The critical period encompassing gestation and the first two years of life is essential for the development of the body, brain, and immune system. Although early-life nutrition during the first 1,000 days has been widely reviewed, this paper provides an updated synthesis linking early feeding practices, long-term disease risk, and parental preconception nutrition within a life-course and public health perspective. It emphasizes the often-overlooked role of paternal nutrition, epigenetic programming, and the continuity of dietary exposures from preconception to complementary feeding, in contrast to previous reviews focusing primarily on maternal or neonatal nutrition. Current evidence on key micronutrients, breastfeeding dynamics, and complementary feeding practices is summarized, along with their mechanistic contributions to immunological maturation, neurodevelopment, and the developmental origins of non-communicable diseases. The review contextualizes findings within the challenges faced by low- and middle-income countries, including the dual burden of malnutrition, social barriers, and health inequities. By integrating biological mechanisms with practical public health considerations, this synthesis aims to bridge the gap between evidence and community-level interventions. The insights provided are intended to guide nutritionists, policymakers, and maternal-child health programs in optimizing health outcomes during this critical developmental window.
Background: Ischemic heart disease (IHD) remains a major global public health concern. This study aimed to determine the hospital-based prevalence of IHD and identify its associated risk factors among patients presenting to a tertiary care hospital in Faisalabad, Pakistan. Methodology: A cross-sectional study was conducted among 7,087 patients presenting to the Faisalabad Institute of Cardiology between September 2023 and February 2024. Of these, 385 patients diagnosed with IHD were included through consecutive sampling. Diagnosis was confirmed via medical records and physician assessment, supported by standard diagnostic criteria, including troponin I testing. Statistical analysis was performed using SAS version 9.0. Associations between variables were assessed using the chi-square test, with a significance level set at p < 0.05. Results: The hospital-based prevalence of IHD was 5.43% (95% CI: 4.92–5.99). Among affected patients, 63.38% were male and 36.62% were female (p = 0.002). The majority were aged over 45 years (81.30%, p = 0.002) and resided in urban areas (58.96%, p = 0.001). Most patients were married (87.53%; p < 0.001) and belonged to the upper-middle socioeconomic class (47.01%; p = 0.001). A sedentary lifestyle was significantly associated with IHD (41.30%; p = 0.001), while a positive family history (64.41%) was the most prevalent risk factor. Conclusion: The findings underscore the importance of demographic and lifestyle factors in the risk profile of IHD. Targeted interventions addressing physical inactivity, obesity, and other modifiable risk factors are essential to reduce disease burden, while acknowledging family history as a key non-modifiable determinant.
Background: Watching cartoons is a common leisure activity among children. Concerns have been raised regarding the potential impact of exposure to violent cartoon content on aggressive behavior. This study aimed to assess aggression among school-going children aged 5–10 years in relation to exposure to violent cartoons in selected schools in Karachi, Pakistan. Methodology: A descriptive cross-sectional study was conducted in selected private schools in Karachi. A total of 340 children were included. Data were collected through parents using the Buss–Perry Aggression Scale to assess children’s aggression levels. Sociodemographic characteristics and cartoon-viewing behaviors were also recorded. Results: Most participants (96.2%, n = 335) reported watching cartoons, with 56.9% (n = 198) belonging to nuclear families. A majority (79.3%, n = 276) watched cartoons while eating. Boys demonstrated significantly higher aggression levels than girls (p = 0.024). Increased aggression was significantly associated with mimicking cartoon characters (p < 0.001), watching cartoons on YouTube (p = 0.002), living in joint families (p = 0.011), and screen time exceeding six hours per day (p = 0.033). Parental characteristics showed that 40.8% of mothers had secondary education, 46.8% of fathers were privately employed, and most mothers were homemakers. Conclusion: No direct association was found between cartoon viewing and aggression. However, specific behaviors such as mimicking cartoon characters and excessive screen time were significantly associated with higher aggression levels. These findings highlight the importance of monitoring children’s media consumption and behavioral responses.
