Coverage and predictors of COVID-19 vaccination in rural districts of Pakistan.

Background: One of the keys to preventing a re-emergence of the COVID-19 pandemic is the attainment and maintenance of high vaccination coverage in urban and rural areas. Aims: To estimate the coverage of COVID-19 vaccination in a rural population and identify the determinants of vaccination. Methodology: A cross-sectional survey was conducted in April 2023 in 5 rural districts of Sindh Province, Pakistan. From each district, 30 clusters (villages) were randomly selected, and 7 households were randomly sampled from each cluster using the 30/7 technique. Household members above 12 years of age were included. Vaccination status was categorized as non-vaccinated, partially vaccinated (either with 1 dose or without booster) and completely vaccinated (2 doses with 1 booster). Adjusted odds ratios with 95% confidence intervals using multinomial logistic regression were computed to determine the factors associated with partial and complete vaccination. Data was analysed using SPSS version 20. Results: Among the 3545 individuals surveyed across 1050 households, 25.9% were not vaccinated, 55.0% were partially vaccinated, and 19.1% were fully vaccinated. Younger age, lack of formal education and residing in flood-affected districts were significantly negatively associated with being vaccinated, while living at <5 km from a vaccination facility was significantly positively associated with partial and complete vaccination. Residents of Dadu (OR=0.03, 95% CI=0.01-0.04), Jamshoro (OR=0.05, 95% CI=0.03-0.08), Hyderabad (OR=0.03, 95% CI=0.02-0.05), and Tando Allahyar (OR=0.09, 95% CI=0.05-0.15) districts were significantly less likely to be completely vaccinated than those in Tharparkar. The most common reasons for not being vaccinated were, the perception that COVID-19 is mild (34.5%), fear of side-effects (22.7%), unavailability of the vaccine (19.8%), and fear of acquiring COVID-19 infection through the vaccine (15.8%). Conclusion: Vaccination coverage was low in some of the districts, particularly the flood-affected districts, mainly due to certain myths. There is a need for community outreaches to debunk myths about COVID-19 vaccination among these rural populations.

Exploring the gaps between training and expected job skills of public health graduates to identify: A way forward.

Objectives: To explore the non-alignment between what is taught in academic programmes for public health and what is actually needed or expected in the field. METHODS: The qualitative phenomenological study was conducted from October 2020 to April 2021 in Karachi after approval from the institutional ethics review board of Jinnah Sindh Medical University, Karachi. The sample comprised major stakeholders including representatives of public health institutions and organisations involved in the implementation of public health programmes. Data was collected through in-depth interviews and focus group discussions using a guide after content validation by an expert. Data was analysed using both inductive and deductive approaches. RESULTS: A total of 13 in-depth interviews and 5 focus group discussions were conducted. Regarding gaps in the process of curriculum development, 2 major concerns emerged; lack of comprehensive involvement of experts in different fields of public health in designing the curriculum, and the lack of incorporation of the feedback provided by students in revising the curriculum. Regarding the content of curriculum, three main themes emerged; theoretical nature of courses, lack of uniformity in all programmes, and poor local contextualisation. The casual approach of students and barriers faced by them in joining public health programmes also affected the quality of such programmes. CONCLUSIONS: Three broad areas of improvement were identified, which included improvement in curriculum, methods of learning, and improving students' approach.

Understanding ethics of reporting health related events in media: A qualitative phenomenological study in Karachi and Peshawar.

