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

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