I read with great interest the article by Ali et al. titled “Perception of Medical Students about Brain Breaks; Identifying the Gap to Improve Learning as per Sustainable Development Goal-4”, published in the September 2025 issue of the Pakistan Journal of Public Health. The authors have highlighted the importance of cognitive rest for medical students. In this study, more than half of the students indicated the need for a brain break after 45 minutes of academic activity. I am writing this letter to suggest that, even though it is a good starting point, further thorough research is needed to scientifically determine the optimal timings and durations of these brain breaks for medical students. The authors also found that excessive brain breaks reduced the participants’ interest in the subject. This also points towards the existence of a “therapeutic window” for these brain breaks. Due to the intense academic environment of Pakistan, students face extremely high rates of burnout, affecting approximately 30% to 60% of medical students (1). This further highlights the need for more research to determine the optimal timings and durations of these very essential brain breaks.
Background: Personality comprises measurable traits that influence individuals’ behaviors and attitudes. This study aimed to examine whether career commitment mediates the relationship between personality traits and career satisfaction among medical doctors. Despite extensive research on personality, its specific association with career satisfaction in the medical profession remains underexplored. Methodology: A correlational study design was employed using a survey to collect data from 300 doctors working in government and private hospitals in Islamabad, Pakistan. Data were analyzed using SPSS version 24. Results: Openness, conscientiousness, extraversion, and agreeableness were positively associated with both career satisfaction and career commitment, whereas neuroticism showed a negative association. Career commitment significantly mediated the relationship between personality traits and career satisfaction. Additionally, monthly income and weekly working hours were identified as significant predictors of career satisfaction. Conclusion: This study highlights the important role of personality traits in shaping career commitment and satisfaction among medical professionals. It contributes to the existing literature by emphasizing the mediating effect of career commitment and providing insights specific to the medical field.
Background: Physicians play a critical role in communicating climate-related health risks to patients; however, barriers to such communication in low- and middle-income countries remain insufficiently understood. This study aimed to explore physicians’ perceptions, practices, and barriers related to climate–health communication in Pakistan and Bangladesh. Methodology: A mixed-method pilot study was conducted using a cross-sectional survey and semi-structured interviews. A total of 124 physicians were surveyed, and 14 physicians participated in in-depth interviews. Quantitative data were analyzed to identify perceived responsibilities and barriers, while qualitative data were thematically analyzed to explore underlying perspectives. Results: Most physicians (89.6%; 95% CI: 82.8–94.4) believed it was their responsibility to educate patients about climate-related health risks. The most commonly reported barriers included lack of knowledge (66.9%), time constraints (65.3%), and perceived patient disinterest (54.0%). Physicians with prior climate-related training were significantly more likely to identify patient skepticism as a barrier (adjusted odds ratio [aOR] = 3.81; 95% CI: 1.36–10.70; p = 0.011). Qualitative analysis identified three key themes: awareness of climate change and health, barriers to effective communication, and recommendations for improving practice. Time limitations and knowledge gaps were consistently emphasized across both data sources. Conclusion: Although physicians recognize their role in climate–health communication, multiple systemic and individual barriers limit effective engagement with patients. As a pilot study using convenience sampling, these findings are exploratory and warrant further validation. Strengthening medical curricula, developing standardized consultation frameworks, and implementing supportive policies may enhance climate–health communication in South Asian healthcare systems.
Background: Pakistan’s Expanded Programme on Immunization (EPI), launched in 1978, aims to provide routine immunization to all children under one year of age. However, multiple challenges persist, including vaccine stock-outs, inadequate cold-chain management, weak microplanning, insufficient social mobilization, and poor documentation. This study aimed to assess the current level of performance motivation among vaccinators and Lady Health Workers (LHWs) involved in immunization delivery, and to identify factors influencing their motivation. Methodology: A cross-sectional study design was employed. Drawing on prior research highlighting the multifaceted determinants of motivation at individual, organizational, and societal levels, structured data collection tools were used to evaluate performance motivation and identify existing gaps. Results: Among vaccine providers, 87.91% were female and 12.09% were male vaccinators engaged in routine immunization. The highest levels of motivation were associated with the nature of responsibilities and autonomy (mean score: 4.76). Training was identified as a key contributor to capacity building (mean: 4.69), followed by peer support (mean: 4.66) and supportive supervision (mean: 4.64). Conversely, dissatisfaction with salaries and incentives, along with limited recognition, were major factors contributing to reduced motivation. Conclusion: Performance motivation among vaccine providers is strongly influenced by supportive supervision, peer support, and the nature of their responsibilities. However, inadequate salaries and incentives significantly undermine motivation. Strengthening financial and non-financial incentives is essential to enhance workforce motivation and improve immunization service delivery.
