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Article ; Online: Facilitators and barriers influencing utilization of services provided by community midwives in district Thatta, Pakistan: a qualitative exploratory study.

Khowaja, Bakhtawar M Hanif / Feroz, Anam Shahil / Saleem, Sarah

2022 Volume 22, Issue 1, Page(s) 506

Abstract: Background: To address the issue of high maternal mortality, the Government of Pakistan initiated a community midwifery program in 2006 to provide skilled birth attendance to women living in rural areas. Despite a large investment in the community ... ...

Abstract	Background: To address the issue of high maternal mortality, the Government of Pakistan initiated a community midwifery program in 2006 to provide skilled birth attendance to women living in rural areas. Despite a large investment in the community midwifery program, research evidence from rural districts of Pakistan suggests that the utilization of maternal and newborn services through community midwives is very low. This exploratory study aimed to understand the facilitators and barriers influencing community midwives' services utilization in district Thatta. Methods: A qualitative study was conducted in the rural district Thatta, Pakistan. Key-informant interviews (KIIs) were conducted with district officials of the Health department (Thatta), Maternal and Newborn Child Health Program, and Midwifery Association of Pakistan (MAP). In-depth Interviews (IDIs) were conducted with midwifery students who were currently enrolled in the midwifery program of the district; trained community midwives providing services in district Thatta, and trained community midwives not continuing their profession. IDIs were also conducted with community women to explore their views about the scope of midwifery practice and the factors influencing the utilization of community midwives' services in district Thatta, Pakistan. Data were analyzed using qualitative thematic analysis. Results: A total of 25 interviews (KIIs = 5; IDIs = 20) were conducted. Two overarching themes were identified: (I) community midwives' skills and competencies; and (II) ownership and supportive supervision. The major hindering factors for community midwives' service utilization included deficiencies in community midwives' training particularly in clinical hands-on training, lack of ownership of community midwifery program, and lack of service structure by the CMWs regulatory body. Conclusion: The study has identified serious gaps in the CMWs program at the level of training and supervision of midwives in Pakistan. The study has also identified factors related to the training of CMWs that could facilitate the program in the context of Pakistan and similar settings.
MeSH term(s)	Female ; Humans ; Infant, Newborn ; Maternal Health Services ; Midwifery ; Pakistan ; Pregnancy ; Qualitative Research ; Rural Health Services
Language	English
Publishing date	2022-06-22
Publishing country	England
Document type	Journal Article
ZDB-ID	2059869-5
ISSN	1471-2393 ; 1471-2393
ISSN (online)	1471-2393
ISSN	1471-2393
DOI	10.1186/s12884-022-04823-8
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Article ; Online: Exploring gestational age, and birth weight assessment in Thatta district, Sindh, Pakistan: Healthcare providers' knowledge, practices, perceived barriers, and the potential of a mobile app for identifying preterm and low birth weight.

Tikmani, Shiyam Sunder / Mårtensson, Thomas / Roujani, Sana / Feroz, Anam Shahil / Seyfulayeva, Ayshe / Mårtensson, Andreas / Brown, Nick / Saleem, Sarah

PloS one

2024 Volume 19, Issue 4, Page(s) e0299395

Abstract: Introduction: Reliable methods for identifying prematurity and low birth weight (LBW) are crucial to ending preventable deaths in newborns. This study explored healthcare providers' (HCPs) knowledge, practice, perceived barriers in assessing gestational ...

Abstract	Introduction: Reliable methods for identifying prematurity and low birth weight (LBW) are crucial to ending preventable deaths in newborns. This study explored healthcare providers' (HCPs) knowledge, practice, perceived barriers in assessing gestational age and birth weight and their referral methods for preterm and LBW infants. The study additionally assessed the potential of using a mobile app for the identification and referral decision of preterm and LBW. Methods: This qualitative descriptive study was conducted in Thatta District, Sindh, Pakistan. Participants, including doctors, nurses, lady health visitors, and midwives, were purposefully selected from a district headquarter hospital, and private providers in the catchment area of Global Network's Maternal and Newborn Health Registry (MNHR). Interviews were conducted using an interview guide after obtaining written informed consent. Audio recordings of the interviews were transcribed and analyzed using NVIVO® software with an inductive approach. Results: The HCPs had extensive knowledge about antenatal and postnatal methods for assessing gestational age. They expressed a preference for antenatal ultrasound due to the perceived accuracy, though accept practical barriers including workload, machine malfunctions, and cost. Postnatal assessment using the Ballard score was only undertaken sparingly due to insufficient training and subjectivity. All HCPs preferred electronic weighing scales for birth weight Barriers encountered included weighing scale calibration and battery issues. There was variation in the definition of prematurity and LBW, leading to delays in referral. Limited resources, inadequate education, and negative parent past experiences were barriers to referral. Foot length measurements were not currently being used. While mobile apps are felt to have potential, unreliable electricity supply and internet connectivity are barriers. Conclusion: The HCPs in this study were knowledgeable in terms of potential tools, but acknowledged the logistical and parental barriers to implementation.
MeSH term(s)	Infant ; Infant, Newborn ; Humans ; Female ; Pregnancy ; Birth Weight ; Gestational Age ; Mobile Applications ; Pakistan ; Infant, Low Birth Weight ; Physicians ; Infant, Newborn, Diseases
Language	English
Publishing date	2024-04-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0299395
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Article ; Online: Role of COVID-19 pandemic in the academic life and well-being of private sector university students: an exploratory qualitative study.

