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Objective: To examine the impact of 30-day hospital readmission for non-communicable diseases on limited health-care resources of a low-income country like Pakistan in the light of available data from Pakistan’s Sehat Sahulat Program. Study Design: Retrospective analytical cross-sectional study. Place and Duration of Study: Health Services Academy, Islamabad Pakistan, from Jan 2016 to Jul 2020. Methodology: Secondary data of patients readmitted with non-communicable diseases in Sehat Sahulat Program, Islamabad, Pakistan. Universal sampling technique was utilized. Data was analyzed using SPSS version 27. Results: Islamabad (ICT) stands second highest for readmissions (n=1270) in which the 30-days readmission rate was 13.69%. Maximum number of readmissions were found in 50-59 years (344, 27.12%). Of 1270 ICT readmissions, 559 (44%) cases were readmitted with non-communicable diseases while rest of 711 (56%) cases were readmitted for acute infectious diseases or surgical procedures. Of 559 non-communicable diseases cases, 236 (42.21%) readmissions were having one non-communicable disease, 63 (11.27%) readmissions exhibited two or more non-communicable diseases and 260 (46.51%) were readmitted because of cancers (CA). Among males, the most common malignancy was CA lungs/ bronchus 24 (19.8%) while among females, CA Breast 80 (56.3%). Conclusion: Non-communicable diseases represent a significant burden on resource constrained, low-income countries. In view of the recurrent admissions that these chronic diseases inevitably incur, better resource allocation may help lessen this burden on fragile health systems creating better clinical outcomes for the penurious strata of Pakistan’s population.

Objective: To evaluate the general status and functioning of health information system (HIS) in district Nowshera. Methodology: An observational study was conducted in district Nowshera Khyber Pakhtunkhwa, Pakistan between June 2015-2016.The study population included all districts, health information system (HIS) health workers in Khyber Pakhtunkhwa. District Nowshera was selected for the purpose on non probability sampling technique. The data collection instruments used in this study was adapted from the PRISM tool package that was modified for the purpose of this study. Results: A total of 30 health facilities of District Nowshera were assessed for Quality of Data and Use of Information through DHIS Diagnostic Tool. 60% of the health facilities compile DHIS data and 93% do not get feedback from DHO office. 94% of the health facilities have not displayed map of their catchment areas. 87% of the health facilities do not arrange meetings regarding the managerial issues. Regarding the use of information, no documentation is available in any health facility of the district. The DHIS workers were assessed and interpreted according to the scale of Mann-Whitney-U method. The organizational and behavioral assessment was done which was statically insignificant. Conclusion: There is an immediate need to install the system wide up gradation of technology and software. The manageable data would help the health personnel and managers to formulate the policies that would be helpful in up grading the standard of HIS and a universal HIS should be operated throughout the province.

Background: Nursing is a Noble profession which is progressive and modernizing; As per need of the situation from a delivering baby and up to the dressing of injured it comes up with various specialties with high qualification of PhDs Nurses. The year 2019 was announced by the Honorable President of republic of Pakistan as Nurses year, keeping in view WHO has announced 2020 the year of Nursing and Midwifery. Authors have explored contributing factors for the selection of the nursing profession particularly and the motivation for future career in nursing. Methods: A cross sectional descriptive study was conducted at rural district of Sindh which includes first year students of three nursing schools through structured questionnaire. Study duration was from October 2016 to February 2017. Sample of 91 participants collected through universal sampling technique (all available population was selected at study area). Results: Respondent’s family has a good image of nursing 62(68.1%) participants were strongly agreed. Response of really want to see their self as a nurse 68(74.7%) participants were strongly agreed. Study showed many factors for taking admission in nursing 54(59.3%) participants responded their parents, Numerous personal factors like admiration nursing profession 58(63.7%) 68(74.7%) believed that they are caring for others. Many of them were enrolled due to the attraction of broad opportunities in nursing 45(49.5%). Conclusion: According to our study findings most of the students chose nursing profession as an alternate but not their first choice, many personal, professional and financial factors attracted the students to get enrolled in nursing.

