Violence Against Health Care Providers: A Mixed-Methods Study from Karachi, Pakistan

Baig, Lubna; Shaikh, Shiraz; Polkowski, Maciej; Ali, Syeda Kausar; Jamali, Seemin; Mazharullah, Lubna; Soomro, Marium; Kumari, Bhavita; Memon, Sobia; Maheshwari, Greesh Kumar; Arif, Saleema

doi:10.1016/j.jemermed.2017.12.047

Cited by 45 publications

(50 citation statements)

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“…These findings are strikingly similar to the study done in Karachi on similar cadres of HCWs, where 30.5% reported verbal while 14.6% revealed having experienced physical violence. 20 The lower frequency of physical violence reported in this study could be due to a shorter recall period of 6 months as compared with the 1-year recall used by most studies. Recall period of 6 months in this study was used to quantify the average number of events.…”

Section: Bmj Global Healthmentioning

confidence: 56%

“…The study started in January 2018 and was completed by the end of the year. sample size and sampling Sample size was estimated with the assumption that an expected 33.5% of HCWs would be experiencing violence taken from a previous study in Karachi, 20 with ±1% accuracy and 95% confidence level; the sample size came out to be 8486 HCWs. Due to budget constraints, data could be collected in any five cities in each of the three provinces (capital cities and districts) and the federal capital.…”

Section: Methods Study Design Population and Settingmentioning

confidence: 99%

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The magnitude and determinants of violence against healthcare workers in Pakistan

et al. 2020

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► Main reasons among hospital HCW's included reaction of attendants to adverse outcomes, impatient behavior of patients and attendants, delay in care and lack of facilities ► Among ambulance workers, main reasons included delay in arrival and shifting of the patient and lack of facilities to provide good quality pre-hospital emergency care ► Among field healthcare workers, misconception of vaccines was the main reason. ► This study proposes interventions according to main reasons of violence.What do the findings imply?► The findings of the study provide directions for different healthcare settings on how to protect HCW's. ► The essential interventions required are increasing resources to provide good quality of care, introducing policies to improve responsiveness to patient's needs, training HCW's in communication and deescalation skills and introducing educational and regulatory measures to improve patient and attendant behavio AbsTrACTObjectives To determine the magnitude and determinants of violence against healthcare workers (HCWs) and to identify the predominant types and causes of violence experienced by them.Methodology A cross-sectional survey based on structured questionnaire adopted from previous surveys and qualitative data was conducted in 4 large cities and 12 districts in 3 provinces of Pakistan. The survey covered 8579 from all cadres of HCWs, including doctors, nurses, technicians, support staff, ambulance workers, vaccinators, lady health visitors, midwives and lady health workers (LHWs). The predictors of overall violence experienced, physical violence experienced and verbal violence experienced were separately analysed for tertiary care hospitals, secondary care hospitals, primary care hospitals and field-level HCWs. Logistic regression was used to compute adjusted ORs with 95% CIs for the association of different factors with the violence experienced. results More than one-third (38.4%) reported having experienced any form of violence in the last 6 months. Verbal violence was the most commonly experienced form (33.9%), followed by physical violence (6.6%). The main reasons for physical violence were death of patients (17.6%), serious condition of patients (16.6%) and delay in care (13.4%). Among the different types of field HCWs, emergency vehicle operators were significantly more likely to experience verbal violence compared with LHWs (adjusted OR=1.97; 95% CI 1.31 to 2.94; p=0.001). Among hospital HCWs, those working in private hospitals were significantly less likely to experience physical violence (adjusted OR=0.52; 95% CI 0.38 to 0.71; p=0.001) and verbal violence (adjusted OR=0.57; 95% CI 0.48 to 0.68

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Section: Bmj Global Healthmentioning

confidence: 56%

Section: Methods Study Design Population and Settingmentioning

confidence: 99%

The magnitude and determinants of violence against healthcare workers in Pakistan

et al. 2020

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“…These suggest that in some settings healthcare providers are also exposed to disrespect and abuse (Bowser 2010). This may be vertical or horizontal bullying (Khalil 2009), disrespect, and even the threat of physical or sexual assault as they travel to and from work (Baig 2018). This has been noted in countries in all income brackets.…”

Section: Introductionmentioning

confidence: 99%

Provision and uptake of routine antenatal services: a qualitative evidence synthesis

