By Dr. Lubna Shahzad
Specialties: Infectious Diseases
Video: BBC/YouTube

Hepatitis:
A Rapidly Spreading Viral Infection in Pakistan
 پاکستان میں تیزی سے پھیلنے والا وائرل اِنفیکشن
 पाकिस्तान में तेजी से फैल रहा वायरल संक्रमण

Introduction:

The word for hepatitis in Urdu is ہیپاٹائٹس. Hepatitis is a serious disease that causes inflammation of the liver. It can be caused by a number of things, including viruses, chemicals, drugs, alcohol, genetic disorders, or an overactive immune system. Hepatitis can lead to a range of health problems, some of which can be fatal۔ According to a 2024 World Health Organization (WHO) Global Hepatitis Report, Pakistan accounts for 44% of new hepatitis B and C infections from unsafe injections. Pakistan has the second-highest burden of hepatitis in the world, with a prevalence of 2.4% for hepatitis B and 4.8% for hepatitis C.  Pakistan’s hepatitis transmission has increased due to unsafe healthcare practices, sharing personal items, and ignorance of sterilization techniques. Many people contract the infection in healthcare settings without realizing it, and the disease is often called a “silent killer” because patients can remain undiagnosed and untreated for years before developing complications and dying.

Pakistan’s struggle to tame hepatitis: an ongoing threat

A potentially deadly liver illnesses Hepatitis B & C are causing a major concern for public health. Hepatitis B is thought to be responsible for 563,000 annual mortality, compared to Hepatitis C’s 366,000. Pakistan is second in terms of the prevalence of chronic HCV infection, with 9.8 million affected. Blood transfusions, hospital stays, dental work, usage of injections, and prior surgery are major risk factors for the spread of the hepatitis C virus. Strong prevention interventions and rigorous management programs are necessary in densely populated, low-income nations like Pakistan to tackle the burden of HBV and HCV patients.

WHO sounds alarm on viral hepatitis infections claiming 3500 lives each day

According to the World Health Organization (WHO) 2024 Global Hepatitis Report, the number of lives lost due to viral hepatitis is increasing. The disease is the second leading infectious cause of death globally — with 1.3 million deaths per year, the same as tuberculosis, a top infectious killer.

The report, released at the World Hepatitis Summit, highlights that despite better tools for diagnosis and treatment, and decreasing product prices, testing and treatment coverage rates have stalled. But, reaching the WHO elimination goal by 2030 should still be achievable, if swift actions are taken now.

New data from 187 countries show that the estimated number of deaths from viral hepatitis increased from 1.1 million in 2019 to 1.3 million in 2022. Of these, 83% were caused by hepatitis B, and 17% by hepatitis C. Every day, there are 3500 people dying globally due to hepatitis B and C infections.

On World Hepatitis Day, WHO is calling on countries to step up efforts to eliminate hepatitis by 2030.With one of the world’s highest rates of hepatitis C, Pakistan is tackling this serious health issue from many angles to improve prevention, diagnosis and treatment.

Hepatitis C

Hepatitis C is a virus that causes chronic liver inflammation and long-term damage. Transmission commonly occurs through infected needles. HCV is treatable with new antiviral medications, but many people don’t know they’re infected. They may not have symptoms until liver disease has progressed to liver failure.

What is hepatitis C?

Hepatitis C is a viral infection that affects your liver. It causes inflammation and swelling, which damages your liver tissues over time. “Hepatitis” means inflammation of the liver. There are many causes of hepatitis, and a few of them are viruses. Compared to other causes of viral hepatitis, though, hepatitis C is much more likely to stay in your body for a long time.

Chronic inflammation over many years does serious damage to your liver. In fact, hepatitis C is one of the leading causes of liver failure and liver transplantation in the world. Most people can’t tell when their liver is inflamed. They don’t develop symptoms until severe damage has already been done.

What is the main cause of hepatitis C?

Hepatitis C is caused by a virus that spreads through contact with blood. Transmission occurs when the blood of an infected person enters the body of an uninfected person. It most commonly occurs when people share needles for injecting intravenous drugs. Worldwide, transmission commonly occurs in medical settings with unsterilized equipment.

What is the difference between hepatitis A, B and C?

Hepatitis A and hepatitis B are different viruses that also cause hepatitis. They differ in the ways they’re contracted and spread, the types of infections they cause and the ways that you can treat them and prevent them. Here are some of the key differences:

How does hepatitis C infection affect me?

Hepatitis C infection has several stages.

Incubation

When you first get a virus, it goes through what’s called an incubation period. This is when it’s busy replicating itself in your body. The virus keeps replicating until it reaches the threshold where your body recognizes the infection. Then your immune system kicks in, and that’s when you begin to notice symptoms.

Acute infection

With hepatitis C, the incubation period can last from two weeks to six months. The acute stage of infection begins when your immune system kicks in. It’s also when you begin to experience symptoms. Most viral infections at the acute stage cause symptoms of illness, such as fever and inflammation in your body. With hepatitis, though, the inflammation is mainly in your liver, and you might not notice it.

Only 20% of people with acute hepatitis C infection have symptoms. People who have symptoms can treat the infection with antivirals. But most don’t have symptoms and don’t know to seek treatment. The acute stage lasts up to three months. Within this period, up to 20% of people effectively fight off the virus and spontaneously clear it from their bodies.

Chronic infection

Most people (80%) are unable to clear the virus by themselves and develop a long-term, chronic infection. This means that their livers are constantly inflamed and swollen. Chronic hepatitis causes liver damage by a process known as cirrhosis. The constant inflammation of the liver eventually leads to scarring.

Cirrhosis progresses slowly over several decades. It might go faster if you have additional liver damage from other causes, such as excessive alcohol use. It might go slower if your liver is in better condition overall. But the end result is that scar tissue prevents your liver from doing its job. The risk of cirrhosis from chronic hepatitis C infection is about 25% after 20 years.

Medications approved for the treatment of hepatitis C, consult your medical provider.

By Dr. Ramsha Zafar
Physician/ Internal Medicine

The Importance of Discussing Personal Hygiene
ذاتی حفظانِ صحت پر بحث کرنے کی اہمیت
व्यक्तिगत स्वच्छता पर चर्चा का महत्व

Although it’s a sensitive subject, personal hygiene is one that needs to be discussed. Beyond the obvious health risks, poor hygiene has far-reaching repercussions. It affects more than just you when you neglect to take regular showers, brush your teeth, and wash your hands. Everyone you interact with is impacted by it. So let’s discuss inadequate personal hygiene, its effects, and the need for daily rituals to help maintain the direction of our hygiene regimen.

The Instances and Effects of Poor Hygiene

Body Odor

Probably the most prevalent indication of inadequate personal hygiene is this. There are other repercussions in addition to discomfort and an awkward scenario for people around you. As a result of your illness, you can experience allergies, persistent itching, and social isolation. Body odor is the result of an interaction between bacteria produced by your apocrine glands and sweat. Therefore, the bacteria grows and the stink gets worse the more unwashed sweat there is. But the root of it all is terrible personal hygiene and actions such as: Bathing infrequently. Donning soiled, odorous socks Avoid taking off your shoes Not giving your feet enough attention Wearing filthy, discolored, or odorous clothing every day Not changing your underpants regularly

Halitosis

Another way that poor dental hygiene affects your oral health is through bad breath, often known as halitosis. The bacteria that are on food particles stick to your teeth when you eat. Regretfully, the powerful, disagreeable stench that these bacteria create after digestion is linked to halitosis. Poor dental hygiene is a major cause of bleeding gums and tooth decay. These oral illnesses are caused by the following behaviors:

An irregular dental brushing schedule

Not using floss after every toothbrushing

Not washing your tongue after brushing your teeth

Overindulging in acidic beverages on a regular basis

Smoking too much

Lice Infestation

An infestation of body lice can be very uncomfortable and dangerous to your health. These lice are tiny insects that dwell in clothing and bedding, where they deposit their eggs. Additionally, they consume the residues on your skin.

