essay on lockdown in pakistan

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Effects of COVID-19 pandemic and lockdown on lifestyle and mental health of students: A retrospective study from Karachi, Pakistan

Effets de la pandémie de covid-19 et du verrouillage sur le mode de vie et la santé mentale des étudiants : une étude rétrospective à karachi, pakistan, associated data, introduction.

Due to the COVID-19 pandemic, many countries imposed lockdowns on their citizens in an attempt to contain the disease. Pakistan is one of these countries. A government mandated lockdown can have mitigating psychological effects on young adults, out of which a large fraction is made up of students. This study aims to investigate the correlations between changes in sleep pattern, perception of time, and digital media usage. Furthermore, it explores the impact of these changes on the mental health of students of different educational levels.

This cross-sectional study was conducted via a web-based questionnaire, from March 24 to April 26, 2020. The survey was targeted at students and 251 responses were obtained. It was a 5-section long questionnaire. The first section inquired about demographics of participants. Each of the other 4 sections was devoted to changes in sleep pattern, perception of time flow, digital media usage and mental health status of students. Close-ended questions with multiple choice responses, dichotomous, interval and 4-point Likert scales were used in the construction of the survey questionnaire. Chi 2 T-tests multinomial and binary logistic regression were used as primary statistical tests. All data were analysed using Statistical Package for Social Science (SPSS) version 23.0 (IBM Corp., Armonk, NY).

Out of 251 adolescents that participated in our study, the majority (70.2%) were females. The mean age of the participants was 19.40 ± 1.62 years. Two-thirds of the respondents did not have much trouble falling asleep (66.5%). The analysis found no significant association between longer sleep periods and procrastination level ( P  = 0.054). Nearly three-fourths (72.9%) of our participants felt that getting through quarantine would have been more difficult if they did not have any electronic gadgets. Of these, a majority (85.8%) had a general feeling of tiredness and lacked motivation ( P  = 0.023). Additionally, a large number of students (69.7%) had reported that time is seemingly moving faster. A significant relationship between increased usage of electronic items and longer sleep periods was also noted ( P  = 0.005). With respect to the level of education, statistically significant values were noted for alarm use both before and after quarantine began ( P  = 0.021 and P  = 0.004, respectively). Further analysis showed that there was a significant difference in the median difference of time spent on social media before the outbreak (3.0 ± 32.46) and time spent on social media after the outbreak (6.0 ± 3.52) in a single day ( P  = 0.000).

Conclusions

Our research has revealed that due to the lockdown imposed by the government in response to COVID-19, the sleeping patterns of the students was affected the most. Our findings show that the increase in use of social media applications led to a widespread increase in the length of sleep, worsening of sleep habits (people sleeping at much later hours than usual), and a general feeling of tiredness. A general lack of recollection regarding what day of the week it was, as well as a change in the perceived flow of time were also notable. All these findings indicate the decline in mental health of students due to the lockdown. Promoting better sleep routines, minimising the use of digital media, and encouragement of students to take up more hobbies could collectively improve the health and mood of students in self-quarantine.

Résumé

En raison de la pandémie de COVID-19, de nombreux pays ont imposé des verrouillages à leurs citoyens pour tenter de contenir la maladie. Le Pakistan est l’un de ces pays. Un verrouillage mandaté par le gouvernement peut avoir des effets psychologiques atténuants sur les jeunes adultes, dont une grande partie est composée d’étudiants. Cette étude vise à étudier les corrélations entre les changements dans les habitudes de sommeil, la perception du temps et l’utilisation des médias numériques. De plus, il explore l’impact de ces changements sur la santé mentale des élèves de différents niveaux d’éducation.

Méthodes

Cette étude transversale a été menée via un questionnaire en ligne, du 24 mars au 26 avril 2020. L’enquête visait les étudiants et 251 réponses ont été obtenues. C’était un questionnaire de 5 sections. La première section a posé des questions sur la démographie des participants. Chacune des 4 autres sections était consacrée aux changements dans les habitudes de sommeil, à la perception de l’écoulement du temps, à l’utilisation des médias numériques et à l’état de santé mentale des élèves. Des questions fermées avec des réponses à choix multiples, des échelles dichotomiques, d’intervalle et de Likert à 4 points ont été utilisées dans la construction du questionnaire d’enquête. Le chi carré, les tests T multinomiaux et la régression logistique binaire ont été utilisés comme tests statistiques primaires. Toutes les données ont été analysées en utilisant Statistical Package for Social Science (SPSS) version 23.0 (IBM Corp., Armonk, NY).

Résultats

Sur 251 adolescents qui ont participé à notre étude, la majorité (70,2 %) étaient des femmes. L’âge moyen des participants était de 19,40 ± 1,62 ans. Les deux tiers des répondants n’avaient pas beaucoup de mal à s’endormir (66,5 %). L’analyse n’a trouvé aucune association significative entre des périodes de sommeil plus longues et le niveau de procrastination ( p  = 0,054). Près des trois quarts (72,9 %) de nos participants ont estimé que passer la quarantaine aurait été plus difficile s’ils n’avaient pas de gadgets électroniques. Parmi ceux-ci, une majorité (85,8 %) avait une sensation générale de fatigue et manquait de motivation ( p  = 0,023). De plus, un grand nombre d’étudiants (69,7 %) ont déclaré que le temps passe apparemment plus vite. Une relation significative entre une utilisation accrue des articles électroniques et des périodes de sommeil plus longues a également été notée ( p  = 0,005). En ce qui concerne le niveau d’éducation, des valeurs statistiquement significatives ont été notées pour l’utilisation des alarmes avant et après le début de la quarantaine ( p  = 0,021 et p = 0,004, respectivement). Une analyse plus approfondie a montré qu’il y avait une différence significative dans la différence médiane entre le temps passé sur les réseaux sociaux avant l’épidémie (3,0 ± 32,46) et le temps passé sur les réseaux sociaux après l’épidémie (6,0 ± 3,52) en une seule journée ( p  = 0,000).

Notre recherche a révélé qu’en raison du verrouillage imposé par le gouvernement en réponse au COVID-19, les habitudes de sommeil des étudiants étaient les plus affectées. Nos résultats montrent que l’augmentation de l’utilisation des applications de médias sociaux a conduit à une augmentation généralisée de la durée du sommeil, à une aggravation des habitudes de sommeil (personnes qui dorment beaucoup plus tard que d’habitude) et à une sensation générale de fatigue. Un manque général de souvenir du jour de la semaine, ainsi qu’un changement dans l’écoulement perçu du temps, étaient également notables. Tous ces résultats indiquent le déclin de la santé mentale des étudiants en raison du verrouillage. La promotion de meilleures habitudes de sommeil, la minimisation de l’utilisation des médias numériques et l’encouragement des étudiants à adopter plus de passe-temps pourraient collectivement améliorer la santé et l’humeur des étudiants en quarantaine.

1. Introduction

COVID-19, which is caused by SARS-Cov-2, was officially declared a pandemic by the WHO on 11th March 2020 [37] . Countries around the globe had to take several precautionary measures to try and lower the infection rate, and in turn, “flatten the curve”. Pakistan also imposed a complete lockdown on the March 21, 2020 [38] after the first few cases appeared.

To mitigate the effects of a lockdown, schools and universities began to use online video conferencing apps, such as Zoom, for education. The lockdown also led to the shutting down of all public spaces, including but not limited to parks, cinemas, gyms, and restaurants. Unfortunately, complying with the government's directives of self-quarantine led to a negative impact on the mental health of students. Many of them posed an increased risk of mood disorders, irritability and depressive symptoms [11] .

The perceived psychological time flow experienced by humans helps them survive in a changing environment [36] . The lockdown, being the changing stimulus, induced a significantly increased difficulty in keeping track of time, with people experiencing confusion about what day of the week it was. Time dilation during lockdown was also experienced with the increased feeling of boredom [7] .

Other studies had shown that being forced to stay at home all day could lead to a disruption in sleep patterns and daytime stress. This increase in stress would then lead to insomnia [35] . People ended up going to sleep and waking up at later hours, while paradoxically reporting lower sleep quality [7] .

In light of the current lockdown scenario, social media has been used to update people about information on COVID-19. Apart from that, it has increasingly been used as a platform to fulfil people's needs for human interaction during the pandemic. The “psychological need” turned into an addictive behaviour with mental health implications. According to a Chinese study, about 82% of the participants who were frequently exposed to social media reported high odds of anxiety as well as Combined Depression and Anxiety (CDA) during the COVID-19 pandemic [29] . There is little evidence in the available literature for a positive association between social media usage and sleeping for longer durations [22] . Existing studies are contradictory to this finding and report a negative association between social media usage and sleep duration. This is possibly because they had focused on these conditions in a natural setting, without the presence of a pandemic. The unique effects of this outbreak on a change in lifestyle are yet to be explored; a gap in literature that needs to be addressed.

The objective of this study was to explore the changes in sleep pattern, subjective perception of time flow, and change in usage of digital media of students during the outbreak. The relationship of these factors was also assessed with the emotional well-being of students. Furthermore, the changes in behaviours and lifestyles of the students of Sindh were also studied.

2. Material and methods

2.1. study setting and design.

A cross-sectional study was conducted from March 24 to April 26, 2020. This study was employed to examine the mental health status of adolescents in Pakistan by monitoring their track of time, disturbances in sleep pattern, and digital media usage during the pandemic.

