Biosafety intervention and follow up assessment in laboratory workers of Karachi, Pakistan

Regular trainings and capacity building are required for all health care workers to ensure that they follow the laid down standard operating procedures and thus avoid any mishap. Delays in such trainings and improper supervision results in their reverting back to their old habits. Post intervention assessment of laboratory workers of public and private sector hospitals of Karachi on adherence to biosafety practices. Quantitative-qualitative cross-sectional survey done from August-November, 2012 using simple random sampling. Study population comprised of 253 laboratory workers of public and private sector hospital laboratories of Karachi. An initial KAP survey on biosafety practices in the laboratories and their workers followed by training and a post intervention evaluation was done in 2008. Four years later these workers were re-evaluated using an anonymous closed ended questionnaire to assess how many are following the training and the standard guidelines. Data was entered and analyzed using SPSS 13.0. Mean and percentages were calculated for quantitative variables and x[2] - test was applied for significance. A total of 253 participants [168 males and 85 females] returned the filled questionnaire Almost all [98.8%] laboratory workers had correct concept on use of personal protective equipment, 85% were neither practicing mouth pipetting for chemical and biological samples, nor using laboratories for eating and drinking purposes while importance of SOP/BOP and laboratory accident record maintenance was acknowledged by over 95%. Knowledge about discarding the used syringe was present in only 68%. A comparison between public and private sector laboratory workers revealed that 37% public sector workers were still discarding syringes in the dustbin as opposed to 3% from private sector. Educational interventions performed almost 4 years ago were still followed by laboratory workers indicating the importance of at least one training every 2-3 years to sensitize them on biosafety

Pattern of diseases, reason of visiting and waiting time at various stages of tertiary hospital

Objectives: To determine the frequency of diseases in children, reasons of visiting out patients department of tertiary care children, hospital and to evaluate the waiting time of patients at different stages of treatment

Study Design: Descriptive observational study

Place And Duration: National Institute of Child Health, Karachi from October 2007 to July 2008

Methodology: Patients up to 13 years of age attending OPD were recruited in to study using simple random sampling procedure. Sample size was 400

Results: Children were selected from three OPDs of NICH, Karachi. Majority of patient were below 5 years of age [69.7% [n=279]]

Mean age was 3.53years + 3.3 with range 155 months [1-156]. The main diseases in medical OPD were respiratory problem 19.43 % [n=34], followed by renal problems 17.7% [n=31], and GIT problem 13.7% [n=24]. In surgical OPD, trauma and fracture 23.2% [n=36], hernia 17.42 % [n=27], and urology 15.5 % [n=24] were important problems in children. Respiratory distress 31.43% [n=22], sepsis 18.61% [n=13], NNJ+ 17.1% [n=12], and constipation 11.43% [n=8], were theicommon disorders in infants attending well baby clinic. Mean number of visits per patient was 2.5 +1.9 [range 1-20]

Conclusion: Most frequent disorders in medical OPD were respiratory problem, trauma and fracture in surgical OPD, and respiratory distress, sepsis and neonatal jaundice at well baby clinic. Availability of free of cost facilities was the main reason for attending the OPD

Knowledge and educational intervention pertaining to viral hepatitis in adolescent male students of urban and rural Sindh, Pakistan

In Pakistan, collective infection rate of hepatitis B surface antigen [HBsAg] and anti-hepatitis C virus [HCV] is 7.6% where as their prevalence are 2.5% and 5% respectively. Most commonly occurring viral hepatitis is hepatitis C, closely followed by hepatitis B and in males both are common, with hepatitis B seen earlier than hepatitis C. A cross sectional study was conducted on 585 adolescent college boys. Respondents were interviewed after informed consent and ensuring confidentiality. An anonymous questionnaire of close ended questions was completed followed by an educational intervention session. Knowledge regarding types of viral hepatitis was known to 11% urban and 22% rural respondents, while 75% from Karachi and 84% from interior Sindh had awareness that hepatitis B and C are infectious diseases. About 58% urban respondents knew that hepatitis B can develop cirrhosis and lead to liver cancer as compared to 73% rural inhabitants. Knowledge regarding spread of hepatitis B and C by transfusing infected blood or blood products or injury by infected sharp or tattooing/ body piercing was known to 43.5% from Karachi and 40% from interior Sindh. About 45% urban and 19% rural respondents were vaccinated for hepatitis B and reasons for not being vaccinated were non awareness and cost of vaccine. Knowledge regarding all aspects of disease was surprisingly better in the rural than urban population. Low vaccination status makes adolescents vulnerable to hepatitis. It is crucial to generate understanding about the disease in general and vaccination for hepatitis B in particular

