Effect of frequency of parent to child maltreatment on symptoms of anxiety disorder in Pakistani adolescents: A community based cohort study.

OBJECTIVE: To investigate the association between Parent to Child Maltreatment and the occurrence of anxiety disorder symptoms among Pakistani adolescents under 18 years. METHOD: A prospective study was conducted to examine the effect of frequency of Parent to child maltreatment (PTC) on the occurrence of anxiety disorders in a community setting. A sample of 800 adolescents who reported none to rare, occasional, and frequent were followed for the occurrence of anxiety disorder symptoms over two years. PTC was evaluated using ICAST-C (International child abuse screening tool). Anxiety disorder symptoms were evaluated using the SCARED (Screen for children anxiety-related disorders) tool. Risk ratios were estimated using Cox Proportional Algorithm. RESULTS: The risk of occurrence of anxiety disorder symptoms in adolescents who have exposure to frequent PTC is 3.8 times (2.9, 4.9) as compared to those with none to rare exposure to PTC. Among adolescents suffering frequent PTC whose, mothers also reported a history of domestic violence, the risk of anxiety disorder symptoms is 3 times (2.2, 4.1) higher. Female gender (RR 1.5; 1.2-1.9), stressful home environment (RR 1.4; 1.1-1.8), and parental substance abuse (RR 1.6; 1.2-2.0) are significant predictors of anxiety disorder symptoms. CONCLUSION: Frequent PTC is significantly associated with the occurrence of anxiety disorder symptoms among Pakistani adolescents. Given these findings, there is a dire need to develop specific interventions to address anxiety disorder symptoms among adolescents and to develop programs to prevent parent to child maltreatment.

A dyadic approach to depression, resilience and quality of life on marital adjustment among infertile couples in Karachi, Pakistan: A cross-sectional study.

BACKGROUND: Infertility is a major reproductive health problem in Pakistan. It has the potential to cause serious negative impact on a couple's marital life and psychological health. AIM: This study aimed to assess the factors associated with maladjustment among infertile couples. METHOD: An analytical cross-sectional design was employed. Validated scales were used to assess marital adjustment, depression, resilience and quality of life among infertile couples. Purposive sampling was employed to enrol 334 infertile couples from a private infertility medical centre, of Karachi, Pakistan. RESULTS: Among couples, marital adjustment scores were comparable, but resilience and quality of life were significantly low among wives whereas depression was significantly high among wives compared with husbands. Wives' marital adjustment was positively correlated with husband's resilience and quality of life and negatively related with his depression. After employing adjusted actor-partner interdependence modelling, wives' own depression and resilience had significant effect on their marital adjustment and their partner's resilience, depression and quality of life did not have any impact on their outcome. On the contrary, wives' resilience had a significant effect in increasing the marital adjustment of their husband. CONCLUSION: This study highlights the need to promote psychological support (resilience building skills) or couples' therapy to all those couples undergoing infertility treatment.

Characteristics and patterns of individuals who have self-harmed: a retrospective descriptive study from Karachi, Pakistan.

BACKGROUND: Self-Harm (SH) is a major global public health problem under-researched in Pakistan due to religious and legal implications. This study aims to identify the characteristics and patterns among patients with SH and factors associated with the intent to die. METHOD: This retrospective descriptive study where SH cases presented to private tertiary care teaching hospital in Karachi, Pakistan, from January 2013 to December 2017 were extracted from HIMS records. Details related to demography, history, associated factors, access to methods used, and intent to die were collected on a structured proforma and analysed using STATA version 14.  RESULTS: A total of 350 cases were analysed. More than half of the reported cases were in the age group 20-39 years. Though only one-fourth of the SH cases had a past psychiatric history, it was found to be significantly (P-value < 0.05) associated with intent to die. Notably, 81% of the cases do not have a history of SH. Drug overdose (61.6%) and insecticides (36.6%) were the two most common methods used. Depression was identified in nearly half of the cases. The most common reason for attempting SH was inter-personal relationship issues (54.3%). CONCLUSION: This paper provides recent data on the characteristics and patterns associated with the intent to die of individuals who have self-harmed. In most cases of SH, past psychiatric history was not evident. Current psychiatric diagnosis and young adults were favoured in this study. The data from this study has limited representation for all demographic representation of SH cases from Pakistan as being from a single private hospital. There is a need for further research on SH in Pakistan.

Perception of postgraduate medical residents regarding educational environment at French Medical Institute for Mothers and Children, Kabul Afghanistan.

