Perceptions And Experiences Of Nursing Students And Faculty Members Regarding Implementation Of The BS-Nursing Programme.

OBJECTIVE: To explore the perceptions and experiences of nursing students and faculty members regarding the implementation of the baccalaureate nursing programme in public-sector setting. Methods: The descriptive, exploratory, qualitative study was conducted at the Khyber Medical University, Peshawar, Pakistan, from April 15, 2020 to April 15, 2021, and comprised undergraduate nursing students and faculty members. Because of the coronavirus disease-2019 pandemic, the subjects were interviewed through telephonic call using a semi-structured interview guide. Data was analysed using the Creswell's analysis approach. RESULTS: Of the 15 subjects, 10(66.6%) were students aged 21-24 years; 7(70%) males and 3(30%) females. The remaining 5(33.3%) subjects were faculty members aged 25-45 years and with teaching experience of 1-18 years; 2(40%) males and 3(60%) females. A total of 85 codes and 17 categories emerged under 5 major themes; programme positive impacts, curriculum revamping, students' challenges, faculty challenges, and recommendations. The participants believed that the four-year undergraduate nursing programme would improve the profession and quality of nursing care. Some perceived challenges were also pointed out regarding the curriculum, faculty, infrastructure and learning resources. Conclusion: Through the provision of an updated curriculum, qualified teaching faculty, appropriate learning resources and proper infrastructure, the undergraduate nursing programme can be successfully implemented in Pakistan.

Perception of postgraduate medical residents regarding educational environment at French Medical Institute for Mothers and Children, Kabul Afghanistan.

OBJECTIVE: To assess the perceptions of postgraduate medical education residents regarding educational environment at a medical institution in Afghanistan. METHODS: The descriptive cross-sectional study was conducted from 2017 to 2018 at the French Medical Institute for Mothers and Children, Kabul, Afghanistan, FMIC, and comprised postgraduate medical residents. Dundee Ready Educational Environment Measure was administered to determine the perception of learning environment by the residents' perceptions related to learning, teachers, academic self-perception, atmosphere and social self-perceptions sub scales. Data was analysed using SPSS 22. RESULTS: Of the 63 subjects, 55(87.30%) were males and 42(66.66%) were married. The overall mean age was 30±4.38 years. There was no significant difference in mean subscales scores and overall scores in relation to participants' age, gender, type of specialty, province and year of training (p>0.05). There was a significant difference in students' perception of teachers in relation with the type of specialty (p<0.05). CONCLUSIONS: The educational environment at the medical institution in Afghanistan was perceived by the students of residency programme as conducive.

Urinary Incontinence: Understanding the Silent Plight of Women.

Urinary incontinence (UI) is defined as the complaint of involuntary loss of urine. UI affects both men and women but is more common in women. It has been identified as a World Health Organization priority. The burden related to UI at local, national, and global levels is huge and its impact in terms of physical, social, mental, and financial aspects makes it a concerning issue. However, there exist several barriers in terms of knowledge and attitude in seeking healthcare among women experiencing UI. This calls upon a multi-disciplinary approach involving professionals from different disciplines and tackling it with collaborative and collective efforts. Key Words: Urinary incontinence, Burden, Multidisciplinary approach, Pakistan, World Health Organization.

The effect of a culturally sensitive mental well-being module on Pakistani nursing students' knowledge and beliefs regarding their own mental health and illness.

This study examined the effect of a mental well-being module on undergraduate nursing students' knowledge and beliefs regarding causes and treatment of mental health and illness, and explored the relationship between these variables and depression and anxiety. The one group design incorporated pre-intervention, intervention and post-intervention phases, in a consecutive sample of 246 students in a 4-year BScN programme in Pakistan. A culturally sensitive, interactive mental well-being module of four hours length was delivered to three groups of approximately 40 students per group. Repeated measures ANOVA was performed to assess the difference in the mean knowledge scores. Paired t-tests investigated between-group differences on the factor scores. A total of 112 students screened positive for anxiety and depression symptoms. Repeated measures ANOVA showed a significant difference in the mean knowledge scores regarding mental illness (P < 0.001). Factor analysis resulted in four factors for the aetiology items. Paired t-test showed significant differences (P < 0.001) between psycho-social and environmental factors, supernatural and religious beliefs, and neuro-genetics. For treatment, significant differences (P < 0.001) were found between all factors - Professional and Help from others, Religiosity and Socialization, and Alternative and Medical Treatment. There was a significant and positive change in students' mental health knowledge, beliefs and mental health-seeking behaviour and diminished stigmatized beliefs. Based on the findings, it is highly recommended to incorporate the mental well-being program in the curriculum.

