Developing health service delivery in a poor and marginalised community in North West Pakistan

Objectives: To improve maternal health and reduce child mortality through developing health service delivery in a poor and marginalised community in North West Pakistan

Methods: This was a multifaceted intervention to extend and strengthen the range and quality of services provided at an existing health centre, in a rural community in Peshawar District, Khyber Pakhtunkhwa Province. The intervention was developed with community involvement and had four main components: service development, staff capacity development, community engagement and the introduction of a micro-credit scheme. The evaluation assessed the efficiency and effectiveness of project implementation, including a survey of maternal and child health indicators

Results: Between 2014 and 2017, a range of new health services were developed at the health centre. Local volunteers were trained to promote health awareness in the community and refer pregnant women to the health centre. The survey indicated health improvements, such as increased vaccination rates for women and children, and a dramatic reduction in unskilled deliveries

Conclusions: Community engagement was essential to achieve much needed maternal and child health improvements in this poor and marginalised community. Sustainability was achieved by training local volunteers as community health workers

Risk factors for multi-drug resistant tuberculosis in patients at tertiary care Hospital, Peshawar

To determine the frequency of common risk factors for multi-drug resistant tuberculosis in patients presented at a tertiary care hospital, Peshawar. Cross-sectional, observational study. Pulmonology Department, Khyber Teaching Hospital, Peshawar, from December 2006 to October 2007. Patients with positive AFB culture and sensitivity results and found resistant to both rifampicin and isoniazid with or with resistance to other first line anti-tuberculosis drugs, were recruited from both Pulmonology Ward and Outpatient Department [OPD]. Informed verbal consent was taken and a questionnaire administered to all participants of the study. Information regarding demographics, education status, occupation, monthly household income, AFB C/S, details of past history of tuberculosis and family history of TB or Multi-Drug Resistant [MDR-TB] was recorded. Data was analyzed on SPSS version 11. A total of 30 patients of MDR-TB were interviewed. Male [n=17] and female [n=13] ratio was 1.3:1. Mean age was 34.2 +/- 15.3 years. Ninety-two percent female and 52.9% male were uneducated. In 56.7%, monthly income was less than 5000 rupees and in 40% between 5000-10,000 rupees. All patients had previous history of Antituberculous Treatment [ATT], in which 20% had undertaken ATT course once, 53.3% twice and 26.7% thrice in the past. In the study group, 13 [43.3%] patients had not completed their first ATT course and 11 of them were receiving ATT from a general practitioner [GP] at that time. Seven [23.3%] patients had family history of TB but no one had documented MDR-TB in the family. Resistance to RH was present in all patients; moreover, 56.7% had resistance to RHEZ+S. The most common factors in the study group were previous history of tuberculosis, repeated courses of ATT, prescribed by different clinicians and unsupervised treatment by a GP during the initial course of ATT

Reliability of diagnosis and asthma knowledge, attitudes and perception [KAP] in rural population of NWFP, Pakistan

Beliefs and attitudes have been proposed as partial explanations for low adherence to medical therapy and the consequent high morbidity from asthma. Out of a database of Rural Health Center in Northern Pakistan, one hundred and seventy three self reported asthmatics were interviewed; 75% of whom were diagnosed by doctors and 25% self diagnosed. The participants' mean age was 39.4'18 years; 59% were females. Thirty seven percent were housewives, 18% farmers, 15% students whereas 40% were unemployed. The mean duration of illness was seventy two months [range 1 to 480 months]. Monthly income of 79% of the participants was less than Rs.5000.00. On assessment, the diagnosis of asthma was confirmed by experts in 143 [83%] cases, mean FEV1 76.6'28.4% predicted; whereas 30 [17%] patients with mean FEV1 48.6'23.1% predicted, were found to be suffering from COPD on the basis of history, examination, spirometry, reversibility testing and response to treatment. The KAP results showed the following perceptions among the asthma patients: Asthma can be cured [50%]; Asthma requires life long medication [54%]; Asthma can not be cured [27%]; My children will also suffer from asthma [26%]; Asthma is fatal disease [53%] and Asthma is contagious disease [50%]. KAP of asthma patients in rural communities regarding asthma is low and majority of the patients have poorly controlled asthma. Self reported asthma should be confirmed by trained health professionals

Knowledge, attitude, perception [KAP] of coal mine workers of Shangla district regarding occupational safety

Coal- miners are at risk of developing several diseases related to their exposure to coal dust and are prone to many accidents. We conducted this study to document Knowledge, Attitude, and Perception [KAP] of 101 randomly selected coalmine workers were assessed. The means of the study sample were; Age 37.56 yrs., BMI of 20.3, duration of work 13 yrs. and work per day of 9.57 hrs. The average family size was 10, 90 were married and 44 were able to read and write. The absence of scientific method of working was evident as 75 participants reported digging and drilling, 14 reported blasting, 9 reported both as methods used for coal extraction. Despite primitive methods used, 751101 were not using any protective gear during work and only 8 out of 101 were aware of coal mine related health hazards. Only 29 participants reported inspection of the one or the other nature during their work period. 19 participants had to avail health related leave of absence for more than 3 month and 76 were currently disabled and retired because of respiratory symptoms. 60 out of 101 were able to recall accidents happening at the coal mines resulting into serious injuries and deaths. Despite being victims of mine, 21 out of 101 were still willing to send their children to work in coalmines. The majority of the miners are unaware of the occupational safety at coalmines and they are underestimating the usefulness of the protective gears and other safety measures

