Journal of Society of Prevention, Advocacy and Research KEMU

Human Resources in Public Healthcare Settings in South Asia in the Last 10 Years

Areej Javaid — 2024-02-12

Human resources are part and parcel of an effective healthcare system. They not only cater to clinical but non-clinical areas of the healthcare system too. Human resources aim to achieve a sustainable healthcare system globally which is a basic right of every living
individual. Objective: To review human resources densities and their input in the healthcare system. We also aim to look at the management of human resources and governmental policies and how this has affected patient care. Methods: A search string was generated and databases used to search for articles included: Pubmed, Google Scholar, and Pakmednet. PRISMA guidelines were adopted to screen articles and select based on the inclusion and exclusion criteria proposed. Results: Out of 922 compiled articles,16 were selected after screening and eligibility selection. These articles showed the availability and competency of human resources from Bangladesh, Afghanistan, Pakistan, and other South Asian countries. Various problems and issues were examined surrounding human resources for health and the impact this has on care in South Asia. Conclusion: Necessary policies that aim to increase the availability of human resources and their competency by decreasing
workload must be carried out so the density increase in South Asia can be seen for human resources in the healthcare system.

Reduced Blood Loss with Intraoperative Artery Ligation During Angiofibroma Excision

Maryam Umar — 2024-01-29

Background: Juvenile Nasopharyngeal Angiofibroma (JNA) is a rare, highly vascularized tumor primarily affecting males during early puberty. Recurrent epistaxis and anemia are common presentations. Intraoperative artery ligation has been proposed as a strategy to minimize blood loss during JNA excision surgeries. This study aims to explore the correlation between intraoperative artery ligation and blood loss in JNA excision surgeries. Objective: To investigate the association between intraoperative artery ligation and blood loss during surgical excision of Juvenile Nasopharyngeal Angiofibroma. Methodology: This retrospective comparative study analyzed medical records of 12 patients who underwent JNA excision surgeries in ENT Unit I of Jinnah Hospital, Lahore. Two groups were compared: patients with intraoperative artery ligation and a control group without this intervention. Stratified Random Sampling was employed, and data, including demographics, clinical presentation, diagnostic information, surgical details, intraoperative blood loss, operative time, blood transfusions, and postoperative complications, were collected. Statistical analysis was performed using SPSS version 23, and a p-value below 0.05 was considered significant. Results: Patients with intraoperative artery ligation showed a focused blood loss distribution. 50% experienced 251-750ml, and none exceeding 750ml. In contrast, the non-ligation group showed a broader range, with 50% experiencing blood loss beyond 750ml. The mean blood loss in the ligation group was 375ml (SD=250ml), while the non-ligation group had a mean of 916.67ml (SD=401.83ml). Statistical analysis confirmed a significant association (p < 0.05) between intraoperative artery ligation and
reduced blood loss. The study suggests that intraoperative artery ligation contributes to a more controlled and moderate blood loss in JNA excision surgeries.
Conclusion: This retrospective comparative study reveals a significant correlation between intraoperative artery ligation and reduced blood loss in Juvenile Nasopharyngeal Angiofibroma excision surgeries. Patients with intraoperative artery ligation demonstrated a more controlled and focused distribution of blood loss, emphasizing its potential efficacy in managing hemorrhage during surgery. The study contributes valuable insights into the application of intraoperative artery ligation in JNA surgeries, providing clinicians with a potential strategy to minimize blood loss and improve surgical outcomes.