Ali, Naureen Akber / Feroz, Anam Shahil / Akber, Noshaba / Khoja, Adeel

BMJ open

2022 Volume 12, Issue 5, Page(s) e055678

Abstract: Objective: The advent of the COVID-19 pandemic has caused a drastic impact on students' life, causing physical and emotional sufferings. Considering the relevance of unprecedented conditions, we explored perceptions and attitudes of students towards ... ...

Abstract	Objective: The advent of the COVID-19 pandemic has caused a drastic impact on students' life, causing physical and emotional sufferings. Considering the relevance of unprecedented conditions, we explored perceptions and attitudes of students towards their academic life and well-being amid the COVID-19 pandemic. Setting: We conducted an exploratory qualitative study using a purposive sampling approach conducted at a single-centre private nursing institution in Karachi, Pakistan. Participants: The current study used in-depth interviews with female university students. Study data were analysed manually using the thematic analysis approach. Primary outcome: The primary outcome is to explore perception of students on academic life and well-being amidst the COVID-19 pandemic. Results: A total of 10 in-depth interviews were conducted between August and September 2020. Four overarching themes were identified: (1) impact of COVID-19 on students' well-being; (2) effect of COVID-19 on students' academic life; (3) current coping mechanisms adopted by students and (4) recommendations to address students' concerns. The pandemic-related stressors served as a major impediment on students' motivation, concentration span and socioeconomic conditions which negatively influenced their well-being and academic life. However, students have adopted diverse coping mechanisms to combat unstable circumstances that include connecting with family and relatives, indulging in diverse activities, and getting academic support from faculty, senior students, and university administration. Students also recommended the need for arranging online mental health services, integrating e-learning mediums in existing academia, and constant efforts by the government to address electricity and internet connectivity issues to promote virtual learning. Conclusion: University students have been struck hard due to rapid pandemic-related transitions in their life. The study finding served as the potential guide for educational institutions and government officials to employ appropriate psychological interventions and provide infrastructure and technical facilities to provide support with their academic journey and overcoming the ongoing pandemic repercussions.
MeSH term(s)	COVID-19/epidemiology ; Female ; Humans ; Pandemics ; Private Sector ; Students/psychology ; Universities
Language	English
Publishing date	2022-05-26
Publishing country	England
Document type	Journal Article
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2021-055678
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Article ; Online: Health Systems Approach to Ensure Quality and Safety Amid COVID-19 Pandemic in Pakistan.

Pradhan, Nousheen Akber / Feroz, Anam Shahil / Shah, Syed Mairajuddin

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP

2021 Volume 31, Issue 1, Page(s) S38–S41

Abstract: Ensuring quality and safe care during the coronavirus disease 2019 (COVID-19) pandemic offers a challenge to already strained health systems in low and middle-income countries (LMICs), such as Pakistan with less shock-absorbing capacities. There is a ... ...

