Pakistan Journal of Public Health is the official journal published by the Health Services Academy, Government of Pakistan. The Academy aspires to become a regional academic center of excellence in public health training, policy advice, and health systems research that is nationally and internationally accredited. The mission of the Academy is to improve the health of the population of Pakistan and its surrounding region by enhancing human resource development and contributing to evidence-based policies and practices. PJPH is a forum for the presentation and promotion of new initiatives and evidence-based research in public health which will potentially inform policies and help in improving health services. It invites all members of the public health domain the exchange ideas, views, concepts, epidemiological data, and research findings.
Beyond the Rules of Thumb: The Need for Standardization of Brain Breaks in Medical Education
I read with great interest the article by Ali et al. titled “Perception of Medical Students about Brain Breaks; Identifying the Gap to Improve Learning as per Sustainable Development Goal-4”, published in the September 2025 issue of the Pakistan Journal of Public Health. The authors have highlighted the importance of cognitive rest for medical students. In this study, more than half of the students indicated the need for a brain break after 45 minutes of academic activity. I am writing this letter to suggest that, even though it is a good starting point, further thorough research is needed to scientifically determine the optimal timings and durations of these brain breaks for medical students. The authors also found that excessive brain breaks reduced the participants’ interest in the subject. This also points towards the existence of a “therapeutic window” for these brain breaks. Due to the intense academic environment of Pakistan, students face extremely high rates of burnout, affecting approximately 30% to 60% of medical students (1). This further highlights the need for more research to determine the optimal timings and durations of these very essential brain breaks.
Copyright (c) 2026 Muhammad Naqi https://creativecommons.org/licenses/by-nc/4.0
From Tragedy to Prevention: Addressing Carbon Monoxide Poisoning Across Pakistan
Multiple cases around Pakistan have continuously been reported on carbon monoxide poisoning in areas like Murree, Rawalpindi, and Pishin. This deadly gas is released from domestic gas geysers and generators. It is odorless and colorless, which is why it is called a silent killer. People in northern areas of Pakistan and Punjab use gas-run geysers during winters in both cars and homes, while generators are used by almost everyone in Pakistan during load shedding, especially in summers, which run on petrol, another major source of carbon monoxide. In 2022, 23 tourists in Murree died from CO poisoning in their cars during a snowstorm (1). Although many factors, like administrative failure and no warnings about harsh weather, do play a role in causing this tragic incident but the report again tells how the stranded tourists died due to poisoning and lack of ventilation. Another such case was reported in Hyderabad, where all 7 of the family members were found dead in their house in the village of Haq Nawaz Junejo. During investigations, it was later found that the generator in that house was completely dry, suggesting carbon monoxide as the main suspect (2).
Copyright (c) 2025 Syeda Efrah Mushtaq https://creativecommons.org/licenses/by-nc/4.0
One Patient, One Attendant: An Overlooked Necessity for Better Patient Care in Pakistan’s Tertiary Care Hospitals
Massive footfall of patients in tertiary care hospitals across Pakistan has become a chronic challenge. These hospitals are overwhelmed not only by patients but also by large groups of attendants accompanying each patient, turning wards into congested, chaotic spaces compromising patient care. An article of DAWN mentions about Non-cooperative behaviour of attendants, who insisted on staying with their patients, also contributed to the overcrowding (1). Although, “one patient, one attendant” policies are being displayed in most of the wards, but enforcement of this very policy remains almost nonexistent. Most patients are accompanied by several attendants who crowd the bedside, restrict staff movement, and interfere during rounds and procedures. One of the major precipitating factor in Pakistani doctors’ burnout and over exhaustion in an already over worked environment is the unwarranted and unnecessary presence of a patient’s attendants in, sometimes, a critical life threatening scenario where either you manage the attendants or save a life. Such encounters lead to arguments, delays, and sometimes violence (2), further highlighting the urgent need for strict policy enforcement. The influx of unnecessary attendants disrupts doctors’ and nurses’ workflow, increases infection risk and compromises patient privacy and adds to hospital waste and resource strain.
Copyright (c) 2026 Saad Bin Toufeeq, Nabeel Ahmad https://creativecommons.org/licenses/by-nc/4.0
From Carbon to Clarity: The Diamond Model of Epigenetic Healing in Population Health
The Diamond Model of Epigenetic Healing is a conceptual framework linking epigenetic adaptation with population-level resilience. Drawing on the metaphor of carbon’s transformation into diamond under stress, the model emphasizes that environmental and social stressors leave measurable epigenetic marks, but targeted interventions can modulate or reverse harmful modifications, termed “epigenetic healing.” This research note summarizes the model, synthesizes supporting evidence, and proposes directions for integrating molecular indicators into public health strategies. Interventions such as prenatal care, nutrition, trauma-informed services, pollution remediation, and social equity policies can produce measurable improvements in epigenetic profiles and downstream health outcomes. Identifying epigenetic markers as population-level indicators reframes prevention to include molecular restoration. Key next steps include community intervention trials with pre/post epigenetic measures, longitudinal cohort analyses linking social determinants with molecular change, and policy evaluation incorporating epigenetic outcomes. Recognizing epigenetic healing reorients public health toward active restoration, supporting longer, healthier lives and improved biological resilience across generations.
Copyright (c) 2025 Verda Tunaligil, Gulsen Meral https://creativecommons.org/licenses/by-nc/4.0
Effectiveness of Online Tools in Enhancing Interactive Learning in Undergraduate Community Medicine Teaching
Background: The integration of digital tools into higher education is pivotal for enhancing pedagogical strategies. This study evaluates the specific impact of online interactive platforms on student engagement and active learning within a competency-based medical curriculum, addressing a gap in comparative efficacy analysis. Methodology: A mixed-methods approach was employed over one academic semester. A cohort of 142 second-year medical students was exposed to integrated sessions using two platforms, Socrative and Kahoot!, within a foundational course. Quantitative data were collected via platform analytics measuring participation rates, response accuracy, and longitudinal engagement. Qualitative feedback was gathered through structured post-intervention surveys and focus groups to assess perceived engagement and utility. Results: Both tools markedly improved active participation, with an average response rate of 96% across all sessions. However, key quantitative differences emerged. Socrative demonstrated a 22% higher rate in sustained in-session participation metrics and was associated with a 31% reduction in student-reported distractions compared to Kahoot!. Survey data indicated that 84% of students found Socrative’s pace and format more conducive to complex problem-solving. Statistical analysis confirmed these differences were significant (p < 0.01). Conclusion: The findings robustly indicate that while both interactive tools are effective, Socrative offers distinct advantages in maintaining focused cognitive engagement. The most important figures, including the 22% higher sustained participation and 31% reduction in distractions, provide compelling evidence for tool selection. Strategically incorporating such platforms, with attention to their specific interactive architectures, can significantly strengthen the pedagogical efficacy of medical training programs, fostering a more attentive and dynamically engaged learning environment.
