Use of psychoactive drugs among patients visiting outpatient clinics in Karachi, Pakistan.

INTRODUCTION: This study was conducted to determine the proportion of usage of psychoactive drugs, and to identify factors associated with its use among patients visiting outpatient clinics of a tertiary care hospital in Karachi, Pakistan. METHODS: A cross-sectional study was conducted involving 461 adult (age 18 years and above) patients, who were surveyed by using interviewer-administered questionnaires. All interviews were conducted by a medical students. Out of the total number of participants, 242 (52.5 percent) were males and 219 (47.5 percent) were females. RESULTS: In all, 118 (25.6 percent) of the respondents were using some sort of psychoactive drugs, however, only 20 (4.3 percent) study subjects were diagnosed with any psychiatric illness. Factors found to be significantly associated with usage of psychoactive drugs included belonging to the female gender (p-value equals 0.019), older (more than 50 years) age (p-value is less than 0.001), being married (p-value equals 0.004), having formal schooling of up to 12 years (p-value equals 0.001) and physical inactivity (p-value equals 0.004). In addition, those whose family members were using psychoactive drug(s) or who suffered from non-communicable diseases were more likely to use psychoactive drugs in comparison to others (p-value is less than 0.001). CONCLUSION: The use of psychoactive drugs is quite common in our patients regardless of having any psychiatric disease. Efforts are required to control and prevent the abuse of these drugs. Education and awareness programmes for doctors and patients may help to prevent the inappropriate use of psychoactive drugs. Regulatory intervention to control use of these drugs is also recommended.

Epilepsy: public knowledge and attitude in a slum area of Karachi, Pakistan.

BACKGROUND: Epilepsy is a common but widely misunderstood illness. Consequently, epileptics suffer from considerable stigmatization in society. Since no studies have detailed the misperceptions about epilepsy in our community, it is not possible to provide focused intervention aimed at eliminating this prejudice. PURPOSE: To assess the knowledge and attitude regarding epilepsy in an adult population of a Karachi slum area. METHODS: A face-to-face interview was conducted on 487 consenting adult non-epileptics (305 males; 182 females) who were conveniently sampled. Chi-square test was employed to calculate the variability in knowledge and attitude with demographic and other variables. RESULTS: In all, 12.5% had never heard about epilepsy. Among the rest, 66.7% identified epilepsy as being non-infectious, while 28.2% were unaware of any treatment available for it. Among the other 71.8%, 62.7% were aware of the existence of anti-epileptic drugs. Religious/spiritual treatment was chosen as the most effective treatment by 33.1%. Males were more likely to identify epilepsy as being non-infectious (p=0.02). Nearly 18% of the respondents would not object to their child marrying an epileptic, 69.5% did not want to socially isolate the epileptics, 83.1% said epileptics could receive academic education, 85.6% said they could perform activities of daily life and 62.4% said they could become useful members of the society. Those who considered epilepsy to be infectious were more likely to carry negative attitudes towards epilepsy (p<0.01 with four attitudes). CONCLUSIONS: Considerable gaps exist in the community's knowledge about epilepsy. Some of these may explain the prevalence of negative attitudes towards this ailment.

Prevalence and factors associated with anxiety and depression among family practitioners in Karachi, Pakistan.

OBJECTIVE: We aimed to assess anxiety and depression and to identify the factors associated with these conditions among family practitioners in Karachi, Pakistan. METHODS: A self-reported postal survey was conducted among 540 family practitioners in Karachi during the months of July - August 2003. Aga Khan University Anxiety and Depression Scale (AKUADS) was used to assess anxiety and depression. Additional questions were also inquired to get information about socio-demographic, professional and lifestyle characters. RESULTS: Using AKUADS, 155 (39%) family practitioners had anxiety and depression. Mutlivariate analysis disclosed five factors to be significantly associated with anxiety and depression; these were female sex (AOR = 6.4, 95% CI 3.2-12.6); age group of < 35 years (AOR = 23.3, 95% CI 9.0-60.3); lack of regular exercise (AOR = 4.9, 95% CI 2.4-10.2) and working for more than 48 hours per week (AOR = 12.7, 95% CI 6.2-26.2). CONCLUSION: This study reveals that prevalence of anxiety and depression among family practitioners in Karachi is high and higher than general population in Karachi. Further research and intervention studies are required to identify preventive measures in this regard and also to assess the impact of these interventions.

