Underdeveloped Healthcare System Research Articles

A scoping review of the management of prostate cancer in Africa

Prostate cancer is one of the most frequently diagnosed cancers in menand a major cause of cancer-related deaths in men, globally. The managementof prostate cancer in Africa is unique; most patients present withadvanced disease as result of a largely under-developed healthcare delivery.However, due to the underdeveloped healthcare system in Africa,there are unique limitations to delivering these treatments. Thus, the needfor this scoping review on the management of prostate cancer in Africa.Aim: To give an account of the pattern of presentation, histological types,investigative and treatment modalities of prostate cancer in Africa. A literaturesearch through PubMed, Google Scholar, and African Journal Onlineon the management of prostate cancer in Africa was conducted. Results arethen reported according to the Preferred Reporting Items for SystematicReview and Meta-analyses extension for Scoping Review. Forty-three articlesfully satisfied the inclusion criteria and were used for this review.The commonest presentation of prostate cancer was lower urinarytract symptoms, followed by bone pain and urinary retention in that order.Adenocarcinoma was the commonest histological type for 98.5% of thestudy. A total 23.3% of patients had hormonal treatment which was the commonesttreatment option. Chemotherapy and open radical prostatectomywere used in 17.7 and 12.9% cases respectively. The use of robot-assistedradical prostatectomy was not an option of care noted in the review. Thefindings of this study highlight the need for integration of modern investigativemodalities and treatment options for prostate cancer in Africa.

Serum levels of sclerostin in prediabetes and its correlation with bone mineral density.

Diabetes is a major burden globally, more commonly so in developing countries, as its complications are detected relatively late due to underdeveloped healthcare systems. These complications, when detected, are more or less irreversible, thereby leading to increased morbidity and mortality. Among these, complications related to bones (mainly osteoporosis) start fairly early (even in the prediabetes stage) but are less emphasized, nonetheless are major contributors to morbidity in diabetics due to increased fracture risk. One of the novel bone markers recently discovered is sclerostin, which helps in the assessment of the effect of hyperglycemia on bone homeostasis. Bone mineral density (BMD) by DXA scan is a good tool to assess the status of bone health but requires modern expensive radiological equipment. In this study, we wanted to see the correlation of serum levels of sclerostin to BMD so that by a simple serum investigation, early detection of poor bone quality in treatment-naive prediabetics can be done. The aim of the study was to measure serum levels of sclerostin in prediabetics, compare them with normoglycemic controls, and find the correlation of serum levels of sclerostin with BMD. 50 prediabetic patients and 50 age, sex, blood pressure, and BMI-matched controls were recruited in the study. In both the groups, serum levels of fasting blood glucose and postprandial glucose, glycated hemoglobin (HbA1c), Vitamin D, fasting insulin, and serum sclerostin levels were measured in both groups using ELISA. The obtained values were compared between the two groups. Bone mineral density is measured by DXA scan in cases and a correlation between BMD and serum levels of sclerostin was observed. Serum sclerostin was significantly higher in the cases [18.22 (19.42) ng/ml] compared to the control group [11.08 (4.73) ng/ml] with a P value of 0.013. The mean of BMD in prediabetes is 1.06 g/cm2, T score is - 1.02, and Z score is - 0.59. There was a significant negative correlation between serum sclerostin levels and BMD in prediabetes (r = -0.404, P < 0.001). Serum levels of sclerostin are increased in prediabetes and correlate well with low BMD in prediabetes, and can therefore be used for early recognition of osteoporosis and fractures in diabetes.

HIV vaccines: Lessons from basic research, clinical trials, and public policy

Forty years since its discovery in 1983, HIV/AIDS still lacks a cure, despite advances in biomedicine that have dramatically improved global understanding of the virus’s biology. Decades of research and improvements to clinical trial infrastructure have promoted the development of novel vaccines for HIV, but these vaccines have shown limited efficacy. The landmark clinical trial “RV144” in Thailand (2003) showed modest efficacy of an HIV vaccine for the first time ever, sparking the formation of public-private partnerships and a wave of other HIV vaccine clinical trials. Around two decades later, the COVID-19 pandemic provided an impetus to move vaccine technology forward and exposed areas for improvement in vaccine and clinical-trial infrastructure. Looking at historical examples from both HIV and COVID-19 research, vaccine trials, and global statistics, it is clear that a successful vaccination campaign will require generous funding, collaboration, clinical trial infrastructure, sharing of data and resources amongst researchers, and policy based on scientific evidence and ethics. Such a successful campaign will also require overcoming several hurdles, such as delivering vaccines to individuals in countries with underdeveloped health care systems and both demographic and geographic disparities in access to care. The perspectives in this article are apropos given the recent development of HIV vaccines that have entered clinical trials.