Abstract	Ensuring quality and safe care during the coronavirus disease 2019 (COVID-19) pandemic offers a challenge to already strained health systems in low and middle-income countries (LMICs), such as Pakistan with less shock-absorbing capacities. There is a dearth of evidence on mechanisms to provide optimum quality care to COVID-19 patients in the resource-constrained healthcare environment. The lessons learned from the Ebola virus outbreak for the deficient health systems and quality improvement are considered to propose strengthening the health systems response to deliver quality-assured care to patients during the current pandemic. In this regard, the World Health Organization (WHO) health systems framework can serve as a guiding principle towards providing quality-assured and safe healthcare services during the ongoing pandemic in Pakistan by ensuring the availability of an adequate workforce, medical supplies and equipment, strong governance, active information system, and adequate health financing to effectively manage COVID-19. Research evidence is needed to be better prepared for an effective and coordinated health systems response to offer quality and safe care to patients. Key Words: Health systems approach, COVID-19 pandemic, Quality of healthcare, Safe care.
MeSH term(s)	COVID-19/epidemiology ; Delivery of Health Care/organization & administration ; Developing Countries ; Humans ; Pakistan/epidemiology ; Pandemics ; SARS-CoV-2
Language	English
Publishing date	2021-02-25
Publishing country	Pakistan
Document type	Journal Article ; Review
ZDB-ID	2276646-7
ISSN	1681-7168 ; 1022-386X
ISSN (online)	1681-7168
ISSN	1022-386X
DOI	10.29271/jcpsp.2021.01.S38
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Article ; Online: Health Systems Approach to Ensure Quality and Safety Amid COVID-19 Pandemic in Pakistan.

Pradhan, Nousheen Akber / Feroz, Anam Shahil / Shah, Syed Mairajuddin

Journal of the College of Physicians and Surgeons--Pakistan : JCPSP

2021 Volume 31, Issue 1, Page(s) S38–S41

Abstract	Ensuring quality and safe care during the coronavirus disease 2019 (COVID-19) pandemic offers a challenge to already strained health systems in low and middle-income countries (LMICs), such as Pakistan with less shock-absorbing capacities. There is a dearth of evidence on mechanisms to provide optimum quality care to COVID-19 patients in the resource-constrained healthcare environment. The lessons learned from the Ebola virus outbreak for the deficient health systems and quality improvement are considered to propose strengthening the health systems response to deliver quality-assured care to patients during the current pandemic. In this regard, the World Health Organization (WHO) health systems framework can serve as a guiding principle towards providing quality-assured and safe healthcare services during the ongoing pandemic in Pakistan by ensuring the availability of an adequate workforce, medical supplies and equipment, strong governance, active information system, and adequate health financing to effectively manage COVID-19. Research evidence is needed to be better prepared for an effective and coordinated health systems response to offer quality and safe care to patients. Key Words: Health systems approach, COVID-19 pandemic, Quality of healthcare, Safe care.
Language	English
Publishing date	2021-09-17
Publishing country	Pakistan
Document type	Journal Article
ZDB-ID	2276646-7
ISSN	1681-7168 ; 1022-386X
ISSN (online)	1681-7168
ISSN	1022-386X
DOI	10.29271/jcpsp.2021.Supp1.S38
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Article: Equipping community health workers with digital tools for pandemic response in LMICs.

Feroz, Anam Shahil / Khoja, Adeel / Saleem, Sarah

Archives of public health = Archives belges de sante publique

2021 Volume 79, Issue 1, Page(s) 1

Abstract: Background: Community health workers (CHWs) are well-positioned to play a pivotal role in fighting the pandemic at the community level. The Covid-19 outbreak has led to a lot of stress and anxiety among CHWs as they are expected to perform pandemic ... ...

Abstract	Background: Community health workers (CHWs) are well-positioned to play a pivotal role in fighting the pandemic at the community level. The Covid-19 outbreak has led to a lot of stress and anxiety among CHWs as they are expected to perform pandemic related tasks along with the delivery of essential healthcare services. In addition, movement restrictions, lockdowns, social distancing, and lack of protective gear have significantly affected CHWs' routine workflow and performance. To optimize CHWs' functioning, there is a renewed interest in supporting CHWs with digital technology to ensure an appropriate pandemic response. Discussion: The current situation has necessitated the use of digital tools for the delivery of Covid-19 related tasks and other essential healthcare services at the community level. Evidence suggests that there has been a significant digital transformation to support CHWs in these critical times such as remote data collection and health assessments, the use of short message service and voice message for health education, use of digital megaphones for encouraging behavior change, and digital contract tracing. A few LMICs such as Uganda and Ethiopia have been successful in operationalizing digital tools to optimize CHWs' functioning for Covid-19 tasks and other essential health services. Conclusion: Yet, in most LMICs, there are some challenges concerning the feasibility and acceptability of using digital tools for CHWs during the Covid-19 pandemic. In most cases, CHWs find it difficult to adopt and use digital health solutions due to lack of training on new digital tools, weak technical support, issues of internet connectivity, and other administrative related challenges. To address these challenges, engaging governments would be essential for training CHWs on user-friendly digital health solutions to improve routine workflow of CHWs during the Covid-19 pandemic.
Language	English
Publishing date	2021-01-04
Publishing country	England
Document type	Journal Article
ZDB-ID	1117688-x
ISSN	2049-3258 ; 0778-7367 ; 0003-9578
ISSN (online)	2049-3258
ISSN	0778-7367 ; 0003-9578
DOI	10.1186/s13690-020-00513-z
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Article ; Online: Assessing mobile phone access, usage, and willingness among women to receive voice message-based mobile health intervention to improve antenatal care attendance in district Thatta, Sindh, Pakistan.

