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The coronavirus also called 2019 novel coronavirus (2019-nCoV) or severe acute respiratory syndrome coronavirus 2 (SARS-2) is notorious for its pandemic corona virus disease 2019 (COVID-19). By 20 April 2020 (11.44 GMT), the pandemicity has inflicted more than 2.42 million people in the world resulting in more than 165,903 deaths (case fatality rate = 14.6%). However, due credit goes to health care professionals for saving 635,761 lives i.e. 26.3% of the total affected population. On the other side, the economy of the countries has drastically been shattered in this scenario. According to an estimate, sole Pakistan will have to meet an economic loss of 1.3 trillion Pak rupees, provided the outbreak is controlled within short time span. Similarly, associated psychological disorders and social displeasure cannot be set aside.

Worldwide, the geriatric population rate is 690 million which is alarmingly high and calls for an increasing need for preventive and curative services. In Pakistan, the elderly population is 11.3 million and is expected to increase to 43.3 million by 2050. With the increasing aging population there is an urgent need to improve standards and provision of elderly care in the country. Few geriatric healthcare organizations exist with weak infrastructure resulting in negligence and poor care of the elderly. Older adults have one or more chronic illnesses and complications that contribute to out-of-pocket payments in 73% of the population. Moreover, due to rapidly changing family value systems and sociocultural values, the elderly population is faced with additional challenges such as elder abuse, loneliness, and social isolation. The shrinking of family structure, industrialization, poverty, and prevalence of chronic illnesses among older adults put a massive burden on the family caregivers. Using SWOT and PESTLE analysis, the paper identifies several gaps and discusses various challenges contributing to the access, implementation, and provision of adequate geriatric care services in Pakistan. The paper proposes several strategies including quality home health screening, evidenced based informed care, and training of healthcare professionals to enhance the provision of compassionate and ethical geriatric services to improve the quality of life of elderly and their caregivers in Pakistan.

Background: Diverse factors influence the career choice of medical students. This study was carried out to identify career preferences and factors influencing specialty selection among undergraduate medical students of Gujranwala Medical College which has students from multiple cities including Lahore, Rawalpindi, and Faisalabad to name a few. Hence this study will be valuable for the medical education sector because understanding career uncertainty at Gujranwala Medical College will also provide ways of developing better tools and counseling programs to help medical students throughout Pakistan prepare for their future. Methods: A descriptive cross-sectional study was conducted among students of Gujranwala medical college. As the sample size for this study was not too large and the targeted audience had close physical proximity, a structured paper questionnaire was used containing multiple-choice questions, dichotomous questions as well as scaling questions with content ranging from their career preferences after MBBS to assessing possible factors that may have influenced their choice of specialty. All information gathered was on a volunteer basis. Anonymity and confidentiality were maintained. The study was approved by the college ethical review committee. A pilot study was done on 20 participants and no discrepancies were found. Results: Out of 218 students, 85 (36%) were male and 133 (61%) were female. Out of the 85 male students, 74 students were undecided about career preference. Out of the 133 female students, 94 students were undecided about career preference. Regarding factors influencing career choice, year/level of study was proven to have a significant association with career choice (p value-value: 0.001). 2nd Year students reported the highest uncertainty (89%), 4th Year students reported the second-highest uncertainty (85%), 5th Year students reported the lowest uncertainty (51%). Career uncertainty also had a significant association with how often students thought about changing their career (p-value: 0.002). The ones who often or always thought about changing careers reported the highest uncertainty (100%), while the ones who never thought about changing careers reported the lowest uncertainty (57%). Conclusion: Study The study has shown that a significant number of medical students are uncertain about their career intentions. Year of study, gender, and general satisfaction with the medical field was proven to be major factors in causing such uncertainty about career choice after MBBS. Final year students were most certain about career intentions along with those who never thought about changing careers. While results were consistent with several national and international studies, variability in said results across different studies was also noted.

This paper reviews the overarching strategies, implementation rigour, achievements, strengths and weaknesses, and challenges and opportunities faced by Pakistan’s National Tuberculosis Control Program (NTP) during the period 2011-2020. NTP’s annual reports, Global Tuberculosis (TB) Report (2019 & 2020), peer-reviewed journal articles, NTP and NSP plans, along with voluminous programmatic data reviewed. Pakistan’s national and provincial tuberculosis control program has treated around four million people and gained more than 90% treatment success. Iterative planning, partnership with the private sector, strategic advocacy, communication, social mobilization, operational research, and increasing domestic funding are essential to improving case notification and treatment success. Lack of adequate political commitment, over-and under-reporting, lack of a systematic mechanism for sputum transport, and inefficient coverage from the private sector are the main areas for improvement. Local and national strategic planning in funding, program development, and implementation is imperative from a multisectoral perspective for ending TB. Ensuring universal health coverage, treating drug-resistant cases, maintaining and strengthening the national health information system, and upgrading the vital registration system is the cornerstone for ending TB.

