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Aim: Pakistan is in dire need of trained family physicians to enhance the quality of primary health care. To build capacity, there is a need to train the trainers on a large scale through a feasible and accessible program. Therefore, for the first time, a three-month online course was designed and piloted, in collaboration with national and international family medicine faculty. The aim of this study was to determine the gap between the pre-course expectations and the post-program perceptions of the participants for* a unique family medicine "Train the Trainers" course. Methods: A longitudinal-observational study was conducted at a private college of Karachi after approval from the Institutional Review Board. The expectations and perceptions of all (31) participants were recorded through a pre- and post-course questionnaire. Data were analyzed through descriptive and analytical statistics on SPSS-26. The responses to the open-ended questions were analyzed by content analytical approach. Results: Out of 20 quantitative items on the questionnaire, four were associated with a positive gap between the expectations and perceptions. One item showed a negative gap, while the rest did not show any significant difference. The majority of the participants expressed that they expected to see an improvement in their teaching skills because of the online course. Conclusion: The online course was successful in meeting the participants' expectations. The course delivery can be revisited to further improve its quality according to the participant's feedback, including an opportunity to ask questions and incorporating some face-to-face sessions.
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Context: Elderly malnourishment remains a largely unexplored area, despite having a significant effect on the level of mortality and morbidity. This study aims to explore the level of malnourishment and identify those at risk of malnourishment among the elderly population presenting to a teaching hospital in Karachi. Aims: To assess nutritional status and its associated factors among the elderly population. Settings and Design: This study was conducted in outpatient clinics of family medicine at a teaching hospital and its outreach primary care centres from December 2020 to December 2021. The study design was cross-sectional. Materials and Methods: The prevalence of malnourishment and at risk of malnourishment with its associated factors were assessed using the Mini-Nutritional Assessment (MNA) scale as a screening tool among the elderly population (65 years and above) presenting to the family medicine OPDs of a teaching hospital. Statistical Analysis: Data were analysed using the Statistical Package for the Social Sciences (SPSS) version 21. Results: A total of 191 patients were recruited into the study, and the majority of them were males (66.5%). Median age and body mass index (BMI) of participants were 70 (IQR = 74-65) years and 24 (IQR = 27-21) kg/m2, respectively. The median MNA scores were 23.5 (IQR = 20.5-26). A total of 92 (48.2%) participants were found to have a normal nutritional status, 81 (42.4%) were found to be at a risk of malnourishment, and 18 (9.4%) were malnourished. On the multivariable regression model, BMI and ability to manage finances were significantly associated with malnourishment. Conclusion: This study shows an alarmingly high rate of the elderly population at risk of developing malnourishment, and financial independence and increasing BMI were associated with a decreased risk of malnourishment.
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Objectives: This is a retrospective cohort analysis of diabetes and its associated factors from Electronic Medical Record (EMR) of 2020-2022 of Indus Hospital Health Network (IHHN), Korangi campus Karachi. Methods: Retrospective cohort study was conducted at Indus Hospital & Health Network (IHHN), Korangi Karachi. Out-patient records of adult patients of 2020-2022 were extracted from EMR of IHHN in March 2023. Descriptive statistics were presented as median (IQR) and frequency and percentage. Chi-square test determined association of risk-factors with diabetes and Wilcoxon-sign-rank test compared change in HbA1C from baseline. Results: Data of 460,799 adult patients were extracted and analyzed. Median age of patients was 38.71 (27.87-52) years. Female preponderance was observed in our study. Out of 460,799, HbA1C was seen in 42,638 (9.25%) patients. Among these 29,596 (69.4%) had a HbA1C ≥ 6.5% while 13,042 (30.6%) had a HbA1C in the pre-diabetes range. Significant association was found between age, baseline creatinine, LDL and diabetes with no association depicted between gender, BMI, blood pressure, triglycerides, HDL and diabetes status. Patients in general had higher HbA1C at baseline as compared to last visit (p-value<0.001). Conclusion: High blood pressure, obesity, increased creatinine, micro albuminurea, high LDL and Triglycerides were important risk factors for diabetes. This study reports a snap shot of the status of diabetes and associated risk-factors in the Pakistani population. This was the first time that a large data was extracted and analyzed from a healthcare institution in Pakistan, which would guide physicians and public health practitioners to take evidence-based decisions for prevention and management of diabetes.
