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Maternal depression is a global mental health and a public health priority. Despite the priority its active detection is still a challenge. We tested the accuracy of an adapted version of Community Informant Detection Tool for Maternal Depression (CIDT-MD) in rural settings of Pakistan. Using a single stage design, trained community informants (lady health workers and lay peers) identified women (pregnant and/or with children) with symptoms of probable depression using CIDT-MD. This was immediately followed by diagnostic interviews of all the women using the Structured Clinical Interview for the Diagnostic and Statistical Manual (SCID-V) for current major depressive episode by trained assessors, blinded to the outcome of CIDT-MD. Data were analyzed using Statistical Package for Social Sciences (Version 25.0, IBM Corp., Armonk, NY, USA) and FACTOR software (Version. 10.3.01, Virgili University, Tarragona, Spain). Descriptive statistics, factor analysis, validity, reliability and known group validity was conducted to evaluate the psychometric properties of the adapted CIDT-MD. In all, 425 women, with mean age of 28 years (SD = 4.7), participated. Nearly 10% were illiterate, while the rest (90%) had an education ranging from eight to 15 years of schooling. The majority (73.2%) of the participants had 1–3 children while only 17.4% had &gt, 3 children. The sensitivity and specificity of CIDT-MD in detecting depressive symptoms was 97.5% (95% CI: 94.2–99.1) and 82.4% (95% CI: 77.8–86.4) respectively. It’s positive predictive value (PPV), 77.3% (95% CI: 72.9–81.2) and the negative predictive value (NPV) was 98.17% (95% CI: 95.7–99.2). While factor analysis revealed high inter-item correlation for most items (0.62–0.77) with an adequately fair Kaiser-Meyer-Olkin (KMO) sampling adequacy (0.73), significant Bartlett’s test of sphericity (p &lt, 0.001). Uni-dimensionality for the CIDT-MD based on one-dimensional congruence (0.97), explained common variance (0.85), excellent internal consistency (0.90), good criterion validity (Area Under Curve = 81%), tester-test reliability (0.87–0.89) and statistically significant known group analysis (p &lt, 0.001). The adapted version of the Community Informant Detection Tool for Maternal Depression is a valid and a reliable tool for active case detection of maternal depression in rural settings of Pakistan.

Objective To assess the improvement in the health information system in the district Nowshera by integrating the data reporting of the Expanded Program on Immunization (EPI) and Lady Health Worker (LHW) programs in the existing system. Methodology The study was conducted at district Nowshera and Swabi, Pakistan between May 2015 and May 2016 for a duration of one year. The data collection instruments used in the study were adapted from the Performance of Routine Information System Management (PRISM) tool package. The study was conducted in three phases during a period of one year. The first three months were utilized for baseline assessment. The next six months were being used for implementing the integration of the EPI and LHW, and the next three months were being used for the post-intervention evaluation. Microsoft Excel software was used to enter and analyze the data. A p < 0.05 was considered as the cut-off value for significance. Results The results indicated that the integration of data from the EPI and LHW with that of the existing Health Information System (HIS) is possible and has the potential for improving the existing system. The least significant results were produced by the use of information, which depicts that the utilization of data in decision making or policy making is still needed to be improved. Moreover, we reported a lack of enforcement and regulation by the authorities in monitoring the feedback system in the HIS. Conclusion The current study revealed significant improvements in the use of information, data quality, and behavior of staff. It is essential to properly train the team on how to operate the District Health Information System (DHIS) to gain adequate and timely data on health status and determinants. Additionally, the integration would benefit in managing the data at not only the national level but at the district level too.

Background: Family planning includes knowledge, services, attitude, policies and practices which enable individuals to decide whether they want to have child and allow them to avoid unwanted pregnancy. Pakistan with population of 195.390 million with estimated population growth rate as 1.89 is the sixth most populous country in the world. Our objectives were to assess the total demand of family planning, contraceptive prevalence rate, unmet need for family planning and factors associated with unmet need of family planning among women of reproductive age group. Methods: We conducted this cross-sectional study on 355 females of reproductive age attending the out-patient department as patient or attendant. Data were collected using structured questionnaire after the participants' verbal consent. Results: The prevalence of unmet need was 34%. The proportion of unmet need for spacing was 63.6% and for limiters it was found to be 36.3%. Contraceptive prevalence rate was 57%. Total demand for family planning was 92.1%.Almost all study participant had knowledge regarding at least one method of contraception. Unmet need of family planning was found to be significantly associated with age and education status of women. High unmet need was there in women with low education status (p=0.047) and older age group (p=0.003). Main reasons for not using contraceptive was family opposition both family and husband (66.9), and fear of side effects (17.3%). Conclusion: More than one third females had unmet need which strongly points towards the strong influence of various socio demographic factors contributing towards the unmet need.

