Community Health Sciences | Department of Community Health Sciences | Aga Khan University
 
The Department of Community Health Sciences works in the area of public and population health sciences to advance health and wellbeing, thereby contributing to Aga Khan University’s vision of serving communities in the developing world and Muslim societies. It applies the University's values of Impact, Quality, Relevance and Access to Public ​Health Education, Research and Practice.​​​​​​​​

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Submissions from 2019

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Nurses' job dissatisfaction and associated factors at public sector tertiary care hospital in Pakistan: A qualitative study, Shazia Bano, Nousheen Pradhan, Narjis Rizvi, and Farid Midhet

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Operationalization of bi-directional screening for tuberculosis and diabetes in private sector healthcare clinics in Karachi, Pakistan, Mashal S. Basir, Shifa Salman Habib, Syed M A. Zaidi, Saira Khowaja, Hamidah Hussain, Rashida A. Ferrand, and Aamir J. Khan

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Polyhydramnios among women in a cluster-randomized trial of ultrasound during prenatal care within five low and low-middle income countries: A secondary analysis of the first look study, Melissa Bauserman, Robert Nathan, Adrien Lokangaka, Elizabeth M. McClure, Janet Moore, Daniel Ishoso, Antoinette Tshefu, Lester Figueroa, Sarah Saleem, and Waseem Mirza

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Time to clarify state obligations and accountability on NCDs with human rights instruments, Kent Buse, Wafa Aftab, Sadika Akhter, Linh Bui Phuong, Haroun Chamli, Minakshi Dahal, Sarah Hawke, and Nousheen Pradhan

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Association between the quality of contraceptive counseling and method continuation: Findings from a prospective cohort study in social franchise clinics in Pakistan and Uganda, Nirali M. Chakraborty, Karen Chang, Benjamin Bellows, Karen A. Grépin, Waqas Hameed, Amanda Kalamar, Xaher Gul, Lynn Atuyambe, and Dominic Montagu

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Evaluating quality of contraceptive counseling: An analysis of the method information index, Karen T. Chang, Mulenga Mukanu, Ben Bellows, Waqas Hameed, Amanda M. Kalamar, Karen A. Grépin, Xaher Gul, and Nirali M. Chakraborty

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Improving identification and child-focused collaborative care for children of parents with a mental illness in Tyrol, Austria, Hanna Christiansen, Annette Bauer, Batool Fatima, Melinda Goodyear, Ingunn Olea Lund, Ingrid Zechmeister-Koss, and Jean Lillian Paul

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Drivers of international variation in prevalence of disabling low back pain: Findings from the cultural and psychosocial influences on disability study, David Coggon, Georgia Ntani, Keith T. Palmer, Vanda E. Felli, Florencia Harari, Leonardo A. Quintana, Sarah A. Felknor, Marianela Rojas, Anna Cattrell, and Muhammad Masood Kadir

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Malpresentation in low- and middle-income countries: Associations with perinatal and maternal outcomes in the global network, Cassandra R. Duffy, Janet L. Moore, Sarah Saleem, Antoinette Tshefu, Carl L. Bose, Elwyn Chomba, Waldemar A. Carlo, Ana L. Garces, Nancy F. Krebs, and NICHD Global Network for Women's and Children's Health Research

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Mortality and cardiovascular and respiratory morbidity in individuals with impaired FEV 1 (PURE): An international, community-based cohort study, MyLinh Duong, Shofiqul Islam, Sumathy Rangarajan, Darryl Leong, Om Kurmi, Koon Teo, Kieran Killian, Gilles Dagenais, Scott Lear, and Romaina Iqbal

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Coronary heart disease, hypertension and use of biomass fuel among women: Comparative cross-sectional study, Zafar Fatmi, Georgia Ntani, and David Coggon

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Regional variation in chronic kidney disease and associated factors in hypertensive individuals in rural South Asia: Findings from control of blood pressure and risk attenuation-Bangladesh, Pakistan and Sri Lanka, Liang Feng, Hithanadura Asita de Silva, Imtiaz Jehan, Anuradhani Kasturiratne, Gulshan Himani, Mohammad Abul Hasnat, Tazeen Jafar, and COBRA-BPS Study Group

