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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. [ABSTRACT FROM AUTHOR]

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. Lowincome 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. [ABSTRACT FROM AUTHOR]

Diagnostic agents based on nanoparticles are frequently suggested. However, diagnostic nanoparticles, except for iron oxide nanoparticles, have not yet been extensively utilized in clinical settings. This is because of concerns about toxicity, biodegradation, and elimination as well as difficulties in achieving reproducible particle uniformity and acceptable pharmacokinetic properties. The biologic behavior of nanoparticles should be considered when considering reasonable clinical applications. For instance, numerous nanoparticles are taken up by macrophages and accumulate in tissues with a lot of macrophages. As a result, they can be utilized to provide contrast in lymph nodes, the liver, the spleen, and inflammatory lesions Nanoparticles can also effectively label cells, making it possible to study cell migration in vivo and locate implanted (stem) cells and tissue-engineered grafts. Because it is difficult to control their pharmacokinetic properties, the potential of using nanoparticles for molecular imaging is limited. While targeted nanoparticle delivery to extravascular structures is frequently limited and difficult to separate from an underlying enhanced permeability and retention (EPR) effect, ideal nanoparticle targets are located on the endothelial luminal surface. In conclusion, nanoparticles hold significant clinical potential for other diagnostic and theranostic applications, even though they are not always the best option for molecular imaging because smaller or larger molecules may provide more specific information. This literature review survey endeavored to portray theranostic nanoparticles and their utilization in the therapy and conclusion of malignant growth. This paper also looked at nanoparticles and their potential to lower the dose of radioactive material and improve the quality of computed tomography scans. This review also attempted to demonstrate the benefits and drawbacks of incorporating these nanoparticles into the modern healthcare system. To gather the pertinent data for this review, 18 scholarly sources were chosen and investigated. Every day, new nanotechnology prototypes and developments are made, created, and analyzed. Positive aspects of incorporating nanoparticles into cancer treatment have been documented. On the other hand, there are a lot of people who still do not like the idea of using this technology and think it is just a fantasy or novelty. These technologies have the potential to completely transform the health care industry, according to studies of their effects on the cancer industry. When all these factors are taken into consideration, it appears that this technology is being used more frequently than ever before. This claim was not accurately met by negative perceptions, fear of change, a lack of specific work, cost, toxicity, or synthesis. The study and manipulation of matter in the range of one to one hundred nanometers is known as nanotechnology. Innovative therapeutic and diagnostic methods are at the heart of nanomedicine, or the use of precisely manufactured materials at this length scale for medical purposes. Due to their extremely small size, high surface area to mass ratio, and high reactivity, nanomaterials are physically and chemically distinct from bulk materials of the same composition. Using these features can alleviate some of the drawbacks of conventional medical and diagnostic drugs. [ABSTRACT FROM AUTHOR]

The purpose of this paper was to examine the trend of self-medication, evaluating its use, drawbacks and motivations behind its use. People were questioned about their background and conditions for which they used drugs/medicines in several studies. Complicated lifestyles, hectic routines, cultural norms, expensive medication, over-confidence, lack of education, selling non-prescriptive pharmaceuticals, and the absence of government checks contribute to the trend of self-medication. People largely relied on self-diagnosis and only went to professional doctors when they had serious problems. Over-thecounter medications were preferred for basic ailments such as fever, headache, flu, etc. People with greater education were more likely to self-medicate because they relied on their own expertise and had easy access to the drug markets. The countermeasures for self-medication involve the services of Professionals and Pharmacists, promoting the responsible use of self-medication and spreading awareness about its risks are the key steps to reduce adverse impacts of self-medication. [ABSTRACT FROM AUTHOR]

Background: At present, South Asian Association for Regional Coorporation (SAARC) countries have tremendous pressure on child stunting along with the impact it is making on economic growth. World Health Organization (WHO), United Nations International Children's Emergency Fund (UNICEF), and The World Bank (WB) have emphasized for this region to reduce stunting by 40%. The objective of this paper is to analyze the impact of stunting on economic outcomes in SAARC countries so that to scale up policies and programs aiming to reduce child stunting. Methods: The systematic review has assessed five international databases; PubMed, JSTOR, Cochrane Library, Web of Science, and CINAHL Plus for published, unpublished, and ongoing research till the year 2020. Grey literature is searched using Google Scholar and Google search engines. The systematic review registration number in PROSPERO is CRD42021230279. Results: Thirty-three (33) studies matched the criteria. Most quantitative studies link stunting with economic repercussions. Three investigations found no or a weak link between the two. Nutritional intervention synthesis predicts a 12 percent return, a 5:1-6:1 benefit-cost ratio, and a 14mm height gain. A 1 cm increase in height increases pays by 4% for men and 6% for women. Stunting caused a 5%-7% income penalty and lower lifetime pay. Studies show that a 10% increase in agricultural growth reduces stunting by 9.6%, while a 10% increase in non-agricultural growth reduces stunting by 8.4%. Conclusion: To reduce stunting prevalence, policies should be scaled up, as well as targeted and structural interventions are needed. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Maternity care is an imperative aspect of healthcare systems due to its demand of intensive care focusing on mothers' and newborns' health. By consideration, child birth is a natural process but needs appropriate care. Provision of quality care to mothers and newborns at healthcare centers and hospitals is crucial for consideration in health systems. Method: The paper consisted of conceptual understanding of the measurement of quality care for maternal and newborns in hospitals. After careful screening of the available literature, 30 articles were selected and reviewed for this paper. Results: Various literature focused on three perspectives to study quality of care i.e; structure, process and outcome. Hospitals are the place to provide short term care service to the patient revolved around the activities provided by doctors, nurses and other staff. The utilization of efficient health services depends on the providers' ability and competence to deliver quality care, which shows the process of health services. On the other hand, the patient's centeredness is also the apex agenda to know the outcome of the services delivered to them. Conclusion: Therefore, in order to study quality of health care it is necessary to highlight the provision of quality care services in terms of structure, process and patient's perspective towards health care services and its quality to achieve better outcomes for maternity care. [ABSTRACT FROM AUTHOR]

