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This research explored the structure of primary, elementary, secondary, and tertiary levels of education and assessment in the academia of Pakistan. The fundamental purpose of the study was to contextualize the assessment system from primary to higher institutions and an examination of recent changes by the educational authorities. It began with a quick history of the examination system, summative assessment, and explained the current education system and the evaluation process in education. The data obtained from the Punjab Examination Commission (PEC) of 5th and 8th grade, from the Board of Intermediate and Secondary Education (BISE) of 9th grade, and the Punjab University for the undergraduate level was used to evaluate the instructional and examination methods. Results showed poor performance, especially in English, as it was not taught by applying modern and effective teaching methods. The outdated evaluation process and inadequate curricula are factors for poor performance.

Plasmodium vivax variant interspersed repeats (vir) refer to the key protein used for escaping the host immune system. Knowledge in the genetic variation of vir genes can be used for the development of vaccines or diagnostic methods. Therefore, we evaluated the genetic diversity of the vir genes of P. vivax populations of several Asian countries, including Pakistan, which is a malaria-endemic country experiencing a significant rise in malaria cases in recent years. We analyzed the genetic diversity and population structure of 4 vir genes (vir 4, vir 12, vir 21, and vir 27) in the Pakistan P. vivax population and compared these features to those of the corresponding vir genes in other Asian countries. In Pakistan, vir 4 (S=198, H=9, Hd=0.889, Tajima's D value=1.12321) was the most genetically heterogenous, while the features of vir 21 (S=8, H=7, Hd=0.664, Tajima's D value=−0.63763) and vir 27 (S=25, H=11, Hd=0.682, Tajima's D value=−2.10836) were relatively conserved. Additionally, vir 4 was the most genetically diverse among Asian P. vivax populations, although within population diversity was low. Meanwhile, vir 21 and vir 27 among all Asian populations were closely related genetically. Our findings on the genetic diversity of vir genes and its relationships between populations in diverse geographical locations contribute toward a better understanding of the genetic characteristics of vir. The high level of genetic diversity of vir 4 suggests that this gene can be a useful genetic marker for understanding the P. vivax population structure. Longitudinal genetic diversity studies of vir genes in P. vivax isolates obtained from more diverse geographical areas are needed to better understand the function of vir genes and their use for the development of malaria control measures, such as vaccines. [ABSTRACT FROM AUTHOR]

Self-medication with antibiotics (SMA) has become considerably common in developing countries, which is a critical factor for driving antibiotic resistance. Individuals involved in SMA generally do not have adequate knowledge regarding the appropriate use, indications and dosage of these drugs. The objective of the present study was to investigate population SMA practices, knowledge and sociodemographic factors associated with SMA in Islamabad, Pakistan. The study adopted a cross-sectional methodology and data collection was performed through an anonymous, structured and pilot-tested questionnaire, which was interview-administered. Inferential statistics and multivariate logistic regression were performed. Out of 480 participants, 55.6% (n = 267) were male with a mean age of 37.1 ± 10.1 years; the total prevalence of SMA was 32.5%. Ciprofloxacin (42.9%) was the most commonly used antibiotic to treat coughs or colds, a runny nose, flu or sore throat, diarrhea or fevers, which were relevant reasons for SMA. Findings from multivariate logistic regression showed that predictors of SMA were: male gender (95% CI: 0.383–1.005), age (95% CI: 0.317–0.953) and highest level of education (95% CI: 0.961–0.649). Despite reasonable access to healthcare facilities, people are still obtaining antibiotics without prescription, bypassing diagnostic and consultative healthcare services. Thus, the government must implement strict healthcare policies to restrict the sale of antibiotics without prescriptions, while at the same time, targeted public awareness campaigns about the proper use of antibiotics are also required. [ABSTRACT FROM AUTHOR]

This research explored the structure of primary, elementary, secondary, and tertiary levels of education and assessment in the academia of Pakistan. The fundamental purpose of the study was to contextualize the assessment system from primary to higher institutions and an examination of recent changes by the educational authorities. It began with a quick history of the examination system, summative assessment, and explained the current education system and the evaluation process in education. The data obtained from the Punjab Examination Commission (PEC) of 5th and 8th grade, from the Board of Intermediate and Secondary Education (BISE) of 9th grade, and the Punjab University for the undergraduate level was used to evaluate the instructional and examination methods. Results showed poor performance, especially in English, as it was not taught by applying modern and effective teaching methods. The outdated evaluation process and inadequate curricula are factors for poor performance. [ABSTRACT FROM AUTHOR]

