Medicine In Pakistan Research Articles

The state of mental health care in Pakistan

Azera Shah, aged 35 years, does not remember the last time she attended a party. She cannot recognise any of her relatives and is not allowed to accompany her family to any functions. A resident of Sahiwal city in Punjab, Pakistan, Shah starts her day with few household chores and then freely roams in nearby streets until sunset. “My mother says that, like any other physical disability, I have this mental illness”, she says with a giggle. “I have been told there is no remedy for it. One has to live and die with it.”

Child Malnutrition in Pakistan: Evidence from Literature.

Pakistan has one of the highest prevalences of child malnutrition as compared to other developing countries. This narrative review was accomplished to examine the published empirical literature on children’s nutritional status in Pakistan. The objectives of this review were to know about the methodological approaches used in previous studies, to assess the overall situation of childhood malnutrition, and to identify the areas that have not yet been studied. This study was carried out to collect and synthesize the relevant data from previously published papers through different scholarly database search engines. The most relevant and current published papers between 2000–2016 were included in this study. The research papers that contain the data related to child malnutrition in Pakistan were assessed. A total of 28 articles was reviewed and almost similar methodologies were used in all of them. Most of the researchers conducted the cross sectional quantitative and descriptive studies, through structured interviews for identifying the causes of child malnutrition. Only one study used the mix method technique for acquiring data from the respondents. For the assessment of malnutrition among children, out of 28 papers, 20 used the World Health Organization (WHO) weight for age, age for height, and height for weight Z-score method. Early marriages, large family size, high fertility rates with a lack of birth spacing, low income, the lack of breast feeding, and exclusive breastfeeding were found to be the themes that repeatedly emerged in the reviewed literature. There is a dire need of qualitative and mixed method researches to understand and have an insight into the underlying factors of child malnutrition in Pakistan.

High-dose vitamin D3 in the treatment of severe acute malnutrition: a multicenter double-blind randomized controlled trial

Vitamin D deficiency is common in children with severe acute malnutrition, in whom it is associated with severe wasting. Ready-to-use therapeutic food (the standard treatment) contains modest amounts of vitamin D that do not reliably correct deficiency. The aim of this study was to determine whether high-dose oral vitamin D3 enhances weight gain and development in children with uncomplicated severe acute malnutrition. We conducted a randomized placebo-controlled trial of high-dose vitamin D3 supplementation in children aged 6-58 mo with uncomplicated severe acute malnutrition in Pakistan. Participants were randomly assigned to receive 2 oral doses of 200,000 IU vitamin D3 or placebo at 2 and 4 wk after starting ready-to-use therapeutic food. The primary outcome was the proportion of participants gaining >15% of baseline weight at 8 wk after starting ready-to-use therapeutic food (the end of the study). Secondary outcomes were mean weight-for-height or -length z score and the proportion of participants with delayed development at the end of the study (assessed with the Denver Development Screening Tool II), adjusted for baseline values. Of the 194 randomly assigned children who started the study, 185 completed the follow-up and were included in the analysis (93 assigned to intervention, 92 to control). High-dose vitamin D3 did not influence the proportion of children gaining >15% of baseline weight at the end of the study (RR: 1.04; 95% CI: 0.94,1.15, P=0.47), but it did increase the weight-for-height or -length z score (adjusted mean difference: 1.07; 95% CI: 0.49,1.65, P<0.001) and reduce the proportion of participants with delayed global development [adjusted RR (aRR): 0.49; 95% CI: 0.31, 0.77, P=0.002], delayed gross motor development (aRR: 0.29; 95% CI: 0.13, 0.64, P=0.002), delayed fine motor development (aRR: 0.59; 95% CI: 0.38, 0.91, P=0.018), and delayed language development (aRR: 0.57; 95% CI: 0.34, 0.96, P=0.036). High-dose vitamin D3 improved the mean weight-for-height or -length z score and developmental indexes in children receiving standard therapy for uncomplicated severe acute malnutrition in Pakistan. This trial was registered at clinicaltrials.gov as NCT03170479.

