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PubMed1992

Family medicine postgraduate training in Pakistan.

There is no organized system of postgraduate training for family medicine or general practice in Pakistan. This paper describes the status of primary health care delivery in Pakistan and the growth of family medicine throughout the world. It stresses the need for organized postgraduate training relevant to the needs of primary health care in Pakistan and describes efforts currently under-way in this regard at the Aga Khan University Medical Centre (AKUMC) in collaboration with the College of Physicians and Surgeons of Pakistan.

Curriculum↗
PubMed2005

An audit of the students' corner of Journal of the Pakistan Medical Association.

OBJECTIVE: To analyze the pattern of the first author's institutional affiliation and the distribution of different article types published in the students' corner of the Journal of Pakistan Medical Association. METHODS: This cross-sectional study was carried out in July 2005 and analyzed the students' corner (whenever present) of the Journal of Pakistan Medical Association from January 1998 to June 2005. RESULTS: For the 90 issues of the journal in the stipulated period, 96 articles were published in the students' corner. Original studies 46 (47.9%) were the most commonly published article category followed by personal opinion/review category (43.8%) and case-reports 8 (8.3%). The number of personal opinion/review articles has been steadily decreasing. Students from Aga Khan University contributed 74 (77.1%) articles followed by students from Ziauddin Medical University 10 (10.4%). Almost 95% of the authors were from private medical colleges. Sindh was the location of the first authors institution in 90 (93.8%) cases. CONCLUSION: A major chunk of all articles published in the students' corner of the Journal of Pakistan Medical Association originates from two private medical colleges in Sindh. Efforts must be made to increase student participation across the country. This may be done by asking students to begin scientific writing by submitting personal opinion articles. Further research is needed to assess the status of student research in terms of published output in Pakistan.

Authorship↗
PubMed2005

Use of traditional, complementary and allopathic medicines in Pakistan by cancer patients.

INTRODUCTION: The healthcare systems of developing countries are complex in that they often accommodate a range of disparate and often competing paradigms of care. This is the case in Pakistan where Indigenous traditional medicine (TM) co-exists with Western allopathic medicine and, in theory at least, with 'globalised' complementary and alternative medicines (CAM). To date we know little about what treatments are being chosen and why in this still predominantly rural country. AIM: To gain a preliminary understanding of patterns of usage of traditional medicine and globalised complementary and alternative medicine by cancer patients in Pakistan. METHOD: Structured survey of 362 cancer patients, from diverse regions in the Punjab and North-west Frontier Province provinces, who were being treated in four different hospitals in Lahore, Pakistan. RESULTS: Use of traditional medicine is high amongst cancer patients, with many patients using a combination of different therapeutic modalities. Unlike studies in Western contexts, this study indicated no relationship between cancer type or sex and use of CAM/TM. However level of education was influential in determining usage of particular TM. There is, however, no uniformity in patterns of use of different TM. CONCLUSION: There is less differentiation between social groups in usage of CAM and TM in Pakistan than has been reported in studies of western cancer patients. Differing levels of use for specific TM highlight the need to get beyond monolithic categorizations (such as TM) to understand use patterns for specific indigenous practices (in their social and cultural context).

Combined Modality Therapy↗
PubMed1996

Molecular genetics of beta-thalassaemia in Pakistan: a basis for prenatal diagnosis.

Thalassaemia is the most common inherited disorder in Pakistan and there are very inadequate treatment facilities for over 4000 homozygotes born each year. Prevention of these disorders therefore forms an essential part of the management of this enormous health problem. We have characterized 1216 beta-thalassaemia alleles from the five major ethnic groups of Pakistan. The complete spectrum comprised 19 different mutations. There are important ethnic and regional differences in the prevalence of mutations. The five most common mutations, IVSI-5 (G-C) (37.3%), Fr 8-9 (+G) (25.9%), del 619 (7.0%), Fr 41-42 (-TTCT) (6.7%) and IVSI-1 (G-T) (5.4%), constitute 82.3% of the total. Fr 8-9 (+G) is the most common mutation in Northern Pakistan (41.3%), whereas IVSI-5 (G-C) is the most frequent mutation in Southern Pakistan (52.2%). Six subjects with transfusion-dependent thalassaemia major showed only a single mutant allele. One subject with transfusion-dependent thalassaemia major showed a novel 17 bp deletion involving Cd126-131. Our findings provide a comprehensive basis for carrying out prenatal diagnosis of thalassaemia in a geographical area where it is found in high frequency.

