Travel and Tropical Medicine

This book contains a suite of original articles, case reports, and review articles on various aspects of travel medicine ranging from refugee and immigrant health to mass gathering medicine. It contains articles on infectious and environmental hazards of travel

Prevalence and determinants of Asthma in adults in Khyber Pakhtunkhwa, Pakistan

Asthma is a chronic inflammatory respiratory disease that is caused by biological and environmental factors. These factors can be in the form of dust, chemicals, smoke, allergens, and viruses. Approximately, 315 million people are affected with asthma worldwide. This study is designed to determine the prevalence of asthma in adults of different ages and its symptoms and main determinants in the Mardan and Peshawar districts of Khyber Pakhtunkhwa. A cross-sectional survey was conducted at Hayatabad Medical Complex Peshawar and Bacha Khan Medical Complex Mardan from May 2020 to March 2021. Data were collected from 1,400 individuals, and the prevalence of asthma was reported to be 22.57% (n=316). Asthma prevalence was reported to be more in men (55.7%) compared to women (44.3%) in Khyber Pakhtunkhwa, Pakistan. Asthma was most common between people aged 18-27 years (31%). The majority of asthma patients were obese (53.8%) compared to non-obese (46.2%) patients. The most common symptoms of asthma were respiratory infections including the common cold, flu and pneumonia (89.87%), followed by chest pain, dyspnea (88.6%) and wheezing (83.54%). %). Risk factors for asthma include allergens exposure to dust mites, pollen, animal dander and cold air, family history of the disease, smoking, consumption of food containing sulphites and preservatives and use of certain medications including beta-blockers and aspirin in the KPK province of Pakistan. The government should conduct awareness campaigns in various cities, where proper lung function tests and other drugs using corticosteroids should be used to control the spread of the disease.  

Point prevalence survey of antimicrobial use during the COVID-19 pandemic among different hospitals in Pakistan : findings and implications

The COVID-19 pandemic has significantly influenced antimicrobial use in hospitals raising concerns regarding increased antimicrobial resistance (AMR) through their overuse. The objective of this study was to assess patterns of antimicrobial prescribing during the current COVID-19 pandemic among hospitals in Pakistan, including the prevalence of COVID-19. A point prevalence survey (PPS) was performed among 11 different hospitals from November 2020 to January 2021. The study included all hospitalized patients receiving an antibiotic on the day of the PPS. The Global-PPS web-based application was used for data entry and analysis. Out of 1024 hospitalized patients, 662 (64.64%) received antimicrobials. The top three most common indications for antimicrobial use were pneumonia (13.3%), central nervous system infections (10.4%) and gastrointestinal indications (10.4%). Ceftriaxone (26.6%), metronidazole (9.7%) and vancomycin (7.9%) were the top three most commonly prescribed antimicrobials among surveyed patients, with the majority of antibiotics administered empirically (97.9%). Most antimicrobials for surgical prophylaxis were given for more than one day, which is a concern. Overall, a high percentage of antimicrobial use, including broad-spectrums, was seen among the different hospitals in Pakistan during the current COVID-19 pandemic. Multifaceted interventions are needed to enhance rational antimicrobial prescribing including limiting their prescribing post-operatively for surgical prophylaxis

An extensive review of patient satisfaction with healthcare services in Bangladesh

Patient satisfaction is a useful measure for providing quality indicators in healthcare services. Assessing patients’ satisfaction is important since it often helps, in absence of healthcare service quality indicators, to determine the quality of health-care delivery and health system responsiveness. Higher levels of patient satisfaction indicate higher levels of patient empowerment, commitment to care and compliance to recommended management–all of which results in better health outcomes. Concern over the quality of healthcare services in Bangladesh has resulted in a loss of faith in healthcare providers, low utilization of public health facilities, and increased outflows of patients from Bangladesh to hospitals abroad. The main barriers to accessing health services are inadequate services and poor quality of existing facilities, shortage of medical supplies, the busyness of doctors due to high patient load, long travel distance to facilities, and long waiting times once facilities were reached, very short consultation time, lack of empathy of the health professionals, their generally callous and casual attitude, aggressive pursuit of monetary gains, poor levels of competence and, occasionally, disregard for the suffering that patients endure without being able to voice their concerns—all of these service failures are frequently reported in the print media. Such failures can play a powerful role in shaping patients\u27 negative attitudes and dissatisfaction with healthcare service providers and healthcare itself. The Ministry of Health and Family Welfare plans and implements the public healthcare delivery through various healthcare infrastructure, from national to the community level. Experience Framework This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens

