1.  Peer Reviewed Title: Pakistan 2006-07: results from the demographic and health survey. Source: Studies in Family Planning. 2009 Sep;40(3):252-257. Abstract: Data for the nationally representative PDHS 2006-07 were collected from 9,255 households, and complete interviews were conducted with 10,023 ever-married women aged 15-49. The fieldwork took place from early September 2006 and February 2007. Summary statistics presented are: 1) General characteristics of the population; 2) Fertility trends; 3) Fertility preferences; 4) Contraception; 5) Marital status; 6) Assistance during delivery; 7) Postpartum variables; 8) Infant mortality; and 9) Disease prevention and treatment. Language: English Keywords: PAKISTAN | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | FERTILITY | AGE SPECIFIC FERTILITY RATE | CONTRACEPTION | REPRODUCTIVE BEHAVIOR | CONTRACEPTIVE PREVALENCE | MARITAL STATUS | INFANT MORTALITY | POSTPARTUM | HEALTH | KNOWLEDGE | AIDS | HIV INFECTIONS | DISEASE PREVENTION | TREATMENT | Developing Countries | Asia, Southern | Asia | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Fertility Rate | Birth Rate | Fertility Measurements | Family Planning | Contraceptive Usage | Nuptiality | Mortality | Puerperium | Reproduction | Sociocultural Factors | Viral Diseases | Diseases | Prevention and Control | Medical Procedures | Medicine | Health Services | Delivery of Health Care Document Number: 339707 |
| 2. Peer Reviewed Title: Emergency contraception: knowledge and attitudes of family physicians of a teaching hospital, Karachi, Pakistan. Author: Abdulghani HM; Karim SI; Irfan F Source: Journal of Health, Population, and Nutrition. 2009 Jun;27(3):339-44. Abstract: This study was conducted to assess the knowledge of family medicine providers and their attitudes towards emergency contraception in a teaching hospital in Karachi, Pakistan. A 21-item questionnaire containing the demographic profile of respondents and questions concerning knowledge of and attitudes towards emergency contraception was distributed among participants. In total, 45 interviews were conducted, with a response rate of 100%, with faculty physicians (33%), residents (27%), medical officers (40%), 36% male and 64% female physicians; of them, the majority (64%) were married. Although the large majority (71%) of the respondents reported considerable familiarity with emergency contraception, objective assessment revealed deficiencies in their knowledge. About 38% of the participants incorrectly chose menstrual irregularity as the most common side-effect of progestin-only emergency contraception pills, and only 33% answered that emergency contraception was not an abortifacient while 42% were unsure. Forty percent of the physicians prescribed emergency contraception in the past. The large majority (71%) of the physicians were familiar with emergency contraception, yet deficiencies in knowledge inaccuracies were identified. Barriers to its use were identified as 'it will promote promiscuity' (31%), religious/ethical reasons (27%), liability (40%), teratogenicity (44%), and inexperience (40%). Overall attitudes regarding emergency contraception were positive; however, most (82%) physicians were unsatisfied with their current knowledge of emergency contraception, and there was a discrepancy between perceptions of physicians and actual knowledge. Interventions providing education to family physicians regarding emergency contraception is strongly recommended. Language: English Keywords: PAKISTAN | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | PHYSICIANS | EMERGENCY CONTRACEPTION | ATTITUDES | KNOWLEDGE | PERCEPTION | FAMILY PLANNING | Developing Countries | Asia, Southern | Asia | Research Methodology | Health Personnel | Delivery of Health Care | Health | Contraception | Psychological Factors | Behavior | Sociocultural Factors Document Number: 341579 |
| 3. Title: High prevalence of HIV infection among injection drug users (IDUs) in Hyderabad and Sukkur, Pakistan. Author: Altaf A; Saleem N; Abbas S; Muzaffar R Source: JPMA. Journal of the Pakistan Medical Association. 2009 Mar;59(3):136-40. Abstract: OBJECTIVE: To estimate size of injection drug users (IDU), determine their high risk behaviours and assess the prevalence of HIV. METHOD: As part of second generation surveillance (SGS), we investigated specific demographic and behavioural characteristics of IDUs in Hyderabad and Sukkur in 2005. It was a cross sectional study. The survey was preceded by geographic mapping to determine size estimation and to define sampling procedures prior to integrated behavioural and biological survey (IBBS). A sample size of at least 400 was calculated for each city. Besides calculating frequencies, chi square was used for comparing variables among HIV positive and negative IDUs like time elapsed as IDU, number of injections, sharing needles and self perception of acquiring HIV infection. RESULTS: A total of 800 (Hyderabad 398; Sukkur 402) questionnaires and DBS samples were collected. The estimated number of IDUs in both cities was 3,225 (Hyderabad 975 and Sukkur 2250 respectively). Average age of IDUs in Hyderabad was 36.5 years and 34.6 years in Sukkur. Sharing of injection equipment for last injection was reported by 34 (8.5%) in Hyderabad and 135 (33.6%) in Sukkur. In both cities behaviours such as injecting drugs for more than 10 years (p = 0.00) and injecting four or more times in a day (p = 0.11) were significantly associated with seropositivity of HIV infection. In Hyderabad the seroprevalence of HIV was 25.4% (101/398) and in Sukkur it was 19.2% (77/402). CONCLUSION: The burden of HIV among IDUs in Hyderabad and Sukkur is extremely high and can play a significant role in transmitting the infection to other vulnerable groups. Language: English Keywords: PAKISTAN | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CROSS SECTIONAL ANALYSIS | PERSONS LIVING WITH HIV/AIDS | IV DRUG USERS | URBAN POPULATION | PREVALENCE | HIV INFECTIONS | RISK BEHAVIOR | HUMAN GEOGRAPHY | NEEDLE SHARING | SELF-PERCEPTION | RISK ASSESSMENT | DEMOGRAPHIC FACTORS | Developing Countries | Asia, Southern | Asia | Research Methodology | Viral Diseases | Diseases | Drug Use and Abuse | Behavior | Population Characteristics | Population | Measurement | Geography | Social Sciences | Science | Sociocultural Factors | Perception | Psychological Factors | Evaluation Document Number: 330915 |
| 4. Peer Reviewed Title: High-risk behaviours among juvenile prison inmates in Pakistan. Author: Altaf A; Janjua NZ; Kristensen S; Zaidi NA; Memon A; Hook EW 3rd; Vermund SH; Shah SA Source: Public Health. 2009 Jul 15; Abstract: OBJECTIVES: To assess the sexual- and drug-use-related risk behaviours of male juvenile detainees in Karachi, Pakistan. DESIGN: Cross-sectional study. METHODS: A cross-sectional study was conducted of prison inmates aged 15-21 years in Karachi Juvenile Prison in 2002. In total, 321 inmates were interviewed about sexual orientation and behaviours, and knowledge about human immunodeficiency virus (HIV) and sexually transmitted infections (STIs). Urine specimens were collected and tested for Chlamydia trachomatis and Neisseria gonorrhoeae using ligase chain reaction. RESULTS: A substantial proportion (n=111, 34.6%) of the participants were sexually active. Sixty-two (19%) and 67 (21%) had had sex with a male or female before incarceration, respectively. Twenty-seven (8.4%) participants had an STI, and 50% of the 109 sexually active participants had had multiple sexual partners. Use of addictive substances was associated with sexual activity. The mean knowledge score computed from the sum of 16 items was 4.7, with a median of 2.9. A large proportion (40%) of participants knew about condoms, but very few (3.4%) had ever used one. The mean+/-standard deviation risk score from nine items was 2.4+/-1.7. On the basis of behavioural and biological markers, 117 (36.4%) participants had high-risk behaviour. In multivariate logistic regression analysis, knowledge, risk perception and age were predictive of higher risk. CONCLUSIONS: HIV risk behaviours are common among adolescent inmates. Although inmates do have knowledge about modes of transmission and condom use, the use of condoms is significantly low. Interventions are needed for behavioural change among this group. Language: English Keywords: PAKISTAN | RESEARCH REPORT | YOUTH | PRISONERS | SEX BEHAVIOR | DRUG USE AND ABUSE | ALCOHOL USE AND ABUSE | KNOWLEDGE | SEXUALLY TRANSMITTED DISEASES | HIV INFECTIONS | AIDS | Developing Countries | Asia, Southern | Asia | Age Factors | Population Characteristics | Demographic Factors | Population | Crime | Social Problems | Sociocultural Factors | Behavior | Reproductive Tract Infections | Infections | Diseases | Viral Diseases Document Number: 342285 |