Income-Based Inequalities and Health Expenditures in Developing &amp; Developed Countries

This study aims to understand the cost-effectiveness of health expenditures and explore why some countries have low expenses but better health outcomes, while others spend more but have underdeveloped healthcare systems. It analyzes income and health expenditures in developed and developing countries using existing literature and data analysis. The findings highlight the need for tailored policies, with developed countries focusing on cost increases and developing countries improving available healthcare services. This research provides insights for future studies and policy development, emphasizing the disparities in health expenditures between developing and developed countries.

Strategies to Operationalize Health Equity in Island Area Health Departments.

Strategies to Operationalize Health Equity in Island Area Health Departments.

Deadly Marburg virus in Ghana, 2022 amidst monkeypox and COVID-19 pandemic: A distressing concern for public health.

Deadly Marburg virus in Ghana, 2022 amidst monkeypox and COVID-19 pandemic: A distressing concern for public health.

Multidrug resistant bacterial infections in severely ill COVID-19 patients admitted in a national referral and teaching hospital, Kenya

BackgroundBacterial infections are a common complication in patients with seasonal viral respiratory tract infections and are associated with poor prognosis, increased risk of intensive care unit admission and 29–55% mortality. Yet, there is limited data on the burden of bacterial infections among COVID-19 patients in Africa, where underdeveloped healthcare systems are likely to play a pertinent role in the epidemiology of the COVID-19 pandemic. Here, we evaluated the etiologies, antimicrobial resistance profiles, risk factors, and outcomes of bacterial infections in severely ill COVID-19 patients.MethodsA descriptive cross-sectional study design was adopted in severely ill COVID-19 patients at Kenyatta National Hospital, Kenya, from October to December 2021. We used a structured questionnaire and case report forms to collect sociodemographics, clinical presentation, and hospitalization outcome data. Blood, nasal/oropharyngeal swabs and tracheal aspirate samples were collected based on the patient's clinical presentation and transported to the Kenyatta National Hospital microbiology laboratory for immediate processing following the standard bacteriological procedures.ResultsWe found at least one bacterial infection in 44.2% (53/120) of the patients sampled, with a 31.7% mortality rate. Pathogens were mainly from the upper respiratory tract (62.7%, 42/67), with gram-negative bacteria dominating (73.1%, 49/67). Males were about three times more likely to acquire bacterial infection (p = 0.015). Those aged 25 to 44 years (p = 0.009), immunized against SARS-CoV-2 (p = 0.027), and admitted to the infectious disease unit ward (p = 0.031) for a short length of stay (0–5 days, p < 0.001) were more likely to have a positive outcome. Multidrug-resistant isolates were the majority (64.3%, 46/67), mainly gram-negative bacteria (69.6%, 32/46). The predominant multidrug-resistant phenotypes were in Enterococcus cloacae (42.9%, 3/7), Klebsiella pneumonia (25%, 4/16), and Escherichia coli (40%, 2/5).ConclusionOur findings highlight a high prevalence of multidrug-resistant bacterial infections in severely ill COVID-19 patients, with male gender as a risk factor for bacterial infection. Elderly Patients, non-SARS-CoV-2 vaccination, intensive care unit admission, and long length of hospital stay were associated with poor outcomes. There is a need to emphasize strict adherence to infection and prevention at KNH-IDU and antimicrobial stewardship in line with local and global AMR control action plans.

