Smokeless tobacco consumption in a multi-ethnic community in Pakistan: a cross-sectional study

Smokeless tobacco is commonly used in south Asia. In addition to causing oral and pharyngeal cancers, its harmful effects are comparable to smoking tobacco. A cross-sectional survey with systematic sampling was conducted in 2010-2011 to investigate smokeless tobacco use in a multi-ethnic, semi-urban population in Islamabad, Pakistan [n = 2030]. The prevalence of smokeless tobacco use was 16.0% [21.6% among males and 8.8% among females]; 51.7% of smokeless tobacco users were also cigarette smokers. The rate of smokeless tobacco use was comparatively high among Pakhtun males [38.2%] and Sindhi females [22.4%]. The associations between smokeless tobacco use and ethnicity, age group, income level and cigarette smoking were statistically significant among male smokeless tobacco users. Of the sample 41.4% [840/2030] had inadequate knowledge about the health problems associated with smokeless tobacco. Appropriate interventions are needed to raise awareness of the health risks and to prevent smokeless tobacco use

Primary health care: what is it and what is it not? Views of teaching faculty at an undergraduate medical college in Pakistan

Over 30 years after the Alma-Ata declaration on primary health care in 1978 there are still misconceptions about the basic concept of primary health care. This study aimed to investigate the knowledge and opinions about various aspects of primary health care and its appropriate implementation among the teaching faculty at Shifa College of Medicine in Islamabad, Pakistan. A structured questionnaire was answered by 70 physicians present at the end of the month seminar. Two-thirds of the doctors [67.1%] believed that primary health care involved only basic health care for common illnesses. Few respondents suggested that community-oriented programmes [4.3%], maternal and child health [2.9%], screening [1.0%] or treatment of noncommunicable diseases [2.9%] should be components of primary care. The concepts to primary health care as defined at Alma-Ata in 1978 were not well understood by teaching faculty from the basic and clinical health sciences in this medical college

Impact of wealth status on health outcomes in Pakistan

Maternal and childhood morbidity and mortality are high in Pakistan and health disparities exist. Multivariate logistic regression analysis of the Pakistan Demographic and Health Survey database 2006-07 was performed. There was an excess of 25 neonatal, 34 infant and 41 under-five deaths per 1000 live births in the poorest quintile of wealth index compared with the richest. Women in the richest quintile had a 35%, 38% and 20% higher probability of getting prenatal care, delivery by skilled provider and emergency obstetric care, respectively. Pakistan needs to enhance social equity so development benefits can accrue to the underprivileged by introducing social protection interventions so that those in the informal sector are not excluded from accessing health care, scaling-up poverty reduction strategies and promoting intersectoral action. This study assesses the independent impact of wealth status, as determined by a validated index, on health outcomes in Pakistan