New face of female sex work in Pakistan: need for innovative interventions

The prime objective of this paper is to contextualize the socio-economic and environmental factors contributing to and resulting from behaviours and practices of FSWs for transmission of STI/HIV infections. Information on these independent predictors is the key to design health systems related interventions for minimizing risks and vulnerabilities of FSWs. In the bio-behavioural survey, 545 FSWs were recruited for the quantitative component and 13 in-depth interviews were completed for qualitative arm. Data was collected on socio-economic characteristics, sexual interactions, marital relationship, violence and harassment and reproductive and sexual health. Most FSWs are illiterate [n=345, 64%], married]n=490, 91%],having children [n=462, 98%] living with their families [n=478, 91%] sell sex part-time during the day at kothie khana's1, small hotels in the locality. The mean age at first intercourse was reported to be 16 years, yet a significant proportion had had sexual contact before the age of 15 [39%] with someone other than their husband [37%]; the experience was perceived [unwanted] [40%] or even [forced] [5%]. The high contraception rate [64%] especially condom use [54%] reported in the quantitative arm of the study was not validated during in-depth interviews due to client preferences. Abortion is used as a frequent method [58%] of contraception, assisted by locally available midwives or dais[2]. A sizeabie proportion reported experiencing STI symptoms [n=317, 63%] for which informal healthcare providers were accessed. Most common perpetuators were husbands [66%] for physical violence and police [43%] for sexual abuse. Female sex trade in Pakistan is mainly part-time by married women who sell sex due to lack of education, skilled training and formal employment resulting from gender disparities. Standardized reproductive and sexual healthcare interventions, involving informal healthcare sector would improve reproductive health indicators, yet socio-economic and gender disparities demand long-term multi-sectoral structural strategies

Road traffic injuries: a new agenda for child Health

This paper reviews literature related to morbidity and mortality in South Asian children due to Road Traffic Injuries [RTIs], almost all of which are preventable. In South Asia after males 15-44 years, RTIs are most common in children 0-15 years old. Under-five fatality rates are about six times higher than in the developed world. Most injuries in low income countries occur in urban areas, where pedestrians, passengers, and cyclists account for around 90% of deaths due to RTIs. This higher fatality among pedestrians is probably due to wider traffic mix and lack of safe pedestrian walking areas. The WHO estimates that RTIs cost countries between 1 and 2% of their Gross Domestic Product. This has critical financial consequences. Vital statistics in South Asia are not reliable, and this leads to an underestimation of the magnitude of RTIs that hampers efforts for its acceptance as a preventable public health problem. Rapid urbanization, high motorization rates and failure to institute preventive measures predict a substantial increase in road traffic deaths in the coming years. Creating a safer environment is important. Use of child passenger restraints, bicycle helmets and targeted education campaigns are effective preventive measures. Legislation and implementation of traffic rules and regulations, road engineering and safe pedestrian areas would help reduce injuries. These measures are in accordance with the WHO's five-year strategy to address RTIs worldwide. This strategy includes national and local capacity building, inclusion of RTI in the public health agendas in the world for prevention and control of the health consequences. Child health in South Asia needs to integrate the new challenge of road traffic injuries for the region. It is critical that interventions for reducing this burden are developed, tested and implemented