Helping babies breathe: assessing the effectiveness of simulation-based high-frequency recurring training in a community-based setting of Pakistan.

BACKGROUND: Birth asphyxia is one of the significant causes of neonatal deaths in Pakistan. Poor newborn resuscitation skills of birth attendants are a major cause of neonatal mortality in low resource settings across the globe. This study aimed to evaluate the effectiveness of the Simulation-Based High-Frequency training of the Helping Babies Breathe for Community Midwives (CMW), in district Gujrat, Pakistan. METHOD: A pre-post-test interventional study design was used. The universal sampling technique was employed to recruit 50 deployed CMWs in the entire district of Gujrat. The pre-tested module and tools of Helping Babies Breathe (2nd edition) were used in the intervention. Using the High Frequency training approach, three one-day training sessions were conducted for CMWs at an interval of 2 months. During the 2 months interval, participants were monitored and supported to practice their skills at their birthing centers. Knowledge and skills were assessed before and after each session. The McNemar and Cochran's Q tests were applied for data analysis. Participants' feedback was also obtained at the end of each training, which was analyzed through descriptive statistics. RESULTS: Data from 34 CMWs were analyzed as they completed all three training sessions and assessments. The results were statistically different after each training session for OSCE B (p-value < 0.05). However, for knowledge and OSCE A, significant improvement was observed after training sessions 1 and 2 only. Pairwise comparison showed that pre-assessment at training 1 was significantly different from most of the repeated measures of knowledge, OSCE A, and OSCE B. Moreover, the learners appreciated the overall training in terms of organization, content, material, assessment, and overall competency. Additionally, due to a small sample size of the CMWs, and a short time of the intervention, significant differences in morbidity and mortality outcomes could not be detected. CONCLUSION: The study concluded that a series of training and continuous supportive supervision and facilitation enhances Helping Babies Breathe (HBB) knowledge retention and skills. The study recommends, periodic, structured and precise HBB trainings, with ongoing quality monitoring activities through blended learning modalities would help sustain and scale-up the intervention.

Developing COVID-19 emergency response centres in geographically challenged areas of Pakistan: A case study of the Aga Khan Development Network.

The inevitable COVID-19 global pandemic has severely affected Pakistan's fragile healthcare system. The system was already facing a significant burden of noncommunicable and other infectious diseases, and the pandemic further exacerbated the disease and the healthcare burden in Pakistan. In such a situation, people who live in geographically challenged areas with limited healthcare infrastructure and resources are more vulnerable to the impacts of a pandemic. The authors share the experience of the development of emergency response centres (ERCs) in the rural remote mountainous regions of Pakistan-Chitral, an initiative that the Government of Pakistan and Aga Khan Health Service Pakistan (AKHSP) implemented to manage the increasing rates of COVID-19 cases in these areas. The authors outline the processes that need to be undertaken to develop such healthcare facilities in a short period of time and discusses the challenges of establishing and operating these centres and the lessons learnt during and after the development of these centres in the remote mountainous regions of Pakistan.

Challenges on-the-way of nursing administration at public hospitals in Kabul, Afghanistan.

PURPOSE: The purpose of this study was to determine the challenges faced by the nursing administration at public hospitals in Kabul, Afghanistan. METHODS: A cross-sectional study design was used to recruit 86 nursing managers and head nurses from 17 public hospitals in Kabul. The participants rated the frequency of 13 challenges that hinder their performance. RESULTS: There were 14 nursing managers and 72 head nurses in the study. Almost 80% of the participants were male with the majority falling in the 35-44 year age bracket. Both nursing managers and head nurses were equally affected by all 13 challenges, except the lack of recognition where head nurses were affected more than the nursing managers (p = .003). The most frequent challenges for both were staff absenteeism and then too many responsibilities. CONCLUSION: There are multiple challenges that hinder the performance of nursing administration that need to be addressed through appropriate national policy and strategies. IMPLICATIONS FOR NURSING MANAGEMENT: The findings of this study can inform policy makers and draw their attention to overcome the challenges faced by nursing management. This will ultimately improve satisfaction leading to improved patient and organisational outcome. The national policy and strategy should address areas that could enable nurses to maintain a balance between household and professional responsibilities; and also encourage the enrolment of female nurses in the profession.

Patient education and mind diversion in supportive care.

Cancer is a growing health problem worldwide. Common treatments include surgery, chemotherapy and radiation therapy. Systemic anti-cancer medications often result in an array of physical and psychological side effects. Supportive care assists patients with cancer in managing multidimensional symptoms that result from treatment or the illness itself. This review discusses supportive care and examines patient counselling and mind-diversion activities, which are safe and cost-effective strategies. Improving cancer patients' health and wellbeing should be encouraged in oncology nursing practice and by teaching students the knowledge and skills needed to provide supportive care.

Knowledge, Attitudes, and Practices Regarding Menstrual Hygiene among Girls in Ghizer, Gilgit, Pakistan.