Copyright (c) 2025 Umme Kulsoom Khattak, Muddsar Hameed, Muhammad Sajeel Turab, Linta Masroor https://creativecommons.org/licenses/by-nc/4.0
Determinants of Post-Stroke Depressive Phenomenon: A Retrospective Cohort Inquiry in a Tertiary Care Hospital in Pakistan
Background: Post-stroke depression (PSD) is a common neuropsychiatric complication that adversely affects quality of life, particularly in low- and middle-income countries such as Pakistan, where comorbid conditions, including diabetes and hypertension, are highly prevalent. This study aimed to determine the prevalence and predictors of PSD. Methodology: A retrospective study was conducted from July to December 2023 at Liaquat National Hospital, Karachi, following approval from the Institutional Ethical Review Committee. Using non-probability consecutive sampling, 372 patients within five years of stroke onset were enrolled during the subacute phase, defined as one-month post-stroke. The Patient Health Questionnaire-9 (PHQ-9) was administered at one month and reassessed at six months. Patients identified with PSD received antidepressant therapy. Data were collected using a semi-structured questionnaire and analyzed through descriptive statistics and inferential tests, including confidence intervals and p-values to determine statistical significance. Results: Among the 372 participants, 35.5% exhibited symptoms of PSD; 90.9% of affected individuals received antidepressants, and 80% of these reported improved mood by six months. No significant association was observed between PSD and National Institute of Health Stroke Scale (NIHSS) scores. Ischemic stroke was strongly associated with higher odds of PSD in both unadjusted and adjusted analyses. Patients younger than 50 years also demonstrated greater susceptibility to depressive symptoms. Hypertension emerged as a significant predictor of PSD, with markedly elevated odds in both models. Overall, 26.9% of patients demonstrated moderate depressive severity on the PHQ-9. Conclusion: Younger age, ischemic stroke subtype, and hypertension were significant predictors of PSD. Antidepressant treatment was widely administered and associated with clinical improvement at six-month follow-up.
Copyright (c) 2025 Haneea Yasir, Saba Zaidi, Ayesha Hafeez Jaka, Malaika Ali, Haya Waseem Ansari https://creativecommons.org/licenses/by-nc/4.0
Assessment of Aggressive Behavior in Children Due To Viewing Violent Cartoons in Selected Schools of Karachi
Background: Watching cartoons is a common leisure activity among children. Concerns have been raised regarding the potential impact of exposure to violent cartoon content on aggressive behavior. This study aimed to assess aggression among school-going children aged 5–10 years in relation to exposure to violent cartoons in selected schools in Karachi, Pakistan. Methodology: A descriptive cross-sectional study was conducted in selected private schools in Karachi. A total of 340 children were included. Data were collected through parents using the Buss–Perry Aggression Scale to assess children’s aggression levels. Sociodemographic characteristics and cartoon-viewing behaviors were also recorded. Results: Most participants (96.2%, n = 335) reported watching cartoons, with 56.9% (n = 198) belonging to nuclear families. A majority (79.3%, n = 276) watched cartoons while eating. Boys demonstrated significantly higher aggression levels than girls (p = 0.024). Increased aggression was significantly associated with mimicking cartoon characters (p < 0.001), watching cartoons on YouTube (p = 0.002), living in joint families (p = 0.011), and screen time exceeding six hours per day (p = 0.033). Parental characteristics showed that 40.8% of mothers had secondary education, 46.8% of fathers were privately employed, and most mothers were homemakers. Conclusion: No direct association was found between cartoon viewing and aggression. However, specific behaviors such as mimicking cartoon characters and excessive screen time were significantly associated with higher aggression levels. These findings highlight the importance of monitoring children’s media consumption and behavioral responses.
Copyright (c) 2026 Neha Arshad, Masooma Farhan , Aftab Ali, Zaeema Ahmer https://creativecommons.org/licenses/by-nc/4.0
Sexual and Reproductive Health Access Among Afghan Refugee Women Using Telehealth in Pakistan
Background: Cultural, religious, and gender-based norms critically constrain Afghan refugee women's access to sexual and reproductive health (SRH) services in Pakistan. This study assessed awareness, utilization, and barriers to SRH services and evaluated the Sehat Kahani telemedicine platform's role in improving access. Methodology: A cross-sectional study was conducted from January to March 2025 at 10 Sehat Kahani e-health clinics in Balochistan and Khyber Pakhtunkhwa. Using purposive sampling, 464 Afghan refugee women aged 18–49 were recruited. Data from structured questionnaires were analyzed in SPSS 26 using descriptive and chi-square statistics (significance p<0.05). Results: While 76% of participants were aware of SRH services, only 61% had utilized them in the past year. Contraceptives (54%) and pregnancy testing (37%) were most used. Key barriers were limited service hours (35%) and distance (28%). Utilization was significantly associated with age, marital status, income, and household size (all p<0.01). Education showed no link to awareness (p=0.56) but a strong association with utilization (p<0.001). Conclusion: A significant gap remains between SRH awareness and utilization, driven by structural barriers. Digital health platforms like Sehat Kahani offer a promising avenue to improve access. Strengthening policy support for such culturally sensitive telemedicine interventions is crucial to bridging this gap for refugee populations.
