Use of public health emergency operations center (PH-EOC) and adaptation of incident management system (IMS) for efficient inter-sectoral coordination and collaboration for effective control of Dengue fever outbreak in Pakistan - 2019.

Public Health Emergency Operations Center (PH-EOC) and Incident Management System (IMS) provides a platform for inter-sectoral coordination, and collaboration to enhance efficiency of response activities and help in effective control of disease outbreaks. Dengue fever (DF) is an emerging serious public health threat with a potential to transform into a public health emergency. Pakistan faced a heavy outbreak of Dengue fever (DF) from August to December 2019. National Institute of Health (NIH), Islamabad activated its Public Health Emergency Operations Center (PH-EOC) with an objective to implement principles and practices of IMS for control of the outbreak. The challenges during inter-sectoral collaboration for response activities were also identified. PH-EOC was activated on 16th September 2019, and remained operational for next 81 days till 05th December 2019. Incident management structure, incident action plan (IAP), and risk communication plan was developed and executed during this phase. Daily morning and evening meetings were held during all operational days. Federal and provincial health departments, district health offices (DHO), and government/private hospitals were coordinated for collection of the data pertaining to Dengue confirmed cases and deaths. As of 05th December 2019, a total of 52,877 confirmed Dengue cases were reported from all across Pakistan with maximum cases reported from Rawalpindi and Islamabad collectively i.e. 20,988 (40%), followed by Karachi 14,768 (28%), and Peshawar 2,699 (5%), while AJK reported 1,690 (3%). A total of 92 deaths happened all across Pakistan, out of which 43 (47%) happened in Karachi, 23 (25%) in Rawalpindi, and 22 (24%) in Islamabad. The response was coordinated through NIH based PH-EOC, but was carried out by relevant federal and provincial district health offices, vector surveillance programs, dengue control programs and sanitation departments respectively. As a part of response plan, vector surveillance, larva source management, and insecticidal spraying i.e. both fogging and indoor residual spraying activities were carried out in hotspots or the areas where confirmed cases were reported. Sanitation departments daily reported the removal of additional 80-100 ton of solid waste from hotspot areas. Hospitals were coordinated for reporting of isolation of DF patients and provision of quality clinical management for admitted patients. The International Federation for Red Cross/Crescent conducted community awareness, and covered 28,800 households in affected areas of Islamabad. Conversely, the DF outbreak was controlled 02-03 weeks ahead of previous years trends. All the coordinated activities were incorporated in a daily situation report (SitRep) and this was widely distributed among all the stakeholders through emails. Additionally, the data was displayed on the dashboard in PH-EOC. The data dashboard at PH-EOC served as an information management hub that visually mapped, tracked, analyzed, and displayed clusters of DF cases and hotspots. Accordingly, SitRep substantiated as the main reporting tool to monitor response activities initiated by rapid response teams at the national and subnational level. The inter-sectoral coordinating efforts made among concerned line departments resulted in a timely response leading to effective handling of a national public health threat. The information distilled from this experience was that the early and judicious activation of PH-EOC with adaptation of IMS under decision making leadership resulted in a well-managed and prompt response executed by different departments/stakeholders, and effective control of the outbreak before its transformation into a public health event/emergency of national or international concern.

Impact of environmental factors on COVID-19 cases and mortalities in major cities of Pakistan.

INTRODUCTION: Climate factors play an important role in the transmission of viruses, such as influenza viruses, MERS-CoV, and SARS-CoV-1. This study aimed to determine the relationship between changes in temperature, humidity, rainfall, and SARS-CoV-2 contagion. Five ecologically and climatically distinct regions were considered-Karachi, Lahore, Islamabad, Peshawar, and Gilgit-Baltistan. METHOD: Data on daily COVID-19 cases and deaths were retrieved from government officials, while meteorological information was collected from Pakistan Meteorological Department.. Statistical analysis was performed using SPSS version 20 and the Spearman rank correlation test was used to analyze the correlation between the meteorological factors and COVID-19 cases and deaths. RESULT: Positive correlation of COVID-19 incidence was observed with all the temperature ranges (maximum, minimum and average) and negative correlation was seen with humidity, DTR and rainfall. COVID-19 deaths were positively associated with temperature and were negatively associated only with humidity. Linear regression showed that for every unit increase in humidity, there was a -3.345 daily significant decrease in COVID-19 cases, while in Karachi for every unit increase in humidity, there remained a 10.104 daily significant increase in cases. In Gilgit-Baltistan, for every unit increase in average temperature and rainfall respectively, significant increases of 0.534 and 1.286 in daily cases were found. CONCLUSION: This study signifies the effect of climate factors on COVID-19 incidence and mortality rate, but climate factors are not the only variable and several other interlinked factors enhance the spread of COVID-19. Hence, effective mitigation policies, enhancing testing capacities, and developing public attitudes toward adopting precautionary measures are important to overcome this overwhelming pandemic.

Assessment of inhalation technique among patients of chronic respiratory disorders in Civil Hospital Karachi: A cross sectional study.

OBJECTIVE: To evaluate the inhaler technique of patients and the awareness acquired during pulmonary teachings given in the beginning of the treatment. METHODS: This cross-sectional study was conducted at Civil Hospital, Karachi, from December 2013 to July 2014, and comprised patients diagnosed with obstructive broncho-pulmonary diseases and who were using inhaler therapy. A questionnaire was designed to assess the technique by an inhaler technique checklist, which was pilot-tested and was filled after obtaining verbal consent. SPSS 19 was used for data analysis. RESULTS: Of the 202 participants, 110(54.45%) were women and 92(45.54%) were men. Moreover, 168(83.2%) used metered-dose inhaler while 34(16.8%) used dry-powder inhaler. Besides, 134(79.8%) patients showed incorrect technique while using metered-dose inhaler while 22(61.1%) used dry-powder inhaler improperly. CONCLUSIONS: In spite of the guidelines given, improper inhalation technique persisted in population leading to uncontrolled asthma and poor treatment compliance.

KNOWLEDGE AWARENESS AND BEHAVIOUR OF NON-MEDICAL STUDENTS ABOUT CARDIOVASCULAR DISEASES.

BACKGROUND: Cardiovascular diseases is the leading cause of death worldwide, yet very little data is available assessing the awareness of the younger population of Pakistan. The purpose of this study was to evaluate the awareness, knowledge and the preventive measures taken to avoid the health issues related to cardiovascular diseases. METHODS: It was a community based cross sectional descriptive study to assess the awareness and behavior in young non medical students. A questionnaire was developed and survey was conducted on 300 non medical students enrolled in different universities of Pakistan. Data analysis was performed using SPSS-16. RESULTS: The sample consisted of 300 students aged between 16 and 32 years. 6.7% of the participants had history of blood pressure, 0.7% had diabetes, and 68.3% had a family history of cardiovascular diseases. 17.4% students were smokers. In the knowledge section, only 22% respondent scored above 20 out of 28 showing lack of knowledge. 42.7% participants were concerned about developing coronary artery diseases. 43.3% and 6.7% knew their blood pressure and cholesterol level respectively.33.3% and 41.7% regulate their dietary fat and salt intake respectively. CONCLUSION: Our study elucidates that cardiovascular diseases are not perceived as major risk by Non Medical Students. Lack of knowledge, physical inactivity, and high positive family history render the target population prone to cardiovascular diseases. The findings of study indicates the need for heart disease awareness campaigns for young population, to escalate the preventive actions and adoption of healthy lifestyles so as to lower the incidence of cardiovascular diseases in Pakistan.