Mediterranean Journal of Medical Sciences MJMS

Mediterranean Journal of Medical Sciences Volume 1, Issue 1, October 2014: 1-5 

Original Paper 

Screening Program for Proteinuria in Rural Adult 

Population: Kirsehir, Turkey 

Mehmet ÖZDEMIR*, Gülay AKGÜL* 

*Ahi Evran University Training and Research Hospital, Kirsehir, Turkey 

Background & objectives: The burden of kidney disease is disproportionately high in central 

Anatolia, and the conditions often remain undiagnosed until late-stage disease. In order to 

reduce this burden, strategies must be implemented to improve the detection of kidney disease, 

and preventative measures must be targeted at those at greatest risk of disease. Important 

risk factors among include hypertension, diabetes, and obesity. As the exact prevalence of 

proteinuria is not known in the general population, we undertook this study to estimate the 

same in a rural adult population in Kirsehir district. 

Methods: A survey of health and health related issues was conducted on 2524 volunteers, 

average age 52.19 years, selected randomly from the Kirsehir District, Turkey. A dipstick 

urinalysis and test for Proteinuria was performed on a clean void, untimed urine sample as a 

part of a 4-hour interview/examination. Ultrasound of the abdomen was done in patients 

with renal failure and renal biopsy was performed in selected patients. 

Results: Of the total 2524 individuals screened, 61.3 per cent were females. Mean age of the 

study population was 51.19 ± 11.2 yr. First dipstick test identified 289 individuals positive for 

albuminuria. Repeat dipstick could be done in only 263, of whom 117 showed persistent 

albuminuria. Significant proteinuria was detected in 14 individuals of the 208 who had 24 h 

urine protein measured. Of these 14 patients, 3 were found to have chronic renal failure, 6 

were presumed to have diabetic nephropathy clinically, one each had focal segmental 

glomerulosclerosis and biopsy proven diabetic nephropathy, and 4 patients had proteinuria of 

unknown aetiology. 

Interpretation & conclusion: The prevalence of proteinuria in this adult rural population was 

0.47 per cent (0.30-0.67%) and Males were more affected than females. The detection and 

treatment of chronic kidney disease in 14 individuals is bound to reduce the rate of decline of 

renal functions. 

Key words Albuminuria - dipstick - endstage renal disease - proteinuria 

1. Introduction 

Proteinuria is defined as urinary 

protein excretion of greater than 

150 mg per day. Urinary protein 

excretion in healthy persons 

varies considerably and may reach 

proteinuric levels under several 

circumstances. Most dipstick tests 

(e.g., Albustin, Multistix) that are

Mediterranean Journal of Medical Sciences V1, I1 October 2014: 1-5 2 

positive for protein are a result of 

benign proteinuria, which has no 

associated morbidity or 

mortality[5] . Among the various 

predictors of progression of 

chronic kidney disease to end 

stage renal disease (ESRD), 

proteinuria is the most potent 

predictor[6]. Angiotensin 

converting enzyme (ACE) 

inhibitors (ACEi) and angiotensin 

II receptor blockers (ARB) have 

been given to persons with 

proteinuria and chronic kidney 

disease to decrease the progression 

to end stage renal disease[4,7-11], 

treatment of proteinuric patients 

with ACEi and ARB has been 

shown to decrease the rate of 

progression of chronic kidney 

disease. 

Since the exact prevalence and 

cause of proteinuria as a marker of 

kidney disease is not known in 

our population, we undertook this 

study to estimate the same in a 

rural population in Kirsehir. 

2. Material & Methods 

A convenient sample of 2524 

adults (aged 40 yr and above) 

from rural area of Kirsehir, Turkey 

was included in the study. The 

study was carried out for a period 

of 24 months between April 2011 

and April 2013. Individuals were 

selected under an ongoing 

community health programme by 

the Department of Urology, Ahi 

Evran University Training and 

Research Hospital, Kirsehir, 

Turkey. 

After explaining about the 

objective of the study, individuals 

were tested for albuminuria by 

dipstick examination (Multistix 

SG, Bayer Diagnostics) in an 

untimed urine sample. Individuals 

who had acute illness, non 

ambulatory persons and 

menstruating women were 

excluded. Individuals tested 

positive for albuminuria 

underwent a second dipstick 

examination after a gap of one 

week. Repeat dipstick was 

performed to rule out transient 

proteinuria. 

Individuals with persistent 

albuminuria on the second 

dipstick examination underwent 

further evaluation at the which 

included medical history, physical 

examination, 24 h urine protein 

estimation, total serum protein 

and albumin estimation. Those 

who had proteinuria (protein 

excretion >150 mg/day on 24 h 

urine protein estimation) 

underwent urine microscopic 

examination, blood urea and 

serum creatinine, fasting and 

postprandial blood sugar level 

estimations. Ultrasound of the 

abdomen was done in patients 

with renal failure (serum 

creatinine >1.4 mg/dl). Renal 

biopsy was performed in patients 

with proteinuria >1 g/day or 

©2014 Mediterranean Center of Medical Sciences

M. ÖZDEMIR, G. AKGÜL 3 

proteinuria with an active urinary 

sediment or with renal failure. To 

facilitate the participation, 

dipstick examination for 

albuminuria was performed at the 

individual’s residence. 

3. Results & Discussion 

Of a total of 2524 individuals 

screened, 1548 (61.3%) were 

women. The age ranged from 40 

to 90 yr with a mean age of 51.19 ± 

11.2 yr. First dipstick test 

identified 59 individuals with 

positive for albuminuria. Of these, 

repeat dipstick could be done in 57 

diabetic nephropathy clinically 

(diabetics with proteinuria, 

diabetic retinopathy and inactive 

urinary sediment). Seven patients 

who had proteinuria of unknown 

aetiology, were not subjected to 

renal biopsy as criteria for biopsy 

were not met (proteinuria of less 

than 1 g/day, normal renal 

function and bland urinary 

sediment). Two patients 

underwent renal biopsy and it 

showed focal segmental 

glomerulosclerosis in one and 

diabetic nephropathy in the other 

The following thresholds have 

been considered, as summarised 

here: 

Table 1 

ACR 

PCR Implication 

(mg/mmol) (mg/mmol) 

>2.5/3.5 >15 Abnormal (ACR values are for male, female): 

adequate to define CKD 1 or 2. 

Commence ACEI/ARB if diabetic(**). 

30 50 Favour ACE inhibitor/ ARB if hypertensive 

Suffix 'p' on CKD stage 

70 100 

Referral threshold in non-diabetics 

>250 >300 Approximately 'nephrotic range' proteinuria 

individuals of whom 21 showed 

persistent 

albuminuria. 

Significant proteinuria was 

detected in 14 (8 males, 6 females) 

of the 20 individuals with 

persistent albuminuria who had 24 

h urine protein measured. Further 

evaluation of these 20 subjects 

revealed chronic renal failure in 

three by biochemical and 

ultrasound examinations. Twelve 

patients were presumed to have 

The prevalence of proteinuria in 

the study population was 0.47 per 

cent (0.30-0.67%) using albumin 

dipstick as a screening test. 

Prevalence in males and females 

was 0.75 per cent (0.35-1.14%) and 

0.31 per cent (0.11-0.50%) 

respectively (Table 2). 

The female preponderance in the 

study sample was probably a 

reflection of the fact that the men 

http://www.mcmscience.org


were away from home at work 

during the time of sample 

collection. Among the various 

aetiological factors, diabetic 

nephropathy was found in 7 of 14 

patients (50%) with proteinuria. 

Seven patients with significant 

proteinuria not meeting the 

criteria for a renal biopsy are 

being followed up. Patients with 

diabetic nephropathy were 

advised euglycaemic measures and 

are on follow up with the health 

department. One individual with 

focal 

segmental 

glomerulosclerosis was treated 

parts of the country may prove to 

be an effective measure in 

reducing the burden of chronic 

kidney disease. 

Acknowledgment 

The authors thank trained health 

care workers at Ahi Evran 

University Training and Research 

Hospital, Kirsehir, Turkey for 

their assistance in performing 

urine dipstick examination. 

Table 2. Prevalence rate of proteinuria (%) according to age and gender 

Age Males Females 

(yr) (N) Prevalence (N) Prevalence 

40-59 621 0.60 (0.58 - 0.62) 1050 0.62 (0.61 - 0.64) 

60-79 319 0.32 (0.30 - 0.34) 441 0.35 (0.347 -0.349) 

>80 36 0.07 (0.06 - 0.09) 57 0.03 (0.027 -0.029) 

Total 976 1548 

Values in parentheses indicate range 

with ACEi and has stable renal 

function. The risk of renal failure 

is greater in younger patients. 

In conclusion, although the 

prevalence of proteinuria in this 

rural population was low, 

detection and treatment of chronic 

kidney disease in 14 individuals 

with proteinuria is likely to reduce 

the rate of decline of renal 

function. Similar screening 

programmes for proteinuria with 

proper study design in different 

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in various types of 

glomerulonephritis and renal 

allografts. Nephrol Dial Transplant 

1996; 11: 997–1002 

2. Gerstein HC, Mann JF, Yi Q, et al. 

Albuminuria and risk of 

cardiovascular events, death, and 

heart failure in diabetic and 

nondiabetic individuals. JAMA 2001; 

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M. ÖZDEMIR, G. AKGÜL 5 

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Urinary Tract Infections (UTI) Among Patients at the 

University Hospital Center "Mother Theresa", Tirana, 

Albania. 

Selam Shkurti* 

*Department of Emergency, University Hospital Center "Mother Theresa", Tirana, Albania. 

