Displaying publications 1 - 20 of 470 in total

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  1. Atif M, Javaid S, Farooqui M, Sarwar MR
    PLoS One, 2016;11(3):e0151321.
    PMID: 26998830 DOI: 10.1371/journal.pone.0151321
    BACKGROUND: Implementation of the Charter to protect patients' rights is an important criterion to achieve patient-centered approach and receive financial support from the Global Fund. Our study aims to explore the knowledge of tuberculosis (TB) patients about their rights and responsibilities at the Chest Disease Unit of the Bahawal Victoria Hospital, Bahawalpur, Pakistan.
    METHODS: This was a qualitative study. The data from purposefully selected TB patients was collected by in-depth interviews. Eligibility criteria included confirmed diagnosis of TB and enrollment in the TB program. A pilot tested interview protocol was based upon the objectives of the study, and was used uniformly in each interview to maintain the consistency. The sample size was limited by applying the saturation criteria. All interviews were audiotaped and transcribed verbatim. Inductive thematic content analysis was applied to analyze the data and draw conclusions.
    RESULTS: Out of the total 16 patients, four were female, and seven were illiterate. Eight patients were known cases of multi-drug resistant TB. Analysis of the data yielded seven themes; tuberculosis care services, moral support and stigmatization, dignity and privacy, complaints, fear of losing job, information sharing and compliance to the treatment plan, and contribution to eradicate TB. First five represented the rights section while latter two were related to the responsibilities section of the Charter.
    CONCLUSION: Discriminatory access to TB care services and the right to privacy were two major concerns identified in this study. However, the respondents recognized their responsibilities as a TB patient. To ensure uninterrupted investment from the Global Fund, there is a need to implement fair TB care policies which support human rights-based approach.
    Matched MeSH terms: Pakistan
  2. Mubarak N, Hussain I, Raja SA, Khan TM, Zin CS
    J Pak Med Assoc, 2020 Aug;70(8):1475-1476.
    PMID: 32794514 DOI: 10.5455/JPMA.57221
    Matched MeSH terms: Pakistan/epidemiology
  3. Chaudhary FA, Ahmad B, Khalid MD, Fazal A, Javaid MM, Butt DQ
    Hum Vaccin Immunother, 2021 Oct 03;17(10):3365-3370.
    PMID: 34236952 DOI: 10.1080/21645515.2021.1944743
    This study examined the factors associated with acceptance of the COVID-19 vaccine compared to hesitance in the Pakistani population and specifically focusing on the perceived beliefs, knowledge, concerns, risk, and safety perception relating to the COVID-19 vaccine. A total of 423 subjects were recruited from the Pakistan Institute of Medical Sciences, Islamabad, Pakistan. A 27-item valid and reliable questionnaire was used to assess socio-demographic characteristics, acceptance, and hesitance toward COVID-19 vaccine, perceived beliefs, knowledge, perceived concerns, risk, and safety of COVID-19 vaccines and its source of information. Chi-square tests and logistic regression were used for analysis. About 53% of the participants were planning to get vaccinated and a significantly greater proportion of better educated, higher income, and healthier participants in the vaccine acceptance group (p
    Matched MeSH terms: Pakistan
  4. Perveen S, Akram M, Nasar A, Arshad-Ayaz A, Naseem A
    J Community Psychol, 2022 Mar;50(2):666-683.
    PMID: 34217150 DOI: 10.1002/jcop.22652
    This study explores the mechanism for timely and equitable distribution of coronavirus disease 2019 (COVID-19) vaccination among the various communities in Pakistan. It examines the factors that support and/or impede peoples' access and response towards COVID-19 vaccination in Pakistan. The study uses a literature synthesis approach to examine and analyze the situation of the COVID-19 vaccination in Pakistan. The research results show "hesitancy" and "inequality" as two fundamental challenges that hinder the successful delivery of COVID-19 vaccination in Pakistan. People are reluctant to use vaccines due to conspiracy theories and religious beliefs. However, inequality, especially unequal accessibility to all social groups appears to be a more significant barrier to getting a vaccine. We argue that there is a need to mobilize community influence, social media, and mass media campaigns for public education on vaccination programs along with the engagement of religious leaders to endorse the vaccination for the masses. The area of this study is underdeveloped; thereby, future studies are recommended to investigate the possible way for equitable distribution of vaccines in multiple regions.
    Matched MeSH terms: Pakistan
  5. Khahro SH, Memon ZA, Yusoff NIM, Gungat L, Yazid MRM
    Environ Sci Pollut Res Int, 2022 Feb;29(7):10771-10781.
    PMID: 34613546 DOI: 10.1007/s11356-021-16499-2
    Roads play a pivotal role in the overall economic growth of any country. Developed countries allocated sufficient budget to make new roads and to maintain the existing roads. They also have a proper pavement management system (PMS) in practice to manage roads, whereas developing countries suffer from budgetary issues to make new roads and maintain the existing road network. Therefore, this paper explores the awareness of PMS via direct and indirect methods in Pakistan with a proposed framework of the low-cost model and pavement maintenance indicators for developing countries. This paper also performs a scientometric assessment of PMS. A detailed literature review has been carried out for this study, followed by a quantitative study from experienced professionals. The scientometric data is collected from the Scopus database from 1975 to 2020, whereas the data for PMS awareness assessment has been collected using questionnaires from different experts working directly and indirectly in the road management sector. The data has been analyzed using the arithmetic mean because of the nature of the questions and scope of the study. The direct method results show that experts are aware of PMS for a new road, but they have no PMS to rehabilitate roads. The indirect method results show that the authorities are applying various components of PMS, but there is no proper PMS in practice. This paper helps decision-makers to make better decisions and policies for improved road maintenance and rehabilitation. The proposed framework in the study can significantly assist the UN-SDG 9 (Facilitate Sustainable Infrastructure in Developing Countries) and 11 (Affordable and Sustainable Transport System).
    Matched MeSH terms: Pakistan
  6. Adeel A, Kee DMH, Qasim Daghriri Y
    Front Public Health, 2022;10:965278.
    PMID: 36339231 DOI: 10.3389/fpubh.2022.965278
    PURPOSE: We seek to understand whether relationship conflicts of co-workers affect the validation of creative ideas or not. Furthermore, what boundary conditions may help prevent potential drawbacks of relationship conflicts with co-workers to validate their creative ideas?

