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

To determine the factors responsible for diagnostic delay of breast cancer among women

Background: Breast cancer is the most common cancer among women throughout the world. Early diagnosis of this cancer is important for its early treatment and favorable outcome. The diagnostic pathway is divided into patient, doctor and system interval. This study will look into the reasons for delay in diagnosis

Objectives: To determine the frequency of diagnostic delay [patient, doctor and system delay] of breast cancer among adult women [>/= 18 years] and factors responsible for it. Study design, settings and duration: Hospital based cross-sectional study conducted at Oncology/ Radiotherapy unit of Jinnah Post Graduate Medical Centre. Karachi from February 2015 to December 2015

Subjects and Methods: Adult women [2 18 years] diagnosed with breast cancer and reporting at Oncology/Radiotherapy unit of Jinnah Post Graduate Medical Centre, Karachi were enrolled. Convenient sampling was used, sample size was 288 women with breast cancer. Variables included age strata, socio-demographic characteristics, age at menarche, parity and breast feeding history [if applicable], intervals of diagnostic pathway [patient, doctor and system] and reasons of delay. Questionnaire based instrument was used for data collection. SPSS version 16 was used for data analysis and descriptive frequencies

Results: The mean age of the patients was 42 years [range 21-80 years]. Breast lump was the main presenting symptom [90%,]. Complete physical and breast examination was performed by health care provider in 97% cases. Median patient, doctor and system interval was 90, 45 and 35 days respectively. Median diagnostic pathway [patient+ doctor+ system] was 165 days [5.5 months] and ranged from 2- 405 days [13.5 months]. It was further found that after confirmation of the diagnosis, median interval to report to oncology/radiotherapy unit was 18 months. First consultation with the health care provider was delayed due to carelessness in 57%, due to financial reasons in 55%, due to fear of cancer in 23% and due to time constraints to visit hospital by the family members in 13% cases. Univariate regression analysis showed that late presentation to first health care provider by the patient [patient interval] was mostly seen in women having children who were less educated [illiterate/primary] without any ethnic group being specific. Univariate regression analysis showed that delay in reporting to oncology/radiotherapy unit was seen in women without any ethnic group been specific and those having children. Multivariate regression analysis showed that delay in reporting to oncology/radiotherapy units was mostly seen in women aged between 18-25 years who had children and belonged to either Sindhi, Baluchi or Pushto origin

Conclusion: Delay in the diagnosis of breast cancer among adult women attending the tertiary care public sector hospital as not due to doctor or system interval but was due to fear of cancer. Policy statement: Awareness campaigns should be used to communicate to women folks that breast cancer is curable if diagnosed and treated early

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

Assessment of hepatitis B vaccination coverage in children under 5 years of age in two major public sector hospitals of Karachi

To assess Hepatitis B Vaccination coverage of children under 5 years of age attending Paedriatic units of Civil Hospital and National Institute of Child Health Karachi and to identify the reasons for non-compliance. Descriptive cross-sectional survey conducted in Paedriatic units of Civil Hospital and National Institute of Child Health of Karachi over period of eleven months. Subjects and A total 971 children under 5 years of age attending the selected hospitals were randomly selected. A structured questionnaire was used which included age, gender, EPI vaccination status, age at first dose of hepatitis B vaccination [Pentavalent vaccine], services utilized and payment if any, birth history, educational status of the respondent, knowledge about Hepatitis B vaccination, history of Hepatitis B in the family and reasons for non-compliance. SPSS version 15 was used for data analysis and chi-sq at 0.05 alpha level for statistical significance. Univariate and multivariate analysis were used for association of the variables. Out of 971 children who were enrolled, data of 969 children was analyzed. Majority [71%] were out door cases and only 284[29%] were indoor patients. Age distribution showed 447[46%] up to 12 months of age and overall male to female ratio was 1.3:1. Almost 80% children had received one dose of Hepatitis B vaccine, 72% had received two and 65% received all three doses. Age at vaccination showed that 677[70%] children were age appropriately vaccinated and out of these 469[48%] had received their first dose of Hepatitis B vaccination at six weeks. Reasons for non-compliance were parental/family objection 172[18%], intercurrent illness of children 44[5%], and other causes including no knowledge for the vaccination, long distance, loss of vaccination cards and non-availability of vaccine in 63[6%] cases. Univariate analysis showed that children who were vaccinated for BCG, Polio and Measles were more likely to be also vaccinated with Hepatitis B vaccine [significant]. Multivariate analysis showed that apart from above variables education of the respondent and place of delivery were significantly associated with Hepatitis B vaccination of the children. Only 65% children had received all three doses of vaccine and 48% received first dose at six weeks. Major reasons for non-compliance were parental/family objection. Policy message: Efforts should be made to increase the uptake of all 3 doses to ensure full protection against hepatitis B along with education of public to remove misconceptions about vaccination

