1
|
Shaikh BT. Universal health coverage in Pakistan: exploring the landscape of the health system, health seeking behaviours, and utilization of health services. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 27:100440. [PMID: 39015938 PMCID: PMC11251088 DOI: 10.1016/j.lansea.2024.100440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/21/2024] [Accepted: 06/10/2024] [Indexed: 07/18/2024]
Abstract
The attainment of the noble objective of Universal Health Coverage (UHC)- 'leaving no one behind' necessitates sufficient financial resources, an ample supply of skilled healthcare professionals, and the availability of essential services as part of a basic package This paper presents an analysis of the health system, health seeking behaviours and health service utilization en route to UHC in Pakistan. We have used the UHC 14 tracer indicators of service coverage to see where Pakistan stands, what are the gaps and what needs to be done. Pakistan clearly is lagging behind its neighboring countries. The country's health system ought to work on health seeking behaviours and broader determinants of health. The pursuit of UHC demands a shared responsibility and collective action, with stakeholders from different sectors uniting their efforts and expertise. Together, they can establish robust systems, design comprehensive policies, allocate adequate resources, and implement interventions that transcend disciplinary boundaries.
Collapse
|
2
|
van den Boom M, Bennani K, Sismanidis C, Gunneberg C, Khawaja L, Safdar MA, Muhwa C, Heldal E, Cirillo DM, Khan AW, Fatima R, Khan BJ, Tahseen S, ElMedrek MG, Hutin Y. 2022 TB programme review in Pakistan: strengthening governance, with better patient diagnosis and treatment. IJTLD OPEN 2024; 1:136-143. [PMID: 38966411 PMCID: PMC11221579 DOI: 10.5588/ijtldopen.23.0587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/25/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND In Pakistan, 84% of healthcare is provided by the private sector. We conducted an epidemiological and programme review for TB to document progress and guide further efforts. METHODS Surveillance and data systems were assessed before analysing epidemiological data. We reviewed the programme at federal, provincial and peripheral levels and compiled national data along with WHO estimates to describe the evolution of epidemiological and programme indicators. RESULTS In 2021, of the estimated number of TB cases, 55% of overall cases and 18% of drug-resistant cases were diagnosed and treated respectively. The contribution of the private sector in case detection increased from 30% in 2017 to 40% by 2021. For newly diagnosed pulmonary TB cases, the overall proportion of confirmed cases was 52%. In 2021, testing for rifampicin resistance among confirmed cases was 66% for new and 84% for previously treated patients. The treatment success rate exceeded 90% for drug susceptible TB. The main challenges identified were a funding gap (60% in 2021-2023), fragmented electronic systems for data collection and suboptimal coordination among provinces. CONCLUSIONS The main challenges prevent further progress in controlling TB. By addressing these, Pakistan could improve coverage of interventions, including diagnosis and treatment. Bacteriological confirmation using recommended diagnostics also requires further optimisation.