    DESIGN/METHODOLOGY/APPROACH: The proposed model was tested by using multisource data collected across two points in time from final year nursing students and medical dispensers of five nursing colleges of south-Punjab, Pakistan. The model was analyzed with Mplus for random coefficient models for direct effects, mediated moderation, and UCINET for central tendency of creative idea validation.

    FINDINGS: It was found that relationship conflicts with co-workers were negatively related to their validation of creative ideas. However, supervisory support and team affective tone independently attenuate the negative effects of relationship conflicts with co-workers and the validation of creative ideas. Positive affective tone emerged as a positive predictor of creative idea validation. Additionally, positive affective tone as affected by supervisory support attenuated the negative relationship between relationship conflicts with co-workers and their validation of creative ideas. Finally, the relationship between relationship conflicts with co-workers and their validation of creative ideas is more positive when both supervisory support and positive affective tone are high, however, low otherwise.

    PRACTICAL IMPLICATIONS: This study will help policymakers understand what might be hindering the transfer of creative ideas to influential others (Leaders, Managers, etc.) and what they need to do to enhance the creative pool of their organizations. Although developing an environment that fosters creativity is important for the organizations, developing strategies to manage relationship conflicts related to supervisory support and positive affective tone will help transfer creative ideas to higher offices even when there are dysfunctional conflicts.

    ORIGINALITY/VALUE: This research shifts the conventional focus of understanding creativity from the generating side by explaining challenges that creative individuals face in promoting creative ideas with more criticism and offense by coworkers than support. Also, the interplay between the relationship conflicts with co-workers and team affective tone affected by supervisory support for validation of creative ideas enhanced our understanding of the boundary conditions of relationship conflict and creative idea validation.

