Introduction Resistant strains of bacteria are rapidly emerging with increasing inappropriate use of antibiotics rendering them less efficacious. Self-purchasing of antibiotics particularly for viral infections is a key driver of inappropriate use, especially in lower- and middle-income countries. There is a particular issue in countries such as Pakistan. Consequently, there is a need to assess current rates of self-purchasing especially for reserve antibiotics to guide future policies. Aims Assess the extent of current antibiotic sales without a prescription in urban areas of Pakistan. Methodology A multicenter cross-sectional study was conducted in different areas of Punjab, Pakistan using Simulated Client technique. The investigators demanded different predefined antibiotics from WHO AWaRe groups without prescription. Three levels of demand were used to convince the pharmacy staff in order to dispense the antibiotic without a prescription. A data collection form was completed by simulated clients within 15 min of each visit. Results Overall 353 pharmacies and medical stores were visited out of which 96.9% pharmacies and medical stores dispensed antibiotics without demanding a prescription (82.7% at demand level 1 and 14.2% at demand level 2), with only 3.1% of pharmacies refusing to dispense antibiotics. The most frequently dispensed antibiotic was ciprofloxacin (22.1%). Surprisingly, even the reserve group antibiotics were also dispensed without a prescription. In only 25.2% visits, pharmacy staff guided patients about the use of antibiotics, and in only 11.0% pharmacists enquired about other medication history. Conclusion Currently, antibiotics are easily acquired without a legitimate prescription in Pakistan. There is a need for strict adherence to regulations combined with a multi-dimensional approach to enhance appropriate dispensing of antibiotics and limit any dispensing of WHO restricted antibiotics without a prescription.

Due to long duration of treatment and use of several agents, tuberculosis can lead to poor health related quality of life among patients. Objective. The present study was designed to assess health related quality of life among pulmonary tuberculosis patients in Pakistan. Methodology. A descriptive cross-sectional study design was used. SF-36 was self-administered to a sample of 382 pulmonary tuberculosis patients receiving self-administered or directly observed types of treatment, in baseline, initial, or continuous phase of treatment. After data collection, data was cleaned, coded, and statistically analyzed using SPSS version 21.0. Results. The results of the current study highlighted a significant impact on several domains of HRQoL of pulmonary TB patients. Highest HRQoL scores had been observed for the domain of physical functioning (60.03, ±25.779) whereas lowest HRQoL scores were observed for the domain of general health (34.97, ±14.286) perceptions of TB patients followed by bodily pain (43.40, ±24.594). Conclusion. The results of the present study concluded that TB patients had poor HRQoL in spite of the new therapeutic strategies and free availability of medicines. The disease had a negative impact on HRQoL of TB patients across all domains.

*Objective: The study aimed to document the state of insomnia management at community pharmacies in Pakistan. Methods: A cross-sectional study was conducted at randomly selected 371 pharmacies in three cities of Pakistan. Simulated patient visits were performed to collect information on case management of insomnia in terms of history taking and patient counseling at community pharmacies. The data was coded, entered and analyzed by using SPSS Version 16. Kruskal-Wallis and Mann Whitney tests (p<0.05) were performed to find out differences. Results: The patients were mainly handled by salesman 83.8% (n=311), by pharmacist 3.5% (n=13) and pharmacy assistants 12.7% (n=47). The mean dispensing time was 1.11 minutes (SD=5.61) with the range of 0.5 -6 minutes. Of the 371 simulated patients who visited the pharmacies, 72.8% (n=270) subjects were given medicines and 24.3% (n=90) subjects were referred to the doctor for treatment of insomnia. 61.8% (n=193) of the subjects were given benzodiazepines, 35.6% (n=111) antihistamines and 2.6% (n=8) NSAIDs at community pharmacies in the three cities. The mean cost of treatment in case of insomnia was PKR12.7 (SD=10.13, median=10). Conclusions:The disease management of insomnia by community pharmacies in Pakistan is not appropriate. The overall process of history taking, medication counselling and referral practices at community pharmacies either located in rural or urban setting and irrespective of the provider type and location of pharmacies, in the three cities is limited.

Low health literacy is known to be a 'silent killer'. This can be tackled by closing the gaps between health messages and health messengers by using simplified language and including cultural appropriateness. The aim of this review paper was to systematically analyze the concept of health literacy, its measurement tools and related barriers along with interventions used to improve health literacy in developed and developing countries including Pakistan. A total of 54 studies were retrieved from databases related to health literacy among which 33 studies were from developed countries, 16 from developing countries, and 5 studies from Pakistan. The review paper concludes that the multiple dimensions of health literacy are still yet to be clearly explained. Most of the studies used either REALM or TOFHLA for measurement of health literacy, which are not sufficient for measuring health literacy beyond the ability to read and understand medical information.Although, health literacy in most of the developed countries is adequate but it is still questionable in developing countries including Pakistan. Limited studies have examined impact of different interventions for improving health literacy especially in specific populations. Extensive research is required to explore economic implications of limited health literacy on the health system and the cost-effectiveness of interventions to improve health literacy. Furthermore, effectiveness of media literacy education addressing health and language barrier to comprehend medical instructions, prescriptions and drug labels should be investigated.

The aim of this paper is to highlight the role of pharmaceutical care at community pharmacies in Pakistan. The paper draws on the literature related to current dispensing practices at community pharmacies in developing countries as well as in Pakistan. There are approximately 63,000 community pharmacies in Pakistan, and according to an estimate, 80% of the medicines are being distributed through this channel to majority of the population. They often lack adequate facilities, staffing and equipments. Absence of pharmacists and their roles being performed by the non-qualified personnel working at community pharmacies are a common practice. There are 8102 pharmacists who are categorized as a category, 31,000 pharmacy technicians categorized in B & C category in the country. There is a shortage of pharmacists who could be engaged for ensuring good pharmacy practices. There are only ten percent of the total pharmacists who work at community pharmacies in the country according to the Pharmacy Council of Pakistan. All kind of medicines are freely available irrespective of their status as prescription or over the counter drugs. The paper highlights that the professional role of pharmacist in hospitals and community pharmacies is switching from dispensing and sale of drugs, to patient counselling. But, the concept of pharmaceutical care at community pharmacies has not been acknowledged yet in Pakistan. The process of prescription handling is poor and patients are often treated without a proper prescription. Prescription validation, drug labeling and patient counseling are the missing components in effective patient management at the community pharmacies. The paper concludes that although laws exist, but due to lack of accountability and weak regulatory framework their proper implementation is not witnessed. Moreover, due to lack of research and evidence related to problems in dispensing practices in healthcare system of Pakistan, the counteractive actions for resolving these problems are limited.