Background: During outbreaks of infectious diseases like COVID-19, the healthcare-associated infections (HCAIs) pose a burden on public health system. There are very limited data about infection prevention and control (IPC) implementation in the healthcare facilities of Pakistan. The aim of the study was to conduct assessment with the IPC Assessment Framework (IPCAF) tool in healthcare facilities of the least developed areas. Methods: A cross-sectional survey was conducted in 12 tertiary level healthcare facilities (HCF) located in the least developed provinces of Pakistan. The facilities were selected through multistage cluster random methods. A well-structured questionnaire, the "IPCAF tool", was used for data collection. The IPCAF comprises eight sections with a 100 score of each section, thus with a maximum score of 800. The scores from 0 to 800 of the HCFs were divided into four gradual ratings through IPCAF, ie from inadequate to advanced. Results:The median score of all facilities was 405, with a range from inadequate to advanced. One facility (8.3%) fell into the "inadequate" category with a score of 172.5; 5 (41.6%) facilities achieved "basic" category, another 5 (41.6%) being "intermediate", and only one (8.3%) hospital achieved "advanced" status. Region-wise median score of facilities of GB was 307.5, facilities in AJK scored 342.5, and a score of 520 was found for health facilities in KPK. The components of Education and Training, HCAIs Surveillance, and Multimodal Strategies achieved the lowest scores. Conclusion: Most of the facilities have developed an IPC program with key focal persons and IPC committees, but did not have relevant education and training. IPC core capacities are being implemented. Equitable attention is required on all eight components of IPC in all facilities.

No abstract

In Pakistan, the first confirmed case of COVID-19 was reported on 26 February 2020, having the travel history from Iran. Islamabad and Rawalpindi have also been affected by COVID-19 epidemic. On 23 March 2020, the Government of Pakistan has declared smart lockdown all over the country including Islamabad and Rawalpindi. The aim of the study was to identify the status of the knowledge, attitudes and practices regarding COVID-19 among the general population of the twin cities (Islamabad and Rawalpindi) in Pakistan during the COVID-19 outbreak. A cross-sectional web-based survey was conducted from 5 to 19 May 2020, the week during smart lockdown in Islamabad and Rawalpindi. Demographic characteristics were compared with independent-samples ttest, one-way, or Chi-square test. Multivariable linear regression analysis was used to identify factors associated with low knowledge score. Data analyses were conducted with SPSS version 21.0. A total of 1,282 participants completed the questionnaire. Among this final sample, the average age was 30.65 years. Among the survey respondents, 680 (53%) were women, 1096 (86%) held a bachelor's degree or above, 634 (50%) were engaged with the government and private sector and 606 (47%) were married. The overall correct rate of knowledge was 70%. The majority of the respondents agreed that COVID-19 will finally be successfully controlled (59%). Most of the participants had not visited any crowded place (74%) and 95% responded that they have reduced their outdoor activities. In response to precaution measures, 86% stated that they would isolate themselves if they ever felt a fever or cough. The study findings suggest that residents of the two cities have reasonable levels of knowledge on COVID-19. However, it is necessary to launch health education and awareness campaigns to improve the knowledge and practices about COVID-19, to control its transmission.

Background: Public health emergency management systems encountered difficulties in developing countries, especially in Pakistan. The COVID-19 pandemic was extremely challenging for different agencies, departments, and institutions in Pakistan. Public health emergency management depends on a well-established public health emergency operations center that could generate a coordinated response to escalated incidents. We conducted an assessment of public health emergency response and coordination implemented during the COVID-19 pandemic management at a strategic level in Pakistan. Methods: This was mix-method study including qualitative and quantitative data collection processes implemented in 2022-23. Primary data was collected by using a structured questionnaire, and secondary data was collected by desk review. The agencies engaged in pandemic response at the national level in Pakistan were included in the assessment. Results: The overall score of the emergency response coordination system during COVID-19 was 49% for all agencies. We found that agencies faced challenges in leadership, legislation, and financing issues during the pandemic response (44%). None of the agencies had a fully developed framework for joint planning and response system for health emergencies. Roles and responsibilities attached to designated agencies in response were relatively clear (55%) for most of the agencies. Conclusion: An effective public health emergency response is based on multi-departmental coordination, resource mobilization, and correct information. Pakistan must proactively address these and other relevant challenges for future pandemic response.

Background: On July 24, 2017, two cases suspected of acute watery diarrhea (AWD) were reported from tertiary care hospital, Rawalpindi. District health authorities directed to conduct outbreak investigation, identified risk factors and recommend control measures. Methods: A descriptive followed by age-sex matched case control study (1:3) was done from Jul 27 to Aug 02, 2017. Case definition was "sudden onset of loose watery stools (? 3 in past 24hrs) with any of symptoms i.e. vomiting, nausea, abdominal cramps or fever in residents of Amar Pura from July 19 to August 02, 2017". Active and passive case finding technique were done in addtion to hosptial record review. Total 02 stool and 03 water samples were collected for microbiological testing. Odd ratios computed on 95% confidence interval and P value <0.05. Results: Total 18 cases were identified (mean age: 16 year; range: 02 m-55yrs), predominate were male 2.6:1. Overall attack rate (AR) was 7.2/1000 and preponderate affected age group was 15-24 years (AR: 10/1000). Significantly associated risk factors were; use of untreated municipal water (OR:15, CI: 4.00-73.96) and use of untreated well water (OR:14.52, CI: 3.98-59.99). Use of water from filtration plant was found protective association (OR: 0.12, CI: 0.005-0.750). Laboratory found Vibrio Cholera Serotype Inaba in stool samples and coliforms in water samples. Conclusion: Consumption of contaminated water was most probable cause of outbreak. Use of filtered water was found to be a protective measure. Chlorination of water sources and health awareness sessions on water sanitation and hygiene were done in community.