Age In Pakistan Research Articles

Association among Household Wealth, Maternal Employment, and Undernutrition in Children under Three Years of Age in Pakistan.

There is an abundance of studies explaining the separate impact of female employment and household wealth status in reducing malnutrition. However, our study has unraveled the combined impact of maternal employment and household wealth on undernutrition among children under three in Pakistan. Using a sample of 1093 children under three years of age from the Pakistan Demographic and Health Survey 2017-2018, a binary logistic model was employed to gauge factors influencing the children's undernutrition. Our results indicated that children up to a certain age (three years old) with residence in certain regions (Pakistan) and recent episodes of diarrhea had an increased risk of undernutrition. Conversely, secondary and higher maternal education, access to improved water sources, and sanitation facilities lowered the chances of undernutrition in children under three in Pakistan. The interaction between maternal employment and household wealth showed that maternal employment significantly lowered the risk of stunting, being underweight, and wasting among the average, rich, and richest households; however, it did not contribute to child nutrition among the poorer and poor households. Notably, regardless of whether the mother was employed, the wealth status of being rich and richest reduced the risk of stunting, being underweight, and wasting. In overcoming undernutrition, maternal employment significantly contributed to middle-income households. However, in the richer and richest households, the wealth status played a more crucial role compared to the maternal employment. This indicates that while employment plays a supportive role in household resources, the wealth status is overall more influential in reducing undernutrition.

Risk factors of child malnutrition under 5 years: Evidence from Pakistan using the Composite Index of Anthropometric Failure

ObjectivesChild malnutrition is a very serious health issue globally, particularly in emerging countries. Among South Asian countries, Pakistan has been observed to have a high prevalence of child malnutrition. In spite of the implementation of many health strategies and preventive measures for vulnerable populations, this issue is still unresolved and needs further investigation. The purpose of this study was to investigate the role of various social-, maternal-, and child-level factors considered to be responsible for nutritional health disparities among children. MethodsAn assessment method of malnutrition, i.e., Composite Index of Anthropometric Failure (CIAF), was used to detect the prevalence of malnutrition among children under 5 years of age in Pakistan in order to present a comprehensive view that was lacking conventional indices of malnutrition. A binary logistic regression model was fitted to assess the link between malnutrition and socioeconomic, maternal, and child attributes based on CIAF data compiled from weight-for-height, weight-for-age, and height-for-age Z-scores using data from the Pakistan Demographic Health Survey (2017–2018). ResultsA total of 4224 children under 5 years of age were included in the analysis. Approximately half of the children (45.34%) comprised anthropometric failures for the overall prevalence of undernutrition based on CIAF. The results of this study revealed that the leading determinant associated with CIAF was the child's age in months, small birth size, lack of breastfeeding, lack of maternal education, poor economic status of the household, and poor-quality water sources. The factors associated with stunting comprised the child's age in months, small child birth size, underweight maternal body mass index, and uneducated mothers. Only one factor—low household economic profile—was significantly associated with waste. Sindh, Baluchistan, and Khyber Pakhtunkhwa provinces had a higher risk of having wasted children. On the other hand, children aged 25-36 months had higher, small child birth size, underweight maternal BMI, un-educated mother, un-educated father, low economic profile of household experiencing of being underweight. ConclusionsThe findings of this study reinforce the significance of maternal health, parental education, and household economic profile in the prevention of malnutrition within young children of adequate birth size, as well as better overall health care up to adolescence in Pakistan. Well-nourished individuals are a valuable human resource and a requirement for a nation's progress and prosperity. In emerging nations such evidence-based policies are crucial for fostering children's optimal physical and mental development to ensure a healthier future generation. Therefore, the execution of national health policies aimed at the improvement of maternal and societal factors could result in improved nutrition levels among children below 5 years of age in Pakistan.

Factors for the Limited Use of Long-Acting Reversible Contraceptives among Female Health Care Professionals of Reproductive Age in Pakistan's Twin Cities

Factors for the Limited Use of Long-Acting Reversible Contraceptives among Female Health Care Professionals of Reproductive Age in Pakistan's Twin Cities

The Diversity in Tobacco Use Among Women of Reproductive Age (15-49 Years) in Pakistan: A Secondary Analysis of a Multiple Indicator Cluster Survey 2016-2018.

