Suchergebnisse

CONTEXT: Pakistan lags far behind most developing countries in women's health and gender equity. Appropriateness of health care services vis-a-vis the gender specific cultural norms that influence clients' needs are not very visible and are more difficult to monitor. Programs and services need to be sensitively designed to facilitate women's access to physical and social needs. This paper narrates the experience of working with health providers from public and private sectors, community, local government representatives and community-based organizations. Through transformative learning, this endeavour focused on initiating a process of sensitization on gender related health issues for women. APPROACH: The initiative was primarily based on the use of the following two standardized tools: 'Health Workers for Change' for working with health providers and 'Initiating Women Empowerment for Health' for interacting with the community. Both tools focus primarily on women's health and social issues affecting their health status. The research methodology used was predominantly qualitative, using focus group discussions, participatory rural appraisal and interactive workshops. IMPLICATIONS: This approach endeavours to sensitize the health service providers to the health needs of female clients and encourages behavioural changes. Simultaneously, it creates an opportunity to raise awareness among women and the community in general regarding appropriate health-seeking behaviour and the timely use of health services. The information collected is evidence for policy makers regarding the gender-based problems faced by women who are seeking health care and it suggests how to overcome these problems.

Background Globally, around 2.6 million neonatal deaths occur world-wide every year and the numbers of stillbirths is almost similar. Pakistan is ranked among the highest countries in the world for neonatal mortality. In 2016, for every 1000 babies born in Pakistan, 46 died before the end of the first month of life. Also, Pakistan had the highest rate of stillbirths (43.1/1000 births) in 2015. To meet sustainable development (SDG) targets of reducing neonatal mortality and stillbirths, it is essential to gain understanding about the causes of neonatal death and stillbirths. In Pakistan, full autopsies are conducted only in medico-legal cases and are very rarely performed to identify a definitive cause of death (CoD) and because of cost and insufficient staff are generally not feasible. Recently, minimally invasive tissue sampling (MITS) has been used to determine CoD in neonates and stillbirths as it addresses some of the socio-cultural and religious barriers to autopsy. However, it is not known how families and communities will perceive this procedure; therefore, exploring family and healthcare professionals' perceptions regarding MITS is essential in determining acceptable and feasible approaches for Pakistan. Methods The study will employ an exploratory qualitative research design. The study will be conducted at the National Institute of Child Health (NICH) hospital of Karachi. The data collection method will consist of key-informant interviews (KIIs) and focus group discussions (FGDs). FGDs will be conducted with the families and relatives of newborns who are visiting the outpatient department (OPD) and well-baby clinics of NICH hospital. KIIs will be conducted with the NICH - medical director, healthcare providers, professionals involved in proceedings related to death and dying, religious leaders, health sector representatives from the government, public health experts, maternal and child health (MCH) specialists, obstetricians and neonatologists and experts from the bioethics committee. Study data will be analyzed using NVivo 10 software. Discussion The research will help explore specific cultural, religious and socio-behavioral factors that may increase or decrease the acceptability of MITS for identifying COD in neonates and stillbirths. The findings of the qualitative study will provide a better understanding of parents' and healthcare professionals' attitudes towards the use of MITS on neonatal deaths and stillborns.