Determinants of medication nonadherence and physician-switching behavior among outpatient populations in Karachi, Pakistan: a cross-sectional analysis Mubashir Zafar, Tooba Adil, Tafazzul Hyder Zaidi, Hafiza Tooba Siddiqui, Talha Farooq, Areej Sohail, Ayesha Javed, Rashaqha Rahman, Abeer Riaz, Aysha Asif, Areeshah Tariq, Laiba Tanzeem, Muhammad Hunain Aslam, Faareah Mansoor, Ramisha Fahim, Muhammad Noman Siddiqui Discover Public Health, 2026 Medication nonadherence and physician-switching undermine treatment outcomes and strain healthcare systems. This study examined the prevalence and determinants of medication noncompliance and doctor-switching behavior among outpatient populations in Karachi, Pakistan, where socioeconomic and systemic barriers significantly influence care-seeking patterns. A cross-sectional study was conducted from May to August 2024 in a public hospital in Karachi using non-probability convenience sampling. A total of 287 adult outpatients completed a validated, self-administered questionnaire which assessing demographics, medication-taking behavior, non-adherence, healthcare utilization, and physician-switching tendencies. Data were analyzed using descriptive statistics, chi-square tests, and binary logistic regression in SPSS 23.0, with p < 0.05 considered significant. Medication nonadherence was common, with 50.5% reporting frequent missed doses; only 17.4% reported full adherence. Primary nonadherence was low, as 81.5% initiated prescribed treatments. Logistic regression identified poor communication quality as the strongest independent predictor of nonadherence (OR = 4.82; 95% CI 3.21–7.24; p < 0.001), while higher education level (OR = 1.34; 95% CI 1.08–1.67; p = 0.008) and lower medication count (OR = 0.78; 95% CI 0.66–0.92; p = 0.004) were also significant predictors. Physician-switching occurred in 41.1% of respondents, mainly due to dissatisfaction with treatment (31.7%). Key adherence barriers included fear of long-term side effects (51.9%), conflicting medical advice (63.1%), and inadequate physician communication (28.2%). Although most participants (85.4%) felt comfortable discussing concerns, communication gaps remained substantial. Nonadherence and physician-switching are widespread in Karachi, driven by communication deficits, dissatisfaction, and systemic shortcomings. Healthcare providers should prioritize structured communication skills training and patient-centered counseling. Policymakers should address structural barriers—including consultation time, medication cost, and access to consistent care—to reduce both nonadherence and unnecessary physician-switching. Strengthening patient-provider interactions and improving health system responsiveness are essential to enhance adherence and continuity of care.
