Impact of hand hygiene intervention on hand washing ability of school-aged children.

BACKGROUND: To assess the current knowledge related to hand washing and efficiency of intervention on hand washing techniques amongst school children. METHODOLOGY: A randomized control trial was conducted amongst class II students of a private school in Korangi, Karachi. Pre-intervention assessment including baseline knowledge and observed practices of hand washing in comparison with World Health Organization (WHO) standard hand washing techniques was done. This was followed by education and demonstration of proper hand washing steps by principal investigator utilizing visual aids. Participants were then randomized into two group: Group A (education only group) and Group B (education along with glow gel application group). First post-intervention assessment was conducted on same day where both groups were observed for the hand washing steps and scored for hand washing technique. In addition, participants of group B were shown germs under Ultraviolet (UV) light. School was revisited after 1 week later and participants were reassessed for their hand washing technique along with cleanliness grade after applying glow gel and observing under UV light. Data was entered and analyzed using SPSS version 21.0. RESULT: No significant differences were found in median hand washing scores pre-intervention between both the groups (Group A vs B: 4 vs 5, P value = 0.659), while significant improvement in median hand washing scores was seen post intervention in group B as compared to group A (7 vs 6, P value = 0.011). However, no significant differences were seen in median hand washing scores at follow-up between both the groups (Group A vs B: 9 vs 8.5, P value = 0.715) but a significant improvement was observed in both the groups in the hand washing practices from baseline (P-value = 0.000). On the contrary, no significant differences were found in median cleanliness grade between both the groups (Median for both the groups was 5, P value = 0.695). CONCLUSIONS: Hand washing education utilizing various aids is an effective method to improve children's hand washing capability. This short-term intervention was effective even in absence of glow gel, but no cleanliness of hands was observed in both the groups.

Parental perception on screen time and psychological distress among young children.

OBJECTIVE: We aimed to assess the parent-reported screen time of children, identify the perceived risk factors for increased screen time and its relationship to psychological distress in children. MATERIALS AND METHOD: A cross sectional study was conducted at a teaching hospital in Karachi, Pakistan. A total of 230 employees from medical and non-medical departments were included. Participants were employees with child/children ages 4-12 year who consented to participate in the study, we included 135 fathers and 91 mothers. The questionnaire included (i) demographic data (ii) Media history exam form and (iii) parent reported strength and difficult questionnaire (SDQ). RESULT: The average daily screen time reported was 2.5 (1.5-5) hour for boys and 2 (1-4) hour for girls. Preschoolers had greater screen time as compared to school-aged children (Median (IQR): 3 (1.5-5.6) vs 2 (1-4), P = 0.46). The children owned devices with approximately equal distribution of preschoolers and school-aged children (19 (27.1%) and 48 (30%), P = 0.661 respectively). Emotional score was found higher in school-aged group in comparison to preschoolers (p = 0.036). Moreover, mother screen time and number of devices owned by a child were found to be positively associated with child's screen time. CONCLUSION: We conclude that as we are embracing the digital age providing a tech free zone to children is virtually impossible. Children screen time related activities in our part of the world exceeds the limitation. Parental awareness and co-viewing screen with their children are essential to avoid media related behavior problems.

Self-medication among people visiting outpatient clinics of a Tertiary care hospital, Karachi.