Because your armpits and groin are high-humidity areas, lice prefer to settle there. To prevent a lice infestation, it is crucial to regularly bathe and wear clean, new clothes every day.

To ward against any such infestation, refrain from doing the following:

Rarely taking a shower

Failing to change your linens at least once every week

Not giving your clothing a thorough wash

Dressing in soiled or odorous clothing

Effects on Intimate Life

Your Romantic Life Is Damped by Poor Personal Hygiene. Nobody likes to be close to someone who stinks and who might be ill or infectious. Therefore, poor personal cleanliness will prevent you from developing a genuine and deep romantic relationship. Kissing, cuddling, and sexual intimacy may become less appealing if one partner is consistently unclean.

Health Problems

Poor hygiene can lead to a range of health issues. Skin infections, dental problems, and gastrointestinal issues are common among individuals with inadequate hygiene practices. Neglecting basic hygiene can also exacerbate chronic conditions like diabetes and lead to severe infections. In extreme cases, poor hygiene can contribute to the development and spread of infectious diseases, posing a threat to public health.

Social Stigma

Individuals with poor personal hygiene often face social isolation and stigmatization. The unpleasant odors and visible signs of neglect can lead to avoidance by others, impacting social relationships and self-esteem. This social stigma can create a vicious cycle, where individuals become further isolated and less likely to seek help or improve their hygiene practices.

Public Health Risks

Poor personal hygiene is not just an individual problem; it has significant public health implications. Inadequate hygiene practices can contribute to the spread of infectious diseases, impacting entire communities. For example, poor hand hygiene can facilitate the transmission of illnesses like the flu, norovirus, and other contagious diseases. Public health campaigns emphasize the importance of hygiene to prevent such outbreaks, but challenges remain in reaching and educating all segments of the population.

Workplace Issues

Poor hygiene can lead to problems in the workplace. Employees with inadequate hygiene may face conflicts with coworkers, impacting team dynamics and productivity. In some cases, poor hygiene can lead to disciplinary action or even job loss. Employers must balance sensitivity towards personal issues with the need to maintain a healthy and professional work environment.

Children are particularly vulnerable to the consequences of poor hygiene. Inadequate hygiene practices can lead to frequent illnesses, affecting school attendance and academic performance. Additionally, children who are not taught good hygiene practices at home may struggle to adopt these habits later in life. Schools play a crucial role in educating children about hygiene, but parental involvement is equally important.

How Personal Hygiene Impacts Education

Personal hygiene is the key to a life well lived. Clean skin, neatly trimmed hair and nails, and clean clothes are all important to our health. They all play a role in keeping illness and disease away.  But it doesn’t end there. Personal hygiene affects us in many different ways, both directly and indirectly. One of those ways is our education. Believe it or not, personal hygiene does impact our education

It Lowers a Child’s Self Esteem

Let’s face it; others’ harsh words and opinions can hurt.  When a child is made fun of for not having the newest clothes or shoes, it can break their self-confidence. What’s worse is when they are made fun of for their poor hygiene. Dirty clothes, body odor, or bad breath are all easy targets for bullies to pick on.

Sometimes, it’s not even meant as bullying. Children can be brutally honest and don’t know they are embarrassing someone or hurting their feelings. This can cause a child to become an outcast in their class, and even affect their desire to attend school.

This affects a child’s confidence to take part in class activities. They will be less likely to ask questions when they need help. They will try not to draw any added attention to themselves. They will intentionally not participate, causing them to miss out on opportunities in school. Worrying about what others think or say can disrupt their focus on learning.

It Lowers a Child’s Attendance

Hygiene issues can even go so far as to affect a student’s attendance. Children who get bullied may fake being sick so they don’t have to face the bully that day.  Sometimes the schools will get involved and call the parents. Parents may need to go pick up their children who need to bathe or ask them to bring fresh clothes. This causes the children to miss lessons or tests while they deal with hygiene issues at school.

Middle and high-school-aged girls may miss several days of school monthly. This is because of their menstrual cycle if they don’t have enough supplies to make it through the school day.

It Lowers a Child’s Grades

A lack of participation and possibly a high absence rate leads to poor grades. Missing a lot of school means missing tests, classwork, and the opportunity to get extra help. Lack of participation causes a student to miss out on information needed to understand hard concepts. This will cause them to perform poorly on coursework, leading to poor grades.

The more days a student can attend, and participate in class, the better they will do. It’s a domino effect; poor hygiene leads to a lack of confidence, which ultimately leads to missing school days, or missing out on opportunities to learn.

Hygiene and Students

Grade school-aged children tell it like it is and aren’t afraid to call out a child with poor hygiene. But the problem with bullying because of hygiene tends to pick up in middle school. For starters, middle school is the time when most students begin puberty. This leads to issues such as body odor, which a student hasn’t had to deal with yet. Parents must take the time to teach them about these changes. This includes how to wash properly and use deodorant daily.

This age group is outgrowing their childhood ways and figuring themselves out. They try to push the envelope to see what they can and cannot get away with. So, they’re more likely to bully other students for fun. Unfortunately, those with poor hygiene are easy targets.

For students who have been social outcasts since grade school, this tends to continue into high school. They get used to the social scene and eventually accept it. They continue to stay under the radar, and stay away from students they know will bully them. High school issues such as dating or underage drinking can also influence children with poor hygiene.

They may use drinking as a crutch due to the stigma surrounding them socially. They may use it to numb the pain of being left out socially, and watching other students flourish.

Make a Change That Matters

It’s important to teach children early in life how to care for themselves. It will prevent unnecessary illness or health conditions, and relieve some self-esteem issues. Let’s face it – kids have enough to deal with these days with the influence of social media.

Keeping your child clean and healthy gives them the confidence to ask that question in class, try out for the team, audition for that part, and so much more. It allows them to live a full life without worrying about others looking down on them for not taking care of themselves. Be sure to talk with your child about:

• Brushing their teeth when they wake up and before bed
• Washing their face when they wake up and before bed
• Using floss and mouthwash regularly for good dental hygiene
• Showering every other day to clean their body and hair
• Trim hair and nails regularly
• Washing their hands frequently, especially after using the bathroom
• Menstrual cycles for young women, the proper supplies needed, and what they need to do monthly
• Teaching young men about shaving when the time comes

For parents who can’t afford hygiene supplies for their household, there are resources that can help.

Sexually Transmitted Diseases Resulting from Poor Personal Hygiene

While poor personal hygiene itself does not directly cause sexually transmitted diseases (STDs), it can contribute to conditions that may increase the risk of contracting or spreading these infections. Here’s how:

Increased Susceptibility to Infections: Poor hygiene can lead to bacterial and fungal infections in the genital area, which can compromise the skin and mucous membranes. This can make it easier for STDs to take hold if exposed.

Irritation and Micro tears: Lack of proper hygiene can cause irritation, inflammation, and micro tears in the genital area due to the build-up of sweat, bacteria, and other irritants. These micro tears can serve as entry points for pathogens, increasing the risk of infection.

Reduced Detection and Treatment: Poor hygiene can mask symptoms of STDs, such as unusual discharge or sores, leading to delayed detection and treatment. This not only worsens the individual’s health but also increases the risk of transmission to partners.

Impaired Immune Response: Chronic poor hygiene can affect overall health and immune function, making the body less capable of fighting off infections, including STDs.

Transmission through Poor Practices: Sharing personal items like towels or razors without proper cleaning can potentially transmit infections. While not common, it adds another layer of risk, especially if cuts or abrasions are present.

Behavioral Correlation: Poor personal hygiene may correlate with other risky behaviors, such as inconsistent condom use or multiple sexual partners, further increasing the risk of STDs.