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Di Paolo, Marcello Di Pumpo, Guodong Ding, Hoa Thi Do, Mai Ngoc Do, Thao Huynh Phuong Do, Klara Georgieva Dokova, Neda Dolatkhah, Fariba Dorostkar, Ojas Prakashbhai Doshi, Paulo Magno Martins Dourado, Robert Kokou Dowou, Senbagam Duraisamy, Oyewole Christopher Durojaiye, Siddhartha Dutta, Osamudiamen Ebohon, Mohammad Hossein Ebrahimi, Abdelaziz Ed-Dra, Cynthia Edeh, Hisham Atan Edinur, Ferry Efendi, Foolad Eghbali, Ebrahim Eini, Michael Ekholuenetale, Seraphine Mojoko Eko, Rabie Adel El Arab, Iman El Sayed, Maysaa El Sayed Zaki, Ahmed Eldaboush, Marwan El-Deyarbi, Muhammed Elhadi, Yasir Ahmed Mohammed Elhadi, Mohamed Elhoumed, Omar Abdelsadek Abdou Elmeligy, Mohamed A Elmonem, Mohamed Hassan Elnaem, Mohammed Elshaer, Abdelgawad Salah Eltahawy, Setegn Eshetie, Babak Eshrati, Gilbert Eshun, Majid Eslami, Heidar Fadavian, Adeniyi Francis Fagbamigbe, Ildar Ravisovich Fakhradiyev, Markus Fally, Qiping Fan, Mohammad Farahmand, Abdullah Farasani, Mohammad Fareed, Aisha Farhana, Syed Muhammad 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Khalifa, Anees Ahmed Khalil, Pantea Khalili, Faham Khamesipour, Ajmal Khan, Faiz Ullah Ullah Khan, Iman Waheed Khan, Iqra Hamid Khan, Maseer Khan, Mohammad Idreesh Khan, Muhammad Umer Khan, Serab Khan, Yusuf Saleem Khan, Zahid Khan, Sameer Uttamaro Khasbage, Haitham Khatatbeh, Moawiah Mohammad Khatatbeh, Khalid A Kheirallah, Mehdi Khezeli, Parisa Khoshvaght, Samira Khoshvaght, Farbod Khosravi, Sepehr Khosravi, Grace Kim, Hye Jun Kim, Min Seo Kim, Ruth W Kimokoti, Sanjay Kini B, Adnan Kisa, Sezer Kisa, Ladli Kishore, Desmond Klu, Shivakumar KM, Sonali Kochhar, Sky Wei Chee Koh, Ali-Asghar Kolahi, Farzad Kompani, Wolyu Erkano Korma, Tapos Kormoker, Vladimir Andreevich Korshunov, Oleksii Korzh, Karel Kostev, Parvaiz A Koul, James-Paul Kretchy, Kewal Krishan, Mohammed Kuddus, Claudia E. 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Duraisamy, Siddhartha Dutta, Sulagna Dutta, Aziz Eftekharimehrabad, Foolad Eghbali, Terje Andreas Eikemo, Michael Ekholuenetale, Temitope Cyrus Ekundayo, Eman D El Desouky, Abdelfatteh EL Omri, Iman El Sayed, Maysaa El Sayed Zaki, Mohamed Ahmed Eladl, Iffat Elbarazi, Marwan El-Deyarbi, Noha Mousaad Elemam, Muhammed Elhadi, Yasir Ahmed Mohammed Elhadi, Rami Elmorsi, Adel B Elmoselhi, Abdelgawad Salah Eltahawy, Tadele Emagneneh, Setegn Eshetie, Sharareh Eskandarieh, Elochukwu Ezenwankwo, Elisa Fabbro, Heidar Fadavian, Adeniyi Francis Fagbamigbe, Ayesha Fahim, Razana Faiz, Ildar Ravisovich Fakhradiyev, Luca Falzone, Mohammad Farahmand, Seyed Nooreddin Faraji, Mahsa Faramarzpour, Mohammad Fareed, Aisha Farhana, Zaki Farhana, MoezAlIslam Ezzat Mahmoud Faris, Syed Muhammad Yousaf Farooq, Zareen Fatima, Alireza Feizkhah, Ginenus Fekadu, Allegra Ferrari, Nuno Ferreira, Florian Fischer, James L Fisher, Luisa S Flor, Bobirca Teodor Florin, Alina-Ioana Forray, Celia Fortuna Rodrigues, Takeshi Fukumoto, Peter Andras Gaal, Muktar A Gadanya, Dominic Dormenyo Gadeka, Márió Gajdács, Silvano Gallus, Dingwei Gao, Jacopo Garlasco, Anteneh Gashaw, Rupesh K Gautam, Miglas Welay Gebregergis, Teferi Gebru Gebremeskel, Beza A Gelaw, Ali Gerami Matin, Urge Gerema, Genanew K Getahun, Fataneh Ghadirian, Kazem Ghaffari, Arin Ghamkhar, Mohammad-Reza