OBJECTIVE: To assess the perceptions of postgraduate medical education residents regarding educational environment at a medical institution in Afghanistan. METHODS: The descriptive cross-sectional study was conducted from 2017 to 2018 at the French Medical Institute for Mothers and Children, Kabul, Afghanistan, FMIC, and comprised postgraduate medical residents. Dundee Ready Educational Environment Measure was administered to determine the perception of learning environment by the residents' perceptions related to learning, teachers, academic self-perception, atmosphere and social self-perceptions sub scales. Data was analysed using SPSS 22. RESULTS: Of the 63 subjects, 55(87.30%) were males and 42(66.66%) were married. The overall mean age was 30±4.38 years. There was no significant difference in mean subscales scores and overall scores in relation to participants' age, gender, type of specialty, province and year of training (p>0.05). There was a significant difference in students' perception of teachers in relation with the type of specialty (p<0.05). CONCLUSIONS: The educational environment at the medical institution in Afghanistan was perceived by the students of residency programme as conducive.

The role of parent-to-child maltreatment in the pathway of self-reported depressive symptoms in Pakistani adolescents.

BACKGROUND: Parent-to-child maltreatment has been demonstrated to drastically affect a child's mental well-being and plays a significant role in developing depressive symptoms. However, little is established about the effect of frequency of parent-to-child maltreatment on the development of depressive symptoms among Pakistani adolescents. METHODS: A longitudinal prospective study was conducted, from 2015 to 2017, with 800 adolescents aged 11-17 years old recruited from 32 systematically selected urban and peri-urban areas of Karachi. First, these adolescents were screened for parent-to-child maltreatment in 2015 in a cross-sectional survey. Children with diagnosed psychiatric conditions were excluded from the study. In the second phase, these individuals were followed for 2 years to investigate the symptoms of depressive disorder using a validated tool, "CES-D (Center for Epidemiological Studies) Depression scale." The Cox proportional algorithm was used to examine the relationship between the frequency of parent-to-child maltreatment and depressive symptoms. RESULTS: Approximately 11% of frequently, 9% of occasionally parent-to-child, and 7%of negligibly maltreated adolescents reported depressive symptoms over 2 years. The other significant predictors of depressive symptoms were no formal education of the child (RR: 3.15, 95% CI: 1.35-7.34), presence of stressful home environment (RR: 2.19, 95% CI: 1.22-3.94), and having both uneducated parents (RR: 1.70, 95% CI: 0.90-3.21). The frequently maltreated females were found to have 4 times the higher risk compared to rarely maltreated males. In addition, frequently maltreated males were twice likely to develop depressive symptoms. CONCLUSION: The results suggested that frequent parent-to-child maltreatment occurring during childhood leads to the development of depressive symptoms later in the adolescence period. Thus, there is a dire need for interventions to raise awareness among the society on the issue of parent-to-child mistreatment to minimize later mental health consequences.

Capacity building in nurse educators in a Global Leadership Mentoring Community.

Globally, nurse educators participate in the three main role activities of teaching, scholarship, and service. Matching for different global locations and career stages, 12 mentor-mentee pairs completed a one-year coordinated virtual program through Sigma Theta Tau International's Global Leadership Mentoring Community and mentees reported building their nurse educator capacities. The authors describe factors that potentially influence international mentoring such as language, time, technology, and key characteristics of mentoring relationships. Growth in educator roles occurred in the contexts of the culture of academe itself and Boyer's definitions of scholarship. Consistent with Sigma's vision statement, nurse educators have a global presence and responsibility to prepare competent nurses who can advance the health of the world's people. Readers may benefit for future planning of mentoring activities to build capacities in nurse educator roles through international interactions.

Longitudinal association between parental-to-child-Maltreatment and self-reported Generalized Anxiety Disorder symptoms in Pakistani Adolescents.