INTRODUCTION: Menstrual hygiene is a critical issue encountered by women and girls of reproductive age that negatively affects their health and empowerment. It is still deemed a taboo subject in several parts of the world, and girls hesitate to discuss menstruation with their family members, friends, or schoolteachers, which creates hurdles when they experience their menarche. Girls residing in rural areas encounter more problems, since they lack proper resources and knowledge to manage their menstruation in school as well as at home. The purpose of this study was to evaluate the knowledge, attitudes, and practices regarding the menstrual hygiene of girls residing in rural areas of Gilgit, Pakistan. METHODS: A descriptive cross-sectional design was used to assess the study questions. The consecutive sampling technique was applied to recruit 300 female participants from remote areas of Gilgit, Pakistan, who were 13 to 22 years old. A pre-tested questionnaire was utilized to collect the data, and SPSS version 21.0 was used to analyze them. RESULTS: The study found that more than half of the participants had a poor level of knowledge and practices and negative attitudes towards menstrual hygiene. This could be due to many cultural and social factors associated with menstrual hygiene. CONCLUSIONS: The study concluded that the study participants were not knowledgeable about menstrual hygiene. They had poor practices and attitudes regarding menstrual hygiene. Hence, it is recommended that frequent sessions should be conducted by healthcare workers to enhance the knowledge of parents, teachers, and young girls, to increase their positive attitudes and practices regarding menstrual hygiene.

Implementing midwifery led care in Pakistan.

Pakistan's maternal and neonatal mortality rate compares unfavourably with the UK and much of the world (McIntyre 2010). The high rates of maternal and neonatal mortality in Pakistan are due to inadequate maternal, neonatal and child care, too few skilled birth attendants, insufficient competent midwives, ineffective and unaffordable basic and comprehensive emergency obstetric services. In this article, the introduction of the first midwifery led units in an urban hospital setting in Karachi, its rationale and projected future plans will be described.

Maternal and newborn outcomes of care from community midwives in Pakistan: A retrospective analysis of routine maternity data.

OBJECTIVE: The study aimed to determine the maternal and newborn outcomes of Community Midwives' (CMWs') services in Pakistan as recorded in the provincial Management Information System (MIS) of the government's Maternal Newborn and Child Health (MNCH) program of Sindh province. METHODOLOGY: A descriptive retrospective design was used to examine the monthly reports of CMWs, stored in the MNCH-MIS, for the period of January 2013 to December 2015. A total of 200 CMWs were randomly selected from 23 districts of the Sindh province. The outcomes of the CMWs' services were analyzed, using descriptive statistics. RESULTS: The analysis of data of 23 districts revealed that a total of 103,836 antenatal care were attended by 200 CMWs who were selected for the study. For intranatal care, 23,296 cases were registered, of which 78.3% (n = 18, 233) returned to these CMWs at the time of delivery. During the period, 17,849 were live births. The still birth rate was calculated to be 13.4/1000, the abortion rate was 7.3 per 1000 pregnant women, newborn mortality rate was 12.4/1000 live births, and the maternal mortality ratio was 142.5/100,000 live births. Moreover, the low birth weight newborns were 9% of the total live births. CONCLUSION: This study indicates that although the outcomes for CMWs are better than for some other cadres in Pakistan, they are still inadequate compared to midwives trained to the international standards. The outcomes presented in this study are in line with the challenges of CMWs survival reported in the earlier studies. This strongly indicate need for improvement in CMWs pre-service and in-service education to meet the international quality standards set by ICM.

We need higher education: Voice of nursing administration from Kabul, Afghanistan.

AIM: To explore the educational profile of nursing managers and head nurses at public hospitals in Kabul, Afghanistan. DESIGN: A descriptive cross-sectional study design was employed. METHOD: A self-administered pre-tested questionnaire was used to recruit 86 nursing managers and head nurses from 17 public hospitals in Kabul. SPSS version 19 was used to analyze and report the data through descriptive statistics. RESULTS: It was found that, none of the participant was prepared with higher education in nursing; rather they had only diploma in nursing; and 84.9% of them had completed their nursing diploma before 2002.; 11.6% of participants were currently studying; and all were in non-nursing disciplines. On the other hand 100% of the participants expressed intention for further studies mainly in leadership and management, computer skill, English language, in-service nursing trainings and higher education in nursing.

Influence of supportive care on chemotherapy patients' self-care behaviour and satisfaction: A pilot study conducted in Karachi, Pakistan.