Anti-fibrotic effects of polygonum plebeium r.br. in CCl4-induced hepatic damage and fibrosis in rats

Introduction: Asian countries have the highest burden of liver diseases. Polygonum plebeium (P. plebeium), a.k.a. the common knotweed, is a species of plant in the knotwood family that can act as a blood purifier and has been widely used in Pakistan to cure liver disorders like jaundice and hepatitis. The plant is also used in the treatment of pneumonia, bowel complaints, diarrhea, dysentery, eczema and ring worms. Tannins, flavonoids, saponins and alkaloids are the major components of P. plebeium. Since its use in folk medicine in Pakistan, there has been little scientific evidence or information on it. Therefore, this study was aimed at investigating the anti-fibrotic effects of P. plebeium in carbon tetrachloride (CCl4)-induced hepatic toxicity and fibrosis.&#x0D; Methods: The extracts of whole plant of P. plebeium were prepared and administered by oral gavage in rats. Liver fibrosis was induced by intraperitoneal (i.p.) administration of CCl4. To evaluate the hepatoprotective activity of P. plebeium, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transpeptidase (γGT) levels were quantified. Histological evaluation of liver tissue revealed tissue necrosis and extracellular matrix deposition. Real-time PCR was done to evaluate mRNA expression of genes related to liver fibrosis.&#x0D; Results: The groups treated with P. plebeium extract showed an ablation in liver damage; the elevated enzyme levels of ALT, AST and γGT were decreased. Treatment with P. plebeium extract treatment restored the CCl4-induced tissue fibrosis by significantly suppressing alpha-smooth muscle actin (α-SMA), tumor growth factor beta (TGF-β) and collagen mRNA expression levels. Histology of liver sections also showed that the CCl4-induced fibrosis was improved in the treatment groups.&#x0D; Conclusion: Polygonum plebeium has therapeutic potential and can be used for preventing fibrosis in inflammatory liver disease.

Biofortified High Zinc Wheat: The Traditional Staple Dietary Food to Address Malnutrition in Pakistan

Background: The footprints of zinc dietary nutrient deficiency are resulting in a widespread burden of stunting, wasting and underweight in children under five years, and reproductive development in women over a population of 100 million in Pakistan. The zinc malnutrition could be addressed by consumption of biofortified high zinc wheat flour, a staple food, in complemented with food supplementation, food diversification and food fortification interventions in the country. Methodology: This evidence-based research publication focused on micronutrients malnutrition on human health and capital. Literature was taken from last 20 years papers published in several peers reviewed scientific journals. Papers regarding malnutrition were mainly focused. The primary data was collected from R&D institutions and secondary data from Pakistan National Nutrition Survey 2011. Various sites, viz. www.harvestplus.org, www.ifpri.org, http://www.ars.usda.gov/ba/bhnrc/ndl, http://data.unicef.org: www.fao.org: http://wholibdoc.who.int/publications were also visited. Results: In Pakistan, the recently released biofortified high zinc wheat variety “Zincol-2016” had a higher quantum of 37 mg Zn kg-1 compared to 25.0 mg Zn kg-1 in grain portion in other commercially grown wheat varieties. Upon consuming biofortified wheat flour, zinc concentration increased from 681.3 to 792.3 µg L-1 in human plasma. Furthermore, even an increase in dietary zinc by an amount of 2.0 mg Zn capita-1 day-1 may result in halving the endemic problem of zinc malnutrition, with a little change in food diversity pattern. Conclusion: The consumption of biofortified high zinc wheat variety “Zincol-2016” containing 37 mg Zn kg-1 compared to 25.0 mg Zn kg-1 in conventional wheat varieties could result in alleviating zinc malnutrition to the extent of 50% in the malnourished population. Thereby, it is a potential complementary staple food with other contemporary interventions to address malnutrition in Pakistan.

