Exploring the gaps between training and expected job skills of public health graduates to identify: A way forward.

Objectives: To explore the non-alignment between what is taught in academic programmes for public health and what is actually needed or expected in the field. METHODS: The qualitative phenomenological study was conducted from October 2020 to April 2021 in Karachi after approval from the institutional ethics review board of Jinnah Sindh Medical University, Karachi. The sample comprised major stakeholders including representatives of public health institutions and organisations involved in the implementation of public health programmes. Data was collected through in-depth interviews and focus group discussions using a guide after content validation by an expert. Data was analysed using both inductive and deductive approaches. RESULTS: A total of 13 in-depth interviews and 5 focus group discussions were conducted. Regarding gaps in the process of curriculum development, 2 major concerns emerged; lack of comprehensive involvement of experts in different fields of public health in designing the curriculum, and the lack of incorporation of the feedback provided by students in revising the curriculum. Regarding the content of curriculum, three main themes emerged; theoretical nature of courses, lack of uniformity in all programmes, and poor local contextualisation. The casual approach of students and barriers faced by them in joining public health programmes also affected the quality of such programmes. CONCLUSIONS: Three broad areas of improvement were identified, which included improvement in curriculum, methods of learning, and improving students' approach.

Understanding ethics of reporting health related events in media: A qualitative phenomenological study in Karachi and Peshawar.

Objective: The specific objectives of this study were to identify the ethical issues in reporting of health-related events in media and suggest ways to improve it. Method: This was a qualitative phenomenological study conducted by APPNA Institute of Public Health, Jinnah Sindh Medical University in collaboration with Institute of Public Health, Khyber Medical University from January to April 2022. A total of 38 focus group discussions and in-depth interviews were conducted either face to face at place of convenience of interviewees or online. The participants were health reporters, healthcare workers (HCWs), and representatives of law enforcement agencies in two cities i.e., Karachi and Peshawar. Data were analyzed by using the deductive and inductive approaches, by four independent experts including the Principal Investigator (PI) and three research fellows. Results: Ethical issues related to health reporting in the field included interference of the reporters in rescue efforts during an emergency and interference in emergency medical care of the victims. In reporting, careless disregard for patient confidentiality and privacy; using unreliable sources of information; using wrong terminology; sensationalizing the news and jumping to conclusions in cases of malpractice were reported as main problems. Negative influences on health reporting included poor training of the reporters on health reporting ethics, organizational pressures, and lack of cooperation by relevant health authorities. Conclusion: The quality of health reporting can be improved by building the capacity of health reporters in understanding the ethical issues and their social responsibilities toward health.

Validation of HF-Bioelectrical Impedance Analysis versus Body Mass Index in Classifying Overweight and Obese Pakistani Adults.

Purpose: To determine the validity of hand-to-foot bioelectrical impedance analysis (HF-BIA) versus body mass index (BMI) to assess overweight and obesity status in adults against a reference method, dual-energy x-ray absorptiometry (DXA). Patients and Methods: It is a validation study conducted on 206 Pakistani adults ≥20 years recruited through convenience sampling technique at PNS Shifa Hospital and Jinnah Post Medical Centre, Karachi, Pakistan. Results: HF-BIA showed better sensitivity of 90.1% and 100% specificity with no false positive, but 9% false negative as compared to BMI which indicated 80.3% sensitivity and 100% specificity with a false-negative rate of 19.6%.HF-BIA also showed better sensitivity 80.9-97.1% with 100% specificity and PPV across all age groups. The correlation coefficient between BMI and DXA bf% (r=0.67) was moderate and less than the correlation coefficient between HF-BIA and DXA bf % (r=0.87). Kappa agreement showed weak to a fair agreement between BMI and DXA bf % (0.1 overall; 0.22 men; 0.14 women) compared to HF-BIA, which had a better agreement between BIA bf% and DXA bf% (0.43 overall; 0.46 men; 0.34 women). HF-BIA bf % demonstrated a better discriminatory power than BMI (AUC of ≥0.91) and was better predictor of body fat than BMI. Conclusion: HF-BIA is a more accurate method than BMI and may be used consistently throughout the country in primary care and research to identify the fat-based overweight and obese in the Pakistani population.

Army Public School Terrorist Attack - Perceptions and Experiences of school children of Karachi.

Objectives: To explore the experiences and perceptions of school children of Karachi after the Army Public School (APS) attack. Methods: It was a qualitative transcendental phenomenological study. Data collection started nine months after the attack, in September 2015, and continued till November 2019. Study participants were school children from Army, Government, and Private schools. The sampling strategy was convenience. Data collection of 53 students was done by focus group discussions and in depth interviews. Data analysis was performed using the phenomenological analytical techniques of Colaizzi. Results: Inductive analysis of the qualitative data gave rise to three themes - The journey beyond fear, Response of parents and schools and Role of media. Conclusion: The study concluded that the APS attack was the source of emotional distress and fear for the school children of Karachi as they personalized the event due to the nature of the attack. Immediately after the incident, they were in anger, grief, and fear, which altered their daily life activities and caused apprehensions in socializing and attending school. However, later they became highly motivated to study and gained courage. This motivation is revenge from terrorists as they wanted to keep children away from schools.