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

Factors affecting academic performance of primary school children

To determine the socio-economic, psychosocial, environmental and student related factors affecting academic performance of public and private primary school children. Descriptive cross-sectional survey of 600 students [300 each from public and private primary schools] using randomly selected children from Saddar town, Karachi. Using selected schools and children, information was collected on a questionnaire. The factors studied included socio-economic, psychosocial, school and home environment and student related factors. SPSS version 15 was used for data analysis and chi-sq at 0.05 alpha level for significance test. Univariate and multi variate analysis were used to find out the association of the variables. A total of 600 students filled the questionnaire of whom 300 were from private and 300 from public sector schools. The mean age of children was 11.37 +/- 1.52 with male to female ratio of 1:1.8 in public schools and 1:0.9 in private schools. Socio-economic status was classified as good, fair and poor using the parent's job and number of family members working. Almost 34% children belonging to public and 65% to private schools were categorized as good. Among the public school children 65% fathers and 58% mothers were literate while, these figures were 62% and 67% among private school children. Overall 25% school children did not regularly take breakfast. Almost 50% public and 20% private school children remained absent once a week. Overall 35% children did not have adequate sleep and 22% children of public and 14% of private schools were suffering from some kind of illness. Based on BMI overall 24% children were underweight while, obesity was seen in 3% public and 11% private school students. Parent's help in completing school homework was twice more in those studying in private school [11% public and 22% private] thus showing a better academic performance of students in private school [poor performance seen in 40% public and 16% private]. Cognitive behavior evaluated from learning habits and overall psychosocial condition was good in both types of school children and school environment of 43% public and 54% private school was also good. Majority of the schools had no sports or physical training facilities. Using univariate and multivariate analysis it was found that younger age, female gender, better socio-economic condition, habit of taking breakfast, better condition of school, and regular attendance were significantly associated with better academic performance. Academic performance of public school children was poor as compared to private schools. Socio-economic, psychosocial, school and home environment and student's own factors, affected their academic performance. School and out of school factors both need to be improved for achieving good school achievement of primary school children

Perceptions and practices for the control of dengue fever in Karachi - A school based survey

To determine the perceptions and practices for the control of Dengue fever in secondary school children of Saddar town Karachi. Cross-sectional survey based on cluster sampling done over 6 months. Data was collected from 1320 secondary school children of both gender belonging to public and private schools [total 14] of Saddar town, Karachi. A structured self administered questionnaire was used which included variables like age, gender, class pass, knowledge of dengue fever, its control and preventive methods used at their homes. Data was analyzed on SPSS version 15 and chi square was applied for statistical significance. Data was analyzed for 1270 students as others had incomplete information. Participation was 650[51%] from public and 620[49%] from private schools. Majority 517[41%] of the students were 15-16 years old [mean 14.5 STD +/- 1.6] with male to female ratio of 1.1:1. About 890[70%] students had knowledge about dengue fever and its control methods mostly received from television [82%]. Though 72% knew that mosquito is the causative agent but only 13% were aware of its biting habits. Almost 66% students believed that dengue infection could be controlled and 33% thought that mosquito elimination is a good method to the control disease. Majority [90%] students stated that they keep water utensils covered at their homes. Overall 59% students had good knowledge about dengue fever and its control methods but only 21% were practicing it. School students had sufficient knowledge about dengue fever and its control but this knowledge did not change their behavior was not translated into practice. Educational programmes should focus on translating knowledge into practice

Health seeking behavior of adult patients attending OPDS of public sector hospitals in Karachi

