Displaying publications 41 - 60 of 452 in total

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  1. Qureshi A, Syed Sulaiman SA, Rehman W, Mehmood A, Idrees S, Kumar N
    PLoS One, 2023;18(5):e0285736.
    PMID: 37220099 DOI: 10.1371/journal.pone.0285736
    BACKGROUND: The response to the vaccine may vary among individuals. Hence, it is important to know how often individuals experience side effects after immunization against COVID-19.

    OBJECTIVE: This study aimed to assess the incidence of side effects following COVID-19 vaccination across different vaccine recipients in Southern Pakistan and identify the potential factors associated with these side effects in the population.

    METHODS: The survey was conducted across Pakistan through Google-forms Links from August to October 2021. The questionnaire included demographic information and COVID-19 vaccine information. Chi-square (x2) was performed for comparative analysis to check the significance level with P <0.05. The final analysis included 507 participants who had received COVID-19 vaccines.

    RESULTS: Of the total 507 COVID-19 vaccines recipients, 24.9% received CoronaVac, 36.5% received BBIBP-CorV, 14.2% received BNT162b2, 13.8% received AZD1222, and 10.7% received mRNA-1273. The most prominent side effects after the first dose were fever, weakness, lethargy, and pain at the site of injection. Moreover, the most commonly reported side effects after the second dose were pain at the injection site, headache, body ache, lethargy, fever, chills, flu-like symptoms, and diarrhea.

    CONCLUSION: Our results suggested that the side effects due to COVID-19 vaccination can vary between the first and second doses and type of COVID-19 vaccine. Our findings suggest continuing monitoring of vaccine safety and the importance of individualized risk-benefit assessment for COVID-19 immunization.

    Matched MeSH terms: Pakistan
  2. Mustafa ZU, Maqbool F, Wahid M, Salman M, Haroon S, Khan YH, et al.
    Rev Soc Bras Med Trop, 2023;56:e0044.
    PMID: 37283345 DOI: 10.1590/0037-8682-0044-2023
    BACKGROUND: Safety and efficacy concerns regarding coronavirus disease 2019 (COVID-19) vaccines are common among the public and have a negative impact on their uptake. We aimed to report the adverse effects currently associated with the vaccine in Pakistan to build confidence among the population for its adoption.

    METHODS: A cross-sectional study was conducted in five districts of the Punjab province of Pakistan between January and March 2022. The participants were recruited using convenience sampling. All data were analyzed using SPSS 22.

    RESULTS: We recruited 1622 people with the majority aged between 25-45 years. Of these, 51% were female, including 27 pregnant women and 42 lactating mothers. Most participants had received the Sinopharm (62.6%) or Sinovac (17.8%) vaccines. The incidences of at least one side effect after the first (N = 1622), second (N = 1484), and booster doses (N = 219) of the COVID-19 vaccine were 16.5%, 20.1%, and 32%, respectively. Inflammation/erythema at the injection site, pain at the injection site, fever, and bone/muscle pain were common side effects of vaccination. No significant differences were observed in the adverse effect scores between all demographic variables except for pregnancy (P = 0.012) after the initial dose. No significant association was observed between any variable and the side effect scores of the second and booster doses of the vaccine.

    CONCLUSIONS: Our study showed a 16-32% prevalence of self-reported side effects after the first, second, and booster COVID-19 vaccinations. Most adverse effects were mild and transient, indicating the safety of different COVID-19 vaccines.