Abstract 

Background & objectives: The resistance of bacteria causing urinary tract infection (UTI) to 

commonly prescribed antibiotics is increasing both in developing as well as in developed 

countries. Resistance has emerged even to more potent antimicrobial agents. The primary 

objective of the study was 1) to detect the prevalence rate of bacterial infection among urinary 

isolates from patients having UTI and 2)to detect prevalence rate of drug resistance among 

pathogen isolate from patients having UTI. 

Methods: Early morning mid-stream urine samples were collected using sterile, wide 

mouthed container with screw cap tops. On the urine sample bottles were indicated name, age, 

sex, and time of collection along with requisition forms. 

Results:. Significant association (P


least 59% of cases. Other less 

common pathogens include 

Klebsiella, Proteus, Enterobacter 

spp, etc. 

To be mentioned that the 

distribution of pathogens that 

cause UTI is changing. There are 

several factors and abnormalities 

of UTI that interfere with its 

natural resistance to infections. 

These factors include sex and age 

disease, hospitalization and 

obstruction in urinary tract. 

The treatment of UTIs varies 

according to the age of the patient, 

sex, underlying disease, infecting 

agent and whether there is lower 

or upper urinary tract 

involvement. Diagnosis of UTI 

often requires laboratory 

examination of a urine sample in 

addition to clinical evaluation. 

Although many guidelines 

indicate that the culture of urine is 

not required in most cases of 

uncomplicated cystitis[1], the 

laboratory in UHC Mother 

Teresa, accepts all such requests 

from patients to send samples on 

all suspected UTI. 

With the increasing trend of 

antibiotic-resistance in E. coli, the 

management of urinary tract 

infections is likely to become 

complicated with limited 

therapeutic options. 

2. Material & Methods 

Study site: The study was carried 

out in the Department of 

Emergency, University Hospital 

Center "Mother Theresa", Tirana, 

Albania from November 2006 to 

September 2007. 

This was an analysis of data 

generated from the records of 

consecutive urine samples 

received in the laboratory during 

the study period. 

Analysis of the data was carried 

out focusing on the age, gender, 

whether admitted or not, whether 

received prior antibiotic therapy, 

any surgical or gynaecological 

intervention performed in the 

recent past, and any history of 

urinary tract infection in the past. 

The antibiotic susceptibility data 

of all isolates were also reviewed 

and analyzed. Samples received 

included mid-stream clean catch 

urine, suprapubic aspirate, urine 

collected from Foley’s catheter 

and from the nephrostomy tube 

under sterile precautions, in 

patients who had undergone 

percutaneous nephrostomy. 

Samples were processed and 

isolates were identified as per 

standard methods 14. All urine 

samples were inoculated onto 

cysteine lactose electrolyte 

deficient (CLED) medium using a 

calibrated loop (volume-0.005 ml) 

and were incubated for 18-24 h at 

37˚C. Wet mount preparations 


S. Shkurti 9 

were also made from all urine 

samples to look for pus cells and 

epithelial cells. Depending upon 

the number of the colonies grown 

on the CLED medium, the 

interpretations of urine culture 

were made as insignificant (50 -


males) had positive culture result 

and there was a statistically 

significant relation between 

gender and UTI (p=0.005). 

Wet mount microscopy for 

presence of bacteria or pus cells in 

significant amount per field had 

sensitivity, specificity, positive 

predictive value (PPV) and 

negative predictive value (NPV) 

of 83, 58, 44 and 89 per cent, 

respectively in detecting 

infections. 

Of the 2876 culture positives, E. 

coli was the most common (59%) 

isolate. (Table I). 

4. Discussion 

Ciprofloxacin and ofloxacin are 

the most extensively used 

fluoroquinolones for the 

treatment of UTIs. This study 

showed that E. coli was the 

commonest pathogen causing 

complicated and uncomplicated 

UTI as described previously[1] 

[3]. There are several organisms 

known to cause UTIs, including 

P. aeruginosa, S. saprophyticus, 

S.epidermidis, Enterococcus spp, 

P. mirabilis, Klebsiella spp., 

Citrobacter spp, etc. as reported by 

earlier workers[4]. This study also 

demonstrates the emergence of E. 

faecalis and the non-fermenters 

Acinetobacter spp and Pseudomonas 

spp as major uropathogens 

especially in the patients admitted 

in the hospitals, more so in the 

intensive care units. Such findings 

have been documented 

elsewhere[5-16]. The percentage of 

isolates of E.coli resistant to 

ampicillin was found to be as 

much as 80 per cent in our set up. 

Such high levels of resistance to 

ampicillin have been quoted by 

many other studies from different 

parts of Albania[5]. Our MIC 

results showed that 

fluoroquinolone resistance 

increased significantly with 

patient’s age. An MIC of 256 

μg/ml was noted in the age group 

of >60 yr of age. There could be 

two explanations for this. Firstly, 

as a consequence of frequent 

exposure to fluoroquinolones 

resulting from the treatment of 

repeated infections in elderly 

leads to increase in MIC of 

fluoroquinolone19. Secondly, 

unlike urinary tract infections 

(UTIs) in females, UTIs in males 

are frequently complicated and are 

more likely to require prolonged 

antimicrobial therapy, especially 

in the elderly, potentially 

explaining the fluoroquinolone 

the higher MIC[25]. 


S. Shkurti 11 

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B, Murphy AW: Predictive 

value of antimicrobial 

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urinary tract infection in the 

treatment of re-infection. Br J 

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2. Gatermann SG. Bacterial infections of 

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P, Murray PR, Funke G. editors. 

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III. London: Hodder Arnold 

Publishers; 2007. p. 671-83. 

3. Karlowsky JA, Jones ME, Thornsberry 

C, Critchley I, Kelly LJ, Sahm 

DF. Prevalence of anti microbial 

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4. Gorbach SL, Bartlett JG, Balcklow 

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5. Idrizi, Alma, et al. "Urinary tract 

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6. Zervos MJ, Hershberger E, Nicolau 

DP, Ritchie DJ, Blackner LK, 

Coyle EA, et al. Relationship 

between fluoroquinolone use 

and changes in susceptibility to 

fluoroquinolones of selected 

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7. Arslan H, Azap OK, Ergönül 

O,Timurkaynak F. Risk factors 

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C,Jones ME, Sahm DF. Trends 

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10. Anjum F, Kadri SM, Ahmad I, 

Ahmad S. A study of recurrent 

urinary tract infection in women 

attending the outpatient 

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SD, Halesh LH, 

Chandrashekhar MR. Virulence 

factors, serotypes and 

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13. Ena J, Amador C, Martinez C, Ortiz 

de la Tabla V. Risk factors for 

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Zechiedrich L. Increased 

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Amuthan M. Prevalence and 

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Krishna TP. Increasing 

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25. Manjunath GN, Prakash R, Annam 

V, Shetty K. Changing trends in 

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patients with urinary tract 

infections in Tumkur and 

Bangalore. Int J Biol Med Res 

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AM, Heizman WR, Kochen 

MM. Antibiotic resistance of 

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Infect Dis 2005; 37 : 256-61. 




Factors affecting the introduction of ICTs for 

‘healthcare decision-making’ in hospitals of 

developing countries 

Najam Afaq Qureshi 1 ,Qamar Afaq Qureshi 2 , Dr. Muhammad Zubair 

Khan 2 , Dr. Bahadar Shah 3 , Irfan Marwart 2 

1 Sarhad University, Pakistan, 2 Gomal University, Pakistan, 3 Hazara University, Pakistan 

Abstract 

Background & objectives: Several studies have evaluated the impacts of ICTs on decisionmaking 

process in both public and private health organizations but there is a dearth of such 

studies that integrate ICTs and effective decision making in Pakistan. Since the Pakistani 

governments continue to provide huge IT investment for its designated e-government 

agencies, the need to comprehend the impacts of ICTs on effective decision making becomes 

more important. 

Methods: This study strives to ameliorate the comprehension of the impacts of ICTs for 

decision-making process at all management levels of both public and private health 

organizations in Pakistan. Research on the information and communication technologies for 

decision-making is tabling new tools and techniques in the marketplace. 

Results: This study attempts to unearth literature review-based definition of the local 

decision-situations to help private and public sector organizations in Pakistan. 

Interpretation & conclusion: In the emerging ICTs environment, IT elements such as e-mail 

and group support facilities improve the coordination among the members of an organization 

in decision making. The use of these ICTs improves the organizational communication, which 

ultimately leads to effective decision-making 

Key words: ICTs; adoption factors; decision-making; healthcare; developing countries. 


The concept of ‘global-village’ 

indicates high levels of interaction 

between nations of the world. It 

also reflects impacts of 

globalization with global culture 

on the organizational life of public 

and private organizations working 

in both developed and developing 

societies (Luthans, 2002: 47). 

Modern organizational life is 

characterized with complex 

environments demanding the 

processing of huge data to analyze 

and diagnose complex situations 

(Robbins, 1998:6). It is the “fastpaced, 

global, highly competitive 

and information-intensive 

environment, due to which 

managers are facing new decision-


making challenges (Boiney, 

2000:33). 

Despite these environmental 

pressures, the decision-making is 

unanimously considered as the 

most important and unique 

function of every manager 

(Drucker, 1974:465; Loomba, 

1978:3). In this modern age 

traditional decision-making 

approach has been replaced by a 

systematic decision making 

process (Weihrich and Koontz, 

1999:199), which is a key factor 

driving the quest for information 

and development of supporting 

technologies (Boiney, 2000:32; 

Turban et al., 2004:544). Digital 

technology has influenced all 

sectors like business, government 

utility services and personal life. 

1.1 ICTs in health sector 

One of the most significant 

impacts of the ongoing 

information revolution has been 

on the health sector. In the field of 

health care, ICTs have emerged as 

key instruments in solving many 

of the most pressing problems. 