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Floods are the most common natural disasters in the world. Currently Pakistan is in an acute emergency situation due to the recent flood that occurred as a result of the monsoon rains in July-August 2022. Unfortunately, the country was already under an economic crisis and was just recovering from the COVID pandemic when this devastating calamity struck. Almost one-third of the country's land was affected, with millions of houses damaged and property lost. As the victims are displaced and local health units are flooded, their medical needs are being met through medical flood relief camps arranged by public and private sector welfare organizations. Due to a lack of disaster preparedness and policies, most of the healthcare workers are untrained to manage medical flood relief camps and are hence learning from experience rather than following any standardized policy guidelines. We did not find any guidelines for organization and management of a flood relief camp in previous literature. As natural disasters continue to cause mass destruction every few years, there is a need to devise policies and procedures for disaster preparedness and hazard reduction. This paper is thus an effort to provide the best possible delivery of acute health services in a developing country during and after a flood in the transit phase, while the government and other non-governmental organizations (NGOs) help communities rebuild their health system.
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OBJECTIVE: To determine factors associated with anxiety and depression among neurosurgeons after vaccination during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: An online survey was completed by neurosurgeons worldwide over 4 weeks. Depression in neurosurgeons was assessed by the 20-item self-reporting questionnaire. RESULTS: A total of 534 responses were received and analyzed. Almost half of the respondents were from Asia (50.9%), followed by Europe (38.8%). The majority of the respondents were <40 years old (88%), and almost two thirds were trainees (62.2%). Half of the respondents worked in departments with <40 beds (50.7%), and the majority were practicing in the private sector (72.5%). Most of the respondents (85.8%) had COVID-19-positive colleagues in their department, and 64% had exposure to a COVID-19-positive colleague, family member, and/or patient. More than half of the respondents were exposed to infected patients and/or colleagues, and almost half (43.1%) underwent COVID-19 testing when exposed. Nearly half of the respondents underwent COVID-19 testing more than twice (52.4%). Of respondents, 83% had received at least the first dose of the vaccine. The odds of depression among vaccinated respondents were found to be significantly less than among unvaccinated respondents in the univariable model. CONCLUSIONS: Among health care workers, neurosurgeons are one of the groups indirectly affected by the pandemic. Adaptation to the new normal and advent of vaccines is speculated to control psychological distress among all groups of health care workers, including neurosurgeons. We found that odds of depression among vaccinated people were lower than among people who were not vaccinated.
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COVID-19 , Vacunas , Adulto , COVID-19/epidemiología , Prueba de COVID-19 , Vacunas contra la COVID-19 , Depresión/epidemiología , Humanos , Neurocirujanos , Pandemias , SARS-CoV-2 , Encuestas y CuestionariosRESUMEN
Context: Mental health ailments like anxiety and depression are common during the antenatal period. Uncertainty during COVID-19 pandemic has markedly increased its prevalence in the general population. Pregnancy, being emotionally and physically exhausting, makes mothers more susceptible to developing mental disorders like anxiety and depression. Aims: To investigate prevalence and associated risk factors of antenatal anxiety and depression among women in Karachi, Pakistan. Settings and Design: This cross-sectional study was conducted in the department of obstetrics and gynecology during May 2020 till May 2021. Methods and Material: The study explored anxiety, depression, and associated factors in pregnant women attending antenatal clinics at a tertiary care hospital located in Karachi, Pakistan, during the COVID-19 pandemic by using the hospital anxiety and depression scale (HADS) as a screening tool. Statistical Analysis: Data was entered in SPSS version 21 for statistical analysis. Results: A total of 390 patients were enrolled in the study with mean age of 28.06 ± 4.52 years. Mean week of pregnancy at the time of enrolment into the study was 32.7 ± 3.1. Prevalence of anxiety and depression was 46.7% and 33.1%, respectively. On multivariable analysis, polyhydramnios was a risk factor of anxiety, whereas low income and unplanned pregnancy were substantially linked to depression. Fear of visiting doctor was a common risk factor for both anxiety and depression. Conclusion: In a catastrophe like the COVID-19 pandemic, attempts to address heightened anxiety during antenatal visits will undoubtedly benefit maternal and fetal mental health. As a response, strategies to manage high anxiety symptoms should be taken into consideration.