Background: The purpose of this study was to find out how well-informed health care professionals and the general population in Pakistan are about Tuberculosis. Methods: A systematic review of all published articles until Apr 2021 was performed using Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. PubMed, UpToDate, Cochrane Library, and Google Scholar were searched for relevant published studies using related MESH terms and keywords. Results: Finally, thirteen papers were chosen as meeting the inclusion criteria. In all of the research, there was a lack of information and awareness. Private practitioners lacked the ability to maintain follow-up, educate the public, motivate patients, and stick to the therapeutic regimen. Tuberculosis had an impact on a person's personal and social life. A negative outcome occurred from a delay in diagnosis. Conclusion: Community mobilization to spread general awareness is necessary eradicating tuberculosis. The establishment of a national training programme for health-care professionals is required. Incorporating the pharmacist's involvement in the launch of community-based awareness initiatives are critical, if Pakistan is to be Tuberculosis-free country.

This narrative review of the public private mix (PPM) TB plan by comprehensively evaluated the performance of this initiative in case reporting, management, treatment outcome, affordability, and accessibility from the district health system data to the TB Control Programs. Comprehensive literature review was done from the peer-reviewed journals; reports including global and national TB control programs along with technical guidelines on PPM were reviewed. This paper focusses on PPM model in the TB case notification since its establishment in Pakistan based on the data reported by national TB control mechanisms by reviewing the involvement of and TB case contribution by private health care providers, active case finding through chest camps, TB case finding through enhanced case findings in large private hospitals, and case finding through lady health workers. PPM is a promising strategy for TB care and control and scaling up of PPM should include financial support in addition to material inputs. Moreover, improving program governance and training for the health care providers with the help of integrated collaborative mechanisms is warranted. There should be a standard reporting system for private practitioners for setting up standard guidelines for the Tuberculosis treatment.

Background: The paper presents the salient features of a comprehensive treatment package for drug resistant tuberculosis (DR-TB), its adaptation and implementation in two indoor care hospital settings in Pakistan, and lessons learned from this implementation. Methods: A pilot study was undertaken on a group of 100 patients at two Programmatic Management of Drug-Resistant TB (PMDT) sites. Fifty patients each were selected from the Samli Sanatorium Murree and the Lady Reading Hospital, Peshawar by the National Tuberculosis Control authorities, and delivered a comprehensive package of services, including psychosocial and food support. Data were collected using standard TB tools and surveillance indicators. The results were compared between intervention and a historical cohort of DR-TB patients. Results: Among the total 100 patients, the treatment success rate was 88%, the failure rate was 4%, while there were 7% deaths. A patient was transferred out while none were lost to follow-up, indicating much improvement over the historical cohort. Patients ranked the economic support, free medicines and nutritional support as most helpful, while majority of providers found the intervention sustainable. Conclusion: A comprehensive package including the psychosocial support can be crucial in enhancing DR-TB outcomes. Regular interaction with patients and improved nutrition leads to improved treatment adherence, while capacity building of psychologists and home visits can further benefit the DR-TB patients leading to their cure.

This paper aims to assess the effectiveness of strategies adopted by national health systems across the globe in different ‘geographical regions’ in the Northern Hemisphere to combat COVID-19 pandemic. Data is included since the first case was reported in November 2019 till mid-April 2020. Sources of information are COVID-19 case repositories, official country websites, university research teams’ perspectives, official briefings, and available published research articles to date. We triangulated all data to formulate a comprehensive illustration of COVID-19 situation in each country included. It has been found that the 2002-2004 SARS outbreak experienced in China, Taiwan, and South Korea saw better strategies adopted by leadership to combat COVID-19 pandemic containment as compared to Iran, Italy, and the United States of America. Saudi Arabia has so far been successful in the implementation of containment strategies as there is no large outbreak in major cities or confined areas as prisons. The situation has yet to unfold in India and Pakistan, which exhibit their own weaknesses in policy formulation or implementation in response to health crises. This review provides conclusive evidence that timely travel bans, early detection of COVID-19 spread through exhaustive and reliable testing, and the establishment of a central, fully authorized body to foresee health trends and implement appropriate containment measures are essential to contain the spread of the virus.