Base Sequence↗
PubMed1997

Pakistan's community health workers.

Pakistan's health characteristics are worse than those of other Asian countries at similar stages of development. Its mortality rate for children under five is 139 per 1,000, and its maternal mortality is 60 per 10,000. Malnutrition in women and children is widespread; 50 per cent of children under five are stunted. Pakistan's population growth rate of 3.1 per cent per year is among the highest in Asia. The high population growth rate and poor health status of many people call for extensive health care services, but, unfortunately, health services do not reach most of the people of Pakistan. Partly because the training of doctors and nurses is lengthy and expensive, there is an acute shortage of health care providers, especially women. Although female health professionals are preferred for caring for women, cultural constraints inhibit women from seeking education. Such is the multifaceted dilemma in the provision of primary health care in Pakistan.

Community Health Workers↗
PubMed2003

Nutritional status comparison of rural with urban school children in Faisalabad District, Pakistan.

INTRODUCTION: Health and nutrition problems are the result of unsatisfactory food intake or severe and repeated infections, or a combination of both, and are closely linked to inadequate health services and an unhealthy environment. In Pakistan, there is a significant difference in the economic status, life style and nutrition between urban and rural populations, and between male and female children. Such differences affect the health and nutritional status of children. This study was undertaken in order to assess the nutritional and growth status of male and female school-going children aged 6-12 years from rural and urban areas in Pakistan. METHODS: Data were collected from male and female school-going children aged 6-12 years in and around Faisalabad, Pakistan. A total of 2042 children (853 male, 1189 female) were studied for being underweight, and for stunting and wasting. Of the males, 42.3% were from urban and 57.7% were from rural areas. Of the females, 72.7% were from urban and 27.3% were from rural areas. RESULTS: A total of 36.1% children were stunted and 45.3% were underweight; 25.2% were below standard weight for height. Among the urban children, 33% were below the standard for height (stunted), and 32.3% were below the standard for weight (underweight); 32.7% were wasted. Of the rural children, 40.9% were stunted, 64.7% were underweight and 33.3% were wasted. The rural female group was the most affected and malnourished with 61.8% stunted and 84% underweight; 67.1% were wasted. CONCLUSION: It is suggested that a comprehensive strategy be implemented in developing countries, especially Pakistan, in order to prevent infant and child under-nourishment. In addition to poverty alleviation, the underlying causes that work against food security, food safety, womens' education, safe water supply, sanitation and adequate health care must be addressed.

Journal Article↗
PubMed2003

Applying WHO's health systems performance assessment in Pakistan: critical reflections.

The World Health Organization (WHO) proposed a health systems performance assessment framework in 2000, which met with quick and often severe criticisms in terms of process, methods and utility. However, a country specific reflection for the potential application of this framework has not been published to-date from South Asia. This paper reviews the recent literature and critiques and analyzes the potential for applying the framework in Pakistan. Deconstruction of the framework into its five component parts--health (level, distribution), responsiveness (level, distribution) and fair financing--allows an assessment of data needs for generation of specific indicators. This paper proposes that three of the five components may be attempted in Pakistan due to the availability of specific data; however the two components of responsiveness will require the collection of new primary data and present a considerable challenge. The conduct of a burden of disease study, assessment of health expenditures using household consumption surveys, and use of numerous national surveys will allow for optimal utilization of available information in Pakistan. The assimilation and analysis of available data will also be critical in informing national health decision-making.

Data Collection↗
PubMed1991

Detection of HPV DNA in neoplastic and non-neoplastic cervical specimens from Pakistan and Japan by non-isotopic in situ hybridization.

