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  1. Shah S, Abbas G, Riaz N, Anees Ur Rehman, Hanif M, Rasool MF
    Expert Rev Pharmacoecon Outcomes Res, 2020 Aug;20(4):343-354.
    PMID: 32530725 DOI: 10.1080/14737167.2020.1782196
    BACKGROUND: Communicable diseases such as AIDS/HIV, dengue fever, and malaria have a great burden and subsequent economic loss in the Asian region. The purpose of this article is to review the widespread burden of communicable diseases and related health-care burden for the patient in Asia and the Pacific.

    AREAS COVERED: In Central Asia, the number of new AIDS cases increased by 29%. It is more endemic in the poor population with variations in the cost of illness. Dengue is prevalent in more than 100 countries, including the Asia-Pacific region. In Southeast Asia, the annual economic burden of dengue fever was between $ 610 and $ 1,384 million, with a per capita cost of $ 1.06 to $ 2.41. Globally, 2.9 billion people are at risk of developing malaria, 90% of whom are residents of the Asia and Pacific region. The annual per capita cost of malaria control ranged from $ 0.11 to $ 39.06 and for elimination from $ 0.18 to $ 27.

    EXPERT OPINION: The cost of AIDS, dengue, and malaria varies from country to country due to different health-care systems. The literature review has shown that the cost of dengue disease and malaria is poorly documented.

  2. Aziz MM, Alboghdadly A, Rasool MF, Shaalan MS, Goresh HK, Najjar MF, et al.
    Heliyon, 2023 Dec;9(12):e23112.
    PMID: 38144360 DOI: 10.1016/j.heliyon.2023.e23112
    OBJECTIVES: This study aimed to assess compliance with legal requirements, safe medication storage and staffing standards in community pharmacies in Punjab, Pakistan.

    METHOD: We conducted a three-step cross-sectional study using observations, questionnaires and face-to-face interviews in 544 systematically-selected community pharmacies. We used descriptive statistic and one-way ANOVA to assess the data.

    RESULTS: Only 23 (4.2 %) pharmacies had accurate area and only 3.9 % had appropriate walls. In total, 23.3 % had glass-fronted shelves and 38.2 % had a glass door. More than half (53.8 %) had separate narcotics shelves and 43.0 % a separate shelf of expired medicines. Less than half (47.5 %) of the pharmacies were able to maintain hygiene. About 36.2 % of the pharmacies segregated different types of product. Drugs were protected from direct sunlight in most (61.3 %) pharmacies, but the refrigerator was working properly in less than half (43.4 %) and only a very small number (2.4 %) had an alternative power supply for the refrigerator. Only 37 (6.8 %) were able to maintain an appropriate room temperature. The vast majority (93.0 %) displayed a valid drug sale license, but a qualified person/pharmacist was only present in 4.8 %. The average number of employees was 4.2, and more than 71.0 % of staff had 10-12 years of formal education. Only 0.2 % of employees could explain term "PRN", although 57.3 % explained "IV" correctly. About 22.8 % replied correctly about the room temperature but the vast majority (97.6 %) did not know about cold chain temperature. The location of the pharmacy (p-value = 0.045) affected its performance.

    CONCLUSIONS: Noncompliance with legal requirements, unsafe drug storage and limited human resources reflect the poor enforcement of drug laws in Pakistan. The findings suggest that there is a need to strengthen inspection and management of community pharmacies.

  3. 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.
  4. Butt MD, Ong SC, Wahab MU, Rasool MF, Saleem F, Hashmi A, et al.
    Int J Environ Res Public Health, 2022 Oct 02;19(19).
    PMID: 36231911 DOI: 10.3390/ijerph191912611
    BACKGROUND: Diabetes is a major chronic illness that negatively influences individuals and society. Therefore, this research aimed to analyze and evaluate the cost associated with diabetes management, specific to the Pakistani Type 2 diabetes population. Research scheme and methods: A survey randomly collected information and data from diabetes patients throughout Pakistan out-patient clinics. Direct and indirect costs were evaluated, and data were analyzed with descriptive and inferential statistics.

    RESULTS: An overall of 1839 diabetes patients participated in the study. The results have shown that direct and indirect costs are positively associated with the participants' socio-demographic characteristics, except for household income and educational status. The annual total cost of diabetes care was USD 740.1, amongst which the share of the direct cost was USD 646.7, and the indirect cost was USD 93.65. Most direct costs comprised medicine (USD 274.5) and hospitalization (USD 319.7). In contrast, the productivity loss of the patients had the highest contribution to the indirect cost (USD 81.36).