Palliative Medicine in Pakistan: A Developing Country's Perspective

We read the paper “Oncology and Palliative Medicine: Providing Comprehensive Care for Patients with Cancer” by Finn et al with great interest. The authors are right in their assessment that palliative medicine encompasses patient care from diagnosis through potential survivorship.[1][1] We would

Dual mechanisms of anti-muscarinic and Ca++ antagonistic activities to validate the folkloric uses of Cyperus niveus Retz. as antispasmodic and antidiarrheal

Ethnopharmacological relevanceCyperus species are famous for their traditional uses and very commonly used for their anti-spasmodic and anti-diarrheal activities. Cyperus niveus Retz. is used in local traditional system of medicine in Pakistan to treat diarrhea and emesis. Aim of the studyThe aim of the study was to validate the traditional uses and to provide the possible mechanisms for the medicinal use of Cyperus niveus Retz. as anti-spasmodic, anti-diarrheal and anti emetic. Materials and methodsThe in-vivo studies of anti-diarrheal, charcoal meal GI transit test and anti-emetic activities were conducted in rats, mice and chicks respectively, while isolated tissues of rabbit's jejunum and rat's ileum were used for in-vitro experiments. Phytochemical analysis was also undertaken. ResultsThe phytochemical study of hydro-ethanolic extract of Cyperus niveus Retz. showed the presence of flavonoids, phenols, alkaloids, tannins, saponins and glycosides. Cn. Cr caused significant inhibition of castor oil-induced diarrhea in rats (300,500 & 700mg/kg) using loperamide (10mg/kg, p.o) as standard. Cn. Cr also significantly decreased the motility in charcoal meal GI transit test at 100–200mg/kg in mice, using atropine (3.0mg/kg) as positive control. In jejunum tissue, Cn. Cr relaxed carbachol(1µM) and K+(80mM)-induced contractions, similar to the effect of dicyclomine. Pre-incubation of isolated rat ileum tissues with Cn. Cr (0.1mg/mL) caused the corresponding shift of CCh concentration response curve (CRC) to right without decrease in max. response whereas at the concentration of 0.3mg/mL caused the rightward nonparallel shift with max. response suppression, similar to dicyclomine. Antimuscarinic effect was further confirmed when prior administration of Cn. Cr (0.1, 0.3 and 1mg/mL) caused concentration dependent inhibition of induced contractions of carbachol, comparable to atropine (1µM). To confirm the Ca2+ channel blocking (CCB), the rabbit jejunum was pre-incubated with Cn. Cr (0.3 & 1.0mg/mL), produced a shift in CRCs of calcium toward right with decrease in the maximum response at next concentration, similar to that of dicyclomine. The organic fraction of Cyperus niveus Retz. (Cn. Dcm) showed Ca2+ antagonist and anticholinergic activities with higher potency against K+(80mM) induced contractions, like verapamil, while aqueous fraction (Cn. Aq) relaxed only carbachol(1µM) induced contractions with no prominent effect on K+ (80mM)-contractions even at the higher concentration of 10mg/mL, similar to atropine. Cn. Cr also showed significant anti-emetic effect in Chick emesis model using chlorpromazine as standard. ConclusionThis study shows the presence of antidiarrheal and spasmolytic activities in Cyperus niveus Retz. extract, mediated by dual blocking mechanisms of muscarinic receptors and Ca2+ channels. The results further indicate the presence of anti-emetic activity in Cn. Cr, which may be because of its anti-muscarinic potential. This study provides the scientific bases to the traditional use of Cn. Cr in diarrhea and emesis.

Evolution of Emergency Medicine in Pakistan –A Fellow’s Perspective

Evolution of Emergency Medicine in Pakistan –A Fellow’s Perspective

Dynamics of evidence-informed health policy making in Pakistan.