Collapse
Affiliation(s)
- M van den Boom
- World Health Organization (WHO), Regional Office for the Eastern Mediterranean Region, Cairo, Egypt
| | - K Bennani
- World Health Organization (WHO), Regional Office for the Eastern Mediterranean Region, Cairo, Egypt
| | | | | | - L Khawaja
- WHO, Country Office for Pakistan, Islamabad, Pakistan
| | - M A Safdar
- WHO, Country Office for Pakistan, Islamabad, Pakistan
| | - C Muhwa
- Respiratory Society of Kenya, Kenya
- Department of Medicine, Dermatology and Therapeutics, Kenyatta University, Nairobi, Kenya
| | - E Heldal
- Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo, Norway
| | - D M Cirillo
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - A W Khan
- Pakistan Ministry of National Health Services, Regulations & Coordination, Government of Pakistan, Islamabad, Pakistan
| | - R Fatima
- Pakistan Ministry of National Health Services, Regulations & Coordination, Government of Pakistan, Islamabad, Pakistan
| | - B J Khan
- Pakistan Ministry of National Health Services, Regulations & Coordination, Government of Pakistan, Islamabad, Pakistan
| | - S Tahseen
- Pakistan Ministry of National Health Services, Regulations & Coordination, Government of Pakistan, Islamabad, Pakistan
| | - M G ElMedrek
- World Health Organization (WHO), Regional Office for the Eastern Mediterranean Region, Cairo, Egypt
| | - Y Hutin
- World Health Organization (WHO), Regional Office for the Eastern Mediterranean Region, Cairo, Egypt
| |
Collapse
|
3
|
Xiong Y, Millones AK, Farroñay S, Torres I, Acosta D, Jordan DR, Jimenez J, Wippel C, Jenkins HE, Lecca L, Yuen CM. Impact of the private sector on spatial accessibility to chest radiography services in Lima, Peru. IJTLD OPEN 2024; 1:144-146. [PMID: 38698907 PMCID: PMC11065097 DOI: 10.5588/ijtldopen.23.0460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/03/2023] [Indexed: 05/05/2024]
Affiliation(s)
- Yiqi Xiong
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | | | - Demetrice R Jordan
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Christoph Wippel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Helen E Jenkins
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Leonid Lecca
- Socios En Salud Sucursal Peru, Lima, Peru
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Courtney M Yuen
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
4
|
Zaidi SMA, Jamal WZ, Ibrahim U, Khowaja S, Khan AJ, Creswell J. A social enterprise model for TB detection and treatment through the private sector in Pakistan. IJTLD OPEN 2024; 1:63-68. [PMID: 38966691 PMCID: PMC11221596 DOI: 10.5588/ijtldopen.23.0376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/01/2023] [Indexed: 07/06/2024]
Abstract
BACKGROUND Existing models to increase TB case notifications from the private sector in Pakistan are financially unsustainable and have achieved modest success due to limited coverage. OBJECTIVE To evaluate the impact of a social enterprise model (SEM) intervention on TB case detection in Karachi, Pakistan, and to assess its financial sustainability. METHODS Purpose-built centres were established within the private sector that integrated TB screening, diagnostics and treatment and operated 12 hours per day with convenient locations to improve access. TB services were offered free of cost, and revenue generation took place through user fees from other diagnostics. Private providers with a focus on the informal sector were engaged through community workers to generate screening referrals. RESULTS Overall 171,488 people were screened and 18,683 cases were notified, including 197 individuals with drug-resistant TB. Annual TB notifications in Karachi increased from 18,105 in 2014 to a maximum of 25,840 (40% increase). The proportion of cases in Karachi notified by the centres grew to 27% in 2020. Commercial revenue reached USD288,065 and enabled operating cost recovery of 15%. Average cost per TB case notified was USD203. CONCLUSION The SEM intervention contributed a large proportion of notifications in Karachi and achieved modest cost recovery.
Collapse
Affiliation(s)
- S M A Zaidi
- WHO Collaborating Centre for Tuberculosis Research and Innovation, Institute for Global Health, University College London, UK
- Community Health Solutions, Karachi
| | | | | | - S Khowaja
- Interactive Research & Development, Karachi, Pakistan
| | - A J Khan
- Interactive Research & Development, Karachi, Pakistan
| | - J Creswell