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Prevalence and correlates of cardiometabolic multimorbidity among hypertensive individuals: A cross-sectional study in rural South Asia—Bangladesh, Pakistan and Sri Lanka, Liang Feng, Imtiaz Jehan, H Asita de Silva, Aliya Naheed, Hamida Farazdaq, Samina Hirani Samina Hirani, Anuradhani Kasturiratne, Channa D. Ranasinha, Md Tauhidul Islam, Ali Tanweer Siddiquee, and Tazeen Jafar

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Regional variation in comorbid prediabetes and diabetes and associated factors among hypertensive individuals in rural Bangladesh, Pakistan, and Sri Lanka, Liang Feng, Aliya Naheed, H. Asita de Silva, Imtiaz Jehan, Rubhana Raqib, Md Tauhidul Islam, Nathasha Luke, Anuradhani Kasturiratne, Hamida Farazdaq, Sahar Senan, Tazeen Jafar, and COBRA-BPS Study Group

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Using mobile phones to improve young people's sexual and reproductive health in low- and middle-income countries: A systematic review protocol to identify barriers, facilitators and reported interventions, Anam Shahil Feroz, Farina Abrejo, Sumera Aziz Ali, Rozina Nuruddin, and Sarah Saleem

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Perceptions of health professionals regarding minimally invasive tissue sampling (MITS) to identify the cause of death in stillbirths and neonates: Results from a qualitative study, Anam Shahil Feroz, Anum Shiraz Ali, Mohsina Noor Ibrahim, Elizabeth M. McClure, Shiyam Sunder Tikmani, Sayyeda Reza, Zahid Abbasi, Afia Zafar, Sameen Siddiqi, and Sarah Saleem

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Perceptions of parents and religious leaders regarding minimal invasive tissue sampling to identify the cause of death in stillbirths and neonates: Results from a qualitative study, Anam Shahil Feroz, Mohsina Noor Ibrahim, Elizabeth M. McClure, Anum Shiraz Ali, Shiyam Sunder Tikmani, Sayyeda Reza, Zahid Abbasi, Jamal Raza, Haleema Yasmin, Khadija Bano, Afia Zafar, Sameen Siddiqi, Robert L. Goldenberg, and Sarah Saleem

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Traditional birth attendants and birth outcomes in low-middle income countries: A review, Ana Garces, Elizabeth M. McClure, Leopoldo Espinoza, Sarah Saleem, Lester Figueroa, Sherri Bucher, and Robert L. Goldenberg

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Methodological gaps and opportunities for studying multisectoral collaboration for health in low- and middle-income countries, Douglas Glandon, Shinjini Mondal, Ida Okeyo, Shehla Zaidi, Mishal S. Khan, Osman Dar, and Sara Bennett

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Deep venous thrombosis in a patient with acquired factor VIII deficiency: A case report, Dreen Gul, Fazal Ur Rehman, Sumera Aziz Ali, and Savera Aziz Ali

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A study protocol for an mHealth, multi-centre randomized control trial to promote use of postpartum contraception amongst rural women in Punjab, Pakistan, Xaher Gul, Waqas Hameed, Sharmeen Hussain, Ishaque Sheikh, and Junaid-Ur-Rehman Siddiqui

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A multicountry randomized controlled trial of comprehensive maternal nutrition supplementation initiated before conception: The women first trial, K Michael Hambidge, Jamie E. Westcott, Ana Garcés, Lester Figueroa, Shivaprasad S. Goudar, Sangappa M. Dhaded, Omrana Pasha, Sumera Aziz Ali, and Antoinette Tshefu

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A prospective, population-based study of trends in operative vaginal delivery compared to cesarean delivery rates in low- and middle-income countries, 2010-2016, Margo S. Harrison, Sarah Saleem, Sumera Aziz Ali, Omrana Pasha, Elwyn Chomba, Waldemar A. Carlo, Ana L. Garces, Nancy F. Krebs, K Michael Hambidge, and Shivaprasad S. Goudar

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Needs assessment regarding occupational health and safety interventions among textile workers: A qualitative case study in Karachi, Pakistan, Numan Hussain, Muhammad Masood Kadir, Asaad Ahmed Nafees, Rozina Karmaliani, and Tanzil Jamali

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Health effects of household solid fuel use: Findings from 11 countries within the prospective urban and rural epidemiology study, Perry Hystad, MyLinh Duong, Michael Brauer, Andrew Larkin, Raphael Arku, Om P. Kurmi, Wen Qi Fan, Alvaro Avezum, Iqbal Azam Syed, and On behalf of Prospective Urban and Rural Epidemiological (PURE) Study investigators

