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 Table of Contents  
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 4  |  Page : 174-176

Sociocultural and economic determinants of COVID-19 transmission in Pakistan: The way forward


1 Pharmacy Unit, Paraplegic Center, Peshawar, Pakistan
2 Department of Medicine, Hayatabad Medical Complex, Peshawar, Pakistan
3 Department of Social work, University of Peshawar; Paraplegic Center, Hayatabad, Peshawar, Pakistan
4 Department of Internal Medicine, Kabir Medical College, Peshawar, Pakistan
5 Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan

Date of Submission08-Jun-2020
Date of Acceptance23-Jul-2020
Date of Web Publication8-Sep-2020

Correspondence Address:
Iftikhar Ali
Paraplegic Center, Hayatabad, Peshawar, Khyber Pakhtunkhwa 25000
Pakistan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/SHB.SHB_31_20

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How to cite this article:
Ali I, Siraj A, Hassan Z, Ashraf A, Ullah I, Khan F. Sociocultural and economic determinants of COVID-19 transmission in Pakistan: The way forward. Soc Health Behav 2020;3:174-6

How to cite this URL:
Ali I, Siraj A, Hassan Z, Ashraf A, Ullah I, Khan F. Sociocultural and economic determinants of COVID-19 transmission in Pakistan: The way forward. Soc Health Behav [serial online] 2020 [cited 2020 Sep 18];3:174-6. Available from: http://www.shbonweb.com/text.asp?2020/3/4/174/294532



Dear Editor,

The World Health Organization has declared the novel coronavirus disease (COVID-19) as a pandemic due to its massive transmission rates throughout the world.[1] This seemingly trivial word choice carries grave connotations for the entire world. It implies the failure to curtail the spread of the COVID-19 transmission, and alarms the rest of the world of what is coming their way. Despite the ongoing efforts, the number of cases is on the rise everyday. The incidence in South Asian countries such as Pakistan is been reported much lower than the developed countries (for example: United States, Italy, Spain, etc.), which can be due to limited diagnostic facilities.[2] However, in Pakistan, there had been reported 234,508 confirmed COVID-19 cases and 4839 deaths by July 07,2020.[3] As imposing the preventive measures (e.g., lockdown and social isolation) is a bit difficult for the country (due to sociocultural and economic conditions), Pakistan is claimed to be heading toward a COVID-19 emergency.[4]


  Sociocultural and Economic Determinants of Transmission Top


Socioeconomic disparities, religious and cultural activities, naive behavior, and nonchalant attitudes are the elements that have a significant impact on the outbreaks.[5] Keeping in view the constant upward trajectory of the COVID-19 cases, we discuss the multifaceted social, economical, cultural, and religious determinants of its transmission.

As there is no doubt that Pakistan's health-care system is under-resourced along with organizational mismanagement, so that makes it inadequate and unfit for combating COVID-19 crisis.[6] Besides the burdened health-care system, societal patterns, religious beliefs, public perception, and practices are the variables that have a substantial impact on the current outbreak and therefore require consideration while shaping policy statements to address the crisis.[4],[7]

Owing to the geographic and demographic vastness of the country and the stratification of its social and cultural standing, religious traditions and customs exist simultaneously with weak social and human indices such as poverty, over population, and low literacy rate. Terrorism, improper water supply, poor sanitary conditions, and nonadherence to laws and regulations contribute to its concerns.[8],[9],[10]

Pakistan has 24% of the total population living below the national poverty line and about 39% are poor, based on the multidimensional index of poverty.[11] Majority of the population live on daily wages,[9] and it is unlikely that lockdown and social distancing will work for them. If they suddenly lose their employment, millions will be unable to survive for more than a few weeks. It is a challenging situation as the state takes into consideration the benefits and pitfalls of imposing an immediate lockdown in the cities. The dependence on one another also carries economic implications. On a global scale, the pandemic has brought the global economy to recession. However, its effects can also be seen on a much smaller section the society. An example is the labor class, which struggles on a daily basis for survival and lives from hand to mouth. Not being able to find work, they are shoved further down the poverty line. This prompts them to come out of isolation and become noncompliant with the government guidelines. Understanding the level of education and social awareness of the population is something all administrations must consider. Suicides cases have been recorded throughout the country due to the lockdown (imposed on 22nd March nationwide) that has triggered to sudden economic fallout and recession.[12]