Neglected Tropical Diseases (NTDs)

There are high levels of neglected tropical diseases (NTDs) in South Asia, which are associated with poor hygiene women and girls have the additional burden of dealing with menstrual hygiene, which, if left ignored, also leads to infections and ill-health. Lack of resources and infrastructure, for example, gender-specific toilets at schools, places an additional burden on girls who are at increased odds of incurring hygiene-related problems and being subject to sexual violence perpetrated by teachers and male students.

Addressing the Problem

Education and Awareness

Education and awareness are vital to improving personal hygiene. Public health campaigns can help inform people about the importance of hygiene and the correct practices to maintain it. Schools, community centers, and healthcare providers can offer workshops and resources to educate individuals of all ages. Tailored approaches that consider cultural differences and specific community needs are essential for effective education.

To address the issue of poor personal hygiene among hotel workers and tandoor walas, several measures can be implemented:

Comprehensive Training: Regular training sessions on hygiene and food safety should be mandatory for all staff. Training should include proper handwashing techniques, the use of gloves, and the importance of maintaining personal cleanliness.

Improved Facilities: Employers should ensure that all workers have access to adequate handwashing stations, clean uniforms, and personal protective equipment like gloves and hairnets.

Strict Enforcement: Regular inspections and strict enforcement of hygiene standards are necessary. Establishments that fail to comply should face penalties, including fines and temporary closure.

Awareness Campaigns: Public health organizations should run awareness campaigns to educate both workers and consumers about the risks of poor hygiene and the importance of food safety.

Incentives for Good Practices: Providing incentives for workers who adhere to hygiene standards can motivate others. Recognition programs, bonuses, and other rewards can encourage better practices.

Cultural Shift: Efforts should be made to shift cultural attitudes towards hygiene through education and public awareness initiatives. This can include school programs, community workshops, and media campaigns.

Maintenance of Menstrual and genital hygiene

Maintaining good personal hygiene can help reduce the risk of infections and improve overall genital health. Tampons, pads, and other sanitary items should be changed on a regular basis. Hand washing should be done both before and after changing any sanitary goods.

Regular Cleaning: Vaginas are self-cleaning, therefore cleaning them with soap might upset the natural bacterial balance and result in diseases. Cleaning the vulva, or external area of the vagina, with a light soap and water should only be necessary once a day.

When cleaning an uncircumcised penis, one should carefully draw back the foreskin and use warm water or soap to wash below.

Proper Drying: Ensure the area is thoroughly dried to prevent fungal growth.

Safe Practices: Avoid sharing personal items that come into contact with the genital area.

Protective Measures: Use condoms and practice safe sex to reduce the risk of STD transmission.

Regular Check-Ups: Get regular medical check-ups and STD screenings, especially if sexually active with multiple partners.

Improving Access

Improving access to hygiene products and facilities is crucial, especially in underserved communities. Governments and non-profit organizations can collaborate to provide essential hygiene products such as soap, toothpaste, sanitary pads, and clean water. Mobile hygiene units offering showers and laundry services can make a significant difference for the homeless population. Ensuring that public restrooms are clean and accessible can also help address hygiene issues in urban areas.

Mental Health Support

Addressing mental health issues is critical in the battle against poor personal hygiene. Mental health services should be readily available and accessible, and there should be no stigma associated with seeking help. Integrating mental health support into primary care can help identify individuals struggling

with hygiene due to mental health conditions and provide them with the necessary support and resources.

Community Support

Community programs can play a vital role in improving personal hygiene. Initiatives such as providing free hygiene kits, setting up community showers, and organizing educational workshops can help those in need. Community support groups can also offer a safe space for individuals to discuss their challenges and receive encouragement and assistance.

School Programs

Schools are in a unique position to instill good hygiene practices in children from an early age. Integrating hygiene education into the school curriculum can ensure that children understand the importance of personal hygiene and how to maintain it. Schools can also provide facilities and resources, such as handwashing stations and hygiene supplies, to encourage good practices.

Tips for maintaining good hygiene

The following are useful pointers for developing a hygiene routine: Develop it into a habit: A new habit can be incorporated into daily life with consistent practice. Focus on only one thing at a time and practice it until it comes naturally.

Set reminders: One excellent technique to make sure you don’t forget anything is to use the notes app on your phone.

Employ incentives: Children can be highly motivated to maintain their hygiene by using a sticker chart.

Invest in high-quality toiletries: Using scented items can motivate some people to follow through on their hygiene regimen.

Conclusion

Poor personal hygiene is a multifaceted problem with significant implications for individual and public health. It is driven by a variety of factors, including lack of education, socioeconomic challenges, mental health issues, busy lifestyles, cultural differences, and homelessness. The consequences of poor hygiene range from health problems and social stigma to public health risks and workplace issues.

Addressing this problem requires a comprehensive and multi-pronged approach. Education and awareness campaigns can inform people about the importance of hygiene and how to maintain it. Improving access to hygiene products and facilities, particularly for underserved communities, is crucial. Mental health support must be integrated into healthcare systems to help those struggling with hygiene due to psychological conditions. Community programs can provide direct assistance and support, and school programs can instill good hygiene practices in children from an early age.

By addressing these areas, we can improve individual health outcomes, reduce social stigma, and enhance public health. It is a collective responsibility that involves individuals, communities, healthcare providers, educators, and policymakers working together to create a healthier and more hygienic society.

By Dr. Ramsha Zafar
Physician/Internal Medicine

Poor Personal Hygiene Spread Diseases
ناقص ذاتی حِفظانِ صحت سے بیماریاں پھیلتی ہیں۔
ख़राब व्यक्तिगत स्वच्छता से बीमारियाँ फैलती हैं

Good hygiene is the passport to the land of good health.

Introduction:

The term “personal hygiene” describes the upkeep of bodily cleanliness. Given that access to the infrastructure that supports hygiene, such as soap, water, and sanitation, makes hygiene a structurally created personal concern at the individual level. According to a classist power system that guarantees capital and power accrue at the top and places the middle and lower-middle classes at the bottom of society, people’s access to this infrastructure depends on their class standing. Therefore, those from class positions without access to sufficient infrastructure supporting hygiene are the ones who lack hygiene and are therefore unable to engage in hygienic behaviors that would enable them to maintain decent hygiene. This takes the form of some traits that are indicators of social status, such as body odor and dirty appearance.

Poor personal hygiene arises from either intentional or unintentional neglect of your body’s cleanliness and health requirements. Your body begins to look unhealthy, you experience unwanted health concerns, and your overall well-being is affected.

Personal hygiene is a fundamental aspect of human health and well-being, yet it remains a significant problem in the modern world. Poor personal hygiene can lead to a myriad of health issues, social stigmatization, and broader public health concerns. While the prevalence and impact of poor personal hygiene are often more severe in underdeveloped countries, developed nations are not immune to this problem. This article explores the reasons behind poor personal hygiene, its consequences, and potential solutions to mitigate this pervasive problem.

Why hygiene matters

Personal Hygiene behavior and practices play a major role in health promotion and disease prevention. Socio-demographic, behavioral, and psychological factors sway a person’s overall adaptation of good practices. Disease burden leading to loss of productivity and its influence on the economy cannot be overstated. As medical professionals come in contact with a large number of people, they carry the potential to be super-spreaders in disease outbreaks. Thus, it is of utmost importance that medics and paramedics maintain hygiene to the highest standards.

Personal Hygiene matters when it affects your life or that of the people around you. In the most extreme cases, when left unattended, poor hygiene can breed disease that can affect you or others. For example, not washing your hands after you use the toilet, handle food, or touch dirty surfaces can spread bacteria, viruses, and parasites. These can lead to infections and diseases, like food poisoning, gastroenteritis, cold and flu, and hepatitis A — just to name a few.

Poor dental hygiene can lead to tooth decay and gum disease, which can also affect the heart. Not bathing can result in a skin condition called dermatitis neglecta and secondary infections.