    CONCLUSION: This study showed that direct costs significantly contributed to diabetes's overall cost in Pakistan and overall diabetes management estimated to be 1.67% (USD 24.42 billion) of the country's total gross domestic product. The expense of medications and hospitalization mostly drove the direct cost. Additionally, patients' loss of productivity contributed significantly to the indirect cost. It is high time for healthcare policymakers to address this huge healthcare burden. It is time to develop a thorough diabetes management plan to be implemented nationwide.

  5. Butt MD, Ong SC, Butt FZ, Sajjad A, Rasool MF, Imran I, et al.
    Int J Environ Res Public Health, 2022 Nov 18;19(22).
    PMID: 36429988 DOI: 10.3390/ijerph192215266
    BACKGROUND: Kidney failure is a global health problem with a worldwide mean prevalence rate of 13.4%. Kidney failure remains symptomless during most of the early stages until symptoms appear in the advanced stages. Kidney failure is associated with a decrease in health-related quality of life (HRQOL), deterioration in physical and mental health, and an increased risk of cardiovascular morbidity and mortality. This study aimed to evaluate the factors associated with decreased HRQOL and other factors affecting the overall health of patients. Another objective was to measure how medication adherence and depression could affect the overall HRQOL in patients with kidney failure.

    METHODOLOGY: The study used a prospective follow-up mix methodology approach with six-month follow-ups of patients. The participants included in the study population were those with chronic kidney disease grade 4 and kidney failure. Pre-validated and translated questionnaires (Kidney Disease Quality of Life-Short Form, Hamilton Depression Rating Scale Urdu Version, and Morisky Lewis Greens Adherence Scale) and assessment tools were used to collect data.

    RESULTS: This study recruited 314 patients after an initial assessment based on inclusion criteria. The mean age of the study population was 54.64 ± 15.33 years. There was a 47.6% male and a 52.4% female population. Hypertension and diabetes mellitus remained the most predominant comorbid condition, affecting 64.2% and 74.6% of the population, respectively. The study suggested a significant (p < 0.05) deterioration in the mental health composite score with worsening laboratory variables, particularly hematological and iron studies. Demographic variables significantly impact medication adherence. HRQOL was found to be deteriorating with a significant impact on mental health compared to physical health.

    CONCLUSIONS: Patients on maintenance dialysis for kidney failure have a significant burden of physical and mental symptoms, depression, and low HRQOL. Given the substantial and well-known declines in physical and psychological well-being among kidney failure patients receiving hemodialysis, the findings of this research imply that these areas related to health should receive special attention in the growing and expanding population of kidney failure patients.

  6. Nisar M, Tasleem Z, Muhammad SA, Javid A, Rasool MF, Karuniawati H, et al.
    Cost Eff Resour Alloc, 2024 Sep 05;22(1):65.
    PMID: 39237946 DOI: 10.1186/s12962-024-00566-9
    BACKGROUND: The direct and indirect costs of chronic kidney disease (CKD) are substantial and increase over time. Concerns regarding our capacity to manage the financial burden that CKD) places on patients, caregivers, and society are raised by its increasing prevalence and progression. Lack of awareness of CKD's economic effects is a major reason that lawmakers and administrators pay little attention to this chronic illness.

    OBJECTIVE: We aimed to analyze the direct burden of CKD across Asian countries and evaluate the main cost drivers among all mentioned cost centers in previous studies.

    METHODOLOGY: Related works evaluating the expenditures of CKD from the perspective of the patient were interpreted by a thorough search of PUBMED and GOOGLE SCHOLAR.

    RESULTS: Country-wise, in Asia, the direct mean average medical costs in RRT patients were reported in 8 studies as $4574, $18668, $2901, $6848, $16669, $3489, $5945, and $6344 in Singapore, Korea, Taiwan, China, Jordan, Vietnam, Lebanon, and India respectively and the direct mean average medical costs in non-RRT patients were reported in six studies as $3412, $2241, $4534, $290 and $1500 in Singapore, Japan, China, Vietnam, and India respectively.

    CONCLUSION: Hemodialysis is the main cost driver having an average mean cost of $23,358 per patient per year while the average mean cost of disease management is $4977 per patient per year. More research is needed to understand the specific economic challenges disadvantaged populations face, including the impact of income, education, and access to healthcare resources on the financial burden of CKD.