Adolescent's perspective on reproductive health: a study from Karachi

To determine the existing knowledge, attitude and behavior about reproductive and sexual health in adolescents of Karachi and seek their opinion about reproductive health education. Study type, settings and duration: A cross sectional study was conducted on adolescents [17-19 years] of both gender studying in colleges of Karachi during 2010. Subjects and Methods: Using stratified sampling procedure, a cross sectional study was carried out. After informed consent and ensuring confidentiality an anonymous quantitative questionnaire was completed to ascertain the knowledge of adolescents on reproductive health. A total of 912 adolescents [470 males and 442 females] of 12 public and private sector colleges of Karachi participated in the study. Acquaintance to reproductive health was present in 75% males and 71% females and most participants confirmed discussing reproductive health issues with friends. About 81% males and 91% females affirmed for a need for enhanced reproductive health education and awareness while over 50% of the respondents were of the opinion that the right age for reproductive health education was 16 to 18 years. Confining sexual activity to one partner and avoiding exposure to blood and needles for the prevention of AIDS was known to 38% males and 44% females but the prevention of sexually transmitted infections using condoms, was known to only 1/3 rd of the respondents. Although 70% of the respondents of both genders knew that pregnancy can be avoided but only 20% knew about contraceptives. Most adolescents' knew about the reproductive cycle but were not well aware of how to avoid exposures to sexually transmitted infections and pregnancies. Policy message: Reproductive health education is insufficient in adolescents should be gender specific and socio culturally sensitive

Rhesus negative blood incompatibility: knowledge of primiparous in a community

Incidence and the complication rate of Rh incompatibility varies in different parts of the world and the low incidence of Rh negativity often leads to the neglect of rhesus incompatibility in many parts of Asia. To assess the knowledge of primiparous and females with first child, regarding Rh incompatibility and its risk to mother and child and create awareness amongst them about the importance of blood grouping during pregnancy. Cross sectional study, done in Korangi town Sector 33-B to 33-F of Union Council -7 of Karachi, consisting of 5000 randomly selected houses. About 350 primiparous and female with first child were selected by using systemic sampling plan. A structured questionnaire was used to assess the knowledge regarding Rh disease and hemolytic disease of newborn, after taking informed written consent. Testing for blood group was done at the site and report cards were issued to all participants. Information about Rh related aliments were also given to all participants to enhance their awareness about Rh disease. A total of 350 females were interviewed and checked for blood group and 8.3% were found to be Rh negative. Only 2% women had knowledge about complications related to negative blood group during and after pregnancy. Majority [94.3%] were not aware that what precautions should be taken if a mother's blood group is Rh negative. Knowledge about blood groups, Rh incompatibility and its complications during pregnancy and after child birth was very low and needs to be addressed through public education. Blood grouping of married pair may be helpful in early diagnosis of Rh -ve blood incompatibility

Blood pressure, body mass index and waist circumference of school going children of Karachi

Exposure to cardiovascular risk factors during childhood may be associated with the development of atherosclerosis later in life. To determine blood pressure, body mass index and waist circumference in school going children of Karachi. A descriptive cross sectional study was conducted in schools of Karachi. Children from randomly selected public and private sector schools, aged between 8-14 years were included. Height, weight, body mass index, waist circumference and blood pressure of each child were recorded. All children with raised blood pressure were re-evaluated and their detailed history and physical examination was carried out. Of the total 500 children, 41[8.2%] were over weight, [23[9.2%] boys and 18 [7.2%] girls] and 33[6.6%] were obese [21 [8.4%] boys and 12[4.8%] girls]. Waist percentile > 90 was found in 65[26%] boys and 89[35.6%] girls and all obese [33] children had waist percentile >/= 90. Over all 21[4.2%] and 28[5.6%] children had raised systolic and diastolic blood pressure [>/= 95[th] percentile] respectively. With increasing status of body mass index, there was an increase in both systolic and diastolic blood pressure. Over weight and obese children had significantly [p<0.001] higher blood pressure values than children with healthy weight. In obese category, 3[9%] children were hypertensive [systolic and diastolic blood pressure >/= 95[th] percentile], 2[6.%, systolic] and 4[12.% diastolic] were pre-hypertensive [>=90<95] while over weight was marked by hypertension in 3[7.3%] and pre-hypertension in 5[12.2%]. Present findings are in accordance with the definition that 5% of children in any given population would be classified as having high blood pressure and an increase in body mass index and waist circumference was found associated with raised blood pressure. The study recommends a need for measuring blood pressure in children during health maintenance visits, to identify children at greatest risk of obesity in adolescent and suggest interventions before chronic overweight is established. Education department should introduce healthy life style behaviour in school curricula to improve the health of our younger generation

Anthropometric assessment of nutritional status and socio-demographic characteristics in children up to 2 years of age

