Dr. Shaheer Ellahi - Profile on Academia.edu (original) (raw)

Papers by Dr. Shaheer Ellahi

Psychiatric Quarterly , 2021

This study explores the pre-diagnosis perceptions and experiences of semi-urban women regarding m... more This study explores the pre-diagnosis perceptions and experiences of semi-urban women regarding maternal depression and the issues in the follow-up of its treatment. Using the patient's end of Kleinman's Explanatory Model of Illness, it documents the whole episode of maternal depression in women. The main focus group of this study includes the women diagnosed with maternal depression and registered in the health facilities of Rawalpindi. Research was conducted in one primary health facility i.e. rural health centre of Khayaban e Sir Syed and one secondary health facility i.e. the Tehsil Headquarter Hospital of Taxila that were subject to the Mother and Child Health Program under the Rural Health Sector Reform Project in Punjab. The data shows that the socio-cultural setting of the women affects their perspectives and beliefs regarding maternal depression as well as shapes their health-seeking behavior, as there seemed to be a preference of religious and cultural coping mechanisms resulting in poor compliance with medical services and hurdles in the follow-up of medical treatment. Through understanding the illness beliefs of these women, effective measures can be taken for the provision of better health facilities and ensuring their follow-up.

Socio-psychological Perceptions & Experiences of Etiology amongst Type II Diabetics; A Qualitative Study of Primary Health Care in Rural Sargodha

Bahria Journal of Professional Psychology , 2019

The presented study explored the patients’ perspectives and experiences regarding the cause of il... more The presented study explored the patients’ perspectives and experiences regarding the cause of illness (etiology) and mode of onset. The study aimed to understand the socio-psychological factors that lead to certain decisions in terms of reaching the health facility for diagnosis and treatment. The study used the theoretical framework of patients’ explanatory model of Arthur Kleinman (1978). The study was conducted in Chak 104 North Bound Sargodha by using District Health Information System. The above mentioned locale was found to have most number of diabetics without any outreach. An in-depth interview guide was designed based on preliminary field work and informal interviews with the registered patients in the catchment area of Rural Health Center (RHC) Chak 104 NB. The in-depth interviews were conducted with (N=71) adherent and non-adherent male and female diabetic individuals. The study found that most of the respondents related their illness with trauma, tragic episode(s) and experiencing grief and sadness. Respondents related the cause of diabetes with the death of a family member, downfall in business and experience of certain domestic and financial issues. The findings of the current study are consistent with various studies references, and it has implications for the stakeholders and primary health care providers the perceptions and experiences of the diabetics for capacity building and contextualizing the diabetes care in the rural areas of Punjab, Pakistan.

Pandemic Preparedness and Techno Stress among Faculty of DAIs in Covid-19

Sir Syed Journal of Education & Social Research (SJESR), 2020

Amid COVID-19 pandemic in Pakistan, the Higher Education Commission of Pakistan announced the clo... more Amid COVID-19 pandemic in Pakistan, the Higher Education Commission of Pakistan announced the closure of all public and private universities and Higher Education Institutes from mid of March 2020. The paper highlights the issues faced by the university faculty in terms of techno-stress due to a lack of pandemic preparedness. The data gathered for this research is qualitative using the exploratory methodology. The methods of the study are In-depth interviews and FGDs. Interview guide and FGD Checklist are tools employed to gather data from the faculty of sixteen Pakistani universities which is sorted thematically and illustrated through descriptive statistics. The findings of the study suggest that the global pandemic has seriously affected the higher education sector in Pakistan. The private universities and the heavily funded public universities have taken off in a bullish mode. However, the public sector universities are coping up in a bearish trend. The faculty's response also corresponds with the transition to online teaching. Besides the university's efforts to ease out learning through an online interface, the majority of the faculty is feeling overburdened with additional responsibilities about online teaching. The study highlights the gap between policymaking and the on-ground situation of the universities in terms of online readiness.

