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Background: Antimicrobial resistance (AMR) is prevalent among south Asian countries including Pakistan mainly due to excessive and inappropriate use of antibiotics including among children. Globally, the majority of the population especially in low- and middle-income countries (LMICs) visit ambulatory care facilities seeking care Objectives: The objectives of the current study were to evaluate the appropriateness of antibiotics prescribed among children below the age of 12 years in six ambulatory care health facilities against the WHO AWaRe book, 2022. The findings providing a basis for future initiatives. Methods: A cross-sectional study was conducted among children below the age of 12 years in six ambulatory care health facilities among two districts of Punjab, over a period of three months (January–March 2023). Results: Out of total of 399 children included in the study, 58.4% were male in the age group > 1 to 5 years (41.6%). The most common illnesses diagnosed were sinusitis (39.8%) followed by bronchitis (20.3%), and community-acquired pneumonia (15.8%). All the study participants were prescribed at least one antibiotic where only 35.8% (n = 143) of the prescribed antibiotics were deemed appropriate according to the indication. Out of 143 designated appropriate, 134 were appropriate according to the duration of prescribed antibiotics, 137 were appropriate according to the frequency of prescribed antibiotics and 139 were appropriate as per the route of administration. Inappropriate antibiotic therapy was more prevalent in basic health units than rural health centers (p = 0.004), and was higher in older children. Overall, 343 (83.3%) of the antibiotics prescribed were from 'Access' category followed by 69 (16.7%) from the 'Watch' category. Conclusion: Our study concluded a high proportion of inappropriate antibiotic use in ambulatory care facilities. Consequently, urgent measures are needed to improve future prescribing and curb AMR. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) declared the monkeypox outbreak a public health emergency in June 2022. In Pakistan, positive cases of monkeypox were reported in April 2023. Healthcare workers (HCWs) are considered as a front-line force to combat such outbreaks. A questionnaire-based cross-sectional study was conducted among 11 public sector educational institutions in Punjab, Pakistan, during May and June 2023 among final year medical, pharmacy, and nursing students concerning their knowledge of monkeypox. This included the signs/symptoms of monkeypox. Healthcare students were chosen as they are the HCWs of tomorrow. A total of 389 healthcare students participated in the study, with a mean age of 23.17 ± 1.72 years, and the majority were female. The mean knowledge score was 17.69 ± 4.55 (95% CI 17.24–18.14) out of a maximum total knowledge score of 26 (each correct answer was given a score of 1). The proportion of students with good, moderate, and poor knowledge was 21.6%, 43.2%, and 35.2%, respectively. Age (p = 0.017), gender (p < 0.001), and education (p < 0.001) had a significant impact on the knowledge score. In the multivariate linear regression model, education was the only significant factor linked to knowledge scores. Overall, the majority of future HCWs had moderate knowledge of monkeypox. Consequently, educational activities are needed to improve monkeypox-related knowledge among future HCWs. Furthermore, emerging infectious diseases should be routinely incorporated into HCW curricula. [ABSTRACT FROM AUTHOR]

Suicide is the fourth leading cause of death among young people. COVID-19 pandemic has exacerbated various factors which could lead to suicidal ideation. Therefore, this study was aimed to assess self-harm and suicidal ideation among university students in Pakistan. We conducted an online, cross-sectional study among students of four major Pakistani universities. The generalized anxiety scale and patient health questionnaire were used to screen students for anxiety, depression and suicidal ideation/self-harm. Suicidal ideation/selfharm was determined from the ninth-item (score =1) of the patient health questionnaire. Brief-COPE was used to assess coping methods. This study included 1134 respondents (age 21.76 ± 3.48 years; female 70.5%). Around 32% students reported having thoughts of death and/or self-harm in the past 2 weeks (several days 14.8%, over half the days 7.1%, and nearly every day 10.2%). Moreover, these thoughts were equally prevalent among the demographics. Suicidal ideation/self-harm was found to be increased by the severity of generalized anxiety and depression (p < 0.001). In conclusion, the rate of suicidal ideation/self-harm is alarmingly high in Pakistani university students during the COVID-19 pandemic. There is a dire need to initiate the psychological measures to prevent suicidal behaviors in Pakistani youth. Addressing mental health disparities and preparing support systems to mitigate mental health consequences as the pandemic evolves will continue to be needed urgently. [ABSTRACT FROM AUTHOR]