    Matched MeSH terms: Pakistan/epidemiology
  3. Iqbal S, Ashfaq T, Azlan Bin Taib C, Rizal Razalli M
    PLoS One, 2023;18(4):e0283679.
    PMID: 37053303 DOI: 10.1371/journal.pone.0283679
    This study aims to differentiate between perceived quality culture (QC) and service quality (SQ) in public and private universities; and to examine the effect of QC on SQ in both types of universities, individually and collectively. This is a quantitative study in which data are collected from administrative and quality managers of randomly selected universities in Pakistan through face-to-face and online surveys. Of the 150 questionnaires distributed, a total of 111 questionnaires are received, of which 105 are valid, giving a response rate of 70%. The collected data are then analyzed by descriptive and causal research methods using SPSS-25 and PLS-SEM. The findings reveal significant differences in perceived QC and SQ between public and private universities; however, public universities scored higher on both variables than private universities. Furthermore, the results show the significant effect of QC on SQ individually and collectively in public and private universities; however, this relationship is stronger for private universities than for public universities. The findings of the study may help administrative and quality managers to improve SQ by cultivating QC in their respective universities, thereby improving organizational performance. This study extends theoretical knowledge by introducing QC as a predictor variable and then measuring SQ from a dual perspective (internal and external customers) in a university setting, which is less explored in the existing literature.
    Matched MeSH terms: Pakistan
  4. Bhutto MY, Khan MA, Sun C, Hashim S, Khan HT
    PLoS One, 2023;18(3):e0281527.
    PMID: 36961791 DOI: 10.1371/journal.pone.0281527
    Organic food has gained much importance due to consumers' rising environmental and health concerns. Purchase intention of organic food has been explored widely, but the repurchase intention of organic food has gained little attention among researchers. So, it has become important to explore repurchase intention among generation Z; a generation considered more educated and aware of rising environmental concerns. Generation Z is more tech-savvy and brand conscious, so its impact on repurchase intention through consumer satisfaction has been explored. The data in this paper was collected from 400 respondents through a structured questionnaire in Islamabad, Pakistan. We used the PLS-SEM approach for data analysis and results; we found that social media influence and brand purchase impact brand awareness and positively impact brand awareness on consumer satisfaction. Moreover, it is also found that consumer satisfaction positively impacts the repurchase intention of organic food. Our study found that Generation Z has a strong social media influence, so marketers' managers must consider and address the issues when consumers consider social media for their concerns and suggestion.
    Matched MeSH terms: Pakistan
  5. Adil SO, Musa KI, Uddin F, Shafique K, Khan A, Islam MA
    Front Endocrinol (Lausanne), 2023;14:1223424.
    PMID: 37876536 DOI: 10.3389/fendo.2023.1223424
    INTRODUCTION: Anthropometric indices are affordable and non-invasive methods for screening metabolic syndrome (MetS). However, determining the most effective index for screening can be challenging.

    OBJECTIVE: To investigate the accuracy of anthropometric indices as a screening tool for predicting MetS among apparently healthy individuals in Karachi, Pakistan.

    METHODS: A community-based cross-sectional survey was conducted in Karachi, Pakistan, from February 2022 to August 2022. A total of 1,065 apparently healthy individuals aged 25 years and above were included. MetS was diagnosed using International Diabetes Federation guidelines. Anthropometric indices were defined based on body mass index (BMI), neck circumference (NC), mid-upper arm circumference (MUAC), waist circumference (WC), waist to height ratio (WHtR), conicity index, reciprocal ponderal index (RPI), body shape index (BSI), and visceral adiposity index (VAI). The analysis involved the utilization of Pearson's correlation test and independent t-test to examine inferential statistics. The receiver operating characteristic (ROC) analysis was also applied to evaluate the predictive capacities of various anthropometric indices regarding metabolic risk factors. Moreover, the area under the curve (AUC) was computed, and the chosen anthropometric indices' optimal cutoff values were determined.

    RESULTS: All anthropometric indices, except for RPI in males and BSI in females, were significantly higher in MetS than those without MetS. VAI [AUC 0.820 (95% CI 0.78-0.86)], WC [AUC 0.751 (95% CI 0.72-0.79)], WHtR [AUC 0.732 (95% CI 0.69-0.77)], and BMI [AUC 0.708 (95% CI 0.66-0.75)] had significantly higher AUC for predicting MetS in males, whereas VAI [AUC 0.693 (95% CI 0.64-0.75)], WHtR [AUC 0.649 (95% CI 0.59-0.70)], WC [AUC 0.646 (95% CI 0.59-0.61)], BMI [AUC 0.641 (95% CI 0.59-0.69)], and MUAC [AUC 0.626 (95% CI 0.57-0.68)] had significantly higher AUC for predicting MetS in females. The AUC of NC for males was 0.656 (95% CI 0.61-0.70), while that for females was 0.580 (95% CI 0.52-0.64). The optimal cutoff points for all anthropometric indices exhibited a high degree of sensitivity and specificity in predicting the onset of MetS.

    CONCLUSION: BMI, WC, WHtR, and VAI were the most important anthropometric predictors for MetS in apparently healthy individuals of Pakistan, while BSI was found to be the weakest indicator.