Downe

Finlayson²,

Tunçalp

et al. 2019

Cochrane Database of Systematic Reviews

104

110

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Background Antenatal care (ANC) is a core component of maternity care. However, both quality of care provision and rates of attendance vary widely between and within countries. Qualitative research can assess factors underlying variation, including acceptability, feasibility, and the values and beliefs that frame provision and uptake of ANC programmes.  This synthesis links to the Cochrane Reviews of the effectiveness of different antenatal models of care. It was designed to inform the World Health Organization guidelines for a positive pregnancy experience and to provide insights for the design and implementation of improved antenatal care in the future. Objectives To identify, appraise, and synthesise qualitative studies exploring: · Women’s views and experiences of attending ANC; and factors influencing the uptake of ANC arising from women’s accounts; · Healthcare providers’ views and experiences of providing ANC; and factors influencing the provision of ANC arising from the accounts of healthcare providers. Search methods To find primary studies we searched MEDLINE, Ovid; Embase, Ovid; CINAHL, EbscoHost; PsycINFO, EbscoHost; AMED, EbscoHost; LILACS, VHL; and African Journals Online (AJOL) from January 2000 to February 2019. We handsearched reference lists of included papers and checked the contents pages of 50 relevant journals through Zetoc alerts received during the searching phase. Selection criteria We included studies that used qualitative methodology and that met our quality threshold; that explored the views and experiences of routine ANC among healthy, pregnant and postnatal women or among healthcare providers offering this care, including doctors, midwives, nurses, lay health workers and traditional birth attendants; and that took place in any setting where ANC was provided.  We excluded studies of ANC programmes designed for women with specific complications. We also excluded studies of programmes that focused solely on antenatal education. Data collection and analysis Two authors undertook data extraction, logged study characteristics, and assessed study quality. We used meta‐ethnographic and Framework techniques to code and categorise study data. We developed findings from the data and presented these in a 'Summary of Qualitative Findings' (SoQF) table. We assessed confidence in each finding using GRADE‐CERQual. We used these findings to generate higher‐level explanatory thematic domains. We then developed two lines of argument syntheses, one from service user data, and one from healthcare provider data. In addition, we mapped the findings to relevant Cochrane effectiveness reviews to assess how far review authors had taken account of behavioural and organisational factors in the design and implementation of the interventions they tested. We also translated the findings into logic models to explain full, partial and no up...

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“…The major source of water to Keenjhar Lake is Kalari Baghar (KB) feeder canal, bringing water from the Indus the whole year and is supplemented by occasional floods from the surrounding areas [18]. It is the primary source of water for Karachi, the largest and most populous city in the country [22]. Nearly 50,000 people living in the surroundings directly rely on the lake for their living, mainly through fishing and tourism [21,23].…”

Section: Study Area and Sampling Locationsmentioning

confidence: 99%

Pollution Loads and Ecological Risk Assessment of Metals and a Metalloid in the Surface Sediment of Keenjhar Lake, Pakistan

Imran¹,

Ullah²,

Shaikh³

2020

Pol. J. Environ. Stud.

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This study aims to analyze the concentrations of heavy metals and a metalloid in the surface sediments of Keenjhar Lake, Sindh, Pakistan that pose a risk to the lake ecosystem. The concentrations and ecological risks associated with eight metals and a metalloid (As, Pb, Cd, Cu, Mn, Fe, Ni, Hg, and Cr) from surface sediments of the lake, was evaluated at 10 sampling locations. The overall 95 th percentile concentrations of trace elements were observed as As (29.1), Pb (7.6), Cd (0.68), Cu (9.3), Mn (56.43), Fe (352.3), Ni (10.36), and Cr (29.61) mg/kg. Metal wise as well as aggregated levels of contamination were studied. It was observed that all metals except Hg were detected in the lake sediment. Based on the geo-accumulation index and enrichment factor, Cr, Cu, Mn, Ni, and Pb showed low pollution levels, while As, Cd, and Fe showed a high degree of contamination. Based on the 95 th percentile, the average values of EF for As, Cd and Fe were observed as 274%, 300% and 907% respectively. Pollution Load Index reflected metals and metalloid contamination near the warning threshold, with an average value of 0.825. The Nemerow integrated pollution index (range 6.79-7.59, i.e., >3) and degree of contamination (range 12-24) suggested strong pollution levels. According to the findings of the ecological risk index, Cd showed high ecological risk (between 160-320) at all sampling sites, and potential ecological risk index was at moderate risk level (between 150-300) at all locations. Multivariate analysis of the metals and a metalloid classified as As, Cd, and Fe in one group with the remaining metals in another group show that metals of each group originate from the same source.

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Violence Against Health Care Providers: A Mixed-Methods Study from Karachi, Pakistan

Cited by 45 publications

References 8 publications

The magnitude and determinants of violence against healthcare workers in Pakistan

The magnitude and determinants of violence against healthcare workers in Pakistan

Provision and uptake of routine antenatal services: a qualitative evidence synthesis

Pollution Loads and Ecological Risk Assessment of Metals and a Metalloid in the Surface Sediment of Keenjhar Lake, Pakistan

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