2.2. Sample size, exclusion and inclusion criteria

With a population of 47.9 million [39] in Sindh, 29% of the Pakistani population is aged between 15 and 29 [40] . This information was used to calculate a sample size of 317 using Open Epi (Open Source Epidemiologic Statistics for Public Health. A confidence interval of 95% with a 5% margin of error was considered. Young adults aged between 14–24 years, currently studying at secondary school level or higher were included in our survey. Any respondent that did not fall into the stated age range (14–24 years), or who was not currently studying in any education level was excluded from the study.

2.3. Sampling technique and data collection

An online survey was conducted anonymously, using a self-administered approach. None of the applicants were coerced into filling out the survey, and had full authority to leave the study at any time. The participants were made aware of their rights in the disclaimer section before the survey. They agreed to partake in the survey after reading the consent section, which explicitly mentioned subject confidentiality and no credit or monetary compensation for participation. A convenient homogenous sampling technique was adopted. The sampling frame was intentionally constrained and was shared with students who fall into the age group (14–24). This was done because students are more likely to be heavy technology users and are at a greater risk of disturbed sleep [7] . A final sample of 251 participants completed the survey. The responses were manually sifted to ensure validity of the inclusion criteria.

2.4. The questionnaire

Following an extensive literature review, a five-section questionnaire was designed for data collection. The questions were mostly self-made; however, the layout of the questionnaire was inspired by Cellini et al. [7] . The first section asked for basic sociodemographic details (age, gender, and education level). The second sectioned was focused on inquiring about the respondent's personal perception of time. In the third section, their sleep patterns were assessed. A series of close-ended questions were asked in order to obtain details of the duration and quality of sleep, feelings of insomnia, and the change in number of dreams experienced. The fourth section was on digital media usage, which investigated the hours, spent on digital media, status of online classes, and frequency of exposure to COVID-19 related news. The final section on mental health was included so that we could check the impact of changes in time awareness, sleeping pattern, and digital media usage on the mental health status of students in Sindh.

2.5. Statistical analysis

The data was analysed using the Statistical Package of Social Sciences (SPSS) version 23.0 (IBM Corp., Armonk, NY). To interpret the gathered data, categorical variables were expressed using frequencies and percentages and continuous variables were presented using means and standard deviations. A Chi 2 was used to evaluate the sociodemographic factors with the sleeping patterns, time perceptions, and digital media usage. Interlinking associations between the sections with dichotomous variables were also drawn. Questions, which were answered out of a range of options [for example, strongly disagree to strongly agree in the question for social media usage], were measured on a 4-point Likert scale. To find out the significant nominal dependent factors associated with the ordinal independent variables, multinomial and binary logistic regressions were used, depending on the number of nominal outcomes. Lastly, a paired sample T-test was used to investigate the differences in usage of digital media before and during the pandemic. A P -value of less than 0.05 was considered as statistically significant.

3.1. Socio-demographics

Out of 251 adolescents that participated in our study, the majority ( n  = 177/251, 70.2%) were females while the rest were males with a mean age of 19.40 ± 1.62 years. At the time of the study, approximately four-fifths of the students were attending a university (207/251, 82.4%), a little less than two-fifths were receiving higher secondary education ( n  = 40/251, 15.9%), while the minority of participants ( n  = 4/251, 1.6%) were going to school.

3.2. Association of mental health status and changes in sleep pattern

No significant difference in levels of procrastination experienced by the participants who slept at odd timings was revealed ( P  = 0.092) ( Fig. 1 ). Approximately one-third ( n  = 40/251, 29.6%) of the respondents reported having learnt no new skill during the pandemic. Furthermore, more than half of the participants reported sleeping in one single stretch and staying awake for the rest of the day ( n  = 134/251, 53.4%). In addition, a significant relationship between longer sleep durations and a general feeling of tiredness was obtained ( P  = 0.002), although interestingly, the analysis found no significant association between longer sleep periods and procrastination level ( P  = 0.054). The participants who dreamt more than usual were also associated with sleeping for longer periods ( P  = 0.013), having more frequent family conflicts ( P  = 0.015), and were unmotivated/tired ( P  = 0.004). Two-thirds of the respondents did not have much trouble falling asleep ( n  = 167/251, 66.5%). Upon further analysis, the association between experiencing insomnia, with learning a new skill and focusing on hobbies were both found to be statistically significant ( P  = 0.004) and ( P  = 0.001), respectively. Moreover, respondents who spent more time with their family ( n  = 71/84, 84.5%), and who reconnected with a friend ( n  = 53/84, 63.1%) reportedly did not experience insomnia. However, no significant relations were determined ( P  = 0.358) and ( P  = 0.532) respectively.

Association of changes in sleep pattern with mental health of students.

3.3. Association of mental health status and digital media usage

A negative relationship between a student's institute taking online classes and new skills being learnt by the student was observed. For students whose institutes were conducting classes, a larger percentage of participants reported not to learn a new skill (55.8%). Out of those who did not have online classes, a majority (63%) were learning a new skill. This relationship later proved to be insignificant ( P  = 0.065). More than half ( n  = 32/52, 61.5%) of our participants who thought online classes were useful had also been focusing more on their hobbies ( P  = 0.022), and almost all ( n  = 50/52, 96.2%) of these students admitted that they were spending more time with family ( P  = 0.000). Furthermore, nearly three-fourths ( n  = 183/251, 72.9%) of our participants felt that getting through quarantine would have been more difficult if they did not have any electronic gadgets. Of these, a majority ( n  = 157/183, 85.8%) had a general feeling of tiredness and lacked motivation ( P  = 0.023). Two-thirds of our total participants (65.7%), who strongly agreed to an increase in social media usage, also reported tiredness/lack of motivation, and a very significant relationship was obtained ( P  = 0.000). An increase in social media usage also had an impact on family arguments, and the number of arguments was shown to have increased ( P  = 0.038). Surprisingly, there was no significant impact demonstrated by an increase in electronic media usage on the hobbies ( P  = 0.141), and time spent with family ( P  = 0.904). Exposure to nCOVID-19 related news showed no significant relationship with the feeling of tiredness/no motivation ( P  = 0.760).

3.4. Association of mental health status and perception of time flow

Our analysis showed that a larger percentage of females (71.5%), compared to males (65.3%) had perceived that time was moving faster ( P  = 0.083) ( Fig. 2 ). Of the students who had reported that time was seemingly moving more quickly, 85.1% had also reported having felt tired and/or unmotivated ( P  = 0.069). A significant relationship was found between the recollection of what day of the week it was, and being tired/unmotivated ( P  = 0.000). Of the students who reportedly usually knew the day of the week, 73.3% of them usually felt tired. However, of those who did not know the day of the week, a larger percentage (90.4%) usually felt tired/unmotivated. Regarding the participants who felt that time was moving faster, roughly half (48%) said that they focused on their hobbies, while the other 52% did not. For the participants who did not feel that time was moving any faster, 70.5% responded that they had focused on their hobbies ( P  = 0.019). Almost all the participants ( n  = 219/251, 87.3%) had said that they were spending more time with their families, with around half ( n  = 114/251, 45.2%) claiming to have been in more arguments with the people they have been living with. Amongst them, around half ( n  = 106/219, 48.4%) said that they could usually tell what day of the week it was, while the other half could not ( P  = 0.069). Around two-thirds of the respondents ( n  = 156/251, 62.2%) who felt that time was seemingly moving faster had also claimed to continuously come up with new projects to work on, but then kept procrastinating on them ( P  = 0.000).

Association of perception of time flow with mental health of students.

3.5. Association of changes in sleep pattern and digital media usage

Some statistically significant relations that were found in this section were the time of sleep with institute taking online classes ( P  = 0.000), the usefulness of online classes with time of sleep ( P  = 0.004), alarm usage before and after quarantine with usefulness of online classes ( P  = 0.045 and 0.000 respectively), and alarm usage now with length of use of electronic items ( P  = 0.036) ( Fig. 3 ). A significant relationship between increased usage of electronic items and longer sleep periods was also noted ( P  = 0.005), along with increased usage of electronic items and an increased number of dreams experienced ( P  = 0.007).

Association digital media usage with changes in sleep pattern.

3.6. Association of perception of time flow and changes in Sleep pattern

One-third of the students ( n  = 85/251, 33.9%), who had been sleeping for longer periods during quarantine, had also reported to have felt that time had been moving faster. Similarly, around one-fifths of the students ( n  = 55/251, 21.9%) who had reported that their length of sleep varied had also reported feeling that time had been moving faster ( P  = 0.141). Additionally, a large number of students ( n  = 175/251, 69.7%) had reported that time is seemingly moving faster; however, the times during which these students had slept were quite evenly spread out, with the least number of students ( n  = 18/251, 7.17%) sleeping between 2 AM to 4 AM. In the case of those who reported that time was not moving faster ( n  = 44/251, 17.5%), around two-thirds ( n  = 29/44, 65.9%) had usually fallen asleep between 10PM to 2AM ( P  = 0.048). An insignificant relationship was also noted between the times a person slept, with usually knowing what day of the week it was ( P  = 0.009). A small fraction of students ( n  = 28/251, 11.2%) reported to have both suffered from insomnia, and could tell what day of the week it was. In contrast, around three times the number of students ( n  = 88/251, 35.1%) reported that they did not have insomnia and were able to tell the day of the week it was ( P  = 0.004).