Objective: The specific objectives of this study were to identify the ethical issues in reporting of health-related events in media and suggest ways to improve it. Method: This was a qualitative phenomenological study conducted by APPNA Institute of Public Health, Jinnah Sindh Medical University in collaboration with Institute of Public Health, Khyber Medical University from January to April 2022. A total of 38 focus group discussions and in-depth interviews were conducted either face to face at place of convenience of interviewees or online. The participants were health reporters, healthcare workers (HCWs), and representatives of law enforcement agencies in two cities i.e., Karachi and Peshawar. Data were analyzed by using the deductive and inductive approaches, by four independent experts including the Principal Investigator (PI) and three research fellows. Results: Ethical issues related to health reporting in the field included interference of the reporters in rescue efforts during an emergency and interference in emergency medical care of the victims. In reporting, careless disregard for patient confidentiality and privacy; using unreliable sources of information; using wrong terminology; sensationalizing the news and jumping to conclusions in cases of malpractice were reported as main problems. Negative influences on health reporting included poor training of the reporters on health reporting ethics, organizational pressures, and lack of cooperation by relevant health authorities. Conclusion: The quality of health reporting can be improved by building the capacity of health reporters in understanding the ethical issues and their social responsibilities toward health.

Compliance with smoke-free legislation and smoking behaviour: an observational field study in Karachi, Pakistan.

Objective: To observe compliance with smoke-free law at different public places in an urban setting. METHODS: The cross-sectional study was conducted from January to June 2022 after approval from the ethics review board of Jinnah Sindh Medical University, Karachi, at public places, including public and private offices, health institutions, education institutions, malls, markets and eateries, in 5 districts of Karachi. Boundary, entrance, waiting areas/corridors, toilet areas and eating areas were assessed using a checklist for smoke-free law compliance. Places were considered compliant if no smoking activity, cigarette butt litter or ashtrays was found. Data was analysed using SPSS 21. RESULTS: Out of 400 places observed, there were 80(20%) in each of the 5 districts. Overall, 36(44%) of the venues showed indoor compliance and 10(12%) showed outdoor compliance. Presence of cigarette butts was observed at 350(87.5%) outdoor places around the boundary of the premises. Only 38(9.5%) of the places had no smoking boards outdoors and at the entrance, with 16(4%) being clearly visible. Also, 27(43%) of educational institutions had a cigarette shop within 50 metres of the boundary. Conclusion: The city was found to have poor implementation of smoke-free laws, especially for outdoor areas, exposing the public to constant second-hand smoke.

Association between residential green spaces and pregnancy outcomes: a systematic review and meta-analysis.

Residential exposure to greenness has shown positive influences on pregnancy outcomes like birth weight, preterm births, and small to gestational age (SGA) deliveries. We aimed to comprehensively review and investigate these associations by conducting a systematic review with meta-analysis. Relevant studies were retrieved from PubMed, EMBASE, ScienceDirect, and Google Scholar databases before June 2023. Summary effect estimates included birth weight, low birth weight (LBW), preterm births, and SGA which were calculated for 0.1 unit increase in residential greenness exposure. Overall quality of the evidence was examined through Joanna Briggs Institute (JBI) critical appraisal tool. The review included 31 articles and found a statistically significant increase in birth weight measured at 250 m buffer distance (ß = 8.95, 95% CI = 1.63-16.27). Green spaces were also associated with lower odds of LBW (OR = 0.97, 95% CI = 0.96-0.98). Residential greenness had positive impacts on pregnancy outcomes that calls for emphasis on urban planning, especially in developing countries.

Changes in caloric consumption, physical activity, body mass index and sleeping pattern during holy month of Ramadan among doctors of a public sector University.

Objectives: To determine the change in caloric intake, physical activity, body mass index and sleeping pattern during Ramadan among doctors. METHODS: The longitudinal study was conducted at a public-sector medical university in Karachi from April to May 2020, and comprised healthy doctors of either gender who planned to fast during Ramadan. Data was collected using a multitude of validated structured tools by trained data collectors. Data was analysed using SPSS 20. RESULTS: Of the 193 subjects, 103(53.4%) were females and 90(46.6%) were males. The overall mean age was 30.05±9.4 years. Caloric intake in the month before Ramadan was significantly higher 2288±495kcal/day than during Ramadan 2089±491kcal/day (p<0.001). Calories from proteins decreased and those from fats increased (p<0.001). Metabolic equivalent of task per minute per week increased significantly during Ramadan (p<0.001). Overall sleep per day decreased significantly, and there was an increase in daytime sleep and a decrease in night-time sleep (p<0.05). Body mass index also dropped significantly (p=0.005). CONCLUSIONS: Fasting during Ramadan had a positive effect on body mass index and physical activity levels of doctors, while the quality of diet and sleep was affected negatively.

