Frequency of anemia in pregnancy and its association with socio-demographic factors in women visiting a tertiary care hospital in Rawalpindi

Objective: The objective was to find out the frequency of anemia during pregnancy and its association with the different socio-economic factors

Study Design: A descriptive cross-sectional study

Place and Duration of Study: District headquarter hospital Rawalpindi, from September-November 2015

Material and Methods: The pre-diagnosed 196 pregnant anemic women were included in the study. Grand multipara pregnant women, anemia due to bleeding disorders and having chronic illnesses were excluded from the study. The pretested questionnaire along with Pakistan Social Living Standards Measurements [PSLM] prepared poverty score card was used. The study variables age, maternal education, abortions, parity and poverty were studied. The data collected were analyzed through SPSS 20.0 and Chi-square test was used to find out association between demographic variables and severity of anemia at a significance level of p< 0.05

Results: The frequency of anemia in the sample [n=196] observed as mild, moderate and severe +was 34.2% [67], 64.3% [126] and 1.5% [3] respectively. The mean [SD] hemoglobin recorded was 8.9 +/- 0.9g/dl [range=6.2- 10.9g/dl]. The mean [SD] age in the sample was 23.7+/- 4.2 years [range=17-40 years] while 92% [182] of the subjects were below poverty line. Majority of the pregnant anemic women were illiterate constituting 56.6% [111] of the total sample

Conclusion: There was a strong association between poverty, illiteracy, previous history of abortions, age and severity of anemia. Education, poverty, illiteracy, access to fortified sources, iron supplementation, deworming, and access to clean drinking water and sanitation, insecticides infections, inadequate nutrient intake all factors must be improved for success of anemia prevention strategies in developing countries like Pakistan

Comparison of quality of life of cancer patients undergoing chemotherapy in a tertiary care hospital, Rawalpindi

Objective: To compare the Quality of Life [QOL] of cancer patients at different chemotherapy [CT] cycles

Study Design: Cross sectional analytical

Place and Duration of Study: Tertiary Care Hospital, Rawalpindi

Material and Methods: Study was conducted in a Tertiary Care Hospital in Rawalpindi. Non-probability purposive sampling technique was used to select a sample of 50 cancer patients undergoing chemotherapy. The patients were grouped in two on the basis of number of chemotherapy cycles, those having 2 CT cycles. After taking informed consent the data was collected using the European Quality of Life Questionnaire [EORTC QLQ-C30] to measure QOL in the patients. Data was entered and analyzed using SPSS version 21. Baseline distinctiveness [demographic and HRQOL] was summarized by descriptive statistics. Mean and standard deviation of individual items in the two scales was calculated in two groups and statistical inference was drawn using Independent T test between the two groups, p value of

Results: The study sample comprised of 31 males and 19 females. Mean age of participants was 43.88 +/- 12.72 [Range 18-70] with the most common age group being 41-50 years. There was a male preponderance [63%] and majority 36% were doing house hold work. Among the 50 subjects, 32% were suffering from lung carcinoma, 26% had genitourinary cancer, 24% had cancer of the oral cavity while 18% had carcinoma breast. As per the QOL scoring, in the Global Health Scale [GHS] the four items of symptom scale that is fatigue [p=0.02], nausea [p=0.00], pain [p=0.01] and appetite loss [0.03] attained a significant difference. Nevertheless, a significant difference was found between the level of QOL in patients with 2 cycles [p< 0.001]. In the functional scale items only role functioning was significant

Conclusion: This study suggests that the quality of life is related to chemotherapy cycles. Although QOL scoring system did not show significant improvement in all areas of our study, but the obtained results indicated a significant association between QOL and number of CT cycles in cancer patients

Healthcare in Pakistan-A systems perspective

Health system in Pakistan has witnessed evolution and dates back to the medieval, traditional health care, health for all approach, primary health care approach and health systems strengthening approach for better health outcomes. The main objectives of health system are improvement in health, fairness in distribution of risk and finances and responsiveness to the non medical needs of the population. With decreasing expenditure on health care, booming private health sector and flourishing pharmaceutical industry, government can only reduce catastrophic health expenditures by the poor and impoverished through an efficient, effective, accessible and responsive public health system. Inter sectoral collaboration, community participation, social protection, equitable distribution of resources, people centric health policy, health work force development, evidence based health information system and quality assurance of essential medicines will strengthen health system in Pakistan

Awareness among butchers regarding crimean congo hemorrhagic fever in rawalpindi cantt