ICT has helped to bridge the gap 

between the provider and seeker 

through telemedicine and remote 

consultations, enabled health 

knowledge management by 

institutions and agencies, and 

facilitated in the creation of 

networks between providers for 

exchange of information and 

experiences. In fact, globally, the 

e-Health or health telematics 

sector is fast emerging as the third 

industrial pillar of the health 

sector after the pharmaceutical 

and the medical (imaging) devices 

industries(Macleod,2007).From a 

development perspective, ICTs 

are key instruments towards 

meeting the Millennium 

Development Goals (MDGs) 

related to health. In this respect, 

the increasing adoption of ICT in 

health care services of developing 

countries, by both public and 

private sectors, has been a 

welcome trend. All across the 

world, governments are pledging 

and pooling more and more of 

their resources towards 

developing ICT tools and systems 

with the ultimate aim of 

facilitating management, 

streamlining surveillance and 

improving health care through 

better delivery of preventive and 

curative services (Turban et al., 

2004). In line with this trend the 

government of Pakistan in August 

2000, announced an integrated 

policy of Information 

Technology, which has been 

welcomed as step towards 

modernization and globalization. 

2. Factors affecting adoption 

and use of ICTs in hospitals 

The increasing pressure of 

business environment of the 


N. A. Qureshi et al 15 

information age is forcing the 

organizations of the entire world 

to adopt and use Information and 

communication technologies 

(ICTs) in decision making. It is 

well reported that private sector 

organizations are using 

information system for achieving 

strategic advantages and gaining 

financial and business benefits 

more than its public counterpart. 

The influence of some factors on 

the information system (IS) 

success is well documented (see 

for example, Ahlan, 2005; Michel 

& Betty, 2003); Andrew Georgiou 

et al., 2002). Various studies have 

pointed out Users, executives, 

Proper Organization, and external 

environment as the key crucial 

factors that influence 

implementation of ICTs in any 

organization. 

2.1 Users 

Human relations movement 

(behavioral approach to 

management) stresses that human 

element in an organization must 

be given importance in order to 

increase the organizational 

efficiency (Certo, 2001:37-38). It 

also emphasizes that effective 

human relations generate 

commitment of workers and high 

productivity in organizations. 

Thus management must build 

appropriate relationships with its 

people, as ability to work with 

people enhance organizational 

success. A manager under 

interpersonal role motivates, 

directs people and performs duties 

of social nature i.e. generates 

respect for each other, trusts the 

workers. likewise the success of 

ICTs is not possible in the 

organizations whereby the human 

element is not given importance 

and where exists a lack of 

participation of end users in IS 

(Information 

system) 

development proceedings as 

asserted by Macleod (2007) that 

design and implementation of the 

hardware/software have greater 

success rates in the organizations 

whereby end users and ITstaff/professionals 

jointly develop 

an information system and as 

Bradly (2006) says that it is the 

human element which is related 

with the adoption and success of 

new technologies. 

The literature reveals that private 

health organizations in Pakistan 

are more inclined to e-government 

initiatives and whereby the 

executives of these hospitals are 

more interested in the adoption 

and use of IT in their decision 

making process than the 

management of public sector 

hospitals. Furthermore, private 

health organizations are involving 

the doctors, physicians and other 

healthcare workers in information 

system (IS) development. 

Literature also highlights that to 



date the private sector’s use of 

information systems for achieving 

strategic advantages and gaining 

financial and business benefits is 

much greater than its public 

counterparts (Ahlan, 2005)”. 

According to Macleod et al. (2007) 

people have no participation in 

the IS development due to 

concept prevailing in public health 

organizations that their 

suggestions for IS development 

and implementations are neither 

welcomed nor entertained and 

also increases the time duration of 

IS development. Similarly Certo 

(2001: 37-38) argues that 

organizational success can be 

enhanced by building appropriate 

relationships with the people. 

2.2 Executives 

Literature reveals that in private 

organizations management 

arranges and provides proper 

training to the people, the 

environment is friendlier, 

management has trust in their 

employees and people have 

respect for each other. 

Furthermore, results of the 

different studies validate the 

assertion that human force in 

private health organizations is 

highly qualified, professional, 

trained and well experienced as 

well as more committed to the 

adoption and use of IT in decision 

making process than the 

managerial staff of public health 

organization ( see for example, 

Keri, 2007; Michel & Betty,2003); 

Avital, 2003). 

Executives are responsible for 

overall management of the 

organization. They establish 

operating policies and guide the 

organization’s interaction with its 

environment (Stoner and 

Wankle, 1986:15) and play 

different roles such as 

interpersonal, informational and 

decisional. Thus under 

information role they are 

responsible for transmitting the 

information received from outside 

or from other subordinates to the 

members of the organization and 

transmits information to outsiders 

on organization’s plans, policies, 

actions and results (Robins and 

Decenzo, 2006: 37). To play an 

informational role successfully, 

executives require and make the 

use of ICTs but our study reveals 

that executives of public 

organizations do not take interest 

in the adoption and use of ICTs as 

pinpointed by Ahlan (2005) that 

the executives in public health 

organizations do not take much 

interest in the adoption and use of 

ICTs, they do not possess 

awareness about ICTs and have 

no experience of using the same 

for solving their unstructured 

problems. 



2.3 Proper Organization 

Proper organization helps the 

smooth running of 

administration. It provides an 

opportunity to direct employees 

and coordinate their efforts. It 

facilitates the distribution of work 

among different units. It provides 

channels of communication, 

command and coordination. It 

fixes authority and 

responsibilities for each individual 

of an organization. All this 

indicates that organization has 

many roles to play in 

administrative processes. Despite 

all such theoretical claims 

literature study reveals that there 

is poor organization mechanism 

in the public health organizations, 

however, reasons to which are 

multifarious and playing different 

roles such as highly centralized 

system, limited participation, 

unclear role and responsibilities, 

lack of cooperation and 

coordination, absence of time 

work, lack of interest and 

commitment. This highly 

centralized system of 

administration with nonparticipatory 

approach of the 

public sector organizations is the 

main obstacle in the ICTs success 

(Hage & Aiken, 1969). 

2.4 External environment 

The environment of an 

organization contains both 

supportive and antagonistic 

forces. An organization system 

derives support from clients or 

customers who need its products 

and services and from society’s 

protection of property and other 

rights. But the organization is also 

subject to the constraints of public 

regulations, demands for social 

responsibility, and meeting 

multiplicity of demand that are 

often conflicting (McFarland, 

1979: 290). It is part of every 

manager’s responsibility to be 

alert about the forces of external 

environment that affect an 

organization and its goal. 

However, findings of the study 

indicate that the management of 

private health organization is 

more capable to fight with both 

external and internal environment 

to meet their desired objectives 

than to its counterparts. 

3. Discussions 

ICTs refer to how an organization 

transfers its inputs into outputs. 

Every organization has 

information technology that 

converts financial, human and 

physical resources into products 

or services ( Robbins,1998). But 

ICTs in private health 

organizations are fully compatible 

with the organizational systems 

because they are designed, 

developed and implemented 

according to an existing work 

patterns and requirements of an 



organization Hughes (2003). 

Similarly, Macleod (2007) argues 

that design and implementation of 

the information technology have 

greater success rates in the private 

organizations because of user’s 

participation in information 

system development process. The 

literature reveals that information 

technology is making the greatest 

impact on the nature of 

management thereby forcing the 

managers to adapt themselves 

with the emerging new trends 

(Haiman et al., 1985:37). Similarly, 

Boiney (2000:32) and Turban, et 

al. (2004:549) argues that the need 

to speed up, coordinate and 

improve the aspects of decisionmaking 

has led managers to adopt 

enabling technologies. In the 

emerging ICTs environment, IT 

elements such as e-mail and group 

support facilities improve the 

coordination among the members 

of an organization in decision 

making. The use of these ICTs 

improves the organizational 

communication, which ultimately 

leads to effective decision-making 

(Rockart and Short, 1989). 

Furthermore ICTs are very useful 

means for collection and 

dissemination of information that 

is why most of the executives and 

the managers of private health 

organizations use e-mails 

frequently because they believe 

that ICTs can convey things more 

effectively Keri (2007). 

4. Conclusion 

Quick access to relevant and valid 

information is possible through 

information and communication 

technologies. Furthermore these 

new technologies provide 

information that is needed for 

better decision-making on the 

issues affecting an organization 

regarding human and material 

resources. Majority of the 

managers try to be rational while 

making decisions but to do so they 

must follow the steps of rational 

making process i.e. defining the 

problem situation, develop the 

alternatives, evaluate the 

alternatives and select the best one 

available and finally 

implementation and monitoring 

of the decision. In addition the 

‘development of the alternatives – 

phase’ of decision-making process 

will not be effective until the 

availability of timely and accurate 

information to analyze the 

decision situation and generate as 

many alternatives as possible too 

stresses the importance of 

information and developing 

alternatives for effective 

decisions. 

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Assessment Of Nutritionnal Status Of Hiv 

Infected And Hiv Negative Pregnant Women In 

Ngaoundere, Cameroon 

M Dangwe 1, 2 , C M Mbofung 1 

1 Laboratory of Biophysics, food biochemistry and Nutrition 

2 Laboratory of Protestant hospital of Ngaoundere 

Background & objectives: Malnutrition (underfeeding) can affect the treatment of AIDS in 

that it reduces the ability of the intestine to absorb drugs, organic substances and 

micronutrients. Underfeeding could also increase the chances of transmission of the disease 

from an infected mother to the baby during pregnancy. The objective of this study is to 

compare the energy intake, weigh rate and nutritional status between the HIV and non HIV 

pregnant women attending two referrals hospitals in Ngaoundere (Cameroon). 