BACKGROUND AND AIM: "Self-medication" is the self-use of medicines for treatment of illnesses. Inappropriate use of medicines without prescription leads to unwanted adverse effects, harmful drug interactions, and antibiotic resistance which is an emerging concern in developing countries due to escalating burden of infectious diseases. This study aims at identifying the frequency and contributing factors of self-medication, nature of illness, and types of medicines used without doctor's prescription. MATERIAL AND METHODS: This cross sectional study was conducted at Indus Hospital Karachi between March 2017 and December 2018. Two hundred and forty people of any age visiting the outpatient clinics of the Indus hospital consenting to participate were included. Whereas all clinicians including medical officers, specialists and consultants were excluded from the study. RESULTS: Three-fifth (n = 147; 61.3%) of the participants reported that they did self-medication either for themselves or for their children in the past one year. The most common symptoms for which self-medication was done were fever (n = 82, 55.8%), cough/cold (n = 38; 25.8%) or diarrhea (n = 22; 15.0%). Out of which, 122 (83%) did self-medication based on their previous experience, 18 (12.2%) used previous doctor's prescriptions, whereas 22 (15%) reported that other people advised them. Education, presence of unused medicines at home, and those who have heard of antibiotic were found to be the significant risk factors associated with self-medication. CONCLUSION: Among Pakistani population, the frequency of self-medication is very high, with most people practicing self-medication on the basis of their previous experiences. It puts them at risk of experiencing adverse reactions and most importantly antibiotic resistance.

Predictive factors for acquiring HCV infection in the population residing in high endemic, resource-limited settings.

BACKGROUND: In a country like Pakistan, a high prevalence of HCV persists due to a lack of awareness among the masses and the absence of adequate medical facilities in less privileged areas. Therefore, this study aimed to develop a risk-based screening tool based on the identification of predictive factors for HCV in the adult population in Karachi, Pakistan, which can later be validated for implementation. METHODOLOGY: A case-control study design was adopted and data was collected through an interview-based questionnaire from among 284 patients visiting the Family Medicine Department at The Indus Hospital, Karachi on whom the anti-HCV antibody test was conducted. Received data was then entered and analyzed using Statistical Package for the Social Sciences (SPSS) version 21.0. RESULT: Analysis indicated that in the entire cohort, marital status, employment status, history of being operated on in the past, family history of HCV infection, and body piercing were the factors significantly associated with positive HCV antibody. Results thus achieved show that the anti-HCV-positive rate was higher in ever married, employed, having had surgery, and family history of HCV infection (aOR: 2.42, 3.5, 2.04 and 2.5, P = 0.043, 0.002, 0.011 and 0.005, respectively). CONCLUSIONS: It is concluded that future research may be conducted enrolling the heterogeneous population to further probe the HCV burden and incidence in our society to initiate educational purposes. This goal can be achieved through commercial advertisements and free public lectures for disease prevention and better health awareness among the masses and the curers.

Knowledge of standard precautions among healthcare professionals at a Teaching Hospital in Karachi, Pakistan.

BACKGROUND AND AIM: Hospital-acquired infections (HAIs) are infections acquired by patients during their hospital stay which they did not have previously. This also includes infections acquired by healthcare professionals while managing infected patients. Since both healthcare professionals and patients can be a source of spreading infections across there is a need of practicing standard precautions religiously, to minimize this risk. This study aimed to assess the knowledge of healthcare professionals working at The Indus Hospital, a tertiary care hospital of Karachi, Pakistan. MATERIAL AND METHODS: This cross-sectional study was conducted between March 2017 and July 2018. 205 employees working at The Indus Hospital, Karachi were recruited in this study. A self-made questionnaire based on CDC guidelines was administered to the participants and their responses were recorded. RESULTS: Among all participants, nearly two-thirds (70%) had a very good knowledge of the use of standard precautions, 19.5% had good knowledge, and 12.2% had average/below average knowledge. Of those having very good knowledge, most of them were doctors (60%). Older age groups had more knowledge than the younger age groups. CONCLUSION: Our study concluded that among different healthcare workers, the nurses had less knowledge as compared to doctors. There was a significant association found between the age of the healthcare professionals and the information he/she has on the standard precautions. Improving the knowledge of doctors and nurses would help in breaking the chain of nosocomial infections and will decrease the burden of infectious diseases on our society.

Relationship of FIB-4 index with transient elastography in chronic hepatitis C patients having APRI ≥ 0.5 - ≤2 in a resource-limited setting in Pakistan.