Objective: To study the awareness of butchers regarding Crimean-Congo Haemorrhagic fever [CCHF] in relation to their education level

Study Design: Cross sectional survey

Place and Duration of Study: Conducted from January to March 2015 in Qasaiee Chowk and Tench Bhatta markets of ward 5 of Rawalpindi cantt

Material and Methods: Sample size was calculated using G-Power sample size calculator at 95% confidence level with an effect size of 0.38. Ward 5 of Rawalpindi cantt was chosen through lottery method and all available professional butchers in the markets were interviewed with informed consent

A pre-tested 14 items closed ended questionnaire was used and interview was conducted by a well briefed team of medical students. Data was analyzed using SPSS version 20.0

Results: Results showed that only 14 [9.33%] butchers knew the name of CCHF. Out of these 10 [71.4%] had some form of formal education

All 14 of these had heard about CCHF from television proving it to be an important medium of information. However none of the 150 respondents took any preventive measure against CCHF

Conclusion: Our study concluded that the level of awareness regarding CCHF in butchers is very low and no preventive measures are taken by them. Also the level of education has a significant effect on the awareness

Mental health challenges and solutions in low and middle income countries -a health system perspective

There are many gaps in establishing an active mental health system in low and middle income countries. In this article we have reviewed multiple studies focusing low and middle income countries to explore the barriers, challenges, solutions and opportunities regarding improvement of mental health system in these countries. Literature emphasizes political with good financing ,effective policies ,multi-sartorial and holistic approach encompassing linkage between health and non-health sectors leading to equitable access of mental health to populations in low and middle income countries

Regular breakfast consumption associated with high intelligence quotient: myth or reality?

To find the frequency of regular breakfast consumption among Pakistani teenagers while the other objective was to find out the association between breakfast consumers [BC] and intelligence quotient [IQ]. This comparative cross sectional study was conducted on 102 students of a Public School Rawalpindi from August 2013 to January 2014. Participants were categorised into two groups i.e. regular breakfast consumers [RBC] and irregular breakfast consumers [IBC] according to their breakfast habits. A standardized questionnaire of Wechsler Intelligence Scale for Childrenwas used for IQ assessment. Data was then entered and analysed in SPSS version 20. Out of the 102 individuals with mean age 17.17 +/- 0.631, 58 [56.9%] were females and 44 [43.1%] were males. There were 63 [61.8%] RBC while 39 [38.2%] were IBC. Among RBC there were 7 [6.9%] in challenged, 5 [4.9%] were below average, 33 [32.4%] in average group, 14 [13.7%] in above average and 4 [3.9%] in gifted group. While among IBC, there was 1 [1%] among the severely challenged, 3 [2.9%] in challenged, 8 [7.8%] in below average, 22 [21.6%] in average group, 4 [3.9%] in above average and 1 [1%] in gifted group. There was no significant association found between breakfast intake and IQ level among students [p=0.98]. More than half of the students were having regular breakfast. There was no significant association found among breakfast consumers and IQ. However the IQ score was more among RBC as compared to IBC

Comparison of rapid and conventional corneal collagen cross linking in patients having Keratoconus

To compare the effect of rapid and conventional methods of corneal collagen cross linking [CXL] on visual acuity [VA] and corneal parameters in Keratoconus. Randomized control trial. Armed Forces Institute of Ophthalmology, Feb 2012 to Apr 2013. Thirty patients, fifteen in each group, were randomized by non probability consecutive sampling to rapid or conventional CXL group. Pre and post operative [6 months] best corrected visual acuity [BCVA], anterior and posterior keratometric [K] values and pachymetry were recorded. Intra and inter group comparison of all these parameters were statistically analyzed. All thrty patients showed either stabilization or improvement in BCVA. Both groups showed comparable results in terms of improvement BCVA [p = 0.682], reduction in the corneal thickness at thinnest point [p = 0.062], anterior flat and steep K [p = 0.633, p = 0.443 respectively] and posterior flat and steep K values [p = 0.130, p = 0.068] at six months duration. Conventional and rapid methods of CXL are comparable in terms of their effect on VA and corneal parameters

Anorexia nervosa among teenage girls:emerging or prevalent?

