Magnitude and factors associated with child abuse in a mega city of developing country pakistan.

OBJECTIVE: Child abuse is one of the major challenges for health care providers. This study was conducted to determine the burden of child abuse (physical & emotional) and the factors associated with it in an urban city of Pakistan. METHODS: This cross-sectional study was conducted in primary care clinics affiliated with a tertiary care hospital in Karachi, Pakistan between March to December 2010. Mothers with children aged between 6 and 12 years were included in the study. Those mothers' suffering from any acute illness like high grade fever, were excluded. A total of 412 mothers were recruited through consecutive sampling and written informed consent was taken. A pre-tested questionnaire was used to seek information about child abuse. Data was analyzed using SPSS version 19 and multivariable logistic regression was used to identify the factors (age, gender of child, family structure, educational status of parents, and mother's perception of her home environment) associated with child abuse. FINDINGS: Of the total 412 mothers, final analysis was conducted on 379 mothers. In all, 32.5% of children had been abused, 25.5% physically and 17.9% emotionally. Abuse was reported more among children whose mothers had minimal or no schooling (P=0.02), who were abused by their husbands (P<0.001), not satisfied with their marital life (P<0.001), and stressful home environment (P=0.02). In the multivariate analysis, the factors found to be independently associated with child abuse were mothers abused by their husbands (AOR=4.2; 95%CI: 2.2-7.9) and child being a girl (AOR=8.7; 95%CI: 4.5-16.8). CONCLUSION: The prevention of child abuse can be achieved through comprehensive, multifaceted and integrated approaches requiring joint efforts by the government, policy makers, stake holders, social workers, educationists, and public health practitioners.

Factors associated with Helicobacter pylori infection, results from a developing country - Pakistan.

BACKGROUND: It is known that blood group antigens are related to the development of peptic ulcer and gastric carcinoma. Infections due to H. pylori are most widespread among the developing regions due to poor standard of public health. This study sought to determine the association of H. pylori with ABO blood groups, age, gender, and smoking status among inpatients at a public sector hospital in Karachi. MATERIALS AND METHODS: A cross-sectional study was conducted at endoscopy suite at a public sector hospital in Karachi in the year 2011. All the symptomatic patients coming for upper GIT endoscopy were included in this study. RESULTS: Biopsy for histopathology was taken from 93 patients, with an age range from 15-65 years. Age group of 15 to 20 years was found to be associated with H. pylori infection but without significance (p-value 0.83). In all, 36 (38.7%) turned out to be H. pylori positive with a significant male preponderance (p=0.04). Distribution of ABO blood groups in H. pylori positive group were A=31.4%, B=15.4%, AB=25.0% and O=53.7%, with a statistically significant link for blood group O (p=0.05) . Rhesus factor was also compared but significant relationship was evident (p-value 0.73). CONCLUSIONS: This study demonstrated that H. pylori infection can be related to ABO blood group, middle age persons and male gender. People of blood group O are more prone to develop infection related gastritis, ulcers, and even perforations, so they should be more cautious against transmission of the bacterium.

Patients' evaluations of family practice care and attributes of a good family physician.

OBJECTIVE: Patient evaluation of family practice care is the most direct assessment of quality of healthcare services provided. This study aimed to evaluate family practice care and to assess patient views on the attributes of a good family physician. METHODS: A multicentre cross-sectional study was conducted at 18 family practice clinics of Aga Khan Hospital, Karachi, Pakistan. A total of 600 adult patients (aged over 18 years and visiting the clinic for more than a year) were approached consecutively to take part in this study. A pre-tested structured questionnaire including the EUROPEP was used by trained medical graduates to collect patient information. Data were analysed using SPSS v. 19; the internal consistency and reliability of the EUROPEP were tested. Means and proportions were reported for individual items of the questionnaire and a P-value of < 0.05 was considered statistically significant. RESULTS: Of 600 patients, 502 (83.67%) agreed to participate and were interviewed. About one-third (72.3%) were females and 38% were within the age group 35-50 years. The overall mean scale score on EUROPEP was 82.8 (± 18.0), the score was higher for females at 83.7 (± 17.4) points. The three statements that were most highly rated for assessing family practice care were listening to the patient (mean = 4.54, SD = 0.92), thoroughness (mean score = 4.46, SD = 0.04) and proper physical examination (mean score = 4.44, SD = 1.07). The poorly rated statements were waiting time (excellent 9.8% vs poor 45.6%) and physician not accessible on telephone (36.5% excellent vs 35.5% poor). CONCLUSION: The results of this study identified some areas of improvement in family practice, such as accessibility of family practice on telephone and reduction in waiting times. Strategies should be devised regarding these issues at continuous medical education platform so that these attributes can be adapted to improve the overall quality of care.

