Educational Intervention among Barbers to Improve Their Knowledge regarding HIV/AIDS: A Pilot Study from a South Asian Country.

One of the Millennium Development Goals is to combat HIV, the burden of which continues to increase in developing countries, like Pakistan. The prevalence is high among the high-risk population, and the use of unsterilized surgical instruments, traditional straight razors, and blades adds to the spread of this disease. This study assesses the effect of an educational intervention on the knowledge of 70 barbers practising in a suburban community in Pakistan regarding HIV and its symptoms and transmission. At baseline, only 10% of the barbers reported that they had ever heard about HIV compared to 49% after the intervention. Similarly, 4% and 6% of them had good knowledge at baseline about symptoms and transmission of the disease, increasing to 39% and 43% respectively, after the intervention (p<0.001). The results of this educational intervention warrant consideration of activation of mass campaigns to increase public awareness about bloodborne diseases and to educate personnel who might harm the persons in their communities by unsafe practices.

Preventable Lifestyle Risk Factors for Non-Communicable Diseases in the Pakistan Adolescents Schools Study 1 (PASS-1) / 예방의학회지

OBJECTIVES: The rising burden of preventable risk factors for non-communicable diseases (NCDs) among adolescents is a major public health challenge worldwide. We identified the preventable risk factors for NCDs in adolescents. METHODS: In a school-based study, pre-tested structured questionnaires were completed by 414 adolescents (14 to 17 years) at six schools in three cities in Pakistan. The chi-squared test and adjusted odds ratio (aOR) with 95% confidence interval (CI) were calculated in a multinomial logistic regression analysis. RESULTS: Over 80% of the adolescents had unhealthy diets, and 54% were physically inactive. Most adolescents were exposed to passive smoking, and 14% were also current smokers. More than one-third of participants chewed betel nut, and one-quarter used oral tobacco. More girls were physically inactive (OR, 4.07; 95% CI, 2.69 to 6.17), whereas a greater proportion of boys were current smokers (OR, 2.17; 95% CI, 1.19 to 3.91), exposed to passive smoking (OR, 2.57; 95% CI, 1.72 to 3.83), and using betel nut (OR, 2.03; 95% CI, 1.34 to 3.06). Only 3.1% of the participants were without any preventable lifestyle risk factor for NCDs, and over 80% had > or =2 factors. Co-existence of risk factors was independently associated with fathers being blue-collar workers (aOR, 3.57; 95% CI, 1.07 to 11.92) and parents not treating their child fairly (aOR, 5.05; 95% CI, 1.29 to 19.78). CONCLUSIONS: Most of the adolescents studied had preventable risk factors for NCDs. These results warrant comprehensive and integrated interventions to prevent lifestyle risk factors, and parents are front-line stakeholders.

Screening of hepatitis B and C among people visiting general practice clinics in a rural district of Sindh, Pakistan

Hepatitis B [HB], Hepatitis C [HC] and their risk factors are amongst the major health problems in developing countries including Pakistan. This study aimed to screen for HB and HC among people who visited General Practice clinics and also to identify the differences of screening positive cases by age and sex. This was a retrospective study conducted in Tando Muhammad Khan city, one of the rural districts of Sindh. All together we reviewed 5989 laboratory reports of people for hepatitis B and C on consecutive basis from two laboratories. A pre-designed and structured perform was used to collect the required information. Chi-squared test and univariate analysis was calculated to assess the difference in HB and HC proportion by age groups and sex. One-fourth of reports were positive for at least one entity whereas 8% and 17% of reviewed reports of adults [>18 years and above] were screened positive for HB and HC respectively. Positive screened tests were higher among older age group compared to young age group [HB: older age group=56.6% vs. younger age group=43.4%; OR=1.07] and [HC: older age group=58.3% vs. younger age group=41.7%; OR=1.08]. In the same way, positive screened tests were higher among men compared to women [HB: men=67.0% vs. women=33.0%; OR=1.2] and [HC: men=62.0% vs. women=38.0%; OR=1.3]. A large proportion of people were screened positive for HB and HC in this study. Prevention and screening are suggested at larger scale for urgent planning and implementation of intervention strategies in this regard. Further research is also recommended to explore this important health issue at large scale

