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Background: Pakistan is facing a double burden of disease. Nutrition has an impact on nutritionally related non-communicable diseases. Malnutrition in adolescent age continues in adulthood so interventions in this stage can help us fight this emerging problem. Objective: To determine the nutritional status of school-going adolescents and their eating patterns and then compare them between public and private secondary schools of Lahore. Methods: This analytical cross-sectional study was done on 372 school-going adolescents from 01.03.2023 to 20.06.2023 (3.5 months). A self-structured questionnaire was filled with interviews by convenience sampling. Weight and height were measured and BMI was plotted on WHO z charts to determine the nutritional status. Data were entered and analyzed by SPSS Version 21. The chi-square test was used to compare BMI and its determinants. Factors found significant were subjected to Binary logistic regression. P-value = 0.05 was taken as significant. Results: Out of the 372 school-going adolescent participants had a mean age of 14.86 years SD ± 1.75 (164 males and 208 females). 76(20.43%) were underweight, 201 (54.03%) had normal weight, 66(17.74%) were overweight and 29(7.8%) were obese. Public Schools had higher odds of undernutrition AOR 1.49 and lower odds of overweight and obesity AOR 0.38. Males had a reduced chance of undernutrition AOR 0.59 while the increased odds of overweight/Obesity AOR 1.81. Age groups 11 to 15 years had reduced odds of undernutrition as compared to 16 to 19 years AOR 0.53 and increased odds of overweight/obesity as compared to 16 to 19 years AOR 2.00. Conclusion: There is a significant difference in the nutritional status and eating habits of adolescents between public and private schools. Undernutrition is higher in public schools, among females and age 16 to 19 years. Nutritional interventions should be strengthened in school health services. [ABSTRACT FROM AUTHOR]

Background: COVID-19 household transmissibility remains unclear in Pakistan. To understand the dynamics of Severe Acute Respiratory Syndrome Coronavirus disease epidemiology, this study estimated Secondary Attack Rate (SAR) among household and close contacts of index cases in Pakistan using a statistical transmission model. Methodology: A retrospective cohort study was conducted using an inclusive contact tracing dataset from the provinces of Punjab and Khyber-Pakhtunkhwa to estimate SAR. We considered the probability of an infected person transmitting the infection to close contacts regardless of residential addresses. This means that close contacts were identified irrespective of their relationship with the index case. We assessed demographic determinants of COVID-19 infectivity and transmissibility. For this purpose based on evolving evidence, and as CDC recommends fully vaccinated people get tested 5–7 days after close contact with a person with suspected or confirmed COVID-19. Therefore we followed the same procedure in the close contacts for secondary infection. Findings: During the study period from 15th May 2020 to 15th Jan 2021, a total of 339 (33.9%) index cases were studied from 1000 cases initially notified. Among close contact groups (n = 739), households were identified with an assumed mean incubation period of 8.2+4.3 days and a maximum incubation period of 15 days. SAR estimated here is among the household contacts. 117 secondary cases from 739 household contacts, with SAR 11.1% (95% CI 9.0–13.6). All together (240) SAR achieved was 32.48% (95% CI; 29.12–37.87) for symptomatic and confirmed cases. The potential risk factors for SAR identified here included; old age group (>45 years of age), male (gender), household members >5, and residency in urban areas and for index cases high age group. Overall local reproductive number (R) based on the observed household contact frequencies for index/primary cases was 0.9 (95% CI 0.47–1.21) in Khyber Pakhtunkhwa and 1.3 (95% CI 0.73–1.56) in Punjab. Conclusions: SAR estimated here was high especially in the second phase of the COVID-19 pandemic in Pakistan. The results highlight the need to adopt rigorous preventive measures to cut the chain of viral transmission and prevent another wave of COVID-19. [ABSTRACT FROM AUTHOR]

Background: Despite the availability of antiretroviral therapy (ART), HIV is still responsible for substantial illness and death, especially in developing countries. Early start of treatment (ART) is associated with better therapeutic outcome, reduced transmissibility of HIV, reduction in loss to follow-up, and remarkably reduced death rate. Objectives: To find out the factors associated with early and late Initiation of ART among patients affected by HIV in Lahore, Pakistan. Methods: From November 2017 to April 2018, researchers conducted an analytical cross-sectional study on 156 HIV patients aged 18 and older that began antiretroviral therapy (ART) at Jinnah & Mayo Hospital, Lahore's HIV clinics. Samples were selected by non-probability convenience sampling and Univariate and multivariate analyses were performed to assess factors related to early and late Initiation of ART. The p-value of less than <0.05 was taken as statistically significant. Results: Among 156 HIV patients, 62.4% were more than 25 years, while 74.6% were male. The proportion of patients who started HIV therapy at an early stage of disease was 68.8%, while the delayed start of HIV therapy was seen in 31.2% study population. Two factors, type of household income and initial CD4 count (cells/ mm3), were reported to relate to early and late ART initiation. Conclusion: The study results highlighted the need to stress upon early treatment of HIV, giving special attention to how programs, research, policies, strict supervision, and required interventions can provide support in the continuum of HIV care. [ABSTRACT FROM AUTHOR]