Ghasemi, Shakiba Ghasemi Assl, Ahmad Ghashghaee, Fariba Ghassemi, Ramy Mohamed Ghazy, Ehsan Gholami, Elena Ghotbi, Arun Ghuge, Konstantinos Giannakis, Syed Abdullah Gilani, Alessandro Girombelli, Kimiya Gohari, Ali Golchin, Mahaveer Golechha, Melika Golmohammadi, Giuseppe Gorini, Swati Goyal, Teklit Grum, Shi-Yang Guan, Mohammed Ibrahim Mohialdeen Gubari, Avirup Guha, Damitha Asanga Gunawardane, Zheng Guo, Zhifeng Guo, Bhawna Gupta, Vivek Kumar Gupta, Najah R Hadi, Dariush Haghmorad, Arvin Haj-Mirzaian, Pritam Halder, Islam M Hamad, Randah R Hamadeh, Nadia M Hamdy, Asif Hanif, Victoria Funmilayo Hanson, Mohd Anul Haq, Ashanul Haque, Md Aminul Haque, Josep Maria Haro, Sara Harsini, Eka Mishbahatul Marah Has, Ahmed I Hasaballah, Ikramul Hasan, Md Kamrul Hasan, Mohammad Hashem Hashempur, Treska S Hassan, Simon I Hay, Golnaz Heidari, Mohammad Heidari, Hossein Heli, Claudiu Herteliu, Kasuni Akalanka Hewa Marambage, Sumudu Avanthi Hewage, Majid Heydari, Ramesh Holla, Mehdi Hoseinzadeh, Alamgir Hossain, Md Jubayer Hossain, Md Sabbir Hossain, Mohammad Bellal Hossain, Mohamed Hsairi, Junjie Huang, Yefei Huang, Mega Hasanul Huda, Waqar Husain, Kiavash Hushmandi, Javid Hussain, Salman Hussain, Dursa Hussein, Mohammed Asif Hussein, Bing-Fang Hwang, Olabisi Fatimo Ibitoye, Segun Emmanuel Ibitoye, Reem Ibrahim, Anel Ibrayeva, Pulwasha Maria Iftikhar, Adalia Ikiroma, Olayinka Stephen Ilesanmi, Irena M Ilic, Milena D Ilic, Muhammad Hamza Ilyas, Andreea Iuliana Ionescu, Radu Tudor Ionescu, Lalu Muhammad Irham, Mustafa Alhaji Isa, Md Rabiul Islam, Md Shahinul Islam, Farhad Islami, Faisal Ismail, Louis Jacob, Kathryn H Jacobsen, Farhad Jadidi-Niaragh, Vennila Jaganathan, Fatemeh Jahanshahi, Haitham Jahrami, Ammar Abdulrahman Jairoun, Abhishek Jaiswal, Mihajlo Jakovljevic, Sahbanathul Missiriya Jalal, Pooya Jalali, Mohamed Jalloh, Armaan Jamal, Qazi Mohammad Sajid Jamal, Navid Jamali, Jerin James, Hasan Jamil, Rajiv Janardhanan, Talha Jawaid, Qassim Jawell Odah Abed, Shubha Jayaram, Yovanthi Anurangi Jayasinghe, Harerimana Jean de Dieu, Sun Ha Jee, Alelign Tasew Jema, Seogsong Jeong, Fan Jiang, Min Jiang, Wenyi Jin, Mohammad Jokar, Jost B Jonas, Tamas Joo, Jobinse Jose, Akaninyene Paul Joseph, Nitin Joseph, Krupal Joshi, Charity Ehimwenma Joshua, Jacek Jerzy Jozwiak, Billingsley Kaambwa, Ali Kabir, Leila R Kalankesh, Khalil Kalavani, Md Moustafa Kamal, Samuel Berchi Kankam, Kehinde Kazeem Kanmodi, Suthanthira Kannan S, Rami S Kantar, Neeti Kapoor, Dattatreya Kar, Sujita Kumar Kar, Mehrdad Karajizadeh, Reema A Karasneh, Mohammad Amin Karimi, Arman Karimi Behnagh, Faizan Zaffar Kashoo, Manoj Kumar Kashyap, Nigussie Assefa Kassaw, Mohd Adnan Kausar, Yousef Saleh Khader, Pantea Khalili, Alireza Khalilian, Ghazaleh Khalili-Tanha, Mohamed Khalis, Faham Khamesipour, Amjad Khan, Gulfaraz Khan, Iqra Hamid Khan, Md Abdullah Saeed Khan, Muhammad Hamza Khan, Muhammad Umer Khan, Muzamil Khan, Salman Ali Khan, Serab Khan, Sumaiya Khan, Yusuf Saleem Khan, Sameer Uttamaro Khasbage, Khaled Khatab, Moawiah Mohammad Khatatbeh, Peyman