An obvious lack of hygiene can also affect a person’s work and social life. Some companies have a hygiene policy in place for the protection of employees and company image, especially if you have a public-facing role. If you work in the food industry or in healthcare, proper hygiene is detrimental to the safety of everyone you’re in contact with.

Personal hygiene: it’s one of those delicate topics, but one that must be addressed. The effects of poor hygiene are far-reaching beyond the obvious health concerns. Failing to frequently wash your hands, brush your teeth, and take showers doesn’t just affect you. It affects everyone you interact with. So let’s talk about poor personal hygiene, its impact, and why we need to have daily routines to help keep our hygiene regimen headed in the right direction all the time.

As well as having negative social affects, poor hygiene and hand washing causes health problems. Poor hygiene can cause sickness and disease. Poor hygiene can also cause social rejection and may also lead to bullying, low confidence and low self-esteem.

Here are examples of both kinds.

• Poor personal hygiene:
  • not showering often
  • not brushing teeth
  • not washing hands before or after handling food
  • not washing hands after using the toilet

• Poor environmental hygiene:
  • not regularly cleaning areas that breed bacteria, like the kitchen and bathroom
  • leaving garbage sitting out
  • not cooking or storing food properly
  • not doing laundry often (clothing and sheets)

Here are some signs that are indicative of poor hygiene in yourself or someone else:

• Body Odor from not showering regularly
• unwashed or disheveled hair
• Bad Breath, food between teeth, or signs of tooth decay and gingivitis
• wearing soiled clothing
• dirty and untrimmed fingernails and toenails

Ways to have good hygiene

Here are some easy ways to practice good hygiene:

• Brush your teeth twice a day. Doing it when you get up and before you go to bed makes it easier to get into a routine. Remember: You only need to brush for 2 minutes for a good clean, so you can do it even if you’re short on time.
• Wash your body daily. A quick shower or bath is all you need, as long as you cover the important parts (Think: pits and private bits). If access to water is limited, use a damp cloth or sponge to wash your genitals, around your anus, under your arms, between any skin folds, and under your breasts.
• Wash your clothes and bedding regularly. Doing laundry once per week is sufficient, whether by machine or hand. If you need to re-wear clothing, a quick wash in the sink and hanging it to dry for the next day works fine. Keeping your body clean lets you extend the time between washing clothing and sheets.
• Wash your hands often. If COVID-19 taught us anything, it’s that washing our hands goes a long way in keeping us healthy and reducing the spread of illness. Remember to wash your hands before and after contact with shared, or potentially unsanitary or contaminated surfaces to protect yourself and others.
• Wipe properly after going to the toilet. Wiping properly after going to the toilet will keep underwear clean and unpleasant odors at bay. Always wipe front to back to keep bacteria away from the urethra to avoid urinary infections. Body wipes or a bidet work, too. (Though keep in mind that wipes can make life hard for sanitation workers. So if you don’t need them, it’s best to stick with TP). If pain or a disability makes it hard to wipe, consider a toilet paper aid.
• Wash your hair at least every 3 days. Most people don’t need to shampoo their hair more than daily. How often you should wash depends on how oily or dry your hair is, how much you sweat, and how much product you use. Every 2 to 3 days is fine for most people, but feel free to experiment by extending the time between washes. Bouncy shampoo commercial hair is nice, but a healthy scalp is the priority.

Poor Personal Hygiene Prevalence in Developing Nations

In underdeveloped nations, inadequate personal hygiene is frequently associated with limited access to fundamental resources and infrastructure. A lack of sanitary facilities, a scarcity of hygiene supplies, and an inadequate water supply are problems that many communities encounter. It becomes challenging, if not impossible, to maintain personal cleanliness in these circumstances.

Poor Personal Hygiene Prevalence in Developed Nations

The problems associated with inadequate personal hygiene are more complicated in modern nations. Hygiene problems are caused by a variety of variables, including lifestyle choices, cultural variations, mental health disorders, and socioeconomic inequality, even with the abundance of facilities available. A lack of attention to personal hygiene can also result from the fast-paced lifestyle of wealthy nations.

Reasons for Poor Personal Hygiene

Lack of Education

One of the primary reasons for poor personal hygiene is a lack of education. Many individuals are not adequately informed about the importance of maintaining hygiene and the practices necessary to achieve it. Education on personal hygiene is often inconsistent, with some people receiving comprehensive guidance while others receive little to none. Schools, parents, and community programs play a crucial role in disseminating information about hygiene practices, but gaps remain.

Alarming State of Personal Hygiene Among Hotel Workers and Tandoor Walas in Pakistan.

In Pakistan, the hospitality and food service industries are vital to the economy, providing employment and contributing significantly to the country’s cultural and culinary landscape. However, an ongoing issue that undermines these sectors is the poor personal hygiene of hotel workers and tandoor walas. This problem is particularly pronounced and poses serious health risks to customers. Common issues include:

Unclean Hands: Many workers neglect proper handwashing, leading to the handling of food with dirty hands. With those same unwashed hands, they knead the dough, embedding dirt and bacteria into every bite. Moreover, long nails caked with layers of dust and mud are a glaring testament to extremely poor hygiene.

Sweating: In hot kitchens, especially near tandoors, excessive sweating can lead to contamination if sweat drips into food or onto hands.

Lack of Handwashing Post-Toilet: A significant number of workers fail to wash their hands after using the toilet, resulting in the spread of harmful bacteria.

No Use of Gloves: Gloves are rarely used, and when they are, they are often not changed frequently enough to be effective.

Unsanitary Practices: Actions such as scratching the body, fingering the nose, or touching the face and then handling food are commonplace.

Unsecured hair can easily fall into customers’ food, compromising hygiene and customer satisfaction.

Health Risks

The health risks associated with these unhygienic practices are severe. Foodborne illnesses can easily spread through contaminated food, leading to outbreaks of diseases such as typhoid, cholera, hepatitis A, and gastroenteritis. The World Health Organization (WHO) estimates that unsafe food causes 600 million cases of foodborne illnesses globally each year, with developing countries like Pakistan being particularly affected due to poor hygiene standards.

Real-World Incidents

Several incidents in Pakistan highlight the dire consequences of poor hygiene. For instance, in Karachi, a popular local eatery faced a scandal after several customers fell ill due to food poisoning. Investigations revealed that kitchen staff, including the tandoor wala, were not following basic hygiene practices. Similar incidents have been reported in Lahore and Islamabad, where food establishments were temporarily shut down due to health code violations linked to poor worker hygiene.

Contributing Factors

Several factors contribute to the poor hygiene practices among hotel workers and tandoor walas in Pakistan:

Lack of Training: Many workers are not adequately trained in hygiene and food safety protocols. This is particularly true for tandoor walas, who often learn their trade informally.

Inadequate Facilities: Many food establishments do not provide adequate facilities for maintaining hygiene, such as sufficient handwashing stations and clean uniforms.

Cultural Attitudes: In some communities, there is a lack of awareness about the importance of personal hygiene in preventing disease transmission.

Economic Constraints: Low wages and long working hours can lead to worker fatigue and negligence in following hygiene practices.

Management Apathy: In some cases, the management of food establishments does not prioritize hygiene, focusing instead on cutting costs and increasing turnover.

A UNICEF report found that 22.2 million Pakistani residents do not have proper sanitation and toilets, in a country of 200 million; with around 10% of the population lacking such privileges, diseases like polio, XDR typhoid, diarrhea, hepatitis, and cholera take the center stage. These water-borne diseases lead to the death of nearly 94,000 people every year where 53,000, nearly 56.4%, of them are children under the age of 5

Socioeconomic Factors

Socioeconomic status is a significant determinant of personal hygiene. Individuals from lower socioeconomic backgrounds often struggle to access basic hygiene products such as soap, toothpaste, and clean water. Financial constraints can force people to prioritize other essentials over hygiene products, leading to inadequate personal care. Many people neglect brushing their teeth due to economic constraints, resulting in bad breath and dirty yellow teeth. The lack of soap also leads to infrequent bathing, causing a sweaty smell and an unpresentable appearance. These hygiene issues make it difficult for others to interact with them comfortably. Additionally, inadequate living conditions, such as overcrowded housing and lack of sanitation facilities, exacerbate the problem.