    Matched MeSH terms: Pakistan/epidemiology
  6. Rehman IU, Khan TM, Bukhsh A, Munawar K, Suleiman AK, Ming LC, et al.
    J Pediatr Nurs, 2023;72:e179-e186.
    PMID: 37414623 DOI: 10.1016/j.pedn.2023.06.026
    BACKGROUND: Thalassemia is a persistent hemolytic disease and has debilitating effects on patients and their parents. Parents of these children experience pain and suffer from additional emotional strain as they provide daily and lifetime care and are mostly concerned about the health and future of their children.

    AIM: The study aimed to understand the experiences of parents of children with thalassemia related to their family, financial, social, treatment, and psychological issues in Pakistan.

    METHODS: This descriptive phenomenological study recruited 21 parents of children with thalassemia through purposive sampling until data saturation was achieved. Analysis of transcribed interviews was performed through Colaizzi's method and themes and subthemes revolving around diagnosis, challenges, and treatment issues were extracted.

    FINDINGS: A total of 21 Pakistani parents participated in this study. Most of the participants were females (n = 16, 76.19%), housewives/stay-at-home moms (n = 13 (61.90%), and were uneducated (n = 6, 28.57%). Regarding genetic traits, only three (14.28%) parents declared that they had genetic traits of thalassemia. The findings of our study revealed that thalassemia is enormously influenced by psychosocial and economic problems because of this disease in their families.

    CONCLUSION: Our findings indicated that parents of these children face multi-faceted challenges, such as physical, socio-emotional, financial, and familial. These findings may lead to an adequate understanding of their individual needs and efficient utilization of supportive and care programs.

    PRACTICE IMPLICATIONS: An understanding of such experiences, involving those distinctive to Pakistani culture, is especially vital to inform the care of these children and enhance their quality of life.

