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ORIGINAL ARTICLE
Year : 2022  |  Volume : 11  |  Issue : 1  |  Page : 23-33

Prevalence of classified groups of health problems in the local, internally displaced persons, and Afghan people in the District Bannu, Khyber Pakhtunkhwa, Pakistan


Elementary and Secondary Education Department, Peshawar, Khyber Pakhtunkhwa, Pakistan

Date of Submission01-Mar-2022
Date of Acceptance04-Apr-2022
Date of Web Publication2-May-2022

Correspondence Address:
Muhammad Ashraf Khan
Elementary and Secondary Education Department, Peshawar, Khyber Pakhtunkhwa
Pakistan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjhs.sjhs_31_22

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  Abstract 


Background: Health problems are one of the global concerns and affected mostly human well-being and performance. Aims: The current study determined the prevalence of different classified groups of health problems in the local, internally displaced persons, and Afghan people living in Bannu during 2016–2019. Settings and Design/Methods and Materials: This is a retrospective study. Data were taken from the official computerized record of all patients who visited the outpatient department in the Khalifa Gul Nawaz Teaching Hospital, Bannu, for diagnosis and treatment during the study period. Statistical Analysis: Pearson's Chi-square test and Fisher's exact test were used to determine the significant difference, followed by post hoc tests pairwise. Results: Aggregate data for the said period indicated medical category with 18.2% health cases, followed by children (11.4%), eye (10.7%), chest (9.4%), and orthopedic (7.9%). Each of the remaining health problems showed ≤5.7% prevalence. Men demonstrated 37.1% of health cases, followed by women (35.4%), and children (27.5%). The local population showed a less annual prevalence of cases in 2016 compared to the remaining years, while internally displaced persons contributed 29.5% and 9.8% of overall cases in 2016 and 2017, respectively. Afghans accounted for <0.2% annually and an aggregate of 0.15% of overall cases. The local population data also indicated health problems were highest in men (≥37.4%) followed by women (≤37.2%) each year from 2016 to 2019, while internally displaced person data showed children had the highest prevalence (≥39.8%) of health cases followed by women (≤30.3%) each in 2016 and 2017. Afghan men showed the highest prevalence (35.5%) of all Afghan cases, followed by Afghan children (33.2%) in 2016, while Afghan women showed the highest prevalence of ≥39.8% of all Afghan cases annually during 2017-2019, followed by Afghan children (≤36%). The local population accounted for 91.4% of cases, followed by internally displaced persons 8.5%, and Afghan people 0.1% of cases. Conclusions: Overall, medical group and men showed the highest number of cases. The local population showed higher cases during 2017–2019. Both Afghan men and women showed reduced prevalence and increased prevalence during 2018–2019 and 2019, respectively.

Keywords: Afghan, Bannu, health problems, internally displaced persons, medical, prevalence


How to cite this article:
Khan MA. Prevalence of classified groups of health problems in the local, internally displaced persons, and Afghan people in the District Bannu, Khyber Pakhtunkhwa, Pakistan. Saudi J Health Sci 2022;11:23-33

How to cite this URL:
Khan MA. Prevalence of classified groups of health problems in the local, internally displaced persons, and Afghan people in the District Bannu, Khyber Pakhtunkhwa, Pakistan. Saudi J Health Sci [serial online] 2022 [cited 2022 Aug 15];11:23-33. Available from: https://www.saudijhealthsci.org/text.asp?2022/11/1/23/344488




  Introduction Top


Health is a state of complete physical, mental, and social well-being of an individual.[1] Strong health system plays its role in alleviating socioeconomic challenges such as poverty and illiteracy.[2],[3] Human health states are classified as death, disease, disability, destitution, dysfunction, and discomfort. It is affected by environmental factors, such as safe water and sanitation, nutrition, poverty, working conditions, climate, or access to healthcare.[4] Human beings are subject to many health issues including numerous diseases. Some of the diseases and other health problems require patients' hospitalization. The outpatient department (OPD) is considered to be the first point of contact of patients with a hospital/health center, where both outpatient and inpatient treatments are provided to the patients. The health problems are generally categorized into groups [Table 1] such as injuries, abnormalities, malfunctioning, and diseases of humans share common symptoms and signs through OPD/clinical manifestations and the patients are recorded accordingly.
Table 1: Major categories (groups) of the international classification of diseases and related health problems

