Health care utilization for diarrhea and fever in 4 urban slums in Karachi

To estimate the fraction of fever and diarrhea patients making use of private practitioners, self-treatment, hospital care, drug vendors, community health centers and traditional healers. A cross-sectional survey. Four slums in and around Karachi during October and November, 2001. A sample of 1842 households was selected with probability proportional to size of the slum. The household head or a representative was asked regarding the treatment providers for diarrhea and cases of fever persistent for 3 days or more. Only households with an actual case of fever and/or diarrhea were included in the analysis. The study found that more than half of diarrhea and fever cases are seen by private practitioners. Self medication with medicines available in the home or specifically purchased for the disease episode from a drug vendor combined provides 13% to 18% of health care. Only between 11% and 13% of patients are seen by the public sector, hospitals and community health centers. There was no significant difference between the choice of health care provider for diarrhea and fever cases. In this survey, the majority of fever and diarrhea patients presented first to private practitioners and not to drug vendors or the public sector. Successful passive surveillance of febrile or diarrheal illness in these communities has to integrate private practitioners

Status Epilepticus in children: a five-year experience at Aga Khan University Hospital

Status epilepticus is an under diagnosed entity in Pakistan. It is a potentially reversible condition but has a high mortality, if it is not recognized and managed on time. The purpose of this study was to determine the clinical profile and the relationship of mortality of status epilepticus with its known risk factors. This was a retrospective study. Medical records of all the patients admitted in the last five years [19982002] with a diagnosis of status epilepticus [ICDcode 345.30, 345.31] were reviewed. Data was recorded on a Performa and analyzed by using the statistical programme SPSS, chi square and Fischer exact test. The total number of patients were twenty-four. Sixteen patients were males [66.7%]. Mean age was fiftyeight months and mean duration of hospital stay 5.5 days [range 2 to 22 days]. Eight patients were diagnosed to have epilepsy. Four [16.7%] had a previous history of status epilepticus. Three patients presented with status epilepticus for the first time without any previous history of seizures. Ten patients required midazolam infusion [41.7%] and out of these 3 [12.5%] were also given thiopentone infusion to control the seizures. Nine patients were shifted to the ICU for ventilation and control of seizures. Mortality in our study was 25%. Risk factors for mortality included age less than or equal to one year, abnormal MRI, type of the status epilepticus and the total duration of status epilepticus. No significant relationship was found with any of the known risk factors Status epilepticus is a neurological emergency. A very high mortality was seen in our study. No risk factors were identified for this high mortality

Written clinical scenarios as a method to study prescribing behavior of physicians

Prescribing behavior of physicians attending a continuous medical education session at the Aga Khan University Hospital were studied by administering a questionnaire with written clinical scenarios. Sixty physicians returned the questionnaire. Five to fourteen physicians did not write the prescriptions for one or more diseases. Eleven to forty-nine physicians wrote prescriptions of generic nature without mentioning the specific drugs dose or duration. It is concluded that prescription writing for a given clinical scenario may not be a good method to study the prescribing behavior of physicians

Self-reported feeding advice by physicians for common childhood lllnesses

A nutritious diet is important for recovery during illnesses. Dietary advice by physicians and consumption of food by the patients are often based upon their hot and cold concepts and beliefs about various foods rather than on scientific basis. To look at the food-advising behaviour of physicians during illnesses and to know the maternal concepts about various foods being hot or cold. A questionnaire was served to the physicians participating in a continuous medical education session held at the Aga Khan University and Hospital, asking them to write the foods they advise or restrict during different illnesses such as fever, jaundice etc. Mothers of sick children suffering from diarrhea and other illnesses were also interviewed to know their concepts about various foods. Six [10%] out of sixty physicians believed in hot and cold concepts of the food. A variety of common foods were either restricted or strongly recommended by 10% to 50% of these physicians without any scientific basis, 23% physicians restricted fatty foods in jaundice, 17% physicians restricted in cough and cold. Although the interviewed mothers believed in hot-cold concepts of food but 55-63% of them were not sure what is meant by hot or cold food. In spite of that 70-80% of these mothers classified chicken, meat, egg, brinjal, masoor and mangoes are hot foods and rice, yogurt, moong, banana and orange as cold foods. Hot-Cold concept of food exists not only in mothers but also in physicians. Proper education regarding food intake is mandatory for both mothers and physicians to ascertain adequate intake of calories during sickness

Evaluation of objective structural clinical examination [OSCE] for undergraduate students at the Aga Khan university, Karachi