Covid-19: Studying Policy Gap in Relation to Role of Primary Health Care in Pakistan

Global Social Sciences Review , 2020

The novel COVID-19 pandemic is yet to unfold its impact and long-run consequences. Both developed... more The novel COVID-19 pandemic is yet to unfold its impact and long-run consequences. Both developed and developing nations are trying their level best to cope and address the current situation in their respective affected regions with the help of the international guidelines and through their own experiences. The policies play an effective and efficient role in understanding different dimensions of the practices including social distancing, washing hands, wearing masks and most above all the lockdown. Such series of actions demand strong policy and learning both from global scenarios and national or provincial experiences. This study suggests how the policy gap may be identified to especially link the primary health care for the adequate response to this challenge. The study covered the editions of the latest news journals, newspapers, websites published between the months of March 2020 to April 2020 because the Pandemic paced up in these months.

Delivering integrated hypertension care at private health facilities in urban Pakistan: a process evaluation.

BJGP Open, 2018

Background In Pakistan about 18% of all adults are affected by hypertension, and only one in eigh... more Background
In Pakistan about 18% of all adults are affected by hypertension, and only one in eight of the prevalent cases have their hypertension controlled. As in many other low-middle income countries, a public-private partnership approach is being considered for delivering non-communicable disease care in urban areas.

Aim
This process evaluation was undertaken to understand how an integrated care intervention was experienced by the care providers and patients, and to inform modifications before possible scaling.

Design & setting
The mixed-methods study was conducted as part of a cluster randomised trial on integrated hypertension care at 26 private clinics.

Method
The care practices were assessed by analysing the clinical records of 1138 registered patients with hypertension. Then semi-structured interviews with service providers and patients were used to understand their respective care experiences. A framework approach was applied to analyse and interpret the qualitative data.

Results
District-led objective selection and context-sensitive staff training helped to get the clinics engaged in partnership working. About one-third of patients with hypertension had associated diabetes or renal compromise. The prescription of drugs is influenced by multiple non-clinical considerations of providers and patients. Many doctors allowed the use of home-based remedies as supplements to the prescribed allopathic drugs. Female patients faced more challenges in managing lifestyle changes. The intervention improved adherence to follow-up visits, but patient attrition remained a challenge.

Conclusion
The integrated hypertension care intervention at private clinics is feasible, and leads to improved diagnosis and treatment in low-income country urban setting. The authors recommend continued implementation research and informed scaling of hypertension care at private clinics.

Enhanced hypertension care through private clinics in Pakistan: a cluster randomised trial

BJGP Open, 2019

Background: Hypertension in Pakistan affects 33% of people aged ≥45 years, and in urban areas aro... more Background: Hypertension in Pakistan affects 33% of people aged ≥45 years, and in urban areas around 70% of basic health care occurs in private facilities.

Aim: To assess whether enhanced care at urban private clinics resulted in better control of hypertension, cardiovascular disease (CVD) risk factors, and treatment adherence.

Design & setting: A two-arm cluster randomised controlled trial was conducted at 26 private clinics (in three districts of Punjab) between January 2015-September 2016. Both arms had enhanced screening and diagnosis of hypertension and related conditions, and patient recording processes. Intervention facilities also had a clinical care guide, additional drugs for hypertension, a patient lifestyle education flipchart, associated training, and mobile phone follow-up.

Method: Clinics were randomised in a 1:1 ratio (sealed envelope lottery method). A total of 574 intervention and 564 control patients in 13 clusters in each arm were recruited (male and female, aged ≥25 years, systolic blood pressure [SBP] >140 mmHg, and/or diastolic blood pressure [DBP] >90 mmHg). The primary outcome was change in SBP from baseline to 9-month follow-up.Staff and patients were not blinded, but outcome assessors were blinded.

Results: Nine-month primary outcomes were available for 522/574 (90.9%) intervention and 484/564 (85.8%) control participants (all clusters). The unadjusted cluster-level analysis results were as follows: mean intervention outcome was -25.2 mmHg (95% confidence intervals [CI] = -29.9 to-20.6); mean control outcome was -9.4 mmHg (95% CI = 21.2 to 2.2); and mean control-intervention difference was 15.8 (95% CI = 3.6 to 28.0; P = 0.01).

Conclusion: The findings and separate process evaluation support the scaling of an integrated CVD-hypertension care intervention in urban private clinics in areas lacking public primary care in Pakistan.

Keywords: Cluster randomised controlled trial; contextualised care package; general practice; hypertension; primary care; primary private clinics.

Process evaluation of integrated diabetes management at primary healthcare facilities in Pakistan: a mixed-methods study

BJGP Open, 2018

Background: Integrated care for diabetes and associated conditions at primary level health facili... more Background: Integrated care for diabetes and associated conditions at primary level health facilities can make care available to a much larger population, especially in rural areas.