Increasing Vaccine Uptake Interventions: Lessons Learnt from South Asia

Talha Bin Kashif — 2024-01-30

Background: Vaccinations are arguably the most effective tool for preventing infectious diseases and reducing mortality. Pakistan reports some of the highest numbers in the world for unvaccinated children. The low vaccine uptake is attributable to numerous factors, such as illiteracy, vaccine hesitancy, and lack of resources. Given these challenges, effective policymaking is crucial for improving uptake and reducing childhood mortality. This study aims to review the data on vaccine uptake interventions in South Asia and provide insight into their effectiveness and impactfulness in guiding future endeavors in the country. Objective: To assess various vaccine uptake interventions aimed at Pakistani and other South Asian communities. To compare their effects in terms of increased vaccine awareness and coverage and decrease in disease prevalence, especially of communicable diseases. Methodology: The study systematically assessed literature related to vaccine uptake interventions using the PubMed and Google Scholar electronic databases. Articles were systematically screened and checked for eligibility according to PRISMA guidelines. They were assessed for quality and risk of bias, and finally added to the review. Statistical analysis was performed for available data, odds ratio and % increase in outcome were calculated for interventions, and forest plot was plotted where possible. P-values were calculated to check for significance, and heterogeneity was assessed using chi-square, tau, and I² tests. Results: The search yielded a total of 434 results, and after screening and eligibility check, 14 remaining studies were included in the review. Interventions were classified as either educational, vaccine delivery based, incentive based, and reminder based interventions. 8 studies reported educational interventions. The highest vaccine coverage odds were reported for DPT-3 coverage (Andersson, 2009) as a result of Focused Group Discussion Intervention (OD 95% CI = 3.46 [2.62, 4.58] p<0.0001) and BCG vaccine (Anjum, 2004) with House-to-House health messages (OD 95% CI = 3.10 [1.55, 6.19, p<0.001), with more than three times odds of vaccination as compared to no intervention (Control). There were 4 studies in the Delivery-based intervention group and two each in incentive and reminder groups. Upon comparison, multifaceted interventions targeted at vaccine awareness and delivery show the greatest odds of increasing vaccine coverage. Conclusions: The current systematic review includes the first quantitative analysis of vaccine uptake interventions specific to the South-Asian population. The significance of multifaceted interventions targeting vaccine literacy and delivery is evident from the results and should be considered during state-level decision-making. Further research with better resources and broader scope should be conducted to gather critical evidence on the topic.

Awareness of ChatGPT Among Medical Students and Trainee/Residents

Hina Lateef — 2024-02-12

Objectives: This study aims to assess the awareness of ChatGPT among medical students and postgraduate trainees.Study Design: Descriptive cross-sectional study Place and duration of study: Study was conducted for a period of three months from May to July 2023 at BMY Health. Methodology: Our study targeted 370 medical students and postgraduate trainees from reputable institutions across Punjab using a convenient sampling technique. The data collection tool was a structured online questionnaire that assessed the participant's
familiarity with ChatGPT, perceived usefulness, and intentions to use it in the future. Results: Most of the respondents (78%) were from the age group 20-30yr. Among the respondents 54.7% (204) were females. Study reveals that males are more active users (27.2% using once weekly) as compared to females (19.2% using once weekly). 41.5% (39) of male MBBS students reported having full knowledge of ChatGPT compared to 30% (18) of female MBBS students. 28.6% (16) of male postgraduate trainees said they have full knowledge of ChatGPT compared to 10.3% (7) of female postgraduate trainees. 31.6% (6) of male BDS students have full knowledge of ChatGPT as compared to 9.1% (7) of female BDS students. Conclusion: Medical students and trainees have moderate awareness of ChatGPT but positively perceive its utility in clinical decision-making, research, and education.

Causes of Suicides in Pakistan

Shah Gul Zahra — 2024-02-16

Background: Suicide is a complex phenomenon that involves social, cultural, biological, psychological, and environmental factors. Pakistan is a low-income Muslim country, in which suicide cases have increased in recent years. Aim: Our review focuses on the causes of suicide in Pakistan. Methodology: A systematic review was done to find out about the causes of suicide in Pakistan. Databases like PubMed, Google Scholar, and Science Direct were searched using keywords like “suicide”, “suicide attempt”, “etiology”, “causes”, and “Pakistan”. A total of 208 articles were screened out of which only 7 met our inclusion criteria. The rest were excluded because the data wasn’t of Pakistan or wasn’t just limited to Pakistan, Qualitative data were extracted from these articles and were tabulated and exposed to the major causes of suicide in Pakistan. Results: Systematic review was conducted to find out about the causes of suicide in different age groups, genders, and regional groups. The majority of suicides were linked to domestic problems. Most suicide attempts were done by females, married people, and youth, indicating the strong association of gender bias, family disputes, and depression, with suicide. Mental health problems, unemployment and prolonged illnesses, and low income also contributed a great deal to suicide. Other causes like social injustice, failure in love, failure in exams, bullying, and sexual abuse were also there. There is a need for greater attention and in-depth studies to elaborate on causative mechanisms for these public health issues. Conclusions: The most common reasons that compel an individual to take his/her own life are depression/mental illness, socioeconomic conditions, domestic violence and disputes, unemployment, and some major failure in life.