Mental Health Issues

Mental health conditions like depression, anxiety, and other psychological disorders can lead to neglect of personal hygiene. Individuals struggling with these conditions may lack the motivation or energy to perform routine hygiene tasks. People with mental health issues are often sent out of their homes as no one wants to be with them. They end up straying on the streets with no money, no home, and no resources for personal hygiene. This exacerbates their condition and further isolates them from society.

Furthermore, the stigma associated with mental health can prevent individuals from seeking the help they need, thereby perpetuating poor hygiene practices.

Busy Lifestyles

The fast-paced nature of modern life often leads to people prioritizing work and other activities over personal hygiene. Long working hours, demanding schedules, and the pressure to balance multiple responsibilities can result in hygiene being neglected. This issue is particularly prevalent in urban areas where the hustle and bustle of daily life can overwhelm individuals, leading to shortcuts in personal care routines.

Homelessness

Homelessness is a critical factor contributing to poor personal hygiene. Individuals who are homeless often lack access to basic hygiene facilities, such as showers and clean bathrooms. The transient and precarious nature of homelessness makes it challenging to maintain regular hygiene routines.

The Struggles of Maintaining Hygiene for Slum Dwellers in Pakistan and India

People living in jhuggis (slums) often lack access to essential facilities such as clean water, washrooms, shelter, and basic amenities. Their harsh living conditions make maintaining personal hygiene standards nearly impossible. These individuals, whose primary means of survival may involve begging, face numerous challenges in accessing sanitary resources. Without regular access to clean water, they cannot wash their hands or bathe regularly, increasing the risk of illness and infection. The absence of proper washrooms forces them to relieve themselves in unsanitary conditions, further compromising their health. Overcrowding in slums exacerbates these issues, as diseases can spread rapidly in close quarters.

Negligence or Indifference

Some individuals may not prioritize hygiene due to habits, depression, or lack of perceived importance.

The Hidden Health Risks of Street Food: A Closer Look at Hygiene Practices

In the bustling streets, people eagerly consume goolgappas, papri chat, dahi bhallas, and sweets, oblivious to the flies swarming around. Vendors, drenched in sweat under the scorching sun, prepare these delights with bare, grimy hands. Utensils are “cleaned” in a single, filthy bucket, reused from dawn to dusk without change. The water in this bucket turns murky and foul, yet serves both as a handwash and a cutlery cleaner. Hygiene is an afterthought as street food enthusiasts savor flavors, unaware of the invisible health risks lurking in every bite.

In the sweltering summer, vendors serve juices and goolas in grimy glasses, used by countless people without a single wash. Each sip carries the risk of disease as hygiene is blatantly ignored. The refreshing drinks become a cocktail of germs, endangering every consumer.

Poor Upbringing

Poor upbringing often correlates with poor personal hygiene habits, as individuals may not have been taught or encouraged to prioritize cleanliness and hygiene practices in their daily lives.

Unhygienic Habits: Spitting and Urinating on Roads

In underdeveloped countries, the bad habits of spitting on roads and urinating on the roadside are distressingly common. These unsanitary practices contribute to public health hazards and environmental pollution. Streets often reek with the stench of urine and spitting spreads diseases, making public spaces unpleasant and unsafe. The lack of proper sanitation facilities and public awareness exacerbates this issue.

Lice Infestation
Body lice infestation is quite uncomfortable and hazardous to your health. These lice are small insects that live and lay eggs in clothing and bedding. They also feed on the residues found on your skin.

Lice tend to colonize in your armpits and groin, as these are the areas with a lot of humidity. So, it’s important to take regular baths, and wear clean, fresh clothes each day to avoid any lice infestation.

Avoid doing the following to stave off any such infestation:

Infrequent showering
Not changing your bedding at least every week
Not washing your clothes very well
Wearing dirty and/or smelly clothes

The Disadvantages of Poor Hygiene

Adverse Impact on Your Social Life
Poor physical hygiene leads to visible markers of poor health in your body. This makes others see you as a source of infections and diseases. For example, excessive coughing and sneezing without any attempt to cover your mouth, and emitting foul odors will lead to people avoiding you. They also won’t tell you what’s wrong, because each person’s hygiene is his/her responsibility.

It Affects Your Presentation
Your presentation is more than your communication skills – it’s the total package. Poor hygiene can negatively affect your presentation. It makes people perceive you differently and they may even make wrong judgments about your abilities and performance.

Adverse Impact on Your Career
Having poor personal hygiene can hinder your career advancement as well. Persons with such issues may have difficulties being promoted or earning pay increases. Furthermore, you may be subject to:

Jokes about your poor hygiene that damage your reputation at work
Lower self-esteem and confidence in yourself
Concerns about the possibility that you may pass contagious illnesses to other members of your team.

Poor Personal Hygiene Dampens Your Romantic Life
No one wants to get close to someone with body odors, and who may be sick and/or contagious. So matters of lax personal hygiene will be a block to your ability to form a deep and meaningful romantic relationship.

Our grooming routines not only make a statement about us, but also directly affect underlying health.

On a basic level, personal hygiene means cleaning and grooming your body, nails, hair, and teeth. It also extends to your clothing and the tools that you use for cleaning and grooming. Keeping spaces like your bathroom clean is often an extension of good personal hygiene.

What many people don’t often consider is how personal hygiene can affect numerous aspects of your life. It may improve health and limit the risk of illness or disease. It can also make you feel better about yourself, improve your work life, and make you more confident and approachable in social settings.

The effects go beyond physical health and socializing. Poor hygiene can cause or exacerbate depression or anxiety problems and make a person isolate themselves.

Many people learn oral hygiene and bathing habits at a young age and shaving, laundry, and other practices when they get older. Because of this progression, poor personal hygiene is a sensitive topic. You may be reluctant to bring up issues because you do not want to offend the person or criticize them for not doing something they should have learned at a young age.

However, this is an essential issue because hygiene choices have a profound impact on quality of life as well as mental and physical health. Here is a closer look at how proper and poor hygiene can affect your life.

Improves Overall Health and Wellness
Personal hygiene helps you protect against certain diseases. It also brings a higher level of overall health and wellness. Your immune system and other essential systems within your body can function better if they are not being bombarded by preventable infections caused by poor hygiene practices.

Also, proper handwashing can limit the danger of contracting a cold or flu virus. Your hygiene practices can also affect those around you. If you are preparing food, caring for children, or working on surfaces used by others, unwashed hands may transmit bacteria, a virus, or other illnesses to those who are close to you.

Improves Personal and Professional Relationships
Poor hygiene may cause issues in social settings. Many people will find it unpleasant to be around someone with a bad body odor or breath. Others may feel that being around someone with inadequate hygiene will reflect poorly on their image in a workplace or social group.

If you have poor hygiene, this avoidance dynamic can make career advancement difficult. Furthermore, it can isolate you both at work and socially.

Those with good hygiene, however, will not experience this barrier when trying to connect with people socially or cooperate with co-workers professionally.

Social and Professional Acceptance
Personal cleanliness alone will not get you more friends or make a job promotion more likely. However, you might consider it a prerequisite for social and professional acceptance. Whether it is fair or not, good hygiene will help create an acceptable image with friends, professional peers, and decision-makers at work. Without the distraction of poor hygiene, making both social and professional connections easier.