Kheirandish Zarandi, Feriha Fatima Khidri, Parisa Khoshvaght, Jagdish Khubchandani, Ermias A Kibru, Ruth W Kimokoti, Yohannes Kinfu, Adnan Kisa, Nazarii Kobyliak, Timea Kocsis, Farzad Kompani, Elizabeth Koomson-Yalley, Karel Kostev, Archana Koul, Irene Akwo Kretchy, Ananya Kuanar, Raja Amir Hassan Kuchay, Mohammed Kuddus, Mukhtar Kulimbet, G Anil Kumar, Nithin Kumar, Rakesh Kumar, Vijay Kumar, Aria Kusuma, Dian Kusuma, Assylkhan Kuttybayev, Grace Kwakyewaa Kyei, Carlo La Vecchia, Chandrakant Lahariya, Daphne Teck Ching Lai, Jianguo Lai, Balzhan Lakanova, Judit Lám, Tian Lan, Iván Landires, Francesco Lanfranchi, Tamás Lantos, Mahrukh Latif, Caterina Ledda, Ivan Lee, Seung Won Lee, Wei-Chen Lee, Gebretsadik Kiros Lema, Elvynna Leong, Cheru Tesema Leshargie, Jinbo Li, Ming-Chieh Li, Yanxue Lian, Rong Liu, Xianliang Liu, Xiaofeng Liu, Xuefeng Liu, Tewachew Muche Liyeh, Madeeha Shahzad Lodhi, Platon D Lopukhov, Alessandra Lugo, Peng Luo, Angelina M Lutambi, Miltiadis D Lytras, Hawraz Ibrahim M Amin, Kevin Sheng-Kai Ma, Zheng Feei Ma, Raymond Saa-Eru Maalman, Edward Augustine Magwe, Nozad Hussein Mahmood, Mansour Adam Mahmoud, Rashidul Alam Mahumud, Ahmad Azam Malik, Tabarak Malik, Deborah Carvalho Malta, Doste Rashid Mamand, Farheen Mansoor, Marjan Mansourian, Mohammad Ali Mansournia, Lorenzo Giovanni Mantovani, Shaista Manzoor, Kaleem Maqsood, Hamid Reza Marateb, Santi Martini, Miquel Martorell, Roy Rillera Marzo, Sammer Marzouk, Medha Mathur, Neeta Mathur, Fernanda Penido Matozinhos, Steven M McPhail, Jitendra Kumar Meena, Ravi Mehrotra, Subhash Mehto, Hadush Negash Meles, Satish Melwani, Godfred Antony Menezes, Emiru Ayalew Mengistie, Sultan Ayoub Meo, Tuomo J Meretoja, Rahwa Adisu Mesfin, Tomislav Mestrovic, Mohamed M M Metwally, Malathi Mini, Mojgan Mirghafourvand, Seyed Ali Mirshahvalad, Amaresh Mishra, Sanjeev Misra, Prasanna Mithra, Jama Mohamed, Mona Gamal Mohamed, Nouh Saad Mohamed, Taj Mohammad, Mohammad Kazem Mohammadi, Abdollah Mohammadian-Hafshejani, Al-Kassim Hassan Mohammed, Ammas Siraj Mohammed, Shafiu Mohammed, Syam Mohan, Parvin Mohseni, Nagaishwarya Moka, Ali H Mokdad, Shaher Momani, Maryam Moradi, Yousef Moradi, Paula Moraga, Shane Douglas Morrison, Fatemeh Motaharinezhad, Rohith Motappa, Seyed Mohamad Sadegh Mousavi Kiasary, Mohamed Awad Abdalaziz Mousnad, Rabia Mubarak, Sumaira Mubarik, Jibran Sualeh Muhammad, Sukhes Mukherjee, Francesk Mulita, Chalie Mulugeta, Sara Mumtaz, Anjana Munshi, Efren Murillo-Zamora, Christopher J L Murray, Abdisalam Hassan Muse, Ali Mushtaq, Saima Mushtaq, Ana-Maria Musina, Mubarak Taiwo Mustapha, Saravanan Muthupandian, Woojae Myung, Ahamarshan Jayaraman Nagarajan, Mohsen Naghavi, Pirouz Naghavi, Tapas Sadasivan Nair, Hastyar Hama Rashid Najmuldeen, Yvonne Nartey, Abdulqadir J Nashwan, Hamide Nasiri, Zuhair S Natto, Javaid Nauman, Muhammad Naveed, Nawsherwan, Shalini Ganesh Nayak, Md Fahad Shahariar Nayon, Athare Nazri-Panjaki, Amanuel Tebabal Nega, Alina Gabriela Negru, Mohammad Hadi Nematollahi, Robina Khan Niazi, Luciano Nieddu, Taxiarchis