Antituberculous treatment; outcome at outpatient TB clinic in Khyber teaching hospital Peshawar

To determine the clinical profile and treatment outcome of patients with tuberculosis. Descriptive study. Outpatient TB clinic, Khyber Teaching Hospital Peshawar. From 1[st] January 2002 to 31[st] December 2002. Diagnosed case of tuberculosis were registered according to WHO guidelines and treated under the conventional strategy of monthly visits. Patients were assessed for treatment outcome. 134 patients were registered and treated as per WHO guidelines. Out of 134 patients, 72[53.7%] patients were males and 62[46.2%] were females. Ninety-nine [73.6%] patients were in age range of 10 - 40 years. The mean age at the time of diagnosis was 22 years. In category-I, there were 64 patients [47.7%], 4[3%] were in category -II and 66[49.3%] in category -III. Fever and cough were the most common presenting symptom. In this study, pulmonary TB was seen more commonly [n=76] than extra pulmonary TB [n=58]. Out of 76 patients with pulmonary TB, 31 have sputum smear positive. After initial intensive treatment, 30 patients became sputum smear negative. 26 out of 31 were cured and 91 out of 108 had completed the treatment, one patient died, 11 were declared as defaulter, 5 were transferred out. The cure rate is satisfactory but the default rate is worrying

Frequency and trends of cigarette smoking among peshawar University students

To determine the frequency of cigarette smoking among students of Peshawar University and compare it with the previous study conducted in year 2000. A cross sectional study was conducted and data was collected on a self-administered questionnaire from the participants selected from the departments of Peshawar University. The study was conducted among the students of Peshawar,University from Sep 2003 to March 2004. A sample of 550 students was invited to participate in this study. "After signing the consent, information on demographics, smoking habits, media influences and health histories were obtained using the standardized questionnaire. The data after;auditing was analysed using SPSS version 12.1. The results of 436 participants was analysed further and 114 questionnaires were found either blank or incomplete. Current smokers in the study were 119 [27%] and ex smokers were 69 [16%] There were 114 [34%] and 5 [5%] smokers among 336 male and 100 female students, respectively. The mean age of starting smoking was 17 years [range 28 to 6 years] and 87% smoker's students had one or more smokers in their families. The brand of cigarettes favored by 42% of the smokers was Gold Leaf and 90 percent of the smokers claimed they were influenced by the advertisement in the electronic and print media. 85% of the smokers were aware of the health warnings on cigarette packets. Comparing the result of this study 2 "Year 03" to the study 1 "Year 2000", the number of smokers in the University students has significantly increased to 27% from 15%[p <.001] overall; in male to 34% from 20% and females to 5% from 1%, respectively

Prevalence of cigarette smoking among Peshawar university students

The aim of this study was to determine the prevalence of smoking among University students in Peshawar. A simple random sample of 511 students was invited to participate in this study. A structured questionnaire was used to elicit information on demographics, smoking habits, media influences and health histories from the participants of the study. The smokers in the sample population were 77 [15%] among them 99% were male and 1% were female with a mean age of 21 years. Seven% of the smokers started smoking before the age of 10, 26% at ages 11-16 and 57% at ages 17-21 and 10% after age 21. The influencing factor of smokers in the family was evident with 10% of fathers, 14.3% brothers and 13% cousins being cigarette smokers. The brand of cigarette favored by 42% of the smokers was Gold Leaf and 91% of the smokers claimed that they were influenced by cigarette advertisements. The social smokers were 14%, and 25% smoked due to peer pressure and another 25% smoked only in College. Less than 40% of the smokers had a hobby or did regular exercise to keep fit and 26% complained of illnesses related to ear, nose and throat. However it was encouraging to note that 56% of the smokers wanted to quit the habit. The information gathered in this study facilitates the understanding of various influencing factors that revolve around young smokers. It also highlights the need to help young smokers quit the habit, by providing them healthy choices that may include counseling, and nicotine replacement therapy, among many others

Patient satisfaction survey at emergency satellite hospital, Nahaqi in rural Peshawar

A survey was conducted to assess the current status of Emergency Satellite Hospital [ESH] as compared to its function before July 2001. The management of this hospital has been taken over by Abaseen Foundation on the basis of public/private partnership with the health Ministry of the Government of N.W.F.P. A structured questionnaire was developed to elicit information on patient's satisfaction on the quality of health care services, hospital staff interactions, hospital environment and also to determine areas for improvement at ESH, through patient opinion on OPD fee structure, staff appraisals and hospital infrastructure. The survey revealed that almost every department of the hospital has shown improvement, in particular, the improved X-Ray facility and Laboratory facility enhances the diagnosis and treatment procedures at the hospital. The participants suggested that the hospital needs an Eye specialist and a Surgeon to be added to its clinical specialties so that the rural patients need not travel to the city for these services. This rural population dwell below the poverty line and their urgent demand is for free medicines. In this article the authors have attempted to acknowledge the patients experiences, values and preferences and document this information to effectively use it for improving services in the hospital and establish good governance for clinical practice through shared decision making between patients and health care providers