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Article ; Online: Women's perceptions about mobile health solutions for selection and use of family planning methods in Karachi

Farina Gul Abrejo / Romaina Iqbal / Sarah Saleem

BMC Women's Health, Vol 22, Iss 1, Pp 1-

a feasibility study

2022 Volume 11

Abstract: Abstract Background The qualitative study explored the feasibility and acceptability of potential mHealth intervention for women living in low socio-economic areas to increase the uptake of family planning. The study also examined providers' perceptions' ...

Abstract	Abstract Background The qualitative study explored the feasibility and acceptability of potential mHealth intervention for women living in low socio-economic areas to increase the uptake of family planning. The study also examined providers' perceptions' potential benefits of mHealth intervention. Methods The qualitative exploratory study recorded the perception of 23 women and conducted seven in-depth interviews with the providers of family planning services. These interviews assessed women's attitudes through; personal experience based on the usage of smartphones and family planning, acceptability for personal benefits, features of mobile applications and the convenient language, and self-efficacy for identifying the potential impact of mHealth intervention to increase women's empowerment for family planning usage. Results Three predetermined themes were used to record women’s perceptions. Women's personal experience identified that women in low-socioeconomic areas use mobile phones frequently and also use them for gaining information related to health. Few women have experience using mobile phones to get information about sexual and reproductive health. Women considered; poor counselling and high transport costs to the facilities as significant barriers to getting family planning services. Perceived acceptability discussed the potential features of the mHealth app. Women considered that including short videos instead of written material would help them to understand its usage and complete information about family planning methods, including; dosage, expected side effects, and potential benefits suggested to include in the app. Women perceived that the mHealth intervention would save their transport costs to the facility and fill the information gap about family planning methods. In comparison, providers considered it would save time in counselling and motivating women at the facility. One of the significant factors discussed was self-efficacy in the form of women's empowerment in deciding on family planning. ...
Keywords	mHealth ; Mobile health ; Family planning ; Low socio-economic areas ; The feasibility of family planning ; Acceptability of family planning ; Gynecology and obstetrics ; RG1-991 ; Public aspects of medicine ; RA1-1270
Subject code	300
Language	English
Publishing date	2022-12-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Do empowered women receive better quality antenatal care in Pakistan? An analysis of demographic and health survey data.

Muhammad Asim / Waqas Hameed / Sarah Saleem

PLoS ONE, Vol 17, Iss 1, p e

2022 Volume 0262323

Abstract: Introduction Quality antenatal care is a window of opportunity for improving maternal and neonatal outcomes. Numerous studies have shown a positive effect of women empowerment on improved coverage of maternal and reproductive health services, including ... ...

Abstract	Introduction Quality antenatal care is a window of opportunity for improving maternal and neonatal outcomes. Numerous studies have shown a positive effect of women empowerment on improved coverage of maternal and reproductive health services, including antenatal care (ANC). However, there is scarce evidence on the association between women's empowerment and improved ANC services both in terms of coverage and quality. Addressing this gap, this paper examines the relationship between multi-dimensional measures of women empowerment on utilization of quality ANC (service coverage and consultation) in Pakistan. Methods We used Pakistan Demographic and Health Survey 2017-18 (PDHS) data which comprises of 6,602 currently married women aged between 15-49 years who had a live birth in the past five years preceding the survey. Our exposure variables were three-dimensional measures of women empowerment (social independence, decision making, and attitude towards domestic violence), and our outcome variables were quality of antenatal coverage [i.e. a composite binary measure based on skilled ANC (trained professional), timeliness (1st ANC visit during first trimester), sufficiency of ANC visits (4 or more)] and quality of ANC consultation (i.e. receiving at least 7 or more essential antenatal components out of 8). Data were analysed in Stata 16.0 software. Descriptive statistics were used to describe sample characteristics and binary logistic regression was employed to assess the association between empowerment and quality of antenatal care. Results We found that 41.4% of the women received quality ANC coverage and 30.6% received quality ANC consultations during pregnancy. After controlling for a number of socio-economic and demographic factors, all three measures of women's empowerment independently showed a positive relationship with both outcomes. Women with high autonomy (i.e. strongly opposed the notion of violence) in the domain of attitude to violence are 1.66 (95% CI 1.30-2.10) and 1.45 (95% CI 1.19-1.75) and times ...
Keywords	Medicine ; R ; Science ; Q
Subject code	360 ; 300
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Gutka consumption and dietary partialities explaining anemia in women of a coastal slum of Karachi, Pakistan

Ameer Muhammad / Sarah Saleem / Daniyaal Ahmad / Eleze Tariq / Yasir Shafiq

PLoS ONE, Vol 17, Iss

A mixed-method study

2022 Volume 10

Abstract: Background Limited literature is available on the dietary pattern and its consequences on health of women living in coastal slums of Karachi, Pakistan. Material and methods The study employed a mixed-method approach where concurrent quantitative and ... ...