Telemedicine Practice: Current Challenges of Consent and Autonomy, Patient Privacy and Data Security Worldwide

Aqsa Mustafa — 2024-02-16

Background: Telemedicine, facilitating medical services remotely, introduces ethical concerns. Safeguarding patient data, ensuring informed consent, addressing access disparities, and managing biases in artificial intelligence-driven diagnoses are critical. Navigating these challenges ethically is essential for harnessing telemedicine benefits while upholding patient trust and welfare. Objective: To ascertain the primary obstacles affecting global telemedicine practice, including issues concerning patient confidentiality, privacy, autonomy, informed consent, and data security. Methodology: Conducted a systematic literature review, for which we searched two databases (Pubmed and Google Scholar) between January 2018 to December 2022. Broad terms such as ethical issues, legal issues, health care providers were used as keyword searches. The authors used a narrative approach according to PRISMA guidelines 2020 (Checklist). The authors did a qualitative synthesis of selected studies according to inclusion criteria. The inclusion criteria required articles that reported ethical and legal concerns associated with the use of telemedicine; the full texts articles were electronically available and published in English. Systematic reviews and papers in other languages are not a part of the study. Results: Results showed that most reported ethical and legal concerns were related to privacy and confidentiality, followed by informed consent, patient autonomy and data security. From the 16 papers reviewed, authors identified or discussed the following ethical concerns faced by healthcare professionals during the use of telemedicine: patient privacy was addressed in 75% (n = 12/16) studies, informed consent 56.25% (n = 9/16), patient autonomy 31.25% (n = 5/16), data security 25% (n = 4/16). Conclusions: In the dynamic landscape of telemedicine, healthcare providers and policy makers play pivotal roles in addressing its ethical and legal concerns. Collaborative efforts are essential to establish clear guidelines, secure patient data, ensure informed consent, and create adaptable regulations, fostering a responsible and effective telemedicine ecosystem.

Frequency of Diabetes Mellitus in Thalassemia Major Patients in Thalassemia Center, Sir Ganga Ram Hospital, Lahore

Hafiza Anam Saleem Khan — 2024-01-29

Background: Diabetes mellitus (DM) represents a significant complication in individuals with thalassemia major (TM),(1) yet the underlying mechanisms and risk factors are not yet completely understood. Aim of this study is to investigate the frequency and associated factors of Diabetes Mellitus in Thalassemia Major patients and describing relationship between genetic predisposition, iron overload and metabolic dysfunction. Objectives: Determining the frequency of Diabetes Mellitus among Thalassemia Major patients presenting at the Thalassemia Center, Sir Ganga Ram Hospital, Lahore. Additionally, the study aims to describe demographic factor, clinical parameters and family history profiles associated with the presence of DM. Methods: A cross-sectional study was carried out from July 2023 to October 2023, involving data collection from medical records of Thalassemia Major patients over a three-month period. Demographic characteristics, including age and gender; clinical parameters such as the number of blood transfusions; and family history profiles of thalassemia and Diabetes Mellitus were
analyzed. Statistical analysis, including chi-square tests, was used to assess associations and significance levels. Results: The study included 129 Thalassemia Major patients, with a majority falling within the 5-11 years age group (70%) and a slight predominance of males (56%). There wer no significant associations upon analysis between age, gender, or the number of blood transfusions and DM. There was a significant correlation between positive family history of thalassemia (p = 0.0047) and Diabetes Mellitus (p = 0.0026) with the presence of Diabetes Mellitus among Thalassemia Major patients. Conclusion: Despite the lack of significant associations with demographic and clinical parameters, the findings emphasize the need for targeted screening and intervention strategies for high-risk individuals. (2)