PROBLEMS OF ENSURING HUMAN RIGHTS TO PUBLIC SERVICES FOR THE RESIDENTS OF THE UNITED TERRITORIAL COMMUNITIES OF UKRAINE

Modern Ukraine is characterized by a period of fundamental changes in state-building and law-making. Since 2014 the ongoing constitutional reform is aimed at optimal organization of local self-government. By searching the ways to decentralize, Ukraine aims to ensure the proper functioning of basic municipal institutions. The united territorial community (UTC) is the primary element of local democracy and therefore plays an important role in addressing issues related to the daily needs of community members. The local level authorities provide ineffective governance and they do not provide the scope of public services that residents need, especially in rural areas. The existence of an underdeveloped health care system in Ukraine has led to low quality and inaccessibility of medical care to the population, especially in rural areas. The beginning of the rural healthcare reform was laid by the adoption of the Law of Ukraine, “On increasing the availability and quality of medical care in rural areas.” The system for high-quality and affordable healthcare to rural residents can be created by: 1) optimizing delivery; 2) training; 3) access to specialized facilities; 4) telehealth; 5) creating appropriate infrastructure; 6) working conditions and living standards for healthcare professionals; 7) preventive measures for public health; 8) ensuring interaction between central and local executive authorities. UTCs must utilize the powers granted to them by law to create a client-oriented system of public administration while protecting citizens’ constitutional rights – particularly their rights to health protection and healthcare.

Palliative Care education in Armenia: perspectives of first-year Armenian physician\xa0residents

BackgroundDue to developing demographic changes, including an aging society and the increasing prevalence of non-communicable diseases, Palliative Care is increasingly highlighted as a universal healthcare need. The need for Palliative Care in Armenia is set against the context of an underdeveloped healthcare system. Further, the absence of palliative medicine within medical education, particularly undergraduate education in Armenia presents a major barrier to improving care. This research aimed to assess the perception of young Armenian physicians’ understanding of Palliative Care, its perceived status in Armenia and the experience and influence of any engaged Palliative Care education.MethodsTwenty Armenian first-year residents with different specializations were interviewed July and September 2016 regarding: understanding/knowledge, experiences, perceived competence, and expectations of Palliative Care and Palliative Care education. The transcripts from these semi-structured interviews were analyzed using Qualitative Content Analysis.ResultsParticipants perceived that Armenia’s health care system lacked sufficient Palliative Care and Palliative Care education. Although elements of Palliative Care were included in different specialty teaching, this provided just a partial understanding of typical Palliative Care patients/symptoms, approaches to holistic care, and crucially key communication skills. Challenges noted by participants in caring for Palliative Care patients included emotional difficulties, communication of diagnosis/prognosis, uninformed patients and concerns for patients, families, and physicians. Self-confidence in caring for patients with incurable illness varied. Participants hoped for increasing availability and accessibility of Palliative Care, and extension of clinical education in Palliative Care at all levels (undergraduate, postgraduate, specialization).ConclusionsAbsence of training has resulted in misconceptions and ignorance of common concepts and practices in Palliative Care. Palliative Care education needs to be systematically developed and integrated into clinical training within Armenia. This research may provide a rallying call for changes within the core curricula in Armenia and may also encourage collaborative development in associated countries of the Caucasus region.

A Review of Antibiotic Dispensing and Use in Asia

In particular, antibiotics are a crucial drug in pharmaceutical treatment. These drugs are used to treat and prevent infectious illnesses all around the globe, but particularly in Asia, where the majority of the population has poor to moderate incomes. Asia is noted for having nations with underdeveloped healthcare systems, a lack of services in rural regions, and improper medication counseling. There are certain groups that reside in regions with less developed medical technology. Patients who get proper prescriptions and counseling are more likely to take their medications as prescribed, acquire trust for and understanding of antibiotics, and refrain from misusing them. Although the central Asian nations in this review paper have experienced problems with the distribution and use of antibiotics. Antibiotics are used to treat or stop the spread of a specific bacterial illness inside the body. Although they offer certain advantages, antibiotics may sometimes have serious adverse effects, such as antibiotic resistance. The majority of Asian nations have limited resources, connections, and locations when it comes to drug awareness and oversight. Many times, low-poor nations decide to give medicine without a prescription due to a lack of funding or because the pharmacist is unable to generate any cash. Because of community misuse of antibiotics and a lack of knowledge about how to handle these specific prescriptions, the distribution of antibiotics requires adequate responsibility and direction with appropriate counseling. This review article aims to increase understanding of the use and administration of antibiotics as well as the execution of public health awareness intervention activities as a means to lessen this problem.