This is an opinion paper on the process leading to the initiation of a model multisectoral accountability framework (MAF) project in the coastal district of Sindh. Dopasi Foundation in collaboration with Stop TB Partnership Pakistan conducted several meetings with senior policymakers of Sindh province drawing their attention towards the international commitment for establishing a Multisectoral Accountability Framework (MAF) to control TB. Thereafter, operational meetings were held with key government functionaries and district Badin. Subsequently the first sensitization meeting of stakeholders comprising of the district MAF team was convened and a problem analysis encompassing the current case notification, intersectoral challenges were drawn from the discussion these includes; likely benefits, zakat provision, mapping of community services, augmenting the role of drug inspectors, sputum transport and various dimensions related to the control and elimination of TB was conducted. This problem analysis, MAF implemented in the district and found effective in case detection likewise; during 2020, 2,519 TB cases were notified as compared to 2,464 in 2019, depicting a nominal increase, despite an overall decline of 17% in TB notifications owing to COVID-19 nationwide, while promoting self-reliance, pooling of resources and comparative advantages of each partner. This extremely cost-effective exercise based on WHO principles showed promising results, although the COVID-19 related disruption rendered a proper program evaluation impracticable. It is recommended that the government leaders need to work effectively with ministerial officials, civil society and affected communities, parliamentarians, private sector and academia, involved in diverse sectors including health and social protection, justice, labor, among others through this effective MAF.

School Health Services (SHS) are school health programs that promote health in school children. The value of SHS is recognized globally and practices around SHS vary with different regions. Its positive outcomes are already acknowledged by high-income countries, where education ministries are typically involved in cultivating comprehensive School Health Services. Low-income countries remain hesitant to implement SHS, due to various constraints. In Pakistan, SHS have been introduced and restructured several times, but never comprehensively executed. Private schools in Pakistan offer better health programs than public schools but none of the schools follow standardized school health guidelines. This paper aims to analyze the role of SHS in Pakistan and provide several recommendations regarding the establishment of SHS in local schools. The proposed suggestions revolve around establishing model clinics in schools, which would be central to subsequent school-based health programs in Pakistan. If properly designed and equipped, school clinics can support a wide range of health outcomes, from emergency first aid care, to immunizations, to health education. The involvement of ministries and national authorities is encouraged for smooth delivery of SHS and compliance with public health guidelines.

Background: The world has historically faced and recovered from many pandemics. The most recent global pandemic that the whole world is facing is Novel Coronavirus – Covid-19. The objective of current study is to compare and forecast COVID-19 trends for Pakistan and India. Methods: The data set for this research is obtained from the World Health Organization (WHO) online repository (https://covid19.who.int/). The time period we have considered since the first corona related case and death were observed in both countries. This research paper analyzes corona related cases and deaths in Pakistan and India till 28th February 2021, a total of 578,797 cases in Pakistan and 11,096,731 cases in India has been confirmed including 128,37 and 1,570,51 deaths respectively. The Auto-Regressive Integrated Moving Average (ARIMA) model is used to forecast the variables cumulative cases and deaths. It is simple to use and more predictive than any other regression model. Results: Based on the current trend, the forecast graph reveals that the number of cumulative corona cases could reach 999,767 in Pakistan and 16,481,122 in India up to 31st December 2021. Conclusion: This research found that corona related cumulative cases and deaths are on the rise in both countries. The pandemic situation in India is worse than in Pakistan nevertheless both countries are at high risk. There is a sudden increasing pattern in the number of corona related cases in both countries. Both governments must impose effective policies to control this pandemic.

In Pakistan, where the vaccination rate is dismally low and where the huge population remains unvaccinated, vaccination in children might be considered a privilege and a luxury. But with several countries such as Canada, United States, China, Indonesia, and Israel forging ahead with vaccinating children and the United Kingdom slowly following their footsteps and with mounting evidence, it might not be prudent to keep children side-lined from vaccination in Pakistan. This paper presents some evidence for vaccination in children and highlights the need and urgency for vaccinating children in Pakistan. Clinical trials of Pfizer/NBiotech, Moderna and SinoVac’s CoronaVac has shown promising results and higher antibody titres in children as compared to adults. For herd immunity to be effective and to curb this pandemic, it is prudent to initiate vaccination in children in Pakistan at the earliest.