To determine health seeking behavior pattern and factors associated with it in adult patients attending OPDs of public sector hospitals in Karachi. Cross-sectional hospital based survey conducted on 384 adult patients attending OPDs of two major public sector hospitals in Karachi, selected using convenient sampling technique. Structured questionnaire was used which included age, gender, language spoken, educational and socio-economic status, beliefs regarding illness, autonomy of the patients, symptoms, duration, severity of the illness and type of care sought. Data was analyzed on SPSS version 15; chi-sq was used at 0.05 alpha level for statistical significance. Out of 384 patients, 53%[202] were from Civil Hospital and 47% [182] from Jinnah Post Graduate Medical Centre, Karachi. Overall, there were 54%[209] males and 46%[175] females with 52% cases [199] 31-60 years old. Almost 94%[361] patients believed that headache, common cold and low grade fever are mild illnesses and do not require treatment whereas 96%[369] perceived hypertension, diabetes mellitus, numbness and fits as a serious illness which required treatment. Doctor was the first preference to seek treatment by 89%[341] with 23%[89] using home remedies and 5%[19] treated the disease themselves. About 52%[198] had free will to select their health care providers. About 84%[322] patients preferred going to public sector hospitals due to its free medicines and laboratory tests while 87%[335] used public sector hospital due to more qualified doctors and 77%[295] due to free medicines. In case of emergency 51%[195] preferred private doctors due to less waiting time from doctors visit to start of treatment. Overall 98%[375] said that they sought appropriate medical care, 1%[4] inappropriate and 1%[5] prompt care for their illness. Socio-economic status and health expenditure were two important determinants for health seeking behavior over-riding age, gender and ethnicity. Misconceptions' regarding illness existed among the patients. Government should introduce reforms in health sector especially in health financing, expenditure, and consumer behavior for the benefit of poor people

Prevalence of shisha smoking in college, university and madarsa students aged 20-25 years in Pakistan

To estimate the prevalence of shisha smoking, its trends and associated factors in college, university and madarsa students aged 20-25 years in Pakistan. This survey was done on 7582 subjects belonging to 71 institutions from five cities and Federal Capital Islamabad, using a population based sample. Data was collected using cluster sampling from public/private colleges, universities and madarsas. After taking informed consent, about 10% students from each speciality including both genders were collected using a structured self administered questionnaire designed in Urdu and English. Variables included age, gender, socio-economic status, habits, trends, knowledge and perceptions about shisha smoking. The study was approved by Institutional Review Board. Data was analyzed on SPSS version 15 and chi square was used for statistical significance. Out of 71 educational institutions, 43 were public and 28 private including 8 madarsas. There were 2971 students from professional and 4174 from non-professional institutions. Overall prevalence of shisha smoking was 19.7% [n=1410] being more common in males [29.8%] than females [10.4%] Students started smoking shisha at 17-18 years age [57.2%] and almost 75% started this habit in year 2009-2010. The highest prevalence of shisha smoking was seen in Federal Capital Islamabad [28.1%], and lowest in Peshawar [11.2%]. The shisha smoking was more in professional and private educational institutions [p<0.000] with almost 29% students using it in engineering colleges and none using it in madarsas [alma/alia courses]. The trend was highest in students belonging to high socio-economic status [30.7%] and those already smoking cigarettes [74.1%] Pleasure seeking was the commonest reason for smoking shisha [7.1%] and almost 11% students were influenced by their friends. Shisha cafe's were site used by most smokers and majority preferred double apple or mint flavor. Almost a quarter [23.8%] students smoked shisha just for enjoyment and 12.1% thought that it is less harmful than cigarette smoking. Almost 20% students in colleges and universities are smoking shisha. Majority thinking shisha to be harmless or less harmful than cigarette smoking indicating that knowledge about adverse effects of shisha smoking is tremendously low in this educated youth of our country. Shisha should be subjected to the same regulation as cigarettes and other tobacco products and public should be educated about its harmful effects

Measles antibodies in children aged 5-7 years in Karachi

To assess the presence of antibodies in children aged between 5-7 years and correlate it with the vaccination and previous exposure to measles and also assess the need for a booster dose of vaccine. A serological cross-sectional survey was conducted in school children age 5-7 years, selected using convenient sampling technique from Saddar town, Karachi. Variables included age, gender, immunization status, past history of clinical measles and the age at time of disease. Measles specific IgG antibody titers were estimated by ELISA at PMRC, Shaikh Zayed Hospital, Lahore. Consent was obtained from guardians of the children. Study was analyzed on SPSS version 15. A total of 500 children were studied with 278[55%] aged between 6.1-7 years and equal male to female ratio. Of the total, 415[83%] children had received measles vaccination in the past amongst whom 68[16%] had history of suffering from measles in the past. IgG antibodies were found in 401[80%] with majority [58% n=231] aged between 6.1-7 years and more females showed protection [M:F ratio 43:57]. Despite receiving vaccination 42 children suffered from clinical measles between 1-7 years of age while another 22 suffered from measles before their first birthday. Protective antibodies were found in 80% school children while 20% were still un-protected with the current regime of measles vaccination. Vaccination strategy for measles needs to be reviewed for two dose vaccination schedule

