verbal/social autopsy [VASA] child mortality inquiry to investigate under-five mortality determinants in slums of Karachi, Pakistan: a mix methods interventional study

Background Pakistan stands along top ten countries responsible for two-third of global child mortality burden. To improve Child Mortality [CM] estimates in Pakistan, there is an exigent need to understand the in-depth reasoning behind mortalities. In Pakistan, the data on cause-of-death [CoD] for a large number of child mortalities in Pakistan is either not available or not suitable for use. Pakistan uses an alternative technique called Verbal autopsy [VA]. Since VA only determines the biological cause of death [BCoD], and does not capture multitude of other modifiable social, cultural and health system determinants, it has a limited importance. Such non-biological determinants are captured by another technique i.e. Social Autopsy [SA]

Objective by integrating VA with SA, extended set of mortality related determinants will be explored, in addition to strengthening death notification coverage and assigning CoD in such missed out mortalities

Method under the working group of Health Advocacy Council for Women and Children [HACWC] in collaboration with Child Registry of Pakistan [CROP], mixed method [QUAN-QUAL] interventional study will be carried out in urban-slums of Karachi city using VASA-integrated under-five mortality investigative technique. Parents of dead children will be interviewed. Second stage of study will be followed by qualitative interviews with different cadres of stakeholders

Expected Outcomes by focusing the specific determinants related to case-management and care-seeking process [identified by The Pathway to Survival Framework-TPtoSF] an in-depth understanding of related determinants can be achieved, which will help in crafting potential interventions required to limit the barriers that increase the chances of CM in developing nations

"Ratio of gender dependency", a comparative study between Karachi and Hyderabad's populace

Karachi and Hyderabad both are metropolitan cities of Pakistan but Karachi is more developed and mobilized city than Hyderabad. This difference may possibly bring change in the gender dependency ratio. Gender is the socially and culturally shaped characteristics for males and females [sexes] of any society; both genders have to perform the roles which are expected from them. Gender dependency is the result of the cultural practices in any society while the culture in developing societies is masculine by its nature and men are the one who lead, secure and are responsible for bread earning for their families. To confirm this fact, data from 500 respondents was collected from Karachi and Hyderabad, age between 25 to 40 years, Questions about respondent's experience, hesitation, insecurity, independency in decision making were also the part of detail questionnaire. This study shows that the ratio of educated population was high in Hyderabad. In both cities females were more dependent than males, Females of Karachi were more confident and independent in their lives and the level of insecurity was high in females of Hyderabad. Findings proposed the importance of education, development and mobility on the road to independent life

Early marriages leads to low self-esteem of young girls

The focus of this study is to be acquainted with the level of trust and reliance regarding reproductive health concerns among early married females. Many females around the globe are subjected to early marriage with immature minds and bodies, and they are forced to shoulder heavy duties, early pregnancies, harsh family behaviors, family disputes, behavioral problems and understanding problems. Early pregnancies and other health problems have a great impact on their self-esteem, confidence level and their trust on elders to share their problems. When females are married at early age, they are not only deprived of their education but they are also not aware of the health consequences and their solutions. A cross-sectional observational study was conducted in Karachi and data was collected through detailed interview among 100 subjects [married and unmarried females]. 41.98% of the unmarried girls relied on lady doctors for their reproductive health problems whereas 37.50% of married girls approached mothers and few talked to lady doctors while most of them were not sharing theirs obstacles with anyone. It is concluded that females in their teens before marriage had normal self-esteem and courage to share their problems, on the other hand early marriages were found to cause a decline in their levels of self-esteem due to domestic pressures, less social buck up, fears of in-laws and husbands

Psychosocial experiences of women with vesicovaginal fistula: a qualitative approach

Vesicovaginal fistula [VVF] is a condition associated with a number of physical and psychological consequences. In order to gain a deeper understanding of the issues faced by women diagnosed with VVF, a qualitative exploratory study was carried out to explore the experiences of women suffering from VVF. The study included 8 women hospitalized with the diagnosis of vesicovaginal fistula at Kohi Goth Women's Hospital, Karachi, Pakistan. Semi structured interviews of each participant were conducted, recorded, and transcribed. Five major themes were identified, among which all of the participants experienced physical discomforts, psychological disturbances, issues with social and interpersonal relationships and financial constraints. However, concerns with religious practices were experienced by 87.5% of the participants. Pakistani women who are suffering through VVF face many challenges. Combined efforts should be made to offer supportive services to women suffering from this condition.

Difficulties in diagnosis of acute appendicitis in pregnancy

This series of five cases of acute appendicitis during different stages of pregnancy highlights the difficulties surrounding the diagnosis of acute appendicitis in pregnancy, especially during the late second and third trimesters. All these cases illustrate the need for a high index of suspicion so that laparotomy is performed at an early stage of the disease. Delay in management results in increased morbidity complications and prolonged hospital stay