3.7. Association of socio-demographics and changes in sleep pattern

When asked about how their lengths of sleep were affected by the quarantine, about half ( n  = 118/251, 47.0%) of the students answered that they have been sleeping for longer periods, while an additional one-third ( n  = 88/251, 35.1%) reported that their sleep lengths vary from the normal ( P  = 0.062). A larger percentage of females had reported having used alarm clocks before quarantine, than males (92.6% versus 82.7%) ( P  = 0.018). With respect to the level of education, statistically significant values were noted for alarm use both before and after quarantine began ( P  = 0.021 and P  = 0.004, respectively). Furthermore, an insignificant relationship between age with time of sleep ( P  = 0.007), and between the level of education with time of sleep was found ( P  = 0.033). Among the males, 11.3% more had reportedly slept in one single stretch as compared to females. However, this was not a significant relationship ( P  = 0.127).

3.8. Association of socio-demographic factors and mental health status

The analysis revealed a strong association of gender with mental health parameters. Female respondents had reportedly felt more unmotivated ( n  = 151/176, 85.8%) ( P  = 0.034), and had procrastinated throughout the day ( n  = 152/176, 86.4%) ( P  = 0.006). A significant positive result was also observed stating that most females ( n  = 113/176, 64.2%) did not engage in any physical activity ( P  = 0.039), but rather spent time learning a new skill ( P  = 0.010). Unexpectedly, the analysis did not confirm any statistical significance between the level of education our respondents were receiving and their mental health status. Lastly, the majority of respondents from the age bracket (17–19) ( n  = 72/176, 40.9%) claimed to learn no new skill during the pandemic ( P  = 0.024).

3.9. Association of perception of time flow and digital media usage

A significant relationship was shown between the usefulness of online classes and a person's recollection of what day of the week it was. People who thought their classes were useful could usually also tell what day of the week it was ( P  = 0.025). Furthermore, participants, who could usually not report what day of the week, were more likely to admit to an increase in usage of electronic items ( P  = 0.046). Further analysis showed that there was a significant difference in the median difference of time spent on social media before the outbreak (3.0 ± 32.46) and time spent on social media after the outbreak (6.0 ± 3.52) in a single day ( P  = 0.000).

4. Discussion

Previous studies have shown a dramatic increase in the prevalence of mental health problems like depression, anxiety, and stress levels due to lockdown [25] . Evidence is also available for changes in the subjective perception of time flow, increased digital media usage, and sleep pattern [7] . This study investigated these changes and associated these factors with students’ emotional well-being and routine activities in students of the age group (14–24).

Our study revealed a significant difference between the digital media usage before and after the COVID-19 outbreak, possibly due to the shift to virtual classes. Our results showed that many students ( n  = 224/251, 89.3%) had to take online classes offered by their institutions. The students may have also been consuming more digital media to alleviate boredom [30] and obtain more COVID-19 related information [4] .

Moreover, most people who thought online classes were not useful had also reported not focusing on any hobbies and skills and had generally felt tired/unmotivated. The plausible explanation for this is that these students possibly struggled to understand and adapt to e-learning, consequently leading to a loss in interest in other activities, which is a sign of mental health issues [14] , [34] . Therefore, certain steps must be taken both by the student and the institutions to boost productivity, while also making the learning environment more accommodating.

Out of the 89.3% of our participants who had online classes during the lockdown, many reported that they were not useful. The inaccessibility to the internet in some areas due to poor infrastructure, a lack of communication between students and teachers, and various technical difficulties faced both by the teachers and students – such as not knowing how to navigate the video conference application – may have been important reasons for why many students did not think online classes were effective [3] .

Of the participants, 55.4% involved in family conflicts also dreamt more than usual, while 65.9% of those who were not involved in any conflicts reported that they were not dreaming more than usual; thus, a direct correlation is shown between these two factors. Studies have found that the emotional intensity experienced in daily events is an important determinant of dream content as it increases the probability of those events being incorporated into a person's dreams [27] . The emotional exhaustion that the participants experienced due to family conflicts is a possible hypothesis for the increased negative dreaming frequency, a topic that should be explored in future studies. Furthermore, participants who reported having dreamt more than usual had also reported sleeping for extended periods. Results from other findings confirm that sleeping for longer periods results in increased REM (Rapid Eye Movement) states [26] . It is also well known that REM sleep has a vital role in processing emotional experiences from waking-life, strongly contributing to long-term storage of emotional memory [26] . This is why dreams experienced during the REM stage are more likely to be recalled [12] . For the participants who had reported to have felt tired and/or unmotivated, and could not tell what day of the week it was, it can be discerned that there is a correlation between negative emotions of the students and their memories, as explained and explored by Schweizer et al. [28] .

Most of our respondents who did not experience insomnia were learning a new skill and focusing on their hobbies during the quarantine. This result ties nicely with previous studies that provide strong evidence between adequate sleep and memory consolidation [6] . Further studies have also proven how a newly learnt skill is transformed from a temporary to a permanent state, also known as post-training consolidation or ‘offline learning’ while one is sleeping [8] .

The results also suggest that the students who managed to keep themselves busy by working on some sort of project had felt that time was seemingly moving faster. Ongoing research has indicated that one's perceptions of time can be affected by factors such as emotions and actions [9] , [33] . Therefore, by keeping themselves busy with their university assignments and hobbies, the students managed to stay focused. They were thus not forced to stay bored and did not have to worry about the time all day.

Our study revealed that students who used social media more had reportedly slept for longer periods. This result contradicted many other old research papers that reported the opposite [13] , [32] . The likely explanation would be that these studies were conducted before the quarantine. While evaluating associations of media usage with sleep duration, SOL (“sleep onset latency”) was the most determining factor in these studies. As mentioned by Touitou et al., waking time was almost constant among adolescents because school started early in the morning. Late-onset of sleep and fixed waking early in the morning resulted in a shortened sleep duration. However, due to lockdown and closed educational institutions, participants in our study were not bound in any such way of waking early in the morning. Therefore, it can be established that participants in our research, using excessive media, possibly found it harder and longer to fall asleep (as previous studies indicate), but later compensated it with a long wake-up time, thus having prolonged sleep duration. Furthermore, due to the lockdown, most of these students had not gone out for many days unless necessary, and so were living under very different conditions than those of the previous studies. These factors may have collectively worked together to produce the seemingly anomalous results.

With the imposition of a strict lockdown due to COVID-19, the problematic phenomenon of ‘bedtime procrastination’ had become quite prevalent. Bedtime procrastination is defined as “failing to go to bed at the intended time, even if no external circumstances prevent a person from doing so” [16] . Many previous findings have found significant associations of bedtime procrastination with insufficient and low quality sleep [16] , [20] . However, contrary to the findings of [16] , [20] , we did not find any significant association. This may have been because most of the respondents had received enough sleep; 47% slept for longer periods during quarantine, 35.1% reported their sleep lengths to be variable, and 17.9% claimed they were not sleeping for longer durations. Furthermore, it is also important to highlight that our sample population is different from those of previous findings, as we were targeting students [age group: 14–24]. This age group has been proven to have better sleep quality than older age groups [31] , which possibly makes up for the effect that bedtime procrastination has on sleep quality. Hence, it is safe to assume that our results, in this case, are justifiable. This finding is well substantiated by Lund et al., who correctly puts forth other predictors of bedtime delay amongst college students (other than low quality and insufficient sleep) such as academic stress or incompetent physical health [18] .

As opposed to men, a larger proportion of women had reported not exercising during the quarantine. This could be linked to the fact that a larger proportion of women had also reported having felt tired and/or unmotivated during quarantine [17] . Those women who did exercise mostly did so indoors, especially compared to men (36% of men exercised outdoors compared to 23.9% of women). The likely explanation could be the procrastination levels, which were found to be significantly higher in women than in men in our study. The lack of awareness regarding how to exercise, and lack of access to in-home exercise equipment are some of the many major issues, which limit women's exercise to indoors [19] .

The large rural population and low literacy rate in Pakistan [23] creates a chaotic online environment, causing inaccurate information to spread quickly. In this study, self-reported lack of motivation, tiredness, and frequency of getting involved with family conflicts – all of which come under DSM-V criteria of mental health problems [14] – were significantly positively related to media usage after controlling all covariates. This was consistent with a similar study from Wuhan [10] . This correlation could be due to the spread of misinformation comprising of rumours, false reports and stories, and “conspiracy theories” which people are being bombarded with online social media every day [2] , [5] . Television programs in Pakistan are not thoroughly fact-checked [5] . Simultaneously, the reported use of hyperbolic/inappropriate words that only enhance fear and anxiety among the population has also increased [5] . All this negativity portrayed on social media is quite communicable [21] , [24] and can be detrimental to people's mental health [15] . To fight the spread of this misinformation, The United Nations development programme (UNDP) team is currently working with national institutions to make valid COVID-19 related information more accessible to the Pakistani population [41] . An excellent way to deal with this current situation is to host television, or social media live sessions and programs comprising of health workers and mental health professionals who can give reliable advice on how to follow the standard operating procedures best and offer words of encouragement to help boost the morale of the people [1] .

