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Ul Mustafa Z, Batool A, Ibrar H, Salman M, Khan YH, Mallhi TH, Meyer JC, Godman B, Moore CE. Bacterial co-infections, secondary infections and antimicrobial use among hospitalized COVID-19 patients in the sixth wave in Pakistan: findings and implications. Expert Rev Anti Infect Ther 2024; 22:229-240. [PMID: 38146949 DOI: 10.1080/14787210.2023.2299387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/15/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION Previous studies in Pakistan have shown considerable over prescribing of antibiotics in patients hospitalized with COVID-19 despite very low prevalence of bacterial infections. Irrational use of antibiotics will worsen antimicrobial resistance (AMR). METHODS Retrospective analysis of medical records of patients in the COVID-19 wards of three tertiary care hospitals to assess antibiotic use during the sixth COVID-19 wave. RESULTS A total of 284 patients were included, most were male (66.9%), aged 30-50 years (50.7%) with diabetes mellitus the most common comorbidity. The most common symptoms at presentation were cough (47.9%) and arthralgia-myalgia (41.5%). Around 3% were asymptomatic, 34.9% had mild, 30.3% moderate, and 23.6% had severe disease, with 8.1% critical. Chest X-ray abnormalities were seen in 43.3% of patients and 37% had elevated white cell counts, with 35.2% having elevated C-reactive protein levels. Around 91% COVID-19 patients were prescribed antibiotics during their hospital stay, with only a few with proven bacterial co-infections or secondary bacterial infections. Most antibiotics were from the 'Watch' category (90.8%) followed by the 'Reserve' category (4.8%), similar to previous COVID-19 waves. CONCLUSION There continued to be excessive antibiotics use among hospitalized COVID-19 patients in Pakistan. Urgent measures are needed to address inappropriate prescribing including greater prescribing of Access antibiotics where pertinent.
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Affiliation(s)
- Zia Ul Mustafa
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan, Pakistan
| | - Arfa Batool
- Department of Medicine, Sheikh Zaid Medical College, Rahim Yar Khan, Pakistan
| | - Hadia Ibrar
- Department of Medicine, Wah Medical College, Rawalpindi, Pakistan
| | - Muhammad Salman
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore, Pakistan
| | - Yusra Habib Khan
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
| | - Tauqeer Hussain Mallhi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
| | - Johanna C Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
- Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow, UK
| | - Catrin E Moore
- Centre for Neonatal and Pediatric Infection, St. George's University of London, London, UK
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Javed H, Khaliq A, Mirza S, Khan R, Fatima W. Evolution of COVID-19 infection in Punjab; trends during five waves of infection in the province of Punjab. BMC Infect Dis 2024; 24:348. [PMID: 38528471 DOI: 10.1186/s12879-024-09157-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/20/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Pakistan witnessed five waves of COVID-19 infections during the pandemic. Punjab, the largest province of Pakistan, remained the epicentre due to a high infection rate. Administrative data for five waves of the pandemic was analyzed to determine the rate of infections and the significance of pharmacological and non-pharmacological interventions on the severity and duration of infection. METHODOLOGY COVID-19 data from March 2020 to May 2023 was obtained from the Provincial Public Health Reference Laboratory (PPHRL), Punjab AIDS Control Program, Lahore. The data included samples from index cases, contacts, and recovered patients. A total of 36,252,48 cases were screened for COVID-19, and 90,923 (2.50%) were detected positive by RT-PCR, accounting for 5.69% of the cases reported positive throughout the country. RESULTS Among the positive cases, 50.86% (n = 46,244) cases were new cases (registered for the first time), 40.41% (n = 36751) were the contact cases traced from the newly identified cases and 8.62% (n = 7842) repeated cases. The positivity rates among index cases were reported to be 2.37%, 2.34%, 4.61%, 2.09%, and 1.19%, respectively, for the five respective COVID-19 pandemic waves. Distribution by gender indicated that 64% of males and 35% of females were infected during the pandemic. The age factor demonstrated the most susceptibility to infection in women aged 19-29 years, whereas most males between the ages of 29-39 had an infection. Susceptibility to COVID-19 infection was observed to be equally likely between males and females; however, clinical outcomes indicated that infections in males were more severe and often resulted in fatalities as compared to those in females. This trend was also reflected in the viral titer as measured by the Ct values, where 40% of males had Ct values < 25 (an indicator of high viral titers) compared to 30% of females with Ct values < 25. CONCLUSION Overall, our data indicated that infection rates remained stable throughout the pandemic except for 3rd wave, which showed a higher incidence of infection rate of 4%. Additionally, data showed a positive impact of masking, social distancing, and immunization, as indicated by the shorter window of high infection rates.
