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Reprinted from Pakistan Journal of Medical Sciences. 2020;36(7):1471-1477.
Scarlett Letter: A study based on experience
of stigma by COVID-19 
patients in quarantine
Nazish Imran1, Hadia Afzal2 , Irum Aamer3, Ali Hashmi4,
Bilquis Shabbir5, Aftab Asif6, Saeed Farooq7


Background and Objectives: Stigma around COVID-19 is a major barrier in global efforts to control the COVID 19 pandemic. Limited data is available regarding stigma faced by COVID-19 patients in low- and middle-income countries (LMIC). The aim of the current study was to explore the stigma experienced by hospitalized patients with COVID-19 illness in Lahore, Pakistan.

Methods: Following Institutional Review Board approval and informed consent, patients were assessed using modified HIV short form stigma scale and open-ended questions. Questions focused on experiences, feelings, and opinions as to how patients feel and how they were treated prior to and during the hospitalization. Data analysis for quantitative data was performed using SPSS-20, while qualitative responses were interpreted by content analysis method.

Results: One hundred and fourteen patients were interviewed (Mean age 38.8 years + 15.3) with 53.5% being males. Widespread experience of stigma was reported by patients particularly for concerns about public attitudes (7.43 + 1.43) & disclosure (6.89 + 1.45). Main themes which emerged from the qualitative responses were social stigma and rejection, humiliating behaviour of others, breach of confidentiality, loss of trust/ respect, and impact of COVID-19 diagnosis on their business.

Conclusions: Existence of significant stigma among COVID-19 patients isolated in a tertiary care hospital in a LMIC highlights the need for culturally sensitive strategies to address it.

KEYWORDS: Coronavirus, COVID-19, Discrimination, Stigma, Pakistan, Global efforts.

How to cite this:
Imran N, Afzal H, Aamer I, Hashmi A, Shabbir B, Asif A, et al. Scarlett Letter: A study based on experience of stigma by COVID-19 patients in quarantine. Pak J Med Sci. 2020;36(7):1471-1477. doi:

Reprinted from Pakistan Journal of Medical Sciences. 2020;36(7):1435-1440.
Prevalence of stroke in Pakistan: Findings 
from Khyber Pakhtunkhwa integrated 
population health survey (KP-IPHS) 2016-17
Akhtar Sherin1, Zia Ul-Haq2, Sheraz Fazid3,
Basharat Hussain Shah4, Maria Ishaq Khattak5, Fazal Nabi6


Objective: To study the prevalence of stroke and associated risk factors in Khyber Pakhtunkhwa (KP) province of Pakistan.

Methods: This study was a part of cross-sectional KP Integrated Population Health Survey 2016-17 conducted on population aging ≥18 years at 24 districts of KP. Primary (n=1061) and secondary sampling units (n=15724) were developed, based on urban/rural and socio-economic status. Each primary-unit comprised of 250-300 households. Sample was selected through a multi-staged stratified systematic cluster sampling technique by taking every 16th household per rural and every 12th household per urban-unit. A validated “Cincinnati Stroke Scale” for identification of stroke patients in community was used along with demographics and potential risk factors.

Results: Among the 15724 randomly selected households, 22500 participants (51.4% females; 74.6% rural areas, mean age 42±12.6 years) were interviewed. Stroke was identified in 271 cases (137 males, 134 females; Mean age=43.39±0.85 years) and prevalence of stroke was 1.2% (1200 per 100,000 population). Obesity/overweight (38.8%), hypertension (21.8%), smoking (6.6%) and known diabetes mellitus (5.9%) were the common associated risk factors of stroke. Age groups >60 years (adjusted OR=1.68; 95% CI: 1.05-2.68); urban area (adjusted OR=1.68; 95% CI: 1.29-2.19); unemployment (adjusted OR=3.78; 95% CI: 2.49-5.73) and lower formal (primary) education (adjusted OR 2.18; 95% CI: 1.30-3.64) were significantly associated with stroke (p <0.05).

Conclusion: Prevalence of stroke is 1.2% in the province of KP. Obesity, hypertension, smoking and Diabetes Mellitus are the common associated risk factors of stroke. Higher age, urban area, unemployment and lower formal education are significantly associated with stroke.

KEYWORDS: KP-IPHS, Stroke, Prevalence, Risk factors, Hypertension, Diabetes Mellitus, Obesity, Smoking, Dyslipidemias, Pakistan.

How to cite this: Sherin A, Ul-Haq Z, Fazid S, Shah BH, Khattak MI, Nabi F. Prevalence of stroke in Pakistan: Findings from Khyber Pakhtunkhwa integrated population health survey (KP-IPHS) 2016-17. Pak J Med Sci. 2020;36(7):1435-1440. doi:

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