| 5. Title: Collecting reliable information about violence against women safely in household interviews: experience from a large-scale national survey in South Asia. Author: Andersson N; Cockcroft A; Ansari N; Omer K; Chaudhry UU; Khan A; Pearson L Source: Violence Against Women. 2009 Apr;15(4):482-96. Abstract: This article describes the first national survey of violence against women in Pakistan from 2001 to 2004 covering 23,430 women. The survey took account of methodological and ethical recommendations, ensuring privacy of interviews through one person interviewing the mother-in-law while another interviewed the eligible woman privately. The training module for interviewers focused on empathy with respondents, notably increasing disclosure rates. Only 3% of women declined to participate, and 1% were not permitted to participate. Among women who disclosed physical violence, only one third had previously told anyone. Surveys of violence against women in Pakistan not using methods to minimize underreporting could seriously underestimate prevalence. Language: English Keywords: PAKISTAN | RESEARCH REPORT | DATA COLLECTION | DATA QUALITY | RELIABILITY | DOMESTIC VIOLENCE | VIOLENCE AGAINST WOMEN | SAFETY | INTERVIEWS | PROGRAM EVALUATION | Developing Countries | Asia, Southern | Asia | Research Methodology | Data Analysis | Measurement | Crime | Social Problems | Sociocultural Factors | Public Health | Health | Programs | Organization and Administration Document Number: 341635 |
6.  Title: PRISM tools for assessing, monitoring, and evaluating RHIS performance. Author: Aqil A; Lippeveld T Source: Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, Carolina Population Center [CPC], MEASURE Evaluation, 2009 Mar. [32] p. (MS-09-34USAID Cooperative Agreement No. GPO-A-00-03-00003-00) Abstract: PRISM Framework and its tools applications have expanded since 2004. Now it has been applied in Pakistan, Uganda, South Africa, Mexico, Paraguay, Honduras, Haiti, China and Cote d'Ivore for assessment and evaluation. It has been applied in diverse countries of Africa, Asia, Latin America and Carribean continents. While these applications showed the strengths and appropriateness of PRISM Framework and its tools in identifying strengths and weaknesses of the routine information systems, they brought some challenges to attention. First, to make a distinction between RHIS performance indicators -accuracy, timeliness and completeness, from their counterpart processes. Second, to keep minimum variables in various tools for triangulation of information to avoid respondent's burden of filling the details. Third, better measurement of use of information. Thus, there was a need to revise the PRISM tools. Uganda PRISM evaluation in 2007 for testing its reliability and validity also helped to make the revisions. PRISM tools version 3.0 meets old and new challenges in assessing, monitoring and evaluation of RHIS. Language: English Keywords: PAKISTAN | MEXICO | HONDURAS | HAITI | CHINA | PARAGUAY | SOUTH AFRICA | UGANDA | SUMMARY REPORT | EVALUATION | INFORMATION PROCESSING | DATA COLLECTION | MANAGEMENT | PROGRAM ACTIVITIES | Developing Countries | Asia, Southern | Asia | North America | Americas | Central America | Latin America | Caribbean | Asia, Eastern | South America, Central | South America | Africa, Southern | Africa, Sub Saharan | Africa | Africa, Eastern | Information | Research Methodology | Organization and Administration | Programs Document Number: 339994 |
| 7. Peer Reviewed Title: Education gender gaps in Pakistan: Is the labor market to blame? Author: Aslam M Source: Economic Development and Cultural Change. 2009 Jul;57(4):747-784. Abstract: Differential labor market returns to male and female education are one potential explanation for large gender gaps in education in Pakistan. We empirically test this explanation by estimating private returns to education separately for male and female wage earners. This article contributes to the literature by using a variety of methodologies (ordinary least squares, Heckman correction, two-stage least squares, and household fixed effects) in order to estimate economic returns to education. The latest nationally representative data-the Pakistan Integrated Household Survey (2002)-are used. Earnings function estimates consistently reveal a sizable gender asymmetry in economic returns to education, with returns to women's education being substantially and statistically significantly higher than men's. The return to an additional year of schooling ranges between 7% and 11% for men and between 13% and 18% for women. There are also large, direct returns to women's education at low levels of schooling, and the education-earnings profile is more convex for women than for men. However, a decomposition of the gender wage gap (into the component "explained" by differing male and female endowments and the residual component) suggests that there is highly differentiated treatment by employers. We conclude that the total labor market returns are much higher for men, despite returns to education being higher for women. This suggests that parents may have an investment motive in allocating more resources to boys than to girls within households. Language: English Keywords: PAKISTAN | RESEARCH REPORT | STATISTICAL REGRESSION | MULTIVARIATE ANALYSIS | MATHEMATICAL MODEL | LABOR FORCE | SPOUSE | EDUCATIONAL STATUS | GENDER ISSUES | SEX FACTORS | INEQUALITIES | INCOME | PARENTAL INVOLVEMENT | Developing Countries | Asia, Southern | Asia | Data Analysis | Research Methodology | Theoretical Models | Human Resources | Economic Factors | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Socioeconomic Status | Socioeconomic Factors | Population Characteristics | Demographic Factors | Population | Child Rearing | Behavior Document Number: 341095 |