There are typically lower COVID-19 vaccination rates among developing versus higher-income countries, which is exacerbated by greater vaccine hesitancy. However, despite the increasing evidence of safety, parents are still reluctant to vaccinate their children against COVID-19. This is a concern in countries experiencing successive waves, such as Pakistan. Consequently, the objective of this study was to gain better understanding and practice regarding parents vaccinating their children against COVID-19 in Pakistan. A cross-sectional study was conducted to measure parents' attitudes towards vaccinating their children. In total, 451 parents participated in the study, giving a response rate of 70.4%; 67.4% were female, 43.2% belonged to the 40–49 years age group, and 47.7% had three children, with 73% of parents fully immunized against COVID-19. We found that 84.7% of parents did not consider COVID-19 to be a very serious issue, and 53.9% considered that their children were not at high risk of COVID-19. Overall, only a quarter of the study participants had currently vaccinated their children and 11.8% were willing to vaccinate their children in the near future. Parents who had a better knowledge of COVID-19, secondary or higher education, children who had chronic illness, and those parents whose children had been infected with COVID-19 were more likely to have their children vaccinated. The most common reasons for vaccine hesitancy were "my child is not at high risk of COVID-19" (61%) and "I am afraid to put/inject a foreign object inside my child's body" (52.2%). Overall, vaccine acceptance was low among the parents of the children. Those parents with higher education, chronic illnesses, greater knowledge of COVID-19 and its vaccines, and those whose children had been infected with COVID-19 were significantly (p < 0.001) inclined towards vaccinating their children. Effective campaigns as well as awareness sessions are needed to address misinformation and reduce vaccine hesitancy. [ABSTRACT FROM AUTHOR]

Background: The influenza A(H1N1)pdm09 pandemic highlighted the need for reliable disease burden estimation from low‐ and middle‐income countries like Pakistan. We designed retrospective age‐stratified estimation of influenza‐related severe acute respiratory infections (SARIs) incidence in Islamabad Pakistan 2017–2019. Materials and Methods: The catchment area was mapped on SARI data from one designated influenza sentinel site and other healthcare facilities in the Islamabad region. The incidence rate was calculated as per 100,000 for each age group with 95% confidence interval. Results: The catchment population for the sentinel site was 0.7 million against the total denominator of 1.015 million, and incidence rates were adjusted. During January 2017 to December 2019, among 13,905 hospitalizations, 6715 (48%) patients were enrolled; 1208 of these (18%) were positive for influenza. During 2017, influenza A/H3 dominated with 52% detections followed by A(H1N1)pdm09 (35%) and influenza B (13%). Furthermore, elderly 65+ years age group had highest hospitalizations and influenza positive. The incidence rates of all cause respiratory and influenza‐related SARI were highest among children >5 years; highest incidence was found in 0 to 11 month/year group with 424/100,000 cases and lowest in 5–15 years 56/100,000. The estimated average annual influenza‐associated hospitalization percentage was 29.3% during the study period. Conclusion: Influenza accounts for a significant proportion of respiratory morbidity and hospitalization. These estimates would enable governments for evidence‐based decisions and priority allocation of health resources. It is necessary to test for other respiratory pathogens for more clear disease burden estimation. [ABSTRACT FROM AUTHOR]

Background: Antibiotic resistance is a growing public health concern. One of the main reasons contributing to it is the inappropriate use of antibiotics. As medical students will soon be responsible for prescribing antimicrobials tomorrow, it is important to know their understanding of this issue today. Objective: This questionnaire-based study aims to judge the awareness among medical students regarding antibiotic resistance. Study type, settings & duration: A descriptive cross-sectional study conducted at CMH Lahore Medical College, Lahore, Pakistan from November to December 2021. Methodology: This study was conducted among fourth and final year students of MBBS. The questionnaire was shared in Google docs and disseminated to students via social media. The data was analyzed using SPSS version 26. Results: Most students (97.3%) were aware of antibiotic resistance and knew that skipping antibiotic doses affects the treatment outcome. Students of 5th year (43%) were more aware that taking antibiotics will not speed up the recovery process of a sore throat or cough (p=0.002). However, students of 4th year were more aware that antibiotics are to be used solely for bacterial infections than their counterparts in 5th year (p<0.001). Conclusion: This study shows that the theoretical knowledge gained by medical students is not necessarily reflected in their actual behavior. Therefore, more emphasis must be laid upon outcome-based learning in medical schools so that students learn to handle antibiotics in a more responsible manner. [ABSTRACT FROM AUTHOR]