Massive footfall of patients in tertiary care hospitals across Pakistan has become a chronic challenge. These hospitals are overwhelmed not only by patients but also by large groups of attendants accompanying each patient, turning wards into congested, chaotic spaces compromising patient care. An article of DAWN mentions about Non-cooperative behaviour of attendants, who insisted on staying with their patients, also contributed to the overcrowding (1). Although, “one patient, one attendant” policies are being displayed in most of the wards, but enforcement of this very policy remains almost nonexistent. Most patients are accompanied by several attendants who crowd the bedside, restrict staff movement, and interfere during rounds and procedures. One of the major precipitating factor in Pakistani doctors’ burnout and over exhaustion in an already over worked environment is the unwarranted and unnecessary presence of a patient’s attendants in, sometimes, a critical life threatening scenario where either you manage the attendants or save a life. Such encounters lead to arguments, delays, and sometimes violence (2), further highlighting the urgent need for strict policy enforcement. The influx of unnecessary attendants disrupts doctors’ and nurses’ workflow, increases infection risk and compromises patient privacy and adds to hospital waste and resource strain.
Background: Chickenpox is a highly contagious viral disease characterized by a polymorphic rash and systemic manifestations. Although traditionally considered a childhood illness, its prevalence among adults is notably higher in tropical regions such as Pakistan, where it is often associated with poorer outcomes. However, factors contributing to adverse prognosis in adults remain insufficiently explored. This study aimed to identify factors affecting outcomes among hospitalized adult patients with chickenpox. Methodology: A prospective cohort study was conducted at Pak Emirates Military Hospital and Combined Military Hospital, Rawalpindi, from July 1 to December 31, 2024. After obtaining informed consent, patients were admitted to the dermatology ward, and baseline investigations were performed. All patients received acyclovir upon admission and were followed throughout their hospital stay. Data were analyzed using SPSS version 23.0. Results: A total of 53 patients were included, with a mean age of 30.63 years (range: 17–41 years). The mean duration of hospital stay was 5.53 days, while the mean total duration of illness was 7.79 days. Dysphagia (p = 0.014) and high-grade fever (p = 0.012) were significantly associated with prolonged hospital stay. In contrast, transaminitis (p = 0.586), thrombocytopenia (p = 0.492), leukopenia (p = 0.651), and initiation of acyclovir within 72 hours of symptom onset (p = 0.126) were not significantly associated with prolonged hospitalization. Conclusion: Chickenpox represents a significant health burden among adults in Pakistan. Dysphagia and severity of fever are important predictors of prolonged hospital stay. Early identification and management of high-risk patients may help reduce disease severity and alleviate pressure on healthcare systems.
Background: Asymptomatic bacteriuria (ASB) is common in pregnant women and can result in major consequences such as preterm labor and low birth weight. However, its identification is frequently neglected, and the rising frequency of antimicrobial resistance (AMR) complicates its treatment. This study examined the prevalence of Asymptomatic Bacteriuria and antimicrobial resistance trends in urinary pathogens in pregnant women who visit antenatal clinics. Methodology: This cross-sectional study was conducted at Ali Fatima Hospital, Lahore, over six months. A self-designed questionnaire was used for data collection, with non-probability random sampling. One hundred and fifteen pregnant women were enrolled. Urine samples were grown to identify bacterial infections, and an antibiotic susceptibility test was carried out using standard microbiological techniques. Results: The study found that 12.2% of pregnant women had ASB, with Escherichia coli (40.0%) followed by Klebsiella spp. (22.6%) being the most common pathogens. Antibiotic resistance was high, with Ampicillin showing 32.2% resistance, while Nitrofurantoin and Fosfomycin showed higher sensitivity. Age, education, and gestational age were all significantly associated with ASB prevalence. Conclusion: Asymptomatic Bacteriuria is common in pregnant women, and there is high antibiotic resistance. E. coli was discovered as the most common pathogen that was resistant to ampicillin. The major indicators for ASB included a history of the trimester, parity, education, and low socioeconomic position.