Preventing Multimorbidity with Lifestyle Interventions in Sub-Saharan Africa: A New Challenge for Public Health in Low and Middle-Income Countries.

Objectives: Low and Middle-Income Countries are experiencing a fast-paced epidemiological rise in clusters of non-communicable diseases such as diabetes and cardiovascular disease, forming an imminent rise in multimorbidity. However, preventing multimorbidity has received little attention in LMICs, especially in Sub-Saharan African Countries. Methods: Narrative review which scoped the most recent evidence in LMICs about multimorbidity determinants and appropriated them for potential multimorbidity prevention strategies. Results: MMD in LMICs is affected by several determinants including increased age, female sex, environment, lower socio-economic status, obesity, and lifestyle behaviours, especially poor nutrition, and physical inactivity. Multimorbidity public health interventions in LMICs, especially in Sub-Saharan Africa are currently impeded by local and regional economic disparity, underdeveloped healthcare systems, and concurrent prevalence of communicable and non-communicable diseases. However, lifestyle interventions that are targeted towards preventing highly prevalent multimorbidity clusters, especially hypertension, diabetes, and cardiovascular disease, can provide early prevention of multimorbidity, especially within Sub-Saharan African countries with emerging economies and socio-economic disparity. Conclusion: Future public health initiatives should consider targeted lifestyle interventions and appropriate policies and guidelines in preventing multimorbidity in LMICs.

COVID-19 third wave: a challenge for overburdened and underdeveloped healthcare system of Pakistan.

To the Editor, Countries around the globe have observed the dynamic pattern of COVID-19 associated morbidity and mortality in which the first wave was observed in spring 2020 that considerably moderated during the summer. The second wave emerged in fall 2020, which subsequently decreased in early 2021. But now COVID-19 third wave is on the line with an inclined rate and is considered more infectious in some of the countries [1]. In Pakistan, COVID-19 has caused 630,471 confirmed cases with about 13,863 deaths by 21 March 2021 as shown in Figure (a). The rate of positive cases was highest (23%) in June 2020, which dropped to 1.7% by September 2020. Later, it began to rise, reaching 7.45% in January 2021 and 3% in February 2021. Now it is on the rise again and already reached 8% by 19 March 2021 Figure (b). According to the National Command and Operating Center (NCOC) of Pakistan, COVID-19 cases rose to 22,018 in the last 10 days, which is a 68% increase in the cases from the proceeding 10 days, as shown in Figure c. The author declares there is no conflict of interest.

Sociocultural Challenges in the Implementation of COVID-19 Public Health Measures: Results From a Qualitative Study in Punjab, Pakistan.

Informed public health measures are crucial to curb the COVID-19 pandemic. The sociocultural context is important to understand the success or failure of implementing public health measures. This study explores the social and behavioral response to COVID-19 and unveils challenges in the implementation of related public health measures in Pakistan. Within this qualitative study, we conducted 34 telephonic/online in-depth interviews with youths, adults, elderly people, and healthcare professionals in the Punjab province of Pakistan. Framework analysis was used for data analysis. People's poor understanding about COVID-19 and the need for preventive measures were the major challenge in implementing public health preventive strategies. Study participants reported that the lockdown strategy increased poverty and unemployment. People's poor living conditions and living environment compelled them not to follow social distancing and restricting themselves to home. Additionally, an underdeveloped healthcare system was one of the major challenges for Pakistan. The culture of denial in Pakistan related to the epidemiology of COVID-19 was an important challenge within the implementation of public health preventive measures. It is extremely important that public health experts and social scientists work together to understand the contextual sociocultural factors which shape behaviors associated with the spread of a pandemic.

