Healthcare in Pakistan: Navigating Challenges and Building a Brighter Future.

A healthcare system is one of the most essential pillars of any country. The primary role of a healthcare system is to ensure that all people get the best available health facilities in a timely, acceptable, affordable, and accessible manner. However, for a healthcare system to function as such, it requires proper infrastructure and financial support. To a large extent, the healthcare system in Pakistan is facing several challenges. There is a massive shortage of hospitals, doctors, nurses, and paramedical staff. Most life-saving medications are too expensive for people to afford. Now and then, there is a shortage of medicines in the market. Above all, there exists a lack of trust in the healthcare system, which gives way to the ever-increasing quackery in the country. Two parallel systems exist in the healthcare system of Pakistan. One consists of public hospitals, and the other consists of private hospitals. The former is short even of basic healthcare facilities, and the latter is too costly for the people of Pakistan to afford. Solutions to the stumbling and compromised healthcare system of Pakistan are adequate financial support and infrastructure development. Stakeholders need to invest in the healthcare system; otherwise, the healthcare system in Pakistan will continue fighting for its survival rather than improving and competing with the healthcare systems of other nations in the region.

Attitudes and Factors Determining the Practice of Routine Medical Checkups in the People of Rawalpindi, Pakistan: A Cross-Sectional Study.

INTRODUCTION: Routine medical checkup (RMC) is a screening and preventive technique that is implied to detect non-communicable diseases (NCDs). This study aims to assess the awareness in public regarding RMC, the association between education level and level of familiarity regarding RMC, and factors that prevent and encourage the practice of RMC by the public. METHODS: This is a cross-sectional study carried out in Rawalpindi, Pakistan. Health professionals and individuals who refused to consent were excluded from the study. Data was collected using a mixed-mode questionnaire, and convenient sampling was used. The sample size was calculated to be 355 according to the WHO sample size calculator. A total of 356 individuals participated in this study after giving informed consent. Both male and female adults aged 18 or older and residents of Rawalpindi were included in the study. Individuals younger than 18 were excluded.  Results: Among the 356 study participants, 160 (45%) were males, and 196 (55%) were females. The mean age was 27.57±10.027. Among the total participants, 33 (9.3%) individuals had primary-level education, 100 (28.1%) individuals had secondary-level education, and 233 (62.6%) had graduate-level education. A total of 329 (92.9%) participants knew that RMCs could help in early diagnosis and treatment. On the contrary, only 154 (43.3%) people knew that RMCs involve screening all body tissues. Only 329 (92.4%) participants said that they were aware that timely diagnosis through RMC can lead to early treatment. Graduates were generally more aware of different aspects of RMCs, especially in the domains of awareness regarding what an RMC is and that RMC can help in timely diagnosis compared to participants who had primary or secondary level of education (p<0.001). Females had a greater overall awareness of RMCs than males (p<0.001). Graduates were more likely to undergo RMCs than people educated till the primary or secondary level (p<0.001). The most common reason for undergoing RMC was "just concerned about health," which was selected by 130 (36.5%) participants. The most common reason mentioned by participants for not having an RMC was ''heavy cost,'' mentioned by 104 (29.2%) participants.  Conclusion: Most of the participants of this study were well educated and were students in terms of profession. The majority of the study population knew that RMCs could help in early diagnosis and treatment. Awareness regarding RMCs was linked to educational level. Females had overall better knowledge regarding RMCs than men. The most common reported reason to have an RMC was a health concern, and the most common reported reason for not having an RMC was its high cost.

Epidemiological Comparison of Anorectal Malformation With Other Gastrointestinal Abnormalities in Patients in the Pediatric Ward.

Background Anorectal malformations are congenital defects wherein there is defective development of the anus and rectum. For babies born with congenital anorectal malformations, prompt treatment is crucial which requires detection of the anomalies at the earliest. This study aimed to determine the epidemiology ofanorectal malformations in the Pediatric Unit of a tertiary care hospital in Pakistan over a period of 19 months. Methodology An analytical cross-sectional study was conducted retrospectively from January 2020 to September 2021 using a non-randomized consecutive sampling technique. Patients aged less than eight years were included, whereas burnt, torn, and incomplete records from the Hospital Management Information System (HMIS) were excluded. SPSS version 26 (IBM Corp., Armonk, NY, USA) was used for data entry and analysis. Binomial and multinomial logistic regression were applied for analyzing the association between explanatory and dependent variables. Results Of the 1,108 patients, 72 (6.5%) patients had anorectal malformations. Gastrointestinal diseases made up about 64.3% of all diseases. Among gastrointestinal causes, the prevalence of anorectal malformation was up to 10.1%. The mortality of anorectal malformation patients was low (2.85%) compared to mortalities due to other gastrointestinal abnormalities (8.25%). Anorectal malformation had significantly lower odds of mortality (adjusted odds ratio = 0.19, p < 0.05) compared to other gastrointestinal abnormalities. Conclusions This study has provided data about the prevalence of anorectal malformation and its mortality which were calculated as 6.5% and 2.58%, respectively. Female gender, neonates, and delayed presentation were seen to have higher mortality, highlighting the need to screen all neonates pre- and post-natally to avoid any misdiagnosis.

Psychosocial Impact of Electrical Burn in Children: A Follow-Up Study Conducted at a Tertiary Care Hospital.

Introduction Electrical burn injuries are very common in the pediatric population and are usually accidental and sometimes occupational. The objective of our study was to evaluate the epidemiology of electrical burn injuries and prospectively evaluate the long-term psychosocial impact of electrical burn injuries in children. Materials and methods A qualitative interview study was conducted prospectively among sixty patients presented to Holy Family Hospital, Rawalpindi, Pakistan. Demographic details, mode of presentation, detail of injury, total body surface area, initial condition, and surgical interventions were noted during their stay at the hospital. Their physical and psychological outcomes were evaluated by administering the Strength and Difficulties Questionnaire (SDQ) and Body Dysmorphic Disorder Questionnaire (BDDQ) via telephonic interviews after six weeks of discharge from the hospital. The study was conducted over a span of 1 year from January 2021 to January 2022. Results There were 60 patients who presented to the department of pediatric surgery during the span of the study. The mean age was 9.9 years ± 3.133 years (SD) and 80% of the patients were above 8 years of age with a male-to-female percentage of 86.67% to 13.33%, respectively. Forty-two (70%) patients incurred high-voltage electrical burns while 18 (30%) suffered low-voltage electrical burns. Mortality was 13.33% (n=8). Out of 52 patients who survived, 35 (67.30%) were labeled as having Body Dysmorphic Disorder upon administration of BDDQ through a six-week follow-up. The majority of the patients had abnormal or borderline results in different scales of SDQ. Conclusion The long-term psychological stress and the varied spectrum of psychiatric disorders in electrical burn patients are profound. The prevention of burn injuries can be effectively achieved by educating parents about safety measures and improving health infrastructure. Implementation of a dedicated national program for psychological support of burn patients should be made accessible to all patients.

Aphallia: A Very Rare Congenital Anomaly, With Associated Genitourinary And Ano-Rectal Malformation.

Aphallia or penile agenesis is very rare congenital anomaly of unknown cause occurring 1 in 30 million live births. Very little has been written in literature about aphallia. There is absent phallus and urethra may open abnormally in perineum or into rectum posing various surgical, social and psychological implications as the child grows. We are presenting 03 cases of aphallia with associated congenital anomalies such as unilateral renal agenesis, bilateral undescended testes, anorectal malformation and rectovasical fistula.