Community-based health education: A pilot module on maternal and child health for public health students in Pakistan

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Despite efforts, Pakistan continues to face high maternal and child mortality rates. Recognizing the potential of universities in improving community health through outreach programs, this project aims to enhance the capabilities of the existing Center for Research in Maternal and Child Health within the Department of Public Health by developing a Community-Based Education module in MCH. Methods Led by a team with expertise in maternal and child health, medical education, and curriculum development, the module was created using the PARE framework (Preparation, Action, Reflection, and Evaluation) for community-based course planning. The module content development process entailed an extensive review of curricula from both Pakistani and international universities, alongside baseline surveys with community mothers, consultations with faculty members and health department officials, and assessments of student needs. Results The resulting 124-page module comprehensively addresses prevailing maternal and child health challenges in Pakistan. Structured into two main chapters on 1) maternal health and 2) child health, each chapter is further divided into six sub-chapters. It covers nutrition, health conditions, healthcare service utilization, sanitation, and hygiene issues relevant to MCH. Conclusions Moving forward, the project will embark on faculty and student training sessions to facilitate module implementation in community settings, followed by a year-long deployment within target communities. Evaluation mechanisms will gauge module effectiveness through pre- and post-test analyses of community and student data. This endeavor heralds a pioneering initiative in Pakistan, epitomizing the integration of community-based education and university partnerships to enhance the educational experience of public health students. Plans are underway to expand this initiative to other universities across Punjab province, ensuring its sustainability and scalability for broader community impact Community-based education public health maternal and child health community Figures Figure 1 Background The critical role of maternal and child health (MCH) in the developmental trajectories of nations is universally acknowledged, with the health of mothers and children being pivotal determinants of overall societal progress. Alarming global statistics reveal that every two minutes, a woman succumbs to complications arising during pregnancy or childbirth, with 95% of these fatalities occurring in low-resource settings [ 1 ]. Pakistan, with its population of approximately 230 million, reported 186 maternal deaths per 100,000 live births in 2019, alongside significant rates of neonatal, infant, and child mortality, underscores a critical public health crisis. Annually, Pakistan witnesses approximately five million pregnancies, with 15% of these cases experiencing severe medical or obstetric complications [ 2 ]. Various determinants, including inadequate dietary intake, lack of antenatal care, insufficient preparation for delivery, and improper child spacing, result in adverse pregnancy outcomes such as preterm births, low birth weight, and stunted growth [ 3 ]. These conditions contribute to the heightened risk of acute or chronic malnutrition among children, further exacerbating the public health challenge. The prevailing underutilization of maternal and child healthcare services in Pakistan, particularly in rural areas, can be attributed to a complex interplay of social, religious, and cultural constraints [ 4 ]. This scenario necessitates a strategic reassessment and restructuring of MCH programs, emphasizing not only the enhancement of healthcare facilities but also the mobilization of community awareness and participation. In Pakistani social setup, universities can play its great role to improve the health of communities through community outreach program. Many studies provide evidence that academic institutions, particularly through community-academic partnerships and community-based education (CBE), can be helpful in strengthening community awareness regarding health issues [ 5 – 6 ]. Universities and higher education institutions are increasingly recognized not merely as repositories of knowledge but as dynamic catalysts for societal transformation, thereby contributing to societal advancement at large [ 7 ]. The challenges of globalization, coupled with its consequent health threats, have underscored the necessity for higher education institutions to not only contributing to the cultivation of sustainable, healthy communities but also ensuring the continuous adaptation of the educational system to align with the exigencies of the real world [ 7 ]. The principal objectives of higher education institutions extend beyond the mere dissemination of theoretical knowledge. They encompass the promotion of research, empowerment of communities, and the preparation of students for effective engagement in real-life settings [ 8 ]. This comprehensive approach is crucial for fostering a well-rounded educational experience that equips students with the requisite skills, knowledge, and competencies to navigate and address the complexities of the contemporary world [ 7 ]. However, the specific needs and challenges of communities are not monolithic; they are as diverse as the communities themselves. This diversity introduces a layer of complexity into the educational paradigm, raising pertinent questions about the nature of the ‘real world’ for which students are being prepared [ 8 ]. In response to this ambiguity, higher education institutions are tasked with developing curricula and pedagogical strategies that are not only robust and flexible but also responsive to the varying demands and challenges of different community contexts. The integration of Community-Based Education (CBE) into the curriculum serves as a pivotal strategy in this regard. CBE offers a practical framework through which students can engage directly with community issues, allowing them to apply theoretical knowledge to real-world problems, thereby enhancing their learning experience and making tangible contributions to community well-being [ 9 ]. Moreover, community-academic partnerships emerge as a critical component in this educational ecosystem, facilitating a symbiotic relationship between higher education institutions and the communities they serve. Through these partnerships, institutions can gain insights into the specific needs and challenges of communities, which, in turn, can inform curriculum development and research agendas. Simultaneously, communities benefit from the knowledge, innovations, and resources that flow from these collaborations, leading to mutual growth and development. CBE approach necessitates a commitment to adaptive learning, continuous engagement with community stakeholders, and a proactive stance on addressing the health and societal challenges of our time. By aligning their educational missions with these objectives, higher education institutions can play a pivotal role in shaping resilient, healthy, and sustainable communities, thereby contributing to the broader societal good. In Pakistan, a significant portion of the healthcare budget is spent on curative medicine and public health/preventive medicine is a neglected discipline. In Punjab, there are only few institutions that offer a degree in public health. In all these institutions, there is no concept of CBE. Additionally, the curriculum is classroom-based, and teachers have lack of experience and skills in organizing and teaching in the field. So, there is an urgent need to design and develop a CBE module that aims at serving the needs of students, teachers, healthcare providers and local communities. Given this backdrop, this project seeks to strengthen and expand the capabilities of the existing Center for Research in Maternal and Child Health (CRMCH) within the Department of Public Health by developing a CBE module in MCH. By fostering community-university partnerships, the initiative aims to enhance the skills, competencies, and knowledge of students and healthcare professionals in the MNCH domain. Through this integrated approach, students will not only gain insights into the health needs and challenges of the communities they will serve but also contribute to research endeavors that can inform policy decisions at both local and national levels, thereby advancing the agenda for MCH improvement in Pakistan. Methods A four-member team was developed having extensive research and teaching experience in the field of MCH, medical education and curriculum development. This diverse team added their knowledge and expertise on MCH, community based learning, andragogical methods, and the socio-cultural determinants of health. Between May to December 2022, we worked with the community to develop the CBE module under the umbrella of CRMCH at the Department of Public Health, University of the Punjab, Pakistan. This work was part of a broader postdoctoral research project undertaken by the first author in association with the Foundation for Advancement of International Medical Education and Research (FAIMER) Institute, USA. It was a pilot project, first of its kind in Punjab, Pakistan. We used the common guide for community-based course planning PARE (Preparation, Action, Reflection and Evaluation) [ 10 ] for developing the CBE module. Our research expertise in MCH, combined with our practical experience from working in various community settings on MCH issues, and teaching courses on reproductive health, influenced the module development process. This expertise informed the pedagogical approach, ensuring the effective communication of complex ideas to students. The blend of theoretical knowledge and hands-on experience likely enriched the module content, providing a well-rounded perspective on topics related to MCH. We gave a two-day in-person introductory training to the team. We developed the content of CBE module on the basis of the following sources: Review of four-year curriculum of BS Public Health from different Pakistani universities to determine where CBE was being offered. Additionally, curricula from different universities around the world offering CBE particularly in MCH and relevant literature retrieved from PubMed and Scopus were reviewed that informed the contents of the module and reference materials. Following the detailed review of all courses, we found no university is offering CBE in public health, nor in any other discipline. From our previous knowledge, we identified that students need to do internship in their fifth semester (third year), so after discussion with the faculty, at the first step we identified the 3-credit internship as a suitable place to offer CBE module. Student internship is a course where students need to work as internee with any research or community organization for five hours/day, five days a week for six weeks (total 150 hours). Baseline survey with mothers from the community: Community health needs assessment during May to July 2022 (n = 254 respondents of 1,500 population [eligible people]; 90% response rate [ 11 ]). Consultative meeting of three hours with seven faculty members who were involved in public health teaching and research at Department of Public Health. We presented our aims at this meeting and sought their feedback. Discussions with Provincial Health Department officials: From August to September 2022, we met with officials from the Director General Health, Department of Primary and Secondary Health Department of Punjab province, Chairman Punjab higher education commission and non-governmental organizations such as UNICEF and WHO and sought their input and suggestions for developing the contents of the module. Consultative meeting of three hours with the healthcare providers working in MCH domain in August 2022. Need assessment with the students: To identify gaps with respect to CBE in the current curriculum and to understand student expectations for the CBE module, we conducted