Economic burden of thalassemia on parents of thalassemic children: a multi-centre study

Objectives To determine the economic burden of thalassemia on parents of thalassemic children

Study design, settings and duration: Descriptive nonprobability, purposive sampling done in PHRC Research Centres of Multan, Lahore, Islamabad, Karachi, Peshawar and Quetta from July 2013 to June 2014

Patients and Methods: After taking informed written consent, parents/guardians of thalassemia major children were interviewed. All information was recorded on the pre-tested questionnaire. Data was entered and analyzed using SPSS version 11

Results: A total of 600 guardians/ parents of the thalassemic children were included in the study. There were 57% boys and 43% girls with a mean age of 9.40 +/- 5.66 years. Among them, 47.8% were from rural and 52.2 % from urban areas. Almost 71% children were transfusion dependent. The family history of cousin/interfamilial marriage was present in 78.2% while parental consanguinity was present in 72.8%. Only 1.7% parents got premarital screening for thalassemia. In private sector 56.8% had to pay nothing while others had to pay from Rs. 500 to Rs. 2000 per visit. Expenditure per month in private thalassemia centres showed that 57% had to bear no cost at all, 12.2% had to spend up to Rs. 1000, while 24.8% Rs. 1001 to 5000 and 6% had to pay more than Rs. 5000. In the government sector cost per visit in 35.5% was up to Rs. 500 while others had to pay between Rs. 501 to more than Rs. 2000. Monthly cost at government sector almost doubled. Total expenditure [private and government sector] per month was Rs. 9626 for each patient

Conclusion: Total cost [both direct and indirect] for the management of thalassemia was quite high and this cost puts significant economic burden on the affected thalassemic families. This disease puts social, financial and psychological impacts on suffering families, so prevention-based strategies like premarital screening, prenatal diagnosis and genetic counseling should be adopted in Pakistan. A national screening project for thalassemia is the need of the day

Transmission of Anti-HCV from mother to infant and its natural course

Background: Anti HCV is transferred from positive mother to her newborn. To prevent this transfer of anti HCV, many health care providers stop the mother from breast feeding and recommend the checking of the newborn for anti HCV. If found positive, they take it as a chronic infection and recommend treatment of the child as soon as possible. Prohibition from breast feeding not only pushes these neonates towards nutritional deficiencies but also make them prone to infections. The testing also stigmatizes the mother and her newborn for life. The literature proves that this antibody transfer is passive and clears in majority of cases without any residual disease. Mother to infant transfer of anti-HCV and its natural course in Pakistani population is not known

Objectives: To determine the frequency of anti-HCV positivity and its natural course in infants born to anti-HCV reactive mothers

Subjects and Methods: Anti-HCV reactive mothers were registered from gynecology department and labor room of Nishtar Hospital Multan from 07-10-2010 to 07-04-2011, using non probability purposive sampling. The ALT of mothers was also checked. The babies born to these mothers were checked for anti- HCV by ELISA and ALT at 0 day [at the time of birth] and then at 6, 12, 18 and 24 months using venous blood samples. Data was entered and analyzed using SPSS-11

Results: Out of 35 anti-HCV reactive mothers; only one had ALT above the upper limit of normal [> 40 IU/L]. A total of 35 babies were born to these mothers, out of whom 34[97.1%] were reactive to anti-HCV at the time of birth and only one was non reactive. At 6 months 2 babies had expired and 3 were lost to follow up, leaving 30 babies. Out of these 30 babies 11 became non-reactive and 19 were still reactive for anti-HCV at 6months. At 12 months, all 19 anti-HCV reactive cases became non reactive, indicating passive transfer of antibodies from the mother to these neonates which they lost by 12 months. ALT of all babies except 3 was raised at 6 months [> 40 IU/L] which became normal during the subsequent visits

Conclusion: Almost all children born to anti-HCV positive mothers were reactive at the time of delivery but they all became non-reactive by the age of 12 months indicating passive transfer of anti HCV from the mother to the neonate