This article discusses the need for primary healthcare system reforms in Pakistan to achieve universal health coverage. Primary healthcare is essential for a country's health system, providing the first point of contact for patients and aiming to achieve physical, psychological, and social well-being. However, Pakistan's primary health centers face challenges such as inadequate staffing, equipment, and poor service quality. The article emphasizes the importance of strengthening primary healthcare, increasing health budgets, and ensuring accountability in the health system to achieve universal health coverage. [Extracted from the article]

Background: Reliable and peer reviewed information is of immense importance for preventive, diagnostic and curative solutions and efforts should be done to minimize inaccurate infodemics among post graduate trainee doctors. Objective: The aim of the study was to access the use of Peer Reviewed and Non-Peer Reviewed Information by post graduate trainee doctors for COVID-19 Pandemic in Pakistan. Methods: The study was analytical cross sectional in design and was conducted in 3193 post graduate trainee doctors employing Electronic Logbook (elog) system of College of Physicians and Surgeons, Pakistan. An online survey included demographic characteristics, year of training, specialty and sources of information used for COVID-19 pandemic. Results: Total 3193 study participants from all provinces of Pakistan were included with mean age of 28.68 years. Majority of participants (58.66%) used both peer reviewed and non-peer reviewed information source for getting updated guidelines and information about COVID-19. According to bivariate analysis results, significant differences were revealed between the source of information and the age (p < 0.001), province (p < 0.001) and gender (p < 0.002). Multivariate logistic regression results showed that the age less than 30 years (AOR = 1.311, 95% (CI: 0.800, 2.146), working in Khyber Pakhtunkhwa province (AOR = 1.549, 95% (CI: 1.210-1.982) and female gender(AOR = 1.551, 95% (CI: 1.303, 1.847). was significantly associated with increased use of social media for getting information. Conclusion: Use of non-peer reviewed information for COVID-19 pandemic by postgraduate trainee doctors is common. [ABSTRACT FROM AUTHOR]

aimoor Akram Khan,4 Aabish Mehreen Khan,5 Amjad Khan,6 Rabia Nazim,7 Khadija Tahira81Department of Public Health, Institute of Social and Cultural Studies, University of Punjab, Lahore, Pakistan; 2Department of Public Health, Institute of Social and Cultural Studies, University of Punjab, Lahore, Pakistan; 3Department of Community Medicine, King Edward Medical University, Lahore, Pakistan; 4Department of Community Medicine, King Edward Medical University, Lahore, Pakistan; 5Department of Community Medicine, King Edward Medical University, Lahore, Pakistan; 6Department of Public Health, University of Haripur, Khyber Pakhtunkhwa, Pakistan; 7Department of Community Medicine, King Edward Medical University, Lahore, Pakistan; 8Department of Public Health, Institute of Social and Cultural Studies, University of Punjab, Lahore, PakistanCorrespondence: Khunsa JunaidDepartment of Public Health, Institute of Social and Cultural Studies, University of Punjab, Lahore, 75500, PakistanEmail khunsajunaidmir@gmail.com Background: Depression is defined as a psychiatric disorder characterized by depressed mood, lack of concentration, diminished energy, disturbed sleep, and low self-esteem. Depression is more prevalent in HIV/AIDS patients than the general population. There is no published study available that reveals the present status of depression among HIV patients in Pakistan. As such, the present study was conducted to determine the prevalence and associated factors of depression among HIV/AIDS patients attending the HIV clinic of Jinnah Hospital, Lahore, Pakistan. Methods: A hospital-based cross-sectional study was carried out from February to March 2019 in Lahore. Data were collected from 158 HIV/AIDS patients using a pretested, standardized, structured interviewer-administered questionnaire. Nonprobability convenience sampling was used to recruit the study participants. Depression was evaluated using the Patient Health Questionnaire. SPSS version 23 was used to analyze the data. Binary logistic regression models were used to determine the various factors associated with depression. AORs with 95% CIs were used to assess the magnitude of associations between depression and associated factors. Results: The mean age of the study participants was 35.03 years± 9.123. Prevalence of depression among HIV/AIDS patients was 32.2%. Living in a rural area (AOR 5.60, 95% CI 2.20, 14.15), fear of stigma and discrimination (AOR 3.505, 95% CI 1.364, 9.008), having worked abroad (AOR 3.017, 95% CI 1.134, 8.031), and history of substance abuse (AOR 4.147, 95% CI 1.673, 10.28) were significantly associated with depression. Conclusion: The prevalence of depression among HIV/AIDS patients is very high in Pakistan. Therefore, it is suggested that guidelines formulated to screen and treat depression among HIV patients. [ABSTRACT FROM AUTHOR]