| 8. Peer Reviewed Title: Political feasibility of scaling-up five evidence-informed HIV interventions in Pakistan: a policy analysis. Author: Buse K; Lalji N; Mayhew SH; Imran M; Hawkes SJ Source: Sexually Transmitted Infections. 2009 Apr;85(Suppl 2):ii37-ii42. Abstract: Background: Drawing on policy theories, an assessment was made of the perceived political feasibility of scaling-up five evidence-based interventions to curb Pakistan's HIV epidemic: needle and syringe exchange programmes; targeted behaviour change communication; sexual health care for male and transgender sex workers; sexual and reproductive health care for female sex workers; and promoting and protecting the rights of those at greatest risk. Method: A questionnaire was emailed to 40 stakeholders and completed by 22. They expressed their level of agreement with 15 statements for each intervention (related to variables associated with policy success). Semi-structured interviews were conducted with 12 respondents. Results: The interventions represent considerable change from the status quo, but are perceived to respond to widely acknowledged problems. These perceptions, held by the HIV policy elite, need to be set in the context of the prevailing view that the AIDS response is not warranted given the small and concentrated nature of the epidemic and that the interventions do not resonate closely with values held by society. The interventions were perceived to be evidence-based, supported by at least one donor and subject to little resistance from frontline staff as they will be implemented by contracted non-government organisations. The results were mixed in terms of other factors determining political feasibility, including the extent to which interventions are easy to explain, exhibit simple technical features, require few additional funds, are supported and not opposed by powerful stakeholders. Conclusion: The interventions stand a good chance of being implemented although they depend on donor support. The prospects for scaling them would be improved by ongoing policy analysis and strengthening of domestic constituencies among the target groups. Language: English Keywords: PAKISTAN | RESEARCH REPORT | THEORETICAL MODELS | KAP SURVEYS | POLICYMAKERS | IV DRUG USERS | SEX WORKERS | HIV PREVENTION | BEHAVIOR CHANGE COMMUNICATION | POLICY DEVELOPMENT | HEALTH POLICY | INTERVENTIONS | CAPACITY BUILDING | SEXUALLY TRANSMITTED DISEASE PREVENTION | SYRINGE | NEEDLE SHARING | SOCIAL POLICY | Developing Countries | Asia, Southern | Asia | Research Methodology | Surveys | Sampling Studies | Studies | Administrative Personnel | Organization and Administration | Drug Use and Abuse | Behavior | Sex Behavior | HIV Infections | Viral Diseases | Diseases | Communication Programs | Communication | Behavior Change | Planning | Policy | Political Factors | Sociocultural Factors | Programs | Program Sustainability | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Risk Behavior Document Number: 340114 |
| 9. Title: The impact of socioeconomic and demographic variables on poverty: a village study. Author: Chaudhry IS; Malik S; ul Hassan A Source: Lahore Journal of Economics. 2009 Summer;14(1):39-68. Abstract: Poverty is a complex phenomenon based on a network of interlocking economic, social, political, and demographic factors. An understanding of the extent, nature, and determinants of rural poverty is a precondition for effective public policy to reduce poverty in rural Pakistan. The present study attempts to analyze the impact of socioeconomic and demographic characteristics of households on poverty, using primary data collected in the village ofBetti Nala in Tehsil Jatoi, district MuzaJfargarh in southern Punjab. We have used two distinct approaches: (i) a poverty profile, and (ii) an econometric approach in our empirical analysis. The results show that household size, dependency on household, participation, landholdings, and number oflivestock have a Significant impact on poverty incidence. Our final conclusion is that efforts should be made to improve socioeconomic foctors in general and demographic foctors in particular to alleviate rural poverty in remote areas of Pakistan, while land should beallotted to landless households. Language: English Keywords: PAKISTAN | RESEARCH REPORT | RURAL AREAS | RURAL POPULATION | LOW INCOME POPULATION | POVERTY | SOCIOECONOMIC FACTORS | INTERMEDIATE VARIABLES | NEEDS | IMPACT | Developing Countries | Asia, Southern | Asia | Geographic Factors | Population | Population Characteristics | Demographic Factors | Social Class | Socioeconomic Status | Economic Factors | Population Dynamics | Communication Document Number: 340236 |
| 10. Title: Effects of female literacy on family size. Author: Chaudhry MA; Irshad S Source: Pakistan Journal of Medical Research. 2009 Jan-Mar;48(1):4-7. Abstract: Background: Education may indirectly lead to wider use of contraceptives and reduction in fertility. Female education reduces her vulnerability to unwanted pregnancies as a result of increased age at first marriage, being more aware of available contraceptive methods and by limiting family size. Objectives: To determine the effects of female literacy on family size and ascertain indirect effects of education on age at marriage, desired family size, use and knowledge of contraception and female autonomy. Methods: This cross-sectional study was carried out in 2005 and included 150 females from Outpatient Department of Combined Military Hospital and Military Hospital, Rawalpindi. The inclusion criteria was married females having children while educational status was an independent variable. Data was collected through convenience sampling using a questionnaire and was analysed using SPSS version II. Results: A total of 150 women were selected for the study, their marriage age ranged from 11-35 years. Forty two were uneducated and rest had some degree of education. Out of the total, 125 were using contraceptives. One hundred and thirty (87%) females desired small family and the fertility gap was higher in educated females. One hundred and thirty (87%) had knowledge of family planning with media being the strongest source of dissemination of information. One hundred and thirty-six (91%) females favored education of girl child. About 82% educated females had a small family with 3 or less children while only 18% had 4 or more children. Only 4 (10%) uneducated females had small family and rest 38 (90%) had a large family size. Conclusion: Educated women have fewer children, are more likely to use contraception and marry later. Improving educational status of women seems to be a cost effective intervention for controlling population growth in developing countries like Pakistan. Language: English Keywords: PAKISTAN | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | WOMEN | FAMILY SIZE | MARRIAGE AGE | LITERACY | KNOWLEDGE | CONTRACEPTIVE USAGE | FAMILY SIZE, DESIRED | Developing Countries | Asia, Southern | Asia | Research Methodology | Demographic Factors | Population | Family Characteristics | Family and Household | Sociocultural Factors | Marriage Patterns | Marriage | Nuptiality | Educational Status | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Contraception | Family Planning Document Number: 340190 |
| 11. Peer Reviewed Title: Understanding the context of male and transgender sex work using peer ethnography. Author: Collumbien M; Quereshi AA; Mayhew SH; Rizvi N; Rabbani A; Rolfe B; Verma RK; Rehman H; Naveed-i-Rahat Source: Sexually Transmitted Infections. 2009 Apr;85(Suppl 2):ii3-ii7. Abstract: Objectives: To distinguish between three distinct groups of male and transgender sex workers in Pakistan and to demonstrate how members of these stigmatised groups need to be engaged in the research process to go beyond stated norms of behaviour. Methods: A peer ethnography study was undertaken in a major city in Pakistan. 15 male and 15 transgender sex workers were trained as peer researchers to each interview three peers in their network. Analysis was based on interviews with peer researchers as well as observation of dynamics during training and analysis workshops. Results: The research process revealed that, within the epidemiological category of biological males who sell sex, there are three sociologically different sexual identities: khusras (transgender), khotkis (feminised males) and banthas (mainstream male identity). Both khusras and khotkis are organised in strong social structures based on a shared identity. While these networks provide emotional and material support, they also come with rigid group norms based on expected "feminine" behaviours. In everyday reality, sex workers showed fluidity in both behaviour and identity according to the situational context, transgressing both wider societal and group norms. The informal observational component in peer ethnography was crucial for the accurate interpretation of interview data. Participant accounts of behaviour and relationships are shaped by the research contexts including who interviews them, at what stage of familiarity and who may overhear the conversation. Conclusions: To avoid imposing a "false clarity" on categorisation of identity and assumed behaviour, it is necessary to go beyond verbal accounts to document the fluidity of everyday reality. Language: English Keywords: PAKISTAN | RESEARCH REPORT | KAP SURVEYS | EPIDEMIOLOGIC METHODS | QUALITATIVE RESEARCH | MEN | SOCIAL NETWORKS | HOMOSEXUALS | SEX WORKERS | PEER GROUPS | ANTHROPOLOGY, CULTURAL | STIGMA | WORKSHOPS | VALUE ORIENTATION | Developing Countries | Asia, Southern | Asia | Surveys | Sampling Studies | Studies | Research Methodology | Demographic Factors | Population | Friends and Relatives | Family and Household | Sociocultural Factors | Sex Behavior | Behavior | Knowledge Sources | Communication | Anthropology | Social Sciences | Science | Social Problems | Education | Psychological Factors Document Number: 340119 |