Tobacco use in women of reproductive age group (15-9 years) may contribute to poor maternal and child health outcomes. We estimated the prevalence of smokeless tobacco (ST), cigarette, and waterpipe use among these women in Pakistan and explored associations with socio-economic differences and birth weights after recent childbirths (past 2 years). We used the Multiple Indicator Cluster Surveys datasets from three provinces in Pakistan. Prevalence was generated for current use of tobacco among women with recent childbirth (WWRC) and without recent childbirth (WWoRC). We further compared socio-economic status and birth weights between tobacco users and non-users. The prevalence of current ST use was 1.4% and 2.5%, and waterpipe smoking was 1.2% and 1.8%, in WWRC and WWoRC, respectively. ST use varied across Pakistan's provinces by 13 percentage points in WWRC and WWoRC while waterpipe smoking by 10 and 15 percentage points, respectively. The odds of using any form of tobacco were significantly lower with higher levels of education or wealth index. Compared to children born to mothers who did not use tobacco, the birth weight of children born to mothers who smoked waterpipe was on average 0.83 kg (95% CI -1.6 to -0.1) lower whereas it was 0.33 kg (95% CI -0.9 to 0.3) higher for ST users. Tobacco use among women of reproductive age in Pakistan varied significantly based on province and tobacco type. Waterpipe smoking was associated with a reduction in birth weight. Raising awareness of the harms of tobacco use among women of reproductive age and targeting interventions in high-burden regions of Pakistan should be prioritized. The prevalence of current smokeless tobacco use and waterpipe smoking varied significantly in Pakistan (~13 and ~15 percentage points, respectively) among women of reproductive age, and there seems to be little change in tobacco use behavior around pregnancy and early motherhood. The study highlights a need to better understand the prevalence of tobacco use in Pakistan, and further contextual research is warranted to understand the reasons for such high tobacco use in certain areas. This information highlights the need for improving current tobacco control interventions and policies, including measures that could help reduce its use and prevent its uptake. Furthermore, compared to children born to mothers who did not use any form of tobacco, we found a statistically significant difference (830 g) in birth weight for babies born to mothers who at the time of the interview smoked waterpipe and a non-statistically significant difference of about 330 g for children born to mothers who at the time of the interview used smokeless tobacco. In addition to our findings, some literature suggests the association of waterpipe smoking with low birth weight. A possible explanation could be the exposure to smoke that contains toxicants from the tobacco product itself in addition to the burning of charcoal, which is required when using waterpipe. Waterpipe smoking also results in high exposures to carbon monoxide and polycyclic aromatic hydrocarbons, which are known to be carcinogenic and teratogenic. In terms of smokeless tobacco use, further research is warranted to understand its impact on birth outcomes through longitudinal studies accounting for diverse products, its constituents and the amount of consumption.

Are social determinants associated with depression among married women of reproductive age? A mixed methods study from urban slums of Islamabad, Pakistan.

Depression among married women of reproductive age is on the rise in Pakistan, owing to post-COVID-19 phase, super-inflation, increasing poverty, deteriorating law and order situation and perpetuating the uncertain political situation in the country. This study aimed to investigate the factors associated with depression among married women of reproductive age in Pakistan, using a mixed methods approach. The quantitative phase utilized the Urdu version of the Patient Health Questionnaire-9 (PHQ-9) to assess depression among 340 married women. Twelve women with higher scores on the PHQ-9 were selected for in-depth interviews in the qualitative phase. The quantitative analysis revealed a higher prevalence of depression among women with poor socioeconomic status, lower educational levels, larger family sizes, and recent deaths in the family. In the qualitative phase, the main themes identified were the impact of social conditions, such as societal expectations and gender roles, the influence of medical conditions on mental health, financial difficulties, the stress associated with caring for a larger number of children, and the emotional burden of recent deaths in the family. This study highlights the importance of addressing depression among married women of reproductive age in Pakistan. It is crucial to focus on early diagnosis and prompt treatment to mitigate the adverse effects of depression on the affected individuals and their families. Targeted interventions should consider the social determinants of depression, including improving socioeconomic conditions through safety nets, providing mental health support at the primary health care level, and addressing the specific health issues and needs of women in the reproductive age group. A multi-pronged approach and health system's thinking can reduce the burden of depression among women, ultimately enhancing their overall well-being, productivity and quality of life.