- Stop TB Partnership, Global Health Campus, Geneva, Switzerland
| |
Collapse
|
5
|
Sassi A, Lestari BW, El Muna KUN, Oga-Omenka C, Afifah N, Widarna R, Huria L, Aguilera Vasquez N, Benedetti A, Hadisoemarto PF, Daniels B, Das J, Pai M, Alisjahbana B. Impact of the COVID-19 pandemic on quality of tuberculosis care in private facilities in Bandung, Indonesia: a repeated cross-sectional standardized patients study. BMC Public Health 2024; 24:102. [PMID: 38183023 PMCID: PMC10771004 DOI: 10.1186/s12889-023-17001-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/16/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Indonesia has the second highest incidence of tuberculosis in the world. While 74% of people with tuberculosis in Indonesia first accessed the private health sector when seeking care for their symptoms, only 18% of tuberculosis notifications originate in the private sector. Little is known about the impact of the COVID-19 pandemic on the private sector. Using unannounced standardized patient visits to private providers, we aimed to measure quality of tuberculosis care during the COVID-19 pandemic. METHODS A cross-sectional study was conducted using standardized patients in Bandung City, West Java, Indonesia. Ten standardized patients completed 292 visits with private providers between 9 July 2021 and 21 January 2022, wherein standardized patients presented a presumptive tuberculosis case. Results were compared to standardized patients surveys conducted in the same geographical area before the onset of COVID-19. RESULTS Overall, 35% (95% confidence interval (CI): 29.2-40.4%) of visits were managed correctly according to national tuberculosis guidelines. There were no significant differences in the clinical management of presumptive tuberculosis patients before and during the COVID-19 pandemic, apart from an increase in temperature checks (adjusted odds ratio (aOR): 8.05, 95% CI: 2.96-21.9, p < 0.001) and a decrease in throat examinations (aOR 0.16, 95% CI: 0.06-0.41, p = 0.002) conducted during the pandemic. CONCLUSIONS Results indicate that providers successfully identify tuberculosis in their patients yet do not manage them according to national guidelines. There were no major changes found in quality of tuberculosis care due to the COVID-19 pandemic. As tuberculosis notifications have declined in Indonesia due to the COVID-19 pandemic, there remains an urgent need to increase private provider engagement in Indonesia and improve quality of care.
Collapse
Affiliation(s)
- Angelina Sassi
- Department of Epidemiology, Biostatistics, and Occupational Health, and McGill International TB Centre, McGill University, Montreal, Canada
| | - Bony Wiem Lestari
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
- Department of Public Health, Universitas Padjadjaran, Bandung, Indonesia
| | - Kuuni Ulfah Naila El Muna
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
- Department of Public Health, Universitas Nahdlatul Ulama Surabaya, Surabaya, Indonesia
| | - Charity Oga-Omenka
- Department of Epidemiology, Biostatistics, and Occupational Health, and McGill International TB Centre, McGill University, Montreal, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Nur Afifah
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | - Rodiah Widarna
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | - Lavanya Huria
- Department of Epidemiology, Biostatistics, and Occupational Health, and McGill International TB Centre, McGill University, Montreal, Canada
| | - Nathaly Aguilera Vasquez
- Department of Epidemiology, Biostatistics, and Occupational Health, and McGill International TB Centre, McGill University, Montreal, Canada
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics, and Occupational Health, and McGill International TB Centre, McGill University, Montreal, Canada
- Department of Medicine, McGill University, Montreal, Canada
| | - Panji Fortuna Hadisoemarto
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
- Department of Public Health, Universitas Padjadjaran, Bandung, Indonesia
| | - Benjamin Daniels
- McCourt School of Public Policy, Georgetown University, Washington, DC, USA
| | - Jishnu Das
- McCourt School of Public Policy, Georgetown University, Washington, DC, USA
| | - Madhukar Pai
- Department of Epidemiology, Biostatistics, and Occupational Health, and McGill International TB Centre, McGill University, Montreal, Canada
| | - Bachti Alisjahbana
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia.
