Prevalence of risk factors for noncommunicable diseases in adults: key findings from the Pakistan STEPS survey

Background: Pakistan lacks data on the prevalence of risk factors for common noncommunicable diseases [NCDs]. Objectives: This study aimed to determine the prevalence of risk factors for NCDs among a population-based sample in Punjab and Sindh provinces, Pakistan. Methods: This study was conducted in 2013–2014. The NCD risk factors examined were: current daily smoking, eating fewer than 5 servings of fruits/vegetable a day, low physical activity, overweight and obesity. A total of 7 710 households were selected and 1 adult was enrolled from each household. Data were collected using the WHO STEPS instrument [Step 1 and 2], and analysed according to the STEPS statistical plan. Results: The prevalence of tobacco use was 19.7%. The majority of the respondents [96.5%] consumed fewer than 5 servings of fruits/vegetables a day, 41.5% had a low level of physical activity, 26.3% were overweight and 14.9% were obese. The prevalence of stage I and stage II hypertension, including those on medication, was 37% and 15.9% respectively. The prevalence of NCD risk factors differed significantly by sex and occupation [P = 0.0001] but not by age group [P = 0.118], level of education [P = 0.668] and province [P = 0.056]. Only 0.6% of the sample had none of the 5 NCD risk factors while 40% had 3–5. Conclusion: The high prevalence of NCD risk factors in Punjab and Sindh provinces is of concern. Urgent public health interventions are needed to reduce them, especially in youth and young adults

Asymptomatic dengue infection in adults of major cities of Pakistan

OBJECTIVE@#To determine the asymptomatic dengue infection in adults of Pakistani population.@*METHODS@#This study was conducted in five major cities (Islamabad, Karachi, Lahore, Multan, and Peshawar) of Pakistan. A total of 5 230 adults aged 18 years and above without a history of dengue fever at any point in their life were enrolled from participating laboratories. Those who were confirmed for dengue previously were excluded. Of the total, 62.6% (n = 3 276) were male with an average age of 34.6 years. Participants were briefed about the objectives of the study, and written consent was obtained to perform dengue IgG test using enzyme linked immunosorbent assay. The brief information related to age, gender and area was also taken on proforma.@*RESULTS@#Overall 32.3% (n = 1 691) was having asymptomatic dengue infection which was 67.5% (n = 756) in Karachi followed by 39.1% (n = 391) in Islamabad, 29.9% (n = 316) in Lahore and 21% (n = 228) in Peshawar and none from Multan. More males were affected with asymptomatic dengue infection than females. The asymptomatic dengue infection was significantly higher in different cities; however, there was no significant difference with respect to age groups.@*CONCLUSIONS@#The asymptomatic dengue infection is higher in cities i.e. Karachi, Islamabad and Lahore which are at risk of developing secondary dengue infections. There is a need of awareness among the public about secondary dengue infection.

Asymptomatic dengue infection in adults of major cities of Pakistan

Objective To determine the asymptomatic dengue infection in adults of Pakistani population. Methods This study was conducted in five major cities (Islamabad, Karachi, Lahore, Multan, and Peshawar) of Pakistan. A total of 5 230 adults aged 18 years and above without a history of dengue fever at any point in their life were enrolled from participating laboratories. Those who were confirmed for dengue previously were excluded. Of the total, 62.6% (n = 3 276) were male with an average age of 34.6 years. Participants were briefed about the objectives of the study, and written consent was obtained to perform dengue IgG test using enzyme linked immunosorbent assay. The brief information related to age, gender and area was also taken on proforma. Results Overall 32.3% (n = 1 691) was having asymptomatic dengue infection which was 67.5% (n = 756) in Karachi followed by 39.1% (n = 391) in Islamabad, 29.9% (n = 316) in Lahore and 21% (n = 228) in Peshawar and none from Multan. More males were affected with asymptomatic dengue infection than females. The asymptomatic dengue infection was significantly higher in different cities; however, there was no significant difference with respect to age groups. Conclusions The asymptomatic dengue infection is higher in cities i.e. Karachi, Islamabad and Lahore which are at risk of developing secondary dengue infections. There is a need of awareness among the public about secondary dengue infection.