    Matched MeSH terms: Pakistan
  7. Wang B, Waris M, Adamiak K, Adnan M, Hamad HA, Bhatti SM
    PLoS One, 2024;19(4):e0295853.
    PMID: 38625885 DOI: 10.1371/journal.pone.0295853
    The COVID-19 pandemic has emerged as a significant event of the current century, introducing substantial transformations in economic and social activities worldwide. The primary objective of this study is to investigate the relationship between daily COVID-19 cases and Pakistan stock market (PSX) return volatility. To assess the relationship between daily COVID-19 cases and the PSX return volatility, we collected secondary data from the World Health Organization (WHO) and the PSX website, specifically focusing on the PSX 100 index, spanning from March 15, 2020, to March 31, 2021. We used the GARCH family models for measuring the volatility and the COVID-19 impact on the stock market performance. Our E-GARCH findings show that there is long-term persistence in the return volatility of the stock market of Pakistan in the period of the COVID-19 timeline because ARCH alpha (ω1) and GARCH beta (ω2) are significant. Moreover, is asymmetrical effect is found in the stock market of Pakistan during the COVID-19 period due to Gamma (ѱ) being significant for PSX. Our DCC-GARCH results show that the COVID-19 active cases have a long-term spillover impact on the Pakistan stock market. Therefore, the need of strong planning and alternative platform should be needed in the distress period to promote the stock market and investor should advised to make diversified international portfolio by investing in high and low volatility stock market to save their income. This study advocated the implications for investors to invest in low volatility stock especially during the period of pandemics to protect their return on investment. Moreover, policy makers and the regulators can make effective policies to maintain financial stability during pandemics that is very important for the country's economic development.
    Matched MeSH terms: Pakistan/epidemiology
  8. Siddiqui A, Ahmed A, Tanveer M, Saqlain M, Kow CS, Hasan SS
    Vaccine, 2021 08 31;39(37):5251-5253.
    PMID: 34364719 DOI: 10.1016/j.vaccine.2021.07.072
    Matched MeSH terms: Pakistan
  9. Godman B, Haque M, Kumar S, Islam S, Charan J, Akter F, et al.
    Curr Med Res Opin, 2021 09;37(9):1529-1545.
    PMID: 34166174 DOI: 10.1080/03007995.2021.1946024
    INTRODUCTION: Prevalence rates for diabetes mellitus continue to rise, which, coupled with increasing costs of complications, has appreciably increased expenditure in recent years. Poor glycaemic control including hypoglycaemia enhances complication rates and associated morbidity, mortality and costs. Consequently, this needs to be addressed. Whilst the majority of patients with diabetes have type-2 diabetes, a considerable number of patients with diabetes require insulin to help control their diabetes. Long-acting insulin analogues were developed to reduce hypoglycaemia associated with insulin and help improve adherence, which can be a concern. However, their considerably higher costs have impacted on their funding and use, especially in countries with affordability issues. Biosimilars can help reduce the costs of long-acting insulin analogues thereby increasing available choices. However, the availability and use of long-acting insulin analogues can be affected by limited price reductions versus originators and limited demand-side initiatives to encourage their use. Consequently, we wanted to assess current utilisation rates for long-acting insulin analogues, especially biosimilars, and the rationale for patterns seen, across multiple Asian countries ranging from Japan (high-income) to Pakistan (lower-income) to inform future strategies.

    METHODOLOGY: Multiple approaches including assessing utilization and prices of insulins including biosimilars among six Asian countries and comparing the findings especially with other middle-income countries.

    RESULTS: Typically, there was increasing use of long-acting insulin analogues among the selected Asian countries. This was especially the case enhanced by biosimilars in Bangladesh, India, and Malaysia reflecting their perceived benefits. However, there was limited use in Pakistan due to issues of affordability similar to a number of African countries. The high use of biosimilars in Bangladesh, India and Malaysia was helped by issues of affordability and local production. The limited use of biosimilars in Japan and Korea reflects limited price reductions and demand-side initiatives similar to a number of European countries.

    CONCLUSIONS: Increasing use of long-acting insulin analogues across countries is welcomed, adding to the range of insulins available, which increasingly includes biosimilars. A number of activities are needed to enhance the use of long-acting insulin analogue biosimilars in Japan, Korea and Pakistan.

