Healthcare Facilities In Pakistan Research Articles

Service quality in contracted facilities.

The purpose of this paper is to explore the readiness of contracted and non-contracted first-level healthcare facilities in Pakistan to deliver quality maternal and neonatal health (MNH) care. A balanced scorecard (BSC) was used as the assessment framework. Using a cross-sectional study design, two rural health centers (RHCs) contracted out to Aga Khan Health Service, Pakistan were compared with four government managed RHCs. A BSC was designed to assess RHC readiness to deliver good quality MNH care. In total 20 indicators were developed, representing five BSC domains: health facility functionality, service provision, staff capacity, staff and patient satisfaction. Validated data collection tools were used to collect information. Pearson χ2, Fisher's Exact and the Mann-Whitney tests were applied as appropriate to detect significant service quality differences among the two facilities. Contracted facilities were generally found to be better than non-contracted facilities in all five BSC domains. Patients' inclination for facility-based delivery at contracted facilities was, however, significantly higher than non-contracted facilities (80 percent contracted vs 43 percent non-contracted, p=0.006). The study shows that contracting out initiatives have the potential to improve MNH care. This is the first study to compare MNH service delivery quality across contracted and non-contracted facilities using BSC as the assessment framework.

Prescribing of bisphosphonates and antibiotics in Pakistan: challenges and opportunities for the future

Introduction: The appropriate management of patients with osteoporosis and the rational use of antibiotics are growing concerns in Pakistan. The first step to improve patient care is to understand current prescribing patterns and the rationale behind these patterns. Aim: To assesses utilisation patterns, prescribing behaviour and the potential rationale among a range of medicines including bisphosphonates and antibiotics. Subsequently, use the findings to suggest potential future policies for all key stakeholders to improve patient care in the future. Methodology: A questionnaire based, cross-sectional study in both private and public health care facilities in Pakistan, conducted between January 2011 and December 2012, involving 438 physicians and15824 prescriptions. The second study involved 9984 outpatient prescriptions, 127 in-patient cases and over 100 prescribers and dispensers. Results: There was adequate history taking and examinations in approximately half of the physicians surveyed, with prescribing typically taking into account issues such as disease severity (84% of respondents) and the socioeconomic status of patients (53%). Prescribing of bisphosphonates was common certainly compared to medicines to treat cardiovascular diseases and diabetes. However, there are concerns with the low use of generics, high rate of antibiotic prescribing, variable availability of medicines, medical representatives being a key source of information on medicines and typically a limited number of formularies. Discussion: There are considerable opportunities to improve the rational use of medicines in Pakistan including physician education, prescribing guidance and formularies. In addition, educating patients and physicians concerning antibiotics. These should be co-ordinated among key stakeholder groups. There is also a need to ensure low prices for generics and enhance their utilisation.

Severe maternal outcomes and their predictors among Pakistani women in the WHO Multicountry Survey on Maternal and Newborn Health

ObjectiveTo determine the incidence of, and the demographic and obstetric factors associated with, severe maternal outcome (SMO) among women presenting at healthcare facilities in Pakistan. MethodsA cross-sectional study was conducted in 16 healthcare facilities across Pakistan that had been selected for the WHO Multicountry Survey on Maternal and Newborn health. The hospital records of women who delivered at a participating facility or were admitted with SMO (defined as maternal death or near miss) within 7days of delivery/abortion were reviewed for a period of 2–3months in 2011. The incidence of SMO, its associated demographic and obstetric characteristics, and the influence of various maternal health interventions were assessed. ResultsAmong 13 175 included women, 132 (1.0%) had an SMO (94 [0.7%] near miss and 38 [0.3%] died). The maternal mortality ratio was 299 deaths per 100 000 live births. Major causes of SMO included postpartum hemorrhage (64 [48.5%] women), hypertensive disorders (34 [25.8%]), and ruptured uterus (9 [6.8]). Illiteracy, anemia, and several obstetric complications (e.g. eclampsia) were significant contributors. ConclusionImproving education, nutrition, and uniform implementation of obstetric care protocols are needed for better maternal and neonatal health in Pakistan.

