Poor knowledge--predictor of nonadherence to universal precautions for blood borne pathogens at first level care facilities in Pakistan

Background: We conducted an assessment of knowledge about blood borne pathogens (BBP) and use of universal precautions at first level care facilities (FLCF) in two districts of Pakistan.Methods: We conducted a cross-sectional survey and selected three different types of FLCFs ; public, general practitioners and unqualified practitioners through stratified random sampling technique. At each facility, we interviewed a prescriber, a dispenser, and a housekeeper for knowledge of BBPs transmission and preventive practices, risk perception, and use of universal precautions. We performed multiple linear regression to assess the effect of knowledge score (11 items) on the practice of universal precautions score (4 items- use of gloves, gown, needle recapping, and HBV vaccination).Results: We interviewed 239 subjects. Most of the participants 128 (53%) were recruited from general practitioners clinics and 166 (69.5%) of them were dispensers. Mean (SD) knowledge score was 3.8 (2.3) with median of 4. MBBS prescribers had the highest knowledge score while the housekeepers had the lowest. Mean universal precautions use score was 2.7 +/- 2.1. Knowledge about mode of transmission and the work experience alone, significantly predicted universal precaution use in multiple linear regression model (adR2 = 0.093).CONCLUSION: Knowledge about mode of transmission of blood borne pathogens is very low. Use of universal precautions can improve with increase in knowledge

Assessing the impact of heat waves on childhood immunization coverage in Sindh, Pakistan: Insights from 132.4 million doses recorded in the provincial electronic immunization registry (2018-2024).

INTRODUCTION: Heat waves, intensified by climate change, are increasingly challenging health systems, particularly in low- and middle-income countries (LMICs). Pakistan, ranked among the top 10 most climate-vulnerable nations, faces significant challenges in maintaining routine immunization coverage rates amid soaring temperatures. This study examines the impact of heat waves on immunization delivery in Sindh Province of Pakistan, a region highly vulnerable to climate-induced disruptions. METHODS: We analyzed child-level data from the provincial electronic immunization registry for 132.4 million immunization doses administered between January 1, 2018, to July 31, 2024. We used the clustered panel univariate and multivariable Poisson and negative binomial regressions to analyze the association between high temperature alert days (33 °C to 39.9 °C) and heat waves (> 40 °C) and immunizations, by vaccination modality (fixed site, routine outreach, enhanced outreach). The analysis controlled for external shocks, such as floods, the COVID-19 pandemic, and vaccinators' strikes, and accounted for geographic and temporal variation. RESULTS: Heat waves and high temperature alert days (≥33 °C) significantly reduced immunizations, with routine and enhanced outreach activities being most affected (13.6 % and 21.2 % decline respectively). Fixed-site immunizations witnessed a comparatively lower decline i.e. 5.8 %. Rural Divisions Larkana and Sukkur were disproportionately affected, while Karachi exhibited minimal impact. Despite the negative impact of heat waves, immunization efforts intensified during external shocks like floods and the COVID-19 pandemic, particularly through prolonged and frequent outreach activities. DISCUSSION: Heat waves disrupted vaccine service delivery leading to reduced immunization coverage in Sindh, disproportionately affecting immunizations administered through outreach activities. Geographic and temporal variations highlight the need for localized strategies, including improved infrastructure, optimized outreach schedules, and robust vaccine cold chains. Future research should explore long-term adaptive strategies for maintaining vaccination coverage amid increasing impact of climate change, especially in low-resource settings

Integrating humanities in healthcare: a mixed-methods study for development and testing of a humanities curriculum for front-line health workers in Karachi, Pakistan