A Wake-Up Call: The Emerging Crisis of Colon Cancer in Young Age in Pakistan.

Null.

The Impact of Terrorism on Fertility: Evidence From Women of Childbearing Age in Pakistan

Direct and indirect exposure to terrorist attacks can have a significant impact on major life decisions, including the choice of whether to have a child. This study aims to investigate how terrorist attacks affect fertility. By pooling data from three years of cross-sectional surveys conducted between 2010 and 2015 by the Pakistan Bureau of Statistics, our findings reveal a positive correlation between terrorist attacks and fertility among women of childbearing age in Pakistan. Specifically, the probability of giving birth two years following a terrorist attack in one’s home district, all else equal, is 64 percent, compared to the probability of a woman not giving birth two years following a terrorist attack, which is 36 percent. Furthermore, our analysis demonstrates that persistent terrorist attacks, that is, domestic and non-suicide incidents, result in higher probabilities of giving birth during a particular year. Conversely, less common and more prominent terrorist attacks – transnational and suicide incidents – result in lower probabilities of giving birth during a particular year. Additionally, we find that women from above-average-income households, those with higher education levels, older mothers, and those residing in rural areas are more likely to adjust their fertility upwards in response to terrorist attacks.

Cervical Cancer Awareness and Attitude Towards Cervical Cancer Screening and Human Papillomavirus Vaccines Among Urban Women of Karachi, Pakistan.

Cervical cancer is the second most common cancer among women under 50 years of age in Pakistan. The current study was designed to assess the level of awareness through educational outreach presentations about cervical cancer, Papanicolaou (Pap) smear test, and human papillomavirus (HPV) vaccination in Karachi, Pakistan. Women from different urban hospitals were enrolled. Participants participated in a 45-minute presentation on cervical cancer awareness led by student pharmacists from Nazeer Hussain University, Karachi. A pre-and post-test was administered to assess the impact of the intervention. Descriptive statistics were used to summarize the findings, and a t-test was used for matched comparison, and a p-value <0.05 for statistical significance. A total of 150 women participated in the study. The study found that Pakistani women living in urban settings were less knowledgeable about the causes of cervical cancer and prevention. After the presentation, we observed a 45% increase in knowledge, and 31% of participants said they would obtain a Pap smear test in the next six months. Supervised pharmacy student-led presentations on cervical cancer educational awareness that significantly impacted women participants. Pharmacists can play a key role in reducing cervical cancer deaths through increased awareness, education, prevention, and immunization.

Prevalence and Risk Factors for Iron Deficiency Anemia among Children under Five and Women of Reproductive Age in Pakistan: Findings from the National Nutrition Survey 2018.