Background: Nursing is an important tier for the health care delivery system. Nurses are holding essential and largest part of health delivery system from direct care to management, performing many functions for the smooth operations of the health care delivery system. Nursing education ignored in Pakistan nowadays many nurses are being enrolled in nursing schools every year. Changes people to join nursing profession may vary from one another. Objectives: Our study's objectives were to explore motivating factors for the nursing profession, and to assess the motivational factors among student nurses. Methods: We conducted Focus Group Discussions with nursing students. Thematic content analysis was done after assigning codes, making sub categories and categories and then driving sub themes and themes. Results: Factors such as wish to become nurse, mostly an alternate as failure to get admission in medicine, to fulfill parents wish, financial support job either public or private and get a chance to settle abroad, and seeking stipend during training. Easy public, private or clinic set up and jobs abroad. According to our study findings most students chose nursing profession as alternate but not their first choice, many personal, professional and financial factors attract students to enroll into the nursing. Conclusion: We conclude that most of the nursing student's perceive nursing being more suitable for females supporting their financial health.

Background Global burden of cardiovascular diseases is alarming which is intricately linked with health literacy. To what extent improvement in health literacy can lower down cardiovascular diseases occurrence has not yet properly documented. This study focused on assessing the knowledge and existing lifestyle behavior about cardiac diseases among university students. We further aimed to improve this awareness after imparting an educational intervention among undergraduate non-medical students to sensitize them about risk factors. Method A pre and post approaches with cross sectional study design was conducted in University of Gujrat during April–September 2017. Using structured questionnaire comprising of response items about hypertension, heart attack, stroke and preventive practices, data was randomly collected from students (n = 100). Survey respondents were also given a lecture regarding cardiovascular diseases awareness and a post test evaluation was also conducted on same group of students. Results With response rate of 86.95%, mean age of participating students was 21.2 (SD ± 1.34) years. Female students comprised of 53% out of which 57% were from rural background. Assessment of cardiovascular disease knowledge revealed maximum mean pre test score 30.53 (SD ± 7.61) and for post test 40.65 (SD ± 4.34) (p

Introduction: Stroke is a major cause of death with hypertension being identified as an important modifiable risk factor. Prompt identification of stroke symptoms and timely management is noted to be significant in lowering both morbidity and mortality. Baseline stroke knowledge in hypertensive patients is crucial to develop effectively targeted, and appropriate health promotion campaigns; thus, the main objectives of this study are to assess the awareness of stroke and to determine health-seeking practices among hypertensive patients. Materials and methods: A standardized questionnaire survey regarding awareness and practices about stroke among hypertensive patients was conducted in a tertiary care hospital of Islamabad. The sample size was calculated as 384. Results: Out of 384 patients evaluated, 80.5% had heard about stroke, 71.6% knew someone with stroke, and 76% identified the brain as the organ affected. Sudden onset numbness of limb (66.9%) and hypertension (93.5%) were common warning symptom and risk factor identified. 87.5% would take stroke patients to a hospital. Only 45.1% of the patients took their medications regularly, and 38% checked their blood pressure. Conclusion: Majority of hypertensive patients were aware of stroke but the awareness of risk factors and warning signs was poor. Stroke prevention practices were also sub-optimal. There is a need to increase knowledge regarding risk factors, which will benefit the community at large.

© 2017 Informa UK Limited, trading as Taylor & Francis Group. Background: The Patient Health Questionnaire (PHQ-9) possesses many characteristics of a good screening tool and has the capacity to be used for screening depression in patients with coronary artery disease (CAD). Aim: To examine the psychometric properties and criterion validity of the PHQ-9 to screen and detect depression in patients with CAD in Pakistan. Design: In this validation study, 150 patients with CAD completed the Urdu version of the PHQ-9. The major depressive episode module of the Mini International Neuropsychiatric Interview (MINI) was used as the gold standard. Results: The Urdu version of the PHQ-9 revealed a good internal consistency with Cronbach’s alpha of 0.83. Optimal sensitivity (76%) and specificity (76%) were achieved using the cut-off score of PHQ-9 ≥6, with area under the ROC curve of 0.86. Conclusion: The Urdu version of the PHQ-9 has acceptable psychometric properties to screen and detect major depression in patients with CAD.

Mainstream preventive interventions often fail to reach poor populations with a high risk of cardiovascular diseases (CVDs) in Pakistan. A community-based CVD primary prevention project aimed at developing approaches to reduce risk factors in such populations was established by Heartfile in collaboration with the National Rural Support Program in the district of Lodhran. The project implemented a range of activities integrated with existing social and health service mechanisms during a three year intervention period 2000/01-03/04. These were targeted in 4 key settings: community health education, mass media interventions, training of health professionals and health education through Lady Health Workers. The project received support from the Department for International Development, UK. At the community level, a pre-test-post-test quasi-experimental design was used for examining project outcomes related to the community component of the intervention. Pre and post-intervention (training) evaluations were conducted involving all health care providers in randomly selected workshops in order to determine baseline levels of knowledge and the impact of training on knowledge level. In order to assess practices of physician and non-physician health care providers patient interviews, with control comparisons were conducted at each health care facility. Significant positive changes were observed in knowledge levels at a community level in the district of intervention compared with baseline knowledge levels particularly in relation to a heart healthy diet, beneficial level of physical activity, the causes of high blood pressure and heart attack and the effects of high blood pressure and active and passive smoking on health. Significant changes in behaviors at a practice level were not shown in the district of intervention. However the project played a critical role in spurring national action for the prevention and control of non-communicable diseases and introducing sustainable public health interventions for poor communities in Pakistan.