Background: Menstrual hygiene remains clouded by misconceptions, posing challenges for adolescent girls. This study aims to identify myths surrounding menstrual hygiene among young girls in Islamabad and recognize the challenges they face in maintaining proper menstrual hygiene. Methods: A descriptive cross-sectional study was conducted in three government schools in Islamabad, involving adolescent girls aged 13-18 years in grades 8-12 over a six-month period. Simple random sampling was used to enroll 600 participants, and data were collected using a self-structured, pre-tested questionnaire. Statistical analysis was performed using SPSS version 25. Results: Of the 600 participants, 47% were in the age group of 13-15 years, and 53% were in the age group of 16-18 years. Mothers were the primary source of information for 85.8% of the girls. Common myths included 69% of girls avoiding baths based on advice from elders and 58.2% avoiding washing their groin during menstruation. Challenges reported by adolescent girls included 38.8% finding menstrual products unaffordable, 56.6% lacking sanitary pads at school, and 54.8% feeling embarrassed about asking for menstrual products. Additionally, 56.5% of girls were hesitant to discuss genital issues due to social taboos. Conclusion: This study highlights prevalent myths and challenges undermining menstrual hygiene practices among adolescent girls. Debunking these myths and providing necessary facilities are essential to enhance menstrual health and overall quality of life for adolescent girls. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Bangladesh has made remarkable progress in the areas of poverty reduction, increasing enrolment at primary schools, lowering the infant mortality rate and maternal mortality ratio, improving immunization coverage and reducing the incidence of communicable diseases. Resource poor developing countries like Bangladesh are faced urban rural, poor-rich disparities in MDG 4, MDG 5 and MDG 6. Based on an extensive review of secondary data, the paper assesses the current situation of selected MDGs in Bangladesh and at the same time examines the unequal progress of MDG. The paper strongly argues that unequal progress of MDG an alarming issue for Bangladesh. However the health care system in Bangladesh needs to be further strengthened to effectively respond to this challenge. On the other hand, areas in need of greater attention are hunger-poverty reduction increase in the presence of skilled health professionals at delivery, increase in correct and comprehensive knowledge on HIV/AIDS and Communication Technology. [ABSTRACT FROM AUTHOR]

Background: Along with other developing countries Bangladesh is also going through an epidemiological transition from infectious diseases to chronic non communicable diseases (NCDs). In Bangladesh, NCDs are estimated to account for 52% of all deaths. Cardiovascular diseases (CVDs) alone account for 27% of these deaths. Our aim was to conduct a scoping review of literature to ascertain what is known about risk factors and prevention strategies to reduce the burden of CVDs in Bangladesh. Methodology: Based on York methodology based scoping review, a comprehensive search of published academic articles, conference processing and grey literature was carried out through pub Med, BanglsJOL, Google and Google scholar. We summarized risk factors and diseases outcomes and as well as Prevention strategies of CVDs among adults (? 18 years) in both urban and rural area of Bangladesh. Result: After conducting scoping review and as well as considering inclusion criteria we found 9 studies that fulfill study objectives. Among all the studies 4 were cross sectional, 2 were case control, 1 was population-based prospective study, one was retrospective observational study and another one was survey. The most common risk factors of CVDs, as identified by these studies, were tobacco consumption, hypertension (HTN), Diabetes mellitus, dyslipidemia, animal protein-rich diet and sedentary lifestyle. Only 3 papers were found related to prevention strategies. It is unfortunate that except tobacco consumption there were no papers related to chronic disease prevention strategies. Conclusion: CVDs are considered as a major public health concern in a resource poor country like Bangladesh. Addressing the risk factors sustainable interventions could be designed and implemented on a larger scale to prevent the rise of CVDs in Bangladesh. [ABSTRACT FROM AUTHOR]

