Sociocultural Challenges in the Implementation of COVID-19 Public Health Measures: Results From a Qualitative Study in Punjab, Pakistan.
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ABSTRACT:
SUBMITTER: Zakar R
PROVIDER: S-EPMC8329025 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Purpose: This study intends to outline the capacity of anesthesia health system in public hospitals of Punjab, Pakistan.Methods: A cross-sectional survey among public hospitals of Punjab was carried out that provide emergency and elective surgical care. We measured capacity in terms of infrastructure; surgical, anesthetic, and obstetric (SAO) workforce; surgical interventions; information management; equipment; and medication which was accomplished between October 2020 and February 2021.Results: Out of 106 public hospitals in Punjab, almost 40% had only one anesthesia provider. Only 50% of the hospitals reported round the clock availability of anesthesia providers for surgical cases. While caesarean sections were carried out in more than 90% of health facilities, general surgery, pediatric surgery, and open fracture surgery were conducted only in 50% of the hospitals. Although local and general anesthetic agents were available in the majority of hospitals, essential medicines for safe anesthesia were not available in all hospitals.Conclusion: This first comprehensive assessment of anesthesia health system capacity exposed a crucial deficiency of critical supplies and workforce for providing safe anesthesia and, hence, safe surgery. The surveyed facilities had an uneven division of resources.
| S-EPMC8671656 | biostudies-literature
Project description:ObjectivesAnaesthesia delivery in Pakistan remains limited to conventional intraoperative procedures, with research showing ongoing challenges in quality and resourcing. We aimed to identify systemic challenges in the delivery of the WHO-World Federation of Societies of Anaesthesiologists' (WHO-WFSA) 'highly recommended' standards of quality anaesthesia services for surgical support in Pakistan's Punjab province.Study design and settingThis single-method qualitative study included 22 semistructured interviews with purposively selected anaesthesia system experts in Punjab province, including heads of teaching hospital anaesthesia departments, healthcare commission (HCC) representatives and health department officials. We analysed data thematically, using deductive and inductive coding.Participants10 participants worked as anaesthesia department heads of teaching hospitals across Punjab, 5 worked for the HCC and 7 worked for the health department. All were selected purposively and had at least 5 years of experience working as head of department or serving in legislative departments.ResultsWe identified three themes experienced as major challenges within the specialty, namely anaesthetist recruitment and retention, quality of care and in-service training, and discrepancies between specialities. Findings indicated that workforce shortages and maldistribution, insufficient in-service training and standards, inadequate equipment maintenance and lack of anaesthesia representation in decision-making compromised anaesthesia provision quality and safety.ConclusionsImproving anaesthesia provision in Punjab would require increasing physician and non-physician anaesthetist numbers and rotation to peripheral postings, strengthening training quality and ensuring availability of WFSA-specified essential equipment and supplies. To achieve essential anaesthesia provision standards, policy interventions are needed to, for example, balance anaesthesiologist and surgeon/obstetrician-gynaecologist numbers, require that anaesthesiology postgraduates work a few years in-country (eg, scholarship bonds), ensure in-service training attendance for skills updates and implement quality assurance standards for equipment and supplies.
| S-EPMC10748997 | biostudies-literature
Project description:Policies centered to respond to the COVID-19 pandemic have created recessionary economic impacts. Adverse income shocks have caused malnutrition and food insecurity and have increased the need for food assistance. The present study examines the impact of the COVID-19 pandemic on food insecurity and investigates the determinants of food security and coping strategies in the Punjab province of Pakistan. Data were collected through the internet and received responses from 370 respondents. The household food insecurity access scale (HFIAS) model was applied to examine food insecurity, and a logit regression model was used to analyze its determining factors. The results illustrate that food insecurity substantially increased during the COVID-19 pandemic. Households' demographics and socioeconomic factors have influence on food insecurity. Households with a large family size and people in quarantine found more food insecurity during the COVID-19 pandemic, while financial assistance played a role in a decline in food insecurity. Households handle the negative income shocks by eating less preferred food and getting support from government and charity organizations. It is suggested that stakeholders and responsible institutes provide financial assistance to support low-income families in order to enhance food security. Furthermore, policymakers should strengthen social safety nets and aid programs such as the Ehsas income program in the province of the country.