    Matched MeSH terms: Pakistan/epidemiology
  7. Raza A, Jauhar J, Abdul Rahim NF, Memon U, Matloob S
    PLoS One, 2023;18(10):e0288527.
    PMID: 37796908 DOI: 10.1371/journal.pone.0288527
    In Pakistan, women outnumber men in medical colleges with 80 percent enrollment, yet many fail to practice medicine following graduation. Pakistan Medical Council (PMC) states 50 percent of graduated women doctors either did not practice or left employment in a short period. Thus, the non-servicing women doctors are assumed as the one of the major causes for the overall doctors' shortage in the country. Addressing this enduring matter, this study aims to explore and understand the factors that discourage women doctors from practicing medicine in Pakistani hospitals. The study employed qualitative exploratory inquiry with an interpretive paradigm to attain a deeper understanding of the problem. 59-semi structured interviews were conducted by non-working women doctors across the entirety of Pakistan. The narratives were then analyzed by thematic analysis using ATLAS.ti 22. The findings have resulted in the three major themes, i.e., workplace challenges, socio-cultural obstructions, and familial restrictions that possibly obstruct women from practicing medicine in hospitals. The findings suggested that accepting traditional cultural values, including entrenched gender roles in society, deters women from practicing medicine. The prevailing patriarchal societal system includes stereotypes against working women; early marriages hinder women from practicing medicine. The prevailing societal system upholds the influence of in-laws and a husband for women doctor professional employment. As a result, severe work-life conflict was reported where most women doctors ended up in their profession in the middle of struggling between socially rooted gender roles as homemakers and their professional careers-furthermore, the study found various workplace issues that posit an additional burden on already struggling women doctors. Issues include poor recruitment and selection process, transfer constraints, excessive workload with inadequate salary, harassment, gender discrimination, unsafe work environment, and little support from the administration highly contribute to the shortage of women doctors in Pakistan.
    Matched MeSH terms: Pakistan
  8. Kayani UN, Aysan AF, Gul A, Haider SA, Ahmad S
    PLoS One, 2023;18(10):e0291261.
    PMID: 37819995 DOI: 10.1371/journal.pone.0291261
    Maintaining a stable exchange rate is a challenging task for the world, especially for developing economies. This study examines the impact of asymmetric exchange rates on trade flows in selected Asian countries and finds that the effects of increased exchange rate volatility on exports and imports differ among Pakistan, Malaysia, Japan, and Korea. The quarterly data from the period 1980 to 2018 is collected from the International Financial Statistics (IFS) database maintained by the International Monetary Fund (IMF). We employ both linear and non-linear Autoregressive Distributed Lag (ARDL) models for estimation. The non-linear models yielded more significant findings, while the linear models did not indicate any significant effects of exchange rate volatility on trade flows. The results of the study suggest that in the case of Pakistan, both the linear and non-linear models indicate that increased exchange rate volatility adversely affects exports and imports, while decreased volatility enhances both. This implies that stabilizing the exchange rate would be beneficial for Pakistan's trade. In contrast, the linear model applied to Malaysia shows no long-run effects of exchange rate volatility on exports. However, the result suggests that decreased volatility stimulates Malaysia's exports. Therefore, in the case of Malaysia, stabilizing the exchange rate could contribute to boosting exports. We also found that increased exchange rate volatility boosts exports of Japan. On the other hand, decreased volatility hurts exports of Japan. As for the long-run effects of exchange rate volatility on imports, we found that increased volatility boosts imports of Korea. The study provides various policy implications regarding the impact of exchange rate volatility on trade flows in developing economies. The study highlights the importance of country-specific considerations in understanding the impact of exchange rate volatility on trade flows, and has important policy implications for promoting trade and economic growth in these nations. It emphasizes the need to model exchange rate volatility separately for developed and developing countries and to continue research and analysis to identify ways to mitigate its negative effects on the economy.
    Matched MeSH terms: Pakistan
  9. Tahir MJ, Zaman M, Saffi J, Asghar MS, Tariq W, Ahmed F, et al.
    Front Public Health, 2023;11:1151936.
    PMID: 37333546 DOI: 10.3389/fpubh.2023.1151936
    Typhoid fever, a common enteric disease in Pakistan, caused by Salmonella typhi, is becoming an extended drug-resistant organism and is preventable through the typhoid conjugate vaccine (TCV). Public adherence to preventive measures is influenced by knowledge and attitude toward the vaccine. This study investigates the knowledge, attitudes, and practices of the general population of Pakistan toward TCV. The differences in mean scores and factors associated with typhoid conjugate vaccine knowledge, attitudes, and practices were investigated. A total of 918 responses were received with a mean age of 25.9 ± 9.6, 51% were women, and 59.6% had graduation-level education. The majority of them responded that vaccines prevent illness (85.3%) and decrease mortality and disability (92.6%), and typhoid could be prevented by vaccination (86.7%). In total, 77.7 and 80.8% considered TCV safe and effective, respectively. Of 389 participants with children, 53.47% had vaccinated children, according to the extended program on immunization (EPI). Higher family income has a higher odds ratio (OR) for willingness toward booster dose of TCV [crude odds ratio (COR) = 4.920, p-value <0.01; adjusted odds ratio (aOR) = 2.853, value of p <0.001], and negative attitude regarding the protective effect of TCV has less willingness toward the booster dose with statistical significance (COR = 0.388, value of p = 0.017; aOR = 0.198, value of p = 0.011). The general population of Pakistan had a good level of knowledge about the benefits of TCV, and attitude and practices are in favor of the usage of TCV. However, a few religious misconceptions are prevalent in public requiring the efforts to overcome them to promote the usage of vaccines to prevent the disease and antibiotic resistance.
    Matched MeSH terms: Pakistan
  10. Tharwani ZH, Bilal W, Khan HA, Kumar P, Butt MS, Hamdana AH, et al.
    Inquiry, 2023;60:469580231167024.
    PMID: 37085986 DOI: 10.1177/00469580231167024
    Over the years, several developing countries have been suffering from high infant and child mortality rates, however, according to the recent statistics, Pakistan falls high on the list. Our narrative review of copious research on this topic highlights that several factors, such as complications associated with premature births, high prevalence of birth defects, lack of vaccination, unsafe deliveries, poor breastfeeding practices, complications during delivery, sudden infant death syndrome (SIDS), poor socioeconomic conditions, and a struggling healthcare system, have influenced these rates. Bearing in mind the urgency of addressing the increased infant and child mortality rate in Pakistan, multiple steps must be taken in order to prevent unnecessary deaths. An effective initiative could be spreading awareness and education among women, as a lack of education among women has been indirectly linked to increased child mortality in Pakistan across many researches conducted on the issue. Furthermore, the government should invest in healthcare by hiring more physicians and providing better supplies and improving infrastructure, especially in underdeveloped areas, to decrease child mortality due to lack of clean water and poor hygiene. Lastly, telemedicine should be made common in order to provide easy access to women who cannot visit the hospital.
    Matched MeSH terms: Pakistan/epidemiology
  11. Hayat M, Ahmad N, Mohkumuddin S, Ali Khan SL, Khan AH, Haq NU, et al.
    PLoS One, 2023;18(4):e0284439.
    PMID: 37058504 DOI: 10.1371/journal.pone.0284439
    BACKGROUND: Drug therapy problems (DTPs) are common among patients suffering from chronic kidney disease (CKD). However, there is a lack of information about DTPs and its predictors among CKD patients from Pakistan.