Purpose: Antimicrobial resistance (AMR) is leading to greater therapeutic cost, length of hospital stays, adverse events, morbidity and mortality. Hospital-based antimicrobial stewardship programs (ASPs) engaging physicians, pharmacists, microbiologists and nurses are considered as effective way to ensure appropriate use of antimicrobial agents. The aims of our study were to assess nurses' perception, involvement, confidence and barriers towards hospital-based ASPs, and use the findings to provide future guidance. Methods: A web-based, cross-sectional study was conducted among the nurses serving at eleven hospitals of Punjab province of Pakistan during a period of two months (December 2021-January 2022). Data were collected using a validated self-administered questionnaire. All data were analyzed using SPSS version 22. Results: A total of 583 nurses participated in the study (response rate = 77.7%). All the participants were female staff nurses and 86% had a minimum of 3 years of working experience. The overall median score on the perception towards ASPs among the nurses was 18 (IQR: 16, 19) on a 0 to 20 scale whereas median score on the involvement in ASPs was 18 (IQR: 15, 37) on a 0 to 64 scale. Median perception and involvement score were statistically significantly differed by age (p < 0.001) and years of experience (p < 0.001). The overall median score on the confidence to perform ASP activities was 22 (IQR: 14, 24) on a 0 to 28 scale. Lack of knowledge, insufficient support from administration, and heavy workload were found to be the common barriers to perform ASP. Conclusion: Our study concluded that Pakistani nurses have positive perception but limited involvement in ASPs. Moreover, they are confident to perform ASP besides many barriers. [ABSTRACT FROM AUTHOR]

Background: Emerging countries continue to suffer gravely from insufficient healthcare funding, which adversely affects access to quality healthcare and ultimately the health status of citizens. By using panel data from the World Development Indicators, the study examined the determinants of health care expenditure among twenty-two (22) emerging countries from the year 2000 to 2018.Methods: The study employed cross-section dependence and homogeneity tests to confirm cross-sectional dependence and to deal with homogeneity issues. The Quantile regression technique is employed to test for the relationship between private and public health care expenses and its determinants. The Pooled mean group causality test is used to examine the causal connections among the variables.Results: The outcome of the quantile regression test revealed that economic growth and aging population could induce healthcare costs in emerging countries. However, the impact of industrialization, agricultural activities, and technological advancement on health expenses are found to be noticeably heterogeneous at the various quantile levels. Unidirectional causality was found between industrialization and public health expenses; whereas two-way causal influence was reveled amongst public health expenditure and GDP per capita; public health expenditure and agricultural activities.Conclusion: It is therefore suggested that effective and integrated strategies should be considered by industries and agricultural sectors to help reduce preventable diseases that will ultimately reduce healthcare costs among the emerging countries. [ABSTRACT FROM AUTHOR]

Background: Since drug utilization evaluation is essential to assess the appropriate use of medications, the present study was carried out to evaluate antibiotics use for children upper respiratory tract infections (URTIs). Methods: A retrospective, cross-sectional study was conducted in the six health care settings of central Punjab, Pakistan. Medical records of children ≤ 12 years who were admitted in the study settings from 1st Jan-28th Feb 2019 were reviewed. Patterns of antibiotic use were assessed in the light of the WHO prescribing indicators and appropriateness of antibiotics treatment was assessed from British National Formulary for children. Results: A total of 1843 cases of URTI were analyzed, containing 6635 total medications. All of the patients were given antibiotics (mean 1.94 ± 0.63 antibiotics). Cephalosporin was the most commonly used antibiotics class (37.8%) followed by penicillins. Injections were given to all the patients. Only 11% of the cases received appropriate therapy according to the indication. Of these (n = 204), around 93% received right dose whereas right frequency and duration were found in 96.5% and 95.5% of the cases, respectively. Conclusion: Our study revealed alarmingly high utilization of antibiotics among Pakistani children with URTIs. A great emphasis should be placed on implementing antimicrobial stewardship strategies for the rational use of antimicrobials in Pakistan and pharmacists should be in the front and centre to lead antimicrobial stewardship. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess COVID-19-related knowledge, attitudes, and preventive practices of two Pakistani university populations. Methods: A cross-sectional study was conducted among students and employees of two higher education institutions in Lahore, Pakistan, namely the University of Lahore and the Gulab Devi Educational Complex. Participants were recruited using a convenient sampling method. A validated 45-item, self-administered questionnaire was used to collect data. Total possible scores were 0–14 for knowledge (scores < 7, 7–10 and > 10 were considered to indicate poor, moderate and good knowledge, respectively); 0–7 for attitude (scores > 5 were considered to indicate a good attitude); and 0–18 for COVID-19 preventative practices (scores > 12 were considered to indicate good preventative practices). Results: Of the 417 enrolled participants, 416 reported that they were aware of COVID-19 and social media was the major source of their information. Mean scores were 10.12 ± 2.20 for knowledge (good, moderate and poor knowledge in 50.2%, 42.8% and 7.0% of participants, respectively); 5.74 ± 1.28 for attitude (65.4% of individuals had a positive attitude); and 11.04 ± 3.34 for COVID-19 preventative practices (only 36.5% of participants had good preventive practices). Conclusion: Pakistani university students and employees have good knowledge and attitudes regarding COVID-19, but unsatisfactory preventive practices. Therefore, health regulators should use multiple communication approaches, such as electronic, print and social media, phone messages, etc., to increase awareness and improve practices related to COVID-19. [ABSTRACT FROM AUTHOR]