Retrospective analysis of metabolic syndrome: prevalence and distribution in executive population in urban pakistan.

Background. Metabolic Syndrome (MetS) is a major public health concern. Objective. The aim of this study was to estimate the frequency of MetS, its components, and factors associated with MetS amongst apparently healthy individuals in Pakistan. Methods. A retrospective cross-sectional study was conducted at the executive Clinics of Aga Khan Hospital, Pakistan. Medical records of patients aged ≥18 years visiting the clinics from July 2011 to December 2011 were consecutively reviewed. Records in which either MetS components data or 10% of overall data was missing were excluded. A total of 1329 participants' records was included in final analysis. Data was analyzed using SPSS version 19 and multivariable logistic regression was used to identify the factors associated with MetS. Results. A total of 847 (63.7%) participants had MetS; mean age of the participants were 47.6 ± 11.6 years. About 70.4% were males and 29.6% were females. Approximately 70% of participants had BMI ≥25 kg/m(2). MetS was associated with male gender (AOR = 2.1; 95% C.I: 1.6-3.2) and history of diabetes among parents (AOR = 3.0; 95% C.I: 1.6-6.0). Conclusion. This study shows that a large proportion of population has MetS and is overweight or obese. This requires urgent interventions on part of health care providers' especially family physicians. Educating masses about life style factors can make a difference. Further researches on this issue are warranted.

Knowledge practice gaps about needle stick injuries among healthcare workers at tertiary care hospitals of Pakistan.

BACKGROUND: The aim of our study were to assess the knowledge and practice gaps about Needle Stick Injuries (NSIs) and their associated factors among Health Care Workers' (HCWs) at tertiary care hospitals of Pakistan. METHODS: A cross-sectional study was conducted in two tertiary care teaching hospitals in Karachi, Pakistan, representing both private and public health sector. During the months of January to May 2008, trained medical graduates interviewed 497 HCWs (Doctors and Nurses) who were working in those particular hospitals for more than a year and were willing to participate in the study. RESULTS: Overall the knowledge about transmission of HBV HCV and HIV was good. However, 19.1 and 12.3% HCWs had misconception about the transmission of malaria and tuberculosis by NSIs; more female and working as a nurse. Furthermore, a large number of participants had lack of knowledge for the transmission of infectious mononucleosis. Over two third of study subjects were not vaccinated for hepatitis B infection, again more females (p = 0.002) and nurses (p < 0.001). Large numbers of study participants were not wearing protective cloths, and do not us sharp containers. Similarly, preponderance of study subjects does not avoid breaking needle by hands and leave syringes open; these poor practices are significantly more prevalent among those working for more than five years and doctors (p = 0.003). CONCLUSION: In addition to lack of knowledge, poor practices were reported in this study. Proper curriculum reform and training are required to protect the health Care workers and patients. Further research and interventions are suggested in this regards.

Preventable lifestyle risk factors for non-communicable diseases in the Pakistan Adolescents Schools Study 1 (PASS-1).

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 ≥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.

Cardiovascular Disease-Related Lifestyle Factors among People with Type 2 Diabetes in Pakistan: A Multicentre Study for the Prevalence, Clustering, and Associated Sociodemographic Determinants.

Background. We evaluated the prevalence and clustering pattern of cardiovascular disease (CVD) related lifestyle factors and their association with CVD among patients with type 2 diabetes. We also examined the association of these factors with various socio-demographic characteristics. Methods. A total of 1000 patients with type 2 diabetes were interviewed in a cross-sectional, multi-center study in out-patient clinics in Karachi, Pakistan. Results. In this study 30.3% study participants had CVD. Majority of the patients were physically inactive and had adverse psychosocial factors. Forty percent of the study participants were exposed to passive smoking while 12.7% were current smokers. Only 8.8% of study subjects had none of the studied lifestyle factor, 27.5% had one, while 63.7% had two or three factors. CVDs were independently associated with physical inactivity, adverse psychosocial factors, passive smoking and clustering of two or three lifestyle factors. Physical inactivity was more prevalent among females and patients with no/less education. Proportion of adverse psychosocial factors were higher among females, elders and patients with no/less education. Clustering of these lifestyle factors was significantly higher among females, elderly and no/less educated patients. Conclusion. These results suggest the need of comprehensive and integrated interventions to reduce the prevalence of lifestyle factors.

Prevalence of physical inactivity and barriers to physical activity among obese attendants at a community health-care center in Karachi, Pakistan.