OBJECTIVE: We aimed to study the extent of liver fibrosis in chronic hepatitis C patients with indeterminate APRI score of ≥ 0.5 - ≤2 (between higher and lower cut off value) and correlate it to transient elastography (TE) and FIB 4 index. METHOD: A cross-sectional study, 80 patients with CHC mono infection, APRI score ≥ 0.5 - ≤2 were interviewed from the cohort visiting the CHC program clinic at a tertiary care hospital in Karachi, Pakistan. Data were analyzed using STATA 14.0 and R 3.5.2 and SPSS 24.0 software according to their capabilities. RESULT: Of 80 patients, 50 (62.5%) were females and 30 (37.5%) were males with mean (±SD) ages of 41.73 (±11.5) years and 41.16 (±9.24) years respectively. The FIB 4 value among indeterminate APRI was reported as 1.47 (IQR 1.05-2.43). TE categories was reported: F0-F1 (n = 29; 36%), F1-F2 (n = 10; 12.5%), F2 (n = 9; 11.2%) F3 (n = 13; 16.2%), F3-F4 (n = 1; 1.2%) F4 (n = 18; 22.5%). FIB4 had a moderate positive correlation with TE while a weak positive correlation was found between APRI and TE (0.488, P < 0.0001 and 0.289, P < 0.001, respectively). TE was taken as a gold standard and compared with FIB4. The model constructed reported FIB4 as a good prediction for liver fibrosis with diagnostic accuracy 72%. CONCLUSION: The combination of two serum markers proves to be a low-cost noninvasive testing strategy for CHC patients having an indeterminate APRI score. By being readily accessible both biochemical scores can simplify liver assessment in lower middle-income countries (LMIC) and help family physicians to take appropriate decisions about treatment initiation with minimum delays.

Bullying in school children: How much do teachers know?

CONTEXT: Bullying is an emerging serious problem in schools worldwide resulting in physical and mental health problems in victimized children. Teachers play a critical role in identifying the acts of bullying, assisting the children who are victimized, linking up with healthcare providers for managing physical and emotional consequences of bullying, as well as managing bullying at school. AIMS: To determine teachers' knowledge regarding bullying among secondary school children. SETTINGS AND DESIGN: A cross-sectional study conducted in five public and five private schools of Jamshed Town, Karachi, Pakistan. METHODS AND MATERIALS: The study continued from October 2012 to February 2013. Stratified random sampling was used to select teachers. Data were collected through a pre-piloted structured questionnaire. STATISTICAL ANALYSIS USED: Data were analyzed using the SPSS v19.0. Descriptive analysis was done by calculating frequencies and percentages of the categorical variables such as teacher's age, educational level, and presence of adequate knowledge regarding bullying. The outcome variable of interest was knowledge about bullying. RESULTS: Almost half of the153 teachers (n = 82, 53.6%) lacked adequate knowledge about bullying in school children. A statistically significant association was present between knowledge of bullying with gender (P-value = 0.02), educational level of the teachers (P-value = 0.05), years of teaching experience (P-value = 0.04), and educational training of teachers (P-value = 0.01). CONCLUSIONS: More than half of the teachers were deficient in their knowledge about bullying in school children.

Leprosy manifesting with type 2 leprae reaction in a patient presenting with chronic fever: A case report.

Leprosy is a chronic granulomatous disease involving the skin and nerves, leading to a debilitating condition. Leprosy has been controlled in most parts of the world; therefore physicians are not very well versed in the recognition, management and assessment of this disease. The protean manifestations of leprosy often lead to delays in diagnosis and increase the morbidity. We present a case of a 33-year-old male with fever, lymphadenopathy, nodular skin lesions, uveitis and arthritis. Lymphnode, bonemarrow and skin biopsy revealed 3+ AFB smear with negative AFB cultures, leading to the diagnosis of leprosy. The course of illness was complicated by flare of Erythema Nodosum Leprosum (ENL).

Parental perception and childhood obesity: Contributors to incorrect perception.