| 12. Peer Reviewed Title: Factors associated with an explosive HIV epidemic among injecting drug users in Sargodha, Pakistan. Author: Emmanuel F; Archibald C; Razaque A; Sandstrom P Source: Journal of Acquired Immune Deficiency Syndromes. 2009 May 1;51(1):85-90. Abstract: BACKGROUND: During a routine surveillance round, an extremely high prevalence of 51.3% was found among injecting drug users (IDUs) in Sargodha, a small town in Pakistan. This sharp increase of HIV among this group warranted an urgent need to explore the factors leading toward this explosion of HIV infection among IDUs at this very location to direct the policy makers in designing preventive activities, especially in the context of HIV prevention. METHODS: In 2007, 400 current IDUs were recruited through multistage cluster sampling based on mapping studies. Participants provided dried blood spot samples for HIV testing and completed a questionnaire on demographic characteristics and sexual/drug injecting behaviors. Logistic regression was used to examine the independent association of multiple variables with HIV infection. RESULTS: Of the 400 IDUs tested, 205 (51.3%) were HIV positive confirmed through enzyme-linked immunosorbent assay and Western blot. In multivariate analysis, geographical location of IDUs [adjusted odds ratio (aOR) 2.4 for IDUs located in the northern zone vs southern zone, 95% confidence interval (CI) 1.5 to 3.7], injected in groups (aOR 1.8, 95% CI 1.1 to 3.1), and sharing injecting paraphernalia with other IDUs (aOR 1.5, 95% CI 1.0 to 2.4) were strong correlates of HIV infection. CONCLUSIONS: Effective outreach programs need to be developed to provide a comprehensive package of HIV prevention services to IDUs not reached by existing services, entry into drug abuse treatment and medical care needs to be facilitated, and essential legal and social services need to be provided with community participation. Language: English Keywords: PAKISTAN | RESEARCH REPORT | SAMPLING STUDIES | STATISTICAL REGRESSION | IV DRUG USERS | HIV INFECTIONS | EPIDEMICS | PREVALENCE | RISK FACTORS | NEEDLE SHARING | SEX BEHAVIOR | QUESTIONNAIRES | KNOWLEDGE | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Data Analysis | Drug Use and Abuse | Behavior | Viral Diseases | Diseases | Measurement | Health | Risk Behavior | Sociocultural Factors Document Number: 342369 |
| 13. Peer Reviewed Title: What do young adults know about the HIV/AIDS epidemic? Findings from a population based study in Karachi, Pakistan. Author: Farid-ul-Hasnain S; Johansson E; Krantz G Source: BMC Infectious Diseases. 2009;9:38. Abstract: BACKGROUND: HIVAIDS is spreading globally, hitting the younger generations. In Pakistan, the prevalence of HIV in high-risk subpopulations is five per cent or higher. This poses a serious threat of a generalised epidemic especially among the younger population. In the wake of HIVAIDS epidemic this is worrying as a well informed younger generation is crucial in restricting the spread of this epidemic. This study investigated Pakistani young adults' (male and female) knowledge and awareness of the HIV/AIDS disease. METHODS: A population-based, cross-sectional study of 1,650 male and female adults aged 17-21 years living in Karachi was conducted using a structured questionnaire. A multi-stage cluster sampling design was used to collect data representative of the general population in an urban area. Bivariate and multivariate analyses were performed separately for males and females. RESULTS: Of 1,650 subjects, 24 per cent (n = 390) reported that they had not heard of HIV/AIDS. Among the males, those with a poor knowledge were younger (AOR = 2.20; 95 per cent CI, 1.38, 3.49), with less than six years of schooling (AOR = 2.46; 1.29 4.68) and no computer at home (AOR = 1.88; 1.06 3.34). Among the females, the risk factors for poor knowledge were young age (AOR = 1.74; 1.22, 2.50), low socio-economic status (AOR = 1.54; 1.06, 2.22), lack of enrolment at school/college (AOR = 1.61; 1.09, 2.39) and being unmarried (AOR = 1.85; 1.05, 3.26). CONCLUSION: Alarming gaps in knowledge relating to HIV/AIDS were detected. The study emphasises the need to educate young adults and equip them with the appropriate information and skills to enable them to protect themselves from HIV/AIDS. However, taboos surrounding public discussions of sexuality remain a key constraint to preventive activities. Language: English Keywords: PAKISTAN | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | ADULTS | YOUTH | NEEDS | INFORMATION | HEALTH EDUCATION | KNOWLEDGE | HIV INFECTIONS | RISK FACTORS | Developing Countries | Asia, Southern | Asia | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Economic Factors | Education | Sociocultural Factors | Viral Diseases | Diseases | Health Document Number: 341350 |
| 14. Title: Report on the FIGO-SOGP Saving the Mothers and Newborn Health Project in Pakistan. An NFOG concern [editorial] Author: Grunewald C; Moller B Source: Acta Obstetricia et Gynecologica Scandinavica. 2009;88(2):132-3. Abstract: FIGO is increasing its involvement in female health matters around the world. Funds have been solicited for Saving the Mothers and Newborn Health Projects in 12 developing countries. The obstetrics and gynecology society and midwifery association of each project country has been affiliated to a Western society, in what is called 'twinning'. The Swedish Association of Obstetricians and Gynecologists (SFOG) has twinned with the Society of Obstetricians and Gynaecologists of Pakistan (SOGP). The SFOG board has signed a letter of understanding. A similar arrangement has been created between the Danish society (DSOG) and its Nigerian counterpart. Both twinning projects are supported by NFOG. In Pakistan, achievements so far are promising despite formidable problems in society, health care and security. (excerpt) Language: English Keywords: PAKISTAN | GLOBAL | RESEARCH REPORT | MOTHERS | INFANT | MATERNAL HEALTH | POSTPARTUM | BLEEDING | SAFE MOTHERHOOD | REPRODUCTIVE HEALTH | Developing Countries | Asia, Southern | Asia | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Health | Puerperium | Reproduction | Signs and Symptoms | Diseases Document Number: 330197 |
