assessment of the knowledge and attitude towards family planning among educated married men of urban Islamabad, Pakistan

Background: Pakistan is the 6th most populous country of the world and also among one of the first Asian countries to begin family planning program yet the current contraceptive prevalence rates [CPR] stand at 35%. Men are the critically missing client as focus is always on women

Objectives: To assess the knowledge and attitude towards family planning by educated married men of Islamabad

Study design, settings and duration: Cross sectional study was conducted in twelve public and private sector organizations of Islamabad for duration of 12 months in 2014

Subjects and Methods: Total 300 educated married men age 20 to 60 years who had completed at least 12 years of formal education were enrolled after taking the informed written consent. Data was collected using a structured pre-tested questionnaire through an anonymous interview. Grading scale was used for knowledge and attitude evaluation. 10 marks were given to correct answer and agreement with positive statement. Score less than 70% is categorized as poor, 71-80% fair, 81-90% good and above 90% as very good

Results: Mean age of the study participants was 36 +/- 7 years. About 177 [59%] of the study participants were graduate. Nearly all [99%] participants had heard at least one family planning method while 141 [47%] had poor knowledge. Regarding male contraceptive methods, only 33 [11%] of the study participants know about the permanent birth control methods for men with a misconception that vasectomy decreases male's sexual desire in 267 [89%] of participants. Meanwhile only 18 [6%] study participants are aware that condoms are available both for male and female use. About 193 [64%] study participants were currently using at least one family planning method in an order of with drawl [24%], male condom [13%], and injectables [9%] while 10% don't know that their wives were currently using contraceptive methods or not. Only 3% of the males had poor attitude score. Among the positive attitude males, 99 [33%] had fair score. While 186 [62%] had good score while only 06 [2%] had very good score indicating that generally educated males have positive attitude towards family planning. Overall non response rate was very i.e. 32%

Conclusion: The study reveals positive attitude and poor knowledge of family planning methods among almost half of the study participants who are educated and are resident of urban Islamabad. High non response rate reflects that even educated men are very reluctant to talk and share information's on this topic. Increased use of traditional and temporary family planning methods highlights that positive attitude does not always lead to use to contraceptives

Assessment of attitude, an insight from hepatitis patients and their relatives/ attendants of Islamabad, Pakistan

Background: Pakistan is the 2[nd] highest hepatitis C prevalent country while hepatitis B endemnicity is intermediate. Population has poor knowledge and understanding of these diseases therefore they face different types of stigmas. Stigmatization leads to barriers in the access of prevention and care of this disease. This study was conducted to evaluate the feelings and experiences of patients and their attendants [relatives] about hepatitis B and C and identify the gaps to ease access to treatment and care

Study design, settings and duration: Qualitative study conducted in Pakistan Institute of Medical Sciences and Federal Government Services Hospital, Islamabad for 08 months

Patients and Methods: Patients suffering from hepatitis B and C and their relatives who came to the OPDs of PIMS and Polyclinic were selected from the study. After taking consent from these 2 hospitals and consent from participants, the patients and relatives were grouped into 4 groups each comprising of 5-8 participants. Four focus group discussions [FGD's] were conducted for these patients and their attendants separately. Structured FGD guide was developed and special probes were used to stimulate discussion

Results: There were 06 participants in each of patient group and 07 subjects in relative groups. Among patients, majority had negative perceptions about disease and related the disease with fear. They had misconceptions about disease spread. Most of them experienced change in the attitude of family members, relatives and friends especially in sharing clothes, shoes, and utensils. Break up of relationships and discrimination in getting a job due to the disease was also reported resulting in social and financial problems. The attendants also had negative perception about the disease and its mode of transmission. Although they were cautious about the sharing of utensils and during patient care but they had positive feeling for their patient

Conclusion: Due to misconception about disease spread, the attendants/relatives were not sharing items of daily use items like cloths, crockery and bed linen with the patients thus giving them a feeling of dejection. Proper information about disease spread and its prevention along with the counseling of the patients and their attendants/relatives may build a positive relationship between them and thus ease help and care which is required for these patients

Policy message: There is need of public awareness about mode of transmission of hepatitis B and C and its preventive measures

Prevalence of shisha smoking in college, university and madarsa students aged 20-25 years in Pakistan

To estimate the prevalence of shisha smoking, its trends and associated factors in college, university and madarsa students aged 20-25 years in Pakistan. This survey was done on 7582 subjects belonging to 71 institutions from five cities and Federal Capital Islamabad, using a population based sample. Data was collected using cluster sampling from public/private colleges, universities and madarsas. After taking informed consent, about 10% students from each speciality including both genders were collected using a structured self administered questionnaire designed in Urdu and English. Variables included age, gender, socio-economic status, habits, trends, knowledge and perceptions about shisha smoking. The study was approved by Institutional Review Board. Data was analyzed on SPSS version 15 and chi square was used for statistical significance. Out of 71 educational institutions, 43 were public and 28 private including 8 madarsas. There were 2971 students from professional and 4174 from non-professional institutions. Overall prevalence of shisha smoking was 19.7% [n=1410] being more common in males [29.8%] than females [10.4%] Students started smoking shisha at 17-18 years age [57.2%] and almost 75% started this habit in year 2009-2010. The highest prevalence of shisha smoking was seen in Federal Capital Islamabad [28.1%], and lowest in Peshawar [11.2%]. The shisha smoking was more in professional and private educational institutions [p<0.000] with almost 29% students using it in engineering colleges and none using it in madarsas [alma/alia courses]. The trend was highest in students belonging to high socio-economic status [30.7%] and those already smoking cigarettes [74.1%] Pleasure seeking was the commonest reason for smoking shisha [7.1%] and almost 11% students were influenced by their friends. Shisha cafe's were site used by most smokers and majority preferred double apple or mint flavor. Almost a quarter [23.8%] students smoked shisha just for enjoyment and 12.1% thought that it is less harmful than cigarette smoking. Almost 20% students in colleges and universities are smoking shisha. Majority thinking shisha to be harmless or less harmful than cigarette smoking indicating that knowledge about adverse effects of shisha smoking is tremendously low in this educated youth of our country. Shisha should be subjected to the same regulation as cigarettes and other tobacco products and public should be educated about its harmful effects