In order to determine the prevalence and type-specific distribution of human papillomavirus (HPV) in women from Pakistan, a country with a low cervical cancer rate (hospital-based data), and to compare these results with their counter-parts in Japan, we studied 56 non-neoplastic cervical tissues and 162 cervical carcinoma cases from both countries. HPV infection was defined by in situ hybridization in paraffin-embedded tissues using biotinylated HPV 6/11, 16 and 18 probes. The overall positivity rates in non-neoplastic and neoplastic cervical tissues from Pakistan were 33% and 88%, while in those from Japan the rates were 46% and 80%, respectively. High-risk HPVs (16 & 18) were found in 17% of the non-neoplastic specimens and in 69% of cervical carcinoma cases from Pakistan, while Japanese figures in this respect were 19% and 68%, respectively. No correlation was found between the type-specific distribution or prevalence of HPV and the geographic location of the cases examined in the 2 countries. However, in comparison to Japanese women, the incidence of HPV-16-positive cervical carcinoma in Pakistani women decreased significantly (p less than 0.05) in the oldest age group as compared to the youngest age group.

Adenocarcinoma↗
PubMed2004

Social factors associated with chronic depression among a population-based sample of women in rural Pakistan.

OBJECTIVE: Previous studies have reported a high prevalence of depression in women in Pakistan. This paper investigates whether risk factors for chronic depression established in studies performed in Western countries can explain this high prevalence. METHOD: A two-phase survey using the self-rating questionnaire (SRQ) for common mental disorders and the Psychiatric Assessment Schedule was performed on a general population sample in rural Pakistan. Demographic data and results of the Life Events and Difficulties Schedule were analysed in relation to SRQ score and psychiatric disorder. RESULTS: A total of 145 women were screened. High SRQ score was associated with low educational status, not having a confidant, having four or more children, being older, not being married and living in a house with more than three people per room. Regression analysis demonstrated that the first three of these independently contributed to SRQ score. In the interviewed sample (74 women), only educational level independently contributed to the presence of depression. In addition, the least educated group experienced the greatest number of marked difficulties: 67% of them had experienced both marked housing and financial difficulties compared to 28% and 25% of the other educational groups (p = 0.005). Experiencing both housing and financial difficulties was a significant risk factor for depression in women with secondary education, but not for those without secondary education. CONCLUSIONS: This study suggests that high levels of social adversity and low levels of education are strongly associated with depression in women in Pakistan. The other vulnerability factors found in the West (such as lack of a confidant, the presence of three or more young children at home, or loss of mother during childhood) may be of lesser importance in this population.

Adolescent↗
PubMed2026

Genomic insights of first varicella zoster clade9 strain: a potential silent surge in Pakistan.

The study presents the first-time detection of one of the rare clades (clade9 strain) of varicella zoster virus (VZV) from Pakistan. The next-generation sequencing confirmed wild-type clade9 strain through clade-specific markers at C5827A, T33722C, T33725C, T33728C, T38055C, G69424A, C87841T and T95241C and restriction profile of PstI+BgII+SmaI-. The rarely reported SNPs (22/134) were detected along with 12/42 rare amino-acid mutations. However, the mutations at C77Y, Q43H, D613E and A2V were predicted to be not-tolerated hence might affect protein function. The VZV (PV934234) strain clustered with clade9 strains upon phylogenetics. Thus, the first-time detection of clade9 raises concern of limited genomic surveillance of VZV in Pakistan. This necessitates genomic surveillance and continuous clinical vigilance in Pakistan to avoid any potential silent surge in the country.

Clade 9↗
PubMed1987

Undergraduate medical education in underdeveloped countries: the case of Pakistan.

The type of medical education of a country is closely linked with its system of health care. Any health care system, with its own peculiarities, requires a certain type of doctor who can function effectively in the given environment. The same is the case with underdeveloped capitalist countries, such as Pakistan, where a skewed, elitist, curative model of health care exists. In Pakistan, where the literacy levels in the native tongue are very low, medicine is taught in English, and nearly all prescribed textbooks are written in and for the West. Conditions specific to Pakistan, such as the degree of cheating in exams, the time lost due to closure, and the level of debate concerning the medical system may find their parallels in other UDCs. Since it is the social and economic forces, which, in the final analysis, determine the system of health care and medical education, one cannot expect any significant improvement within the existing class structure. Only in a country where the masses have control over the production and distribution of resources, can the systems of health care and medical education be brought in line with the real needs of the community and of the country.

Attitude of Health Personnel↗
PubMed1989

The detoxification of high dose heroin addicts in Pakistan.