About the usage of the alarm, it was consistently observed that alarm usage had decreased, often significantly amongst the students. The most likely explanation is the fact that the students had no reason to wake up early in the morning since all the educational institutes were closed, and whatever online classes they had may have been held later in the day. By this time, the students woke up naturally. It is also possible that many students did not attend their classes, as many had reported in the survey that they thought the classes were not useful to them (53.6% of the total participants).

5. Limitations

One of the potential methodological limitations of this study was the sampling bias that may have overestimated the measured relationships. It is possible that most participants who agreed to participate in this study were the ones who experienced changes in their sleep patterns and mental health. Secondly, it is a cross-sectional study showing a snapshot of the situation in a sub-developed area for a specific time. Longitudinal studies are further needed in other topographical and different economic regions. Self-reported measures were used rather than clinical diagnosis. Hence, effective intervention studies need to be conducted, with proper scientific tools, such as actigraphy to monitor circadian rhythm sleep disorders, in order to formulate concrete solutions. Another limitation was the recall bias. Some participants might not have reported their results accurately. The study was focused on students studying in the city only, and out of those, 82.5% who agreed to participate were from universities, so our research was potentially was limited. We recommend future studies to be more generalised, collect information from a larger sample size to get a better picture.

6. Conclusions

Our study revealed that the general student population of Sindh reported signs of mental health issues due to the lockdown. The significant pattern of mental health problems was largely driven by a changing sleep pattern and an increased use of social networking sites. The majority of our respondents did not experience insomnia and received adequate sleep or slept for longer durations during quarantine. A significant relationship was also found between knowing what day of the week it was, and their feeling of tiredness and lack of motivation. Furthermore, large differences between the rate of digital media usage before and after lockdown were observed. The alarm usage after lockdown had also drastically decreased. In addition, sociodemographic factors were also related to changes in sleep pattern and mental health issues amongst students.

Even after the corona virus disease 2019 (COVID-19) pandemic ends, the psychological effects of lockdown will continue to persist. Hence, it is essential to plan strategies for more vulnerable groups, e.g. young adults. Further studies need to be conducted with special consideration to the stress associated with academic delays, disrupted routine and reduced social interactions. New evidence found in these studies can be used to design effective mental health support program for students.

Ethical approval

The authors declare that the work described has been carried out in accordance with the Declaration of Helsinki of the World Medical Association revised in 2013 for experiments involving humans as well as in accordance with the EU Directive 2010/63/EU for animal experiments. None of the applicants were coerced into filling out the survey, and had full authority to withdraw from the study at any time. The participants were fully made aware of their rights in the disclaimer section before the survey. They agreed to partake in the survey after reading the consent section, which explicitly mentioned subject confidentiality and no credit or monetary compensation for participation. The questionnaires were collected anonymously.

Disclosure of interest

The authors declare that they have no competing interest.

Appendix A Supplementary data associated with this article can be found, in the online version, at https://doi.org/10.1016/j.amp.2021.02.004 .

Online Supplement. Supplementary data

The pandemic deals a blow to Pakistan’s democracy

Subscribe to the center for middle east policy newsletter, madiha afzal madiha afzal fellow - foreign policy , center for middle east policy , strobe talbott center for security, strategy, and technology @madihaafzal.

August 6, 2020

As Pakistan continues to deal with COVID-19 — with more than 280,000 cases to date and over 6,000 dead — in the face of a struggling economy, the pandemic is dealing a blow to its fledgling democracy. While Pakistan has brought new coronavirus cases and deaths under control in the past month, the pandemic’s aftershocks have weakened the country’s current civilian government, further emboldened its military, and brought about a broader crackdown on dissent.

The military steps into the “gap”

I, along with other analysts as well as public health experts, criticized Pakistani Prime Minister Imran Khan’s initial response to the coronavirus for being weak and indecisive . He refused to implement a nationwide lockdown, letting Pakistan’s four provinces implement their own lockdowns. The provincial actions limited the initial spread of the virus. Khan focused instead on a gimmicky coronavirus youth “Tiger Force” that would help the government disseminate its message. His government first caved in to the religious right to keep mosques open during Ramadan and then allowed markets to reopen too quickly toward the end of Ramadan in May, resulting in a spike of cases across the country in June, stretching its hospitals and doctors to the limit. Khan’s messaging during this time was muddled .

The country’s powerful military, reportedly unhappy both with Khan’s response and that it drew criticism, had publicly backed a tougher lockdown at the same time that Khan opposed it in March. It then started taking a more visible role in the coronavirus response. When the virus seemed to be spiraling out of control in June, the National Command and Operation Center (NCOC) — the joint civilian-military body created to coordinate the national COVID response, in which high-ranking military officers play increasingly visible roles, enforced “smart” lockdowns in hundreds of COVID hotspots across the country. The military’s intelligence agencies led in surveillance and contact tracing efforts. (Khan still chairs meetings of the National Coordination Committee, the decisionmaking arm of the NCOC, but the army chief General Qamar Bajwa also attends many of those meetings.)

As the military’s involvement has grown, the pandemic has been brought under control in the country — at least for now, with Pakistan on the other side of its first wave (see graphs below). The communications aspect of the pandemic response is certainly being managed better. Critics contend that the government is under-testing, thus making the picture appear rosier than it is, but case positivity rates in Pakistan — the proportion of positive cases among those who are tested — have also declined, suggesting that the situation really is improving. Though the causes behind the declining cases and deaths aren’t completely clear — even Khan acknowledged he was surprised by the speed of the decline — nor is it clear how long the decline will last, it seems the government’s strategy of “smart” hotspot lockdowns across the country, combined with keeping restaurants and large indoor venues (e.g. marriage halls) closed, has worked. (Khan has argued that this validates his approach against a blanket lockdown.)

Beyond former and current military men being highly visible on the COVID response — the executive director of Pakistan’s National Institute of Health is also a major general — Khan’s cabinet is increasingly populated by former military men. Retired Lieutenant General Asim Bajwa, a former head of the Inter Services Public Relations (the military’s public relations arm) and the current head of the China Pakistan Economic Corridor Authority, was appointed the prime minister’s new special assistant on information and broadcasting in April. There are other ways the military’s growing role in civilian affairs is visible: In June, it was Chief of Army Staff General Qamar Javed Bajwa, not Khan, who took a trip to Kabul and met with President Ashraf Ghani and chief negotiator Abdullah Abdullah on the Afghan peace process. General Qamar Bajwa is also U.S. Secretary of State Mike Pompeo’s main Pakistani interlocutor on the peace process.

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The military’s increasing control seems to be a response to the initial performance by Khan and his government on COVID. As a retired general told the Financial Times: “The government left a big gap in its handling of the coronavirus. The army has tried to fill that gap, there was no choice.” There were also several other factors at play: Khan’s apparent decline in popularity with the public, an exposé of a sugar industry scam, fissures within Khan’s party’s ranks, and the fracturing of his weak coalition in parliament. Pakistan’s military used similar excuses in the past to destabilize democratically-elected governments behind the scenes. The cycle is repeating yet again.

A “minus-one” formula

In June, rumors began to float in Islamabad that Khan’s hold on power was precarious and he might not last much longer as prime minister. He took to the floor of the National Assembly to address the rumors in a long, rambling speech on his government’s performance. Khan even brought up the opposition’s call for a “minus-one” formula: the idea that he should step down to pacify opposition parties while his government finishes out its term. That is essentially how former Prime Minister Nawaz Sharif’s party survived its term in government — without Nawaz. In his speech, Khan insisted that he would finish his term.

Khan’s strident tactics in the past as an opposition politician haven’t helped him now that he’s in power, in terms of dealing with the current opposition. During a sit-in that lasted for weeks in 2014, Khan clamored for Nawaz Sharif’s ouster every night while standing on a shipping container, and some say he is reaping what he sowed. But part of the problem is also the structure of civilian-military relations in Pakistan: Pakistan’s powerful military relies on performance legitimacy for itself, but also for civilian governments, and quickly loses patience with them once their performance falters. The military does not wait for the civilians to be voted out but progressively asserts control, or pushes for their ouster, as it did in the 1990s, destabilizing Pakistan’s entire democratic enterprise. In this playbook, opposition parties often work as pawns for the military, willing to go beyond parliament — such as with “multi-party conferences” or back-room deals — to destabilize the incumbent government. In recent weeks, the current opposition parties, the Pakistan Muslim League-Nawaz (PML-N) and the Pakistan People’s Party (PPP), have fit right into those prescribed roles. The public, too, has become accustomed to this cycle, and begins to lose patience during a government’s term rather than waiting for elections.

When it comes to Pakistan, stories of the military’s growing control may seem to blur into each other. Is anything different this time? Khan was the military’s favored candidate in the 2018 election, and it paved the path to his election. He has gone out of his way to be accommodating to the military, including by extending the current army chief’s tenure. For a time after his election, it seemed that Khan’s closeness with the military might give him the space to implement the domestic policies that he wanted. It seems that period is over. Khan is now clearly constrained by a military whose role has grown progressively through Khan’s term in office and has expanded to the ambit of domestic policy during the pandemic. (Khan’s aides deny this, saying that Khan is still “ calling the shots ,” with the army’s support — a repetition of Khan’s mantra that they are “on the same page.”)

Wither provincial autonomy?

