Self-reported illnesses in Thatta: Evidence from a rural and underdeveloped district in Sindh province, Pakistan

Self-reported illnesses (SRI) surveys are widely used as a low-cost substitute for weak Disease Surveillance Systems in low- and low-middle-income countries. In this paper, we report findings of a district-level disease prevalence survey of all types of illnesses including chronic, infectious, injuries and accidents, and maternal and child health in a rural district in Pakistan.

A district-level survey was conducted in Thatta in 2019 with a population-representative sample of all ages (n = 7811) a. Survey included questions on demographics and SRIs from the respondents. Prevalence was estimated for all SRIs categorized into six major and 16 minor illnesses. The influence of important socio-demographic covariates on the illnesses and multiple comorbidities was explored by estimating prevalence ratios with a Generalized Linear Model of the Poisson family and by Zero-Inflated Poison Distribution respectively.

36.57% of the respondents to the survey reported at least one SRI. Prevalence of communicable illnesses was 20.7%, followed by non-communicable illnesses (4.8%), Gastrointestinal disorders (4.4%), and injuries/disabilities (1.9%). Urban inhabitants were more likely to have Chronic Obstructive Pulmonary Disorders (3.34%) and Diabetes (1.62%). Females were most likely to have injuries (1.20,), disabilities (1.59), and Musculoskeletal Disorders (1.25). Children aged < 1 year (0.80) and elderly >65 years (0.78) were more likely to have comorbidities.

Our estimated prevalence of SRI is quite higher than the prevalence of unknown SRIs in national-level surveys in Pakistan. This research's findings serve as an example of aiding evidence-based priority settings within the health sector. Our findings on gender, and young and old age as positive predictors of SRI are consistent with similar surveys in a few LMICs.

We provide evidence of a complete disease profile of a district that is otherwise unavailable in the country. This study can reshape the existing health surveys and to aid evidence-based priority settings in the health sector. We, however, support strengthening the Disease Surveillance System as a reliable source of disease prevalence data.