Risk factors of breast cancer among patients in a tertiary care hospitals in Afghanistan: a case control study.

BACKGROUND: Breast cancer is the second most common causes of women's death, worldwide. Data on risk factors associated with female breast cancer in the Afghan population is very limited. The aim of our study was to identifying risk factor associated with female breast cancer in Afghanistan. METHODS: A retrospective case-control study was conducted with inclusion of 201 cases and 201 controls. Patient information was collected by interviewing the patient through a structured questionnaire. Histopathological information was collected from the hospital integrated laboratory management system. The data was analyzed by using logistic regression with univariate and multivariable analyses to determine the association between breast cancer and predictors. RESULTS: The results of the current study showed that factors such as: age (OR = 1.02; 95%CI: 0.99-1.04; p-0.148); age at menarche (OR = 0.83; 95%CI: 0.72-0.92; p-0.008); age at first baby (OR = 1.14; 95%CI: 1.07-1.20; p- < 0.001); illiteracy (OR = 1.93; 95%CI: 1.16-3.22; p-0.011); smoking (OR = 2.01; 95%CI: 1.01-3.99; p-0.04) and family history of cancer (OR = 1.98; 95%CI: 1.18-3.32; p-0.009) were significantly associated with breast cancer. However, our study did not demonstrate any statistically significant correlation between breast cancer and some of the predictors that were previously highlighted in literature, such as: marital status, Body Mass Index (BMI), use of hormonal contraceptive, breastfeeding and exercise. CONCLUSION: Our study demonstrated that age at menarche, and age at first baby birth, illiteracy, smoking and family history of cancer were significant risk factors associated with development of breast cancer among women in Afghanistan. Health education of women regarding aforementioned predisposing factors are therefore, expected to be valuable in decreasing the burden of breast cancer with reduction of its burden on the healthcare system in Afghanistan.

Factors Associated With Child Maltreatment Among Children Aged 11 to 17 Years in Community Settings of Karachi, Pakistan, Using Belsky Ecological Framework.

Child maltreatment is considered as a global social issue and results as combined effect of parental background, socioeconomic environment, family structure, and child characteristics. The aim of this study was to determine factors associated with child maltreatment among children aged 11 to 17 years in Karachi, Pakistan. A cross-sectional survey of 800 pairs (children ranging from 11 to 17 years old and their parents) was randomly selected from 32 clusters of Karachi, using multistage cluster sampling. A structured questionnaire was adopted from the International Society for the Prevention of Child Abuse and Neglect (International Child Abuse Screening Tool for Parent [ICAST-P] and for Child [ICAST-C]). Multiple linear regression technique was used to assess the association of factors with child maltreatment score, by using STATA software. Our study found that children who always get bullied and mistreated by their siblings are at increased risk of getting maltreatment by parents (adjusted ß: 10.78, 95% CI = [8.5, 13.05]).The mean estimated ICAST-C score increases by 9.86 (95% CI = [6.17, 13.55]) for children with exposure of verbal abuse and quarrel within family members. The mean estimated ICAST-C score increases by 5.09 among male children as compared with female children (95% CI = [3.65, 6.52]). Among children whose family always fight with each other and whose parents have exposure to childhood maltreatment, the mean estimated ICAST-C score increases by 22.25 (95% CI = [16.53, 27.98]). This study reflects the potential factors of child maltreatment in Karachi. Our findings provide evidence to raise awareness about child maltreatment.

Physical Maltreatment and Its Associated Factors Among Adolescents in Karachi, Pakistan.

In many developing countries, physical child maltreatment is considered as an acceptable disciplinary strategy. The aim of this study was to identify factors associated with physical maltreatment among adolescents in Karachi, Pakistan. A survey of 800 adolescents was done using a structured questionnaire adopted by The International Society for the Prevention of Child Abuse and Neglect. Multiple linear regression methods were used to measure the factors associated with child physical maltreatment. The mean physical score was 17.5 ± 4.9, whereas the minimum and maximum score was 11 and 40, respectively. The total variability in physical scores was found to be 42% explained by child's gender, child's age, sibling abuse, verbal abuse/ quarreling within family, child's height, socioeconomic wealth index, marital status, interaction between parental exposure to childhood abuse and physical fighting using hard object, interaction between parental education and age of mother, and interaction between parental history of psychiatric illness and physical fighting by parents.