Copyright (c) 2025 Rahim Hirani, Muhammad Muzzamil, Sara Saeed Khurram, Mahek Karim https://creativecommons.org/licenses/by-nc/4.0
Prevalence of Eating Disorders among Media Persons such as Actors, Models, Hosts, Anchors and Celebrities
Background: People in media usually faced immense pressure to maintain their body shape and particular appearance to meet societal standards of beautification. It led to a higher level of stress in these individuals to strictly control their weight. This study aimed to figure out the prevalence of eating disorders in people attached to media including actors, TV anchors, models, hosts and celebrities. Methodology: This study utilized a cross-sectional design to investigate the prevalence of eating disorders among media professionals. Simple random sampling technique was utilized to select the participants from the targeted population. A total of (n = 60) samples were collected, half of them were males and the other half were females by using Taro Yamini formula. Results: A total of 60 participants (mean age 22.45 ± 3.33 years) were enrolled for the study, with equal gender ratios (50% male, 50% female). In regards to participant BMI classifications, 6.7% were identified as underweight, 51.7% normal, 35.0% overweight, and 6.7% obese. Using EAT-26 scoring, 58.3% of participants were identified as having an eating disorder. Behavioral patterns reflected binge-eating, self-induced vomiting, use of weight-control medications, and excessive exercise at varying frequencies with just a handful, 1-2.% of participants reporting extreme forms of behavioral patterns daily. Analyzing BMI categories and eating disorder status through chi-square analysis did not reveal an association (p > 0.05). Independent sample t-tests confirmed substantial gender differences in current weight, highest weight, lowest weight, and ideal weight (all p < 0.01), with men reporting higher weight across the board. Conclusion: This study concluded that the prevalence of eating disorders was high in media personnels, while males reported higher weight metric when compared with females.
Copyright (c) 2025 Muhammad Jawad, Javeria Nawaz, Umme Zohra, Muhammad Abdullah Khan, Ahsan Khalil, Hafsa Tahir https://creativecommons.org/licenses/by-nc/4.0
Strategies to Enhance Healthcare Delivery at Lower Cost and Greater Efficiency: A Qualitative Study of Hospital Administrators in Punjab, Pakistan
Background: Healthcare systems in low- and middle-income countries like Pakistan face increasing pressure to deliver high-quality services at lower costs amid limited fiscal space and governance challenges. Hospital administrators play a key role in implementing reforms, yet little research has explored their perspectives on improving healthcare efficiency and delivery. The objective of the study was to explore strategies proposed by hospital administrators for improving healthcare delivery outcomes while reducing costs and enhancing efficiency in Punjab, Pakistan. Methodology: An exploratory descriptive qualitative study based on written responses was conducted at public and private tertiary hospitals across Punjab province. Participants: Sixty hospital administrators with medical degrees. The sample size was determined to be adequate for thematic saturation, which was achieved after 55 responses. Respondents had a mean age of 47 years (range 35–62); 35 were male and 25 females, with an average of 11 years of administrative experience. Participants provided written responses in English to a structured open-ended question. Data were analyzed using Braun and Clarke’s six-phase thematic analysis framework [1], with independent coding by two researchers to ensure reliability. Themes were derived through iterative coding, categorization, and consensus discussions. Results: Four overarching themes were identified: (1) strengthening governance and leadership, (2) optimizing human resources and training, (3) ensuring financial efficiency and accountability, and (4) improving patient-centered care and hospital processes. Each theme encompassed sub-themes such as transparent communication, merit-based recruitment, digitized procurement, and patient feedback mechanisms. Misunderstandings regarding the World Federation for Medical Education (WFME) were also noted, with two-thirds of administrators confusing recognition of national bodies with direct accreditation of institutions, leading to misaligned policy and resource allocation. Conclusion: Hospital administrators emphasized governance reforms, financial accountability, and workforce optimization as critical strategies for improving healthcare delivery in Pakistan. Addressing leadership misconceptions, particularly about WFME’s role, and enhancing regulatory communication will be essential for achieving sustainable efficiency improvements.
Copyright (c) 2025 Vaneeza Khan, Abeera Fawad Khan, Ayesha Junaid, Junaid Sarfraz Khan https://creativecommons.org/licenses/by-nc/4.0
Knowledge, Attitude, and Practices of First Aid Skills among Undergraduate Medical Students of Peshawar, Pakistan
Background: First aid refers to the immediate care administered following injury or acute illness prior to the arrival of professional medical assistance, intended to preserve life and minimize complications. This study aimed to assess and compare the knowledge, attitude, and practices (KAP) regarding first-aid skills among undergraduate medical students. Methodology: A descriptive cross-sectional study was conducted over six months (February–August 2023) involving 400 MBBS students from the third, fourth, and final years across two public and two private medical colleges in Peshawar. Data were collected via convenience sampling using a validated, self-administered structured questionnaire and analyzed using SPSS to determine frequencies and percentages. Results: Findings were stratified by institution type. Regarding theoretical knowledge, 72.5% of public sector students provided correct responses compared to 72.0% from the private sector. A positive attitude toward first aid administration was observed in 91.6% of public sector students versus 89.5% of private sector students. However, practical proficiency was lower; only 55.7% of public sector students and 45.6% of private sector students demonstrated correct management of emergency scenarios. Conclusion: While the majority of students exhibited adequate knowledge and a positive attitude toward first aid, practical application remains a significant gap. Approximately half of the respondents had never administered first aid, and proficiency in emergency management was suboptimal. These findings underscore the necessity of integrating comprehensive, hands-on first aid training programs into the medical curriculum.