Methods:A cross sectional study using 24-hour dietary recall was applied to a sample of 109 

women, randomly selected from a population-based and anthropometric data were done. 

Results: Result show that HIV negative pregnant women consumed less energy intake per 

day than the HIV infected pregnant women at all age groups with no significant difference 

(F cal =1.19, p=0.317). Gain in weight between the HIV infected and HIV negative pregnant 

women in relation to their various age groups was no significant (F= 1.23, p=0.27). There was 

no significant influence of HIV status in pregnant women BMI (F=2 29, p=0.133). 

Interpretation & conclusion:In this study, the higher consumption of energy by HIV infected 

pregnant women than HIV negative women could be because HIV infected pregnant women 

were at the beginning of the infection which has not yet affected the immune system. In the 

two referral hospital of Ngaoundere besides HIV screening tests, should be also nutritional 

services to advice these women on their nutritional habits. 

Keywords: Malnutrition, Body mass Index, HIV/AIDS, energy consumption 


Acquired Immune Deficiency 

Syndrome (AIDS) is an 

infectious disease caused by the 

Human Immunodeficiency Virus 

(HIV) which appeared for the 

first time in the mid 1980 (BICE, 

1993). The Human 

Immunodeficiency Virus (HIV) 

reproduces in certain blood cells 

and more specifically in the white 

blood cells (WBC). The HIV 

thus attacks and weakens the 

immune system rendering the 

victim vulnerable to infections. It


has ravaged sub-Sahara Africa for 

decades and is still a major cause 

of adult morbidity and mortality 

(Masanjala, 2007). Recent 

estimates by the World Health 

Organization (WHO) show that 

about 33.3 million people are living 

with HIV/AIDS worldwide with 

22.5 million living in sub-Saharan 

Africa (Global Report, 2010). The 

prevalence in Cameroon stands at 

5.5 % with the Adamawa region 

occupying the 5 th position with 6.9 

% (Comité National de Lutte 

contre le Sida, 2004). 

Studies outlined that there 

is a relationship between 

malnutrition and AIDS (AIDS 

institute, 1995). Research shows 

that, the chance of infection with 

the HIV virus might be reduced 

in individuals who have good 

nutritional status with 

micronutrients and especially, 

vitamin A playing significant 

roles (ACC, 1998). Malnutrition 

(underfeeding) can affect the 

treatment of AIDS in that it 

reduces the ability of the 

intestines to absorb drugs, organic 

substances and micronutrients. 

Underfeeding could also increase 

the chances of transmission of the 

disease from an infected mother 

to the baby during pregnancy 

(Semba, 1997). 

This affirmation thus necessitates 

certain questions on the 

increasing rate of HIV positives 

in this region of the world, which 

is one of the most affected 

(CNLS, 2004). One would 

therefore be tempted to believe 

that underfeeding plays an 

important role in increasing the 

damaging effects of the 

HIV/AIDS. In the town of 

Ngaoundere, there is a dearth of 

informations on the relationship 

between underfeeding and 

HIV/AIDS. Thus, this study was 

undertaken to compare the energy 

intake, weight rate and nutritional 

status between the HIV and non- 

HIV pregnant women attending 

two referrals hospitals in 

Ngaoundere, Cameroon. 

2. Materials And Methods 

Study Area 

Ngaoundere is the capital city of 

the Adamawa Region, Cameroon. 

The city is located at latitude 

7 0 .19’N and longitude 13 0 34’E. Its 

population was estimated at 

about 230,000 inhabitants in 2001 

(Tchotsoua, 2006).The Adamaoua 

region is high in altitude; its 

whether is between 22 and 25 0 . 

This plateau contains 2 types of 

climates: the Sudanese type of 

tropical climate and the 

Cameroon type of equatorial 

climate. The Sudanese type of 

tropical climate has a dry season 

covering the period of November 

to March; then comes the moist 

season with down falls ranging 

from 900 mm to 1500mm. The 



Cameroon type of equatorial 

climate has a long dry season 

followed by a long rainy season. 

The down falls here range 

1500mm to 2000mm per year 

(Okouba and al., 2010). 

Study population and Design 

The study was cross-sectional in 

design. Pregnant women that 

attended antenatal services of the 

two referral hospitals in 

Ngaoundere (Protestant and 

Regional) were enrolled for the 

study. The study was conducted 

from May 2003 to January 2005. A 

total of 109 pregnant women at 

their third trimester were 

randomly selected and enrolled 

for the study. They were grouped 

into HIV infected (13) and non- 

HIV infected (96). 

Four age groups were ranged for 

the evaluation of age influence as 

a factor studied ( 27 years). 

Questionnaire Administration 

Questionnaires were administered 

to the women to collect data on: 

Age, level of education, number of 

children, gravidity, preferred 

meals, family inherited illnesses, 

certain disease frequency in the 

family and pre-natal treatments. 

Nutritional feeding habits were 

obtained through interviews on 

the diets. A 24-hour dietary recall 

was applied to a sample of 

women, randomly selected from a 

random population-based study 

sample. Most of the women had 

common feeding habits and their 

common meals were reported to 

be cereals (maize), tubers 

(cassava) and vegetables. The 

conversion of quantity consumed 

into calories was done with the 

help of a chart on food and 

nutritive value (FAO, 1968; 

Yadang, 2000). 

Assessment of nutritional status 

of the pregnant women 

Anthropometry is the 

measurement of human body. It is 

a quantitative method and is 

highly sensitive to nutritional 

status (Amuta and Houmsou, 

2009). The anthropometric 

factors: Weight (Kg) and Height 

(m) were used to calculate the 

Body Mass Index (BMI) as: 

() 

BMI = 

( ) 

As the aforementioned formula 

reflects the human body without 

pregnancy, we subtracted the 

foetal weight from the total 

weight of the pregnant woman to 

get the exact BMI. 

We generally assume that a body 

mass index less than 18.5 implies 

that the woman is thin and 

between 18.5 and 25, we say the 

woman has a normal weight 

meanwhile values superior than 25 

indicates over weight (Gallagher 

and al.,2000). 



Statistical analysis 

Collected data were analyzed 

using Statgraphics 3.0. The one 

way ANOVA test was used to 

find significant difference 

between the means. The 

significance level was at p≤0.05 

level. 

3. Results 

Comparison of energy intake 

between HIV infected and HIV 

negative pregnant 

women in Ngaoundere, 

Cameroon 

The quantity of energy consumed 

by HIV negative pregnant women 

and HIV infected pregnant 

women is shown in Figure 1. The 

result shows that HIV negative 

pregnant women consumed less 

energy intake per day than the 

HIV infected pregnant women at 

all age groups with no significant 

difference (F cal =1.19, p=0.317). 

Variation in weight gain of HIV 

infected and HIV negative 

pregnant women. 

Studies and analysis of the weight 

parameter of HIV infected and 

HIV negative pregnant women 

showed that the daily weight gain 

by HIV negative pregnant women 

is 0,041 ± 0,029 kg/day , 0.042 ± 

0,033 kg/day; 0,054 ± 0,047 kg/day; 

0,057 ±0.06 kg/day for group I, II, 

III and IV respectively, 

meanwhile for HIV infected 

women it is 0.038 ± 0.023kg/day; 

0.039 ± 0.014kg/day; 0,044 ± 

0,012kg/day; 0,017 ± 0.037 kg/day 

for group I, II, III and IV 

respectively (Figure 2). No 

significance difference was 

observed in weight gain between 

the HIV infected and HIV 

negative pregnant women in 

relation to their various age 

groups (F= 1.23, p=0.27). 

Body Mass Index (BMI) of HIV 


pregnant women 

The body mass index of HIV 


pregnant women is shown in 

Figure 3. It is observed that HIV 

status does not influence pregnant 

women BMI (F=2 29, p=0.133). 

Pregnant women were grouped 

into 3 depending on their Body 

Mass Index (Table 1). Results 

showed that 0,92% of the HIV 

infected pregnant women are 

underweight , 7,34% are of 

normal size, and 3,67% are 

overweight, while 0.92% of the 

negative were of underweight 

46,79%are of normal size, and 

40,36% are overweight. Although 

according to the body mass index 

of women at the start of 

pregnancy, 18.34% are thin and 

81.65% normal. 



Table 1: Percentages on the Body Mass Index of HIV infected and HIV negative pregnant 

women in relation to their age group. 

Number 

BMI (Kg/m 2 ) HIV positive (%) HIV Negative (%) 

Underweight (< 18.5) 1 (0,92) 1 (0,92) 

Normal weight (18.5-25) 8 (7,34) 51 (46,79) 

Overweight (˃ 25) 4 (3,67) 44 (40,36) 

4000 

3500 

3000 

2500 

Energy (Kcal/J) 

2000 

1500 

1000 

500 


HIV infected pregnant women 

0 

< 19 19-22 23-26 27-35 

(Years) 

Fig1: Comparison of energy intake between HIV infected and HIV negative 

pregnant women in relation to age. 



120 

100 



80 

weight *10 -3 (kg) 

60 

40 

20 

0 


4. Discussion 

Generally, the energy intake by 


appears to be higher than that of 

HIV negative pregnant women. 

This could be because HIV 

infected pregnant women were at 

the beginning of the infection 

which has not yet affected the 

immune system. It could be also 

due to the fact that there were not 

aware of their HIV status which 

could have affected their mind 

therefore influencing them to lose 

weight through their thoughts. A 

study reported that the quantity 

of energy necessary for pregnant 

women of the third trimester is 

2,250 kcal per day. However, a 

comparison of the energy taken by 

the HIV negative and HIV 

infected pregnant women in this 

study revealed that the energy 

levels were higher than values 

reported by Dupin and al 

(1992).This could be justified by 

the fact that these pregnant 

women were in the third trimester 

of pregnancy when they have the 

tendency of eating a lot 

irrespective of their HIV status. 