Effects of Poor Personal Hygiene
Poor hygiene affects your outward appearance. Stained clothes, ungroomed hair, long, dirty nails, and oily, patchy skin are signs of a lack of personal care.

People often associate poor hygiene with unpleasant body odor, bad breath, or visible signs of dirt. Some people may also consider rashes, oily skin, or other preventable or treatable appearance flaws as examples of poor hygiene.

Here are some potential effects of poor hygiene.

Depleted Mental Health
Poor hygiene relates to mental health in two ways. First, an unclean appearance can cause social and professional isolation. Feelings of loneliness and failure caused by this isolation can harm your mental health and lead to chronic depression or social anxiety.

In some cases, the progression of poor hygiene and mental health issues gets reversed. People with depression may cease caring about hygiene practices. In these instances, the lack of cleanliness is a symptom of a mental disorder, not its cause.

Increased Health Risks
Poor hygiene can increase the risk of illness or disease. These are not diseases that you typically catch by chance, but rather are illnesses that come from a lack of personal cleanliness.

Many diseases that affect the skin surface and gastrointestinal tract come from poor bathing practices, wearing dirty clothes, and not washing your hands before handling food. The CDC’s list of hygiene-related illnesses also includes parasitic fungal infections that will remain in or on your body until they are treated.

Lack of Self-Esteem
Self-esteem and physical appearance are closely related to each other. How you care for your body and appearance is closely connected to your self-image. If people avoid you at work or in social situations because of poor hygiene, your self-esteem will likely suffer.

This can lead to a downward spiral with poor self-esteem, causing a why-bother view of personal hygiene and only leading to further avoidance and isolation.

Poor Physical Appearance
A lack of hygiene can also lead to a poor physical appearance. In some cases, an improper bathing regimen may cause skin issues or hair loss. You can reverse these physical appearance problems if you find an effective hair loss treatment or skin medication.

Such treatments can become a part of your hygiene routine going forward. By personalizing your regimen in this way, you ensure that you perform basic hygiene practices and also address specific issues needed for better mental and physical health. 

Disclaimer:
This article is for informational purposes only and should not be taken as a medical advice. While we hope you find this content useful, it is only intended to serve as a starting point. Your next step is to speak with a qualified, licensed health professional who can provide advice tailored to your individual circumstances. Nothing in this article, nor in any associated resources, should be construed as financial, medical or legal advice. Furthermore, while we have made good faith efforts to ensure that the information presented was correct as of the date the content was prepared, we are unable to guarantee that it remains accurate today.

Neither Sada-e-Watan (Melody Media Productions) nor its sponsoring partners make any warranties or representations as to the accuracy, applicability, completeness, or suitability for any particular purpose of the information contained herein.

By Dr. Ramsha Zafar
Physician/Internal Medicine

Pakistan’s Healthcare Crisis
پاکستان میں حِفظانِ صحت کا بُحران
ُपाकिस्तान का स्वास्थ्य सेवा संकट

“Healthy citizens are the greatest asset any country can have.”
“Physical fitness is not only one of the most important keys to a healthy body, it is the basic of dynamic and creative intellectual activity.” 
“There is no health without mental health; mental health is too important to be left to the professionals alone, and mental health is everyone’s business.”
“So many people spend their health gaining wealth, and then have to spend their wealth to regain their health.” 
“If your health is poor, you cannot enjoy life to the fullest, no matter how successful and wealthy you are.”
God has given us life as a priceless gift, hence we must take good care of our body, mind and soul.”

Good Health

Good health may be the most valued attribute of life. Daily, we express our concern for others by inquiring about their health and wishing them well. Material concerns are overshadowed when our own health is threatened; good health is recognized as essential for the pursuit of happiness. We all want to live a long life with ‘good health’. But what does that really mean? Clinicians often define ‘good health’ as the absence of disease. Indeed, modern biomedical research focuses on finding remedies for specific ailments, that, when absent, will yield ‘good health’. We can be healthy if we do not have a recognized disease but can also be healthy if we can manage a condition and look to live life to the full. Focusing on good health and what makes us well, rather than on bad health and what makes us sick, moves us to consider assets rather than deficits. People and communities have assets which determine their health, and these can be built on and strengthened. Looked at from this point of view we can see health as a public good, as something that everyone should work towards and the best attainable health as a human right.

Health Care Crisis in Pakistan

A healthcare system is a structured assembly of resources and personnel aimed at delivering healthcare services tailored to meet the needs, goals, and satisfaction of a nation’s populace. With 195 countries worldwide, each endeavor to enhance health and lessen disease burden within the framework of global healthcare. Four prevalent models exist globally, amalgamating public and private facilities, and offering a compelling rationale for healthcare system operation.

Pakistan, the fifth most populous country globally with nearly 225 million people, faces numerous developmental challenges impacting its healthcare system. Pakistan is positioned at 122nd among 190 nations in the World Health Organization’s performance assessment.

Although there has been an increase in life expectancy from 61.1 years in 1990 to 65.9 years in 2019, Pakistan ranks 154th among 195 countries in the Healthcare Access and Quality Index, as per a Lancet study. Despite improvements since 1990, with the Healthcare Access and Quality index rising from 26.8 to 37.6 in 2016, Pakistan still ranks 164th out of 188 countries in terms of the United Nations Sustainable Development Goals and their attainability by 2030.

IN Pakistan, the most important aspect of well-being is also the most neglected. In its 76-year history, Pakistan’s successive governments — civil and military — have not made health a priority. It is woeful that discussions around health policy receive little to no space in the agenda of political parties. And while the media tends to report heavily on specific heath-related crises — such as the spread of polio and child deaths in Thar — meaningful debate around the causes of abysmal health services is virtually absent.

The result of this apathy is appalling health indicators. The infant mortality rate in Pakistan is 68 per 1,000 births, compared to 38 in India and eight in Sri Lanka. Life expectancy in Pakistan for women is 67 years, as compared to 73 in Bangladesh and 78 in Thailand. The maternal mortality rate in Pakistan is 170 per 100,000 live births, in contrast to 30 in Sri Lanka and 20 in Thailand.

The indifference of Pakistan’s government to health is reflected in the fact that Pakistan spends a mere 0.9pc of its GDP on health. Only two countries, the Democratic Republic of Congo and Bangladesh, have a lower ratio of GDP to health spending.

Another indication of the government’s neglect is the fact that public expenditure on health accounts for a little over one-third of Pakistan’s total health expenditure. Pakistan’s citizens rely heavily on private healthcare, which they avail primarily through out-of-pocket payments. This is in stark contrast not only to the developed West, but also to developing countries such as Thailand and Sri Lanka, where public expenditure accounts for most of health spending. The poor quality of government provided health services in Pakistan is the major reason behind the large role played by the private sector in healthcare.

Beveridge model

Pakistan has maintained the British healthcare system, known as the “Beveridge model,” since its partition. This system operates with primary, secondary, and tertiary levels of healthcare.

Primary Health Care

Primary healthcare in Pakistan comprises basic health units, dispensaries, Maternal & Child Health Centers (MNCH), and private clinics at the community level. In Sindh, primary healthcare is supported by the government but managed by external private and non-government organizations like People’s Primary Healthcare Initiative (PPHI Sindh), Shifa Foundation, and HANDS. The government’s primary healthcare system is bolstered by 100,000 Lady Health Workers (LHWs) and an increasing number of community midwives (CMWs), among other community-based workers.

Secondary Health Care

Secondary healthcare includes tehsil and district hospitals, both government-run and some private hospitals. Treatment at government hospitals is provided free of cost.

Tertiary Health Care

Tertiary healthcare encompasses private and government hospitals equipped to perform minor and major surgeries. Most cities have two or more tertiary hospitals, including Class “A” military hospitals, offering free healthcare services and 24-hour emergency care.

Other Health Services

The government’s “Sehat Sahulat Program” aims to provide basic medical care to the lower class without financial risks. The Maternal and child health centers run by lady health workers, focus on family planning and reproductive health.

