Amna Mirza | Lahore University of Management Sciences (original) (raw)

Papers by Amna Mirza

Vaccine, 2020

Background: COVID-19 pandemic has affected routine immunization globally. Impact will likely be h... more Background: COVID-19 pandemic has affected routine immunization globally. Impact will likely be higher in low and middle-income countries with limited healthcare resources and fragile health systems. We quantified the impact, spatial heterogeneity, and determinants for childhood immunizations of 48 million population affected in the Sindh province of Pakistan. Methods: We extracted individual immunization records from real-time provincial Electronic Immunization Registry from September 23, 2019, to July 11, 2020. Comparing baseline (6 months preceding the lockdown) and the COVID-19 lockdown period, we analyzed the impact on daily immunization coverage rate for each antigen by geographical area. We used multivariable logistic regression to explore the predictors associated with immunizations during the lockdown. Results: There was a 52.5% decline in the daily average total number of vaccinations administered during lockdown compared to baseline. The highest decline was seen for Bacille Calmette Guérin (BCG) (40.6% (958/2360) immunization at fixed sites. Around 8438 children/day were missing immunization during the lockdown. Enrollments declined furthest in rural districts, urban sub-districts with large slums, and polio-endemic super high-risk sub-districts. Pentavalent-3 (penta-3) immunization rates were higher in infants born in hospitals (RR: 1.09; 95% CI: 1.04-1.15) and those with mothers having higher education (RR: 1.19-1.50; 95% CI: 1.13-1.65). Likelihood of penta-3 immunization was reduced by 5% for each week of delayed enrollment into the immunization program. Conclusion: One out of every two children in Sindh province has missed their routine vaccinations during the provincial COVID-19 lockdown. The pool of un-immunized children is expanding during lockdown, leaving them susceptible to vaccine-preventable diseases. There is a need for tailored interventions to promote immunization visits and safe service delivery. Higher maternal education, facility-based births, and early enrollment into the immunization program continue to show a positive association with immunization uptake, even during a challenging lockdown.

Human Vaccines & Immunotherapeutics, 2022

PURPOSE Vaccination of adolescent girls against human papillomavirus (HPV) significantly reduces ... more PURPOSE Vaccination of adolescent girls against human papillomavirus (HPV) significantly reduces the incidence of cervical cancer. HPV vaccines are available in Pakistan but plans to develop HPV vaccination program are at a nascent stage. We conducted a formative study to explore adolescent girls' knowledge and perspectives on HPV and cervical cancer and collect their recommendations for implementing an HPV vaccination program in their community. METHODS Using qualitative exploratory study design, we conducted four focus group discussions (FGDs) with 12 adolescent girls per group in District West, Karachi. We recruited unmarried girls aged 16-19 years from schools and community settings between May-December 2020. Data analysis was done using NVivo. RESULTS Overall, participants displayed a positive attitude toward HPV vaccine. However, they were unfamiliar with basic concepts related to female reproductive health. Female relatives were indicated as girls' preferred point of contact for discussions on HPV and cervical cancer, but fathers were portrayed as decision-making authority on vaccination. Participants indicated vaccine hesitancy among parents may affect HPV vaccination uptake. Girls suggested individual household visits and community-based camps as strategies for successful implementation of HPV vaccination program. A solid foundation of trust between girls' families, program managers, and other stakeholders emerged as a key asset for the program's success. CONCLUSION Adolescent girls' suggestions of informing key decision-makers in the family (particularly fathers) of the benefits of HPV vaccination, establishing trust with vaccine providers, and increasing accessibility of vaccinations should be explored for successful implementation of an HPV vaccination program in Pakistan.

This paper aims to look into the possibility of the character of the Amoralist, who is capable of... more This paper aims to look into the possibility of the character of the Amoralist, who is capable of making sound moral judgments, but fails to be motivated by them. It will first explain who the Amoralist is and try to understand the character through analyzing moral motivation. Generally, the externalist account of moral judgments caters to the possibility of the Amoralist, while an internalist account, leaves no room for the Amoralist to exist. Using Smith’s internalism as an example, I will argue that internalism is misguided because it wrongly assumes a necessary link between moral judgments and moral action. I will also point to some problematic assumptions made by Smith’s account of internalism, proving that the Amoralist can exist as a conceptual possibility.

