Creating synergies for health systems strengthening through partnerships in Pakistan - a case study of the national eye health programme

Blindness and visual impairment are major causes of noncommunicable diseases in Pakistan. Two national population-based blindness surveys conducted in 1988 and 2002-04 demonstrated a reduction in prevalence of blindness from 1.78% to 0.9% with a significant drop in cataract blindness as a result of accelerated nationwide interventions and eye care integration in primary health care. In addition, between 2006 and 2008r 88 facilities were upgraded as a result of the national eye health programme. These measures resulted in a 279% increase in eye outpatient attendances and a 375% increase in eye surgeries performed. Investment in human resources development and policy change contributed significantly to the sustainability of the programme. Key challenges facing the programme include aligning national eye health strategies with health system strengthening informed through health systems research. This gaper attempts to document this extraordinary success

Management aspects and associated problems of established esophageal strictures

There are different ways of management of an established esophageal stricture. Treatment is also influenced by the different factors like healthcare facilities, attendant difficulties in referral and follow up. These factors play an important role in our community. In the last six years there were 18 cases with established esophageal stricture, resulting from untreated gastro-esophageal reflux, and corrosive injuries. In the first instance in every case an attempt was made for dilatation with an endoscopic bouginage. High percentage of failure to dilate lead to various operative procedures, like clonic and reverse gastric tube construction. In this article an attempt has been made to analyze the problems that these patients face, merits and demerits of each procedure, immediate and late complications that were encountered

rare abnormality of median nasal cleft

Bifid nose with median nasal cleft lip is a rare congenital anomaly. Only a few cases are noted in medical literature. In this report an infant with median nasal cleft, hypertelorism and median cleft lip is presented. Its operative management and postoperative results are also described

Parapharyngeal space lesions: experience at P I MS

Parapharyngeal space lesions are relatively uncommon. During the period 1988 to 1992, 11 patients were seen with parapharyngeal space lesion at the otolaryngology department of the Pakistan Institute of Medical Sciences, Islamabad. All of these were benign except for 3 cases [73% benign verses 27% malignant]. Schwannoma was the most common lesion encountered [27%]. The use of computed tomography was found helpful not only in diagnosing the lesion but also in planning the surgery. The cervical submandibular approach was adequate in most of the cases