Health service underutilization and its associated factors for chronic diseases patients in poverty-stricken areas in China: a multilevel analysis

BackgroundUnderutilization of health services among chronic non-communicable disease sufferers, especially for hypertension (HBP) and diabetes mellitus (DM), was considered as a significant contributing factor to substantial cases in terms of both avoidable morbidity and mortality. However, evidence on health services underutilization and its associated factors in poverty-stricken areas remain scarce based on previous literature. This study aims to describe health services underutilization for people diagnosed with chronic diseases in impoverished regions and to identify its associated factors, which are expected to provide practical implications for the implementations of interventions tailored to the specific needs of disadvantaged residents in rural China to achieve effective utilization of health services in a timely manner.MethodsData were collected from a cross-sectional survey conducted through face-to-face interviews among 2413 patients from six counties in rural central China in 2019. The Anderson behavioral model was adopted to explore the associated factors. A two-level logistic model was employed to investigate the association strengths reflected by adjusted odds ratios (AOR) and 95% confidence intervals in forest plots.ResultsOn average, 17.58% of the respondents with HBP and 14.87% with DM had experienced health services underutilization during 1 month before the survey. Multilevel logistic regression indicated that predisposing factors (age), enabling factors (income and a regular source of care), and need factors (self-reported health score) were the common predictors of health service underutilization both for hypertensive and diabetic patients in impoverished areas, among which obtaining a regular source of care was found to be relatively determinant as a protective factor for health services underutilization after controlling for other covariates.ConclusionsOur results suggested that the implementation of a series of comprehensive strategies should be addressed throughout policy-making procedures to improve the provision of regular source of care as a significant determinant for reducing health services underutilization, thus ultimately achieving equal utilization of health services in impoverished regions, especially among chronic disease patients. Our findings are expected to provide practical implications for other developing countries confronted with similar challenges resulting from underdeveloped healthcare systems and aging population structures.

Prevalence and Determinants of Pre-Cancerous Cervical Lesion and Human Papillomavirus Among HIV-Infected and HIV-Uninfected Women in North-West Ethiopia: A Comparative Retrospective Cross-Sectional Study.

BackgroundThe poor socio-economic status, underdeveloped health care system, and the high HIV/AIDS burden have potentially increased the incidence of cervical cancer in sub-Saharan Africa (SSA) including Ethiopia. Studies on the magnitude of pre-cancerous cervical lesion and human papillomavirus (HPV) among HIV-infected women are still limited, particularly in the current study setting. Thus, we determined the prevalence of pre-cancerous cervical lesion and HPV among HIV-infected women in comparison with HIV-uninfected women at Debre Tabor Comprehensive Specialized Hospital (DTCSH), North-West Ethiopia.MethodsHospital-based comparative retrospective cross-sectional study was conducted among 546 women from July 2018 to January 2020 at DTCSH. All records during the study period were collected using a structured checklist. Epi data version 4.02 and SPSS version 25.0 were used for data entry and analysis, respectively.ResultsThe overall prevalence of pre-cancerous cervical lesion among 546 women was 8.8%. The prevalence of pre-cancerous cervical lesion was comparable between HIV-infected (9.3%) and HIV-uninfected women (8.6%) (p = 0.859). Age >45 years old, widowed marital status, multiparous (women ≥ 5 childbirths), and educational status were independent contributing factors of a pre-cancerous cervical lesion. Regarding HPV prevalence, among 109 screened women, 7 (6.4%) were positive for both HPV 16 and 18 strains.ConclusionHIV infection was not statistically correlated with the magnitude of pre-cancerous cervical lesion (p = 0.859). Women in the study setting developed pre-cancerous cervical lesions irrespective of their HIV status. Hence, we recommend routine screening of women for pre-cancerous cervical lesion and HPV infection regardless of their HIV status for early management and prevention of associated morbidity and/or mortality.

