Magnitude and factors associated with child abuse in a mega city of developing country Pakistan

Objective: Child abuse is one of the major challenges for health care providers. This study was conducted to determine the burden of child abuse [physical and emotional] and the factors associated with it in an urban city of Pakistan

Methods: This cross-sectional study was conducted in primary care clinics affiliated with a tertiary care hospital in Karachi, Pakistan between March to December 2010. Mothers with children aged between 6 and 12 years were included in the study. Those mothers' suffering from any acute illness like high grade fever, were excluded. A total of 412 mothers were recruited through consecutive sampling and written informed consent was taken. A pre-tested questionnaire was used to seek information about child abuse. Data was analyzed using SPSS version 19 and multivariable logistic regression was used to identify the factors [age, gender of child, family structure, educational status of parents, and mother's perception of her home environment] associated with child abuse

Findings: Of the total 412 mothers, final analysis was conducted on 379 mothers. In all, 32.5% of children had been abused, 25.5% physically and 17.9% emotionally. Abuse was reported more among children whose mothers had minimal or no schooling [P=0.02], who were abused by their husbands [P<0.001], not satisfied with their marital life [P<0.001], and stressful home environment [P=0.02]. In the multivariate analysis, the factors found to be independently associated with child abuse were mothers abused by their husbands [AOR=4.2; 95%CI: 2.2-7.9] and child being a girl [AOR=8.7; 95%CI: 4.5-16.8]

Conclusion: The prevention of child abuse can be achieved through comprehensive, multifaceted and integrated approaches requiring joint efforts by the government, policy makers, stake holders, social workers, educationists, and public health practitioners

Role of self-efficacy in promoting healthy behavior: smoking cessation as an example

Self-efficacy is defined as an individual's perceived capability to perform a behavior for accomplishment of a desirable goal. Enhanced personal self-efficacy is associated with a positive self-concept and self-appraisal of personal control which develops through experiences of mastery and the anticipation of competent performance. This paper aims to analyze the role of self-efficacy in promoting healthy behavior. A case scenario has been discussed to support the concept of self-efficacy in promoting healthy behavior taking smoking cessation as a case

accuracy of ultrasound in the diagnosis of congenital abnormalities

To determine the accuracy of ultrasound in the diagnosis of congenital abnormalities at the Aga Khan University Hospital, Karachi. The data of congenital abnormalities was obtained from the obstetrical database and medical records of all cases complicated by congenital abnormalities, delivering from January 2001 to December 2003 and was reviewed. Antenatal ultrasounds had been performed by operators with different level of experience. In addition this data was retrieved from the termination and Congenital anomaly register. A structured data collection form was used to collect information of different variables of interest. Congenital abnormalities, complicated 2.8%[n=170], of all deliveries, including all cases of termination of pregnancy, stillbirth and live births. Out of the total, 11.6% occurred in women above the age of 35 years. Consanguinity was found in 18.2% cases. Prenatal diagnosis was made in just under half of the cases [48.8%]. Central nervous system and renal abnormalities were commonly diagnosed. However, facial defects, heart defects or skeletal defects were more commonly missed. Antenatal ultrasound successfully diagnosed foetal abnormalities in 48.8% of cases, and more than 90% Central Nervous system defects and renal abnormalities. In contrast about a quarter of Cardiac defects and none of the facial defects were detected. Based on these findings we recommend that the Sonologist should incorporate four chamber view of the heart and also look at the face carefully

Comparison of job satisfaction and stress among male and female doctors in teaching hospitals of Karachi

Background: Job dissatisfaction and stress among doctors affect the quality of health care. We assessed the levels of satisfaction for workplace characteristics and job stress among doctors of three teaching hospitals in Karachi

Methods: A postal-survey was conducted between May to June 2002. Satisfaction for workplace characteristics and stress were inquired and graded by Likert scale [1=very low to 5= very high]. Questions were also asked about its affect on their lives. In order to calculate the differences in means of job satisfaction and stress score by sex of doctors, chi-square and t-test with 95% confidence interval [CI] were used. Out of 270 doctors approached conveniently, 189 [70%] responded and 182 questionnaires were found complete for analysis

Results: Majority [68%] of the doctors was not satisfied with their jobs. Overall, the mean scores for satisfaction were low for workplace characteristics. Lowest scores were found for pay and benefits 2.12 [SE 0.8], safety and security 2.15 [SE 0.8] and workload 2.69 [SE 0.9]. Female doctors had significantly lower satisfaction about workload [mean job satisfaction score difference = 0.60; 95%CI, 0.24-0.97], relation with colleagues [mean job satisfaction score difference = 0.49; 95%CI, 0.11-0.87] and autonomy [mean job satisfaction score difference = 0.45; 95%CI, 0.07-0.82] as compared to their male counterparts. Overall, 48% of doctors graded job stress from high to very high levels

Conclusion: Majority of doctors working at these teaching hospitals of Karachi had poor satisfaction level for workplace characteristics and higher levels of job stress. This suggests that immediate steps should be taken for their control and management. This study invites further research to explore, implement and evaluate intervention strategies for prevention of stress and improvement in job satisfaction

Evidence-based care of type 2 diabetes mellitus: nonpharmacological and pharmacological management

This three-part article provides an overview of the evidence-based care of patients with type 2 diabetes mellitus, in the view of recent literature and research. Type 2 diabetes is the focus of this review, since, it is much more common and accounts for 90-95% of all diabetic cases worldwide. Part-I discussed the epidemiological overview of the disease at the global and national levels; followed by the rationale and criteria for screening and diagnosis of type 2 diabetes including the important components that should be assessed at an initial evaluation of the patient. Part-II provides key information about the non-pharmacological and pharmacological management of type 2 diabetes. Meanwhile, part-III will review the prevention, screening and management of long-term complications among persons with type 2 diabetes

Role of subantihypertensive dose of lisinopril in regression of hypertensive left ventricle hypertrophy

Left ventrical hypertrophy [LVH]: an independent cardiovascular risk factor is present in a significant number of hypertensive patients. The reversal of LHV is a desirable therapeutic goal in the treatment of hypertension because the prognosis of the patients, whose treatment has led to the regression in cardiac hypertrophy is markdly better than that of patients in whom regression in cardiac hypertrophy fails to be achieved. Lisinopril, an ACE inhibitor has been shown to alter the anatomy of heart positively, even used in subantihypertensive dose, suggesting the mortant role of RAS, in the onset and progression of LVH, whereas moduretic almost did not produce any change in the size of the ventricle despite favourable effect on BP