| 15. Title: Emergency maternal and child health training courses and advocacy to achieve millennium development goals in a poorly resourced country; challenges and opportunities. Author: Hafeez A; Zafar S; Qureshi F; Mirza I; Bile K; Southall DP Source: JPMA. Journal of the Pakistan Medical Association. 2009 Apr;59(4):243-6. Abstract: Our three years' experience of Essential Surgical Skills-Emergency Maternal and Child Health (ESS-EMCH) Programme in Pakistan suggests that despite a compromised healthcare delivery system, a tangible improvement in the management of emergencies in pregnancy, the neonate and children can be achieved by adopting a novel but robust mechanism of effective advocacy along with provision of innovative, evidence based and high quality training for healthcare staff. Language: English Keywords: PAKISTAN | RESEARCH REPORT | GOALS | CHILD HEALTH | CHILD MORTALITY | INFANT MORTALITY | TRAINING ACTIVITIES | IMPLEMENTATION | EMERGENCY SERVICES | QUALITY CONTROL | Developing Countries | Asia, Southern | Asia | Planning | Organization and Administration | Health | Mortality | Population Dynamics | Demographic Factors | Population | Training Programs | Education | Programs | Health Services | Delivery of Health Care Document Number: 341536 |
| 16. Title: Knowledge about AIDS/HIV infection among women attending obstetrics and gynaecology clinic at a university hospital. Author: Haider G; Zohra N; Nisar N; Munir AA Source: JPMA. Journal of the Pakistan Medical Association. 2009 Feb;59(2):95-8. Abstract: OBJECTIVE: To determine the level of awareness about Human Immune-deficiency Virus Infection and Auto Immune Deficiency Syndrome (HIV/AIDS) among women attending obstetrics and gynaecology clinic. METHODS: A descriptive cross-sectional study was conducted in the obstetric and gynaecology clinic at Isra University Hospital Hyderabad Pakistan from April to June 2007. A total of 189 women attending the obstetric and gynaecology clinic between ages 20 and 50 years were included. Informed consent was taken and information was collected by a pre-designed questionnaire to assess the level of awareness about HIV/AIDS. Data analysis was done by computer software, SPSS version 11. RESULTS: Out of the total, 86.8% women had heard about HIV/AIDS. A large majority of women knew that it is transmitted by close sexual relationship, through infected blood, can be transmitted from mother to baby and knew that it is transmitted by reuse of infected needles while only 40.7% knew that it can be transmitted during delivery. The respondents had the knowledge that multiple sexual partners (79.4%), prostitutes and homosexual males (49.7%), drug addicts (49.7%) were high risk groups. Regarding prevention of AIDS, 70.9% mentioned avoiding homosexuality, 58.7% knew the use of condoms and 74.7% women knew that screening of blood in laboratories before transfusion can prevent AIDS. CONCLUSION: The level of awareness regarding HIV/AIDS transmission and prevention was satisfactory among women attending the out-patient department of a gynaecology and obstetrics department. However, number of misconceptions needs to be corrected. Language: English Keywords: PAKISTAN | RESEARCH REPORT | KAP SURVEYS | CROSS SECTIONAL ANALYSIS | WOMEN IN DEVELOPMENT | MEN HAVING SEX WITH MEN | SEX WORKERS | MULTIPLE PARTNERS | KNOWLEDGE | HIV TRANSMISSION | SEX BEHAVIOR | RISK BEHAVIOR | BLOOD TRANSFUSION | MOTHER-TO-CHILD TRANSMISSION | CHILDBIRTH | NEEDLE SHARING | Developing Countries | Asia, Southern | Asia | Surveys | Sampling Studies | Studies | Research Methodology | Economic Development | Economic Factors | Behavior | Sexual Partners | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Transmission | Infections | Pregnancy Outcomes | Pregnancy | Reproduction Document Number: 330906 |
| 17. Peer Reviewed Title: HIV and other sexually transmitted infections among men, transgenders and women selling sex in two cities in Pakistan: a cross-sectional prevalence survey. Author: Hawkes S; Collumbien M; Platt L; Lalji N; Andreasen A; Chow J; Muzaffar R; ur-Rehman H; Siddiqui N; Hasan S; Bokhari A Source: Sexually Transmitted Infections. 2009 Apr;85(Suppl 2):ii8-ii16. Abstract: Objectives: The extent and possibilities of spread of the HIV epidemic are not fully understood in Pakistan. A survey was conducted among men, women and transgender populations selling sex in Rawalpindi (Punjab) and Abbottabad (North West Frontier Province) in order to inform evidence-based programme planning. Methods: A cross-sectional survey was performed with participants recruited through respondent-driven sampling. Male and transgender sex workers were analysed in three gender groups; women were analysed as one group. Behavioural surveys were conducted and clinical specimens collected. Laboratory tests looked for evidence of acute infection (gonorrhoea, Chlamydia, syphilis, Trichomonas) and infection over the lifetime (HIV, herpes simplex virus-2, syphilis). Predictors of infection were explored using univariable and multivariable logistic regression. Results: The prevalence of HIV was low in 917 male and transgender sex workers and absent in 533 female sex workers in the study. High levels of current sexually transmitted infections were found, predominantly among transgender sex workers. Risk behaviours were common and knowledge of HIV was extremely low. Multivariable analysis found a large number of factors associated with higher levels of infection, including experience of forced first sex. Protection against risk was low, but those sex workers who reported using condoms at last sex had lower rates of infection. Conclusions: The HIV epidemic is currently in its early stages among people who sell sex, but there may be potential for a much greater spread given the levels of other sexually transmitted infections found and the concomitant low levels of both protective knowledge and risk-reducing behaviours. Action is needed now to avert an epidemic. Framing interventions by upholding the recognition and protection of human rights is vital. Language: English Keywords: PAKISTAN | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CROSS SECTIONAL ANALYSIS | KAP SURVEYS | MULTIVARIATE ANALYSIS | SEX WORKERS | PREVALENCE | PROGRAM DESIGN | HIV PREVENTION | SEXUALLY TRANSMITTED DISEASES | SEX FACTORS | RISK BEHAVIOR | SEX BEHAVIOR | KNOWLEDGE | Developing Countries | Asia, Southern | Asia | Research Methodology | Surveys | Sampling Studies | Studies | Data Analysis | Behavior | Measurement | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Reproductive Tract Infections | Infections | Population Characteristics | Demographic Factors | Population | Sociocultural Factors Document Number: 340118 |
| 18. Peer Reviewed Title: Endemic measles in Karachi, Pakistan and validation of IMCI criteria for measles. Author: Hussain H; Omer SB; Khan AJ; Bhurgri A; Memon A; Halsey NA Source: Acta Paediatrica. 2009 Apr;98(4):720-4. Abstract: AIM: To estimate the incidence of measles in Karachi, Pakistan and to determine the proportion of children with measles based on the WHO integrated management of childhood illness (IMCI) criteria with a positive IgM for measles or dengue. METHODS: Patients up to 14 years old were screened for febrile rash illnesses at five Karachi hospitals. Active measles cases were classified as measles, measles with eye and mouth complications, or severe complicated measles using IMCI criteria. RESULTS: Screening 1,219,061 patients over a 39-month period identified 3503 qualified children. Most (76.8%) measles cases occurred in children under five years of age. The average annual incidence rate was 0.68 per 1000 in year 1; 0.19 in year 2 and 0.08 in year 3 of surveillance. Pneumonia and diarrhoea were the most common complications. Of 18.1% hospitalized, 1.6% died. Of 2286 children tested, 1599 (69.9%) were measles IgM positive. Of 542 measles IgM negative children, 66 (12%) were dengue IgM positive. The predictive positive value for the IMCI case definition was 75%. CONCLUSION: The IMCI case definitions for measles is reasonable but may overestimate measles incidence. Measles continues to be a public health problem in Pakistan; increased efforts to control measles are urgently needed. Language: English Keywords: PAKISTAN | RESEARCH REPORT | EPIDEMIOLOGY | VALIDITY | INCIDENCE | MEASLES | MANAGEMENT | PROGRAM EVALUATION | Developing Countries | Asia, Southern | Asia | Public Health | Health | Measurement | Research Methodology | Viral Diseases | Diseases | Organization and Administration | Programs Document Number: 342103 |