Abstract	Background Limited literature is available on the dietary pattern and its consequences on health of women living in coastal slums of Karachi, Pakistan. Material and methods The study employed a mixed-method approach where concurrent quantitative and qualitative assessments were carried out. An analytical cross-sectional survey was conducted to collect information on demographic, household, obstetrics characteristics, and dietary pattern of married women of reproductive age (MWRA). Blood samples were collected to identify the hemoglobin level to determine anemia. For the qualitative component, focus group discussions were carried out with women and in-depth interviews with shopkeepers to understand the availability of food items at household level and in local markets respectively. In addition, observational visits were carried out at different points in time to the local market to document the availability of iron-rich foods for the community. Results The overall prevalence of anemia in sample population was 68.0%. Women with no formal education (AOR: 2.93 95% CI: 1.90–4.52), who consumed gutka (AOR: 2.84 95% CI: 1.81–4.46), did not eat red meat (AOR: 1.68 95% CI: 1.06–2.65), and only had seafood (AOR: 4.56 95% CI: 1.38–15.02) were more likely to be anemic as compared to their counterparts. Qualitative data revealed that any kind of meat and fruits were beyond the reach of community people due to non-affordable cost. A high percentage of women used a locally produced recreational substance known as gutka which gives them a feeling of wellbeing and suppresses hunger. Conclusion In our study population, lack of access to diversity of food items, illiteracy, and use of gutka are the statistically significant factors which are associated with anemia in married women of this coastal slum area. The lack of demand for diversity in food is related to poverty and preference of spending money on gutka.
Keywords	Medicine ; R ; Science ; Q
Subject code	360
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The unspoken grief of multiple stillbirths in rural Pakistan

Muhammad Asim / Sehrish Karim / Hajra Khwaja / Waqas Hameed / Sarah Saleem

BMC Women's Health, Vol 22, Iss 1, Pp 1-

an interpretative phenomenological study

2022 Volume 11

Abstract: Abstract Background Pakistan has the highest rate of stillbirth (30.6 stillbirths per 1000 total births) as compared to other South Asian countries. The psychological impact of stillbirths on bereaved women is well documented; however, there is a dearth ... ...

Abstract	Abstract Background Pakistan has the highest rate of stillbirth (30.6 stillbirths per 1000 total births) as compared to other South Asian countries. The psychological impact of stillbirths on bereaved women is well documented; however, there is a dearth of literature on lived experiences of women with multiple stillbirths in Pakistan. Objective The purpose of this research is to understand the lived experiences of women who had multiple stillbirths in Thatta, Pakistan. Methods An interpretative phenomenological study was conducted in district Thatta with eight women who experienced more than one stillbirth. A semi-structured in-depth interview guide was used for data collection. The data were analyzed by using thematic analysis approach. Results The results of this study show that experiencing multiple stillbirths has a devastating impact on women’s mental and social wellbeing. The women who experienced multiple stillbirths are stigmatized as “child-killer” or cursed or being punished by God. They are avoided in social gatherings within the families and community, because of these social pressures these women seek spiritual and religious treatment, and struggle to conceive again to deliver a live baby. It was observed that the psycho-social and medical needs of these bereaved women remain unaddressed not only by the healthcare system but also by the society at large. Conclusions The physical, social and mental well-being of women who experience multiple stillbirth are at stake. These women are being considered social outcast. Health care providers including physicians, lady health workers, and traditional birth attendants should be trained on provision of psychosocial support along with the routine care that they provide in communities and health facilities. The health care providers should also inform the bereaved women about the biomedical causes of stillbirths that would be helpful to mitigate the stigma associated with stillbirths. Moreover, the health care providers should also counsel family members ...
Keywords	Multiple stillbiths ; Mental health ; Spiritual treatment ; Social wellbeing ; Stigma ; Phenomenology ; Gynecology and obstetrics ; RG1-991 ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2022-02-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Equipping community health workers with digital tools for pandemic response in LMICs

Anam Shahil Feroz / Adeel Khoja / Sarah Saleem

Archives of Public Health, Vol 79, Iss 1, Pp 1-

2021 Volume 4

Abstract: 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 ... ...

Abstract	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.
Keywords	Community health workers (CHWs) ; Digital tools ; Covid-19 ; Low-middle-income countries ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The construction process for pre-stressed ultra high performance concrete communication tower.

Voo Yen Lai / Farzad Hejazi / Sarah Saleem

PLoS ONE, Vol 15, Iss 11, p e

2020 Volume 0238654

Abstract: Towers are important structures for installing radio equipment to emit electromagnetic waves that allow radio, television and/or mobile communications to function. Feasibility, cost, and speed of the construction are considered in the design process as ... ...