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Affiliation(s)
- Hasnain Javed
- Provincial Public Health Reference Laboratory, Punjab AIDS Control Program, Lahore, Pakistan
| | - Aasia Khaliq
- Department of Life Sciences, Lahore University of Management Sciences (LUMS), Lahore, Pakistan
| | - Shaper Mirza
- Department of Life Sciences, Lahore University of Management Sciences (LUMS), Lahore, Pakistan.
| | - Rimsha Khan
- Provincial Public Health Reference Laboratory, Punjab AIDS Control Program, Lahore, Pakistan
- Institute of Biochemistry and Biotechnology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Warda Fatima
- Institute of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan
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Chaudhry RM, Minhas S, Khan MA, Nargus S, Nawadat K, Khan MA, Kashif M. COVID-19 Testing Trend: A Retrospective Analysis of the Three Major Pandemic Waves in Punjab, Pakistan. Cureus 2024; 16:e52309. [PMID: 38357059 PMCID: PMC10866180 DOI: 10.7759/cureus.52309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND/OBJECTIVES There is some evidence in the literature of under-testing of COVID-19 cases in Pakistan. This study aims to explore COVID-19 testing trends and the factors affecting them in a lower middle-income country for future infectious disease policy-making and intervention strategies. METHODOLOGY The study was conducted as a serial cross-sectional study during the three major peaks from March 2020 to June 2021 on 1616 participants in Punjab, Pakistan. This is the first study to explore COVID-19 testing trends in association with flu-like symptoms (FLS) and the factors affecting all three major waves in Pakistan. RESULTS The results show that in all three waves, only 18.8% reported COVID-19 tested despite that 86.7% thought they had already had COVID-19, with 51.3% reporting having FLS and 35.6% with exposure to FLS from their families and 19.8% of positive testing rate among their family members. Out of the survey participants, 66% received vaccination, and over 80% had their eligible family members immunized. Fear of contracting COVID-19 was 69.7% in all three waves. Factors positively associated with the uptake of testing were the age group of 31-40 years with an adjusted odds ratio of 3.27 (95% confidence interval (CI): 2.09-5.12) for the second wave and an adjusted odds ratio of 13.75 (95% CI: 9.43-20.01) for the third wave and traveling abroad with odds of 3.08 times when the reference was inland traveling. The adjusted odds ratio to test for FLS was 1.62 (95% CI: 1.21-2.16). CONCLUSION In this study, there is convincing evidence of COVID-19 under-testing and thus under-reporting. This study also suggests that fear-based interventions may be counterproductive; however, economic factors such as education, employment, and traveling are significant in guiding the behavior for infectious disease prevention and management.