Background: This study was designed with the objective to evaluate the fundamental risk factors of malnutrition among children in Lahore city and its outskirts, Pakistan. Methods: Data of four hundred and five children with age group less than 5 years was collected from Children hospital and Jinnah hospital, Lahore. We used weight-for-height anthropometric index, designed by World Health Organization (WHO), to measure the nutritional status of children. Preliminary analysis was performed by using Pearson Chi-square and Gamma statistics to check the association between factors (demographic, socio-economic and health related variables) and response variable i.e., nutritional status. Then, proportional odds model (POM) was fitted to the information collected. Results: Of 405 children included in the study, 33% (135) were found malnourished, whereas, approximately 67% (270) were found nourished. Findings of the study revealed that child’s age, maternal education level, socio-economic status, maternal age at the birth of child, low birth spacing, status of antenatal-postnatal care, incomplete vaccinations, exclusive breastfeeding, prevalence of fever, cough and recurrent episodes of diarrhea were the significant risk factors of malnutrition. Prevalence of acute respiratory infection (ARI) was turned out to be insignificant risk factor. In this study, parallel lines assumption was satisfied and proportional odds model was fitted well with p-value greater than 5% level of significance. Conclusion: This paper highlights the significant risk factors that are affecting the child’s health. Recognizing and understanding the identified risk factors would be very helpful in prevention of malnutrition in Pakistan.

Background: TB REACH is a grant-making initiative launched by the Stop TB Partnership in January 2010 to support innovative approaches and technologies to find and treat people with active TB disease, drug-resistant TB, or TB infection. Since then, TB REACH has launched eight Waves of funding to pilot untested, but promising technologies, tools, and approaches. The objective of this paper was to review the grants implemented in Pakistan in the decade since TB REACH’s inception and to summarize the approaches used, document the results, and assess the impact of these projects on local and international policy. Methods: We searched the TB REACH’s Grant Management System (GMS), which is a database for information on all grants awarded through the initiative, for recipient organisations in Pakistan from 2010 until June 2020. Data was abstracted for the following topic areas: type of grant, focus of work, case finding strategies, risk groups screened and impact on case finding. Results: Through eight waves of funding, TB REACH has supported 28 grants for 21 different interventions in Pakistan worth a total of USD 13.4 million. Overall, 19 of these projects aimed to improve detection, linkage to treatment and reporting of TB and two were product innovation grants for developing resources and materials to aide TB service delivery. Conclusion: TB REACH support has facilitated the introduction of new technologies, establishment of innovative processes in both public and private sector and approaches for addressing TB in key populations. The TB response in Pakistan and globally will continue to require innovation and disruption of ‘business as usual' approaches if we are to End TB.

Background: Past research demonstrated a link between homelessness and the increased risk of HIV and other sexually transmitted infections (STIs). However, ways to reduce young people’s risk of homelessness and sexual health risks have not been adequately addressed. This paper, based on the first detailed sociological exploration into the lived experiences of homeless young people, argues for the adoption of a holistic and integrated approach to health promotion that goes beyond the health sector. Methods: In-depth interviews were conducted with twenty-nine homeless young people, aged 16-25-year-old, from Rawalpindi, Pakistan. Results: A combination of socio-structural and interpersonal forces shaped participants’ pathways to homelessness and their experiences of street life – notably regarding sex work – and produce contexts of competing risks where HIV/STIs prevention became a secondary concern. Participants had a reasonable knowledge regarding nature, transmission, prevention, and to some extent, treatment of HIV/STIs. Nevertheless, this knowledge did not help them much, as most of the participants used condoms inconsistently with clients and intimate partners. Financial considerations, fear of violence from clients, and social obligations in intimate partnerships contributed to participants inconsistent condom use, increasing their risk of HIV/STIs. Conclusion: The results indicate the importance of the Ottawa Charter of health promotion, which suggests that conventional health promotion approaches are potentially suboptimal in shaping health behaviours supportive of good health. Notably, building healthy public policies, creating supportive environments, strengthening community actions, developing personal skills, and reorienting health services can help to improve young people’s socioeconomic status, which is inextricably linked with sexual health behaviour and status.