Treatment services in Pakistan have been swamped by the recent appearance and rapid growth of heroin abuse, and there is an urgent need to initiate and strengthen effective responses. This paper presents the results of an exercise in national monitoring of heroin detoxification services in Pakistan. The study also offers the first systematic description of the withdrawal response of heroin addicts dependent upon doses greatly in excess of those reported in developed countries. The trial was conducted at four major treatment centres and looks at three of the most widely used detoxification procedures in Pakistan (symptomatic treatment only, opium reduction plus symptomatic treatment and clonidine). Data are presented on 118 addicts receiving inpatient detoxification from heroin. The results indicate that all three detoxification methods reduced peak levels of withdrawal symptoms to acceptable levels, and that all produced a return to baseline levels of symptomatology within 10 days or less. The three most persistent symptoms were aches and pains, restlessness and insomnia. Several differences were found between treatments, notably with regard to the number of drugs required to modify the withdrawal response. The implications of these and other results are discussed.

Adolescent↗
PubMed2006

Background demographics and risk behaviors of injecting drug users in Karachi, Pakistan.

OBJECTIVE: To find the prevalence of HIV infection and risk behaviors among injecting drug users (IDUs) in Karachi, Pakistan. DESIGN: A cross-sectional study of IDUs conducted in Karachi, Pakistan from February through June 1996. RESULTS: Of the 242 IDUs, 11 (4%) refused HIV testing. One (0.4%; 95% confidence interval (CI) = 0.37-0.48%) was HIV positive. All subjects were male. Over the past 6 months 47% had engaged in receptive needle sharing, 38% had perceived a change in their social network, 22% had had sexual intercourse, of whom only 7% always used condoms, and none had washed their needles with bleach. Younger age (28 vs. 31 years; p = 0.01), younger age at first injection (25 vs. 28 years; p = 0.001), fewer years of schooling (3 vs. 5 years; p = 0.001), lower monthly income (70 dollars vs. 80 dollars; p = 0.03), inhaling fumes of heroin from a foil in the year before injecting (OR = 4.8; CI = 2.2-10.3), injecting first time with heroin (OR = 3.6; CI = 1.2-12.6), having a temporary job (OR = 2.5; CI = 1.2-5.2), and a perceived change in one's social network (OR = 4.4; CI = 2.4-7.9) were all associated with receptive needle sharing. IDUs who knew about HIV spread through contaminated needles were less likely to share (OR = 0.4; CI 0.2-0.8). In the final logistic regression model receptive needle sharing was associated with inhaling of fumes of heroin on a foil in the year prior to injecting (adjusted OR = 5.6; CI = 2.6-12.0), a perceived change in one's social network (adjusted OR = 4.0; CI = 2.2-7.4), and inversely associated with age at first time of injection (beta = -0.07; p = 0.002). CONCLUSION: Background HIV prevalence was low among IDUs in Karachi despite high-risk behavior in 1996. In order to control HIV transmission among IDUs in Pakistan, continual HIV surveillance with well-coordinated and effective HIV risk reduction, and drug demand reduction programs need to be implemented among drug users.

Adult↗
PubMed2005

Measuring the burden of premature mortality in Pakistan: use of sentinel surveillance systems.

INTRODUCTION: In developing countries, finding valid and reliable data is a great challenge. The Federal Bureau of Statistics in Pakistan maintains a surveillance system that records vital events. Results are reported as the Pakistan Demographic Survey (PDS). METHODS: The adjusted mortality data from PDS-1997 was used to estimate the burden of premature mortality using the healthy life year (HeaLY) methodology. RESULTS: The burden of premature mortality for Pakistan was 367 HeaLYs lost per 1000 population. More than half of the HeaLYs are being lost due to infection, maternal and perinatal conditions, and malnutrition. CONCLUSION: In the absence of a system maintaining reliable information regarding vital events, PDS provides a good alternate source of such information that can be used to aid policy making for health care and future research.

Adolescent↗
PubMed2007

The impact of political context upon the health policy process in Pakistan.

BACKGROUND: Analysis of the political context is important for the understanding of a health policy and its success, because contextual factors may significantly influence the health policy process and health. This article describes how the political context in Pakistan influences the health policy process. METHODS: We used qualitative research methods based on document analysis and interviews of relevant actors in analysing the impact of the political context on the health policy process. Document analysis included policy documents and official reports of the health ministries, health-related departments and international agencies. Interviewees included relevant actors involved in the health policy process at local, provincial, national and international levels. RESULTS: Pakistan has experienced unbalanced power structures and frequent changes in government, which has disturbed health resources and has resulted in a centralized health system that hinders wider participation and disrupts health policy-making, planning and implementation. CONCLUSION: It is concluded that the political context has had a negative influence on the health policy process in Pakistan.