Nicotine dependence and intention to quit among electronic, conventional and dual cigarette users in Karachi.

OBJECTIVE: To compare nicotine dependence and intention to quit among different types of smokers. METHODS: The comparative cross-sectional study was conducted from November 2018 to October 2019 in Karachi after approval from the ethics review committee of the Jinnah Sindh Medical University, and comprised conventional, electronic and dual cigarette users. Data was collected using a structured questionnaire regarding socio-demographics, usage characteristics, and intention to quit. The validated Hooked on Nicotine Checklist was also used. Data was analysed using SPSS 22. RESULTS: Of the 246 subjects, 82(33%) were conventional cigarette users with a mean age of 27.41±8.7 years, 82(33.3%) were electronic cigarette users having mean age of 30.37±9.16 years, and 82(33.3%) were dual cigarette users with a mean age of 28.89±9.07 years. The use of electronic cigarette was more in people with higher age (p=0.01), married (p=0.001) and having higher income (p=0.05). Compared to conventional cigarette users, electronic cigarette users showed lower odds of high nicotine dependence (odds ratio: 0.38, 95% confidence interval: 0.18-0.80). No significant difference was observed in intention to quit among different types of cigarette users (p>0.05). CONCLUSIONS: Electronic cigarettes users were comparatively less nicotine-dependent compared to the users of other types of cigarettes. Electronic cigarettes should only be recommended to conventional users with the intention to quit.

Characteristics, reasons and patterns of Road Traffic Injuries presenting in emergency department of a tertiary care public hospital in Karachi.

Objectives: To determine the main characteristics, reasons and patterns of road traffic injuries (RTIs) in a tertiary care public hospital of Karachi. Methods: It was a hospital based cross sectional study conducted in a public tertiary care hospital emergency department with a sample size 425 selected conveniently. Participants included the consenting victims or caretaking attendants of road traffic injuries (RTIs) from 25th May to 28th June in 2019. A structured questionnaire was developed after literature review and was translated into "Urdu" language. The questionnaire collected detailed information on socio-demographic characteristics, possible reasons of RTI's such as condition of vehicle, over speeding and breaking traffic rules. Data was analyzed by using software SPSS version 20. Results: Almost half of RTI victims (43.1%) belonged to the age group 18-29. Majority of the victims were males (86.6%). The most common vehicle involved was motorbike (87.50%) followed by Rickshaw (6.8%) and Car (2.4%). Majority of RTIs occurred on main road (75.30%). The most common sites of injuries were lower limb (64%), upper limb (37.60%) and head (32.2%). The severe injuries were significantly more likely to happen in events in which direct collision with other vehicle/thing was involved, road conditions were wet and pedestrian were crossing the road. Conclusion: Motorbikes were involved in majority of RTIs. Main reasons of RTIs included irresponsible road behaviors including over-speeding, careless road crossing, breaking the signal and riding on wet roads which lead to moderate to severe injuries in almost two thirds of participants.

Enhancing satisfaction and respect for health care personnel: a mixed-methods case study of a community-based intervention.

Health care personnel (HCP) face violence as a result of lack of satisfaction and respect among community members. It is imperative for HCP to engage in social work by involving communities for enhancing satisfaction and respect for them. This study attempted to provide insight on this phenomenon by using a mixed-methods concurrent embedded approach. Communities were selected based on modified Solomon four-group design from Karachi in southern province and from three cities of northern province, Khyber Pakhtunkhwa of Pakistan. Focus group discussions and in-depth interviews took place for formulating the quantitative tool. Six hundred pretests were done prior to introducing low-cost community-based interventions followed by 601 posttests. We found increased levels of satisfaction in both provinces, whereas level of respect increased significantly in Karachi in the southern province only. Qualitative interviews revealed the important role played by media and religious leaders. These findings suggest that satisfaction and respect for HCP can be enhanced through community support, involvement of religious leaders, and effective media campaigns.