Konstantinos Nikolouzakis, Amin Reza Nikpoor, Vikram Niranjan, Abebe Melis Nisro, Lawrence Achilles Nnyanzi, Shuhei Nomura, Mamoona Noreen, Sana Noreen, Fred Nugen, Felix Kwasi Nyande, Chimezie Igwegbe Nzoputam, Ogochukwu Janet Nzoputam, Bogdan Oancea, Vincent Adeiza Obakachi, Onome Bright Oghenetega, In-Hwan Oh, Hassan Okati-Aliabad, Sylvester Reuben Okeke, Akinkunmi Paul Okekunle, Osaretin Christabel Okonji, Andrew T Olagunju, Abdullahi Olaleye Olawuyi, Folorunsho Bright Omage, Abidemi E Omonisi, Alicia H Ong, Obinna E Onwujekwe, Michal Ordak, Hans Orru, Doris Verónica Ortega-Altamirano, Esteban Ortiz-Prado, Augustus Osborne, Eric Osei, Elham H Othman, Irene Amoakoh Owusu, Ifeoluwa Temitayo Oyeyemi, Ilker Ozsahin, Mahesh P A, Alicia Padron-Monedero, Jagadish Rao Padubidri, Dimpal Manilal Paija, Giuseppina Palena, Tejasri Paluvai, Adrian Pana, Diana Ioana Panaite, Sujogya Kumar Panda, Songhomitra Panda-Jonas, Deepshikha Pande Katare, Seithikurippu R Pandi-Perumal, Sunil Kumar Panigrahi, Parinaz Paranjkhoo, Romil R Parikh, Chulwoo Park, Sungchul Park, Tae Hwan Park, S Yasamin Parvar, Maja Pasovic, Roberto Passera, Heta Pavan Patel, Jenish Patel, Mitesh Patel, Niki Rut Patel, Riya Jayesh Patel, Satyananda Patel, Hamidreza Pazoki Toroudi, Jarmila Pekarcikova, Richard G Pestell, Olumuyiwa James Peter, Tung Thanh Pham, Daniela Pierannunzio, Zahra Zahid Piracha, Saeed Pirouzpanah, Evgenii Plotnikov, Thantrira Porntaveetus, Sajjad Pourasghary, Farzad Pourghazi, Naeimeh Pourtaheri, Jalandhar Pradhan, Thejeswar N Prakasham, Chandra P Prasad, Akila Prashant, Elton Junio Sady Prates, Harsh Priya, Shuby Puthussery, Husam Qanash, Nameer Hashim Qasim, Asma Saleem Qazi, Zhipeng Qi, Shahazad Niwazi Qurashi, Deepthi R, Venkatraman Radhakrishnan, Hadi Raeisi Shahraki, Yashpal Singh Raghav Raghav, Pracheth Raghuveer, Hawbash Mohammed-Amin Rahim, Sajjad Rahimi, Fryad Majeed Rahman, Md Mijanur Rahman, Mohammad Meshbahur Rahman, Mosiur Rahman, Muhammad Aziz Rahman, Amir Masoud Rahmani, Masoud Rahmati, Jeffrey Pradeep Raj, Sathish Rajaa, Judah Rajendran, Mohammad Amin Rajizadeh, Kairolla Dyusenbayevich Rakhimov, Majed Ramadan, Chitra Ramasamy, Shakthi Kumaran Ramasamy, Marzieh Ramezani Farani, Robinson Ramírez-Vélez, Muhammad Ramzan, Nemanja Rancic, Devarajan Rathish, Santosh Kumar Rauniyar, Salman Rawaf, Asit Ray, Mohammad Rayati, Aqeeb Ur Rehman, Najeeb Ur Rehman, Ana Reis-Mendes, Mina Rezaei, Nazila Rezaei, Nima Rezaei, Hermano Alexandre Lima Rocha, Thales Philipe Rodrigues da Silva, David Rojas-Rueda, Gholamreza Roshandel, Amirhossein Roshanshad, Hanieh Rouzbahani, Reza Rouzbahani, Shiva Rouzbahani, Sharmistha Roy, Maha Mohamed Saber-Ayad, Kabir P Sadarangani, Basema Ahmad Saddik, Tarannom Sadegh, Erfan Sadeghi, Fatemeh Sadeghi-Ghyassi, Mohd Saeed, Umar Saeed, Maryam Saeedi, Ashok Kumar Sah, Ahmad Sahban Rafsanjani, Fatemeh Saheb Sharif-Askari, Narjes Saheb Sharif-Askari, Amirhossein Sahebkar, Umakanta Sahoo, Pragyan Monalisa Sahoo, Zahra Saif, Morteza Saki, Dorsa Salabat, Afeez Abolarinwa Salami, Luciane