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Relationship of sociodemographic factors with serum levels of vitamin D in a healthy population of Pakistan, Khalida Iqbal, Najmul Islam, Naseema Mehboobali, Ali Asghar, Saleem Perwaiz Iqbal, and Mohammad Perwaiz Iqbal

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New leadership for the WHO regional office for the eastern Mediterranean: Exceptional election in an exceptional time, Samer Jabbour, Sameen Siddiqi, Rita Giacaman, Hani Serag, Jawad Al-Lawati, Amirhossein Takian, Habiba Ben Romdhane, Elsheikh Badr, Laith J. Abu-Raddad, and Aida Seif El-Dawla

Understanding the usability of digital app by lady health worker program for delivering maternal child care in two district of Pakistan- An exploratory case study, Rawshan Jabeen

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Vitamin E inhibits apoptosis of human CD34+-derived erythroid progenitor cells obtained from healthy adults, Tanveer Jilani, Irfan Khan, Asmat Salim, Farina Bilwani, Bushra Moiz, Iqbal Azam Syed, and Mohammad Iqbal

Proportion and determination of medication adherence failure among patients after coronary artery bypass grafting at a tertiary care hospital in Karachi, Pakistan: An analytical cross sectional study, Ahsun Jiwani

Health care responses to meet the need of patients with lower limb amputation at a tertiary care hospital: A qualitative descriptive study, Saba Saleem Kabani

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Facilitators and barriers toward food security of afghan refugees residing in Karachi, Pakistan, Mahasti Khakpour, Romaina Iqbal, Naveera Ghulam Hussain, Rachel Engler-Stringer, Mustafa Koc, Joseph Garcea, Marwa Farag, Carol Henry, and Hassan Vatanparast

Assessment of the per-hospital and facility-based trauma care in Kabul, Afghanistan : A mixed method study, Umerdad Khudadad

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Pregnant women in four low-middle income countries have a high prevalence of inadequate dietary intakes that are improved by dietary diversity, Rebecca L. Lander, K Michael Hambidge, Jamie E. Westcott, Gabriela Tejeda, Tshilenge S. Diba, Shivanand C. Mastiholi, Umber S. Khan, Ana Garcés, Sumera Aziz Ali, Sarah Saleem, and On Behalf Of The Women First Preconception Nutrition Trial Group

Experiences and coping of family members of individuals with substance use disorder residing in an urban squatter settlements area of Karachi, Pakistan, Malik

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Health expenditure and utilization survey Thatta district, 2019, Muhammad Ashar Malik, Wajeeha Raza, and Riaz Karimi

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Pakistan developmental origins of health and disease (DOHaD) society: Addressing the 'DO' component of DOHaD, Nuruddin Badruddin Mohammed, Rozina Nuruddin, and Akbar Shoukat Ali

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MultiTex RCT - A multifaceted intervention package for protection against cotton dust exposure among textile workers - A cluster randomized controlled trial in Pakistan: Study protocol, Asaad Ahmed Nafees, Sara De Matteis, Muhammad Masood Kadir, Peter Burney, David Coggon, Sean Semple, and Paul Cullinan

Factors associated with fresh stillbirths of e 28 weeks of gestation at tertiary care hospital of Pakistan: A case-control study, Seemab Naqvi

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Time to adopt developmental origins of health and disease (DOHaD) science in Pakistan, Rozina Nuruddin, Akbar Shoukat Ali, and Nuruddin Badruddin Mohammed

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Joint association of urinary sodium and potassium excretion with cardiovascular events and mortality: Prospective cohort study, Martin O'Donnell, Andrew Mente, Sumathy Rangarajan, Matthew J. McQueen, Neil O'Leary, Lu Yin, Xiaoyun Liu, Sumathi Swaminathan, Rasha Khatib, and Romaina Iqbal

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Occupational health outcomes among international migrant workers, Kristine Husøy Onarheim, Dianne Egli-Gany, and Wafa Aftab

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Maternal anaemia and maternal, fetal, and neonatal outcomes in a prospective cohort study in India and Pakistan, S Parks, M K. Hoffman, S S. Goudar, A Patel, Sarah Saleem, Sumera Aziz Ali, R L. Goldenberg, P L. Hibberd, J Moore, and D Wallace