Late diagnosis of treatable breast cancer is the reason for higher breast cancer mortality. Until now, no public breast cancer facility has been established in the Islamabad Capital Territory. First, a Federal Breast Screening Center (FBSC) was established. Afterward, awareness campaigns about breast cancer were organized among the public. Subsequently, women above 40 years of age were provided with mammography screenings. Data were analyzed in SPSS version 22.0. An intervention was performed using a six tier approach to strengthening the health system. Utilizing the offices of the FBSC and the national breast cancer screening campaign, breast cancer awareness has become a national cause and is being advocated by the highest offices of the country. The number of females undergoing mammography has increased each year, starting from 39 in 2015 to 1403 in 2019. Most of the cases were BI-RAD I (n = 2201, 50.74%) followed by BI-RAD II (n = 864, 19.92%), BI-RAD III (n = 516, 11.89%), BI-RAD IV (n = 384, 8.85%), BI-RAD V (n = 161, 3.71%), and BI-RVAD VI (n = 60, 1.38%). The current study has theoretical and practical implications for the contemplation of policymakers. The FBSC can serve as a model center for the establishment of centers in other parts of the country, thereby promoting nationwide screening coverage.

Impulse indicator saturation is a popular method for outlier detection in time series modeling, which outperforms the least trimmed squares (LTS), M-estimator, and MM-estimator. However, using the IIS method for outlier detection in cross-sectional analysis has remained unexplored. In this paper, we probe the feasibility of the IIS method for cross-sectional data. Meanwhile, we are interested in forecasting performance and covariate selection in the presence of outliers. IIS method uses Autometrics techniques to estimate the covariates and outlier as the number of covariates P > n observations. Besides Autometrics, regularization techniques are a well-known method for covariate selection and forecasting in high-dimensional analysis. However, the efficiency of regularization techniques for the IIS method has remained unexplored. For this purpose, we explore the efficiency of regularization techniques for out-of-sample forecast in the presence of outliers with 6 and 4 standard deviations (SD) and orthogonal covariates. The simulation results indicate that SCAD and MCP outperform in forecasting and covariate selection with 4 SD (20% and 5% outliers) compared to Autometrics. However, LASSO and AdaLASSO select more covariates than SCAD and MCP and possess higher RMSE. Overall, regularization techniques possess the least RMSE than Autometrics, as Autometrics possesses the least average gauge at the cost of the least average potency. We use COVID-19 cross-sectional data collected from 1 July 2021 to 30 September 2021 for real data analysis. The SCAD and MCP select CRP level, gender, and other comorbidities as an important predictor of hospital stay with the least out-of-sample RMSE of 7.45 and 7.50, respectively.

Hospital readmissions pose a threat to the constrained health resources, especially in resource-poor low-and middle-income countries. In such scenarios, appropriate technologies to reduce avoidable readmissions in hospitals require innovative interventions. mHealth and teach-back communication are robust interventions, utilized for the reduction in preventable hospital readmissions. This review was conducted to highlight the effectiveness of mHealth and teach-back communication in hospital readmission reduction with a view to provide the best available evidence on such interventions. Two authors independently searched for appropriate MeSH terms in three databases (PubMed, Wiley, and Google Scholar). After screening the titles and abstracts, shortlisted manuscripts were subjected to quality assessment and analysis. Two authors checked the manuscripts for quality assessment and assigned scores utilizing the QualSyst tool. The average of the scores assigned by the reviewers was calculated to assign a summary quality score (SQS) to each study. Higher scores showed methodological vigor and robustness. Search strategies retrieved a total of 1932 articles after the removal of duplicates. After screening titles and abstracts, 54 articles were shortlisted. The complete reading resulted in the selection of 17 papers published between 2002 and 2019. Most of the studies were interventional and all the studies focused on hospital readmission reduction as the primary or secondary outcome. mHealth and teach-back communication were the two most common interventions that catered for the hospital readmissions. Among mHealth studies (11 out of 17), seven studies showed a significant reduction in hospital readmissions while four did not exhibit any significant reduction. Among the teach-back communication group (6 out of 17), the majority of the studies (5 out of 6) showed a significant reduction in hospital readmissions while one publication did not elicit a significant hospital readmission reduction. mHealth and teach-back communication methods showed positive effects on hospital readmission reduction. These interventions can be utilized in resource-constrained settings, especially low- and middle-income countries, to reduce preventable readmissions.