a 1.5 hours interactive session with all BS Public Health students in May 2022. One briefing and feedback session of the whole team in September 2022. The findings of the community health needs assessment (paper published elsewhere [ 11 ]) highlighted the issues related to MCH, hygiene and sanitation as their main concerns in the targeted community. The CBE module was developed around these highlighted issues by following ethics of working with vulnerable communities and targeting their social and behavioral change aspects. The CBE module was developed and implemented in University of the Punjab, the largest public sector university in Pakistan comprising of five campuses, 19 faculties, 138 departments/centers/institutes, 991 full-time/regular and 300 part-time faculty members, and 49,520 on-campus students. As a pilot project, 120 third year students of Bachelor in Public Health were recruited over a period of two years. Students were involved in the module development activities from its inception. They were the part of selection of community, baseline community health need assessment, consultative meetings with faculty and healthcare providers, and implementation and evaluation of the module. It was made compulsory for all public health students by making it a part of their internship program. Results The module spans 124 pages and is structured to comprehensively address maternal and child health concerns in Pakistan. It commences with an introduction highlighting the current situation of MCH in the country, providing context for the subsequent discussions. Key concepts and terminology essential for understanding the module are also elucidated. The module is organized into two main chapters focusing on 1) maternal health and 2) child health. Each chapter is further segmented into six sub-chapters or sections (Table 1 and Fig. 1 provide a detailed breakdown of the contents). Table 1 Module chapters, sub-chapters, learning objectives and core contents Module chapters Module sub-chapters Learning objectives Core content Maternal health Maternal health and maternal diet • Define macro and micronutrients, outlining their sources and significance in maintaining overall health. • Explain the concept of Daily Recommended Intake (DRI) of energy, and delineate the variations in energy requirements across different life stages of females, including adolescence, adulthood, pregnancy, and menopause. • Interpret nutritional guidelines and recommendations provided by authoritative health organizations for energy intake in females at different life stages. • Develop proficiency in calculating and adjusting energy needs based on individual factors and lifestyle variations. • Design personalized diet plans tailored to different age groups of females, considering their unique energy requirements, dietary preferences, and cultural backgrounds. • Incorporate locally available foods and traditional cuisines into diet plans, ensuring cultural relevance and accessibility. • Introduction to macro- and micronutrients i. Define macro- and micronutrients, highlighting their essential roles in supporting overall health. ii. Explore sources of macro- and micronutrients, with a focus on commonly available local foods in Pakistani households. iii. Provide examples of local foods rich in various macro- and micronutrients, emphasizing their importance in achieving a balanced diet. • Daily recommended intake (DRI) of energy and body mass index (BMI) i. Introduce the concept of DRI of energy, explaining how it relates to maintaining optimal health and well-being. ii. Discuss the role of BMI in assessing nutritional status and determining energy requirements. iii. Illustrate the relationship between energy intake, expenditure, and BMI, emphasizing the importance of balance for overall health. • Energy requirement by age and lifestyle i. Examine factors influencing energy requirements, including age, gender, physical activity level, and metabolic rate. ii. Discuss variations in energy needs across different age groups and lifestyles, considering factors such as growth, physical activity, and metabolic changes. iii. Provide guidelines for estimating energy requirements based on individual factors and lifestyle considerations. • Energy requirement during different phases of a female’s life i. Explore the specific energy needs of females during key life stages, including adolescence, pregnancy, and lactation. ii. Discuss physiological changes and increased energy demands associated with each phase, emphasizing the importance of meeting nutritional needs for maternal and fetal health. iii. Provide practical recommendations for adjusting energy intake to support optimal health during these critical life stages. Hygiene and sanitation • Define the concept of personal hygiene and its significance in preventing illness, promoting health, and enhancing overall well-being. • Explain the importance of maintaining good personal hygiene practices in preventing the spread of infectious diseases, including respiratory infections, gastrointestinal illnesses, and skin infections. • Identify common personal hygiene practices, including hand hygiene, oral hygiene, body hygiene, and menstrual hygiene management, and their role in reducing the risk of infections. • Develop practical skills in designing easy-to-use and adaptable techniques for maintaining personal hygiene in daily life, considering individual preferences, resources, and environmental conditions. • Demonstrate proper hand washing techniques, including the use of soap and water or hand sanitizer, to effectively remove dirt, germs, and contaminants from hands. • Personal hygiene practices i. Hand hygiene: Proper hand washing techniques, including when and how to wash hands effectively with soap and water or hand sanitizer. ii. Foot hygiene: Importance of keeping feet clean and dry to prevent fungal infections and odors, along with proper footwear care. iii. Skin hygiene: Maintaining skin health through regular bathing or showering, using appropriate skincare products, and addressing skin conditions. iv. Clothing hygiene: Importance of wearing clean clothes and proper laundering techniques to prevent the spread of germs and odors. v. Oral hygiene: Brushing teeth, flossing, and mouthwash use to maintain oral health, prevent cavities, gum disease, and bad breath. • Consequences of poor hygiene i. Contamination: How failure to maintain hygiene practices can lead to the presence of harmful microorganisms on surfaces, objects, or in the environment. ii. Infections: Risks of contracting infectious diseases, such as colds, flu, gastrointestinal illnesses, and skin infections, due to poor hygiene. iii. Transmission: How pathogens can spread through direct contact, airborne droplets, contaminated surfaces, or shared items in settings such as homes, schools, and healthcare facilities • Control measures to prevent disease transmission i. Hand hygiene: Proper handwashing techniques, frequency, and duration to effectively remove germs and prevent the spread of infections. ii. Surface cleaning: Importance of regularly cleaning and disinfecting surfaces and objects, particularly high-touch areas, to reduce the risk of contamination. iii. Drying: Ensuring proper drying of hands, surfaces, and laundry to prevent the survival and spread of pathogens in moist environments. iv. Airing: Allowing adequate ventilation and air circulation in indoor spaces to reduce the concentration of airborne pathogens and maintain air quality. Antenatal care (ANC) • Understanding the concept of ANC and its importance • Identify signs of anemia through physical examination of women • Identify warning signs of pregnancy among women • Define the importance of health education and counseling in promoting healthy behaviors, informed decision-making, and self-care practices during pregnancy. • Understanding the concept of ANC and its importance i. Define antenatal care and its significance in promoting maternal and fetal health during pregnancy. ii. Explain the goals and components of ANC, including medical assessments, screenings, health education, and counseling services. iii. Analyze the impact of timely and regular ANC visits on reducing maternal and neonatal mortality and morbidity rates. • Identification of signs of anemia through physical examination of women i. Recognize the physical signs and symptoms of anemia in pregnant women, such as pallor, fatigue, shortness of breath, and rapid heart rate. ii. Understand the importance of routine hemoglobin testing and other laboratory investigations for detecting and managing anemia during pregnancy. iii. Discuss the implications of untreated or inadequately managed anemia on maternal and fetal health outcomes. • Identification of warning signs of pregnancy among women i. Identify common warning signs and symptoms of pregnancy complications, such as vaginal bleeding, severe abdominal pain, persistent headaches, and reduced fetal movements. ii. Understand the significance of early detection and timely management of pregnancy complications to prevent adverse maternal and neonatal outcomes. iii. Discuss the role of healthcare providers in educating pregnant women about recognizing and reporting warning signs for prompt medical intervention. • Importance of health education and counseling in ANC i. Define the importance of health education and counseling in promoting healthy behaviors, informed decision-making, and self-care practices during pregnancy. ii. Discuss topics commonly addressed during ANC sessions, including nutrition, physical activity, childbirth preparation, breastfeeding, and newborn care. iii. Explore effective communication strategies for delivering culturally sensitive and evidence-based health information to pregnant women and their families. Family planning • Address the need and importance of family planning • Distinguish between different types of family planning methods • Identify barriers to access and barriers to utilization of family planning methods in different communities • Introduction to family planning and its need i. Define family planning and its importance in enabling individuals to make informed decisions about the number and spacing of children they desire. ii. Discuss the role of family planning in promoting maternal and child health, empowering women, and contributing to socioeconomic development. • Research findings highlighting unmet family planning needs i. Review global and national research findings identifying unmet family planning needs among women, with a focus on Pakistan. ii. Explore factors contributing to unmet needs, such as lack of access to services, socio-cultural barriers, and inadequate information about contraceptive methods. • Benefits of family planning methods i. Examine the benefits of various family planning methods in preventing unintended pregnancies, improving maternal and child health outcomes, and empowering individuals and couples to plan their families • Determinants of utilization of family planning services i. Analyze research findings highlighting determinants influencing the utilization of family planning services, including socio-demographic factors, knowledge and attitudes towards contraception, accessibility of services, and cultural beliefs. • Family planning methods Discuss surgical and non-surgical, permanent and temporary, male and female methods of family planning, including contraception, sterilization, hormonal methods, barrier methods, and fertility awareness-based methods. • Socio-cultural and religious barriers Explore socio-cultural and religious barriers associated with the utilization of family planning methods in Pakistan, including cultural norms, gender roles, religious beliefs, and misconceptions about contraception. • GATHER technique for family planning counseling Introduce the GATHER technique for effective family planning counseling, emphasizing its components: Greet, Ask, Tell, Help, Explain, and Return. • Introduction to intra-natal care and its aim Define intra-natal care and its aim in ensuring the health and well-being of pregnant women and their newborns during childbirth and the immediate postpartum