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Arsenic contamination of drinking water and mitigation in Pakistan: A case of Indus River basin, Unaib Rabbani and Zafar Fatmi

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Status of maternal and child health in an urban squatter settlement of Karachi, Pakistan: Results from a round of surveillance, Unaib Rabbani, Maryam Huda, Aysha Zahidie, and Fauziah Rabbani

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LMP1 expression in bone marrow trephines of patients with multiple myeloma confers a survival advantage, Sheerien Rajput, Khurram Minhas, Iqbal Azam Syed, Usman Shaikh, Azhar Hussain, and El Nasir Lalani

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Polio: From eradication to systematic, sustained control, Oliver Razum, Devi Sridhar, Albrecht Jahn, Shehla Zaidi, Gorik Ooms, and Olaf Müller

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Cholestyramine, a cost-effective yet efficacious anti-dote in digoxin toxicity, Fazal Ur Rehman, Zain Mushtaq, Savera Aziz Ali, Abdul Baqi, Mahreen Muzammil, and Sumera Aziz Ali

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Prevalence and factors associated with violence against women in Pakistan, Narjis Rizvi, Anam Shahil Feroz, Saba Pervez, and Oyinlola Oyebode

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Socioeconomic status and risk of cardiovascular disease in 20 low-income, middle-income, and high-income countries: The prospective urban rural epidemiologic (PURE) study, Annika Rosengren, Andrew Smyth, Sumathy Rangarajan, Chinthanie Ramasundarahettige, Shrikant I. Bangdiwala, Khalid F. AlHabib, Alvaro Avezum, Kristina Bengtsson Boström, Jephat Chifamba, and Romaina Iqbal

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A systematic review of observational studies, demonstrating smoking among school going adolescents, Shafquat Rozi, Gillian Lancaster, Sadia Mahmud, Zahid Ahmad Butt, Talat Roome, and Nida Zahid

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Effectiveness of a school based smokeless tobacco intervention: A cluster randomized trial, Shafquat Rozi, Nida Zahid, Talat Roome, Maryam Pyar Ali Lakhdir, Sobia Sawani, Anam Razzak, and Zahid Ahmad Butt

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Factors associated with geriatric morbidity and impairment in a megacity of Pakistan, Saniya Sabzwari, Romaina Iqbal, Zafar Fatmi, and Iqbal Azam Syed

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Building global partnerships through shared curricula for an MPH programme in India and Sri Lanka, Nalini Sathiakumar, Meghan Tipre, Rajitha Wickremasinghe, Vinod Bhat, Muhammad Masood Kadir, David Coggon, Arunasalem Pathemeswaran, Ramachandra Kamath, G. Arunkumar, Zafar Fatmi, Tamika Smith, Sanjay Pattanshetty, and Elizabeth Delzell

Factor associated with smokeless tobacco use in rural women and health systems readiness to address it, Inayat Muhammad Shahroz

Exploring the readiness of health care professionals regarding use of music therapy as procedural support in pediatric tertiary health care setting, Karachi, Rupani Sania Shamsuddin

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Review of the governance of public sector hospitals in Pakistan: Lessons for the future, Sameen Siddiqi, Meesha Iqbal, and Wafa Aftab

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Kangaroo mother care: Opportunities and implications for rural Pakistan, Hasan Nawaz Tahir and Zafar Fatmi

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A prevalence of hepatitis C in pregnant women of Pakistan: A systematic review, Shiyam Sunder Tikmani, Sumera Aziz Ali, Sayyeda Reza, and Prashant Tikmani

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Trends of antenatal care during pregnancy in low- and middle-income countries: Findings from the global network maternal and newborn health registry, Shiyam Sunder Tikmani, Sumera Aziz Ali, Sarah Saleem, Carla M. Bann, Musaku Mwenechanya, Waldemar A. Carlo, Lester Figueroa, Ana L. Garces, Nancy F. Krebs, and Archana Patel

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Medical doctors' offline computer-assisted digital education: Systematic review by the digital health education collaboration, Hayfaa Abdelmageed Wahabi, Samia Ahmed Esmaeil, Khawater Hassan Bahkali, Maher Abdelraheim Titi, Yasser Sami Amer, Amel Ahmed Fayed, Amr Jamal, Nasriah Zakaria, Amna Rehana Siddiqui, and Monika Semwal