BACKGROUND: Parent-to-child maltreatment is considered one of the risk factors for Generalized Anxiety Disorder (GAD) symptoms, but this hypothesis has not been adequately tested in Pakistani settings. AIM: This study aimed to examine the association between parent-to-child maltreatment and the risk of developing GAD symptoms among adolescents. METHODS: The association of none to rare, occasionally, and frequently parent-to-child maltreatment with the incidence of GAD symptoms was investigated in a sample of 800 adolescents aged 11-17 years who were followed for two years. Parent-to-child maltreatment was assessed using ICAST-C (International child abuse screening tool). GAD Symptoms were determined by SCARED (Screen for children anxiety-related disorders). Cox Proportional Algorithm was used to estimate risk ratios. RESULTS: Among children with both uneducated parents, frequently maltreatment was associated with 7.31 (2.20-24.04) times the risk of GAD symptoms compared to none to rare maltreatment. In contrast, the risk of GAD symptoms in frequently maltreated children was 5.58 times (1.40-21.97) than negligibly maltreated children with either educated parent. CONCLUSION: The frequency of parent-to-child maltreatment is significantly associated with an increased risk of developing GAD symptoms in which parental education plays a crucial role. Parents should be imparted with the awareness of the consequences of child maltreatment. In Pakistani settings the need to have this awareness is even more necessary due to the culturally acceptable disciplinary measures used by parents.

The effect of a culturally sensitive mental well-being module on Pakistani nursing students' knowledge and beliefs regarding their own mental health and illness.

This study examined the effect of a mental well-being module on undergraduate nursing students' knowledge and beliefs regarding causes and treatment of mental health and illness, and explored the relationship between these variables and depression and anxiety. The one group design incorporated pre-intervention, intervention and post-intervention phases, in a consecutive sample of 246 students in a 4-year BScN programme in Pakistan. A culturally sensitive, interactive mental well-being module of four hours length was delivered to three groups of approximately 40 students per group. Repeated measures ANOVA was performed to assess the difference in the mean knowledge scores. Paired t-tests investigated between-group differences on the factor scores. A total of 112 students screened positive for anxiety and depression symptoms. Repeated measures ANOVA showed a significant difference in the mean knowledge scores regarding mental illness (P < 0.001). Factor analysis resulted in four factors for the aetiology items. Paired t-test showed significant differences (P < 0.001) between psycho-social and environmental factors, supernatural and religious beliefs, and neuro-genetics. For treatment, significant differences (P < 0.001) were found between all factors - Professional and Help from others, Religiosity and Socialization, and Alternative and Medical Treatment. There was a significant and positive change in students' mental health knowledge, beliefs and mental health-seeking behaviour and diminished stigmatized beliefs. Based on the findings, it is highly recommended to incorporate the mental well-being program in the curriculum.

Physical Maltreatment and Its Associated Factors Among Adolescents in Karachi, Pakistan.

In many developing countries, physical child maltreatment is considered as an acceptable disciplinary strategy. The aim of this study was to identify factors associated with physical maltreatment among adolescents in Karachi, Pakistan. A survey of 800 adolescents was done using a structured questionnaire adopted by The International Society for the Prevention of Child Abuse and Neglect. Multiple linear regression methods were used to measure the factors associated with child physical maltreatment. The mean physical score was 17.5 ± 4.9, whereas the minimum and maximum score was 11 and 40, respectively. The total variability in physical scores was found to be 42% explained by child's gender, child's age, sibling abuse, verbal abuse/ quarreling within family, child's height, socioeconomic wealth index, marital status, interaction between parental exposure to childhood abuse and physical fighting using hard object, interaction between parental education and age of mother, and interaction between parental history of psychiatric illness and physical fighting by parents.

Factors Associated With Child Maltreatment Among Children Aged 11 to 17 Years in Community Settings of Karachi, Pakistan, Using Belsky Ecological Framework.

Child maltreatment is considered as a global social issue and results as combined effect of parental background, socioeconomic environment, family structure, and child characteristics. The aim of this study was to determine factors associated with child maltreatment among children aged 11 to 17 years in Karachi, Pakistan. A cross-sectional survey of 800 pairs (children ranging from 11 to 17 years old and their parents) was randomly selected from 32 clusters of Karachi, using multistage cluster sampling. A structured questionnaire was adopted from the International Society for the Prevention of Child Abuse and Neglect (International Child Abuse Screening Tool for Parent [ICAST-P] and for Child [ICAST-C]). Multiple linear regression technique was used to assess the association of factors with child maltreatment score, by using STATA software. Our study found that children who always get bullied and mistreated by their siblings are at increased risk of getting maltreatment by parents (adjusted ß: 10.78, 95% CI = [8.5, 13.05]).The mean estimated ICAST-C score increases by 9.86 (95% CI = [6.17, 13.55]) for children with exposure of verbal abuse and quarrel within family members. The mean estimated ICAST-C score increases by 5.09 among male children as compared with female children (95% CI = [3.65, 6.52]). Among children whose family always fight with each other and whose parents have exposure to childhood maltreatment, the mean estimated ICAST-C score increases by 22.25 (95% CI = [16.53, 27.98]). This study reflects the potential factors of child maltreatment in Karachi. Our findings provide evidence to raise awareness about child maltreatment.