period. • Intra-natal care services Explore the features, advantages, and disadvantages of intra-natal care services, including domiciliary midwifery care, institutional care, home helps, maternity homes, transport facilities, blood transfusion services, diagnostic and laboratory facilities, and arrangements for consultation and referrals. Intra-natal and post-natal care • Distinguish between intra-natal and post-natal care and discuss their importance • Identify post-natal mother and newborn danger signs • Introduction to intra-natal care and its aim • Intra-natal care services, its features, advantages and disadvantages: Domiciliary midwifery care, institutional care, home helps, maternity homes, transport facilities for midwives, ambulance services, blood transfusion services, diagnostic and laboratory facilities, and arrangements for consultation and referrals • Rooming-in and its importance • Postnatal care, its objectives and services • Care of newborn in postnatal care: Resuscitation; APGAR scoring system; care of cord, eyes and skin of newborn; general physical appearance of newborn and physical examination for abnormalities • Post-natal mother and new-born danger signs Child health Child health, growth and development • Distinguish between different types of malnutrition among children • Identify severely acute malnutrition (SAM), moderately acute malnutrition (MAM), and at risk of malnutrition children by taking anthropometric measures • Growth among infants and children • Malnutrition and its types: stunting, wasting, acute and chronic malnutrition; SAM, MAM, and risk of malnutrition • Management of malnutrition and introduction to Ready-to-use-therapeutic food (RUTF) • Taking anthropometric measures of the child including height, weight, head circumference, and mid upper-arm circumference (MUAC) • Video illustrations of taking anthropometric measures of children • Mock exercises for hands on practice of taking anthropometric measures Diet in infancy • Discuss the nutritional requirement in childhood and the importance of breast milk • Make recipes for easy to make and home-friendly complimentary feeds for infants using locally available and everyday use ingredients • Nutritional requirement in childhood • Stages of breast milk and variations in composition: Colostrum, transitional milk, mature milk, and foremilk • Risks associated with not breastfeeding • Disadvantages of bottle-feeding • Exclusive and complimentary feeding • The cultural concept of ghutti in Pakistan • Easy to make and home-friendly complimentary feeding for infants Breastfeeding and lactation management • Discuss the importance of early initiation of breastfeeding • Identify the major breastfeeding difficulties and define their management strategies • Early initiation of breastfeeding and its importance • Management of breastfeeding difficulties: inverted nipples, breast engorgement, poor latch, sore nipples, baby suckling issues, baby falls asleep during nursing, plugged ducts, mastitis signs of infection and Thrush treatment, Raynaud’s nipple vasospasm and perceived and actual low milk supply • Prenatal breastfeeding education and feeding positions: Good and poor latch • Video illustrations for achieving successful breastfeeding • Counseling related to initiation of breastfeeding and management of breastfeeding difficulties Child vaccination • Define the concept and importance of timely child immunization • Understand different vaccinations, their need and side-effects • Introduction to child immunization and its importance • EPI vaccination schedule: BCG; OPV I, II and III; Pneumococcal I, II and III; MR I and II; and typhoid • Importance of giving vaccines at recommended time • Minor side effects of vaccines: fever, irritability, headache, rash, soreness, pain, redness, swelling, small lump at injection site, abscess or scar. • Contraindications for immunization • Fully immunized, partially immunized and zero-dose children Psychomotor development • Define the concept of psychomotor development and the role of family members and proper nutrition in the psychomotor development of the child • Differentiate between different psychomotor developmental skills • Distinguish between the developmental landmarks among infants, 1–2 years of age children, 3–4 years of age children, 4–5 years of age children • Introduction to psychomotor development • Developmental landmarks in infants, 1–2 years of age children, 3–4 years of age children, 4–5 years of age children: cognitive, language, fine motor, gross motor, social and self-mastery, Dangers signs of pneumonia and diarrhea in childhood • Identify early symptoms and danger signs of pneumonia and diarrhea among children • Understand at-home prevention of dehydration from diarrhea • Describe chocking and how it can be managed • Pneumonia and diarrhea in childhood, and their early symptoms and danger signs • Prevention of dehydration from diarrhea • ORS day • Preparation of ORS at home • Chocking and its management among infants and children • Video illustrations on chocking management Working with communities Community engagement and working with communities • Explain the inter-connectedness of entering in community, community engagement, community mobilization, community awareness and community participation • Identify and address the specific needs of communities • Entering community and community engagement: introduction and rapport; initial informal session; technical session; and ending session • Identifying the needs of community: survey questionnaires, observations, informal discussions, focused group discussions, taking field notes • Mock exercises and community-based activities for designing tailored interventions to address community needs • Community awareness and community mobilization Field ethics and challenges • Explain why field ethics are important while working with communities • Identify field challenges and discuss how different challenges can be managed • Field ethics: autonomy (the right to complete information, privacy, confidentiality, informed consent, respect), addressing sensitive issues, building relation with the community, being an in-sider • Field challenges and their management: Whether conditions, conflicts, work order management, reduced team efficiency, uncertainty, real-time communication, opportunity assessment, building rapport, identification of stakeholders and gatekeepers • Discussing different scenarios of field challenges and brainstorming on how these can be managed Health promotion and health education • Understand the concepts of health promotion and health education • Discuss the importance of roles and responsibilities of public health professional • Design and apply tailored health education campaigns in community • Introducing health promotion and health education • Tailoring health education according to the needs of community • Classroom and community-based activities of tailoring health education according to specific needs: Personal hygiene and care; family planning; home preparation of infant food; infant and child care; maternal and child diet; and ANC, intra-natal and post-natal care • Public Health professionals’ responsibilities and roles One of the distinguishing features of the module is its emphasis on practical fieldwork alongside a theoretical study. A balanced approach is taken where half of the credit hours are allocated to theoretical learning, while the remaining half is dedicated to hands-on community engagement. This ensures that students gain practical experience and exposure to real-world scenarios alongside their theoretical knowledge. Tailored specifically for students pursuing a BS in Public Health, the module necessitates a 45-day community-based education period spread over one year, with students dedicating four hours per day to fieldwork. The module encompasses a variety of activities aimed at fostering practical skills and understanding among students. These include counseling sessions with mothers, screening for malnutrition, identification of developmental delays, and social mobilization efforts on health issues. Furthermore, students are supposed to be trained in making referrals to relevant healthcare facilities such as the CRMCH and associated clinics or hospitals for family planning, lactation, or child nutrition support. The module will use multimedia tools, including videos to enhance students' comprehension of practical concepts. We will utilize different training modalities such as interactive lectures, brainstorming sessions, simulations, mock exercises, reflection and group work with case study to engage students in the learning process. By providing students with community-based learning experiences, the module aims to cultivate their interpersonal communication skills and deepen their understanding of the social determinants of health. It equips them with the knowledge and skills necessary to address maternal and child health issues within their communities. The development of this module was facilitated by the proactive initiative of the head of the Department of Public Health, leveraging their position to drive positive change in the educational curriculum. Discussion The dual focus of the CBE module on community impact and student development underscores its role in enhancing educational quality and public health outcomes. This holistic approach ensures that the benefits of academic programs extend beyond the classroom, affecting tangible community health improvements and enriching student competencies [ 5 – 6 ]. Overall, the implementation of the module in community not only bridge the gap between academic learning and practical application but also foster a sustainable partnership between the university and the community, setting a precedent for future public health initiatives [ 7 ]. The development of a structured CBE Module in MCH aims to enhance the services provided by the existing CRMCH within the Department of Public Health. Following a three-week training period covering both theoretical and practical aspects of the module, implementation will commence within the community for duration of one year. In the subsequent step, the effectiveness of the module will be evaluated through pre- and post-test analysis of data gathered from both the community and participating students. This project represents a pioneering initiative in Pakistan, utilizing the concepts of community-based education and community-university partnership to enrich the educational experience of public health students. Initially introduced as a pilot program, the module will eventually become a mandatory component of the degree program. Sustainability will be ensured by assigning final-year students who have participated in the module implementation as supervisors for incoming students on a voluntary basis. For post-intervention assessment, an end-line survey will be conducted with the mothers who received the intervention. This survey aims to assess the impact of the community-based education module on improving community health indicators. Students’ learning outcomes will be evaluated through regular progress reports and assessments. The lead researcher will maintain ongoing communication with community focal persons or agencies to gauge their satisfaction with the consultation provided by students. Reflection and formative evaluation will occur throughout the implementation process, with events arranged to celebrate achievements of both students and the community. Following feedback from the end-line survey and student learning evaluations, modifications and revisions will be made to the CBE Module. Upon finalization, the module will undergo approval processes at the Board of Studies, Board of Faculties, and Academic Council to become part of the students’ internship program. Meetings with the Higher Education Commission and Punjab Higher Education Commission will be held to discuss extending the CBE Module training and implementation to catchment areas of other universities. The ultimate goal is to institutionalize the CBE Module and ensure its continuation for community outreach in all universities across Punjab. Conclusions