Background: The paradigm of healthcare delivery has shifted to emphasize holistic, integrated patient care. Dentists, as acknowledged by the World Health Organization (WHO), play a key role in systemic disease prevention and control. Non-communicable diseases (NCDs), including cardiovascular diseases (CVDs), diabetes, hepatitis B, and HIV/AIDS, are highly prevalent in Pakistan. Chairside medical screenings in dental settings could serve as a public health strategy for early detection of systemic diseases, yet patient attitudes toward these screenings remain understudied in Pakistan. The objective of the study was to assess patient attitude and willingness to chairside screening for systemic diseases in a hospital-based dental setting in Peshawar. Methodology: A descriptive cross-sectional study was conducted at the dental outpatient department of Police Services Hospital, Peshawar, over six months from February to July 2025. A total of 420 patients aged 20 years and above were selected using consecutive sampling. Data were collected through a pretested structured questionnaire and analyzed using SPSS v22. Associations between demographic, socioeconomic factors, and willingness for screening were assessed through Chi-square, t-tests, and ANOVA and p value <0.05 was consider significant. Results: The findings revealed significant associations (p < 0.05) between age, gender, education, employment, and willingness to undergo chairside screening. Women and younger participants were more willing, while educational attainment and employment status positively influenced acceptance. Socioeconomic disparities were evident, with lower willingness in economically disadvantaged groups. Conclusion: The study highlights a generally positive attitude toward chairside screenings, with key demographic and socioeconomic factors influencing willingness. These insights can inform strategies to integrate chairside screening into routine dental visits, improving early detection and preventive healthcare in Pakistan.
The aim is to highlight the existing barriers to reproductive health and hygiene awareness among adolescents in rural Sindh and to emphasize the contributing educational and communication gaps, considering their possible outcomes in preventable health care problems. A comparative study was performed in rural and urban government schools in District Khairpur. According to the study, there were informational barriers to reproductive hygiene among adolescent girls. Most students were unaware about it before menarche, with the highest portion being rural girls. The primary source of information was mothers. In addition, a considerable proportion of mothers had limited formal education and were generally homemakers, reflecting sociodemographic factors that may impact health communication within homes. Students reported receiving few or no menstrual-related sessions in school. Roughly two-thirds of students considered school sanitation and disposal installations inadequate, particularly in rural settings. Regarding hygiene operation, rural students showed less information about menstrual hygiene management. These findings emphasize not only informational deficiencies but also infrastructural limitations that may limit the effective hygiene management in teens (1).
We would like to highlight the recent advances in antiviral drug availability in Pakistan and their potential impact on public health. The approval of Tafenoquine for Plasmodium vivax malaria represents a major step in malaria control, offering a single‑dose cure when supported by G6PD testing (1). Likewise, the local licensing of Lenacapavir for HIV, through voluntary agreements with Gilead, provides a promising long‑acting option that may improve both treatment and prevention outcomes (2). The wider use of direct-acting antivirals (DAAs) such as Sofosbuvir-based regimens has already transformed Hepatitis C management, enabling highly effective interferon‑free therapy (3). In addition, domestic production of Remdesivir has strengthened Pakistan’s response to COVID‑19 (4), while Tecovirimat access through WHO support for mpox reflects growing preparedness against emerging infections (5).
Vitamin D deficiency impacts over 1 billion individuals globally and qualifies as a pandemic, yet it remains largely unrecognized by healthcare systems in low- and middle-income countries (LMICs). The combined prevalence of serum 25-hydroxyvitamin D levels below 50 nmol/L is 56% in LMICs, with even greater rates among pregnant women, adolescents, and the elderly. South Asia is significantly affected, with adult deficiency rates surpassing 65% in Pakistan, Bangladesh, and India. This Opinion and Analysis advocates for large-scale action to address vitamin D deficiency in LMICs, explores reasons for the ongoing deficiency in sunny regions, and discusses why universal biochemical testing is not the appropriate solution. Drawing on global and regional epidemiology, the Bill & Melinda Gates Foundation and the New York Academy of Sciences expert roadmap, country-level cost-effectiveness modelling, and the Finnish precedent of mandatory food fortification, we argue that three policy instruments used together can shift the population distribution of 25-hydroxyvitamin D within a few years: mandatory fortification of staple foods such as edible oil and milk; targeted supplementation of high-risk groups; and clear public-health communication on sensible sun exposure and dietary sources. This package is biologically sound, operationally feasible, and economically attractive. Cost-effectiveness analyses from India and the United Kingdom suggest that fortification is cost-saving at the population level. The case for ministries of health in Pakistan, India, Bangladesh, and other LMICs to make vitamin D mandatorily available through the foods their populations already eat is now stronger than the case for further delay.