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Context: Depression among the elderly is falsely considered as a normal part of aging and hence remains un-diagnosed in the majority. Elderly people are at a high risk of depression, which may produce a negative impact on their quality of life. Depression is a potentially treatable condition; hence, it is worthwhile to explore its burden in order to ensure its timely evaluation and management. Aims: To determine the frequency and predictors of depression among the elderly population of Karachi. Settings and Design: The current study was a cross-sectional study, conducted in out-patient clinics of a tertiary care hospital and its out-reach centers located in different areas of Karachi. Methods and Material: Patients aged 60 years and above were enrolled in the study. Demographic profiles and physical health conditions were investigated. Depression was assessed using Geriatric Depression Scale-15. Statistical Analysis: Data were entered in SPSS version 21 for statistical analysis. Results: A total of 232 participants were enrolled into the study with a median age of 65.8 [inter-quartile range = 61-69] years. Out of 232 participants, 186 (80.2%) were found to be depressed. In the multi-variable model, employment status, financial issues, and peer groups were left as independent predictors of depression. Conclusion: The current study found a significant burden of depression among elderly people in Karachi. Employment status, financial problems, and relationship with peers have been identified as risk factors of depression. There might be over-reporting of depression as the data collection was conducted during the coronavirus disease 2019 first wave. Hence, further community-based research is warranted to confirm the findings.
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We aimed to determine the frequency of depression, anxiety and insomnia; identify associated factors; and compare these outcomes amongst a privileged and underprivileged class of Pakistan. A cross-sectional online and face to face survey was conducted in Karachi from April 2020 to May 2020. Validated depression (World Health Organization self-reporting questionnaire), anxiety (general anxiety and depression scale) and insomnia (insomnia severity index) scales were used. Out of 447 participants, the majority were less than 30 years (63.8%) and females (57.7%); 20.8% study participants belonged to poor or very poor socioeconomic status; 17% respondents were from lower middle status and 38% belonged to the higher middle or rich class. Depression, anxiety and insomnia were identified in 30%, 30.63% and 8.5% of participants, respectively. The prevalence of depression, anxiety and insomnia among privileged people was 37.8%, 16.6% and 11.3% respectively whereas among underprivileged were 17.8%, 16.6% and 4.1% respectively. There were significant differences in frequencies of depression (p<0.001), anxiety (p<0.001) and insomnia (p=0.009) among the privileged and underprivileged classes. We found a high prevalence of depression, anxiety and insomnia among both the privileged and underprivileged Pakistani population and a policy needs to be devised to ensure the mental health of Pakistani population.