Screening for tuberculosis among household contacts of index patients

Household contacts of sputum positive pulmonary TB cases are at a high risk of getting infected with tuberculosis therefore symptomatic or vulnerable individuals should be screened and treated early. To determine the prevalence of pulmonary tuberculosis in the households contacts of index patients having pulmonary tuberculosis infection using standard diagnostic tests and refer the positive cases to DOTS program for treatment. This national descriptive study was conducted in seven Centers of PMRC throughout Pakistan form November 2010 to March 2012. A total of 580 index adult patients suffering from pulmonary tuberculosis, being treated at DOTs Centers of major tertiary care hospitals of Karachi, Lahore, Multan, Peshawar and Quetta living within 5-8 kilometers of the hospital, who consented to participate in the study were selected from the DOTs centres. Generally one but occasionally two close contacts of these index patients [spouses, parents or siblings] were called to the hospital for screening of TB using chest Xray, smear microscopy and tuberculin skin test. Out of 800 contacts screened, 125 [15.6%] were positive on sputum smear examination while 113 had infiltration on X-rays along with positive tuberculin skin test [Indurations of >10 mm] making a definitive diagnosis of TB. Calcified lesions were seen on X-rays in another 91 cases giving evidence of past infection, however 26 of these were AFB positive indicating either the relapse of disease or active lesion. Low grade fever and weight loss were the most significant findings in contacts that were positive on sputum smear and radiology. Almost 15.6% household contacts of pulmonary tuberculosis patients have pulmonary tuberculosis. Health care providers in general and DOTs staff in particular should be trained to inform all index cases that their close contacts especially those suffering from weight loss and fever should be screened for tuberculosis and treated if required

Anemia in pregnancy; related risk factors in under developed area

To see frequency of anemia and its related risk factors in pregnant women in an under developed area of Southern Punjab. Descriptive study. Ante natal outpatient clinic Tehsil Headquarter Hospital Kabirwala [Khanewal]. October2006 to March 2007. Sampling technique: Non-probability purposive. Two hundred and fifty pregnant ladies attending ante natal outpatient clinic at Tehsil Headquarter Hospital Kabirwala [Khanewal] irrespective of reproductive age, socio economic, educational and residential status were included in this study. After taking consent a pre-designed proforma was filled in. Hemoglobin level was checked. Subjects were categorized according to the hemoglobin levels into mild [10.0-10.9 g /dl], moderate [8.0-9.9 g/dl] and severe [< 8.0 g/dl] anemia. Two hundred and fifty pregnant women were studied. Mean age of the pregnant women was 28.28 +/- 5.20 years. Out of these 250 pregnant women, 138 [55.2%] were anemic and out of these 83 [60.14%] were moderately anemic while 55 [39.86%] had mild anemia and none of these had sever anemia. Among participating pregnant women, 28 [11.2%] were in 1st trimester, 85 [34%] in 2nd trimester and 137 [54.8%] were in the 3rd trimester. Anemia was observed in 10 [35.71%] women in first trimester, 35 [41.18%] in 2nd trimester and 93 [67.88%] in 3rd trimester. One hundred and thirty two women were from rural background, out of these, 83 [62.88%] were anemic. Seventy were uneducated and out of these, 58 [82.88%] were anemic while 180 women were educated and of these 81 [45%] were anemic. Ninety five [38%] were having poor dietary habits and out of these, 78 [82.10%] were anemic. One hundred eight pregnant ladies were not taking any iron supplement, out these 83 [76.85%] were anemic while 142 [56.8%] pregnant ladies were taking iron supplements, out of these 55 [38.73%] were anemic. Twenty one pregnant women were with gravida more than 6 and out of these 19 [90.47%] were anemic, of these 11 [57.89%] had moderate anemia while 8 [42.10%] were mildly anemic. The results of present study showed high frequency of anemia in the targeted population. Anemia was related with poor dietary habits especially poor iron intake. Anemia was more related with multi gravidity

Nosocomial infections and development of antibiotic resistance in hospitals global issue

Nosocomial infections and antibiotics go shoulder to shoulder and where there are infections, there are always antibiotics. Hmergencc of antibiotic resistance in hospitals is global issue. This paper aims to alert the health policy makers, medical staff, microbiologisls and other experts to consider more clearly the serious threat of nosocomial infections. This is for the consideration of Pakistan Ministry of Health to become actively involved in the development of a structured and coherent approach to the problem. The approach should focus on formation and implementation of a set of objectives, responsibilities, structures, surveillance system, and technical guideline of medical personnel pertaining to nosocomial infections. There is an urgent need to consider 'active management' of antibiotic usage