An extensive review of patient satisfaction with healthcare services in Bangladesh

Patient satisfaction is a useful measure for providing quality indicators in healthcare services. Assessing patients’ satisfaction is important since it often helps, in absence of healthcare service quality indicators, to determine the quality of health-care delivery and health system responsiveness. Higher levels of patient satisfaction indicate higher levels of patient empowerment, commitment to care and compliance to recommended management–all of which results in better health outcomes. Concern over the quality of healthcare services in Bangladesh has resulted in a loss of faith in healthcare providers, low utilization of public health facilities, and increased outflows of patients from Bangladesh to hospitals abroad. The main barriers to accessing health services are inadequate services and poor quality of existing facilities, shortage of medical supplies, the busyness of doctors due to high patient load, long travel distance to facilities, and long waiting times once facilities were reached, very short consultation time, lack of empathy of the health professionals, their generally callous and casual attitude, aggressive pursuit of monetary gains, poor levels of competence and, occasionally, disregard for the suffering that patients endure without being able to voice their concerns—all of these service failures are frequently reported in the print media. Such failures can play a powerful role in shaping patients\u27 negative attitudes and dissatisfaction with healthcare service providers and healthcare itself. The Ministry of Health and Family Welfare plans and implements the public healthcare delivery through various healthcare infrastructure, from national to the community level. Experience Framework This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens

Emerg Infect Dis

Emerging Infectious Diseases is providing access to these abstracts on behalf of the ICEID 2022 program committee (http://www.iceid.org), which performed peer review. ICEID is organized by the Centers for Disease Control and Prevention and Task Force for Global Health, Inc.Emerging Infectious Diseases has not edited or proofread these materials and is not responsible for inaccuracies or omissions. All information is subject to change. Comments and corrections should be brought to the attention of the authors.Suggested citation: Authors. Title [abstract]. International Conference on Emerging Infectious Diseases 2022 poster and oral presentation abstracts. Emerg Infect Dis. 2022 Sep [date cited]. http://www.cdc.gov/EID/pdfs/ICEID2022.pdf2022PMC94238981187

Liver diseases in the Asia-Pacific region: a Lancet Gastroenterology & Hepatology Commission

The Asia-Pacific region is home to more than half of the global population and accounted for 62.6% of global deaths due to liver diseases in 2015. 54.3% of global deaths due to cirrhosis, 72.7% of global deaths due to hepatocellular carcinoma, and more than two-thirds of the global burden of acute viral hepatitis occurred in this region in 2015. Chronic hepatitis B virus (HBV) infection caused more than half of the deaths due to cirrhosis in the region, followed by alcohol consumption (20.8%), non-alcoholic fatty liver disease (NAFLD; 12.1%), and chronic infection with hepatitis C virus (HCV; 15.7%). In 2015, HBV accounted for about half the cases of hepatocellular carcinoma in the region. Preventive strategies for viral hepatitis-related liver disease include increasing access to clean drinking water and sanitation. HBV vaccination programmes for neonates have been implemented by all countries, although birthdose coverage is extremely suboptimal in some. Availability of screening tests for blood and tissue, donor recall policies, and harm reduction strategies are in their initial stages in most countries. Many governments have put HBV and HCV drugs on their essential medicines lists and the availability of generic versions of these drugs has reduced costs. Efforts to eliminate viral hepatitis as a public health threat, together with the rapid increase in per-capita alcohol consumption in countries and the epidemic of obesity, are expected to change the spectrum of liver diseases in the Asia-Pacific region in the near future. The increasing burden of alcohol-related liver diseases can be contained through government policies to limit consumption and promote less harmful patterns of alcohol use, which are in place in some countries but need to be enforced more strictly. Steps are needed to control obesity and NAFLD, including policies to promote healthy lifestyles and regulate the food industry. Inadequate infrastructure and insufficient health-care personnel trained in liver diseases are issues that also need to be addressed in the Asia-Pacific region. The policy response of most governments to liver diseases has thus far been inadequate and poorly funded. There must be a renewed focus on prevention, early detection, timely referral, and research into the best means to introduce and improve health interventions to reduce the burden of liver diseases in the Asia-Pacific region.ope