СВЯТЫЕ ИСТОЧНИКИ И НАРОДНАЯ РЕЛИГИОЗНОСТЬ ПРАВОСЛАВНОГО НАСЕЛЕНИЯ УРАЛА В 1954–1964 ГОДАХ

The tradition of attributing mythological and religious meanings to natural phenomena, the formation of a ritual culture associated with trees, stones, water sources, atmospheric phenomena, etc., refers to the most ancient sacred practices of human communities. This stimulated philosophical, cultural, and anthropological studies of this phenomenon in the context of Orthodox culture, aimed at identifying the relations between pagan and Christian symbols and rituals and analyzing the problem of dual faith among the Orthodox population of Russia. Historical studies of the manifestations of folk religiosity are still at the stage of generalizing empirical material. The subject of the article is a study of folk religious practices in the historical context of Khrushchev’s anti-religious campaign. The focus of the study is on the Orthodox traditions of venerating water sources. The specificity of the approach is the analysis of the elements of folk religiosity (using the example of the veneration of “holy sources”) as a manifestation of everyday practices of adaptation and survival of believers in the USSR. Despite the banishment of religion from public space in the era of Nikita Khrushchev, belief in miracles and miraculous healings and visits to holy places were common not only among Orthodox Soviet people, but also among those who were considered “atheists”. Regional features of folk religion in the Urals were the redefinition of holy places in the multi-ethnic space of the region and the use of water sources for folk medicine in an underdeveloped health care system. For certain categories of Soviet citizens (former priests, monks and nuns, marginalized elements, etc.), the sphere of folk religiosity was a space for the realization of subjectivity, different from the “normative” one. As a result of a comparative-historical approach, it is shown that the practices of venerating holy sources in the Urals fit into the all-union framework of the phenomenon.

Emerging centers can provide textbook outcomes (TO) for Pancreatoduodenectomy (PD): a multicenter study from India

Introduction: Textbook Outcome has recently been introduced as novel quality measure for pancreatic surgery. Centralization is one of the strategies proposed in Western Europe and USA for providing quality outcomes following PD. With large populations and underdeveloped healthcare system, applicability of ´centralization´ for low-middle income countries (LMIC) such as India remains debatable. For LMIC the challenges are:-Rapid development of well equipped new centers to provide healthcare facilities closer to populations / decrease overwhelming workload of existing centers-Provide quality care at affordable costs We investigated whether TO for PD can be achieved at such ´emerging´ centers. Methods: Two surgeons trained at same institution from 2000 - 2005 set up independent centers for major digestive tract surgery in North & Western India. The outcomes of PD were retrospectively analyzed. Results: Eighty seven patients underwent PD (Team 1 - 39, 10 years; Team 2 - 48, 7 years). TO were achieved in 82.7% patients (Figure1). The median length of stay (postoperative) was 10days. In hospital or 30-day mortality was 2 (2.2%). Three (3.4%) patients had CR-POPF. The cost of treatment ranged from 6000 USD (uncomplicated) to 18,000 -20000 USD (complicated; Clavien-Dindo 4). The demographic, technical details and outcomes for the 2 groups are provided in Table 1. Conclusion: Well trained surgical teams at emerging centers in LMIC can achieve TO following PD. Development of new well equipped centers manned by adequately trained personnel is reasonable strategy for LMIC for providing quality care at affordable costs.PP04-078Demographic, technical details and outcomes of PDParameterTeam 1 (n=39)Team 2 (n=48)Total (n=87)Mean Age (range)55.8 (19-71)56.5 (26-78)Site: Pancreas / Ampulla / Bile duct / Duodenum09 / 17 / 07 / 0614 / 20 / 08 / 0623 / 37 / 15 / 12PJ details: Duct-mucosa / Dunking39 / 046 / 0285 / 02Outcomes: POPF (B & C) / Mortality03 / 020 / 003 / 02Hemorrhage020103Clavien-Dindo Grade: None / 1 / 2 / 3 / 4 / 511 / 05 / 15 / 04 / 02 / 0211 / 20 / 14 / 03 / 0 / 022 / 25 / 29 / 07 / 02 / 02Readmission (30 day)020507Bile leak010102Textbook Outcomes29 (74.4%)43 (89.6%)72 (82.7%) Open table in a new tab

