Assessment of Risk to Healthcare Workers During the COVID-19 Pandemic: A Tertiary Care Facility Based Cross-sectional Study in Pakistan

Objective: To assess the risk of COVID-19 to healthcare workers (HCWs) in Tertiary care hospitals and its association with demographic factors. Study Design: Cross-sectional analytical study. Place and Duration of Study: Tertiary Care Hospital, Rawalpindi Pakistan, from May to Dec 2020. Methodology: Healthcare workers working in a designated COVID-19 Tertiary care hospital were included in the study. A modified "Risk assessment and management of exposure of HCWs in the context of COVID-19 tool" was distributed. HCWs were categorized as "high risk" and "low risk" of COVID-19 infection. Frequency and percentages were computed for demographic variables. Results: A total of 182 healthcare workers were included, and 167(91.7%) returned the study questionnaire. Most of them were nurses (n=65, 40.1%) working in the medical unit (n=99, 61.1%). Low risk HCWs were 73.5%( n=119) and only 26.5%( n=43)were high risk. Gender (p-value: .02) and type of HCWs (p-value: .01) were significantly associated with the risk of COVID-19. Conclusion: One-fourth of HCWs were at high risk of COVID-19 virus infection. Female gender and nurses were more likely to acquire COVID-19 infection

Assessment of knowledge, preventive behaviours and risk perception related to Covid-19 among medical students of Rawalpindi

Objectives: The study was conducted to determine the knowledge, preventive behaviours and perception of risk related to Covid-19 among the medical students who are the front line workers and are more susceptible to be infected. Methodology: This analytical cross sectional study was conducted in medical students of 1st, 2nd and 3rd year MBBS of various medical institutions of Rawalpindi. Study duration was 5 months (March 2020 to July 2020). The sample size was 425. Age ranging from 18 to 21 and 273 (64.2%) comprised of females. The inclusion criteria were those students who gave consent and filled out the questionnaire and the exclusion criteria was who didn't concede. The data was analysed on SPSS. Confidence interval was set to be 95% with 5% margin of error. Results: Most of the students were aware of the basic Covid-19 related knowledge like common symptoms, incubation period, transmission and the basic preventive measures which was on average higher than the previous studies conducted on medical students and on health care workers. Students were also having high level of performance in preventive behaviours in perspective of Covid-19 but risk perception is of moderate level. Conclusion: Participants were found to have high levels of knowledge related to Covid-19 except use of N95 masks and use of anti-viral drugs for treatment. Among self-reported preventive behaviours section, lowest score is related to frequency of cleaning and disinfecting items that can be easily touched with hands (i.e. door handles and surfaces). Participants had moderate risk perception despite having high levels of knowledge and high performance in self-reported behaviours. Keywords: Covid-19, medical students, risk perceptio

Sleep Quality and Its Possible Predictors Among University Students of Islamabad, Pakistan

Objective: To assess sleep quality among Islamabad university students and find predictors of poor sleep quality. Study Design: Cross-sectional analytic study Place and Duration of Study: Capital University of Science and Technology ,Islamabad Pakistan, from Feb to Jun 2019 Methodology: The study population (n=397) was undergraduate students from all eight semesters of four faculties. The dependent variable sleep quality was measured through a standard validated tool, Pittsburgh Sleep Quality Index (PSQI). Results: Out of 397 participants, 158(40%) were hostelities and 239(60%) were day scholars. There were 134(33.5%) students having a good sleep, and 263(66.5%) were having a bad sleep, according to PSQI scores obtained. Association analysis showed a statistically significant association between sleep quality and heavy meals, gadget use, drinking beverages before bedtime,sleeping in a noisy room, and type of residence (p ≤ 0.001). Study findings showed gadget use before bedtime (AOR=4.472,95% CI=2.674-7.478), residence type (AOR=2.323,95% CI=1.4-3.855), sleeping in a noisy room (AOR=2.241,95% CI=1.369-3.665)and heavy meal before bedtime (AOR=1.985,95% CL=1.142-3.451) were significant predictors of poor sleep quality. Conclusion: It was concluded that two out of three students need better sleep quality. Universities should give preparatory assistance for developing and executing health promotion and educational curricula