Treatment and vaccination for hepatitis C: present and future

Hepatitis C is caused by Hepatitis C Virus [HCV], detriments the quality of life of 170 million people around the globe. Although, much has been known about the biology of the virus in recent years, a complete cure of hepatitis C remains difficult in a large majority of patients. The current treatment regimen comprising pegylated interferon alpha and ribavirin has sub-optimal effectiveness especially in patients infected with HCV genotype 1. The development of an effective vaccine against the virus as well as a potent anti-viral therapy remains urgently needed. Herein, we give a brief overview of the molecular biology of hepatitis C and the postulated mechanisms of hepatitis C pathogenesis. The issues surrounding the current treatment of hepatic C, the promising new therapies on the horizon and the experimental strategies to develop a vaccine have also been discussed in a greater detail

audit of the quality of care indicators for the management of diabetes in family practice clinics in Karachi, Pakistan

Management of diabetes is a painstaking and careful approach. This study was aimed to evaluate the quality of care for the management of diabetes provided by family practitioners to their patients having diabetes. This is a retrospective audit of medical records conducted in a tertiary care teaching hospital of private sector in Karachi for one month. For this study, 150 medical records of patients with type 2 diabetes that visited family practice clinics for their diabetes care were examined. A total of 88 patient's medical records were selected and analyzed who attended the studied clinics for at least one year and had minimum of four out-patient visits. Majority [68%] of the audited medical records were of females. Of the total medical records analyzed, only one-quarter of the cases qualified the criteria of 'excellent' or 'good' diabetes care. Monitoring of body weight of the patient was only one indicator which was according the recommendations in 100% case at every visit. The other nearest quality of care indicator documented was blood glucose advice at every visit in 79.5% [95% CI: 71.1-87.9] of cases. Physical activity advised/reinforced at every visit was least observed [27.3%; 95% CI: 18.0-36.6]. In addition, blood sugar control was reported in less than a quarter [23.9%] with 95% CI of 15.0-32.8. This work has identified a big gap in the management of type 2 diabetes provided by family practitioners. In addition, majority of the patients found to have poor glycemic control. Interventions are suggested to improve the quality of diabetes care. More such audits and research are recommended at the larger scale

Cost effectiveness of screening of all newly recruited employees for diabetes at a tertiary care hospital

Diabetes Mellitus is a disease which remains asymptomatic for long duration of time and usually diagnosed either when gets complicated or by routine or opportunistic screening. The practice of universal screening is not recommended, particularly in constraint resources. However, we embarked with a study to assess the yield of recommended screening for Type 2 diabetes in all the newly recruited employees at a tertiary care hospital in Karachi. All the information required for this study was collected from medical records of all newly recruited employees of nursing services department of a tertiary care hospital of Karachi, Pakistan, over a period of 5 months [August 2004 to December 2004]. Out of 360 subjects, 326, whose information was found to be complete, were included for final analysis. Mean age of the study subjects was 25.3 +/- 4.7 years and their mean casual plasma glucose level was 99.1 +/- 16.3 mg/dl. 315 [96.6%] study subjects had casual plasma glucose level of 139 mg/dl or less. Only 10 [3.1%] study subjects had casual plasma glucose levels between 140 to 199 mg/dl. Just one employee, 41 years old, was found to have casual plasma glucose level of 213 mg/dl. In this study, screening of all individuals for diabetes had a very low yield. Recommendation of universal screening for diabetes does not represent a good use of resources and perhaps not cost-effective. However, periodic screening of high risk individuals should be warranted

Sleep Deprivation and its associated factors among general ward patients at a Tertiary Care Hospital in Pakistan

To estimate the occurrence rate of sleep deprivation and to identify the environmental, staff-related and patient-related factors associated with SD among general ward patients of a tertiary care hospital in Pakistan. In a cross-sectional study, a pre-tested questionnaire was administered to 108 patients admitted into the general medical and general surgical wards of Aga Khan University Hospital, Karachi. In all, 50 [46.3%] respondents felt deprived of adequate sleep in the hospital. Worry about illness disturbed the night-time sleep of 47 [43.5%] patients; most of these had SD [70%] [p<0.001]. Other patients' noise disturbed 31.5% of study subjects and a significant majority [68%] of these had SD [p=0.003]. Over 17% of study subjects reported cell phone's ringing as a disturbing factor; more by those with SD [68%] compared to those with no SD [32%]; again the difference was significant [p=0.003]. Physical discomfort and presence of cannula were reported as disturbing factors by 41.7% and 28.7% of the study subjects respectively but these were not significantly associated with SD. Our study revealed that sleep deprivation occurs commonly among general ward patients in tertiary care setting. Factors found to be associated with SD were amenable to modification to a greater extent

