Background: While Pakistan’s Programmatic Management of Drug-Resistant Tuberculosis (PMDT) progra... more Background: While Pakistan’s Programmatic Management of Drug-Resistant Tuberculosis (PMDT) programme, launched in 2010, initially yielded significant gains in treatment outcomes, performance has since plateaued, and in some cases, regressed.Objective: To critically investigate why the PMDT programme, well-structured and generously resourced as it is, could not improve upon or sustain this early success and to illustrate the use of practice theory as a framework to analyse functioning of health systems.Method: A practice theory-informed ethnographic study was conducted at three PMDT clinics. The analysis drew on 9 months of participant observation and in-depth interviews with 13 healthcare providers and four managers.Results: The PMDT model primarily focused on materialities such as infrastructure, drugs and numbers of people tested, and little on developing competencies of the PMDT staff to provide responsive care. This emphasis on materialities, and the linked focus of accountabili...
International journal of health policy and management, Jan 28, 2023
Background: Non-adherence to treatment is a frequently observed phenomenon amongst those on long-... more Background: Non-adherence to treatment is a frequently observed phenomenon amongst those on long-term treatment for chronic illnesses. This qualitative study draws upon the tenets of 'practice theory' to reveal what shapes patients' ability to adhere to the demanding treatment for drug-resistant tuberculosis (DR-TB) at three treatment sites in Khyber-Pakhtunkhwa (KP) province of Pakistan. Methods: This qualitative study involved observation of service provision over a period of nine months of stay at, and embedment within the three treatment sites and in-depth interviews with 13 service providers and 22 patients who became non-adherent to their treatment. Results: Consistent with the extensive research based on the barriers and facilitator approach, both patients, and providers in our study also talked of patients' doubts about diagnosis and treatment efficacy, side-effects of drugs, economic constraints, unreliable disbursements of monetary incentive, attitude of providers and co-morbidities as reasons for nonadherence to treatment. Applying a practice theory perspective yielded more contextualised insights; inadequate help with patients' physical complaints, unempathetic responses to their queries, and failure to provide essential information, created conditions which hindered the establishment and maintenance of the 'practice' of adhering to treatment. These supply-side gaps created confusion, bred resentment, and exacerbated pre-existing distrust of public health services among patients, and ultimately drove them to disengage with the TB services and stop their treatment. Conclusion: We argue that the lack of supply-side 'responsiveness' to patient needs beyond the provision of a few material inputs is what is lacking in the existing DR-TB program in Pakistan. We conclude that unless Pakistan's TB program explicitly engages with these supply side, system level gaps, patients will continue to struggle to adhere to their treatments and the TB program will continue to lose patients. Conceptually, we make a case for reimagining the act of adherence (or not) to long-term treatment as a 'Practice. '
Background and Objective: The epidemiology of central line-associated bloodstream infections in A... more Background and Objective: The epidemiology of central line-associated bloodstream infections in Al Noor Hospital Specialist Hospital has not previously been reported. We sought to describe time-trends in central line-associated bloodstream infections rates, etiology, and responsible pathogens for the period January 1, 2016-December 31, 2018. Materials and Methods: All 120 patients age 18 years and older admitted to all departments of a Tertiary Hospital who had double lumen catheters inserted during the study period were followed up and monitored for central line-associated bloodstream infections. Results: From 120 patients who had a central venous catheter inserted, 20 developed blood infections. The catheterization duration was significantly longer with approximately 11 days among the infected against 6 days in non-infected. The most frequently isolated organism was Klebsiella pneumonieae. The infection rate recorded were 30.67, 23.06, and 16.39 per 1000 catheter days in 2016, 201...
Innovative Journal of Medical and Health Science, 2019
Background: Tuberculosis (TB) has existed for millennia and remains a major global health problem... more Background: Tuberculosis (TB) has existed for millennia and remains a major global health problem. Although it may be assumed that in general health care workers (HCWs) know about MDR-TB and its implications, several studies from around the globe have found that HCWs do not always exhibit sufficient knowledge, positive attitudes, and acceptable practices regarding preventing and treating MDR-TB. Methods: A cross sectional study was conducted by means of self-administered semi structured questionnaires that was provided to health care workers of NRH from March 10 to April 2, 2017. Using convenient sampling technique, from 155 health professionals’ 140 individuals returned the questionnaires. The data was analyzed using SPSS version 20. Descriptive statistics was used to determine frequency and percentage. Chi-square test was used to identify the relationships between dependent and independent variables (P<0.05 and 95% CI). Results: The mean age of participants was 30.76+6.42 years...