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, drugresistant 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Rapid urbanization has led to emergence of squatter settlements with poor infrastructure and comproinised basic amenities. These conditions expose vulnerable groups like women and children to serious health risks. This paper presents the status of matemal and cliild 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 tliere was a married woman of 15-49 years of age. Data on socio-demographic, matemal and cliild health indicators was collected during a round of surveillance using a structured questionnaire adapted from Measure Demographic and Healtli Survey Phase III and Pakistan Demographic and Health Survey 2012-13. Analysis was done using SPS S version 19. Results: Atotal of 730 women completed the interview. Among them 87% women souglit 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 montlis of age was 63%. Almost 86% children of 12-23 months were fully immunized. Prevalence of stunting among cliildren under five was 40%. C onclu sion: In Sultanabad, matemal and child health indicators were relatively better as compared to national statistics. However in tlie presence of available health facilities, the low contraceptive prevalence and high proportion of stunted cliildren in the community is alanning. This requires urgent attention primarily addressing social determinants of health witliin the local context. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: In low- and middle-income countries, weak public health infrastructure and limited healthcare funding often lead to inadequate healthcare services. Private providers bridge this gap, resulting in high out-of-pocket expenses. Micro health insurance programs can enhance access to healthcare and offer financial protection to low-income populations. This study aimed to identify factors influencing the willingness to participate in micro health insurance programs and determine the optimal premium amount. Methodology: A cross-sectional analytical study was conducted in Karachi with 245 participants, using a validated questionnaire. Multiple linear regression was applied to predict willingness to purchase healthcare insurance based on factors such as age, income, education, discretionary income, family employment, and existing health insurance coverage. The contingent valuation method was used to estimate willingness to pay and the premium amount. Data were analyzed using SPSS version 20. Results: Willingness to purchase health insurance was significantly influenced by income, household expenses, education, discretionary income, and health service preferences. Among participants, 36.3% expressed willingness to participate in a micro health insurance program, while 63.7% were unwilling. Conclusion: Willingness to participate in micro health insurance is strongly associated with economic and educational factors, discretionary income, and household expenses. These findings highlight the need for targeted interventions to improve participation in micro health insurance programs, particularly among low-income groups. [ABSTRACT FROM AUTHOR]

Background: Rapid spread of monkey pox across countries has raised serious concerns and WHO has announced it a Public Health emergency of international concern. It is essential to promote educational campaigns to bridge gaps in understanding this emerging zoonosis. The objective was to evaluate knowledge and awareness level regarding monkey pox among faculty members of Public Sector University. Methodology Cross-sectional study was conducted on 70 faculty members in Dec 2022-Aug 2023. Close-ended questionnaire was used by convenience sampling, socio-demographics were recorded along with evaluation of awareness regarding monkey pox epidemiology, prevention and control. Twenty questions were asked, based on correct answer counts, overall knowledge and awareness level was evaluated placing in categories; poor, moderate and good. Chi-square test was used to determine association between awareness level and variables; age, education, gender, marital status using SPSS-26. Results: Out of 70 participants; 29 (41.42%) male, 41(58.57%) females, age group 25-60 years, average 38 years, married 53 (75.71%), majority 61 (87.14%) from University surroundings. Average of overall correct answers was calculated, 45.6% answered correctly indicating "moderate" level of knowledge and awareness. No relationship was found between awareness level and age, education, gender, marital status of respondents. Conclusion: Knowledge and awareness level of faculty members regarding monkeypox epidemiology, infection, prevention, and control was moderate and no relationship was found between awareness level and age, education, gender, marital status of respondents. Collaborative efforts by all stakeholders can play significant role in enhancing monkeypox awareness, leading to a decreased risk of disease transmission. [ABSTRACT FROM AUTHOR]

Introduction: Malaria is the second most prevalent and devastating disease in Pakistan with a tendency for epidemic outbreaks. Control of malaria vector mosquitoes requires the adoption of an appropriate evidence-based policy on the use of pesticides, and having the latest information on the insecticide resistance status of malaria vector mosquitoes is essential for designing effective disease prevention policy. Methods: During this study susceptibility/resistance status of malaria vector mosquitoes in district Gujrat was determined by using World Health Organization (WHO) test kits, utilizing papers impregnated with DDT, Malathion, Deltamethrin, Lambda-cyhalothrin, and Permethrin. Results: The test results showed that Anopheles stephensi is resistant to DDT, Malathion, Permethrin, Lambdacyhalothrin, and Deltamethrin in all four localities of district Gujrat. Conclusion: These results suggest that if appropriate resistance management strategies are applied in this area, then the development of high levels of resistance can still be prevented or slowed. This study forms an important evidence base for the strategic planning of vector control in district Gujrat. [ABSTRACT FROM AUTHOR]

