Chronic bronchitis and chronic obstructive pulmonary disease [COPD] among textile workers in Karachi, Pakistan

Objective: To determine the frequency and predictors of chronic bronchitis and COPD among textile workers in Karachi, Pakistan

Study Design: Cross-sectional survey

Place and Duration of Study: Karachi, Pakistan, from October to December 2009

Methodology: Male textile workers from 15 mills of Karachi were inducted. Data was collected using American Thoracic Society respiratory questionnaire [ATS-DLD-78-a] and spirometry

Results: Out of 372 participants, 29 [7.8%] workers had chronic bronchitis [4, 9.1% aged >/= 40 years] and 25 [6.7%] had COPD [12, 27.2% aged >/= 40 years]. Workers with chronic bronchitis had significantly decreased lung function compared to the healthy workers. Those reporting severe self-perceived dust exposure at work, >/= 10 pack years of smoking, uneducated, longer duration of work [>/= 11 years], and ever smokers were more likely to have chronic bronchitis or COPD. In the multivariate analyses, severe self-perceived dust exposure at work [AOR = 7.4; 95% CI: 1.9, 28.0], family history of respiratory illness/symptoms [AOR = 4.8; 95% CI: 1.1, 20.9] and lack of education [AOR = 4.2; 95% CI: 1.1, 16.9] were significant predictors of chronic bronchitis. Duration of work >/= 11 years [AOR = 5.5; 95% CI: 1.5, 19.7] and pack years of smoking >/= 10 years [AOR = 3.5; 95% CI: 1.1, 11.7] were strong predictors for COPD

Conclusion: There is a high frequency of chronic bronchitis and COPD among textile workers. Multiple important predictors for prevention are identified

Available interventions for prevention of cotton dust-associated lung diseases among textile workers

The authors reviewed literature on interventions for cotton dust-associated lung diseases among textile workers. Internet sources [PubMed, Cochrane Library, Google and Google Scholar] were accessed and interventions were categorized into: Engineering or administrative controls, or personal protective equipment [PPE]. Ten relevant articles were shortlisted, five related to engineering controls [pre-processing, bactericidal treatment of cotton, improved workplace design, machinery and dust control measures]. Administrative controls may involve setting standards, environmental surveillance, periodic medical examinations, and workers training. Although specific guidelines are available regarding the use of PPEs, but there was little literature on their effectiveness. It was concluded that there is a dearth of literature regarding field-based assessment of interventions for control of cotton dust associated respiratory diseases and the available studies primarily focus on pre-processing of cotton. This review highlights the uncertainties that remain; and recommends several areas for future research on respiratory health of textile workers

Strategies for prevention of road traffic injuries [RTIS] in pakistan: situational analysis

Road traffic injuries [RTIs] are one of the leading causes of death among productive age group. Using systems approach framework [SAP], current preventive strategies for RTI control were reviewed in Pakistan. A review of the literature was done using four international search engines. Only ten studies on preventive strategies for RTI stemming from Pakistan were found. The first Road Traffic Injuries Research Network [RTIRN] surveillance system for road traffic injuries was established in urban city [Karachi] in Pakistan has shown promise for injury control and should be scaled up to other cities. Enforcement of traffic laws on seat-belt and helmet wearing is poor. National Highway and Motorway Police Ordinance [2000] was one of the few legislative measure so far taken in Pakistan. Using SAP, efforts are required to implement interventions targeting human, vehicle design and also making environment safer for road users

Vaccine effectiveness and risk factors associated with measles among children presenting to the hospitals of Karachi, Pakistan