Aim: This process evaluation was to understand how the authors' integrated care was implemented and experienced by the care providers and patients, and to inform modifications prior to province-wide scale-up.

Design & setting: The mixed-method study was conducted as part of a cluster randomised trial on integrated diabetes care at 14 public health facilities.

Method: The care practices were assessed by analysing the routine clinical records of 495 registered patients with diabetes. Then semi-structured interviews with service providers and patients were used to understand their respective care experiences. A framework approach was applied to analyse and interpret the qualitative data.

Results: The intervention and the study were implemented as intended under routine conditions in rural health centres. Key service processes effectively delivered included: skill-based training; screening and diagnostic tests; treatment card records; and the additional case management as per desk guide, including monitoring progress in glucose and weight at follow-up consultations, and mobile phone calls to help adherence. However, social and cultural factors affected clients' ability to change lifestyles, especially for women. The intervention effect was limited by the short study follow-up of only 9 months.

Conclusion: Integrated diabetes care was feasible, both for providers and patients, and potentially scalable at primary care facilities under routine conditions in Pakistan. Additional operational interventions are required for sustained drug supplies, supervision, in-service training, and to address the social challenges to healthy activity and eating, especially for women.

Feasibility of delivering integrated COPDasthma care at primary and secondary level public healthcare facilities in Pakistan: a process evaluation

BJGP Open, 2019

Background: In Pakistan,the estimated prevalence of chronic obstructive pulmonary disease (COPD) ... more Background: In Pakistan,the estimated prevalence of chronic obstructive pulmonary disease (COPD) and asthma are 2.1% and 4.3% respectively, and existing care is grossly lacking both in coverage and quality. An integrated approach is recommended for delivering COPD and asthma care at public health facilities. Aim: To understand how an integrated care package was experienced by care providers and patients, and to inform modifications prior to scaling up. Design & setting: The mixed-methods study was conducted as part of cluster randomised trials on integrated COPD and asthma care at 30 public health facilities. Method: The care practices were assessed by analysing the clinical records of n = 451 asthma and n = 313 COPD patients. Semi-structured interviews with service providers and patients were used to understand their care experiences. A framework approach was applied to analyse and interpret qualitative data. Results: Utilisation of public health facilities for chronic lung conditions was low, mainly because of the non-availability of inhalers. When diagnosed, around two-thirds (69%) of male and more than half (55%) of female patients had severe airway obstruction. The practice of prescribing inhalers differed between intervention and control arms. Patient non-adherence to follow-up visits remained a major treatment challenge (though attrition was lower and slower in the intervention arm). Around half of the male responders who smoked at baseline reported having quit smoking. Conclusion: The integrated care of chronic lung conditions at public health facilities is feasible and leads to improved diagnosis and treatment in a low-income country setting. The authors recommend scaling of the intervention with continued implementation research, especially on improving patient adherence to treatment.

Effectiveness of an integrated diabetes care package at primary healthcare facilities: a cluster randomised trial in Pakistan

BJGP Open, 2019

Background There were an estimated 7 million people living with diabetes in Pakistan in 2014, and... more Background There were an estimated 7 million people living with diabetes in Pakistan in 2014, and this is predicted to reach 11.4 million by 2030.

Aim To assess if an integrated care package can achieve better control of diabetes.

Design & setting The pragmatic cluster randomised controlled trial (cRCT) was conducted from December 2014–June 2016 at 14 primary healthcare facilities in Sargodha district. Opportunistic screening, diagnostic testing, and patient recording processes were introduced in both the control 'testing, treating, and recording' (TTR) arm, and the intervention 'additional case management' (ACM) arm, which also included a clinical care guide and pictorial flipbook for lifestyle education, associated clinician training, and mobile phone follow-up.

Method Clinics were randomised on a 1:1 basis (sealed envelope lottery method) and 250 patients recruited in the ACM arm and 245 in the TTR-only arm (age ≥25 years and HbA1c >7%). The primary outcome was mean change in HbA1c (%) from baseline to 9-month follow-up. Patients and staff were not blinded.