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Affiliation(s)
- Rabia M Chaudhry
- Oral Medicine, Akhtar Saeed Medical and Dental College, Lahore, PAK
- Public Health, University Institute of Public Health, The University of Lahore, Lahore, PAK
| | - Sadia Minhas
- Microbiology, The University of Lahore, Lahore, PAK
- Oral Pathology, Akhtar Saeed Medical and Dental College, Lahore, PAK
| | - Mehroz A Khan
- College of Dentistry, Akhtar Saeed Medical and Dental College, Lahore, PAK
| | - Shumaila Nargus
- Public Health, University Institute of Public Health, The University of Lahore, Lahore, PAK
| | - Kanza Nawadat
- College of Dentistry, Akhtar Saeed Medical and Dental College, Lahore, PAK
| | - Muhammad Athar Khan
- Oral and Maxillofacial Surgery, Bakhtawar Amin Medical and Dental College, Multan, PAK
| | - Muhammad Kashif
- Oral Pathology, Bakhtawar Amin Medical and Dental College, Multan, PAK
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Sayeed MA, Shalim E, Farooqui F, Farman S, Khan M, Iqbal A, Ahmed I, Rajput AW, Razzaque A, Quraishy S. Comparison of the Disease Severity and Outcome of Vaccinated COVID-19 Patients with Unvaccinated Patients in a Specialized COVID-19 Facility: A Retrospective Cohort Study from Karachi, Pakistan. Vaccines (Basel) 2023; 11:1178. [PMID: 37514994 PMCID: PMC10386639 DOI: 10.3390/vaccines11071178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023] Open
Abstract
We compared the clinical characteristics and outcome of vaccinated hospitalized COVID-19 patients with unvaccinated hospitalized COVID-19 patients. A retrospective cohort study was conducted at the Sindh Infectious Diseases Hospital and Research Center, Karachi, Pakistan. A total of 1407 hospitalized COVID-19 positive patients were included from April 2021 to March 2022, of which 812 (57.71%) were males. Of the 1407, 378 (26.87%) patients were vaccinated while 1029 (73.13%) were unvaccinated. Of the vaccinated patients, 160 (42.32%) were partially vaccinated while 218 (57.68%) were fully vaccinated (vaccine breakthrough infection). Fewer unvaccinated COVID-19 patients survived compared to vaccinated patients (62.5% vs. 70%, RR 0.89, 95% CI: 0.82-0.96, p-value = 0.004). Despite there being more vaccinated patients above 60 years of age (60.05% vs. 47.13%), their risk of mortality was lower by 43% (OR = 0.578; CI = 0.4201 to 0.7980, p = 0.0009). On survival analysis, vaccinated patients had better 30-day survival compared to unvaccinated patients (p = 0.028). Moreover, comparing waves 3-5, unvaccinated patients of wave 4, which was driven by the delta variant, had the worst survival (51.8%, p ≤ 0.001) while vaccinated patients of wave 3 (driven by the alpha variant) had the best survival (71.6%).
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Affiliation(s)
- Muneeba Ahsan Sayeed
- Sindh Infectious Diseases Hospital & Research Center, Karachi 75300, Pakistan
- Infectious Diseases Department, Dow University of Health Sciences, Karachi 75300, Pakistan
| | - Elisha Shalim
- Sindh Infectious Diseases Hospital & Research Center, Karachi 75300, Pakistan
- Infectious Diseases Department, Dow University of Health Sciences, Karachi 75300, Pakistan
| | - Fizza Farooqui
- Sindh Infectious Diseases Hospital & Research Center, Karachi 75300, Pakistan
- Infectious Diseases Department, Dow University of Health Sciences, Karachi 75300, Pakistan
| | - Shaiza Farman
- Sindh Infectious Diseases Hospital & Research Center, Karachi 75300, Pakistan
- Infectious Diseases Department, Dow University of Health Sciences, Karachi 75300, Pakistan
| | - Maheen Khan
- Sindh Infectious Diseases Hospital & Research Center, Karachi 75300, Pakistan
- Infectious Diseases Department, Dow University of Health Sciences, Karachi 75300, Pakistan
| | - Anika Iqbal
- Sindh Infectious Diseases Hospital & Research Center, Karachi 75300, Pakistan
- Infectious Diseases Department, Dow University of Health Sciences, Karachi 75300, Pakistan
| | - Ishfaque Ahmed
- Sindh Infectious Diseases Hospital & Research Center, Karachi 75300, Pakistan
- Infectious Diseases Department, Dow University of Health Sciences, Karachi 75300, Pakistan
| | - Abdul Wahid Rajput
- Sindh Infectious Diseases Hospital & Research Center, Karachi 75300, Pakistan
- Infectious Diseases Department, Dow University of Health Sciences, Karachi 75300, Pakistan
| | - Abdul Razzaque
- Sindh Infectious Diseases Hospital & Research Center, Karachi 75300, Pakistan
- Infectious Diseases Department, Dow University of Health Sciences, Karachi 75300, Pakistan
| | - Saeed Quraishy
- Sindh Infectious Diseases Hospital & Research Center, Karachi 75300, Pakistan
- Infectious Diseases Department, Dow University of Health Sciences, Karachi 75300, Pakistan