Assessment of injection practices in public sector expanded programme of immunization clinics in Karachi

A safe injection is defined as one that does not harm the receipent, expose the health worker to avoidable risk or result in waste that is harmful to others. To assess injection practices in Public Sector Expanded Programme of Immunization [EPI] clinics in three urban towns of Karachi and see if these clinics meet the necessary requirement for staff competence, supply of vaccines, injection equipment and their disposal. This was a health centre based cross-sectional survey conducted in 49 Public Sector EPI clinics from June 2008 to March 2009. These clinics were selected using random table from three urban towns i.e. Saddar, Lyari and Jamshed town of Karachi. Variables of the study were socio-demographic characteristics of the vaccinators including their training qualifications, staff competence, information regarding supply of vaccines, injection equipment, puncture proof safety boxes, maintenance of cold chain and vaccination/medical waste disposal. WHO tool for the assessment of injection safety was used as a questionnaire for the collection of data and it was analyzed on computer package SPSS version 11. Data showed that 35 [71%] vaccinators were males and of the total, 38 [78%] vaccinators were less than 30 years of age, 45 [92%] were trained dispensers but also trained for vaccinations and 4 [8%] staff nurses. It was observed that in all clinics disposable syringes were used for BCG and AD syringes were used for DPT, Measles and Hepatitis vaccination. Adequate amount of vaccines, injection equipment and puncture proof safety boxes were available, cold chain for the preservation of vaccines was well maintained, used syringes/needles were not re-used, families did not bring their own syringes for vaccination. Recapping of used syringes was observed in 20% clinics, skin barrier [piece of gauze under the thumb] while breaking vaccine bottles was not practiced in any EPI clinic. All used syringes and needles were thrown in puncture proof safety boxes. There was no history of needle prick injuries among vaccinators. Policy Document for safe injection practice and waste disposal was not found in any EPI clinic and the staff was ignorant about it. The study concludes that in all 49 EPI clinics, injection practice was safe except its method of waste disposal, sufficient amount of vaccines, injection equipment, and puncture proof safety boxes were available and staffs of these clinics were well trained. The policy document for safe disposal of sharp waste/vaccination waste should be available at all clinics and hospitals and staff should be trained for its use

Effect of smoking on the health of family members in district South Karachi

The inhalation of tobacco smoke by non-smokers is termed as passive smoking or involuntary smoking, or smoke inhaled by non-smoker is also known as second hand smoke or environmental tobacco smoke, which produces acute and chronic effects on humans. To see the effects of passive smoking on respiratory illness and pulmonary functions in smoker and non-smoker family members[spouse and children only] in District South of Karachi and to estimate the magnitude of such illness, risk factors and association. This community based retrospective cohort study was conducted in two groups of individuals, 437 smoker and 405 non-smoker family members [spouse and children only] selected randomly using multi-stage sampling method from three towns of District South of Karachi. Data was collected through a questionnaire where information was sought from about various respiratory complaints like cough, chest tightness, allergy etc. Peak flow reading of sample persons [excluding children under 5] using Mini Bell Peak Flow Meter was measured. Data was analyzed by using SPSS version 10. The study showed that 100[23%] individuals living with smokers gave history of respiratory illness [allergic rhinitis, wheeze and chronic cough] as compared to 78[19%] [RR=1.2, 95% Confidence Interval CI: [0.9-1.5] non-smoker family members. This percentage was 24[20%], 54[23%] and 42[25%] in smoker families in Saddar, Lyari and Jamshed town as compared to 24[17%], 26[20%] and 28[21%] in non-smoker families in these respective towns. It was also found that respiratory illness in spouses, children 6 years and above and under 5 was 19[22%], 59[20%] and 25[36%] in smoker families as compared to 14[16%], 52[23%] and 31[33%] in non-smoker families. The study further showed that most common symptom of respiratory illness in children under 5 was wheeze and cough, in children 6 years and above it was allergic rhinitis and in spouse it was asthma. There was no significant difference in peak flow readings in the two groups of families. Long duration of exposure to passive smoking and sharing bedroom [smoker bedroom] were two risk factors for respiratory illness found statistically significant in this study. Although the relative risk of developing respiratory illness was more in smoker as compared to non-smoker families but this was not statistically significant. Respiratory illness was more in smoker families as compared to non-smoker families, long duration of exposure to passive smoking and sharing of bedroom [smoker bedroom] were two major risk factors for respiratory illness

