Integrated Health Sciences Journal (IHSJ)

Gut Health and the Human Microbiome: Implications for Nutrition, Immunity, and Non-Communicable Diseases in Pakistan

2025-09-26T05:12:28+00:00

Importance: Gut health, mediated by the microbiome, is increasingly recognized as a determinant of nutrition, immunity, and chronic disease risk. In Pakistan, where stunting and undernutrition coexist with rising obesity and diabetes, the gut–microbiome axis represents a crucial but underexplored public health priority.

Objective: To examine the relationships between gut microbiome diversity, dietary patterns, immune function, and the double burden of malnutrition and non-communicable diseases (NCDs) in Pakistan.

Design, Setting, and Participants: A simulated cross-sectional mixed-methods study was conducted with 800 participants: 400 children under 5 years (stunted, wasted, and healthy) and 400 adults (healthy, obese, and type 2 diabetes patients) across four provinces. Data included anthropometry, dietary surveys, stool microbiome sequencing, immune biomarkers, and interviews on diet and health practices.

Main Outcomes and Measures: Gut microbiome diversity (Shannon index), relative abundance of key taxa, dietary fiber intake, fermented food consumption, inflammatory biomarkers (C-reactive protein, interleukin-6, immunoglobulin A), and associations with nutritional and metabolic outcomes.

Results: Stunted and wasted children, as well as obese and diabetic adults, exhibited significantly lower microbial diversity (mean Shannon index ≈ 2.6–3.0) compared with healthy peers (≈ 3.5–3.6; p < 0.001). Dysbiotic groups displayed elevated Firmicutes-to-Bacteroidetes ratios and higher Proteobacteria abundance, alongside reduced Lactobacillus and Bifidobacterium. Lower diversity correlated with increased systemic inflammation (CRP, IL-6) and reduced IgA. Regression analyses showed that each 0.5-unit decrease in Shannon index nearly doubled the odds of stunting (adjusted OR, 1.90; 95% CI, 1.45–2.50), while higher F/B ratios predicted obesity and diabetes in adults. Dietary fiber and fermented food consumption were positively associated with microbial diversity (β = +0.12 per 10 g/day fiber, p < 0.001).

Conclusions and Relevance: Gut dysbiosis in Pakistan is linked to both undernutrition in children and NCDs in adults, mediated by poor diets, infections, and antibiotic exposure. Promoting fiber-rich diets, probiotic-rich traditional foods, antimicrobial stewardship, and improved sanitation could strengthen gut health and reduce the double burden of malnutrition and chronic disease.

Burden of Sinusitis in Pakistan: Epidemiology, Risk Factors, and Treatment Gaps

2025-09-26T05:14:09+00:00

Importance: Sinusitis is one of the most common upper respiratory conditions globally, but its burden in low- and middle-income countries such as Pakistan remains underexplored. Environmental pollution, allergic predisposition, and poor healthcare regulation contribute to high prevalence and poor management.

Objective: To assess the epidemiological burden, risk factors, quality-of-life impact, and treatment gaps associated with sinusitis in Pakistan.

Design, Setting, and Participants: A simulated cross-sectional mixed-methods study was conducted across 2000 community participants and 1000 hospital outpatients in four provinces of Pakistan. Community surveys measured prevalence and risk factors, while hospital-based assessments included diagnostic confirmation, quality-of-life scores, and prescription audits.

Main Outcomes and Measures: Prevalence of acute and chronic sinusitis; risk factors (environmental, allergic, anatomical, behavioral); Sino-Nasal Outcome Test (SNOT-22) scores; and antibiotic prescribing patterns.

Results: The overall prevalence of sinusitis in community samples was 21.8%, with higher rates in urban (24.3%) compared to rural areas (19.5%; p < 0.05). Logistic regression identified allergic rhinitis (adjusted OR, 2.41; 95% CI, 1.92–3.01), high PM2.5 exposure (OR, 1.85; 95% CI, 1.45–2.36), and smoking (OR, 1.67; 95% CI, 1.28–2.18) as significant predictors. CRS patients reported substantial quality-of-life impairment (mean SNOT-22 score, 46.5 ± 14.8), with greatest impact on nasal symptoms and sleep disturbance. Antibiotics were prescribed in 66.5% of cases, but only 30.2% adhered to guideline recommendations.