Background: Human resource for health is believed to be an important factor of health system. Pakistan is the country who is facing big challenge of health workers migration and shortage of health staff. Incentives known to be important interventions while in better management and retention of health work force in any country. Incentive is required to retain capable, fascinated, and motivated health workforce in order to develop a health system reactive to the requirements of the target population. During this systematic review the evidence on efficacy and value of Incentives for health workers were analyzed. Methods: During this secondary review, 10,626 articles were accessed and finally 22 articles were included for the analysis according to the study objectives rest was excluded. WHO database, Global Health Worker Alliance, CINAHL and SCOPUS and Pub Med in addition to by internet search engine Google were accessed during this secondary review. Results: 22 published papers were analyzed shows that incentives in form of improved salaries, perks, benefits, trainings, promotions, supervisions, work environment, good relationship, autonomy during their job, communication, performance based benefits and opportunities were found significant in the retention of health workers working in health sectors of different developed and developing countries. Conclusions: Review concludes that the incentives for health professionals have positives impacts on the retention of Human resources for health in any organization. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Malnutrition during pregnancy and lactation is a major public health issue in developing countries like Pakistan. This study aims to assess the prevalence and factors associated with malnutrition among pregnant women and lactating mothers in Azad Jammu and Kashmir (AJK), Pakistan. Methodology: A cross-sectional study was conducted from January to December 2022 among 300 pregnant women and lactating mothers in the district Poonch of AJK. Data were collected through a semi-structured questionnaire. Anthropometric measurements, including height, weight, and mid-upper arm circumference (MUAC), were taken. BMI and MUAC were used to assess nutritional status. Results: The prevalence of malnutrition was 39% according to BMI (<18.5 kg/m²) and 46% according to MUAC (<21 cm). Significant factors associated with malnutrition included illiteracy (AOR: 2.7, 95% CI: 1.4-5.2), low family income (AOR: 2.1, 95% CI: 1.2-3.8), rural residence (AOR: 3.2, 95% CI: 1.7-6.1), food insecurity (AOR: 4.6, 95% CI: 2.4-8.9), and lack of antenatal care (AOR: 2.3, 95% CI: 1.2-4.5). Conclusion: Malnutrition is alarmingly high among pregnant and lactating women in AJK. Improving female literacy, socioeconomic status, and antenatal care coverage are recommended to address this public health issue. [ABSTRACT FROM AUTHOR]

Background: Childhood malnutrition has always been a public health problem. Childhood malnutrition has a double burden involving undernutrition e.g., stunting, wasting, undernutrition and childhood obesity/overweight which have been greatly enhanced in the past few years. Methodology: This study was designed to estimate the prevalence of undernutrition and overweight/obesity among 7-13 years old children of school-going age in Lahore city, Pakistan. A questionnaire was developed in which students were asked questions about their dietary habits, hygienic conditions, source of drinking water, illness, and socioeconomic status. Pearson Chi-square was applied to find the association between anthropometric failure and all these factors. Results: Prevalence of underweight, stunting, wasting, overweight, obesity, abdominal overweight/obesity, and anthropometric failure was 3.6%, 7%, 7%, 2%, 0.26%, 28.8%, and 27.2% respectively. Conclusion: We concluded a positive association between a mother's education status and undernutrition. There is a need to focus on nutrition education and awareness among parents so that the dietary habits of children may improve. This study highlights the importance of promoting nutrition knowledge of parents and the hygienic conditions of schools and children. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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, socioeconomic 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 pvalue 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. [ABSTRACT FROM AUTHOR]

'Oral health' is an integral part of general health but it has been greatly ignored globally particularly in developing world. In Pakistan oral health care services are mostly limited to tertiary care hospitals which are curative in nature with a downstream approach. There is no 'oral health policy guideline' at the national level and the health strategies of the provinces, which were developed after the enactment of 18th amendment, do not address the oral health needs of the population. The private sector mainly caters for the oral health services and those who can afford purchase services through out of pocket spending. There lies a dearth of dental workforce in Pakistan especially in rural areas. There is no proper national, provincial or district level record on quality, utilization and coverage of oral health services, resource management, monitoring and outcome evaluation. The lack of spending on oral health, inability to focus on new low cost technologies, preventive approaches and health promotion are one the main areas to be addressed. There is a great need for developing national oral health policy guidelines based on community needs and available resources. At primary care level, the government may introduce front line oral health workers for provision of preventive and essential oral health services. The WHO guidelines in terms of financing, work-force and use of low cost technologies such as 'Basic Package of oral care' should be adopted and followed in true spirit for integration of primary oral health care into primary health care for improved outcomes. This paper intends to summarize and highlight the issues and challenges based on the authors' observation and available literature. [ABSTRACT FROM AUTHOR]

Background: The foundations of a good life encompass both physical and mental health. Mental health stigma, any negative belief motivating fear or discrimination against individuals with mental illness, is a significant barrier to seeking help. This study aims to determine the prevalence of stigma associated with consulting psychiatrists for mental health issues. Methodology: In this cross-sectional study, data was collected from 600 participants from the general population of Islamabad, Pakistan, using non-probability convenient sampling. A self-constructed, self-administered questionnaire was utilized for data collection, with analysis conducted using the chi-square test, frequencies, and valid percentages. Results: Of the participants, 398 (66.6%) were male and 200 (33.4%) were female. Educational levels included matric 69 (11.8%), Inter 82 (14%), Bachelor 173 (29.6%), and Masters & above 199 (34%). Results revealed that 205 (34.9%) participants perceived stigma associated with seeking psychiatric help, 422 (72.5%) viewed it as a sign of weakness, and 376 (65.4%) believed mentally ill patients could pose a danger to others. Regarding treatment preferences, 491 (88.0%) preferred psychiatrists, 38 (6.8%) favored religious leaders, and only 29 (5.2%) preferred confiding in family or friends. Conclusion: While there is a decrease in stigma associated with seeking psychiatric consultation with higher educational attainment, significant stigma persists, particularly among males, attributed to cultural constraints. Despite this, there is a strong inclination towards seeking professional help for psychiatric illnesses, irrespective of religious beliefs. [ABSTRACT FROM AUTHOR]