Knowledge, Attitude, and Practices (KAP)
Copyright (c) 2025 Hamza, Naveeda Sarwar https://creativecommons.org/licenses/by-nc/4.0
Association of Adverse Childhood Experiences with Self-Harm Ideation among Students at Selected Universities of Karachi
Background: Self-harm (SH) is an important yet understudied public health concern among university students in Pakistan. Suicide is reported as the leading cause of death in this population, accounting for approximately 19% of all deaths. International literature highlights a strong association between adverse childhood experiences (ACEs) and self-harm ideation (SHI); however, evidence from Pakistani university populations remains limited. This study aimed to examine the association between ACEs and SHI among university students in Karachi, Pakistan. Methodology: An analytical cross-sectional study was conducted over one year across three selected universities in Karachi. Using non-probability purposive sampling, 420 students were recruited and interviewed using the Suicide Behaviors Questionnaire–Revised and the Adverse Childhood Experiences Questionnaire. The Chi-square test was applied to identify statistically significant associations, with p < 0.05 considered significant. Results: Nearly half of the participants (45%) reported SHI. Exposure to ACEs was significantly associated with SHI (OR = 2.31, 95% CI = 1.52–3.49, p < 0.001). Specific ACEs significantly linked to SHI included emotional abuse, physical abuse, emotional neglect, physical neglect, sexual abuse, domestic violence, and parental separation or divorce. Additional factors associated with higher SHI included female gender, nuclear family structure, and histories of bullying, smoking, and substance use. Conclusion: This study demonstrates strong associations between SHI and multiple ACE categories among university students in Karachi. Early identification, targeted prevention strategies, and timely referral to mental health professionals are essential to reduce the risk of self-harm in this vulnerable population.
Copyright (c) 2025 Shireen Fatima, Sameera Ali Rizvi, Nida Shoaib https://creativecommons.org/licenses/by-nc/4.0
Inaccessibility of tPA in Pakistan: A barrier to timely stroke management
Stroke is a leading global health challenge, considered as the second leading cause of death (about 7 million) and third for combined death and disability. Recent findings demonstrate that between 1990 and 2021, stroke incidents have risen by 70% and stroke-related mortality by 44% with the majority of stroke-related mortality (87.2%) and DALYs (89.4%) occurring in low-income and lower-middle-income regions (1). According to the World Health Organization (WHO), stroke is responsible for approximately 9.7% of all deaths in the Pakistan, resulting in around 141,432 fatalities each year (2). These figures underline a substantial and growing public health challenge. However, health-care system in Pakistan is not well-equipped to manage the immediate and ongoing needs of stroke patients effectively.
Copyright (c) 2025 Hassan E Muhammad, Hamza Sajid https://creativecommons.org/licenses/by-nc/4.0
Nutrition in the First 1000 Days: Foundation for a Lifetime
The critical period encompassing gestation and the first two years of life is essential for the development of the body, brain, and immune system. Although early-life nutrition during the first 1,000 days has been widely reviewed, this paper provides an updated synthesis linking early feeding practices, long-term disease risk, and parental preconception nutrition within a life-course and public health perspective. It emphasizes the often-overlooked role of paternal nutrition, epigenetic programming, and the continuity of dietary exposures from preconception to complementary feeding, in contrast to previous reviews focusing primarily on maternal or neonatal nutrition. Current evidence on key micronutrients, breastfeeding dynamics, and complementary feeding practices is summarized, along with their mechanistic contributions to immunological maturation, neurodevelopment, and the developmental origins of non-communicable diseases. The review contextualizes findings within the challenges faced by low- and middle-income countries, including the dual burden of malnutrition, social barriers, and health inequities. By integrating biological mechanisms with practical public health considerations, this synthesis aims to bridge the gap between evidence and community-level interventions. The insights provided are intended to guide nutritionists, policymakers, and maternal-child health programs in optimizing health outcomes during this critical developmental window.
breastfeeding for child and maternal health
infants and young child feeding practices
Copyright (c) 2026 Rameen Fatima https://creativecommons.org/licenses/by-nc/4.0
Impact of a Simple Educational Intervention Against Tuberculosis Among High School Children in Lahore, Pakistan
Background: Tuberculosis (TB) remains a significant public health challenge in Pakistan despite the availability of effective treatment. Raising awareness among students can contribute to early detection and disease prevention. This quasi-experimental study assessed the impact of a targeted educational intervention on TB-related knowledge among schoolchildren. Methodology: A quasi-experimental study was conducted from December 2023 to September 2024 among 71 school students aged 10–14 years in grades 6–8 in an outskirt area of Lahore, Pakistan. Students were assigned to teacher-led (n=36) or expert-led (n=35) tuberculosis awareness sessions. A WHO-adapted, reliable KAP questionnaire assessed knowledge at baseline and six months post-intervention. Both groups received six monthly sessions, and changes in knowledge scores were analyzed and compared using SPSS-26. Results: Out of 118 students, 11 did not provide consent, 16 missed one or more intervention sessions, and 20 did not completely answer the questionnaire and were therefore excluded from the final analysis. A total of 71 students gave complete answers to the pre-test questionnaire. The mean age of the students for group A was 12.85 ± 2.11 SD (in years), and for group B, it was 12.67 ± 1.23 SD (in years). In total, there were 38% boys and 62% girls. The mean percentage of all pre-test participants (71 students) involved was 55.9%, which improved to 80.1% in Group A (36 students) and 92.6% in Group B (35 students) after intervention. Both groups showed substantial improvement, but the increase was greater in the expert-led group. Conclusion: Both educational approaches significantly influenced TB knowledge, with expert-led sessions yielding superior outcomes. These findings suggest that integrating expert-guided TB awareness programs into school curricula could enhance long-term public health impact.
Copyright (c) 2025 Shamaila Hassnain, Noor Shahid, Uzma Hafeez, Amna Hassnain https://creativecommons.org/licenses/by-nc/4.0
Scaling Modern Family Planning Through the Challenge Initiative: Insights from 15 Urban Districts in Pakistan
Background: The Challenge Initiative (TCI) is a global platform operating in 13 countries, with implementation in Pakistan led by Greenstar Social Marketing. Partnering with 15 local governments, TCI delivers high-impact interventions (HIIs) in government’s priority areas to expand universal access to reproductive health and family planning, while advocating for behavioral change. This study aimed to assess the effect of TCI’s HIIs on the uptake of short-acting methods (SAM), long-acting reversible contraception (LARCs), and permanent methods (PM) in 15 urban districts of Pakistan. Methodology: Starting in June 2022, TCI introduced multiple HIIs across 15 urban districts. Performance was evaluated using data from the Contraceptive Logistics Management Information System (cLMIS) from June 2020 to August 2024. A two-sample t-test was applied to estimate the interventions’ effect on average monthly client volume per district. Results: Average monthly clients increased by 715 for SAM (1,425 to 2,150), 740 for LARCs (670 to 1,410), and 66 for PM (88 to 154), with total monthly clients rising by 1,521 (2,183 to 3,704). Since June 2022, TCI-supported facilities have served approximately 678,200 modern family planning clients—60% SAM, 35% LARCs, and 5% PM—and generated 288,010 unique additional users across all districts. Conclusion: TCI has substantially expanded access to modern family planning services in 15 urban districts, contributing 288,010 additional users—a critical step toward Pakistan’s FP2030 commitments. By strengthening local government capacity, TCI promotes sustainability and long-term program ownership.