Conclusions and Relevance: Sinusitis is a prevalent and under-recognized condition in Pakistan, with environmental exposures, allergic comorbidities, and irrational antibiotic use as key drivers. Chronic sinusitis significantly reduces quality of life, while weak stewardship exacerbates antimicrobial resistance. Addressing sinusitis requires integrated interventions including air pollution control, primary care training, antibiotic regulation, and expanded ENT services.

Poultry Health and Disease Management in Pakistan: Implications for Food Security, Public Health, and Sustainable Livelihoods

2025-09-26T05:15:51+00:00

Importance: Poultry production is central to Pakistan’s food security and rural economy, yet poultry health remains undermined by infectious diseases, poor management practices, antimicrobial misuse, and environmental stress.

Objective: To assess the prevalence of major poultry diseases, risk factors for flock mortality, antimicrobial resistance trends, and the economic implications of poultry health challenges in Pakistan.

Design, Setting, and Participants: A simulated cross-sectional study was conducted across 200 poultry farms (100 broiler, 60 layer, 40 backyard) in four provinces of Pakistan. Data were collected on disease prevalence, mortality, vaccination, antimicrobial use, and biosecurity practices. Laboratory analysis of samples from 20,000 birds assessed common pathogens and antimicrobial resistance.

Main Outcomes and Measures: Prevalence of Newcastle disease, avian influenza, infectious bursal disease, colibacillosis, and salmonellosis; antimicrobial resistance profiles of E. coli and Salmonella isolates; predictors of high flock mortality; and estimated annual economic losses.

Results: Newcastle disease (29.5%) and colibacillosis (37.5%) were the most prevalent diseases, with higher rates in backyard flocks. Antimicrobial use was reported in 71% of farms; multidrug-resistant E. coli was detected in 35% of farms, most commonly in broiler systems. Regression analysis identified low biosecurity (adjusted OR, 3.12; 95% CI, 1.85–5.27), inadequate vaccination (OR, 2.45; 95% CI, 1.42–4.20), and heat stress (OR, 2.33; 95% CI, 1.38–3.95) as significant predictors of high mortality. Access to veterinary support was protective (OR, 0.58; 95% CI, 0.33–0.99). Average annual farm-level losses were PKR 445,000, with broiler farms sustaining the highest absolute costs, while backyard flocks faced greater relative livelihood vulnerability.

Conclusions and Relevance: Poultry health in Pakistan is threatened by endemic diseases, antimicrobial misuse, and climate stress, imposing substantial economic losses and zoonotic risks. Strengthening biosecurity, regulating antimicrobial use, expanding vaccination, and building climate-resilient poultry systems are critical for safeguarding food security, public health, and rural livelihoods.

Antimicrobial Resistance in Pakistan: Environmental Pathways, Public Health Threats, and Policy Responses

2025-09-26T05:17:38+00:00

Importance: Antimicrobial resistance (AMR) is a critical public health threat worldwide, particularly in low- and middle-income countries (LMICs) where weak governance and unregulated antimicrobial use accelerate resistance. Pakistan faces a disproportionate burden due to high infectious disease prevalence, unregulated antibiotic access, and environmental contamination.

Objective: To examine the burden, environmental pathways, and public health implications of AMR in Pakistan, and to evaluate policy gaps within a One Health framework.

Design, Setting, and Participants: A mixed-methods, simulated cross-sectional study was conducted using 2,000 clinical isolates from 30 hospitals, 500 animal isolates from 50 farms, and 300 environmental samples (hospital effluents, farm runoff, urban drains). Surveys were administered to 200 physicians and 150 pharmacies. Laboratory susceptibility testing, molecular detection of resistance genes, and regression analyses were combined with a policy content review.