B Salaroli, Rahman Shah Zaib Saleem, Mohamed A Saleh, Mahdi Salehi, Saad Samargandy, Yoseph Leonardo Samodra, Abdallah M Samy, Sandeep G Sangle, Elaheh Sanjari, Milena M Santric-Milicevic, Aswini Saravanan, Saman Sargazi, Mohammad Sarmadi, Sachin C Sarode, Brijesh Sathian, Aanchal Satija, Naghmeh Sattarahmady, Mehrdad Savabi Far, Monika Sawhney, Christophe Schinckus, Amin Sedigh, Hamidreza Seifmanesh, Mario Šekerija, Siddharthan Selvaraj, Vimalraj Selvaraj, Mohammad H Semreen, Pallav Sengupta, Subramanian Senthilkumaran, Dragos Serban, Yashendra Sethi, Seyed Mohammad Seyed Alshohadaei, Allen Seylani, Muhammad Shahab, Muhammad Shahbaz, Samiah Shahid, Syed Ahsan Shahid, Wajeehah Shahid, Fatemeh Shahrahmani, Hamid R Shahsavari, Masood Ali Shaikh, Sunder Sham, Muhammad Aaqib Shamim, Farzane Shams, Anas Shamsi, Alfiya Shamsutdinova, Mohd Shanawaz, Abhishek Shankar, Muhammad Junaid Hassan Sharif, Amin Sharifan, Bunty Sharma, Manoj Sharma, Ravi Kumar Sharma, Ujjawal Sharma, Vishal Sharma, Ramzi Shawahna, Maryam Shayan, Fateme Sheida, Ali Sheidaei, Rekha Raghuveer Shenoy, Mahabalesh Shetty, Suraj S Shetty, Desalegn Shiferaw, Tariku Shimels, Aminu Shittu, Chandan Shivamallu, Velizar Shivarov, Ambreen Shoaib, Zahra Shokati Eshkiki, Seyed Afshin Shorofi, Aman Shrestha, Gambhir Shrestha, Sunil Shrestha, Kerem Shuval, Yafei Si, Zahra Siavashpour, Nicole Remaliah Samantha Sibuyi, Emmanuel Edwar Siddig, Mithun Sikdar, Baljinder Singh, Harmanjit Singh, Jasvinder A Singh, Kalpana Singh, Lucky Singh, Paramdeep Singh, Poornima Suryanath Singh, Puneetpal Singh, Ritesh Singh, Rohit Singh, Satwinder Singh, Surendra Singh, Surjit Singh, Mukesh Kumar Sinha, Mahdieh SobhZahedi, Farrukh Sobia, Lencho Kajela Solbana, Anvar Soleimani, Solikhah Solikhah, Sameh S M Soliman, Weiyi Song, Aayushi Sood, Prashant Sood, Manraj Singh Sra, Lokasani Vijaya Sree, Vetriselvan Subramaniyan, Oksana Sulaieva, Muritala Suleiman Odidi, Muhammad Suleman, Anusha Sultan Meo, Zhong Sun, Shanthosh Priyan Sundaram, Thanigaivel Sundaram, Vasuki Suresh, Chandan Kumar Swain, Lukasz Szarpak, Sree Sudha T Y, Rafael Tabarés-Seisdedos, Seyyed Mohammad Tabatabaei, Seyed-Amir Tabatabaeizadeh, Farzad Taghizadeh-Hesary, Seyed Reza Taha, Jabeen Taiba, Iman M Talaat, Ker-Kan Tan, Shynar Tanabayeva, Mohsan Tanveer, Saba Tariq, Seyed Mohammad Tavangar, Abdelghani Tbakhi, Fanuel Alemayehu Tefera, Abainash Tekola, Mohamad-Hani Temsah, Fisaha Haile Tesfay, Azimeraw Arega Tesfu, Rekha Thapar, Hadiza Theyra-Enias, Muthu Thiruvengadam, Rekha Thiruvengadam, Jansje Henny Vera Ticoalu, Krishna Tiwari, Roman Topor-Madry, Adetunji T Toriola, Mathilde Touvier, Tam Quoc Minh Tran, Thang Huu Tran, Aniefiok John Udoakang, Atta Ullah, Saeed Ullah, Srikanth Umakanthan, Shehu Salihu Umar, Brigid Unim, Bhaskaran Unnikrishnan, Jeba Mahiad Urmey, Asokan Govindaraj Vaithinathan, Javad Varasteh, Pavani Varma, Sampara Vasishta, Baskar Venkidasamy, Poonam Verma, Francesco S Violante, Sergey Konstantinovitch Vladimirov, Vasily Vlassov, Simona Ruxandra Volovat, Yasir Waheed, Mugi