Background: There is evidence that household point-of-use water treatment products can reduce the enormous burden of water-borne illness. Nevertheless, adoption among the global poor is very low, and little evidence exists on why. Methods: We gave 600 households in poor communities in Dhaka, Bangladesh randomly-ordered two-month free trials of four water treatment products: dilute liquid chlorine, sodium dichloroisocyanurate tablets, a combined flocculant-disinfectant powdered mixture, and a silver-coated ceramic siphon filter. Consumers also received education on the dangers of untreated drinking water. (...) We measured which products consumers used with self-reports, observation, and chlorine tests. We also measured drinking water's contamination with E. coli. Findings: Households reported highest usage of the filter, although no product had even 30% usage. E. coli concentrations in stored drinking water were generally lowest when households had Water Guard. Households that self-reported product usage had large reductions in E. coli concentrations with any product as compared to controls. Conclusion: Traditional arguments for the low adoption of POU products focus on affordability, consumers' lack of information about germs and the dangers of unsafe water, and specific products not meshing with a household's preferences. In this study we provided free trials, repeated informational messages explaining the dangers of untreated water, and a variety of product designs. The low usage of all products despite such efforts makes clear that important barriers exist beyond cost, information, and variation among these four product designs. Without a better understanding of the choices and aspirations of the target end-users, household-based water treatment is unlikely to reduce morbidity and mortality substantially in urban Bangladesh and similar populations. © 2011 Luoto et al. (shrink)

Monitoring of clinical trials is important to ensure adherence to protocol, to safeguard the rights of research participants and to achieve compliance with principles of good clinical practice. Recent regulatory changes in India require Ethics Committees to keep an oversight of ongoing clinical trials including on-site monitoring. In this article, we share the experience of on-site monitoring of clinical trials by the Ethics Committee of a tertiary care, academic and research centre in India. We found a large number of shortcomings (...) in the areas of informed consent, adverse events, insurance and reimbursement, which would not have been detected by off-site document review. Interestingly, many shortcomings were also not detected by on-site monitoring arranged by clinical trial sponsors. We therefore conclude that on-site monitoring of ongoing clinical trials is a highly important activity for Indian Ethics Committees. (shrink)

We examined a largely ignored but imperative dimension of safety literature by testing the impact of ethical leadership style on organizational safety performance. We also tested dual mediating paths of safety culture and safety consciousness in the relationship between ethical leadership style and organizational safety consciousness. Data were collected from a large public sector telecom company in Pakistan. Confirmatory factor analysis was used to assess the reliability and validity of the study scales and model fit. Preacher and Hayes’s macro of (...) mediation was employed to test the direct and indirect paths proposed in the study. The findings suggest that ethical leadership has a positive impact on organizational safety performance. Partial mediating roles of safety culture and safety consciousness were also found between the dependent and independent variables. Theoretical and practical implications are discussed. (shrink)

Objective: The global outbreak of COVID-19 has greatly affected individual's lives around the world and resulted in various negative psychological consequences. During the pandemic, reflection on and attention to COVID-19 may help in dealing with its symptomology but frequent and persistent thoughts about the situation can be unhealthy. The present study examined the direct and indirect associations between obsession concerning COVID-19, psychological distress, life satisfaction, and meaning in life.Design: This mediation study presents a primary analysis of normative data collected after (...) the initial outbreak of COVID-19 in Pakistan. Parametric bootstrapping was used to test the mediation models of subjective well-being, the extent of the effect, and meaning in life as parallel and serial mediators concerning the associations between COVID-19 obsession and psychological distress measures.Setting: A sample of 1,002 adults were recruited utilizing an online survey between April to May 2020. They were aged between 19 and 45 years and normalized on population characteristics.Results: Two out of three mediators in parallel mediation fully mediated the relationship between obsession and psychological distress illustrating that high-level obsessions were associated with low levels of satisfaction with life and presence of meaning in life and search for meaning in life. Psychological distress is likely to decrease in the presence of a high level of satisfaction with life and meaning. Moreover, satisfaction with life and search for meaning in life significantly mediated the association between COVID-19 obsession.Conclusion: The present study showed that life satisfaction and search for meaning in life may play a significant role in decreasing psychological distress during the COVID-19 pandemic. (shrink)