In conclusion, improving community health is a complex endeavor that requires a concerted effort to address the environmental, social, and cultural determinants of health. The establishment of an MCH center within the university and development of CBE module in MCH marks a significant step forward in creating health interventions that are both meaningful and impactful. This project represents a pioneering initiative in Pakistan, utilizing the concepts of community-based education and community-university partnership to enrich the educational experience of public health students. It serves as a model for how targeted, community-based education can address specific health issues effectively while empowering both the community and future health professionals. Abbreviations BS Bachelor CBE Community Based Education CRMCH Center of Research on Maternal and Child Health FAIMER Foundation for Advancement of International Medical Education and Research MCH Maternal and Child Health UNICEF United Nations Children’s Fund WHO World Health Organization Declarations Ethical approval and consent to participate The provincial and district health departments of Punjab, Pakistan, gave their approval for the study to be conducted. The study was conducted after the approval of the Ethical Review and Advanced Study Research Board of the University of Punjab, Pakistan (ref-No.D/358/FIMS). It followed the Declaration of Helsinki’s principles. Written informed consent was obtained from the parents of the participants after introducing them to the purpose of the study. Consent for publication Not applicable. Availability of data and materials Data is available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research received no supporting funds from any funding agency in the public, commercial, or not-for-profit sector. Authors’ contributions Conceptualization: R.Z; Data curation: RZ, NMZ; Formal analysis: RZ, NMZ, FF; Writing– original draft: RZ, NMZ; Writing– reviewing & editing: A.T., F.F.; supervision: A.T. All authors read and approved the final version of the manuscript. Acknowledgments We extend our heartfelt gratitude to all the individuals and organizations who contributed to the realization of this study. First and foremost, we wish to acknowledge the invaluable contributions of the community members who participated in this research. Special thanks are also due to the dedicated team of researchers and support staff who worked tirelessly to ensure the successful completion of this study. We are particularly grateful to the Foundation for Advancement of International Medical Education and Research (FAIMER) faculty for their invaluable guidance and support throughout the research process. Their expertise and mentorship have been crucial in shaping the research design, analysis, and interpretation of findings. The FAIMER faculty’s dedication to fostering global health education and research has significantly enriched our study and contributed to its success. References World Health Organization. Maternal Mortality. 2023. https://www.who.int/news-room/fact-sheets/detail/maternal-mortality . Accessed 3 January 2024. Khan YP, Bhutta SZ, Munim S, Bhutta ZA. Maternal health and survival in Pakistan: Issues and options. J Obstet Gynaecol Can. 2009;31(10):920–9. 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Higher education institutions as drivers of sustainable communities: A case study of the University of Southern Santa Catarina empowering the community. In: Filho WL, Tortato U, Frankenberger F, editors. Universities and Sustainable Communities: Meeting the Goals of the Agenda 2030. Cham: Springer; 2019. pp. 805–23. Zinser R. A curriculum model of a foundation for educating the global citizens of the future. Horiz. 2012;20(1):64–73. Magzoub ME, Schmidt HG. A Taxonomy of Community-based Medical Education. Acad Med. 2000;75(7):699–707. Bandy J. Community engaged teaching step by step. Vanderbilt University Center for Teaching. https://cft.vanderbilt.edu/guides-sub-pages/community-engaged-teaching-step-by-step/ . Accessed 20 April 2022. Zakar R, Zakar NM, Shahzad R, Tekian A, Fischer F. Community Health Needs Assessment: Findings from a Community- University Partnership Strengthening Program on Maternal and Child Health in Pakistan., Preprint. https://doi.org/10.21203/rs.3.rs-3944292/v1 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 04 Dec, 2025 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 24 Jun, 2024 Editor assigned by journal 24 Jun, 2024 Submission checks completed at journal 20 Jun, 2024 First submitted to journal 01 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4514328","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":318147160,"identity":"6f574b14-8657-4526-a244-1143488b6a91","order_by":0,"name":"Rubeena Zakar","email":"","orcid":"","institution":"University of the Punjab","correspondingAuthor":false,"prefix":"","firstName":"Rubeena","middleName":"","lastName":"Zakar","suffix":""},{"id":318147162,"identity":"f200c721-9ad1-4214-9ebf-ebcba59437c4","order_by":1,"name":"Ara Tekian","email":"","orcid":"","institution":"University of Illinois","correspondingAuthor":false,"prefix":"","firstName":"Ara","middleName":"","lastName":"Tekian","suffix":""},{"id":318147164,"identity":"616e7855-f67d-415b-8c02-9c85de2562aa","order_by":2,"name":"Nazoora Manal Zakar","email":"","orcid":"","institution":"Akhtar Saeed Medical College","correspondingAuthor":false,"prefix":"","firstName":"Nazoora","middleName":"Manal","lastName":"Zakar","suffix":""},{"id":318147166,"identity":"3fba3712-71f8-4d4c-bd86-d57bb322ff12","order_by":3,"name":"Florian Fischer","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFklEQVRIie2PsWrDMBCGrwis5YxXmxb3Fa4IDIVCXkXGq2kDXTIEIgg4W2c/jovAWdy9hVKSxXPAUFoIoZKbTnE8d9A36H5O+jgdgMPxD+Erc0gblgDMVAwATSE49k9BfbyywSpXkeoVGlf6UP0qd1RZBUYUxurdZv4OyPm2m84+UKxfnrvZdB8Dz6phxctKWbcmoLgsm0dMmvssaogEYDs4ZmJegvS0DR7zC4nJK1KkiFIV5jQ8xSoHbQJvmX+QKEoU30ZZqPBhd1ZJC6tAwnwlkUJM7BQJYX5mfS+D9EljvwvWEsMmT24ViZsC2+GP8aW++PrUMQbrbYdzOQlWjXhT+/g64NlmcMyfetryxt47HA6HY5QfsvhOLaVQ1DcAAAAASUVORK5CYII=","orcid":"","institution":"Charité – Universitätsmedizin Berlin","correspondingAuthor":true,"prefix":"","firstName":"Florian","middleName":"","lastName":"Fischer","suffix":""}],"badges":[],"createdAt":"2024-06-01 15:53:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4514328/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4514328/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-025-08245-w","type":"published","date":"2025-12-04T15:56:54+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":60610928,"identity":"395bdc84-0a45-4fb7-9824-9c9925bd365c","added_by":"auto","created_at":"2024-07-18 18:31:12","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":54575,"visible":true,"origin":"","legend":"\u003cp\u003eChapters and sub-chapters of the community-based education module\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4514328/v1/e2827ac6f4088b8d75e229a7.jpg"},{"id":97723754,"identity":"f4d26476-db46-437e-90d6-d576525d3216","added_by":"auto","created_at":"2025-12-08 16:03:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":926095,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4514328/v1/15663c4b-ca2f-46dd-ae5c-5987a8ca8155.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Community-based health education: A pilot module on maternal and child health for public health students in Pakistan","fulltext":[{"header":"Background","content":"\u003cp\u003eThe critical role of maternal and child health (MCH) in the developmental trajectories of nations is universally acknowledged, with the health of mothers and children being pivotal determinants of overall societal progress. Alarming global statistics reveal that every two minutes, a woman succumbs to complications arising during pregnancy or childbirth, with 95% of these fatalities occurring in low-resource settings [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePakistan, with its population of approximately 230\u0026nbsp;million, reported 186 maternal deaths per 100,000 live births in 2019, alongside significant rates of neonatal, infant, and child mortality, underscores a critical public health crisis. Annually, Pakistan witnesses approximately five million pregnancies, with 15% of these cases experiencing severe medical or obstetric complications [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Various determinants, including inadequate dietary intake, lack of antenatal care, insufficient preparation for delivery, and improper child spacing, result in adverse pregnancy outcomes such as preterm births, low birth weight, and stunted growth [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. These conditions contribute to the heightened risk of acute or chronic malnutrition among children, further exacerbating the public health challenge. The prevailing underutilization of maternal and child healthcare services in Pakistan, particularly in rural areas, can be attributed to a complex interplay of social, religious, and cultural constraints [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This scenario necessitates a strategic reassessment and restructuring of MCH programs, emphasizing not only the enhancement of healthcare facilities but also the mobilization of community awareness and participation.\u003c/p\u003e \u003cp\u003eIn Pakistani social setup, universities can play its great role to improve the health of communities through community outreach program. Many studies provide evidence that academic institutions, particularly through community-academic partnerships and community-based education (CBE), can be helpful in strengthening community awareness regarding health issues [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Universities and higher education institutions are increasingly recognized not merely as repositories of knowledge but as dynamic catalysts for societal transformation, thereby contributing to societal advancement at large [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The challenges of globalization, coupled with its consequent health threats, have underscored the necessity for higher education institutions to not only contributing to the cultivation of sustainable, healthy communities but also ensuring the continuous adaptation of the educational system to align with the exigencies of the real world [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe principal objectives of higher education institutions extend beyond the mere dissemination of theoretical knowledge. They encompass the promotion of research, empowerment of communities, and the preparation of students for effective engagement in real-life settings [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This comprehensive approach is crucial for fostering a well-rounded educational experience that equips students with the requisite skills, knowledge, and competencies to navigate and address the complexities of the contemporary world [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, the specific needs and challenges of communities are not monolithic; they are as diverse as the communities themselves. This diversity introduces a layer of complexity into the educational paradigm, raising pertinent questions about the nature of the \u0026lsquo;real world\u0026rsquo; for which students are being prepared [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn response to this ambiguity, higher education institutions are tasked with developing curricula and pedagogical strategies that are not only robust and flexible but also responsive to the varying demands and challenges of different community contexts. The integration of Community-Based Education (CBE) into the curriculum serves as a pivotal strategy in this regard. CBE offers a practical framework through which students can engage directly with community issues, allowing them to apply theoretical knowledge to real-world problems, thereby enhancing their learning experience and making tangible contributions to community well-being [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMoreover, community-academic partnerships emerge as a critical component in this educational ecosystem, facilitating a symbiotic relationship between higher education institutions and the communities they serve. Through these partnerships, institutions can gain insights into the specific needs and challenges of communities, which, in turn, can inform curriculum development and research agendas. Simultaneously, communities benefit from the knowledge, innovations, and resources that flow from these collaborations, leading to mutual growth and development. CBE approach necessitates a commitment to adaptive learning, continuous engagement with community stakeholders, and a proactive stance on addressing the health and societal challenges of our time. By aligning their educational missions with these objectives, higher education institutions can play a pivotal role in shaping resilient, healthy, and sustainable communities, thereby contributing to the broader societal good.