My paper aims to explain how the workability of Rawls’ overlapping consensus is based on certain ... more My paper aims to explain how the workability of Rawls’ overlapping consensus is based on certain key assumptions which are unrealistic. I will show that the assumption he uses fail to sufficiently cater to the fact of pluralism, and overlooks the idea that political agents can have fundamentally different political views. I will argue that a satisfactory understanding of pluralism and political agents, would lead one to reject the overlapping consensus as an unworkable and unrealistic political ideal.

Quasi-realism claims that an anti-realist can earn the right to the truth-predicate. In this pape... more Quasi-realism claims that an anti-realist can earn the right to the truth-predicate. In this paper I want to show that quasi-realism is an inconsistent theory. This is because firstly, quasi-realism has an internal inconsistency in its theory of truth. I argue that fast-track quasi-realism and slow-track quasi-realism cannot be employed together for a theory of truth, as Blackburn claims, because they contradict each other. Secondly, Blackburn’s projectivism and quasi-realism both borrow problematic terms that are inconsistent with expressivism, which quasi-realism aims to defend.

This paper attempts to understand the factors that affect the wages of females, with particular e... more This paper attempts to understand the factors that affect the wages of females, with particular emphasis on education and ethnicity .The two ethnic groups being considered are black and Hispanic. By establishing the connection between the ethnic group a female belongs to and the wages she earns, we hope to isolate the effect of ethnicity on wages, and determine if racial discrimination can be used to explain some differences in wages. This concept of discrimination on wages has been a highly studied one by economists, in multicultural societies like the US.

This paper attempts to explain the strength of the relationship between number of cigarettes smok... more This paper attempts to explain the strength of the relationship between number of cigarettes smoked and income of a person. The smoking behavior of the person has been an important subject of discussion for the economists for many years and also for public policy analysts because of the negative effects of smoking on the environment and health of the people. Among all other factors that affect a person's smoking behavior, the income of the person and price of the cigarette deserve close attention. It raises highly pertinent question whether government should increase prices of cigarettes to control smoking.

Vaccine, 2020

Background: COVID-19 pandemic has affected routine immunization globally. Impact will likely be h... more Background: COVID-19 pandemic has affected routine immunization globally. Impact will likely be higher in low and middle-income countries with limited healthcare resources and fragile health systems. We quantified the impact, spatial heterogeneity, and determinants for childhood immunizations of 48 million population affected in the Sindh province of Pakistan. Methods: We extracted individual immunization records from real-time provincial Electronic Immunization Registry from September 23, 2019, to July 11, 2020. Comparing baseline (6 months preceding the lockdown) and the COVID-19 lockdown period, we analyzed the impact on daily immunization coverage rate for each antigen by geographical area. We used multivariable logistic regression to explore the predictors associated with immunizations during the lockdown. Results: There was a 52.5% decline in the daily average total number of vaccinations administered during lockdown compared to baseline. The highest decline was seen for Bacille Calmette Guérin (BCG) (40.6% (958/2360) immunization at fixed sites. Around 8438 children/day were missing immunization during the lockdown. Enrollments declined furthest in rural districts, urban sub-districts with large slums, and polio-endemic super high-risk sub-districts. Pentavalent-3 (penta-3) immunization rates were higher in infants born in hospitals (RR: 1.09; 95% CI: 1.04-1.15) and those with mothers having higher education (RR: 1.19-1.50; 95% CI: 1.13-1.65). Likelihood of penta-3 immunization was reduced by 5% for each week of delayed enrollment into the immunization program. Conclusion: One out of every two children in Sindh province has missed their routine vaccinations during the provincial COVID-19 lockdown. The pool of un-immunized children is expanding during lockdown, leaving them susceptible to vaccine-preventable diseases. There is a need for tailored interventions to promote immunization visits and safe service delivery. Higher maternal education, facility-based births, and early enrollment into the immunization program continue to show a positive association with immunization uptake, even during a challenging lockdown.

