Al-Azhar Assiut Medical Journal

: 2016  |  Volume : 14  |  Issue : 2  |  Page : 45-

Malpractice: a story of a low socioeconomic country

Hamza H Khan1, Muhammad H Farooq Khan1, Ghulam H Khan1, Abid N Khan Adil2,  
1 Graduate, Shifa College of Medicine, Islamabad, Pakistan
2 Internal Medicine, Khyber Teaching Hospital, Peshawar, Pakistan

Correspondence Address:
Hamza H Khan
C/O Dr. Shamim Hassan, Taizai Street Number 2, Pabbi, District Nowshera, KPK

How to cite this article:
Khan HH, Farooq Khan MH, Khan GH, Khan Adil AN. Malpractice: a story of a low socioeconomic country.Al-Azhar Assiut Med J 2016;14:45-45

How to cite this URL:
Khan HH, Farooq Khan MH, Khan GH, Khan Adil AN. Malpractice: a story of a low socioeconomic country. Al-Azhar Assiut Med J [serial online] 2016 [cited 2020 May 25 ];14:45-45
Available from:

Full Text

Since the first day of medical college, there has always been strong emphasis on ethics and malpractice, but when it comes to practice, it seems like very few have actually incorporated those principles in their routine practice. Every day, patients are being maltreated, and in a low socioeconomic country like Pakistan where the literacy rate and the poverty rate is below average, very few patients actually know their rights or can afford to pursue a legal malpractice suit against their physicians. This malpractice culture is not only limited to government sector hospitals but also very common in private sector hospitals.

One such act of malpractice is the carrying out of unnecessary cesarean sections (C-section) by obstetricians without adequate medical indications. It is estimated that 18.5 million C-sections are conducted worldwide, and about one in every three C-sections conducted are without appropriate medical indications [1]. Similarly, an audit published recently, carried out in a rural referral hospital of Tanzania, reported high rates of unnecessary and potentially avoidable C-sections being conducted [2].

Most common indications for performing C-section include obstructed labor, cephalopelvic disproportion, failure to progress, repeat C-section, fetal distress [3].

During our final year of medical college, we conducted a research on neonates in a well-renowned tertiary healthcare center of a major city of Pakistan and it was very surprising to observe that as many as 162 (58.5%) of the 277 neonates, randomly included in the study, were born through C-section. It should be noted that these figures might represent only this particular tertiary healthcare center, but such trend is observed nationwide

It is recommended that a nationwide audit should be conducted on knowledge, attitude, and practices among obstetricians and a widespread awareness campaign should be carried out against malpractice, as unnecessary and potentially preventable C-sections put strains on already limited resources. By limiting the unnecessary use of resources, the resources can be utilized in a more beneficial way for more deserving patients to save their lives [1]. It is also recommended that laws should be passed in government level to take strict actions against obstetricians who perform C-sections for personal gains without necessary medical indications.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


1Aminu M, Utz B, Halim A, van den Broek N. Reasons for performing a caesarean section in public hospitals in rural Bangladesh. BMC Pregnancy Childbirth 2014;14:130.
2Heemelaar S, Nelissen E, Mdoe P, Kidanto H, van Roosmalen J, Stekelenburg J. Criteria-based audit of caesarean section in a referral hospital in rural Tanzania. Trop Med Int Health 2016;21:525–534.
3Mdegela MH, Muganyizi PS, Pembe AB, Simba DO, van Roosmalen J. How rational are indications for emergency caesarean section in a tertiary hospital in Tanzania?. Tanzan J Health Res 2012;14:236–242.