Introduction: In this era of antimicrobial resistance, knowledge of antibiotics and antimicrobial stewardship (AMS) is paramount for rational use of medications. AMS is considered a core element in the current clinical guidelines in the developed world. However, in Pakistan, the notion, scope and implementation of AMS remain skimpy. Objectives: To appraise the knowledge and perception of Medical Officers (MOs) and Hospital Pharmacists (HPs) about antibiotics and AMS. Materials and Methods: Cross sectional study using a validated questionnaire. Descriptive statistics was used to measure the median and difference in both groups was measured through Mann Whitney U test using SPSS version 23.0. Results: A total of (n= 343) responded to the survey of which n= 308 (89.8%) were MOs and n= 35 (10.2%) were HPs. The perceptions of HPs regarding potential benefits of AMS programs were positive and significantly higher (77.1%) as compared to 52%. Further, 61.4% and 68.6% of MOs and HPs respectively, favored the incorporation of AMS programs in community pharmacy. The overall score showed statistically significant difference (p=0.271) of perceptions among MOs and HPs and the overall score revealed that knowledge of MOs and PPs was statistically significantly different (p=0.145). Conclusion: The knowledge of antibiotic stewardship is better in HPs than MOs, however, the perceptions on AMS are generally positive in both groups. [ABSTRACT FROM AUTHOR]

Introduction: In this era of antimicrobial resistance, knowledge of antibiotics and antimicrobial stewardship (AMS) is paramount for rational use of medications. However, in Pakistan, the notion, scope and implementation of AMS remain skimpy. Objectives: To appraise and compare knowledge of antibiotics and perception about AMS between final year medical and pharmacy students. Materials and Methods: Cross sectional study that deployed a pre-validated questionnaire with two main sections for knowledge and perception on a summative scale. Descriptive statistics was used to measure the median and differences in both groups were measured using Mann-Whitney U Test using SPSS version 23.0. Study was conducted in 12 medical and 9 pharmacy colleges in Punjab. Results: A total of (n= 580) responded to the survey of which n= 143 (24.7%) were Medical and n= 437 (75.3%) were pharmacy student. The perceptions of pharmacy students regarding potential benefits of AMS programs were positive and significantly higher (60.5%) as compared to Medical students (53.2%) in total score. Both groups recommended the incorporation of AMS program at a community pharmacy level to improve rational use of antimicrobial agents. However, the overall score showed statistically significant difference in knowledge in two groups (p=0.107). Conclusion: The knowledge of antibiotics is better in pharmacy students than medical students, however, the perceptions regarding AMS are positive with no significant difference in both groups. Authors suggest to incorporate a dedicated module or post graduate diploma on antibiotic utilization for students who wish to pursue a clinical career in pharmacy. [ABSTRACT FROM AUTHOR]

Introduction: Irrational use of antibiotics is one of the precipitating factors in the development of antimicrobial resistance, the biggest challenge of 21st century. In this era of big data, it is imperative to estimate the use of antibiotics to inform the relevant stakeholders to adopt a proactive approach to reduce the magnitude of the threat of antibiotic resistance. Objectives: To evaluate the use of antibiotics to inform the stakeholders the need of antibiotic stewardship policies. Materials and Methods: A standardized and validated global point prevalence survey tool was used to appraise the use of antibiotics in 29 different hospitals for all inpatients in Gynaecology, Gastroenterology, Neurology, Medicine, Surgery, Orthopaedic and Paediatric wards on the day and time of survey. All other wards were excluded (short stay, dialysis and emergency patients). All the statistical operations were performed using SPSS. Results: A total of (n= 1912) patients were recruited in the study. The top three most commonly prescribed antibiotics were ceftriaxone (58.6%), metronidazole (25%) and moxifloxacin (9.2%), while, the top most reported indication for antibiotics use was: medical prophylaxis (74.5%). Highest use of antibiotics was noted in Medicine ward (38.2%). Conclusion: The study highlighted significant high use of antibiotics especially in prophylaxis and in Medicine wards in hospitals of Punjab. This study should be taken as a red flag for Ministry of Health, Pakistan to promulgate and implement stringent policies for effective stewardship of antibiotics use in Pakistan, otherwise, no action today, there would be no cure tomorrow. [ABSTRACT FROM AUTHOR]

Background: Medical and pharmacy students are future healthcare professionals who will be on the forefront in dealing with antibiotics in hospitals or community settings. Whether the current medical and pharmacy education in Pakistan prepares students to take future roles in antibiotic use remains an under-researched area. Aim: This study aims to compare medical and pharmacy students' perceived preparedness, learning practices and usefulness of the education and training on antibiotic use and resistance imparted during undergraduate studies in Pakistan. Design and Setting: It was amulti-centre cross-sectional survey of medical and pharmacy colleges in Punjab, Pakistan. Method: A self-administered questionnaire was used to collect data from final year medical and pharmacy students. Descriptive statistics were used for categorical variables while independent t-test and One-way ANOVA computed group differences. Result: Nine hundred forty-eight respondents (526 medical and 422 pharmacy students) completed the survey from 26 medical and 19 pharmacy colleges. Majority (76.1%) of the pharmacy students had not completed a clinical rotation in infectious diseases. The top three most often used sources of learning antibiotic use and resistance were the same among the medical and the pharmacy students; included textbooks, Wikipedia, and smart phone apps. Overall self-perceived preparedness scores showed no significant difference between pharmacy and medical students. The least prepared areas by medical and pharmacy students included transition from intravenous to oral antibiotics and interpretation of antibiograms. Both medical and pharmacy students found problem solving sessions attended by a small group of students to be the most useful (very useful) teaching methodology to learn antibiotic use and resistance. Conclusions: Differences exist between medical and pharmacy students in educational resources used, topics covered during undergraduate degree. To curb the growing antibiotic misuse and resistance, the concerned authorities should undertake targeted educational reforms to ensure that future physicians and pharmacists can play a pivotal role in rationalizing the use of antibiotics. [ABSTRACT FROM AUTHOR]