Incorporating evidence is fundamental to maintaining the general acceptance and efficiency in public policies. In Pakistan, different actors—local and global—strive to facilitate the development of evidence-informed health policies. Effective involvement however, requires knowledge of the country-context, i.e. knowing the intricacies of how policies are formulated in Pakistan. Obtaining this knowledge is one of the key steps to making interventions impactful. We carried out a qualitative study to explore the environment of evidence-informed health policy in Pakistan. The study involved 89 participants and comprised three phases including: (1) literature review followed by a consultative meeting with key informants to explore the broad contours of policy formulation, (2) in-depth interviews with participants belonging to various levels of health system to discuss these contours and (3) a roundtable with experts to share and solidify the findings. Policy development is a slow, non-linear process with variable room for incorporation of evidence. Political actors dominate decisions that impact all aspects of policy, i.e. context, process and content. Research contributions are mostly influenced by the priorities of donor agencies—the usual proponents and sponsors of the generation of evidence. Since the devolution of health system in 2012, Pakistan’s provinces continue to follow the same processes as before 2012, with little capacity to generate evidence and incorporate it into health policy. This study highlights the non-systematic, nearly ad hoc way of developing health policy in the country, overly dominated by political actors. Health advocates need to understand the policy process and the actors involved if they are to identify points of impact where their interaction with policy brings the maximum leverage. Moreover, an environment is needed where generation of data gains the importance it deserves and where capacities are enhanced for communicating and understanding evidence, as well as its incorporation into policy.

The Role of Parents' Literacy in Malnutrition of Children Under the Age of Five Years in a Semi-Urban Community of Pakistan: A Case-Control Study.

Objectives: According to a recent survey, Pakistan was ranked as the third highest country with malnutrition and the under-five child mortality. No realistic solution for this growing problem has been found despite the fact that the struggle to tackle the issue of malnutrition among young Pakistani children has been going on for the last several decades. The objective of our study was to look into the relationship between parental education and malnutrition in Pakistan and to make a recommendation to improve the nutritional condition of the children.Method: We carried a case-control study among 400 mothers from February 2016 to July 2016 in a primary health care center located in a peri-urban community in Pakistan. A self-constructed questionnaire comprising of 75 questions was used to collect the data.Results: The mean age of mother was found to be 27.61 ± 5.130. The majority of the mothers were uneducated 168 (42.0%) while only 116 (29.0%) fathers were uneducated. About 226 (56.5%) of the children had a normal nutritional status while 102 (25.5%) had first-degree malnutrition, 52 (13.0%) had second-degree malnutrition, and 20 (5.0%) had a third-degree malnutrition. Higher paternal educational status (p = 0.008) and maternal educational status (p = 0.011) were found to be significantly associated with normal child nutritional status.Conclusion: It is recommended that the education of parents, especially females, in the rural and semi-urban areas should be promoted and given due importance. The focus of all these programs should be the mother in terms of security, employment, literacy, justice, healthcare, food, shelter, and social equality.

Expenditure tracking and review of reproductive maternal, newborn and child health policy in Pakistan.

Since 2001 substantial resources have been allocated to the reproductive, maternal, newborn and child health sector (RMNCH) in Pakistan. Many new programmes have been started and coverage of some existing programmes has been extended to un-served and rural areas. Despite these efforts the Millennium Development Goals (MDGs) 4 and 5 were not achieved (2000-15). Maternal Mortality Ratio was reduced to 170 per 100 000 live births (target 100) by 2013 at an annual reduction rate of 3.6% (1990-2013). Against the target of 46 per 1000 live births, the Under Five Mortality Rate was reduced to 81 per 1000 live births by 2015 at an annual reduction rate of 2.1% (1990-2015). We evaluated the comparative expenditures for the RMNCH sector and analysed impact of public expenditures on the use of the public facilities for the RMNCH services. Expenditure on RMNCH increased by 181% (2000-10), reaching PKR 628.79 billion (US$9.67 billion). The Share of the RMNCH expenditure in the total health expenditure increased from 16 to 21% (2005-10). The share of official development assistance for the RMNCH increased from 36 to 51% (2003-10). Equity was modestly achieved with a greater proportion of the poor using public facilities for the childhood diarrhoea (Concentration Index -0.06 in 2001-02 to - 0.11 in 2010-11) and reduction in the proportion of the rich using the public health facilities for institutional births (Concentration Index 0.30 in 2001-02 to 0.25 in 2010-11). Overall the RMNCH disease control programmes focused on vertical primary health approach and targeted the district health system in the un-served areas. Our findings confirm that diseconomies of scale, donor dependence and supply side perspective could only result in a modest progress towards achieving the MDGs. We call for urgent attention of the policy makers for the integration of the vertical and the routine primary health care and reliance on indigenous sustainable healthcare financing. We also recommend acknowledging economic perspective on health policy and health programmes.