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Ansiedad/epidemiología , COVID-19/psicología , Depresión/epidemiología , Pandemias/estadística & datos numéricos , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Adulto , Ansiedad/psicología , Ansiedad/virología , Control de Enfermedades Transmisibles/métodos , Estudios Transversales , Depresión/psicología , Depresión/virología , Femenino , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Pakistán/epidemiología , Prevalencia , Factores de Riesgo , SARS-CoV-2/patogenicidad , Trastornos del Inicio y del Mantenimiento del Sueño/psicología , Trastornos del Inicio y del Mantenimiento del Sueño/virología , Encuestas y CuestionariosAsunto(s)
COVID-19 , Neurocirugia , Países en Desarrollo , Humanos , Procedimientos NeuroquirúrgicosRESUMEN
Background: Metabolic syndrome (MetS) is a multifactorial disease, whose main stay of prevention and management is life-style modification which is difficult to attain. Combination of herbs have proven more efficacious in multi-targeted diseases, as compared to individual herbs owing to the "effect enhancing and side-effect neutralizing" properties of herbs, which forms the basis of polyherbal therapies This led us to review literature on the efficacy of herbal combinations in MetS. Methods: Electronic search of literature was conducted by using Cinnahl, Pubmed central, Cochrane and Web of Science, whereas, Google scholar was used as secondary search tool. The key words used were "metabolic syndrome, herbal/poly herbal," metabolic syndrome, clinical trial" and the timings were limited between 2005-2020. Results: After filtering and removing duplications by using PRISMA guidelines, search results were limited to 41 studies, out of which 24 studies were evaluated for combinations used in animal models and 15 in clinical trials related to metabolic syndrome. SPICE and SPIDER models were used to assess the clinical trials, whereas, a checklist and a qualitative and a semi-quantitative questionnaire was formulated to report the findings for animal based studies. Taxonomic classification of Poly herbal combinations used in animal and clinical studies was designed. Conclusion: With this study we have identified the potential polyherbal combinations along with a proposed method to validate animal studies through systematic qualitative and quantitative review. This will help researchers to study various herbal combinations in MetS, in the drug development process and will give a future direction to research on prevention and management of MetS through polyherbal combinations.
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INTRODUCTION: Neurosurgery is a challenging field of surgery. A neurosurgeon has to be trained with the finest skills, knowledge, and competencies necessary to provide high-quality patient care. Maintaining postgraduate training standards is a challenge in Pakistan due to low budget allocation to the health sector. This study aims to assess the difference in parameters among different institutes in different sectors and provinces offering neurosurgery training in Pakistan. METHODS: A nationwide survey was conducted by the Neurosurgery Department at Liaquat National Hospital Karachi, from November 2019 to February 2020. Data were collected through a questionnaire from neurosurgery trainees from all over the country. The questionnaire was divided into the following sections: Sociodemographics and infrastructure of training site, clinical skills training and exposure, knowledge-based education, and workload. The data were kept confidential and institutional names were not inquired or disclosed. RESULTS: The response rate was 85.3% (151/177), with more males (80%) than females. The total number of trainees was higher in government than private institutions (P < 0.005). The frequency (P = 0.030) and number of trainees (P < 0.005) inducted per cycle was more among government institutions. Participation in international conferences was higher among trainees in private sector (P = 0.006). The frequency of clinics was significantly higher in private institutions (P < 0.005), though the number of patients seen per clinic was lower than in government sector (P < 0.005). At a provincial level, there was a significant difference in gender distribution (P = 0.020), total number of trainees (P < 0.005), number of residents per induction (P < 0.005), frequency of mortality and morbidity meetings (P < 0.005), morning meetings (P < 0.005), number of calls per week (P < 0.005), number of workshops attended (P < 0.005), exposure to radiation (P = 0.003), frequency of outpatient departments (OPDs) attended per week (P = 0.002), and number of patients seen per OPD (P 0.02). CONCLUSION: This study reported variability in the quality of neurosurgery training programs within public and private sector with even greater differences between the four provinces of Pakistan. We recommend continuous assessments and re-accreditation of these training programs through subject experts and health-care educationists to improve the quality of training programs; hence the quality of service and patient care.
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BACKGROUND: The burden of erectile dysfunction (ED) among the developed countries is found to be quite high. However, there is a paucity of data among developing countries to know its actual burden and factors associated with it. METHODS: The current study is cross-sectional and was conducted in Family Medicine clinics of Liaquat National Hospital during May 2017-January 2018. A total of 450 males participated in this study with the age range of 24-77 years. More than half of the participants were graduates or above. RESULTS: On multivariable analysis, age (aOR = 5.47, 95% CI: 2.74-10.89), alcohol use (aOR = 5.23, 95% CI: 1.45-18.84), diabetes (aOR = 6.61, 95% CI: 3.27-13.36), and current smoking (OR = 2.41, 95% CI: 1.35-4.31) were significantly associated with ED. ED risk was significantly lower in those who either attended secondary school (aOR = 0.33, 95% CI: 0.13-0.88) or were at least graduates (aOR = 0.40, 95% CI: 0.17-0.96) than illiterate when model was adjusted for other covariates. CONCLUSION: Erectile dysfunction in a Pakistani male population highlights the need for routine screening at the primary care level. There is a possibility that the actual burden is underreported due to cultural stigmatization; hence, further research is warranted to validate the findings.
