Impact Of An Educational Intervention On Knowledge Of Health Care Professionals Regarding Hiv-Aids In Lahore, Pakistan.

BACKGROUND: The Acquired Immunodeficiency Syndrome (AIDS) is a disease associated with stigmatization and discrimination worldwide. Even the health care professionals show negative attitude towards these patients. Worldwide need of health education is felt to address the gap in knowledge and attitude of health care professionals while dealing with patients suffering from this disease. METHODS: It was an educational interventional study, conducted in Fatima Memorial College of Medicine and Dentistry in 2015. The sample was collected through Non-Probability purposive technique, targeting both male and female health care professionals interested in attending health education sessions on HIV-AIDS. A self-administered questionnaire was used to assess the knowledge of thirty participants for pre- and post- intervention. RESULTS: The study participants included public health professionals (50%), dentists (16.7%) and clinical professionals (33.3%). A significant difference was observed in knowledge of health care professionals after intervention considering the important reasons as deteriorating moral value (p=0.045) for HIV epidemic in Pakistan, prevalence status of HIV/AIDS (p=0.046), awareness about the free voluntary counselling and testing (VCT) centres /services (p=0.019), interaction with an HIV positive person (p=0.01), discriminatory attitudes due to family member (p=0.032) and availability of services for people living with HIV in Pakistan (p=0.02). CONCLUSIONS: Health educational intervention is a powerful tool for increasing awareness of health care professionals.

Global burden of disease due to smokeless tobacco consumption in adults: analysis of data from 113 countries.

BACKGROUND: Smokeless tobacco is consumed in most countries in the world. In view of its widespread use and increasing awareness of the associated risks, there is a need for a detailed assessment of its impact on health. We present the first global estimates of the burden of disease due to consumption of smokeless tobacco by adults. METHODS: The burden attributable to smokeless tobacco use in adults was estimated as a proportion of the disability-adjusted life-years (DALYs) lost and deaths reported in the 2010 Global Burden of Disease study. We used the comparative risk assessment method, which evaluates changes in population health that result from modifying a population's exposure to a risk factor. Population exposure was extrapolated from country-specific prevalence of smokeless tobacco consumption, and changes in population health were estimated using disease-specific risk estimates (relative risks/odds ratios) associated with it. Country-specific prevalence estimates were obtained through systematically searching for all relevant studies. Disease-specific risks were estimated by conducting systematic reviews and meta-analyses based on epidemiological studies. RESULTS: We found adult smokeless tobacco consumption figures for 115 countries and estimated burden of disease figures for 113 of these countries. Our estimates indicate that in 2010, smokeless tobacco use led to 1.7 million DALYs lost and 62,283 deaths due to cancers of mouth, pharynx and oesophagus and, based on data from the benchmark 52 country INTERHEART study, 4.7 million DALYs lost and 204,309 deaths from ischaemic heart disease. Over 85 % of this burden was in South-East Asia. CONCLUSIONS: Smokeless tobacco results in considerable, potentially preventable, global morbidity and mortality from cancer; estimates in relation to ischaemic heart disease need to be interpreted with more caution, but nonetheless suggest that the likely burden of disease is also substantial. The World Health Organization needs to consider incorporating regulation of smokeless tobacco into its Framework Convention for Tobacco Control.

Competencies required from public health professionals by health based organisations and the role of academia.

OBJECTIVE: To examine the complementarity between what is taught in Masters of Public Health courses and real world expectations of practitioner organisations. METHODS: The online survey of academic institutions and health-related organisations from high- and low-/middle-income countries was conducted between May 16 and August 1, 2011. A combination of snowballing and purposive sampling was used to recruit the respondents. The survey questionnaire was devised using a validated competencies framework. RESULTS: A total of 45 organisations responded to the survey. They were evenly distributed between academic institutions and practitioner organisations, high-income countries and low/middle income ones. There was marked disparity in rating for 14 (22%) of the 63 competencies examined. Practitioner organisations valued practical competencies such as contracting and negotiation skills, whereas academic institutions favoured research-based elements such as critical thinking and data-collection skills. Practitioner organisations also rated less highly course modules such as the dissertation component and research methods. CONCLUSIONS: The lack of congruence between what is taught and what is required could result in public health practitioners being ill-prepared for the demands of the real world. Greater engagement between academic institutions and practitioner organisations is necessary to ensure that Masters of Public Health courses are appropriate and up-to-date.

Patient's perception, compliance to treatment and health education of antiretroviral therapy among HIV patients at a tertiary healthcare setting.