Impact of media health campaign for primary health care among mothers in Karachi

To evaluate the knowledge, attitude and practice of media-based primary health care [i.e. Expanded Programme of Immunization, National Polio Day, oral rehydration therapy, breast feeding, contraceptive practices, modes of spread of hepatitis B, C, and HIV] among mothers with children under five years of age in an urban and a rural area of Karachi and changes in the same after community-based health education. Descriptive study. The study was conducted in two phases. In the first phase 600 mothers with children under five years of age were selected at random [300 urban and 300 rural] for the evaluation of knowledge, attitude and practice of media-based primary health care i.e. Expanded Programme of Immunization, National Polio Day, oral rehydration therapy, breast feeding, contraceptive practices and modes of spread of Hepatitis B, C and HIV. In the second phase, health education on the same components of primary health care was given by lady health workers of the area to the same community for one month. Data of 200 mothers [100 urban and 100 rural] was re-evaluated after three months, to find out if there was any change, in the same. All the three areas were given scores and grade. In this study, 58% were Sindhi speaking. The mean age of mothers was 29 years. Majority [91% urban and 45% rural mothers] had access to one or more media channels. The knowledge of media-based primary health care was poor [seore=10.09] among all mothers but attitude [score=8.07] and practice [score=11.09] was good for the same in more than 70% mothers in both communities. In the second phase of the study, it was found that the knowledge of primary health care had not improved but attitude and practice was good as observed earlier in both communities. Despite the national media based health education of Primary Health Care for decades, knowledge of primary health care was poor among mothers [urban and rural] but attitude and practice was good. Age and exposure to one or more media channels was found statistically significant for good attitude and practice of media based Primary Health Care in urban mothers whereas education of the mothers and exposure to one or more media channels was statistically significant for good knowledge, attitude and practice for the same in rural mothers. After health education, there was no improvement in knowledge of Primary Health Care among all mothers but attitude and practice was good in the majority of mothers in both communities as observed earlier

Practice of informed consent for the treatment of tuberculosis

To find out the practice of informed consent obtained and opinion for seeking it, from patients enrolled under direct observation treatment short course for the treatment of tuberculosis in three public sector chest clinics of Karachi and recommendations accordingly. A cross-sectional hospital based survey. This survey was conducted on 138 patients selected by systematic random sampling method from Lyari, Nazimabad and Malir chest clinics of Karachi. Independent variables of this study were age, gender, educational level, socio-economic status, place of residence and habits of the patients enrolled in direct observation treatment short course. Dependent variables of this study were information about the diagnosis of the disease, drug's dose, duration, intake method, its side effects and voluntary consent/approval for enrolling in the treatment regime prescribed by the health care provider. Inclusion criteria of this study were confirmed diagnosed case of tuberculosis according to criteria set by the said clinic, in the initial intensive phase of the treatment. Exclusion criteria were patients of tuberculosis given treatment on trial basis or patients in the continuation phase of treatment. It was found that 100% patients had no knowledge of informed consent. Patients were informed only verbally about their diagnosis, drugs required to treat their illness, its dose, duration, intake method and side effects by the health staff. Thirty percent patients were unable to recall which part of their body was affected by the disease; 90% remembered the duration of therapy without understanding the difference of initial intensive or continuation phase of the treatment, 57% were taking drugs in the presence of a responsible person; 48% recalled the reason for direct observation of drug intake and 72% were found to be in favor of seeking consent before enrolling themselves in direct observation treatment short course. In this study it was found that the practice of obtaining informed consent was below the standard level of international and ethical acceptability in the studied public sector chest clinics of Karachi

Waste disposal of government health-care facilities in urban area of Karachi - a KAP survey

