Pneumonia, meningitis, and sepsis place a significant economic burden on health care systems, particularly in developing countries. This study estimates treatment costs for these diseases in health facilities in the Northern Areas of Pakistan. Health facility resources are organized by categories--including salaries, capital costs, utilities, overhead, maintenance and supplies--and quantified using activity-based costing (ABC) techniques. The average cost of treatment for an outpatient case of child pneumonia is dollar 13.44. For hospitalized care, the health system spent an average of dollar 71 per episode for pneumonia, dollar 235 for severe pneumonia, and dollar 2,043 for meningitis. These costs provide important background information for the potential introduction of the conjugate Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae vaccines in Pakistan.

The communities studied showed a very high prevalence of hypertension, obesity and a sedentary life style. Despite a high literacy rate, awareness regarding CHD risk factors was low. This underlines the need for measures to increase awareness regarding CHD and its risk factors and a healthy lifestyle in the developing countries.

Objective To determine the incidence of pneumonia and severe pneumonia among children living at high altitudes in Pakistan. Methods A longitudinal cohort study was conducted in which 99 female government health workers in Punial and Ishkoman valleys (Ghizer district, Northern Areas of Pakistan) enrolled children at home, conducted home visits every 2 weeks and actively referred sick children to 15 health centres. Health centre staff used Integrated Management of Childhood Illness criteria to screen all sick children aged 2-35 months and identify those with pneumonia or severe pneumonia. Findings Community health workers enrolled 5204 eligible children at home and followed them over a 14-month period, ending on 31 December 2002. Health centre staff identified 1397 cases of pneumonia and 377 of severe pneumonia in enrolled children aged 2-35 months. Among children reported with pneumonia, 28% had multiple episodes. Incidence rates per 100 child-years of observation were 29.9 for pneumonia and 8.1 for severe pneumonia. Factors associated with a high incidence of pneumonia were younger age, male gender and living at high altitude. Conclusion Pneumonia incidence rates in the Northern Areas of Pakistan are much higher than rates reported at lower altitudes in the country and are similar to those in high-altitude settings in other developing countries. More studies are needed to determine the causes of pneumonia in these high-mountain communities. However, early introduction of the vaccines that are known to prevent pneumonia should be considered. Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español.

The World Health Organization encourages hospitals to become Health Promoting Hospitals (HPH) but adapting this concept to Pakistan has not been investigated. We explore perceptions of healthcare stakeholders about strategies and a priority action-plan to encourage HPHs in Pakistan. We conducted a qualitative study in 2007 where key-informant interviews and focus group discussions were held with healthcare stakeholders in Karachi. Thematic analysis was done and emerging themes were categorized. The HPH core components were perceived as the "standard framework"; however more emphasis was placed on priority actions as to satisfy "basic needs" of patients, staff and the community. This included basic facilities of comfort, health, hygiene, safety, security and emotional support. A change in the traditional mindset from cure to care and identification of key personnel, awareness-raising and cooperation would strengthen advocacy efforts for HPH in Pakistan. RÉSUMÉ L'OMS encourage les hôpitaux à devenir des hôpitaux engagés dans la promotion de la santé, mais l'adaptation de ce concept au Pakistan n'a pas été étudiée. Nous avons dégagé les perceptions des parties prenantes dans le secteur des soins de santé concernant les stratégies et le plan d'action prioritaire afin d'encourager les hôpitaux engagés dans la promotion de la santé au Pakistan. Nous avons conduit une étude qualitative en 2007 au cours de laquelle des entretiens avec des informateurs clés et des groupes de discussion thématiques ont été organisés à Karachi avec les parties prenantes du secteur des soins de santé. Une analyse thématique a été réalisée et les thèmes dégagés ont été classés. Les composantes essentielles des hôpitaux engagés dans la promotion de la santé ont été perçues en tant que « cadre de référence » ; toutefois, l'accent a été mis sur les actions prioritaires afin de satisfaire les « besoins fondamentaux » des patients, du personnel et de la communauté. Ces besoins comprennent des installations de base où l'on trouve confort, santé, hygiène, sécurité, sûreté et soutien psychologique. Une évolution des mentalités vers les soins préventifs, alors qu'elles sont traditionnellement axées sur les soins curatifs, et l'identification des personnels clés, la sensibilisation et la coopération pourraient renforcer les efforts de plaidoyer en faveur des hôpitaux engagés dans la promotion de la santé au Pakistan.‫املتوسط‬ ‫لرشق‬ ‫الصحية‬ ‫املجلة‬ ‫عرش‬ ‫السابع‬ ‫املجلد‬ ‫العارش‬ ‫العدد‬ 739

The lack of implementation and routine screening of management techniques at tertiary care hospitals leads to an increased burden of maternal depression. The consequences are borne emotionally, physically, and mentally by the mother, the child, the overall family, and society. Hence, it is vital to contextualize this mental disorder to design and implement effective healthcare interventions. The study is aimed to assess the knowledge and practices of healthcare professionals, in a tertiary care setting, who deal with depressive symptoms amongst mothers. It gauges whether a psychological screening criterion is being implemented by the clinical staff during prenatal and postnatal visits to recommend steps that can help develop a service framework. A qualitative, exploratory study design was implemented for this research. With purposive sampling, eight in-depth interviews (three nurses and five doctors) at a single tertiary care hospital were conducted categorically using a semi-structured (open and close-ended questions) interview toolkit. Content Analysis was carried out using information gathered from the unit of analysis. The study provided evidence of the existing gaps in one particular tertiary healthcare system, within Pakistan, concerning diagnosis and management of maternal depression. Results highlighted that providers were well-versed with explanations of maternal depression, the aftermath of it, and the current status of healthcare; however, they were minimally educated about the specifics and levels of treatment. The gathered information assisted in recommending steps to develop a service framework.