| 19. Title: Knowledge of emergency contraception among women of childbearing age at a teaching hospital of Karachi. Author: Irfan F; Karim SI; Hashmi S; Ali S; Ali SA Source: JPMA. Journal of the Pakistan Medical Association. 2009 Apr;59(4):235-40. Abstract: OBJECTIVES: To assess knowledge and attitudes about Emergency Contraception among women of childbearing age in Karachi, Pakistan. METHODS: A questionnaire based survey was conducted on 400 married women, attending the family practice clinics at a teaching hospital in Karachi, Pakistan from July to December 2006. Questionnaire was administered to women at the family practice clinic-seeking level of knowledge of emergency contraception (EC) and attitudes towards its use, Ethical requirements of informed consent and confidentiality were ensured Data was entered into Epi data and analyzed in SPSS. RESULTS: Eighty-eight percent of women were not aware of EC. 83% were housewives. Only a small number (11.5%) ever used EC to prevent pregnancy, out of those, the correct timing of effectiveness of post-coital pill was known to only 40% of women while none of these women were aware of the existence of Intra Uteriune Contraceptive Device (IUCD) insertion as an option for EC About 50% of women identified general practitioners or family medicine clinics as their main sources of knowledge about EC. Increased advertising was considered desirable by 72% while 37% considered over the counter availability of EC pill desirable and only 36% of women were uncomfortable to use EC because of religious reasons. CONCLUSION: EC has a potential to offer women an important option for fertility control. Lack of women's knowledge about EC use and availability may account in part for its limited use. There is a need to improve women's education about EC. The primary health care providers can play a major role in informing their patients about emergency contraception. Language: English Keywords: PAKISTAN | RESEARCH REPORT | KAP SURVEYS | WOMEN IN DEVELOPMENT | KNOWLEDGE | EMERGENCY CONTRACEPTION | ATTITUDES | TIME FACTORS | CONTRACEPTIVE USAGE | IUD | ADVERTISING | PHARMACY DISTRIBUTION | CONTRACEPTIVE AVAILABILITY | RELIGION | Developing Countries | Asia, Southern | Asia | Surveys | Sampling Studies | Studies | Research Methodology | Economic Development | Economic Factors | Sociocultural Factors | Contraception | Family Planning | Psychological Factors | Behavior | Population Dynamics | Demographic Factors | Population | Contraceptive Methods | Promotion | Marketing | Nonclinical Distribution | Distributional Activities | Program Activities | Programs | Organization and Administration Document Number: 331281 |
| 20. Peer Reviewed Title: Verbal autopsy of maternal deaths in two districts of Pakistan--filling information gaps. Author: Jafarey SN; Rizvi T; Koblinsky M; Kureshy N Source: Journal of Health, Population, and Nutrition. 2009 Apr;27(2):170-83. Abstract: In Pakistan, the vital registration system is weak, and population-based data on the maternal mortality ratio are limited. This study was carried out to collect information on maternal deaths from different existing sources during the current year-2007 (prospective) and the past two years--2005 and 2006-(retrospective), identify gaps in information, and critically analyze maternal deaths at the community and health-facility levels in two districts in Pakistan. The verbal autopsy questionnaire was administered to households where a maternal death had occurred. No single source had complete data on maternal deaths. Risk factors identified among 128 deceased women were low socioeconomic status, illiteracy, low-earning jobs, parity, and bad obstetric history. These were similar to the findings of earlier studies. Half of the women did seek antenatal care, 34% having made more than four visits. Of the 104 women who died during or after delivery, 38% had delivered in a private facility and 18% in a government facility. The quality of services in both private and public sectors was inadequate. Sixty-nine percent of deaths occurred in the postpartum period, and 51% took place within 24 hours of delivery. The study identified gaps in reporting of maternal deaths and also provided profile of the dead women and the causes of death. Language: English Keywords: PAKISTAN | RESEARCH REPORT | MATERNAL MORTALITY | CAUSES OF DEATH | RISK FACTORS | AUTOPSY | DEATH RECORDS | SOCIOECONOMIC STATUS | PREGNANCY COMPLICATIONS | PREGNANCY OUTCOMES | UTILIZATION OF HEALTH CARE | Developing Countries | Asia, Southern | Asia | Mortality | Population Dynamics | Demographic Factors | Population | Health | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Vital Statistics | Population Statistics | Research Methodology | Socioeconomic Factors | Economic Factors | Diseases | Pregnancy | Reproduction Document Number: 341936 |
| 21. Title: Determinants of low birth weight in urban Pakistan. Author: Janjua NZ; Delzell E; Larson RR; Meleth S; Kristensen S; Kabagambe E; Sathiakumar N Source: Public Health Nutrition. 2009 Jun;12(6):789-98. Abstract: OBJECTIVE: To identify determinants of low birth weight (LBW) in Karachi, Pakistan, including environmental exposures and nutritional status of the mother during pregnancy. DESIGN: Cross-sectional study.ParticipantsFive hundred and forty mother-infant pairs. We interviewed mothers about obstetric history, diet and exposure to Pb. We measured birth weight and blood lead level (BLL). We performed multiple log binomial regression analysis to identify factors related to LBW. RESULTS: Of 540 infants, 100 (18.5 %) weighed Keywords: PAKISTAN | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | URBAN POPULATION | PREGNANCY | LOW BIRTH WEIGHT | ASCORBIC ACID | NUTRITION INDEXES | Developing Countries | Asia, Southern | Asia | Research Methodology | Population Characteristics | Demographic Factors | Population | Reproduction | Birth Weight | Body Weight | Physiology | Biology | Vitamins and Minerals | Nutrition | Health Document Number: 342264 |
| 22. Peer Reviewed Title: Neonatal mortality, risk factors and causes: a prospective population-based cohort study in urban Pakistan. Author: Jehan I; Harris H; Salat S; Zeb A; Mobeen N; Pasha O; McClure EM; Moore J; Wright LL; Goldenberg RL Source: Bulletin of the World Health Organization. 