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Communicable diseases are the prime cause of mortality in Pakistan.[5] The highly prevalent chronic diseases are a major threat to existing health care services[6] including hypertension, diabetes, obesity, heart diseases, and asthma. Pneumonia, diarrhea, and malaria are the leading cause of death in children aged ≤ five years, along with preterm birth and intrapartum-related complications globally.[7] Polio is still endemic in Pakistan,[8] as well as hepatitis B and C with 7.6% prevalence, affected the general population in Pakistan.[9] Pakistan is ranking 5th highest in tuberculosis worldwide,[10] and is among the six WHO Eastern Mediterranean region countries with high malaria transmission.[11] and there is an established HIV concentration among high-risk groups in Pakistan.[12] Pakistan ranked 7th highest among the countries with the highest prevalence of diabetes.[13] Hypertension is one-fourth among individuals aged >18 years, and the percentage of smoking in males is higher (38%) than in females (7%) in Pakistan.[14]

Overall, 435,429 internally displaced persons (IDPs) from North Waziristan (NW) had taken shelter in Bannu district because of severe fighting between the Pakistan military and the militants that started in June 2014 in NW. Similarly, sizeable populations of Afghan refugees (the exact number is not known) have been living in the Bannu district since the 1979 invasion of Afghanistan by the then Soviet Union.

The present study is the first study of its kind in Pakistan on the prevalence of classified groups of health problems in the local, internally displaced persons (IDPs belonging to North Waziristan migrated Bannu), and Afghans living in Bannu, diagnosed through the outpatient department (OPD) at Khalifa Gul Nawaz (KGN) teaching hospital in Bannu during 2016-2019. The present study contributes to the policymakers and the medical authority in Bannu to know the prevalence rate of different health problems and to adopt strategies to prevent/control conditions that contribute to such health issues in the district.


  Materials and Methods Top


People with health problems visit the nearby hospital/health center for a checkup in Pakistan. The OPD is an integral part of the hospital with allotted physical facilities and medical and other staff to provide medical care on an outpatient basis, including diagnosis, observation, consultation, treatment, intervention, and rehabilitation services.

Those patients who need extra care/treatment are hospitalized for complete treatment. They are regularly checked by the concerned physician/surgeon and are prescribed and provided complete medications, as well as treatment and rest, until the person recovers physical, mental, and social well-being.

The present study was approved by the concerned competent authority, Dr. Alam Zeb, district chest specialist and focal person of KGN Hospital with reference No. 01, dated January 20, 2020. Informed consents from the patients are not applicable.

The data was taken from the computer record available at the office of the Secretary Board of Governor (KGN teaching hospital). A consolidated report of the data was prepared for the years 2016 to 2019 to determine the overall prevalence of different classified groups of health problems as well as their prevalence in the three different groups of people: the local population, IDPs, and Afghans living in Bannu.

The data were subjected to the Pearson's Chi-square test and Fisher's exact test to determine the significant difference. One-sample χ2 test was conducted, and a significant difference (P < 0.001) was determined using post hoc tests pairwise comparisons using G-test of health categories (P value adjustment method: Benjamini and Hochberg.[15]


  Results Top


The data pooled over for the period from 2016 to 2019 demonstrated a very significant difference among the local population, Afghan population, and IDPs (Pearson's Chi-square test: χ2 = 10,758, df = 4, and P < 0.0001 and Fisher's exact test: P < 0.001). Similarly, a very significant difference exists among the number of men, women, and children based on aggregate data of the local population (Pearson's χ2 test = 282,899, df = 46, P < 0.0001 and Fisher's exact test: P < 0.001 with simulated P value based on 2000 replicates), while aggregate data based on Afghan population also showed very significance difference (Pearson's Chi-square test: χ2 = 650.96, df = 38, P < 0.0001 and Fisher's exact test: P < 0.001 - test on data except emergency labor room, gastro/hepatology and oncology with no prevalence; Fisher's exact test for count data with simulated P value: based on 2000 replicates), and the aggregate data based on IDPs population also revealed very significance difference (Pearson's Chi-square test χ2 = 42,200, df = 34, P < 0.0001 and Fisher's exact test: P < 0.001 - test on data except those categories with zero prevalence such as neurology, gastro, plastic surgery, labor room, gastro/hepatology and oncology) pair-wise comparisons using G-tests. The Spearman rank correlations indicated a very significant difference (P < 0.0001) between men and women and between men and children, while a significant difference (P < 0.001) exists between women and children among the three groups of people in the local population.