Quackery System

In Pakistan, the quackery system poses a significant challenge to public health and safety. Quackery refers to the practice of individuals falsely claiming to have medical expertise or qualifications and providing unauthorized or ineffective treatments to unsuspecting patients. This system thrives due to various factors, including limited access to qualified healthcare professionals, low health literacy levels, and cultural beliefs.

Quacks often operate in both urban and rural areas, setting up clinics or visiting patients’ homes, offering treatments for a wide range of medical conditions. They may prescribe inappropriate medications, administer injections without proper sterilization, or perform invasive procedures without adequate training, putting patients at risk of serious harm.

Despite efforts by regulatory authorities to crackdown on quackery, enforcement mechanisms are often weak, allowing quacks to continue practicing with impunity.

Collaboration between the Public and Private Sectors

Collaboration between the public and private sectors aims to provide optimal care. However, the healthcare burden has strained the delivery of quality services, particularly within the government setup. Over the past decade, healthcare expenditure has remained below the recommended threshold by the World Health Organization, with only 0.5-0.8% of GDP allocated to healthcare.

Health Infrastructure

Pakistan boasts a diverse healthcare landscape. It incorporates government facilities, para-statal health organizations, private sector entities, civil society initiatives, and philanthropic endeavors. Additionally, alternative and traditional healing methods enjoy widespread popularity across the country.

In 2011, Pakistan underwent significant constitutional reform through the 18th Amendment, leading to the dissolution of the Ministry of Health. Consequently, powers were decentralized, granting provinces greater authority over health infrastructure and financial matters.

The country’s health system is characterized by discrepancies in healthcare delivery between urban and rural areas, as well as a workforce imbalance, with insufficient health managers, nurses, paramedics, and skilled birth attendants in the periphery areas. Healthcare challenges in Pakistan also include inadequate budgetary allocation, shortage of medical professionals, substandard physical infrastructure, rapid population growth, counterfeit and expensive medicines, shortage of paramedical personnel and presence of unlicensed practitioners.

Pakistan faces numerous health challenges from infectious diseases to non-communicable ailments. Pakistan grapples with a multifaceted health crisis exacerbated by various socio-economic factors.

Challenges Encountered in Pakistan’s Health Sector

Infectious Diseases

Infectious diseases constitute a significant component of the healthcare crisis in Pakistan. These diseases, ranging from endemic infections like tuberculosis and hepatitis to periodic outbreaks such as dengue fever and polio, exert a profound impact on the Pakistani population.

One of the primary reasons infectious diseases exacerbate the healthcare crisis in Pakistan is the country’s dense population combined with inadequate healthcare infrastructure. Limited access to clean water, proper sanitation, and healthcare facilities facilitates the spread of infectious agents, leading to heightened disease transmission rates. Additionally, factors such as poverty, overcrowding, and insufficient vaccination coverage contribute to the persistence and resurgence of infectious diseases.

Furthermore, the emergence of antibiotic-resistant strains of pathogens presents a daunting challenge to disease control efforts in Pakistan. Misuse and overuse of antibiotics, coupled with inadequate infection prevention and control measures results in the development and spread of drug-resistant infections, further complicating treatment and management.

Acute respiratory infection (51%)

Children, especially malnourished ones, are most vulnerable to ARI. The National ARI Control Programme initiated in 1990 halved the death rates among children under five in Islamabad within three years. In 2006, there were 16,056,000 reported ARI cases, with 25.6% affecting children under five.

Viral Hepatitis (7.5%)

Hepatitis B and C epidemics are significant in Pakistan due to the overuse of therapeutic injections and syringe reuse in private healthcare. Pakistan’s Hepatitis B prevalence is estimated at 2.5%. The prevalence of Hepatitis C infection is 11.55% among adults. Pakistan stands second globally in terms of hepatitis C virus (HCV) infections, with approximately one in every 10 Pakistanis already affected.

Tuberculosis

Tuberculosis (TB) is an infectious disease caused by bacteria, primarily affecting the lungs. Pakistan’s TB prevalence is 348 per 100,000, with 276 new cases per 100,000 population. The country ranks fourth globally in multidrug-resistant TB prevalence due to delayed diagnosis and improper treatment.

Malaria (16%)

Malaria disproportionately affects lower-class individuals in Pakistan, with unsanitary conditions providing breeding grounds for mosquitoes. Reported cases surged after the 2022 floods, reaching over 1.6 million cases in 2022.

Coronavirus

As of November 2020, Pakistan reported around 326,431 COVID-19 cases, resulting in approximately 7,000 deaths, with older individuals being the most affected. The transmission of the coronavirus in Pakistan occurs primarily through respiratory droplets when an infected person coughs, sneezes, or talks. Close contact with infected individuals and touching surfaces contaminated with the virus also contribute to transmission. Factors such as crowded living conditions, insufficient ventilation, and limited access to healthcare further facilitate the spread of the virus in communities.

Cholera

Cholera, a highly contagious bacterial infection, remains a significant public health concern in Pakistan. The country has experienced outbreaks of cholera, particularly during natural disasters such as floods, where contaminated water sources exacerbate the spread of the disease.

Dengue

Dengue became endemic in Pakistan after its first reported case in 1994, with outbreaks occurring periodically. The spread of dengue fever in Pakistan is fueled by factors such as urbanization, climate change, and inadequate vector control measures, leading to increased mosquito breeding and transmission. Lack of public awareness and limited healthcare resources further contribute to the disease’s prevalence.

Measles

Measles transmission in Pakistan is fueled by factors such as low vaccination coverage, especially among vulnerable populations, inadequate healthcare infrastructure, and challenges in reaching remote areas with vaccination campaigns. Additionally, overcrowded living conditions and limited access to clean water and sanitation contribute to the virus’s rapid spread.

Poliomyelitis

Pakistan and Afghanistan remain the only two countries with endemic wild poliovirus type 1 as of 2023.The spread of polio in Pakistan is primarily attributed to challenges in vaccination coverage, including resistance to vaccination campaigns due to misinformation and misconceptions, inadequate access to healthcare services in remote and conflict-affected areas, and difficulties in reaching high-risk populations. Additionally, the poliovirus can easily spread through contaminated food, water, and direct contact with infected individuals, particularly in communities with poor sanitation and hygiene practices.

HIV/AIDS

The spread of HIV/AIDS in Pakistan is driven by various factors, including inadequate awareness and education about the disease, stigma and discrimination towards affected individuals, limited access to healthcare services, including testing and treatment, high-risk behaviors such as unprotected sex and injecting drug use, and socio-economic disparities.

Infectious diseases not only exact a toll on individual health but also impose a significant economic burden on Pakistan’s healthcare system and society at large. Moreover, infectious disease outbreaks can disrupt economic activities, trade, and tourism, exacerbating poverty and hindering socio-economic development.

Non-communicable diseases (NCDs)

Non-communicable diseases (NCDs) pose a significant public health challenge in Pakistan, contributing to a substantial burden of morbidity and mortality. Common NCDs include cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases. Factors driving the prevalence of NCDs in Pakistan include urbanization, sedentary lifestyles, unhealthy dietary habits, tobacco use, and air pollution.

Cancer

According to recent studies, the five most common malignancies in Pakistan are breast cancer (24.1%), oral cavity (9.6%), colorectal (4.9%), esophagus (4.2%), and liver cancer (3.9%).The majority of deaths in Pakistan were reported to be caused by breast cancer. Pakistan has the highest rate of breast cancer among all Asian countries, with roughly 90000 new cases diagnosed each year, of which 40000 die. Young women typically come with advanced-stage breast cancer, which has a detrimental impact on prognosis. Oral cavity and gastrointestinal malignancies remain exceedingly frequent in both genders. Lung and prostate cancers are far less common. Ovarian cancer also has a high incidence.