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Incidence and contributing factors of glucose intolerance in Saudi postpartum women: Sub-group analysis from RAHMA study, Hayfaa Wahabi, Amel Fayed, Safaa M. S. T Tunkar, Ali Al-Hazmi, and Amna R. Siddiqui

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A new health care model for Pakistan, Mohammad Wasay and Ashar Malik

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Physical activity, sitting, and risk factors of cardiovascular disease: A cross-sectional analysis of the CARRS study, Jingkai Wei, Ranjit Mohan Anjana, Shifalika Goenka, Felipe Lobelo, Roopa Shivashankar, Muhammad Masood Kadir, Nikhil Tandon, Viswanathan Mohan, K M Venkat Narayan, Dorairaj Prabhakaran, and Mohammed K. Ali

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Eel fish bite: An impending emergency in Arabian sea, Sadia Zafar and Zafar Fatmi

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Association between asthma and dental caries amongst 12 - 15 years old children: A school-based cross-sectional study in karachi, pakistan, Wajeeha Zahid, Shafquat Rozi, Farhan Raza Khan, Nida Zahid, and Muhammad Masood Kadir

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Health systems changes after decentralisation: Progress, challenges and dynamics in Pakistan, Shehla Zaidi, Maryam Bigdeli, Etienne V. Langlois, Atif Riaz, David W. Orr, Nasir Idrees, and Jesse B. Bump

Factors associated with neonatal mortality among 2500 g. babies born in hospital setting in district Thatta, Pakistan, A nasted case control study, Farnaz Zehra

Theses/Dissertations from 2018

Perceptions on work related musculoskeletal disorders among nursing students, interns and key informations in tertiary hospital of Karachi : a qualitative descriptive study, Salima Saleem Aamdani

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Exploring health care seeking knowledge, perceptions and practices for childhood diarrhea and pneumonia and their context in a rural Pakistani community, Wafa Aftab, Leah Shipton, Fauziah Rabbani, Kashif Sangrasi, Shagufta Perveen, Aysha Zahidie, Imran Naeem, and Shamim Qazi

Knowledge, attitude and practices of skilled birth attendants towards immediate postpartum family planning services, Shazia Nasim Akbani

Patient safety through the lens of human factors system approach : qualitative exploratory-descriptive study of public and private tertiary care hospitals of Karachi, Ammarah Ali

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The logistics of voucher management: The underreported component in family planning voucher discussions, Moazzam Ali, Madeline Farron, Syed Khurram Azmat, and Waqas Hameed

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Pregnancy Outcomes among Women with an Unintended Pregnancy: Findings from a Prospective Registry in Rural Pakistan, Sumera Aziz Ali, Shiyam Sunder Tikmani, Margo S. Harrison, Sarah Saleem, Robert L. Goldenberg, Elizabeth M. McClure, and Omrana Pasha

Perceptions of stakeholders about the role of health system in suicide prevention in Ghizer, Gilgit-Baltistan, Anila Anjum

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Impact of scaling up Xpert ® MTB/RIF testing for the detection of rifampicin-resistant TB cases in Karachi, Pakistan, W M. Awan, S M A. Zaidi, Shifa Salman Habib, S Khowaja, A Malik, U Khan, R A. Ferrand, J Creswell, and A Khan

Validity evidence of multiple mini interviews for selection into an undergradudate medical education program, Rukhsana Ayub

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Dietary practices of school children in Sindh, Pakistan, Ayesha Aziz, Mehak Pervaiz, Ayesha Khalid, Ayesha Zahid Khan, and Ghazala Rafique

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Assessing family planning service quality and user experiences in social franchising programme - Case studies from two rural districts in Pakistan, Syed Khurram Azmat, Moazzam Ali, Waqas Hameed, and Muhammad Ali Awan

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Effectiveness of training on de-escalation of violence and management of aggressive behavior faced by health care providers in a public sector hospital of Karachi, Lubna Baig, Sana Tanzil, Shiraz Shaikh, Ibrahim Hashmi, Muhammad Arslan Khan, and Maciej Polkowski

Estimating the impact of "Khyber Pakhtunkhwa cancer project" on household economic : cost analysis of chronic myeloid leukemia in Khyber Pakhtunkhwa before & after the cancer project, Muhammad Zeeshan Bangash