Antimicrobial resistance (AMR), a silent pandemic, is a growing public health challenge in Pakistan. In a country where the healthcare system is already constrained and public hospitals have limited capacity to meet patient needs. AMR is turning previously treatable diseases into significant causes of morbidity and mortality. By reducing the effectiveness of available treatments, AMR not only worsens health outcomes but also increases healthcare costs for both individuals and the system as a whole. In 2017, Pakistan’s National Action Plan (NAP) on AMR, aligned with the World Health Organization’s Global Action Plan was launched (1). Among 204 countries, Pakistan remains among countries with a high burden of AMR, ranking 53rd globally for age-standardised mortality associated with anti-microbial resistance in 2021 (2). AMR awareness weeks are regularly observed, and the major drivers of resistance such as over-the-counter antibiotic sales, inappropriate prescribing, and incomplete antibiotic treatment courses are well recognised. However, resistance continues to rise. Pakistan is third largest consumers of antibiotics among LMIC’s (3). Antibiotic misuse is often attributed to poor public knowledge. For many individuals, prolonged illness threatens daily income, and economic stability. This pushes people toward private or informal providers or self-medication. In such circumstances, seeking rapid symptom relief becomes a rational response rather than careless behaviour.
Pakistan faces a grave issue of consistent flooding which has a massive impact on the country. The constantly recurring floods destroy the agriculture of Pakistan and this in turn affects the livelihood and income source of the agricultural workers. Furthermore, the damage to the country's infrastructure is also a setback. When remediation measures are suggested, one of the most often presented solutions is the creation of dams, however, they are far from being an easily managed solution. The creation of dams as a remediation measure is also not the easiest solution due to the excessive ecological, financial, as well as social costs which are required for this to go through. The main essence of this article is examining the advantages and limitations of the construction of dams in Pakistan. This article will discuss various approaches which will focus on solutions related to selective infrastructure with ecosystem-based adaptation, cooperation within boundaries, as well as urban planning which cannot be easily affected by climatic conditions.
Background: Anemia, characterized by reduced hemoglobin levels, impairs the body's capacity for efficient oxygen transport to tissues. As a chronic condition, its persistence is exacerbated by limited patient knowledge and suboptimal self-management, ultimately compromising Health-Related Quality of Life (HRQoL). This study aimed to assess anemia-related knowledge, management practices, and their impact on HRQoL among female anemic patients to inform strategies for improved clinical outcomes. Methodology: A cross-sectional study was conducted at Niazi Medical Complex, Sargodha, utilizing a pre-validated questionnaire alongside the 20-item Short Form Survey (SF-20). Sample size was determined using the Cochran formula, assuming a 31% prevalence and a 95% confidence interval. Data were analyzed using descriptive statistics, Pearson correlation, and Mann–Whitney U and Kruskal–Wallis tests to explore relationships and differences among variables, with statistical significance set at p < 0.05, using SPSS version 26. Results: The majority of participants (59.1%) were aged 16–25 years. Overall, 61.3% (n=223) demonstrated poor knowledge, and 87.9% (n=320) exhibited inadequate management practices. Higher education was significantly associated with better knowledge and practices (p=0.001), while urban residency correlated positively with both (p<0.05). Pearson analysis revealed a significant positive correlation between knowledge and practice scores (r=0.437, p=0.001), suggesting that enhanced knowledge facilitates adoption of better disease management. Furthermore, practice scores were strongly associated with HRQoL outcomes (p<0.05), indicating that appropriate practices improve quality of life. Conversely, knowledge showed no direct significant association with HRQoL. Conclusion: These findings underscore the critical role of education in shaping awareness and health behaviors. Strengthening targeted health education interventions is imperative to improve anemia management and enhance the overall well-being of females in Pakistan.