Background: Studies focusing on the examination of the association between iron deficiency anemia (IDA) and Helicobacter Pylori (H. Pylori) infection is very important especially in developing countries. Therefore, the primary aim of the study was to assess if patients with H. Pylori infection were more prone to IDA than patients who were not suffering from H. Pylori. Methods: Databases used for this purpose include but not limited to Google Scholar, PubMed, Web of Science, MEDLINE, SCOPUS, EMBASE, and the Cochrane Library. As per our detailed search from last ten years data from above sources we found seventeen observational studies and four randomized controlled trials (RCTs) satisfyying our criteria for meta-analyses. By using random effects model we obtained Pooled odds ratio (OR), pooled standardized difference in means (SMD), and 95% confidence intervals (CIs). Forest plots were generated from these values. Results: Meta-analysis from our above study gave very remarkable results [Pooled OR: 1.649; 95% CI: 0.883-3.082; p-value = 0.117]. Results showed decreased likelihood of iron deficiency anemia (IDA) in participants having evidence of Helicobacter Pylori (H. Pylori) as compared to uninfected ones and a remarkable variation was found too in studies (I2 = 88.7%; p-value = 0.001). A significant increase in ferritin (Pooled SMD: 0.504; 95% CI: 0.135-0.873; p-value = 0.007) and hemoglobin (Pooled SMD: 0.476; 95% CI: 0.111-0.840; p-value = 0.011) levels was observed from meta-analyses of four RCTs by giving patient anti-H. Pylori treatment along with iron supplement as compared to using only iron supplement in iron deficiency anemia. Conclusion: Our study gave us conclusive results about decreased likelihood of prevalence of iron deficiency anemia as compared to Helicobacter Pylori (H. Pylori) infection in developing regions. Further to this effect we can say with certainty that combined H. Pylori eradication & iron supplement can be useful in improving values of ferritin and hemoglobin. [ABSTRACT FROM AUTHOR]

Background: COVID-19 illness has the ability to remarkably influence the mental well-being of healthcare workers (HCWs), who are facing this situation standing on frontline. Hence it is of foremost importance to observe mood changes, pattern of sleep and other symptoms of deterioration of mental health for forecasting aggravating factors and to suggest interventions. The purpose of the review is to combine and examine current available material on prevalence of depression in HCWs in current epidemic of COVID-19. Methods: A systematic search of exploration of literature records was carried out till May 30th; 2020.Two reviewers autonomously evaluated complete articles on the basis of already set criteria. For assessment of occurrence of particular mental health issues, the data was pooled by means of random-effects meta-analyses and risk of bias for each study was evaluated. Findings: Eleven research studies were made part of analysis and 25,413 participants were included in the study having estimated prevalence of 30.2% (95% CI 21.55-39·78, I2=99·53%).An assessment of a subgroup of above mentioned group of participants showed that belonging to female gender and being nondoctor were found susceptible to increased risk of depression. Conclusion: Evidence indicates that a high percentage of HCWs suffer from changes in mood and patterns of sleep during this epidemic, focusing the requirement to establish methods for alleviating factors deteriorating mental health during this critical situation [ABSTRACT FROM AUTHOR]

