Protecting the right to health of internally displaced mothers and children: the imperative of inter-cluster coordination for translating best practices into effective participatory action

Substantive progress has been achieved in advancing emergency response interventions during disasters including assistance of internally displaced persons [IDPs]. Explicit operational technical guidelines and management strategies have been successfully applied through the [cluster approach]. In 2008-09 armed conflict in several districts of the Khyber Pakhtunkhwa [KP] province and the Federally Administered Tribal Areas [FATA] of Pakistan resulted in over 2.7 million IDPs. This report describes the response by the Pakistan government, assisted by the hosting populations and humanitarian partners, to deal with the crisis using the cluster approach to ensure the health protection of the IDPs, particularly mothers and children

Launching the first postgraduate diploma in medical entomology and disease vector control in Pakistan

The Health Services Academy has launched a 12-month postgraduate diploma course in medical entomology and disease vector control. The objective is to create a core of experts trained to prevent and control vector-borne diseases. The course is a response to the serious health and socioeconomic burden caused by a number of vector-borne diseases in Pakistan. The persistence, emergence and re-emergence of these diseases is mainly attributed to the scarcity of trained vector-control experts. The training course attempts to fill the gap in trained manpower and thus reduce the morbidity and mortality due to these diseases, resulting in incremental gains to public health. This paper aims to outline the steps taken to establish the course and the perceived challenges to be addressed in order to sustain its future implementation

Implementing the district health system in the framework of primary health care in Pakistan: can the evolving reforms enhance the pace towards the Millennium Development Goals?

There is growing renewed trust in primary health care as the best approach for ensuring equity in the delivery of essential health services. However, Pakistan with one of the most widely spread district health system networks in the region, has not delivered at the expected capacity. A series of health system reform agendas are now stipulated which include the promulgation of an essential health service package, public private partnerships and a people-centred focus. Nevertheless, success of these reforms will hinge on the ability of the three tiers of the government and other stakeholders to work togetherto improve the overall performance of the district health system. This paper provides an overview of thedistrict health system infrastructure and organization of primary health care services in Pakistan, the evolving governance pattern and the operational significance and merit of health system pillars for effective service implementation

Pakistan human resources for health assessment, 2009

Pakistan faces a human resources for health [HRH] crisis. A cross-sectional survey was conducted to overview frontline health workers. A total of 750 health facilities were surveyed across Pakistan. The median estimate of public sector health care workers in the district health system in Pakistan is 417 288, including 46 153 doctors and 41 032 nurses. Another estimated 20 000 doctors work in public sector tertiary care hospitals across the country. A total of 3549 health care workers were interviewed regarding job satisfaction and work environment. The private sector had better work environment scores compared with the public sector. Policy dimensions showed an absence of robust policies in practice. The public sector is inadequately staffed and job satisfaction and work environment need improvement. HRH crisis countries should share experiences, and developmental partners should support them in overcoming the HRH crisis

Sleep and wakefulness during holy month of Ramadan

The aim of this study was to explore sleep changes during the month of Ramadan and to compare the sleep pattern during the fasting and non fasting period in normal healthy individuals. This study was carried out at the department of Physiology FUMC Rawalpindi. Pakistan from 1[st] September 2006 to 31[st] October 2006 during which occurred the holy month of Ramadan from 25[th] September 2006 to 24[th] October 2006. A total of 435 subjects [172 women and 263 men] were provided the sleep cards to record their sleep hours. During Ramadan the total sleep time [TST] for the same individuals showed a significant difference [P<0.05] i.e. during fasting period as compared to non fasting period. During fasting period individuals slept 46 minutes per day more than during none fasting period. Sleep behavior changes during Ramadan in fasting individuals indicate that the life style changes during Ramadan having a significant effect on sleep behavior. Factors other than fasting may play an important role in modifying an individual's behavior during Ramadan. Further studies are needed to confirm these factors and sleep pattern during month of Ramadan

Acute complications of haemodialysis in paediatric age group

To assess acute complications of haemodialysis in patients with end-stage renal disease [ESRD]. Observational study. The Nephrology Department of The Children's Hospital and Institute of Child Health, Lahore over a period of 2 years [January 2001-December 2002]. The children in age group of 6-14 years, suffering from end-stage renal disease [ESRD], were provided renal replacement therapy in the form of haemodialysis mostly twice a week and were observed for the complications of the procedure. A total 519 haemodialysis were performed on 25 patients. The mean age was 11.06 years and weight was 26.8 kg. The clinical problems observed were hypertension in 40.46%, hypotension 3.4%, chest pain 4.04%, headache 13.87%, vomiting 1.73%, gastrointestinal bleeding 1.92%, muscle cramps 8.6% and convulsions 0.57% of sessions. Hypokalemia was main electrolyte disturbance seen during 8%, while fever with rigors and chills in 4.02% of sessions. Minor bleeding from subclavian catheter was seen during 2.89% of sessions while thrombosis, infection and accidental dislodgment in 0.77%, 12.50% and 0.57% of sessions respectively. Technical problems like clotting in dialyzer during 0.95% and failure of ultra-violet control module was seen in 3.42% of sessions. Haemodialysis, a life saving treatment modality, is not without risk of complications. Hypertension, headache, muscle cramps and catheter infections were the most commonly encountered complications in this series

