Expected Time to Achieve SDG 4.6: A Disaggregated Data Analysis for Pakistan

Achieving the sustainable development goals is a massive task but not an impossible one. Can we achieve these goals during the next 13 years? To answer this question, we need to benchmark where Pakistan is today and to figure out how far we have to travel? We have discussed challenges regarding SDGs with reference to data in general and have figured out expected distance to achieve universal literacy goal under SDG4 in particular. Our results show that it is not possible to achieve SDGs using business as usual. Pakistan will hardly be able to achieve 100% literacy even after 100 years of its birth. There is lot of hetrogeniety among provinces, urban and rural population, and between male and female. Some districts have literacy rate around 85% while there are other which have female literacy rate even below 20%. To address these challenges such that “No One is Left Behind” is a gigantic task. However, we believe that learning lessons from districts with significant improvement in literacy over past two decades, strong commitment, academia technical assistance and making governments accountable at levels, these goals are achievable

Analysis of Gender Parity for Pakistan: Ensuring Inclusive and Equitable Quality Education

Considering how much progress has been made in education, and how large an effort is needed to meet gender parity in primary education. Education is at the heart of sustainable improvement and the SDGs, a cause of action and hope. Educating girls as well as boys is an achievable goal and attainable in the near term if substantial resources are matched with comprehensive national strategies for education reform that include measures of accountability and a commitment to ensure every girl and boy in school. Additionally, the study signifies that how far away we are from accomplishing these SDGs. This results ought to set off alerts and prompt a noteworthy scale-up of activities to accomplish SDG 4 and ensuring gender parity. Moreover, it underlines the gaps that where the Pakistan stands today in education and where it has to establish reaching by 2030. Projections illustrate that how much additional exertion will be needed to accomplish gender parity. Such a comprehension could go some approach to have the anticipated evaluations in graphics significantly lifted. While challenges still exist, expected distance to achieve gender parity provides us guidance on to make significant progress. Punjab and urban areas have achieved gender parity for primary enrollments while other provinces need to learn lessons. An emphasis on equity is likewise be required over the full SDG motivation, as the objectives won't be achieved unless advancement is made for all least developed districts and provinces, and for a whole. In short, there may be no better investment for the health and development of Pakistan than investments to educate girls

Expected Time to Achieve SDG 4.6: A Disaggregated Data Analysis for Pakistan

Achieving the sustainable development goals is a massive task but not an impossible one. Can we achieve these goals during the next 13 years? To answer this question, we need to benchmark where Pakistan is today and to figure out how far we have to travel? We have discussed challenges regarding SDGs with reference to data in general and have figured out expected distance to achieve universal literacy goal under SDG4 in particular. Our results show that it is not possible to achieve SDGs using business as usual. Pakistan will hardly be able to achieve 100% literacy even after 100 years of its birth. There is lot of hetrogeniety among provinces, urban and rural population, and between male and female. Some districts have literacy rate around 85% while there are other which have female literacy rate even below 20%. To address these challenges such that “No One is Left Behind” is a gigantic task. However, we believe that learning lessons from districts with significant improvement in literacy over past two decades, strong commitment, academia technical assistance and making governments accountable at levels, these goals are achievable

SDG Index for Pakistan at Provincial Level

Accomplishing Sustainable Development Goals (SDGs) an innovative global agenda of inclusive development, how much progress has been made in some areas and how large an effort is needed to meet the SDGs is the main spirit. This collective journey has at its heart a promise to “leave no one behind”. If current trends persist and the cost of missing this opportunity is losing millions of lives that could have been saved. Are we likely to have enough and proper data to conduct an assessment in a meaningful way? To answer this question, we need to evaluate the current state of progress towards each SDG. To take stock of progress at the national and provincial level, SDG Index is incorporated and ranked to evaluate the best and worst performers. Furthermore, they are analyzed against each SDG and highlights from acute to mild challenges. The resulting SDG scorecard depicts that through business as usual, it is hard to achieve SDGs for Pakistan by 2030. Baluchistan rural is at the bottom while Urban Punjab and Urban KP are have done reasonably well though these regions are also behind the target. There is need to do a lot in the domain of health, education, poverty, water and sanitation and no hunger for all regions. The SDG heatmap makes clear that every province faces major challenges in health, education and gender equality that needs to cope with. A call to governments and stakeholders to recognize the gaps that have been identified in implementation, financing and political will to fulfil this vision and keep this promise. SDG Index can draw attention to the SDGs and their role as a tool for guiding national policies and long-term strategies for inclusive development

Global injury morbidity and mortality from 1990 to 2017 : results from the Global Burden of Disease Study 2017

Correction:Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.Peer reviewe

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Equity trends for the UHC service coverage sub-index for reproductive, maternal, newborn and child health in Pakistan: evidence from demographic health surveys

Abstract Background Pakistan, the world's sixth most populous country and the second largest in South Asia, is facing challenges related to reproductive, maternal, newborn and child health (RMNCH) that are exacerbated by various inequities. RMNCH coverage indicators such as antenatal care (ANC) and deliveries at health facilities have been improving over time, and the maternal mortality ratio (MMR) is gradually declining but not at the desired rates. Analysing and documenting inequities with reference to key characteristics are useful to unmask the disparities and to amicably implement targeted equity-oriented interventions. Methods Pakistan Demographic Health Survey (PDHS) based UHC service coverage tracer indicators were derived for the RMNCH domain at the national and subnational levels for the two rounds of the PDHS in 2012 and 2017. These derivations were subgrouped into wealth quintiles, place of residence, education and mothers’ age. Dumbbell charts were created to show the trends and quintile-specific coverage. The UHC service coverage sub-index for RMNCH was constructed to measure the absolute and relative parity indices, such as high to low absolute difference and high to low ratios, to quantify health inequities. The population attributable risk was computed to determine the overall population health improvement that is possible if all regions have the same level of health services as the reference point (national level) across the equity domains. Results The results indicate an overall improvement in coverage across all indicators over time, but with a higher concentration of data points towards higher coverage among the wealthiest groups, although the poorest quintile continues to have low coverage in all regions. The UHC service coverage sub-index on RMNCH shows that Pakistan has improved from 45 to 63 overall, while Punjab improved from 50 to 59 and Sindh from 43 to 55. The highest improvement is evident in Khyber Pakhtunkhwa (KP) province, which has increased from 31 in 2012 to 51 in 2017. All regions made slow progress in narrowing the gap between the poorest and wealthiest groups, with particularly noteworthy improvements in KP and Sindh, as indicated by the parity ratio. The RMNCH service coverage sub-index gap was the greatest among women aged 15–19 years, those who belonged to the poorest wealth quintile, had no education, and resided in rural areas. Conclusions Analysing existing data sources from an equity lens supports evidence-based policies, programs and practices with a focus on disadvantaged subgroups