Journal of Ayub Medical College, Abbottabad : JAMC
HIV is an epidemic quite unlike any other, combining the problems of a lifelong medical disease w... more HIV is an epidemic quite unlike any other, combining the problems of a lifelong medical disease with immense social, psychological, economic and public health consequences. Since we are living in a global village where human interactions has become fast and frequent, diseases like HIV are no more alien to us. HIV/AIDS in Pakistan is slowly gaining recognition as a public health issue of great importance. Objectives of this study were to determine the prevalence of HIV in pregnant women identified with a high risk factor/behaviour at a tertiary care hospital. It is a Descriptive study. All pregnant women attending antenatal booking clinic were assessed via a pre-designed 'Risk assessment questionnaire'. Women identified with a risk factor were offered HIV Rapid screening test (Capillus HIV1/2). Positive (reactive) results on screening test were confirmed with ELISA. During the study period (March 2007-May 2008), out of 5263 antenatal bookings 785 (14%) women were identified w...
OBJECTIVE: To describe and quantify patients’ self-reported experiences of receiving healthcare f... more OBJECTIVE: To describe and quantify patients’ self-reported experiences of receiving healthcare from Pakistan’s Programmatic Management of Drug-Resistant Tuberculosis (PMDT) model of care, and to understand these experiences within the broader context of Pakistan’s health system.METHOD: This was a cross-sectional survey of patients attending three PMDT clinics in Khyber-Pakhtunkhwa Province in Pakistan.RESULTS: The median consultation time at the PMDT clinics was 10 minutes. In their most recent visit to the PMDT clinic, 34.9% of patients spent >40% of their monthly income to access treatment. To specify, 71% of patients reported spending out-of-pocket for ancillary medicines and 44.7% for laboratory tests. In 10.5% of cases, medicines for drug-resistant TB (DR-TB) were dispensed without the patient attending the clinic. Only 43.7% of treatment supporters regularly accompanied patients to the clinic, and 6% supervised the patient’s intake of medicines. Disbursement of financial s...
International Journal of Medical Research and Health Sciences, 2018
Objective: To describe contextual factors leading to a Needle stick injury (NSI) event; highlight... more Objective: To describe contextual factors leading to a Needle stick injury (NSI) event; highlight challenges faced by hospital employee that increase their vulnerabilities to such an exposure; and identify solutions to prevent future occurrence of these events. Methods: The study was conducted at a tertiary care hospital in Makkah, Saudi Arabia. Twenty in-depth semi-structured interviews with hospital staff who experienced a NSI were carried out aiming to understand system gaps preventing reduction in the incidence of NSI and assess the quality of healthcare provided after such an event. Data was analyzed using thematic analysis. Results are described under four key themes that emerged during analysis including: training on safe handling of sharps; environmental details at the time of NSI; processes followed the incident; employees’ awareness about hospital’s NSI policy. Results: Majority NSI incidents (80%) occurred in emergency room. Causative factors identified leading to a NSI i...
Background: Owing to the nature of their work, sanitary workers in healthcare settings are at an ... more Background: Owing to the nature of their work, sanitary workers in healthcare settings are at an increased risk of acquiring blood borne infections. The purpose of this study was to assess the knowledge, attitude and practices of sanitary staff working in a tertiary care hospital in Saudi Arabia towards the two most common infectious diseases (HIV and Hepatitis B,C) that they may acquire while handling hospital waste. Method: Using a pre-designed, pretested questionnaire this cross-sectional survey was conducted between September 2015 till January 2016. Results: The results revealed only 50% of the participants possessed adequate knowledge about HIV and hepatitis (B,C). Slightly more than half had clear idea of blood and body fluids as possible sources of HIV and Hep (B,C) transmission. A high number of participants believed shaking hands, sharing toilets and contaminated water can transmit these infections. Regarding attitudes, majority expressed negative attitudes such as shame an...
Background: Owing to the nature of their work, sanitary workers in healthcare settings are at an ... more Background: Owing to the nature of their work, sanitary workers in healthcare settings are at an increased risk of acquiring blood borne infections. The purpose of this study was to assess the knowledge, attitude and practices of sanitary staff working in a tertiary care hospital in Saudi Arabia towards the two most common infectious diseases (HIV and Hepatitis B,C) that they may acquire while handling hospital waste. Method: Using a pre-designed, pre-tested questionnaire this cross-sectional survey was conducted between September 2015 till January 2016. Results: The results revealed only 50% of the participants possessed adequate knowledge about HIV and hepatitis (B,C). Slightly more than half had clear idea of blood and body fluids as possible sources of HIV and Hep (B,C) transmission. A high number of participants believed shaking hands, sharing toilets and contaminated water can transmit these infections. Regarding attitudes, majority expressed negative attitudes such as shame a...
