Background: Digital health is well-positioned in low and middle-income countries (LMICs) to revolutionize health care due, in part, to increasing mobile phone access and internet connectivity. This paper evaluates the underlying factors that can potentially facilitate or hinder the progress of digital health in Pakistan. Objective: The objective of this study is to identify the current digital health projects and studies being carried out in Pakistan, as well as the key stakeholders involved in these initiatives. We aim to follow a mixed-methods strategy and to evaluate these projects and studies through a strengths, weaknesses, opportunities, and threats (SWOT) analysis to identify the internal and external factors that can potentially facilitate or hinder the progress of digital health in Pakistan. Methods: This study aims to evaluate digital health projects carried out in the last 5 years in Pakistan with mixed methods. The qualitative and quantitative data obtained from field surveys were categorized according to the World Health Organization’s (WHO) recommended building blocks for health systems research, and the data were analyzed using a SWOT analysis strategy. Results: Of the digital health projects carried out in the last 5 years in Pakistan, 51 are studied. Of these projects, 46% (23/51) used technology for conducting research, 30% (15/51) used technology for implementation, and 12% (6/51) used technology for app development. The health domains targeted were general health (23/51, 46%), immunization (13/51, 26%), and diagnostics (5/51, 10%). Smartphones and devices were used in 55% (28/51) of the interventions, and 59% (30/51) of projects included plans for scaling up. Artificial intelligence (AI) or machine learning (ML) was used in 31% (16/51) of projects, and 74% (38/51) of interventions were being evaluated. The barriers faced by developers during the implementation phase included the populations’ inability to use the technology or mobile phones in 21% (11/51) of projects, costs in 16% (8/51) of projects, and privacy concerns in 12% (6/51) of projects.
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Background: The immunization uptake rates in Pakistan are much lower than desired. Major reasons include lack of awareness, parental forgetfulness regarding schedules, and misinformation regarding vaccines. In light of the COVID-19 pandemic and distancing measures, routine childhood immunization (RCI) coverage has been adversely affected, as caregivers avoid tertiary care hospitals or primary health centers. Innovative and cost-effective measures must be taken to understand and deal with the issue of low immunization rates. However, only a few smartphone-based interventions have been carried out in low- and middle-income countries (LMICs) to improve RCI. Objective: The primary objectives of this study are to evaluate whether a personalized mobile app can improve children’s on-time visits at 10 and 14 weeks of age for RCI as compared with standard care and to determine whether an artificial intelligence model can be incorporated into the app. Secondary objectives are to determine the perceptions and attitudes of caregivers regarding childhood vaccinations and to understand the factors that might influence the effect of a mobile phone–based app on vaccination improvement. Methods: A mixed methods randomized controlled trial was designed with intervention and control arms. The study will be conducted at the Aga Khan University Hospital vaccination center. Caregivers of newborns or infants visiting the center for their children’s 6-week vaccination will be recruited. The intervention arm will have access to a smartphone app with text, voice, video, and pictorial messages regarding RCI. This app will be developed based on the findings of the pretrial qualitative component of the study, in addition to no-show study findings, which will explore caregivers’ perceptions about RCI and a mobile phone–based app in improving RCI coverage. Results: Pretrial qualitative in-depth interviews were conducted in February 2020. Enrollment of study participants for the randomized controlled trial is in process. Study exit interviews will be conducted at the 14-week immunization visits, provided the caregivers visit the immunization facility at that time, or over the phone when the children are 18 weeks of age. Conclusions: This study will generate useful insights into the feasibility, acceptability, and usability of an Android-based smartphone app for improving RCI in Pakistan and in LMICs.