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An approach to identify a minimum and rational proportion of caesarean sections in resource-poor settings: A global network study, José M. Belizán, Nicole Minckas, Elizabeth M. McClure, Sarah Saleem, Janet L. Moore, Shivaprasad S. Goudar, Fabian Esamai, Archana Patel, Elwyn Chomba, and Ana L. Garces

Prevelence and associated factors of childhood obesity among school-going children aged 10-14 years in community-based schools of Karachi, Pakistan, Shaileena S. Bhimani

Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE): a prospective cohort study., Mahshid Dehghan, Andrew Mente, Sumathy Rangarajan, Patrick Sheridan, Viswanathan Mohanv, and Romaina Iqbal

Induction of labour & neurodevelopmental outcome among small for gestational age fetuses with deranged cerebral hemodynamics : a cohort study, Naveen Shaikh Dr

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Factors associated with month 2 smear non-conversion among category 1 tuberculosis patients in Karachi, Pakistan, Kimberly A. D'Souza, Syed M A. Zaidi, Maria Jaswal, Shahid Butt, Saira Khowaja, Shifa Salman Habib, and Amyn A. Malik

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Health systems readiness for adopting mhealth interventions for addressing non-communicable diseases in low- and middle-income countries: A current debate, Anam Shahil Feroz, Muhammad Masood Kadir, and Sarah Saleem

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The need for research evidence to meet health workforce challenges in the eastern Mediterranean region, Fethiye Gulin Gedik, James Buchan, Zafar Mirza, Arash Rashidian, Sameen Siddiqi, and Gilles Dussault

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Improving pregnancy outcomes in low- and middle-income countries, Robert L. Goldenberg, Elizabeth M. McClure, and Sarah Saleem

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Criteria for assigning cause of death for stillbirths and neonatal deaths in research studies in low-middle income countries, Robert L. Goldenberg, Lulu Muhe, Sarah Saleem, Sangappa Dhaded, Shivaprasad S. Goudar, Janna Patterson, Assaye Nigussie, and Elizabeth M. McClure

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Routine antenatal ultrasound in low- And Middle-income Countries: First look - A cluster randomised trial, Robert L. Goldenberg, Robert O. Nathan, David Swanson, Sarah Saleem, Waseem Mirza, Fabian Esamai, David Muyodi, Ana L. Garces, Lester Figueroa, and Elwyn Chomba

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Women's experiences of mistreatment during childbirth: A comparative view of home- and facility-based births in Pakistan, Waqas Hameed and Bilal Iqbal Avan

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Does courtesy bias affect how clients report on objective and subjective measures of family planning service quality? A comparison between facility- and home-based interviews, Waqas Hameed, Muhammad Ishaque, Xaher Gul, Junaid-Ur-Rehman Siddiqui, Sharmeen Hussain, Wajahat Hussain, Aftab Ahmed, and Asma Balal

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What influences family planning in rural Pakistan: Franchised service provider and community health worker perspective, Waqas Hameed, Junaid-ur-Rehman Siddiqui, Muhammad Ishaque, Sharmeen Hussain, Xaher Gul, Hina Najmi, Shehla Noorani, Ghulam Mustafa, and Asma Balal

Frequency of musculoskeletal disorder among physiotherapists in public and private hospitals, Yasir Iqbal

Exploring awareness of children on street regrading road traffic injuries in Karachi, Pakistan : a qualitative study, Munira Ismail

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Determinants of uncontrolled hypertension in rural communities in south Asia-Bangladesh, Pakistan, and Sri Lanka, Tazeen Jafar, Mihir Gandhi, Imtiaz Jehan, Aliya Naheed, H Asita de Silva, Hunaina Shahab, Dewan Alam, Nathasha Luke, Ching Wee Lim Wee Lim, and COBRA-BPS Study Group

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Application of the GPS technology to assess time-location pattern of undergraduate students at a private medical university in Karachi, Pakistan: A pilot study, Tanzil Jamali, Adeel Ahmed Khan, Asaad Ahmed Nafees, Muhammad Ahmed, Syed Iqbal Azam, Muhammad Masood Kadir, and Kiyoung Lee

Stress and social support among fulltime working mohters, Nabea Jawaid

Awareness about occupational hazards and workplace safety measures among construction workers of AKUH: a qualitative exploratory study, Ayesha M Amin Karamali