Prevalence of the classified groups of health problems (2016-2019)

The medical category showed the highest prevalence of 18.2% health problems [Table 2], [Figure 1], followed by children (11.4%), eye (10.7%), chest (9.4%), and orthopedic (7.9%), while oncology showed the lowest prevalence of cases based on the data pooled over all four years: 2016-2019. Men demonstrated 285969 (37.1%) health problems, followed by women 273272 (35.4%) and children 212390 (27.5%) health cases. Local population accounted for 705336 (91.4%) cases, IDPs 65171 (8.5%) cases, and Afghans 1124 (0.1%) cases for the study period.
Table 2: Prevalence of the classified groups of health problems (based on the pooled over data) among the local, internally displaced persons and Afghan people in Bannu during 2016–2019

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Figure 1: Prevalence of health cases (year-wise) of different health groups/categories in Bannu as reported by the Khalifa Gul Nawaz Teaching Hospital Bannu during 2016–2019

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Among the local population, men revealed approximately 38% of cases, followed by women 36.1% and children accounted for 25.9% of cases [Table 2]. The local population also demonstrated the same five top groups of health problems based on prevalence: medical 17.9% followed by eye 11.2%, chest 9.7%, children 9.6%, and orthopedic 8.1%. Overall Men showed a higher prevalence of health problems in medical, eye, chest, and orthopedic categories ranging from 41.2% to 46.3% than women or children in the local population in Bannu during the study period. while women showed a higher prevalence in gynecology (95%), followed by labor room (55.6%) and gastro and hepatology (50%) than men showing prevalence in the local population. Furthermore, children revealed the highest cases as reported by the children OPD (95.4%). In addition, children also revealed more cases regarding pediatric surgical (89.7%), followed by burn center (60.3%), and plastic surgery OPD (48%) than men or women in the local population [Table 2].

Both men and women demonstrated a similar prevalence of health problems in the overall IDP populations during the study period [Table 2]. However, IDPs children suffered comparatively higher accounting for 44.7% of total IDPs patients. The children's department recorded the highest health problems (30%), followed by the medical department (21.3%) among the IDPs. Nevertheless, IDPs did not show any health problems including neurology, gastrology, plastic surgery, labor room, gastro and hepatology, and oncology. Each of the remaining health problems have ≤6.5% prevalence among IDPs [Table 2].

Overall, Afghan women accounted for 45.4% of all Afghan cases, followed by children (34.1%) and males (20.5%) in Bannu during the study period [Table 2]. Similarly, to IDPs, Afghans showed children's OPD recorded the highest health problems (23.6%), followed by the medical (12.8%), Gynecology (11.4%), and chest OPD (10.8%). Nevertheless, similar to IDPs, Afghans did not show any health problems such as labor room, gastro and hepatology, oncology, and emergency. Each of the remaining health problems have ≤6.1% prevalence among Afghans [Table 2].

The pooled data for all three groups of people (locals, IDPs, and Afghans) in 2016 revealed five top classified groups of health problems based on prevalence were medical OPD 19.8%, followed by children 16.6%, chest 10.4%, orthopedic 8.2%, and eye 7.8% [Table 3]. While each of the remaining groups of health problems accounted for prevalence ≤5.5% or 0%. Overall men demonstrated 55093 (34.4%) health problems, followed by women 51484 (32.2%) cases and children 53508 (33.4%) cases. Furthermore, the local population accounted for 112695 (70.4%) cases, IDPs 47176 (29.5%) cases, and Afghans 214 (0.1%) cases. Men showed 37.8%, women 34.3%, and children revealed 27.9% of health cases among the local population. Medical OPD accounted for the highest prevalence 19.3%, followed by chest OPD 11.8%, children 10.6%, orthopedic 9.1, and eye 8.9% in the local population. IDPs-based children's OPD showed the highest prevalence of 31.1%, followed by the medical OPD (21%) and each of the remaining groups of health problems showed ≤7.0% prevalence among the IDPs [Table 3]. Men showed 26.3%, women, 27.1%, while children revealed 46.6% prevalence based on IDPs data. Afghan men showed 35.5% prevalence, followed by Afghan children 33.2%, and Afghan women 31.3% based on the Afghan data. Moreover, Afghan children's OPD showed 17.3% prevalence, followed by chest 15.9% and medical OPD 14.5% in 2016 [Table 3].
Table 3: Prevalence of the classified groups of health problems among the local, internally displaced persons and Afghan people in Bannu in 2016

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Based on the data pooled over for all three groups of people in 2017 revealed five top categorized health problems based on prevalence were: medical OPD 19.9%, followed by children 11.4%, eye 10.3%, orthopedic 8.4%, and chest 8.3% [Table 4]. While each of the remaining groups of health problems accounted for a prevalence of ≤6.8% or 0% in 2017 [Table 4]. Overall men demonstrated 69951 (38%) health problems, followed by women 63883 (34.7%) cases, and children showed 50071 (27.2%) cases. Furthermore, the overall local population accounted for 165792 (90.2%) cases, IDPs 17995 (9.8%) cases, and Afghans 118 (0.1%) cases [Table 4]. Men showed 38.9%, women 35.2%, and children revealed 25.9% of health cases among the local population. IDPs children revealed 39.8% cases, followed by women 30.3%, and men showed 29.9% based on IDPs data. While, Afghan women revealed 39.8% cases, followed by children 34.7% cases, and men showed 25.4% cases of overall Afghan cases in 2017 [Table 4].
Table 4: Prevalence of the classified groups of health problems among the local, internally displaced persons and Afghan people in Bannu in 2017