- Department of Internal Medicine, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
| |
Collapse
|
6
|
Balquis F, Sohail MF, Hamid H, Ullah W, Khan AH, Shahnaz G. Potential and weak links in the management of tuberculosis by Pakistani private pharmacy staff. Front Public Health 2023; 11:983997. [PMID: 36969650 PMCID: PMC10034968 DOI: 10.3389/fpubh.2023.983997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/30/2023] [Indexed: 03/12/2023] Open
Abstract
IntroductionThe emergence of MDR-TB is a global threat and an obstacle to the effective control of TB in Pakistan. A lack of proper TB knowledge among the staff in private pharmacies and the sale of compromised quality anti-TB drugs are the main instigators of multidrug-resistant tuberculosis (MDR-TB). Thus, this study was aimed at investigating the quality and storage conditions of fixed-dose combination (FDC) anti-TB drugs along with the awareness of staff working in private pharmacies regarding the identification of potential patients with TB and dispensing the inappropriate treatment regimens contributing to MDR-TB.MethodsThe study is completed in two phases. In phase I a cross-sectional study is performed using two quantitative research designs, i.e., exploratory and descriptive, to evaluate the knowledge of private pharmacy staff. The sample of 218 pharmacies was selected. While in phase II cross sectional survey is conducted in 10 facilities from where FDC anti TB drugs were sampled for analyzing their quality.ResultResults revealed the presence of pharmacists only at 11.5% of pharmacies. Approximately 81% of staff at pharmacies had no awareness of MDR-TB, while 89% of pharmacies had no TB-related informative materials. The staff identified that most of the patients with TB (70%) were of poor socio-economic class, which restricted their purchase of four FDCs only up to 2–3 months. Only 23% were acquainted with the Pakistan National TB Program (NTP). Except for MDR-TB, the results showed a significant correlation between the experiences of staff with TB awareness. Findings from the quality evaluation of four FDC-TB drugs indicated that the dissolution and content assay of rifampicin were not according to the specifications, and overall, 30% of samples failed to comply with specifications. However, the other quality attributes were within the limits.ConclusionIn light of the data, it can be concluded that private pharmacies could be crucial to the effective management of NTP through the timely identification of patients with TB, appropriate disease and therapy-related education and counseling, and proper storage and stock maintenance.
Collapse
Affiliation(s)
- Fatima Balquis
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
- Department of Pharmacy Practice, Shifa College of Pharmaceutical Sciences, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Muhammad Farhan Sohail
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
- Riphah Institute of Pharmaceutical Sciences, Riphah International University–Lahore Campus, Lahore, Pakistan
| | - Huma Hamid
- Riphah Institute of Pharmaceutical Sciences, Riphah International University–Islamabad Campus, Islamabad, Pakistan
| | - Waseem Ullah
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
- Department of Pharmacy Practice, Shifa College of Pharmaceutical Sciences, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Science, University Sains Malaysia, Gelugor, Penang, Malaysia
| | - Gul Shahnaz
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
- *Correspondence: Gul Shahnaz
| |
Collapse
|
7
|
Rahayu SR, Susilastuti MS, Saefurrohim MZ, Azam M, Indrawati F, Supriyono M, Miarso D, Safitri BD, Daniswara S, Merzistya AN, Amilia R, Affandi MD, Wahidah N, Isbandi, Wandastuti AD, Laila AK, Muflikhah Z. Lost to Follow-Up among Tuberculosis Patients during the Public-Private Mix Era in Rural Area of Indonesia. Ethiop J Health Sci 2023; 33:115-122. [PMID: 36890941 PMCID: PMC9987293 DOI: 10.4314/ejhs.v33i1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Indexed: 03/10/2023] Open
Abstract
Background Indonesia's national Tuberculosis (TB) strategy is public-private mix (PPM). The PPM aims to treat patients who have lost sight during TB treatment as these patients are TB carriers and at risk of transmitting TB. The purpose of this study was to identify predictive factors for loss to follow-up (LFTU) among TB patients receiving treatment when the PPM was at place in Indonesia. Methods The design of this study was a retrospective cohort study. The data used in this study was sourced from the Tuberculosis Information System (SITB) of Semarang which was recorded routinely during 2020-2021. Univariate analysis, crosstabulation, and logistic regression were performed on 3434 TB patients meeting the minimum variables. Results The participation of health facilities in reporting TB during the PPM era in Semarang reached 97.6% consisting of 37 primary healthcare center (100%), 8 public hospitals (100%), 19 private hospitals (90.5%), and a community-based pulmonary health center (100%). The regression analysis reveal that the predictive factors of LTFU-TB during the PPM are the year of diagnosis (AOR=1.541; p-value=<0.001; 95% CI=1.228-1.934), referral status (AOR=1.562, p-value=0.007; 95% CI=1.130-2160), healthcare and social security insurance ownership (AOR=1.638; p-value=<0.001; 95% CI=1.263-2.124), drugs source (AOR=4.667; p-value=0.035; 95% CI=1.117-19.489). Conclusions The PPM strategy in dealing with LTFU patients should focus on TB patients without Healthcare and Social Security Insurance and who receive TB treatment rather than program drugs.