When Khan let the coronavirus response fall to provincial governments this spring, it briefly seemed as if the pandemic might actually help democratic consolidation in Pakistan. Instead, it has opened up a largely unconstructive and inconclusive debate on problems with provincial autonomy and the 18th constitutional amendment that granted it — with those critical of the law pushing back against the initial provincial control of the virus response. Some of the criticisms of the 18th amendment are warranted, but it is no secret that the military doesn’t like the law, which in taking power away from the federal level threatens the military’s power and finances. The provincial autonomy that defined Pakistan’s initial pandemic response is now firmly in the hands of the National Command and Operation Center and the National Coordination Committee.

Illiberalism reigns

The military’s increasing control has also translated to a crackdown on dissent and freedom of the press — a matter on which Khan’s government is studiously quiet. On July 21, a prominent journalist critical of the military and the government, Matiullah Jan, was abducted in Islamabad in broad daylight. He was released that night after an international outcry. In a statement, he said his abduction was the work of forces that are “ against democracy .” And this is not to mention concerns about how intelligence agencies are using militant tracking technologies to trace coronavirus patients and their contacts, and the disturbing potential to use that tracing to crack down further on critical voices.

Pakistan’s provincial governments have also used this time to indulge in illiberal impulses, seemingly taking advantage of a permissive environment to do so. In Punjab, the legislative assembly passed a bill to “protect the foundations of Islam,” by giving the province’s director general of public relations the power to ban any books in the province — published locally or imported — that he or she sees as against the “national interest.” In a similar vein, the head of the Punjab textbook board began banning textbooks chosen by private schools for “anti-Pakistan” or “blasphemous” content — citing objections that the books include Mahatma Gandhi’s quotes or photos of pigs in math equations. Both developments are clearly regressive, a blow to freedoms in Pakistan.

Pakistan’s civilian-military games continue, and democracy loses out

Last week, the state minister for health in Pakistan, a political appointee, resigned , citing political pressure and opposition criticism. Amid the pandemic this summer, Pakistan’s usual civilian-military games continue, with an empowered military and opposition parties all too willing to play the game to help weaken the ruling party. Khan’s political space has now been constricted as much as previous prime ministers, with one difference: He is apparently more willing to cede space to the military for his political preservation. In Pakistan, as in some other countries, the longer-term loser of the pandemic is becoming clear, and it is its democracy.

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Impact of COVID-19 lockdown on quality of life in a literate population in Pakistan

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Erum Shahid, 1 Uzma Taqi 2 and Uzma Fasih 1

Background : Early in the COVID-19 pandemic in Pakistan, complete lockdown was imposed from 24 March 2020: offices, shopping malls, market places, etc. were affected. On 25 March, further restrictions were imposed: hospital outpatient departments were closed and there was a ban on public and private gatherings. The lockdown significantly slowed down economic activities, and halted recreational, educational and religious activities and social gatherings.

Aims : To assess the impact of the COVID-19 lockdown on the quality of life of literate individuals in Pakistan.

Methods : A cross-sectional, descriptive study was conducted from 25 April to 15 May, 2020 among literate Pakistani who understand the English language, aged 10+ years and had internet access. We selected 500 individuals to complete the McGill questionnaire online.

Results : The response rate was 73% (n = 365): 49% males and 51% females. Around one third reported a moderate effect on overall quality of life. Financial life was moderately affected in 45% and both physical life and emotional life in 43% of participants. Spiritual life was excellent in 69%. However, social life was severely affected in 56%. Mild depression was felt by 47% of respondents and 48% felt strongly supported during the COVID-19 lockdown.

Conclusion : The COVID-19 lockdown made little difference to the quality of life of the literate population of Pakistan. A few aspects were moderately affected and social life was badly affected. Spiritual life improved for most individuals.

Keywords: COVID-19, lockdown, pandemic, quality of life, Pakistan

Citation: Shahid E; Taqi U; Fasih U. Impact of COVID-19 lockdown on quality of life in a literate population in Pakistan. East Mediterr Health J. 2022;28(5):329–335. https://doi.org/10.26719/emhj.22.039

Received: 06/09/20; accepted: 24/10/21

Copyright © World Health Organization (WHO) 2022. Open Access. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

Introduction

Wuhan, China, reported its first case of coronavirus disease (COVID-19) in December 2019 (1). By 26th February 2020 the infection had spread outside China (2). Italy was the first country to be affected in Europe and second after China throughout the world in terms of impact (3). Soon the Italian government ordered a nationwide lockdown (4). Spain declared a state of emergency on 14 March and it was followed by similar measures in neighbouring countries (5). Soon, the COVID-19 epidemic spread to 113 countries. Reported registered cases were 118 162 and the mortality rate was 3.63% with 4290 deaths by 11 March 2020 (6). By this date, the World Health Organization had officially acknowledged the COVID-19 outbreak as a pandemic, with a 13-fold increase in the number of cases within just 2 weeks (7).

The Federal Minister of Health in Pakistan confirmed the first 2 cases of coronavirus in Karachi and Islamabad among individuals who had returned from the Islamic Republic of Iran on 26 February 2020 (2,8). Within 15 days, the number of positive COVID-19 cases had reached 20 (9). On 13 March 2020 educational institutes were closed and international flights were suspended (10). Public gatherings in marriage halls, shrines, and festivals were banned from 14 March (11). Complete lockdown was imposed from 24 March (12). Offices, shopping malls, market places, restaurants, parks, and public transport were also shut down (13). On 25 March, further restrictions were imposed closing outpatient departments of hospitals and a ban on intracity and inter-province public transport and public–private gatherings (14). Despite all these precautionary measures, COVID-19 spread swiftly across Pakistan. About 58% of reported cases were due to local transmission (15). Complete lockdown was extended till 9 May 2020 after which lockdown rules were relaxed.

The closing of borders with other countries and within the country affected diverse groups of individuals. It significantly slowed down economic activities and halted recreational, educational and religious activities and social meetings in the country. The closure of social gathering venues (parks, restaurants, masjids, gymnasiums, etc.), the public transport system, and educational institutions had a significant impact on residents, in quarantine and during the lockdown period (16). Children were at home, employees were working from home, and women were burdened with additional household responsibilities. The upper class was missing social get-togethers, leisure activities and traveling, the middle class was worried about paying utility bills and school fees, the lower class was struggling financially day by day to feed their families. It created fear, anxiety and depression among some individuals. People had a fear of getting infected (themselves or their loved ones), fear of death and other mental distress during this outbreak (17). On the other hand, some individuals finally got time to relax, spend time with their families, pursue their hobbies, improve their relationships and religious life (18,19). This is the first study from Pakistan to report on the impact of lockdown on the quality of life due to COVID-19 among literate individuals in Pakistan.

This was a cross-sectional descriptive study conducted from 25 April to 15 May 2020. The study was approved by the ethics committee of Baqai Medical University, number BMU-EC/2020/08(OL). Inclusion criteria were: literate Pakistani individuals, understanding English language, over 10 years old with internet access. Participants who refused to complete the questionnaire and those whose forms were incomplete were excluded from the study. Participants provided informed consent before entering their demographic details. The sample size was 344, calculated with the Raosoft calculator, using a 5% margin of error, 95% confidence level, 20 000 population size and 65% of response distribution (18). The snowball sampling technique was used to recruit participants.

The English language version of the McGill questionnaire was used for data collection to determine the physical, emotional, spiritual, financial and social impact of COVID-19 on quality of life among various individuals during the lockdown. It should be noted that access to the online questionnaire was for the duration of one week only.

The McGill Quality of Life Questionnaire was first published in 1996. It is used to assess 4 essential domains of a population, physical and psychological symptoms, outlook on life and meaningful existence (20). It has 24 items scaled 1–10 with written comments at the end. Participant’s name was not required on the questionnaire to make it confidential and assure the accuracy of responses. In the first section, basic demographic details were included such as age, sex, marital status, occupation and household income.

In the first domain, questions about the quality of life during the lockdown including physical, emotional, social, spiritual and financial life (5 items) were covered. A score of 1 indicated ‘very bad’ or ‘least desirable’ and 10 indicated ‘excellent’ or ‘most desirable’. A higher score would translate to a better quality of life.

The second domain, comprising 8 items, covered physical symptoms such as pain, tiredness, weakness, nausea/vomiting, diarrhoea/constipation, trouble sleeping, shortness of breath, lack of appetite, sweating, immobility, etc. on a 10-point scale, 1 indicating ‘no problem’ and 10 indicating ‘severe problem’. These physical symptoms were graded as mild (score 1–3), moderate (score 4–7) and severe (score 8–10).

Feelings and thoughts were included in the third domain, which had 10 items. The questions covered being depressed, sad, nervous, worthless, loss of control over life and true inner feelings. A score of 1 indicated ‘not at all affected’ and 10 indicated ‘very much affected’. The higher the score in this domain, the more affected the individual. This domain had 3 grades: mildly affected (score 1–3), moderately affected (score 4–7) and severely affected (score 8–10).

In the fourth domain, the participants were asked whether the COVID-19 lockdown had made their quality of life better or worse. The score of 1 on the scale indicated better quality of life and score of 10 indicated a worse impact on quality of life.