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Nadeem MU, Kulich SJ, Bokhari IH. The assessment and validation of the depression, anxiety, and stress scale (DASS-21) among frontline doctors in Pakistan during fifth wave of COVID-19. Front Public Health 2023; 11:1192733. [PMID: 37397733 PMCID: PMC10311542 DOI: 10.3389/fpubh.2023.1192733] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Objective The study aims to document sociodemographic features, address the symptoms and levels of depression, anxiety, and stress among frontline doctors in Pakistan, and validate the depression, anxiety, stress scale (DASS-21) on the context of Pakistan. Method A cross-sectional survey was conducted throughout the regions of Pakistan on frontline doctors to document their sociodemographic patterns and the levels of depression, anxiety, and stress while dealing with the fifth wave (Omicron-variant) of the coronavirus (SARS-CoV-2) pandemic in Pakistan (December 2021-April 2022). Respondents (N = 319) were recruited through a snowball sampling process. Results Though previous literature reported declines in psychological symptoms after earlier waves of COVID-19, these DASS-21 findings show that as the pandemic has worn on, frontline doctors in Pakistan are having considerable personal symptoms of depression (72.7%), anxiety (70.2%), and stress (58.3%). Though specifically related to the COVID-19 pandemic, they rated only moderate levels of depression and stress, however they reported severe levels of anxiety. The results also revealed a positive correlation between depression and anxiety (r = 0.696, p < 0.001), depression and stress (r = 0.761, p < 0.001), and anxiety and stress (r = 0.720, p < 0.001). Conclusion Through the application of all required statistical procedures, DASS-21 is validated in the cultural context of Pakistan among this group of frontline doctors. The findings of this study can provide new directions for the policy makers (government and hospitals' administration) of Pakistan to focus on the mental wellbeing of the doctors under similar enduring public health crises and to protect them from short- or long-term disorders.
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Affiliation(s)
- Muhammad Umar Nadeem
- SISU Intercultural Institute (SII), Shanghai International Studies University (SISU), Shanghai, China
| | - Steve J. Kulich
- SISU Intercultural Institute (SII), Shanghai International Studies University (SISU), Shanghai, China
| | - Ijaz Hussain Bokhari
- School of Commerce and Accountancy, University of Management and Technology (UMT), Lahore, Punjab, Pakistan
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Gul B, Sana M, Saleem A, Mustafa ZU, Salman M, Khan YH, Mallhi TH, Sono TM, Meyer JC, Godman BB. Antimicrobial Dispensing Practices during COVID-19 and the Implications for Pakistan. Antibiotics (Basel) 2023; 12:1018. [PMID: 37370337 PMCID: PMC10294926 DOI: 10.3390/antibiotics12061018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/18/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Antibiotics are one of the most frequently dispensed classes of medicines. However, excessive misuse and abuse enhances antimicrobial resistance (AMR). Previous studies in Pakistan have documented extensive dispensing of 'Watch' and 'Reserve' antibiotics, which is a concern. In view of this, there is a need to assess current dispensing patterns following COVID-19 in Pakistan. A cross-sectional study was undertaken, collecting dispensing data from 39 pharmacies and 53 drug stores from November 2022 to February 2023. Outlets were principally in urban areas (60.9%), with pharmacists/pharmacy technicians present in 32.6% of outlets. In total, 11,092 prescriptions were analyzed; 67.1% of patients were supplied at least one antimicrobial, 74.3% antibiotics, 10.2% antifungals and 7.9% anthelmintics. A total of 33.2% of antimicrobials were supplied without a prescription. Common indications for dispensed antibiotics were respiratory (34.3%) and gastrointestinal (16.8%) infections, which can be self-limiting. In addition, 12% of antibiotics were dispensed for the prevention or treatment of COVID-19. The most frequent antibiotics dispensed were ceftriaxone (18.4%) and amoxicillin (15.4%). Overall, 59.2% antibiotics were 'Watch' antibiotics, followed by 'Access' (40.3%) and 'Reserve' (0.5%) antibiotics. Of the total antibiotics dispensed for treating COVID-19, 68.3% were 'Watch' and 31.7% 'Access'. Overall, there appeared to be an appreciable number of antibiotics dispensed during the recent pandemic, including for patients with COVID-19, alongside generally extensive dispensing of 'Watch' antibiotics. This needs to be urgently addressed with appropriate programs among pharmacists/pharmacy technicians to reduce AMR.
