIS for studying spatial distribution of RTC would help craft better response to RTC in the city and design public policy.

Study designs, use of statistical tests, and statistical analysis software choice in 2015: Results from two Pakistani monthly Medline indexed journals.

Assessment of research articles in terms of study designs used, statistical tests applied and the use of statistical analysis programmes help determine research activity profile and trends in the country. In this descriptive study, all original articles published by Journal of Pakistan Medical Association (JPMA) and Journal of the College of Physicians and Surgeons Pakistan (JCPSP), in the year 2015 were reviewed in terms of study designs used, application of statistical tests, and the use of statistical analysis programmes. JPMA and JCPSP published 192 and 128 original articles, respectively, in the year 2015. Results of this study indicate that cross-sectional study design, bivariate inferential statistical analysis entailing comparison between two variables/groups, and use of statistical software programme SPSS to be the most common study design, inferential statistical analysis, and statistical analysis software programmes, respectively. These results echo previously published assessment of these two journals for the year 2014.

Spatial distribution of health consultations in the past two weeks by provider type and district: Pakistan Social and Living Standards Measurement Survey 2014-15.

Place is a nexus between epidemiology and Geographic Information System. In this study, the Pakistan Social and Living Standards Measurement survey 2014-15 data on percent distribution of health consultations, in the past 2-weeks by type of healthcare provider were mapped cumulatively, as well as disaggregated by urban and rural areas, using a GIS programme to visualize spatial distribution in the country by district. Private sector is the main and preferred provider for healthcare services when Pakistanis get sick or injured. Differences between and within provinces - at the district level - exist, but in spite of significant investment by the government in public sector health and nutrition services; most people prefer going to private dispensaries and hospitals. Harnessing the visualization power of GIS for better decision making in health sector is contingent upon easy availability of up-to-date GIS shapefiles to analyze and depict health data on maps.