Quality of Life Among Cancer Survivors in South Asia

Tahreem Rauf — 2024-01-29

Background: Cancer survivorship has increased in South Asia, negatively impacting their health and wellbeing in terms of mental, social, emotional, physical, and economic well-being. Several factors, including sociodemographic, clinical, treatment-related, behavioral, and psychosocial aspects, all have an substantial effect on of QOL of cancer survivors. Our aim is to determine QOL among cancer survivors in South Asia, challenges faced by cancer survivors, factors enhancing and deteriorating QOL, and measures that can be taken to improve QOL. Method: We conducted a systematic literature review and systematically assessed the literature to identify relevant research about South Asian cancer survivors' quality of life in English only. We searched two databases (Google Scholar, and PubMed), In each of which we searched and selected all the articles and research having the keywords: Cancer survivors, quality of life, and South Asia. After reading the abstract and titles of the study, we read full articles and retrieved data according to PRISMA. The data extracted was compiled through Microsoft Excel. No meta-analysis and quantitative syntheses were done. Results: A total of 20 articles were identified. Of which 60% showed a negative effect on various domains of QOL of cancer survivors in South Asian countries. Most common factors identified were chemotherapy and effects of low of self-esteem, sexual dysfunction, limb impairment and physical restriction. Only 10 % of reviewed articles (2 articles) did not show a decline in QOL in cancer survivors. Conclusion: It has been found that there is a general detrimental influence on the quality living of cancer sufferers in this part of the world. Given the grave consequences, awareness must be raised to combat such dire circumstances and alleviate the overall quality care.

Incidence and Causes of Discharging Ear after Mastoid Exploration

Bakht Aziz — 2024-01-29

Background: Chronic ear diseases, common in developing countries, often require mastoid exploration, leading to post-operative ear discharge. This study, conducted at ENT Unit I of Jinnah Hospital (November 2022 to November 2023), investigates postoperative ear discharge incidences across different mastoid exploration techniques. Objective: This cross-sectional study conducted at ENT Unit I of Jinnah Hospital, Lahore, from November 2022 to November 2023 aimed to investigate the incidence of post-operative ear discharge following different mastoid exploration techniques. The study sought to establish associations between surgical techniques and post-operative outcomes, including the nature of discharge and causative organisms.– Methods: A sample of 18 ears, systematically divided into three groups based on the surgical technique. The groups included Cortical Mastoidectomy (Group A), Radical Mastoidectomy (Group B), and Modified Radical Mastoidectomy (Group C). Purposive sampling was employed, and data were collected from patient records, including demographic information, surgical
techniques, and culture results of ear discharge samples. Statistical analysis, including chi-square tests and Fisher's exact tests, was conducted to determine associations, with a significance level set at 0.05 Results: Incidence rates for Groups A, B, and C were 66.67%, 100%, and 54.55%, resulting in an overall incidence of 55.17% Microbiological analysis revealed prevalent causative organisms, including Pseudomonas aeruginosa and Staphylococcus aureus. Statistical analysis confirmed a significant association between surgical technique and outcomes. Conclusion: The study underscores the significance of tailoring mastoid exploration techniques to minimize post-operative ear discharge. Understanding the microbiological profile enhances targeted interventions for better patient outcomes.