Feroz, Anam Shahil / Ali, Naureen Akber / Saleem, Sarah

Reproductive health

2020 Volume 17, Issue 1, Page(s) 104

Abstract: Background: Pakistan has one of the highest maternal mortality ratios worldwide at 276/100,000 live births and only 51% percent of women receive four or more ANC visits. This means that there are missed opportunities for almost half of the women who ... ...

Abstract	Background: Pakistan has one of the highest maternal mortality ratios worldwide at 276/100,000 live births and only 51% percent of women receive four or more ANC visits. This means that there are missed opportunities for almost half of the women who were not able to seek the recommended antenatal visits. In Thatta district, the maternal mortality ratio is estimated at 313/100,000 live births. Various studies reported that mHealth interventions have proven to be effective to improve antenatal care and postnatal care services. However, the feasibility and effectiveness of mobile health interventions to increase uptake of preventive maternal healthcare services among pregnant women in different settings may be different due to differing patient demographics, cultural diversity, environmental and behavioral factors, availability and accessibility to mobile phones, and budgetary constraints. Prior to implementing a similar intervention in Thatta District, it is crucially important to assess the mobile phone access, usage and willingness among women to receive voice-message based mHealth intervention to improve antenatal care attendance. Methods: A cross-sectional quantitative study will be used to assess mobile phone access, usage and willingness among women to receive voice-message based mHealth intervention to improve antenatal care attendance in district Thatta. The study will be conducted in Thatta district of Sindh province. Married women of reproductive age (MWRA), who are residing in selected villages of Mirpur Sakro and willing to participate will be included in the study. Multistage sampling technique will be used to recruit the 415 study participants. A structured questionnaire has been designed on Epicollect to collect data from 415 women. Data will be analyzed using IBM SPSS Statistics version 23, with a level of significance as < 0.05. Discussion: This research project will provide invaluable information on the current access, usage of mobile phones among women of district Thatta and their willingness to receive voice messages to improve the antenatal care services. The study will also highlight demographic, sociocultural and economic factors associated with women willingness and readiness to receive voice messages regarding antenatal care.
MeSH term(s)	Cell Phone/statistics & numerical data ; Cross-Sectional Studies ; Female ; Humans ; Pakistan ; Pregnancy ; Prenatal Care ; Telemedicine
Language	English
Publishing date	2020-07-06
Publishing country	England
Document type	Journal Article
ISSN	1742-4755
ISSN (online)	1742-4755
DOI	10.1186/s12978-020-00956-1
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Article ; Online: Exploring digital health interventions to support community health workers in low-and-middle-income countries during the COVID-19 pandemic: a scoping review protocol.

Feroz, Anam Shahil / Valliani, Komal / Khwaja, Hajra / Karim, Sehrish

BMJ open

2021 Volume 11, Issue 9, Page(s) e053871

Abstract: Introduction: COVID-19 has significantly affected community health workers' (CHWs) performance as they are expected to perform pandemic-related tasks along with routine essential healthcare services. A plausible way to optimise CHWs' functioning during ... ...

Abstract	Introduction: COVID-19 has significantly affected community health workers' (CHWs) performance as they are expected to perform pandemic-related tasks along with routine essential healthcare services. A plausible way to optimise CHWs' functioning during this pandemic is to couple the efforts of CHWs with digital tools. So far, no systematic evidence is available on the use of digital health interventions to support CHWs in low-middle-income countries (LMICs) amid the COVID-19 pandemic. The article describes a protocol for a scoping review of primary research studies that aim to map evidence on the use of unique digital health interventions to support CHWs during COVID-19 in LMICs. Methods and analysis: Our methodology has been adapted from scoping review guidelines provided by Arksey and O'Malley, Levac Ethics and dissemination: Formal ethical approval is not required, as primary data will not be collected in this study. The results from our scoping review will provide valuable insight into the use of digital health interventions to optimise CHWs' functioning and will reveal current knowledge gaps in research. The results will be disseminated through journal publications and conference presentations.
MeSH term(s)	COVID-19 ; Community Health Workers ; Developing Countries ; Humans ; Pandemics/prevention & control ; Research Design ; Review Literature as Topic ; SARS-CoV-2
Language	English
Publishing date	2021-09-24
Publishing country	England
Document type	Journal Article
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2021-053871
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Article: Exploring Caregivers' Perspectives and Perceived Acceptability of a Mobile-Based Telemonitoring Program to Support Pregnant Women at High-Risk for Preeclampsia in Karachi, Pakistan: A Qualitative Descriptive Study.