Effect of low-cost interventions to reduce the incidence of violent events in two public sector tertiary-care emergency departments, Pakistan.

Background: Violence against health care workers has been widely reported in Pakistan. Aims: This study, from September 2019 to April 2020, aimed to determine the effect of low-cost interventions to reduce violent events in two tertiary-care emergency departments in Karachi and Peshawar, Pakistan. Methods: In phase one, a surveillance system was established in each department and information on violent events was recorded for three months. In phase two, low-cost interventions designed to reduce violent events were introduced, e.g. awareness-raising material on violence for patients, training for health care workers and visitor identification cards. Violent events were then recorded for another three months and the percentage difference in number of violent events was calculated. Results: In Karachi, 256 violent events occurred before the intervention and 225 after the intervention, a 12.1% reduction. Physical violence events decreased significantly by 42.9% (P = 0.044). The number of events perpetrated by health care workers decreased by 61.9% (P = 0.016) while those perpetrated by patients decreased only by 5.7% (P = 0.538). In Peshawar, 90 violent events occurred before the intervention and 45 events after, a 50.0% reduction (P = 0.009). The number of events perpetrated by health care workers was the same in both phases. Events perpetrated by patients or their companions decreased significantly by 59.72% (P = 0.001). Conclusion: Violence against health care workers can be reduced significantly by improving their prevention and de-escalation skills. Client educational interventions, supplemented with hospital regulations and patient guidance, can also help reduce the incidence of violent events.

How frequent is burnout among informal caregivers of disabled children? Findings from a cross-sectional study in Karachi, Pakistan.

BACKGROUND: Informal caregivers are those who care for children without getting paid. They are often more prone to stress due to their extra daily tasks which leads to burnout. This study aimed to determine the frequency and associated risk factors of burnout among informal caregivers of children with disabilities in Karachi. METHODOLOGY: A cross-sectional study was done in 10 rehabilitation institutes of Karachi with 310 mothers of children with disabilities from infancy till 18 years of age in 2019. Pretested questionnaire was administered to collect data in which 31 mothers were interviewed through convenience sampling from each rehabilitation institute. To assess burnout, the Maslach Burnout Inventory (MBI) was used. Association of different variables of study participants with the scores of its three subdimensions, Emotional Exhaustion (EE), Depersonalization (DP) and Personal Accomplishment (PA), were analysed using linear regression modelling. RESULTS: Mean EE score was high in 6.5% of the mothers while PA scores were low in 58.7% of the mothers. High EE with low PA (defined by our team as 'burnout') was found in 4.2% of the mothers, with none of them reporting high levels of DP. Linear regression analysis significantly predicted higher EE scores of mothers with more than one disabled child while lower EE scores were significantly predicted in highly educated mothers and mothers who spent more time in caregiving. Higher PA scores were also significantly predicted for highly educated mothers. DP scores were significantly predicted to be higher in mothers who had highly educated husband/guardian, employed mothers and those living in joint families whereas they were significantly predicted to be lower in highly educated mothers. CONCLUSION: We have identified that mothers who are less educated, have more than one child with disability and who live in joint families will need extra support and input to prevent burnout.

Frequency and risk factors of musculoskeletal disorders in high risk occupation workers in Urban, Karachi.

OBJECTIVE: To determine the frequency and risk factors of musculoskeletal disorders in high-risk occupation workers in an urban setting. METHODS: The analytical cross-sectional study was conducted in Karachi from July to December 2020, and comprised office workers, operation theatre technicians and coolies. The presence of musculoskeletal disorders was assessed using the Nordic Musculoskeletal Questionnaire to determine factors associated with moderate to severe condition. Data was analysed using SPSS 20. RESULTS: Of the 300 male subjects, 100(33.3%) each were office workers, operation theatre technicians and coolies. The overall mean age was 33.25±6.8 years (range: 18-50 years). The overall prevalence of musculoskeletal disorders was 179(59.7%). Besides, 117(65.4%) patients with musculoskeletal disorders had intermediate stage of the disease. The lower back and neck were the most common site of trouble involved in preceding 12 months 111(43.6%) each. CONCLUSIONS: Prevalence of musculoskeletal disorders was found to be a common problem affecting high-risk occupational workers.