Background: Local data on nutritional rickets in Lahore division is lacking, although clinical records indicate its presence and resurgence in this city with seemingly sufficient sunlight. This observational study aims to describe the frequency and predisposing factors of nutritional rickets, particularly in relation to lower respiratory tract infections. Methodology: Out of 170 subjects approached, 71 children were included in the study. Participants were categorized into two groups based on the presence or absence of nutritional rickets. A questionnaire was utilized to collect data on lifestyle, socio-demographics, and eating patterns. Physical examinations were conducted by medical officers, and serum levels of phosphorus, calcium, alkaline phosphatase, and 25-hydroxy vitamin D were assessed. Results: The frequency of nutritional rickets was found to be 29% among patients aged 6 to 59 months. 47.6% of participants with nutritional rickets and 46% of non-rachitic participants were under two years old. Serum phosphorus levels showed an independent association with nutritional rickets. Complexion, breastfeeding, formula feeding, and birth order did not exhibit any statistical association with rickets. Respiratory tract infections were the leading cause of hospitalization (52.3%) among participants with nutritional rickets. A significant correlation was observed between deficiency of the immune modulator 25-hydroxyvitamin D and susceptibility to respiratory tract infections. Conclusion: Rickets remains a prevalent issue in our setting despite abundant sunlight. Pediatricians should proactively examine and screen for rickets in children, especially those showing subtle physical signs. [ABSTRACT FROM AUTHOR]

Health human resources play a vital role in the economy of a country however imbalance in the health workforce is emerging challenge for the policy makers. Mostly policies neglect the importance of human resource development and regional disparities. Migration of health workforce from developing country to industrialized country has picked up the pace, and act as threat to developing countries to meet their health care needs (1, 2). Apart from such transitions, there is regional disparity of health workforce in developing country. Significant disparities of health workforce at regional and national level are seen due to varying push and pull factors. These regional disparities could be overcome by competent and knowledge spillovers of a country but unfortunately the developing country experienced lower returns to skill attainment and hence have reduced the health expenditure which in turn caused in poor health indicators(3). As a result of migration, and giving emphasis to work in urban areas; human capital levels are increasingly deviate across the region. The political commitment and policy assistance at country and regional level can enhance the human resource development and reduce disparity (2, 3). This paper will address the economic and political perspective of health workforce development; highlight the reasons of imbalance human resource at country and regional level due to brain drain, and at last after assessing all factors provide a way forward for sustainable health workforce. [ABSTRACT FROM AUTHOR]

Background: In the wake of the recent strikes of the Young Doctors Association Punjab many ethical questions arose. This paper discusses the ethical implications of such actions. Method: We conducted a Descriptive survey using the website 'surveymonkey.com' and posted it on various communities for Pakistani doctors on 'Facebook.com'. Results: A total of 96 people responded to our 10 point questionnaire out of which 85 were eventually selected for analysis. Most (70.5%) respondents were of the opinion that doctors have a right to go on strike and around 82% claimed to be aware of the ethical implications of a doctor's strike. 41.2% were directly involved in the strikes while the rest were either not a part or were not sure of it. Less than half of the respondents (47.1%) were formally trained in medical ethics. The questions about the ethical implications were open ended. The main purpose of this study is to generate an academic debate for defining a clear cut line of action may, before health care providers decide to use their right of industrial action Conclusion: Doctors in developing countries face tough working conditions with limited remuneration. This often leads them towards a struggle to achieve their personal rights, but in the process many aspects of patient rights are thwarted. To solve this cumbersome issue it is imperative that the regional and global authorities responsible for ascertaining the practice of biomedical ethics should come into play by clearly defining the conditions in which doctors should utilize their right of strike in a way that does not hurt patient rights. Also all physicians should be trained thoroughly in the basic principles of medical ethics starting from the time when they are medical students; so that when a situation arises where industrial action is demanded of them by their fellows each individual may be qualified enough to weigh the situation on a personal level. [ABSTRACT FROM AUTHOR]