Copyright (c) 2025 Junaid-ur-Rehman Siddiqui, Muhammad Aslam Bajwa, Zafar Ali Dehraj, Saman Rai, Khalil Ahmed Sikhani, Saqib Ali Shaikh, Faisal Mahar, Aaliya Habib, Ghazunfer Abbas, Syed Azizur Rab https://creativecommons.org/licenses/by-nc/4.0
Global Caries Experience in Adults and Elderly: Relationship with Country Level Income and Current Tobacco Smoking
Background: Dental caries remains a major global public health concern. This study aimed to evaluate the worldwide distribution of caries experience among adults and older adults, and to examine the impact of current tobacco smoking and country-level income on caries experience. Methodology: This ecological study utilized data on caries experience and current smoking prevalence from the World Health Organization (WHO), and income classifications from the World Bank. Caries experience was measured using the Decayed, Missing, and Filled Teeth (DMFT) index. DMFT scores and smoking prevalence were compared across low, lower-middle, upper-middle, and high-income countries. Bivariate and multivariate analyses were conducted to assess the relationships among variables. Results: Globally, adults had a lower mean DMFT score (9.62 ± 5.01) compared to the elderly (19.46 ± 6.72). The global prevalence of current smoking in adults was 19.80%. Low-income countries had significantly lower caries experience in both adults (P<0.001) and the elderly (P=0.009), and also lower adult smoking prevalence (P<0.001) compared to high-income countries. Adult caries experience was positively correlated with country-level income (r=0.58, P<0.001), smoking prevalence (r=0.26, P=0.006), and elderly caries experience (r=0.82, P<0.001). Multivariate analysis confirmed significant associations between adult caries experience and country-level income (B=2.64, P<0.001), and between elderly and adult caries experience (B=0.94, P<0.001). Conclusion: Global disparities in dental caries exist across income levels and age groups. Caries experience in adults is significantly influenced by both national income and caries levels in the elderly population.
Copyright (c) 2025 Muhammad Ashraf Nazir, Faris Nemat , Ahmad Talal , Muhammad Awais Ashraf, Muhammad Waleed Ashraf, Khalid Almas https://creativecommons.org/licenses/by-nc/4.0
Barriers to Climate-Health Communication Among Physicians in Pakistan and Bangladesh: A Mixed-Method Pilot Study
Background: Physicians play a critical role in communicating climate-related health risks to patients; however, barriers to such communication in low- and middle-income countries remain insufficiently understood. This study aimed to explore physicians’ perceptions, practices, and barriers related to climate–health communication in Pakistan and Bangladesh. Methodology: A mixed-method pilot study was conducted using a cross-sectional survey and semi-structured interviews. A total of 124 physicians were surveyed, and 14 physicians participated in in-depth interviews. Quantitative data were analyzed to identify perceived responsibilities and barriers, while qualitative data were thematically analyzed to explore underlying perspectives. Results: Most physicians (89.6%; 95% CI: 82.8–94.4) believed it was their responsibility to educate patients about climate-related health risks. The most commonly reported barriers included lack of knowledge (66.9%), time constraints (65.3%), and perceived patient disinterest (54.0%). Physicians with prior climate-related training were significantly more likely to identify patient skepticism as a barrier (adjusted odds ratio [aOR] = 3.81; 95% CI: 1.36–10.70; p = 0.011). Qualitative analysis identified three key themes: awareness of climate change and health, barriers to effective communication, and recommendations for improving practice. Time limitations and knowledge gaps were consistently emphasized across both data sources. Conclusion: Although physicians recognize their role in climate–health communication, multiple systemic and individual barriers limit effective engagement with patients. As a pilot study using convenience sampling, these findings are exploratory and warrant further validation. Strengthening medical curricula, developing standardized consultation frameworks, and implementing supportive policies may enhance climate–health communication in South Asian healthcare systems.
low- and middle-income countries (LMICs)
Copyright (c) 2026 Tehzeeb Zulfiqar, Hina Jawaid, Abdul Jalil Khan, Asif Rehman, Md Ferdous Rahman, Muhammad Hassam Khan, Husnulmaab Ali https://creativecommons.org/licenses/by-nc/4.0
Unveiling Gender Disparities: A Cross-Sectional Assessment of Patient’s Perception in Dental Care
Background: Gender preferences are observed when it comes to strong religious, ethnic, and communal issues. Our community is dominated by men, and gender stereotype has influenced every field, including the medicine and dentistry as well when it comes to choose the health professionals. So, this study was conducted to determine patients' perceptions and preferences for gender stereotypes in local dental services. Methodology: A descriptive cross-sectional study was conducted at Altamash Institute of Dental Medicine, Karachi, with ERB approval from 1st February to 31st March 2022. After informed verbal consent, they were provided with a self-administered, structured, closed-ended questionnaire (Cronbach's α=0.897) containing 21 questions. With Open Epi calculated sample size was 249, a total of 252 completed questionnaires were considered in the study based on the eligibility criteria. The data was tabulated with required descriptive and interferential analysis using SPSS 26, considering 0.05 p-value statistically significant. Results: The findings revealed that most of the dental practice characteristics are connected with gender, specifically when it comes to the males who still preferred males for dental services with statistically significant differences in most of the attributes (p > 0.05). Conclusion: Concerning the patient’s gender, the male patients preferred male dentists, whereas female patients had no gender preferences for the dentist.