    OBJECTIVES: To evaluate the frequency, type and predictors of various types of DTPs among CKD patients at a tertiary-care hospital in Pakistan.

    METHODOLOGY: This was a cross-sectional study carried out at Sandeman Provincial Hospital, Quetta between 1-11-2020 and 31-1-2021. It included 303 non-dialysis ambulatory patients of CKD-stage 3 and above. Cipolle et al., criterion was used for classifying the DTPs and a clinician at the study site checked the identified DTPs for accuracy. Data were analyzed by SPSS 23. Multivariate analysis was conducted to find the predictors of individual types of DTPs. A p-value <0.05 was considered statistically significant.

    RESULTS: The patients received a total of 2265 drugs with a median of eight drugs per patient (range: 3-15 drugs). A total of 576 DTPs were identified among 86.1% patients with a median of two DTPs (interquartile range 1-3) per patient. Dosage too high (53.5%) was the most common DTP followed by adverse drug reactions (ADRs) (50.5%) and need of additional drug therapy (37.6%). In multivariate analysis, patients' age of >40 years emerged as a predictor of unnecessary drug therapy and dosage too high. The odds of needing a different drug product was significantly high in patients with cardiovascular diseases (CVD) and diabetes mellitus (DM). The dosage too low had significant association with CVD. The risk of ADRs was significantly high in elderly patients (>60 years) and those with CVD. The presence of hypertension, DM and CKD stage-5 emerged as predictors of dosage too high.

    CONCLUSION: This study revealed a high prevalence of DTPs among CKD patients. Targeted interventions in high risk patients may reduce the frequency of DTPs at the study site.

    Matched MeSH terms: Pakistan/epidemiology
  12. Rafiq M, Farrukh M, Attiq S, Shahzad F, Khan I
    Work, 2023;75(3):877-886.
    PMID: 36683474 DOI: 10.3233/WOR-211363
    BACKGROUND: The demand for innovation and satisfaction is increasing rapidly due to technological advancement and the fast-changing business environment.

    OBJECTIVE: The purpose of this article is to investigate how job crafting augments work outputs (i.e., innovation performance and career satisfaction) through work engagement.

    METHODS: Data were collected from 477 workers working in the Pakistan manufacturing sector. A structural equation modeling technique was used to investigate the mediation model.

    RESULTS: Job crafting has a direct and indirect association with innovation performance and career satisfaction - via employees' work engagement. Additionally, the mediating impact was stronger for innovation performance than for career satisfaction. The findings advocate that managers should pay attention to employees' job crafting to improve employees' work engagement in manufacturing organizations. To improve employees' innovation performance and career satisfaction via work engagement, it is important to improve organization-wide job crafting in traditional manufacturing organizations. Strategic and managerial actions related to job crafting might boost employees' engagement in the organization that environments provide incessantly better outcomes.

    CONCLUSION: By linking job crafting and work engagement to their attitude towards career satisfaction and innovation performance in Pakistani manufacturing firms, this study adds a new dimension to the study of Pakistani manufacturing employees and typically to the best practices in career debates. This knowledge is important and unique because it accentuates that in addition to work engagement, which focuses primarily on employee growth in the organization, job crafting should also be given equal importance to advance manufacturing employees' outcomes.

    Matched MeSH terms: Pakistan
  13. Massud A, Khan AH, Syed Sulaiman SA, Ahmad N, Shafqat M, Ming LC
    PLoS One, 2023;18(8):e0287966.
    PMID: 37561810 DOI: 10.1371/journal.pone.0287966
    INTRODUCTION: Tuberculosis (TB), a curable and preventable infectious disease, becomes difficult to treat if resistance against most effective and tolerable first line anti-TB drugs is developed. The objective of the present study was to evaluate the treatment outcomes and predictors of poor outcomes among drug-resistant tuberculosis (DR-TB) patients treated at a programmatic management unit of drug resistant tuberculosis (PMDT) unit, Punjab, Pakistan.