Inadequate Family Planning

Family planning programs in Pakistan face several challenges, including limited access to contraceptive services, and cultural and religious barriers. Additionally, conservative social norms and gender inequalities may hinder discussions and decisions related to family planning.

Maternal Mortality Ratio

The maternal mortality ratio in Pakistan stands at 154 per 100,000 live births as of 2020. Notably, it’s 26% more elevated in rural regions compared to urban areas. As per the 2019 Pakistan Demographic Health Survey, obstetric hemorrhage accounts for 41% of maternal deaths in the country, while hypertensive disorders contribute to 29% of these fatalities.

Role of Nutrition in Child Health

Nutrition plays a pivotal role in child health, yet both lack and excess poses significant challenges. Insufficient nutrition can lead to stunted growth, weakened immunity, and cognitive impairments, contributing to a child health crisis. Conversely, over-nutrition, often linked with excessive calorie intake and poor dietary choices, increases the risk of obesity, diabetes, and cardiovascular diseases from a young age.

Environmental threats

Environmental hazards such as ecosystem degradation, deforestation, accelerated industrialization, advanced technologies, vehicle emissions, and evolving lifestyles marked by excessive reliance on refrigeration, air conditioning, cosmetics, fragrances, and deodorants, contribute to the amplification of the greenhouse effect. This amplification is driven by the emission of gases such as CFCs, SO2, and NO2, resulting in ozone depletion in the stratosphere and heightened levels in the troposphere. These factors collectively lead to environmental pollution, global warming, and a rise in sea levels, posing imminent threats to both human and aquatic life. Droughts exacerbate health risks, including food insecurity, malnutrition, anemia, night blindness, and scurvy. Meanwhile, escalating temperatures heighten the threat of heatstroke, malaria, dengue fever, respiratory illnesses, and cardiovascular diseases.

In 2022, Pakistan experienced a devastating illustration of the health impacts of climate change through widespread flooding. This event submerged approximately one-third of the nation, impacting 33 million individuals, with children constituting half of the affected population. The floods inflicted severe damage on water infrastructure across the affected regions, compelling over 5.4 million people to depend solely on polluted water sources such as ponds and wells for their daily needs.

Lack of Quality Medical Education

Institutions responsible for medical, dental, and nursing education lack adequate resources and staffing. Medical graduates should be mandated to serve in rural areas for a year to address healthcare disparities. While community-oriented medical education is widespread in Pakistan, graduates need further orientation to instill a sense of commitment to their communities. Public health education requires more attention from policymakers and professionals to meet international standards.

Research in the Health Sector

Medical research lacks interest and focus, hindering scholars’ efforts to keep pace with global advancements. Research is inconsistently integrated into undergraduate curricula across medical colleges. Postgraduate students lack adequate training in writing medical research papers, presenting a challenge to producing high-quality research.

Human Resource Development

Human resource development in the health sector does not align with demand-supply dynamics. Priority should be given to in-service refresher training to enhance personnel skills. Advanced nursing services must evolve to meet community health needs and future challenges. Female nurses face social and moral threats in male-dominated environments, necessitating conducive work environments. The recruitment of male nurses should be considered to alleviate the challenges faced by female nurses. Salary packages and incentives for healthcare professionals do not match market rates, leading to a brain drain. According to the Pakistan Medical and Dental Council (PMDC), there are 118,160 registered doctors, resulting in a population/doctor ratio of 1,310. The number of registered dentists is 6,761, with a population/dentist ratio of 25,297. The total registered nurses are 33,427, leading to a population/nurse ratio of 4,636. This data underscores the scarcity of healthcare professionals in Pakistan, requiring urgent attention.

Population Explosion

The burden of an overwhelmingly growing population and its impact on socio-economic development is evident through several concerning health indicators:

• Population quadrupled since 1947, reaching 156 million.
• Population doubling time stands at 37 years, with the current growth rate recorded at 1.86%.
• Unmet family planning needs remain high at 33%.
• Total Government expenditure on health per capita is only 4%.
• The contraceptive prevalence rate remains at 34%.
• Alarmingly, the rate of low birth weight stands at 37%, indicating potential health risks for newborns and future generations.

Future of Public Health

The future of public health requires concerted efforts from public health agencies, policymakers, and academic institutions to address key areas and enhance the quality of life for all citizens:

Medical Care: Enhancing access to quality medical services and promoting preventive care initiatives.

Biomedical Research: Investing in research to drive innovations in healthcare and disease prevention.

Strategic Planning: Developing comprehensive strategies to address public health challenges effectively.

Health Disparities Elimination: Implementing measures to reduce disparities in healthcare access and outcomes among different population groups.

Advances in Information Technology: Leveraging technology for data management, surveillance, and healthcare delivery.

Biotechnology: Harnessing biotechnological advancements for medical breakthroughs and disease control.

Health Services Regulation: Enforcing policies for the planning, development, and regulation of healthcare services and workforce.

Food and Drug Regulation: Ensuring the safety and efficacy of food and drug products through effective regulation.

Environmental Pollution Control: Implementing measures to mitigate environmental hazards and protect public health.

International Collaboration: Strengthening international cooperation and agreements for disease control and health information exchange.

Community Health Services Evaluation: Conducting independent evaluations to assess the effectiveness and quality of community health services.

Consumer Representation: Including diverse community voices in policymaking to address cultural, racial, and linguistic disparities and protect vulnerable populations.

Data Collection and Management: Improving systems for collecting, analyzing, and disseminating health-related data and resources.

Healthcare Financing: Developing sustainable healthcare financing mechanisms, including health insurance, to ensure universal access to care.

Workplace Safety: Promoting ergonomic practices and safety measures to protect the health and well-being of workers.

By prioritizing these areas and fostering collaboration across sectors, we can build a stronger foundation for public health and improve outcomes for communities worldwide.

Vaccination: Certain vaccines are obligatory for individuals residing in Pakistan, encompassing the Polio vaccine, BCG for childhood tuberculosis, Pentavalent vaccine (comprising DTP, Hepatitis B, and Hib) for protection against Diphtheria, Tetanus, Pertussis, Hepatitis B, Hib pneumonia, and meningitis, along with the Measles and Rotavirus vaccines.

Foreign Aid

Pakistan urgently requires foreign assistance from various organizations, encompassing financial aid, equipment, and cutting-edge AI technology, to combat its prevailing health crisis. The influx of resources is vital to bolster healthcare infrastructure, enhance treatment capabilities, and streamline diagnostic processes. With the integration of AI technology, Pakistan can significantly improve disease detection, treatment planning, and healthcare management systems, thereby augmenting the effectiveness and efficiency of its healthcare sector. By fostering international partnerships and leveraging technological advancements, Pakistan can emerge from its health crisis with strengthened resilience and enhanced capacity to address the healthcare needs of its populace.

Conclusion

Good health may be the most valued attribute of life. Daily, we express our concern for others by inquiring about their health and wishing them well. Material concerns are overshadowed when our own health is threatened; good health is recognized as essential for the pursuit of happiness.

The health crisis in Pakistan demands urgent attention and comprehensive solutions. With a burgeoning population, inadequate healthcare infrastructure, and limited access to essential services, the country faces multifaceted challenges. High rates of maternal and child mortality, infectious diseases, and non-communicable illnesses underscore the urgent need for improved healthcare delivery, strengthened public health systems, and increased investment in preventive measures. Addressing socio-economic disparities, enhancing health education, and promoting healthy lifestyles are essential to any sustainable solution. Moreover, tackling environmental degradation, water and food security issues and climate change impacts are imperative to mitigate future health risks. Collaborative efforts between the government, healthcare providers, civil society, and international partners are essential to address the root causes of the health crisis and ensure the well-being of all Pakistanis. A concerted, multi-sectoral approach is crucial to overcoming these challenges and building a healthier future for the nation.