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BACKGROUND: Neurosurgery in Pakistan is an advanced field with significant challenges. The training program tests one's endurance, knowledge, empathy, and dedication. The training structure in Pakistan consists of 5 years, of which 2 years are spent in general surgery followed by 3 years of dedicated neurosurgery. This study aimed to conduct a survey to address the quality of neurosurgery training in Pakistan so that its strengths and deficiencies could be identified, recommendations could be made, and actions could be taken toward improvement. METHODS: A nationwide survey was conducted of neurosurgery residents from all over Pakistan. An e-mail invitation was sent to 177 neurosurgery residents certified by the College of Physicians and Surgeons Pakistan from 22 institutes in all provinces of Pakistan. The questionnaire was divided into the following sections: sociodemographics of participants, infrastructure of training site, clinical skills training and exposure, and knowledge-based education. Data were collected through Google Forms and analyzed using statistical software. RESULTS: A total of 151 residents responded to the survey. More than half of the institutes had >10 neurosurgery residents in their department (59.6%). More than half of the residents did not attend any international conference during their residency (51%). More than one fourth of the residents did not participate in any hands-on workshop during their residency tenure. CONCLUSIONS: The neurosurgical training program in Pakistan requires updating of the curriculum with better implementation. These data will help the College of Physicians and Surgeons Pakistan in standardizing neurosurgical training across Pakistan to improve competence among trainees.
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Neurocirugia/educación , Procedimientos Neuroquirúrgicos/educación , Adulto , Competencia Clínica , Curriculum , Países en Desarrollo , Femenino , Humanos , Internado y Residencia , Masculino , Pakistán , Encuestas y CuestionariosRESUMEN
Health care workers (HCW) are especially vulnerable to developing mental health problems in pandemic situations. The impact may be much devastating in developing countries due to fragmented health care system. Our study aims to explore the underlying burden of depression and its related factors among health care workers in South Asian countries. Data was collected through an online survey. A total of 476 health care workers including doctors, nurses, and paramedical staff participated from Pakistan, India, and Sri Lanka. A validated WHO Self Reporting Questionnaire (SRQ-20) was used to screen for Depression. A 25.7% prevalence of depression was reported among health care workers. Almost 70% of them were either not satisfied or partially satisfied with the provided personal protective equipment. On multivariable analysis, females gender (aOR=1.80, 95% CI: 1.11 - 2.90), fear of unprotection (aOR=1.80, 95% CI: 1.11 - 2.90), confirmed COVID-19 case in workplace (aOR=1.98, 95% CI= 1.18 - 3.33) and family (aOR=2.98, 95% CI: 1.02 - 8.70) were found to be independent predictors of depression among healthcare workers. Depression among HCW in South-Asian countries is quite alarming. This may jeopardize attention to other non-COVID health problems which are still on a priority in developing countries.