Background: While Pakistan’s Programmatic Management of Drug-Resistant Tuberculosis (PMDT) progra... more Background: While Pakistan’s Programmatic Management of Drug-Resistant Tuberculosis (PMDT) programme, launched in 2010, initially yielded significant gains in treatment outcomes, performance has since plateaued, and in some cases, regressed.Objective: To critically investigate why the PMDT programme, well-structured and generously resourced as it is, could not improve upon or sustain this early success and to illustrate the use of practice theory as a framework to analyse functioning of health systems.Method: A practice theory-informed ethnographic study was conducted at three PMDT clinics. The analysis drew on 9 months of participant observation and in-depth interviews with 13 healthcare providers and four managers.Results: The PMDT model primarily focused on materialities such as infrastructure, drugs and numbers of people tested, and little on developing competencies of the PMDT staff to provide responsive care. This emphasis on materialities, and the linked focus of accountabili...
International journal of health policy and management, Jan 28, 2023
Background: Non-adherence to treatment is a frequently observed phenomenon amongst those on long-... more Background: Non-adherence to treatment is a frequently observed phenomenon amongst those on long-term treatment for chronic illnesses. This qualitative study draws upon the tenets of 'practice theory' to reveal what shapes patients' ability to adhere to the demanding treatment for drug-resistant tuberculosis (DR-TB) at three treatment sites in Khyber-Pakhtunkhwa (KP) province of Pakistan. Methods: This qualitative study involved observation of service provision over a period of nine months of stay at, and embedment within the three treatment sites and in-depth interviews with 13 service providers and 22 patients who became non-adherent to their treatment. Results: Consistent with the extensive research based on the barriers and facilitator approach, both patients, and providers in our study also talked of patients' doubts about diagnosis and treatment efficacy, side-effects of drugs, economic constraints, unreliable disbursements of monetary incentive, attitude of providers and co-morbidities as reasons for nonadherence to treatment. Applying a practice theory perspective yielded more contextualised insights; inadequate help with patients' physical complaints, unempathetic responses to their queries, and failure to provide essential information, created conditions which hindered the establishment and maintenance of the 'practice' of adhering to treatment. These supply-side gaps created confusion, bred resentment, and exacerbated pre-existing distrust of public health services among patients, and ultimately drove them to disengage with the TB services and stop their treatment. Conclusion: We argue that the lack of supply-side 'responsiveness' to patient needs beyond the provision of a few material inputs is what is lacking in the existing DR-TB program in Pakistan. We conclude that unless Pakistan's TB program explicitly engages with these supply side, system level gaps, patients will continue to struggle to adhere to their treatments and the TB program will continue to lose patients. Conceptually, we make a case for reimagining the act of adherence (or not) to long-term treatment as a 'Practice. '
Background and Objective: The epidemiology of central line-associated bloodstream infections in A... more Background and Objective: The epidemiology of central line-associated bloodstream infections in Al Noor Hospital Specialist Hospital has not previously been reported. We sought to describe time-trends in central line-associated bloodstream infections rates, etiology, and responsible pathogens for the period January 1, 2016-December 31, 2018. Materials and Methods: All 120 patients age 18 years and older admitted to all departments of a Tertiary Hospital who had double lumen catheters inserted during the study period were followed up and monitored for central line-associated bloodstream infections. Results: From 120 patients who had a central venous catheter inserted, 20 developed blood infections. The catheterization duration was significantly longer with approximately 11 days among the infected against 6 days in non-infected. The most frequently isolated organism was Klebsiella pneumonieae. The infection rate recorded were 30.67, 23.06, and 16.39 per 1000 catheter days in 2016, 201...
Innovative Journal of Medical and Health Science, 2019
Background: Tuberculosis (TB) has existed for millennia and remains a major global health problem... more Background: Tuberculosis (TB) has existed for millennia and remains a major global health problem. Although it may be assumed that in general health care workers (HCWs) know about MDR-TB and its implications, several studies from around the globe have found that HCWs do not always exhibit sufficient knowledge, positive attitudes, and acceptable practices regarding preventing and treating MDR-TB. Methods: A cross sectional study was conducted by means of self-administered semi structured questionnaires that was provided to health care workers of NRH from March 10 to April 2, 2017. Using convenient sampling technique, from 155 health professionals’ 140 individuals returned the questionnaires. The data was analyzed using SPSS version 20. Descriptive statistics was used to determine frequency and percentage. Chi-square test was used to identify the relationships between dependent and independent variables (P<0.05 and 95% CI). Results: The mean age of participants was 30.76+6.42 years...