Anemia remains a global public health problem, especially in developing countries. It affects primarily children under five (CU5), women of reproductive age (WRA), and pregnant women due to their higher need for iron. The most common form of anemia is iron-deficiency anemia (IDA). IDA is estimated to cause half of all anemia cases and one million deaths per year worldwide. However, there remains a lack of well-documented and biochemically assessed prevalence of IDA based on the representative population-based samples globally and regionally. In this study, we aimed to assess the National Nutrition Survey (NNS) 2018 to identify the prevalence and risk factors of IDA in Pakistani CU5 and WRA. Secondary analysis was conducted on the NNS 2018, a cross-sectional survey, which collected data on dietary practices, malnutrition, and food insecurity. Anemia was defined as hemoglobin levels < 11.0 g/dL in children and 12.0 g/dL in women. IDA was defined as low hemoglobin and low ferritin (<12 ng/mL) levels, adjusted for inflammation using AGP and CRP biomarkers in CU5 and WRA. Univariate and multivariable logistic regressions were conducted using Stata statistical software (version 16). We also compared the IDA rates of NNS 2018 and 2011. A total of 17,814 CU5 and 22,114 WRA were included in the analysis. Of the CU5, 28.9% had IDA, while 18.4% of WRA reported to experience IDA. Among the CU5, IDA was most prevalent among male children aged 6-23 months living in rural areas and with the presence of diarrhea and fevers in the last 2 weeks. Children whose mothers had no education, were aged 20-34 years, and employed, had a higher prevalence of IDA. Married WRA, who are employed, living in rural areas, and with no education, had a higher prevalence of IDA. In the multivariable logistic regression, children aged 6-23 months (AOR = 1.19, 95% CI [1.08-1.33], p < 0.001) and with the presence of diarrhea in the last 2 weeks (AOR = 1.32, 95% CI [1.13-1.54], p < 0.001) or fever (AOR = 1.16, 95% CI [1.02-1.32], p = 0.02) had higher odds of IDA. At the household level, the odds of IDA among CU5 were higher in the poorest households (AOR = 1.27, 95% CI [1.08-1.50], p = 0.005), with ≥5 CU5 (AOR = 1.99, 95% CI [1.28-3.11], p = 0.002), and with no access to improved sanitation facilities (AOR = 1.17, 95% CI [1.02-1.34], p = 0.026). For WRA, the multivariable logistic regression found that the odds of IDA were higher among women with vitamin A deficiency (Severe: AOR = 1.26, 95% CI [1.05-1.52], p = 0.013; Mild: AOR = 1.36, 95% CI [1.23-1.51], p < 0.001), zinc deficiency (AOR = 1.42, 95% CI [1.28-1.57], p < 0.001), no education (AOR = 1.53, 95% CI [1.30-1.81], p < 0.001), and from severely food insecure households (AOR = 1.20, 95% CI [1.07-1.34], p = 0.001). The odds of IDA were lower among women whose body mass index was overweight (AOR = 0.77, 95% CI [0.69-0.86], p < 0.001) or obese (AOR = 0.71, 95% CI [0.62-0.81], p < 0.001). The child's age, presence of diarrhea or fever, place of residence, household size, wealth status, and access to sanitation facilities were significantly associated with IDA among CU5 in Pakistan. For WRA, education, body mass index, vitamin A and zinc status, household food security status, wealth status, and access to sanitation facilities were significantly associated with IDA. Large, well-established, government-funded programmes focused on micronutrient supplementation, food fortification, the diversification of food supplies, and the treatment and prevention of infectious and parasitic diseases are needed to prevent IDA and all forms of anemia among children and women in Pakistan.

Individual and Community-Level Risk Factors for Giardiasis in Children under Five Years of Age in Pakistan: A Prospective Multi-Regional Study.

This study aimed to estimate the prevalence of Giardia lamblia infection and identify associated risk factors at both individual and community levels in a pediatric population in different agroecological zones of Khyber Pakhtunkhwa, Pakistan. A community-based cross-sectional study was conducted from March to December 2022. Using stratified sampling, 1026 households were recruited from nine agroecological zones. Stool samples were collected from 1026 children up to the age of five years and processed for detection of Giardia using a commercial ELISA kit. Data on potential risk factors were collected using a pre-structured questionnaire. A multivariable logistic regression model was used to identify risk factors associated with giardiasis. The study found that the prevalence of giardiasis in the study area was 3.31%. Children aged 13-24 months were found to be at higher risk for giardiasis. Illiterate mothers and fathers attending daycare institutions/kindergartens, mothers not practicing hand washing during critical times, households with companion animals, and homes where stray dogs/cats enter were identified as predictors of giardiasis at the individual level. Children living in sub-mountain valleys use un-piped water, inadequate domestic water storage vessels, drink un-boiled or unfiltered water, live near rubbish heaps or un-paved streets/pathways, and have unimproved latrine facilities were identified as risk factors of giardiasis at the community level. The study highlights the need for integrated intervention approaches at both individual and community levels to reduce the incidence of giardiasis in Khyber Pakhtunkhwa, Pakistan. Interventions aimed at promoting behavioral change and providing safe and adequate water sources, combined with individual-level interventions such as hand washing and awareness of giardiasis prevention methods, would be critical to addressing this health concern. Inter-sectoral collaboration between the health sector and other sectors would also be necessary to achieve meaningful progress in reducing the incidence of giardiasis in resource-limited areas.