\u003c/p\u003e \u003cp\u003eIn Pakistan, a significant portion of the healthcare budget is spent on curative medicine and public health/preventive medicine is a neglected discipline. In Punjab, there are only few institutions that offer a degree in public health. In all these institutions, there is no concept of CBE. Additionally, the curriculum is classroom-based, and teachers have lack of experience and skills in organizing and teaching in the field. So, there is an urgent need to design and develop a CBE module that aims at serving the needs of students, teachers, healthcare providers and local communities.\u003c/p\u003e \u003cp\u003eGiven this backdrop, this project seeks to strengthen and expand the capabilities of the existing Center for Research in Maternal and Child Health (CRMCH) within the Department of Public Health by developing a CBE module in MCH. By fostering community-university partnerships, the initiative aims to enhance the skills, competencies, and knowledge of students and healthcare professionals in the MNCH domain. Through this integrated approach, students will not only gain insights into the health needs and challenges of the communities they will serve but also contribute to research endeavors that can inform policy decisions at both local and national levels, thereby advancing the agenda for MCH improvement in Pakistan.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA four-member team was developed having extensive research and teaching experience in the field of MCH, medical education and curriculum development. This diverse team added their knowledge and expertise on MCH, community based learning, andragogical methods, and the socio-cultural determinants of health.\u003c/p\u003e \u003cp\u003eBetween May to December 2022, we worked with the community to develop the CBE module under the umbrella of CRMCH at the Department of Public Health, University of the Punjab, Pakistan. This work was part of a broader postdoctoral research project undertaken by the first author in association with the Foundation for Advancement of International Medical Education and Research (FAIMER) Institute, USA. It was a pilot project, first of its kind in Punjab, Pakistan.\u003c/p\u003e \u003cp\u003eWe used the common guide for community-based course planning \u003cem\u003ePARE\u003c/em\u003e (Preparation, Action, Reflection and Evaluation) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] for developing the CBE module. Our research expertise in MCH, combined with our practical experience from working in various community settings on MCH issues, and teaching courses on reproductive health, influenced the module development process. This expertise informed the pedagogical approach, ensuring the effective communication of complex ideas to students. The blend of theoretical knowledge and hands-on experience likely enriched the module content, providing a well-rounded perspective on topics related to MCH.\u003c/p\u003e \u003cp\u003eWe gave a two-day in-person introductory training to the team. We developed the content of CBE module on the basis of the following sources:\u003c/p\u003e \u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e Review of four-year curriculum of BS Public Health from different Pakistani universities to determine where CBE was being offered. Additionally, curricula from different universities around the world offering CBE particularly in MCH and relevant literature retrieved from PubMed and Scopus were reviewed that informed the contents of the module and reference materials. Following the detailed review of all courses, we found no university is offering CBE in public health, nor in any other discipline. From our previous knowledge, we identified that students need to do internship in their fifth semester (third year), so after discussion with the faculty, at the first step we identified the 3-credit internship as a suitable place to offer CBE module. Student internship is a course where students need to work as internee with any research or community organization for five hours/day, five days a week for six weeks (total 150 hours).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eBaseline survey with mothers from the community: Community health needs assessment during May to July 2022 (n\u0026thinsp;=\u0026thinsp;254 respondents of 1,500 population [eligible people]; 90% response rate [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eConsultative meeting of three hours with seven faculty members who were involved in public health teaching and research at Department of Public Health. We presented our aims at this meeting and sought their feedback.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eDiscussions with Provincial Health Department officials: From August to September 2022, we met with officials from the Director General Health, Department of Primary and Secondary Health Department of Punjab province, Chairman Punjab higher education commission and non-governmental organizations such as UNICEF and WHO and sought their input and suggestions for developing the contents of the module.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eConsultative meeting of three hours with the healthcare providers working in MCH domain in August 2022.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eNeed assessment with the students: To identify gaps with respect to CBE in the current curriculum and to understand student expectations for the CBE module, we conducted a 1.5 hours interactive session with all BS Public Health students in May 2022.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eOne briefing and feedback session of the whole team in September 2022.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e \u003cp\u003eThe findings of the community health needs assessment (paper published elsewhere [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]) highlighted the issues related to MCH, hygiene and sanitation as their main concerns in the targeted community. The CBE module was developed around these highlighted issues by following ethics of working with vulnerable communities and targeting their social and behavioral change aspects.\u003c/p\u003e \u003cp\u003eThe CBE module was developed and implemented in University of the Punjab, the largest public sector university in Pakistan comprising of five campuses, 19 faculties, 138 departments/centers/institutes, 991 full-time/regular and 300 part-time faculty members, and 49,520 on-campus students. As a pilot project, 120 third year students of Bachelor in Public Health were recruited over a period of two years. Students were involved in the module development activities from its inception. They were the part of selection of community, baseline community health need assessment, consultative meetings with faculty and healthcare providers, and implementation and evaluation of the module. It was made compulsory for all public health students by making it a part of their internship program.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe module spans 124 pages and is structured to comprehensively address maternal and child health concerns in Pakistan. It commences with an introduction highlighting the current situation of MCH in the country, providing context for the subsequent discussions. Key concepts and terminology essential for understanding the module are also elucidated.\u003c/p\u003e \u003cp\u003eThe module is organized into two main chapters focusing on 1) maternal health and 2) child health. Each chapter is further segmented into six sub-chapters or sections (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e provide a detailed breakdown of the contents).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eModule chapters, sub-chapters, learning objectives and core contents\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModule chapters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModule sub-chapters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLearning objectives\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCore content\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eMaternal health\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaternal health and maternal diet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Define macro and micronutrients, outlining their sources and significance in maintaining overall health.\u003c/p\u003e \u003cp\u003e\u0026bull; Explain the concept of Daily Recommended Intake (DRI) of energy, and delineate the variations in energy requirements across different life stages of females, including adolescence, adulthood, pregnancy, and menopause.\u003c/p\u003e \u003cp\u003e\u0026bull; Interpret nutritional guidelines and recommendations provided by authoritative health organizations for energy intake in females at different life stages.\u003c/p\u003e \u003cp\u003e\u0026bull; Develop proficiency in calculating and adjusting energy needs based on individual factors and lifestyle variations.\u003c/p\u003e \u003cp\u003e\u0026bull; Design personalized diet plans tailored to different age groups of females, considering their unique energy requirements, dietary preferences, and cultural backgrounds.\u003c/p\u003e \u003cp\u003e\u0026bull; Incorporate locally available foods and traditional cuisines into diet plans, ensuring cultural relevance and accessibility.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Introduction to macro- and micronutrients\u003c/p\u003e \u003cp\u003ei. Define macro- and micronutrients, highlighting their essential roles in supporting overall health.\u003c/p\u003e \u003cp\u003eii. Explore sources of macro- and micronutrients, with a focus on commonly available local foods in Pakistani households.\u003c/p\u003e \u003cp\u003eiii. Provide examples of local foods rich in various macro- and micronutrients, emphasizing their importance in achieving a balanced diet.\u003c/p\u003e \u003cp\u003e\u0026bull; Daily recommended intake (DRI) of energy and body mass index (BMI)\u003c/p\u003e \u003cp\u003ei. Introduce the concept of DRI of energy, explaining how it relates to maintaining optimal health and well-being.\u003c/p\u003e \u003cp\u003eii. Discuss the role of BMI in assessing nutritional status and determining energy requirements.\u003c/p\u003e \u003cp\u003eiii. Illustrate the relationship between energy intake, expenditure, and BMI, emphasizing the importance of balance for overall health.\u003c/p\u003e \u003cp\u003e\u0026bull; Energy requirement by age and lifestyle\u003c/p\u003e \u003cp\u003ei. Examine factors influencing energy requirements, including age, gender, physical activity level, and metabolic rate.\u003c/p\u003e \u003cp\u003eii. Discuss variations in energy needs across different age groups and lifestyles, considering factors such as growth, physical activity, and metabolic changes.\u003c/p\u003e \u003cp\u003eiii. Provide guidelines for estimating energy requirements based on individual factors and lifestyle considerations.\u003c/p\u003e \u003cp\u003e\u0026bull; Energy requirement during different phases of a female\u0026rsquo;s life\u003c/p\u003e \u003cp\u003ei. Explore the specific energy needs of females during key life stages, including adolescence, pregnancy, and lactation.