BackgroundOne of the global targets for non-communicable diseases is to reduce the prevalence of hypertension by 25% by year 2025. In Pakistan, prevalence of hypertension is reported to be 24.9% among males and in females the prevalence is 24.7%. The purpose of this study was to test the deliverability of a multicomponent based intervention for reduction of high blood pressure to recommended 140/90 mm of Hg and to test its effectiveness in control of hypertension among hypertensive patients.MethodsUsing a randomized controlled trial, double blinded study design, the intervention was pilot-tested for its appropriateness for implementation in hospital. The intervention was given to hypertensive patients in the intervention group. A total of 240 participants were screened and recruited into the trial after obtaining an informed consent. An ethical approval was sought from Health Services Academy. Data was collected from December 2019 to March 2020. All the data was entered and analyzed uing SPSS version 21.ResultsImplementation of a multi-component intervention to test DCP3 based strategies for management and control of hypertension in a hospital setting during three months yielded – 23.9 mm Hg of systolic blood pressure reduction (95% confidence interval, p ≤ 0.005). A significant reduction in the blood pressure to recommended target in intervention group was achieved in 6th, 8th and 12th week. As compared to patients in usual care group, improved health outcomes were achieved for diet control, reduction in salt intake and an increased physical exercise among hypertensive patients. Regular follow up and strict adherence to prescribed medicines was observed in both groups.ConclusionStudy findings concluded that the multicomponent intervention particlulary use of low salt and lifestyle modifications is effective in hypertension reduction. Involving family members of the patient was an essential component of non-pharmacologocal treatment which was found to be beneficial for management and control of hypertension.Trial registration: The study was registered in clinicaltrials.gov number NCT04336631 dated April 07, 2020.

Maternal depression is a global mental health and a public health priority. Despite the priority its active detection is still a challenge. We tested the accuracy of an adapted version of Community Informant Detection Tool for Maternal Depression (CIDT-MD) in rural settings of Pakistan. Using a single stage design, trained community informants (lady health workers and lay peers) identified women (pregnant and/or with children) with symptoms of probable depression using CIDT-MD. This was immediately followed by diagnostic interviews of all the women using the Structured Clinical Interview for the Diagnostic and Statistical Manual (SCID-V) for current major depressive episode by trained assessors, blinded to the outcome of CIDT-MD. Data were analyzed using Statistical Package for Social Sciences (Version 25.0, IBM Corp., Armonk, NY, USA) and FACTOR software (Version. 10.3.01, Virgili University, Tarragona, Spain). Descriptive statistics, factor analysis, validity, reliability and known group validity was conducted to evaluate the psychometric properties of the adapted CIDT-MD. In all, 425 women, with mean age of 28 years (SD = 4.7), participated. Nearly 10% were illiterate, while the rest (90%) had an education ranging from eight to 15 years of schooling. The majority (73.2%) of the participants had 1–3 children while only 17.4% had &gt, 3 children. The sensitivity and specificity of CIDT-MD in detecting depressive symptoms was 97.5% (95% CI: 94.2–99.1) and 82.4% (95% CI: 77.8–86.4) respectively. It’s positive predictive value (PPV), 77.3% (95% CI: 72.9–81.2) and the negative predictive value (NPV) was 98.17% (95% CI: 95.7–99.2). While factor analysis revealed high inter-item correlation for most items (0.62–0.77) with an adequately fair Kaiser-Meyer-Olkin (KMO) sampling adequacy (0.73), significant Bartlett’s test of sphericity (p &lt, 0.001). Uni-dimensionality for the CIDT-MD based on one-dimensional congruence (0.97), explained common variance (0.85), excellent internal consistency (0.90), good criterion validity (Area Under Curve = 81%), tester-test reliability (0.87–0.89) and statistically significant known group analysis (p &lt, 0.001). The adapted version of the Community Informant Detection Tool for Maternal Depression is a valid and a reliable tool for active case detection of maternal depression in rural settings of Pakistan.

Objective To assess the improvement in the health information system in the district Nowshera by integrating the data reporting of the Expanded Program on Immunization (EPI) and Lady Health Worker (LHW) programs in the existing system. Methodology The study was conducted at district Nowshera and Swabi, Pakistan between May 2015 and May 2016 for a duration of one year. The data collection instruments used in the study were adapted from the Performance of Routine Information System Management (PRISM) tool package. The study was conducted in three phases during a period of one year. The first three months were utilized for baseline assessment. The next six months were being used for implementing the integration of the EPI and LHW, and the next three months were being used for the post-intervention evaluation. Microsoft Excel software was used to enter and analyze the data. A p < 0.05 was considered as the cut-off value for significance. Results The results indicated that the integration of data from the EPI and LHW with that of the existing Health Information System (HIS) is possible and has the potential for improving the existing system. The least significant results were produced by the use of information, which depicts that the utilization of data in decision making or policy making is still needed to be improved. Moreover, we reported a lack of enforcement and regulation by the authorities in monitoring the feedback system in the HIS. Conclusion The current study revealed significant improvements in the use of information, data quality, and behavior of staff. It is essential to properly train the team on how to operate the District Health Information System (DHIS) to gain adequate and timely data on health status and determinants. Additionally, the integration would benefit in managing the data at not only the national level but at the district level too.