In our study group, we noticed 

that infected pregnant women and 

non infected pregnant women 

gain weight during pregnancy. 

We observe that the biggest mean 

rates of gain for 3 rd trimester of 

pregnancy in our population 

group is 0,399kg/wk for HIV 

negative pregnant women and 

0,308 kg/wk for HIV infected 

pregnant women. The presumably 

gain weight from HIV-uninfected 

adult women from the United 

States and Europe are 0,30 to 0,54 

kg/wk during the 3 rd trimester. 

However, people on whom we 

worked have weight ranges these 

values. This result is similar to 

those reported by Strauss and al. 

(1999) and Ladner and al (1998), 

but contrasts that of Kim and al. 

(1996) who observed HIV 

infected subjects to be suffering 

from underfeeding and weight 

lost at the onset of the infection. 

The difference between our study 

and that observed by Kim et al. 

(1996) is that the subjects enrolled 

in our study were found to have 

more energy intake than the 

recommended 

energy 

consumption. The energy surplus 

consumed by these pregnant 

women would have compensated 

the expected weight. We did not 

find further evidence in the 

literature that suggested 

differences in the pattern of 

weight gain by HIV status. But 

we know that lean body mass loss 

can be improved when nutrition 

counseling is combined with 

nutritional interventions (Stack 

and al.,1996). The body mass index 

observed in our study show that 

HIV status does not influence the 



weight gain by pregnant women. 

This result is similar with studies 

reported in Tanzania who find 

that there is not significant 

difference between body mass 

index infected and HIV-negative 

women (Villamor and al., 2004). 

This could be justified by the fact 

that these infected women are at 

the beginning of their illness. 

5. Conclusion 

Our study report that, no 

significant difference was 

observed between HIV infected 

and HIV negative pregnant 

women with regards to energy 

intake and weight gain. Our 

results also showed that age 

groups and HIV status had no 

significant influence on the 

pregnant women’s Body Mass 

Index. Besides HIV screenings 

test, were done to the women 

attending their antenatal services 

in there should be also nutritional 

services to advice these women on 

their nutritional habits. 

Acknowledgements 

The authors thank the 

pregnant women that attended the 

regional and protestant hospitals 

of the Adamaoua region for their 

kindness and collaboration which 

allowed successful data collection. 

The nurses of antenatal services 

both hospitals are also 

acknowledged. 

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spatialisation à l’aide pour un 

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et de la société. HDR. 

Discipline (Géographie 

Aménagement-Environnement). 

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Dreyfuss; Ana Baylín * ; Gernard 

Msamanga; Wafaie W. Fawzi * 

(2004). Weight loss during 

pregnancy is associated with 

adverse pregnancy outcomes 

among HIV-1 infected women 

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Nutritional Sciences. 

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nutritive de quelques mets de 

l’Extrême-Nord Cameroun. 

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Issues and Prospects of e-health in Pakistan 

Qamar Afaq Qureshi 1 , Najam Afaq Qureshi 2 , , Dr. Muhammad Zubair 

Khan 2 , Dr. Allah Nawaz 1 Dr. Bahadar Shah 3 , 

1 Gomal University, Pakistan 2 Sarhad University, Pakistan, , 3 Hazara University, Pakistan 

Abstract 

Background & objectives: In connection with access to information in developing countries, 

information flows through existing networks of communication is a main theme in the current 

IS literature . 

Methods:Information-intensive infrastructure is a requirement for information dissemination 

due to the shortage of network infrastructure in the majority of developing states. It is 

verified by many researchers that information managing technologies with their main purpose 

of ‘handling information’ have the advantage to enhance already existing technologies by 

making better information-communication a priori to new ICT innovations .Presently health 

information system infrastructure is deficient in resources to meet the demands and needs of 

increasing population in developing countries. Health care systems of developing countries 

have major barriers like poverty and lack of technological sophistication. 

Results:The basic difficulties or barriers in using information technologies include poor or 

inadequate infrastructure, insufficient access to the hardware and inadequate or poor 

resources allocation. By eliminating these barriers population health status can be improved in 

developing countries. 

Interpretation & conclusion: This study aims to determine the main issues and prospects for e- 

health in the current situation of developing countries like Pakistan and the way forward for 

policy makers to manage all issues in future for more effective and rational decision-making 

in healthcare organizations. 

Key words: e-health; challenges; prospects; developing countries; Pakistan 


E–health is a latest platform for 

handling many healthcare issues. 

E-health systems have presented 

so many gadgets which are being 

used by both developed and 

developing states. Healthcare 

related IS and hardware is now 

inexpensively obtainable all over 

the world. On the other hand 

successful adoption and use of e- 

health systems depends on the 

suitable infrastructure (Khoja et 

al., 2012). The readiness and 

awareness of doctors and 

physicians about the usage of ITapplications 

in hospitals can be


developed and maintained by 

providing proper tools and devices 

and proper training on regular 

intervals for more rapid access to 

information on internet. For 

handling users- related issues and 

maintaining regular use of ICTs 

in health organizations, healthcare 

providers must be given 

opportunity to take part in 

information systems development 

process and include the IScontents 

according to their 

requirements (Rezai-Rad et al., 

2012). 

Concentrating on informationcentered 

ICT applications in 

developing countries is 

comparatively a new sphere and 

subject in the domain of health 

informatics (Kimaro & Titlestad, 

2008). Sound evidence-based 

literature extracted on influence 

assessments or outcome 

measurements is still lacking 

regarding ICTs-applications in 

the healthcare sector (Rezai-Rad 

et al., 2012). Published evidences 

are presently available on this 

topic and are at pilot or the proofof-concept 

stage. In many cases, 

the statements are not individual 

analyses, rather are based on 

collective skills and practices, 

consensus statements, and policies 

(Soar et al., 2012). 

The significance of the concepts 

of ‘information’, ‘information 

first’ has been advocated by many 

IS researchers for the successful 

adoption and use of the ITapplications 

in any organization 

and involvement towards the 

‘information-centered ICT’ 

concept is a major example 

(Nyella & Mndeme, 2010). 

Furthermore the ICT-applications 

may only bring small direct 

benefits for poverty alleviation 

and the possibility for ICTapplications 

depends on both 

financial and access to cultural, 

political and educational 

resources. And finally, the access 

to social assets and increasing 

confidence and support through 

locally contextualized social 

networks built through 

community-based initiatives is 

more crucial than looking for 

access to new information from 

digital ICTs (Khoja et al.,2012). 

Many studies reveal that doctors 

and physicians in developing 

countries are not given an 

opportunity to be take part in 

information system development 

process, consequently IS/ICTs do 

not possess the features which are 

according to the needs of 

healthcare providers (Rezai-Rad et 

al., 2012).Although e-health 

systems in developing countries is 

not a new concept any longer but 

there is sluggish usage of internet 

among healthcare providers due to 

lack of the capability to read, be 


Q. A. Qureshi et al. 33 

aware of and use a variety of 

technical terms on 

internet(Hogan 

& 

Palmer,2005).Furthermore the 

little use of internet among 

healthcare professionals of 

developing nations like Pakistan 

is mostly because of improper 

tools and devices and shortage of 

proper training programs 

regarding eHealth systems(Malik 

et al., 2008). 

Doctors and physicians in 

developing countries complaint 

that IS and particularly the 

interfaces are not user friendly. In 

addition IT- applications in 

healthcare sector are inflexible in 

nature consequently create users’ 

related problems .The software in 

the hospitals of developing 

countries do not have the contents 

in native languages regarding e- 

health systems (Chetley,2006). E- 

health projects in developing 

countries generally unsuccessful 

due to a shortage of ITprofessionals 

and their knowledge 

and expertise in e-health systems 

(Kimaro & Nhampossa, 2005). ITprofessionals 

require training and 

education in order to effectively 

use all e-health applications 

.Training should be a frequent 

feature and healthcare 

professional must be given the 

training at least once a year (Qazi 

& Ali, 2009). 

2. e-Health in Pakistan 

In all bad surroundings and 

situations, Pakistan is making its 

efforts for the war on terror and 

people of the country are facing 

many challenges and even die in 

this war in bomb blasts. 

Healthcare system is a 

requirement for developing 

countries like Pakistan. At 

present, in Pakistan near about 

seventy five percent of population 

resides in rural areas where road 

and transport facilities are 

inadequate, shortage of healthcare 

providers in rural areas, 

professional physicians and 

surgeons are least interested to go 

in far flung areas because of poor 

infrastructure, patients being 

carried on their own way to arrive 

at the city hospital for an instant 

healthcare or diagnoses which 

could have without difficulty been 

treated at their own locations 

provided medical consultations 

are available (Saleem, 2010). The 

majority of cities in Pakistan 

facilitate telecommunications 

links, more than 1800 cities of 

Pakistan have access to 531,787 

broadband connections and 400 

cities are on Fiber Optic, giving 

possibility to access universal 

health 

information. 

Implementation of any 

information system at the start is 

not up to the mark but it will also 

provide solutions usually in 



emergency situations (Ansari et 

al.,2012). 

There has been an explosion in 

knowledge and information 

management activity, mainly in 

healthcare sector over the 

previous few years. By and large, 

hospitals and medical schools 

have started using the services of 

doctors who possess computer and 

computerization skills. These 

organizations have also obtained 

complicated information systems 

to collect and retrieve 

accumulated knowledge. Ehealth 

system includes many elements 

such as telemedicine, teleeducation, 

telematics for better 

management of healthcare and 

research (Kijsanayotin , 

Kasitipradith & Pannarunothai 

,2010). There are four areas where 

health informatics is performing 

an escalating role in healthcare 

development: a) administrative, 

b) education and training, c) 

quality improvement and d) the 

recovery of efficiency of health 

care services (Bhutto et al., 2010). 