\u003c/p\u003e \u003cp\u003eii. Discuss physiological changes and increased energy demands associated with each phase, emphasizing the importance of meeting nutritional needs for maternal and fetal health.\u003c/p\u003e \u003cp\u003eiii. Provide practical recommendations for adjusting energy intake to support optimal health during these critical life stages.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHygiene and sanitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Define the concept of personal hygiene and its significance in preventing illness, promoting health, and enhancing overall well-being.\u003c/p\u003e \u003cp\u003e\u0026bull; Explain the importance of maintaining good personal hygiene practices in preventing the spread of infectious diseases, including respiratory infections, gastrointestinal illnesses, and skin infections.\u003c/p\u003e \u003cp\u003e\u0026bull; Identify common personal hygiene practices, including hand hygiene, oral hygiene, body hygiene, and menstrual hygiene management, and their role in reducing the risk of infections.\u003c/p\u003e \u003cp\u003e\u0026bull; Develop practical skills in designing easy-to-use and adaptable techniques for maintaining personal hygiene in daily life, considering individual preferences, resources, and environmental conditions.\u003c/p\u003e \u003cp\u003e\u0026bull; Demonstrate proper hand washing techniques, including the use of soap and water or hand sanitizer, to effectively remove dirt, germs, and contaminants from hands.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Personal hygiene practices\u003c/p\u003e \u003cp\u003ei. Hand hygiene: Proper hand washing techniques, including when and how to wash hands effectively with soap and water or hand sanitizer.\u003c/p\u003e \u003cp\u003eii. Foot hygiene: Importance of keeping feet clean and dry to prevent fungal infections and odors, along with proper footwear care.\u003c/p\u003e \u003cp\u003eiii. Skin hygiene: Maintaining skin health through regular bathing or showering, using appropriate skincare products, and addressing skin conditions.\u003c/p\u003e \u003cp\u003eiv. Clothing hygiene: Importance of wearing clean clothes and proper laundering techniques to prevent the spread of germs and odors.\u003c/p\u003e \u003cp\u003ev. Oral hygiene: Brushing teeth, flossing, and mouthwash use to maintain oral health, prevent cavities, gum disease, and bad breath.\u003c/p\u003e \u003cp\u003e\u0026bull; Consequences of poor hygiene\u003c/p\u003e \u003cp\u003ei. Contamination: How failure to maintain hygiene practices can lead to the presence of harmful microorganisms on surfaces, objects, or in the environment.\u003c/p\u003e \u003cp\u003eii. Infections: Risks of contracting infectious diseases, such as colds, flu, gastrointestinal illnesses, and skin infections, due to poor hygiene.\u003c/p\u003e \u003cp\u003eiii. Transmission: How pathogens can spread through direct contact, airborne droplets, contaminated surfaces, or shared items in settings such as homes, schools, and healthcare facilities\u003c/p\u003e \u003cp\u003e\u0026bull; Control measures to prevent disease transmission\u003c/p\u003e \u003cp\u003ei. Hand hygiene: Proper handwashing techniques, frequency, and duration to effectively remove germs and prevent the spread of infections.\u003c/p\u003e \u003cp\u003eii. Surface cleaning: Importance of regularly cleaning and disinfecting surfaces and objects, particularly high-touch areas, to reduce the risk of contamination.\u003c/p\u003e \u003cp\u003eiii. Drying: Ensuring proper drying of hands, surfaces, and laundry to prevent the survival and spread of pathogens in moist environments.\u003c/p\u003e \u003cp\u003eiv. Airing: Allowing adequate ventilation and air circulation in indoor spaces to reduce the concentration of airborne pathogens and maintain air quality.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAntenatal care (ANC)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Understanding the concept of ANC and its importance\u003c/p\u003e \u003cp\u003e\u0026bull; Identify signs of anemia through physical examination of women\u003c/p\u003e \u003cp\u003e\u0026bull; Identify warning signs of pregnancy among women\u003c/p\u003e \u003cp\u003e\u0026bull; Define the importance of health education and counseling in promoting healthy behaviors, informed decision-making, and self-care practices during pregnancy.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Understanding the concept of ANC and its importance\u003c/p\u003e \u003cp\u003ei. Define antenatal care and its significance in promoting maternal and fetal health during pregnancy.\u003c/p\u003e \u003cp\u003eii. Explain the goals and components of ANC, including medical assessments, screenings, health education, and counseling services.\u003c/p\u003e \u003cp\u003eiii. Analyze the impact of timely and regular ANC visits on reducing maternal and neonatal mortality and morbidity rates.\u003c/p\u003e \u003cp\u003e\u0026bull; Identification of signs of anemia through physical examination of women\u003c/p\u003e \u003cp\u003ei. Recognize the physical signs and symptoms of anemia in pregnant women, such as pallor, fatigue, shortness of breath, and rapid heart rate.\u003c/p\u003e \u003cp\u003eii. Understand the importance of routine hemoglobin testing and other laboratory investigations for detecting and managing anemia during pregnancy.\u003c/p\u003e \u003cp\u003eiii. Discuss the implications of untreated or inadequately managed anemia on maternal and fetal health outcomes.\u003c/p\u003e \u003cp\u003e\u0026bull; Identification of warning signs of pregnancy among women\u003c/p\u003e \u003cp\u003ei. Identify common warning signs and symptoms of pregnancy complications, such as vaginal bleeding, severe abdominal pain, persistent headaches, and reduced fetal movements.\u003c/p\u003e \u003cp\u003eii. Understand the significance of early detection and timely management of pregnancy complications to prevent adverse maternal and neonatal outcomes.\u003c/p\u003e \u003cp\u003eiii. Discuss the role of healthcare providers in educating pregnant women about recognizing and reporting warning signs for prompt medical intervention.\u003c/p\u003e \u003cp\u003e\u0026bull; Importance of health education and counseling in ANC\u003c/p\u003e \u003cp\u003ei. Define the importance of health education and counseling in promoting healthy behaviors, informed decision-making, and self-care practices during pregnancy.\u003c/p\u003e \u003cp\u003eii. Discuss topics commonly addressed during ANC sessions, including nutrition, physical activity, childbirth preparation, breastfeeding, and newborn care.\u003c/p\u003e \u003cp\u003eiii. Explore effective communication strategies for delivering culturally sensitive and evidence-based health information to pregnant women and their families.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFamily planning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Address the need and importance of family planning\u003c/p\u003e \u003cp\u003e\u0026bull; Distinguish between different types of family planning methods\u003c/p\u003e \u003cp\u003e\u0026bull; Identify barriers to access and barriers to utilization of family planning methods in different communities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Introduction to family planning and its need\u003c/p\u003e \u003cp\u003ei. Define family planning and its importance in enabling individuals to make informed decisions about the number and spacing of children they desire.\u003c/p\u003e \u003cp\u003eii. Discuss the role of family planning in promoting maternal and child health, empowering women, and contributing to socioeconomic development.\u003c/p\u003e \u003cp\u003e\u0026bull; Research findings highlighting unmet family planning needs\u003c/p\u003e \u003cp\u003ei. Review global and national research findings identifying unmet family planning needs among women, with a focus on Pakistan.\u003c/p\u003e \u003cp\u003eii. Explore factors contributing to unmet needs, such as lack of access to services, socio-cultural barriers, and inadequate information about contraceptive methods.\u003c/p\u003e \u003cp\u003e\u0026bull; Benefits of family planning methods\u003c/p\u003e \u003cp\u003ei. Examine the benefits of various family planning methods in preventing unintended pregnancies, improving maternal and child health outcomes, and empowering individuals and couples to plan their families\u003c/p\u003e \u003cp\u003e\u0026bull; Determinants of utilization of family planning services\u003c/p\u003e \u003cp\u003ei. Analyze research findings highlighting determinants influencing the utilization of family planning services, including socio-demographic factors, knowledge and attitudes towards contraception, accessibility of services, and cultural beliefs.\u003c/p\u003e \u003cp\u003e\u0026bull; Family planning methods\u003c/p\u003e \u003cp\u003eDiscuss surgical and non-surgical, permanent and temporary, male and female methods of family planning, including contraception, sterilization, hormonal methods, barrier methods, and fertility awareness-based methods.\u003c/p\u003e \u003cp\u003e\u0026bull; Socio-cultural and religious barriers\u003c/p\u003e \u003cp\u003eExplore socio-cultural and religious barriers associated with the utilization of family planning methods in Pakistan, including cultural norms, gender roles, religious beliefs, and misconceptions about contraception.\u003c/p\u003e \u003cp\u003e\u0026bull; GATHER technique for family planning counseling\u003c/p\u003e \u003cp\u003eIntroduce the GATHER technique for effective family planning counseling, emphasizing its components: Greet, Ask, Tell, Help, Explain, and Return.\u003c/p\u003e \u003cp\u003e\u0026bull; Introduction to intra-natal care and its aim\u003c/p\u003e \u003cp\u003eDefine intra-natal care and its aim in ensuring the health and well-being of pregnant women and their newborns during childbirth and the immediate postpartum period.\u003c/p\u003e \u003cp\u003e\u0026bull; Intra-natal care services\u003c/p\u003e \u003cp\u003eExplore the features, advantages, and disadvantages of intra-natal care services, including domiciliary midwifery care, institutional care, home helps, maternity homes, transport facilities, blood transfusion services, diagnostic and laboratory facilities, and arrangements for consultation and referrals.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntra-natal and post-natal care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Distinguish between intra-natal and post-natal care and discuss their importance\u003c/p\u003e \u003cp\u003e\u0026bull; Identify post-natal mother and newborn danger signs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Introduction to intra-natal care and its aim\u003c/p\u003e \u003cp\u003e\u0026bull; Intra-natal care services, its features, advantages and disadvantages: Domiciliary midwifery care, institutional care, home helps, maternity homes, transport facilities for midwives, ambulance services, blood transfusion services, diagnostic and laboratory facilities, and arrangements for consultation and referrals\u003c/p\u003e \u003cp\u003e\u0026bull; Rooming-in and its importance\u003c/p\u003e \u003cp\u003e\u0026bull; Postnatal care, its objectives and services\u003c/p\u003e \u003cp\u003e\u0026bull; Care of newborn in postnatal care: Resuscitation; APGAR scoring system; care of cord, eyes and skin of newborn; general physical appearance of newborn and physical examination for abnormalities\u003c/p\u003e \u003cp\u003e\u0026bull; Post-natal mother and new-born danger signs\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eChild health\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChild health, growth and development\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Distinguish between different types of malnutrition among children\u003c/p\u003e \u003cp\u003e\u0026bull; Identify severely acute malnutrition (SAM), moderately acute malnutrition (MAM), and at risk of malnutrition children by taking anthropometric measures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Growth among infants and children\u003c/p\u003e \u003cp\u003e\u0026bull; Malnutrition and its types: stunting, wasting, acute and chronic malnutrition; SAM, MAM, and