| S-EPMC8224546 | biostudies-literature
Project description:ObjectivesReal-time COVID-19 spread mapping and monitoring to identify lockdown and semi-lockdown areas using hotspot analysis and geographic information systems and also near future prediction modeling for risk of COVID-19 in Punjab, Pakistan.Study designData for all COVID-19 cases were collected until 20 October 2020 in Punjab Province.MethodsThe methodology included geotagging COVID-19 cases to understand the trans-mobility areas for COVID-19 and characterize risk. The hotspot analysis technique was used to identify the number of areas in danger zones and the number of people affected by COVID-19. The complete lockdown areas were marked down geographically to be selected by the government of Pakistan based on increased numbers of cases.ResultsAs per predictive model estimates, almost 9.2 million people are COVID-19 infected by 20 October 2020 in Punjab Province. The compound growth rate of COVID-19 decreased to 0.012% per day and doubling rate increased to 364.5 days in Punjab Province. Based on Pueyo model predictions from past temporal data, it is more likely that Punjab and Pakistan entered into peak around the first week of July 2020, and the decline of growth rate (and doubling rate) of reported cases started afterward. Hospital load was also measured through the Pueyo model, and mostly, people in the 60+ years age group are expected to dominate the hospitalized population.ConclusionsPakistan is experiencing a high number of COVID-19 cases, with the maximum share from Punjab, Pakistan. Statistical modeling and compound growth estimation formulation were done through the Pueyo model, which was applied in Pakistan to identify the compound growth of COVID-19 patients and predicting numbers of patients shortly by slightly modifying it as per the local context.
| S-EPMC7654357 | biostudies-literature
Project description:Vaccine hesitancy is widespread in many parts of the globe, particularly in low-middle-income countries. Therefore, we surveyed a sample of hospitalized COVID-19 patients to assess COVID-19 vaccine acceptance and vaccine hesitancy in a low-middle-income country. A cross-sectional sample of 385 confirmed reverse transcriptase-polymerase chain reaction COVID-19 patients treated at secondary and tertiary care hospitals in Punjab, Pakistan, were analyzed to assess COVID-19 vaccine uptake and vaccine hesitancy. The construct validity and reliability of the 11-item vaccine hesitancy questionnaire were also examined. In addition, multivariate logistic regression was used. The majority of the COVID-19 patients admitted to hospitals were not vaccinated (84%). Of those who were willing to receive vaccination, the majority (55%) considered vaccines an effective way to protect people from COVID-19. However, those who were not willing to receive their COVID-19 vaccine had significantly higher hesitancy than those willing to receive their COVID-19 vaccine. In addition, older hospitalized COVID-19 patients aged 60 years or above (20-29 years: OR 0.10; 95% CI 0.01-0.72, p = 0.001) and patients from urban areas (OR 3.16 95% CI 1.27-7.87, p = 0.013) were more likely to receive the COVID-19 vaccine than younger patients and patients from rural areas. Patients with no formal education had significantly higher hesitancy (OR 5.26; 96% CI 1.85-14.97, p = 0.002) than participants with graduation and above education. More than half of the study's participants did not trust information shared on social media about COVID-19 vaccines and cited newspapers/news channels as their main source of information. The study provides important insights into COVID-19 vaccine acceptance and the impact of vaccination campaigns. Many unvaccinated COVID-19 patients in hospitals highlight the need for an effective vaccination drive to protect people from acquiring infection and subsequent hospitalization.
| S-EPMC9611380 | biostudies-literature
Project description:BackgroundA disproportionately high rate of maternal deaths is reported in developing and underdeveloped regions of the world. Much of this is associated with social and cultural factors, which form barriers to women utilizing appropriate maternal healthcare. A huge body of research is available on maternal mortality in developing countries. Nevertheless, there is a lack of literature on the socio-cultural factors leading to maternal mortality within the context of the Three Delays Model. The current study aims to explore socio-cultural factors leading to a delay in seeking care in maternal healthcare in South Punjab, Pakistan.MethodsWe used a qualitative method and performed three types of data collection with different target groups: (1) 60 key informant interviews with gynaecologists, (2) four focus group discussions with Lady Health Workers (LHWs), and (3) ten case studies among family members of deceased mothers. The study was conducted in Dera Ghazi Khan, situated in South Punjab, Pakistan. The data was analysed with the help of thematic analysis.ResultsThe study identified that delay in seeking care-and the potentially resulting maternal mortality-is more likely to occur in Pakistan due to certain social and cultural factors. Poor socioeconomic status, limited knowledge about maternal care, and financial constraints among rural people were the main barriers to seeking care. The low status of women and male domination keeps women less empowered. The preference for traditional birth attendants results in maternal deaths. In addition, early marriages and lack of family planning, which are deeply entrenched in cultural values, religion and traditions-e.g., the influence of traditional or spiritual healers-prevented young girls from obtaining maternal healthcare.ConclusionThe prevalence of high maternal mortality is deeply alarming in Pakistan. The uphill struggle to reduce deaths among pregnant women is firmly rooted in addressing certain socio-cultural practices, which create constraints for women seeking maternal care. The focus on poverty reduction and enhancing decision-making power is essential for supporting women's right to medical care.