HPR9 Do Children Experience Inequality of Opportunity in Childhood Malnutrition in Pakistan: Evidence from Pakistan Demographic and Health Survey

Pakistan has high prevalence of childhood malnutrition amongst developing countries. National Nutritional Survey 2018 showed 44% of children were stunted. Different circumstances have the potential to create inequality of opportunity in child health. This study aims to identify the drivers of inequality of opportunity in childhood malnutrition among children below five years of age in Pakistan.

Trends and risk factors of stillbirth among women of reproductive age in Pakistan: A multivariate decomposition analysis.

Every year, 2 million babies are stillborn in the world. Globally, there has been a decline in the stillbirth rate of 2%. Despite advancements in prenatal care and the implementation of new medical technologies, the incidence of early stillbirths remains unchanged. A slight decrease in the rate of late-term stillbirth has been observed. Pakistan ranked third in South Asia for having the highest stillbirth rate. Compared to its neighbors and other developing nations, Pakistan has shown a lack of progress in reducing maternal and neonatal fatalities. Therefore, the purpose of this study is to use a multivariate decomposition analysis to examine the trends and factors that have contributed to the change in the stillbirth rate over time. To conduct this study, we used a secondary data analysis approach and analyzed data from the Pakistan Demographic and Health Survey (PDHS) of 2012-2013 and 2017-2018). For the analysis, a total sample of 15,068 births in 2017-2018 and 13,558 births in the PDHS from 2012 to 2013 were taken into account. Using the MVDCMP function within STATA version 15 statistical software, a logit-based multivariate decomposition model was fitted to determine the variables that influence the change in stillbirth. The current study used two cross-sectional surveys to identify important risk factors for stillbirths. Over the past 5 years, Pakistan's stillbirth rate has risen from 3.98 to 5.75%. According to the total multivariate decomposition analysis, the change in coefficient (change in the effect of attributes) accounted for 81.17% of the overall change in the proportion of stillbirths. In contrast, the change in endowment was not statistically significant. Changes in maternal education, individual and community-level wealth status, and mode of delivery all significantly impacted the rate of stillbirths over time. Stillbirths increased in Pakistan from 2012 to 2017. Stillbirths are observed more frequently for women residing in Punjab, Sindh, and rural areas. A major concern that is directly related to the prevalence of stillbirths in Pakistan is the lack of accessible, affordable, and high-quality maternal healthcare facilities. Older, overweight, and uneducated women are more likely to have stillbirths than women who deliver vaginally. High parity and short birth intervals also accelerated the rate of stillbirths. An effective remedy to control stillbirths is the provision of accessible and affordable healthcare services. Awareness campaigns for the health education of pregnant women should focus on raising awareness to support better pregnancy outcomes for poor women living in communities with higher education levels. The risk of stillbirth can be reduced by offering free diagnostics for early detection of birth complications in low-resource settings and referring these cases to knowledgeable gynecologists for safe delivery.

Normative Data of Fugl Meyer Assessment on Upper Extremity in Post Stroke Population