To determine the risk factors regarding guardian's practices associated with development of Measles and also find out effectiveness of Measles vaccine among children less than 12 years of age presenting to the hospitals of Karachi. Matched case control study. Multicenter surveillance was conducted in 11 public and private sector hospitals of Karachi from January 2011 to September 2012 in consultation with World Health Organization Measles Surveillance Cell. Cases were children aged less than 12 years with Measles presenting to the hospitals. Controls for cases were enrolled from the same hospitals without Measles, matched for age and gender. Studied variables were analyzed by multivariate conditional logistic regression analysis adjusted for age and gender. Measles cases were more likely to have mothers with 'lower education' [adjusted matched Odds Ratio or mOR: 3.2 [95% CI: 1.2 - 7.6], for < 5 years of schooling adjusted mOR: 2.2 [95% CI: 1.0 - 5.7] for 6 - 10 years of schooling]. Children with Measles were also more likely to be not given breast milk in initial 2 years of life [adjusted mOR: 2.6, 95% CI 1.0 - 7.0]. Cases were also more likely to have never received vaccination [adjusted mOR: 10.1, 95% CI 4.5 - 22.5] and having no other children vaccinated at home [adjusted mOR: 3, 95% CI 1.5 - 5.3]. Vaccine effectiveness for single dose was found to be 87.4 [95% CI: 76.1 - 93.4], while for two doses it was approximately 93% [95% CI: 86.2 - 96.6]. For Measles elimination, mother's education on breast feeding and appropriate weaning practices is required

Preventable Lifestyle Risk Factors for Non-Communicable Diseases in the Pakistan Adolescents Schools Study 1 (PASS-1) / 예방의학회지

OBJECTIVES: The rising burden of preventable risk factors for non-communicable diseases (NCDs) among adolescents is a major public health challenge worldwide. We identified the preventable risk factors for NCDs in adolescents. METHODS: In a school-based study, pre-tested structured questionnaires were completed by 414 adolescents (14 to 17 years) at six schools in three cities in Pakistan. The chi-squared test and adjusted odds ratio (aOR) with 95% confidence interval (CI) were calculated in a multinomial logistic regression analysis. RESULTS: Over 80% of the adolescents had unhealthy diets, and 54% were physically inactive. Most adolescents were exposed to passive smoking, and 14% were also current smokers. More than one-third of participants chewed betel nut, and one-quarter used oral tobacco. More girls were physically inactive (OR, 4.07; 95% CI, 2.69 to 6.17), whereas a greater proportion of boys were current smokers (OR, 2.17; 95% CI, 1.19 to 3.91), exposed to passive smoking (OR, 2.57; 95% CI, 1.72 to 3.83), and using betel nut (OR, 2.03; 95% CI, 1.34 to 3.06). Only 3.1% of the participants were without any preventable lifestyle risk factor for NCDs, and over 80% had > or =2 factors. Co-existence of risk factors was independently associated with fathers being blue-collar workers (aOR, 3.57; 95% CI, 1.07 to 11.92) and parents not treating their child fairly (aOR, 5.05; 95% CI, 1.29 to 19.78). CONCLUSIONS: Most of the adolescents studied had preventable risk factors for NCDs. These results warrant comprehensive and integrated interventions to prevent lifestyle risk factors, and parents are front-line stakeholders.

Coverage and predictors of vaccination among children of 1-4 years of age in a rural sub-district of Sindh

To estimate the proportion of children 1-4 years of age vaccinated in the first year of their life and determine socio-demographic factors associated with vaccination in the rural sub-district Khairpur, Sindh, Pakistan. Cross-sectional study. The study was conducted in 9 Union Councils of sub-district Gambat, district Khairpur, Sindh, from August to October 2008. A questionnaire based representative multi-stage cluster survey was conducted. A total of 549 children aged 1-4 years were assessed for coverage and predictors of vaccination. Univariate and multivariate analysis was done using logistic regression to determine the unadjusted and adjusted relationship between socio-demographic predictor and outcome [vaccination status]. The coverage for complete vaccination was 71.9% [95%CI=68.1%-75.7%]. Educational level of mother [p=0.042], father [p=0.001] and child birth at hospital [p=0.006] were significantly associated with the vaccination status. Mother's educational level of intermediate and above was the strongest predictor [OR=12.19, 95%CI=1.57-94.3] for vaccination. Education of parents, particularly mother's education was important determinant of vaccination status of the children. In addition, distance from taluka health facility and misconception of parents were among the main reasons of not getting the children vaccinated. There is a need to educate the parents especially mothers about the importance of vaccination and organize EPI services at Basic Health Unit level to improve the vaccination coverage in rural areas of Pakistan

