Burden and associated factors for caregivers of the elderly in a developing country

The elderly population in South Asia is growing. In Pakistan trained caregivers are scarce and culturally not acceptable. This study assessed the level of stress experienced by caregivers of the elderly and determined the association of care giving burden with different characteristics of the elderly. A cross-sectional, questionnaire based study was conducted using nonprobability purposive sampling. All consenting participants aged 60 years and above needing help with at least one activity of daily living or two instrumental activities of daily living were included. 350 participants were assessed for perceived care giver burden. Care providers were mostly female [68.9%]. Half [50.3%] of the caregivers had a positive score on a perceived care burden scale. Financial impact had a strong correlation [0.79] with perceived caregiver burden. Higher dependency levels of a physical and cognitive nature posed greater burden on caregivers. Behavioural issues of the elderly such as verbal abuse and difficulty sleeping were predictors of a higher caregiver burden. Caregiver burden is a significant issue for those caring for elderly family members in Karachi, Pakistan

Prevalence and risk factors of mycrobacterium tuberculosis infection among prisoners in Kabul central prison [Puli Charkhi], Afghanistan

Afghanistan has the second highest tuberculosis [TB] burden in the Eastern Mediterranean Region with 76,000 new cases and 20,000 deaths each year. Among the highest risk settings for TB acquisition and transmission are prisons. There is a paucity of data to inform evidence-based design of health policies to control TB in prisons. This study aimed to determine the prevalence and relevant risk factors of TB in Kabul Puli Charkhi Prison. A cross-sectional study was conducted in Kabul Central Prison from January to September 2006. Using a structured questionnaire and tuberculin skin test [PPD], a total of 250 prisoners were selected using a stratified random sampling technique. Those who were sentenced to death, had less than 3 months remaining of their sentence, had a previously confirmed case of TB, or were pregnant, were excluded. The prevalence of TB infection was 55.7% [132/237] among the prison population. Using comparison analysis of two outcome groups [positive and negative PPD], we found that age [odds ratio [OR] = 4.14], income [OR = 7.62], duration of incarceration [OR = 2.62], accommodation area [OR = 3.51], personal hygiene [OR = 15.13], content of food [OR = 5.58] and low-grade fever [OR = 3.25] were positively associated with TB infection. To control TB in this environment, attention should be given to high risk groups such as those in low socio-economic classes, the elderly, and low-weight individuals. Rebuilding of damaged prison facilities and better distribution of prisoners will prevent overcrowding and decrease the likelihood of TB transmission. Improving the quality of food and hygiene would also reduce the level of infection. Based on preliminary findings of this study, the National TB program has strengthened its existing activities in prisons and has made a commitment to establish a comprehensive TB centre

Development of a stress scale for pregnant women in the South Asian context: the A-Z Stress Scale

Stress in pregnancy can lead to low-birth-weight and preterm babies and to psychological consequences such as anxiety and depression during pregnancy and the puerperium. Previous scales to measure stress contain items that overlap with the symptoms of pregnancy. A stress scale was developed based on in-depth interviews with pregnant women in Pakistan. Construct validity, test-retest reliability and inter-rater reliability were carried out. Cronbach alpha was 0.82 for the 30 short-listed items, with item-total correlations of 0.2-0.8. Multidimensional scaling determined 2 dimensions: socioenvironmental hassles and chronic illnesses. This was the first scale developed for pregnant women based on stressors in a developing country in South Asia

Maternal and newborn care: practices and beliefs of traditional birth attendants in Sindh, Pakistan

Maternal mortality, infant mortality and neonatal mortality are high in Pakistan where maternal health services depend upon traditional birth attendants [TBAs]. We examined the practices of TBAs in Dadu district in rural Sindh from September to November 1998 by interviewing and hosting focus group discussions with 17 TBAs. Health care personnel and other important members of the community were also interviewed. TBAs worked in areas demarcated by extended families, ethnicity or geographical access and a system of seniority was observed. Only one TBA was formally trained and antenatal and postnatal care concepts, cleanliness and equipment were inadequate. Communities trusted the TBAs and remunerated them according to factors particular to each birth. TBAs need training and to be linked with the formal health sector to effect change and to decrease maternal and neonatal mortality