Collapse
Affiliation(s)
- Sri R Rahayu
- Public Health Department, Sport Science Faculty, Universitas Negeri Semarang, Indonesia
| | | | - Muhamad Z Saefurrohim
- Semarang City Health Office, Semarang, Indonesia.,Master of Public Health, Postgraduate, Universitas Negeri Semarang, Indonesia
| | - Mahalul Azam
- Public Health Department, Sport Science Faculty, Universitas Negeri Semarang, Indonesia
| | - Fitri Indrawati
- Public Health Department, Sport Science Faculty, Universitas Negeri Semarang, Indonesia
| | | | - Dani Miarso
- Semarang City Health Office, Semarang, Indonesia
| | | | | | - Aufiena Na Merzistya
- Public Health Department, Sport Science Faculty, Universitas Negeri Semarang, Indonesia
| | - Rizqi Amilia
- Gadjah Mada University Academic Hospital, Yogyakarta
| | - Mustafa D Affandi
- Public Health Department, Sport Science Faculty, Universitas Negeri Semarang, Indonesia
| | - Nur Wahidah
- Public Health Department, Sport Science Faculty, Universitas Negeri Semarang, Indonesia
| | - Isbandi
- Master of Public Health, Postgraduate, Universitas Negeri Semarang, Indonesia
| | - Anggun D Wandastuti
- Master of Public Health, Postgraduate, Universitas Negeri Semarang, Indonesia
| | - Annisa K Laila
- Public Health Department, Sport Science Faculty, Universitas Negeri Semarang, Indonesia
| | - Zuyyinatun Muflikhah
- Public Health Department, Sport Science Faculty, Universitas Negeri Semarang, Indonesia
| |
Collapse
|
8
|
Chaiya C, Panezai S, Saqib SE, Ashraf M. Satisfaction of Tuberculosis Patients with Directly Observed Treatment Strategy under Pakistan Health Care Policy: A Mixed-Method Study. Healthcare (Basel) 2022; 10:healthcare10122529. [PMID: 36554053 PMCID: PMC9778783 DOI: 10.3390/healthcare10122529] [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] [Received: 10/31/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
(1) Background: Patients' satisfaction is based on the perceived health care services of individuals and is influenced by the level of care provided by the health care system. It is often based on the patients' expectations of care and self-assessment of their experiences. The success of the Directly Observed Treatment Strategy (DOTS) also depends on the quality of health care provided at the Tuberculosis (TB) centers, which can be evaluated by satisfaction levels of the patients. (2) Methods: A tuberculosis facility-based cross-sectional study was carried out in Khyber Pakhtunkhwa province in Pakistan. A mixed-method approach was adopted for data collection. An interviewer-administered questionnaire was used for quantitative data collection from 269 patients who were registered at 11 TB centers and private clinics. Qualitative data were collected through 20 in-depth interviews, 15 key informant interviews, and a focus-group discussion. Binary logistic regression was employed for analysis of the data. (3) Results: More than half of the respondents (63.94%) were satisfied with the DOTS strategy. A high percentage of patients were dissatisfied with the availability of safe water, waiting space for patients, waiting time, privacy, and the processing of appointments. Results from the binary logistic regression showed that gender (AOR = 2.21, CI 1.07-4.58, p = 0.033), marital status (AOR = 3.12, CI 1.45-6.73, p = 0.004), employment status (AOR = 5.22, CI 2.44-1.21, p = 0.000), home ownership (AOR = 3.82, CI 1.94-7.54, p = 0.000), literacy (AOR = 2.17, CI 1.11-4.25, p = 0.023), households' main occupation (AOR = 4.42, CI 1.12-17.38, p = 0.033), and level of income (AOR = 2.39, CI 1.13-5.04, p = 0.023) were the significant factors affecting satisfaction levels of the patients. (4) Conclusion: There are a number of areas that need improvement for successful TB eradication. Significant work is required to improve the quality of TB care in these specific areas from the patients' perspective. For instance, female health workers' involvement in the DOTS program can solve the problems of female respondents in rural areas. Improving the infrastructure facilities at the TB centers, allocation of doctors and nurses at the rural health centers would result in positive outcomes of the DOTS in Pakistan as well as in other developing countries.