    Matched MeSH terms: Pakistan
  10. Mohsin M, Zhang J, Saidur R, Sun H, Sait SM
    Environ Sci Pollut Res Int, 2019 Aug;26(22):22494-22511.
    PMID: 31161545 DOI: 10.1007/s11356-019-05564-6
    In this study, we proposed integrated tools to evaluate the wind power potential, economic viability, and prioritize 15 proposed sites for the installation of wind farms. Initially, we used modified Weibull distribution model coupled with power law to assess the wind power potential. Secondly, we employed value cost method to estimate per unit cost ($/kWh) of proposed sites. Lastly, we used Fuzzy Technique for Order of Preference by Similarity to Ideal Solution (F-TOPSIS) to rank the best alternatives. The results indicate that Pakistan has enormous wind power potential that cost varies from 0.06 $/kWh to 0.58 $/kWh; thus, sites S12, S13, S14, and S15 are considered as the most economic viable locations for the installation of wind power project, while remaining sites are considered to be less important, due to other complexities. The further analysis using Fuzzy-TOPSIS method reveals that site S13 is the most optimal location followed by S12, S14, and S14 for the development of wind power project. We proposed that government should formulate wind power policy for the implementation of wind power projects in order to meet energy demand of the country.
    Matched MeSH terms: Pakistan
  11. Sadiq M, Alajlani S, Hussain MS, Ahmad R, Bashir F, Chupradit S
    Environ Sci Pollut Res Int, 2022 Mar;29(14):20963-20975.
    PMID: 34748177 DOI: 10.1007/s11356-021-17276-x
    The role of risk assessment and capital structure is vital for the sustainable growth of firms and increasing the shareholders' wealth. This research explores the correlation between firm risk and capital structure using datasets from the sugar and cement sectors of Pakistan as a developing economy. This study is unique as it involved two firms of different nature (sugar firms operate seasonally while cement firms operate yearly) to view the real picture on the impact of risk and structure assessment on firms' credibility and shareholders' wealth. For this purpose, 15-year data (2000-2014) containing the financial statements of the target sectors were collected and the ANOVA analysis was applied with credit risk, liquidity risk, systematic risk, and firm size were used as the regressor variables, firm growth and dividend payout ratio as the control variables, and leverage as the regression variable. The findings showed that credit risk and liquidity risk are significantly correlated with leverage. This suggests that decision-makers pertaining to firms' risk and efficiency must focus more on risk to pursue a stronger and sustainable increase in shareholder wealth.
    Matched MeSH terms: Pakistan
  12. Tariq W, Asar MAT, Tahir MJ, Ullah I, Ahmad Q, Raza A, et al.
    Front Public Health, 2022;10:1036800.
    PMID: 36684982 DOI: 10.3389/fpubh.2022.1036800
    BACKGROUND: Telemedicine is the provision of healthcare services through information and communication technology with the potential to mobilize all facets of the health sector to prevent the spread of COVID-19, provide quality healthcare, protect patients, doctors, and the public from exposure to disease, and reduce the burden on the healthcare system. This study aims to identify knowledge, perceptions, willingness to use, and the impact of the COVID-19 pandemic on telemedicine awareness.

    METHODS: A cross-sectional study was conducted from 27 May 2020 to 17 June 2020 using the convenient sampling technique in the general population of Pakistan. Data were collected by designing an online questionnaire consisting of demographic information, knowledge, attitude perceptions, barriers, utilization, and the impact of the COVID-19 pandemic on telemedicine.

    RESULTS: Of the 602 participants included in the study, 70.1% had heard about telemedicine, 54.3% had a good understanding of the definition of "telemedicine," 81.4% had not used telemedicine in the past, 29.9% did not know that telemedicine was available before the COVID-19 pandemic, and 70.4% responded that the COVID-19 pandemic had changed their attitudes toward telemedicine. Gender (p = 0.017) and family income (p = 0.027) had a significant association with the perception of the benefits of telemedicine.

    CONCLUSION: The knowledge and usage of telemedicine are lacking due to inadequate awareness and technology. The need of the hour is to maximize the application of telemedicine to overcome the deficiencies of the healthcare system. Hence, it is essential to increase awareness through various means and develop an appropriate infrastructure to attain maximum benefits from telehealth services.