Background: Essential healthcare was made universally accessible to individuals and families in the community by the means acceptable to them through their full participation and at a cost that the community and country could afford. For achieving the set goals of the Primary Health Care (PHC) components the adequate availability of the required well motivated, properly trained and skilled health workforce was essential. It has recently been reported that World Health Organization (WHO) has called for a revival of Primary Health Care [2]. A number of authors have emphasized over quality improvement and recommend the devising strategies to improve training and education of the health professionals. It was suggested by them that primary health care workers should be discussed at the policy level and must be considered on priority level. Methods: A qualitative Study was conducted. The phenomenological approach was used. Twelve in-depth interviews and six focus group discussions were conducted. Detailed feedback from the outreach health workers was obtained, analyzed and the result was interpreted. Results: Most of the health workers don’t have any issue regarding pay and other allowances. The main issues for the health workers are security threats. Most of the staff is not working according to their job description due to less number of workers in District Sherani. The supply of medicines in the outreach area is in demand and is not delivered timely. However, supply of vaccines is always timely and with maintaining the cold chain. The supervision of Senior Health Managers is Supportive and Monitoring of Administration is also helpful. Conclusion: From all the above study, it can be concluded that outreach health workers are an integral part of human resource for health, which is ultimately a basic building block of a health system. No health system can be successful without the proper functioning of these outreach health workers.

Background: Family planning includes knowledge, services, attitude, policies and practices which enable individuals to decide whether they want to have child and allow them to avoid unwanted pregnancy. Pakistan with population of 195.390 million with estimated population growth rate as 1.89 is the sixth most populous country in the world. Our objectives were to assess the total demand of family planning, contraceptive prevalence rate, unmet need for family planning and factors associated with unmet need of family planning among women of reproductive age group. Methods: We conducted this cross-sectional study on 355 females of reproductive age attending the out-patient department as patient or attendant. Data were collected using structured questionnaire after the participants' verbal consent. Results: The prevalence of unmet need was 34%. The proportion of unmet need for spacing was 63.6% and for limiters it was found to be 36.3%. Contraceptive prevalence rate was 57%. Total demand for family planning was 92.1%.Almost all study participant had knowledge regarding at least one method of contraception. Unmet need of family planning was found to be significantly associated with age and education status of women. High unmet need was there in women with low education status (p=0.047) and older age group (p=0.003). Main reasons for not using contraceptive was family opposition both family and husband (66.9), and fear of side effects (17.3%). Conclusion: More than one third females had unmet need which strongly points towards the strong influence of various socio demographic factors contributing towards the unmet need.

Background: Nursing is an important tier for the health care delivery system. Nurses are holding essential and largest part of health delivery system from direct care to management, performing many functions for the smooth operations of the health care delivery system. Nursing education ignored in Pakistan nowadays many nurses are being enrolled in nursing schools every year. Changes people to join nursing profession may vary from one another. Objectives: Our study's objectives were to explore motivating factors for the nursing profession, and to assess the motivational factors among student nurses. Methods: We conducted Focus Group Discussions with nursing students. Thematic content analysis was done after assigning codes, making sub categories and categories and then driving sub themes and themes. Results: Factors such as wish to become nurse, mostly an alternate as failure to get admission in medicine, to fulfill parents wish, financial support job either public or private and get a chance to settle abroad, and seeking stipend during training. Easy public, private or clinic set up and jobs abroad. According to our study findings most students chose nursing profession as alternate but not their first choice, many personal, professional and financial factors attract students to enroll into the nursing. Conclusion: We conclude that most of the nursing student's perceive nursing being more suitable for females supporting their financial health.