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Affiliation(s)
- Bushra Gul
- Department of Medicines, Tehsil Head Quarter (THQ) Hospital, District Bhakkar, Darya Khan 3000, Punjab, Pakistan;
| | - Maria Sana
- Department of Medicine, Faisalabad Medical University, Faisalabad 38000, Punjab, Pakistan; (M.S.); (A.S.)
| | - Aneela Saleem
- Department of Medicine, Faisalabad Medical University, Faisalabad 38000, Punjab, Pakistan; (M.S.); (A.S.)
| | - Zia Ul Mustafa
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor 11800, Penang, Malaysia
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan 57400, Punja, Pakistan
| | - Muhammad Salman
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore 54000, Punja, Pakistan;
| | - Yusra Habib Khan
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka 72388, Saudi Arabia; (Y.H.K.); (T.H.M.)
| | - Tauqeer Hussain Mallhi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka 72388, Saudi Arabia; (Y.H.K.); (T.H.M.)
| | - Tiyani Milta Sono
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, Gauteng, South Africa; (T.M.S.); (J.C.M.)
- Saselamani Pharmacy, Saselamani 0928, Limpopo, South Africa
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, Gauteng, South Africa; (T.M.S.); (J.C.M.)
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, Gauteng, South Africa
| | - Brian B. Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, Gauteng, South Africa; (T.M.S.); (J.C.M.)
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow G4 0RE, UK
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman P.O. Box 346, United Arab Emirates
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Amjad Z, Maryam I, Munir M, Salman M, Baraka MA, Mustafa ZU, Khan YH, Mallhi TH, Hasan SS, Meyer JC, Godman B. COVID-19 Vaccines Status, Acceptance and Hesitancy among Maintenance Hemodialysis Patients: A Cross-Sectional Study and the Implications for Pakistan and Beyond. Vaccines (Basel) 2023; 11:904. [PMID: 37243008 PMCID: PMC10223584 DOI: 10.3390/vaccines11050904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/17/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
COVID-19 vaccine hesitancy continues to be a widespread problem in Pakistan due to various conspiracy beliefs, myths and misconceptions. Since the hemodialysis population is at a higher risk of contracting infections, we sought to investigate the current COVID-19 immunization status and reasons for any vaccine hesitancy among these patients in Pakistan. This cross-sectional study was conducted among maintenance hemodialysis patients at six hospitals in the Punjab Province of Pakistan. Data were collected anonymously using a questionnaire. A total of 399 hemodialysis patients took part in the survey, the majority of them were male (56%) and aged 45-64 years. A calculated 62.4% of the patients reported receiving at least one dose of the COVID-19 vaccine. Of those vaccinated (249), 73.5% had received two doses and 16.9% had received a booster dose. The most common reasons for vaccination were "being aware they were at high risk" (89.6%), "fear of getting infected" (89.2%) and "willingness to fight against COVID-19-pandemic" (83.9%). Of the 150 patients who had not yet been vaccinated, only 10 showed a willingness to take the COVID-19 vaccine. The major reasons for refusal included "COVID-19 is not a real problem" (75%), the "corona vaccine is a conspiracy (72.1%)" and "I don't need the vaccine" (60.7%). Our study revealed that only 62% patients receiving hemodialysis were partially or completely vaccinated against COVID-19. Consequently, there is a need to initiate aggressive approaches to educate this high-risk population in order to address their concerns with vaccine safety and efficacy as well as correct current myths and misconceptions to improve the COVID-19 immunization status in this population.