Violence against health care workers in rural areas of Sindh, Pakistan.

OBJECTIVE: To determine the magnitude of violence against healthcare workers in a rural setting, and the consequences of this violence on their personal and professional lives. METHODS: The descriptive, quantitative, cross-sectional study was conducted in 4 rural districts of the Sindh province of Pakistan from February to December 2019, and comprised healthcare workers, including doctors, nurses, support staff and field workers. Data was collected using a structured questionnaire. Data was analysed using SPSS 22. RESULTS: Of the 1622 subjects, 929(57.3%) were males and 693(42.7%) were females. The overall mean age was 35.55+/-10.05 years. The largest cluster was that of doctors 396(24.4%), followed by technicians 202(12.5%). Overall, 522(32.2%) subjects had a professional experience of 1-5 years. Violence at workplace in any form was experienced by 693(42.7%) subjects. Verbal violence had been experienced by 396(24.4%) subjects, while 228(14.1%) had witnessed it. The corresponding numbers for physical violence were 122(7.5%) and 22(1.4%). Verbal violence was more prevalent compared to physical violence (p<0.01). The major effect was that the healthcare workers remained alert 537(33.1%), felt frustrated 524(32.3%) and disturbed 503(31%). Also, 272(16.8%) subjects were planning to migrate or quit the profession. CONCLUSIONS: Violence was found to be a significant issue in rural Sindh.

Psychological impact of COVID-19 Pandemic and associated factors on college students.

OBJECTIVE: To determine the psychological impact of coronavirus disease-2019 pandemic on college students, and to explore factors influencing their anxiety and depression levels. METHODS: The cross-sectional study was conducted from October 2020 to January 2021 at the Jinnah Sindh Medical University, Karachi, and comprised medical students of either gender in the first to third year of the academic programme. Data was collected using a pretested online structured questionnaire comprising demographic information, academic problems, daily life difficulties and the 25-item Aga Khan University Anxiety and Depression Scale. Data was analysed using SPSS22. RESULTS: Of the 397 students, 72(18.1%) were males and 325(81.9%) were females. The overall mean age of the sample was 19.9±1.2 years. Of the total, 221(55.7%) students were found to be anxious and depressed. Factors related to academic difficulties and daily life issues had significant correlation (p<0.05) with anxiety and depression. Multiple linear regression analysis indicated that the need for some form of mental health support was the most significant (p<0.001) predictor of anxiety and depression, followed by family issues (p<0.001) and social media (p<0.001). Anxiety and depression were also significantly associated with fear of family or friend getting coronavirus disease-2019 (p=0.003), lack of attentiveness to study (p=0.040) and felt anxiety when ordering food online (p=0.019). CONCLUSIONS: With better understanding, academic institutions and healthcare policymakers may take measures and mitigate students' distress during the pandemic.

Ethnic differences in the receptors status of estrogen, progesterone and Her2/Neu among breast cancer women: A single institution experience.