Lady health workers (LHWs) provide lifesaving maternal and child health services to >60% of Pakistan’s population but are poorly compensated and overburdened. Moreover, LHWs’ training does not incorporate efforts to nurture attributes necessary for equitable and holistic healthcare delivery. We developed an interdisciplinary humanities curriculum, deriving its strengths from local art and literature, to enhance character virtues such as empathy and connection, interpersonal communication skills, compassion and purpose among LHWs. We tested the curriculum’s feasibility and impact to enhance character strengths among LHWs. We conducted a multiphase mixed-methods pilot study in two towns of Karachi, Pakistan. We delivered the humanities curriculum to 48 LHWs via 12 weekly sessions, from 15 June to 2 September 2021. We developed a multiconstruct character strength survey that was administered preintervention and postintervention to assess the impact of the training. In-depth interviews were conducted with a subset of randomly selected participating LHWs. Of 48 participants, 47 (98%) completed the training, and 34 (71%) attended all 12 sessions. Scores for all outcomes increased between baseline and endline, with highest increase (10.0 points, 95% CI 2.91 to 17.02; p=0.006) observed for empathy/connection. LHWs provided positive feedback on the training and its impact in terms of improving their confidence, empathy/connection and ability to communicate with clients. Participants also rated the sessions highly in terms of the content’s usefulness (mean: 9.7/10; SD: 0.16), the success of the sessions (mean: 9.7/10; SD: 0.17) and overall satisfaction (mean: 8.2/10; SD: 3.3). A humanities-based training for front-line health workers is a feasible intervention with demonstrated impact of nurturing key character strengths, notably empathy/connection and interpersonal communication. Evidence from this study highlights the value of a humanities-based training, grounded in local literature and cultural values, that can ultimately translate to improved well-being of LHWs thus contributing to better health outcomes among the populations they serve

Estimating prevalence and identifying predictors of zero-dose pentavalent and never-immunized children under two years of age in Kashmore and Sujawal Districts of Sindh, Pakistan: An analysis of household survey data.

INTRODUCTION: Despite intensified global efforts to enhance immunization coverage, one in five children continue to miss out on life-saving vaccines, leaving them vulnerable to a range of vaccine-preventable diseases. In 2022, 14.3 million children failed to receive even a single dose of the pentavalent vaccine (Penta-1) by their first birthday, classified as "zero-dose penta". Additionally, some children have not received any vaccinations at all and have had no contact with healthcare services-these are referred to as "never-immunized" children. Collectively, both groups-zero-dose penta and never-immunized children-are termed "true zero-dose" to emphasize the critical need for targeted interventions that ensure no child is left behind in immunization efforts. METHODS: We conducted a household (HH) survey from August 10 to December 19, 2022, in Kashmore and Sujawal, two districts in Sindh, Pakistan, with low immunization coverage. The survey targeted children aged 12-23 months who had not received the Penta-1 vaccine by their first birthday. Our study aimed to determine the community-based prevalence of zero-dose penta and never-immunized children, compare their sociodemographic characteristics and immunization histories, and identify predictors of these outcomes. RESULTS: Of the 2,091 children surveyed, 497 (23.8%) were zero-dose penta, and 587 (28.1%) were never-immunized. Together, these groups constitute 51.9% of the survey population, referred to as 'true zero-dose'. The remaining 1,007 (48.1%) were either fully or partially immunized. Multivariate analysis indicated that absence of antenatal care (ANC) significantly increased the risk of children being classified as zero-dose penta (RRR = 1.68; 95% CI: 1.04-2.72; p < 0.035) and never-immunized (RRR = 2.07; 95% CI: 1.25-3.45; p < 0.005). Furthermore, the absence of Lady Health Worker (LHW) visits significantly increased the risk of children being classified as zero-dose penta (RRR = 2.55; 95% CI: 1.26-5.16; p < 0.009), and the absence of vaccinator visits significantly increased the risk of being never-immunized (RRR = 4.44; 95% CI: 2.68-7.36; p < 0.001). CONCLUSION: Despite global efforts for achieving universal immunization, half of the surveyed children remained true zero-dose, highlighting significant gaps in the ability of immunization programs to reach underserved communities. To address this issue, it is essential to enhance ANC coverage and leverage frontline health workers (FHWs) to identify and engage with clusters of zero-dose children effectively. These measures will ensure that no child is left behind, advancing health equity and safeguarding future generations

“A Quiet Giant in the Fight for Equity”—Hamidah Hussain

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