  7. Rehman AU, Shah S, Abbas G, Harun SN, Shakeel S, Hussain R, et al.
    Sci Rep, 2021 Jun 30;11(1):13578.
    PMID: 34193949 DOI: 10.1038/s41598-021-92968-5
    Compromised lung function is a common feature of COPD patients, but certain factors increase the rate of lung function decline in COPD patients. The objective of the current study was to investigate the effect of different clinically important factors responsible for rapid deterioration of lung function quantified as ≥ 60 ml decline in FEV1 over a period of one year. COPD patients recruited from the chest clinic of Penang hospital were followed-up for one year from August 2018 to August 2019. Rapid deterioration of lung function was defined as greater than 60 ml/year decline in force expiratory volume in one second. Among 367 included patients 73.84% were male, with mean age 65.26 (9.6) years and % predicted FEV1 51.07 (11.84). 30.27% patients showed mean decline of ≥ 60 ml in FEV1. The regression analysis showed that current smoking relative risk (RR) = 2.38 (1.78-3.07), p 
  8. Rehman AU, Muhammad SA, Tasleem Z, Alsaedi A, Dar M, Iqbal MO, et al.
    Sci Rep, 2021 11 19;11(1):22598.
    PMID: 34799609 DOI: 10.1038/s41598-021-01551-5
    Chronic obstructive pulmonary disease (COPD) is associated with substantial humanistic and socioeconomic burden on patients and their caregivers. COPD is expected to be 7th leading cause of disease burden till 2030. The objective of the current study was to assess the humanistic and socioeconomic burden of COPD patients and their caregivers in Malaysia. The burden includes the cost of management of COPD, QOL of COPD patients and their caregivers, work productivity and activity impairment of COPD patients and their caregivers due to COPD. One hundred and fifty COPD patients and their caregivers from the chest clinic of Penang Hospital were included in the study from August 2018 to August 2019. Caregiving cost was estimated using the replacement cost approach, while humanistic and social burden was assessed with the help of health status questionnaires. Overall, 64.66% and 7.1% of COPD patients reported to depend on informal caregivers and professional caregivers respectively. COPD patients reported dyspnoea score as 2.31 (1.31), EQ-5D-5L utility index 0.57 (0.23), CCI 2.3 (1.4), SGRQ-C 49.23 (18.61), productivity loss 31.87% and activity impairment 17.42%. Caregivers reported dyspnoea score as 0.72 (0.14), EQ-5D-5L utility index 0.57 (0.23), productivity loss 7.19% and social activity limitation as 21.63% due to taking care of COPD patients. In addition to the huge direct cost of management, COPD is also associated with substantial burden on society in terms of compromised quality of life, reduced efficiency at the workplace, activity impairment and caregiver burden.
  9. Rasool MF, Rehman AU, Khan I, Latif M, Ahmad I, Shakeel S, et al.
    PLoS One, 2023;18(1):e0276277.
    PMID: 36693042 DOI: 10.1371/journal.pone.0276277
    Patients suffering from chronic diseases are more likely to experience pDDIs due to older age, prolonged treatment, severe illness and greater number of prescribed drugs. The objective of the current study was to assess the prevalence of pDDIs and risk factors associated with occurrence of pDDIs in chronic disease patients attending outpatient clinics for regular check-ups. Patients suffering from diabetes, chronic obstructive pulmonary disease (COPD), stroke and osteoporosis were included in the study. This study was a cross sectional, observational, prospective study that included 337 patients from outpatient clinics of respiratory ward, cardiac ward and orthopedic ward of Nishter Hospital Multan, Pakistan. The mean number of interactions per patient was 1.68. A greater risk for occurrence of pDDI was associated with older age ≥ 60 years (OR = 1.95, 95% CI = 1.44-2.37, p<0.001); polypharmacy (≥ 5 drugs) (OR = 3.74, 95% CI 2.32-4.54, p<0.001); overburden (OR = 2.23, 95% CI = 1.64-3.16, p<0.01); CCI score (OR = 1.28, 95% CI = 1.04-1.84, p<0.001); multiple prescribers to one patient (OR = 1.18, 95% CI = 1.06-1.41, p<0.01); and trainee practitioner (OR = 1.09, 95% CI = 1.01-1.28, p<0.01). Old age, polypharmacy, overburden healthcare system, higher comorbidity index, multiple prescribers to one patient and trainee practitioner were associated with increased risk of occurrence of pDDIs in chronic disease patients.
  10. Rehman AU, Khattak M, Mushtaq U, Latif M, Ahmad I, Rasool MF, et al.
    Front Public Health, 2023;11:1244450.
    PMID: 38074769 DOI: 10.3389/fpubh.2023.1244450
    BACKGROUND: The existence of Type 2 Diabetes Mellitus (DM) in tuberculosis (TB) patients is very dangerous for the health of patients. One of the major concerns is the emergence of MDR-TB in such patients. It is suspected that the development of MDR-TB further worsens the treatment outcomes of TB such as treatment failure and thus, causes disease progression.

