BackgroundExtreme heat exposure is a growing public health concern. In this trial, we tested the impact of a community health worker (CHW) led heat education programme on all-cause mortality, unplanned hospital visits and changes in knowledge and practices in Karachi, Pakistan.MethodsThe Heat Emergency Awareness and Treatment trial was a community-based, open-label, two-group, unblinded cluster-randomised controlled trial that implemented a CHW-led educational intervention between March and May 2018 in Karachi, Pakistan. We randomly assigned (1:1) 16 clusters, each with ~185 households or 1000 population, to the intervention or usual care (control group). We collected data on all-cause mortality, unplanned hospital visits, evidence of heat illness through surveillance and a knowledge and practice survey during the summer months of 2017 (preintervention) and 2018 (postintervention).FindingsWe recruited 18 554 participants from 2991 households (9877 individuals (1593 households) in the control group and 8668 individuals (1398 households) in the intervention group). After controlling for temporal trends, there was a 38% (adjusted OR 0.62, 95% CI 0.49 to 0.77) reduction in hospital visits for any cause in the intervention group compared with the control group. In addition, there was an improvement in many areas of knowledge and practices, but there was no significant difference in all-cause mortality.InterpretationA CHW-led community intervention was associated with decreased unscheduled hospital visits, improved heat literacy and practices but did not impact all-cause mortality. CHWs could play an essential role in preparing communities for extreme heat events.Trial registration numberNCT03513315.
<p><b>1. </b><b>Methodology</b></p> <p><b>2.1 </b><b>Study population and sample</b></p> <p>The target population selected for the feedback consisted of people living in Karachi, the biggest city of Pakistan, an industrial hub, and a port city comprising over 15 million population. The demographics included age, gender, profession, students, working, non-working, retired, etc. The city was under complete lockdown since the 1<sup>st</sup> week of April. The study conducted in the third week from April 16-23, 2020 for assessment of the mental health of the population in the context of lockdown and confinement due to COVID-19 in Pakistan. Because of the large population, the stigma attached to mental health, and ethical considerations the questionnaire was kept anonymous and the non-probability convenience sampling technique was used.</p> <p><b>2.2 </b><b>Rating instruments</b></p> <p>The Research instruments PHQ-9 was used for the assessment of the mental health of the population (Hartung et al., 2017; Hinz et al., 2006) under three week's lockdown during COVID-19. Patient Health Questionnaire (PHQ-9) is a nine-item depression severity measuring instrument with a total score of 20. Depression Severity Scores represent: 0-5 = Mild, 6-10 = Moderate 11-15 = Moderately Severe 16-20 = Severe Depression (Kroenke et al., 2010). <b> </b></p> <p><b>2.3 </b><b>Data analysis </b></p> <p>PHQ-9 and GAD-7 forms designed on Google form and survey was conducted online sharing the link via Emails, Whatsapp, Facebook, and LinkedIn using 120 research volunteers. The respondent cooperation and readiness were high as it was anonymous, easy to complete within 3 minutes, and submission over a single click through their cell phone. The survey started on 16<sup>th</sup> April and was completed within seven days by April 21. The 6876 respondents completed the questionnaire included in the final analysis. The statistical analytical tool SPSS was implied for descriptive analyses. Initially, descriptive analysis was conducted to describe the demographic characteristics of people of Karachi under lockdown for the last three weeks (April 16 to April 23). Secondly, the prevalence of severity of depression symptoms was measured on a rating scale of minimal, mild, moderate, and severe stratified by gender, age, and occupation.</p> <p><b>2.4 </b><b>Ethical considerations</b></p> <p>The ethical committee of qualified psychiatrists and psychologists of BasicNeeds Pakistan endorsed the study. The respondents were not required to provide any personal information and identity to keep the survey anonymous; consequently, they participated in the study.</p> <p><b>2.5 </b><b>Demographic information</b></p> <p>The demographic elements consisted of age (18-65 in five categories), gender (Male & Female), professionals, students, and entrepreneurs (self-employed and owners of the SMEs). The study was confined to the urban population who faced strict lockdown restrictions and complete closure.</p>
<p><b>1. </b><b>Methodology</b></p> <p><b>2.1 </b><b>Study population and sample</b></p> <p>The target population selected for the feedback consisted of people living in Karachi, the biggest city of Pakistan, an industrial hub, and a port city comprising over 15 million population. The demographics included age, gender, profession, students, working, non-working, retired, etc. The city was under complete lockdown since the 1<sup>st</sup> week of April. The study conducted in the third week from April 16-23, 2020 for assessment of the mental health of the population in the context of lockdown and confinement due to COVID-19 in Pakistan. Because of the large population, the stigma attached to mental health, and ethical considerations the questionnaire was kept anonymous and the non-probability convenience sampling technique was used.</p> <p><b>2.2 </b><b>Rating instruments</b></p> <p>The Research instruments PHQ-9 was used for the assessment of the mental health of the population (Hartung et al., 2017; Hinz et al., 2006) under three week's lockdown during COVID-19. Patient Health Questionnaire (PHQ-9) is a nine-item depression severity measuring instrument with a total score of 20. Depression Severity Scores represent: 0-5 = Mild, 6-10 = Moderate 11-15 = Moderately Severe 16-20 = Severe Depression (Kroenke et al., 2010). <b> </b></p> <p><b>2.3 </b><b>Data analysis </b></p> <p>PHQ-9 and GAD-7 forms designed on Google form and survey was conducted online sharing the link via Emails, Whatsapp, Facebook, and LinkedIn using 120 research volunteers. The respondent cooperation and readiness were high as it was anonymous, easy to complete within 3 minutes, and submission over a single click through their cell phone. The survey started on 16<sup>th</sup> April and was completed within seven days by April 21. The 6876 respondents completed the questionnaire included in the final analysis. The statistical analytical tool SPSS was implied for descriptive analyses. Initially, descriptive analysis was conducted to describe the demographic characteristics of people of Karachi under lockdown for the last three weeks (April 16 to April 23). Secondly, the prevalence of severity of depression symptoms was measured on a rating scale of minimal, mild, moderate, and severe stratified by gender, age, and occupation.</p> <p><b>2.4 </b><b>Ethical considerations</b></p> <p>The ethical committee of qualified psychiatrists and psychologists of BasicNeeds Pakistan endorsed the study. The respondents were not required to provide any personal information and identity to keep the survey anonymous; consequently, they participated in the study.</p> <p><b>2.5 </b><b>Demographic information</b></p> <p>The demographic elements consisted of age (18-65 in five categories), gender (Male & Female), professionals, students, and entrepreneurs (self-employed and owners of the SMEs). The study was confined to the urban population who faced strict lockdown restrictions and complete closure.</p>
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