BACKGROUND: Overweight and obesity are significant public health problems worldwide with serious health consequences. With increasing urbanization and modernization there has been an increase in prevalence of obesity that is attributed to reduced levels of physical activity (PA). However, little is known about the prevalence of physical inactivity and factors that prohibit physical activity among Pakistani population. This cross-sectional study is aimed at estimating the prevalence of physical inactivity, and determining associated barriers in obese attendants accompanying patients coming to a Community Health Center in Karachi, Pakistan. FINDINGS: PA was assessed by using international physical activity questionnaire (IPAQ). Barriers to PA were also assessed in inactive obese attendants. A pre-tested questionnaire was used to collect data from a total of 350 obese attendants. Among 350 study participants 254 (72.6%) were found to be physically inactive (95% CI: 68.0%, 77.2%). Multivariable logistic regression analysis indicated that age greater than 33 years, BMI greater than 33 kg/m2 and family history of obesity were independently and significantly associated with physical inactivity. Moreover, there was a significant interaction between family structure and gender; females living in extended families were about twice more likely to be inactive, whereas males from extended families were six times more likely to be inactive relative to females from nuclear families. Lack of information, motivation and skills, spouse & family support, accessibility to places for physical activity, cost effective facilities and time were found to be important barriers to PA. CONCLUSIONS: Considering the public health implications of physical inactivity it is essential to promote PA in context of an individual's health and environment. Findings highlight considerable barriers to PA among obese individuals that need to be addressed during counseling sessions with physicians.

Underestimation of weight and its associated factors among overweight and obese adults in Pakistan: a cross sectional study.

BACKGROUND: Weight loss is known to decrease the health risks associated with being overweight and obese. Awareness of overweight status is an important determinant of weight loss attempts and may have more of an impact on one's decision to lose weight than objective weight status. We therefore investigated the perception of weight among adults attending primary care clinics in Karachi, Pakistan, and compared it to their weight categories based on BMI (Body Mass Index), focusing on the underestimation of weight in overweight and obese individuals. We also explored the factors associated with underestimation of weight in these individuals. METHODS: This was a cross sectional study conducted on 493 adults presenting to the three primary care clinics affiliated with a tertiary care hospital in Karachi, Pakistan. We conducted face to face interviews to gather data on a pre-coded questionnaire. The questionnaire included detail on demographics, presence of comorbid conditions, and questions regarding weight assessment. We measured height and weight of the participants and calculated the BMI. The BMI was categorized into normal weight, overweight and obese based on the revised definitions for Asian populations. Perception about weight was determined by asking the study participants the following question: Do you consider yourself to be a) thin b) just right c) overweight d) obese. We compared the responses with the categorized BMI. To identify factors associated with underestimation of weight, we used simple and multiple logistic regression to calculate crude odds Ratios (OR) and adjusted Odds Ratios (AOR) with 95% Confidence Intervals. RESULTS: Overall 45.8% (n = 226) of the study participants were obese and 18% (n = 89) were overweight. There was poor agreement between self perception and actual BMI (Kappa = 0.24, SE = 0.027, p < 0.001). Among obese participants a large proportion (73%) did not perceive themselves as obese, although half (n = 102) of them thought they may be overweight. Among the overweight participants, half (n = 41) of them didn't recognize themselves as overweight. Factors associated with misperception of weight in overweight and obese participants were age ≥ 40 years (AOR = 3.4; 95% CI: 1.8-6.4), male gender (AOR = 2.97; 95% CI: 1.6-5.5), being happy with ones' weight (AOR = 6.4; 95% CI: 3.4-12.1), and not knowing one's ideal weight (AOR = 2.45, 95% CI: 1.10-5.47). CONCLUSION: In this cross sectional survey, we observed marked discordance between the actual and perceived weight. Underestimation of individual weight was more common in older participants (≥ 40 years), men, participants happy with their weight and participants not aware of their ideal weight. Accurate perception of one's actual weight is critical for individuals to be receptive to public health messages about weight maintenance or weight loss goals. Therefore educating people about their correct weight, healthy weights and prevention of weight gain are important steps towards addressing the issue of obesity in Pakistan.

Predictors of oral tobacco use among young adult patients visiting family medicine clinics in Karachi, Pakistan.

Prevalence of cancers associated with the use of oral tobacco (OT) is rising very rapidly and prevention of use is the best option to tackle this scenario. This cross-sectional study estimated the proportion of OT use and predictors associated with its initiation and determined the knowledge, attitude and practices of OT users. A total of 231 young adult patients (15-30 years age) were interviewed by medical students in family practice clinics in Karachi, Pakistan. OT use was considered as usage of any of the following: betel quid (paan) with tobacco, betel nuts with tobacco (gutkha), and snuff (naswar). Overall, 49.8% (95% CI=43.3-56.2) subjects had used OT at least in one form. Multivariable analysis demonstrated independent association of OT users with secondary education level (adjusted OR=3.6; 95% CI=1.6-8.1) and use of OT by a family member (OR=2.3; 95% CI=1.3-4.0). Among OT users, 37.4% started after being inspired by friends/peer pressure, 60% using for more than 5 years, 53.2 % users reported getting physical/mental comfort from the use of OT while 31.6% tried to quit this habit but failed. We suggest socially and culturally acceptable educational and behavioral interventions for control of OT usage and hence to prevent its associated cancers.