In Pakistan 72% of population 

lives in rural areas and 28% of 

population lives in urban areas. 

Condition of health can be 

determined effortlessly from the 

reality that there are 74 physicians 

per 100,000 persons in early 2000s. 

There are several rural areas 

where people have not seen a 

capable and skilled health 

professional in their entire life 

(Bhutto et al., 2010). The 

municipal areas of Sindh are well 

equipped with health facilities; 

which are not enough for huge 

population but facilities are there, 

whereas rural Sindh does not have 

well equipped health facilities. 

Available possessions at urban 

areas can be shared as well as 

expanded to the rural areas with 

the help of digital connectivity. 

Particularly, Karachi capital city 

of Sindh holds very latest 

healthcare facilities (Durrani et 

al., 2012). 

In urgent cases where instant 

medical treatment is very vital, 

current studies reveal that before 

time and particular pre-hospital 

patient management leads to the 

patient’s survival. Especially in 

cases of serious head injuries, 

spinal cord or internal organs 

damage and pain, the way the 

events are treated and transported 

is critical for the forthcoming 

well-being of the patients 

.Bringing improvements in 

healthcare services and remain fit 

and healthy is one of the most 

discussed and key issues in our 

society. The acceptance of ITapplications 

in healthcare sector 

have very solid and successful 

attempt for the provision of 

improved healthcare services 

(Malik et al., 2008). But constant 



guidelines must be developed and 

agreed across the board in 

connection with the processing of 

health-related data, with 

particular explanations regarding 

diagnostic notes, which stress and 

assure its protection and 

confidentiality, as well as free and 

open access, by the patients to 

their own data. Furthermore the 

potential technical knowledge 

difficulties can be neutralized by 

making sure that the ITapplication 

is both technically 

possible and clinically suitable. In 

addition to that all citizens, 

doctors & physicians and policy 

makers must acknowledge and 

appreciate the adoption and use of 

eHealth systems (Bhutto et al., 

2010). 

The significance of a health 

information system (HMIS) 

cannot be neglected in a country 

like Pakistan because health 

policies and planning in any 

country generally depend on the 

accurate and well-timed 

information on various health 

issues (Ali & Horikoshi, 2002). In 

Pakistan, before the 1990s, a 

number of vertical programs with 

categorical disease-specific 

information systems ended in 

disorganized data transmission, 

which made evaluation of 

program usefulness difficult for 

managers. In 1991-92, the Ministry 

of Health (MoH) started an 

assessment study of existing HIS 

and transformed the reporting 

systems into a comprehensive 

National HMIS through a 

consultative procedure (Qazi & 

Ali, 2004). However, there is need 

to develop integrated disease close 

watch infrastructure and technical 

competence in tropical countries 

on the reporting and scientific 

evidence necessities of the 

sanitary agreement under the 

WTO (Singer & deCastro, 2007). 

Health information is 

information about people’s health 

and what they, government, and 

others are doing about it. It 

explains the occurrence, 

frequency, and reasons of major 

diseases, as well as accessibility 

and efficiency of curative 

activities (Ali & Horikoshi, 2002; 

Khalid et al.,2008). Under the 

transfer of power initiative, 

Pakistan's MoH has advocated 

strengthening of health 

information systems for more 

informed decision-making in 

planning, managing, checking and 

control of healthcare services for 

improved service delivery in the 

districts. However, the efforts at 

increasing information systems 

have generally proved 

unproductive and sometimes 

counterproductive. Analyses of 

the malfunctioning often fail to 

notice the perceptions of 



stakeholders as an important 

factor (Ansari et al., 2012). 

Given the large health 

infrastructure in Pakistan both 

public and private, supplying to a 

population of 137 million people, 

there had been a need to build up 

and start a national health 

management information system 

which is able to collect, process, 

analyze and provide criticism on 

all health related data including 

information on input, process and 

output indicators (Gururajan et 

al.,2008). The national feedback 

reports on the new HMIS admit a 

slow development in scope and 

reporting reliability, but also note 

the continued need for 

improvement in the quality and 

usage of information at various 

levels. A study carried out in 2000 

pointed out that the information 

produced via HMIS was unrelated 

and the data did not help 

managers to make decisions 

(Bhutto et al., 2010). 

Ministries of Health are 

approving Computer Software in 

order to get better health data 

collection, stretch, storage, 

analysis and distribution in their 

Health Information Systems 

(Khoja et al., 2008). Computer 

software are obtained through 

various means including buying 

on-shelf software, indenture based 

software, and donated software. 

Most of the Software acquired 

through these means is not 

distributed with their source codes 

in that they are proprietary 

software. However, the data 

elements of Health Information 

Systems are changing regularly 

due to changing disease patterns; 

incoming and outdated drugs, and 

changing health policies (Ishtiaq 

et al., 2012). 

As software requires to be redesigned 

from time to time to take 

on changing requirements arises 

there is a need to think about 

efforts on open source software. 

With Open Source Software 

development method, the 

software is distributed with their 

source code which means that a 

Ministry of Health can uphold its 

software with no unique 

developers (Mostafa et al., 2011). 

The characteristics of Open 

Source Software development 

approaches seems to be 

appropriate in developing 

software for Health Information 

System in that health information 

systems institutions has full 

access to their software source 

codes and thus can bring in any 

changes according to their 

requirements instantly. In the 

case, the Ministry has no ICT 

capacity (say human resources) to 

be able to change the software; the 

software can be restructured by 

any computer expert and not 



necessarily the ones who have 

developed that software (Durrani 

et al., 2012). 

3. Issues & Prospects 

Pakistan health services and 

health signs are usually poor 

especially in the far flung and 

rural areas. Out of 1000 infants 

76.6 persons of them die and the 

death rate under age 5 is 10.1 %. 

Malaria occurrence is 0.75 per 1000 

persons, whereas, TB incidence is 

181 persons per 100,000. The health 

expenses have been very low and 

not adequate to give good health 

to people. For example the 

development spending was Rs. 

14.272 billion for the year 2007-08, 

and the recent expenditure was. 

Rs. 3.791 billion. Improved health 

enhances the output of the labor 

force, strengthens their economic 

conditions and eventually enables 

them to lead a superior life. To 

achieve better, competent, 

effective and industrious 

workforce, governments promote 

the healthcare services. Moreover 

the present state of affairs of the 

human resource, a small 

adjustment in public sector 

expenses on healthcare services 

can have a strong influence on the 

workforce and thus the economic 

development. 

E-Health is slowly but surely 

becoming popular throughout the 

world. This is ordinary and the 

routine in the developed countries 

but developing nations are so far 

initializing to implement and use 

eHealth systems for better 

healthcare services (Sarkar, 2008). 

The appearance and advent of 

IS/ICTs have opened new views 

for the countries to handle their 

problems consequently the 

developing countries are also 

making efforts to implement these 

tools and gadgets. On the other 

hand, there are several difficulties 

and barriers which needs to be 

removed away prior to taking full 

benefits of IT-applications for 

healthcare (Chanda & Shaw, 

2010). 

E-Health is the adoption and use 

of ICTs that includes the internet 

for more improved and better 

delivery of healthcare services 

(Eng, 2001). Another writer 

remarks that e-Health is a new 

and very potential subject and 

field of medical informatics, 

referring to the organization and 

delivery of healthcare services and 

information using the Internet 

and interrelated technologies 

(Pagliari et al., 2005). It is also 

noteworthy that the majority of 

the studies about eHealth and its 

successful adoption and use have 

been carried-out in both developed 

(Eysenbach, 2001; Alvarez, 2004; 

Pagliari et al., 2005) and 

developing states (Mosse & Sahay 



2003; Braa et al.2004; Chanda& 

Shaw, 2010). 

A number of aspects and features 

have been exposed as the crucial 

factors in creating or destroying 

the functions and tasks of e- 

Health system everywhere. 

Though, the research indicates 

that ‘top-management-support’ 

and ‘government-ePolicies’ play 

leading role in all the matters 

concerning to the planning, 

development, adoption and use of 

new ehealth systems along with 

their maintenance on continual 

basis(Scott et al., 2002). This 

becomes extremely important in 

case of the developing countries 

like Pakistan. The developing 

nations have extra issues of 

‘digital-literacy’ of all the 

government authorities, 

developers of the systems and 

definitely the future users of 

ehealth applications (Lang & 

Mertes, 2011). 

It is not just the willingness and 

acceptability of the all the 

expected users in an organization 

which controls and decides the 

success and failure of the e-Health 

initiatives rather it also contains 

the approach and stance of 

government (external authority) 

as well as the top management of 

the organization (internal 

executives) (Kimaro & 

Nhampossa,2007). Keeping in 

view the specified responsibility 

and function of top management, 

it is not unexpected that the 

interest and support of the 

executives in an organization has 

been one of the most generally 

talked-about organizational 

factors for the successful 

implementation of eHealth 

projects (Hussein et al., 2007).A 

lot of studies on the role of top 

management support for the 

success of e-health systems have 

been conducted (Sajjad et al., 2009; 

Qaisar & Khan, 2010). 

E-Health policy is fastened with 

the availability of resources along 

with the professionalism is needed 

for the proper utilization of the 

resources, implementing plans 

and receiving the results. Lack of 

professional frame of mind and 

the attitude is apparently the 

bigger concern and matter for 

those developing states which 

have the resources (Scott et al., 

2005).Government eHealth 

policies make an environment 

where the likelihood of using 

resources effectively is increased, 

the professionals find their 

suitable places and exercise 

faithfully and the future of ITapplication 

in healthcare becomes 

clearly identifiable (Shaqrah, 

2010). 