Human Vaccines & Immunotherapeutics, 2022

PURPOSE Vaccination of adolescent girls against human papillomavirus (HPV) significantly reduces ... more PURPOSE Vaccination of adolescent girls against human papillomavirus (HPV) significantly reduces the incidence of cervical cancer. HPV vaccines are available in Pakistan but plans to develop HPV vaccination program are at a nascent stage. We conducted a formative study to explore adolescent girls' knowledge and perspectives on HPV and cervical cancer and collect their recommendations for implementing an HPV vaccination program in their community. METHODS Using qualitative exploratory study design, we conducted four focus group discussions (FGDs) with 12 adolescent girls per group in District West, Karachi. We recruited unmarried girls aged 16-19 years from schools and community settings between May-December 2020. Data analysis was done using NVivo. RESULTS Overall, participants displayed a positive attitude toward HPV vaccine. However, they were unfamiliar with basic concepts related to female reproductive health. Female relatives were indicated as girls' preferred point of contact for discussions on HPV and cervical cancer, but fathers were portrayed as decision-making authority on vaccination. Participants indicated vaccine hesitancy among parents may affect HPV vaccination uptake. Girls suggested individual household visits and community-based camps as strategies for successful implementation of HPV vaccination program. A solid foundation of trust between girls' families, program managers, and other stakeholders emerged as a key asset for the program's success. CONCLUSION Adolescent girls' suggestions of informing key decision-makers in the family (particularly fathers) of the benefits of HPV vaccination, establishing trust with vaccine providers, and increasing accessibility of vaccinations should be explored for successful implementation of an HPV vaccination program in Pakistan.

This paper aims to look into the possibility of the character of the Amoralist, who is capable of... more This paper aims to look into the possibility of the character of the Amoralist, who is capable of making sound moral judgments, but fails to be motivated by them. It will first explain who the Amoralist is and try to understand the character through analyzing moral motivation. Generally, the externalist account of moral judgments caters to the possibility of the Amoralist, while an internalist account, leaves no room for the Amoralist to exist. Using Smith’s internalism as an example, I will argue that internalism is misguided because it wrongly assumes a necessary link between moral judgments and moral action. I will also point to some problematic assumptions made by Smith’s account of internalism, proving that the Amoralist can exist as a conceptual possibility.

My paper aims to explain how the workability of Rawls’ overlapping consensus is based on certain ... more My paper aims to explain how the workability of Rawls’ overlapping consensus is based on certain key assumptions which are unrealistic. I will show that the assumption he uses fail to sufficiently cater to the fact of pluralism, and overlooks the idea that political agents can have fundamentally different political views. I will argue that a satisfactory understanding of pluralism and political agents, would lead one to reject the overlapping consensus as an unworkable and unrealistic political ideal.

Quasi-realism claims that an anti-realist can earn the right to the truth-predicate. In this pape... more Quasi-realism claims that an anti-realist can earn the right to the truth-predicate. In this paper I want to show that quasi-realism is an inconsistent theory. This is because firstly, quasi-realism has an internal inconsistency in its theory of truth. I argue that fast-track quasi-realism and slow-track quasi-realism cannot be employed together for a theory of truth, as Blackburn claims, because they contradict each other. Secondly, Blackburn’s projectivism and quasi-realism both borrow problematic terms that are inconsistent with expressivism, which quasi-realism aims to defend.

This paper attempts to understand the factors that affect the wages of females, with particular e... more This paper attempts to understand the factors that affect the wages of females, with particular emphasis on education and ethnicity .The two ethnic groups being considered are black and Hispanic. By establishing the connection between the ethnic group a female belongs to and the wages she earns, we hope to isolate the effect of ethnicity on wages, and determine if racial discrimination can be used to explain some differences in wages. This concept of discrimination on wages has been a highly studied one by economists, in multicultural societies like the US.

This paper attempts to explain the strength of the relationship between number of cigarettes smok... more This paper attempts to explain the strength of the relationship between number of cigarettes smoked and income of a person. The smoking behavior of the person has been an important subject of discussion for the economists for many years and also for public policy analysts because of the negative effects of smoking on the environment and health of the people. Among all other factors that affect a person's smoking behavior, the income of the person and price of the cigarette deserve close attention. It raises highly pertinent question whether government should increase prices of cigarettes to control smoking.