risk of malnutrition\u003c/p\u003e \u003cp\u003e\u0026bull; Management of malnutrition and introduction to Ready-to-use-therapeutic food (RUTF)\u003c/p\u003e \u003cp\u003e\u0026bull; Taking anthropometric measures of the child including height, weight, head circumference, and mid upper-arm circumference (MUAC)\u003c/p\u003e \u003cp\u003e\u0026bull; Video illustrations of taking anthropometric measures of children\u003c/p\u003e \u003cp\u003e\u0026bull; Mock exercises for hands on practice of taking anthropometric measures\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiet in infancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Discuss the nutritional requirement in childhood and the importance of breast milk\u003c/p\u003e \u003cp\u003e\u0026bull; Make recipes for easy to make and home-friendly complimentary feeds for infants using locally available and everyday use ingredients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Nutritional requirement in childhood\u003c/p\u003e \u003cp\u003e\u0026bull; Stages of breast milk and variations in composition: Colostrum, transitional milk, mature milk, and foremilk\u003c/p\u003e \u003cp\u003e\u0026bull; Risks associated with not breastfeeding\u003c/p\u003e \u003cp\u003e\u0026bull; Disadvantages of bottle-feeding\u003c/p\u003e \u003cp\u003e\u0026bull; Exclusive and complimentary feeding\u003c/p\u003e \u003cp\u003e\u0026bull; The cultural concept of ghutti in Pakistan\u003c/p\u003e \u003cp\u003e\u0026bull; Easy to make and home-friendly complimentary feeding for infants\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBreastfeeding and lactation management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Discuss the importance of early initiation of breastfeeding\u003c/p\u003e \u003cp\u003e\u0026bull; Identify the major breastfeeding difficulties and define their management strategies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Early initiation of breastfeeding and its importance\u003c/p\u003e \u003cp\u003e\u0026bull; Management of breastfeeding difficulties: inverted nipples, breast engorgement, poor latch, sore nipples, baby suckling issues, baby falls asleep during nursing, plugged ducts, mastitis signs of infection and Thrush treatment, Raynaud\u0026rsquo;s nipple vasospasm and perceived and actual low milk supply\u003c/p\u003e \u003cp\u003e\u0026bull; Prenatal breastfeeding education and feeding positions: Good and poor latch\u003c/p\u003e \u003cp\u003e\u0026bull; Video illustrations for achieving successful breastfeeding\u003c/p\u003e \u003cp\u003e\u0026bull; Counseling related to initiation of breastfeeding and management of breastfeeding difficulties\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChild vaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Define the concept and importance of timely child immunization\u003c/p\u003e \u003cp\u003e\u0026bull; Understand different vaccinations, their need and side-effects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Introduction to child immunization and its importance\u003c/p\u003e \u003cp\u003e\u0026bull; EPI vaccination schedule: BCG; OPV I, II and III; Pneumococcal I, II and III; MR I and II; and typhoid\u003c/p\u003e \u003cp\u003e\u0026bull; Importance of giving vaccines at recommended time\u003c/p\u003e \u003cp\u003e\u0026bull; Minor side effects of vaccines: fever, irritability, headache, rash, soreness, pain, redness, swelling, small lump at injection site, abscess or scar.\u003c/p\u003e \u003cp\u003e\u0026bull; Contraindications for immunization\u003c/p\u003e \u003cp\u003e\u0026bull; Fully immunized, partially immunized and zero-dose children\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychomotor development\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Define the concept of psychomotor development and the role of family members and proper nutrition in the psychomotor development of the child\u003c/p\u003e \u003cp\u003e\u0026bull; Differentiate between different psychomotor developmental skills\u003c/p\u003e \u003cp\u003e\u0026bull; Distinguish between the developmental landmarks among infants, 1\u0026ndash;2 years of age children, 3\u0026ndash;4 years of age children, 4\u0026ndash;5 years of age children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Introduction to psychomotor development\u003c/p\u003e \u003cp\u003e\u0026bull; Developmental landmarks in infants, 1\u0026ndash;2 years of age children, 3\u0026ndash;4 years of age children, 4\u0026ndash;5 years of age children: cognitive, language, fine motor, gross motor, social and self-mastery,\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDangers signs of pneumonia and diarrhea in childhood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Identify early symptoms and danger signs of pneumonia and diarrhea among children\u003c/p\u003e \u003cp\u003e\u0026bull; Understand at-home prevention of dehydration from diarrhea\u003c/p\u003e \u003cp\u003e\u0026bull; Describe chocking and how it can be managed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Pneumonia and diarrhea in childhood, and their early symptoms and danger signs\u003c/p\u003e \u003cp\u003e\u0026bull; Prevention of dehydration from diarrhea\u003c/p\u003e \u003cp\u003e\u0026bull; ORS day\u003c/p\u003e \u003cp\u003e\u0026bull; Preparation of ORS at home\u003c/p\u003e \u003cp\u003e\u0026bull; Chocking and its management among infants and children\u003c/p\u003e \u003cp\u003e\u0026bull; Video illustrations on chocking management\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eWorking with communities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommunity engagement and working with communities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Explain the inter-connectedness of entering in community, community engagement, community mobilization, community awareness and community participation\u003c/p\u003e \u003cp\u003e\u0026bull; Identify and address the specific needs of communities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Entering community and community engagement: introduction and rapport; initial informal session; technical session; and ending session\u003c/p\u003e \u003cp\u003e\u0026bull; Identifying the needs of community: survey questionnaires, observations, informal discussions, focused group discussions, taking field notes\u003c/p\u003e \u003cp\u003e\u0026bull; Mock exercises and community-based activities for designing tailored interventions to address community needs\u003c/p\u003e \u003cp\u003e\u0026bull; Community awareness and community mobilization\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eField ethics and challenges\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Explain why field ethics are important while working with communities\u003c/p\u003e \u003cp\u003e\u0026bull; Identify field challenges and discuss how different challenges can be managed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Field ethics: autonomy (the right to complete information, privacy, confidentiality, informed consent, respect), addressing sensitive issues, building relation with the community, being an in-sider\u003c/p\u003e \u003cp\u003e\u0026bull; Field challenges and their management: Whether conditions, conflicts, work order management, reduced team efficiency, uncertainty, real-time communication, opportunity assessment, building rapport, identification of stakeholders and gatekeepers\u003c/p\u003e \u003cp\u003e\u0026bull; Discussing different scenarios of field challenges and brainstorming on how these can be managed\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth promotion and health education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026bull; Understand the concepts of health promotion and health education\u003c/p\u003e \u003cp\u003e\u0026bull; Discuss the importance of roles and responsibilities of public health professional\u003c/p\u003e \u003cp\u003e\u0026bull; Design and apply tailored health education campaigns in community\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Introducing health promotion and health education\u003c/p\u003e \u003cp\u003e\u0026bull; Tailoring health education according to the needs of community\u003c/p\u003e \u003cp\u003e\u0026bull; Classroom and community-based activities of tailoring health education according to specific needs: Personal hygiene and care; family planning; home preparation of infant food; infant and child care; maternal and child diet; and ANC, intra-natal and post-natal care\u003c/p\u003e \u003cp\u003e\u0026bull; Public Health professionals\u0026rsquo; responsibilities and roles\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eOne of the distinguishing features of the module is its emphasis on practical fieldwork alongside a theoretical study. A balanced approach is taken where half of the credit hours are allocated to theoretical learning, while the remaining half is dedicated to hands-on community engagement. This ensures that students gain practical experience and exposure to real-world scenarios alongside their theoretical knowledge.\u003c/p\u003e \u003cp\u003eTailored specifically for students pursuing a BS in Public Health, the module necessitates a 45-day community-based education period spread over one year, with students dedicating four hours per day to fieldwork.\u003c/p\u003e \u003cp\u003eThe module encompasses a variety of activities aimed at fostering practical skills and understanding among students. These include counseling sessions with mothers, screening for malnutrition, identification of developmental delays, and social mobilization efforts on health issues. Furthermore, students are supposed to be trained in making referrals to relevant healthcare facilities such as the CRMCH and associated clinics or hospitals for family planning, lactation, or child nutrition support. The module will use multimedia tools, including videos to enhance students' comprehension of practical concepts. We will utilize different training modalities such as interactive lectures, brainstorming sessions, simulations, mock exercises, reflection and group work with case study to engage students in the learning process.\u003c/p\u003e \u003cp\u003eBy providing students with community-based learning experiences, the module aims to cultivate their interpersonal communication skills and deepen their understanding of the social determinants of health. It equips them with the knowledge and skills necessary to address maternal and child health issues within their communities. The development of this module was facilitated by the proactive initiative of the head of the Department of Public Health, leveraging their position to drive positive change in the educational curriculum.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe dual focus of the CBE module on community impact and student development underscores its role in enhancing educational quality and public health outcomes. This holistic approach ensures that the benefits of academic programs extend beyond the classroom, affecting tangible community health improvements and enriching student competencies [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Overall, the implementation of the module in community not only bridge the gap between academic learning and practical application but also foster a sustainable partnership between the university and the community, setting a precedent for future public health initiatives [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe development of a structured CBE Module in MCH aims to enhance the services provided by the existing CRMCH within the Department of Public Health. Following a three-week training period covering both theoretical and practical aspects of the module, implementation will commence within the community for duration of one year.\u003c/p\u003e \u003cp\u003eIn the subsequent step, the effectiveness of the module will be evaluated through pre- and post-test analysis of data gathered from both the community and participating students. This project represents a pioneering initiative in Pakistan, utilizing the concepts of community-based education and community-university partnership to enrich the educational experience of public health students.