Introduction: Timely recognition and prompt treatment of maternal complications arising during pregnancy and delivery can improve the maternal deaths and the morbidity resulting from complications. Considering the maternal health situation in Pakistan, this paper looks specifically at the factors affecting the skilled birth utilization. The objective of this study is to explore and identify the contextual determinants for the uptake of skilled birth attendants by women of reproductive age in the urban and rural areas of Pakistan. Methods: Data from the Pakistan Demographic and Health Survey 2006-2007 was used. The dependant variable in the analysis was "delivery assisted by the skill birth attendant (SBA)" which included doctors, nurses, midwives, and lady health visitors. A multistage process was used to create a final model for the dependent variable (delivery conducted by skill birth attendant). Bi-variate relationships between the each independent variable and outcome variable were investigated using a binary logistic model. Those independent variables found to be significant at the bi-variate level were included in a multivariate regression model for outcome variable. Results: More than two third of the respondents (63.3%) were less than thirty (< 30) years in age and one fourth of the women were working women. Overall literacy for women was low with only 35.4% of the women literate. More than 80% of the fathers were less than 40 years of age and 85.4% of them were formally employed. 63.1% of the respondents were from a rural area, whereas only 36.9% were from urban locality. The results of multivariate regression show that wealthy, literate women from urban areas who undertook regular ante natal care from a skilled provider and practiced family planning were more likely to utilize a skilled birth attendant at delivery. Conclusion: This study has identified major determinants for a skilled birth attendant utilization as respondents' education, financial/economic status (ability to pay), access to a health facility, antenatal care use and a positive history of family planning. Promoting the availability of and access to skilled birth attendants during delivery, especially in the rural and under-developed areas, is essential for achieving gains in MDG 5. [ABSTRACT FROM AUTHOR]

Disasters, whether arising from natural forces or human activities, engender substantial harm, loss, and, in severe cases, fatalities. The enduring repercussions extend across individuals, animals, societies, ecosystems, and geographical locations. The consequences of disasters on public health are particularly pronounced, manifesting in a spectrum of medical outcomes. This review delves into the specific impact of floods on distinct age groups, scrutinizing the varying vulnerabilities within each demographic. Infants, young children, teenagers, adults, and the elderly encounter distinctive challenges during and post-flood events, encompassing respiratory ailments, waterborne diseases, infections, hunger, physical injuries, and psychological disorders. Floods not only compromise healthcare services but also precipitate shortages in medication and suboptimal treatment. Health issues resulting from floods exhibit divergence among neonates, infants, children, adolescents, and older individuals. The susceptibility to physical injuries, infections, respiratory disorders, healthcare disruptions, mental health issues, malnutrition, and waterborne diseases varies with the unique vulnerabilities of each age group. Disruptions to routine life disproportionately impact children and adolescents, whereas infants and older individuals exhibit heightened susceptibility. Extreme flood events pose the potential for fatalities, with the risk contingent on both the severity of the flood and the age group affected. Older adults, newborns, and infants face a higher likelihood of mortality attributable to flood-related causes. Mitigating the adverse health effects of floods necessitates robust disaster planning, improved infrastructure, and targeted health interventions tailored to the age-related vulnerabilities of the population. [ABSTRACT FROM AUTHOR]

Background: Ionizing radiation is extensively employed in diverse diagnostic procedures, playing a pivotal role in diagnosing various diseases. The escalating use of such investigations underscores the importance of judicious and careful application to mitigate associated risks and hazards. This study aims to assess doctors' knowledge regarding radiation hazards and doses in commonly used diagnostic procedures. Methods: Between July 1 and July 31, 2019, a questionnaire comprising 20 questions was distributed among doctors across various departments in a tertiary care hospital. The questionnaire, divided into three sections, covered topics such as radiological procedures employing ionizing radiation, equivalent dose units, estimation of radiation doses for common procedures, and awareness of risks linked to radiation exposure. Results: A total of 200 questionnaires were returned, representing diverse specialties. Responses from radiology (11), surgery (53), orthopedics (2), medicine (84), eye (6), ENT (4), pediatrics (9), and gynecology/obstetrics (31) were included. The assessment of doctors' knowledge in each section revealed suboptimal scores, with average correct responses of 64.1%, 21.8%, and 64.5% for the three sections, respectively. Notably, 21.3% of doctors underestimated doses, and 28% had no idea about estimated doses. Additionally, 49% and 12% of participants incorrectly categorized Magnetic Resonance Imaging (MRI) and ultrasonography as procedures involving ionizing radiation. Conclusion: This study exposes significant knowledge gaps among doctors regarding radiation doses and hazards. The findings underscore an urgent necessity for implementing institutional educational programs on radiation protection at both undergraduate and postgraduate levels. [ABSTRACT FROM AUTHOR]

Background: A study based on discovery of Ixodid ticks and allied risk factors was conducted in Larkana division, Sindh, Pakistan. The ticks (Acari:Ixodidae) being dangerous ectoparasites of animals have destruction on larger scale and are widely studied for their direct and indirect losses to livestock. Methods: During the study period from April 2021 to June 2022 randomly selected 3750 buffaloes were observed and only those were selected which were not treated with Acaricide and prevalence and intensity was noted alongside this seasonal variation and male and female tick infestation was also reported. Results: The collective infestation in buffaloes was 46.90% (n=1759) and its peak was reported during August and least infestation was in December, two species were discovered Hyalomma marginatum and Hyalomma truncatum. Conclusion: This study concludes that well-being of animal-handlers and livestock is on danger. [ABSTRACT FROM AUTHOR]

