Establishing a cohort in a developing country: Experiences of the diabetes-tuberculosis treatment outcome cohort study

Background: Prospective cohort studies are instrumental in generating valid scientific evidence based on identifying temporal associations between cause and effect. Researchers in a developing country like Pakistan seldom undertake cohort studies hence little is known about the challenges encountered while conducting them. We describe the retention rates among tuberculosis patients with and without diabetes, look at factors associated with loss to follow up among the cohort and assess operational factors that contributed to retention of cohort

Methods: A prospective cohort study was initiated in October 2013 at the Gulab Devi Chest Hospital, Lahore, Pakistan. We recruited 614 new adult cases of pulmonary tuberculosis, whose diabetic status was ascertained by conducting random and fasting blood glucose tests. The cohort was followed up at the 2nd, 5th and 6th month while on anti-tuberculosis therapy [ATT] and 6 months after ATT completion to determine treatment outcomes among the two groups i.e. patients with diabetes and patients without diabetes

Results: The overall retention rate was 81.9% [n = 503], with 82.3% [93/113] among patients with diabetes and 81.8% [410/501] among patients without diabetes [p = 0.91]. Age [p = 0.001], area of residence [p = 0.029], marital status [p = 0.001], educational qualification [p = <0.001] and smoking [p = 0.026]]were significantly associated with loss to follow up. Respondents were lost to follow up due to inability of research team to contact them as either contact numbers provided were incorrect or switched off [44/111,39.6%]

Conclusion: We were able to retain 81.9% of PTB patients in the diabetes tuberculosis treatment outcome [DITTO] study for 12 months. Retention rates among people with and without diabetes were similar. Older age, rural residence, illiteracy and smoking were associated with loss to follow up. The study employed gender matched data collectors, had a 24-h helpline for patients and sent follow up reminders through telephone calls rather than short messaging service, which might have contributed to retention of cohort

Medical graduates?; result of a cross-sectional study

A universal challenge faced by developing countries these days is the inequitable distribution of health professionals, which compromises the capacity of the health system to deliver efficient and effective health care. Availability of reliable data on medical graduates is important for health planning and development of policies and plans dealing with health workforce labour market. To determine the proportion of medical graduates who remained affiliated with the profession three to six years after graduation from a private medical school, To find out the specialty selection and practice location of these graduates, and to determine the association between their gender and affiliation with the profession. A cross-sectional study was undertaken at the Lahore Medical and Dental College from March to May 2014 selecting graduates through convenience sampling. The graduates were contacted through e-mail, Facebook and telephone. After obtaining voluntary informed consent from the respondents, a pre-tested structured questionnaire was used to collect information.The data was recorded and analysed using the statistical package for social sciences version 16.0. Chi-square test is used to test statistical significance between respondent's gender and their affiliation with the medical profession at p

Hepatitis C virus [HCV] infection; cross-sectional assessment of knowledge and practice about hepatitis C virus [HCV] infection in HCV infected individuals

Background: With a high magnitude of hepatitis C in the country and the burden still rising it was imperative to assess the knowledge of HCV infected individuals, which would determine the further spread of the disease or otherwise based on the adoption of good practices by these patients

Objectives: To evaluate the knowledge and practice regarding HCV in Hepatitis C patients presenting at Ghurki Trust Teaching Hospital, Lahore and to formulate recommendations based on study results to improve knowledge about hepatitis C

Study Design: Descriptive cross-sectional study

Setting: Ghurki Trust Teaching Hospital [GTTH], Lahore

Period: January to May 2015

Methods: The patients of hepatitis C registered at GTTH for treatment were included in the study after obtaining voluntary informed consent from the respondents and approval of the study from the institutional ethical review board. The convenience non-probability sampling technique was used to recruit 169 study participants. A pre-tested structured questionnaire was used to collect information, which was recorded and analyzed using the statistical package for social sciences version 21.0. Data is described in the form of frequencies and percentages for categorical variables and mean and standard deviation for continuous variable

Results: Of the 169 HCV patients, 110[65%] had heard of hepatitis C before acquiring it, the popular source of information regarding HCV was identified as relatives by 67[39.8%] of the patients. 70[41.4%] of the respondents were aware of a virus being the cause of hepatitis C, 140[82.8%] knew that HCV can be spread through sharing injecting equipment, nearly half the respondents 87[51.5%] had asked their family members to get tested for HCV and 68[40.2%] patients practiced safe sex

Conclusion: Majority of the respondents had heard of HCV before acquiring the disease. A large proportion of patients were aware of the disease being spread through sharing injecting equipment. Half of the patients had their family members tested for HCV. But less than half practiced safe sex

