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The rapid growth of the elderly population is a major global demographic and social issue. Unfortunately, there is a shortage of pension plans and social security programmes for this population in developing countries, which has severe consequences for their quality of life and well-being. In this article, we aim to better understand the pension systems in developing country contexts such as Ghana, Pakistan, and Myanmar by reviewing official government materials (for example, pension reports) and the published literature to suggest relevant policy recommendations. We observed several policy implementation gaps and inequities in pension schemes for older people, specifically for informal and private sector workers. Considering the size of formal versus informal economies and the level of development index of each country, we suggest a wide variety of options for pension policies, financing, designing cash benefits, and pension payments to cover all older citizens. This article addresses the unmet needs of the elderly and their wider economic sustainability to ensure social justice and resource utilisation. Governments in developing countries should embrace and establish unique, inclusive, and friendly policies encompassing the informal sector to warrant older adults' functional and social well-being with dignity and honour. [ABSTRACT FROM AUTHOR]

This qualitative case study examines the Education Faculty Perspectives (EFPs) of the Karakoram Public International University in Gilgit-Baltistan, Pakistan, on teachers' experiences of a recently introduced education reform (an Honor's Bachelor of Education program [B. Ed Hons]1 mandated by Pakistan's Higher Education Commission (HEC) in 2010. The B. Ed Hons has replaced the existing pre-service programs nationwide. Our analysis identified several paradoxical themes about borrowing of the B. Ed Hons: at the "talk"/rhetoric level, the program was welcomed as a transformative shift in teacher education; at the "walk"/implementation level, its practicality and sustainability became complicated; at the decolonisation level, the discourses on the colonial nature of knowledge and North-South dependency were muted. Implications for moving from borrowing external "best practices" to producing local solutions are highlighted. The analysis suggests the contextual realities and challenges should be addressed, individual and structural capacities developed, and an incremental, critical-constructive approach to both external and local ideas be pursued, and decolonization discourse included. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of second line injectables containing shorter (duration 9-12 months) and longer treatment regimens (LTR, duration ≥ 20 months) among multidrug-resistant tuberculosis (MDR-TB) patients with no documented resistance and history of treatment with any second-line anti-TB drug (SLD) for ≥ 1 month. Methods: This was an observational cohort study of MDR-TB patients treated at eight PMDT units in Pakistan. Patients' data from baseline until treatment outcomes were collected from Electronic Nominal Recording and Reporting System. The treatment outcomes of "cured" and "treatment completed" were grouped together as successful, whereas "death," "treatment failure," and "lost to follow-up" were collectively grouped as unsuccessful outcomes. Time to sputum culture conversion (SCC) was analyzed using the Kaplan-Meier method and the differences between groups were compared through the log-rank test. Multivariate Cox proportional hazards and binary logistic regression analyses were used to find predictors of time to SCC and unsuccessful treatment outcomes. A p-value < 0.05 was considered statistically significant. Results: A total 701 eligible MDR-TB patients [313 treated with shorter treatment regimen (STR) and 388 treated with LTR at eight centres in Pakistan were evaluated]. Time to achieve SCC was significantly shorter in STR group [mean: 2.03 months, 95% confidence interval (CI):1.79-2.26] than in LTR group (mean: 2.69 months, 95% CI: 2.35-3.03) (p-value<0.001, Log-rank test). Treatment success was higher in STR (83.7%) than in LTR (73.2%) group (p-value <0.001) due to high cure (79.9% vs. 70.9%, p-value = 0.006) and low death (9.9% vs. 18.3%, p-value = 0.002) rates with STR. Treatment with STR emerged the only predictor of early SCC [adjusted Hazards ratio (aHR) = 0.815, p-value = 0.014], whereas, patient's age of 41-60 (OR = 2.62, p-value<0.001) and >60 years (OR = 5.84, p-value<0.001), baseline body weight of 31-60 (OR = 0.36, p-value = 0.001) and >60 kg (OR = 0.23, p-value <0.001), and treatment with LTR (OR = 1.88, p-value = 0.001) had statistically significant association with unsuccessful treatment outcomes. Conclusion: STR exhibited superior anti-microbial activity against MDR-TB. When compared LTR, treatment with STR resulted in significantly early SCC, high cure, and lower death rates among MDR-TB patients who had no documented resistance and history of treatment with any SLD ≥ 1 month. [ABSTRACT FROM AUTHOR]