    Matched MeSH terms: Pakistan/epidemiology
  13. Rehman IU, Bukhsh A, Khan TM
    Travel Med Infect Dis, 2017 Jul-Aug;18:67-69.
    PMID: 28842213 DOI: 10.1016/j.tmaid.2017.08.002
    World Health Organization (WHO) measles surveillance data report a reduction in cases of measles globally from 67,524 cases in 2015 to 16,846 in 2016, and a reduction in deaths from 546,800 to 114,900 during period of 2000-14. Pakistan is among the five nations where almost a million children did not receive their first dose of measles vaccination, and outbreaks of the disease resulted in 4386 cases in 2011, 14,687 cases in 2012 with 310 deaths. In 2013, about 25,401 cases of measles were reported and 321 affected children died. The measles vaccination coverage is very low in Pakistan for both 1st dose and booster dose. To prevent outbreaks of measles in Pakistan a national vaccination program should be launched side by side with a polio eradication program in each district and township and a campaign should be launched to educate parents on measles vaccination for childrens to reduce the measles case fatality rate.
    Matched MeSH terms: Pakistan/epidemiology
  14. Alvi Q, Baloch GM, Chinna K, Dabbagh A
    F1000Res, 2020;9:901.
    PMID: 32802322 DOI: 10.12688/f1000research.24866.1
    Ovarian cancer is a fatal gynaecological cancer and eighth most common cancer in women globally. Lifestyle, reproductive and sociodemographic factors are among the influential parameters that may significantly affect the risk of ovarian cancer and its mortality rate. However, the epidemiological investigations have shown that the risk of ovarian cancers associated with these factors is different in varied geographical distributions. Lifestyle and reproductive factors have not been investigated thoroughly across a wide cultural diversity. The objective of this study is to investigate the association of these factors with ovarian cancer in Pakistan. This investigation will focus on the lifestyle effects of fat intake, intake of tea, habitual exercise, use of talc, personal hygiene, habit of holding urine for long time, obesity on ovarian cancer among Pakistani women.  Reproductive variables will include age at menarche, natural menopausal age, parity, nulliparity (miscarriages, abortion, stillbirths), infertility, fertility treatment, tubal ligation, oral contraceptive use, and family history of breast or ovarian cancer. Sociodemographic variables will include effect of age, income, education, and geographical location. A case-control study will be conducted in the major cancer hospitals of Pakistan and the patients will also be interviewed. The controls will be recruited outside the hospital. For controls the same age limit and residency requirements will be applied. The information gained from this research will be an important contribution to develop programs for health promotion, with a focus on ovarian cancer prevention and women's health. The findings could be used for health policies and planning to prevent ovarian cancer. The research will pave the way for a public policy and interventions to reduce the burden of ovarian cancer in Pakistan.
    Matched MeSH terms: Pakistan/epidemiology
  15. Munawar K, Choudhry FR, Hadi MA, Khan TM
    Subst Use Misuse, 2020;55(5):752-762.
    PMID: 31852359 DOI: 10.1080/10826084.2019.1701036
    Background: Although glue sniffing has been linked with significant morbidity and mortality, it is still under-researched and poorly recognized issue globally. Objective: A scoping review was performed to identify the factors and outcomes related to glue sniffing in India, Pakistan, Nepal and Bangladesh. Methods: Ten databases; Medline via Ovid, Google scholar, EBSCOhost (CINAHL Plus), ProQuest Central, PsycInfo, IndMED, Ovid Embase, Scopus, PubMed, and Science Direct were searched from their inception to January 2019 for both qualitative and quantitative studies examining any aspect of glue-sniffing. Studies published only in English language were included. Prevalence of glue-sniffing in SAARC region was the primary outcome measure. Findings: Of 8951studies screened, 344 were assessed for eligibility and 31 studies were included. The majority of the studies were conducted in India (15) and Pakistan (11). Meta-analysis of proportion, using random effects model, for both primary and secondary outcomes found that the highest incidence of glue sniffing was 57% (0.57, CI 95% 0.49-0.66) in India. The overall incidence of tobacco and naswar (snuff) as was 83% (0.83, 95% CI 0.80-0.86). Conclusions: The prevalence of glue sniffing, especially among street children, is alarmingly high and presents a challenge for health and social services for countries in SAARC region. More research work is required to examine long term impact of glue sniffing on physical and mental health.
    Matched MeSH terms: Pakistan/epidemiology
  16. Rasool MF, Rehman AU, Imran I, Abbas S, Shah S, Abbas G, et al.
    Front Public Health, 2020;8:531038.
    PMID: 33330300 DOI: 10.3389/fpubh.2020.531038
    Introduction: Medication error is unintentional and can be reduced by reducing the risk factors. Patients suffering from chronic diseases are at an increased risk of medication errors. Objective: This work aims to assess the risk factors associated with medication errors among patients suffering from chronic disorders in hospitals of South Punjab, Pakistan. Methodology: Multiple logistic regression analysis was used to assess the impact of different risk factors on the prevalence of medication errors in patients suffering from chronic diseases. Results: A greater risk for the occurrence of medication errors was associated with age ≥60 years (odds ratio, OR = 1.9; 95% CI = 1.3-3.1; p = 0.001), overburdened healthcare system (OR = 2.2; 95% CI = 1.64-3.56; p < 0.000), number of prescribed drugs ≥5 (OR = 1.74; 95% CI = 1.02-2.64; p < 0.000), comorbidities (OR = 2.6; 95% CI = 1.72-3.6; p = 0.003), Charlson comorbidity index (OR = 1.31; 95% CI = 0.49-1.84; p = 0.004), and multiple prescribers to one patient (OR = 1.12; 95% CI = 0.64-1.76; p = 0.001). Conclusion: Older age, overburdened healthcare system, number of prescribed drugs, comorbidities, Charlson comorbidity index, and multiple prescribers to one patient are significant risk factors for the occurrence of medication errors.
    Matched MeSH terms: Pakistan/epidemiology
  17. Mahmood H, Habib M, Aslam W, Khursheed S, Fatima S, Aziz S, et al.
    BMC Res Notes, 2021 Sep 10;14(1):354.
    PMID: 34507605 DOI: 10.1186/s13104-021-05768-5
    OBJECTIVE: Diffuse Large B Cell Lymphoma (DLBCL) is the most common type of Non-Hodgkin Lymphoma (NHL). The aim of this study was to assess the clinico pathological characteristics of DLBCL specifically, among the affected individuals residing in Northern areas of Pakistan who had not been previously included in major lymphoma studies due to their remote location.

