Search

Maryam Huda,1 Fauziah Rabbani,1,2 Leah Shipton,1,3 Wafa Aftab,1 Kausar S Khan,1 Maria Giulia Marini4 1Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan; 2Brain & Mind Institute, Aga Khan University, Karachi, Pakistan; 3Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; 4Research and Health Care Director, Fondazione ISTUD per la Cultura d’Impresa e di Gestione, Milan, ItalyCorrespondence: Fauziah Rabbani, Email fauziah.rabbani@aku.eduBackground: Understanding health-seeking behaviors of caregivers is important to reduce child mortality. Several factors influence decision-making related to childhood illnesses.Objective: The objective of this study was to gather caretaker narratives to develop a comprehensive understanding of the context and process of caregiving at household level during all stages of an episode of diarrhea and pneumonia in children < 5.Methods: Using a narrative interview approach, stories from caregivers of children < 5 were collected from a rural district in Sindh Pakistan. Eleven households with children < 5 were randomly selected and purposive sampling was done to interview 20 caregivers. All data collection was conducted privately in participants’ homes and informed consent taken. Manual content analysis was carried out by three independent researchers and emerging themes drawn.Results: The role of joint family system is integral in making decisions and the child’s paternal grandmother, is an important and trusted source of information regarding child sickness in the household. They often promote home remedies with considerable authority prior to formal consultation with the health care system. Caregivers were generally dissatisfied with doctors in the public sector who were perceived to be providing free consultation with a poor quality of care and long waiting time as compared to private doctors. Financial considerations and child support were favorably addressed in households with a joint family system.Conclusion: The joint family system provides a strong support system, but also tends to reduce parental autonomy in decision-making and delay first contact with formal health providers. Prevalent home remedies, and authority of elders in the family influence management practices. Interventions for reducing improving child mortality should be cognizant of the context of decision-making and social influences at the household level.Keywords: narrative interviews, health-seeking behavior, joint family system, pneumonia, diarrhea, children < 5, caregivers

Fauziah Rabbani,1,2 Hyder Ali Khan,2 Suneel Piryani,2 Nousheen Akber Pradhan,2 Natasha Shaukat,2 Anam Shahil Feroz,2 Shagufta Perveen2 1Office of Research and Graduate Studies, The Aga Khan University, Karachi, Sindh, Pakistan; 2Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, PakistanCorrespondence: Fauziah RabbaniOffice of Research and Graduate Studies, The Aga Khan University, Stadium Road, P.O Box 3500, Karachi, 74800, Sindh, PakistanEmail fauziah.rabbani@aku.eduPurpose: Diarrhea and pneumonia greatly contribute to high childhood mortality in Pakistan. Frontline community health workers or the Lady Health Workers (LHWs) provide care at the doorstep of over 60% of Pakistan’s rural residents. Difficult terrain, lack of supplies, and inadequate supervision put these LHWs at an added disadvantage in the timely diagnosis and delivery of known treatment options to community caregivers (CCGs). This study aims to assess whether a supportive supervision intervention through Lady Health Supervisors (LHSs) using enhanced mentorship and written feedback cards have the potential to improve case management of childhood diarrhea and pneumonia.Study Setting and Design: This perception-based qualitative inquiry nested within the Nigraan Plus trial included LHSs, LHWs, and CCGs as the participants. Twenty-two in-depth interviews (IDIs) and 16 focus group discussions (FGDs) were conducted before a supportive supervision intervention in 2017, and 10 FGDs were conducted in 2019 once the intervention concluded. Data were analyzed using manual content analysis.Results: The perceived ability of LHWs and LHSs to describe the danger signs of diarrhea and pneumonia, classify dehydration and relate respiratory rate to the severity of pneumonia improved over time. Appropriate prescription of zinc in diarrhea and antibiotics in pneumonia was noted. Furthermore, CCGs’ trust in LHWs increased following the intervention, and they reported a growing inclination to contact LHWs as their first point of care. LHWs in the intervention arm were more satisfied with their job due to frequent supervisory visits and continuous feedback by LHSs.Conclusion: Despite geographic, social, and economic inequities, supportive supervision has the potential to improve knowledge, practice, and skills of frontline health workers related to CCM of childhood diarrhea and pneumonia in disadvantaged rural communities. Additionally, the trust of CCGs in the health workers’ ability to manage such cases is also enhanced.Keywords: community health workers, community caregivers, community case management, childhood diarrhea and pneumonia, supportive supervision, Pakistan

A cross-sectional study of patient satisfaction with care was conducted over a period of 1 year from March 2004 to March 2005 in a secondary-level hospital in a peri-urban area of Karachi, Pakistan. Using the SERVQUAL tool and exit interviews, data were collected quarterly from a total of 1533 patients. Results sharing and capacity-building workshops were arranged during the 4 phases of the survey to sensitize the staff of the hospital to work towards improving patient satisfaction. The level of satisfaction of the patients with the outpatient health services provided showed a gradual increase from 34.4% to 82.0% over the 1-year period. [ABSTRACT FROM AUTHOR]

There is no adequate profile of domestic violence in Pakistan although this issue is frequently highlighted by the media. This case study used qualitative and quantitative methods to explore the nature and forms of domestic violence, circumstances, impact and coping mechanisms amongst selected women victims in Karachi. Violence was a continuum: all the women reported verbal abuse, often escalating into physical, emotional, sexual and economic abuse. The husband was the most common perpetrator. Women suffered in silence due to sociocultural norms, misinterpretation of religious beliefs, subordinate status, economic dependence and lack of legal redress. Besides short-term local measures, public policy informed by correct interpretation of religion can bring about a change in prevailing societal norms. [ABSTRACT FROM AUTHOR]