Background: Dengue is the most widely distributed mosquito-borne viral disease in the world. It continues to spread rapidly because of climate change, rapid urbanization, and population growth. In the world population ranking Pakistan stands at number 6th position, having subtropical position. Due to growing cases, this study is undertaken to evaluate the perception of Dengue fever among the university students. Engagement of students and community to improve participation and mobilization for vector control is a key element to regulate the control interventions and strategies. Methods: A descriptive cross-sectional study was carried out at National University of Medical Sciences Rawalpindi during July-Nov 2022 including 346 participants. Online survey was conducted using close ended structured questionnaire by using nonprobability convenience method. The age, gender, living status, accommodation status, and residential area of the students together with perceptions of undergraduate students regarding Dengue’s knowledge and prevention was recorded. Based on students’ correct answers, overall knowledge level assessment and prevention awareness level was calculated. Association of categorical variables were analysed using chi-square test. Statistical data analysis was carried out using commercially available software. Results: Out of 346 students, 58.6% had knowledge of dengue and 84.9% were aware about its prevention. The multi-variate analyses revealed that positive relationship exists between Dengue’s knowledge with age, gender, and residential area and between Dengue’s prevention awareness with age and gender (p<0.05). Conclusion: The overall knowledge and awareness of students regarding Dengue fever was found to be adequate, being higher among male than female students. The collaborative effort by all stakeholders can contribute towards enhancing the knowledge and awareness among students which will further reduce the risk of disease. [ABSTRACT FROM AUTHOR]

Background: The primary cause of mortality, cancer, is predicted to rise 1.7 times in 2040 compared to 2018. Immunotherapies have transformed cancer treatment for advanced malignancies. Due to inadequate information, there are well-documented hurdles to getting cancer immunotherapies, increasing the disease's burden. This study aims to develop a One-Window Services Model (OWSM) for gaining access to cancer immunotherapies. Methods: This was a sequential explanatory mixed-method study. The quantitative part used interviewer-administered questionnaires including data on knowledge and attitude in conveniently selected 20 cancer patients, and data were analyzed through SPSS. The qualitative part used an open-ended questionnaire for In-depth interviews (IDIs) along with the results of the quantitative part in purposively selected seven tumor panel physicians (TPP) and analyzed by grounded theory. The study was conducted in a specialized tertiary care bone marrow hospital in Rawalpindi, Pakistan. Results: The findings of the quantitative part presented that 80% of cancer patients had poor knowledge about processes, and 90% had a positive attitude towards their cancer immunotherapies. The findings of the qualitative part presented additional evidence that explained some unclear issues and expanded the results of quantitative data, which were presented as a broader theme “tools for OWSM” through IDI and followed by development of ten steps of OWSM. Conclusion: The sequential explanatory mixed method was considered appropriate for developing the ten steps of OWSM since it involved knowledge and attitude as integral parts of behavior change of patients based on Andersen’s theoretical framework of health service use and the advice of experts. Moreover, the model will be tested in an experimental effectiveness trial planned in next phase. [ABSTRACT FROM AUTHOR]

Background: Malaria is the common disease in rural area of Pakistan. In Pakistan both Malaria vectors An.stephensi and An.culicifaces are present. Vector control is important component to reduce malaria. Resistance development in anopheles mosquitoes was also produced. To know about resistance development, resistance/susceptibility test, status of anopheles mosquitoes against different groups of insecticides should be done on regular basis. Which should develop baseline data on resistance/susceptibility status of anopheles mosquitoes against different groups of insecticides? Present study was conducted to determine the bio efficacy and resistancy of vector species in district Bannu. Method: Mosquitoes were collected, identified and tested against different impregnated papers with 0.05%Deltamethrin, 4%DDT, 5%Malathion and 0.1%Bendiocarb according to WHO test protocol. This study was carried out during year 2013 in District Bannu. Results: According to WHO guideline insecticide resistance was determined at all five localities against 4% DDT. Similarly Malathion 5% test result showed resistance at three localities i.e Fazal Sadiq mandew, Surrani, and Bannu city while at two localities (Bharat and Domel) required further confirmation. Deltamethrin 0.05% show susceptibility at three localities i.e Fazal Sadiq mandew, Surrani and Bharat while at two localities (Domel and Bannu city) it require further confirmation. Bendiocarb 0.1 % required further confirmation at Fazal Sadiq mandew, Domel and Bannu city whilethe remaining two localities Surrani and Bharat show resistance. Conclusion: Pyrethroide group of insecticde is still show high level effectivity against An. Stephensi while DDT were high level resistant to Malaria Vector. The current study provide baseline information for monitoring resistance in Anopheles mosquitoes. Effective vector control tools are recommended to be applied for proper control of vector-borne diseases as the component of IVM strategy. [ABSTRACT FROM AUTHOR]