Background: Stroke is clinically diagnosed as an acute, localized neurological impairment that is caused by vascular damage (infarction, hemorrhage) to the central nervous system. This main leading cause of demise and dysfunction worldwide resulting in frequent deficit, hemiplegia, which briefly affects upper limb. This multicentered study is the first to provide updated normative reference values for FMA-UE in post stroke adults in wide range of age in Pakistan’s population.&#x0D; Objective: To determine Pakistani normative values of Fugl-Meyer Assessment on upper extremity in post Stroke Population.&#x0D; Methods: Descriptive cross-sectional study on 1260 post-stroke patients was conducted in various public and private physiotherapy centers of country using Fugl-Meyer Assessment (Upper-Extremity) FMA-UE scale after ethical approval. Hemiplegic survivors of both genders aged 45-75 years were taken using convenience sampling technique, informed consent was taken. Statistics was done using SPSS version25.&#x0D; Results: Patients included were 88.3% ischemic and 11.7% hemorrhagic. 44.1% were in acute phase (less than 2 weeks) while 55.9% were in sub-acute (2 weeks to 6 months) phase. Mean score of FMA-UE was 88.63±30.09. The cutoff score/mean value for motor impairment and sensation was recorded as 41.49 ±19.7 and 8.6±3.9 while passive joint motion and pain were calculated 18.93±5.47 and 19.57±5.1 respectively.&#x0D; Conclusion: The scoring, in acute and subacute phases, accentuate the need to follow Pakistani specific modified norms in Asian inhabitants instead of reference values applicable on western population.&#x0D; Keywords: Fugl-Meyer scale, Hemiplegia, Motor control, Post Stroke, Upper extremity.

Anthropometric Patterns and Correlates of Growth Attainment in Under-five Pakistani Children

This study investigates the question whether socio-economic, demographic and environmental variables within a household will affect the growth patterns of under-five Pakistani children. It also examines whether there are differentials in the growth patterns of these children by age and gender. Using the 1990-91 Demographic and Health Survey data, the focus is on children under-five years, the total children identified were 5902 while anthropometric measurement to assess the growth status was available for 4079 children. The results showed that nearly all the socio-demographic, economic and environmental variables were significantly associated with H/A and Wt/A. Children most likely to be stunted and underweight were those whose mothers were aged 40-44 years, mothers with no education, children from rural areas and children with birth interval 24 months, mother’s age, her education and having toilet facilities in the house positively associated with growth attainment. For the Weight/A model succeeding birth interval &gt;24 months, mother’s age, her education and having toilet facilities and electricity in the house, and living in Punjab and NWFP province positively associated with growth attainment. This study will be useful for policy-makers to develop programmes and guidelines needed to improve those socio-economic, demographic and environmental factors, responsible for the poor nutritional status of children under-five years of age in Pakistan.

Genotypic Frequency of RHC Antigen in Women of Reproductive Age in Pakistan

Objective: To determine the genotypic frequency of RHC antigen in females of reproductive age.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Armed Forces Institute of Transfusion (AFIT) and Pak Emirates Military Hospital, (PEMH) in collaboration with NUMS Pakistan, from Dec 2020 to Dec 2021.&#x0D; Methodology: Females aged 16 to 45 years were recruited in the study. Demographic data, including age, parity, ethnicity etc.,was recorded on a proforma. Venous blood samples were collected in EDTA tubes, and DNA was extracted using 5% Chelex TM. A conventional Polymerase chain reaction and amplified products were subjected to Polyacrylamide Gel electrophoresis. &#x0D; Results: Amongst 200 females, 172(86%) had the expression of RHC antigen, while 28(14%) were negative for the respective antigen. These results were valuable in predicting the risk of hemolytic disease in fetuses and newborns and alloimmunization in our population.&#x0D; Conclusion: Females in the reproductive age group had RHC positivity of 86%. This data will help predict the risk of HDFN in future pregnancies and individuals at risk of alloimmunization in RHC-negative women.

Cost optimisation analysis of the expanded programme for immunisation: balancing equity and coverage in Pakistan

IntroductionWith limited resources, attaining maximal average health service coverage can be at odds with maximising equity which attempts to promote greater reach among underserved populations. In this study, we examined...

