Dominos effect finding the missing millions | By Dr Asif Maqsood Butt


Dominos effect finding the missing millions

PAKISTAN is facing triple burden of disease, one must be astonished that double burden is well known and where this triple burden of disease come from; the third issue of Pakistan is the very poor community engagement.

This also reflects low patriotism as well and low practice on religious values.

Prepare for inevitable outbreaks; risk communication and community engagement.

A community can’t be convinced to approach an issue until it realizes that the issue exists, and furthermore, that it affects the community.

Norms, information, knowledge creates experiences; experiences help to develop believes, that further build attitude and so the actions/reactions and behaviour is visualized.

Nations, health care systems, and industries rely on our insights and innovation to create critical readiness plans for ensuring public health resiliency.

Community readiness can be described by nine different levels:

No awareness.


Vague awareness.






High level of community ownership.

In a research conducted by the author regarding “ Specialty choices among future doctors in perspective of public health Rawalpindi” it was revealed that only 2% of future doctors interested in public health / community medicine/ family medicine and that is their 2nd choice; the rest of majority preferred to proceed in clinical specialty as public health.

Policy makers must think on the production of public health specialist and may also introduce variety of public health specialties.

There is a great need to address upon public health role, importance, diversity and where does each specialty fall for its practical application in terms of services.

A doctor must be a seven star doctor / public health specialist must pay attention to improve patient sufferings such as Public Health Facilities, Poor Referral system ,Low Health Care Delivery Services At Primary Health Care, More patients visit to Private Hospitals and clinics, Low compliance, 3 to 4 consultations with different physicians, Low Follow-up, Resistance & Chronicity of diseases & Illnesses, additional observations, Low Regional Screening of diseases, Low Research at Physicians level, Low Social Mobilization.

Role of Family Physicians in disease surveillance, collection of real time statistics, Controlling Epidemic.

Beside Blood pressure, Diabetes, Obesity, communicable diseases such as Hepatitis is one of the concerning issue of Pakistan beside Tuberculosis and HIV/AIDS.

There are 6 main hepatitis viruses, referred to as types A, B, C, D, E& G. classified into acute and chronic based on the duration of the inflammation/insult to the liver <6 months is acute &> 6 months is chronic.

A (HAV) consuming food or drink contaminated with the feces of someone with the infection nausea, fatigue, dark urine, vomiting, fever, jaundice, and anorexia.

B (HBV) making contact with the body fluids of a person with the infection — usually from the woman to the fetus at birth, but occasionally from using contaminated needles or having sex without a condom unease, fatigue, anorexia, and mild illness.

C (HCV) making contact with blood containing the virus spread through contaminated needles of IV drug users no symptoms, but others have unease, fatigue, and anorexia.

D (HDV) same as HBV unease, fatigue, anorexia, and mild illness.  E (HEV) usually through consuming undercooked meat or food or drink contaminated with the feces of someone with the infection, but occasionally from a pregnant woman to a fetus mild illness.

G (HGV) through blood containing the virus mild infection, but most people have no symptoms

Hepatitis is eighth highest cause of mortality, Hepatitis C 7. 1 million, Hepatitis B 5 million. 150,000 new cases each year, According to WHO, 23,720 people died of hepatitis-related causes in Pakistan in 2016, which compares to a bus full of 64 people every day.

• Pakistan has the world’s second highest prevalence of hepatitis C, Projected 20 million deaths between 2015-30.

1 Intermediate endemicity prevalence (2-8%) in hepatitis B and Hepatitis c HVC antibody prevalence is = 2% that is at first tier 2nd tier is –2% and 3rd tier is 0.5%. 2 the efforts are been urged by all the global health authories to reinforce all efforts to find the missing millions and reduce new infections by 90% till 2030 and deaths by 65% for both hepatitis B & C.

Integration, coordination and synchronization at all levels are needed to test, treat & track. Insight, Engagement and to be as a responsible member of Community as client and all professional as service provider must understand the nature of critical situation.

The finding the missing million is a difficult mission but by collective efforts we all shall make this possible and shall make Pakistan hepatitis free very soon.

Inshallah !

Long Live Pakistan.

—The writer is contributing columnist, based in Rawalpindi.


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