OBJECTIVE: To illustrate perceptions, compliance to treatment and satisfaction levels regarding health education services pertaining to the anti-retrovival therapy among HIV and AIDS patients. METHODS: The cross-sectional survey was carried out at the HIV Treatment Centre, Pakistan Institute of Medical Sciences (PIMS), Islamabad, from September 2009 to February 2010 in which patients were interviewed separately regarding their perceptions, compliance to treatment and satisfaction levels regarding health education services pertaining to the anti-retrovival therapy. All data collected was entered into SPSS version 15.0. The data was revalidated and analysed. RESULTS: One hundred and forty patients were interviewed; there were 99 (70.7%) males.. Of the total, 28 (20%) had no knowledge about the beneficial effects of the therapy, and 45 (32 %) ranked health education services extremely beneficial in understanding the anti-retrovival therapy. CONCLUSION: While a significant proportion of patients considered ART either somewhat beneficial or beneficial in treating their ailment, they were unclear about the impact of health education provided at the treatment centre and different forms of print media.

Public health and the undergraduate medical curriculum: are we preparing physicians for the 21st century?

OBJECTIVE: To investigate the adequacy of the undergraduate medical curriculum in Pakistan to address primary healthcare and public health needs of the community at national level. METHODS: The cross-sectional study used standardised pilot-tested instruments from January 12 to July 14, 2010. Stratified purposive sampling technique was employed to include public and private-sector medical colleges in the study. A total of 174 faculty members were interviewed at 11 medical colleges. Data entry and analysis was done using SPSS 17.0. RESULTS: Of the 174 faculty members, 93 (53%) were male. The age of the respondents ranged between 26 and 68 years (Mean: 43 +/- 9 years). Of the participants, 64 (37%) had worked in a primary healthcare facility at some point in their career. Various aspects of maternal, newborn and child health are not covered by the medical curriculum as reported by the faculty members. CONCLUSION: There is disconnection between academia, primary healthcare providers, policymakers and the regulators. The primary healthcare providers have inadequate representation in the curriculum design. There is a need to re-direct financial resources, medical education, and medical practitioners with a focus on addressing the needs of the rural areas.

To determine the probable causes of death in an urban slum community of Pakistan among adults 18 years and above by verbal autopsy.

OBJECTIVE: To identify the probable causes of deaths through verbal autopsy and identify the health problems prevalent in underprivileged and marginalized communities. METHODS: This was a cross-sectional survey conducted at the community of Nurpur Shahan (Urban Slum), Islamabad, Pakistan in January 2010. W.H.O validated questionnaire was used and 300 adults (age > 18 years) were assessed on their knowledge regarding death of their relatives. All data collected was entered into SPSS version 10.0. The data was re-validated and analyzed. RESULTS: Out of the three hundred deaths, 191(63.7%) were male and 109(36%) were female. One hundred and ninety one (63.7%) deaths were due to heart diseases, 69 (23%) due to accidents and 37 (12.3%) due to unknown causes. One hundred and thirty one of the deceased (43.7%) were issued death certificates. CONCLUSION: This study concludes that heart diseases are the most common cause of death in the urban slum community followed by accidents. A significant proportion of the deaths went unreported which suggests the need of record keeping of such deaths to enrich epidemiological purposes and health and safety interventions in such communities. Ways and means have to be searched to cater to the cardiac health care needs of the underprivileged and marginalized segments of the society.

Attitudes and perceived barriers of tertiary level health professionals towards incident reporting in Pakistan.

BACKGROUND: A limited framework of incident reporting exists in most of the health care system in Pakistan. This poses a risk to the patient population and therefore there is a need to find the causes behind the lack of such a system in healthcare settings in Pakistan. AIMS: To determine the attitudes and perceived barriers towards incident reporting among tertiary care health professionals in Pakistan MATERIALS AND METHODS: The study was done in Shifa International Hospitals and consisted of a questionnaire given to 217 randomly selected doctors and nurses. Mean ± SD of continuous variables and frequency (percentage %) of categorical variables are presented. Chi square statistical analysis was used to test the significance of association among doctors and nurses with various outcome variables (motivators to report, perceived barriers, preferred person to report and patient's outcome that influence reporting behaviors). P value of <0.05 was considered significant. Student doctors and student nurses were not included in the study. RESULTS: Unlike consultant, registrars, medical officers and nurses (more than 95% are willing to report), only 20% of house officers will report the incident happened through them. Sixty nine percent of doctors and 67% of nurses perceive 'administration sanction' as a common barrier to incident reporting. Sixty percent of doctors and 80% of nurses would prefer reporting to the head of the department. CONCLUSIONS: By giving immunity from administrative sanction, providing prompt feedback and assurance that the incident reporting will be used to make changes in the system, there is considerable willingness of doctors and nurses to take time out of their busy schedules to submit reports.