    AIM: To investigate the impact of DM on the Emergence of MDR-TB and Treatment Failure in TB-DM comorbid patients.

    METHODOLOGY: The PubMed database was systematically searched until April 03, 2022 (date last searched). Thirty studies met the inclusion criteria and were included in this study after a proper selection process.

    RESULTS: Tuberculosis-Diabetes Mellitus patients were at higher risk to develop MDR-TB as compared to TB-non-DM patients (HR 0.81, 95% CI: 0.60-0.96, p 

  11. Khattak M, Rehman AU, Muqaddas T, Hussain R, Rasool MF, Saleem Z, et al.
    Ann Med, 2024 Dec;56(1):2313683.
    PMID: 38346381 DOI: 10.1080/07853890.2024.2313683
    BACKGROUND: The Directly Observed Treatment-Short Course (DOTS) Programme was implemented by WHO and includes a combination of four anti-tuberculosis (TB) drugs (isoniazid, pyrazinamide, ethambutol and rifampicin) for a period of six months to eradicate the TB infection completely. Diabetes mellitus (DM) is recognized as one of a strong contributor of TB according to World Health Organization (WHO). The presence of diabetes mellitus type 2 (DM type 2) makes TB treatment complicated. Thus, the objective of the current meta-analysis was to identify and quantify the impact of type 2 DM on treatment outcomes of TB patients treated under the DOTS Programme.

    METHODS: This meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Through a systematic review of relevant literature, we focused on studies investigating treatment outcomes including extended treatment duration and recurrence for individuals with both TB and DM undergoing DOTS therapy. The extracted information included study designs, sample sizes, patient characteristics and reported treatment results.

    RESULTS: In 44 studies from different parts of the world, the pooled HR for the impact of DM on extended treatment duration and reoccurrence were HR 0.72, 95% CI 0.56-0.83, p 

  12. Rehman AU, Tasleem Z, Muhammad SA, Rasool MF, Shah S, Jabeen G, et al.
    Front Public Health, 2024;12:1365744.
    PMID: 39494082 DOI: 10.3389/fpubh.2024.1365744
    BACKGROUND: The COVID-19 comorbid population is at higher risk of developing severe health issues like acute respiratory distress syndrome, coagulation syndrome, metabolic acidosis, and septic shock, potentially leading to patient death. Patients' knowledge, attitudes, and practices (KAP) significantly influence their response to the pandemic and aid in enhancing health policy implementation.

    OBJECTIVE: To identify and evaluate the pattern and associated factors to COVID-19 knowledge, attitude, and practice among individuals with comorbidities.

    METHODOLOGY: The systematic review followed the PRISMA guidelines. Relevant studies assessing the KAP of comorbid patients were retrieved by carefully searching the PubMed and Google Scholar databases. The appraisal tool for cross-sectional studies was used to determine the quality of the included studies and the risk of biases.

    RESULTS: Eighteen studies met the inclusion criteria and were included in the review. The pooled sample size of the included studies was 9,104. Different comorbidities reported in the studies include hypertension, diabetes, psychological disorders, and cancer. Pooled analysis showed that 65% of patients showed good knowledge, 57% of patients showed a positive attitude and 51% of patients followed good practices to manage the COVID-19 in presence of their comorbid condition. Significant factors impacting knowledge, attitude and practice in COVID-19 comorbid patients were ethnicity OR 1.78 [95% CI 1.35-2.32]; educational status 3.2 [2.79-3.58]; urban residence 2.43 [1.65-3.02]; employment Status 1.67[1.34-2.12]; financial Status 4.02[3.66-4.38]; occupation 3.65[3.31-4.25]; information Source 2.64[2.19-3.26]; comorbidity 3.28[2.78-3.61]; and duration of chronic illness 1.59[1.31-2.04].

    CONCLUSION: Comorbid COVID-19 patients showed good knowledge, positive attitude and good practice towards the management of the disease.

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