Background: Menopause is a natural phase in a woman’s life, when menstrual periods stop due to hormonal changes. These changes can affect not only physical health but also emotional well-being and sexual functioning, ultimately affecting a woman’s overall quality of life. This study aimed to evaluate the association between sexual functioning and quality of life among menopausal women in Pakistan. Methodology: This cross-sectional study was conducted in five towns of Karachi, Pakistan, from June 2023 to February 2024. The Female Sexual Function Index (FSFI) and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) were employed to assess the sexual functioning of menopausal women and their association with their quality of life. Results: A total of 390 menopausal women participated in this study. The mean of the total FSFI score was calculated to be 18.58 ± 4.89, suggesting mild to moderate female sexual functioning among the menopausal women. Pearson's correlation analysis revealed significant positive associations between total FSFI scores and all four WHOQOL-BREF domains (Physical Health: r = 0.621; Psychological Health: r = 0.488; Social Relations: r = 0.662; Environment: r = 0.601; all p < 0.01). Psychological health showed a notable positive correlation with sexual satisfaction (r = 0.371, p < 0.01), and pain during intercourse was negatively associated with physical and psychological health domains. Conclusion: This study highlighted the importance of incorporating both psychological and sexual well-being into healthcare interventions for Pakistani women undergoing menopause to ensure a better quality of life.
Background: Medical students frequently face rigorous academic schedules and lifestyle constraints that impact their dietary habits and nutritional status. Variations in living arrangements, particularly between hostel residences and private accommodations, can further influence food choices and overall energy intake. These factors may significantly affect body mass index (BMI) and long-term health outcomes. This study aimed to investigate food consumption patterns and their association with BMI among medical students in different residential settings. Methodology: A cross-sectional study was conducted at Lahore Medical and Dental College, Pakistan, from August to October 2024. Utilizing convenience sampling, 115 fourth- and final-year MBBS students participated. Data were gathered using a structured self-reported questionnaire, covering background information, food consumption patterns, and anthropometric measurements. BMI was categorized as underweight, normal, overweight, or obese. Statistical analysis was performed using SPSS version 22, with significance set at p ≤ 0.05. Results: The majority of participants (65.2%) were aged 23-24 years, with 57.4% males and 42.6% females. Most students (80.9%) resided in hostels. Normal BMI was recorded in 69.6% of students, while 28.7% were classified as overweight or obese. Significant dissatisfaction was noted concerning food variety and cleanliness of dining areas. Social factors significantly influenced eating behaviours, particularly among hostel residents. Conclusion: A significant relationship exists between food consumption patterns and BMI among medical students. Dissatisfaction with hostel food quality may lead to unhealthy eating habits. Interventions should focus on improving food quality and promoting nutritional education, healthy food access, and physical activity.
Background: Cultural, religious, and gender-based norms critically constrain Afghan refugee women's access to sexual and reproductive health (SRH) services in Pakistan. This study assessed awareness, utilization, and barriers to SRH services and evaluated the Sehat Kahani telemedicine platform's role in improving access. Methodology: A cross-sectional study was conducted from January to March 2025 at 10 Sehat Kahani e-health clinics in Balochistan and Khyber Pakhtunkhwa. Using purposive sampling, 464 Afghan refugee women aged 18–49 were recruited. Data from structured questionnaires were analyzed in SPSS 26 using descriptive and chi-square statistics (significance p<0.05). Results: While 76% of participants were aware of SRH services, only 61% had utilized them in the past year. Contraceptives (54%) and pregnancy testing (37%) were most used. Key barriers were limited service hours (35%) and distance (28%). Utilization was significantly associated with age, marital status, income, and household size (all p<0.01). Education showed no link to awareness (p=0.56) but a strong association with utilization (p<0.001). Conclusion: A significant gap remains between SRH awareness and utilization, driven by structural barriers. Digital health platforms like Sehat Kahani offer a promising avenue to improve access. Strengthening policy support for such culturally sensitive telemedicine interventions is crucial to bridging this gap for refugee populations.
