Linkages between poverty and food insecurity in Pakistan: Evidence from urban and rural households in Peshawar.

Objective: To assess household poverty, sanitation and hygiene practices, and food security in both urban and rural settlements of district Peshawar. Methods: We conducted this cross-sectional study from March 2019 to October 2019 in the urban and rural households of Peshawar, KPK. Using stratified random sampling, 554 households (HH) having children and young adolescents of age 5-19 years, adult men > 19 - 62 years, and adult women >19 - 62 years were included in this study. Data was collected using comprehensive tool comprised of all validated questionnaires and was analyzed using SPSS Version 24.0. Result: Within the urban clusters, the maximum number of households (n=29) were from Gari Baloch and the minimum number of households (n=7) were from Gulberg. In the rural clusters, the maximum number of households surveyed (n=41) were from Lamara, minimum(n=21) was from Chargula. The average age of household heads was 44.5 ±12.5 with mean age slightly higher in urban areas (45.1 ±11.8) compared to 44.0 ±13.2 in rural areas. The mean poverty score was 56.8 (±11.6) with 72.1% non-poor households, and 94.2% households being food secure. Handwashing practices were highly prevalent among all the HH, however, handwashing practices before eating were comparatively lower in all HH (45.2%), lowest (37.8%) among rural households. Conclusion: The findings of the study revealed both non-poor and food secure households with satisfactory water, hygiene and sanitation practices.

Awareness, perceptions of and compliance with tobacco control policies among naswar vendors in Khyber Pakhtunkhwa Pakistan.

INTRODUCTION: Regulatory compliance in the retail environment is integral to the success of tobacco control. We assessed compliance among naswar (smokeless tobacco product widely used in South Asia) vendors with tobacco control laws. We also assessed their awareness of tobacco-related harms and policies and perceived effect of policies on their sales. METHODS: We surveyed 286 naswar vendors in three districts of the Khyber Pakhtunkhwa province of Pakistan. We recruited general and specialty vendors from urban and rural areas through multistage cluster sampling. Compliance was measured for promotion, sale to/by minors and tax paid on naswar. We used logistic regression analyses for assessing the association between the outcome variables (awareness of tobacco harms and laws, perceptions about the effect of policies on business and compliance with laws) and their predictors. RESULTS: Most vendors (70%) were aware of tobacco-related harms of naswar. Although educated vendors were more aware of tobacco control policies, the greatest awareness was for a ban on sales to/by minors (21% overall). The majority of vendors (76%) violated this policy (measured by self-report), and violations were more common among rural than urban vendors (OR 2.27, 95% CI 1.05 to 4.96). Most vendors (71%) violated a ban on promotion of naswar. Vendors perceived tax increases and sales ban to/by minors as most detrimental for business. CONCLUSIONS: There was poor awareness and compliance among naswar vendors in Pakistan with tobacco control laws. This study finds potential areas for policy interventions that can reduce urban/rural disparities in implementation of and compliance with tobacco control laws.

Perception of Master of Public Health Students regarding E-Learning in Covid-19 Era: A New Normal in Lower- and Middle-Income Countries.

Objectives: To explore the perception of postgraduate public health students regarding e-learning in context to Covid-19 pandemic and its effect on their academic performances. Methods: This cross-sectional study was conducted at Sarhad Institute of Health Science, SUIT Peshawar from 3rd October 2020 to 4th February 2021. The Census method was incorporated for sample selection. Participation in the study was subjected to consent by participants. A self-administered questionnaire was used for data collection. Data was analyzed using SPSS Version-26. Results: Out of 95 participants, 72 (75.8%) were males and 23 (24.2%) were females. The mean grade point average (GPA) of previous semester-1 and semester-2, when they were having a conventional education system on campus before the pandemic was 2.741±0.499 and 2.643±.498 respectively. The current mean GPA of semesters 1, 2, and 3 who had online classes during this pandemic was 2.41±0.66, 3.06±0.51, and 2.80±0.47 respectively. Fifty-one (53.7%) students preferred to use mobile for e-learning. Convenience to the use-learning management system (LMS) was 67.4% and 72.6% responded that their academic performance was positively affected by e-learning. Logistic regression revealed that source of learning (p 0.99), uninterrupted internet (p 0.87), convenience with LMS (p 0.17), stress (p 0.505), convenient communication with faculty (p 0.69), and compatibility with professional routine (p 0.21) were not significantly associated with good academic performance, however, students of semester 2 (p 0.001) and those using laptops (p 0.02) were more likely to get a GPA of 3.0 or above. Conclusions: Students in this study had a positive perception regarding e-learning however, there is a definite need to amalgamate both online and on-campus learning modalities for post-graduate students especially during the uncertain situations.