Feroz, Anam Shahil / Meghani, Salima Nazim / Yasmin, Haleema / Saleem, Sarah / Bhutta, Zulfiqar / Arshad, Hajraa / Seto, Emily

Healthcare (Basel, Switzerland)

2023 Volume 11, Issue 3

Abstract: Very little is known about the perspectives of the caregivers on the use of telemonitoring (TM) interventions in low-middle-income countries. Understanding caregivers' perspectives on TM interventions is crucial, given that caregiving activities are ... ...

Abstract	Very little is known about the perspectives of the caregivers on the use of telemonitoring (TM) interventions in low-middle-income countries. Understanding caregivers' perspectives on TM interventions is crucial, given that caregiving activities are correlated with the social, emotional, and clinical outcomes among pregnant women. This study aims to explore caregivers' perspectives and perceived acceptability of a mobile phone-based TM program to support pregnant women at high-risk for preeclampsia. A qualitative description design was used to conduct and analyze 28 semi-structured interviews with a diverse group of caregivers. The study was conducted at the Jinnah Post Graduate Medical Center, Karachi, Pakistan. The caregivers were identified through purposive sampling and additional caregivers were interviewed until the point of data saturation. The conventional content analysis technique was used to analyze digital audio recordings of the caregiver interviews. All caregivers embraced the proposed mobile phone-based TM program because they perceived many benefits, including a reduction in caregivers' anxiety and workload, increased convenience, and cost-effectiveness. However, the caregivers cited several caveats to the future implementation of the TM program including the inability of some women and caregivers to use the TM program and the poor acceptance of the TM system among less educated and non-tech savvy families. Our study recommends developing a TM program to reduce the caregiver stress and workload, designing a context-specific TM program using a user-centric approach, training caregivers on the use of the TM program, sensitizing caregivers on the benefits of the TM program, and developing a low-cost TM program to maximize access.
Language	English
Publishing date	2023-01-30
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2721009-1
ISSN	2227-9032
ISSN	2227-9032
DOI	10.3390/healthcare11030392
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Article ; Online: Rigorous Hand Hygiene Practices Among Health Care Workers Reduce Hospital-Associated Infections During the COVID-19 Pandemic.

Roshan, Rozina / Feroz, Anam Shahil / Rafique, Zohra / Virani, Nazleen

Journal of primary care & community health

2020 Volume 11, Page(s) 2150132720943331

Abstract: The experiences of these recent months have left us with as many new questions as they have given us new solutions. The main question that infection prevention and control department is having these days is "Why have hospital-associated infections (HAIs) ...

Abstract	The experiences of these recent months have left us with as many new questions as they have given us new solutions. The main question that infection prevention and control department is having these days is "Why have hospital-associated infections (HAIs) reduced during COVID-19 pandemic?" What is the one unique strategy that has brought decline in increasing HAIs? Would it be appropriate to say that rigorous hand hygiene practices among health care workers (HCWs) have reduced HAIs in a tertiary care hospital of Pakistan? This commentary is written to understand the effect of rigorous hand hygiene among HCWs on number of HAIs during COVID-19 pandemic. Given the seriousness of this outbreak, it was observed that the hand hygiene has occupied a new place of importance in the minds of HCWs. We observed 4 times increase in the consumption of hand sanitizers after COVID-19 outbreak. The increased consumption of hand sanitizers was reflected in improved hand hygiene practices. A reduction was observed in the number of HAIs after the COVID-19 outbreak, and we assume that the dip in HAIs is associated with the improvement in hand hygiene practices in the recent months. In the wake of COVID-19 pandemic, these trends reassure us that hand hygiene compliance by HCWs alone can be effective in reducing HAIs in a hospital setting.
MeSH term(s)	COVID-19 ; Coronavirus Infections/epidemiology ; Cross Infection/prevention & control ; Guideline Adherence ; Hand Hygiene ; Health Personnel/psychology ; Humans ; Pakistan/epidemiology ; Pandemics ; Pneumonia, Viral/epidemiology ; Practice Guidelines as Topic ; Tertiary Care Centers
Keywords	covid19
Language	English
Publishing date	2020-07-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	2550221-9
ISSN	2150-1327 ; 2150-1319
ISSN (online)	2150-1327
ISSN	2150-1319
DOI	10.1177/2150132720943331
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