Background: The objective is to determine the impact of lockdown in TB care services in Pakistan and to provide suggestion for future recommendations. Methods: Extensive literature review of published articles along with NTP reports was done. The TB case detection data for the year 2020 along with the impact of COVID-19 on TB infrastructure and resources were also reviewed. Results: There was a drop in the TB notification rate during 2020 due to COVID-19 and its ramifications on the Health Sector. Health care workers being on the frontline are more prone towards acquiring COVID-19, particularly with a marked deficiency of personal protective equipment (PPEs) that has had a demoralizing effect among health professionals. Besides this the diagnostic and treatment facilities for Tuberculosis were also interrupted badly. Conclusion: The lockdown has adversely affected the health services, particularly routine immunization and TB care services, including diagnosis and case notification which declined significantly. Moreover, upgradation of strategies for the provision of services will prove to be extremely beneficial for both COVID-19 and the people with Tuberculosis. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) in children is difficult to detect and often needs specialists to diagnose; the health system is supposed to refer to higher level of health care when diagnosis is not settled in a sick child. In Pakistan, the primary health care level can usually not diagnose childhood TB and will refer to a paediatricians working at a secondary or tertiary care hospital. We aimed to determine the health services access to child TB services in Pakistan. We aimed to determine the geographical access to child TB services in Pakistan. We used geospatial analysis to calculate the distance from the nearest public health facility to settlements, using qGIS, as well as population living within the World Health Organization's (WHO) recommended 5-km distance. At primary health care level, 14.1% of facilities report child TB cases to national tuberculosis program and 74% of the population had geographical access to general primary health care within 5-km radius. To secondary- and tertiary-level health care, 33.5% of the population had geographical access within 5-km radius. The average distance from a facility for diagnosis of childhood TB was 26.3 km from all settlement to the nearest child TB sites. The population of one province (Balochistan) had longer distances to health care services. With fairly good coverage of primary health care but lower coverage of specialist care for childhood TB, the health system depends heavily on a good referral system from the communities. [ABSTRACT FROM AUTHOR]

Introduction: It could be challenging for healthcare workers to diagnose patients with factitious disorder who present with rare ophthalmologic manifestations such as haemolacria, because of the unavailability of adequate literature and associated guidelines. The present case report aims to fulfill this knowledge gap. Case Presentation: A 20‐year‐old tribal illiterate married female patient with symptoms of bleeding episodes from her left eye was admitted to the hospital. An extensive workup was done for diagnosing possible bleeding disorders but all the parameters were normal. Later on, she was diagnosed with factitious disorder presenting haemolacria after sufficient evidence at the psychiatric unit observations. The patient was treated accordingly, counseled and discharged, but lost‐out to follow‐ups. Practical Implications: The present case is reported from a developing country, Pakistan, for the first‐time may help in diagnosing patients suffering from factitious disorder with unusual ophthalmologic problems. [ABSTRACT FROM AUTHOR]