Preventing osteoporosis epidemic by exercise interventions

Osteoporosis is a chronic metabolic disease of bones, affecting millions of people worldwide with alarming future projections. It is a very costly disease due to its chronic nature and un-wanted consequences. The best way to tackle this condition is prevention. The objectives of this review are to appreciate the importance of regular physical activity and exercise for the prevention of osteoporosis and to make recommendations about exercise intervention. Regular physical activity and exercise is well-proved as a cost-effective intervention for the prevention and treatment of osteoporosis. Exercise not only improves bone health, it also increases muscle strength, coordination, balance, flexibility and leads to better overall health. Thus, encouraging regular physical activity at all ages should be recommended to prevent osteoporosis. In particular, promoting exercise at a younger age should be a top priority when bones are in growing and maturity phase; hence to prevent the future emergence of osteoporosis. Family Physicians and Community Health Nurses can play a vital role in this regard

Knowledge about tuberculosis among patients attending family practice clinics in Karachi

Tuberculosis is on the rise throughout the world and better understanding and knowledge about tuberculosis remains an important tool in its control. The objective of this study was to determine the level of knowledge about tuberculosis among patients attending Family Practice clinics in Karachi. Family practice clinics affiliated to a tertiary care hospital in Karachi, Pakistan during July to September 2003. Total 204 subjects aged 18 years and above were interviewed on convenient basis in a cross-sectional survey. Data was collected through a pre-tested structured questionnaire which comprised of socio-demographic variables and questions about cause, transmission, common clinical features and cure of tuberculosis. Respondents were predominantly female [58%] with an extended family structure [78%]. More than one-third [35%] of the respondents were illiterate and almost a similar proportion [31%] had received primary education. Only 39% of study subjects knew that tuberculosis is an infectious disease, 19% reported that there is an asymptomatic stage of infection, 33% said that it is curable with proper treatment while 51% considered tuberculosis as a preventable disease. Forty-five percent of respondents did not know about possible consequences of uncured cases and 61% did not know tuberculosis as one of the major health problems of Pakistan. In this study, majority of study subjects had poor knowledge about tuberculosis, its prevention and magnitude. Proper knowledge and education about tuberculosis is vital to cope the challenge of this devastating disease. Family Practitioner, being first care providers to the community can play a critical role to raise knowledge about tuberculosis prevention

Diabetes and hypertension: public awareness and lifestyle-findings of a health mela

To determine the frequencies of diabetes, hypertension and their established lifestyle risk factors and to assess the level of awareness about diabetes and hypertension amongst persons attending a health mela at the Aga Khan University Hospital [AKUH], Karachi. Design: Cross-sectional, analytical study. Place and Duration of Study: One-day health mela held at AKUH, Karachi. Subjects and A total of 264 participants were administered structured questionnaire to obtain demographic data and perceptions about diabetes and hypertension after taking verbal informed consent. Height, weight, blood pressure and random blood glucose were measured. Overall frequency of type 2 diabetes was 13.6%, impaired glucose tolerance [IGT] 8.3% and hypertension 24%. Frequency of diabetes and hypertension in both men and women increased with increasing age [p<0.001] and body mass index [p=0.02]. Over half the men and women with type 2 diabetes [53% and 57% respectively] and 42% men and 60% women with IGT also had hypertension. Diabetes and hypertension were correctly defined by 52% and 37% subjects respectively and this was significantly associated with educational level [p=.001]. Lack of physical exercise was observed in 59% participants, while 53.6% men and 67.5% women were overweight/obese. As compared to women, men used more additional salt [p=0.03] and had more outside meals [p<0.001] and snacks [p=0.01]. High frequencies of diabetes, hypertension, obesity, unhealthy nutrition and lack of exercise were observed in the study population. Emphasis on health education is needed to increase public awareness of the warning signs and risk factors of these common conditions