In spite of the abilities and 

benefits of e-Health and 



Telemedicine for sustainability of 

eHealth systems, some barriers, at 

different levels, are required to be 

overcome for health systems to 

take full advantage of these 

opportunities. These barriers are 

not 

uni-dimensional, 

concentrating on technical 

knowledge as assumed in the past, 

but somewhat a multidimensional 

concept, surrounding technical 

knowledge, economic feasibility, 

organizational support and 

behavior adaptation. The 

Telemedicine Alliance, a 

collaboration between the World 

Health Organization, the 

European Space Agency and the 

International 

Telecommunications Union 

studied e-Health and 

Telemedicine adoption trends 

through personal interviews with 

54 European telecommunications 

experts, health policy makers, and 

healthcare providers (Rhidian, & 

Hughes 2003). 

3.1 Specific Issues of Developing 

States like Pakistan 

These Issues of Developing States 

are divided into following groups: 

1. National Policies towards 

HIT: Efficient, effective and 

secure national policy can address 

the local health needs according to 

the changing environment is 

needed. These policies can be 

devised by policy makers and 

practitioners to assess and 

implement research evidences. 

Enforcing the legislation is 

difficult in developing countries 

and acceptance by the community 

for the transformation of any 

system is hard. 

2. Poor eHealthcare design: 

Many e-healthcare systems are 

developed by Information 

Technology (IT) solution 

companies which operate for the 

purpose of getting profit. These 

companies are interested with the 

financial gain from e-healthcare 

products that they produce. They 

concentrate much in producing 

usable products for healthcare 

institutions and hence causing 

privacy, security and 

confidentiality to suffer. In order 

to resolve this, efforts to secure e- 

healthcare systems need to be 

taken from design of the systems 

to implementation in order for the 

developments that have been 

achieved so far to be rolled to the 

real world. 

3. Organizational Barriers: 

Organizations and people play a 

very critical role in implementing 

and transformation of an 

information system. First of all 

there are no documented studies 

available regarding level and use, 

benefits, cost, risk analysis and 

other aspects of health technology 

in health sector of underdeveloped 

countries and if they are available 

for the developing countries they 



are not well communicated. 

Secondly, people at higher 

positions and posts, whose needs 

of reporting are adequately being 

catered by the existing system, do 

not favor HIT as they think that 

the employment of new 

technology is wastage of both the 

money and time. Hospitals must 

address the apprehension of 

physicians because if by using 

HIT their professional 

responsibilities become difficult 

they will never support its use. 

4. Social and Cultural 

Barriers: Digital divide and e- 

readiness are major social and 

cultural barriers in establishment 

and use of health information 

system. These barriers include 

lack of stakeholder’s interest, less 

motivation, anxiety to adapt and 

use new technology. Health care 

personnel are difficult to convince 

for use of new health 

technologies. As they are more 

comfortable with their 

conventional approach and 

routine practice so it is 

complicated to transform health 

information system from paper 

based to digital format (Durrani et 

al., 2012). 

5. Infrastructure-related 

Issues: Most of underdeveloped 

countries do not have required 

technological infrastructure to 

establish national health 

information system hence cannot 

promote HIT in private and 

public hospitals. Reshaping 

infrastructure of existing health 

system is very crucial. Most 

developing countries do not have 

adequate required infrastructure 

such as computer hardware, 

software, wired and wireless 

communication channels, 

Internet, and skilled professional 

human resource. The availability 

and operation of these 

components of digital 

Infrastructure are necessary for 

establishment and promotion of 

HIT in under developed 

countries. Strong infrastructure is 

required for the strong health 

information system to improve 

existing health system by 

planning and introducing new 

health care interventions which 

results in achieving better health 

goal. There are poor or inadequate 

resources allocation for 

implementation and use of the 

health technology in the 

developing countries. 

6. Hardware/Software: HIT 

requires specialized software and 

hardware to improve public health 

by making evidence based 

decisions. Often these software 

and hardware tools are costly and 

require sufficient training for 

proper operation. 

7. Poor Availability of 

Internet: Poor internet availability 

is a vital infrastructure barrier. 

Health care specialists have poor 

access to real time information 



and the available information is 

not according to the local 

situation. This available 

information cannot be used for 

evidence based decisions. Without 

having a proper local area network 

and internet facility interorganizational 

and intraorganizational 

communication is 

not possible. This is a backbone 

for any information system. 

8. Lack of Professionals & 

their Trainings: A computerized 

information system requires 

skilled personnel for its effective 

operation. Training is one of the 

aspects for use of any new 

technology. Deficiency of skilled 

workforce can be overcome by 

providing appropriate training in 

the required area. A proper 

training module in constructing 

architecture of a reliable database 

should be available. If it is not 

implemented then outcomes or 

results gained by such type of 

databases gives unauthentic 

results which can neither be used 

for decision making process nor 

for evidence based practice. 

Training requires cost as well as 

time. 

9. Cost and Time 

Constraints: Major problem in 

organizing workshops and 

trainings for establishment and 

implementation of HIT in under 

developed countries is financial 

and time constraint. 

Transformation of any system is a 

difficult task and cannot complete 

in short time period. Barriers like 

lack of skilled workforce, 

infrastructure, and cost along with 

other effects like initial decrease 

of productivity due to adjustment 

with new technological 

environment and system itself 

impose strong limits to the 

introduction and adoption of new 

health technologies. It requires 

years and years for transformation 

process to complete. 

10. Educational Barriers: 

Professional education in health 

informatics is badly ignored and 

missing in curriculum of medical 

institutes for undergraduates. 

Although module of education 

related to IT use in research is 

included in postgraduate 

curriculum but it is the need of 

the hour to include this area in 

medical professional education at 

graduate level. Transformation of 

our existing paper based health 

system into computerized 

information system is not possible 

without providing the basic IT 

knowledge to health professionals. 

11. Fear of losing Control over 

Data: The shift from traditional 

healthcare to e-healthcare 

involves the transformation of 

records from paper-based to 

digital format. These records are 

referred to as Electronic 

Healthcare Record (EHR). 

Grimson (2001) defines and 

characterizes the next generation 



EHR as the longitudinal cradle-tograve 

records readily accessible 

and available over the Internet. 

These records will be linked to 

clinical protocols and guidelines to 

drive the delivery of healthcare to 

the individual. The presence of 

these records over the Internet 

facilitates record sharing between 

physicians. However, patients 

usually feel that they are losing 

control of their data hence 

resisting e-healthcare adoption. 

3.2 Prospects of e-Health in 

Pakistan 

The healthcare facilities in 

Pakistan has got better and 

increased in figure each year but 

this increase is not proportionate 

to the population growth 

.Therefore; the healthcare 

facilities are not that enough 

which can fulfill the needs and 

necessities of a large population. 

Persons particularly in rural areas 

face more difficulties of poor 

health than the people living in 

urban areas. Likewise, there has 

been a rise in expenses on 

healthcare planning and 

implementation but these 

expenditures on more and 

expanded healthcare setups are 

not enough for the population 

which is growing faster than the 

increase in the expenditure 

(Saleem, 2009). Moreover, there is 

also an increase in the number of 

doctors, dentists and physicians 

every year .The increase in 

doctors and dentists number is 

more than the population growth 

which has decreased the number 

of patients/people for each doctor 

and dentist for treatment. 

In the present times of 

management, a practical and 

structured information system is 

more or less a need and main 

concern of many organizations 

especially the healthcare 

institutions. In Pakistan, the old 

techniques and methods for data 

collection and analysis must be 

changed if the information in 

healthcare sector is to be used 

correctly for more effective 

healthcare-related activities and 

decisions. The Ministry of 

Health, Government of Pakistan, 

in alliance with the provincial 

health departments and 

international agencies developed a 

National HMIS during 1990-93 

(Ali & Horikoshi, 2002). The 

facility based HMIS is one of the 

most influential tool for the 

planning and management of 

healthcare services. In view of the 

existing huge health 

infrastructure, stretched all over 

the country in terms of health 

facilities, services, staff, drugs and 

supplies etc. there has been a 

requirement to start a wellorganized 

information system 

responding to the information 

needs of various decision making 



levels of the healthcare 

organizations(Durrani & 

Khoja, 2009). 

The relationship between the 

ICTs and better healthcare 

service delivery has been 

discussed significantly 

(Ferraro, 2008; Nowak, 2008). 

The present studies have 

focused on the introduction of 

particular technologies, such as 

the cell phone or the Internet, 

but few have examined 

empirically the relationship in 

detail (Fraser et al.,2007; 

Kollmann et al., 2007). One 

probable method of tackling 

this dispute is appraisal and 

evaluation of user needs before 

adoption and use of eHealth 

systems. However, user studies 

which can be very helpful and 

productive for adoption of ITapplications 

in healthcare 

sector but unfortunately these 

studies are not always carried 

out at the right time in design 

and development cycle 

(Saleem, 2010). 

A lot of healthcare 

organizations implement 

telemedicine technology for the 

development of healthcare 

services and increase usefulness 

& effectiveness. The 

willingness of healthcare 

organizations and the 

availability of the suitable 

conditions are driving forces for 

the implementation and use of 

telemedicine. Earlier studies 

showed that a telemedicine 

program can be disobeyed by 

organizational culture and work 

processes (Wootton, 2008) 

One main obstruction in e- 

Healthcare implementation, either 

in developed or developing states 

is privacy, secrecy and security 

concerns of e-Health systems. 

The American government, for 

example, for the year 2009 

reserved 19 billion dollars for ITapplications 

in healthcare sector. 