    METHODS: This prospective observational study was conducted at a a PMDT unit in Multan, Punjab, Pakistan. A total of 271 eligible culture positive DR-TB patients enrolled for treatment at the study site between January 2016 and May 2017 were followed till their treatment outcomes were recorded. World Health Organization's (WHO) defined criteria was used for categorizing treatment outcomes. The outcomes of cured and treatment completed were collectively placed as successful outcomes, while death, lost to follow-up (LTFU) and treatment failure were grouped as unsuccessful outcomes. Multivariable binary logistic regression analysis was employed for getting predictors of unsuccessful treatment outcomes. A p-value <0.05 was considered statistically significant.

    RESULTS: Of the 271 DR-TB patients analysed, nearly half (51.3%) were males. The patient's (Mean ± SD) age was 36.75 ± 15.69 years. A total of 69% patients achieved successful outcomes with 185 (68.2%) patients being cured and 2 (0.7%) completed therapy. Of the remaining 84 patients with unsuccessful outcomes, 48 (17.7%) died, 2 (0.7%) were declared treatment failure, 34 (12.5%) were loss to follow up. After adjusting for confounders, patients' age > 50 years (OR 2.149 (1.005-4.592) with p-value 0.048 and baseline lung cavitation (OR 7.798 (3.82-15.919) with p-value <0.001 were significantly associated with unsuccessful treatment outcomes.

    CONCLUSIONS: The treatment success rate (69%) in the current study participants was below the target set by WHO (>75%). Paying special attention and timely intervention in patients with high risk of unsuccessful treatment outcomes may help in improving treatment outcomes at the study site.

    Matched MeSH terms: Pakistan/epidemiology
  14. Jamil H, Idrees M, Idrees K, Tariq W, Sayyeda Q, Asghar MS, et al.
    PLoS One, 2023;18(8):e0279952.
    PMID: 37561764 DOI: 10.1371/journal.pone.0279952
    BACKGROUND: Monkeypox (mpox), re-emerging zoonotic infectious disease, is striking the world with serious public health concerns, especially in non-endemic countries. The public's knowledge and attitude towards the monkeypox virus (MPXV) influence their adherence to preventive strategies. Therefore, we aimed to assess the public's knowledge, attitudes, and perceptions (KAP) of MPXV in Pakistan.

    METHODS: We collected data for this cross-sectional study from 1040 participants via online self-reported questionnaire from July 5th, 2022, to August 1st, 2022. The questionnaire consisted of a total of 29 items in four sections, assessing socio-demographics, knowledge, attitudes, and practices regarding MPXV. The data were analyzed using IBM SPSS V.25, and factors associated with MPXV knowledge, attitude, and practices were identified by using logistic regression analyses.

    RESULTS: A total of 1040 participants were included. 61.4% were male, and 57.2% had graduation level education. Only 34.4% had good knowledge about MPXV, and 30% knew the effectiveness of the smallpox vaccine against MPXV. 41.7% had a positive attitude, 48.6% agreed that it is a fatal disease, and 44.6% were in favour of banning travel from endemic to non-endemic regions. 57.7% had good practices, and 69.9% would use protective measures if MPXV became an epidemic. Binary logistic regression analysis revealed that gender and education significantly impacted knowledge (p<0.05). While monthly income status had a significant impact on attitudes (p<0.05). The practices were positively correlated with gender and education (p<0.05).

    CONCLUSION: The majority of study participants had inadequate levels of knowledge, and attitudes regarding MPXV. To prevent the emergence and spread of MPXV in Pakistan, a comprehensive strategic framework for public health education must be established and implemented.