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Medical OPD accounted for the highest prevalence 19.7% among the different groups of health problems of the local population [Table 4], followed by eye OPD 10.9%, children 9.7%, and each orthopedic and chest 8.6% in the local population and each of the remaining groups of health problems showed ≤7.1% prevalence in 2017. IDPs demonstrated children's OPD has the highest prevalence of 27.1%, followed by the medical OPD (22%). While each of the remaining groups of health problems showed ≤5.9% prevalence in IDPs in 2017 [Table 4]. Afghan children showed 17.8% cases, followed by chest 13.6% and medical OPD 12.7%. While each of the remaining health problems showed ≤ 9.3% prevalence in Afghans in 2017 [Table 4].

The combined data of the local population and Afghans in 2018 [Table 5] indicated medical OPD contributed 17.1%, followed by by eyes 11.1%, chest 10.7%, children 10%, and orthopedic 7.8%, and local population also showed same percentage prevalence of the same groups of health problems and each of the remaining groups of health problems showed ≤5.9% or 0% prevalence in the local population. Afghans showed the prevalence of children OPD (28.3%), followed by medical OPD 11.4%, gynae 11.2%, chest 10%, and orthopedic 6.3% in 2018. Each of the the remaining health problems showed ≤5.3% prevalence in Afghans [Table 5]. Overall men demonstrated 87105 (37.9%) health problems, followed by women 84195 (36.6%) cases, while children showed 58509 (25.5%) cases [Table 5]. Furthermore, the overall local population accounted for 229317 (99.8%) cases and Afghans accounted for 492 (0.2%) cases in 2018. Afghan women showed 47.8% of cases, followed by Afghan children 36%, and Afghan men (16.3%) based on the Afghan data in 2018 [Table 5].
Table 5: Prevalence of the classified groups of health problems among the local and Afghan people in Bannu in 2018

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The combined data of the local population and Afghans in 2019 [Table 6] demonstrated prevalence: medical OPD 16.5%, eye 12.7%, children 8.7%, chest 8.3%, and orthopedic 7.4%, and each of the remaining groups of health problems accounted for ≤6.3% or 0% [Table 6]. Overall men demonstrated 73820 (37.3%) health problems, followed by women 73710 (37.3%) cases, while children showed 50302 (25.4%) cases. Furthermore, the overall local population accounted for 197532 (99.8%) cases, and Afghans accounted for 300 (0.2%) cases. Mens showed 37.3%, women, 37.2%, and children revealed 25.4% of health cases among the local population. While, Afghan data demonstrated Afghan women showed 53.7%, followed by Afghan children (31.3%), and Afghan men (15%) in 2019 [Table 6].
Table 6: Prevalence of the classified groups of health problems among the local and Afghan people in Bannu in 2019

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Medical OPD accounted for the highest prevalence 16.5%, followed by eye OPD 12.8%, children 8.7%, chest 8.3%, and orthopedic 7.4% in the local population [Table 6]. While each of the remaining groups of health problems showed ≤6.3% or 0% prevalence in the local population. Afghan children showed 22.7% prevalence, followed by Afghan gynae 15% and Afghan medical OPD 14%, and each of the remaining health problems showed ≤7.3% or 0% prevalence in Afghans in 2019 [Table 6].

The medical health category showed the highest cases [Figure 1] among all the health cases each year during the study period (2016–2019). Overall data indicated that 2018 showed a higher prevalence of the cases compared to the remaining years in the categories including medical, chest, orthopedic, eye, surgical, ENT, gyne, dental, and urology [Figure 1], while 2019 demonstrated health categories including cardiology, skin, neurology, and gastro indicated higher prevalence than in the remaining years [Figure 1].

The local population contributed to 70.4% of the overall health problems in 2016. Nevertheless, it accounted for >90% of health problems from 2017 through 2019. IDPs contributed 29.5% in 2016, and 9.8% to overall health problems in 2017. While Afghans accounted for less than 0.2% of all health cases each year from 2016 through 2019. Afghan men led to 35.5% prevalence in 2016, 25.4% in 2017, and accounting for 15-16% prevalence in 2018 and 2019 based on the total Afghans who visited KGN hospital in Bannu. Nevertheless, Afghan women demonstrated variation over years: increasing continuously from 31.3% in 2016 to 53.7% prevalence in 2019 of overall Afghan patients. While Afghan children contributed 31.3 to 36% of the total Afghan patients during 2016-19. Afghan data showed children's OPD as the most highly prevalent health problem during 2016-17, and medical and children's OPD were the most prevalent health problems in 2018 and 2019, respectively in all Afghans who visited KGN hospital [Table 5] and [Table 6].


