Reinvigorating postpartum intrauterine contraceptive device use in Pakistan: an observational assessment of competency-based training of health providers using low-cost simulation models.

BACKGROUND: Improved training approaches have the potential to overcome barriers to the use of postpartum intrauterine devices (PPIUDs) in Pakistan, including a shortage of female providers who are able to insert the device. This study assessed the effectiveness and acceptability of a competency-based onsite training approach that employed a newly developed anatomic model (the Mama-U) to train doctors and midwives on postpartum family planning (PPFP) and the insertion of PPIUDs. METHODS: An observational, mixed methods study conducted training evaluations and knowledge and skills assessments with 11 trainers and 88 doctors and midwives who participated in eight PPIUD training sessions. Two months later, follow-up interviews and clinical assessments were conducted with 20 providers, and interviews and a focus group discussion were conducted with 85 married women who received a PPIUD from a trained provider. RESULTS: The training significantly improved provider knowledge (p < 0.001), and follow-up assessments showed that clinical skills were retained for at least two months post-training. After training, 81.8% of providers were confident in their ability to provide PPIUD services, and midwives and doctors had similar PPIUD insertion skills. However, midwives were more likely than doctors to meet all 10 key requirements during PPIUD counseling sessions (63.9% versus 13.3%, p = 0.004). Providers found the Mama-U model to be a useful tool for client counseling as well as training and skills practice, and clients agreed. Trainers identified the low cost, light weight, and portability of the Mama-U model as advantages over the conventional training model and noted that its abstract shape reduced embarrassment among trainers, providers, and clients. CONCLUSIONS: Competency-based training with the Mama-U model can improve the quality of PPIUD counseling and PPIUD insertion services and has the potential to extend PPFP/PPIUD service delivery to midwives working in rural Pakistan. The portable, low-cost Mama-U permits onsite, on-the-job PPIUD insertion training that is tailored to the local setting; it is also well suited for the continuing practice that providers need to maintain their skills. Further research is needed to confirm the usefulness and cost-effectiveness of the Mama-U at scale and in other settings.

KNOWLEDGE AND PERCEPTION OF ARECA/SMOKELESS TOBACCO USERS ABOUT ORAL CANCER.

BACKGROUND: According to World Health Organization (WHO), six million deaths are attributable to tobacco use globally, of which nearly 1.2 million occur in South-East Asia. Use of smokeless tobacco is highly prevalent in subcontinent and is home to over 250 million smokeless tobacco (ST) users. ST is a major public health problem. It cause localized oral lesions and poses risk for developing oral cancers owing to it containing more than 30 cancer causing substances, in addition to nicotine which is a highly addictive. This study was conducted to assess the overall knowledge and compare knowledge, attitude and perceptions of ST users presenting to private and public health care facilities. METHODS: This cross sectional comparative study was carried out from April to July 2011 to establish the details of underlying factors and perceptions of areca/ST users presenting in public and private health care facilities of Karachi. Through systematic random sampling, 464 male and female users (≥ 14 years) were interviewed. The data was analysed in SPSS-16. RESULTS: Mean age of the users of Private Clinic (PC) was 25 ± 7.183 years while that of Public hospitals (PH) respondents was 34 ± 11.3 years. The respondents present in PC (94%) had comparatively more knowledge than the users in PH (75%). About 78% of the study population in PH wanted to quit this habit of chewing whereas 88% in PC have the same attitude (p-0.01). About 68% in Public and 89% in Private clinics ever tried to quit but failed; (p-0.000). CONCLUSION: Although respondents have substantial knowledge about the harmful effects of smokeless tobacco but due to their perceived psychological and emotional dependency, they remain addicted.

Are patients with pulmonary tuberculosis identified by active and by passive case detection different? A cross-sectional study in Pakistan.

OBJECTIVES: Our objective was to compare the characteristics of patients with pulmonary tuberculosis (TB) identified through "extended contact screening" (ECS) with those of patients identified through routine passive case finding (PCF). METHODS: Active TB case finding by ECS was tested from 2013-2015. This was a cross-sectional study based on data collected from ECS and routine program data from Lahore, Faisalabad, and Rawalpindi districts, and Islamabad in 2015. Characteristics of patients identified through ECS and PCF were compared. RESULTS: Of the 12,114 patients with pulmonary TB in the study, 4604 (38%) were identified through ECS, of whom 4052 (88%) had bacteriological confirmation. Male patients comprised 56.2% (95% confidence interval [CI] 54.8-57.6) of patients with pulmonary TB identified through ECS and 49.7% (95% CI 48.6-50.8) of those identified through PCF. The proportion of bacteriologically confirmed cases was 88.0% (95% CI 87.1-88.9) in the ECS group and 50.3% (95% CI 49.2-51.4) in the PCF group. By regression analysis we found that compared with patients aged 15-44 years, children aged <15 years had higher chances of being identified through ECS (adjusted odds ratio 2.69; 95% CI 2.21-3.28). There was a higher chance of cases being detected by ECS in Faisalabad (adjusted odds ratio 2.57; 95% CI 2.01-3.29) than in Islamabad. CONCLUSION: ECS identified a higher proportion of male and child patients with pulmonary TB than routine case finding; both of these groups are more often unidentified through routine TB control.