Prescription and dispensing practices in public sector health facilities in Pakistan: survey report

Objectives: To gather information on existing prescription practices, dispensing practices and patient satisfaction in government health services of the NWFP, Baluchistan and Punjab province

Methods:A cross sectional study design was used for this purpose. Ten health care facilities were selected from each province keeping appropriate representation from first level health facilities, district health facilities and tertiary care hospital. Analysis of selected indicators was carried out on the basis of provinces, health facilities, gender and different age groups

Results: Documentation of 914 responses was completed from three provinces. Almost equal distribution of encounters was maintained representing different health facilities. Forty seven percent of encounters involved children under 15 years of age. Female patients comprised of 56% and the mean age of the entire sample was 26 years. The mean dispensing time was only 38 seconds, the mean consultation time was 1.79 minutes and the average number of drugs per prescription turned out to be 2.7 out of which only 1.6 drugs were being dispensed from the facility. More than half of the prescriptions contained antibiotics and 15% of patients were prescribed with injectables. Only half of the patients expressed satisfaction with their visit to health facility

Conclusion: Like many other developing countries, prescription and dispensing practices are not satisfactory in public sector health facilities of Pakistan. Appropriate and workable solutions need to be developed and implemented in the country to improve systems. Regular audits and qualitative studies should become part of the effort

Evaluation and comparison of coronary heart disease risk factor profiles of children in a country with developing economy

To define the risk factors [RF] profile and prevalence rates of high risk factors in an urban Pakistani community and compare it to the RF profile and prevalence rates of Pakistan National Health Survey. The present study included RF relevant data of 400 house hold children selected by open invitation as a part of Metroville Health Study [MHS], a risk factor modification study which was a cooperation between National Heart Lung Blood institute [NHLBI] USA and National Institute of Cardiovascular Diseases Pakistan. The base line data of 389 girls and 417 boys age 5-17 was included. PMRC data of 5067 and NHANES III survey data of 10,252 US children was used for comparison with MHS. RF analyzed were height weight, SBP, DBP, BMI and serum cholesterol. Comparisons between MHS and PMRC and US were made by using two tailed student t test and of high RF were defined as those exceeding US standards and expressed as percentages. The RF factor profile of urban Metroville children was worse than the national average of PMRC children. Except for diastolic blood pressure in both boys and girls and SBP in PMRC boys, all other RF were less than US children. Prevalence rates were higher in urban Metroville community, i.e., MHS compared to the PMRC which represents national average data. RF profile of Pakistani children has been presented and effect of urbanization demonstrated by comparing the PMRC and MHS RF profile. Hypertension in Pakistani children has emerged as a single most important RF requiring urgent prevention

Pattern of neonatal mortality in Military Hospital, Rawalpindi

The study was undertaken to determine neonatal mortality rate [NMR] and pattern of diseases in our set up of Military Hospital [MH], Rawalpindi. Cohort study of all the newborns delivered in maternity ward of MH, over a period of 6 months was carried out. Follow up was done over a period of one month. IMMR in our study population was 27 per thousand live births, 12% of all the babies were low birth weight and 5.9% were premature. Major causes of mortality were birth asphyxia, infections, respiratory distress and congenital infections. The results were comparable with other regional studies. The incidence of mortality, low birth weight and prematurity along with other complications is still high in our region of the world cost effective and simple measures should be adopted as a remedy

Compound palmar ganglion: a case report and literature review

A 36-year-old laborer presented with bilocular swelling, bulging above and below the flexor retinaculm of the right hand with transmitted fluid impulse. A clinical diagnosis of compound palmar ganglion of tuberculous nature was made at the time of surgery, and confirmed later by pathological examination. Complete excision of the ganglion was performed, followed by oral anti-tuberculos drugs for 9 months. The patient was cured. This is a rare condition and the current knowledge about its pathology and management is reviewed

Giant cell tumour of the acromion

A case of osteoclastoma of the acromion process, is surgical management and a review of the literature are presented