Patient satisfaction; OPD services in a tertiary care hospital of Lahore

Patient satisfaction is a relative phenomenon, which embodies the patients perceived need, his expectations from the health system, and experience of health care. To determine the level of patient satisfaction towards OPD services with reference to doctor-patient interaction, registration desk, waiting area, and overall health facilities. Descriptive cross sectional study. Tertiary care hospital of Lahore. April 2013. A sample of 250 patients was selected by employing systematic random sampling technique. The patients were interviewed and data was collected using a pretested questionnaire. Data was analyzed using the statistical package for social sciences [SPSS] version 16.00. Data was presented in figures and tables. It was described using frequencies, percentages and mean. Majority of the patients i.e 232 [94%] reported being satisfied with the doctor. A vast majority agreed that hospital was clean 233 [94%] and adequately ventilated 224 [90%]. The hospital staff in the waiting area was found to be respectful 220 [89%] and fair 198 [80%] towards the patients. The patients had no difficulty locating the reception desk of the health facility 235 [95%]. A large proportion of patients i.e.220 [89%] said they would re-visit the hospital. The patients were highly satisfied with their doctors and were ready to re-visit the hospital. It is recommended that further studies should be conducted to assess patient satisfaction in the secondary and primary care health facilities and efforts should be made to get regular feedback from the patients

Outbreak of dengue fever in Lahore: study of risk factors

Dengue fever is a rapidly emerging arthropod born viral disease threatening to become an international public health problem. Approximately 500,000 people suffer from dengue haemorrhagic fever and dengue shock syndrome with 20,000 deaths annually. Objective of this study was to look into the risk factors associated with the development of dengue fever. This crosssectional descriptive study was conducted on patients admitted in various hospitals of Lahore with suspected Dengue fever. Data was collected on a questionnaire from 109 conveniently selected patients. Mean age of the patients was 34 +/- 16.5 years, and majority [80, 73.4%] were male. Seropositivity for dengue was found in 78 [71.5%]. The study did not find significant statistical association of seropositivity with demographic variables. However, source of water supply was found associated with dengue seropositivity [p=0.002]. Source of water is a determinant of contracting dengue fever owing to it a breeding media for mosquitoes. All other phenomena associated with use of water and sanitation needs to be part of long term control of dengue that will also contribute to controlling other diseases with the same determinants.

Teaching methodologies; What is the students' perspective?

To determine preferences of medical students for modes of teaching, qualities of a good teacher and assessment techniques in medical education. A descriptive cross-sectional study. Lahore Medical and Dental College, Lahore. January 2011. All students of third and fourth year MBBS classes were included in the study [n=127]. A pre-tested questionnaire was used for data collection. A 7-point Likert scale ranging from 1[strongly disagree] to 7[strongly agree] was used to determine student's preferences of teaching styles. The data was recorded using SPSS version 16.0. Descriptive statistics were computed. The preferred teaching methods for basic science subjects were skills laboratory 88[70%], followed by problem based learning 70[55%] and interactive lectures 65[51%]. The same teaching methods i.e. skills laboratory 101[80%], problem based learning 89[70%] and interactive lectures 79[62%] were also popular for the teaching of clinical science subjects. The least preferred teaching method for both basic 51[40%] and clinical 58[46%] sciences was didactic lectures. The desirable quality of a good teacher was reported as teaching skills 111[87%] and the preferred assessment technique was found to be multiple choice questions 90[71%]. Students prefer the student centred teaching styles as opposed to the traditional approach. Good teaching skill is the most desirable quality of a teacher and most students like to be assessed by multiple choice questions

Medical students' perspective about role-plays as a teaching strategy in community medicine

To assess the students' perspective about role-plays conducted as a teaching methodology in community medicine. A quasi-experimental study. Department of Community Medicine at Fatima Memorial College of Medicine and Dentistry from July to November 2010. A probability technique of simple random sampling was used to collect 63 students from the third and fourth year MBBS who were randomly distributed in five sub-groups. They were variously ascribed the roles of obsceners, participants and helpers. A questionnaire was distributed to collect student's responses. The data was analyzed on SPSS version 17 to compare the responses. Chi-square test was applied and p-value was fixed at < 0.05 as significant. Sixty-three students were selected as participants of this study in which 46 belonged to the fourth year MBBS class [73%] and 17 were third year MBBS students [27%]. There were 13 male [20.6%] and 50 female [79.4%] students. Role-plays were identified as most effective method of teaching [n = 25, 37.9%] followed by lectures [n = 17, 25.8%, p = 0.054]. Fifty-two students [78.5%] admitted that role-plays improved their knowledge of the subject, 55 [84.6%] said that it will help them in their clinical performance. Fifty-nine participants [89.4%] found role-plays interesting and 49 [74.2%] wanted to incorporate role-plays as a part of curriculum. Fifty-six of the participants [88.9%] agreed that role-plays improved their communication skills. Twenty-one participants [31.8%] believed that it helped them in making acquaintance with the local situation. Forty-six students [76.7%] identified role-plays as a feasible way of andragogy [p = 0.005] and 48 [76.2%] said that it provoked critical thinking about the subject [p = 0.038]. Fifty-four students [85.7%] admitted that their attention span was better in role-plays as compared to lectures [p = 0.047]. Role-plays were well accepted by the students as an effective teaching methodology and can be incorporated as a part of teaching strategies in Community Medicine