    RESULTS: Mean age of the patients was 49.7 years. Male: female ratio was 1.5:1. Primary site was lymph node in 99 (71.74%) patients, out of which, 36 (26.09%) patients had B symptoms and 19 (13.77%) patients had stage IV disease. 39 (28.26%) patients had primary extra nodal involvement, 4 (2.90%) patients had B symptoms and 3 (2.17%) had stage IV disease. Extra nodal sites involved in primary extra nodal DLBCL were gastrointestinal tract (GIT) 19 (48.72%), tonsils 6 (15.38%), spine 4 (10.26%), soft tissue swelling 3 (7.69%), parotid gland 2 (5.13%), thyroid 2 (5.13%) central nervous system (CNS) 1 (2.56), breast 1 (2.56%) and bone marrow 1 (2.56%). Our study revealed increased percentage of patients with nodal DLBCL in stage IV and with B symptoms. Few patients with primary extra nodal DLBCL had B symptoms and stage IV disease at presentation. GIT was the most common site of involvement in primary extra nodal DLBCL.

    Matched MeSH terms: Pakistan/epidemiology
  18. Tanveer M, Ahmed A, Siddiqui A, Rehman IU, Hashmi FK
    Public Health, 2021 09;198:e15-e16.
    PMID: 34187703 DOI: 10.1016/j.puhe.2021.05.019
    Matched MeSH terms: Pakistan/epidemiology
  19. Ullah S, Daud H, Dass SC, Fanaee-T H, Kausarian H, Khalil A
    PMID: 32098247 DOI: 10.3390/ijerph17041413
    The number of tuberculosis (TB) cases in Pakistan ranks fifth in the world. The National TB Control Program (NTP) has recently reported more than 462,920 TB patients in Khyber Pakhtunkhwa province, Pakistan from 2002 to 2017. This study aims to identify spatial and space-time clusters of TB cases in Khyber Pakhtunkhwa province Pakistan during 2015-2019 to design effective interventions. The spatial and space-time cluster analyses were conducted at the district-level based on the reported TB cases from January 2015 to April 2019 using space-time scan statistics (SaTScan). The most likely spatial and space-time clusters were detected in the northern rural part of the province. Additionally, two districts in the west were detected as the secondary space-time clusters. The most likely space-time cluster shows a tendency of spread toward the neighboring districts in the central part, and the most likely spatial cluster shows a tendency of spread toward the neighboring districts in the south. Most of the space-time clusters were detected at the start of the study period 2015-2016. The potential TB clusters in the remote rural part might be associated to the dry-cool climate and lack of access to the healthcare centers in the remote areas.
    Matched MeSH terms: Pakistan/epidemiology
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