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COVID-19 , Pandemias , Ansiedad , Depresión/epidemiología , Femenino , Personal de Salud , Humanos , India/epidemiología , Pakistán/epidemiología , Prevalencia , Factores de Riesgo , SARS-CoV-2RESUMEN
BACKGROUND: COVID-19 is a global pandemic and has become a major public health burden worldwide. With already fragile healthcare systems it can have long lasting effects in developing countries. Outbreaks especially a pandemic situation evokes fear related behaviors among healthcare professionals and there is always an increased risk of mental health disorders. Therefore, this study aims to determine knowledge and perception about this pandemic, prevalence and factors associated with anxiety/depression among frontline physicians of Pakistan. METHODS: Data were collected through an online survey released in the last week of March-2020. 389 frontline physicians from all four provinces and 65 cities of Pakistan participated. Survey questionnaire consisted of 4 parts including informed consent section, demographic section, knowledge and perception about COVID-19 pandemic and assessment of depression through World Health Organization Self-reporting questionnaire (SRQ-20). A score of 8 or above on SRQ-20 was used as cut-off to label the participant as depressed. Data was analyzed using SPSS version22. RESULTS: A 43% prevalence of anxiety/depression among frontline physicians of Pakistan was reported. Almost all the doctors had moderate to high knowledge score. Majority of participants marked N-95 mask as "essential" during aerosol generating procedures, assessing patients with respiratory symptoms, in COVID patient-care area, ER triage and direct care of COVID-19 patient. Only 12% of the doctors were fully satisfied with the provision of PPEs and almost 94% felt unprotected. In multivariable model, assessing more than five COVID suspects/day (aOR = 2.73, 95% CI: 1.65-4.52), working 20 h/week or less (aOR = 2.11, 1.27-3.49), having children among household members (aOR = 1.58, 95% CI: 1.00-2.50) and moderate to low knowledge of the infection (aOR = 2.69, 95% CI: 1.68-4.31) were found to be independent predictors of anxiety/depression among physicians. CONCLUSION: Anxiety/depression among more than a third of frontline doctors of Pakistan warrants the need to address mental health of doctors caring for patients during this pandemic; control modifiable factors associated with it and explore the effectiveness of interventions to promote psychological well-being of physicians.
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Ansiedad/psicología , Betacoronavirus , Infecciones por Coronavirus/psicología , Depresión/psicología , Médicos/psicología , Neumonía Viral/psicología , Adulto , COVID-19 , Infecciones por Coronavirus/epidemiología , Femenino , Personal de Salud/psicología , Humanos , Masculino , Salud Mental , Pakistán , Pandemias , Neumonía Viral/epidemiología , Prevalencia , Resiliencia Psicológica , SARS-CoV-2 , Encuestas y CuestionariosRESUMEN
OBJECTIVE: The goal of this survey was to determine factors associated with anxiety/depression among neurosurgeons during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: An online survey was performed of neurosurgeons worldwide, conducted over 3 weeks. Depression in neurosurgeons was assessed by Self-Reporting Questionnaire-20. RESULTS: A total of 375 responses were received from 52 countries. Among all neurosurgeons, 34% felt tense, 32.5% were unhappy, 25% experienced insomnia, almost 20% had headaches, and 5% had suicidal ideation during the pandemic. Of participants, 14% had a score on Self-Reporting Questionnaire-20 consistent with depression. The likelihood of depression was significantly higher among those who did not receive guidance about self-protection from their institutions (odds ratio [OR], 2.47), those who did not feel safe with provided personal protective equipments (OR, 3.13), and those whose families considered their workplace unsafe (OR, 2.29). Depression was less likely in neurosurgeons who had minor concerns, compared with those with significant health concerns for their families (OR, 0.36). In multivariate analysis after controlling for effects of other covariates, odds of depression were significantly higher among neurosurgeons who did not feel safe with the provided personal protective equipment (OR, 2.43) and who were exposed to a COVID-19-positive colleague (OR, 2.54). Participants who had moderate concerns for their families had lesser odds of anxiety/depression than did those with significant concerns (OR, 0.28). CONCLUSIONS: Based on the modifiable risk factors of depression in this study, it is recommended that the safety of neurosurgeons be ensured by providing appropriate safety measures for them to regain their confidence and hence reduce the incidence of depression.
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Betacoronavirus/patogenicidad , Infecciones por Coronavirus , Depresión , Neurocirujanos , Pandemias , Equipo de Protección Personal , Neumonía Viral , Adulto , Ansiedad , COVID-19 , Infecciones por Coronavirus/virología , Humanos , Salud Mental , Neumonía Viral/virología , SARS-CoV-2 , Encuestas y CuestionariosRESUMEN
Sphingomonas paucimobilis is a rare organism that usually infects immunocompromised patients and is known to cause nosocomial infections from mild to severe pathogenicity. Recently a few community acquired infections have been identified in relatively healthy adult patients with diabetes and alcoholics. We report a case of a 10 years old previously healthy child who presented with fever for a month and was found to have a positive blood cu lt ure for Sphi ngomon as pauc imobil is.