The COVID-19 has caused the deadliest pandemic around the globe, emerged from the city of Wuhan, China by the end of 2019 and affected all continents of the world, with severe health implications and as well as financial-damage. Pakistan is also amongst the top badly effected countries in terms of casualties and financial loss due to COVID-19. By 20th March, 2021, Pakistan reported 623,135 total confirmed cases and 13,799 deaths. A state space model called 'Bayesian Dynamic Linear Model' (BDLM) was used for the forecast of daily new infections, deaths and recover cases regarding COVID-19. For the estimation of states of the models and forecasting new observations, the recursive Kalman filter was used. Twenty days ahead forecast show that the maximum number of new infections are 4,031 per day with 95% prediction interval (3,319–4,743). Death forecast shows that the maximum number of the deaths with 95% prediction interval are 81 and (67–93), respectively. Maximum daily recoveries are 3,464 with 95% prediction interval (2,887–5,423) in the next 20 days. The average number of new infections, deaths and recover cases are 3,282, 52 and 1,840, respectively, in the upcoming 20 days. As the data generation processes based on the latest data has been identified, therefore it can be updated with the availability of new data to provide latest forecast. [ABSTRACT FROM AUTHOR]

Background: In Pakistan, annually 20,000 children deaths reported due to measles. This outbreak was investigated with the objectives to identify the associated risk factors and recommend appropriate control measures to prevent future outbreaks. Methods: A case was defined as any child presented with fever, generalized maculopapular rash with one of the following symptoms; cough, coryza or conjunctivitis during March-April 2011 in Skardu district. Two healthy age and sex matched controls were selected for each case from the same neighborhood. Information was collected on demographics, date of onset of illness and possible risk factors. Results: A total of 29 suspected measles cases were identified. The overall attack rate was 19% and the most affected age group was 9-19 months (attack rates 16%). Measles vaccination was lower among children with measles (OR. 4, C.I 1.8-12.5, p<0.05). The proportion of parents who consider measles as dangerous was significantly higher among the parents of cases (OR 3.6, CI 1.4-9.3, P 0.006). Better educated mothers were more likely to get their child vaccinated (OR 4, CI, 2.1-7.9, p<0.05) and history of contact was found associated with the disease (OR 7.2, CI 3.5-12.7, p 0.002). Multivariate analysis yielded significant association of following risk factors; vaccination status (OR 3.8, CI 1.8-12.5, p 0.005) and history of contact (OR 3.2, CI 1.0-10.7, p<0.05) with the disease. Conclusion: Lower vaccination coverage and lack of awareness about measles among parents was the most probable cause of this outbreak. Improvement in routine vaccination coverage and health education on the safety of immunization was recommended. [ABSTRACT FROM AUTHOR]

Background: Dengue has emerged as a vector-borne disease with an increase in number of cases with multiple outbreaks throughout Pakistan and hospitalization each passing year, thus stretching available health resources in Pakistan. Methods: This was a descriptive cross-sectional study involving 233 dengue fever indoor cases. Complete clinical findings were recorded followed by laboratory and other diagnostic tests. Results: Most of the cases were admitted from peri-urban areas of Islamabad with symptoms of fever. Seasonal patterns of typical post-monsoon and clusters of cases from low socio-economic backgrounds from areas of Bhara Kau, Bari-Imam, Sohan and G6 and G-7 sectors were found. Platelets and WBCs counts were found on the lower side of the normal values. IgM and IgG and NS1 tests were performed. Affected age group) was young (20-40 years) and male gender being more exposed to vector. Conclusion: Dengue has emerged in the poor peri-urban areas of Islamabad typically in post-monsoon seasons reaching peak during the months of September, gradually declining and waning off in the month of December. A combination of clinical symptoms and diagnostic tests IgM, IgG and NS1 could greatly help in early diagnosis and treatment of cases thus minimizing compilations and mortality. [ABSTRACT FROM AUTHOR]