    Matched MeSH terms: Pakistan
  15. Siddiqui MB, Ng CW, Low WY, Abid K
    PLoS One, 2023;18(12):e0278149.
    PMID: 38109305 DOI: 10.1371/journal.pone.0278149
    The majority (40%) of the world's under-five mortality burden is concentrated in nations like Nigeria (16.5%), India (16%), Pakistan (8%), and the Democratic Republic of the Congo (6%), where an undetermined number of under-five deaths go unrecorded. In low-resource settings throughout the world, the Verbal Autopsy-Social Autopsy (VASA) technique may assist assess under-five mortality estimates, assigning medical and social causes of death, and identifying relevant determinants. Uncertainty regarding missing data in high-burden nations like Pakistan necessitates a valid and reliable VASA instrument. This is the first study to validate Child Health Epidemiology Reference Group-CHERG's VASA tool globally. In Pakistan, data from such a valid and reliable tool is vital for policy. This paper reports on the VASA tool in Karachi, Pakistan. Validity and reliability of the CHERG VASA tool were tested using face, content, discriminant validation, and reliability tests on one hundred randomly selected mothers who had recently experienced an under-five child death event. Data were computed on SPSS (version-21) and R software. Testing revealed high Item-content Validity Index (I-CVI) (>81.43%); high Cronbach's Alpha (0.843); the accuracy of between 75-100% of the discriminants classifying births to live and stillbirths; and I-CVI (>82.07% and 88.98% respectively) with high accuracy (92% and 97% respectively) for assigning biological and social causes of child deaths, respectively. The CHERG VASA questionnaire was found relevant to the conceptual framework and valid in Pakistan. This valid tool can assign accurate medical and non-medical causes of child mortality cases occurring in Pakistan.
    Matched MeSH terms: Pakistan/epidemiology
  16. Shukar S, Zahoor F, Omer S, Awan SE, Yang C, Fang Y
    Int J Environ Res Public Health, 2022 Dec 06;19(23).
    PMID: 36498446 DOI: 10.3390/ijerph192316373
    This study aimed to examine the current situation of anti-cancer drug shortages in Pakistan, namely its determinants, impacts, adopted mitigation strategies, and proposed solutions. Qualitative semi-structured, in-depth interviews were conducted with 25 pharmacists in oncology hospitals in Pakistan from August to October 2021. Data were collected in person and online, recorded, and subjected to inductive thematic analysis after being transcribed verbatim. Most participants experienced anti-cancer drug shortages that increased during the pandemic. Etoposide, paclitaxel, vincristine, dacarbazine, and methotrexate were frequently short. Important causes included the compromised role of regulatory authorities, lack of local production, and inventory mismanagement. The impacts were delayed/suboptimal treatment and out-of-pocket costs for patients, patients' prioritization, increased workload, negative work environment, and patients' trust issues for pharmacists. The participants proposed that a cautious regulator's role is needed to revise policies for all stakeholders and support all stakeholders financially at their level to increase access to these medicines. Based on the outcomes, it is clear that anti-cancer medicine shortages are a current issue in Pakistan. Governmental authorities need to play a role in revising policies for all levels of the drug supply chain and promoting local production of these drugs. Stakeholders should also collaborate and manage inventory.
    Matched MeSH terms: Pakistan
  17. Jamil H, Din MFU, Tahir MJ, Saqlain M, Hassan Z, Khan MA, et al.
    PLoS Negl Trop Dis, 2022 Dec;16(12):e0010988.
    PMID: 36480553 DOI: 10.1371/journal.pntd.0010988
    BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF) continues to pose a serious threat to the fragile healthcare system of Pakistan with a continuous increase of morbidity and mortality. The present study aimed to assess the knowledge, attitudes, and practices regarding CCHF among general people who resided in Pakistan.

    METHODS: An online cross-sectional survey design was applied, and a convenience sampling technique was used to recruit 1039 adult people from Pakistan. Data were collected from September 08 to October 12, 2021. The questionnaire consisted of a total of 32 questions in four parts assessing socio-demographics, as well as knowledge, attitudes, and practices regarding CCHF. All statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS), and logistic regression analyses were performed to determine the factors associated with good knowledge, positive attitudes, and good practices.

    RESULTS: Alarmingly, 51.5% of participants heard about CCHF infection before administering the survey. Among these, 20.2%, 33.3%, and 48.2% of the study participants had demonstrated good knowledge, positive attitudes, and good practices, respectively. Binary logistic regression analysis revealed that education and income status had a significant impact on knowledge and attitudes (p<0.05). Similarly, the mean attitude scores differed significantly by age, education, and income status (p<0.05).