Insight into COVID-19 Responses and Initiatives from Pakistan.

The coronavirus pandemic is a rapidly evolving outbreak that has tremendously distressed people worldwide. The paper aims to present some key rapid responses and initiatives to COVID-19 undertaken in Pakistan. The information has been gathered by reviewing material and documents pertinent to COVID-19 in the context of Pakistan. The incidences of COVID-19 cases are gradually increasing; however, the case fatality rate is relatively lower in Pakistan as compared to developed countries. The government has taken massive actions, in terms of lockdowns, quarantine homes, testing facilities, closure of schools, and mass gatherings at places, to combat COVID-19. However, the measures seem to be insufficient due to the fear and stigma attached to it and the low socio-economic conditions. The government has launched initiatives, like Ehsaas cash dissemination programme, for the underprivileged families to address their basic needs; and philanthropic organisations are also coming forward to support these families. The spread of the pandemic is gradually increasing in Pakistan and we recommend strategies like increasing public awareness campaigns, improving screening capacity, and contact tracing to augment the efficiency of the current responses and initiatives. Key Words: COVID-19, Pakistan, Responses, Initiatives.

Mental Health Challenges and Psycho-social Interventions amid COVID-19 Pandemic: A Call to Action for Pakistan.

The increase in death and spread-related coronavirus (COVID-19) has shifted the world focus to the containment of the disease by emphasising measures to prevent spread in the general population. Such a complex, threatening, and unprecedented situation has left the psycho-social wellbeing needs of general public unaddressed. This paper aims to review the current COVID-19 scenario and its effects on the psycho-social wellbeing of people; and an attempt to shed some light on the aforementioned questions. Furthermore, the review will propose some recommendations for overcoming the mental illness issues, during and after the COVID-19 outbreak. We extracted information from reliable published international and national literature and reviewed anecdotes from media content from January to June 2020. The mental health implications of this outbreak will be long-lasting; however, by prioritising, investing diligently, and taking a collective approach, this challenge can be dealt with in a promising manner. Key Words: Mental health, Psycho-social interventions, COVID-19, Pakistan.

Implementation of Simulation: A Contemporary Strategy to Enhance Clinical Skills of Undergraduate Students in Mental Health Nursing.

Simulation is an innovative teaching strategy that supports student centered learning. It improves therapeutic communication skills with clients. Additionally, it enhances critical thinking, problem solving, and confidence among students, in a non-threatening and safe environment, without posing a risk to actual patients. This paper describes the process of application of simulation for undergraduate nursing students enrolled in a mental health nursing course. The project aimed to determine the significance of simulation to improve the communication skills and confidence level, and to decrease the anxiety of undergraduate nursing students, prior to attending mental health clinical. The Experiential Learning (ELT), by Kolb in 1984, was chosen as a framework for the simulation strategy. The simulation experience was a stepwise process that comprised a briefing session with students to explain them the process and purpose of the simulation activity, followed by a two-day simulation experience. The experience comprised students' interaction with Simulated Patients (SP), who had been prepared to manifest symptoms of depression, mania, and schizophrenia. The later part of the experience was a debriefing session, in which students were provided an opportunity for self-reflection and for thinking a way forward, to enhance their clinical competency, using their video recording. The students' evaluation regarding the simulation experience was positive and they suggested that it be integrated in the mental health nursing course.

Psychological distress and its associated factors among informal care givers of disabled young adults with traumatic brain injuries.

OBJECTIVE: To measure the psychological distress among the informal caregivers of disabled young adults with traumatic brain injuries (TBI) and to identify its associated factors. METHODS: An analytical cross sectional study was conducted with 76 informal caregivers of young adults (19 - 50 years) with TBI, using admission records of one of the tertiary care hospitals in Karachi, Pakistan from 2015 to 2016. Data were collected using a structured questionnaire comprising a general demographic questionnaire and the General Health Questionnaire- 28. The effect of the predictors on the psychological distress was determined by applying multiple linear regression analysis. RESULTS: The mean score of the psychological distress was found to be 23.5±14.28. The findings indicated that anxiety and insomnia, and social dysfunction were the most affected domains of psychological distress; whereas, depression was the least affected. Factors including the management of finances, number of children, patient's gender, and patient's level of disability and lack of socialization were positively associated with the level of distress. As reported by participants, religious beliefs served as a coping mechanism for most of them. CONCLUSIONS: The study showed a high level of distress among informal caregivers of young adults with TBI. For recognizing the psychological effects of TBI in patients and their informal caregivers, it is important to initiate and ensure the provision of psychological support to the patients and their families.