Background: On 8th may, 2012, civil dispensary Kuwardu village (5000 population) of district Skardu reported an unusual increase in number of cases with high grade fever, abdominal discomfort and anorexia. A team from health department was deputed to investigate the outbreak with the objectives to identify the associated risk factors and provide recommendations for control. Methods: A Case was defined as a person living in village Kuwardu with fever >38oc and with one of these symptoms: abdominal discomfort, vomiting, diarrhea and positive Typhidot test (IgM) between 30 April - 27 May, 2012. Cases were enrolled through active case finding. Equal numbers of age and sex matched controls were enrolled from the neighborhood. Descriptive statistics, univariate and multivariate analysis was done. Qualitative assessment of the environment was also done. Results: A total of 98 cases were identified in which 66% (n= 65) were female. Mean age was 32 years (12-65 years). Age group 21-30 years (n= 32, 32.7%) were the most affected group. Drinking water from the storage tanks (OR=16.6), living in the same house (OR=20.28) were associated with illness. Six water samples were tested and found unfit for human consumption. Multiple logistic regression shows association of household size (>5 person in room of house) (OR 7.46), typhoid patients handling and cooking food (OR=13.43) and drinking water from storage tank (OR 12.62) with disease. Conclusion: Contamination of drinking water sources with human fecal matter was the most probable cause of this outbreak. Awareness campaign was initiated. The importance of hand-washing practices before cooking and after attending the toilet was highlighted. Developing toilets away from drinking water sources were advocated. Based on our recommendation Public Health Engineering Department has prioritized setting up treated water system and have sent request for funds allocation. [ABSTRACT FROM AUTHOR]

Cotton workers in small weaving household factories (power looms) in Pakistan are typically exposed to high levels of cotton dusts. Working in the textile manufacturing industry has been classified as a possible human carcinogen (group 2B) by the International Agency for Research on Cancer. The study set out to determine potential cytotoxic and genotoxic effects of occupational exposure to cotton dusts in exfoliated buccal cells of exposed cotton workers. Nuclear anomalies reflecting cytotoxic and genotoxic effects were evaluated in a representative sample of 51 exposed male cotton weavers and in the same number of age-matched male non-exposed subjects applying the micronucleus cytome assay. Nuclear anomalies reflecting cytotoxicity (karyolysis, karyorrhexis, condensed chromatin and pyknosis) were significantly elevated in exposed cotton workers. The frequency of micronucleated cells increased significantly with increasing years of work in power looms (odds ratio = 1.043 per year; 95% confidence interval: 1.012-1.076, P = 0.007). Results were consistent with the typical inflammatory pattern and injury in epithelia due to unprotected occupational exposure to cotton dusts and other toxic, allergic and infectious substances in the working areas of the cotton industry. Occupational exposure in power looms induces cytotoxic effects and, upon chronic exposure, DNA damage. This may eventually result in typical obstructive patterns of pulmonary symptoms and in a clinical condition called byssinosis in exposed cotton workers. Long exposure may lead to chronic inflammation and cumulative damage of DNA in buccal stem cells that may indicate an increased risk of oropharyngeal cancer. [ABSTRACT FROM AUTHOR]

The present study is aimed to assess the fluctuations that have taken place in expenditures of health indicators in Pakistan during 1998-2006 and to forecast the public health expenditure in Pakistan, with testing the hypothesis that public expenditure on health has an increasing trend in Pakistan. Secondary data about major indicators of health expenditure are number of hospitals, number of dispensaries, number of basic health units and sub health centres, maternity and child health centres, rural health centres, number of total beds etc have been taken from economic survey of Pakistan 2006-2007. The study shows that on average the total public health expenditure on health sector in Pakistan during 1998-2006 was Rs 31354.4 (million). During 1998-2006 the average of number of hospitals is 900.5, dispensaries is 4607.1, basic health units and sub health centres is 5256.6, maternity and child health centres is 881.1, rural health centres is 542.8, TB centres is 279.2, total beds is 9723.7, and total population per bed is 1465.22. There is a continuous rising tendency observed in all variables. Based upon the study as there is an increasing tendency for the demand of such types of facilities, therefore the Government should take into consideration the increasing demand for these facilities. The government should focus on this issue and should increase the shares of budget allocated for this end. [ABSTRACT FROM AUTHOR]