Results The primary outcome was available for n = 238/250 (95.2%) participants in the ACM arm and n = 219/245 (89.4%) participants in the TTR-only arm (all clusters). Cluster level mean outcome was -2.26 pp (95% confidence intervals [CI] = -2.99 to -1.53) for the ACM arm, and -1.44 pp (95% CI = -2.34 to -0.54) for the TTR-only arm. Cluster level mean ACM–TTR difference (covariate-unadjusted) was -0.82 pp (95% CI = -1.86 to 0.21; P = 0.11).

Conclusion The ACM intervention in public healthcare facilities did not show a statistically significant effect on HbA1c reduction compared to the control (TTR-only) arm. Future evaluation should assess changes after a longer follow-up period, and minimal care enhancement in the comparator (control) arm.

; In Pakistan, private clinics are a major source of care for minor ailments. Individuals general... more ; In Pakistan, private clinics are a major source of care for minor ailments. Individuals generally pay for the services. Provision of child development care at private clinics can make these services available more widely. The study explored the potentially feasible arrangements and modalities for delivering early child development care at private clinics. A small-scale exploratory formative qualitative research was conducted in January 2016 addressing care provider and consumer perspectives. The focus group discussions with clinic staff were conducted at the research head office, whereas discussions with mothers and community advocates were arranged in the respective communities. A total of four focus group discussions (each with 6 – 8 participants) were conducted: private clinic doctors; paramedics; mothers; and community advocates. The key dimensions covered were: clinic setup, management and business model. The space for consultation, drug-dispensing and waiting do provide visual privacy without adequate conversation privacy. Majority of private clinics operate in evening, whereas mothers prefer morning-time to visit clinic. Less qualified clinic assistants necessitate a set of structured care delivery products for quality ECD care. The findings have been used to inform the ECD care delivery modalities (e.g. staff role, consultation, community-advocate engagement) and products (e.g. pictorial counseling tool and staff training) in Pakistan.

Cities have changed vastly over a large period of time and have shaped a new era of development i... more Cities have changed vastly over a large period of time and have shaped a new era of development in the world. These urban centers have powerful networks, which help them function at a national and international level. On the other hand, the number of models also explains how slums are by-product of cities. With the economic growth and development in infrastructure, there is a vast area/field to be explored by various researchers and that is the creation of slums and challenges of liveability in it. The present research has explored the Dharavi Slums in Mumbai, India.

Languages are indeed the carriers of various implicit phenomenon including concept formations, of... more Languages are indeed the carriers of various implicit phenomenon including concept formations, off loading ideas, operationalizing memories, collective consciousness, transmission of knowledge and preservation of cultural knowledge. The present study explored the perceptions of the local people in village of talagang and also people living in the city of talagang. Both urban and rural voices were documented and were analyzed thematically. The research also provided areas for future research especially studying the impact of dominance of the foreign language and shaping of various local concepts and its linkages with the global market.

Globalization has mushroomed a host of complex issues which are relatively new; the erosion of th... more Globalization has mushroomed a host of complex issues which are relatively new; the erosion of the nation-state, the decaying morality of people, the subjugation of weaker cultures by powerful ones, the increasing commoditization of cultures, the increasing gap between the rich and poor, and the creation of ‘others’ living in the same locality. At the same time, many scholars conceive it to be a magical force characterized by progression, development, and the coming together of the world in strange ways that strangles time, space and distance. Some regard it to be something which should be welcomed and celebrated. This essay seeks to describe the various scholarly voices within the globalization debate and examines how these voices explain the varied and differential impact of this phenomenon on the Third World.

The first of the development concerns is the changed economic role of the services sector. It has... more The first of the development concerns is the changed economic role of the services sector. It has been common to describe these as Cinderella sectors, which are not getting appropriate attention from the researchers and the professionals of the field. As the shares of services in national economies continue to prosper, and linkages of these elements of the economy with other economic sectors are extended, this tendency to overlook services has become less justifiable. There has been increasing effort to understand service activities since the early 1980s.

The prime role of the health care provider is to help the patient alleviate or free from pain and... more The prime role of the health care provider is to help the patient alleviate or free from pain and suffering, however, it is also important to know that the suffering and pain both physical and non-physical varies from culture to culture. It is also evident that few components of the culture like dance, music, religious ritual are explicitly visible, but there is always way much more beneath the surface of it. Thus, it is very important not for the medical anthropologists, but also the health care providers at all levels to understand the cultural construction of a disease and how certain illness is being diagnosed, treated, discussed and lived. The present research was conducted in the Village 104 (Shumali), Village 103 (Shumali) and Tehsil Sillanwai of district Sargodha by using the purposive sampling method. Total 09 in-depth interviews were conducted along with 4 FGDS with different age groups of the community including older aged and married (above 40 but below 55 years) both male and female in each category.

