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Management of maternal depression: Qualitative exploration of perceptions of healthcare professionals from a public tertiary care hospital, Karachi, Pakistan.

ABSTRACT: The lack of implementation and routine screening of management techniques at tertiary care hospitals leads to an increased burden of maternal depression. The consequences are borne emotionally, physically, and mentally by the mother, the child, the overall family, and society. Hence, it is vital to contextualize this mental disorder to design and implement effective healthcare interventions. The study is aimed to assess the knowledge and practices of healthcare professionals, in a tertiary care setting, who deal with depressive symptoms amongst mothers. It gauges whether a psychological screening criterion is being implemented by the clinical staff during prenatal and postnatal visits to recommend steps that can help develop a service framework. A qualitative, exploratory study design was implemented for this research. With purposive sampling, eight in-depth interviews (three nurses and five doctors) at a single tertiary care hospital were conducted categorically using a semi-structured (open and close-ended questions) interview toolkit. Content Analysis was carried out using information gathered from the unit of analysis. The study provided evidence of the existing gaps in one particular tertiary healthcare system, within Pakistan, concerning diagnosis and management of maternal depression. Results highlighted that providers were well-versed with explanations of maternal depression, the aftermath of it, and the current status of healthcare; however, they were minimally educated about the specifics and levels of treatment. The gathered information assisted in recommending steps to develop a service framework.

SUBMITTER: Jawed M

PROVIDER: S-EPMC8263250 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundPsychiatric disorders affect about 450 million individuals worldwide. A number of treatment modalities such as psychotropic medications, psychotherapy and electroconvulsive therapy can be used to treat these disorders. Attitudes of general public play a pivotal role in effective utilization of mental health services. We explored the perceptions of general public of Karachi, Pakistan regarding psychotherapy.MethodsA cross-sectional study was conducted in Karachi, Pakistan during July-August, 2008. A three-step sampling strategy and a structured questionnaire were employed to survey knowledge and perceptions of adult general public about psychotherapy. Descriptive statistics were used for baseline characteristics. Logistic regression models were used to investigate any significant associations between baseline characteristics of the participants and their perceptions.ResultsThe study sample comprised of 985 individuals (536 males; 531 financially independent) with an average age of 36.7 years (SD 13.54 years) and 12.5 years (SD 3.09 years) of education were included. Majority (59.4%; n = 585) claimed to be aware of psychotherapy as a treatment option for psychiatric disorders but 47.5% of these (n = 278/585) failed to identify its correct definition. Concerns voiced by the participants about psychotherapy included stigma (48.7%) and breech in confidentiality (39.5%); 60.7% opined it cost effective and 86.5% favored its use as an adjuvant modality. A preference for psychotherapy as the treatment strategy for psychiatric disorders was demonstrated by 46.6% (n = 459/985). Younger, more educated, financially independent and female participants were more likely to prefer psychotherapy as were those who deemed it cost effective.ConclusionPositive attitudes regarding the acceptability, clinical utility and cost-effectiveness of psychotherapy were observed in a sample representative of general public of Karachi, Pakistan. These findings highlight its potential utility for devising pragmatic mental health strategies in the face of limited resources.

Project description:ObjectiveTo explore healthcare provider's perspectives and experiences of the barriers and facilitators to treat and manage COVID-19 cases.Design and settingWe conducted an exploratory qualitative study using a purposive sampling approach, at a private tertiary care teaching hospital in Karachi, Pakistan. Study data were analysed manually using the conventional content analysis technique.ParticipantsKey-informant interviews (KIIs) were conducted with senior management and hospital leadership and in-depth interviews (IDIs) were conducted with front-line healthcare providers.ResultsA total of 31 interviews (KIIs=19; IDIs=12) were conducted, between April and May 2020. Three overarching themes emerged. The first was 'challenges faced by front-line healthcare providers working in COVID-19 wards. Healthcare workers experienced increased anxiety due to the fear of acquiring infection and transmitting it to their family members. They felt overwhelmed due to the exhaustive donning and doffing process, intense work and stigmatisation. The second theme was 'enablers supporting healthcare providers to deal with the COVID-19 pandemic'. Front liners pointed out several enabling factors that supported hospital staff including a safe hospital environment, adequate training, a strong system of information sharing and supportive management. The third theme was 'recommendations to support the healthcare workforce during the COVID-19 crisis'. Healthcare workers recommended measures to mitigate current challenges including providing risk allowance to front-line healthcare providers, preparing a backup health workforce, and establishing a platform to address the mental health needs of the healthcare providers.ConclusionThis study provides an initial evidence base of healthcare providers' experiences of managing patients with COVID-19 in the early stage of the pandemic and highlights measures needed to address the encountered challenges. It offers lessons for hospitals in low-income and middle-income countries to ensure a safe working environment for front-line workers in their fight against COVID-19.

Project description:Purpose To estimate the burden of infectious diseases and the seasonality of mosquito-borne diseases seen at The Indus Hospital, Karachi (TIH). Methodology We performed a retrospective data analysis of all infectious diseases (ID) cases, retrieved from medical records over a five-year period starting from 1 January 2012 till 31 December 2016 at The Indus Hospital (TIH), which is a 150-bed, charity-based, tertiary-care health facility. The collected data has been categorized into three groups: (A) public health-related diseases, including community and environmental IDs, i.e., mosquito-borne diseases such as malaria and dengue, respiratory tract infections, diarrheal diseases, typhoid, and hepatitis; (B) systemic infection related IDs that target individual anatomical or physiological systems such as the respiratory tract, urinary tract, skin and soft tissue, and the cardiac system, and lastly, those IDs which are (C) programmatically managed at TIH, namely cases from the tuberculosis (TB), human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), and malaria clinics, and the rabies prevention center. As the study is an audit, ethical approval was waived by the institutional review board (IRB). Result Overall data from 71,815 patients were assessed. In the public health group (A), the main bulk of diseases were due to malaria, tuberculosis, respiratory tract infections (upper and lower), and diarrheal diseases in both males and females in descending order; there was preponderance of malaria, respiratory tract infections, and diarrheal diseases in males, and of tuberculosis among females. Among the systemic diseases group (B), urinary tract infections (UTIs) had a disproportionately high incidence, followed by skin and soft tissue infections, while bone and joint infections and diabetic foot had equal incidence. In the programmatic group (C), the highest number of cases seen was dog bites followed by drug-sensitive TB. Overall, the six most common infections were malaria, cases of dog bites, tuberculosis, respiratory tract infections, diarrheal diseases, and hepatitis C. More women than men had TB; diarrheal disease and respiratory tract infections were more common in children. UTIs were the most common systemic infections among both men and women. Conclusion There is a great need to have an effective surveillance mechanism of preventable diseases at the national level. Our study highlights the diversity of cases that should direct medical curriculum development, post-graduate training, and health services improvement.

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Management of maternal depression: Qualitative exploration of perceptions of healthcare professionals from a public tertiary care hospital, Karachi, Pakistan.

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