The internal consistency reliability of the tool was 0.462–0.852 and test–retest reliability was 0.512–0.861.This tool has been tested for reliability and validity in different populations (20–23)

Data collection and analysis

The questionnaire was set on Google Form and the link was sent to 500 participants online via e-mail and social media applications, including WhatsApp and Facebook. We included literate Pakistani individuals, who understood English language, aged over 10 years, had internet access and enrolled through the snowball sampling technique. Participants who refused to complete the questionnaire and those who submitted incomplete forms were excluded from the study. Participants provided informed consent before entering demographic details. Access to the online questionnaire was for the duration of one week only. Questionnaires returned with complete answers were included for data analysis. Questionnaires with incomplete information were discarded. Data were analysed using Excel. Frequencies were generated for categorical data. Responses were compared among males and females to see the social, spiritual, emotional and financial impact on quality of life.

A total of 500 participants were requested to complete the questionnaire online; 384 responded and among these, 365 forms had complete data. The response rate for participants with complete data was 73%. Data analysis was done on 365 participants, 179 (49%) males and 186 (51%) females. Their ages ranged from 10 to 80 years; the largest group was the 41–50 years age group (24%). Only 4% were aged 61+ years ( Table 1 ). Around one third of the respondents (116) were students, followed by housewives (19%). Almost half the participants (47%) had no income. Other demographic details are given in Table 1 .

Grading of physical, emotional, spiritual, financial and social life was done according to sex ( Table 2 ). Physical and emotional life was moderately affected among most of the males and females, i.e. 158 (43%) of total participants. However, social life was severely affected among 204 (56%) participants of both sexes. Spiritual life was excellent among 251 (69%) participants. Just over a quarter (99) were severely affected financially. A similar proportion (94) felt severely depressed, with 117 reporting that they felt very sad and 133 severely worried during the lockdown. Just under half (176) of the participants felt strongly supported ( Table 2 ).

Physical life was reported as bad by 25 (31.6%) participants aged 10–20 years. It was excellent in 36 (40.4%) of those aged 41–50 years and spiritual life was excellent in 47 (73.4%) of individuals in age group 31–40 years. Severe depression was reported by 20 (31.2%) individuals aged 31–40 years ( Table 3 ).

Overall quality of life was neither better nor worse in 32% (117) of respondents. Quality of life was reported as being better by 11% (40) and worse by 2.5% (9).

The primary outcome of our study was the measure of the effect of the COVID-19 lockdown on the quality of life of literate Pakistani. In this study, for 32% of the participants overall quality of life was neither better nor worse. A similar study conducted in China on the quality of health and mental health of residents of Jinzhou reported a mild stressful impact after the COVID-19 pandemic (18). The study was carried out during the preliminary stages of the disease, in the absence of a lockdown, in Jinzhou city, which is situated away from Wuhan. We started our study on 25 April, after a complete lockdown of the country with nearly 10 000 infected cases. The death toll reported in Pakistan was 192 as of 20 April (24).

The COVID-19 pandemic affected all economic activities and crashed stock markets across the globe. Many businesses were shut down and there was downsizing with widespread employment losses (25). Financial life was moderately affected in 45% and severely affected in 27% of our respondents. Our study did not include labourers working for daily wages or illiterate individuals without internet access. Their outcome may differ from our results. The real-world economy was shaken by the coronavirus, with the suspension of business activities and mandatory stay at home for millions of people. It has been estimated that Pakistan would be left with 25 million unemployed due to the lockdown, pushing millions towards poverty and hunger (26).

The spiritual life of most of the respondents, i.e. 69%, in this study was reported as excellent. Lockdown and the disastrous effect of COVID-19 have certainly caused people all over the world to ponder over their faith. Our study started on 25 April, at the beginning of the holy month of Ramadan. Muslims devote this month enthusiastically to practising their religion. The lockdown probably had a positive impact on the spiritual life of the participants.

Many of the respondents in our study were mildly depressed, sad or worried about the magnitude of the lockdown and the pandemic. Depression was severe in the age group 31–40 years, followed by the 21–30 years group. In contrast a study in Pune, India indicated that the majority of their respondents were not anxious or stressed by the pandemic and lockdown (27).

The social life of participants was the most strongly affected due to the lockdown. In our study, the social life of more than half the respondents i.e. (56%) was badly affected by the lockdown. On the other hand, 48% of individuals felt strongly supported during the lockdown. Only 18.4% felt not much supported. A Chinese study reported an increase in family and social support among participants during the lockdown (18). More than 60% of participants reported increased support from friends and family during the SARS epidemic of 2003 in Hong Kong (19). Reasons cited for the increase in support by families included slowing of the pace of society, thus bringing families together (19). Families in Pakistan are closely knit, mostly living in an extended family system from grandparents to uncles, aunts and cousins living under one roof. Under these circumstances, lockdown provided excellent family time. They were able to spend more time relaxing, exercising and resting during the pandemic (18). Lockdown had a good impact on building family relations (19).

Globally, the COVID-19 infection caused high mortality along with psychological and mental catastrophe (28). Fortunately, the mortality rate Pakistan was not as high as in other countries like Italy at 7.2%, Spain at 7.3%, the Islamic Republic of Iran at 7.6%, and China at 2.3% (29). Currently, the mortality rate in Pakistan is 1.3% (30). Low mortality rates have caused Pakistan and its population to view the coronavirus as the least of their problems (31). This pandemic has transformed the world. Millions have been infected with the virus and the lifestyles of even non-infected individuals have changed. Lifestyles after the pandemic will be entirely different.

Our study has certain limitations. First was the cross-sectional design as causal associations between factors cannot be established in this study design. Second, this study was conducted in the early stage of lockdown. Data collected during later stages of lockdown may provide different results as around 100 000 lost their jobs and many lost their loved ones during the pandemic. We recommend further studies of the late stage of lockdown to assess the long-term impact and to compare the effects on quality of life among the population. Third, the McGill Quality of Life Questionnaire has been tested for reliability and validity in patients suffering from chronic diseases. However, in our study participants were recruited from the community, hence we acknowledge that the validity and reliability for the general population might be different from that for sick patients.

We have identified through this study that social life and mental health were affected most, so avenues for mental health counselling should be considered for the general population during pandemics or public health emergencies. Economically, COVID-19 has created high level uncertainty and job insecurity among the population. Unemployed people are not only in need of financial help but also mental health counselling.

The strength of this study is its being the first one to investigate the social, spiritual, financial and emotional impacts of the COVID-19 lockdown on quality of life among literate Pakistani individuals.

The lockdown due to COVID-19 had little effect on the quality of life of literate Pakistani population although some aspects of life (physical, emotional and financial life) were moderately affected and social life was badly affected. Spiritual life was excellent for most individuals.

Funding : None.

Competing interests : None declared.

Impact du confinement dû à la COVID-19 sur la qualité de vie d'une population alphabétisée au Pakistan

Contexte : Au début de la pandémie de COVID-19 au Pakistan, un confinement total a été imposé à partir du 24 mars 2020 : les bureaux, les centres commerciaux, les marchés, etc. ont été impactés. Le 25 mars, d'autres restrictions ont été mises en place : fermeture des services des consultations externes des hôpitaux et interdiction des rassemblements publics et privés. Le confinement a considérablement ralenti les activités économiques et a interrompu les activités récréatives, éducatives et religieuses ainsi que les rassemblements sociaux.

Objectifs : Mesurer l'impact du confinement dû à la COVID-19 sur la qualité de vie des personnes alphabétisées au Pakistan.

Méthodes : Une étude transversale descriptive a été menée du 25 avril au 15 mai 2020 auprès de personnes pakistanaises alphabétisées, comprenant la langue anglaise, âgées de 10 ans et plus et ayant accès à Internet. Nous avons sélectionné 500 personnes pour remplir le questionnaire McGill en ligne.

Résultats : Le taux de réponse était de 73 % (n = 365) : 49 % d'hommes et 51 % de femmes. Près d'un tiers ont signalé un effet modéré sur la qualité de vie globale. La situation financière était modérément affectée pour

45 % des participants alors que l'activité physique et la dimention émotionnelle l'étaient pour 43 %. La vie spirituelle était excellente pour 69 % des participants. Cependant, la vie sociale a été fortement perturbée dans 56 % des cas. Une légère dépression a été ressentie par 47 % des personnes interrogées et 48 % se sont senties bien accompagnées pendant le confinement dû à la COVID-19.

Conclusion : Le confinement imposé par la COVID-19 n'a eu que peu d'impact sur la qualité de vie de la population pakistanaise alphabétisée. Quelques aspects ont été modérément affectés et la vie sociale a été fortement perturbée. La vie spirituelle s'est améliorée pour la plupart des individus.

تأثير الإغلاق بسبب كوفيد-19 على نوعية حياة السكان المتعلمين في باكستان

إروم شهيد، أوزما تقي، أوزما فاسيه

الخلفية : في وقت مبكر من انتشار جائحة كوفيد-19 في باكستان، فُرِض إغلاق كامل اعتبارًا من 24 مارس/ آذار 2020: حيث تأثرت المصالح، ومراكز التسوق، والأسواق، وغير ذلك. وفي 25 مارس/ آذار، فُرضت قيود أخرى: فأُغلقت أقسام المرضى الخارجيين في المستشفيات، وفُرِض حظر على التجمعات العامة والخاصة. وأدى الإغلاق إلى إبطاءِ وتيرة الأنشطة الاقتصادية إبطاءً ملحوظًا، ووقْفِ الأنشطة الترفيهية والتعليمية والدينية، والتجمعات الاجتماعية.

الأهداف : هدفت هذه الدراسة الى إدراك الأثر الذي خلفه كوفيد-19على نوعية الحياة في صفوف الأفراد المتعلمين في باكستان بعد الإغلاق.