Macrovascular complications and their associated factors among persons with type 2 diabetes in Karachi, Pakistan--a multi-center study.

OBJECTIVE: To assess the prevalence of macrovascular complications and factors associated with these complications among persons with Type 2 diabetes. METHODS: A multi-center, cross-sectional survey was conducted in three diabetes clinics of Karachi from November 2000 to April 2001. Six hundred and seventy-two persons were interviewed to determine the prevalence of ischemic heart disease (IHD), cerebrovascular disease (CVA) and diabetic foot (DF). Demographic data and co-variables obtained include age, sex, duration of diabetes, body mass index (BMI), smoking status, exercise habits and history of hypertension (HTN). RESULTS: Overall, 26.4%, 6.8% and 3.9% of individuals had IHD, CVA and DF respectively. Multiple logistic regression analysis showed that subjects having IHD were more likely to have HTN (AOR=1.88, 95% CI 1.31-2.69), not performing regular exercise (AOR = 2.09, 95% CI 1.39-3.17) and be current smokers (AOR = 1.85, 95% CI 1.10-3.10) Subjects having CVA were more likely to have diabetes for more than 5 years (AOR = 1.94, 95% CI 0.97-3.87). Males were more prone than females to have DF (AOR = 3.48, 95% CI 1.46-8.31). Those who had DF were more likely to have diabetes for more than 5 years (AOR = 3.29, 95% CI 1.09-9.89) and of reporting current smoking (AOR = 4.01, 95% CI 1.49-10.71). CONCLUSION: Large proportions of persons with Type 2 diabetes were suffering from preventable macrovascular complications in Karachi, Pakistan. There is a need to develop risk factor modification interventions to reduce the impact of long-term complications.

Risk factors for cardiovascular disease in school children--a pilot study.

OBJECTIVE: To assess the frequencies of risk factors for cardiovascular disease in school children. The information may help in designing interventions aimed at modifying unhealthy lifestyle in children, which may reduce the later incidence of cardiovascular disease in adults. METHODS: A cross-sectional study was conducted on 206 students (ages 14-18 years), enrolled in higher secondary school. Students were interviewed about their lifestyles, family history of cardiovascular disease and its risk factors. Moreover, they were assessed for height, weight and blood pressure. RESULTS: Twenty nine percent of the children were physically inactive, 31% were taking unhealthy diet daily, 21% were overweight (BMI > or = 25) and 6% were smokers. History of paternal smoking was reported by 36% of the children, and among them 76% of fathers smoked in the presence of their children. Family history of cardiac disease, hypertension and diabetes were positive in 4%, 23% and 16% of the children respectively. Overall, 58% of the children had at least one modifiable risk factor. CONCLUSION: Majority of the children had modifiable risk factors for cardiovascular disease. Prevention efforts are required early in life, using strategies for behavioral modification and health promotion.

Knowledge about hepatitis B and C among patients attending family medicine clinics in Karachi.

Knowledge about hepatitis B and C was assessed in a cross-sectional study of 300 adults aged 18 or older attending family medicine clinics at The Aga Khan University Hospital, Karachi. Most knew that hepatitis B and C are viral diseases that primarily affect the liver, but knowledge about risk factors for disease transmission was poor. Approximately 70% knew that hepatitis B is vaccine preventable; 60% had the misconception that hepatitis C is also vaccine preventable. The majority incorrectly believed that people with hepatitis B or C should follow the diet 'parhaiz'. Generally women knew more than men about the diseases. This study suggests that health education about these infections should be provided to the public. Family physicians can play an important role in educating people about the prevention of these diseases.

Knowledge about hepatitis B and C among patients attending family medicine clinics in Karachi

Knowledge about hepatitis B and C was assessed in a cross-sectional study of 300 adults aged 18 or older attending family medicine clinics at The Aga Khan University Hospital, Karachi. Most knew that hepatitis B and C are viral diseases that primarily affect the liver, but knowledge about risk factors for disease transmission was poor. Approximately 70% knew that hepatitis B is vaccine preventable; 60% had the misconception that hepatitis C is also vaccine preventable. The majority incorrectly believed that people with hepatitis B or C should follow the diet 'parhaiz'. Generally women knew more than men about the diseases. This study suggests that health education about these infections should be provided to the public. Family physicians can play an important role in educating people about the prevention of these diseases