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Background: Intellectual disability (ID) is a developmental disorder that causes considerably below-average intellectual performance and adaptive behaviour. In the context of the present study, families raising a child with ID are reported to experience multiple challenges that appear not to be well documented in Pakistan. Methods and procedures: Pakistan, which was conducted in Karachi, Pakistan, followed participatory action research, in which the researcher and participants examined their existing experiences of informal social support and then created, implemented, and evaluated actions to strengthen this informal social support. A total of five families (n = 25) participated in the study. These participating families comprise parents, siblings, and significant others, i.e., aunts, uncles, and grandparents, living with the child with ID. Families with children with ID were selected through a school for children with ID who are under 12 years old. This qualitative action research was conducted in two distinct parts, i.e., a) exploratory part and b) action part. This paper presents the findings of the first exploratory part of the study. Aim: The exploratory phase aimed to explore and examine the experiences and challenges families may experience with informal social support while caring for a child with an intellectual disability in Karachi, Pakistan. Findings: Parents often sacrifice their personal needs and aspirations for their children, leading to decreased tolerance and anxiety. Lack of communication, support, and assistance from family members is another significant issue. Stigmatisation and discrimination from school, relatives, and friends can cause depression and distress. The study emphasises the need for a unified and coordinated approach to support and care. Religious beliefs, siblings, and close friends provide comfort and well-being. When parents manage to connect with similar families, they have the opportunity to express a collective commitment to caregiving. Conclusion: To strengthen the situation, families propose enhancing intimacy and competency within homes and taking action at the governmental level. Governments must provide appropriate services, such as nurses supporting families, support groups, and religious traditions, to promote acceptance and holistic development for intellectually disabled children.
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Routine immunization (RI) of children is the most effective and timely public health intervention for decreasing child mortality rates around the globe. Pakistan being a low-and-middle-income-country (LMIC) has one of the highest child mortality rates in the world occurring mainly due to vaccine-preventable diseases (VPDs). For improving RI coverage, a critical need is to establish potential RI defaulters at an early stage, so that appropriate interventions can be targeted towards such population who are identified to be at risk of missing on their scheduled vaccine uptakes. In this paper, a machine learning (ML) based predictive model has been proposed to predict defaulting and non-defaulting children on upcoming immunization visits and examine the effect of its underlying contributing factors. The predictive model uses data obtained from Paigham-e-Sehat study having immunization records of 3,113 children. The design of predictive model is based on obtaining optimal results across accuracy, specificity, and sensitivity, to ensure model outcomes remain practically relevant to the problem addressed. Further optimization of predictive model is obtained through selection of significant features and removing data bias. Nine machine learning algorithms were applied for prediction of defaulting children for the next immunization visit. The results showed that the random forest model achieves the optimal accuracy of 81.9% with 83.6% sensitivity and 80.3% specificity. The main determinants of vaccination coverage were found to be vaccine coverage at birth, parental education, and socio-economic conditions of the defaulting group. This information can assist relevant policy makers to take proactive and effective measures for developing evidence based targeted and timely interventions for defaulting children.
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De auteur beschrijft de migrantenstroom in de grensplaats Velika Kladuša (Bosnië en Herzegovina). Sinds een jaar of twee is dit stadje de laatste halte voor migranten die via de Balkanroute naar de EU reist. Vanuit het binnenland arriveren onophoudelijk groepjes migranten die één richting uitgaan: Europa. Inmiddels kent het stadje duizenden migranten uit Azië, bijvoorbeeld uit Pakistan en Afghanistan maar ook uit Noord-Afrikaanse landen, zoals Algerije en Marokko. Zodra het kan, steken zij de grens over. Toen de eerste groepen migranten destijds aankwamen, stond de lokale bevolking onmiddellijk klaar om hun de nodige ondersteuning en hulp aan te bieden. De middelen in Velika Kladuša zijn schaars. Er is een hoge werkeloosheid, het leven is relatief duur en er is weinig inkomen. Vanuit de hoofdstad komt nauwelijks ondersteuning. Het toenemende aantal vluchtelingen legt een grote druk op de weinige beschikbare middelen. Verhalen over overlast, criminaliteit en seksueel ongewenst gedrag nemen toe. Dat leidt tot vechtpartijen en demonstraties waarbij wapens zichtbaar aanwezig zijn. De Bosniërs zien de migranten nu als bedreiging en willen dat ze zo snel mogelijk vertrekken. De auteur pleit voor ondersteuning voor zowel de bewoners als de migranten. De EU behoort daarin het voortouw te nemen en samen met de Bosnische overheid op te trekken.