Fagonia olivieri prevented hepatorenal injuries induced with gentamicin in rat.

Gentamicin is used clinically against Gram negative bacteria because of its efficacy. However, it causes renal injuries and failure at clinical dosages on account of induced oxidative stress. Fagonia olivieri is used in kidneys, liver, alimentary canal and cardiovascular disorders in local system of medicine in Pakistan. This study evaluates the protective abilities of methanol extract of F. olivieri (FOM) against the liver and renal injuries induced with gentamicin in rat. Sprague-Dawley male rats were treated with gentamicin (80mg/kg) alone or with silymarin (50mg/kg) as standard antioxidant drug. The other groups of rats were treated with gentamicin along with FOM (200mg/kg, 400mg/kg) or FOM (400mg/kg) alone. Effect of FOM was investigated on body weight, urine and serum biochemical markers, enzymatic antioxidants of renal and liver along with histopathological alterations. FOM was investigated by GC-MS for the presence of bioactive constituents. Treatment of FOM to rats ameliorated the gentamicin induced toxicity and increased the percent increase in body weight while decreased the absolute and relative weight of hepatic and kidneys. Gentamicin increased the level of specific gravity, count of RBCs and WBCs, and urobilinogen in urine; and AST, ALT, ALP, LDH, total bilirubin, total cholesterol, triglycerides and LDL in serum. Level of lipid peroxides in terms of thiobarbituric acid reactive substances (TBARS) and DNA damages increased while the GSH contents and activity level of CAT, SOD, GSH-Px and GR decreased with gentamicin in liver and kidney samples. Co-treatment of FOM, dose dependently, alleviated the injuries induced with gentamicin. Histopathological studies of liver and kidneys supported the protective abilities of FOM. GC-MS analysis indicated the presence of various compounds including hexadecanoic acid, 2-methoxy-4-vinylphenol, benzoic acid and thalicpureine in the FOM. Results of the present investigation suggested the protective potential of FOM against the oxidative injuries of gentamicin that could be attributed by phytochemicals having antioxidant and free radical scavenging abilities.

Psychological Healing in Pakistan: From Sufism to Culturally Adapted Cognitive Behaviour Therapy

The current paper provides an overview of the cultural and religious background of Pakistan; the current situation of mental health in Pakistan with special emphasis on cultural adaptation of cognitive behaviour therapy (CBT) in Pakistan. In the context of Sufism- Islamic Mindfulness, it is interesting to note that it has been easy to explain the concepts of CBT to the therapists and clients in Pakistan, but the process to culturally adapt CBT in Pakistani culture, had to be based on patience while generating evidence for it. Our group has taken the responsibility to do that and so far, have been successful in the endeavours pertaining to research and service development, described in this paper.

Assessment of active pharmaceutical ingredients in drug registration procedures in Pakistan: implications for the future

