Daily contact with a patient and poor housing affordability as determinants of pulmonary tuberculosis in urban Pakistan

This study aimed to evaluate the factors associated with pulmonary tuberculosis [TB] among individuals aged 15 years or more in urban Karachi, Pakistan. A case-control design was implemented in three major tertiary-care hospitals to select cases [n = 342] with active pulmonary TB [i.e. two sputum smears positive for Mycobacterium tuberculosis with clinical and radiographic evidence of current pulmonary TB and diagnosed between August 2002 and October 2003. Selected controls [n = 342] were surgery patients from the same hospitals at time of recruitment of the cases, without clinical and radiographic evidence of pulmonary TB. Multivariable logistic regression model showed that daily contact with a pulmonary TB patient [adjusted odds ratio [OR[adj]] = 5.07; 95% CI: 3.31, 7.78], and poor housing affordability [i.e. rented vs. owned] [OR[adj] = 1.59; 95% CI: 1.13, 2.26] were significantly associated with pulmonary TB status. The overall adjusted summary population attributable risk [%] for both the risk factors together was 38.7. Reaching out to underprivileged TB patients for delivery of DOTS and focused education of patients and their contacts about M. tuberculosis transmission mode may substantially minimize pulmonary TB risk in this and similar settings

Prevalence and risk factors contributing to depression among pregnant women in district Chitral, Pakistan

To estimate the prevalence of depression and its associated factors among pregnant women in district Chitral, Pakistan. A descriptive cross sectional study. The study was carried out in a public hospital in district Chitral, Pakistan from May 2008 to June 2008. A consecutive sample of 340 pregnant women was approached for recruitment in the study. A short translated Khowar version of the Aga Khan University Anxiety and Depression Scale [AKUADS] was used to detect depression and a questionnaire was used to determine the associated factors of depression. The data were analyzed by SPSS version 15 using descriptive statistics and multiple logistic regression technique. Using the AKUADS, at a cut off score of e" 13, the prevalence of antenatal depression was around 34%. The multivariate analysis showed that verbal/physical abuse [P=<0.001], unplanned pregnancy [P=<0.001], and illiteracy [P=<0.001] were independently associated with depression. More than one third of pregnant women in district Chitral suffer from depression and this is associated with illiteracy, verbal/physical abuse and unplanned pregnancy. Policies must aim to incorporate routine screening programs for depression in obstetric care. Service providers can be trained to detect and manage depression and to refer women to the appropriate services. Counseling of couples may prevent unplanned pregnancies and reduce domestic violence

Coverage and factors associated with tetanus toxoid vaccination status among females of reproductive age in Peshawar

To estimate the coverage and determine the factors associated with tetanus toxoid vaccination status among females of reproductive age. Cross-sectional study. District Peshawar, NWFP, from July to September 2002. A total of 646 females of reproductive age [15-49] years were selected from both urban and rural areas of Peshawar through stratified cluster sampling. A pre-tested structured questionnaire was administered to females. Two logistic regression models were built, one for all females and one for married females only. Overall 65.0% females were vaccinated [95% confidence interval [CI] [61.3%, 68.6%]. For all females, the variables that were significantly associated with vaccination status were marital status [OR= 8.5, 95% CI [4.7, 15.6]], source of information regarding tetanus toxoid [TT] vaccination, knowledge regarding TT vaccination, visits of lady health worker [LHW] to a household [OR = 2.3, 95% CI [1.4, 3.9] and restriction on TT vaccination [OR = 28.7, 95% CI [3.5, 237.9]]. For the married females, the variables that were significantly associated with vaccination status were source of information; visits of LHW to a household [OR = 2.8, 95% CI [1.5 to 5.2]] and an interaction between knowledge regarding TT vaccination and antenatal care visits. These findings are of public health concern as a majority of females is not vaccinated according to WHO recommendations. It is recommended that maternal and neonatal tetanus [MNT] vaccination campaigns should include lady health workers at implementation stage