Abstract	Towers are important structures for installing radio equipment to emit electromagnetic waves that allow radio, television and/or mobile communications to function. Feasibility, cost, and speed of the construction are considered in the design process as well as providing stability and functionality for the communication tower. This study proposes the new design for construction of segmental tubular section communication tower with ultra-high-performance fibre concrete (UHPFC) material and prestress tendon to gain durability, ductility, and strength. The proposed mix design for UHPFC in this study which used for construction of communication tower is consisted of densified Silica Fume, Silica fine and coarse Sand and hooked-ends Steel Fiber. The prestressed tendon is used in the tower body to provide sufficient strength against the lateral load. The proposed design allows the tower to be built with three precast segments that are connected using bolts and nuts. This paper presents a novel method of construction and installation of the communication tower. The advantages of proposed design and construction process include rapid casting of the precast segment for the tower and efficient installation of segments in the project. The use of UHPFC material with high strength and prestress tendon can reduce the size and thickness of the tower as well as the cost of construction. Notably, this material can also facilitate the construction and installation procedure.
Keywords	Medicine ; R ; Science ; Q
Subject code	690
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Using mobile phones to improve community health workers performance in low-and-middle-income countries

Anam Feroz / Rawshan Jabeen / Sarah Saleem

BMC Public Health, Vol 20, Iss 1, Pp 1-

2020 Volume 6

Abstract: Abstract Background In low-and-middle-income countries community health workers are the core component of the PHC system as they act as a liaison between the communities and the healthcare facilities. Evidence suggests that the services offered by these ... ...

Abstract	Abstract Background In low-and-middle-income countries community health workers are the core component of the PHC system as they act as a liaison between the communities and the healthcare facilities. Evidence suggests that the services offered by these workers have helped in the decline of maternal and child morbidity and mortality rates and the burden of communicable and non-communicable diseases. However, the coverage and the overall progress towards achieving the SDG targets is very sluggish. The recent consensus concerning this current pace of progress, is that it relates to financial and human resources constraints. CHWs are overburdened as they are expected to accomplish more although they may not obtain the required support to perform their duties. The health systems of LMICs, have given very little attention to the work environment of CHWs; which has negatively affected CHWs productivity, and quality of services. This debate is intended to explore the potential of mobile phone technology in LMICs for improving CHWs performance and effectiveness. Discussion To improve CHWs productivity, some studies involved the use of mobile phones for data collection and reporting, while other studies used mobile technology for patient to provider communication, patient education, CHWs supervision, and monitoring and evaluation. A wide range of benefits exists for using mobile phones including reduction in CHWs workload, improvement in data collection, reporting and monitoring, provision of quality healthcare services, supportive supervision, better organization of CHWs tasks and improvement in community health outcomes. However, a number of studies suggests that CHWs encounter unique challenges when adopting and using mobile health solutions for health service delivery such as, lack of CHWs training on new mHealth solutions, weak technical support, issues of internet connectivity and other administrative challenges. Future research efforts should be directed to explore health system readiness for adopting sustainable ...
Keywords	Community health workers ; Mobile phones ; Performance ; Productivity ; Low-middle-income countries ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Inclusive, supportive and dignified maternity care (SDMC)-Development and feasibility assessment of an intervention package for public health systems

Bilal Iqbal Avan / Waqas Hameed / Bushra Khan / Muhammad Asim / Sarah Saleem / Sameen Siddiqi

PLoS ONE, Vol 17, Iss 2, p e

A study protocol.

2022 Volume 0263635

Abstract: Introduction Mistreatment, discrimination, and poor psycho-social support during childbirth at health facilities are common in lower- and middle-income countries. Despite a policy directive from the World Health Organisation (WHO), no operational model ... ...

Abstract	Introduction Mistreatment, discrimination, and poor psycho-social support during childbirth at health facilities are common in lower- and middle-income countries. Despite a policy directive from the World Health Organisation (WHO), no operational model exists that effectively demonstrates incorporation of these guidelines in routine facility-based maternity services. This early-phase implementation research aims to develop, implement, and test the feasibility of a service-delivery strategy to promote the culture of supportive and dignified maternity care (SDMC) at public health facilities. Methods Guided by human-centred design approach, the implementation of this study will be divided into two phases: development of intervention, and implementing and testing feasibility. The service-delivery intervention will be co-created along with relevant stakeholders and informed by contextual evidence that is generated through formative research. It will include capacity-building of maternity teams, and the improvement of governance and accountability mechanisms within public health facilities. The technical content will be primarily based on WHO's intrapartum care guidelines and mental health Gap Action Programme (mhGAP) materials. A mixed-method, pre-post design will be used for feasibility assessment. The intervention will be implemented at six secondary-level healthcare facilities in two districts of southern Sindh, Pakistan. Data from multiple sources will be collected before, during and after the implementation of the intervention. We will assess the coverage of the intervention, challenges faced, and changes in maternity teams' understanding and attitude towards SDMC. Additionally, women's maternity experiences and psycho-social well-being-will inform the success of the intervention. Expected outcomes Evidence from this implementation research will enhance understanding of health systems challenges and opportunities around SDMC. A key output from this research will be the SDMC service-delivery package, comprising a ...
Keywords	Medicine ; R ; Science ; Q
Subject code	360
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Inclusive, supportive and dignified maternity care (SDMC)—Development and feasibility assessment of an intervention package for public health systems