Background: Although all healthcare employees are open to work-related injuries but medical laboratory workers are more exposed to blood and other possibly contagious items are at greater risk of developing various blood borne infections. Recognizing frequency and context of contact to blood and bloodborne pathogens might be aid in developing policies for prevention. Objectives: to find the frequency and types of occupational health hazards along with needle stick damages in medical laboratory employees in Lahore, Pakistan. Methodology: Hospital based, analytical cross-sectional study was done from November 2018 to January 2019.A total of 217 medical laboratory personnel were enrolled by non-probability convenience sampling. Pre-tested self-administered questionnaire was used for data collection. Absolute number with percentage was used to present the descriptive data while to determine the statistical association between associated factors and occupational exposure, chi-square analysis was used. A p value of < 0.05 was considered as statistical significant. Results: A total 217 medical laboratory workers were made part of the study with the mean age of contributors was 36.1 years (±10.0 years). About 94 (46.8%) of medical laboratory workers gave history of needle prick. 57 (28.4%) respondents were open to non-biological hazardous material, while 37(18.4%) became exposed to natural/organic dangerous substances and about 16(8%) participants had exposure to both natural and non-natural risks. The most common cause of work-related injuries reported in the medical laboratory workers was ergonomics risk elements (23 including errors, tours, crowded working environment and workroom. Type of hospitals, job category and experience were statistically significantly associated with needle stick injury. Conclusion: The present research represented high proportion of various types of occupational hazards. Needle stick injuries and exposure of HBC and HCV infection were quite common among laboratory workers. Therefore, there should be monitoring system which could be offered correct information regarding occupational hazards and needle stick injury. Pertinent stakeholders need to develop policies to make a encouraging working environment and enhance their devotion to worldwide safety measures. [ABSTRACT FROM AUTHOR]

Background: Pakistan is one of the highest burden countries for HCV. Hepatitis has unique transmission risk factors which vary based on geography and other factors. Objective: To assess risk factors for HCV and HBV transmission in an urban city population of district Lahore, at Hepatitis Prevention and Treatment Clinic (HPTC) primarily serving as a hepatitis clinic, serving a large catchment area. Methods: A clinical based cross-sectional study was conducted in 2018 at HPTC Lahore, Pakistan. Total of 1081 out of 22231 eligible patients blood samples were screened out for hepatitis B (HBsAg) and C (Anti- HCV) irrespective of age and gender through ELISA. Results: HBV and HCV was 8.0% and 52.35% in the study population respectively. Males were more affected with HBV (64.0%) than females (36.0%). While HCV seroprevalence was significantly higher in females (59.6%) than males (40.4%). The coinfection recorded here was 2.40%. Multivariable logistic regression analysis of predicting variables showed that factors including, IV injections, barber shaving, blood donation and history of having more than ten injections were found associated as potential risk factors (OR>1: P-value<0.05) with the occurrence of HBV. Whereas, factors including, dental procedure, blood donation and visit to beauty parlor were significantly associated as risk factors (OR>1 : P-value<0.05) with HCV occurrence. Conclusion: Considering all the patients a single cohort irrespective of age and gender data analysis showed that exposure to dental procedures is significantly associated with the occurrence of HCV. [ABSTRACT FROM AUTHOR]

Exogenous hospital associated-infections can be acquired via hospital environment, medical procedures and hospital staffs. 2 In accordance to a recent multicenter study conducted in Europe, the prevalence of hospital-associated infection is 51% in intensive care unit patients and cumulative incidence is 17 episodes per 1000 patient-days among high-risk adults in developed countries. 9 There should be nosocomial infection surveillance system of health-associated data in order to monitor the nosocomial infection rate and assess the efficiency of infection control activity. [Extracted from the article]

Rabies, a viral illness classified as a neglected tropical disease by the World Health Organization (WHO), causes thousands of people to die annually, primarily in underprivileged communities of Africa and Asia. In the context of a single health framework, one of the primary objectives of this literature review is to examine the major factors and challenges that maintain the endemic status of dog-mediated human rabies in Pakistan. Rabies-endemic countries have an imperative need to work on preventive strategies to lessen the burden of this terrible disease as per guidelines of World Organization for Animal Health (WOAH) and WHO. Lack of public awareness, free-roaming dogs, and cold chain mismanagement of vaccinations are the 3 most significant factors contributing to the increasing number of dog bite injuries and suspected rabies cases in animals and humans. To control dog-mediated rabies, Pakistan must initiate and strongly support a national One Health project, a subsidized supply of human and animal rabies vaccine in public hospitals, and designated rabies prevention centers at an affordable cost. People should be educated regarding responsible pet ownership and follow-up of basic preventive measures. Empowerment of labs equipped with surveillance systems are also additionally required to strengthen rabies control and prevention activities at least in regional levels. This article gives valuable information for scholars and policymakers who wish to comprehend why this disease remains endemic due to multiplex interplay of zoonotic, medical, and anthropological risk factors and transmission chains in animal and human sectors through viral reservoirs. Achieving the 'Zero By 2030' goal in Pakistan requires joint immediate action from the government, society, and all health departments at regional, provincial, and national level. [ABSTRACT FROM AUTHOR]