2009 Feb;87(2):130-8. Abstract: OBJECTIVE: To evaluate the prevalence, sex distribution and causes of neonatal mortality, as well as its risk factors, in an urban Pakistani population with access to obstetric and neonatal care. METHODS: Study area women were enrolled at 20-26 weeks' gestation in a prospective population-based cohort study that was conducted from 2003 to 2005. Physical examinations, antenatal laboratory tests and anthropometric measures were performed, and gestational age was determined by ultrasound to confirm eligibility. Demographic and health data were also collected on pretested study forms by trained female research staff. The women and neonates were seen again within 48 hours postpartum and at day 28 after the birth. All neonatal deaths were reviewed using the Pattinson et al. system to assign obstetric and final causes of death; the circumstances of the death were determined by asking the mother or family and by reviewing hospital records. Frequencies and rates were calculated, and 95% confidence intervals were determined for mortality rates. Relative risks were calculated to evaluate the associations between potential risk factors and neonatal death. Logistic regression models were used to compute adjusted odds ratios. FINDINGS: Birth outcomes were ascertained for 1280 (94%) of the 1369 women enrolled. The 28-day neonatal mortality rate was 47.3 per 1000 live births. Preterm birth, Caesarean section and intrapartum complications were associated with neonatal death. Some 45% of the deaths occurred within 48 hours and 73% within the first week. The primary obstetric causes of death were preterm labour (34%) and intrapartum asphyxia (21%). Final causes were classified as immaturity-related (26%), birth asphyxia or hypoxia (26%) and infection (23%). Neither delivery in a health facility nor by health professionals was associated with fewer neonatal deaths. The Caesarean section rate was 19%. Almost all (88%) neonates who died received treatment and 75% died in the hospital. CONCLUSION: In an urban population with good access to professional care, we found a high neonatal mortality rate, often due to preventable conditions. These results suggest that, to decrease neonatal mortality, improved health service quality is crucial. Language: English Keywords: PAKISTAN | RESEARCH REPORT | PROSPECTIVE STUDIES | URBAN POPULATION | NEONATAL MORTALITY | RISK FACTORS | PREVALENCE | PREMATURE LABOR | CESAREAN SECTION | CAUSES OF DEATH | MATERNAL-CHILD HEALTH SERVICES | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Infant Mortality | Mortality | Population Dynamics | Health | Measurement | Pregnancy Outcomes | Pregnancy | Reproduction | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Primary Health Care Document Number: 341787 |
| 23. Title: The hidden figure: sexual intimate partner violence among Pakistani women. Author: Kapadia MZ; Saleem S; Karim MS Source: European Journal of Public Health. 2009 Aug 7; Abstract: BACKGROUND: The objectives of the present study were to determine the magnitude and factors associated with sexual intimate partner violence (SIPV) in women presenting to tertiary-care hospitals of Karachi, Pakistan. METHODS: Five hundred women who presented to four tertiary-care hospitals to deliver were interviewed from September to December 2005. SIPV was assessed by using questions on sexual abuse in WHO Domestic Violence Module designed to determine intimate partner violence. Multiple logistic regression analysis was applied to determine factors associated with SIPV. RESULTS: Twenty-one percent of women reported experiencing sexual violence in their married life. Gravida with five or more pregnancies [adjusted odds ratio (AOR) = 2.78; 95% confidence interval (CI) 1.12-6.96], index pregnancy as unwanted (AOR = 2.64; CI 1.16-6.02) and conflict with in-laws (AOR 1.9 CI 1.14-3.16) were independently associated with sexual abuse. Women who had social support were less likely to be abused by their intimate partners (AOR 0.76; CI 0.58-0.98). CONCLUSION: One in five women reported spousal sexual abuse in their married life. Women having more than five children, unwanted pregnancies or reporting differences with in-laws are more likely to be subjected to such abuse. Social support protects women from sexual abuse by intimate partner. Language: English Keywords: DEVELOPING COUNTRIES | PAKISTAN | RESEARCH REPORT | WOMEN | CLIENTS | TERTIARY SECTOR | HOSPITALS | DOMESTIC VIOLENCE | RISK FACTORS | SEXUAL ABUSE | SOCIAL PROTECTION | Asia, Southern | Asia | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | Macroeconomic Factors | Economic Factors | Health Facilities | Delivery of Health Care | Health | Crime | Social Problems | Sociocultural Factors | Political Factors Document Number: 342536 |
| 24. Title: HIV and homosexuality in Pakistan [letter] Author: Khan A Source: Lancet Infectious Diseases. 2009 Apr;9(4):204; author reply 205-6. Abstract: Language: English Keywords: PAKISTAN | CRITIQUE | SEX WORKERS | HOMOSEXUALS | SEXUALITY | HIV INFECTIONS | PROMOTION | CRIME | Developing Countries | Asia, Southern | Asia | Sex Behavior | Behavior | Personality | Psychological Factors | Viral Diseases | Diseases | Marketing | Economic Factors | Social Problems | Sociocultural Factors Document Number: 341023 |
| 25. Title: Care seeking for STI symptoms in Pakistan. Author: Khan AA; Naghma-e-Rehan; Qayyum K; Khan A Source: JPMA. Journal of the Pakistan Medical Association. 2009 Sep;59(9):628-30. Abstract: OBJECTIVE: To estimate the frequency of Sexually Transmitted Infections (STIs) among sex workers and drug users in Pakistan. METHODS: Interviews were conducted on 3640 sex workers, injection drug users and truckers about STI symptoms within the past year and currently and the care they sought for them. RESULTS: Nearly half (46%) reported STI symptoms in the past 12 months and 55% went for treatment. Most of the care sought was from the private sector and more by IDUs and female sex workers. Increasing age or having a genital ulcer predicted care seeking. CONCLUSIONS: The results suggest the need to understand the factors determining care seeking among members of high risk groups; and emphasizing the role of the private health care providers in treatment and control of STIs. Language: English Keywords: PAKISTAN | RESEARCH REPORT | INTERVIEWS | SEX WORKERS | WOMEN | IV DRUG USERS | TRUCK DRIVERS | SEXUALLY TRANSMITTED DISEASES | SIGNS AND SYMPTOMS | TREATMENT | Developing Countries | Asia, Southern | Asia | Data Collection | Research Methodology | Sex Behavior | Behavior | Demographic Factors | Population | Drug Use and Abuse | Labor Force | Human Resources | Economic Factors | Reproductive Tract Infections | Infections | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 342954 |
| 26. Title: HIV and homosexuality in Pakistan [letter] Author: Khan FH Source: Lancet Infectious Diseases. 2009 Apr;9(4):204-5; author reply 205-6. Abstract: Language: English Keywords: PAKISTAN | CRITIQUE | MEN | HOMOSEXUALS | MEN HAVING SEX WITH MEN | SEXUALITY | CONDOM USE | LEGISLATION | SEX BEHAVIOR | Developing Countries | Asia, Southern | Asia | Demographic Factors | Population | Behavior | Personality | Psychological Factors | Risk Reduction Behavior | Political Factors | Sociocultural Factors Document Number: 341022 |
| 27. Peer Reviewed Title: Protecting the unprotected: mixed-method research on drug use, sex work and rights in Pakistan's fight against HIV/AIDS. Author: Mayhew S; Collumbien M; Qureshi A; Platt L; Rafiq N; Faisel A; Lalji N; Hawkes S Source: Sexually Transmitted Infections. 2009 Apr;85(Suppl 2):ii31-ii36. Abstract: Objectives: To investigate the nature and extent of human rights abuses against three vulnerable groups (injecting drug users (IDUs) and male and female sex workers), to understand the social and sexual linkages between them and to examine how protecting their rights could enhance the impact of HIV prevention policies. Methods: In-depth interviews were carried out with 38 high-risk respondents (IDUs and female, male and transgender sex workers) and a bio-behavioural survey was performed of 813 IDU/sex worker respondents in Rawalpindi. Results: People in all vulnerable groups interacted both sexually and socially. All groups experienced human rights abuses by state and non-state actors which increased their HIV risk. Non-state actors, including relations and sex worker clients, are responsible for verbal, physical and sexual violence. State actors (particularly police) perpetrate harassment, exploitation and abuse of all vulnerable groups with impunity. Health service providers fail to provide adequate services for vulnerable groups. Conclusions: High levels of discrimination and abuse of human dignity of all groups studied were revealed. This violates their physical and mental integrity and also leads to an increased risk of HIV. The sexual and social interactions between groups mean that human rights abuses experienced by one high-risk group can increase the risk of HIV both for them and other groups. The protection of human rights needs to become an integral part of a multisector response to the risk of HIV/AIDS by state and non-state agencies. The Government of Pakistan should work at both legal and programme levels to protect the rights of, and minimise discrimination against, groups vulnerable to HIV in order to reduce the potential for the spread of HIV before the epidemic takes hold. Language: English Keywords: PAKISTAN | METHODOLOGICAL STUDIES | KAP SURVEYS | SEX WORKERS | SOCIAL NETWORKS | IV DRUG USERS | POLICE | SEX BEHAVIOR | STIGMA | DRUG USE AND ABUSE | HUMAN RIGHTS | SOCIAL DISCRIMINATION | HIV PREVENTION | RISK BEHAVIOR | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Surveys | Sampling Studies | Behavior | Friends and Relatives | Family and Household | Sociocultural Factors | Corrections Officers | Government | Political Factors | Social Problems | HIV Infections | Viral Diseases | Diseases Document Number: 340115 |