There are densely packed metropolitans in Pakistan, which have close contacts and are also highly mobile.[13] A smaller household will have a lesser risk of transmission. Sweden's significant proportion of single-person homes has been reported as one justification for why more robust social-distancing restrictions are not considered appropriate. Moreover, the existence of multi-generational residences in Italy continues to intensify the virus' influence.[14] Ease of transportation and communication within and between peoples of different cities has contributed to the rapid development of the country. However, these same connections now make us vulnerable. All reported cases in Pakistan had been due to direct travel from Iran.[10] As of July 06, 2020, the US is ranked first in the number of total 19-nCoV cases.[2] This can be attributed partly to the delay in the implementation of nationwide lockdown and also due to the variation in state and federal measures taken. A ban on public transportation between different cities in Pakistan has been implemented in an attempt to curtail this generating more social problems thus far. Similarly, the western borders were closed; all international flights were temporarily suspended, with effect from March 21, 2020. Educational institutions were closed, and social gatherings were also banned.

Another aspect is that of religion, which revolves around the concept of bringing people together. With the ban on social gatherings and congregations, this puts many people of faith in a unique dilemma. Friday prayers in mosques, Church Mass on Sundays, and other religious holy days are banned in many parts of the world. This has sparked outrage and protests, which defeats the purpose of these bans in the first place. Lack of understanding was common across the country, and despite repeated warnings that these public practices would intensify the spread of infection, mass prayer events persisted.[10] The ban was strongly opposed by religious scholars who considered the closure of mosques as part of a conspiracy against Islam. Pakistanis who returned from Iran and those attended a religious event in Punjab, as many as 50% of the former and 15% of the latter tested positive.[15] The pilgrims who returned home after performing Umrah also contributed in spreading 19-nCoV in parts of Pakistan.[4] The deep religious and cultural ritual of community festivities in Pakistan and close relations with family members and neighbors are significant social and interpersonal influences that presented significant challenges.[10] Handshake and body hug is our cultural practice. Despite recommendation to avoid body contact, in order to intercept the spread of coronavirus, there is a section of society which regards this practice harmless on religious grounds.

The battle against this outbreak, fought with self and enforced isolation, is taking the mental health toll and could prompt another crisis. Cultures may differ across the globe, but one thing is certain, humans long for connections. This is especially true for people in the subcontinent, where joint family system is the norm. This isolation deprives them of that link.


  The Way Forward Top


Much of this leads to the value of ensuring that the right form of information is propagated and pseudo-scientific activities are negated. In the context of Pakistan, the people gobble up health-related information about the coronavirus outbreak, but it will not be sufficed for controlling the virus. Bringing substantial behavioral improvement is needed to be successful in public health programs. The degree to which these improvements can be brought about in a brief period of time is perplexing, but it has paramount importance as the outbreak is bustling.

Communication for the development can be used as a possible technique[16] for public awareness of the importance and contribution of interventions – including lockdown and physical distancing – within the general context of health communication. This technique is evidence based and its objective can be achieved by various channels in different levels of society. Such approaches could therefore help create understanding, change attitudes, and improve personal behavior. Preventative measures practices including self-isolation and social distancing must be met with strategies to dissipate speculation and misconceptions, and actions to minimize prejudices and worries. In a predominantly faith following and joint family culture society like Pakistan, the involvement of religious leaders/clerics of different sects and social media activists cannot be overruled.

Addressing the current crisis ultimately involves a comprehensive approach that combines the infrastructural, financial, mental, and psychological dimensions adequately to prepare us for any emergency response. As the 19-nCoV arrived in the Pakistan, this will be a long fight with a growing, and possibly re-emerging pathogen. This demands to be dealt with evidence-based practice. For the foreseeable future, Pakistan needs to increase its public health spending to develop a stable health-care system and cope quickly and efficiently with overarching religious values, societal norms, and cultural practices to promote people's methodological temperament. Keeping in view the falling economy, poor and overstretched health-care system, low literacy rate, the country cannot afford to cope with the possible devastating outcome we see in Italy.

It is obvious that self-isolation and social distancing are not empty words that everyone can and must abide by abide by. Its evidence is promising. People should understand and respect the importance of these measures. However, the implications it has on the common man cannot be ignored. It falls on the governments to fully understand the needs of the populations they administer and adjust their strategy accordingly. This aspect needs to be understood and the reason for every step needs to be clarified explicitly to the public. Nonetheless, a prolonged economic downturn would trigger adverse health effects, ranging from “deaths of desperation” to strains on public health budgets, which may result in more deaths associated with 19-CoV than containment would save from this disease.[17] Timely intervention on a nationwide level by the government can prove to slow down the pace of this pandemic. The state policy should include placing full state power on the line regardless of any political, spiritual, sociocultural, and financial constraints. The nation is running out of time quickly and the shoddy policies of the government can only make the situation worse.