OBJECTIVE: To determine parental recognition of their child's weight, and to identify the contributing reasons for incorrect perception. METHODS: This cross-sectional study was conducted from April to October 2010 at Aga Khan University Hospital, Karachi, and comprised parents of healthy children aged 5-14 years. An interviewer-based pre-tested questionnaire consisting of socio-demographic details, anthropometric measurements, and parental perception about their child's weight was administered. Data was analysed using SPSS 21. Both univariate and multivariate logistic regression were applied to assess for the risk factors associated with incorrect parental perception. RESULTS: Parents of a total of 330 eligible children were approached, but 305(92.4%) agreed to participate. Of them, 196(64.3%) were mothers and 109(35.7%) were fathers. Overall, 179(58.7%) parents incorrectly perceived their child's weight status. On univariate regression analysis, age (p=0.001) and body mass index of the child (p=0.006) and parental occupation (p=0.018) were significant risk factors of incorrect perception. CONCLUSIONS: Marked difference was observed between measured and perceived weight of children by the parents.

Professional satisfaction of family physicians in Pakistan--results of a cross-sectional postal survey.

OBJECTIVE: To assess the level of professional satisfaction amongst family physicians of Pakistan and to identify the factors associated with professional dissatisfaction. METHODS: The study was part of a larger national survey for "Status of PostgraduateTraining and Continuing Medical Education of Family Physicians in Pakistan" which was a cross-sectional, postal survey of family physicians conducted over 10 months between November 2009 and September 2010. The main outcome variables were professional satisfaction, as well as reasons for professional satisfaction and dissatisfaction. SPSS 17 was used for data analysis. Multivariable logistic regression was used to determine factors associated with professional dissatisfaction. RESULTS: Of the total 1200 survey forms distributed, 288 (24%) were received back. The mean age of the participants was 37 +/- 9 years with a range between 26 and 72 years. Of the total, 226 (78.5%) were males. Overall, 213 (74%) family physicians were satisfied with their profession. The factors significantly associated with professional dissatisfaction included the participants opinion that they were not respected by the public (OR: 11.6, C.I: 1.9-71.5); as well as regretting being a doctor (OR:62.9, C.I: 8.4-469.8). CONCLUSIONS: Most of the family physicians had professional satisfaction, but a minority had regrets about being a doctor and were dissatisfied over how their profession affected their family life. Further research may be needed to study work-life balance amongst family physicians of Pakistan.

Psychotherapy as a treatment modality for psychiatric disorders: Perceptions of general public of Karachi, Pakistan.

BACKGROUND: Psychiatric disorders affect about 450 million individuals worldwide. A number of treatment modalities such as psychotropic medications, psychotherapy and electroconvulsive therapy can be used to treat these disorders. Attitudes of general public play a pivotal role in effective utilization of mental health services. We explored the perceptions of general public of Karachi, Pakistan regarding psychotherapy. METHODS: A cross-sectional study was conducted in Karachi, Pakistan during July-August, 2008. A three-step sampling strategy and a structured questionnaire were employed to survey knowledge and perceptions of adult general public about psychotherapy. Descriptive statistics were used for baseline characteristics. Logistic regression models were used to investigate any significant associations between baseline characteristics of the participants and their perceptions. RESULTS: The study sample comprised of 985 individuals (536 males; 531 financially independent) with an average age of 36.7 years (SD 13.54 years) and 12.5 years (SD 3.09 years) of education were included. Majority (59.4%; n = 585) claimed to be aware of psychotherapy as a treatment option for psychiatric disorders but 47.5% of these (n = 278/585) failed to identify its correct definition. Concerns voiced by the participants about psychotherapy included stigma (48.7%) and breech in confidentiality (39.5%); 60.7% opined it cost effective and 86.5% favored its use as an adjuvant modality. A preference for psychotherapy as the treatment strategy for psychiatric disorders was demonstrated by 46.6% (n = 459/985). Younger, more educated, financially independent and female participants were more likely to prefer psychotherapy as were those who deemed it cost effective. CONCLUSION: Positive attitudes regarding the acceptability, clinical utility and cost-effectiveness of psychotherapy were observed in a sample representative of general public of Karachi, Pakistan. These findings highlight its potential utility for devising pragmatic mental health strategies in the face of limited resources.