| 28. Peer Reviewed Title: STI prevalence and associated factors among urban men in Pakistan. Author: Mir AM; Wajid A; Reichenbach L; Khan M Source: Sexually Transmitted Infections. 2009 Jun;85(3):199-200. Abstract: OBJECTIVES: To measure the prevalence of selected sexually transmitted infections (STIs) among urban men in Pakistan and identify associated factors. METHODS: A cross-sectional survey of 2400 urban men aged 16-45 years was carried out in six cities of Pakistan. Respondents were selected through a multistage systematic sampling design. After obtaining informed consent a structured behavioural questionnaire was administered. Blood and urine samples were also collected and tested for HIV (ELISA), HSV-2 (ELISA) syphilis (RPR and TPHA), chlamydia (PCR) and gonorrhoea (PCR). RESULTS: Of the 2383 respondents whose results were received, 4.4% (n = 106) tested positive for at least one of the five STIs. The prevalence of the individual organisms was as follows: syphilis, 1.3%; HIV, 0.1%; HSV-2, 3.4%; gonorrhoea, 0.8% and chlamydia, no cases. City-wise, the highest prevalence was in Karachi (8.5%) followed by Lahore (5.3%), Faisalabad (4.0%) Quetta (4.3%), Rawalpindi (2.5%) and Peshawar (2.0%). At the univariate and multivariate level, older age, less schooling, and having more than four sexual partners were significantly associated with the presence of an STI. 92% of men who tested positive for any STI were asymptomatic. CONCLUSIONS: HIV prevalence in Pakistan remains low, however, the emergence of genital herpes is a matter of concern as it could lead to a future conduit for HIV spread. Health education messages should target less educated segments of society and specifically advocate safe sex practices and early diagnosis. Language: English Keywords: PAKISTAN | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | PREVALENCE | URBAN POPULATION | MEN | RESPONDENTS | LABORATORY PROCEDURES | SEXUALLY TRANSMITTED DISEASES | HERPES GENITALIS | EXAMINATIONS AND DIAGNOSES | TESTING | Developing Countries | Asia, Southern | Asia | Research Methodology | Measurement | Population Characteristics | Demographic Factors | Population | Surveys | Sampling Studies | Studies | Laboratory Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Reproductive Tract Infections | Infections | Diseases Document Number: 342670 |
| 29. Peer Reviewed Title: Does sex of children matter? Implications for fertility in Pakistan. Author: Muhammad A Source: Journal of Biosocial Science. 2009 Jan;41(1):39-50. Abstract: Preference for children of either sex is considered a constraint on fertility decline as it induces many couples to keep adding on surviving children in the hope of having a desired sex composition of children. However, preferences for children of a particular sex may differ in relation to demographic and socioeconomic characteristics of women, traditional values and cultural practices, such as propagating a family name, providing economic advantages, and obtaining a medium of social and economic security in times of illness, unemployment and old age. Utilizing the Pakistan Integrated Household Survey (2001-02), this paper aims at investigating the existence of sex preference and examines sex preference differentials by different attributes of women in Pakistan. The results reveal that there is a desire to have another child in the presence of all children of one sex, either sons or daughters. The desire to have a son with only or mostly daughters, however, is stronger than the desire to have a daughter with only or mostly sons. This behaviour will retard fertility decline unless there is a shift in the desire to have children of both sexes in Pakistan. Language: English Keywords: PAKISTAN | RESEARCH REPORT | SURVEYS | SONS | DAUGHTERS | SEX PREFERENCE | REPRODUCTIVE BEHAVIOR | FERTILITY DECLINE | Developing Countries | Asia, Southern | Asia | Sampling Studies | Studies | Research Methodology | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Value Orientation | Psychological Factors | Behavior | Fertility | Population Dynamics | Demographic Factors | Population | Fertility Changes Document Number: 330511 |
| 30. Peer Reviewed Title: Prevalence of HIV, HCV and sexually transmitted infections among injecting drug users in Rawalpindi and Abbottabad, Pakistan: evidence for an emerging injection-related HIV epidemic. Author: Platt L; Vickerman P; Collumbien M; Hasan S; Lalji N; Mayhew S; Muzaffar R; Andreasen A; Hawkes S Source: Sexually Transmitted Infections. 2009 Apr;85(Suppl 2):ii17-ii22. Abstract: Objectives: To measure the prevalence of hepatitis C virus (HCV), HIV and sexually transmitted infections (STI) among injecting drug users (IDUs) in Rawalpindi and Abbottabad and to examine risk factors associated with HIV and HCV. Methods: Two cross-sectional surveys were performed of community-recruited IDUs with collection of clinical specimens for testing of HCV, HIV and other STIs. Behavioural data were collected through intervieweradministered questionnaires. Characteristics and risk behaviours were compared across cities. Univariate and multivariate analyses explored risk factors associated with HIV and HCV. Results: The prevalence of HIV was 2.6% (95% CI 0.83% to 4.5%) in Rawalpindi (n=302) and zero in Abbottabad (n=102). The prevalence of HCV was significantly higher in Rawalpindi at 17.3% (95% CI 13.0% to 21.6%) than in Abbottabad at 8% (95% CI 2.6% to 13.4%). The prevalence of other STIs was low in both cities, with ,2% of participants having current gonorrhoea or Chlamydia and ,3% with active syphilis. Injecting risk behaviours were greater in Rawalpindi. An increased risk of HCV was associated with using informal sources as a main source of new needles/syringes (OR 2.8, 95% CI 1.3 to 6.0) compared with pharmacies and a history of drug treatment (OR 3.7, 95% CI 0.9 to 11.6). Reporting symptoms of an STI was associated with decreased odds of HIV in Rawalpindi (OR 0.02, 95% CI 0.03 to 0.9). Conclusions: The findings suggest recent transmission of HIV and HCV and point to the urgent need for the provision of clean needles/syringes to IDUs and a review of how needles/syringes are currently provided via healthcare establishments. Language: English Keywords: PAKISTAN | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | CROSS SECTIONAL ANALYSIS | MULTIVARIATE ANALYSIS | IV DRUG USERS | PERSONS LIVING WITH HIV/AIDS | PREVALENCE | HIV INFECTIONS | HEPATITIS | SEXUALLY TRANSMITTED DISEASES | RISK BEHAVIOR | Developing Countries | Asia, Southern | Asia | Research Methodology | Data Analysis | Drug Use and Abuse | Behavior | Viral Diseases | Diseases | Measurement | Reproductive Tract Infections | Infections Document Number: 340117 |
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