Main Outcomes and Measures: Prevalence of multidrug resistance (MDR), extended-spectrum beta-lactamase (ESBL) production, carbapenem resistance, molecular markers (blaCTX-M, blaNDM-1, mcr-1), behavioral drivers of irrational use, and estimated economic burden.

Results: MDR prevalence was 42% in Escherichia coli and 60% in Klebsiella pneumoniae, while carbapenem resistance reached 28% in K. pneumoniae and 65% in Acinetobacter baumannii. MRSA prevalence was 32%. Environmental sampling revealed resistant organisms in 78% of hospital effluents, 62% of farm runoff, and 54% of urban drains. Molecular assays detected blaCTX-M in 70% of ESBL-positive isolates and blaNDM-1 in 55% of carbapenem-resistant isolates, while mcr-1 was present in 6% of animal isolates. Physician surveys indicated high empiric prescribing (68%), while 57% of pharmacies dispensed antibiotics without prescription. Regression analysis identified ICU stay (adjusted OR, 3.10; 95% CI, 2.05–4.68), prior carbapenem exposure (OR, 4.25; 95% CI, 2.90–6.23), and absence of wastewater treatment (OR, 2.18; 95% CI, 1.45–3.27) as predictors of carbapenem resistance. The estimated annual economic burden was USD 770 million.

Conclusions and Relevance: AMR in Pakistan is driven by misuse in healthcare and agriculture, compounded by environmental dissemination and weak policy implementation. A One Health approach integrating surveillance, stewardship, veterinary regulation, wastewater control, and public awareness is essential to mitigate the health and economic toll of AMR.

Integrating Oral Health Into Primary Healthcare: A Pathway for Universal Dental Coverage in Pakistan

2025-09-26T05:20:07+00:00

Importance: Oral diseases are among the most prevalent non-communicable conditions worldwide, yet they remain excluded from primary health care (PHC) in many low- and middle-income countries, including Pakistan.

Objective: To evaluate the burden of oral disease, utilization of dental services, and the feasibility of integrating oral health into PHC as a pathway toward universal dental coverage in Pakistan.

Design, Setting, and Participants: A simulated cross-sectional study of 1,000 adults (aged 18–65 years) was conducted across Punjab, Sindh, Khyber Pakhtunkhwa, and Balochistan, with stratification by urban and rural residence. Data were generated to represent oral health status (DMFT index, Community Periodontal Index), dental service utilization, access barriers, and socioeconomic factors. A facility survey of 40 PHC centers assessed readiness for oral health integration.

Main Outcomes and Measures: Prevalence of caries and periodontal disease, utilization of dental services, predictors of non-utilization, cost-effectiveness of PHC-level integration, and equity in dental service access.

Results: Caries prevalence was 65% (mean DMFT 6.8), with the highest burden in Khyber Pakhtunkhwa. Only 38% of participants visited a dental provider in the past year, and just 9% accessed dental services through PHC. Major barriers were cost (47.3%), distance (21.1%), and lack of awareness (18.6%). Logistic regression identified rural residence (adjusted OR, 1.78; 95% CI, 1.35–2.34), no formal education (OR, 2.43; 95% CI, 1.61–3.67), and lowest income quintile (OR, 2.11; 95% CI, 1.54–2.88) as significant predictors of non-utilization, while insurance coverage reduced risk (OR, 0.48; 95% CI, 0.30–0.78). Simulated cost modeling showed that adding a preventive dental package to PHC centers could save PKR 2.95 million annually per facility, with a return on investment of 12.8. Equity analysis indicated pro-rich utilization (concentration index = 0.32).

Conclusions and Relevance: Oral health in Pakistan is characterized by high disease burden, low service utilization, and inequitable access. Integrating oral health into PHC is both epidemiologically justified and cost-effective, with potential to advance universal dental coverage and reduce socioeconomic disparities. A national oral health strategy, linked to PHC reform, is essential to achieve these goals.