Objectives: To find out frequency of anorexia nervosa [AN] among teenage girls [TG] and to find out the knowledge and practice regarding anorexia nervosa among teenage girls

Methods: A cross sectional study was conducted at higher secondary public school, Rawalpindi from June 2013 till December 2013. A sample of 100 female students of the age group 13-19 years were inducted by systematic sampling technique. Mixed pretested questionnaire was filled after informed verbal consent. Data was entered and analysed using SPSS version 20

Results: Participants mean age was 15.81 +/- 1.323 years. Mean weight, mean height and mean body mass index were found to be 50.34 +/- 10.445 kg, 160.14 +/- 7.846 cm and 19.675 +/- 4.1477 kg/m2 respectively. Anorexia nervosa was found in 42 [42%] teenage girls while 58 [58%] were not having anorexia nervosa. Sufficient knowledge and positive practice were found to be present in 57 [57%] and 49 [49%] respectively. Statistically no significant association was found between KP and AN [p=0.73]

Conclusion: Anorexia nervosa is an emerging health concern in Pakistan. Anorexia prevalent behaviour was observed in almost half of the teenage girls

Association of vitamin d deficiency with tuberculosis in adult patients reporting to a tertiary care hospital of Rawalpindi

To compare the mean vitamin D levels in pulmonary tuberculosis patients and healthy controls and to find out the frequency and association of vitamin D deficiency in patients with tuberculosis. Study Design: Case control study. Pulmonology department, Military Hospital Rawalpindi from Jan 2013 to Dec 2013. Patients and Methods: Fifty two incident outdoor pulmonary tuberculosis patients were selected with 52 age and gender matched controls. Tuberculosis was diagnosed by the sputum examination through gene Xpert technique from National Institute of Health [NIH], Islamabad. Serum 25-hydroxvitamin D level <50 nmol/1 [electrochemiluminescene assay] was taken as vitamin D deficiency. Mean vitamin D was much lower [20.688 +/- 14.065 nmol/1] in cases as compared to the controls [57.917 +/- 18.197 nmol/1] which was statistically significant [p<0.001]. Forty nine [94%] cases and 18 [34.6%] controls were found to be vitamin D deficient. [Odd's Ratio = 3.8, 95% CI = 2.423-5.999, p>0.00l]. Sensitive tuberculosis patients had mean vit D levels of 18.55 +/- 9.99 nmol/1 while multi-drug resistant tuberculosis patients had the mean serum vitamin D levels of 22.38 +/- 16.60 nmol/1 but the difference was statistically insignificant [p > 0.05]. Significant vitamin D deficiency was seen in newly diagnosed TB patients. It was found that vitamin D deficiency is associated with tuberculosis, but its causal role has not been established

Type A and Type B personality among undergraduate medical students: need for psychosocial rehabilitation

To find out the frequency of Type A and Type B personality among the students of Undergraduate Medical College. To find association between student year and personality type. A descriptive cross sectional study was conducted at Undergraduate Medical College, Rawalpindi from Sept. 2012 till Feb. 2013. Among 500 sample size, 100 students from each MBBS year were inducted by probability systematic sampling technique. After taking consent from the institute and students, data was collected on BECK anxiety inventory [BAI] questionnaire. According to BAI scale, students were identified as Type A or B personality. Data was analyzed using SPSS version 20. To find association between student year and personality type, Chi-square test of significance with 95% confidence level was used. First, second, third, fourth and final year students had 5 [1%], 6 [1.2%], 11 [2.2%], 13 [2.6%] and 19 [3.8%] type A personality respectively. Among all the study participants [n=500], total number of type A was 54 [10.8%] and type B personality students were 446 [89.2%]. Type A personality was 29 [11.6%] in female students [n=250] and 25 [10%] in male students [n=250]. Association between student year and personality type was significant [p=0.010] at 95% confidence level. Type A personality students existed in every class and there was a gradual increase in the number of type A personality students from 1[st] year to final year in an undergraduate medical college of Rawalpindi. Significant association was observed in student year and type A personality

Health management information system in district health care

To study the existing Health Management Information System being practiced in Basic Health Unit and recommend measures to improve. Descriptive cross sectional study. Basic health unit. This study was conducted in Basic Health Units of Tehsil Taxilla from January to December 2008 in district Rawalpindi. Patients and Subjects were the staff working at basic health units dealing with data entry. Structured questionnaire was developed and data was collected by interview. The findings of the study revealed that although timeliness of reporting was 100% but only 70% were accurate. It was found out that 84% of the information was being analysed and 64% of the reporting facilities were getting feedback. There was no use of the information for decision making. The results of the study demonstrated that the timeliness of reporting is up to the mark but the processing of the information conveyed by the basic health unit on health management information system indicators is not being carried out at the executive district officer health office Rawalpindi. Thus not making any use of the information available for planning health activities and decision making