However, in spite of this massive 

investment, e-healthcare adoption 

in the USA is still hesitant. Its 

expected users for instance 

doctors and physicians are not 

convinced about the security 

issues and concerns of 

information systems in healthcare 

organizations therefore they resist 

the implementation and use of the 

same. Furthermore, patients are 

also worried about the privacy of 

their medical records. This has 

been influenced by a number of 

existing cases involving violations 

in e-healthcare information 

systems. However, we disagree 

that adoption of eHealth systems 

is not a financial problem as such. 

It goes beyond, to include human 

faith and belief. Therefore, in 

spite of concentrating on securing 

funds for e-healthcare 



implementation, developing states 

have to think about the human 

factor as well (Durrani & Khoja, 

2009). 

Though we suggest the use of Free 

and Open Source Software 

(FOSS) (from operating system 

to EHR software) but due to 

shortage of money, these products 

are linked with many challenges. 

As these products are “free”, its 

users do not have any support and 

maintenance from development 

teams. The government of 

developing countries needs to set 

aside sufficient finances for staff 

training in the healthcare sector. 

If e-health is to succeed in 

developing nations it needs to be 

take care of. We need to develop 

our own local abilities and 

infrastructure, based on local 

demand. 

The shared understanding and 

collaboration is a coordinated, 

synchronous activity that is the 

outcome of a continued effort to 

construct and uphold a shared 

conception of a problem. 

Cooperation is working jointly to 

achieve shared goals surrounded 

by joint and supportive activities 

individuals look for results which 

are advantageous to themselves 

and helpful to all other group 

members. Methodically and 

thoroughly structuring those basic 

elements into group learning 

circumstances helps ensure joint 

efforts and makes possible the 

closely controlled implementation 

of joint learning for lasting 

success (Kaplan, 2000). The 

advantages of collaborative 

learning are that persons bring 

different ideas in a collaborative 

environment and work on the 

way to the growth of a shared 

understanding and building usual 

knowledge (Tan , 2005). At 

present, the existing 

understanding seems to be that 

collaboration is a synonym for 

high-quality learning and good 

educational technology; more or 

less any web-based application is 

labeled as collaboration 

(Heinzelmann et al., 2003). 

Ever increasing charges for 

healthcare services and fast 

increase and development of the 

knowledge have led the doctors 

and physicians to work in a 

collaborative way and share 

knowledge and skills. It is usually 

understood that healthcare 

professionals working in a 

collaborative style, can deliver 

healthcare services in a successful 

and well-organized manner. 

Collaborative learning process can 

exchange of ideas within little 

groups not only enhances interest 

between the participants but also 

generates and encourages critical 

thinking. Collaboration in 

healthcare organizations requires 



establishing a platform, and 

governmental responsibility to 

support sharing knowledge and 

experiences among healthcare 

workers (Durrani & Khoja, 2009). 

Collaboration and healthcare 

teams are very common in 

hospitals for durable and lasting 

healthcare facilities, but teams are 

often not available to providers in 

the community where the 

majority of practitioners work 

separately. Collaboration makes 

group members more adaptable 

and ultimately replaceable as the 

group as a learning community 

shares knowledge and 

experiences. Collaborative 

learning in healthcare 

organizations need to make and 

establish the environment that 

supports and encourages sharing 

of knowledge such as: government 

policy, IT infrastructure, top 

management support, and 

business process management to 

give doctors and physicians the 

capability of discussion and 

reflection (Scott et al., 2005). 

Pakistan’s ministry for healthcare 

has forecasted that Pakistan is 

grasping important benefits from 

the up-and-coming information 

economy. This is reflected in the 

current infrastructure investment 

and other hi-tech developments. 

In spite of this development, it 

seems that Pakistan is very slow 

in healthcare services provision. 

The slow adoption and use of ITapplications 

in the developing 

states like India and Pakistan is 

because of lack of management 

support (the perceived complexity 

and cost (Li et al., 2005, Houston 

et al., 2003, Lu et al., 2003); 

sensitive character and make-up 

of information and logistics 

contained in a healthcare facility, 

nature and type of risk involved, 

demands for high quality of 

healthcare, high litigation cost and 

lack of infrastructure, the level of 

absorption and assimilation with 

existing health systems(Li et al., 

2005) and the requirement for 

other resources to support 

technology infrastructure 

(Davenport, 2005, Lu et al., 2003). 

While there is an increase in the 

usage of new technologies but 

there are limited studies on the 

perceptions and awareness of 

doctors and physicians about the 

adoption and use of ITapplications 

in healthcare sector 

(Eastes, 2001, Li et al., 2005). 

Earlier studies that have used 

existing models to predict 

behavior determinants of adoption 

of technologies in healthcare have 

demonstrated their inadequacy. 

Further, the uptake of wireless 

and handheld tools and devices is 

either on a very small level on an 

individual level but are not at 

organizational levels in Pakistan. 



There is limited research available 

on determinants and factors that 

are critical to understanding user 

perceptions of technologies 

specific to healthcare on a larger 

scale. Therefore, any knowledge 

of these factors of adoption of 

new technology will help the 

healthcare administrators to 

develop suitable policies in order 

to handle the ever-increasing 

demands of healthcare services. 

This is more valid in the case of 

Pakistan because of the demands 

placed on the healthcare services 

and rising interest in wireless 

technologies in the health domain. 

The culture of Pakistani 

environment has always 

encouraged the use of technology. 

This is high on the programs and 

plans at country and federal level 

government. The healthcare 

sector in Pakistan is operating in 

an environment of strong 

regulatory framework, cost 

reduction, high competition, and 

expectation of high quality of 

services, high demand on the 

healthcare sector, limited 

resources, and the demand for 

providing high quality of care - 

anytime anywhere. Factors such 

as familiarity, infrastructure, cost, 

clinical process, quality of care, 

management support, policies and 

procedures, security, availability 

of appropriate wireless 

application, trust and knowledge 

of the technology will facilitate 

the adoption and hence the use of 

wireless handheld devices in 

Pakistani healthcare environment. 

4. Discussions 

The process of developing and 

implementing IS in the context of 

developing countries is a 

challenging endeavor. This 

challenge mainly emanates from 

existing adverse situation of the 

installed base that is characterized 

by uneven infrastructural 

development across regions, 

inadequate skilled manpower, lack 

of integration of exiting 

standards, work practices, and 

varying political commitment and 

organizational support at different 

levels (Raghupathi & Wu, 2011). 

Simply acquiring and 

implementing e-Health 

technology alone would be 

insufficient to accomplish clinical 

performance and, subsequently, 

drive adoption and diffusion. E- 

Health technology should be 

integrated effectively with the 

organizational change and 

improvement (Asangansi et al., 

2008). The improvement in 

processes requires the 

optimization of clinical functions 

and processes which should be 

supported by the technology and 

not driven by it. By doing this it is 

likely to generate significant 

patient outcomes and financial 



improvements with health 

organizations. This is estimated in 

terms of attracting more patients, 

saving effort and time (Bhutto et 

al., 2010).Furthermore, in the 

context of developing states like 

Pakistan, the cost constitutes an 

important factor which will affect 

the integration and, subsequently, 

the success of eHealth systems in 

a particular setting. Although cost 

aspects are not directly explored, 

however, efforts to save time, 

reduction in inaccuracies and high 

quality information are real 

components of the cost (Somu & 

Bhaskar,2011). While existing 

research suggests that wireless 

technology has the power to 

decrease scheduling time and 

medical errors thereby enhancing 

the quality in patient care, there is 

bleak evidence on the 

comparisons of costs before and 

after the implementation of 

wireless technologies. It entails 

that there is a big space for further 

research to assess the hypothesis 

that costs have the potential to 

affect clinical usefulness and 

threaten widespread adoption 

(Juma et al., 2012). Use of e-health 

systems in developing countries 

holds many threats, along with 

the expected advantages. The 

main risk of using ICTs is the 

unintentional broadening of the 

gap in health status and 

knowledge between various 

segments of the population, thus 

escalating rather than addressing 

healthcare inequalities. One 

method to stay away from this 

divide is for government 

authorities and hospitals in 

developing countries to evaluate 

and make them ready for change 

before adoption and use of ITapplications. 

This process of 

preparation for eHealth related 

change is also termed as eHealth 

readiness (Durrani et al., 2012). 

eHealth readiness is determined 

by assessing the comparative 

status of governments, healthcare 

organizations, or expected users in 

those areas most critical for 

acceptance and success of 

programs using ICT (Rezai-Rad 

et al., 2012). 

5. Conclusions 

Literature reveals that e-Health 

systems are the future of every 

healthcare service being provided 

in the advanced, developing and 

poor states. developing states are 

interested and busy in the 

improvement of healthcare-sector 

and that is why these nations keep 

on to decentralize their political 

and healthcare systems, they need 

to make available all the required 

payments and grants for the weak 

and insufficient resources and 

powerless abilities and 

qualifications of the urban areas. 

Although the speed and tempo of 

introducing digital systems for 



healthcare is altogether different 

from advanced to developing 

countries like Pakistan, all the 

states are making all out efforts to 

adopt these systems. This attitude 

is based on the fact that the ICTs 

have offered such options that 

were almost unimaginable so far. 

E-Health systems are helping the 

developing and poor states in 

resolving their long standing 

problems in healthcare facilities 

and services. Furthermore, the 

research tells that once a country 

is capable to introduced e-Health 

system, its success depends on the 

users’ ‘e-Readiness’ for willingly 

using the new systems. A huge 

body of research is underway to 

explore the dynamics of users’ 

readiness. There are several 

variables which determine the 

users’ attitude however the most 

powerful and unavoidable 

determinant is the ‘digitalliteracy’ 

of the prospected users. 

Research shows that as the 

computer literacy of the e-Health 

users (like doctors) increases, the 

possibility of successful e-Health 

operations also increases. 

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