Association of depression and resilience with fertility quality of life among patients presenting to the infertility centre for treatment in Karachi, Pakistan.

BACKGROUND: In Pakistan there is a dire need to explore the quality of life in infertile males and females and its undesirable psychological outcomes. This, study aimed to compare the quality of life (QoL) of males and females visiting an infertility centre for treatment and to assess its association with resilience, depression, and other socio-demographic factors. METHODS: An Analytical Cross-Sectional study was conducted amongst infertile males and females at the Australian Concept Infertility Medical Centre (ACIMC), Karachi, Pakistan. The non-probability (purposive) sampling strategy was used to recruit the participants. The sample size was 668. Data was analysed using STATA version 12. FertiQoL tool, Beck II Depression Inventory Tool and Resilience Scale 14 (RS-14) were used for assessing the quality of life, depression and resilience respectively of infertile patients. RESULTS: Total 668 infertile patients, 334 males and 334 females participated in the study. The mean age was 35.53 ± 6.72, among males, and 30.87 ± 6.12 among females. The mean resilience scores were significantly higher among males, (77.64 ± 8.56), as compared to females (76.19 ± 8.69) (95% CI; - 2.757, - 0.1347). However, a significantly higher proportion of females were depressed (13.8%) as compared to males (6%). The mean QoL scores for the general health domain, emotional domain, mind and body domain, and relational domain, and the total QoL were significantly higher in males as compared to females (p value< 0.001); however, QoL for the social domain was not significantly different in both the groups. On multivariable linear regression resilience and depression among males had a significant association with QoL, after adjusting for the covariates educational status, monthly income, and number of friends. Similar association was observed among females after adjusting for the covariate monthly income only. CONCLUSION: Fertility related QoL of men and women has a significant association with no formal education, number of friends, income, depression and resilience. Therefore, health care professionals in the field of infertility must be adequately trained to respond to the needs of individuals going through these psychological problems.

Insight into COVID-19 Responses and Initiatives from Pakistan.

The coronavirus pandemic is a rapidly evolving outbreak that has tremendously distressed people worldwide. The paper aims to present some key rapid responses and initiatives to COVID-19 undertaken in Pakistan. The information has been gathered by reviewing material and documents pertinent to COVID-19 in the context of Pakistan. The incidences of COVID-19 cases are gradually increasing; however, the case fatality rate is relatively lower in Pakistan as compared to developed countries. The government has taken massive actions, in terms of lockdowns, quarantine homes, testing facilities, closure of schools, and mass gatherings at places, to combat COVID-19. However, the measures seem to be insufficient due to the fear and stigma attached to it and the low socio-economic conditions. The government has launched initiatives, like Ehsaas cash dissemination programme, for the underprivileged families to address their basic needs; and philanthropic organisations are also coming forward to support these families. The spread of the pandemic is gradually increasing in Pakistan and we recommend strategies like increasing public awareness campaigns, improving screening capacity, and contact tracing to augment the efficiency of the current responses and initiatives. Key Words: COVID-19, Pakistan, Responses, Initiatives.

Mental Health Challenges and Psycho-social Interventions amid COVID-19 Pandemic: A Call to Action for Pakistan.

The increase in death and spread-related coronavirus (COVID-19) has shifted the world focus to the containment of the disease by emphasising measures to prevent spread in the general population. Such a complex, threatening, and unprecedented situation has left the psycho-social wellbeing needs of general public unaddressed. This paper aims to review the current COVID-19 scenario and its effects on the psycho-social wellbeing of people; and an attempt to shed some light on the aforementioned questions. Furthermore, the review will propose some recommendations for overcoming the mental illness issues, during and after the COVID-19 outbreak. We extracted information from reliable published international and national literature and reviewed anecdotes from media content from January to June 2020. The mental health implications of this outbreak will be long-lasting; however, by prioritising, investing diligently, and taking a collective approach, this challenge can be dealt with in a promising manner. Key Words: Mental health, Psycho-social interventions, COVID-19, Pakistan.

Implementation of Simulation: A Contemporary Strategy to Enhance Clinical Skills of Undergraduate Students in Mental Health Nursing.