Seroprevalence of measles antibodies in school going children in Pakistan

To determine the Seroprevalence of measles IgG antibodies in school going children [age 4 to7.5 years] and assess the need for second dose of vaccination. Study type, settings and duration: National study in randomly selected primary school children for a duration of 12 months. Subjects and Methods: A national representative sample of 6000 school going children between 5-7 years of age was taken out. As 500 children were already studied an year before in Islamabad, therefore, 2500 children from Punjab, 2000 from Sindh and 500 each from Khyber Pakhtonkhaw and Balochistan making a total of 6000 children. These children were selected from major cities of Pakistan that included Peshawar, Lahore, Multan, Faisalabad, Karachi, Hyderabad, and Quetta. Consent was taken from the parents and principals of the schools for collection of blood samples. About 5 ml of whole blood was taken from which serum was separated and stored for testing. Measles antibody titres [serum IgG antibodies] were measured by enzyme-linked Immunosorbant assay [ELISA]. Antibodies concentration<200 m IU was considered negative [non-protective]; those having levels between 200-300 m IU were labeled as border line and>300 m IU as positive [protective]. For the purpose of analysis, ages of the children were divided into three groups

Preanalytical errors and their impact on tests in clinical laboratory practice

There are pre-analytical, analytical and post analytical factors that contribute to accurate test results in clinical laboratories. Pre-analytical variables account for 32-75% of laboratory errors, and encompass the time from when the test is ordered by the physician until the sample is ready for analysis. Most mistakes often occur before the samples are analysed. There is a need for stronger coordination between clinicians and personnel working outside the laboratory for improving the test quality

Frequency of microalbuminuria in diabetic patients of Islamabad and Rawalpindi

To assess the frequency of microalbuminuria and correlate it with the risk of renal failure in diabetic patients and correlate microalbuminuria with serum Creatinine, a marker of renal damage. Type of study and Setting: This was a descriptive study done at Public Health Laboratories Division [PHLD] of National Institute of Health from May 2004 to April 2005. Two hundred known diabetic patients [both type I and type II] visiting were included in the study. Data on age, gender, family history, systolic and diastolic blood pressure, height and weight was recorded on a questionnaire. Urine and blood specimen were collected and analyzed for proteinuria, microalbuminuria, blood glucose and Creatinine, using Randox kit methods. Fasting plasma glucose level of 126 mg/dl or above was taken as diagnostic criteria for diabetes mellitus, as per standards of WHO. All patients of both genders irrespective of age who had type I or II diabetes for over 5 years and a negative urine dipstick test were selected for the study. Patients with other causes of proteinuria, recent respiratory and urinary tract infection, high grade fever and with clinical proteinuria were excluded. Out of 200 cases 56 [28%] had microalbuminuria. Thirty three patients [59%] had microalbuminuria of less than 75 mg/L. The mean age of the patients was 46.5 years and mean duration of diabetes was 7.63 years. Both in type-1 and type-II diabetes microalbuminuria positivity rate [microalbumin level 20 to 300mg/L] was almost similar i.e. 29% and 27.8%, respectively. No significant relationship was found between gender and microalbuminuria in both types of diabetics. Serum Creatinine, a marker of renal damage, was also measured in all 200 cases and out of 56 microalbuminuria positive cases, only 20 [36%] had a raised serum Creatinine. Patients with microalbuminuria of less than 75 mg/L are the candidates for therapeutic and dietary interventions as they are at the risk of nephropathy and other complications. For the early diagnosis of renal damage in diabetic patients, microalbuminuria is the better marker than serum Creatinine

Fertility and choice of family planing practices in rural Islamabad

To determine the level of family planning knowledge, practices and the reasons for the use of less effective methods in the rural areas of Islamabad. A cross sectional descriptive study based on demographic survey of house hold members in a convenient sample population. Information on family planning was collected from the child bearing age married couples practicing family planning. Data was collected through a questionnaire in Urdu. Information was collected on household composition, education level of the couple, family planning knowledge and its use. The interviews conducted were on voluntary bases and thirty females declined the interview. The study was done on 138 ever-married couples aged 50 or younger to know their family planning knowledge and practices. There were 309 married women of child bearing age out of whom 239 [78%] had the knowledge of family planning and 185 were practicing family planning methods. In uneducated women the total fertility rate was 5.0, while in women with secondary or higher education the total fertility rate was 4.0 lifetime births per women. The most commonly used contraceptive was the condom 39%, followed the IUD 33%. oral pills 10%, indictable 10% and tubal ligation 8% The preference of using less effective methods of family planning was mainly influenced by the desire of a male baby and pairing of a male child. Sixty two percent of the couples with no male child used condoms while there was not a single case of tubal ligation in this group. About 38% couples with two male children used condoms and 15% also had tubal ligation. Overall, 80% of users obtained the method from the near by family planning units, while 20% got it from the pharmacies, markets, private hospitals or clinics