Introduction: Stroke is a major cause of death with hypertension being identified as an important modifiable risk factor. Prompt identification of stroke symptoms and timely management is noted to be significant in lowering both morbidity and mortality. Baseline stroke knowledge in hypertensive patients is crucial to develop effectively targeted, and appropriate health promotion campaigns; thus, the main objectives of this study are to assess the awareness of stroke and to determine health-seeking practices among hypertensive patients. Materials and methods: A standardized questionnaire survey regarding awareness and practices about stroke among hypertensive patients was conducted in a tertiary care hospital of Islamabad. The sample size was calculated as 384. Results: Out of 384 patients evaluated, 80.5% had heard about stroke, 71.6% knew someone with stroke, and 76% identified the brain as the organ affected. Sudden onset numbness of limb (66.9%) and hypertension (93.5%) were common warning symptom and risk factor identified. 87.5% would take stroke patients to a hospital. Only 45.1% of the patients took their medications regularly, and 38% checked their blood pressure. Conclusion: Majority of hypertensive patients were aware of stroke but the awareness of risk factors and warning signs was poor. Stroke prevention practices were also sub-optimal. There is a need to increase knowledge regarding risk factors, which will benefit the community at large.

Software defect prediction (SDP) models are used to improve effort and testing estimate of software by identifying defective modules beforehand. Precision, recall/true positive rate and false positive rate have been used to evaluate the performance of models. In literature, area under receiver operating characteristic curve (AUC-ROC) has been used to evaluate the model performance. The standard learning goal of the defect model is to optimize the (AUC-ROC). Use of this measure has also been advocated in numerous benchmarking studies. The literature has discussed the performance bar (or so-called ceiling effect) of AUC-ROC targeted models. The literature has also indicated the use of area under precision recall curve (AUC-PR) as an evaluation parameter for the models. This study investigates if AUC-PR curve gives different information regarding model performance. To this end this study ranks the existing models based on AUC-ROC and AUC-PR and report the change in ranking of these models. The change in ranking gives an opportunity to study if the ceiling effect can be managed and AUC-PR (instead of AUC-ROC) can be considered as a goal for the prediction models. AUC-PR based evaluation of the models can help avoid the extra cost, time, and effort employed to test non-defective modules.

Introduction: Diabetic guidelines are important tools to provide evidence based structured diabetic care. There are no national guidelines and it has been noted that diabetic care is suboptimal in Pakistan.The objective of our study was to identify various contextual barriers and propose possible solutions foroptimal diabetic guideline use by physicians in Pakistan. Study Design: Quasi experimental study. Setting: Two hospitals in Lahore Pakistan. Period: Jan to Dec 2016. Methodology: We analyzed data of 53 Physicians from two hospitals in Lahore Pakistan. These physicians were recruited in a quasi-experimental study done by the authors to check the effectiveness of m-health technology for improving diabetic guideline adherence and also to check the various barriers to diabetic guidelines adherence. The responses were obtained on Likert scale and were analyzed by factor analysis. Results: Majority of participating physicians were postgraduate trainees 34(64.1%) and females 33(62.3%). Majority 41(77.3%) were in the age group 20-29 years. Majority of the physicians agreed that diabetic guideline were helpful in diabetic management 46(86.8%) however they also noted following several barriers to diabetic guidelines adherence.These barriers were grouped into organizational, patients and physicians related factors by factor analysis. Majority of the physicians cited lack of patient care time, patient work overload, noncompliance and financial constraints in diabetic patients, lack of education in diabetics and diabetic guideline information among doctors and patients as major barriers for adherence to diabetic guidelines. Cultural differences between doctors and diabetic patients and lack of incentives and consequences for doctors to use diabetic guidelines were not considered as important as the rest of the variables. Conclusion: This study illustrates the various contextual barriers for diabetic guidelines implementation categorized into patient factors; physician factors; and systemic factors. It is important to identify and mitigate these barriers for effective diabetic guidelines implementation.

