To determine patients' perceptions and attitudes for blood transfusion

Background: Blood transfusion is a risky procedure due to transmission of various infections and reactions of unmatched blood transfusion. Many blood transfusion related problems can be prevented to some extent if patients and their family members are involved in transfusion related procedure

Objectives: To determine patients' perceptions for the recall of consent process, risks, benefits and attitude for blood transfusion

Study design, settings and duration: Hospital based cross-sectional study done on adult patients admitted in Orthopedic and Surgical wards of Civil Hospital, Karachi from November 2014 to January 2015

Patients and Methods: Using convenient sampling, a total of 350 patients who were admitted and received blood transfusion were included in the study. Variables included age, gender, educational status, language spoken, recall of consent for blood transfusion, risks, benefits and attitudes for blood transfusion. Questionnaire based instrument was used for data collection. SPSS version16 was used for descriptive frequencies

Results: Of the total 98% patients were neither asked nor recalled for the consent of blood transfusion. Only 19 [5%] patients were informed about the risks and 77 [22%] about the benefits of blood transfusion. About 236 [67%] patients were of the opinion that blood of family members, if transfused, carries fewer chances of risk/reactions and 213 [61%] patients stated that they will prefer to receive blood transfusion from their family members. Only, 16 [5%] said that would refuse blood transfusion even if it was needed and will prefer blood alternatives. Overall 326 [93%] patients had poor perception and 262 [75%] good perception for blood transfusion

Conclusion: The consent for blood transfusion was missing in majority of the cases and risks and benefits were not explained to the patients

Policy statement: Institutional Bioethics Committees should take notice of these shortcomings

Case-control study for measles outbreak in a tertiary care hospital

Objectives: To compare the profile of measles patients [cases] with non-measles [controls] admitted in Pediatric units of Civil Hospital, Karachi during the measles epidemic

Study type, settings and duration: Retrospective, case control, hospital record analysis of children admitted in pediatric units of Civil Hospital, Karachi from October 2012-March 2013

Subjects and Methods: From the list provided by the ward authorities, case records of children [cases] admitted in pediatric units of Civil Hospital, Karachi with the clinical diagnosis of measles were selected using convenient sampling. From the same wards, age and gender matched non-measles cases [controls] were also selected. The signs, symptoms, mortality and hospital stay of cases and controls were taken from the hospital record, while some information like socio-economic status, vaccination status, symptoms, number of days ill before presenting to health facility, health status of the child, history of similar illness in the family, neighbors, relatives and history of calamity in the area in recent past was taken from the parents or care givers telephonically. Sample size of 300 children [150 cases, 150 controls] was calculated

Results: Out of 150 children having measles, 84 [56%] were females. Most cases reported to health facility after a median of 8 days of onset of symptoms. Almost 98 [65%] children were vaccinated for measles and 52 [35%] were not vaccinated Median age of cases, vaccinated for measles was 30 months while median age of cases not vaccinated for measles was 21 months. All cases had history of fever and maculo-papular rash. Death occurred in 10 [7%] cases due to pneumonia. There was history of measles in their family in 90 [60%] cases, 54 [36%] had measles in neighbors and 30 [20%] in relatives. Out of 150 controls, 76 [51%] were vaccinated for measles and 74 [49%] were not vaccinated. The main reason for admission was pneumonia in 78 [52%] and bronchial asthma in 45 [30%]. The risk of measles was 0.83 times higher for cases who were vaccinated for measles as compared to controls who were vaccinated for measles. Using univariate analysis, symptoms of breathlessness and lower respiratory tract infection at the time of admission were significantly associated with measles disease. Using multivariate analysis, children between 9 to 60 months of age, presenting with breathlessness and lower respiratory tract infection had a significantly high chance of suffering from measles disease

Conclusion: Almost 65% who had received measles vaccination as per their mothers statement suffered from measles

Policy message: Measles outbreak occurring in many children despite getting measles vaccine needs further workup both for the timing of vaccination, actual verification of vaccination and its efficacy

Pneumococcal infections in children under 5 in karachi: a retrospective analysis

To analyze the hospital case records of children under five years of age for Pneumococcal pneumonia. Retrospective case record analysis of children admitted in pediatric units of Civil Hospital, Karachi, from 2011 to 2012. This case record analysis was conducted on children under 5 years of age who were admitted and diagnosed to have pneumonia. The clinical criteria used for the diagnosis of pneumonia were taken from WHO [IMCI]. Variables studied included age, gender, birth and feeding history, vaccination status, symptoms/signs on admission and diagnosis. Information was collected on a questionnaire. SPSS version 15 was used for analysis. Out of 820 case records retrieved, diagnosis of pneumonia was written on the files in 637 [78%]. Fifty two percent [333] children were age appropriately vaccinated. Majority [62%] of children were up to 11 months of age and male to female ratio was 1.4:1. Commonest symptoms were fever, cough and respiratory distress. Pneumonia was severe in 124 [19%] children and out of these 96 children were less than 12 months of age and they had a respiratory rate of more than 50 per minute with more than two danger signs. Pneumonia was more severe among un-vaccinated [schedule EPI immunization] group. Blood culture reports were available in only 14 children and none were positive for Streptococcalpneumoniae. Majority of the children with pneumonia were less than 12 months of age and severity of pneumonia was more in un-vaccinated children. This study can be used as a baseline for pneumonia or pneumococcal disease in children under 5 years and compared with the drop in the pneumonia cases after the introduction of Pneumococcal Conjugate Vaccine in schedule EPI programme