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Affiliation(s)
- Zara Amjad
- Department of Paediatrics, District Head Quarter (DHQ), Bhakkar 30000, Pakistan;
| | - Iqra Maryam
- Department of Medicine, Jinnah Hospital Lahore, Lahore 54000, Pakistan;
| | - Maria Munir
- Department of Medicine, Faisalabad Medical University, Faisalabad 38000, Pakistan;
| | - Muhammad Salman
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore 54000, Pakistan;
| | - Mohamed A. Baraka
- Clinical Pharmacy Program, College of Pharmacy, Al Ain Campus, Al Ain University, Abu Dhabi P.O. Box 64141, United Arab Emirates;
- Clinical Pharmacy Department, College of Pharmacy, Al-Azhar University, Cairo 11651, Egypt
| | - Zia Ul Mustafa
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor 11800, Penang, Malaysia
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan 57400, Pakistan
| | - Yusra Habib Khan
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka 72388, Saudi Arabia
| | - Tauqeer Hussain Mallhi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka 72388, Saudi Arabia
| | - Syed Shahzad Hasan
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Molotlegi Street, Ga-Rankuwa 0208, South Africa
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman P.O. Box 346, United Arab Emirates
- Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow G4 0RE, UK
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Co-Infections, Secondary Infections, and Antimicrobial Use in Patients Hospitalized with COVID-19 during the First Five Waves of the Pandemic in Pakistan; Findings and Implications. Antibiotics (Basel) 2022; 11:antibiotics11060789. [PMID: 35740195 PMCID: PMC9219883 DOI: 10.3390/antibiotics11060789] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 02/01/2023] Open
Abstract
Background: COVID-19 patients are typically prescribed antibiotics empirically despite concerns. There is a need to evaluate antibiotic use among hospitalized COVID-19 patients during successive pandemic waves in Pakistan alongside co-infection rates. Methods: A retrospective review of patient records among five tertiary care hospitals during successive waves was conducted. Data were collected from confirmed COVID-19 patients during the first five waves. Results: 3221 patients were included. The majority were male (51.53%), residents from urban areas (56.35%) and aged >50 years (52.06%). Cough, fever and a sore throat were the clinical symptoms in 20.39%, 12.97% and 9.50% of patients, respectively. A total of 23.62% of COVID-19 patients presented with typically mild disease and 45.48% presented with moderate disease. A high prevalence of antibiotic prescribing (89.69%), averaging 1.66 antibiotics per patient despite there only being 1.14% bacterial co-infections and 3.14% secondary infections, was found. Antibiotic use significantly increased with increasing severity, elevated WBCs and CRP levels, a need for oxygen and admittance to the ICU; however, this decreased significantly after the second wave (p < 0.001). Commonly prescribed antibiotics were piperacillin plus an enzyme inhibitor (20.66%), azithromycin (17.37%) and meropenem (15.45%). Common pathogens were Staphylococcus aureus (24.19%) and Streptococcus pneumoniae (20.96%). The majority of the prescribed antibiotics (93.35%) were from the WHO’s “Watch” category. Conclusions: Excessive prescribing of antibiotics is still occurring among COVID-19 patients in Pakistan; however, rates are reducing. Urgent measures are needed for further reductions.
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Malik B, Lyndon N, Chin YW, Hussain B, Malik S. Health Help-Seeking Behavior: The Scavengers' Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116457. [PMID: 35682041 PMCID: PMC9180387 DOI: 10.3390/ijerph19116457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 02/04/2023]
Abstract
Scavengers are prone to various health problems, hence seeking healthcare is inevitable. Despite the importance of the help-seeking behavior of scavengers, it has not been addressed explicitly in the existing literature. Addressing this gap, this study intends to explore the help-seeking behavior of scavengers and to identify the factors that influence healthcare utilization among them. This qualitative study conducted thirty-one in-depth interviews through a semi-structured interview guide and analyzed them using thematic analysis. Andersen’s Behavioral Model of Health Service Use was employed to explore the findings. The findings showed that the scavengers utilized multiple healthcare options depending on the severity and reoccurrence of the illness. The process of help-seeking and health services utilization was largely influenced by the cost of the health service, long distance to the health facility, traveling cost and waiting time. The study highlights the need for scavengers’ enrolment in micro health insurance schemes. The initiative would facilitate scavengers’ access to medical care. Health awareness campaigns and the provision of free mobile medical services, especially at the landfill sites, would also improve curative treatment among scavengers.