  Discussion Top


The present study is the first of its kind in Pakistan taking into account three groups of people, (1) the local population: the major local population of the district Bannu and the minor population of adjacent areas including Lakki Marwat and Karak districts, (2) the IDPs or internally displaced persons who migrated from the North Waziristan district to Bannu, and (3) Afghans living in Bannu since 1979. The current study contributes a lot to the practice of health professionals in Bannu by providing information on the overall health status of the community and helping them to emphasize and focus more on the health groups with high prevalence in the community. The present study also helps the public and the policymakers to adopt a strategy and collaborate to cope with such problems and safeguard the community in the Bannu. Nevertheless, the study has its limitations: (1) it only described the major categories of health problems and did not mention the different types of diseases/injuries included in each category, (2) it does not provide any information about the epidemiology of the diseases/factors responsible for the health problems in the study area, and (3) the study did not demonstrate the monthly/seasonal prevalence of the health problems. There is no source of potential bias or imprecision in the present study.

Pakistan military has launched a military operation known as Zarb-i-Azb including airstrikes against various militant groups in NW on June 15, 2014, along the Pakistan–Afghanistan border in response to the June 8 attack on Jinnah International Airport in Karachi. Up to 30,000 soldiers were involved in the operation resulted in the large-scale displacing of common peoples (known as IDPs) from North Waziristan to take shelter in neighboring districts of Bannu, Lakki Marwat, Karak, Dera Ismail Khan (D. I. Khan) and Kohat in Khyber Pakhtunkhwa, Pakistan.

A total of 995,515 people (92,702 families) were registered as displaced from the North Waziristan district into neighboring districts including Bannu.[16] They are settled in both host communities and as in the camps set up by the provincial government of Khyber Pakhtunkhwa. They were provided shelters and food items during their stay in the Bannu during 2014–2017 by the Government of Khyber Pakhtunkhwa with the help of foreign donor agencies such as United States Agency for International Development. Women and children make up 73% of the IDP community. According to the assessment report of IDP's[17] based on the data taken from the women and children hospital Bannu: The total IDPs in Bannu were 435429 including men 114,596, women 137,301, and children 183,532. Overall, the military operations against militants in 2015 led to 1.8 million Pakistani people being internally/temporarily displaced.[18]

Similar comprehensive literature on health problems is not available in Pakistan. Nevertheless, some of the previous studies on the prevalence of diseases in IDPs are available: The most prevalent infectious diseases in IDPs were acute diarrhea 33% or 2,296 cases and acute tract respiratory infections 19.2% or 1,336 cases, followed by pyrexia of unknown origin (PUO) 10.6% or 742 cases, and skin infections 2% or 134 cases of the total patient consultations from 22nd June, to 14th July, 2014.[19] Lack of proper shelters, unhygienic conditions, access to clean water, overcrowdedness, and extreme weather conditions in the camps have contributed to the aforementioned health problems in IDPs in Bannu. Both IDPs and refugees have the same reasons for displacement; nevertheless, the legal position of IDPs is different from the refugees because they are displaced within the country and are under the protection of their own country.[20],[21]

Since 1979, the continuously ongoing war in Afghanistan has created a constant influx of Afghan people to Pakistan for shelter, refuge, and sometimes business. In 1990, 3.27 million registered Afghan refugees were living in Pakistan.[22],[23] In addition, many of them were rehabilitated in Afghanistan during 2017–2019. The global population of forcibly displaced people increased to 65.6 million in 2016.[24] Some previous studies regarding Afghans showed that cardiovascular problems are the major causes of death while respiratory tract infections (major: upper respiratory tract infections) are the most prevailed (48.05%) health issue in Afghan refugees in Pakistan.[25] Furthermore, skin diseases and diarrhea collectively accounted for 21.08% of Afghan refugees.[25] They also suffered from typhoid and measles, and overall, females were more vulnerable to the diseases compared to males in Afghan refugees[25] because females followed less hygienic conditions than males. Afghan refugees were more vulnerable to the disease compared to the indigenous population in Pakistan because they migrated from nonendemic areas in Afghanistan to the endemic area in Pakistan, as they are not immune to native strains.[25],[26]