Efforts to build research capacity and capability in low and middle income countries (LMIC) has progressed over the last three decades, yet it confronts many challenges including issues with communicating or even negotiating across different cultures. Implementing global research requires a broader understanding of community engagement and participatory research approaches. There is a considerable amount of guidance available on community engagement in clinical trials, especially for studies for HIV/aids, even culturally specific codes for recruiting vulnerable populations such as the San (...) or Maori people. However, the same cannot be said for implementing research in global health. In an effort to build on this work, the Pakistan Institute of Living and Learning and University College London in the UK sought to better understand differences in beliefs, values and norms of local communities in Pakistan. In particular, they have sought to help researchers from high income countries (HIC) understand how their values are perceived and understood by the local indigenous researchers in Pakistan. To achieve this end, a group discussion was organised with indigenous researchers at Pakistan Institute of Living and Learning. The discussion will ultimately help inform the development of a cultural protocol for researchers from HIC engaging with communities in LMIC. This discussion revealed five common themes; (1) religious principles and rules, (2) differing concepts of and moral emphasis on autonomy and privacy, (3) importance of respect and trust; (4) cultural differences (etiquette); (5) custom and tradition (gift giving and hospitality). Based on the above themes, we present a preliminary cultural analysis to raise awareness and to prepare researchers from HIC conducting cross cultural research in Pakistan. This is likely to be particularly relevant in collectivistic cultures where social interconnectedness, family and community is valued above individual autonomy and the self is not considered central to moral thinking. In certain cultures, HIC ideas of individual autonomy, the notion of informed consent may be regarded as a collective family decision. In addition, there may still be acceptance of traditional professional roles such as ‘doctor knows best’, while respect and privacy may have very different meanings. (shrink)

Background: Post-mortem needle biopsies have been used in resource-poor settings to determine cause of death and there is interest in using them in Bangladesh. However, we did not know how families and communities would perceive this procedure or how they would decide whether or not to consent to a post-mortem needle biopsy. The goal of this study was to better understand family and community concerns and decision-making about post-mortem needle biopsies in this low-income, predominantly Muslim country in order to design (...) an informed consent process. Methods: We conducted 16 group discussions with family members of persons who died during an outbreak of Nipah virus illness during 2004-2008 and 11 key informant interviews with their community and religious leaders. Qualitative researchers first described the post-mortem needle biopsy procedure and asked participants whether they would have agreed to this procedure during the outbreak. Researchers probed participants about the circumstances under which the procedure would be acceptable, if any, their concerns about the procedure, and how they would decide whether or not to consent to the procedure. Results: Overall, most participants agreed that post-mortem needle biopsies would be acceptable in some situations, particularly if they benefitted society. This procedure was deemed more acceptable than full autopsy because it would not require major delays in burial or remove organs, and did not require cutting or stitching of the body. It could be performed before the ritual bathing of the body in either the community or hospital setting. However, before consent would be granted for such a procedure, the research team must gain the trust of the family and community which could be difficult. Although consent may only be provided by the guardians of the body, decisions about consent for the procedure would involve extended family and community and religious leaders. Conclusions: The possible acceptability of this procedure during outbreaks represents an important opportunity to better characterize cause of death in Bangladesh which could lead to improved public health interventions to prevent these deaths. Obstacles for research teams will include engaging all major stakeholders in decision-making and quickly building a trusting relationship with the family and community, which will be difficult given the short window of time prior to the ritual bathing of the body. (shrink)