Factors Associated with Postoperative Pain among Patients after Cardiac Surgery in the Tertiary Care Teaching Hospital of Karachi, Pakistan.

BACKGROUND: Pain is the subjective feeling of an individual, which affects the overall recovery of patients after cardiac surgery. Postoperative pain is the most inadequately managed symptom of cardiac surgery. Subsequently, there are many factors that can either hinder or facilitate pain management, including patients' beliefs, cultural values, physiological features, hospital policies, and healthcare providers' knowledge and beliefs. The purpose of this research was to identify factors associated with postoperative pain and its management, after cardiac surgery, among patients in a tertiary care hospital in Karachi, Pakistan. METHODS: Quantitative correlational study design was employed to attain the study purpose. Data were collected from 136 adult cardiac surgery patients admitted in the Cardiothoracic Surgery (CTS) Department, of tertiary care hospital. A self-developed questionnaire tool was used to gather information from patients. Data was then analyzed on SPSS version 19. Mann-Whitney U, Kruskal Wallis, and Spearman tests were applied to find the associations between the pain levels and of the independent variables. RESULTS: The mean pain scores of the first, second, and third postoperative days were found to be 2.98, 2.96, and 2.98, respectively. The findings also showed that BMI and the types of surgery were significantly associated with postoperative pain. Patients' beliefs regarding drug dependency, fear of adverse effects, and postoperative physical activities were also associated with pain. Furthermore, the nurses' education level and reluctance in medication administration due to fear of adverse effects were found to be significant too. CONCLUSION: The study identified some of the important factors that were associated with postoperative pain. The results suggest the need for the enhancement of patients' education on drug dependency, adverse effects, and physical activity, before cardiac surgery. The nurses should be educated on pain management keeping the patients' culture and other perceptions of pain in mind.

Feed-forward: Paving ways for students' subsequent learning.

BACKGROUND: Written feedback assists students in refining their future academic work. However, students prefer having feed-forward instead of feedback by their instructors that are the comments provided to them on drafts prior to the actual assignment submission. The current literature describes two common ways to convey feed-forward: the foremost one is on outlines while the second is on drafts. However, no existing literature had been found yet for sufficient guidance on the ideal approach of feed-forward to facilitate students' subsequent learning. DESIGN: A Quasi-experimental study design was employed to determine the effectiveness of feed-forward on outline versus drafts. SETTING: Study was conducted in a private nursing institution in Karachi, Pakistan. PARTICIPANTS: 118 third-year undergraduate nursing students participated in the study. METHODS: Using consecutive sampling, 118 students were enrolled and equally divided in to two groups, each comprising of 59 students in the control and intervention arm. Control group received feed-forward through standard practice i.e. on their assignment outline while the intervention group received feed-forward on the draft of their scholarly paper. RESULTS: The performance of intervention arm had an upper hand over that of control wing as portrayed by their increased overall assignment and academic writing scores (of students on IELTs bands). The set outcomes also reflected better results in terms of the (reduced) frequency of visits to their instructors for clarification of written feedback. All in all, this research deduced that feed-forward on drafts is far more beneficial in contrast to that on an outline as it reinforces students' learning. CONCLUSION: The study findings affirmed that feed-forward is a useful strategy to enhance students' subsequent learning.

Quality of Life and Its Determinants in Adult Cancer Patients Undergoing Chemotherapy Treatment in Pakistan.