Frequency of hypercalcemia in patients of multiple myeloma in Karachi

To determine the frequency of hypercalcemia and skeletal abnormalities in multiple myeloma patients. Cross-sectional study. Study was conducted from January 1999 to July 2004 at the Aga Khan University Hospital [AKUH], a tertiary care hospital in Karachi, Pakistan. Medical records of all the diagnosed cases of multiple myeloma at their presentation to hospital were reviewed. The frequency of hypercalcemia and skeletal lesions was calculated. Independent sample test and chi-square test as appropriate, was applied to calculate the difference in parameters between normocalcemic and hypercalcemic patients. Sixty-seven percent patients were males and 33% were females. The mean age was 61 +/- 11 years. Of the 105 study patients, 51.2% had hypercalcemia [S.Ca >2.64 mmol/l]. Radiological survey showed different levels of skeletal involvement in 89.8% of patients. It was also found that 94.3% of hypercalcemic patients had skeletal lesions, out of which 20% had advanced [stage 3] bone lesions. Also noteworthy was the fact that 84.6% of normocalcemic patients had mild /moderate [stage 1 and 2] skeletal lesions. There was higher frequency of hypercalcemia in multiple myeloma patients in this series. Skeletal lesions were present in significant number of these patients. It is suggested that patients with multiple myeloma should be checked for serum corrected calcium and radiological surveys be included in routine workup for early detection and prevention of hypercalcemia and skeletal lesions

Comparison of job satisfaction and stress among male and female doctors in teaching hospitals of Karachi

Background: Job dissatisfaction and stress among doctors affect the quality of health care. We assessed the levels of satisfaction for workplace characteristics and job stress among doctors of three teaching hospitals in Karachi

Methods: A postal-survey was conducted between May to June 2002. Satisfaction for workplace characteristics and stress were inquired and graded by Likert scale [1=very low to 5= very high]. Questions were also asked about its affect on their lives. In order to calculate the differences in means of job satisfaction and stress score by sex of doctors, chi-square and t-test with 95% confidence interval [CI] were used. Out of 270 doctors approached conveniently, 189 [70%] responded and 182 questionnaires were found complete for analysis

Results: Majority [68%] of the doctors was not satisfied with their jobs. Overall, the mean scores for satisfaction were low for workplace characteristics. Lowest scores were found for pay and benefits 2.12 [SE 0.8], safety and security 2.15 [SE 0.8] and workload 2.69 [SE 0.9]. Female doctors had significantly lower satisfaction about workload [mean job satisfaction score difference = 0.60; 95%CI, 0.24-0.97], relation with colleagues [mean job satisfaction score difference = 0.49; 95%CI, 0.11-0.87] and autonomy [mean job satisfaction score difference = 0.45; 95%CI, 0.07-0.82] as compared to their male counterparts. Overall, 48% of doctors graded job stress from high to very high levels

Conclusion: Majority of doctors working at these teaching hospitals of Karachi had poor satisfaction level for workplace characteristics and higher levels of job stress. This suggests that immediate steps should be taken for their control and management. This study invites further research to explore, implement and evaluate intervention strategies for prevention of stress and improvement in job satisfaction

Determinants of therapeutic injection overuse among communities in Sindh, Pakistan

Unsafe injections including reuse of disposable syringe is very common in developing countries including Pakistan. Healthcare providers unnecessarily prescribe injections to patients suggesting that patients ask for injections. We conducted this qualitative study to determine the reasons of overuse of therapeutic injections by the communities in Sindh province of Pakistan. Using field-tested focus group guides of World Health Organization, eighteen focus group discussions [FGDs] were conducted with community members of rural Sindh, peri-urban and urban Karachi during January-February 2001. Injections are overused in Sindh, Pakistan, because patients prefer them, believing that they provide quick relief, and perceive them as a therapeutic norm and standard practice. According to community members initiative of prescription of injections are taken by doctors. Overuse of injections is of particular concern as patients are not aware of the risks associated with reuse of injection equipment. Doctors and television are considered as the most credible source of providing healthcare information. There is a need to educate communities regarding rationale use of therapeutic injections. Open discussion and frequent communication between doctors and patient should be encouraged. Mass media could play a vital role in educating communities about risks of unsafe injections