The prevalence of HIV in CSWs, drug users, and prisoners in Sindh is low at present. Intervention programs implemented at this stage can make an impact in HIV prevention.

BackgroundAs a response to a changing operating environment, healthcare administrators are implementing modern management tools in their organizations. The balanced scorecard (BSC) is considered a viable tool in high-income countries to improve hospital performance. The BSC has not been applied to hospital settings in low-income countries nor has the context for implementation been examined. This study explored contextual perspectives in relation to BSC implementation in a Pakistani hospital.MethodsFour clinical units of this hospital were involved in the BSC implementation based on their willingness to participate. Implementation included sensitization of units towards the BSC, developing specialty specific BSCs and reporting of performance based on the BSC during administrative meetings. Pettigrew and Whipp's context (why), process (how) and content (what) framework of strategic change was used to guide data collection and analysis. Data collection methods included quantitative tools (a validated culture assessment questionnaire) and qualitative approaches including key informant interviews and participant observation.ResultsMethod triangulation provided common and contrasting results between the four units. A participatory culture, supportive leadership, financial and non-financial incentives, the presentation of clear direction by integrating support for the BSC in policies, resources, and routine activities emerged as desirable attributes for BSC implementation. The two units that lagged behind were more involved in direct inpatient care and carried a considerable clinical workload. Role clarification and consensus about the purpose and benefits of the BSC were noted as key strategies for overcoming implementation challenges in two clinical units that were relatively ahead in BSC implementation. It was noted that, rather than seeking to replace existing information systems, initiatives such as the BSC could be readily adopted if they are built on existing infrastructures and data networks.ConclusionVariable levels of the BSC implementation were observed in this study. Those intending to apply the BSC in other hospital settings need to ensure a participatory culture, clear institutional mandate, appropriate leadership support, proper reward and recognition system, and sensitization to BSC benefits.

Summaryobjective To investigate the behaviour, knowledge of risks, and attitudes towards injections among patients at a clinic in Karachi. methods In March 1995, trained staff administered a structured questionnaire to 198 consecutive new adult patients attending a university clinic in Karachi, Pakistan. results Half (97; 49%) of the patients received injections at their last visit to a health care provider. 35% had received 10 or more injections in the last year. 64% felt that injections were more powerful and were willing to pay more for them than for pills. 84% preferred pills or advice over injections if told they were equally effective, 83% believed that a used needle could transmit a fatal disease, and 86% believed that it is usually possible to get better without an injection. 91% reported that the doctor always recommends an injection; few patients (9%) ever asked for one. Injections were given without much regard for the chief complaint of the patient. Some needles (n ϭ 21) for the injection came from bowls of water: of those from closed packets (n ϭ 116), 68 were 'cleaned' by wiping or placing them in water. 91% of patients (180) knew at least one risk of reuse of needles. Patients who knew three or more risks of using unclean needles were 0.14 times as likely to have had more than five injections per year in the last 5 years but only if the patients had 8 or more years of education. conclusion Patients receive injections from doctors in Pakistan frequently, indiscriminately and often without proper safety precautions. They are aware of both positive and negative aspects of injections but are likely to do what the doctor suggests. Interventions to reduce risky overuse of injections should focus on patients' general education and knowledge of the risks of injections to empower them to choose healthier therapies.

Background: Cerebral palsy (CP) is the most common developmental disability in children. Neuro-imaging in CP is widely used investigation. Imaging study can visualize the anatomical location of lesion in brain. The aim of this study was to find out the extent of non-progressive damage in brain among children with CP. Methods: This was a cross-sectional study. Data were collected from the out-patient department of Institute of Pediatric Neurodisorders & Autism (IPNA), Bangabandhu Sheikh Mujib Medical University (BSMMU) from December, 2019 to March, 2020. Results: Total 88 cases (age up to 14 years) were reviewed. There was male predominance and male to female ratio was 2:1. Computed tomography (CT) scan was done in majority of patients (71 cases) and magnetic resonance imaging (MRI) in 17 cases. Major abnormalities were atrophy in 34.1% cases, ventricular dilatation in 14.8% cases, encephalomalacia in 19.3% cases and basal ganglia lesion in 11.4% cases. Overall in CT scan group, 95.77% cases were abnormal and in MRI group, 88.23% were abnormal. Conclusion: Atrophy of the brain was the most common finding in neuro-imaging of patients with CP and developmental disabilities. Neuro-imaging is very useful and recommended for the children with developmental delay and CP cases. It may help to classify the CP and may give a clue for further investigations such as metabolic screening and genetic testing. Birdem Med J 2021; 11(2): 112-115