طرق البحث : أُجريت دراسة وصفية مقطعية في الفترة من 25 أبريل/ نيسان إلى 15 مايو/ أيار 2020، شملت أفرادًا باكستانيين متعلمين، ممن يفهمون اللغة الإنجليزية، وتزيد أعمارهم على 10 سنوات، ولديهم القدرة على استخدام الإنترنت. واستُخدم استبيان McGill عبر الإنترنت لتقييم الأثر المترتب على نوعية الحياة.

النتائج : جرى اختيار 500 مشارك، وطُلب منهم استكمال الاستبيان إلكترونيًّا. وبلغ معدل الاستجابة 73% (العدد = 365): 49% للذكور و51% للإناث. وأُبلغ نحو ثلث المشاركين بتأثير معتدل على نوعية الحياة بشكل عام. وكانت الأحوال المالية جيدة لدى 44%، والنشاط البدني جيدًا لدى 43%، والحياة العاطفية جيدة لدى 43% من المشاركين. أيضًا كانت الحياة الروحية ممتازة لدى 69%. ومع ذلك، تأثرت الحياة الاجتماعية بشدة لدى 56%. وشعر 47% من المستجيبين بالاكتئاب الخفيف، بينما شعر 48% منهم بأنهم حظوا بدعم جيد خلال فترة الإغلاق بسبب كوفيد-19.

الاستنتاجات : لم يُحدِث الإغلاق بسبب كوفيد-19 فرقًا يُعْتدُّ به فيما يتعلق بنوعية الحياة في صفوف السكان المتعلمين في باكستان. فقد تأثرت بعض الجوانب تأثرًا معتدلًا بينما تأثرت الحياة الاجتماعية بشدة. وتحسنت الحياة الروحية لمعظم الأفراد.

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COVID-19 persuaded lockdown impact on local environmental restoration in Pakistan

Affiliations.

• 1 Department of Physics, Allama Iqbal Open University, Islamabad, Pakistan.
• 2 Department of Physics, Allama Iqbal Open University, Islamabad, Pakistan. [email protected].
• 3 Oil and Gas Development Corporation Limited, Islamabad, Pakistan.
• 4 Department of Agriculture, Allama Iqbal Open University, Islamabad, Pakistan.
• 5 Department of Materials Science and Engineering, University of Ioannina, 451 10, Ioannina, Greece.
• 6 Department of Environmental Sciences, Allama Iqbal Open University, Islamabad, H-8, Pakistan.
• PMID: 35275286
• PMCID: PMC8914446
• DOI: 10.1007/s10661-022-09916-7

Coronavirus disease 2019 (COVID-19) pandemic adversely affected human beings. The novel coronavirus has claimed millions of lives all over the globe. Most countries around the world, including Pakistan, restricted people's social activities and ordered strict lockdowns throughout the country, to control the fatality of the novel coronavirus. The persuaded lockdown impact on the local environment was estimated. In the present study, we assessed air quality changes in four cities of Pakistan, namely Islamabad, Karachi, Lahore, and Peshawar, based on particulate matter (PM 2.5 ), using "Temtop Airing 1000," which is capable of detecting and quantifying PM 2.5 . The Air Quality Index (AQI) was evaluated in three specific time spans: the COVID-19 pandemic pre- and post-lockdown period (January 1, 2020 to March 20, 2020, and May 16, 2020 to June 30, 2020 respectively), and the COVID-19 pandemic period (March 21 2020 to May 15, 2020). We compared land-monitored AQI levels for the above three periods of time. For validation, air quality was navigated by the Moderate Resolution Imaging Spectrometer (MODIS) satellite during the first semester (January 1 to June 30) of 2019 and 2020. It is seen that the concentration of PM 2.5 was considerably reduced in 2020 (more than 50%), ranging from ~ 0.05 to 0.3 kg⋅m 3 , compared to the same period in 2019. The results revealed that the AQI was considerably reduced during the lockdown period. This finding is a very promising as the inhabitants of the planet Earth can be guaranteed the possibility of a green environment in the future.

Keywords: AQI; Land sensor; MERRA-2; Navigation; PM2.5; Pandemic.

© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.

• Air Pollutants* / analysis
• COVID-19* / epidemiology
• Communicable Disease Control
• Environmental Monitoring / methods
• Environmental Restoration and Remediation*
• Pakistan / epidemiology
• Air Pollutants

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Pakistan’s Lockdown Ended a Month Ago. Now Hospital Signs Read ‘Full.’

Medical workers are falling ill in Pakistan at alarming rates as the country registers at least 100,000 new coronavirus cases since the lockdown was lifted.

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By Zia ur-Rehman ,  Salman Masood and Maria Abi-Habib

KARACHI — Pakistanis stricken by the coronavirus are being turned away from hospitals that have simply closed their gates and put up signs reading “full house.” Doctors and nurses are falling ill at alarming rates, and are also coming under physical assault from desperate and angry families.

When Pakistan ’s government lifted its lockdown on May 9, it warned that the already impoverished country could no longer withstand the shutdown needed to mitigate the pandemic’s spread. But now left unshackled, the virus is meting out devastation in other ways, and panic is rising.

Before reopening, Pakistan had recorded about 25,000 infections. A month later, the country recorded an additional 100,000 cases — almost certainly an undercount — and the pandemic shows no signs of abating. At least 2,356 people have died of Covid-19, according to official figures released Thursday.

Pakistan is now reporting so many new cases that it is among the World Health Organization’s top 10 countries where the virus is on the rise. The W.H.O. wrote a letter criticizing the government’s efforts on June 7 and recommended that lockdown be reimposed, stating that Pakistan did not meet any of the criteria needed to lift it.

Medical professionals now expect the virus to peak in July or August and infect up to 900,000, adding further strain to an already shaky health care system some warn may collapse.

But government officials have ruled out the possibility of a further lockdown and dismissed the recommendations by the W.H.O.

On a recent day in the sprawling port city of Karachi, Ali Hussain and his brother shuttled between public hospitals, looking for help and receiving none. Mr. Hussain’s older brother had a severe cough and fever but had been unable to get a coronavirus test for days.

“We cannot afford the private hospitals, they are charging tens of thousands rupees,” said Mr. Hussain, who earned 20,000 rupees per month, about $121, working at a textile mill before the lockdown.

Like many others, the Hussain family is suffering not only because of the coronavirus itself but also the economic devastation the pandemic has wrought. Mr. Hussain said he and his brother could barely afford to feed themselves since they lost their jobs in March, let alone pay for private care.

“We are completely broke and we do not know what to do,” Mr. Hussain lamented.

The World Bank projects that Pakistan’s economy will contract by 0.2 percent next fiscal year. Up to 18 million of the country’s 74 million jobs could be lost, according to the Pakistan Institute of Development Economics, an independent research firm set up by the government.

More immediately, Pakistan’s struggling health care sector is in deep crisis.

Only a third of Karachi’s 600 beds in intensive care wards are available to treat coronavirus patients in the city’s private and public hospitals, for a population of about 20 million, according to local health officials. According to the W.H.O., only 751 ventilators are dedicated to the pandemic in Pakistan, the world’s fifth most populous country, with some 200 million people.

Health care workers admit privately that they are referring patients like Mr. Hussain’s brother to other hospitals they know are at or over capacity because they fear being attacked by desperate families. Medical workers across Pakistan are being assaulted on a near-daily basis for not being able to admit patients or having to tell families that their loved ones had died.

“Our hospitals are completely exhausted,” said one doctor, who asked for his name to be withheld because he is a government employee.

Late last month, a family attacked the staff of one Karachi hospital with knives and iron rods after doctors declared their relative dead, rampaging through the emergency ward. On May 14, the emergency department of another major government hospital in Karachi was ransacked after health care workers refused to give over the body of their loved one, warning the family could contract the virus by handling the remains without using any precautions.

After several similar episodes, employees say that many hospitals are now handing over the bodies of coronavirus victims to their families anyway, worried more about the violent backlash than the pandemic’s spread.

The anger reflects the grief and panic that is setting in across the country, and also an erosion of trust between the state and its citizens.

Prime Minister Imran Khan and other officials have frequently dismissed the virus as a common flu, then rushed to urge people to stay home before dismissing the severity of the pandemic again. Unfounded rumors have spread on social media that the government is inflating coronavirus numbers to milk the international community for more aid money, secretly leaving patients to die of other causes.

The already low morale among health care workers has plummeted further since the lockdown was lifted. In March, doctors and nurses threatened to walk off the job and some called in sick , refusing to work if the government did not provide them with personal protective equipment. Some had to spend up to half of their salaries to buy their own masks, prices skyrocketing as panicked citizens hoarded supplies.

So far, at least 35 health care workers have died of the pandemic, the Pakistan Medical Association said in a statement Thursday. At least 3,600 health care workers are infected with the virus, according to official figures.

The government “did not listen to what doctors were saying. Now the result of this negligence is obvious,” the Pakistan Medical Association said in its statement.

In Punjab, the country’s most populous province, a doctors’ association claimed earlier this month that 40 percent of the province’s medical staff had tested positive for coronavirus.

“While the pandemic stares us all in the face, the morale of health care providers has hit rock bottom,” said Dr. Salman Haseeb Chaudhry, who represents the Young Doctors Association, at a news conference this month.

