Background Pakistan has the highest rate of stillbirth (30.6 stillbirths per 1000 total births) as compared to other South Asian countries. The psychological impact of stillbirths on bereaved women is well documented; however, there is a dearth of literature on lived experiences of women with multiple stillbirths in Pakistan. Objective The purpose of this research is to understand the lived experiences of women who had multiple stillbirths in Thatta, Pakistan. Methods An interpretative phenomenological study was conducted in district Thatta with eight women who experienced more than one stillbirth. A semi-structured in-depth interview guide was used for data collection. The data were analyzed by using thematic analysis approach. Results The results of this study show that experiencing multiple stillbirths has a devastating impact on women’s mental and social wellbeing. The women who experienced multiple stillbirths are stigmatized as “child-killer” or cursed or being punished by God. They are avoided in social gatherings within the families and community, because of these social pressures these women seek spiritual and religious treatment, and struggle to conceive again to deliver a live baby. It was observed that the psycho-social and medical needs of these bereaved women remain unaddressed not only by the healthcare system but also by the society at large. Conclusions The physical, social and mental well-being of women who experience multiple stillbirth are at stake. These women are being considered social outcast. Health care providers including physicians, lady health workers, and traditional birth attendants should be trained on provision of psychosocial support along with the routine care that they provide in communities and health facilities. The health care providers should also inform the bereaved women about the biomedical causes of stillbirths that would be helpful to mitigate the stigma associated with stillbirths. Moreover, the health care providers should also counsel family members especially in-laws of these sorrowful women about the biomedical causes of stillbirths that would also be helpful to mitigate the stigma associated with stillbirths.

Background Despite recommendation by the World Health Organization (WHO), influenza vaccination coverage among high‐risk groups remains suboptimal in Afghanistan. This study aims to document the knowledge, attitudes, and practices of seasonal influenza vaccine uptake among two priority groups, pregnant women (PWs) and healthcare workers (HCWs). Methods This cross‐sectional study enrolled PWs and HCWs in Kabul, Afghanistan, from September to December 2021. Data on vaccine intention and uptake, knowledge, and attitudes towards vaccination were collected. Simple linear regression was used to predict the impact of sociodemographic characteristics on the KAP score. Results A total of 420 PWs were enrolled in Afghanistan. The majority (89%) of these women had never heard of the influenza vaccine but 76% intended to receive the vaccine. Of the 220 HCWs enrolled, 88% were unvaccinated. Accessibility and cost were factors which encouraged vaccination among HCWs. Fear of side effects and affordability were identified as key barriers. HCWs reported high level of vaccine intention (93%). PWs aged under 18 years (β: 6.5, P = 0.004), between 18 and 24 years (β: 2.9, P = 0.014), currently employed (β: 5.8, P = 0.004), and vaccinated against COVID‐19 (β: 2.8, P = 0.01) were likely to have a higher attitude score. Among HCWs, being female was a predictor for poor vaccination practice (β: −1.33, P < 0.001) whereas being vaccinated against COVID‐19 was a predictor for higher practice score (β: 2.4, P < 0.001). Conclusion To increase influenza vaccination coverage among priority groups, efforts should be made to address issues such as lack of knowledge, limited availability, and cost barriers.

Background: Vaccination against COVID-19 is one of the control measures for an ongoing COVID-19 pandemic. Vaccine acceptance is known to be low in Pakistani population, we identified the factors associated with vaccine hesitancy (VH) for COVID-19 at the time of first introduction of this vaccine for elderly and health care workers. Methods: An online survey was launched using a google form during March to April 2021 to assess VH in adult (> 18 years) Pakistani population. The survey form determined VH individuals who declined to questions on getting vaccinated and maintained a perspective of reluctance to vaccinate. In addition to sociodemographic characteristics, observation of standard precautions, and sources of information on COVID-19 vaccine were inquired. Results: Of the 278 responses 80% of the study population was less than 45 years of age, 68% were males, 91% had 16 or more years of education, 39% were in health care profession, 81% reported consistent use of face masks in public places, 68% sanitized hands each time, 35% always avoided social gatherings, 24% had received vaccination, 20% had suffered from COVID-19, and 45.7% were vaccine hesitant. At multivariable level, being health care worker, increasing mean precautionary score, not being vaccinated against COVID-19 and those with concerns for vaccine safety were the contributing factors for VH. Participants who presumed COVID-19 vaccine was safe were 90% less hesitant to get COVID-19 vaccine (Adjusted Prevalence Ratio: 0.1; 95% CI 0.09, 0.29) than who were uncertain on vaccine safety.Conclusion: Reliable safety information on COVID-19 vaccine and trust building influenced VH, to mass vaccinate Pakistani population to control the pandemic.

IntroductionCOVID-19 has significantly affected community health workers’ (CHWs) performance as they are expected to perform pandemic-related tasks along with routine essential healthcare services. A plausible way to optimise CHWs’ functioning during this pandemic is to couple the efforts of CHWs with digital tools. So far, no systematic evidence is available on the use of digital health interventions to support CHWs in low-middle-income countries (LMICs) amid the COVID-19 pandemic. The article describes a protocol for a scoping review of primary research studies that aim to map evidence on the use of unique digital health interventions to support CHWs during COVID-19 in LMICs.Methods and analysisOur methodology has been adapted from scoping review guidelines provided by Arksey and O’Malley, Levac et al. and the Joanna Briggs Institute. Our search strategy has been developed for the following four main electronic databases: Excerpta Medica Database, Medical Literature Analysis and Retrieval System Online, Cochrane Central Register of Controlled Trials and Cumulated Index to Nursing and Allied Health Literature. Google Scholar and reference tracking will be used for supplementary searches. Each article will be screened against eligibility criteria by two independent researchers at the title and abstract and full-text level. The review will include studies that targeted digital health interventions at CHWs’ level to provide support in delivering COVID-19-related and other essential healthcare services. A date limit of 31 December 2019 to the present date will be placed on the search and English language articles will be included.Ethics and disseminationFormal ethical approval is not required, as primary data will not be collected in this study. The results from our scoping review will provide valuable insight into the use of digital health interventions to optimise CHWs’ functioning and will reveal current knowledge gaps in research. The results will be disseminated through journal publications and conference presentations.

Introduction: Sepsis is a life-threatening illness caused by the body's response to uncontrolled infection. Different studies have been conducted to identify risk factors associated with the diagnosis of sepsis and mortality, but there has been considerably less focus on mortality due to sepsis-induced blood pressure. The current study was conducted to determine the incidence of mortality within 30 days among patients with sepsis-induced blood pressure drop and its risk factors.