Copyright (c) 2025 Rabia Arshad, Thelma Farst Bashir, Samrah Jawed, Rehan Ahmad, Zunaira Khalid https://creativecommons.org/licenses/by-nc/4.0
Barriers in the Use of Contraceptives among Married Women of Childbearing Age
Background: Despite early family planning initiatives in Pakistan, high fertility rates and low contraceptive uptake persist. This study explores barriers impeding effective population control among married women of reproductive age. Methodology: A cross-sectional study was conducted from September 2023 to September 2024 at PAF Hospital, Islamabad. Using systematic sampling, married women aged 15–45 years were recruited for face-to-face interviews. Data were analyzed using SPSS, with chi-square tests employed to examine associations between contraceptive knowledge, demographic factors, and practices. Results: Ninety married Muslim women participated, most aged 26–35 years (53.3%) and residing in urban areas (80%). Over two-thirds (74.4%) reported husbands employed in government service. Contraceptive knowledge was high (94.4%): 85 respondents were aware of condoms, 83 of oral pills, and 66 of intrauterine devices (IUDs). At the time of the survey, 70% reported contraceptive use—predominantly condoms (33.3%), followed by withdrawal (15.6%) and oral pills (11.1%). Major barriers included fear of side effects (68.9%) and perceived risk of infections (51.1%). Among knowledgeable respondents, 61% reported usage. Notably, 93.5% of those fearing side effects did not use contraception, while 59.5% of those perceiving benefits as outweighing risks reported usage. Conclusion: Although awareness of contraception was high, uptake remained constrained by concerns over side effects and continued fertility desires. Targeted counseling and community-based interventions addressing misconceptions may improve contraceptive adoption.
Copyright (c) 2025 Asma Chaudhary, Syeda Aliha Sajjad, Hadiqa Sajid, Tooba Mukhtar, Shazmeen Iftikhar, Maryam Shahid, Aisha Chaudhary, Rukhsana Khan https://creativecommons.org/licenses/by-nc/4.0
Successful Utilization of the Electronic Client Reporting within HMIS: A Step Towards Data Digitalization in Sindh Province, Pakistan
Background: The implementation of electronic case reporting (ECR) within the contraceptive Logistics Management Information System (cLMIS) represents a significant advancement in health data management by the Population Welfare Department in Sindh, Pakistan. This initiative, piloted in 200 Family Welfare Centres, aims to improve the quality and efficiency of family planning services, particularly in peri-urban areas where infrastructure challenges remain. Methodology: A qualitative research design was used, with purposive sampling of 95 respondents, including District Population Officers, Family Welfare Workers, Family Welfare Assistants, and Social Mobilizers. Data was collected through direct observations, Focus Group Discussions (FGDs), and in-depth interviews. Thematic analysis was employed to identify recurring themes related to the benefits and challenges of ECR implementation. Results: Participants highlighted significant improvements in data quality, reduced time spent on data entry, and enhanced accessibility to logistics information. However, challenges such as resistance to the system from older staff, limited access to technology (e.g., smartphones, laptops), and inadequate internet connectivity in remote areas were noted. These issues were compounded by a reluctance to adopt the new system, particularly among those nearing retirement. Conclusion: The implementation of ECR within cLMIS demonstrates considerable potential to enhance the management of family planning services in low-resource settings. While technological barriers and resistance to change pose challenges, the benefits of improved data accuracy, efficiency, and logistics access suggest that ECR could play a crucial role in strengthening health systems in similar contexts.
contraceptive management information system
Copyright (c) 2025 Tahira Sahar, Irum Imran, Faisal Mahar, Zafar Ali Dehraj, Junaid-ur-Rehman Siddiqui, Aaliya Habib, Ghazunfer Abbas, Syed Azizur Rab https://creativecommons.org/licenses/by-nc/4.0
Social Marketing (GSM) Pakistan is a leading development sector partner of provincial and national governments in health and population sectors. The organization believes in responding to the on-ground situations in a proactive manner. Understanding the importance of reaching out to the urban population, especially living in the urban slums of major cities, GSM has joined hands with the Federal and Provincial governments for Islamabad, and Sindh and Punjab through The Challenge Initiative (TCI) platform funded by the Bayer and the Gates Foundations. TCI began implementation of its high-impact interventions (HIIs) in 15 densely populated urban districts of Pakistan, in collaboration with the provincial departments of Population Welfare and Health. TCI is a global platform which is currently being implemented in 13 countries in Africa and Asia and is managed centrally by the Johns Hopkins Bloomberg School of Public Health. In Pakistan, Greenstar Social Marketing has been leading the implementation of HIIs since June 2022. The high-impact interventions selected for Pakistan focus on improving service delivery, demand generation, and advocacy for modern family planning (FP). Under service delivery, there are eight HIIs: 1) Integrated In-reaches, which are dedicated facility-based days for providing family planning services, 2) Integrated Out-reaches, which refers to contraceptive services provided through outreach vans and satellite camps, 3) Family Planning Integration, which refers to the integration of modern family planning services into other health areas such as vaccination or disease prevention, 4) Post-partum Family Planning and 5) Post-Abortion Family Planning refers to the provision of modern contraception to women after their delivery or abortion, 6) On-the-Job Training, refers to the on-the-job training provided to field staff by senior medical staff on provision of contraceptive counselling and services, 7) Whole Site Orientation refers to facility-based sessions where each staff member including facility’s janitorial staff and guards, is oriented on modern family planning methods to facilitate clients better, and 8) Facility Makeover refers to infrastructural renovation of facilities financially supported by TCI. Under demand-generation, the main HII is Community Health Workers which refers to either the training of existing of health workers of government departments on social mobilization for modern contraceptive methods or recruitment of community health volunteers (CHVs) for the same purpose.