Simulation is an innovative teaching strategy that supports student centered learning. It improves therapeutic communication skills with clients. Additionally, it enhances critical thinking, problem solving, and confidence among students, in a non-threatening and safe environment, without posing a risk to actual patients. This paper describes the process of application of simulation for undergraduate nursing students enrolled in a mental health nursing course. The project aimed to determine the significance of simulation to improve the communication skills and confidence level, and to decrease the anxiety of undergraduate nursing students, prior to attending mental health clinical. The Experiential Learning (ELT), by Kolb in 1984, was chosen as a framework for the simulation strategy. The simulation experience was a stepwise process that comprised a briefing session with students to explain them the process and purpose of the simulation activity, followed by a two-day simulation experience. The experience comprised students' interaction with Simulated Patients (SP), who had been prepared to manifest symptoms of depression, mania, and schizophrenia. The later part of the experience was a debriefing session, in which students were provided an opportunity for self-reflection and for thinking a way forward, to enhance their clinical competency, using their video recording. The students' evaluation regarding the simulation experience was positive and they suggested that it be integrated in the mental health nursing course.

Prevalence of anxiety and depressive symptoms and their association with multimorbidity and demographic factors: a community-based, cross-sectional survey in Karachi, Pakistan.

OBJECTIVE: This study aimed to estimate the prevalence of anxiety and depressive symptoms and their association with multimorbidity and the demographic characteristics of adults aged 30 years and above in Karachi, Pakistan. DESIGN: Observational cross-sectional study. STUDY SETTING AND PARTICIPANTS: The study was carried out among a general population aged 30 years and above residing in the Gulshan-e-Iqbal town of Karachi, Pakistan. The study participants were recruited using the systematic random sampling approach based on the inclusion criteria. The data collected from 2867 participants were analysed. MAIN OUTCOME MEASURES: The primary outcome of the study was the prevalence of anxiety and depressive symptoms, measured with the Aga Khan University Anxiety Depression Scale. The secondary outcome was the association of anxiety and depressive symptoms with multimorbidity as well as with the sociodemographic characteristics of the participants, using binary logistic regression. RESULTS: Out of 2867 individuals, 27.4% reported having anxiety and depressive symptoms. The multivariate logistic regression model revealed that the presence of multimorbidity (adjusted OR (AOR)=1.33, 95% CI 1.11 to 1.58), female gender (AOR=2.40, 95% CI 2.01 to 2.87), illiteracy (AOR=1.51, 95% CI 1.09 to 2.07), more children (AOR=0.74, 95% CI 0.59 to 0.93) and visiting a faith healer (AOR=2.29, 95% CI 1.82 to 2.88) were the significant factors associated with anxiety and depressive symptoms. CONCLUSION: This study revealed a moderately high prevalence of anxiety and depressive symptoms among adults aged 30 years and above in Karachi, Pakistan. The key variables associated with anxiety and depressive symptoms were multimorbidity, female gender, lower level of education, more children and visiting faith healers.

Intergenerational transmission of child maltreatment: Predictors of child emotional maltreatment among 11 to 17 years old children residing in communities of Karachi, Pakistan.

OBJECTIVE: Families where parents had childhood history of victimization may likely to abuse their children; hence contributing as an important predictor of child emotional maltreatment (CEM). This study aimed to determine the relationship of intergenerational abuse with CEM among 11-17 years old children residing in peri-urban and urban communities of Karachi, Pakistan. METHOD: Structured interviews were conducted with 800 children and parents-pair using validated questionnaire "International Child Abuse Screening Tool for Child (ICAST-C)" comprised of 4 domains. Domain of child emotional maltreatment was considered as outcome (CEM-score). The relationship between Parental history of childhood victimization and CEM-Score was measured using linear regression. RESULTS: The average CEM-score was came to be 19+5.2 among children whom parental history of childhood victimization was present (P < 0.001). The estimated mean CEM-score increased by 5.59 units (95% CI= {2.61, 8.51}) among children whom parents had a history of childhood victimization (Intergenerational abuse) with severe physical familial abuse. CONCLUSION: The current study provided evidence on intergenerational transmission of maltreatment suggesting early prevention to break the cycle of child maltreatment through generations. Preventive measures can be taken, once a parental history of childhood victimization has been identified, by providing appropriate services to those families who belong to lower socioeconomic status, where mothers are young, presence of siblings' rivalry/ bullying and/or violence among family members. However, these factors do not explain a complete causality of the intergenerational transmission therefore additional factors, for instance parenting styles must be taken into consideration.