• Comparison in characteristics of tuberculosis (TB) patients by case finding strategies in Pakistan. • Extended contact screening detected a higher proportion of men and children. • Active case finding is as an important addition to routine TB control. Our objective was to compare the characteristics of patients with pulmonary tuberculosis (TB) identified through "extended contact screening" (ECS) with those of patients identified through routine passive case finding (PCF). Active TB case finding by ECS was tested from 2013–2015. This was a cross-sectional study based on data collected from ECS and routine program data from Lahore, Faisalabad, and Rawalpindi districts, and Islamabad in 2015. Characteristics of patients identified through ECS and PCF were compared. Of the 12,114 patients with pulmonary TB in the study, 4604 (38%) were identified through ECS, of whom 4052 (88%) had bacteriological confirmation. Male patients comprised 56.2% (95% confidence interval [CI] 54.8–57.6) of patients with pulmonary TB identified through ECS and 49.7% (95% CI 48.6–50.8) of those identified through PCF. The proportion of bacteriologically confirmed cases was 88.0% (95% CI 87.1–88.9) in the ECS group and 50.3% (95% CI 49.2–51.4) in the PCF group. By regression analysis we found that compared with patients aged 15–44 years, children aged <15 years had higher chances of being identified through ECS (adjusted odds ratio 2.69; 95% CI 2.21–3.28). There was a higher chance of cases being detected by ECS in Faisalabad (adjusted odds ratio 2.57; 95% CI 2.01–3.29) than in Islamabad. ECS identified a higher proportion of male and child patients with pulmonary TB than routine case finding; both of these groups are more often unidentified through routine TB control. [ABSTRACT FROM AUTHOR]

Climate change has a significant impact on the intensity and spread of dengue outbreaks. The objective of this study is to assess the number of dengue transmission suitable days (DTSD) in Pakistan for the baseline (1976-2005) and future (2006-2035, 2041-2070, and 2071-2099) periods under Representative Concentration Pathway (RCP4.5 and RCP8.5) scenarios. Moreover, potential spatiotemporal shift and future hotspots of DTSD due to climate change were also identified. The analysis is based on fourteen CMIP5 models that have been downscaled and bias-corrected with quantile delta mapping technique, which addresses data stationarity constraints while preserving future climate signal. The results show a higher DTSD during the monsoon season in the baseline in the study area except for Sindh (SN) and South Punjab (SP). In future periods, there is a temporal shift (extension) towards pre- and post-monsoon. During the baseline period, the top ten hotspot cities with a higher frequency of DTSD are Karachi, Hyderabad, Sialkot, Jhelum, Lahore, Islamabad, Balakot, Peshawar, Kohat, and Faisalabad. However, as a result of climate change, there is an elevation-dependent shift in DTSD to high-altitude cities, e.g. in the 2020s, Kotli, Muzaffarabad, and Drosh; in the 2050s, Garhi Dopatta, Quetta, and Zhob; and in the 2080s, Chitral and Bunji. Karachi, Islamabad, and Balakot will remain highly vulnerable to dengue outbreaks for all the future periods of the twenty-first century. Our findings also indicate that DTSD would spread across Pakistan, particularly in areas where we have never seen dengue infections previously. The good news is that the DTSD in current hotspot cities is projected to decrease in the future due to climate change. There is also a temporal shift in the region during the post- and pre-monsoon season, which provides suitable breeding conditions for dengue mosquitos due to freshwater; therefore, local authorities need to take adaption and mitigation actions., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Introduction: Medication nonadherence leads to poor health outcomes, frequent complications, and high economic impact. Our objective was to assess the determinants of adherence to medication regimens among patients with hypertension., Methods: We conducted a cross-sectional study of patients with hypertension attending the cardiology clinic of a tertiary care hospital in Islamabad, Pakistan. Data were collected by using semistructured questionnaires. A score of 7 or 8 on the 8-item Morisky Medication Adherence Scale was classified as good adherence, 6 as moderate, and less than 6 as nonadherence. Logistic regression was performed to determine covariates associated with medication adherence., Results: We enrolled 450 patients with hypertension (mean age, 54.5 y; SD, 10.6). Medication adherence was good among 115 (25.6%) patients and moderate among 165 (36.7%); 170 (37.8%) patients were nonadherent. Most patients (72.7%) had uncontrolled hypertension. Nearly half (49.6%) were unable to afford monthly medication. In bivariate analysis, nonadherence was associated with female sex (odds ratio [OR], 1.44; P = .003) and long waiting times in the health care facility (OR, 2.93; P = .005); the presence of comorbidities (OR, 0.62; P = .01) was associated with good adherence. In multivariate analysis, nonadherence was associated with unaffordability of treatment (OR, 2.25; P = .002) and uncontrolled hypertension (OR, 3.16; P < .001). Good adherence determinants included adequate counseling (OR, 0.29; P < .001) and education (OR, 0.61; P = .02)., Conclusion: Addressing identified barriers, including medication affordability and patient counseling, should be included in Pakistan's national policy on noncommunicable disease.

