Road traffic injuries in Pakistan: challenges in estimation through routine hospital data

Injuries are becoming one of the most important public health challenges at the dawn of the new century. It is estimated that almost one fifth of the total global burden of disease is due to injuries. Road traffic injuries [RTIs] are a leading cause. This is a cross-sectional survey based on hospital records of Rawalpini General Hospital for reference year 2005. The yearly hospital record showed that a total of 119,214 persons visited the emergency during 2005. Twenty-four percent [28,679] of these cases were retained in the emergency department for treatment and 64% 18229 cases of the retained cases were shifted to concerned wards for further management. Injuries amounted to a total of 1,244 [6.8%] cases were recorded in the ER as RTIs. The proportion of injured males was [71%]. The surgical/orthopaedics presentations were 33% of the total ER cases with injuries. The amount of missing information was [11%] and the deficiency of the data regarding emergency admissions indicated flaws in the information systems. The findings surprisingly showed that RTIs have a very low proportion in the total presentations and this leads to doubts about the information systems at the hospital. The inability to follow the progress of these cases indicates that the data is under reported. Furthermore the small percentage of cases requiring retention in ER and even smaller requiring admission leads to the conclusion that a majority of the presenting cases in the ER may be outpatient cases, who for lack of an evening outpatient clinic, are coming to the ER. Further investigation is required involving other public/private sector hospitals to estimate the magnitude of the problem and comprehensiveness of the relevant data is also required

Equity shortfalls and failure of the welfare state: community willingness to pay for health care at government facilities in Jehlum [Pakistan]

The question of willingness to pay is very crucial in planning for services. In Pakistan, the long-term issues of sustainability of health systems particularly, allocation of finances have routinely been addressed by planners with insufficient data and unclear goals. This study was conducted with the objectives to determine the demand for health care services in the community; at first level care facilities and community level and determine the willingness of the community [Willingness to pay] to participate in cost sharing mechanisms for provision of primary health care in fee for service and prepayment mechanisms. A cross sectional stratified household interview survey of 600 households was carried out in urban and rural areas of district Jehlum, to address the financial sustainability of government health care interventions at the community level and to explore the question of willingness to pay for health care and their ability to participate in the cost sharing mechanisms. In response to willingness to pay at a Government facility to obtain health care 437 [72.7%] of the households expressed their willingness to pay for health care. In 72% of the cases, cost was not considered as a barrier in seeking care and only 19% of the cases considered cost as a partial barrier; the rest said that cost prohibited seeking care. A majority across all strata is willing to pay for consultation and medicines at public sector facilities, although the responses from the low income groups exhibit a slight decrease in the willingness to pay. The willingness to pay is marginally affected by income, place of residence and/or cost of the treatment incurred. The findings of this study suggest that the community is willing to pay for health care at the public sector facilities if payment can ensure provision of essential curative services and medications at improved quality levels

Factors affecting tuberculosis control: decision making at the household level

To explore the factors influencing decision-making process at household level vis-a-vis decision to seek health care, decision regarding the type of care and the decision to continue treatment. Design: Cross-sectional study. Place and Duration of Study: Government TB Center, Rawalpindi, from 16th January 2002 to 28th February 2002. Subjects and In total, 100 smear positive patients were included in the study. First questionnaire was administered to first 50 randomly selected patients. The ethnographic decision models [EDM] were developed from the responses. The second questionnaire, derived from these models, was administered to the second group of randomly selected 50 patients to test the predictive ability of the EDM. Decision-making regarding treatment of tuberculosis was influenced by patients knowledge about the disease itself as well as its severity, infectivity and curability. Close relatives were found to play a critical role at all the decision-making levels. The EDM developed on these results had 80-90% ability to predict the decision-making in tuberculosis patients. Effective health education, easy accessibility to treatment centres and trained and motivated health care providers can go a long way in making national TB control program a success