Comparison of undergraduate educational environment in medical and nursing program using the DREEM tool.

INTRODUCTION: Educational environment (EE) in a health educational institute can bring about an enduring impact on the students' motivation, knowledge, critical thinking along with their social life. Therefore, identifying strengths and the need for change in the education environment is vital for the enhancement of the students' learning. OBJECTIVE: This study aimed to compare the perceptions of nursing and medical students about their EE in a private university, Karachi Pakistan. METHODOLOGY: Data from two cross-sectional studies of 884 students from both medical and nursing schools of Aga Khan University was acquired and analyzed. EE was measured by a well-known inventory i.e. 'Dundee' Reading Educational Environment Measure (DREEM). The scores were constructed using standardized guidelines. Mann-Whitney U test and two way ANOVA were used in statistical analysis. RESULTS: With 84.1% average response rate, the mean + SD DREEM score was measured as 126 ±â€¯20.3. Nursing students regarded more positive perception about their EE (127.3 ±â€¯19.3) as compared to medical students (124.6 ±â€¯21.3) and was found to be statistically significant (P = 0.027). Medical students scored higher in the domain of Perception of Atmosphere (PoA); whereas, nursing students scored higher in Academic Self Perception (ASP). Both of the groups have rated lower scores on the domain of Perception of Teaching (PoT). CONCLUSION: Both medical and nursing students appreciated the EE pertaining to Perception of Learning (PoA), Academic Self- Perception (ASP), Perception of learning (PoL) and Social Self-perception (SSP). The study showed that nursing students' perception on their EE was relatively more satisfactory than medical students. However, both medical and nursing students identified areas of improvement in the domain of Perception of Teaching (PoT). This finding indicates dire need to devise innovative teaching strategies both for medical & nursing education.

Perceptions of nursing students of educational environment at a private undergraduate School of Nursing in Karachi.

OBJECTIVE: To assess educational environment at a nursing school.. METHODS: The cross-sectional survey was carried out from May to October 2016 at Aga Khan University School of Nursing and Midwifery, Karachi, using the Dundee Ready Educational Environment Measure tool. The scores were obtained by merging five sub-scales of the inventory. The average scores of the scale and sub-scales were compared in terms of age, year of study, and living status using Mann-Whitney U test, and among years of study by Kruskal Wallis test.. RESULTS: Of the 442 students, 228(51.6%) had age below 20 years. Overall, 131(29.1%) subjects were in the first year, 152(33.8%) second year, 91(20.2%) third year and 76(16.9%) fourth year. The average Dundee Ready Educational Environment Measure score was 129.92±19.97 with reliability of 88.9%. Students aged 20 years and less had more positive perceptions than students over 20 years (p<0.0001). Students living in hostel secured higher scores (p<0.0001). First year nursing students attained significant highest scores in all sub-scales compared to the rest (p<0.0001). CONCLUSIONS: Scores reveal better perception from younger nursing students, as well as those living in the hostel and those who were in their initial years of nursing education.

Survellience system for child abuse: Bridging the gap between actual and hidden cases.

The dynamics of child abuse have been recognised as a global emerging social issue which is highly associated with child humiliation. The Government of Pakistan has taken many initiatives for addressing issues regarding child abuse and neglect and has designed laws to protect children against exploitation, abuse and violence; however, most of them are not enforced at all or poorly implemented due to lack of proper definition of child abuse and related terms, and different ways of reporting child abuse cases. Most of the non-governmental organisations (NGOs) in Pakistan target extreme cases of child sexual abuse such as child rape or commercial sexual exploitation of children, but cases of physical and psychological abuse are under-reported by the NGOs most of the time. A proper surveillance system is therefore required to identify the hidden cases of all types of child abuse that can lead to effective policy formulation and implementation.

Compliance to antipsychotic medication: a challenge for client, family and health care providers.

Compliance with anti-psychotic medications plays a significant role in managing clients with schizophrenia. It not only helps in controlling the symptoms, but also decreases the risk of relapses and ultimately improves quality of life (QoL) for the clients. However, compliance with anti-psychotic medication remains a challenge for the client, family and healthcare providers. Identification of these associated factors is vital to make appropriate plan to enhance medication compliance. In this paper, various factors are highlighted that are associated with medication compliance in clients with schizophrenia.