This essay seeks to trace the history of the concept of Cultural Relativism and the contextual mo... more This essay seeks to trace the history of the concept of Cultural Relativism and the contextual moorings that governed its development in Anthropology. The essay draws upon a variety of qualitative secondary data sources and reflects upon the many challenges and controversies that the conceptof Cultural Relativism invited and the purposes it serves in Anthropological tradition. The purpose of this essay is to discuss and highlight the various misconceptions that have plagued the concept of Cultural Relativism reflecting the severe dearth of understanding that exists within and outside Anthropological discipline. The first part of this essay is characterized by a dialogue between Relativists’ and Universalists’ epistemology as informed by a number of authors and theoreticians who have indulged at length in these debates while dealing with issues of morality and ethics, the indispensability of universal human rights on one side and the need to be morally non-evaluative on the other. It also sheds light on the practical and methodological considerations and controversies that have historically been entangled with the activity of ethnography and seeks to create a middle ground to reconcile these apparent contradictions. The final segment summarizes the major arguments and offers a few recommendations for anthropologists.

Pakistan is a third world developing country striving to work out challenges arising out of vario... more Pakistan is a third world developing country striving to work out challenges arising out of various manifold dimensions. The social and economic fabric of the society is almost decaying due to internal and external security threats, political instability, and severe economic clench. These multiverse problems have pushed the nation into a pit of undesirable issues and problems. The scope of social problems faced by the elderly population of Rawalpindi is the main theme of this paper. The study reveals that income level or employment status directly affects the area of residence among the targeted sample of study.

It is very obvious that when you have money in your pocket, your participation rate in social gat... more It is very obvious that when you have money in your pocket, your participation rate in social gathering and event is higher as compared to the situation when you have empty pockets. The scenario get more crucial when this happens in old age. This study is an effort to explore the percentiles of social participation of OPs with regards of their financial contribution in Household expenses. The study was conducted in Rawalpindi city and collected data was based on the responses of 384 randomly selected OPs. For data collection a structured tool was implemented which further converted into code plan for data entry and analysis. The results represent the significant relationship exists among financial contribution of OPs and their involvement in household decision making in everyday life. The situation clearly states that those elders who are participating in their family financial issue have more value/respect from their family, especially in term of their involvement in family related issues and matters.

“Ageing is a blessing or a challenge”. Ageing is still a blessing in South- Asian and Muslim coun... more “Ageing is a blessing or a challenge”. Ageing is still a blessing in South- Asian and Muslim countries, but with day by day reducing intensity, while in more developed nations of America and Europe it’s more a like a suffering or passing of days to meet with ultimate reality “Death”. Life longevity increases the figures more than expectation and now this becomes the giant issue to be faced in 21st century. The study was focused to recognize the relationship between the health status of elders and their present economic active roles. Our respondents belong to Rawalpindi City those cross the figure of 60 years of age. To answer the study objective a structured tool was implemented which further converted into a code plan and entered in Epidata and analyzed in SPSS after data collection. Data represents 42.4% (n=384) OPs still economically active, in 79.2% cases participants reported that their children were economically active and 69.5% OPs getting financial assistance from their children. Comparative results categorically show that those respondents who were economically inactive reported high ratio of disease occurrence as compared to the other part. The study suggests that if Government and other concerned stack holders create economic opportunities for OPs, they may LIVE better and HEALTHY life.

Human rights are the rectified social approval of particular social guarantees bestowed upon to a... more Human rights are the rectified social approval of particular social guarantees bestowed upon to a human in reward of his/her duly performed duties being member of human society.Human rights are not fringe benefits; rather these are to be rendered essentially at the societal level in recognition of its members’ contribution in maintenance of the complex social and cultural whole. The aim of this paper is discuss the making of Older Persons’ Index (OPI) with reference to Pakistani context. The index will help compare the local communities, towns, cities,regions and provincial entities in terms of older person’s welfare. The proposed index shall also be helpful in gauging the social consciousness level regarding ageing rights.