    CONCLUSIONS: The findings reflected inadequate levels of knowledge, attitudes, and practices regarding CCHF among general people in Pakistan which may regard as lower than expected. As CCHF is a highly contagious disease, it's urgent to initiate a comprehensive approach to handle the situation before it spreads further in Pakistan.

    Matched MeSH terms: Pakistan/epidemiology
  18. Mustafa ZU, Bashir S, Shahid A, Raees I, Salman M, Merchant HA, et al.
    Viruses, 2022 Oct 25;14(11).
    PMID: 36366442 DOI: 10.3390/v14112344
    This study aimed to assess the vaccination status and factors contributing to vaccine hesitancy among pregnant women in the largest province of Pakistan. A multicentric, prospective, survey-based study using an interviewer-administered tool was conducted among pregnant women attending antenatal clinics between 1 December 2021 through 30 January 2022 across seven hospitals in Pakistan. The healthcare professionals providing care at the participating hospitals administered the survey. Four hundred and five pregnant women fully consented and completed the study. The majority of the study participants (70.6%, n = 286) were aged between 25 and 34 and had a previous successful pregnancy history. More than half of the study participants (56.0%, n = 227) did not receive COVID-19 vaccination at the time of data collection despite their family members (93.9%, n = 372) had already received at least one dose of COVID-19 vaccine. Among those who received COVID-19 vaccination (n = 173), vaccine efficacy, protection for the foetus, and risk of COVID-19-associated hospitalisation were the main driving factors for vaccine hesitancy. The majority of the unvaccinated women (77.8%, n = 182) had no intention of receiving the vaccine. However, more than two-thirds (85.7%, n = 342) consulted the doctor about COVID-19 vaccines, and most were recommended to receive COVID-19 vaccines by the doctors (80.7%, n = 280). Women were significantly more likely to be vaccinated if they had employment (odds ratio [OR] 4.47, 95% confidence interval [CI]: 2.31-8.64) compared with their counterparts who were homemakers, consulted their doctors (OR 0.12, 95% CI: 0.04-0.35), and if they did not have pregnancy-related issues (OR 6.02, 95% CI: 2.36-15.33). In this study, vaccine hesitancy was prevalent, and vaccine uptake was low among pregnant women. Education and employment did impact COVID vaccination uptake, emphasising the need for more targeted efforts to enhance the trust in vaccines.
    Matched MeSH terms: Pakistan/epidemiology
  19. Mustafa ZU, Saleem MS, Ikram MN, Salman M, Butt SA, Khan S, et al.
    Pathog Glob Health, 2022 10;116(7):421-427.
    PMID: 34783630 DOI: 10.1080/20477724.2021.1999716
    There are reports of high rates of antibiotic prescribing among hospitalized patients with COVID-19 around the world. To date, however, there are few reports of prescribing in relation to COVID-19 in Pakistan. Herein, we describe a point prevalence survey of antibiotic prescribing amongst patients hospitalized with suspected or proven COVID-19 in Pakistan. A Point Prevalence Survey (PPS) was undertaken in seven tertiary care health facilities in Punjab Provence, Pakistan. Baseline information about antimicrobial use according to the World Health Organization (WHO) standardized methodology was collected on a single day between 5th and 30 April 2021. A total of 617 patients' records were reviewed and 578 (97.3%) were documented to be receiving an antibiotic on the day of the survey. The majority (84.9%) were COVID-19 PCR positive, 61.1% were male and 34.9% were age 36 to 44 years. One quarter presented with severe disease, and cardiovascular disease was the major comorbidity in 13%. Secondary bacterial infection or co-infection (bacterial infection concurrent with COVID-19) was identified in only 1.4%. On the day of the survey, a mean of 1.7 antibiotics was prescribed per patient and 85.4% antibiotics were recorded as being prescribed for 'prophylaxis'. The most frequently prescribed antibiotics were azithromycin (35.6%), ceftriaxone (32.9%) and meropenem (7.6%). The majority (96.3%) of the antibiotics were empirical and all were from WHO Watch or Reserve categories. Overall, a very high consumption of antibiotics in patients hospitalized with suspected or proven COVID-19 was observed in Pakistan and this is concerning in view of already high rates of antimicrobial resistance in the region. Antimicrobial stewardship programs need to urgently address unnecessary prescribing in the context of COVID-19 infection.
    Matched MeSH terms: Pakistan/epidemiology
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