Journal of Ayub Medical College, Abbottabad : JAMC
HIV is an epidemic quite unlike any other, combining the problems of a lifelong medical disease w... more HIV is an epidemic quite unlike any other, combining the problems of a lifelong medical disease with immense social, psychological, economic and public health consequences. Since we are living in a global village where human interactions has become fast and frequent, diseases like HIV are no more alien to us. HIV/AIDS in Pakistan is slowly gaining recognition as a public health issue of great importance. Objectives of this study were to determine the prevalence of HIV in pregnant women identified with a high risk factor/behaviour at a tertiary care hospital. It is a Descriptive study. All pregnant women attending antenatal booking clinic were assessed via a pre-designed 'Risk assessment questionnaire'. Women identified with a risk factor were offered HIV Rapid screening test (Capillus HIV1/2). Positive (reactive) results on screening test were confirmed with ELISA. During the study period (March 2007-May 2008), out of 5263 antenatal bookings 785 (14%) women were identified w...
OBJECTIVE: To describe and quantify patients’ self-reported experiences of receiving healthcare f... more OBJECTIVE: To describe and quantify patients’ self-reported experiences of receiving healthcare from Pakistan’s Programmatic Management of Drug-Resistant Tuberculosis (PMDT) model of care, and to understand these experiences within the broader context of Pakistan’s health system.METHOD: This was a cross-sectional survey of patients attending three PMDT clinics in Khyber-Pakhtunkhwa Province in Pakistan.RESULTS: The median consultation time at the PMDT clinics was 10 minutes. In their most recent visit to the PMDT clinic, 34.9% of patients spent >40% of their monthly income to access treatment. To specify, 71% of patients reported spending out-of-pocket for ancillary medicines and 44.7% for laboratory tests. In 10.5% of cases, medicines for drug-resistant TB (DR-TB) were dispensed without the patient attending the clinic. Only 43.7% of treatment supporters regularly accompanied patients to the clinic, and 6% supervised the patient’s intake of medicines. Disbursement of financial s...
International Journal of Medical Research and Health Sciences, 2018
Objective: To describe contextual factors leading to a Needle stick injury (NSI) event; highlight... more Objective: To describe contextual factors leading to a Needle stick injury (NSI) event; highlight challenges faced by hospital employee that increase their vulnerabilities to such an exposure; and identify solutions to prevent future occurrence of these events. Methods: The study was conducted at a tertiary care hospital in Makkah, Saudi Arabia. Twenty in-depth semi-structured interviews with hospital staff who experienced a NSI were carried out aiming to understand system gaps preventing reduction in the incidence of NSI and assess the quality of healthcare provided after such an event. Data was analyzed using thematic analysis. Results are described under four key themes that emerged during analysis including: training on safe handling of sharps; environmental details at the time of NSI; processes followed the incident; employees’ awareness about hospital’s NSI policy. Results: Majority NSI incidents (80%) occurred in emergency room. Causative factors identified leading to a NSI i...
Background: Owing to the nature of their work, sanitary workers in healthcare settings are at an ... more Background: Owing to the nature of their work, sanitary workers in healthcare settings are at an increased risk of acquiring blood borne infections. The purpose of this study was to assess the knowledge, attitude and practices of sanitary staff working in a tertiary care hospital in Saudi Arabia towards the two most common infectious diseases (HIV and Hepatitis B,C) that they may acquire while handling hospital waste. Method: Using a pre-designed, pretested questionnaire this cross-sectional survey was conducted between September 2015 till January 2016. Results: The results revealed only 50% of the participants possessed adequate knowledge about HIV and hepatitis (B,C). Slightly more than half had clear idea of blood and body fluids as possible sources of HIV and Hep (B,C) transmission. A high number of participants believed shaking hands, sharing toilets and contaminated water can transmit these infections. Regarding attitudes, majority expressed negative attitudes such as shame an...
Background: Owing to the nature of their work, sanitary workers in healthcare settings are at an ... more Background: Owing to the nature of their work, sanitary workers in healthcare settings are at an increased risk of acquiring blood borne infections. The purpose of this study was to assess the knowledge, attitude and practices of sanitary staff working in a tertiary care hospital in Saudi Arabia towards the two most common infectious diseases (HIV and Hepatitis B,C) that they may acquire while handling hospital waste. Method: Using a pre-designed, pre-tested questionnaire this cross-sectional survey was conducted between September 2015 till January 2016. Results: The results revealed only 50% of the participants possessed adequate knowledge about HIV and hepatitis (B,C). Slightly more than half had clear idea of blood and body fluids as possible sources of HIV and Hep (B,C) transmission. A high number of participants believed shaking hands, sharing toilets and contaminated water can transmit these infections. Regarding attitudes, majority expressed negative attitudes such as shame a...
Uploads
Papers by shazra abbas