Purpose: While large cotton industry plants producing for the foreign market have undergone improvements of occupational hygiene lately, working conditions in power looms producing mainly for the local market are still poor. The respiratory health in workers of power looms has not been studied so far., Methods: In a cross-sectional study, 51 male cotton workers from power looms, 58 from large cotton factories and 52 controls were investigated by spirometry and a symptoms questionnaire. Spirometric measurements and respiratory symptoms were related to exposure duration in large and small factories by multivariate linear regression and logistic regression, respectively, with smoking, age and anthropometric parameters considered as confounders., Results: Work duration in power looms was associated with declines in forced expiratory volume in 1 s, peak flow, maximum midexpiratory flow and forced expiratory flow 75 and an increased risk of obstruction (OR 1.09/year; 95% CI: 1.002 to 1.18) by applying the Global Lung Initiative equations. Except cough that was only associated with smoking, all respiratory symptoms (chest tightness, shortness of breath, fever) increased as a function of duration of exposure in power looms but not in large factories., Conclusions: Despite limitations inherent in the cross-sectional approach, there is evidence for workers in small weaving factories to face an increased risk of pulmonary function loss and respiratory symptoms. Industrial hygiene measures in these small enterprises should be encouraged. Failure to detect adverse respiratory outcomes from occupation in large factories could be due to a 'survivor' (healthy worker) effect., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Objectives: In the cotton industry of Pakistan, 15 million people are employed and exposed to cotton dust, toxic chemicals, noise and physical hazards. The aim of this study was to determine the prevalence of health symptoms, particularly respiratory symptoms, and to measure cotton dust and endotoxin levels in different textile factories of Faisalabad, Pakistan., Methods: A cross-sectional investigation was performed in a representative sample of 47 cotton factories in the Faisalabad region in Punjab, Pakistan. Respiratory symptoms of 800 workers were documented by questionnaire. Occupational safety in the factories was assessed by a trained expert following a checklist, and dust and endotoxin levels in different work areas were measured., Results: Prevalence of respiratory disease symptoms (fever, shortness of breath, chest tightness and cough) was generally high and highest in the weaving section of the cotton industry (20-40% depending on symptoms). This section also displayed the poorest occupational safety ratings and the highest levels of inhalable cotton dust (mean±SD 4.6±2.5 vs 0.95±0.65 mg/m(3) in compact units). In contrast, endotoxin levels were highest in the spinning section (median 1521 EU/m(3)), where high humidity is maintained., Conclusions: There are still poor working conditions in the cotton industry in Pakistan where workers are exposed to different occupational hazards. More health symptoms were reported from small weaving factories (power looms). There is a dire need for improvements in occupational health and safety in this industrial sector with particular focus on power looms., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)