Lived experiences of COVID-19 patients admitted in isolation wards of healthcare centers in Peshawar, Pakistan: A phenomenological perspective.

The emergence of COVID-19 caused a significant global threat, affecting populations worldwide. Its impact extended beyond just physical health, as it inflicted severe damage and challenges to individuals' well-being, leading to a deterioration in mental health. The lived experiences of patients hold a paramount position to explore and understand their perception of care which can ultimately strengthen the health system's delivery domain. This study explores the lived experiences of patients in the isolation ward, their recovery, and the quality of care being provided in the hospital and its effects on their mental health. Study design: A phenomenological qualitative study using in-depth interviews. Methods: We conducted 11 in-depth interviews of COVID-19 patients admitted to the isolation ward of the public hospitals of Peshawar, Pakistan. Participants who stayed for a minimum of 10 days in an isolation ward were included in this study. Interviews were transcribed and analyzed using NVivo 12 software and generated five themes through inductive analysis. Results: Five themes emerged from the participants' lived experiences: Heading towards the hospital, Health Care Quality, Impact on Mental Health, Recovering from COVID-19 and Back on one's feet. These included all the positive and negative lived experiences. Socio-environmental factors along with their experiences of the disease itself and with the healthcare providers guided their reaction which was important conciliators in their experiences during the pandemic. Conclusion: Based on the findings, the environment of isolation had a major influence on the mental well-being of the individuals involved. Considering the important role of the ward environment in shaping patient experiences and outcomes prompts a reevaluation of healthcare practices and policies. By addressing these factors healthcare systems can strive for greater effectiveness, resilience, and compassion in managing the pandemic's impact on patient care.

Cognitive therapy for depression in tuberculosis treatment: protocol for multicentre pragmatic parallel arm randomised control trial with an internal pilot.

INTRODUCTION AND OBJECTIVES: There is an unmet need to develop high-quality evidence addressing tuberculosis (TB)-related mental health comorbidity, particularly in the context of lower-middle-income countries. This study aims to examine the effectiveness and cost-effectiveness of cognitive behavioural therapy (CBT) versus enhanced treatment as usual (ETAU) in improving depressive symptoms in people with TB and comorbid depression, enhancing adherence with anti-TB treatment (ATT) and its implementation in the real-world setting of Pakistan. METHODS: We will conduct a pragmatic parallel arm randomised control trial with an internal pilot. A brief psychological intervention based on CBT has been developed using a combination of qualitative and ethnographic studies. The inbuilt pilot trial will have a sample size of 80, while we plan to recruit 560 (280 per arm) participants in the definitive trial. Participants who started on ATT within 1 month of diagnosis for pulmonary and extrapulmonary TB or multidrug resistant TB (MDR-TB) and meeting the criteria for depression on Patient Health Questionnaire-9 (PHQ-9) will be randomised with 1:1 allocation to receive six sessions of CBT (delivered by TB healthcare workers) or ETAU. Data on the feasibility outcomes of the pilot will be considered to proceed with the definitive trial. Participants will be assessed (by a blinded assessor) for the following main trial primary outcomes: (1) severity of depression using PHQ-9 scale (interviewer-administered questionnaire) at baseline, weeks 8, 24 and 32 postrandomisation and (2) ATT at baseline and week 24 at the end of ATT therapy. ETHICS AND DISSEMINATION: Ethical approval has been obtained from Keele University Research Ethics Committee (ref: 2023-0599-792), Khyber Medical University Ethical Review Board (ref: DIR/KMU-EB/CT/000990) and National Bioethics Committee Pakistan (ref: No.4-87/NBC-998/23/587). The results of this study will be reported in peer-reviewed journals and academic conferences and disseminated to stakeholders and policymakers. TRIAL REGISTRATION NUMBER: ISRCTN10761003.

Seroprevalence of Sars-Cov-2 antibodies among eligible blood donors of Peshawar, Pakistan.