Smog pollution is one of the serious public health concerns worldwide. This study aimed to evaluate the awareness and preventive practices of smog among general population belonging to one of the industrialized cities (Lahore) of Pakistan. A cross-sectional survey was carried out among 607 individuals using a 46-item self-administered questionnaire. Data was analyzed using SPSS (version 20.0). The overall adequate knowledge was 74% (n = 449). Majority of individuals having Science qualifications (89.4%) exhibited adequate knowledge of smog as compared to those with Arts qualifications (OR; 4.73, p-value < 0.001). Significant associations were observed between the practice and family income (OR; 1.710, p-value = 0.004), educational group (OR; 1.648, p-value = 0.011), employment status (OR; 0.371, p-value < 0.001) and smoking history (OR; 0.260, p-value < 0.001). Respondents having good family income were following several preventive measures to avoid interaction with smog pollution. Government and environmental health agencies in Pakistan should take steps to improve the awareness and preventive practices of masses particularly of those with non-science qualification and low income to avoid adverse outcomes associated with smog pollution. Abbreviations: CDGL: City District Government of Lahore; WHO: World Health Organization; EPA: Environmental Protection Agency; USA: United States of America; SPSS: Statistical Program for Social Sciences [ABSTRACT FROM AUTHOR]

• Dog bites can lead to severe consequences, including serious physical injuries. • A total of 2178 patients presented with dog bite injuries, among whom 715 (38.8%) were children and 1463 (61.2%) were adults. • Receiving timely first aid and vaccination can prevent infections. • Dog bite injuries can be prevented by increasing public awareness of safety measures. Dog bite injuries are a common problem globally; however, little is known about the epidemiology of dog bite injury from a low-and-middle-income country like Pakistan. This study aims to determine the epidemiology of dog bite injuries among children and adults from a tertiary care hospital in Karachi, Pakistan. We conducted a cross-sectional study on dog bite patients visiting the emergency department from November 2015 to August 2016 of a major public tertiary care hospital. Data was collected using a structured questionnaire on demographic details, bite history, and management of dog bite victims. Descriptive analysis was reported. Chi-square test was applied to check the associations between age-specific dog bite cases and independent variables. 2178 participants were included in the analysis. 715 (38.8%) were children less than 18 years old, and 1463 (61.2%) were adults over 18 years. A majority of the patients were males (1909, 87.7%). Results show that most dog bite injuries (2052, 94.2%) tend to occur outside the house by stray dogs biting without provocation. People aged 18 years and above (61.2%) and males (children: 84.6%, adults: 89.1%) tend to be bitten more often. Lower limbs are most frequently bitten (children: 69.5%, adults: 85.8%). Free-roaming stray dogs (children: 73.4%, adults: 74.9%) were involved in reported biting cases. Many of the patients did not receive appropriate first aid and instead just washed the wound with soap and water (children: 45.1%, adults: 43.7%). 99% of the victims received Tetanus toxoid, Rabies vaccine, and immunoglobulins while in the emergency department. There is a high burden of dog bite injuries from stray dogs in Karachi, Pakistan. Efforts should be made to create awareness among the general public on the risks of dog bites and on seeking appropriate first aid and medical attention for a dog bite injury. [ABSTRACT FROM AUTHOR]