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Affiliation(s)
- Beenish Malik
- Department of Sociology, School of Social Sciences and Humanities, University of Management and Technology, C-II Block Johar Town, Lahore 54770, Pakistan;
- Correspondence: (B.M.); (N.L.)
| | - Novel Lyndon
- Department of Anthropology and Sociology, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia;
- Correspondence: (B.M.); (N.L.)
| | - Yew Wong Chin
- Department of Anthropology and Sociology, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia;
| | - Basharat Hussain
- Department of Sociology, School of Social Sciences and Humanities, University of Management and Technology, C-II Block Johar Town, Lahore 54770, Pakistan;
| | - Sehrish Malik
- Azman Hashim International Business School, Universiti Teknologi Malaysia, Skudai 81310, Malaysia;
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Alam MT, Mehdi A, Timsaal Y, Rehan M, Kumar A, Shaikh IS, Yasmin F, Memon GM, Ahmed N, Asghar MS. The clinical course, biochemical markers, and clinical outcomes of COVID-19 positive patients from the third wave in Pakistan: A retrospective cohort study. Ann Med Surg (Lond) 2022; 77:103599. [PMID: 35464609 PMCID: PMC9015951 DOI: 10.1016/j.amsu.2022.103599] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/02/2022] [Accepted: 04/05/2022] [Indexed: 12/16/2022] Open
Abstract
Background Third wave of COVID-19 has affected several countries. Case fatality rates from first and second waves are expected to be surpassed by the current wave due to various variant transmissions. This study was aimed to compare and contrast the significant clinical markers between survivors and non-survivors during the third wave of COVID-19 to assess severity and prognosis. Methods It includes all the patients who were diagnosed with COVID-19 polymerase chain reaction (PCR) during the third wave, and were monitored for their disease course and outcomes. A total of 209 patients were included in the analysis via non-probability consecutive sampling method. Results The median age was higher in non-surviving patients (p = 0.010). Majority of deaths occurred in intensive care patients (p < 0.001) and those with diabetes (p = 0.032) and hypertension (p = 0.003). Fever was the most predominant symptom in all patients (78.9%), dyspnea was common among expired individuals (p = 0.043) while recovered patients were more likely to be asymptomatic (p = 0.044). Gastrointestinal symptoms were not found marked during this wave. Being on ventilator has higher mortality (p < 0.001). Predominant radiological findings were interstitial patches or infiltrate (43.7%). Multivariable analysis showed hypertension (p = 0.042), BiPAP/CPAP (p < 0.001), being on ventilator (p = 0.004), and ARDS (p < 0.001) was associated with poor survival while patchy interstitial infiltrates on X-ray had good survival probability (p = 0.032). On Kaplan-Meier survival analysis, hypertension (p = 0.003), BiPAP/CPAP (p = 0.008), ventilator (p = 0.025), ICU stay (p = 0.001), high-grade fever (p = 0.001), and ARDS (p < 0.001) had reduced cumulative survival. Conclusion Certain biochemical markers were more predictive of disease severity in the third-wave than the preceding waves.
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Affiliation(s)
- Muhammad Tanveer Alam
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Asad Mehdi
- Department of Internal Medicine, Civil Hospital, Sukkur, Pakistan
| | - Yumna Timsaal
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Rehan
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Arjun Kumar
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Imran Sarwar Shaikh
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Farah Yasmin
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Gul Muhammad Memon
- Department of Internal Medicine, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Nisar Ahmed
- Department of Internal Medicine, Liaquat National Hospital and Medical College, Karachi, Pakistan
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