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Background: Event Based Surveillance (EBS) is the organized and rapid captures of information about events that are a potential risk to public health. Information can be about events related to occurrence of disease in humans or a potential exposure to a risk e.g. contaminated food,-chemicals or radio nuclear events. In Pakistan it is a recent phenomenon and is a compliment to Indicator Based Surveillance (IBS) which is traditionally going on in public sector health care facilities. Literature on effectiveness and contribution of EBS is scarce. Methodology: A cross sectional study was conducted based on retrospective record review of events reporting in Pakistan. For this purpose, Disease Surveillance and Response Units (DSRU) were identified and descriptive analysis of their reporting per epidemiological week was done. Results: Public sector health facilities were found the most frequent 75% (n=88) in reported events. Vector borne diseases 49% (n=58) were the most frequently reported event. In 85% (n=101) of events, WHO and/or CDC standard case definitions were used followed by operational cases definition 10% (n=12). System was found operational in all provinces and regions and was linked to laboratory based surveillance in all DSRUs. Median delay was found high in Vaccine Preventable Diseases (Measles and Diphtheria), eight days (range: 0-10 days) and Vector borne diseases (Dengue, Chikungunya and CL) six days (range: 0-8 days). Among all, 90% (n=105) response activities were establishment and/or strengthening of surveillance system by training of local staff. All investigations were linked with public health laboratory investigation except for food/water borne outbreak 3% (n=4), where no laboratory confirmation of causative organism was found. Conclusion: Event based surveillance (EBS) should be strengthened as a compliment of IBS and its network should be expanded to regional and district levels. Frequent trainings of health care providers at health facilities and informal sources like media should be done to gather credible and timely information of events' time place and persons involved. However, monitoring and evaluation should be integral part to improve event recording and hence targeted response. [ABSTRACT FROM AUTHOR]

Background: Almost all the developing countries face issues in Healthcare Waste Management, compromising quality of healthcare delivery Methods: In order to assess the Healthcare Waste Management system and practices in public and private hospitals of Pakistan, semi-structured questionnaire sand in-depth interviews in one tertiary, two secondary, and four first level care hospitals were employed. Results: Healthcare Waste Management systems were only found in the tertiary hospitals where colored bins, dedicated trolleys, Personal Protective Equipment, temporary and central storage areas were found. [ABSTRACT FROM AUTHOR]

Background: Exploitation and abusive handling of children through child labour is an important issue which has evaded the attention of global, national and local authorities. Research reveals that child labor is a common phenomenon which runs widely and deeply. This study aims to describe children exploitation through child labor in district Vehari, Pakistan. Methods: We conducted this cross sectional study in both the rural and urban settings of the three tehsils of district Vehari, during the months of May and June 2013. A total of 542 children living in difficult circumstances employed in 11 work categories (94.1% male; average age 13 years) were interviewed using semi-structured questionnaires. Information on socio-demographic characteristics of children, health outcomes, financial exploitation and exposure to physical and sexual abuse was collected. Results: We found that 100% of study subjects were being forced to work and financially exploited for working more than average working hours, i.e. 10.78 (±2.58) hours a day for just Rupees 1000-2500(US$9.72-24.30) per month as wages. For physical abuse, 8.5% of children reported being subjected by the employers and the family members. However, no sexual abuse was reported. Large family size and illiteracy were found to be important predisposing factors. Conclusion: We conclude that exploitation of underprivileged children through child labor is an issue in Vehari. This has evaded the attention of the national and local authorities though there is enough legislation in Pakistan. [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]

Global tuberculosis (TB) burden estimates are aggregated at the national level, despite the likelihood of uneven distribution across and within regions in the same country. Subnational estimates are crucial to producing informed policies and informing budget allocation at more granular levels. In collaboration with the National TB Programme (NTP), we applied a simple and transparent tool to estimate the subnational TB burden in Pakistan. We tailored the SUBnational Burden Estimation for TB (SUBsET) tool to account for the district-level hierarchy of Pakistan. Districts were assigned weighted scores based on population size, level of urbanisation, households with one room, and food insecurity levels. Using the 2022 national TB incidence estimate, we first allocated the burden across administrative units based on data from the 2010-11 TB prevalence survey and subsequently refined this distribution to reflect weighted scores specific to each district. The estimated TB incidence was compared with pulmonary TB notifications to calculate the case detection rate (CDR) for each district. Utilising the updated SUBsET model, we assigned weight scores to 150 districts spanning seven provinces/regions in Pakistan. The estimated TB incidence varied significantly, ranging from 110 (95%CI: 80-145) to 462 (95%CI: 337-607) per 100,000 inhabitants per year. The provinces bearing the highest burden was Sindh (292; 95%CI: 213-384), followed by Khyber Pakhtunkhwa (269; 95%CI: 196-354) and Punjab (243; 95%CI: 177-320). The CDR was below 70% in three-quarters of the districts and over-reporting (>100%) was observed in 10 districts, primarily within Punjab, which suggests that individuals with TB may be crossing district lines to access care. The application of the SUBsET tool through active collaboration with the NTP revealed high heterogeneity in subnational TB incidence in Pakistan, urging a more granular and tailored approach to TB prevention and care. This approach ensured transparency and acceptance of the findings for wider in-country dissemination., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Schwalb et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)