Community mental health in Peshawar, the need to reform

Community mental health is a neglected field in many developing countries including Pakistan. Common mental disorders are high in prevalence, particularly in women. Community mental health services are lacking in Peshawar, which faces a number of challenges owing to sociopolitical instability. The aim of this literature review is to evaluate and interpret current research relevant to community mental health reform, including a review of the evidence regarding community mental health service. A selected review of published literature was undertaken using the PubMed, PsychINFO and Cochrane Database of Systematic Reviews databases. The intervention studies included in this review demonstrate that community based mental health services closely aligned with primary care services have the potential to facilitate improvements in access to care and also improvements in mental health outcomes. It concludes that lack of proper mental health policy and non-integration of mental health in primary health care adversely affects the outcome of mental health progress in community

Coverage and factors associated with tetanus toxoid vaccination status among females of reproductive age in Peshawar

To estimate the coverage and determine the factors associated with tetanus toxoid vaccination status among females of reproductive age. Cross-sectional study. District Peshawar, NWFP, from July to September 2002. A total of 646 females of reproductive age [15-49] years were selected from both urban and rural areas of Peshawar through stratified cluster sampling. A pre-tested structured questionnaire was administered to females. Two logistic regression models were built, one for all females and one for married females only. Overall 65.0% females were vaccinated [95% confidence interval [CI] [61.3%, 68.6%]. For all females, the variables that were significantly associated with vaccination status were marital status [OR= 8.5, 95% CI [4.7, 15.6]], source of information regarding tetanus toxoid [TT] vaccination, knowledge regarding TT vaccination, visits of lady health worker [LHW] to a household [OR = 2.3, 95% CI [1.4, 3.9] and restriction on TT vaccination [OR = 28.7, 95% CI [3.5, 237.9]]. For the married females, the variables that were significantly associated with vaccination status were source of information; visits of LHW to a household [OR = 2.8, 95% CI [1.5 to 5.2]] and an interaction between knowledge regarding TT vaccination and antenatal care visits. These findings are of public health concern as a majority of females is not vaccinated according to WHO recommendations. It is recommended that maternal and neonatal tetanus [MNT] vaccination campaigns should include lady health workers at implementation stage