Bilal Iqbal Avan / Waqas Hameed / Bushra Khan / Muhammad Asim / Sarah Saleem / Sameen Siddiqi

PLoS ONE, Vol 17, Iss

A study protocol

2022 Volume 2

Abstract	Introduction Mistreatment, discrimination, and poor psycho-social support during childbirth at health facilities are common in lower- and middle-income countries. Despite a policy directive from the World Health Organisation (WHO), no operational model exists that effectively demonstrates incorporation of these guidelines in routine facility-based maternity services. This early-phase implementation research aims to develop, implement, and test the feasibility of a service-delivery strategy to promote the culture of supportive and dignified maternity care (SDMC) at public health facilities. Methods Guided by human-centred design approach, the implementation of this study will be divided into two phases: development of intervention, and implementing and testing feasibility. The service-delivery intervention will be co-created along with relevant stakeholders and informed by contextual evidence that is generated through formative research. It will include capacity-building of maternity teams, and the improvement of governance and accountability mechanisms within public health facilities. The technical content will be primarily based on WHO’s intrapartum care guidelines and mental health Gap Action Programme (mhGAP) materials. A mixed-method, pre-post design will be used for feasibility assessment. The intervention will be implemented at six secondary-level healthcare facilities in two districts of southern Sindh, Pakistan. Data from multiple sources will be collected before, during and after the implementation of the intervention. We will assess the coverage of the intervention, challenges faced, and changes in maternity teams’ understanding and attitude towards SDMC. Additionally, women’s maternity experiences and psycho-social well-being—will inform the success of the intervention. Expected outcomes Evidence from this implementation research will enhance understanding of health systems challenges and opportunities around SDMC. A key output from this research will be the SDMC service-delivery package, comprising a ...
Keywords	Medicine ; R ; Science ; Q
Subject code	360
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Feasibility of implementing a mobile phone-based telemonitoring programme to support pregnant women at high-risk for pre-eclampsia in Karachi, Pakistan

Emily Seto / Zulfiqar Bhutta / Anam Shahil Feroz / Sarah Saleem / Haleema Yasmin

BMJ Open, Vol 12, Iss

protocol for a mixed-methods study

2022 Volume 12

Abstract: Introduction High maternal mortality from pre-eclampsia/eclampsia results from lack of early identification and management of pregnant women at high-risk for pre-eclampsia. A potential tool to support pregnant women at high-risk for pre-eclampsia is ... ...

Abstract	Introduction High maternal mortality from pre-eclampsia/eclampsia results from lack of early identification and management of pregnant women at high-risk for pre-eclampsia. A potential tool to support pregnant women at high-risk for pre-eclampsia is telemonitoring. There is limited evidence on the use and effectiveness of telemonitoring for pregnant women in low-income and middle-income countries (LMICs) which limits the understanding of the process and mechanisms through which the intervention works in LMICs. This study will explore the feasibility of implementing a mobile phone-based telemonitoring programme for pregnant women at high-risk for pre-eclampsia in Karachi, Pakistan.Methods and analysis A convergent mixed-methods study will be conducted at the Jinnah Postgraduate Medical Center (JPMC) in Karachi, Pakistan. This study will recruit 50 pregnant women at high-risk for pre-eclampsia to assess clinical feasibility across the five foci of Bowen’s framework including acceptability, demand, implementation, practicality and limited-efficacy testing. Data sources will include semi-structured interviews with the enrolled women, caregivers and clinicians, as well as quantitative data from paper medical records, research logs and server data. The quantitative and qualitative data will be analysed separately and then integrated at the interpretation and reporting levels to advance our understanding of the telemonitoring programme’s feasibility across the five areas of Bowen’s framework.Ethics and dissemination Ethics approvals have been obtained from JPMC, the National Bioethics Committee of Pakistan, University Health Network, Aga Khan University and the University of Toronto. The study results will be disseminated to the scientific community through publications and conference presentations. Findings of the study will provide evidence on the feasibility of using a telemonitoring programme where pregnant women at high-risk for pre-eclampsia in Pakistan will take their own blood pressure readings at home. Lessons ...
Keywords	Medicine ; R
Subject code	300
Language	English
Publishing date	2022-12-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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