Role of media and the media hypes in the aftermath of mass casualty incidents a qualitative thematic content analysis.

Objective: To explore the role of media during mass casualty events and its impact on people. METHODS: The qualitative thematic content analysis was conducted at Jinnah Sindh Medical University, Karachi, from 2018 to 2020 and comprised of semi-structured in-depth interviews and focus group discussions involving participants from the health sector and policymakers at the provincial level. The Frontline Workers such as the ambulance drivers and the first-aid-givers were also included. Data was subjected to conventional content analysis to generate themes. RESULTS: There were 5 in-depth interviews and 4 focus group discussions in the study. Qualitative analysis revealed that the media has a great deal to do in times of a disaster. The media is the strongest weapon and largely impacts people's mind and behaviour, but it has been playing with their emotions and creating unrest among them. Conclusion: There is a need for the policymakers to set guidelines and define the role of the media in times of a disaster.

Validation of a Public Health Tool used for the Assessment of Violence against Healthcare Providers in the Rural Areas of Sindh.

OBJECTIVE: To validate a public health tool for assessing violence and its effects against healthcare providers (HCPs). STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Rural districts of Sindh from June to December 2019. METHODOLOGY: The survey included all the HCPs from the five districts of Sindh such as Sanghar, Thatta, Sukkur, Nawabshah, and Larkana with a minimum of one-year experience. Those not willing to participate in the study were excluded. The main variables were socio-demographic variables, type of violence and effects of violence. Multi-stage cluster sampling was done. Within each district hospital, an equal number of HCPs were recruited from the Emergency, Medical, Surgical, Pediatric, and Gynecology Departments. The main factors of the public health tool were checked by performing principal component analysis, using varimax rotation, to assess the construct validity. Finally, Cronbach's alpha was used to check the reliability of the questionnaire. RESULTS: The Cronbach's alpha value was 0.724, showing satisfactory reliability of the questionnaire. Factor analysis yielded a five-factor solution accounting for 58% of the total variance in the data set. The principal component analysis revealed that the questionnaire used previously for measuring workplace violence and its effects had acceptable reliability and validity. CONCLUSION: This study revealed that this public health tool can be used for assessing violence against HCPs in the rural areas of Sindh. KEY WORDS: Construct validity, Factor analysis, Healthcare providers, Validation, Violence.

Exploring Reproductive Health Impact of COVID 19 pandemic: In Depth Interviews with key stakeholders in Pakistan.

OBJECTIVE: To explore the effects of COVID 19 on reproductive and child health services and gender relations. METHODS: This is a Qualitative Exploratory Research. Due to lockdown, setting was online interviews on Zoom. Sampling was purposive. Five in-depth interviews were conducted in June 2020 followed by compilation of results and manuscript writing in July and August 2020. RESULTS: Maternal Neonatal morbidity and mortality will rise as part of collateral damage of C19. As all routine services of maternity care, family planning, post abortion care and vaccination were also in lockdown. Baby boom, unwanted pregnancies, unsafe abortions and violence against women will be the secondary consequences of C19. CONCLUSION: Some critical services should never stop which include maternal and neonatal essential services. MNCH service continuity has to be maintained to optimize maternal neonatal health, prevent unwanted pregnancy and abortion. With appropriate standard operating procedures, and protective equipments, health facilities need to open. LHWs and community mobilisers with PPEs should continue services.

Mixed method survey to assess the problems and propose solutions for implementation of CME/CPD in Sindh, Pakistan.

OBJECTIVES: To determine the type of CME/CPD sessions attended by doctors, identify the problems with implementation of CME/CPD program and propose possible solutions for successful implementation of CME/CPD Program. METHODS: This was a concurrent triangulation mixed method study. Quantitative questionnaires were filled by faculty and physicians from different specialties. The qualitative component had both focus groups and in depth interviews conducted with different professional bodies (PMA), faculty JSMU, College of Family Physicians. This study was done in 2016-2017. RESULTS: More than half of the participants (53.6%) reported that CPD/CME should be mandatory. Doctors who had graduated from outside Karachi were significantly less likely to report CPD/CME to be mandatory as compared to graduates from Karachi (p=0.004).Top three factors which influenced HCP's to attend CPD/CME included career progression (65.1%), interest (54.7%) and knowledge gap (50.5%). The most common perceived barriers were lack of study leave, cost and work-life imbalance. The implementation issues expressed by different stakeholders included lack of doctor's interest, busy clinical schedule and poor accessibility. CONCLUSION: Mostly medical practioners believe that CPD program is an important step toward enabling physicians to demonstrate their competency and professionalism to themselves and others. The PM&DC has to take practical steps to evaluate the cognitive, clinical, and humanistic attributes of certified doctors.