The incorporation of technology into the training of foreign language teachers has garnered considerable interest among educators, who have increasingly acknowledged the inherent possibilities of innovative tools and applications in augmenting their professional growth. Notwithstanding, these tools allow educators to remain abreast of the most current pedagogical methodologies, augment their instructional expertise, and proficiently cater to the varied requirements of students. This study investigates the incorporation of these tools within the instructional program of educators specializing in foreign languages; with the (...) ultimate aim of unveiling the views of relevant stakeholders on how these tools aid in strengthening their professional growth. The study involved the participation of 107 individuals, comprising both foreign language university lecturers and teacher trainers. Furthermore, a quantitative method of analysis was adopted in analyzing the research data that was collated through the use of an online questionnaire. Several significant findings were made from the research data which were presented and analyzed. The research findings revealed that technology integration seamlessly paves the way for the professional development of foreign language educators. Also, a comprehensive training program, provision of ongoing professional development opportunities, peer collaboration, and establishment of feedback and evaluation mechanisms can aid in countering major limitations of the implementation of technology integration. (shrink)

Background Informed consent is considered to be the standard method for respecting the autonomy of individual participants in research and practices and is thought to be based on several conditions: (1) providing information on the purpose of the research or a specific treatment, what it will entail, (2) the participants being mentally competent to understand the information and weigh it in the balance, and (3) the participants to be free from coercion. While there are studies of informed consent in other (...) countries, especially Low and Middle Income Countries (LMICs), this study explored the experiences of clinicians regarding the process of obtaining informed consent to participate in a Randomised Controlled Trial (RCT) in particular and treatment in general in healthcare settings, both general and mental health, specifically focusing on the tension between individualistic concept of autonomy and collectivist values in cultures such as Pakistan. Methods Qualitative interviews with 20 clinicians from healthcare settings in Pakistan who also served as recruiters in a suicide prevention RCT in Pakistan. The interviews were guided by semi-structured topic guide. All interviews were audio-recorded and transcribed verbatim. Results The interviews revealed that shared decision making was more morally important than individual autonomy, the role of the family played a dominant part in the consent-taking procedure, the decision of the elder and/or family patriarch took prominence, and that clinician-researchers encountered significant challenges in consent process in Pakistan, while recruiting patients into the trial as well as during routine treatment processes in healthcare settings. Four distinct themes emerged which were (1) Family deciding for patients, (2) Benefits of involving family in consent process, (3) Gender disparity in consent process, (4) Challenges experienced by clinician-researchers during consent process in Pakistan. Conclusions The concept of consent is generally considered important in many cultures, however, there are two strands of understanding. There seems to be consensus that participant agreement is necessary to protect the participant but with regards to autonomy there are significant cultural differences whether it is the right for autonomy of the individual (individualistic concept) or family, community, or expert authority in other cultures. In Pakistan clinician-researchers sometimes preferred one approach and sometimes the other as they appreciated the interests of the patient to be. (shrink)

Nusrat Fateh Ali Khan was a foremost singer of qawwâlî. This Muslim devotional music, which is prominent in South Asia, has been developed since the fourteenth century by the Sufi circles of the Chishti brotherhood in order to preach and communicate the teachings of the saints. Inspired by mystic spirituality, Nusrat's music travelled through the East and the West, absorbing some of the features of the musical cultures with which it came in contact. It also travelled through time, (...) transforming the traditional style of the ancient chanted poetry into new forms of musical expression. Nusrat's life and his artistic vicissitudes show the postmodern destiny of qawwâlî as a religious kind of music that apparently went through a process of desacralization and profanation as a result of multiple interpretations by different audiences. In order to discern the conditions of significance, semiotics reconstructs the relation between text and context of interpretation on the ground of structural pertinences. In this way, semiotics offers an analytical standpoint alternative to the postmodernist approach to postmodern cultural phenomena. By surveying the forms of listening that are structurally provided by the textual discourse, semiotics investigates the destiny of the musical and religious meanings of qawwâlî in relation to the process of intercultural translation. (shrink)