Frequency of Hypoglycemia in Neonates with Hypoxic-Ischemic Encephalopathy in the Neonatal Intensive Care Unit of Sir Ganga Ram Hospital, Lahore

Fatima Mahmood — 2024-01-29

Background: Hypoxic-ischemic encephalopathy (HIE) often necessitates admission to neonatal intensive care units (NICUs) for specialized care.– Among the various complications associated with HIE, hypoglycemia is a notable concern due to its potential to exacerbate neurological injury and compromise neurodevelopmental outcomes. However, the frequency of hypoglycemia in neonates with HIE, particularly in resource-limited settings like Pakistan, remains poorly characterized. Objectives: Aim of this study is to determine the frequency of hypoglycemia in neonates with HIE admitted to the NICU of Sir Ganga Ram Hospital, Lahore, Pakistan. By systematically reviewing medical records, this study is aimed to describe the prevalence of hypoglycemia in this population.
Methods: Medical records of neonates diagnosed with HIE and admitted to the NICU were reviewed from July 2023 to October 2023. Data on demographic characteristics, perinatal history, clinical presentation, laboratory investigations including blood glucose levels, and neurodevelopmental outcomes were extracted. The frequency of hypoglycemia was determined as the proportion of neonates with documented hypoglycemia among all neonates diagnosed with HIE during the study period. Results: Among the cohort of neonates diagnosed with HIE (n = 120), 20.8% were found to experience hypoglycemic episodes during their hospital stay. Subgroup analyses revealed associations between hypoglycemia and variables such as gestational age, birth weight, and severity of HIE. Descriptive statistics were used to summarize the demographic characteristics of this population, providing context for understanding the prevalence and implications of hypoglycemia in neonates with HIE. Conclusion: This study highlights the prevalence of hypoglycemia as a common metabolic disturbance in neonates with HIE, underscoring the need for vigilant monitoring and prompt intervention in this vulnerable population. Standardized protocols for managing hypoglycemia in neonates with HIE are imperative to optimize clinical outcomes.

Relationship Between Adverse Childhood Experiences, Childhood Obesity And Risk of Colorectal Cancer in Adulthood: A Systematic Review

Abdullah Shahid Farooq — 2024-03-05

Background: Adverse childhood experiences are traumatic incidents occurring before the age of 18 years that increases the risk of
adult health problems. Such experiences include various types of abuse; physical and emotional neglect; separation between
parents; serious household dysfunction; peer violence and community violence.
Objective: To determine the risk of colorectal cancer in persons in adult life with exposure to early life trauma. To find relation
between adverse experiences in childhood and early life obesity.
Methods: This systematic review was conducted according to PRISMA guidelines 2020. In this review, 5 independent reviewers
extracted the data based on the articles published between 2018 and 2023 with the help of Databases such as PubMed/ Medline and
Google Scholar. In each database, keywords used were: Adverse Childhood Experiences And Childhood Obesity, Adverse Childhood
Experiences OR Childhood Obesity AND Colorectal Cancer, Childhood Obesity AND Colorectal Cancer. Studies reported any
relationship between adverse childhood experiences or childhood obesity and adulthood colorectal cancer were selected..
Results: A total of 22 articles were identified. Out of these 13 (59.1%) explained the positive relationship between adverse childhood
experiences and the development of childhood obesity (increased BMI). The most common childhood adversities related to
increased childhood BMI are Household dysfunction, crime proximity, neglect, bereavement, and abuse. There were 9 (40.9%) of
the 22 identified articles proved a direct relation between childhood obesity and the development of colorectal carcinoma.
Conclusion: Necessary steps must be taken to raise awareness about adverse childhood experiences such as abuse and
community-related issues children face and prevent such risk factors from increasing the overall risk of Colorectal Carcinoma, thus
alleviating the burden on the health system and provide wellness to the society as a whole.

A Impact of Irritable Bowel Syndrome (IBS) on Quality of Life; a Systematic Review