In order to assess the effectiveness of objective structured clinical examination [OSCE] for undergraduate students, a study was done at the Department of Paediatrics of the Aga Khan University by comparing it with other traditional examinations i.e., continuous assessment [CAT], multiple choice questions [MCQs] and oral examination [viva]. The marks obtained by 139 students of class of 1996 to class of 1998 in their end-of-term examinations in CAT, OSCE, MCQs and viva were compared. The marks obtained were 78 +/- 5.4 in OSCE, 64.2 +/- 4 in CAT, 73.1 +/- 10.3 in MCQs and 62.9 +/- 12.6 in viva. The coefficient of correlation [r value] of OSCE with CAT was 0.29 [95% C.I. 0.13-0.32], with MCQs 0.16 [95% C.I. 0.01-0.32] and with viva 0.32 [95% C.I. 0.17-0.47]. Though 7% students had failed in MCQs, 27% failed in viva and none failed in OSCE [minimum passing marks were 55%]. It is recommended that the passing marks for OSCE should be higher than for MCQs or viva

Lactose intolerance in persistent diarrhea during childhood: the role of a traditional rice-lentil [khitchri] and yogurt diet in nutritional management

Lactose intolerance is frequently encountered in children with persistent diarrhoea [PD]. Selection of an appropriate milk-based formulation is a major management problem in the developing world. In a consecutive series of studies, we evaluated the role of feeding a traditional rice-lentil [khitchri] diet alone [KY] or in combination with either soy formula [KY-Soy] a dilute buffalo milk [KY-B], in children [age 6 months-3 years] with PD. Serial observations of stool output, caloric intake and weight gain of these children over a 14 day period indicated satisfactory tolerance of the KY diet with adequate weight gain. The weight gain and stool output was however higher in lactose intolerant children, with the worst results seen with K-Y and buffalo milk combination. While lactose intolerant children with PD do have higher. rates of therapeutic failure, our data indicates that a traditional diet and yogurt combination can be used satisfactorily for nutritional rehabilitation in over 80% of such children

Pediatric prescribing in Karachi

To assess amount of drug overuse we studied drug prescribing for common childhood problems by 65 general practitioners [GPs] and 29 paediatricians. A total of 2433 encounters between GPs or paediatricians and children under five years of age were observed. The presenting complaints were fever in 18%, cough in 9%, both fever and cough in 21%, vomiting in 20% and diarrhoea in 41% of encounters. Antibacterials were prescribed in 49% of encounters, analgesics and antipyretics in 29%, antiemetics in 8% and injectables in 15%. Antidiarrhoeals were prescribed in 41% encounters with children reported to have diarrhoea. Ampicillin and cotrimoxazole were the two common antibacterials prescribed by both GPs and paediatricians. Antibacterials were prescribed in significantly larger number of encounters with GPs than in those with paediatricians. Mean encounter time of patients with GPs was 3.4 +/- 2.7 minutes and with paediatricians 9.7 +/- 4.1 minutes

Aspergillosis presenting as superior vena-caval obstruction: a case report

Aspergillosis is not an uncommon infection both in immunocompromized and immunocompetent patients 1 2. Despite it being more common in immunocompromized patients suffering from diseases like leukemia and other malignancies, systemic and pulmonary aspergillosis has been reported in immunocompetent patients also 3 4. Pulmonary aspergillosis often presents as respiratory infection unresponsive to antibiotics and diagnosed by isolation of fungus on culture of bronchial aspirates. We are reporting a case of ten year old girl having intrathoracic aspergillosis who presented with symptoms of superior vena caval obstruction

Awareness of national ARI control program among practitioners in Karachi and their prescribing behavior for fever in children under five years of age

To see awareness on National ARI Control Program among general practitioners [GPs] and paediatricians in Karachi and to describe their self reported and observed prescribing practice for febrile children under five years of age. Design: Observation of practice of selected practitioners by trained observers and their interview by one of the authors. Setting: clinics of GPs and paediatricians practicing in Karachi. Subjects: Sixty seven GPs and twenty seven paediatricans. Main outcome measures: Number of practitioners aware of National ARI control programme, self reported and observed prescribing of antibiotics for febrile children. Sixty two GPs and five paediatricians had never heard of National ARI Control Programme. 31 [46%] GPs and 3 [11%] paediatricians reported to prescribe antibiotics for febrile children without any focus of infection. Parental demand and expansive tests were the two main reasons quated for prescribing antibiotics. Observation of practice revealed that antibiotics were prescribed in 59% of encounters with GPs and 49% encounters with paediatricions for febrile children under five years of age. Practitioners in Karachi are not aware of National ARI Control Programme Pakistan. Antibiotics are often prescribed for febrile children without clinical evidence of bacterial infection