Systems for the management of respiratory disease in primary care--an international series: Pakistan.

Introduction: Pakistan has a population exceeding 160 million. Communicable diseases remain the most important health problem in Pakistan, with non-communicable diseases and injuries comprising a quarter of all deaths.

National Policy And Health Service Model: The government provides a multi-tiered healthcare system, from the Basic Health Unit at the village level, ranging up to the tertiary care teaching hospitals in the larger cities. These facilities are accessible to all, and are usually free or highly subsidised. Patients have the choice to see a private or government GP, a specialist, or an alternative medicine healer. The current National Health Policy focusses mainly on prevention of communicable diseases, as well as improving primary and secondary health care services.

Epidemiology: Only 6% of 13 to 14 year olds are medically diagnosed as having asthma, and more than half report symptoms of rhinitis. The prevalence of chronic bronchitis in patients over 65 is 14% and 6% in rural females and males, respectively, and 9% (with no sex difference) in urban areas. The higher rates of chronic bronchitis observed in females in rural areas may be attributed to high levels of indoor air pollution due to cooking over smoking fires. It is estimated that 36% of adult males, and 9% of females, smoke, and the cigarette consumption per person per year in Pakistan is among the highest in South Asia. Pakistan is ranked 7th among the 22 highest tuberculosis disease burden countries in the world. In 2006 the number of all TB cases was 76,668 compared to 97,245 in 2004. It is estimated that 70-80,000 people are infected with HIV, but only 3,000 AIDS cases have been reported so far. The incidence of acute respiratory infections in children varies, and is a common cause of morbidity. In adults, it is estimated that pneumonia may affect as many as 2.8 million Pakistanis.

Access To Care: Patients usually can access their local GPs or alternative medical practitioners with relative ease. In villages in remote areas, access to government-run health care facilities can sometimes be quite difficult.

Facilities Available: Respiratory illnesses like asthma, allergy and COPD, are still a relatively low priority area, and even simple equipment--e.g. a peak flow meter--is not commonly available. Specialised equipment like spirometers and allergy testing facilities are only available in a few larger cities and hospitals.

Future Developments: The WHO's Global Alliance against Chronic Respiratory Diseases (GARD) is expected to be launched in 2008. This will be a platform for strengthening primary care respiratory activities with the involvement of the International Primary Care Respiratory Group (IPCRG). Various non-governmental organisations have plans to promote awareness regarding all aspects of allergy, asthma, COPD, and other chronic respiratory diseases, in the future.