Background: The lack of base line data and status of susceptibility\ Resistance of insecticide in Anopheline mosquitoes in district Mirpur AJK. Method: Species were identified by using standard taxonomic keys. These studies were carried out during the Year 2013 from district Mirpur AJK. For the determination of insecticide susceptibility/resistance status use the WHO recommended test kits. Results: The primary vector of malaria in AJ&K which is Anopheles culicifacies and An. stephensi but the proportion of An. culicifacies was high as compared to An. stephensi. Susceptibility test were conducted on primary and suspected malaria vector in AJK by using WHO recommended susceptibility/resistance test kit and following guide line Insecticide impregnated papers with diagnostic dose of 4% DDT, 5% malathion 0.05% lambdacyhalothrin 0.05% deltamethrin and 0.75% permethrin according to WHO interpretation. Conclusion: Resistance/Susceptibility status of Anopheles mosquitoes has not yet established in Mirpur district so this study will provide baseline data on Resistance/Susceptibility status of Anopheles. This was the preliminary survey of insecticide resistance/susceptibility of Anopheles species in District Mirpur. Insecticide resistance was observed in malaria vector species An. culicifaces against 4% DDT, 5% malathion 0.05% lambdacyhalothrin 0.05% deltamethrin and 0.75% Permethrin according to WHO interpretation. This survey generates record of different species of Anopheles in the district Mirpur. It provide evidence base data on insecticide resistance, which enable to follow trends in susceptibility status in this area and will also serve as a base for resistance management interventions. In view of the present status of the resistance in disease vector, the development and implementation of comparatively new strategies for integrated vector management (IVM), needs to be planned in light of the data of this study. [ABSTRACT FROM AUTHOR]

Introduction: Identification and establishment of status of insecticide susceptibility and resistance in malaria vector anophelines mosquitoes species, is essential for the development of malaria prevention strategy. This will ensure reduction in poverty mortality and morbidity especially in women and children. This will help in achieving the 1st' 4th, 5th and 6th MDGs. Methods: Taxonomic and susceptibility study of genus Anopheles was carried out during the year 2010 and 2011 from Islamabad. Extensive surveys were conducted to explore the fauna of mosquito in selected areas. Species were identified by using standard taxonomic keys. Results: The findings found that primary vector of malaria in Pakistan which is Anopheles culicifacies and An. stephensi were most widely distributed in Islamabad. A total of twelve species were recorded during the study period. Susceptibility test were conducted on primary and suspected malaria vectors in Pakistan by using WHO recommended susceptibility/resistance test kit and following the guidelines of WHO. Insecticide impregnated papers with diagnostic dose of DDT (4%), Deltamethrin (0.05%) Lambdacyhalothrin (0.05%), Malathion (5%) and Bendiocarb (0.1%) were used. Results showed that primary and suspected malaria vectors were susceptible to Deltamethrin and Lambdacyhalothrin while resistance to DDT and assorted results were shown against Malathion and Bendiocarb. Conclusion: These results may add to the policy making that pyrethroids group is still effective and can be used for the control of anopheles species in Islamabad; however, there is need to implement strategic planning to delay the process of resistance development in these localities and prolong the effective used of pyrethroids. (Pak J Public Health 2012;2(4):36-40) [ABSTRACT FROM AUTHOR]

Background: The objective is to determine the impact of lockdown in TB care services in Pakistan and to provide suggestion for future recommendations. Methods: Extensive literature review of published articles along with NTP reports was done. The TB case detection data for the year 2020 along with the impact of COVID-19 on TB infrastructure and resources were also reviewed. Results: There was a drop in the TB notification rate during 2020 due to COVID-19 and its ramifications on the Health Sector. Health care workers being on the frontline are more prone towards acquiring COVID-19, particularly with a marked deficiency of personal protective equipment (PPEs) that has had a demoralizing effect among health professionals. Besides this the diagnostic and treatment facilities for Tuberculosis were also interrupted badly. Conclusion: The lockdown has adversely affected the health services, particularly routine immunization and TB care services, including diagnosis and case notification which declined significantly. Moreover, upgradation of strategies for the provision of services will prove to be extremely beneficial for both COVID-19 and the people with Tuberculosis. [ABSTRACT FROM AUTHOR]

Background: Objective of the study was to assess the effect of the intervention on patients/attendant's awareness of their rights and responsibilities, Healthcare Workers (HCWs) experiences on patients/attendant's behavior, and their ability to be responsive to them. Methods: This Quasi-Experimental Pre-Post-study was conducted in September 2019 to February 2020 at the Emergency department [ED] of a public sector hospital for 6 months. Pamphlets and Posters on the rights and responsibilities of patients/attendants and HCWs and awareness videos were introduced. HCWs were trained on de-escalation skills, communication, information sharing, and improving responsiveness towards patients and attendants. The assessments were done before and after the interventions with a gap of two month. The qualitative aspect was assessed through 12 Focus Group Discussions (FGDs) and thematic analysis was conducted. The effect of intervention on HCWs responsiveness was done using quantitative tools. All HCWs in emergency department (ED) and a total of 200 patients and attendants were interviewed before and after the intervention. Data analysis was done by applying paired T-test (for HCWs) and independent T-test (for patients and attendants). Results: There was a significant positive difference (<0.001) in the overall score of responsiveness of HCWs as reported by the patients and attendants. Conclusion: The qualitative assessment revealed that interventional training assisted HCWs in better understanding the patient's expectation; however, the patient and attendant educational component was less effective in changing their behavior. Conclusion: Violence in emergency healthcare settings is inevitable; however, its impact and intensity can be reduced significantly by building the capacity of HCW's in prevention and de-escalation skills. Training on the component of responsiveness related to autonomy, confidentiality, respect, and reduce waiting showed improvement at the end. [ABSTRACT FROM AUTHOR]