Wahidin, Xingxin Wang, Yanzhong Wang, Ronny Westerman, Yohanes Cakrapradipta Wibowo, Dakshitha Praneeth Wickramasinghe, Nuwan Darshana Wickramasinghe, Andrew Awuah Wireko, Nathnael Abera Woldehana, Axel Walter Wolf, Florence Gyembuzie Wongnaah, Minichil Chanie Worku, James Fan Wu, Peng Wu, Shulan Wu, Ratna Dwi Wulandari, Guangqin Xiao, Wanqing Xie, Wanqing Xu, Yuyan Xu, Saba Yahoo (Syed), Galal Yahya, Yuichiro Yano, Laiang Yao, Amir Yarahmadi, Sanni Yaya, Meghdad Yeganeh, Mohammad Hossein YektaKooshali, Saber Yezli, Yazachew Engida Yismaw, Dong Keon Yon, Naohiro Yonemoto, Chuanhua Yu, Chun-Wei Yuan, Quan Yuan, Meliz Yuvali, Vesna Zadnik, Mubashir Zafar, Manijeh Zaghampour, Dilmurat Zairov, Nazar Zaki, Giulia Zamagni, Iman Zare, Mohammad Javad Zare Sakhvidi, Mohammed Zawiah, Mohammed G M Zeariya, Qibing Zeng, Daniel Xin Zhang, Liqun Zhang, Xiaoyi Zhang, Hanqing Zhao, Zhongyi Zhao, Claire Chenwen Zhong, Bin Zhu, Shijie Zhu, Zhounan Zhu, Abzal Zhumagaliuly, Hafsa Zia, Magdalena Zielińska, Mohamed Ali Zoromba, Sa'ed H Zyoud, Stein Emil Vollset, Theo Vos, Lisa M Force, Marie Ng Lancet Oncology, 2026
Breast Cancer Awareness and the Practice of Self Breast Examination Among Undergraduate Students in Karachi, Pakistan Mubashir Zafar, Tafazzul Hyder Zaidi, Nadira Hyder Zaidi, Amber Ilyas, Syeda Ruqaya Neha Majeed, Iqra Manzoor, Tooba Sajid, Saadia Akram, Kiran Mehtab, Rahat Naz, Ayesha Mubbashir Asia Pacific Journal of Clinical Oncology, 2026 BackgroundBreast cancer remains one of the most prevalent malignancies affecting women worldwide, and breast self‐examination (BSE) is acknowledged as a sensitive method for its early detection. This study aimed to assess the level of awareness regarding both breast cancer and BSE among undergraduate students in Karachi, Pakistan.MethodologyA cross‐sectional survey was conducted at a public‐sector university in Karachi. A total of 328 female students were selected using multistage stratified cluster sampling. The Chi‐square test was employed to evaluate differences in awareness levels across various socio‐demographic characteristics, with a p value of less than 0.05 considered statistically significant. All ethical guidelines were strictly adhered to throughout the study.ResultsThe mean age of the participants was 22 years. The study revealed that younger age groups (18–22 years), first‐year students from various colleges, and students enrolled in business programs exhibited significantly lower levels of awareness regarding both breast cancer and BSE (p value <0.005). Overall, appropriate levels of awareness were reported by 45.1% of the participants for breast cancer and 47.3% for BSE.ConclusionThe findings indicate that the awareness levels regarding breast cancer and BSE are inadequate, particularly among first‐year students and those pursuing business‐related studies. These results underscore the need for targeted educational interventions to enhance awareness and promote the early detection and effective management of breast cancer through the practice of BSE.