In the current study, the top five prevailed groups of health problems were medical, followed by children, eye, chest, and orthopedic. The medical category demonstrated the highest number of patients because of the higher prevalence of common diseases such as common fever, malaria, typhoid, and cholera among the common people living in the Bannu. Children group occupy the second position because of their higher vulnerability to diseases, are more exposed to unhygienic conditions, and generally have lower immunity power. Similarly, eye and chest health problems increasing partly because of an increase in air pollution due to toxic gases and smoke particles. The high prevalence of orthopedic health problems is because of changes in the lifestyle and use of food. The higher prevalence of these health problems in men than women or children in the local population is because men are comparatively more exposed to vulnerable conditions. Overall Afghan women contributed approximately 45.4% to the health problems in Afghans and IDPs children contributed 44.7% of health problems in all IDPs because both groups of people are relatively more exposed to the unhygienic conditions in Bannu. Both IDPs and Afghans did not show health problems including labor room, gastro and hepatology, oncology, and emergency during the study period. The increase in the percentage of health problems in the local population from 70.4% in 2016 [Table 3] to >90% during 2017–2019 [Table 4], [Table 5], [Table 6] may be due to the high influx of IDPs into the Bannu that created an unhygienic condition. The decrease in the percentage of health problems in IDPs from 29.5% in 2016 to 9.8% of health problems in 2017 [Table 4]is based on the fact of health services provided to them by the provincial government of Khyber Pakhtunkhwa with the help of foreign donors. Overall, 1124 Afghans including 231 (20.6%) men, 510 (45.4%) women, and 383 (34.1%) children were recorded as patients by KGN Hospital in Bannu during the study period [Table 2]. The Afghan men also availed health services provided to IDPs during the study period which resulted in Afghan men led to reduced prevalence from 35.5% in 2016 [Table 3] to 15%–16% prevalence in 2018 and 2019 [Table 5] and [Table 6] based on the Afghan data. Nevertheless, women Afghans demonstrated an increase from 31.3% in 2016 to 53.7% prevalence in 2019 [Table 6] partly because IDPs were more emphasized than Afghan women and the unhygienic conditions developed by the large influx of IDPs into Bannu. In Pakistan, communicable, maternal, perinatal, and nutritional conditions accounted for 38% of deaths while noncommunicable diseases (NCDs) account for 51% of total deaths whereas injuries contribute to the remaining 11% of deaths.[10],[25] NCDs include diabetes, chronic respiratory diseases, cardiovascular diseases, cancer, and their related risk factors.[27]

The health-care sector in Pakistan is one of the most important sectors[28] and has been run by government/or private sector authority,[29] civil society, and philanthropic contributors.[30] All people have equal access to quality health services under the universal health coverage program in Pakistan. More than 60 million people in Pakistan living under the poverty line have no access to health facilities due to limited resources/finance.[5] Lady health workers and community midwives have a major contribution to the government's health-care system in Pakistan.[31] Health problems in a country such as Pakistan with a less developed health-care system due to lack of resources, and unawareness in common people regarding disease is a serious dilemma.

A sedentary lifestyle, environmental pollution, unhealthy dietary habits, smoking, and alcoholism resulted in NCDs.[32] Unhygienic conditions including uncollected waste, unsafe water, poor drainage, and open sewers contribute to various health problems in the community.[33] Sepsis, hemorrhage, and hypertensive crises cause maternal deaths commonly in Pakistan, and the country has one of the highest prevalence of underweight children in South Asia.[14] Similarly, stunting, micronutrient deficiencies, and low birth weight babies also play their role in the high level of mortality in mothers and children in Pakistan.[34] The mental health problems in Pakistan are due to poverty, low literacy, unemployment, gender discrimination, and a huge treatment gap. Lower access to and affordability of essential medicines exist in Pakistan,[33] and the poor people are likely to have lower levels of health, nutrition, immunization, and family planning coverage in the country.[35]

Many Asian and African countries demonstrate an alarming rate of increase in health problems. While there emerging new diseases such as acquired immunodeficiency syndrome, dengue, and disease by a coronavirus in the world, it is increasingly difficult for less developed countries worldwide to fight the disease to control. Similarly, technological development adversely affected the environment resulting in the pollution that severely negatively impacted humans' health and led to tension, cancer, disease of the skin, respiratory system, digestive system, and food poisoning. The alarming increase in population in Pakistan contributed to overcrowdedness and increased unhygienic conditions and thus resulted in deteriorating health status in the country.