At a protest among health care workers on Tuesday, Shafiq Awan, the leader of a paramedic association in Karachi, said the government was not heeding their advice.

“We need protective gear, not salutes and praises. If we start dying or are unable to work, who will treat patients?” Mr. Awan asked.

Under withering criticism, Prime Minister Khan hit back on Thursday, saying that his government had responded adequately to the pandemic.

Mr. Khan was at first reluctant to impose a lockdown, stating in early March that the country’s economy could not weather the fallout. By the end of that month, the country’s powerful military sidelined Mr. Khan to shut down the country.

Both the government and military came under immense pressure from Pakistan’s powerful Islamists to loosen the lockdown during Ramadan, the holy month of fasting that started in April and ended last month. After just a few weeks, the lockdown was lifted.

“We are a low middle-income country, with two-thirds of the population dependent on daily incomes,” Dr. Zafar Mirza, the de facto health minister, said Wednesday.

“We have to make tough policy choices to strike a balance between lives and livelihoods.”

Maria Abi-Habib is a South Asia correspondent, based in Delhi. Before joining The Times in 2017, she was a roving Middle East correspondent for The Wall Street Journal. More about Maria Abi-Habib

Essay on Inflation in Pakistan for Students

by Pakiology | Apr 21, 2024 | Essay | 0 comments

In this essay on inflation in Pakistan, we will look at the causes, effects, and solutions to this issue that has been affecting the country for decades. The term ‘inflation’ refers to a sustained rise in the prices of goods and services in an economy. In Pakistan, inflation has been a major concern since the late 1990s, with the Consumer Price Index (CPI) reaching a peak in 2023. We will explore the various factors that have contributed to inflation in Pakistan, its economic effects, and what can be done to address the issue.

Page Contents

Essay on Inflation Outlines

Causes of inflation in pakistan, effects of inflation, solution to control inflation.

• Introduction

Inflation in Pakistan is caused by several factors, which can be divided into two main categories: domestic and external. The main domestic causes of inflation are an increase in money supply, an increase in government spending, an increase in indirect taxes, and a decrease in economic growth.

The most significant contributor to inflation in Pakistan is an increase in the money supply. When there is too much money chasing after too few goods, prices rise, creating a situation known as demand-pull inflation. An increase in the money supply can be caused by the central bank printing more money or by the government borrowing more money from the public.

In addition, higher government spending can lead to inflation. This occurs when the government prints more money to finance its expenditure or borrows from the public and transfers the cost of this additional spending to businesses and consumers. This leads to higher prices for goods and services. Indirect taxes are another major factor that contributes to inflation in Pakistan. When indirect taxes are increased, prices of goods and services also increase, leading to an overall rise in prices.

Finally, low economic growth can also cause inflation in Pakistan. A weak economy reduces people’s purchasing power, forcing them to buy less, which reduces demand and leads to lower prices. However, when economic growth stalls, businesses are unable to sell their products at the same price as before, leading to a rise in prices.

Overall, inflation in Pakistan is caused by a combination of domestic and external factors. These include an increase in money supply, higher government spending, increases in indirect taxes, and a decrease in economic growth.

The effects of inflation on the economy can be both positive and negative. Inflation erodes the purchasing power of money, meaning that each unit of currency is worth less than it was before. This means that, as the cost of living increases, people can purchase fewer goods and services for the same amount of money. As a result, their standard of living decreases.

Inflation also reduces the real return on investments and savings, which can have a detrimental effect on economic growth. When inflation is high, people prefer to save their money rather than invest in a business or other activities. This reduces the availability of capital and results in slower economic growth.

In addition to decreasing standards of living, inflation can lead to unemployment if companies are not able to increase wages at the same rate as prices rise. This can lead to an increase in poverty, as people struggle to afford necessities. Furthermore, when prices rise faster than wages, it puts pressure on government budgets and can increase public debt.

Inflation can also cause the value of the local currency to depreciate against foreign currencies. This has a direct impact on the cost of imports and makes domestic goods less competitive in international markets. It can also have an indirect impact on exports, as it reduces the competitiveness of local producers in foreign markets.

Inflation is a serious issue in Pakistan, and it needs to be addressed to improve the country’s economic conditions. The following are some of the measures that can be taken to control inflation in Pakistan:

1. Fiscal policy: A strong fiscal policy is necessary for controlling inflation. The government should increase its revenue by implementing taxes on the wealthy and reducing public spending. This will help reduce budget deficits, which will result in lower inflation.

2. Monetary policy: The State Bank of Pakistan should adopt a tighter monetary policy to control inflation. It should raise interest rates so that investors have an incentive to save rather than spend, thus curbing demand-pull inflation.

3. Supply-side measures: There should be an increase in the production of essential commodities and products to meet the demand of consumers. This will help reduce prices and inflation in the long run.

4. Subsidies: The government should provide subsidies to those who are suffering due to the high prices of essential items. This will help them cope with the rising cost of living and ensure that they have access to essential goods and services.

5. Stabilizing exchange rate: A stable exchange rate between foreign currencies and the rupee is necessary for controlling inflation. The State Bank of Pakistan should strive to keep the rupee’s value stable by using currency swaps and other methods.

These measures can go a long way in controlling inflation in Pakistan. By taking these measures, the government can help improve the country’s economic condition and create an environment conducive to investment and growth.

What is inflation in simple words?

Inflation is a sustained increase in the general price level of goods and services in an economy over a period of time.

What are the 4 main causes of inflation?

The 4 main causes of inflation are: Demand-pull inflation: when there is an increase in demand for goods and services that outstrip the economy’s ability to produce them. Cost-push inflation: when the cost of production increases, causing companies to raise prices to maintain their profit margins. Built-in inflation: when businesses expect prices to rise and build that expectation into their prices, causing a self-fulfilling cycle of inflation. Imported inflation: when the cost of imported goods increases, leading to higher prices for consumers.

What are the 5 main causes of inflation?

The 4 main causes of inflation are: 1. Demand-pull inflation 2. Cost-push inflation 3. Built-in inflation 4. Imported inflation 5. Monetary inflation

What is inflation introduction?

Inflation is a phenomenon that has been observed throughout history. It refers to the sustained increase in the general price level of goods and services in an economy over a period of time.

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1000 Words Essay on 14 August in English Medium for Students

1000 Words Essay on 14 August in English Medium for Students – 14th August is a day of great significance for the people of Pakistan as it marks the country’s independence from British rule. On this day in 1947, Pakistan emerged as an independent sovereign state, ending centuries of colonial rule. Independence Day is celebrated throughout Pakistan with great enthusiasm and patriotism, as it commemorates the sacrifices of the freedom fighters and the birth of a new nation. 1000 Words Essay on 14 August in English Medium for Students

Table of Contents

Historical Background:

The struggle for independence in the Indian subcontinent was a long and arduous one, marked by numerous protests, movements, and sacrifices. The demand for a separate Muslim state gained momentum under the leadership of Muhammad Ali Jinnah, who believed that Muslims needed a separate homeland where they could live according to their religious and cultural beliefs.

The Pakistan Resolution:

The demand for a separate Muslim state was first articulated in the Pakistan Resolution, which was passed on 23rd March 1940, during the annual session of the All-India Muslim League in Lahore. The resolution called for the creation of independent states for Muslims in areas where they were in a majority, in order to safeguard their political, cultural, and economic rights.

Partition of British India:

The partition of British India into two separate states, India and Pakistan, was announced on 3rd June 1947, by the British government. According to the plan, the areas with a Muslim majority were to form the new state of Pakistan, while the rest of the territory would become the secular state of India. The partition led to widespread violence and bloodshed as millions of people migrated across the newly drawn borders.

Independence Day Celebrations:

Independence Day is celebrated throughout Pakistan with great fervor and enthusiasm. The day begins with the hoisting of the national flag at the President House, the Prime Minister House, and other government buildings. Special prayers are offered in mosques for the prosperity and well-being of the nation.

Flag Hoisting Ceremony:

The main event of the day is the flag hoisting ceremony, which takes place at the national monument in Islamabad. The ceremony is attended by the President, the Prime Minister, and other dignitaries, as well as members of the public. The national flag is hoisted amidst the singing of the national anthem, followed by a 21-gun salute.

Cultural Events and Parades:

Independence Day is also marked by cultural events, parades, and fireworks displays across the country. People dress up in traditional attire, sing patriotic songs, and participate in various cultural activities to celebrate the occasion. Special programs are also organized on television and radio to mark the day.

Renewal of Commitment:

Independence Day is not just a day of celebration, but also a time to reflect on the ideals and principles upon which Pakistan was founded. It is a time to renew our commitment to the values of democracy, freedom, and equality, and to work towards building a prosperous and progressive nation.

Challenges and Opportunities:

While Pakistan has made significant progress since independence, the country still faces many challenges, including poverty, unemployment, terrorism, and political instability. However, Independence Day serves as a reminder of the resilience and determination of the Pakistani people, and the potential for a brighter future.

Conclusion:

Independence Day is a day of pride and joy for the people of Pakistan, as they celebrate the birth of their nation and the freedom for which so many sacrificed their lives. It is a time to remember the struggles and sacrifices of the past, and to recommit ourselves to building a better future for the coming generations. As we celebrate 75 years of independence, let us renew our pledge to work towards a more prosperous, peaceful, and progressive Pakistan. 1000 Words Essay on 14 August in English Medium for Students

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