Copyright (c) 2025 Syed Azizur Rab https://creativecommons.org/licenses/by-nc/4.0
Understanding the Predictive Utility of Intention to Use Modern Family Planning Methods: A Comprehensive Theoretical and Empirical Review
According to the Pakistan Demographic and Health Survey (2017-18), there is universal awareness of family planning amongst married women of reproductive age, however, use of modern contraception remains low in Pakistan at 25 percent. This review aims to highlight the value of intention to use modern family planning methods as a critical measure for bridging the awareness-behavior gap. This study conducted a narrative review using systematic searches in PubMed, PsycINFO, Web of Sciences, and Google Scholar for articles published between January 2010 and May 2015. Articles providing theoretical grounding for intention before January 2010 were also included. Search terms included “family planning intention”, “contraceptive adoption”, “theory of reasoned action”, “theory of planned behavior”, “integrated behavioral model”, and “Pakistan family planning intention”. This review discussed the reasoned-action theories which posit intention as the primary predictor of behavior while also underpinning its psychosocial determinants. Moreover, the review also discussed studies that underpin the predictive utility of intention to use over unmet need, traditionally used to inform family planning programs, and how intention captured through demographic surveys can be used to inform program design. Intention alongside its determinants can play a pivotal role in program monitoring and evaluation as well highlighting critical individual and community-level factors that influence modern contraceptive uptake.
Copyright (c) 2025 Junaid-ur-Rehman Siddiqui, Bushra Rahim Butt, Aaliya Habib, Ghazunfer Abbas, Syed Azizur Rab https://creativecommons.org/licenses/by-nc/4.0
General Disease Trends Among Students at University of Haripur, Pakistan
Background: Globally, university students face significant stress due to academic demands, extracurricular responsibilities, and daily challenges. This psychological strain often manifests as mild to moderate physical symptoms. The primary objective of this study was to examine the types and frequency of health complaints reported by students. Methodology: The study was conducted at a university campus with over 4,000 enrolled students. Data were collected over a ten-month period, during which 1,061 students sought medical attention at the university clinic. Data analysis was performed using R software. Results: The most reported health issues were generalized body aches (42.5%), upper respiratory tract infections (16.4%), abdominal pain or diarrhoea (14.7%), fever (12.4%), and flu-like symptoms (9.3%). A gender-based breakdown showed a higher incidence among male students (59.4%) compared to females (40.6%). Semester-wise distribution revealed the second semester as the most affected (24.6%). Department-wise analysis indicated that students from Information Technology (21%) reported the highest number of health complaints, followed by Medical Laboratory Technology (16.1%) and Microbiology (10.3%). Time series analysis identified a peak in reported cases between January and April 2019. Conclusion: The findings highlight a substantial burden of physical health complaints among university students, linked to academic stress. The results underscore the need for targeted health communication and wellness strategies to support students’ physical and mental well-being during their academic tenure.
Copyright (c) 2025 Ehtisham Altaf, Ahmad Umar, Syed Hanzila Azhar, Shahbaz Ahmad Zakki https://creativecommons.org/licenses/by-nc/4.0
Evolution and Challenges of Public Health Data Systems for Family Planning Service Delivery in Punjab Province, Pakistan
An effective and responsive health system is based on timely decision making based on accurate and real time data. Strong health information systems are a pre-requisite for effective health system especially in the context of family planning service delivery. This opinion piece provides an overview of health data system fragmentation in Punjab specifically the ones related to family planning, including the District Health Information System (DHIS), Lady Health Workers-Management Information System (LHW–MIS), Contraceptive Logistic Management Information System (cLMIS), Electronic Medical Records (EMR), and the Hospital Management Information System (HMIS). While each system is well intended to serve a particular purpose, however, their lack of compatibility and integration has created data silos and redundancies, which presents a major challenge for effective decision making. The main hurdles for a seamless health information system start from ambiguous and fragmented policies, human resource shortages, limited digital infrastructure and staff technical capacity to manual data-entry and insufficient and irregular data validation. These obstacles affect real-time monitoring of contraceptive availability and utilization and effectiveness of service delivery. The restructuring of health department in Punjab - merger of Health and Population Welfare departments and outsourcing of Basic Health Units (BHUs) and Rural Health Centers (RHCs) to private medical practitioners, without standard guidelines for data reporting, recording and management have further aggravated the issues. This opinion piece recommends that the data systems be integrated into a unified health information platform for data-entry and reporting.
Copyright (c) 2025 Aaliya Habib, Muhammad Aslam Bajwa, Sadiq Ali, Junaid-ur-Rehman Siddiqui, Ghazunfer Abbas, Syed Azizur Rab https://creativecommons.org/licenses/by-nc/4.0
Missing Voices: Why Youth Must Be Central to Pakistan’s Family Planning Agenda
Pakistan’s government has a decades-old commitment to family planning, but the population indicators show that the progress is far from ideal. The modern contraceptive prevalence rate has been at 24% for a decade while the unmet need for family planning is quite high at 17 percent (1). Population researchers and experts are working to understand the reasons behind this slow and inconsistent progress. One significant yet less discussed factor is the non-inclusion of young people in family planning. Pakistan is currently going through a demographic transition; a significant portion of its population, approximately 60 percent, is below the age of 30 (2). Modern contraceptive prevalence rate drops to six percent for married girls aged 15-19 and 13 percent for married women aged 20-24 years (1). These findings indicate that young people are far behind in their access to family planning information and services. It is imperative for the population sector policymakers to come up with well-structured youth-inclusive family planning programs to ensure that the country has the full support of this crucial segment of its population. Thus far youth has not received the due attention in policy and practice around family planning even though they represent the largest segment population of Pakistan, they have never received the proportionate attention regarding their sexual and reproductive health (SRH), including information and access to family planning. They come across significant sexual and reproductive health challenges such as limited or no access to necessary information, stigma related to contraceptives use, and a lack of youth-friendly health information and services (3). The conservative culture and traditional taboos around sexuality, and sexual and reproductive health of youth in Pakistan contributes to creating barriers to awareness and service delivery, which consequently results in low modern contraceptive prevalence rate amongst youth (4).