Employment Generation Challenges and Strategies for Pakistan: A Diagnostic Analysis

The employment challenges are getting more complex and worse because youth under the age of 30 constitute 64 percent of the total population. The gradual increase in labor force participation is adding more pressure to the labor market to generate employment opportunities. Hence, the growth in employment generation is essential to match the unprecedented number of young people entering working age in Pakistan. Moreover, the structural transition process involving labor movement from low-to-high productive activities has been much slower in Pakistan than in other Asian countries like China. This study identifies all major concerns regarding employment challenges in Pakistan and identifies various strategies and policies while adopting a diagnostic approach to employment policy. The reason for adopting the diagnostic approach/framework is to develop an understanding of the factors which are responsible for the slow growth of employment in formal sectors and significant constraints for generating more employment. It attempts to assess various elements that may find a place in developing strategies and policies. While designing effective policies for employment, policymakers must consider all aspects like population, demographics, types of unemployment, economic condition, social structure, and development stage of a country. Meanwhile, the role of entrepreneurial activities and the private sector, technological changes, development of labor-intensive industries and SMEs, improving skills and knowledge, youth employment programs, active labor market policies (ALMPs), and macroeconomic policies are core elements that should be considered to design effectual policies for employment generation.

Five Year Experience of Breast Cancer Surgeries

Aim: To audit the breast cancer surgeries and to establish the age groups and stage at which breast cancer patients present in our institution. Study design: Retrospective study Place and duration of study: Department of Surgery, Jinnah Hospital, Lahore from January 1st 2017 to December 31st 2021. Methodology: Four hundred and seventy-one breast cancer patients were sorted out. The data included the stage of presentation of breast cancer, age at presentation, year of presentation, gender and surgeries performed according to stage of carcinoma of breast. Results: The patient of breast carcinoma usually presents for medical help in her forties (31%) while patients presented between 18 to 86 years of age. Most patients however presented in stage III. Frequent sentinel lymph node biopsies with breast conservation surgery. All stage III breast carcinoma patients were treated with MRM and level II axillary clearance. BCS with sentinel lymph node biopsy was done for early breast cancer. Conclusion: Carcinoma of breast presents in earlier age in Pakistan as compared to West. Despite limited resources and non-compliant patient population, we are striving to provide standard treatment to all breast cancer patients. Increase in sentinel lymph node biopsies instead of axillary clearance shows this expedition. Keywords: Breast conservation with sentinel biopsy, Stage, Age

Prescribing Practices of Antibiotics for Acute Diarrhea in Children Aged Less than Five Years Old in Pakistan

Introduction: Childhood diarrhea accounts for 16% of child deaths in Pakistan. Irrational prescribing of antibiotics, prescribing of antibiotics for viral infections, self-medication using antibiotics, prescription sharing, and refilling are very common practices in Pakistan. The aim of this study was to evaluate the prescribing practices of antibiotics for acute diarrhea in children less than five years of age at a Secondary Healthcare Hospital of Pakistan and to assess the compliance of prescribers with authentic clinical guidelines of treatment for childhood acute diarrhea. Method: A cross-sectional study was conducted for a period of one year, from August 2020 to August 2021, at a Secondary Care Hospital of Karachi, Pakistan. It was based on the collection of outpatient clinic prescriptions of children aged less than five years and suffering from acute diarrhea. The regimens or suggested therapies by prescribers for acute diarrhea were assessed as per The National Institute of Care and Health Excellence and World Health Organization guidelines. A brief questionnaire was also distributed among prescribers, pharmacists, and caretakers of children to extract their opinions regarding antibiotic prescribing in acute diarrhea.Results: Antibiotics were inappropriately prescribed for acute diarrhea among children in Pakistan because p-value was less than 0.05 (p&lt;0.05) as calculated by descriptive statistical tools using Z-test. More than 90% prescriptions of acute diarrhea in children less than five years of age failed to comply with the authentic treatment guidelines.Discussion: Due to the limited knowledge of prescribers regarding treatment guidelines and compliance of parents with antibiotic prescribing for diseases in children, irrational prescribing of antibiotics for acute diarrhea in children less than five years of age is frequent in Pakistan. Healthcare professionals must be adequately trained to ensure the proper management of acute diarrhea by following authentic clinical guidelines. Conclusion: Antibiotics are irrationally prescribed for acute diarrhea in children less than five years of age in Pakistan and prescriptions do not comply with authentic clinical guidelines.

Prevelance of Ovarian Cancer and its Corelation with Age in Pakistan

Prevelance of Ovarian Cancer and its Corelation with Age in Pakistan