Socio-economic and demographic factors associated with injecting drug use among drug users in Karachi, Pakistan

To identify the socio-economic and demographic factors associated with injecting drug users [IDUs] in Karachi. We recruited 242 IDUs [taking drugs through sub-dermal routes] and 231 non-IDUs [taking drugs other than sub-dermal routes] from February through June 1996. IDUs were interviewed regarding socio-demographic factors, economic condition, and social network [marital status, living with spouse]. In addition, information regarding location of drug users within the city [districts of Karachi] and current history of sexually transmitted diseases [STDs] were gathered. Moreover, blood samples were also obtained for HIV testing. Multivariate analysis showed that the income generation via illegal modes [AOR 1.6, 95% CI 1.0-2.6], non-sharing of income with family [AOR 1.7, 95% CI 1.1-2.7] and presence of suicidal thoughts [AOR 2.0, 95% CI 1.1-3.8] were associated with the use of drugs through injections. Further, drug users from districts West, East and Central were more likely to use drug through injection as compared to drug users from district South. The history of genital herpes was also found to be associated with injecting drug use. One IDU was found seropositive for HIV.The high-risk behaviors, such as illegal modes of earning and presence of suicidal thoughts, among IDUs suggest that the group needs rehabilitation programme. Moreover, non-sharing of income suggest that IDUs are isolated from social network, therefore primary prevention activities with focus on improving socio-economic conditions and social networking can reduce drug use through injections. Focused interventions on target districts would be helpful in reducing IDU

Knowledge about hepatitis B and C among patients attending family medicine clinics in Karachi

Knowledge about hepatitis B and C was assessed in a cross-sectional study of 300 adults aged 18 or older attending family medicine clinics at The Aga Khan University Hospital, Karachi. Most knew that hepatitis B and C are viral diseases that primarily affect the liver, but knowledge about risk factors for disease transmission was poor. Approximately 70% knew that hepatitis B is vaccine preventable; 60% had the misconception that hepatitis C is also vaccine preventable. The majority incorrectly believed that people with hepatitis B or C should follow the diet 'parhaiz'. Generally women knew more than men about the diseases. This study suggests that health education about these infections should be provided to the public. Family physicians can play an important role in educating people about the prevention of these diseases

Comparison of clinical and laparoscopic features of infertile women suffering from genital tuberculosis [TB] or pelvic inflammatory disease [PID] or endometriosis

The objective of the study was to analyze the clinical and Laparoscopic features, which may help to differentiate between infertility in females due to Genital Tuberculosis from Pelvic Inflammatory Disease [PID] and Endometriosis. This case control study was carried out in a teaching tertiary care hospital. Medical records were searched from 1st January 1987 to 31st December 2000 and 43 infertile women with biopsy proven genital tract tuberculosis were found. Equal number of infertile females with diagnosed PID and Endometriosis were randomly selected. Comparisons were done between features of Genital Tuberculosis with PID and Endometriosis separately and also genital tuberculosis with combined controls of PID and Endometriosis. Patients with genital tuberculosis commonly had primary infertility. PID and Endometriosis patients had early menarche and increased duration of menstruation. On physical examination, patients with Genital Tuberculosis were found to have short heights. No significant findings were observes in the pelvic examination and menstruation history between the comparison groups. Laparoscopic examination revealed that fallopian tubes were abnormal, tortuous, bilaterally blocked and thickly adherent more commonly in Genital Tuberculosis when compared to other groups. The primary infertility patients with chronic malnutrition and massive adhesive fallopian tubes on laparoscopic examination should be evaluated for genital tuberculosis