Covid-19 In Pakistan: Where Do We Stand And What Is The Way Forward?

At the outset of year 2020, COVID-19 emerged as a new public health threat and the world resorted to a diverse range of combating plots including lock down downs, social distancing, advocating precautions like wearing masks, using sanitizers etc. Pakistan followed the same pathway despite the fact that the virus resulted in less severe morbidity and mortality as compared to the rest of the world. Nevertheless, the fear and panic it created due owing to virulence and subsequent outcomes of corona illness was of alarming magnitude. Pakistan went for smarter, conservative and prudent plans and kept the balance between saving lives and livelihoods. Health system showed its inherent weaknesses and it was soon realized that a multi-sectoral response would be needed to address the catastrophe. A large majority is inclined to call it a 'new normal' and is persuading to go on with life; for sure, by adopting a health system thinking.

Correction to: Health seeking behaviour, delayed presentation and its impact among oral cancer patients in Pakistan: a retrospective qualitative study.

In the original publication of this article [1], an author's name needs to be revised from Babar Tasneen Shaikh to Babar Tasneem Shaikh.

Health seeking behaviour, delayed presentation and its impact among oral cancer patients in Pakistan: a retrospective qualitative study.

BACKGROUND: Delayed diagnosis of Oral Cancer (OC) can mean a difference in quality and expectancy of life for the patient. This delay could be from the healthcare side, or more importantly from the patient's side. Globally, there are studies enumerating the causes for delays from the patients' side in seeking healthcare for Oral Cancer; however, no similar research is found in the context of Pakistan. This study endeavoured to understand the health seeking behaviour, reasons for delay in consultation and the impact on OC patients' lives. METHODS: In-depth interviews were conducted with randomly selected OC patients at a private sector tertiary care facility in Islamabad (who met the inclusion criteria of having successfully been treated for Oral Cancer) which caters to the most diverse population for the treatment of Oral Cancer. Theoretical saturation was achieved at 14 interviews. All participants gave verbal consent for participation, which was recorded prior to the interviews. RESULTS: Patients (age range 43-68 years) had received the surgical treatment and radiation. The reported delay before seeking a proper medical advice ranged from 1 month to 2 years. Lack of awareness about OC risk factors, symptoms, and whom to approach for treatment were the main reasons. Most respondents relied on self-treatment considering the non-healing wound/ulcer to be a minor issue until they were advised a consultation with a specialist. Treatment started within 1-3 months after a confirmed diagnosis on biopsy. The reported average expenditure on treatment was US$5000-10,000, mostly covered through a private health insurance and others borrowed the money. CONCLUSION: A socio-behavioural change campaign for the general population can result in earlier presentation of the OC, minimizing the financial burden on the patient as well as the health system, and improving the quality of life of the patients.

Hospital preparedness for disaster and mass casualty management in Pakistan: A cross-sectional evaluation study.

BACKGROUND: World Health Organization has advocated preemptive readiness of health systems to manage disas-trous events. Pakistan is known to be highly susceptible to disasters on the one hand and significantly lacking in coping ability on the other. Preparedness of health facilities in such locales is especially important, despite which there is little published evidence regarding hospitals' response capacity in Pakistan. METHODS: From 12 most disaster prone districts of the country, a purposive sample of 20 hospitals was assessed us-ing 51 indicators, scored as fully (2), partially (1), or not prepared (0). Two domains, disaster preparedness and mass casualty management, and five subdomains, networking, planning, staff-readiness, materials, and safety, were evalu-ated. Proportions of maximum possible scores achieved by an entity were categorized as acceptable (≥66 percent), par-tial (35-65 percent), or inadequate (<35 percent). RESULTS: Out of the 20 hospitals, 14 (70 percent) were secondary and 3 tertiary level facilities (30 percent). Overall, hospitals were partially prepared with a score of 54.0 percent, 95 percent confidence interval [52.3 percent, 54.7 percent]. Disaster preparedness, 55.2 percent [54.0, 57.0], was significantly better prepared than mass casualty management, 49.2 percent [46.8, 51.6], p < 0.001. Overall, facility safety was the least prepared among the subdomains, 38.3 per-cent [31.8, 44.8], while materials were the best, 75.9 percent [72.6, 79.3]. The least prepared subdomains were staff-readiness in Punjab, 52.1 percent [47.5, 56.8], and facility safety in KP, 29.2 percent [22.1, 36.4]. CONCLUSIONS: Hospitals' preparedness for disaster and mass casualty management is deficient in these most vulner-able districts of Pakistan. Improvement initiatives commensurate with locale vulnerabilities should be instituted.

Polio immunization in Pakistan: ethical issues and challenges.

BACKGROUND: Immunization should be considered a basic human right to health and well-being. It is everybody's business, and it is everybody's responsibility: the individual, the community, the health system and the state. This paper attempts to review some of the literature that highlights the ethical and religious concerns surrounding polio vaccination and what approaches may be used to counter the problems faced in Pakistan. METHODS: This paper is developed through a literature review on public health and polio in Pakistan, consulting local, regional and globally published peer reviewed articles focussing on religion, culture, ethics and public health. DISCUSSION: Human behaviour, including the utilization and acceptability of healthcare services, is greatly influenced by religious beliefs and dogmas. Immunization, specifically for the purpose of polio eradication, has been a topic under focus and in the news in Pakistan. The government is doing its best through a variety of interventions to increase access, inform the public and increase vaccination rates. Nevertheless, the country still faces a huge challenge from certain stern pockets of uncompromising populations who resist and refuse vaccination. Beliefs, practices and cultural norms overshadow public health priorities and ethics. Understanding of the context, therefore, is critical to determine the social hindrances in polio eradication and strategize thereon. CONCLUSION: Having programmatic, system-wide, socio-cultural and of course ethical dimensions, the policy makers and the programme managers in Pakistan must attempt to address the multitude of challenges to polio vaccination, whereby the plan of action developed within the ethical norms could potentially lead to an ultimate success.

Prevalence of the metabolic syndrome and its component abnormalities among school age Pakistani children.

BACKGROUND: Concurrence of central adiposity, hypertension, hyperglycaemia, and atherogenic dyslipidaemia has been termed as the metabolic syndrome. High prevalence of the syndrome has been reported globally over the last decade. METHODS: This cross-sectional study is based on a sample of eighty five children, ranging in age from six to twelve years. After parental consent, height, weight, waist circumference,, and blood pressure were measured and investigation requests for fasting plasma glucose and fasting lipid profile were given. Children with known metabolic disorders, and those using metabolic-profile-altering medication were excluded. RESULTS: The prevalence of metabolic syndrome, according to the various definitions, varied from as high as 16.5% (95% CI: 9.3-26.1%) to as low as 1.8% (95% CI: 0.03-6.4%). The most prevalent of the component abnormalities was blood pressure above 90th percentile, positive in 54% (95% CI: 43.0-65.0). HDL-c was low (≤1.3 mmol/L) in 36.5% (95% I: 26.3-47.6%), and waist circumference high (>75th percentile) in 30.6% (95% CI: 21.0-41.5%). Both systolic blood pressure and triglycerides to HDL-cholesterol ratio showed a linear trend of increasing with increasing quartiles of waist and body mass index (BMI). CONCLUSION: Depending on the cut-off values used for defining the component abnormalities, the metabolic syndrome may be quite prevalent in this population. Waist circumference above 75th percentile and even a single reading of blood pressure above 90th percentile should be considered a warning sign, indicating further investigation and lifestyle interventions.