Introduction: There are concerns over the quality of generic medicines in Pakistan. This is due to perceived non-compliance with good manufacturing practice (GMP), whereby the quality of the raw materials is not being assessed. If not addressed, this will impact on the potential for generics exports from Pakistan, as well as on patient care. Consequently, there is a need to assess the current assessment and regulatory situation in Pakistan and to recommend a way forward that ensures the future quality of products. Objective: To assess the quality of the raw materials that are either imported to, or manufactured in Pakistan, that are then used to produce a leading analgesic (ibuprofen). As part of the assessment, the presence and levels of impurities will be determined. Subsequently, the findings will be used to recommend potential regulatory changes to improve patient care. Methods: The quality of 27 sourced raw materials and the reference product were assessed using a variety of quality assessment methodologies, including assay tests, and infrared spectroscopy and UV-spectrophotometry. The calculated values were then compared to values documented in the Certificate of Analysis (CoA), and high performance liquid chromatography (HPLC). Results: All but one sample passed the spectroscopy identification tests. However, 81.5% of samples failed to comply with pharmacopoeia assay limits. There were also concerns with the use of HPLC methods used to assess the quality of raw materials, and over the fact that assay values obtained were not the same as those listed in the CoA. In addition, where manufacturers had concerns over the amount of ibuprofen in the raw material, rather than rejecting the product, they typically used higher quantities to make up any shortfall. Conclusions: The results of this study demonstrate that there is an urgent need to improve the registration process for generic products in Pakistan. This should include implementing Common Technical Documents (CTDs) based on international standards. In this way, we will see generics being produced that result in improved patient care and that have potential for export from Pakistan.

STATE OF HEALTHCARE QUALITY AND PATIENT SAFETY IN PAKISTAN

Many low and middle income countries have developed their own national accreditation standards and accreditation systems for regulating and improving the quality of healthcare services. Healthcare quality is defined as the degree to which health services to individuals and populations increases the likelihood of desired health outcomes and are consistent with current professional knowledge. This paper attempts to assess the state of Pakistan's healthcare quality and patient safety in a structured way using Donabedian's model. Some of the key specific challenges identified for Pakistan's healthcare quality initiatives are lack of national healthcare accreditation system and integrated national guidelines, policies and procedures on healthcare quality and patient safety. Lack of national quality care indicators. Absence of an organizational culture that holds people accountable and lack of pre-service and in-service training for health staff in quality care management and leadership with little contextual research on quality care initiatives. Possible ways to improve the state of health care quality in Pakistan may include (i) up gradation and implementation of policies and procedures that regulate quality and patient safety issues in healthcare settings across the country (ii) introduction of a national healthcare accreditation programme across the nation (iii) development of networks and consortia between public and private sectors in Pakistan (iv) capacity building of health care professionals in quality and patient safety (v) Formulation of quality improvement teams at national and provincial level (vi) development of a culture of accountability and ownership (vii) learning from experiences of other countries and implementation quality care tools and locally validated indicators.

Organizational Benefits of Computerized Physican Order Entry (CPOE) System in Pakistan.

Electronic prescribing is also known as Computerized Physician Order Entry (CPOE). It is a computer-aided system which offers the health professionals a robust platform for entering the prescription electronically. Due to paucity of facilities in Pakistan which are available around the world, there is an observable overburden on the health professionals and practitioners. CPOE system has shown to be very effective in minimizing medication errors. CPOE is beneficial for both patient and health organizations. There is great deal of interest in the adoption of this system in our healthcare system. The results state clearly that this system is equally beneficial for organizations who want to adopt this system as perceived by the health professionals. It supports the idea of adoption and implementation of CPOE in healthcare facilities healthcare institutes. CPOE must be adopted to ease and optimize nursing services in Pakistani healthcare system.

A Gender Analysis Of Health Policy In Pakistan

Pakistan is signatory to international commitments to promote gender equality and equity. This has seen introduction of a number of gender mainstreaming policy initiatives in the last ten years. Despite these initiatives gender mainstreaming still needs a lot to do in all sectors of policy. Therefore, aim of this research is to analyze the policies of health sector and analyze the extent to which it has been adapted to gender needs. For secondary analysis the original policy documents and other reports and studies related to the health sector were analyzed. Gender Reform Action Plan (GRAP) was also analyzed which is the main instrument through which the government of Pakistan seeks to address the deep rooted gender inequality in Pakistani society. Analysis shows that the redressing discrimination on gender biasness is necessary to ensure equality and equity to less class privileged groups. Results also show that in health policy the gender component is included but superficially. If policies do not consciously aim to reduce inequalities as their primary target, whether these inequalities are in the form of income/asset distribution, in access to effective social protection, or by way of legal citizenship rights, these policies will necessarily result in discrimination. Eliminating the social and economic hurdles that obstruct equality must be the foundation of every policy intention, otherwise policy initiatives will merely end up duplicating and reinforcing existing discrimination against marginalised sectors, especially women, minorities and the poor.