| S-EPMC8130310 | biostudies-literature
Project description:An extended range of host susceptibility including camel has been evidenced for some of the important veterinary and public health pathogens, such as brucellosis, peste des petits ruminants (PPR) and bluetongue (BT). However, in disease endemic settings across many parts of the globe, most of the disease control interventions accounts for small and large ruminants, whereas unusual hosts and/or natural reservoirs, such as camels, remain neglected for disease control measures including routine vaccination. Such a policy drawback not only plays an important role in disease epizootiology particularly in settings where disease is endemic, but also serves an obstacle in disease control and subsequent eradication in future. With this background, using pre-validated ELISA and molecular assays [multiplex PCR, reverse transcriptase (RT)-PCR and real-time (rt)-PCR], we conducted a large-scale pathogen- and antibody-based surveillance for brucellosis, peste des petits ruminants and bluetongue in camel population (n = 992) originating from a wide geographical region in southern part of the Punjab province, Pakistan. Varying in each of the selected districts, the seroprevalence was found to be maximum for bluetongue [n = 697 (70.26%, 95% CI: 67.29-73.07)], followed by PPR [n = 193 (19.46%, 95% CI: 17.07-22.09)] and brucellosis [n = 66 (6.65%, 95% CI: 5.22-8.43)]. Odds of seroprevalence were more significantly associated with pregnancy status (non-pregnant, OR = 2.23, 95% CI: 1.86-5.63, p<0.01), farming system (mixed-animal, OR = 2.59, 95% CI: 1.56-4.29, p<0.01), breed (Desi, OR = 1.97, 95% CI: 1.28-4.03, p<0.01) and farmer education (illiterate, OR = 3.17, 95% CI: 1.45-6.93, p<0.01) for BTV, body condition (normal, OR = 3.54, 95% CI: 1.92-6.54, p<0.01) and breed (Desi, OR = 2.19, 95% CI: 1.09-4.40, p<0.01) for brucellosis, and feeding system for PPR (grazing, OR = 2.75, 95% CI: 1.79-4.22, p<0.01). Among the total herds included (n = 74), genome corresponding to BT virus (BTV) and brucellosis was detected in 14 (18.92%, 95 CI: 11.09-30.04) and 19 herds (25.68%, 95% CI: 16.54-37.38), respectively. None of the herds was detected with genome of PPR virus (PPRV). Among the positive herds, serotype 1, 8 and 11 were detected for BTV while all the herds were exclusively positive to B. abortus. Taken together, the study highlights the role of potential disease reservoirs in the persistence and transmission of selected diseases in their susceptible hosts and, therefore, urges necessary interventions (e.g., inclusion of camels for vaccine etc.) for the control of diseases from their endemic setting worldwide.