Pakistan has second highest burden of hepatitis C virus (HCV) infected patients in the World. Little is known about the molecular epidemiology and risk factors for prevailing HCV genotypes in Pakistan. Considering this a multicenter cross-sectional study was conducted at 23different viral hepatitis control and prevention centers. A total of 175,897 patients were registered and screened for HCV, out of which 73,180 (41.6%) were found positive on Architect screening test. The screened positive patients were sequentially tested on RT-PCR; where 41,241 (56.35%) were detected positive. Molecular characterization results showed genotype 3 (73.9%) as the most prevalent type, followed by genotype 1 (9.7%), and genotype 4 (0.3%) was isolated for the first time in Pakistan. On regression analysis; risk factors associated with genotype 3 and 1 included; age group of 30–50 years, rural residence, exposure to >10 injections, barber shaving, circumcision by barbers, and low literacy rate. Phylogenetic analysis based on genotypes identified in this study and sequences isolated from Pakistan in last 10 years demonstrated that genotype 3 and 1 are endemic locally in Punjab province. The high prevalence rate of HCV is a threat for a generalized epidemic and genetic recombination with such variability of genotypes identified here is an alarming condition. More focused attention and resources should be spent in awareness of the population to prevent the spread of HCV among high risk population. • its the first study in Pakistan reporting HCV genotype 4 in a large cohort. • sequence analysis and genotyping is carried out on a large sample size. • this study reports an emerging pattern of HCV endemic highlighting the threat of epidemic in the country. [ABSTRACT FROM AUTHOR]

Background Childhood immunization programs in underdeveloped nations can improve children's growth and nutritional status and prevent growth delays while protecting against infectious diseases and meeting growth norms. This study aimed to assess the impact of vaccination status on the anthropometric indices of children aged 12-18 months at an Expanded Programme on Immunization vaccination center and compare the anthropometric indices of growth in children with complete and incomplete vaccination statuses. Methodology This study was conducted at the rural health center in Kala Shah Kaku, Pakistan, from November 2023 to December 2023. Children aged 12-18 months were enrolled and their vaccination status was recorded. Height and weight were measured using World Health Organization growth charts. The data were analyzed using descriptive statistics and chi-square and Fisher's exact tests. A p-value <0.05 was considered statistically significant. Results The mean age of the 110 children who visited the vaccination site for this study was 16.36 months ± 2.415. There were 28 (25.5%) stunted children. In the study, 17.6 (16%) participants were underweight, and 15.95 (14.5%) were wasted. Of the children, 79% had received all recommended vaccinations. A statistically significant (p < 0.05) association was found between vaccination and nutritional status. Conclusions This study emphasizes the significance of vaccination in promoting child health and nutrition, reducing stunting risk, and ensuring equitable access to vaccination services and comprehensive healthcare interventions. This can help mitigate the malnutrition burden and promote optimal growth, contributing to global health and development goals., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Review Board, King Edward Medical University issued approval 319/RC/KEMU. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Siddiqui et al.)

Background: Many human immunodeficiency virus (HIV) infected patients suffer from depr-ession, but a little focus is given to detecting and treating depression in primary health care. Detection of depression can be improved by introducing short, reliable, and valid screening instruments., Aim: To determine the psychometric properties of the patient health questionnaire-2 (PHQ-2) and patient health questionnaire-9 (PHQ-9) for depression screening and diagnosis, and the sensitivity and specificity of the PHQ-2 in HIV infected patients., Methods: A cross-sectional study was conducted on 158 HIV-infected patients aged 18 years and above in Lahore, Pakistan. PHQ-2 was implemented to screen depression. PHQ-9 was implemented to diagnose major depressive disorder as a reference standard. Reliability, Validity tests and receiver operating characteristic curve were computed., Results: The Cronbach's alpha of PHQ-2 and PHQ-9 were 0.732 and 0.759, respectively. The study results showed that the score of 2 on PHQ-2 indicates the highest Youden's index of 0.924, with both sensitivity and specificity of 0.96, and the area under the curve for PHQ-2 was 0.98 (95%CI: 0.953-0.998)., Conclusion: Good psychometric properties for the PHQ-2 and PHQ-9 indicated their significant potential as tools for depression screening and diagnosis in the HIV-infected population., Competing Interests: Conflict-of-interest statement: All the authors have no conflicts of interest., (©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.)