Janitorial Services of Pak Army Hospitals, a Critical Analysis

Objective: To identify the existing system of janitorial services in the army hospitals, and to give recommendations for standardized policy formulation in military hospitals. Study Design: Cross-sectional study. Place and Duration of Study: Tertiary Care Hospitals, namely Hospital A, B and C, at Rawalpindi Pakistan, from Oct 2019 Jan 2020. Methodology: Responses from 401 Healthcare Administrators (HCAs), Nurses and Janitorial staff were collected through a validated questionnaire, and hospitals' documents/ SOPs, cleaning audit reports, feedback process documents, communication mechanisms and training schedules were reviewed. Results: Out of 401 respondents, the majority were females (54.4%, 5 were HCAs, 143 were Nurses, and 70 were Janitorial staff). The availability of SOPs was associated with cleaning functional areas of hospitals (p=0.001). Awareness of the risk of infection among healthcare workers was associated with Hepatitis B vaccination (p=0.03). Knowledge of hospital areas regarding cleanliness among hospital workers was linked to providing cleanliness training according to job requirements (p=0.001). Conclusion: Hospital A performed admirably in most areas but was found to need more human resources, with staff shortages, high turnover, and a lack of adherence to SOPs. To achieve optimum performance, existing and emerging technology must be integrated with sanitary worker preparation and career development; costs must be reduced. Keywords: Hospital environment, Infection control and disinfectants, Janitorial service, Training

Post Discharge mHealth and Teach-Back Communication Effectiveness on Hospital Readmissions: A Systematic Review

Hospital readmissions pose a threat to the constrained health resources, especially in resource-poor low-and middle-income countries. In such scenarios, appropriate technologies to reduce avoidable readmissions in hospitals require innovative interventions. mHealth and teach-back communication are robust interventions, utilized for the reduction in preventable hospital readmissions. This review was conducted to highlight the effectiveness of mHealth and teach-back communication in hospital readmission reduction with a view to provide the best available evidence on such interventions. Two authors independently searched for appropriate MeSH terms in three databases (PubMed, Wiley, and Google Scholar). After screening the titles and abstracts, shortlisted manuscripts were subjected to quality assessment and analysis. Two authors checked the manuscripts for quality assessment and assigned scores utilizing the QualSyst tool. The average of the scores assigned by the reviewers was calculated to assign a summary quality score (SQS) to each study. Higher scores showed methodological vigor and robustness. Search strategies retrieved a total of 1932 articles after the removal of duplicates. After screening titles and abstracts, 54 articles were shortlisted. The complete reading resulted in the selection of 17 papers published between 2002 and 2019. Most of the studies were interventional and all the studies focused on hospital readmission reduction as the primary or secondary outcome. mHealth and teach-back communication were the two most common interventions that catered for the hospital readmissions. Among mHealth studies (11 out of 17), seven studies showed a significant reduction in hospital readmissions while four did not exhibit any significant reduction. Among the teach-back communication group (6 out of 17), the majority of the studies (5 out of 6) showed a significant reduction in hospital readmissions while one publication did not elicit a significant hospital readmission reduction. mHealth and teach-back communication methods showed positive effects on hospital readmission reduction. These interventions can be utilized in resource-constrained settings, especially low- and middle-income countries, to reduce preventable readmissions

HEALTHCARE IN PAKISTAN–A SYSTEMS PERSPECTIVE

Health system in Pakistan has witnessed evolution and dates back to the medieval, traditional health care, health for all approach, primary health care approach and health systems strengthening approach for better health outcomes. The main objectives of health system are improvement in health, fairness in distribution of risk and finances and responsiveness to the non medical needs of the population. With decreasing expenditure on health care, booming private health sector and flourishing pharmaceutical industry, government can only reduce catastrophic health expenditures by the poor and impoverished through an efficient, effective, accessible and responsive public health system. Inter sectoral collaboration, community participation, social protection, equitable distribution of resources, people centric health policy, health work force development, evidence based health information system and quality assurance of essential medicines will strengthen health system in Pakistan

