South Asia carries the burden of a rapidly changing climate with floods and extreme heat. These disasters further translate into mental health distress, financial stress and detrimental effects on well-being, with women being the most vulnerable. This study aims to demonstrate that mental health screening, referral and resilience-building group sessions can be successfully administered by community health workers and primary health facility staff in a flood-affected rural population of women in Pakistan and provide evidence on the effectiveness of this approach for improving their mental health status.

A quasi-experimental design with a comparison group will be used for the study, preceded by a formative phase. The formative phase evaluated the feasibility of mental health screening by Lady Health Workers (LHWs) in flood-affected areas using a qualitative approach such as focus group discussions and in-depth interviews. Manuals developed by the study team of mPareshan will be used to train LHWs, Lady Health Supervisors (LHS) and health facility staff. Following this, LHWs will briefly screen women aged 18 to 49 years, administer awareness-raising and resilience-building sessions and refer women who screen positive for depression or anxiety to a primary health facility. Physicians at the health facility will confirm the diagnosis and provide counselling to mild-moderate cases, while severe cases would be referred to specialists. Statistical evaluation of quantitative data and thematic content analysis of qualitative data will be conducted to assess the feasibility and impact of the intervention. This trial is registered at clinicaltrials.gov with number NCT06756165.

The study acquired ethical approval from the Ethical Review Committee at Aga Khan University (2024-10475-30776) and the National Bioethics Committee (4-87/NBC-1158/23/481) in Islamabad. Approval was obtained from relevant provincial authorities. The trial will adhere to the ethical principles of autonomy, anonymity, confidentiality, equity and respect. All eligible participants will be provided with informed consent, details regarding the purpose and procedure of the study, and the right to withdraw at any time. Data and information will be anonymised and stored securely. Dissemination of the results of the trial will occur after its completion to stakeholders, participants and the public.

NCT06756165.

This study aimed to estimate the frequency of depression in mothers during the antepartum and postpartum periods and identify predictors of perinatal depression in the tertiary care hospital of Karachi, Pakistan.

Analytical cross-sectional study.

Public Tertiary Care Hospital, Civil Hospital, Karachi, Sindh, Pakistan.

The study involved 262 mothers for the assessment of frequency and predictors of perinatal depression in Pakistan.

The Edinburgh Postpartum Depression Scale (EPDS) was used as the tool to screen for depression. The data were collected through a structured questionnaire encompassing the sociodemographic factors, pregnancy and birth-related information, newborn characteristics sections, family relationship and marital status and psychosocial and psychological history. Mean and SD were computed for continuous data, whereas frequencies and percentages were determined for categorical data. Pearson ² test was applied to determine the association between categorical variables. Predictors of perinatal depression were identified through multivariate logistic regression.

Out of 262 enrolled mothers, 198 screened positive for depressive symptoms using EPDS with a cut-off value ≥10. The mean age of participating mothers was 27.4±5.95 years. Approximately 39.7% of the mothers were illiterate, 75% were housewives and about 42% had a family income of less than US$126. Women with access to a healthcare facility had higher odds of antepartum depression symptoms, possibly due to poor healthcare experiences during antenatal visits. Emotional support by husband reduces the odds by 45.8% while experiencing abuse increases odds by three times. Significant predictors of postpartum depression symptoms included decision-making power, which reduced the odds of postpartum depression symptoms by 72.5% and emotional support by 80%.

The study concluded that maternal decision-making power is a significant protective factor against postpartum depression. Strikingly, access to health facilities by the mother was associated with higher odds of antepartum depression. Other factors, including household income, husband’s employment status, domestic violence, emotional support and family abuse, did not show significant associations with either antepartum or postpartum depression. These findings emphasise the importance of routine screening to identify women at risk during the perinatal period.

Our research aimed to assess the feasibility of digital health in enhancing healthcare access in the semiurban areas of Karachi, Pakistan.

This qualitative descriptive study was employed at three villages in Gadap, Karachi, Pakistan, with varying socioeconomic contexts, using a feasibility framework. Ethical approval was provided by the Ethical Review Committee (ERC) of The Aga Khan University.

Through purposive sampling, demand and supply-side stakeholders (N=152) were invited to participate in the study, including community leaders, activists and members, representatives from non-governmental organisations, public and private sector healthcare providers, and digital healthcare providers and experts. Both inductive and deductive approaches were used for data analysis.

The assessment of feasible demand-side and supply-side factors would be extremely useful in the planning and implementation of a sustainable digital health programme.

Digital health is an acceptable and practically feasible option and is a potential solution to enhance healthcare access and equity, particularly in semiurban and rural remote areas, where healthcare access is limited. Digital healthcare should not replace inperson healthcare but should instead be offered in combination with it, preferably through a ‘Hub & Spoke Model’ facility. Few challenges exist in implementing digital health, including privacy, ethical issues, lack of evidence-based standards, inadequate training of healthcare providers, technological barriers and access to digital health services by vulnerable populations, such as the elderly, women, individuals who are illiterate and those of low-income class.

Our study concludes that digital healthcare is a dire need and is a potential solution to enhance healthcare access and equity, as it is acceptable and practically feasible. A mix of inperson and digital health consultation should be offered through a hub and spoke model. Few challenges to implementing digital health exist and should be addressed by tailoring digital health through co-creation and engaging all stakeholders.