\u003c/p\u003e \u003cp\u003eInitially introduced as a pilot program, the module will eventually become a mandatory component of the degree program. Sustainability will be ensured by assigning final-year students who have participated in the module implementation as supervisors for incoming students on a voluntary basis.\u003c/p\u003e \u003cp\u003eFor post-intervention assessment, an end-line survey will be conducted with the mothers who received the intervention. This survey aims to assess the impact of the community-based education module on improving community health indicators. Students\u0026rsquo; learning outcomes will be evaluated through regular progress reports and assessments.\u003c/p\u003e \u003cp\u003eThe lead researcher will maintain ongoing communication with community focal persons or agencies to gauge their satisfaction with the consultation provided by students. Reflection and formative evaluation will occur throughout the implementation process, with events arranged to celebrate achievements of both students and the community.\u003c/p\u003e \u003cp\u003eFollowing feedback from the end-line survey and student learning evaluations, modifications and revisions will be made to the CBE Module. Upon finalization, the module will undergo approval processes at the Board of Studies, Board of Faculties, and Academic Council to become part of the students\u0026rsquo; internship program.\u003c/p\u003e \u003cp\u003eMeetings with the Higher Education Commission and Punjab Higher Education Commission will be held to discuss extending the CBE Module training and implementation to catchment areas of other universities. The ultimate goal is to institutionalize the CBE Module and ensure its continuation for community outreach in all universities across Punjab.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, improving community health is a complex endeavor that requires a concerted effort to address the environmental, social, and cultural determinants of health. The establishment of an MCH center within the university and development of CBE module in MCH marks a significant step forward in creating health interventions that are both meaningful and impactful.\u003c/p\u003e \u003cp\u003eThis project represents a pioneering initiative in Pakistan, utilizing the concepts of community-based education and community-university partnership to enrich the educational experience of public health students. It serves as a model for how targeted, community-based education can address specific health issues effectively while empowering both the community and future health professionals.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBS Bachelor \u003c/p\u003e\n\u003cp\u003eCBE Community Based Education \u003c/p\u003e\n\u003cp\u003eCRMCH Center of Research on Maternal and Child Health \u003c/p\u003e\n\u003cp\u003eFAIMER Foundation for Advancement of International Medical Education and Research \u003c/p\u003e\n\u003cp\u003eMCH Maternal and Child Health \u003c/p\u003e\n\u003cp\u003eUNICEF United Nations Children\u0026rsquo;s Fund\u003c/p\u003e\n\u003cp\u003eWHO World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe provincial and district health departments of Punjab, Pakistan, gave their approval for the study to be conducted. The study was conducted after the approval of the Ethical Review and Advanced Study Research Board of the University of Punjab, Pakistan (ref-No.D/358/FIMS). It followed the Declaration of Helsinki\u0026rsquo;s principles. Written informed consent was obtained from the parents of the participants after introducing them to the purpose of the study.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData is available from the corresponding author upon reasonable request.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no supporting funds from any funding agency in the public, commercial, or not-for-profit sector.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: R.Z; Data curation: RZ, NMZ; Formal analysis: RZ, NMZ, FF; Writing\u0026ndash; original draft: RZ, NMZ; Writing\u0026ndash; reviewing \u0026amp; editing: A.T., F.F.; supervision: A.T. All authors read and approved the final version of the manuscript.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe extend our heartfelt gratitude to all the individuals and organizations who contributed to the realization of this study. First and foremost, we wish to acknowledge the invaluable contributions of the community members who participated in this research. Special thanks are also due to the dedicated team of researchers and support staff who worked tirelessly to ensure the successful completion of this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe are particularly grateful to the Foundation for Advancement of International Medical Education and Research (FAIMER) faculty for their invaluable guidance and support throughout the research process. Their expertise and mentorship have been crucial in shaping the research design, analysis, and interpretation of findings. The FAIMER faculty\u0026rsquo;s dedication to fostering global health education and research has significantly enriched our study and contributed to its success.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. Maternal Mortality. 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/maternal-mortality\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/maternal-mortality\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 3 January 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhan YP, Bhutta SZ, Munim S, Bhutta ZA. Maternal health and survival in Pakistan: Issues and options. J Obstet Gynaecol Can. 2009;31(10):920\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTette EMA, Sifah EK, Nartey ET, Nuro-Ameyaw P, Tete-Donkor P, Biritwun R. Maternal profiles and social determinants of malnutrition and the MDGs: What have we learnt? BMC Pub Health. 2016;16:214.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOmer S, Zakar R, Zakar MZ, Fischer F. The influence of social and cultural practices on maternal mortality: A qualitative study from South Punjab, Pakistan. Reprod Health. 2021;18:97.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKakara M, Martinak E, McCormick B, Morales KH, Bogner HR, Jacobs D, Tuto LW. The Bridging the gaps program: Three decades of collaborative service-oriented learning in the health professions. Acad Med. 2024;99(5):500\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMariam DH, Sagay AS, Arubaku W, Bailey RJ, Baingana RK, Burani A, et al. Community-based education programs in Africa: Faculty experience within the medical education partnership initiative (MEPI) network. Acad Med. 2014;9(8):S50\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ede Amorim WS, Neiva SD, Castro BC, et al. Higher education institutions as drivers of sustainable communities: A case study of the University of Southern Santa Catarina empowering the community. In: Filho WL, Tortato U, Frankenberger F, editors. Universities and Sustainable Communities: Meeting the Goals of the Agenda 2030. Cham: Springer; 2019. pp. 805\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZinser R. A curriculum model of a foundation for educating the global citizens of the future. Horiz. 2012;20(1):64\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMagzoub ME, Schmidt HG. A Taxonomy of Community-based Medical Education. Acad Med. 2000;75(7):699\u0026ndash;707.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBandy J. Community engaged teaching step by step. Vanderbilt University Center for Teaching. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://cft.vanderbilt.edu/guides-sub-pages/community-engaged-teaching-step-by-step/\u003c/span\u003e\u003cspan address=\"https://cft.vanderbilt.edu/guides-sub-pages/community-engaged-teaching-step-by-step/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 20 April 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZakar R, Zakar NM, Shahzad R, Tekian A, Fischer F. Community Health Needs Assessment: Findings from a Community- University Partnership Strengthening Program on Maternal and Child Health in Pakistan., Preprint. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.21203/rs.3.rs-3944292/v1\u003c/span\u003e\u003cspan address=\"10.21203/rs.3.rs-3944292/v1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Community-based education, public health, maternal and child health, community","lastPublishedDoi":"10.21203/rs.3.rs-4514328/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4514328/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMaternal and child health (MCH) plays a critical role in the development of nations, with the well-being of mothers and children being essential for societal progress. Despite efforts, Pakistan continues to face high maternal and child mortality rates. Recognizing the potential of universities in improving community health through outreach programs, this project aims to enhance the capabilities of the existing Center for Research in Maternal and Child Health within the Department of Public Health by developing a Community-Based Education module in MCH.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eLed by a team with expertise in maternal and child health, medical education, and curriculum development, the module was created using the PARE framework (Preparation, Action, Reflection, and Evaluation) for community-based course planning. The module content development process entailed an extensive review of curricula from both Pakistani and international universities, alongside baseline surveys with community mothers, consultations with faculty members and health department officials, and assessments of student needs.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe resulting 124-page module comprehensively addresses prevailing maternal and child health challenges in Pakistan. Structured into two main chapters on 1) maternal health and 2) child health, each chapter is further divided into six sub-chapters. It covers nutrition, health conditions, healthcare service utilization, sanitation, and hygiene issues relevant to MCH.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMoving forward, the project will embark on faculty and student training sessions to facilitate module implementation in community settings, followed by a year-long deployment within target communities. Evaluation mechanisms will gauge module effectiveness through pre- and post-test analyses of community and student data. This endeavor heralds a pioneering initiative in Pakistan, epitomizing the integration of community-based education and university partnerships to enhance the educational experience of public health students. Plans are underway to expand this initiative to other universities across Punjab province, ensuring its sustainability and scalability for broader community impact\u003c/p\u003e","manuscriptTitle":"Community-based health education: A pilot module on maternal and child health for public health students in Pakistan","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-18 18:23:07","doi":"10.21203/rs.3.rs-4514328/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-06-24T07:41:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-24T07:17:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-20T11:29:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2024-06-01T15:49:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6a2f8b23-0c75-4990-acfe-f12742a2bb3d","owner":[],"postedDate":"July 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-08T15:59:08+00:00","versionOfRecord":{"articleIdentity":"rs-4514328","link":"https://doi.org/10.1186/s12909-025-08245-w","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2025-12-04 15:56:54","publishedOnDateReadable":"December 4th, 2025"},"versionCreatedAt":"2024-07-18 18:23:07","video":"","vorDoi":"10.1186/s12909-025-08245-w","vorDoiUrl":"https://doi.org/10.1186/s12909-025-08245-w","workflowStages":[]},"version":"v1","identity":"rs-4514328","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4514328","identity":"rs-4514328","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}