Background: To restrain antibiotic resistance, the Centers for Disease Control and Prevention (CDC), United States of America, urges all hospital settings to implement the Core Elements of Hospital Antibiotic Stewardship Programs (CEHASP). However, the concept of hospital-based antibiotic stewardship programs is relatively new in Low- and Middle-Income Countries. Aim: To appraise the adherence of the tertiary care hospitals to seven CEHASPs. Design and Setting: A cross-sectional study in the tertiary care hospitals in Punjab, Pakistan. Method: CEHASP assessment tool, (a checklist) was used to collect data from the eligible hospitals based on purposive sampling. The check list had 19 statements to cover seven CEHASPs: Hospital Leadership Commitment, Accountability, Pharmacy Expertise, Action (Implement Interventions to Improve Antibiotic Use), Tracking Antibiotic Use and Outcomes, Reporting Antibiotic Use and Outcomes, and Education. For each statement, a response of "YES", "NO" or "Under Process" constituted a score of 2, 0 and 1, respectively, where the higher the scores the better the adherence. Categorical variables were described through descriptive statistics, while independent t-test computed group differences. Result: A total of 68 hospitals (n = 33 public, n = 35 private) participated with a response rate of 79.1%. No hospital demonstrated "Perfect" adherence. Roughly half private (48.6%) and more than half public (54.5%) sector hospitals were "Poor" in adherence. Based on the mean score, there was no significant difference between the private and the public hospitals in terms of comparison of individual core elements. The two most neglected core elements emerged as top priority area were: Reporting Antibiotic Use and Outcomes and Tracking Antibiotic Use and Outcomes.Conclusion: The current response of Pakistan to implement hospital-based antibiotic stewardship programs is inadequate. This study points out significant gaps of practice both in public and private tertiary care hospitals. A majority of the core elements of antibiotic stewardship are either absent or "Under Process". The deficiency/priority areas mentioned require immediate attention of the concerned stakeholders in Pakistan. [ABSTRACT FROM AUTHOR]

Introduction: Antimicrobial stewardship modules have gained popularity in the educational circles in developed countries. These modules prepare students on the concepts of rational use of antimicrobials to avoid antimicrobial resistance. However, in Pakistan, limited studies have evaluated the extent these concepts are taught in pharmacy and medical schools through students' perspective. Objectives: To explore medical and pharmacy student's perspective on the quality of education delivered to inculcate concepts of antibiotic use and resistance. Materials and Methods: Cross sectional study using a validated questionnaire. Descriptive statistics was used to measure the median and differences in both groups were measured using Chi square test using SPSS version 23.0. Results: A total of 550 students responded the survey of which 330 were Pharm-D and 220 were MBBS students from 23 medical and 19 pharmacy institute across Punjab. Mean correct knowledge score was 56%, with statistically significant differences between study sites and sources of information used to learn about antimicrobials. Only 23% had completed a clinical infectious diseases rotation during medical or Pharmacy College while, 61% students rated the education regarding appropriate use of antimicrobials to be useful or very useful. More than 80% pharmacy students reported lack of training on the rite duration of treatment for specific infections. Conclusion: The study findings implied a dissatisfaction of both pharmacy and medical students on the quality of education regarding AMS and antibiotic use. There is serious lacking in practical training especially in pharmacy schools. However, students are enthusiastic to learn more through problem-based learning. [ABSTRACT FROM AUTHOR]

Introduction: World Health Organization (WHO) has defined core indicators for drug use evaluation, which cover four main parameters of the drug use process i.e., quality in prescribing, dispensing, health care facilities and patient care. However, limited data is available to highlight the level of compliance to these indicators in Pakistan. Objectives: To evaluate and compare drug use process per WHO core indicators in private and public hospitals of Lahore. Materials and Methods: A cross sectional study to collect data using WHO standardized questionnaire during June-July 2019. Descriptive statistics was used, and data were analysed using SPSS. Results: 1229 prescriptions/patients were assessed in 17 hospitals (12 public and 5 private). In public hospital, mean number of drugs per encounter was 3.15, while, generic names were prescribed for 4.15%, as compared to 3.3% and 4% in private hospitals respectively. Similarly, antibiotics and injectable prescription were higher in private hospitals i.e., 50% and 20% respectively as compared to 19.4% and 6.67%. However, patient knowledge, average consultation and dispensing times were significantly better in private hospitals as compared to public. Not a single drug was adequately labelled in public or private hospital. Formulary was present in all. Conclusion: Study highlighted significant lacking in generic prescribing, rampant injectable practices, limited consultation and dispensing times, and poor knowledge of patients especially in Public hospitals. Together these factors contribute to pervasive irrational use of medicines. [ABSTRACT FROM AUTHOR]