Contraceptive use intention among women in Pakistan: Application of theory of planned behavior

by Zoya Waqas, Aisha Irum, Muhammad Ibrahim, Maheen Sughra, Sanaa Khan, Ayesha Khan, Adnan Ahmad Khan

Introduction

Unintended pregnancies remain a major public health concern globally and in Pakistan, where family planning (FP) uptake continues to be hindered by entrenched social and behavioral barriers. This study applies the Theory of Planned Behavior (TPB) to examine how attitudes, subjective norms, and perceived behavioral control (PBC) shape women’s contraceptive intentions in Pakistan.

Methods

We analyzed data from 13,335 non-pregnant women aged 15–49 using the Pakistan Demographic and Health Survey (PDHS) 2017–18. Partial Least Squares Structural Equation Modeling (PLS-SEM) was used to test TPB pathways. Model reliability, validity, and fit were assessed using Composite Reliability, Average Variance Extracted, discriminant validity indices, and bootstrapped estimates to ensure analytical rigor.

Results

Over half of respondents lacked formal education, and most (84%) were unemployed. Only 23% had FP knowledge, and 96% were unaware of contraceptive side effects. Subjective norms negatively influenced contraceptive intentions (β = −0.056, p  Conclusion

The study demonstrates the applicability of TPB for understanding contraceptive intentions in a collectivist, patriarchal context. Subjective norms and PBC emerge as critical determinants, underscoring the need for interventions that engage families, strengthen women’s autonomy, and improve access to FP services. The findings offer a theoretically grounded and policy-relevant framework for designing behaviorally informed family planning programs in Pakistan.

Evaluating the clinical care, quality of life and overall experiences of patients with primary biliary cholangitis (PBC) during the pandemic: A Canadian mixed-methods study

by Elizabeth Baguley, Madelyn Knaub, Jessica VanDyke, Gideon Hirschfield, Mark G. Swain, Gail Wright, Deirdre McCaughey, Abdel Aziz Shaheen

Pandemic restrictions impacted healthcare, particularly during the first year. We evaluated the impact of the pandemic on quality of life and clinical care among patients with primary biliary cholangitis (PBC). This mixed-methods study administered quality of life surveys (Fear of COVID-19 Scale [FCV-19S], EuroQol 5-dimension 3-level [EQ-5D-3L], 29-item Patient-Reported Outcomes Measurement Instrument Survey [PROMIS-29]) and a PBC Care Delivery questionnaire to 348 Canadian PBC patients, followed by two focus groups with patients (n = 14) and stakeholders (n = 3). Quality of life scores were compared among sub-groups (i.e., care delays and pandemic appointment type) and with various reference populations. Most participants were female (94.0%) and Caucasian (88.2%), with a median age of 63.0 years (IQR: 55.9–71.2). During the pandemic, 75.8% had the majority (≥ 50%) of their hepatologist appointments virtually, but only 22.4% preferred to continue with virtual care post-pandemic. Participants with care delays had worse scores on the FCV-19S (p = 0.014), EQ-5D-3L (p = 0.009), and PROMIS-29 (i.e., fatigue, anxiety, sleep disturbance, ability to participate in social roles and activities, p p 

Factors associated with prolonged viral shedding in COVID-19 infection: A retrospective cohort from Karachi, Pakistan

by Lokesh Kumar, Ishfaque Ahmed, Chanchal Kumari, Nosheen Nasir

Background

The implications of prolonged viral shedding in COVID-19 are of major public health concern. There are several studies elucidating the impact on transmission; there is a lack of data on outcomes. The objective of this study was to identify factors associated with prolonged viral shedding and its impact on disease outcomes in COVID-19.

Methods

This retrospective cohort was conducted on hospitalized throat swab-PCR confirmed COVID-19 patients admitted between March 01, 2020, and June 07, 2020, at the Aga Khan University Hospital in Karachi, Pakistan. Demographic, treatment and successive SARS CoV-2 PCR data were extracted from medical records using a structured proforma. Prolonged viral shedding was defined as PCR positivity greater than or equal to 15 days from the first positive PCR. Outcomes studied included in-hospital mortality, length of stay, and requirement of mechanical ventilation.

Results

Out of 435 patients, only 110 could be assessed for time to negativity. 47 patients (42.7%) had viral shedding for more than 15 days compared to 63 (57.3%) patients with viral shedding for less than 15 days. The median duration of time to negativity in the prolonged shedding group was 25 days compared to 9 days in the other group. The median age was 54, and it was similar in both groups. Most of the patients had mild diseases in both groups. There was no statistically significant difference between either of the groups in terms of in-hospital mortality (2/47 versus 1/63) and length of stay (9 versus 8) days.

Conclusion

This study did not find any factors associated with prolonged viral shedding in COVID-19, and there was no impact of prolonged viral shedding on in-hospital mortality.