OBJECTIVE: Cancer is a leading cause of death worldwide. Likewise, in Pakistan, it is a major health problem, with an approximate increase each year. Cancer treatment, particularly chemotherapy, produces a detrimental effect on individuals' well-being. Since the past few years, quality of life (QOL) is considered as the primary goal of cancer treatment in patients' survival. This study aimed to assess the QOL and its determinants in adult cancer patients undergoing chemotherapy treatment. METHODS: An analytical cross-sectional design was employed to achieve the study objectives, utilizing consecutive sampling technique. A total of 150 adult (>19 years) cancer patients were recruited from a Tertiary Care Hospital in Karachi, Pakistan. The data were collected using the Functional Assessment of Cancer Therapy-General, a QOL questionnaire. Multiple linear regression was run to determine the effect of predictor variables, with a mean QOL score. RESULTS: The overall mean score of QOL as 57.37. The domains of physical and emotional well-being were mainly affected by the chemotherapy treatment. Variables such as no previous hospitalization and no significant changes in life events were positively associated with the QOL. On the other hand, being female, unemployed, chemotherapy side effects (>1 week), impaired socialization, and discrimination by family/relatives were negatively associated with the QOL. CONCLUSIONS: The study findings suggested an overall low QOL among adult cancer patients undergoing chemotherapy treatment. It is recognized as a stressful treatment, which adversely affects the QOL of cancer patients. Interventions should focus on both the physical and psychological issues and need to be addressed to improve the QOL of adult cancer patients.

Survellience system for child abuse: Bridging the gap between actual and hidden cases.

The dynamics of child abuse have been recognised as a global emerging social issue which is highly associated with child humiliation. The Government of Pakistan has taken many initiatives for addressing issues regarding child abuse and neglect and has designed laws to protect children against exploitation, abuse and violence; however, most of them are not enforced at all or poorly implemented due to lack of proper definition of child abuse and related terms, and different ways of reporting child abuse cases. Most of the non-governmental organisations (NGOs) in Pakistan target extreme cases of child sexual abuse such as child rape or commercial sexual exploitation of children, but cases of physical and psychological abuse are under-reported by the NGOs most of the time. A proper surveillance system is therefore required to identify the hidden cases of all types of child abuse that can lead to effective policy formulation and implementation.

Perceived Breastfeeding Support Assessment Tool (PBSAT): development and testing of psychometric properties with Pakistani urban working mothers.

INTRODUCTION: breast feeding is an essential source of nutrition among young babies; however, in Pakistan a gradual decline in prevalence of breast feeding, especially among urban working mothers, has been reported. Previous studies among Pakistani urban working mothers have revealed that ensuring exclusivity and continuation of breast feeding is challenging if social and/or workplace environmental support is minimal or absent. This problem indicated a crucial need to assess availability of breast-feeding support for Pakistani urban working mothers by using a comprehensive, reliable, and validated tool in their national language (Urdu). PURPOSE: to develop and test the psychometric properties of the 'Perceived Breastfeeding Support Assessment Tool' (PBSAT) that can gauge Pakistani urban working mothers' perceptions about breast-feeding support. METHODOLOGY: this methodological research was undertaken in five phases. During phase I, a preliminary draft of the PBSAT was developed by using the Socio-ecological model, reviewing literature, and referring to two United States based tools. In Phase II, the instrument was evaluated by seven different experts, and, in Phase III, the instrument was revised, translated, and back translated. In Phase IV, the tool was pilot tested among 20 participants and then modified on the basis of statistical analysis. In Phase V, the refined instrument was tested on 200 breast-feeding working mothers recruited through purposive sampling from the government and private health-care settings in Karachi, Pakistan. Approvals were received from the Ethical Review Committees of the identified settings. FINDINGS: the 29-item based PBSAT revealed an acceptable inter-rater reliability of 0.95, and an internal consistency reliability coefficient (Cronbach's alpha) of 0.85. A construct validity assessment through Exploratory Factor Analysis revealed that the PBSAT has two dimensions, 'workplace environmental support' (12 items; α=0.86) and 'social environmental support' (17 items; α=0.77). CONCLUSION: the study developed a 29-item based two-dimensional tool (in Urdu) that has acceptable psychometric properties. The PBSAT is context specific, comprehensive, and user-friendly, so it can be administered by health-care workers, employers, policy makers, and researchers to improve the quality of services of breast-feeding urban working mothers, and could ultimately improve child health in Pakistan.

Prevalence and associated factors of perceived stress among adolescent girls in Nawabshahi City, Pakistan.