Internet addiction has been seen to rise significantly during the SARS-CoV-2 pandemic especially during the quarantine period. Closure of offices, marketplaces, educational institutes, and lack of social interactions has led to an upsurge in the usage of the internet not only for academic and work but also for relaxation and a muddle through monotonic life amidst pandemic. It is essential to understand the effects of this addiction on the general population. Young's and Temperance's model; one of the behavioral models explain behavioral changes among individuals related to internet addiction amidst crisis. This paper aims to discuss how the intercalated interplay between biological characteristics such as brain plasticity, psychological and predisposing characteristics, environmental and need-based factors during the pandemic have led to internet addiction. This could help health authorities in developing effective methods to reduce internet addiction prevalence through preventive measures like counselling, therapeutic interventions, and a hotline service.

Background: Rapid urbanization has led to emergence of squatter settlements with poor infrastructure and compromised basic amenities. These conditions expose vulnerable groups like women and children to serious health risks. This paper presents the status of maternal and child health in a squatter settlement of Karachi.Methods: Health and Demographic Surveillance System was established in Sultanabad, a squatter settlement of Karachi. Households were eligible to be enrolled if there was a married woman of 15-49 years of age. Data on socio-demographic, maternal and child health indicators was collected during a round of surveillance using a structured questionnaire adapted from Measure Demographic and Health Survey Phase III and Pakistan Demographic and Health Survey 2012-13. Analysis was done using SPSS version 19. Results: A total of 730 women completed the interview. Among them 87% women sought antenatal care during last pregnancy and 79% of the women delivered in a facility. Contraceptive prevalence rate was 32%. Proportion of children exclusively breast fed till six months of age was 63%. Almost 86% children of 12-23 months were fully immunized. Prevalence of stunting among children under five was 40%. Conclusion: In Sultanabad, maternal and child health indicators were relatively better as compared to national statistics. However in the presence of available health facilities, the low contraceptive prevalence and high proportion of stunted children in the community is alarming. This requires urgent attention primarily addressing social determinants of health within the local context.

Many low and middle income countries have developed their own national accreditation standards and accreditation systems for regulating and improving the quality of healthcare services. Healthcare quality is defined as the degree to which health services to individuals and populations increases the likelihood of desired health outcomes and are consistent with current professional knowledge. This paper attempts to assess the state of Pakistan's healthcare quality and patient safety in a structured way using Donabedian's model. Some of the key specific challenges identified for Pakistan's healthcare quality initiatives are lack of national healthcare accreditation system and integrated national guidelines, policies and procedures on healthcare quality and patient safety. Lack of national quality care indicators. Absence of an organizational culture that holds people accountable and lack of pre-service and in-service training for health staff in quality care management and leadership with little contextual research on quality care initiatives. Possible ways to improve the state of health care quality in Pakistan may include (i) up gradation and implementation of policies and procedures that regulate quality and patient safety issues in healthcare settings across the country (ii) introduction of a national healthcare accreditation programme across the nation (iii) development of networks and consortia between public and private sectors in Pakistan (iv) capacity building of health care professionals in quality and patient safety (v) Formulation of quality improvement teams at national and provincial level (vi) development of a culture of accountability and ownership (vii) learning from experiences of other countries and implementation quality care tools and locally validated indicators.

Background: Pakistan has a well-established healthcare system with 70% healthcare needs catered by private health sector. The latter's unregulated and unchecked expansion has resulted in quackery and compromised quality of care. This situation analysis provides a snapshot of health system's quality assurance and accreditation processes. Methods: Two validated questionnaires from World health Organization gauged the current state of health care accreditation and quality of care initiatives in Pakistan. Information was obtained from peer reviewed articles, grey literature, policy documents on government websites and newspapers. Results: Pakistan has a number of regulatory bodies responsible for ensuring quality in healthcare through accreditation and defined standards. National Institute of Health issues updated clinical quality guidelines pertaining to disease epidemics. A national quality policy was also formulated in 2004. However, implementing and ensuring accreditation has been challenging. Though statutory bodies are in place for registering different cadres of healthcare professionals, policies and mechanisms regarding licensure of healthcare establishments are missing. Emergence of national health vision 2012-2020, provincial health sector strategies and healthcare commission acts have focused on regulation of private health sector and accreditation of healthcare establishments. Despite presence of regulatory bodies, there are implementation gaps. Conclusion: This paper highlights some important gaps regarding accreditation and quality in healthcare. Quality assurance should be incorporated into national health policies, programs and strategies. National health policy should include explicit laws concerning quality Indicators and standards for quality in health care. Need to regulate private health sector and ensuring quality in overall healthcare is more than ever.