Risk factors for complicated varicella infection in pediatric oncology patients at a tertiary health care facility in Pakistan

Varicella zoster infection (VZI) is well recognized as a potential cause of morbidity and mortality in immunocompromised pediatric oncology patients (POP). The purpose of this study was to describe the clinical profile and risk factors for complications and outcomes of VZI in POP treated with acyclovir. Medical records of all POP with a discharge diagnosis of VZI over a period of seven years (2005-2011) were reviewed. The demographic features, underlying malignancy, risk factors for VZI, complications, and outcomes were recorded. Thirty-six POP with VZI were identified. Leukemia was the most common underlying malignancy (n = 20, 58.8%), followed by lymphoma (n = 7, 20.6%) and solid organ tumors (n = 7, 20.6%). Most of the cases (41%) were observed in children under five. All patients were treated with acyclovir. Varicella-related complications developed in 10 (29%) patients. The most frequent complication was bloodstream infection (n = 3, 8.8%), followed by pneumonia (n = 2, 5.9%), skin infection (n = 2, 5.9%), hepatitis, renal failure, and encephalitis. Independent risk factors associated with complications were age < five years, weight for age < fifth percentile, delay in seeking care (> seven days after onset of symptoms) and severe neutropenia (ANC < 500/cm). One child died secondary to varicella encephalitis. Our data suggests that young age, poor health-seeking behavior, severe neutropenia, and being underweight are the major risk factors for the development of varicella-related complications in POP in developing countries. These complications could be favorably modified through active immunization of immunocompetent children.

Congenital Factor VII Deficiency in Children at Tertiary Health Care Facility in Pakistan

This study presents the demographics, clinical spectrum, and outcome of patients with congenital factor VII (FVII) deficiency at a tertiary care center over a period of 12 years. Of the 49 patients, 27 (55%) patients were males. Consanguinity was found in 92% of the patients. The median age of symptom onset was 2.4 (interquartile range [IQR]: 1.1-6.5) years with a median age of 5.8 (IQR: 3.1-10) years at diagnosis. Life-threatening complications like intracranial bleeding (ICB) and intra-abdominal bleeding (IAB) were observed in 8 (16.4%) patients. We found that 11 (55%) of the 20 patients with FVII coagulant activity (FVIIc) <1% were either asymptomatic or showed mild phenotype. In contrast, 9 (53%) of the 17 patients with FVIIc >5% were affected by severe symptoms. Age <1 year was the only identified risk factor associated with development of life-threatening bleeding episodes (P = .042; odds ratio 6.46). Overall, 4 (8.2%) died as a consequence of ICB (3 patients) and IAB (1 patient).

The state of affairs at primary health care facilities in Pakistan: where is the State's stewardship?

Primary health care (PHC) services in Pakistan, particularly in rural areas, are in a dismal state. Inadequacies, unfairness and ignorance about the importance of the basic health care provided by these facilitates have led to a disorganized and poorly performing system. This paper reviews the situation in certain PHC facilities in Sindh province. Inadequate medicines and supplies, underutilized family planning services, lack of human resources, faulty equipment, and absence of a proper referral mechanism were some of the key findings. There is therefore an urgent need for radical improvement in the PHC system in order to maximize the appropriate use of PHC facilities. In order to do this, the paper argues that the stewardship role of the State must be strengthened.

Sharp injuries and their determinants among health care workers at first-level care facilities in Sindh Province, Pakistan

To assess the rate and determinants of sharp injuries during the previous 6 months among health care workers at first-level care facilities in two districts of Pakistan. Cross-sectional survey at public, general practitioners and non-licensed private practitioners selected through stratified random sampling. At each facility, we interviewed a prescriber and a dispenser/injection provider about knowledge of bloodborne pathogens transmission and preventive practices, risk perception, and use of precautions and sharp injuries received during the previous 6 months. Multivariable Poisson regression was used to assess the factors associated with the number of sharp injuries. Fifty-four percentage of the 233 workers had at least one injury during the previous 6 months. The overall rate of sharp injuries per person per year was 3.7; among non-physician prescribers (9%), it was 4.3; among dispensers (69%), it was 3.7, and among physicians (18%), it was 2.1. In the multivariable model, work experience, risk perception and type of health care worker were significantly associated with receiving sharp injuries during the previous 6 months. In the model including dispensers only, a higher knowledge score was associated with fewer sharp injuries, while perceived severity of disease and lack of professional qualification were associated with more. Sharp injuries are common in Pakistan. Better knowledge about modes of bloodborne pathogen transmission and professional qualification may reduce their incidence.

Health care resources and public policy in Pakistan.

This study examines the difficulties in instituting a viable system to provide health care facilities in Pakistan. Distribution patterns of existing facilities reveal serious inadequacies related to planning deficiencies, lack of capital, and disregard for socio-cultural factors. Whenever possible, health service development planning must be based on the needs of the population.