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

Knowledge assessment about hazards of smokeless tobacco use in patients coming to a DHQ Hospital

Background: Smokeless tobacco use is not perceived as an addiction in most South East Asian countries therefore both men and women use it frequently

Objectives: To assess the knowledge of smokeless tobacco users about its hazards in District Head quarter hospital, Thatta

Study design, settings and duration: Descriptive cross-sectional study was conducted in District Head Quarter hospital, Thatta for 06 months duration

Subjects and Methods: The statistically calculated sample size was 325. Participants were enrolled using systematic random sampling technique. Written informed consent was taken and information related to demography and smokeless tobacco use was collected from the patients and their relatives on questionnaire. Data was entered and analyzed using SPSS

Results: There were a total of 325 respondents whose mean age was 34 years. Only 4% had higher school certificate or were graduates while 50% had no formal education. The mean age of initiation of Smokeless tobacco [SLT] was 19.3 years. The mean length of use of smokeless tobacco was 13.87 years. The mean number of Smokeless tobacco use was 5.0. Factors influencing SLT use were cultural acceptability, easy access, low price, peer influence and used as mouth freshener. Male respondents were 2.7 times more aware about the hazards of SLT as compared to females [p < 0.001]. Nearly, one-in-three respondents reported trying to give up SLT use in the past

Conclusion: Cultural acceptability, low price and easy access of smokeless tobacco have led to high usage in under privileged uneducated population

Policy message: Tobacco cessation advising and warning should also be placed on smokeless tobacco products and health care providers should advise the smokeless tobacco users to quit it

Economic burden of dengue in four major cities of Pakistan during 2011

To assess the economic burden of dengue infection by calculating cost per patient and disability adjusted life years lost. The cross-sectional study was conducted in Islamabad, Lahore, Faisalabad and Karachi from July 2012 to March 2013. Residential addresses and telephonic numbers of dengue patients were taken from the records of Pakistan Institute of Medical Sciences, Islamabad, Mayo and Ganga Ram Hospital, Lahore, Civil Hospital, Karachi, and Allied Hospital, Faisalabad. A total of 250 dengue confirmed cases - 50 from each hospital - were randomly selected. Information regarding duration of illness and out-of-pocket expenses were collected to estimate the direct cost, while indirect cost [number of work days missed by the patient] was calculated from disability adjusted life years using Murray's formula. Overall, there were 162[65%] men and 88[35%] with a mean age of 30.4 +/- 13.5years. More than half 138[55%] were below 30 years of age. Socio-economically, 145[58%] belonged to low, 70[28%] middle and 35[14%] to high socioeconomic groups. Of the total, 210[84%] cases had dengue fever followed by 32[12.8%] dengue haemorrhagic fever and 8[3.2%] dengue shock syndrome cases. Average duration of illness was 32 +/- 7.1 days. Overall direct cost per patient was Rs.35, 823 [US$358] and average pre-hospitalisation, hospitalisation and post-hospitalisation was Rs.6154, Rs.21, 242 and Rs.8, 427 respectively. The overall disability adjusted life years per million population was 133.76. Although the government had provided free treatment for dengue in public-sector hospitals, still patients had to pay Rs.21, 242 during hospital stay, resulting in substantial burden which needs to be addressed

Persistence of dengue symptoms among discharged dengue cases of Lahore, Pakistan

The signs and symptoms of acute dengue infection are well defined and characterized. However, little data is available about the persistence of these symptoms which depends upon the disease management and patient care. This study was conducted to determine the persistence of dengue symptoms in admitted cases who were discharged from hospital. Data of dengue cases who were admitted in 2 public sector hospitals was retrieved along with their complete addresses. Patients were approached and interviewed after getting the written informed consent. A pre-designed questionnaire was used to collect information about the persistence of dengue symptoms in the patients after they were discharged from hospital. Of 41 cases interviewed, 31 were males and overall mean age was 31 years. The case record showed that 15 cases had dengue shock syndrome, 14 dengue hemorrhagic fever and 12 dengue fever. The average period of illness after getting discharged was 19 days which was significantly higher in females [23 days] as compared to males [18 days]. Majority of the cases [except 04] reported persistence of dengue symptoms in which joint pain [29 cases], itching [17 cases] and exhaustion [14 cases] were more common. The persistence of joint pain after discharge was significantly associated with dengue shock syndrome. The current study showed significant association between joint pain and DSS which could be overcome through proper case management. Furthermore there is a need to follow admitted dengue cases after getting discharged from the hospital to avoid any complications