BACKGROUND AND AIM: Cancer is a daunting illness affecting a vast number of people globally. During the illness trajectory, cancer patients suffer from physical and/or psychosocial issues. These physical and psychosocial issues demand conscious actions by patients to maintain their well-being. Hence, the objective of the pilot study was to evaluate the level of self-care behaviors and satisfaction in women suffering from cancer after exposure to supportive care (education and mind diversion activities) delivered via a patient help group program. METHODS: The study was conducted at the chemotherapy day care unit of one of the tertiary care hospitals located in Karachi, Pakistan. In this study, supportive care interventions were offered via the patient help group program over a 5-week period, and in the 6th week, data were collected. The total sample size of this pilot study was n = 17. Female cancer patients receiving weekly chemotherapy regimen and diagnosed with breast or gynecological cancers were a part of the study. Outcome variables, self-care behavior and satisfaction, were assessed via a self-developed questionnaire. Content validity index of the questionnaire was calculated on the basis of expert review and was found to be 96% for relevancy and 94% for clarity. Frequencies were calculated to evaluate outcome variables. Outcome variable satisfaction was also assessed via few open-ended questions. RESULTS: Participants reported moderate-to-high self-care behaviors and satisfaction after exposure to supportive care interventions delivered via the patient help group program. CONCLUSION: Counseling and mind diversion activities are effective in producing a positive change in chemotherapy patients' self-care behaviors and satisfaction. Therefore, oncology nurses must utilize them in chemotherapy patient care. Future studies should evaluate the effectiveness of these interventions with larger sample size and comparative analysis.

Experiences of the graduates of the first baccalaureate midwifery programme in Pakistan: A descriptive exploratory study.

BACKGROUND: in 2012 the Aga Khan University in Karachi, Pakistan opened the country's first bachelor's degree program in midwifery for women who held diplomas in nursing and midwifery. The principal aims were to prepare midwives who would be competent to provide full-scope practice. For quality assurance, the programme was continuously monitored and assessed. As part of this ongoing evaluation process we sought in-depth feedback from the first graduates about their student experiences. OBJECTIVE: this study aimed to explore the experiences of the first graduates of a Bachelor of Science in Midwifery (BScM) program to deepen our understanding of their views of the program's strengths and difficulties and to obtain their suggestions for change. DESIGN AND METHODS: This qualitative descriptive exploratory study used universal sampling to collect data from all 21 of the first graduates of the BScM Program. Data collection involved focus group discussions using a semi structured interview guide and content analysis. The study was approved by Institutional Ethics Review Committee. FINDINGS: three main themes emerged from the data: (1) Competence acquisition, (2) Attitude transformation, and (3) Strengths and limitations of the program. CONCLUSIONS: the study findings highlighted that the degree program in midwifery had a positive impact on graduates' perceptions of their knowledge, skills, attitudes and ability to implement evidence-based midwifery practice. The graduates regarded the university's environment, teaching-learning strategies, preceptorship model, self-directed learning and exposure to diverse clinical settings as major facilitators in achieving competence.

The first competency-based higher education programme for midwives in the South Asian region--Pakistan.

Midwives in Pakistan and the South Asian region who complete a diploma program face many challenges for career growth and development. The absence of higher education in professional midwifery in the region has contributed to general non-acceptance and invisibility of midwifery. In response to the interest, Aga Khan University (AKU) developed bachelors program in midwifery based on the Global Standards for Midwifery Education developed by the International Confederation of Midwives (ICM) with the vision to equip midwives to provide full-scope practice, develop confidence to practice midwifery independently, become clinical leaders and contribute to the future of midwifery. The final curriculum had a balance of theory and clinical practice in order to develop a high level of clinical competence that would meet the ICM standards and guidelines. The two year bachelors program is currently in progress. The first cohort of 21 midwives graduated in 2014 and a second cohort was enrolled in 2015. There is a planning for a future graduate program in midwifery to prepare individuals for leadership roles in practice, teaching, maternal-child health provision and policy making through a master's degree in midwifery.

Perinatal women's perceptions about midwifery led model of care in secondary care hospitals in Karachi, Pakistan.

OBJECTIVE: the purpose of this study was to explore the perceptions and experiences of perinatal women who have availed of midwifery led model of care (MLC) at secondary care settings in Karachi, Pakistan. DESIGN: a qualitative descriptive exploratory approach using semi-structured interviews. PARTICIPANTS: a purposive sample of 10 women who had used MLC was enroled from each site. FINDINGS: content analysis highlighted that 'women's satisfaction with MLC' emerged as the main theme and, under this theme, the six categories that emerged were: (1) the admired capability and maturity of midwives, (2) the affordability of midwifery services, (3) a personalised relationship, (4) the empowerment of women to make decisions, (5) presence, and (6) a voiced concern regarding lack of marketing of MLC. KEY CONCLUSIONS: the study findings revealed that women had an overall feeling of satisfaction with the maternity care provided by the midwives. Mostly, women appreciated the midwives' expertise in providing maternity care. Majority of the women acknowledged the continuous presence of the midwives during childbirth and the women shared that they were empowered to make decisions related to their care. Most of the women indicated that marketing for MLC is scarce and insufficient. Majority of the women are even not aware of this model; therefore, it is imperative to create awareness and to provide MLC access to women through robust marketing. IMPLICATIONS FOR PRACTICE: the findings of this study may help to advocate and provide women-friendly maternity care, by giving choice and control to women during childbirth, providing comfort to women by using fewer medical interventions, and promoting normality by attending spontaneous vaginal childbirths.