BACKGROUND AND OBJECTIVES: To determine the seroprevalence of SARS-CoV-2 antibodies and the associated risk factors among healthy blood donors from Peshawar Pakistan, during the second and third waves of the COVID-19 pandemic. METHODS: The study was conducted on 4047 healthy (with no history or symptoms of COVID-19) blood donors attending regional blood center Peshawar between Nov 2020 and June 2021. Demographic data was collected and donors were screened for the presence of anti-SARS-CoV-2 antibodies using electrochemiluminescence immunoassay (ECLIA). RESULTS: The mean age of the participants was 27.27±7.13 and the majority (99%) were males. Overall, 59% (2391/4047) of the blood donors were reactive for SARS-CoV-2 antibodies. An increasing trend in seropositivity was observed from 45.5% to 64.8% corresponding to the second and third wave of the pandemic in Pakistan. Logistic regression analysis revealed significantly higher odds of seropositivity among male donors compared to females. Similarly, in multivariable analysis, the odds ratio for seropositivity among blood types AB, A, and B were, 1.6, 1.4, and 1.3 (CI 95%) times higher compared to blood group O (P-value ≤0.0001). CONCLUSIONS: Seropositivity of SARS-CoV-2 antibodies among blood donors gradually increased during the second and third wave of the pandemic in Pakistan indicating a widespread prevalence of Covid-19 in the general population. Susceptibility to SARS-CoV-2 varies with ABO blood types, with blood group O associated with low risk of infection.

Determinants of Response at 2 Months of Treatment in a Cohort of Pakistani Patients with Pulmonary Tuberculosis.

Mycobacterium tuberculosis infection continues to be a major global challenge. All patients with pulmonary tuberculosis are treated with a standard 6-month treatment regimen. Historical data suggest that even with shortened treatment, most patients achieve long-term remission. Risk stratification is a goal for reducing potentially toxic prolonged treatment. This study aimed to determine the factors associated with the early clearance of sputum acid-fast bacilli (AFB). A total of 297 freshly diagnosed patients with pulmonary tuberculosis were included and enrolled in this study. Information related to their ethno-demographic and anthropometric characteristics was collected. We also assessed their complete blood counts, and blood iron, folate, and vitamin B12 levels. We found that the presence of higher levels of acid-fast bacilli (AFB) in diagnostic sputum microscopy was the single most significant prognostic factor associated with early clearance of sputum AFB after 2 months of treatment. All of our patients achieved treatment success after 6 months of treatment and were disease free. Our results support the data obtained from previous studies indicating that AFB clearance at 2 months is unlikely to be a clinically useful biomarker or indicator for therapeutic stratification. Furthermore, demographic, anthropometric, and nutritional factors are not clinically useful biomarkers.

Prevalence of Parental refusal rate and its associated factors in routine immunization by using WHO Vaccine Hesitancy tool: A Cross sectional study at district Bannu, KP, Pakistan.

OBJECTIVE: To determine the vaccination refusal rate, associated factors and perceptions of parents who refused routine immunization for their children using the World Health Organization (WHO) SAGE Working Group on Vaccine Hesitancy Survey Tool. MATERIALS AND METHODS: A cross-sectional survey was conducted using multi-stage cluster sampling in Bannu District, Khyber Pakhtunkhwa Province, Pakistan from March 2019 to July 2019. A WHO validated questionaire was used. The outcome variable was parental refusal of routine immunization of their children. Logistic regression was performed for associations, and multi-regression was applied to identify any confounders. RESULTS: Of 610 parents, 170 (27.9%) refused vaccination of their children. Of these, the majority of mothers had no education [n = 145 (85.3%); p = 0.03], and mothers were less likely to own a mobile phone than fathers [24 (14.1%) vs 152 (89.4%); p ≤ 0.001]. The vaccination refusal rate was higher in parents with food security [n = 88 (51.8%)] compared with parents with minimal food insecurity [n = 62 (36.5%)] and high food insecurity [20 (11.8%); p ≤ 0.05)]. On multi-variate logistic regression, fathers who were employed [adjusted odds ratio (OR) 0.59, 95% confidence interval (CI) 0.37-0.94; p = 0.02] and had a high level of education (adjusted OR 0.21, 95% CI 0.08-0.50; p ≤ 0.001) were less likely to refuse vaccination of their children. Parents with high food insecurity were more likely to refuse vaccination of their children (adjusted OR 2.2, 95% CI 1.0-0.50; p = 0.04) compared with parents with minimal food insecurity (adjusted OR 1.6, 95% CI 1.0-2.5; p = 0.02). CONCLUSION: The vaccination refusal rate was very high among parents, and this was associated with inability to read or write, no education, owning a mobile phone, unemployment and food security.