Copyright (c) 2025 Ghazunfer Abbas, Muhammad Khubaib Kayani https://creativecommons.org/licenses/by-nc/4.0
Knowledge of Radiation Hazards and Safety Practices Among Paramedical Personnel: Evidence from a Tertiary Care Hospital
Background: Ionizing radiation is essential in modern medicine but poses significant occupational risks. Awareness of radiation hazards and safety protocols among paramedical personnel is vital. This study assessed knowledge of radiation protection among radiology staff in a tertiary care hospital in Pakistan. Methodology: A cross-sectional study was conducted at District Headquarter Hospital, Gujranwala (June–November 2024). Using convenience sampling, 150 paramedical personnel completed a structured questionnaire assessing demographics, 13 knowledge items, and attitudes. Knowledge scores were classified as good (≥75%), average (50–74%), and poor (<50%). Data were analyzed using SPSS 26, and associations were tested using Chi-square with Cramer’s V. Results: Most participants had poor knowledge (43.3%), while 40.7% showed good and 16.0% average knowledge. Institutional training strongly predicted higher knowledge scores (χ²=28.3, p<0.001, Cramer’s V=0.47). Significant associations were also found with designation, experience, and department. Conclusion: Radiation protection awareness among paramedical staff was inadequate. Institutional training significantly improved knowledge levels. Regular, structured, and mandatory training programs are needed to strengthen radiation safety culture and minimize occupational risks.
Copyright (c) 2025 Iqbal Hussain Dogar, Safia Ashraf, Kauser Aftab Khan, Riasat Nahra, Kamran Pervez Mir https://creativecommons.org/licenses/by-nc/4.0
Assessing the Sindh Government’s Responsiveness to Family Planning Interventions Using the Challenge Initiative (TCI)’s Innovative Reflection and Action Tool
Background: The Reflection and Action to Improve Self-reliance and Effectiveness (RAISE) tool is a management framework incorporating a responsive feedback (RF) mechanism to assess and strengthen government self-reliance in delivering high-impact interventions. It comprises six domains aligned with the World Health Organization’s (WHO) Six Building Blocks of Health Systems. Methodology: This study, conducted from September 2022 to December 2024 in eight urban districts of Sindh, involved seven assessment cycles. The RAISE tool was adapted to the local context and applied to four domains: Political and Financial Commitment, Capacity Strengthening, Institutionalization of Proven Approaches, and Sustained Demand. A structured multiphase process guided the assessment, including pre-workshop reviews, small-group evaluations, large-group discussions, action plan formulation, and follow-up monitoring in collaboration with local government and stakeholders. Results: At baseline, all districts were at Stage 1, with an average score of 30%. Across seven assessment rounds, substantial improvements were recorded across health system building blocks, with notable gains in leadership, governance, commitment, and financial systems. Persistent challenges were identified in supervision and community engagement. By the end, all districts progressed to the Stage 3 (Expanding phase), surpassing 70 percent indicating improved sustainability in family planning programs. Conclusion: The RAISE tool effectively enhanced family planning interventions and government responsiveness in Sindh, promoting continuous improvement and evidence-based decision-making. Future efforts should address persistent service delivery gaps and explore the tool’s scalability to other regions.
Copyright (c) 2025 Aziza Burfat, Sandeep Kumar Mehraj, Samia Shaikh, Irum Imran, Akbar Abbas Bangash, Junaid-ur-Rehman Siddiqui, Zafar Ali Dehraj , Aaliya Habib, Ghazunfer Abbas, Syed Azizur Rab https://creativecommons.org/licenses/by-nc/4.0
Male Involvement: A Missing Link in Pakistan’s Family Planning Programs
Greenstar Social Marketing is implementing The Challenge Initiative (TCI) project in provinces Punjab and Sindh as well as Islamabad Capital Territory. This program is implemented in partnership with the Departments of Health (DoH) and Population Welfare (PWD) who are leading the implementation program while the role of TCI is limited to provision of technical assistance. Currently, this program is being implemented in 15 districts in Pakistan. Different family planning high impact interventions are being implemented in these selected districts. Direct observation was used to observe clients visiting the government facilities. Three facilities were assessed directly for identifying potential areas for male involvement in Islamabad and Faisalabad districts. Moreover, key stakeholders i.e., DoH and PWD government officials, facility providers and staff, and health workers provided inputs on male engagement during different capacity building sessions. Their responses were noted and discussed in a larger team to strategize for future planning and implementation of the ongoing TCI program. Doctors and LHVs mostly believed that allowing males to enter a facility would make the environment uncomfortable for women. Another major argument for barring men to enter the facility was that talking to them about family planning is a difficult conversation, and female service providers felt that they would struggle during this process. There were a few facilities where a male family welfare assistant was deputed but they also had same approach for the stated matter. Males are being ignored in Pakistan’s family planning programming. Male family health days can be helpful for both community male members and service providers to initiate the discussion and build mutual trust. Training curriculum for relevant cadres should include a chapter on the importance of male involvement. Service providers should receive capacity building sessions on family planning value clarification, communication skills and gender intentionality. Men accompanying their women to the health facility should be welcomed and encouraged.
Copyright (c) 2025 Muhammad Khubaib Kayani, Samia Shaikh, Bushra Rahim Butt, Tanzil ur Rehman, Junaid-ur-Rehman Siddiqui, Aaliya Habib, Ghazunfer Abbas, Syed Azizur Rab https://creativecommons.org/licenses/by-nc/4.0
Mediating Role of Career Commitment in the Relationship Between Personality Traits and Career Satisfaction Among Medical Doctors: A Correlational Study
Background: Personality comprises measurable traits that influence individuals’ behaviors and attitudes. This study aimed to examine whether career commitment mediates the relationship between personality traits and career satisfaction among medical doctors. Despite extensive research on personality, its specific association with career satisfaction in the medical profession remains underexplored. Methodology: A correlational study design was employed using a survey to collect data from 300 doctors working in government and private hospitals in Islamabad, Pakistan. Data were analyzed using SPSS version 24. Results: Openness, conscientiousness, extraversion, and agreeableness were positively associated with both career satisfaction and career commitment, whereas neuroticism showed a negative association. Career commitment significantly mediated the relationship between personality traits and career satisfaction. Additionally, monthly income and weekly working hours were identified as significant predictors of career satisfaction. Conclusion: This study highlights the important role of personality traits in shaping career commitment and satisfaction among medical professionals. It contributes to the existing literature by emphasizing the mediating effect of career commitment and providing insights specific to the medical field.
Copyright (c) 2026 Ayla Khan, Saeeda Khanum, Syed Hanzila Azhar, Vaneeza Khan https://creativecommons.org/licenses/by-nc/4.0