The EPI structure of Pakistan is administratively union council base. Vaccinator is responsible for vaccination services in each union council. LHWs are supposed to support vaccinators in their own registered communities for vaccination activities in the field. Lady health workers have several important duties to perform but vaccinating infants against childhood communicable diseases is one of the most cost-effective public health interventions. Each union council is partially covered with LHWs. There are some areas in South Punjab where routine EPI coverage is below benchmark. The main aim of the study is to measure the performance and effectiveness of LHWs in their own communities for the vaccination of under 2 years old children. Vaccine-preventable diseases incidences are high in South Punjab. Socioeconomic status and literacy rate of population is poor in South Punjab as compared to North and Central Punjab. South Punjab is highly polio-endemic region. The incidence of measles and NNT cases are high in South Punjab. Poliovirus circulation was detected in human in District Lodhran and environmental samples in District Multan. The mortality rate is high due to poor vaccination for measles. The benchmark coverage is 80% for all the antigen of RI vaccination. Overall in Multan Division, fully immunized coverage (12-23 month that is BCG-Measles 1) is 84% in lady health worker covered areas and 76% in lady health worker uncovered areas. Statistical analysis portrays that standard deviation of fully immunized children is quite low in LHWs uncovered areas. Measles 1 and measles 2 coverage are suboptimal in LHWs uncovered areas. Community AEFI awareness is relatively better in LHWs uncovered areas as compared LHWs covered areas. Routine immunization coverage and quality are better in LHWs covered areas. Community AEFI awareness is not up to the mark in LHWs covered areas. Community participation is suboptimal in LHWs covered areas. Their role is well visible to boost up routine immunization at union council levels in each District. There is a need to extend LHWs support in uncovered areas.

Objective: To improve the information about hypertension control in the adult population. Material and Methods: This was descriptive cross-sectional survey based study conducted at rural healthcare centre, Umar Abad, tehsil, karezat, district, Pishin, Balochis tan, Pakistan. Information was collected from the outpatients who visit the rural health center, throughout the examination span, age ranging from (≥18 years) old giving the hypertension by filling self-administrated surveys. The data was collected by two research assistants. Blood pressure was measured by auscultation, using the standardized sphygmomanometer. Blood pressure was measured in the desk posture by a fitting sized handcuff around the arm. Related sample Friedman’s two-way analysis of variance by rank test was performed and (p

Diabetes mellitus is a complex multisystem disease that requires high quality care. Clinical practice guidelines help physicians and patients make the best possible health care decisions and improve health care management of diabetic patients. These guidelines provide the norms for clinical management as well as monitoring of diabetes care. They are not simple algorithms but are based on structured evidence based diabetic management protocols developed from randomized controlled trials. Despite the widespread availability of this diabetic guideline, their use is suboptimal at best. There are several factors blamed for contributing to this missing link from available theoretical guideline recommendations to practical applications of these guidelines. We present a brief review based on available literature review for an ongoing interventional study being done by authors in two tertiary care hospital in Lahore Pakistan for improving adherence to diabetes guidelines. We will discuss guideline implementation cycle and also present a framework encompassing various factors involved in adherence to guidelines. Until recently the emphasis to improve the guideline adherence targeted the factors relating to individual health care professionals in reference to their knowledge, attitude practice of the guidelines. However, we will discuss that broader range of health care systems, organizational factors, and factors relating to patients which may also significantly impact the adherence to the guidelines. The framework emphasises that it is important to understand the factors that act as barriers and contribute to the missing link between theory and practice of diabetic guidelines. This will help plan appropriate strategies in the pre-implementation stage for effective and improved diabetes guidelines adherence and management.

This survey designed to evaluate the satisfaction level and the factors that affect the patient satisfaction regarding health care delivery services with the aim to improve the services in the primary health care settings of Gujranwala. A Cross Sectional Study done on randomly selected patients attending the basic health units of Gujranwala, with more than18 years of age. Pretested structured “Liker scale questionnaire” was used for data collection. Out of total respondents, 62 (41.3%) clients were satisfied with the services provided by the basic health units of Gujranwala. The factors identified to determine patient satisfaction were accessibility of services, behavior of staff, health education, level of cleanliness, drug availability and miscellaneous services. Not a single ranked area of satisfaction noticed. Client’s occupation and income had significant relationship with the patient satisfaction level. Gender, age, and education of clients were not contributing factors; they not affect the client satisfaction level.Less than half clients were satisfied with the services provided by the basic health units. Management of health facilities needs to improve the services.

© 2017 Informa UK Limited, trading as Taylor & Francis Group. Background: The Patient Health Questionnaire (PHQ-9) possesses many characteristics of a good screening tool and has the capacity to be used for screening depression in patients with coronary artery disease (CAD). Aim: To examine the psychometric properties and criterion validity of the PHQ-9 to screen and detect depression in patients with CAD in Pakistan. Design: In this validation study, 150 patients with CAD completed the Urdu version of the PHQ-9. The major depressive episode module of the Mini International Neuropsychiatric Interview (MINI) was used as the gold standard. Results: The Urdu version of the PHQ-9 revealed a good internal consistency with Cronbach’s alpha of 0.83. Optimal sensitivity (76%) and specificity (76%) were achieved using the cut-off score of PHQ-9 ≥6, with area under the ROC curve of 0.86. Conclusion: The Urdu version of the PHQ-9 has acceptable psychometric properties to screen and detect major depression in patients with CAD.