OBJECTIVE: To evaluate the Ethnic Differences in Estrogen (ER), Progesterone (PR) and Her 2/neu receptors among Women with Breast Cancer at JPMC, the largest public sector tertiary care hospital in Karachi. METHODS: The study was conducted at the oncology ward, JPMC Karachi from 1st July 2017 to 31st December 2018. During this period, more than 500 women with breast cancer of different ethnicities visited the oncology ward, however 450 patients were included in the study, as only they had the complete reports on the receptors status and tumour histology. The data collected included tumour histology, grade, receptors status, age and ethnicity. Data was analyzed with SPSS version 20 using the Chi-Square Test to observe statistical differences in the receptors status of different ethnicities. RESULTS: Analysis of receptors status as per ethnicity showed that ER was proportionately more positive in Pushtoon patients at the rate of 28 (75.7%) as compared to Urdu Speaking 116 (60.4%), Punjabis 48 (60%), Sindhis 38(38.7%) and Balochis 26 (61.1%). Similarly, PR and Her-2/neu receptor were also higher in Pushtoons at the rate of 24 (64.9%) and 15 (40.5%) respectively. The behaviour of Triple Positivity was also more prominent in Pushtoons at the rate of 9 (24.3%) and the Pushtoons were also proportionately less likely to be Triple Negative at the rate 05 (13.5%) as compared to other ethnicities. All the results were statistically non significant (p values>0.05). CONCLUSIONS: In this study we observed a relatively higher expression of ER, PR and Her 2/neu Receptors in Pushtoons as compared to other ethnicities. Understanding the factors underlying these differences may provide further insight into the breast cancer aetiology in different populations.

Assessment of a mass media campaign on giving way to ambulances in five cities of Pakistan.

OBJECTIVE: To determine the contribution of a mass media campaign towards encouraging more vehicles to give way to ambulances, and to identify the factors associated with higher likelihood of giving way to ambulances. METHODS: The three-phase observational study was conducted from December 2017 to March 2018 in Karachi, Lahore, Rawalpindi, Islamabad and Peshawar cities of Pakistan. Six road sites in different areas of each city were selected for observation. The surveys in each city were supervised by academic partners, including APPNA Institute of Public Health, Karachi, University of Health Sciences, Lahore, Al-Nafees Medical College, Rawalpindi and Islamabad, and Khyber Medical University, Peshawar. Three observation surveys were carried out before, during and after the media campaign on right of way for ambulances. Only those ambulances were observed which were rushing through and seeking space. The behaviour of only those vehicles was observed which had the space to change the lane when the space was sought from them. The association of the outcome of vehicles giving way to ambulances immediately or in a few seconds with the campaign was determined using logistic regression analysis. RESULTS: After adjustment for city of observation, timing of the day and type of vehicle, vehicles during and after the campaign were significantly more likely give space to ambulance (p<0.05) compared to cars, buses and vans were significantly less likely to give space (p<0.05). CONCLUSIONS: Media campaign produced better results in encouraging vehicle-owners to give right of way to ambulances to ensure timely medical assistance.

Frequency and determinants of timely arrival among patients of acute myocardial infarction at a public sector tertiary care hospital in Karachi.

OBJECTIVE: To determine the time from onset of symptoms to start of fibrinolysis and treatment in acute ST elevated myocardial infarction patients and identify the factors which cause delay in treatment. METHODS: A cross sectional study was conducted at National Institute of Cardiovascular Diseases, Karachi on 360 conveniently selected patients of ST elevated myocardial infarction from July to September in the year 2017. Structured questionnaire was used to obtain detailed information on socio-demographics, factors which cause delay and timing of onset of symptoms to arrival of patient in emergency ward. RESULTS: Overall, the total average time from the start of symptoms to initiation of treatment was 119.85+-63.32 minutes.. Only 5.1% patient reached within one hour while 57.7% reached within two hours. Old age group of 60 and above was positively associated with timely arrival (OR=2.75, 95% CI 1.33-5.68, p=0.006). Significant positive association of using personal car as mode of transport to reach the hospital (OR=5.25, 95% CI 2.94-9.35, p<0.001) was also found as compared to using ambulance. Distance from facility was suggestive of negative association in the model but was statistically insignificant. CONCLUSION: According to the findings of this study, more than one third of patients reached the hospital within two hours of initiation of symptoms while only 5.1% reached within one hour. The delay was mostly pre-hospital attributed to arranging transport, stay at first medical contact and time taken from first medical contact to the hospital.

The magnitude and determinants of violence against healthcare workers in Pakistan.

