Mehtab S. Karim

HealthLine: Speech-based access to health information by low-literate users

Health information access by low-literate community health workers is a pressing need of community health programs across the developing world. We present results from a needs assessment we conducted to understand the health information access practices and needs of various types of health workers in Pakistan. We also present a prototype for speech-based health information access, as well as discuss our experiences from a pilot study involving its use by community health workers in a rural health center.

Case–control study of suicide in Karachi, Pakistan

BACKGROUND In recent years suicide has become a major public health problem in Pakistan. AIMS To identify major risk factors associated with suicides in Karachi, Pakistan. METHOD A matched case-control psychological autopsy study. Interviews were conducted for 100 consecutive suicides, which were matched for age, gender and area of residence with 100 living controls. RESULTS Both univariate analysis and conditional logistic regression model results indicate that predictors of suicides in Pakistan are psychiatric disorders (especially depression), marital status (being married), unemployment, and negative and stressful life events. Only a few individuals were receiving treatment at the time of suicide. None of the victims had been in contact with a health professional in the month before suicide. CONCLUSIONS Suicide in Pakistan is strongly associated with depression, which is under-recognised and under-treated. The absence of an effective primary healthcare system in which mental health could be integrated poses unique challenges for suicide prevention in Pakistan.

Spousal abuse during pregnancy in Karachi, Pakistan

To determine the magnitude of and factors associated with spousal abuse during pregnancy in women presenting to tertiary care hospitals in Karachi, Pakistan.

The hidden figure: sexual intimate partner violence among Pakistani women

BACKGROUND The objectives of the present study were to determine the magnitude and factors associated with sexual intimate partner violence (SIPV) in women presenting to tertiary-care hospitals of Karachi, Pakistan. METHODS Five hundred women who presented to four tertiary-care hospitals to deliver were interviewed from September to December 2005. SIPV was assessed by using questions on sexual abuse in WHO Domestic Violence Module designed to determine intimate partner violence. Multiple logistic regression analysis was applied to determine factors associated with SIPV. RESULTS Twenty-one percent of women reported experiencing sexual violence in their married life. Gravida with five or more pregnancies [adjusted odds ratio (AOR) = 2.78; 95% confidence interval (CI) 1.12-6.96], index pregnancy as unwanted (AOR = 2.64; CI 1.16-6.02) and conflict with in-laws (AOR 1.9 CI 1.14-3.16) were independently associated with sexual abuse. Women who had social support were less likely to be abused by their intimate partners (AOR 0.76; CI 0.58-0.98). CONCLUSION One in five women reported spousal sexual abuse in their married life. Women having more than five children, unwanted pregnancies or reporting differences with in-laws are more likely to be subjected to such abuse. Social support protects women from sexual abuse by intimate partner.

Management information support for district health systems based on primary health care.

The authors consider the overall information requirements for a district health system. After reviewing the context of information support to operational management for primary health care (PHC) district health systems based upon PHC are defined with their principal features described. District management information systems typically have important information missing available data of inappropriate quantity and quality health staff with only limited skills in processing and using information and available information insufficiently used for local decision-making. District decision-making and information use are described in terms of resource allocation and use; use of services coverage and quality; policy and strategy; and assessment of health needs and program effects and impact. Increasing the scope of available information clarifying district needs resources objectives targets and indicators; streamlining procedures for data management; improving the skills of district staff in managing and using information; and broadening the use of information especially within districts and communities can improve district management information support. Closing sections consider the role and potential of microcomputer support for district health systems and policy implications at national and international levels.

Ethnic disparities in routine immunization coverage: a reason for persistent poliovirus circulation in Karachi, Pakistan?

Karachi is the only mega city in the world with persistent poliovirus transmission. We determined routine childhood immunization rates in Karachi and identified predictors of vaccine completion. A population-based cross-sectional survey was conducted in Karachi between August and September 2008. Data on demographics, socioeconomic, and DTP3 vaccination status in children 12 to 23 months old were collected. Logistic regression was used to identify predictors of vaccination completion. Overall, 1401 participants were approached; 1391 consented to participate. Of these, 1038 (75%) were completely vaccinated. Punjabi families had the highest DTP3 coverage (82%), followed by Urdu-speaking families (79%). Pashtun (67%) and Bengali (48%) families had the lowest vaccine coverage. Children of mothers with ≥12 years of schooling (OR = 25.4; 95% CI = 5.7-113.1) were most likely to be vaccinated. A quarter of study participants were unvaccinated. Targeted strategies for boosting DTP3 rates in communities with low immunization coverage are essential for polio eradication in Karachi.

O444 Spousal abuse during pregnancy and the risk of low birth weight

conditions (pooled odds ratio, 0.50; 95% confidence interval, 0.29–0.86; P = 0.012 with DerSimonian-Laird’s model). Metaregression analysis revealed that a heterogeneity involving year of publication, taxane use, and optimal cytoreduction rate was influencing the median overall survival significantly (P = 0.002, P = 0.007, and P =0.012, respectively). However, the ‘betweenstudies’ variation of the number of NAC cycles was not influencing survival (P = 0.701). Conclusion: The current meta-analysis showed that NAC helped the gynecologic oncologist achieve an increased rate of optimal cytoreduction.