Socio-demographic and clinico-pathological analysis of cervical cancer patients at a tertiary care centre in South-south Nigeria

Background: Cervical cancer is a significant public health burden in low- and middle-income countries where access to screening and treatment is limited. It is the leading cause of cancer deaths in women in Africa, often due to late presentation and diagnosis. Aim of this study was to determine the socio-demographic and clinical profile of cervical cancer patients and their relationship with tumour related factors. Methods: This was a retrospective review of all cases of histologically confirmed cervical cancer patients managed at the University of Port Harcourt Teaching Hospital, Port Harcourt, over a 5-year period. A data collection form was used to obtain socio-demographic characteristics and clinical profile from the patients’ case records. Results: The mean age of the women was 53.3±8 years, with the highest prevalence in the 55-64 age group 26 (33.3%). Majority 59 (74.4%) of the women were multiparous, and 50 (64.1%) were married. Most 32 (41%) had primary education and about one-third 24 (30.8%) were farmers. The most common clinical features were vaginal bleeding, foul-smelling vaginal discharge, pelvic pain, and weight loss 46 (59%), while squamous cell carcinoma (SCC) was the predominant histological type 56 (71.8%). Only 9 (11.5%) had any form of screening for early detection of cervical cancer. Most 31 (39%) of the patients presented with stage III disease, with a median hemoglobin level of 6.8 (2.3) g/dl before treatment. About two-third 54 (69%) of them had severe anaemia. There was significant association between marital status and histological type (X2 = 42.096, p-value = 0.001).  Use of oral contraceptive pills (X2 = 7.602, p-value =0.04) and menopausal state (X2 = 6828, p-value =0.05), were significantly associated with cancer stage. Conclusions: There is an urgent need to scale up advocacy for regular screening for cervical cancer and vaccination, to ensure increased awareness, early detection, and prevent the progression of early disease.

Strategies to Improve Antimicrobial Utilization with a Special Focus on Developing Countries

From MDPI via Jisc Publications RouterHistory: accepted 2021-06-02, pub-electronic 2021-06-07Publication status: PublishedAntimicrobial resistance (AMR) is a high priority across countries as it increases morbidity, mortality and costs. Concerns with AMR have resulted in multiple initiatives internationally, nationally and regionally to enhance appropriate antibiotic utilization across sectors to reduce AMR, with the overuse of antibiotics exacerbated by the COVID-19 pandemic. Effectively tackling AMR is crucial for all countries. Principally a narrative review of ongoing activities across sectors was undertaken to improve antimicrobial use and address issues with vaccines including COVID-19. Point prevalence surveys have been successful in hospitals to identify areas for quality improvement programs, principally centering on antimicrobial stewardship programs. These include reducing prolonged antibiotic use to prevent surgical site infections. Multiple activities centering on education have been successful in reducing inappropriate prescribing and dispensing of antimicrobials in ambulatory care for essentially viral infections such as acute respiratory infections. It is imperative to develop new quality indicators for ambulatory care given current concerns, and instigate programs with clear public health messaging to reduce misinformation, essential for pandemics. Regular access to effective treatments is needed to reduce resistance to treatments for HIV, malaria and tuberculosis. Key stakeholder groups can instigate multiple initiatives to reduce AMR. These need to be followed up