Collapse
Affiliation(s)
- Chitralada Chaiya
- College of Politics and Governance, Mahasarakham University, Maha Sarakham 44150, Thailand
- Correspondence: ; Tel.: +66-831-879-358
| | - Sanaullah Panezai
- Department of Geography and Regional Planning, University of Balochistan, Quetta 87300, Pakistan
| | - Shahab E. Saqib
- Directorate of Commerce Education and Management Sciences, Higher Education Department Khyber Pakhtunkhwa, Peshawar 25000, Pakistan
| | - Muhammad Ashraf
- Department of Disaster Management and Development Studies, University of Balochistan, Quetta 87300, Pakistan
| |
Collapse
|
9
|
Khan MA, Bilal W, Asim H, Rahmat ZS, Essar MY, Ahmad S. MDR-TB in Pakistan: Challenges, efforts, and recommendations. Ann Med Surg (Lond) 2022; 79:104009. [PMID: 35860138 PMCID: PMC9289334 DOI: 10.1016/j.amsu.2022.104009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/08/2022] [Accepted: 06/12/2022] [Indexed: 11/24/2022] Open
Abstract
Tuberculosis (TB), a global health concern is also a leading cause of mortality and morbidity across Pakistan affecting a major proportion of the population. The absence of an integrated system to control the spread of TB has led to a rise in multidrug resistant strains of TB (MDR-Tb) which do not exhibit any sensitivity towards the first line therapy for TB. Such adverse circumstances call for effective planning strategies to mitigate the health hazards of MDR-TB. This article briefly highlights the challenges encountered by the already burdened healthcare system and suggests relatively inexpensive approaches to tackle the ongoing crisis associated with MDR-TB on a national scale.
Collapse
Affiliation(s)
| | | | | | | | | | - Shoaib Ahmad
- District Head Quarters Teaching Hospital, Faisalabad, Pakistan
| |
Collapse
|
10
|
Zawedde-Muyanja S, Reuter A, Tovar MA, Hussain H, Loando Mboyo A, Detjen AK, Yuen CM. Provision of Decentralized TB Care Services: A Detect-Treat-Prevent Strategy for Children and Adolescents Affected by TB. Pathogens 2021; 10:1568. [PMID: 34959523 PMCID: PMC8705395 DOI: 10.3390/pathogens10121568] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 11/16/2022] Open
Abstract
In this review, we discuss considerations and successful models for providing decentralized diagnosis, treatment, and prevention services for children and adolescents. Key approaches to building decentralized capacity for childhood TB diagnosis in primary care facilities include provider training and increased access to child-focused diagnostic tools and techniques. Treatment of TB disease should be managed close to where patients live; pediatric formulations of both first- and second-line drugs should be widely available; and any hospitalization should be for as brief a period as medically indicated. TB preventive treatment for child and adolescent contacts must be greatly expanded, which will require home visits to identify contacts, building capacity to rule out TB, and adoption of shorter preventive regimens. Decentralization of TB services should involve the private sector, with collaborations outside the TB program in order to reach children and adolescents where they first enter the health care system. The impact of decentralization will be maximized if programs are family-centered and designed around responding to the needs of children and adolescents affected by TB, as well as their families.
Collapse
Affiliation(s)
- Stella Zawedde-Muyanja
- The Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala P.O. Box 22418, Uganda
| | - Anja Reuter
- Médecins Sans Frontières, Cape Town 7784, South Africa;
| | - Marco A. Tovar
- Socios En Salud Sucursal Perú, Lima 15001, Peru;
- Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima 15067, Peru
| | - Hamidah Hussain
- Interactive Research and Development Global, Singapore 238884, Singapore;
| | - Aime Loando Mboyo
- Elizabeth Glaser Pediatric AIDS Foundation, Kinshasa B.P. 1002030, Democratic Republic of the Congo;
| | - Anne K. Detjen
- United Nations Children’s Fund, New York, NY 10017, USA;
| | - Courtney M. Yuen
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA;
| |
Collapse
|