Government↗
PubMed2005

Interorganizational collaboration for health care between nongovernmental organizations (NGOs) in Pakistan.

The complexity and cost of health systems requires innovative forms of organization to provide accessible health services of an acceptable quality and at an acceptable cost. Interorganizational collaboration (IoC) is an innovation to increase the availability of organizational resources, improve service effectiveness, and improve access to health care. In Pakistan, a weak health system and little collaboration limit access, especially of women and children, to health services. Many nongovernmental organizations (NGOs) provide primary health care to the very poor, and some appear to collaborate to varying degrees; however, this has not been systematically analyzed. The purpose of this qualitative research, the first scientific study of collaboration between NGOs providing health services in Pakistan, was to describe collaboration between three pairs of NGOs providing community-based health services to women in Karachi. A long-term goal is to build a basis for future research linking IoC to access to health care and health outcomes. Findings indicated that collaboration was strongest when there was willingness to cooperate, a need for expertise and funds, and adaptive efficiency. In Pakistan's complex social environment, collaboration tended to be stronger when there was fairly high organizational formalization. Broader IoC appears to be positively associated with women's access to health care. Recommendations are made for future research, education, and management.

Adult↗
PubMed2006

Primary mental health care in rural Punjab, Pakistan: providers, and user perspectives of the effectiveness of treatments.

Neuro-psychiatric disorders are associated with a considerable burden of disease, not only globally, but also in low- and middle-income countries. Epidemiological information about treatment of these disorders is required to help formulate treatment and prevention strategies. The aim of this study was to describe different types of mental health care providers, and examine patients' knowledge of the treatments and their views about its effectiveness in rural Punjab, Pakistan. We conducted a cross-sectional survey of attenders at a 1-day psychiatric consultation clinic in rural Punjab, Pakistan. Patients sought help from five different types of providers and were treated with physical, psychotherapeutic and spiritual treatments. Most recognised psychiatric problems as treatable. There was a discrepancy between belief and knowledge of the treatment of mental disorders; most had a very basic understanding of treatment. They reported general practitioner (GP) treatments as more effective (56%) compared to other practitioners (20%). We argue that treatments given by primary mental health care providers need to be standardised. A systematic appraisal of the theoretical rationale of the mental health treatments prescribed in primary care settings is required in low-income countries like Pakistan. This will help ensure standardisation of care especially regarding spiritual/psychological therapies so that in future valid inferences can be made about their effectiveness in populations. Further work should include improving mental health literacy with special reference to treatments available for mental health problems.

Adult↗
PubMedDate not supplied

An outbreak of cutaneous leishmaniasis in an Afghan refugee settlement in north-west Pakistan.

Cutaneous leishmaniasis (CL) due to Leishmania tropica appears to be an emerging disease in parts of north-east Afghanistan and north-west Pakistan. Timargara, an Afghan refugee camp of 17 years' standing, in the district of Dir, North West Frontier Province of Pakistan, experienced a major outbreak of CL in 1997 for the first time. As part of the investigation, each section of the camp was surveyed for CL. Around 38% of the 9200 inhabitants bore active lesions and a further 13% had scars from earlier attacks. According to interview statements, 99% of earlier infections had healed within the previous 2 years. To confirm the diagnosis, a sample of current CL lesions was examined parasitologically. Amastigotes were detectable by microscopy in only 36% of lesions. However, 48% of slide-negative cases produced positive cultures and some cases negative to both microscopy and culture were positive by PCR. Overall detection rate was about 80%. The sandfly Phlebotomus sergenti, a known vector of L. tropica, was captured within the camp, indicating local transmission. CL has not been reported from this area of Pakistan before. Although the majority of refugees left Afghanistan 2 decades ago, cross-border movement of men is common. The Afghanistan capital, Kabul, is currently experiencing a major epidemic of CL; infected migrant carriers from Kabul are probably the source of the outbreak in Timargara.

Adolescent↗