BACKGROUND: The aim of this study was to determine the prevalence and associated factors of perceived stress among female adolescent in Nawabshah City, Pakistan. METHODS: This study was a sub-analysis of a parent research. Analytical cross-sectional design was used to achieve the study objectives. The study population comprised of school-going female adolescents aged 10-16 years resident of Nawabshah City. Perceived Stress Scale (PSS) and structured questionnaire were employed to measure the prevalence and associated factors of stress respectively. Multiple linear regressions were done to determine the predictors contributing to stress among female adolescents by using SPSS-17. RESULTS: The mean (+/- SD) of perceived stress score of the respondents was 27.84 +/- 2.84 with median 28 and the values were ranging from 19-37 scores for female participants. The final model indicated that among adolescents whose fathers are unemployed, the estimated mean score of stress was 0.734 +/- 0.493 higher than adolescents whose fathers are employed. As the number of rooms in the house increased by one, the estimated mean stress score decreases by 0.213 +/- 0.082. Among adolescents whose parents quarrelled, the estimated mean score of stress was 0.158 +/- 0.051 higher than adolescents whom parents did not quarrel. CONCLUSION: Almost every second female adolescent (58%) reported stress symptoms. The father's unemployment, number of rooms and parental quarrel is associated with risk of stress among female adolescents.

Development of students' critical thinking: the educators' ability to use questioning skills in the baccalaureate programmes in nursing in Pakistan.

OBJECTIVE: To enhance the Critical Thinking skills of educators associated with the nursing baccalaureate programmes in Pakistan. By focusing on the type and level of questions asked by the educators. METHODS: Ninety-one faculty members from 14 out of 17 schools participated in the study. Data on the faculty's questioning skills was obtained through classroom observations and field notes. The duration of the observations was 45-60 minutes. Using Bloom's Taxonomy for cognitive thinking, questions were categorised into high and low categories. RESULTS: Most of the questions (68.9 %) asked by the participants were of lower levels, while some (5.37 %) were ambiguous. In many instances, the participants did not allow a sufficient wait-time for students to think and respond. CONCLUSION: The findings suggest that educators must learn to use the questioning strategy effectively. They should ask higher level questions if they wish to inculcate Critical Thinking in students.

Factors associated with stress among adolescents in the city of Nawabshah, Pakistan.

OBJECTIVE: To identify the risk factors of stress among school-going adolescents in rural Nawabshah, Pakistan. METHODS: The cross-sectional study was conducted in 2005, comprising 800 school-going children of 10-16 years of age in Nawabshah, through simple random sampling. Data was collected using a structured questionnaire to assess the potential risk factors of stress. A modified version of Perceived stress scale was utilized to measure stress level. SPSS 12 was used for statistical analysis, while multiple linear regression analysis was run to identify the factors associated with stress in the study population. RESULTS: Of the total, 529 (66%) children belonged to state-run schools while 271 (34%) were studying at private facilities. The mean age was 13.7+/-1.3 years. The level of stress was positively associated with the number of siblings, parental conflicts, the age of the mother and the number of rooms in the household. There was decreased level of stress among female adolescents (n=474; 59.3%) who had prior information about pubertal body changes than the boys (n=326; 40.8%). CONCLUSION: The study showed that stress among adolescents can be reduced by modifying socio-economic and demographic factors.

Benzodiazepine use among adults residing in the urban settlements of Karachi, Pakistan: a cross sectional study.

BACKGROUND: There are hardly any studies carried out in Pakistan on the usage of benzodiazepines at the level of community. This research was aimed to determine the frequency of benzodiazepine use, along with its associations with socio-demographic and clinical characteristics among community dwelling adults, residing in two urban settlements of Karachi, Pakistan. METHODS: We performed a cross sectional study from August 2008 to December 2009, in 2 areas of Karachi, namely Garden and Sultanabad. We followed the systematic sampling strategy to randomly select the households, with an adult of either sex and of age 18 years or more. Data collection was carried out through interview, using a pre-tested questionnaire, with items on socio-demographic position, medical history and benzodiazepine use. Student's t-test and χ2 test was employed to determine the associations between socio-demographic and clinical characteristics, and their relationship with benzodiazepine use was determined using applied logistic regression. RESULTS: The overall percentage of benzodiazepine consumption was estimated to be 14%. There were significantly more benzodiazepine users in the peri-urban Sultanabad community to the urban community of Garden (p-value = 0.001). The mean age (± SD) for users was 51.3 (± 15.6) years compared to 37.1 (± 14.4) years among non-users. Bromazepam was the most widely used benzodiazepine (29%); followed by diazepam, with a median duration on primary use being 144 weeks (IQR = 48-240). The adjusted logistic regression model revealed that increasing age, location, female sex, unemployment and psychiatric consultation were associated with increased likelihood of benzodiazepine use. CONCLUSION: We believe the unregulated over-the-counter sales of benzodiazepines and social conditions might be playing a role in this high consumption of benzodiazepines in the community.