| S-EPMC7092811 | biostudies-literature
Project description:Plant species of the Poaceae family are not only used as fodder and forage but also contribute substantially to the treatment of various health disorders, particularly in livestock. Consequently, the present study was aimed to document the therapeutic uses of Poaceae practiced by the inhabitants of the Punjab Province for the treatment of various veterinary health disorders. Semi structured interviews, group discussion and field walks were conducted to collect the data. Quantitative indices including cultural significance index (CSI), relative frequency of citations (RFC), fidelity level (FL), relative popularity level (RPL), and Jaccard Index (JI) were used for the data analysis. Traditional uses of 149 species belonging to 60 genera and 16 tribes of 5 sub families of Poaceae were recorded. Whole plants and leaves were the most consistently used parts with 40.94 and 29.53%. The plants were mainly given orally as fodder (59 reports) without processing followed by decoction (35 reports). Most of the species were employed to treat infectious diseases (25.93%), and digestive disorders (14.10%). Triticum aestivum had the highest CSI, RFC and RPL levels at 8.00, 0.96, 1.00, respectively, followed by Oryza sativa and Poa annua. Likewise, T. aestivum and Saccharum spontaneum had 100% FL and ROP. Jaccard index ranged from 12.25 to 0.37. Twelve plant species namely Chrysopogon zizanioides (anti-inflammatory), Pennisetum lanatum (improve bull fertility), Cymbopogon citratus (glandular secretion), Sorghum saccharatum and Themeda triandra (malaria), Aristida funiculate (anticancer), Koeleria argentia (skin allergies), Tetrapogon villosus (antibacterial), Cynodon radiatus (eyes infection), Sporobolus nervosa (Jaundice), Enneapogon persicus (antifungal), and Panicum repens (dysfunctional cattle organs) were reported for the first time, with novel ethnoveterinary uses. The inhabitants of the study area had a strong association with their surrounding plant diversity and possessed significant knowledge on therapeutic uses of Poaceae to treat various health disorders in animals. Plant species with maximum cultural and medicinal values could be a potential source of novel drugs to cure health disorders in animals and human as well.
| S-EPMC7608896 | biostudies-literature
Project description:Inadequate feeding is one of the most critical underlying determinants of child malnutrition. In this study, we explore infant young child feeding (IYCF) and deconstruct breastfeeding barriers in mothers of severely malnourished children in one of the most marginalized districts of Punjab province of Pakistan. Using purposive sampling, 20 lactating mothers are recruited for open-ended semi-structured interviews. Results reveal that barriers to immediate and exclusive breastfeeding include the introduction of pre-lacteal, butter, and cow or formula milk by mothers and grandmothers. Birthing difficulties and ritualizing prelacteal to transfer religion and culture cause the delay of early initiation of breastmilk. The colostrum is also discarded based on its weird physical look. Moreover, household circumstances, limited diet, extra workload, and mental stress associated with marital relationships are other significant barriers. Mothers perceive their breastmilk as thin, impotent, and of bad quality and often complain against breastmilk insufficiency due to general weakness. Furthermore, poor mothers reduce breastfeeding when the fertility burden is high, especially if a female baby is in their womb. Alternatively, outer milk is recommended but washing bottles with detergents often becomes frequent. In conclusion, immediacy, exclusivity, frequency, and duration of breastfeeding are circumscribed owing to multiple social, cultural, and economic causes. Therefore, a holistic approach combining cultural and structural causes might be more relevant for successful IYCF practices in marginalized communities of Pakistan.
| S-EPMC9160796 | biostudies-literature
Project description:IntroductionEchinococcosis is a neglected tropical zoonotic infection that affects both the human and livestock populations. In Pakistan, the infection is long-standing, but data on its molecular epidemiology and genotypic characterization in the southern Punjab region are limited. The aim of the current study was the molecular characterization of human echinococcosis in southern Punjab, Pakistan.MethodsEchinococcal cysts were obtained from a total of 28 surgically treated patients. Patients' demographic characteristics were also recorded. The cyst samples were subjected to further processing to isolate DNA in order to probe the Nad1 and Cyt-b genes, followed by DNA sequencing and phylogenetic analysis for genotypic identification.ResultsThe majority of the echinococcal cysts were from male patients (60.7%). The liver was the most commonly infected organ (60.71%), followed by the lungs (25%), spleen (7.14%), and the mesentery (7.14%). Molecular and genotypic identification through sequencing and phylogenetic tree analysis showed that most of the cysts (24/28, 85.7%) were caused by the species Echinococcus granulosus sensu stricto (E. granulosus s.s.) (G1 and G3), followed by Echinococcus multilocularis (E. multilocularis) and Echinococcus canadensis (E. canadensis) (G6/G7) (3/28, 10.8%, and 1/28, 3.5%, respectively).ConclusionThe current study concluded that the majority of human infections were caused by E. granulosus s.s., followed by the E. multilocularis and E. canadensis species (G6/G7). Genotypic characterization among both human and livestock populations is needed to explore the genetic diversity of echinococcosis.
| S-EPMC10174045 | biostudies-literature