Acknowledgment

We would like to express our great thankfulness to Mohammed A. Mamun, Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh for his support, opinion, and contribution.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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World Health Organization. Novel Coronavirus (2019-ncov) Situation Report-1; 2020. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/. [Last accessed on 2020 Apr 01].  Back to cited text no. 1
    
2.
World Health Organization. Coronavirus Disease 2019(COVID-19) Situation Report – 168; 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200706-covid-19-sitrep-168.pdf?sfvrsn=7fed5c0b_2. [Last accessed on 2020 Jul 07].  Back to cited text no. 2
    
3.
Government of Pakistan. Covid-19 Health Advisory Platform by Ministry of National Health Services Regulations & Coordination; 2020. Available from: http://covid.gov.pk/. [Last accessed on 2020 Jul 07].  Back to cited text no. 3
    
4.
Diplomat T. PilgrimsFirst: How Islamists Are Undermining Pakistan's Fight Against COVID-19; 2020. Available from:https://thediplomat.com/2020/03/pilgrims- first-how-islamists-are-undermining-pakistans-fight-against- covid-19/. [Last accessed on 2020 Mar 30].  Back to cited text no. 4
    
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Omoleke SA, Alabi O, Shuaib F, Braka F, Tegegne SG, Umeh GC, et al. Environmental, economic and socio-cultural risk factors of recurrent seasonal epidemics of cerebrospinal meningitis in Kebbi state, northwestern Nigeria: A qualitative approach. BMC Public Health 2018;18:1318.  Back to cited text no. 5
    
6.
Hussain A, Ali I. Diabetes mellitus in Pakistan: A major public health concern. Arch Pharm Pract 2016;7:30-3.  Back to cited text no. 6
    
7.
United Nations Development Programme-Pakistan. COVID-19 Pandemic Humanity Needs Leadership and Solidarity to Defeat COVID-19; 2020. Available from: https://www.pk.undp.org/content/pakistan/en/home/coronavirus.html. [Last accessed on 2020 Apr 15].  Back to cited text no. 7
    
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Hussain R. The effect of religious, cultural and social identity on population genetic structure among Muslims in Pakistan. Ann Hum Biol 2005;32:145-53.  Back to cited text no. 8
    
9.
Human Development Reports. Human Development Indicators-Pakistan; 2019. Available from: http://hdr.undp.org/en/countries/profiles/PAK. [Last accessed on 2020 Apr 01].  Back to cited text no. 9
    
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Javed B, Sarwer A, Soto EB, Mashwani ZU. Is Pakistan on track to have COVID-19 transmission and mortality rates similar to those of Italy, Iran or the USA? Drugs Ther Perspectives 2020;36:293-7.  Back to cited text no. 10
    
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Humanitarian Response. Balochistan Drought Needs Assessment (BDNA) Report – February 2019. Available from: https://www.humanitarianresponse.info/en/operations/pakistan/documentt/balochistan-drought-needs-assessment-bdna-report -february-2019. [Last accessed on 2020 Apr 16].  Back to cited text no. 11
    
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Hussain I. Three Residents of Khairpur Commit Suicide Due to Hunger During Lockdown; 2020. Available from: https://www.thenews.com.pk/print/641581-three-residents -of-khairpur-commit-suicide-due-to-hunger-during-lockdown. [Last accessed on 2020 Apr 14].  Back to cited text no. 12
    
13.
Scott WA, Mahoney E. Defects of glucose-6-phosphate and 6-phosphogluconate dehydrogenases in Neurospora and their pleiotropic effects. Curr Top Cell Regul 1976;10:205-36.  Back to cited text no. 13
    
14.
Daily Mail. Italy's Coronavirus Crisis 'was Worsened by Multi-generational Homes; 2020. Available from: https://www.dailymail.co.uk/news/article-8125457/Italys-coronavirus-crisis-worsened-multi-generational-homes.html. [Last accessed on 2020 Mar 31].  Back to cited text no. 14
    
15.
Bloomberg. Pakistan Virus Cases Double Led by Pilgrims Returning from Iran; 2020. Available from: https://www.bloomberg.com/news/articles/2020-03-18/pakistan-virus-cases-double-led-by-pilgrims-returning-from- iran. [Last accessed on 2020 Mar 31].  Back to cited text no. 15
    
16.
Servaes J. Development communication – for whom and for what? Communicatio 1995;21:39-49.  Back to cited text no. 16
    
17.
Gilbert M, Dewatripont M, Muraille E, Platteau JP, Goldman M. Preparing for a responsible lockdown exit strategy. Nat Med 2020;26:643-4.  Back to cited text no. 17
    




 

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