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Antibacterianos/uso terapéutico , Bacteriemia/microbiología , Infecciones Comunitarias Adquiridas/microbiología , Infección Hospitalaria/microbiología , Infecciones por Bacterias Gramnegativas/microbiología , Huésped Inmunocomprometido , Sphingomonas/aislamiento & purificación , Bacteriemia/diagnóstico , Bacteriemia/tratamiento farmacológico , Niño , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infección Hospitalaria/diagnóstico , Infecciones por Bacterias Gramnegativas/diagnóstico , Humanos , Masculino , Enfermedades RarasRESUMEN
BACKGROUND: Pakistan is a developing country that has a double burden of communicable and non-communicable disease. Healthcare reform is required to combat these prevailing healthcare issues with the 'family medicine approach' to primary care. Developing a workforce of trained general practitioners (GPs) to implement this approach is essential but challenging, yet there are success stories not only from developed countries but also from a few developing countries. OBJECTIVE: General practice is a specialty that has been recognised only recently in Pakistan. This article reviews the challenges of developing a workforce of trained GPs for primary care and proposes solutions to address the gap. DISCUSSION: Involving all stakeholders and organisations related to the specialty of general practice, integrating the subject of family medicine at an undergraduate level and encouraging postgraduate training and capacity-building through on-the-job training of GPs working in rural and urban primary care are all essential to develop a workforce of trained GPs in Pakistan. At the same time, standardisation and accreditation of primary care sites for training and research through public-private partnership are recommended.
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Medicina Familiar y Comunitaria/métodos , Recursos Humanos/normas , Creación de Capacidad/métodos , Creación de Capacidad/estadística & datos numéricos , Países en Desarrollo/estadística & datos numéricos , Medicina Familiar y Comunitaria/estadística & datos numéricos , Reforma de la Atención de Salud/métodos , Reforma de la Atención de Salud/estadística & datos numéricos , Humanos , Pakistán , Recursos Humanos/estadística & datos numéricosRESUMEN
BACKGROUND: Epidemiologic measures of the dengue burden such as prevalence and incidence are important for policy-making and monitoring the progress of disease control. It is a common practice where epidemiologic and economic research estimate dengue burden based on notification data. However, a basic challenge in estimating the incidence of dengue is that a significant proportion of infected population are asymptomatic. It can be overcome by using mathematical models that relate observed prevalence and mortality to incidence. In this study, we estimate the trend of dengue incidence and hospitalization in Malaysia. METHODS: This study is based entirely on the available secondary data sources on dengue in Malaysia. The age-specific incidence of dengue between 2001 and 2013 was estimated using the prevalence and mortality estimates in an incidence-prevalence-mortality (IPM) model. Data on dengue prevalence were extracted from six sero-surveys conducted in Malaysia between 2001 and 2013; while statistics on dengue notification and Case Fatality Rate were derived from National Dengue Surveillance System. Dengue hospitalization data for the years 2009 to 2013 were extracted from the Health Informatics Centre and the volumes of dengue hospitalization for hospitals with missing data were estimated with Poisson models. RESULTS: The dengue incidence in Malaysia varied from 69.9 to 93.4 per 1000 population (pkp) between 2001 and 2013.The temporal trend in incidence rate was decreasing since 2001. It has been reducing at an average rate of 2.57 pkp per year from 2001 to 2013 (p = 0.011). The age-specific incidence of dengue decreased steadily with dengue incidence reaching zero by age > 70 years. Dengue notification rate has remained stable since 2001 and the number of notified cases each year was only a small fraction of the incident cases (0.7 to 2.3%). Similarly, the dengue hospitalization was larger but still a small fraction of the incident cases (3.0 to 5.6%). CONCLUSION: Dengue incidence can be estimated with the use of sero-prevalence surveys and mortality data. This study highlights a reducing trend of dengue incidence in Malaysia and demonstrates the discrepancy between true dengue disease burden and cases reported by national surveillance system. Sero-prevalence studies with representative samples should be conducted regularly to allow better estimation of dengue burden in Malaysia.