Objectives: To determine the magnitude and determinants of violence against healthcare workers (HCWs) and to identify the predominant types and causes of violence experienced by them. Methodology: A cross-sectional survey based on structured questionnaire adopted from previous surveys and qualitative data was conducted in 4 large cities and 12 districts in 3 provinces of Pakistan. The survey covered 8579 from all cadres of HCWs, including doctors, nurses, technicians, support staff, ambulance workers, vaccinators, lady health visitors, midwives and lady health workers (LHWs). The predictors of overall violence experienced, physical violence experienced and verbal violence experienced were separately analysed for tertiary care hospitals, secondary care hospitals, primary care hospitals and field-level HCWs. Logistic regression was used to compute adjusted ORs with 95% CIs for the association of different factors with the violence experienced. Results: More than one-third (38.4%) reported having experienced any form of violence in the last 6 months. Verbal violence was the most commonly experienced form (33.9%), followed by physical violence (6.6%). The main reasons for physical violence were death of patients (17.6%), serious condition of patients (16.6%) and delay in care (13.4%). Among the different types of field HCWs, emergency vehicle operators were significantly more likely to experience verbal violence compared with LHWs (adjusted OR=1.97; 95% CI 1.31 to 2.94; p=0.001). Among hospital HCWs, those working in private hospitals were significantly less likely to experience physical violence (adjusted OR=0.52; 95% CI 0.38 to 0.71; p=0.001) and verbal violence (adjusted OR=0.57; 95% CI 0.48 to 0.68; p=0.001). Conclusion: Violence against HCWs exists in various forms among all cadres and at different levels of care. The gaps in capacity, resources and policies are evident. Specific strategies need to be adopted for different types of HCWs to protect them against violence.*The study was conducted under the framework of ICRC's Healthcare in Danger Initiative for protection of healthcare against Violence.

Working Conditions and Work-Related Health Issues of Female Domestic Workers in Four Districts of Karachi.

OBJECTIVES: To determine the working conditions and work-related health issues of female domestic workers (FDWs) in four districts of Karachi. METHODS: Population-based cross-sectional study was conducted in four squatter settlements of Karachi with sample size of 406 FDWs in 2018. Pretested questionnaire was administered to collect data through snowball technique. Multivariate logistic regression examined the association between different factors and experiencing violence, work-related injuries, and chemical exposures. RESULTS: Only (14.5%) of domestic workers earned Rs 15 000 (75 GBP month-1) and above. >1% had financial support for the health or education of children. Verbal violence included shouting (40.9%), constant critique of work (17.2%), and job threats (13.5%). Common workplace injuries were cuts (30.8%), burns (27.6%), and bruises (23.6%). Doing laundry showed significant positive association with experiencing cuts [odds ratio (OR) = 2.09; 1.15-3.71], looking after children to bruises (OR = 2.29; 1.07-4.88), and cooking to burns (OR = 4.66; 2.68-8.08). CONCLUSIONS: Creating economic environment which is equal for all low wage workers, setting up domestic labor standards and holding employers accountable to them is essential.

Out of pocket payment for diabetes mellitus in a public hospital of Karachi.

OBJECTIVE: To estimate the out-of-pocket payment on routine management of type 2 diabetes in patients attending a public-sector facility. METHODS: The cross-sectional study was conducted from December 2016 to May 2017 at Jinnah Postgraduate Medical Centre, Karachi, and comprised of persons with type 2 diabeties. A pretested questionnaire was administered to collect data from the patients. Comparisons of average out-of-pocket expenditure were done across different groups on the basis of gender, education, monthly income and duration of disease. SPSS 20 was used for data analysis. RESULTS: Of the 336 subjects, 178(53%) were males and 158(47%) were females. Overall mean age was 52.20+/-12.64 years, and 170(50.6%) were illiterate. The monthly mean cost on diabetes care was PKR2227}2217.70. People with academic level matriculation or higher spent more on the disease (p<0.001). Expenditure increased with the increase in number of years of disease (p<0.001). Participants with income of less than PKR15000 spent higher percentage of their income compared to the participants earning more (p<0.001). CONCLUSIONS: High out-of-pocket expenditure was incurred by people with diabeties. The coverage of social security nets and individual insurance should be broadened to help improve diabetes management.