  Conclusions Top


The aggregate data of the study period showed the medical category revealed the highest prevalence of 140,103 (18.2%) cases of patients, followed by children 87,813 (11.4%), eye 82,231 (10.7%), chest 72,838 (9.4%), and orthopedic 60,940 (7.9%) cases. The aforementioned pattern exists for each year during the study. Both men and women showed a comparable prevalence of health problems during 2016–2019. The local population showed that men were dominant followed by women and children during 2016–2019. IDPs men and women have similar trends. The local population and IDPs showed medical and children's health problems as the most prevalent among the health problems, respectively.

It is suggested that the government should relatively more focus to improve health services/facilities in Bannu and to introduce policies and programs to safeguard people from health hazards of all kinds and raise awareness among common people against the diseases and their prevention.

Acknowledgments

The administrations of the KGN Teaching Hospitals are acknowledged for their permission to obtain the data. I am also thankful to Mr. Ziauddin, computer operator/assistant programmer in the office of the Secretary Board of Governor (KGN) for his assistance in providing me with the data. Thanks also to Dr. Alam Zeb, district chest specialist and focal person (KGN) for the provision of an approval certificate for the present study. I am also very grateful to Jos Feys, the senior research fellow at the KU Leuven University (Catholic University of Leuven, Belgium) for working very hard on a statistical analysis of the data.

Ethical approval statement

The institutional review board of KGN Hospital approved this research with reference No. 1/2020.

Financial support and sponsorship

This study is not funded by any source.

Competing interests

The author declares no competing interest.



 
  References Top

1.
Kühn S, Rieger UM. Health is a state of complete physical, mental and social well-being and not merely absence of disease or infirmity. Surg Obes Relat Dis 2017;13:887.  Back to cited text no. 1
    
2.
Braveman PA, Kumanyika S, Fielding J, Laveist T, Borrell LN, Manderscheid R, et al. Health disparities and health equity: The issue is justice. Am J Public Health 2011;101 Suppl 1:S149-55.  Back to cited text no. 2
    
3.
Malik MA. Fragility and challenges of health systems in pandemic: Lessons from India's second wave of coronavirus disease 2019 (COVID-19). Glob Health J 2022;6:44-9.  Back to cited text no. 3
    
4.
WHO. World Report on Disability. Geneva: WHO; 2011.  Back to cited text no. 4
    
5.
Ahmed MH, Javed MT, Bahadur SU, Tariq N, Tariq A. Major Health Issues in Pakistan. Available from: https://www.technologytimes.pk/2019/07/12/major-health-issues-pakistan/. [Last accessed on 2019 Jul 12].  Back to cited text no. 5
    
6.
Almezaal EA, Elsayed EA, Javed NB, Chandramohan S, AL-Mohaithef M. Chronic disease patients' satisfaction with primary health-care services provided by the second health cluster in Riyadh, Saudi Arabia. Saudi J Health Sci 2021;10:185-90.  Back to cited text no. 6
  [Full text]  
7.
UNICEF. Child Survival: Under-Five Mortality. 2021. Available from: http://data.unicef.org/child-mortality/under-five.html. [Last accessed on 2022 April 20].  Back to cited text no. 7
    
8.
Ghafoor S, Sheikh N. Eradication and current status of poliomyelitis in Pakistan: Ground realities. J Immunol Res 2016;2016:6837824.  Back to cited text no. 8
    
9.
Qureshi H, Bile KM, Jooma R, Alam SE, Afridi HU. Prevalence of hepatitis B and C viral infections in Pakistan: Findings of a national survey appealing for effective prevention and control measures. East Mediterr Health J 2010;16 Suppl: S15-23.  Back to cited text no. 9
    
10.
WHO. Global TB Report. Noncommunicable Diseases Country Profiles 2014. Geneva: WHO; 2014.  Back to cited text no. 10
    
11.
Qureshi NA, Fatima H, Afzal M, Khattak AA, Nawaz MA. Occurrence and seasonal variation of human Plasmodium infection in Punjab Province, Pakistan. BMC Infect Dis 2019;19:935.  Back to cited text no. 11
    
12.
UNAIDS. Global AIDS Response Progress Report. UN, Geneva. 2014. Available from: https://www.unaids.org/sites/default/files/media_asset/GARPR_2014_guidelines_en_0.pdf. [Last accessed on 2022 Apr 21].  Back to cited text no. 12
    
13.
WHO. Global Report on Diabetes. Geneva: WHO; 2016.  Back to cited text no. 13
    
14.
National Health Vision Pakistan (NHVP), 2016-25. Ministry of National Health Services, Government of Pakistan; 2016.  Back to cited text no. 14
    
15.
Benjamini Y, Hochberg Y. Controlling the false discovery rate: A practical and powerful approach to multiple testing. J R Stat Soc Ser B 1995;57:289-300.  Back to cited text no. 15
    