Medico-legal aspects of alleged rape victims in Lahore

To describe the socio-demographic along with the medico-legal characteristics of rape victims reporting to a female police station of Lahore. Study Design: Observational study. Female Police Station in Shadman, Lahore, from, June 1995 to January 2009. A total of 74 cases of alleged rape victims were identified while reviewing all available police files concerning reported rapes and attempted rapes from 1995 to 2008. The data was gathered on preformed questionnaires after conducting the pilot study. All information about victims and alleged offenders were extracted from the police files including socio-demographic profile of the accused and victim both. Use of weapon, evidence of physical and genital r trauma, assailant identification and his relationship with the victim, number of accused persons and location of rape was noted in each case. Examination by doctor and obtaining the specimens were also identified and was related to the outcome of the court case. Chi-square test was applied to determine the association of rape with age and educational status of the victim and the accused. A total of 74 cases of alleged rape were reported in the study period at Shadman Female Police Station. Maximum number of victims was reported in the age group 10-19 years [n=46, 62.2%]. Majority of the accused belonged to 20-39 years' age group constituting 64.8% of the total. Regarding educational status 45 [60.8%] of the victims and 51 [68.9%] of the accused were illiterate. Significant association was found between the educational status of rape victims and accused [p = 0.016] but not between their ages [p = 0.862]. The maximum incidence of rape was reported in unmarried [n = 55, 74.3%] and unemployed [n =61, 82.4%] women. In 14 cases [19%] use of weapon was reported. Physical trauma was reported in 29 [39%] and genital trauma in 14 [19%] cases. The accused were identified as family friends [25%] and neighbours [23%] respectively. Only 21% of the victims were examined by doctor and specimens were obtained in only 14.9% of the cases. Acquittal of the accused was observed in 43% of the cases while 34% cases were still pending; conviction of the accused was observed in only 5% of the cases. Rape victims usually belong to young age group between 10-19 years majority of being unmarried and unemployed. Only a smaller fraction of the victims were examined by doctor and specimens were obtained in only few of the cases

Bullying of medical students

To assess the frequency and forms of bullying experienced by medical students, and the associated factors. Cross-sectional questionnaire-based survey. The study was conducted at a private Medical College of Lahore, from January to February 2010. All the students of first and fourth year classes were included in the study with voluntary and anonymous participation. Self administered-questionnaires were given to the students which were completed by them in the presence of the surveyor. A modified version of the British Medical Associations [BMA] medical student's welfare and education survey form was used for data collection. The data was recorded and analyzed using the statistical package for social sciences version 16.0. Data was described in the form of frequencies and percentages. Chi-square test and Fisher exact test were used to test statistical significance between categorical variables at p

Brucellosis in a high risk occupational group: seroprevalence and analysis of risk factors

To estimate Brucella seropositivity among slaughterhouse workers of Lahore district and to elucidate risk factors associated with seropositivity to Brucella. During the year 2008, a cross-sectional study was conducted in four slaughterhouses of Lahore district. A sample of 360 workers was selected from these slaughterhouses through stratified random sampling on proportional basis. Workers were interviewed using a structured questionnaire to obtain risk factor information and their blood samples were collected to be screened for the presence of anti-Brucella IgG using Enzyme Linked Immunosorbent Assay [ELISA] technique. Data management and analysis were performed using SPSS [statistical package for social sciences] version 16. Risk factors associated with seropositivity to anti-Brucella IgG were identified by constructing a logistic regression model. Of the 360 serum samples tested, 21.7% [95% Cl 17.44% - 25.96%] were positive by ELISA test. The logistic regression model identified age [OR 0.96, 95% Cl 0.94-0.99], assistance in parturition of animal [OR 0.47, 95% Cl 0.23-0.96], consuming raw milk [OR 2.25, 95% Cl 1.04-4.87] and handling sheep [OR 0.30, 95% Cl 0.09- 0.92] as risk factors for Brucella seropositivity among slaughterhouse workers of Lahore district. To reduce the burden of brucellosis, a national brucellosis control programme should be initiated with special emphasis on the high risk population of slaughterhouse workers