To determine the prevalence of diabetes mellitus and its associated risk factors in urban population.The cross-sectional study was carried out at four union councils of Rawalpindi, Pakistan, from May to September 2014, and comprised members of the general public.A questionnaire was administered to obtain information about demographic characteristics and risk factors. Anthropometric and blood pressure measurements were obtained from the participants. Venous blood samples were taken for measuring glycated haemoglobin. SPSS 20 was used for data analysis.Of the 404 participants, 181(44.8%) were men and 223(55.2%) were women. The overall mean age was 42.3±13 years. Overall prevalence of diabetes was 133(32.9%) and that of pre-diabetes was 151(37.4%). The prevalence of diabetes was 203(50.3%) in 50-65 years age group and 143(35.4%) among obese subjects. Diabetes was significantly associated with increasing age (35-49 years (p0.05); 50-65 years (p0.01), positive parental (p0.05) and sibling (p0.05) history of diabetes, hypertension (p0.01) and central obesity (p0.05).The prevalence of diabetes and pre-diabetes was very high. Prevalence increased with increasing age and body mass index. Major independent risk factors were increasing age, central obesity, and family history of diabetes and hypertension.

Mainstream preventive interventions often fail to reach poor populations with a high risk of cardiovascular diseases (CVDs) in Pakistan. A community-based CVD primary prevention project aimed at developing approaches to reduce risk factors in such populations was established by Heartfile in collaboration with the National Rural Support Program in the district of Lodhran. The project implemented a range of activities integrated with existing social and health service mechanisms during a three year intervention period 2000/01-03/04. These were targeted in 4 key settings: community health education, mass media interventions, training of health professionals and health education through Lady Health Workers. The project received support from the Department for International Development, UK. At the community level, a pre-test-post-test quasi-experimental design was used for examining project outcomes related to the community component of the intervention. Pre and post-intervention (training) evaluations were conducted involving all health care providers in randomly selected workshops in order to determine baseline levels of knowledge and the impact of training on knowledge level. In order to assess practices of physician and non-physician health care providers patient interviews, with control comparisons were conducted at each health care facility. Significant positive changes were observed in knowledge levels at a community level in the district of intervention compared with baseline knowledge levels particularly in relation to a heart healthy diet, beneficial level of physical activity, the causes of high blood pressure and heart attack and the effects of high blood pressure and active and passive smoking on health. Significant changes in behaviors at a practice level were not shown in the district of intervention. However the project played a critical role in spurring national action for the prevention and control of non-communicable diseases and introducing sustainable public health interventions for poor communities in Pakistan.

Health of immigrants is challenge for any host country due to multiple reasons. Immigrants of Pakistani origin constitute a significant population in the USA and their population has doubled in last 10 years. This study was conducted to determine factors affecting health service utilization in the state of Maryland, USA.This was a descriptive study, utilizing mixed method research. A sample of 100 respondents from Pakistani immigrants in Maryland was selected through convenience sampling. A structured questionnaire was used for soliciting responses. Three focus group discussions were also conducted for qualitative assessment of health service utilization.Male gender, higher level of education, longer duration of stay, and higher income people had more utilization of health services. Those not having insurance had affordability issues as they had to pay out of pocket for treatment cost. A high proportion of uninsured were resorting to traditional home remedies for treatment. There was a concern on delays in appointment system and long waiting time for elective cases. Most respondents mentioned problem of language while interacting with doctors and need of English speaking family member in medical consultation. Many respondents reported difficulty in availing health services due to job commitments. They had to make arrangements for substitute at their workplaces, which affected their utilization of health services.Low-income immigrants in USA are less likely to have health insurance. Factors affecting service use are out of pocket costs, long waiting time, language problems and immigrants' job commitments. It is recommended to get a clear idea of health systems of USA before moving to US as immigrant.