16.
Pakistan: North Waziristan Displacements Situation Report No. 8. 2014. Available from: https://reliefweb.int/report/pakistan/pakistan-north-waziristan-displacements-situation-report-no-8-24-july-2014. [Last accessed on 2022 Apr 21].  Back to cited text no. 16
    
17.
Assessment Report of IDP's, 2014. Assessment Report of IDP's North Waziristan Agency, FATA, District Bannu-KP; Dated June 24, 2014.  Back to cited text no. 17
    
18.
Internal Displacement Monitoring Centre (IDMC) Pakistan IDP Figures Analysis; 2015. Available from: http://www.internal-displacement.org/south-and-south-east-asia/pakistan/figures-analysis. [Last accessed on 2017 Nov 17].  Back to cited text no. 18
    
19.
Health Situation Report # 9: Pakistan: North Waziristan Displacement; 15th July 2014. Available from: https://reliefweb.int/report/pakistan/health-situation-report-9-pakistan-north-waziristan-displacement. [Last accessed on 2022 Apr 21].  Back to cited text no. 19
    
20.
Guiding principles on internal displacement (GPID), OCHA, UN, September 2004. 43ce1cff2.pdf. [Last accessed 2022 Apr 21].  Back to cited text no. 20
    
21.
David G. Does the USSR have a ''grand strategy''? Reinterpreting the invasion of Afghanistan. J Pea Resea 1987;24:365-79.  Back to cited text no. 21
    
22.
Yusuf F. Size and sociodemographic characteristics of the Afghan refugee population in Pakistan. J Biosoc Sci 1990;22:269-79.  Back to cited text no. 22
    
23.
Jawaid A, Zafar AM, Mahmood SF. Impact of Afghan refugees on the infectious disease profile of Pakistan: Beyond economy. Int J Infect Dis 2008;12:e131-2.  Back to cited text no. 23
    
24.
UNHCR. Global Trends: Forced Displacement in 2016; 2016. Available from: https://www.unhcr.org/globaltrends2016/. [Last accessed on 2022 Apr 21].  Back to cited text no. 24
    
25.
Malik MS, Afzal M, Farid A, Khan FU, Mirza B, Waheed MT. Disease status of Afghan refugees and migrants in Pakistan. Front Public Health 2019;7:185.  Back to cited text no. 25
    
26.
Toole MJ, Waldman RJ. Prevention of excess mortality in refugee and displaced populations in developing countries. JAMA 1990;263:3296-302.  Back to cited text no. 26
    
27.
Nishtar S. NAP-NCD Atlas 2005. National Action Plan for Prevention and Control of Non-Communicable Diseases and Health Promotion in Pakistan. Prevent Control. 2:95–102. Operation Zarb-e-Azb, Wikipedia: Operation Zarb-e-Azb; dated 11th March, 2020.  Back to cited text no. 27
    
28.
Javed SA, Liu S, Mahmoudi A, Nawaz M. Patients' satisfaction and public and private sectors' health care service quality in Pakistan: Application of grey decision analysis approaches. Int J Health Plann Manage 2019;34:e168-82.  Back to cited text no. 28
    
29.
Kurji Z, Premani ZS, Mithani Y. Analysis of the health care system of Pakistan: Lessons learnt and way forward. J Ayub Med Coll Abbottabad 2016;28:601-4.  Back to cited text no. 29
    
30.
Shaikh BT. Health care system in Pakistan. In: Rout HS, editor. Health Care Systems: A Global Survey. New Delhi: New Century Publications; 2011. p. 434-54.  Back to cited text no. 30
    
31.
Hafeez A, Mohamud BK, Shiekh MR, Shah SA, Jooma R. Lady health workers programme in Pakistan: Challenges, achievements and the way forward. J Pak Med Assoc 2011;61:210-5.  Back to cited text no. 31
    
32.
Shumaila A, Iqbal J, Waris H, Ismail M, Naseer A. Health care system in Pakistan; a review. Res Pharm Health Sci 2016;2:211-6.  Back to cited text no. 32
    
33.
Rehman A, Shaikh BT, Ronis KA. Health care seeking patterns and out of pocket payments for children under five years of age living in Katchi Abadis (slums), in Islamabad, Pakistan. Int J Equity Health 2014;13:30.  Back to cited text no. 33
    
34.
National Nutrition Survey 2011. Aga Khan University, Pakistan Medical Research Council, Nutrition Wing, Cabinet Division, Government of Pakistan. Islamabad; 2011.  Back to cited text no. 34
    
35.
Hafeez M. Poverty and poor health in Pakistan: Exploring the effects of privatizing healthcare. Harva Int Rev 2014;35.  Back to cited text no. 35
    


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