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Na een korte inleiding over Yunus, één van de grondleggers van microfinanciering voor armen, wordt de opkomst van de microfinanciering besproken. De toenemende rendementen in de sector zorgen er voor dat private beleggers hierin gaan deelnemen. De veranderende dynamiek die hiermee gepaard gaat komt uitgebreid aan de orde. De kritische houding van klanten zorgt voor De Client Protection Principles, die voor meer bescherming moet zorgen. De klanten weten wat ze willen of niet willen en zij doen in grote getalen mee. Dat hoeven we toch niet eng te vinden?
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Hoofdstuk 15 15.1 Introduction 15.2 An international law perspective 15.3 The American position 15.4 International human rights developments 15.5 Effective remedy and reparations 15.6 Reflections References In the international arena there are some encouraging developments in relation to accountability and transparency for the use of armed drones. It is increasingly recognized that remote pilotless aircraft have become part of modern warfare, and that sometimes they are also used outside the context of armed conflict. Subsequently, both international humanitarian and human rights law can apply. The issue of access to justice, however, receives less explicit socio-political attention. Victims of armed remote pilotless aircraft strikes meet countless challenges in effectuating their right to an effective remedy. Often even a formal recognition that a strike has taken place is lacking. Furthermore, the states involved fail to publicly release information about their own investigations. This makes it difficult for those affected to substantiate their status as a victim and seek justice, including reparations. The international community should, in addition to urging involved states to independently and impartially investigate all armed drone strikes, ensure that access to an effective remedy for civilian victims, whether on an international, transnational or national level, becomes a reality.
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As people age, physiological changes affect their thermal perception, sensitivity and regulation. The ability to respond effectively to temperature fluctuations is compromised with physiological ageing, upsetting the homeostatic balance of health in some. As a result, older people can become vulnerable at extremes of thermal conditions in their environment. With population ageing worldwide, it is an imperative that there is a better understanding of older people’s thermal needs and preferences so that their comfort and wellbeing in their living environment can be optimised and healthy ageing achieved. However, the complex changes affecting the physiological layers of the individual during the ageing process, although largely inevitable, cannot be considered linear. They can happen in different stages, speeds and intensities throughout the ageing process, resulting in an older population with a great level of heterogeneity and risk. Therefore, predicting older people’s thermal requirements in an accurate way requires an in-depth investigation of their individual intrinsic differences. This paper discusses an exploratory study that collected data from 71 participants, aged 65 or above, from 57 households in South Australia, over a period of 9 months in 2019. The paper includes a preliminary evaluation of the effects of individual intrinsic characteristics such as sex, body composition, frailty and other factors, on thermal comfort. It is expected that understanding older people’s thermal comfort from the lens of these diversity-causing parameters could lead to the development of individualised thermal comfort models that fully capture the heterogeneity observed and respond directly to older people’s needs in an effective way. (article starts at page 13)
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Nobelpriiswinnaar Jean Tirole is voorstander van een breder governance concpet dan de traditionele focus op aandeelhouders maar heeft tevens oog voor de tekortkomingen van de 'stakeholder theory'.
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Lawmakers as representatives of the people should resist the anti-competitive proposals of the banking sector and embrace a vision of the digital euro that serves the collective interests of Europeans, Dr Martijn van der Linden and Vicky Van Eyck write. The influence of the banking lobby on policymakers risks undermining the digital euro's potential. Lawmakers as representatives of the people should resist the anticompetitive proposals of the banking sector and embrace a vision of the digital euro that serves the collective interests of Europeans. This means that the digital euro must be attractive, accessible and beneficial to all. The deliberation process must be free from the disproportionate influence of an industry that has much to lose from a level playing field for payment services and financial intermediation.
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