ASSOCIATION OF VITAMIN D DEFICIENCY WITH TUBERCULOSIS IN ADULT PATIENTS REPORTING TO A TERTIARY CARE HOSPITAL OF RAWALPINDI

Objectives: To compare the mean vitamin D levels in pulmonary tuberculosis patients and healthy controls and to find out the frequency and association of vitamin D deficiency in patients with tuberculosis. Study Design: Case control study. Place and Duration of Study: Pulmonology department, Military Hospital Rawalpindi from Jan 2013 to Dec 2013. Patients and Methods: Fifty two incident outdoor pulmonary tuberculosis patients were selected with 52 age and gender matched controls. Tuberculosis was diagnosed by the sputum examination through gene Xpert technique from National Institute of Health (NIH), Islamabad. Serum 25-hydroxvitamin D level <50 nmol/l (electrochemiluminescene assay) was taken as vitamin D deficiency. Results: Mean vitamin D was much lower (20.688 ± 14.065 nmol/l) in cases as compared to the controls (57.917 ± 18.197 nmol/l) which was statistically significant (p 0.05). Conclusion: Significant vitamin D deficiency was seen in newly diagnosed TB patients. It was found that vitamin D deficiency is associated with tuberculosis, but its causal role has not been established

Exploring health seeking behaviour among incidentally diagnosed HIV cases in Rawalpindi, Pakistan: A qualitative perspective

Objective: To identify the determinants of health-seeking behaviour among incidentally diagnosed cases of HIV and to explore the patterns of care seeking behaviour among these HIV infected persons. Method: The qualitative study based on the grounded theory was conducted from February to September 2019 at the Armed Forces Institute of Transfusion, Rawalpindi, Pakistan, and comprised incidentally diagnosed new cases of human immunodeficiency virus. Data was collected using in-depth interviews to understand how local environments and settings impact healthcare-seeking behaviour. Data was analysed using the constant comparison method. Results: Of the 12 patients, 10(83.3%) were male, 1(8.3%) female and 1(8.3%) transgender. The mean age of the sample was 31+5 years. Of the total, 10(83.3%) patients were receiving free antiretroviral treatment from government hospitals in Rawalpindi/Islamabad, while 2 (16.7%) opted for some alternative form of healthcare. Ten (80%) were married and were carrying the diagnosis for >6 months. Processing of human immunodeficiency virus status, value placed in one’s own health, experiences with healthcare provider and medication-related factors were the main themes that emerged from the data. Better counselling services, free-of-cost medication, positive patient-provider relationship and social support were the key players, while non-disclosure due to fear of stigma and beliefs about the disease were the main stumbling blocks. Conclusion: Value placed in one’s own healthcare and thus the need for healthcare services, regardless of social norms, cultural reservations and personal beliefs, was the most important factor affecting the healthcare-seeking behaviour of human immunodeficiency virus patients. Key Words: Grounded theory, Health-seeking behaviour, Human immunodeficiency virus, HIV

Anxiety Experienced By People Searching Internet For Medical Information

Background: A large proportion of people use internet to search for information on medical symptoms. The objective of the study was to assess the frequency of internet use for medical information and its association with anxiety levels. Methodology: A cross-sectional study was conducted in tertiary care hospitals affiliated with National University of Medical Sciences, Islamabad from August to December 2020. Ethical approval was taken. A total of 414 Participants aged 20 and above, belonging to either gender, and having at least primary level education were included in the study, while participants belonging to medical background were excluded. Non-probability convenient sampling technique was used to collect data through a validated questionnaire. Frequencies and percentages were calculated. Chi-square test of significance was applied. P-value less than .05 was considered as statistically significant. Results: Majority i.e., 301 (80%) of the participants stated that the health-related searches exacerbated their anxiety. Participants from lower income groups were more prone to anxiety, while participants from higher income groups were more likely to visit a doctor. There was a significant association between age groups and perceptions, that and web searches lead to review of content on serious illness, persistence of query for illness after web search, and increase in web searches related to perceived condition (p&lt;0.05). Conclusion: There was an increase in Anxiety levels after web searches. It was more pronounced in lowest income group people. Higher income group were more likely to trust web searches results