Malnutrition is one of the major causes of morbidity and mortality in children. It is important to realize that normal length and weight being attained at 1 year of age, would predict the nutritional status at 3 years of age. To asses the nutritional status and the associated socio-demographic characteristics in supposedly healthy children of up to 2 years of age and highlight the importance of anthropometric measurements in routine child health care. A cross- sectional study using purposive sampling technique was conducted on children attending well baby clinic of National Institute of Child Health, Karachi during the year 2003-2005. Anthropometric measurements i.e. height and weight, were measured and a standard questionnaire was used to interview the mothers regarding sociodemographic back ground information after a verbal informed consent and ensuring confidentiality. Height for age, weight for age and weight for height of the children were compared with the National Centre of Health Statistics [NCHS] reference population of the United States, and Z-score < -2 SD were considered as stunted, under weight and wasted respectively. Data was analyzed using SPSS software package. We observed stunting in 22%, wasting in 15% and under weight in 31.6% children. Majority of children with low weight were between 19 - 24 months of age. Regarding socio-economic status of the households, 53.8% had family income less than Rs6000 /month and almost 50% had a family size of 6-10 persons. Parents' education to the level of illiteracy [father, 27% and mother, 40%] and incomplete immunization [20%] were other associated factors for stunting, wasting and under weight. About 32% of children up to 2 years of age in the selected population were under weight, followed by stunning [22%]. Anthropometric measurement of children is a useful in routine child care settings as it will facilitate early identification and timely interventions for emerging health problems

Prevalence of nocturnal enuresis in children: a community study

Enuresis is a common distressing problem among children and can lead to important social or psychological disturbances. To determine the prevalence of nocturnal enuresis in a community. The study was carried out in a community of Korangi town, Karachi from 12[th] January-20[th] March, 2009. A total of 300 children aged 4-14 years, suffering from nocturnal enuresis were included in the study. Information was collected on semi-structured proforma, comprising of personal profile, frequency of bedwetting, drinking of water and urinary habit before going to bed, concern shown by parent/care givers and treatment etc. Respondents were interviewed after taking a verbal informed consent and confidentiality was assured. Data was analyzed using SPSS software package. Of 300 children, 183 [61%] were boys and 117[39%] girls. Bedwetting was common in age group to 10 years and 90% of them were primary enuretic. Most of the parents showed concern about this problem but only 23% consulted a doctor/hakim/homeopath and 19% received treatment. Family history of nocturnal enuresis was present in 35% cases. Though parents were apprehensive about enuresis but only few consulted or received treatment from medical professionals while majority sought orthodox management, probably because of ignorance. Health education about nocturnal enuresis is required for its right management

Perception of adolescent females about viral hepatitis in urban and rural Sindh

To assess perception regarding viral hepatitis among adolescent college girls and to evaluate the frequency of vaccination against hepatitis B of urban [Karachi] and rural [District Kambar Shadad Kot] Sindh. A cross sectional study using cluster sampling technique was conducted in five randomly selected intermediate colleges of Karachi and four of district Kambar Shadadkot during January 2008-February 2009. A total number of 500 adolescent college girls of age group 16-19 years were included in the study; 350 from urban and 150 from rural Sindh. A questionnaire was filled comprising of general information regarding viral hepatitis such as; type of hepatitis, mode of transmission, methods of prevention and status of vaccination etc. Respondents were interviewed after a written informed consent and confidentiality was assured. Data was analyzed using SPSS software package. Total respondents were 500; 350 from urban [Karachi] and 150 from rural [district Kambar Shadadkot] Sindh. Knowledge regarding various types of hepatitis was known to only 4% urban and 7% respondents from rural setup, while 54% from Karachi and 30% from interior Sindh had awareness that hepatitis B and C are infectious diseases. Seventy three percent of urban respondents knew that hepatitis B can develop cirrhosis and lead to liver cancer and 51% from rural population had the acquaintance. Immunization against HBV was recognized by 53% respondents of urban population but despite acquaintance only 28% were found vaccinated and the reason cited for non immunization was lack of awareness and cost of vaccine. Only 16% girls were found vaccinated from rural Sindh. Poor knowledge about hepatitis and vaccination against it amongst adolescents is still alarming and strategies need to be developed by the relevant authorities for creating awareness and to vaccinate them

Assessment of nutritional status in children attending attending basic health unit of Shidi Goth