Waste produced by health-care facilities can be broadly divided into two categories, non-infectious waste comprises 75% to 90% of the total waste, is non-risk health waste, can be disposed of like other waste in municipal landfills whereas infectious waste comprises10% to 25% consist of syringes, needles, chemicals, body parts, drugs etcs, needs treatment before disposal. To find out knowledge, attitude and practice of personnel involved in waste disposal of health-care facilities. Cross-sectional, hospital based survey conducted on 137 personnel involved in waste management of 68 randomly selected health-care facilities, in urban area of Karachi. Data of 9 hospitals, 11 maternity homes and 29 dispensaries, comprising 137 sanitary workers showed that knowledge of all [100%] workers about hospital waste management was poor whereas attitude of 38% and practice of only 2% was good. The study further showed that 24.5% health-care facilities disposed infectious and non-infectious waste without any treatment into public dustbins, 73.7% sanitary workers carry waste in open buckets for final disposal. None of the sanitary workers have undergone routine medical check-ups except when ill, 67.9% were not provided any protective equipment. It was also found that 96.4% were not interested in health education for the safe disposal of health-care facilities waste rather they were just doing their jobs for their earning. Infectious and non-infectious waste were collected together and disposed off in municipal landfills; while liquid waste is disposed off into the sewerage system without any treatment. The study showed that the knowledge, attitude and practice of personnel involved in health care facilities' waste management are extremely poor and proper facilities for management of hospital waste are almost non-existent in Karachi

Effects of community noise on urban population

Community noise or environmental noise is a noise produced by various activities except the one produced by industry. Its main sources are transportation [air, road and rail], construction, public works and human activities. The indoor source of community noise is ventilation system, neighbors, office machines, home appliances and leisure activities. Health effects caused by noise include hearing loss, sleep disturbance annoyance besides many others. To find out the range of effects of community noise [sleep, fatigue and irritation] on housewives of urban population and see its association with age, education and other factors. This was a Questionnaire based exploratory community based cross-sectional survey conducted on 252 housewives selected at random from six localities of three towns i.e. Saddar, Lyari and Jamshed town of Karachi. Data was analyzed on computer package SPSS version 10. In this study 39% housewives were immigrants from India [muhajir], 28% Sindhi, 14% Punjabi, 9% Pashto and 6% were other ethnic groups, mean age of housewives was 35.3 years. It was found that majority 81.01% of housewives were able to listen to television programs in normal volume while 16.0% were listening the same programs at high volume. Similarly most [83.11%] housewives were able to listen to telephonic conversation easily in their homes, 22[8.7%] housewives had been treated for ear problems in the past, 20 [7.9%] gave history of impaired hearing and 1 was using a hearing aid. About 95.2% housewives were speaking in normal volume and 54[21.4%] were using various kinds of medications for chronic medical illnesses. Three point Lickert scale was used to measure the effect of noise for sleep disturbance, fatigue and irritation and it was seen that 34.1% housewives experienced severe sleep disturbance, and about the same percentage 33.3% felts severe fatigue and 33.7% irritation due to noise. All these issues were more frequent in women age over 30 years then those aged less then 30 years. The most common cause of noise pollution was human activities. Housewives were avoiding exposure to noise by moving to quiet corners of their homes and keeping the doors and windows closed. The study showed that almost 33% housewives experienced severe sleep disturbances, fatigue and irritation due to community noise. The problem was more pronounced in housewives who were over 30 years of age. Commonest cause of community noise is the one produced by human activities followed by traffic noise

Media health campaign and its impact on knowledge, attitude and practices in the community

To find out the impact of different health campaign on knowledge, attitude and practices in the community. The media health campaigns included [1] Expanded Programme of Immunization, [2] Polio day, [3] Reproductive Health, [4] Breast Feeding and [5] Oral Rehydration Therapy. Yet another objective was to find out association of the variables studied so as to formulate recommendations based on the study results. Hospital based cross - sectional study conducted on 341 randomly selected mothers. Out patient of Gynaecology and Obstetric Department, Civil Hospital, Karachi. The impact on knowledge, attitude and practice of media health compaign was good on literate mothers i.e. 58.33%, 42.50% and 57.27% respectively. It was also good in mothers who had assess to media and its understanding i.e. 56.27%, 62.20% and 45.17% respectively. Literacy level, assess to one or all form of media and its understanding had significant impact on Knowledge, Attitude and Practice of mother as regard media health campaign. Statistically significant [p value < 0.05]