The association between social media use and attitudes toward nutrition among university students in Saudi Arabia Mubashir Zafar, Layan Zaid Alhamashi, Rakan Yusef Al-Shuwaihani, Shumukh Alshubrami, Majed Saad Alshertan, Rahaf Saadi Alazmi, Mohammed Obaid Aljulaidi Journal of Education and Health Promotion, 2026 BACKGROUND: The increasing consumption of social media among students has caused concerns about its influence on nutrition-related attitudes and behaviors. Research suggests that exposure to food trends, diet culture, and health influencers on platforms, like Instagram and Facebook, can shape students’ perceptions of nutrition. This study examines the relationship between social media use and dietary attitudes, exploring its potential impact on eating habits and nutritional choices. MATERIALS AND METHODS: Study design was a cross-sectional and data collection was done from a public sector university; a stratified sample technique was used to recruit a sample size of 509. Validated and organized questionnaires were used. Correlation and regression analyses were used to examine the relationship between social media engagement and attitudes toward nutrition. RESULTS: Study result revealed that higher social media use was significantly associated with increased odds of disordered eating behaviors, with those using social media for 1–3 h/day having an adjusted odd ratio (AOR) of 2.31 (95% confidence interval [CI]: 1.02–11.36; P = 0.004) and those using it for more than 3 h/day showing an AOR of 5.31 (95% CI: 1.00–28.13; P = 0.050). Married individuals have an AOR of 5.76 (95% CI: 1.68–19.77; P = 0.005) for developing eating disorders. CONCLUSION: The study highlights a substantial association between high social media use and disordered eating behaviors, with prolonged engagement (more than 3 h/day) contributing to increased risk. Marital status emerged as an important predictor. This result emphasizes the need for further research to explore the effect of social media and other sociodemographic factors on eating behaviors, particularly in the context of prevention and intervention strategies.
Assessment of dental health knowledge and practices among diabetic patients at a public health hospital in Karachi, Pakistan Saman Mehtab, Amber Iliyas, Mubashir Zafar, Tafazzul Hyder Zaidi, Tooba Adil, Sajid Mir Narejo Discover Public Health, 2025 Diabetes has high prevalence among population; the aim of this study is to evaluate the level of dental health knowledge and practices among diabetic patients, as diabetes increases the risk of oral health complications. Understanding these factors can help improve targeted oral health interventions in public health settings in Karachi, Pakistan. The cross sectional study was conducted at the Diabetic Clinic of a public health hospital, A total of 120 patients who met the inclusion criteria were selected for participation using simple random sampling. Data were collected through a validated and structured questionnaire, designed to capture relevant demographic, clinical, and behavioral information. For statistical analysis, the Chi-square test was used to assess associations between categorical variables, and cross-tabulation was performed to examine potential relationships between variables. The results revealed that over half of the participants (57.5%, n = 69) were unaware that diabetic patients are more susceptible to oral diseases. Regarding oral hygiene practices, 79.2% (n = 95) of the participants reported brushing their teeth once daily, and 81.7% (n = 98) primarily used a toothbrush with toothpaste. The frequency of dental clinic visits showed a significant difference across age groups (p = 0.001) and education status (p < 0.001), with older and more educated participants visiting more regularly. Additionally, the duration of brushing significantly differed by smoking status (p < 0.001), where non-smokers were more likely to brush for 1–3 min compared to smokers. The study reveals that while diabetic patients possess moderate knowledge about the impact of diabetes on oral health, gaps remain, particularly among males and smokers. Oral health practices such as regular dental visits and adequate brushing duration are suboptimal, especially in less educated and smoking groups.
Knowledge regarding helicobacter pylori infection among patients in hail region of Saudi Arabia Ahmed Nawi Alshammari, Mubashir Zafar, Mohammed Salem Alharbi, Sumayyah Mohammad Almarshedy, Fayez Saud Alreshidi, Hend Faleh Hamad Alreshidi, Ibrahim Abdullah Alnais, Abdulilah Saad Aldhmadi, Abdulaziz Fahad Alhumaid, Rahaf Mulayh Alshammari, Razan Fehaid Alshammari, Ranim Fahad Alhejaily, Syed Shah Mohammed Faiyaz, Mohd Saleem, Malik Asif Hussain Journal of Education and Health Promotion, 2025
Evidence based Intervention to Prevent Anemia among Women of Reproductive Age Group in Developing Countries; Review International Journal of Biology and Biomedical Engineering, 2019
Quality of post graduate medical training in public and private tertiary care hospitals of Karachi Journal of Postgraduate Medical Institute, 2014
Prevalence of smoking and associated risk factors among medical professionals in hospitals of Karachi, Pakistan International Journal of Preventive Medicine, 2014