Impact of Social Media Integration in Teaching Methods on Exam Outcomes.

OBJECTIVE: The objective of this study was to assess the impact of social media integration in teaching methods on exam outcomes. METHODS: This study was conducted at Poonch Medical College, Azad Kashmir, Pakistan from November 2018 to January 2019. All 125 students of 4th year MBBS were included in the study. The mean age of all respondents was 22.96 ± 3.25 years. One unit of special pathology was taught using traditional teaching methods and a second unit was taught using traditional teaching methods supplemented by social media. One exam was taken before the integration of social media and a second exam after its integration. Written informed consent was secured from all the participants before starting the project. RESULTS: The mean difference in examination score after social media integration was 8.97 ± 5.23 which was statistically significant (95% CI -7.954-9.988, p <0.001). However, classroom attendance was significantly higher before social media integration (95% CI 0.668-0.197, p <0.001). Social media integration provided better examination outcomes for the students and gave voice or space to those who never previously asked questions or participated in the class. CONCLUSION: Social media broke down the barriers and students communicated with confidence. Educationists may work together to create a guideline on how social media can be efficiently incorporated in the education system.

What Are We Doing For Injuries? The Burden And Level Of Preparedness For Mass Emergencies In Khyber Pakhtunkhwa Province Of Pakistan.

BACKGROUND: Injuries are one of the highly prevalent public health problems of Pakistan but still we are unable to develop a mechanism for its quantification and management. To understand the reasons of not doing so we need detailed discussion among the leaders of different stakeholders working in area of injuries. In this study, a focus group discussion (FGD) of provincial health leaders was conducted to explore challenges and gaps and identify opportunities for quantification and management of injuries in the province of Khyber Pakhtunkhwa (KP). METHODS: This was a descriptive qualitative study conducted in Khyber Medical University, Peshawar, Pakistan. Study participants were policy makers, academia, senior level health mangers and representatives from international organizations. Purposive sampling was applied to select respondents for FGD from relevant areas to capture diversity of opinions among participants. The data were transcribed verbatim and analyzed thematically through open-coding process. RESULTS: One FGD was conducted in this study with a total of 11 participants. The study participants identified a number of challenges and gaps regarding quantification of injuries' burden in KP province of Pakistan and preparedness of existing health system to cope with mass emergencies. The discussion yielded four areas of detailed discussion which are; developing a surveillance system for injuries, capacity of District Health Information System, existing level of preparedness at provincial and district level and suggestions for improvement of existing situation with plans for capacity improvement. CONCLUSIONS: In countries like Pakistan routine health information system is the better option for quantification of injuries' burden, but needs review of existing indicators and sheer commitment from field level to higher authorities with due consideration of technology assimilation. A multipronged approach is required for preparedness including; trainings on emergency medicine and skills, incentives for staff to fill vacant posts, well equipped ambulances and provision of other supplies on regular basis..

Intramuscular Diclofenac Vs Periprostatic Lidocaine Injection For Controlling Pain Undergoing Transrectal Ultrasound Guided Prostatic Biopsy.

BACKGROUND: Transrectal ultrasound (TRUS) technique for getting prostatic tissue for histopathology is now the standard procedure for malignant lesions of the prostate and imperative diagnostic investigation of patients with clinical specks of prostatic neoplasia. During TRUS guided biopsy, pain control has been important issue therefore, highly potent analgesia before this procedure should be considered on high priority according to current census. Therefore, we compared intramuscular diclofenac injection with sensory blockade of injection lidocaine to abolish pain undergoing prostatic biopsy with TRUS technique. METHODS: Total 200 patients were selected for this study having raised PSA values and suspicious nodule on Digital Rectal Examination. These patients were segregated into two groups by randomization. Group "A" received intramuscular diclofenac and group "B" were infiltrated with lidocaine injection for sensory blockade. RESULTS: Patients in group A was having mean age of 64.5±5.8 years while for group B patients was 65.6±4.9 years (p=0.16). Both groups have statistically insignificant difference in their mean PSA values (p=0.24) and mean prostatic volume (p=0.22). The mean pain scores on visual analogue scale in groups A was 3.5±0.8 and in group B it was 2.4±0.8 (p<0.001). 60% group A patients reported with mild or no pain compared to 90% in group B. (p<0.001).. CONCLUSIONS: Local blockade with lidocaine injection has better pain control as compared to patients experienced pain with intramuscular diclofenac used for prostatic biopsy through TRUS technique..