The National Action Plan for Non-communicable Disease Prevention, Control and Health Promotion in Pakistan (NAP-NCD) incorporates prevention of injuries into a comprehensive NCD prevention effort. This encompasses the prevention of road traffic crashes (RTC)s, occupational injuries, falls, burns and other injuries. In this programme, surveillance of injuries--as part of comprehensive population-based NCD surveillance system, supplemented by multiple data sources--has been stipulated as an entry point, to injury prevention and control efforts. Actions areas for preventing RTCs include interventions to improve road safety education, identification and implementation of safety measures for traffic black-spots, enforcement of seatbelt and helmet laws and the development and implementation of highway ordinances. Recommendations have also been made to establish a road safety committee and to facilitate inter-sectoral action. It has also been deemed essential to enact and enforce legislation on locally manufactured vehicles, regulate drivers' training and licensing and evaluation of Highway Police Force from a performance and fiscal perspective. To prevent worksite injuries, a national consensus has been achieved to develop a comprehensive policy and to enact and enforce legislation for occupational health and safety; to include preventive health in the mandate of organizations dealing with worksite safety and to study patterns of occupational injuries and their determinants with a view to defining precise targets for preventive interventions. In addition NAP-NCD makes a strong case for the establishment of a National Safety Commission, the development of product safety standards for household usage, enforcement of legislation on building safety, and efforts to improve trauma care to the extent that a credible, cost-effective analysis suggests. It also calls for the need to formally evaluate interventions to reduce all forms of violence in Pakistan. Building capacity in the health system for injury prevention and building partnerships for sustainable outcomes in injury prevention have also been defined as priority areas.

Background: Acute Respiratory Infection (ARI) is an important cause of mortality and morbidity in children, especially in under-fives, it is necessary to explore its risk factors for better health of children. Methods: This study was a cross sectional study, conducted in the Federal Government Polyclinic Dispensary of G- 7/3-4, Islamabad on 104 under five children, from April 2016 to June 2016. All the children from 0-59 years of age, irrespective of sex visiting dispensary were included in the study. Structured questionnaire used to collect the data. Frequencies and proportions were calculated as descriptive part of the analysis while Qui/Fisher Exact test was done as inferential analysis by using SPSS. Results: Out of 104 under five children ARI was found in 34 (32.7%). It was more in male children 23 (37.1) compared to female 11 (26.2%). A significant association was found between ARI and child's birthplace, their history of low birth weight, breast-feeding history, vaccination status, mothers education, mother's occupation, number of family members, smoking in fathers, ventilation condition of home, kitchen type, and knowledge of mothers regarding ARI signs and symptoms. Conclusion: The present study found that ARI is prevalent in under five children of the studied area. Results suggested that there is need to enhance the knowledge of mothers regarding ARI risk factors, its signs and symptoms, prevention and treatment.

OBJECTIVE: To explore the perceptions of health workers regarding Health Management InformationSystem (HMIS), within their health facilities providing health care facilities in multiple disciplines undersingle roof.METHODS: A prospective study was planned to explore, understand, and describe the perceptions ofhealth workers regarding HMIS within their health care facilities. The study was carried out in eightselected health care facilities of district Nowshera four facilities were selected from urban and four fromruler area of the district Nowshera.RESULTS: In 6 out of 8(75%) HCFs HMIS record was properly maintained, 29 out of 32(90%) ofhealth care provider were fully aware of the system, 7 out of 8(87%) MCH centers were follow theproper protocol of the system, in 5, EPI centers out of 8(63%) outreach activity, in 4(50%) drop outactivity and in 7(87%) all relevant graphs were updated. In 3(37%), OPD slips and OPD registers, MCHregistered and growth charts were available in 7(87%) vaccination cards and in 5(50%) units monthlyreport charts were found. No feedback or coordination with HMIS coordinator was reported in all 8Health care providing facilities monitoring and supervision,METHODOLOGY: This prospective study was conducted from July 2014 to October 2014 in eighthealth care facilities four from urban and four from ruler area of district Nowshera Khyber PukhtanKhawa Pakistan. Data was collected on pre formed preforms from 32 health care providers who wereinvolved/ responsible for the record maintenance, keeping and reporting of HMIS, i.e. (From in chargeOPD, MCH and EPI centers). The OPD register was tailed with the disease register and recordmaintenance behavior of the HCP was noted. In the same way registers of MCH centers were tailed withthe maternal health register and child health register and growth monitoring registered. Similarly EPIcenter register were tallied with the daily vaccination register. Multiple pre designed questions wereasked from all concerned and their responses were recordedKEY WORDS: HMIS, Health care provider, monthly report form.