Shidi Goth is a slum area at a distance of 35 km. from Karachi and has a population of 10,000, mostly Sindhi and Balochi speaking inhabitants. The population belongs to low socioeconomic strata with low educational background. Assessment of nutritional status and associated factors in children attending basic health unit of Shidi Goth was a joint program of Bin Qasim and National Institute of Child Health, Karachi for primary health care system and community development. To assess nutritional status of children attending Basic Health Unit [BHU] of Shidi Goth. Cross - sectional study done in Basic Health Unit of, Shidi Goth from January, 2004 -December, 2004 uses simple random method. The sample size 78 at 95% confidence level was calculated using computer package, EPI-Info, version 5.0. Seventy eight children [35 male and 43 female] representing 78 households, suffering from various diseases who attended the Basic Health Unit of Shidi Goth were included in the study. A questionnaire was used to interview the parents of the children after a formal verbal consent, regarding number of family members, their social habits, socioeconomic and educational status, common diseases found in children up to 4 years of age, their vaccination status and information about going to school or otherwise, residing in the same house. Of 78 children 44 [56.4%] were up to 1 year of age. Common diseases in children included acute respiratory infections and gastroenteritis. Majority 67 [88.5%] had complete vaccination and only 9[11.5%] were partially vaccinated. Low weight for age was observed in 61[78%] children while severe stunting was found in 34[43.6%] and 5[6.4%] manifested severe wasting. Regarding socioeconomic status of the households, 45[58%] of the families had income less than Rs5,000/month. Average family size was 10/family. Single room occupancy was seen in 32[41%] households and basic facilities i.e. water, electricity, gas and sanitation were available in 48[61.5%] houses. Educational status of the parents was low as 35[45%] fathers and 58[75%] mothers were illiterate. Cigarette, pan and gutka were commonly consumed by the parents. Malnutrition was a major health problem and low education level of parents, large family size and low family income were the factors, contributing to low nutritional status of the children

Protease inhibitor variants in healthy children and those with hepatitis

A study to assess the serum concentration and phenotypes of alpha-1 antitrypsin was conducted on 119 healthy school children and 28 children suffering from acute viral hepatitis. Serum alpha-1 antitrypsin was measured quantitatively by radial immunodiffusion where as phenotypes were determined by isoelectric focusing and further confirmation was done by immunofixation. Ten percent control and 15 percent of the children suffering from acute viral hepatitis had serum alpha-1 antitrypsin level below the normal range. MM was the most common in two groups. Deficiency variant MZ was found in two healthy controls while another variant FZ, associated with deficiency state in two patients with acute hepatitis. Genetic alpha-1 AT deficiency does exist in children but due to lack of facilities the deficiency in most of the cases remain undiagnosed

Genetic markers and duodenal ulcer

Serum pepsinogen, alpha 1-antitrypsin [alpha 1-AT] and blood groups were studied as genetic markers in 32 patients with endoscopically proven duodenal ulcer and 44 control subjects with no family history of ulcer disease. Serum pepsinogen was determined by the modified method of Edward et al, alpha 1-AT by single radial immunodiffusion [RID] and phenotyping was carried out by isoelectric focusing [IEF]. Duodenal ulcer patients with hyper- pepsinogenemia [28%] and low serum alpha 1-AT [35%] had a dominant blood group O, lower mean age, an early onset of disease, a higher frequency of gastrointestinal [GI] bleeding and ulcer perforation. These parameters were found considerably different in patients with normal serum pepsinogen and alpha 1-AT. Phenotype analysis of alpha 1-AT revealed that four duodenal ulcer patients had partial deficiency of the protease inhibitor and none of the normal exhibited the deficiency pattern. The etiology of the disease appears to be genetic anomaly in 28% of patients while the rest [72%] had ulcers as a result of neuroendocrinological or environmental factors

Serum alpha 1 antitrypsin and pulmonary emphysema

Using isoelectric focusing [IEF] and radial immunodiffusion [RID] techniques, serum samples from 100 normal healthy adults and 21 patients with pulmonary emphysema were analysed to identify various alpha 1 antitrypsin phenotypes and the serum concentrations. Ten percent of the patients had low serum values. The normal or most common genetic form, MM, is the predominant phenotype in both controls and patients

Genetic variants of serum alpha 1 antitrypsin

Complete absence of data on alpha 1 antitrypsin in this country prompted us to determine serum levels using radial immunodiffusion [RID] and phenotypes by isoelectric focusing [IEF] in 100 healthy adults [52 males and 48 females]. Mean serum alpha 1 antitrypsin concentration in healthy subjects was 2.47 +/- 0.08 g/l and the main phenotypes MM [70%], M1 M2 [28%] and FM 3 [2%] are infrequent in our population

Serum pepsinogen in duodenal ulcer

Total serum pepsinogen concentration was determined in 100 patients with endoscopically proven duodenal ulcer and an equal number of age and sex matched controls. Serum pepsinogen levels were within normal limits in 82% cases and raised in 17% cases. Comparison of demographic profile of hyper with normopepsinogenemics showed that patients with raised levels had an early onset of the disease, predominantly belonged to blood group "O" and had a higher frequency of duodenal ulcer perforation than those with normal pepsinogen levels