Tuberculosis; awareness about spread and control

To assess the awareness about spread and control of Tuberculosis amongst people presenting at Ghurki Trust Hospital, Lahore. A cross-sectional survey. Lahore Medical and Dental College [LMDC], Lahore. From November and December 2006. A cross-sectional survey was conducted among people presenting at Ghurki Trust Hospital, Lahore, between November and December 2006. A structured questionnaire was used to collect the data. Descriptive statistics were determined in terms of percentages. In the present study, 82% respondents did not know the correct mode of transmission of tuberculosis. Correct modes of transmission including coughing, sneezing, spitting and breathing air were mentioned only by 18%. A large proportion of respondents [76%] knew that tuberculosis presents as cough lasting more than three [3] weeks and having prolonged fever [68%]. Fifty percent of respondents said that government health facilities are the best places for the treatment of TB. Twenty three percent [23%] of respondent mentioned use of medicine as a method of management and treatment. Improving sanitation and nutrition was mentioned to prevent and control TB by respondents in almost equal percentage [20% and 18%]. Poor knowledge and misconceptions concerning tuberculosis are rampant in Pakistani patients. Poor knowledge of TB patients concerning their disease may contribute to the high burden of TB disease in the country

Selection of medical profession by first year medical students

The factors which influence medical students' selection of specific medical specialties have been analyzed by a number of studies in the literature. However, very few studies have been carried out to ascertain the factors which influence students selection of the medical profession itself. The literature review did not identify any such study conducted in Pakistan, therefore this particular venture was undertaken. To establish a baseline of factors that affect student's decision in selecting medical profession and to determine if there was a significant difference in factor by gender. Lahore Medical and Dental College, between January and February 2009. The present study was a cross-sectional survey in which the first year MBBS class of Lahore Medical and Dental College, comprising ninety students were part of the study. Data was collected using a pre-formed structured questionnaire, which was pretested before adoption of the final version. The collected data was analyzed using version 16 of the statistical package for social sciences [SPSS]. Data is presented in the form of tables and figures. It is described in the form of frequencies and percentages. Inferential statistics were done using Fisher Exact test at 5% level, Among 90 respondents, 58 [64%] were females, 74 [82%] were between 18-20 years of age, 81 [90%] had their residence in Pakistan, 57 [63%] of the respondents' fathers and 26 [29%] of their mothers had attained postgraduate education. Of the respondents' parents, 29 [32%] of the fathers and 12 [14%] of the mothers belonged to the medical profession. All students taking two attempts at FSc/A-level/American high examination also took two attempts at the entry test to a medical college [p<0.001]. A large proportion 10 [59%], of students who attempted the entry test twice had fathers who were doctors. The popular reasons for selection of medical profession by the respondents included personal interest [89%], parental wish [58%] and a desire to serve humanity [41%]. Among the respondents 100% males had a personal interest in medical profession in contrast to 83% female respondents [p=0.012], 100% male respondents were influenced by parental wish compared to 34% females [p<0.001], 100% males in contrast to 9% females identified humanitarian concern [p<0.001] as factors influencing selection of medical profession. The prestigious status of the profession, parents being doctors, financial incentives, better career opportunities and a better chance to go abroad were the factors identified by only the male respondents as compared to the female respondents in influencing their choice of medical field [p<0.05]. The overall frequent choices for selection of medical profession included personal interest in the profession, parental wish and a desire to serve humanity. Whereas, parents being in the same profession, financial incentives, better career opportunities and the prestige associated with the profession were identified as motivating factors by only the male respondents

Brucella serology in abattoir workers

Brucellosis is an occupational hazard with those particularly at risk either living in close proximity with animals or handling them. It is a public health problem in developing countries with adverse health implications both for animals and human beings as well as economic implications for individuals and communities. The Objectives were to estimate the seroprevalence of brucellosis among abattoir workers of Lahore District and to determine the association of brucellosis with nature of job of the workers. Data was collected in April 2008. It was a cross-sectional study in which four main slaughterhouses in Lahore were included. The slaughterhouse workers were divided into seven strata based on their nature of job: meat sellers, slaughterers, animal keepers, drivers, cleaners, loaders and vets/paravets. A total of 360 such workers were selected using stratified random sampling technique. Sampling frames for different strata were prepared and from each frame, proportionate numbers, were selected through simple random method using random number tables. Data was obtained using a questionnaire. Additionally blood samples were collected and analyzed for anti-Brucella Immunoglobulin G [IgG] using enzyme-linked immunosorbent assay [ELISA] technique. The seroprevalence of anti-Brucella IgG was found to be 21.7%. A statistically significant difference was observed between the immune status of the respondents and their nature of job [p=0.005], age groups [p=0.013], and duration of job [p=0.003]. The disease is an important public health problem in Pakistan. The disease can be prevented in the slaughterhouse workers through the use of personal protective devices. Public health authorities should educate the general public regarding prevention of the disease with specific emphasis on people working in slaughterhouses