Equity in the use of public services for mother and newborn child health care in Pakistan: a utilization incidence analysis.

BackgroundPoor maternal and infant health indicators are mostly concentrated among low income households in Pakistan and health care expenditures – especially on medical emergencies – are the most common income shocks experienced by the poor. Public investments in health are therefore considered as pro-poor interventions by the government of Pakistan. This study employs nationally representative household data for Pakistan for 2007–08 and 2010–11 to investigate whether benefits from publicly financed services on Mother and Newborn Child Health (MNCH) are effectively captured by the poor in terms of service utilization.MethodsThe study conducts a Utilization Incidence Analysis of the use of public health services for MNCH in Pakistan. For this purpose, the utilization shares of households, ranked by economic status, are computed. The concentration curves are plotted and their dominance is tested against an equal distribution and Lorenz curves to determine whether the distribution is pro-poor and progressive.ResultsAlthough the shares of bottom income groups in the utilization of most services for MNCH have increased between 2007 and 2011, the utilization of some services such as post-natal consultation; institutional maternal delivery; and Tetanus Toxoid injections for pregnant women remains pro-rich in 2011. The utilization of pre-natal consultation, especially through lady health workers and visitors; the use of Family Panning Units; and immunization services is somewhat evenly distributed. The use of Basic Health Units (BHUs) is found to be pro-poor. The provincial analysis reveals that the province of Baluchistan depicts an unusually high level of inequity in the distribution of utilization benefits from almost all public health services. Finally, in terms of progressivity, public spending on all health services analyzed in the study is found to be progressive at the national level implying that investment in MNCH has the potential to redistribute income from rich to the poor.ConclusionTo target the poor effectively, the study recommends expanding the network of BHUs as well as basic reproductive and child health care services. The outreach of health facilities in Baluchistan need to be expanded while targeting the poor effectively by mitigating various access costs that prevent them from using public health services.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-016-0405-x) contains supplementary material, which is available to authorized users.

Why do physicians prefer brand medicines over generic medicines in Pakistan? A quantitative approach

Objectives Generic medicines are recommended and used largely due to their costeffectiveness. Still, physicians prefer brand medicines rather than their generic counter-parts. Therefore, the current research was aimed to evaluate the preferential attitude ofphysicians towards brand medicines over generic medicines in Pakistan.Methods This is a cross-sectional survey which was conducted in two public sectorhospitals in Bahawalpur, Punjab, Pakistan. A total of 150 physicians were interviewedusing a 17-itemed self-administered questionnaire. A 4-point Likert scale was used andresponses were measured as strongly disagree, disagree, agree and strongly agree. ACronbach’s alpha of 0.66 was obtained for all the domains. Statistical analysis wasperformed usingSPSS (version 15.0).Key findings A response rate of 84.3% was achieved. Slightly more than half of thephysicians were men (52.7%) with 64% being specialist doctors, and nearly 61.3% hadmore than 10 years of experience. Slightly more than half of the respondents agreed(n = 99; 66%) that they prefer brand medicines over generic medicines because of higherefficacious potential. This was found to be statistically significant with respect to genderwith men reported greater agreement (P < 0.001). Interestingly all the specialists (n = 96;64%; P = 0.045) agreed not to prefer generics over brand medicines because of lesserpotency.Conclusions It is concluded that physicians’ prescribing practices are significantly affected by their lack of knowledge regarding generic medicines, patient-related factors,and by the influence of pharmaceutical advertisements.Keywords brand medicines; generic medicines; physicians; prescribing

Mental Health professionals’ Perspective of Mental Health in Pakistan

Mental Health professionals’ Perspective of Mental Health in Pakistan