M Usman Khalil — 2024-03-05

Background: IBS is a prevalent GIT disorder known to affect millions worldwide, causing distressing symptoms like abdominal
pain, bloating, and altered bowel habits. Understanding the impact of IBS on quality of life is crucial.
Objective: To censoriously gauge the existing literature on the effects of irritable bowel syndrome on the health, social life, and
academic performance of affected people
Methods: We performed a systematic review of relevant literature from different databases like PubMed and Google Scholar on
the impact of irritable bowel syndrome on quality of life. To ensure transparency in this systemic review, we strictly followed
PRISMA guidelines.
Results: We selected 17 studies after strictly following our inclusion criteria. Every study employed different ways to assess the
impact on the quality of life. Four studies highlighted that a greater degree of work impairment was seen among patients with
irritable bowel syndrome. Seven studies highlighted that anxiety and depression were more prevalent. Moreover, IBS seems to be
more prevalent among females and was also associated with GIT-specific anxiety.
Conclusion: This systematic review underscores the multifaceted impact of IBS on individuals' quality of life, encompassing
health-related quality of life, work productivity, daily activities, and mental health. It also suggests a gender-related susceptibility
to IBS, particularly in females. These findings collectively emphasize the need for comprehensive care and support for individuals
living with IBS to improve their overall well-being.

Determinants and Prevalence of Stunting Among Children Under the Age of Five in Pakistan

Muqaddas Sarwar — 2024-03-05

Background: Stunting is a serious problem related to public health mostly affecting children under five years of age in various middle and low-income countries globally. It is a situation in which the growth and advancement of the human body is reduced.
Objective: This study is purposed to figure out the key factors of stunting and the prevalence of stunting among children under the age of five in Pakistan.
Methods: A comprehensive search on key databases like PubMed, Google Scholar, and ScienceDirect was made for relevant articles published between 2005 to 2022. For data reporting and analysis PRISMA checklist 2020 was used and a sum of 13 articles describing the determinants and prevalence of stunting in different rural and urban communities of Pakistan were selected for this systematic review.
Results: The prevalence of stunting among children under the age of five ranges from 18.58% to 61%, with a pooled prevalence of 39.26%. 12 out of 13 studies mentioned the mother's lack of education (prevalence range:16.6%-98.3%), 10 studies touched upon lower socioeconomic status (prevalence range: 37%-77.8%),8 studies mentioned residence in rural areas (prevalence range: 40.7%-79%), 5 studies showed unsanitary conditions (prevalence range:10.4%-77%), 6 studies mentioned overcrowded families (prevalence range: 26%-64.1%) are the main determinants of stunting among children under the age of five in Pakistan. Only one article brought up that 33.9% of stunted children were underweight at birth and 39.1% children stunted children started weaning before the age of 6 months.
Conclusion: The most recurrent factor was the mother's lack of education, followed by lower socioeconomic status, then residence in rural areas, then overcrowded families, followed by unsanitary conditions and lastly underweight children at birth and weaning age of less than 6 months. The overall pooled prevalence of stunting among children under the age of five in Pakistan is 39.26%.

Non-Provision of Mental Health Services To Parents/Caregivers of Patients with Thalassemia Major in Southeast Asian Countries Despite High Prevalence: A Concerning Dilemma.

Nabeel Ahmad — 2024-02-19

Composing this correspondence to bring to your notice a significant matter that impacts the psychological health of parents and caretakers of individuals with thalassemia major in South Asian Countries: the absence of the availability of mental health provisions for this susceptible and vulnerable community.
Thalassemia major is a genetic blood disorder that requires lifelong medical treatment and management. Caring for a child with thalassemia major can be emotionally and finan- cially challenging for parents and caregivers.1 Research has shown that parents of children with chronic illnesses like thalassemia major are at increased risk for physical distress, psychological ailment, and self-negligence.2 Caregivers are more prone to developing stress due to uncertainty of outcomes,
financial burdens, hopelessness, lack of education regarding the treatment process, and deteriorating condition of their child.3

Smog the New Unfortunate Reality: A Catastrophe Public Health Concern in Decreasing Life Spans of Pakistani Population

Saira Afzal — 2024-02-19

The air pollution that is currently engulfing T Pakistan is a public health emergency. Pakistan's "smog season" begins in the fall and early winter and seems to be getting worse every year. Lahore and other cities in the region frequently rank among the worst places in the world for air quality.1 According to a University of Chicago study, the consequences of the smog will shorten people's lives in Lahore by an average of seven years. The Punjab administration acted decisively after the Air Quality Index (AQI) in Lahore reached a concerning peak of 409 in November.2