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1.  Critical realism: a practical ontology to explain the complexities of smoking and tobacco control in different resource settings 
Global Health Action  2013;6:10.3402/gha.v6i0.19303.
This paper presents critical realism (CR) as an innovative system for research in tobacco prevention and control. CR argues that underlying mechanisms are considered and explored to ensure effective implementation of any program/policy or intervention. Any intervention or program/policy that is transposed from one country to another or one setting to another is complex.
The research was undertaken and analyzed through a critical ethnography lens using CR as a philosophical underpinning. The study relied upon the following components: original fieldwork in Nigeria including participant observation of smokers, in-depth interviews and focus groups with smokers, and in-depth interviews with health professionals working in the area of tobacco control in Nigeria.
Findings from this small ethnographic study in Nigeria, suggest that Critical Realism holds promise for addressing underlying mechanism that links complex influences on smoking.
This paper argues that understanding the underlying mechanisms associated with smoking in different societies will enable a platform for effective implementation of tobacco control policies that work in various settings.
PMCID: PMC3617644  PMID: 23561029
critical realism; smoking; developing countries; Africa; Nigeria; Lagos; health policy; tobacco control
2.  Addressing disparities in maternal health care in Pakistan: gender, class and exclusion 
After more than two decades of the Safe Motherhood Initiative and Millennium Development Goals aimed at reducing maternal mortality, women continue to die in childbirth at unacceptably high rates in Pakistan. While an extensive literature describes various programmatic strategies, it neglects the rigorous analysis of the reasons these strategies have been unsuccessful, especially for women living at the economic and social margins of society. A critical gap in current knowledge is a detailed understanding of the root causes of disparities in maternal health care, and in particular, how gender and class influence policy formulation and the design and delivery of maternal health care services. Taking Pakistan as a case study, this research builds upon two distinct yet interlinked conceptual approaches to understanding the phenomenon of inequity in access to maternal health care: social exclusion and health systems as social institutions.
This four year project consists of two interrelated modules that focus on two distinct groups of participants: (1) poor, disadvantaged women and men and (2) policy makers, program managers and health service providers. Module one will employ critical ethnography to understand the key axes of social exclusion as related to gender, class and zaat and how they affect women’s experiences of using maternal health care. Through health care setting observations, interviews and document review, Module two will assess policy design and delivery of maternal health services.
This research will provide theoretical advances to enhance understanding of the power dynamics of gender and class that may underlie poor women’s marginalization from health care systems in Pakistan. It will also provide empirical evidence to support formulation of maternal health care policies and health care system practices aimed at reducing disparities in maternal health care in Pakistan. Lastly, it will enhance inter-disciplinary research capacity in the emerging field of social exclusion and maternal health and help reduce social inequities and achieve the Millennium Development Goal No. 5.
PMCID: PMC3490894  PMID: 22871056
Social exclusion; Maternal health; Gender; Caste system; Pakistan; Health care system; Class; Health policy; Pregnancy and childbirth; Antenatal care
3.  Maternal deaths in Pakistan: intersection of gender, caste, and social exclusion 
A key aim of countries with high maternal mortality rates is to increase availability of competent maternal health care during pregnancy and childbirth. Yet, despite significant investment, countries with the highest burdens have not reduced their rates to the expected levels. We argue, taking Pakistan as a case study, that improving physical availability of services is necessary but not sufficient for reducing maternal mortality because gender inequities interact with caste and poverty to socially exclude certain groups of women from health services that are otherwise physically available.
Using a critical ethnographic approach, two case studies of women who died during childbirth were pieced together from information gathered during the first six months of fieldwork in a village in Northern Punjab, Pakistan.
Shida did not receive the necessary medical care because her heavily indebted family could not afford it. Zainab, a victim of domestic violence, did not receive any medical care because her martial family could not afford it, nor did they think she deserved it. Both women belonged to lower caste households, which are materially poor households and socially constructed as inferior.
The stories of Shida and Zainab illustrate how a rigidly structured caste hierarchy, the gendered devaluing of females, and the reinforced lack of control that many impoverished women experience conspire to keep women from lifesaving health services that are physically available and should be at their disposal.
PMCID: PMC3247835  PMID: 22165862
4.  Knowledge of and Perceptions about Sexually Transmitted Diseases and Pregnancy: A Qualitative Study among Adolescent Students in Uganda 
This article reports the findings of a qualitative research study carried out in Kabarole district, western Uganda. Knowledge of and perceptions about HIV/AIDS and pregnancy and how both relate to one another were elucidated from eight focus-group discussions with 38 female and 32 male secondary students from four different schools. Widespread misinformation and misconceptions about contraceptives still exist as previously found in this area. There was a serious gap in knowledge and understanding of ‘dual protection’ against sexually transmitted diseases, including HIV/AIDS, and against pregnancy. Fertility was very highly valued, and many girls stated that they would want a child even if they were HIV-positive. Responses of girls showed that they were quite assertive in making decisions to use contraceptives. The reasons for students not being able to understand the interconnectedness of sexually transmitted diseases and pregnancy may lie in the fragmented fashion in which relevant health education is delivered through two separate programmes.
PMCID: PMC2754036  PMID: 18330065
Adolescents; AIDS; Dual protection; HIV infection; Knowledge, attitudes, practices; Perceptions; Qualitative studies; Reproductive health; Sexually transmitted diseases; Uganda

Results 1-4 (4)