STROKE REHABILITATION SERVICES IN PAKISTAN: CURRENT STATUS AND FUTURE DIRECTIONS

Stroke is a leading cause of adult mortality and morbidity worldwide. The incidence of stroke is falling in developed countries, while on the rise in developing countries.1 Pakistan is a low middle-income country with an underdeveloped health care system whose major focus is on the management of communicable diseases.2 Epidemiological data on stroke in Pakistan is limited, based mostly on small samples reported from hospital data.3 Due to the combined efforts of the Pakistan Society of Neurology, Pakistan Stroke Society and the Faculty of Neurology at the College of Physicians and Surgeons of Pakistan (CPSP), the number of neurologists and stroke medicine physicians in the country has increased in the last decade.4 Diagnosis, acute evaluation and management of stroke has also improved. Areas of noted progress include early recognition of signs and symptoms of stroke, timely evacuation to a hospital, early neurology consult, availability of brain imaging (Computed Tomographic scan and Magnetic Resonance Imaging) and access to treatments including tissue plasminogen activator and endovascular procedures.4 At present, this is available only in major cities and hospitals. Despite such improvements in acute stroke management, functional outcomes and community reintegration for stroke patients in Pakistan is generally inadequate, due largely in part to the lack of multi-disciplinary stroke rehabilitation services. We aim to describe the current status of stroke rehabilitation services in Pakistan and discuss the main challenges and barriers towards providing multi-disciplinary stroke rehabilitation. Recommendations to overcome these challenges are also provided.

Measuring Pakistan’s Legislative Preparedness against COVID-19: A Critical Study of Newly Promulgated Law

Background: Since December 2019, the COVID-19 pandemic has challenged the international community on health and legislative fronts. The widespread disease needs an effective response from the health-care system as well as the legislative framework. Pakistan is facing a challenge from the under-developed health-care system as well as a lack of awareness about the available laws to deal with the issue. Awareness about the relevant laws is a precursor to the establishment of rule of law. This study will doctrinally analyse the national laws of Pakistan to make the response more effective. The awareness about the relevant laws will supplement the healthcare response against the pandemic of COVID-19. Since Pakistan is a federation and healthcare is a provincial subject, therefore the study limits itself to the laws of Punjab, the largest populated province of Pakistan. &#x0D; Objectives: This study will analyse the available healthcare laws to deal with the recent outbreak of COVID-19. The focus will remain on the doctrinal measurement of the effectiveness of The Punjab Infectious Diseases (Prevention and Control) Act 2020 (PIDA) vis-à-vis already existing laws. It will also highlight the salient features of the PIDA 2020 along with its effectiveness to deal with the current pandemic.&#x0D; Method: The study benefits from documentary analysis of legal documents. The method is nearer to the doctrinal research method in law. The study will shape itself into two parts. First will be lax lata that will ascertain what is the relevant healthcare law to deal with infectious diseases like COVID-19. The next step will be lax ferenda where the study will propose how it can become more effective to deal with the issue. The research will opt black letter approach.&#x0D; Conclusion: This study finds that the adoption of PIDA 2020 is in spirit with dealing with the pandemic of the COID-19. The law has shown positive trends in protecting the population from the widespread impact of the diseases. The World Health Organization has appreciated Pakistan’s methods and strategies against the first wave of the COVID-19 with reference to response in Punjab, the largest province of Pakistan.

Waiting time and Resource Allocation for Out-patient Department

Long waiting time in Health care facilities remains a major problem in Tanzania, mostly due to increased demand, shortage of medical health professionals and underdeveloped health care system. We attempted to estimate the average waiting time and find the best scenario in reducing out-patient waiting time. Mwananyamala Hospital was selected purposively, as a Regional government hospital in Kinondoni District, Dar es Salaam. A total of 200 selected patients attended OPD from 16th July to 15th August 2018 were observed and recorded the arrival time at each one-minute interval. Results show that patients at Mwananyamala hospital spend an average waiting time of 167 minutes, with a maximum waiting time of 243 minutes (4 hours). Simulation time was 540 minutes (9 hours) under the assumption that the OPD operates from 7:00 am to 4:00 pm. Simulation results suggested the best resource allocation at the OPD be obtained after adding two more staff, a medical doctor and a registration staff, leading to an average waiting time of 38 minutes, which is almost 4 times less than the current situation. These findings demonstrate how simulation can be used to inform hospital management with valuable data to enhance efficiency in managing outpatients.