Anxiety and depression among outpatients with type 2 diabetes: A multi-centre study of prevalence and associated factors.

BACKGROUND: Anxiety and depression contribute to poor disease outcomes among individuals with diabetes. This study aimed to assess the prevalence of anxiety and depression and to identify their associated factors including metabolic components among people with type 2 diabetes. METHODS: We conducted a cross-sectional, multi-center study in four out-patient clinics in Karachi, Pakistan. In all, 889 adults with type-2 diabetes were included in this study. Anxiety and depression were measured by using the Hospital Anxiety and Depression Scale (HADS). Multivariable analysis using multiple logistic regression was carried out to evaluate the combined effect of various factors associated with anxiety and depression, while adjusting for confounding variables. RESULTS: Overall, 57.9% (95% CI = 54.7%, 61.2%) and 43.5% (95% CI = 40.3%, 46.8%) study participants had anxiety and depression respectively. Factors found to be independently associated with anxiety were physical inactivity, having hypertension and ischemic heart disease. For depression, being female, of older age, having hypertension and ischemic heart disease were significantly associated. Metabolic components found to be independently associated with both anxiety and depression were systolic blood pressure, fasting blood glucose and fasting blood triglycerides. Body mass index was independently associated with depression but not with anxiety. CONCLUSION: This study identified that a large proportion of adults with diabetes had anxiety and/or depression, and identified factors associated with these entities. These results alert clinicians to identify and treat anxiety and depression as common components of diabetes care. Additional studies are needed to establish the directional nature of this relationship and to test interventions.

Self examination for breast and testicular cancers: a community-based intervention study.

Prevalence of cancers is growing rapidly in all parts of the word with Pakistan being no exception. Prevention is the best option to tackle this rising epidemic. Screening, early detection and health awareness programs are the cornerstones in this regard. A community-based interventional study was therefore here conducted to assess the effect of health education intervention about knowledge and practice of self-breast examination (SBE) among women and self-testicular examination (STE) among men. A total of 127 (70 females and 57 males) adults (≥ 18 years) from an urban community of Karachi, Pakistan were included after taking informed consent. Interventions were in the local language (Urdu) and included educational and awareness sessions by symposia, lectures and hand-on practice demonstrations about SBE and STE. Informative leaflets and brochures were also used in this regard. Pre-intervention assessment revealed that 57% women had knowledge of SBE and 4% men knew about STE and this proportion increased significantly (p<0.001) after the intervention both in women and in men, by 83% and 72%, respectively Similarly, significant post-intervention improvements were reported for SBE and STE practices (p<0.001). Our results suggest that educational interventions at the community level increase the knowledge and practices of women and men for SBE and STE.

Assessment of quality of care for the management of type 2 diabetes: a multicentre study from a developing country.

BACKGROUND: Complications of diabetes can be prevented or delayed by providing high quality care. This study aimed to document the quality of care provided to people with type 2 diabetes in Pakistan and to identify the difference in care offered at various clinics. DESIGN: Cross-sectional multi-centre study. METHODS: Interviews were undertaken with 672 people with type 2 diabetes attending three different types of diabetes clinic (private clinic (A), non-governmental organisation (B) and public clinic (C)) in Karachi, Pakistan. A structured questionnaire was used to collect socio-demographic and clinical information from patients; quality of care indicators were also confirmed by reference to patients' medical records. RESULTS: Overall, 68% (A: 92%, B: 58% and C: 52%, P<0.001) of study subjects were informed about diabetes complications. Blood pressure (BP) monitoring at every visit was completed for 80% of study respondents (A: 100%, B: 79% and C: 57%, P<0.001). Foot examination was infrequent (53%, A: 98%, B: 52% and C: 8% (P<0.001). Lipid profiles of 48% of patients had been done in the past 12 months (A: 77%, B: 16% and C: 50%, P<0.001). Microalbumin testing had been performed in 32% of patients in the previous year (A: 77%, B: 09% and C: 05%; P<0.001). Most participants had elevated glycaemic (58.2%) and BP levels (84.7%) with higher prevalence among people who attended clinics B and C (P<0.001). Overall, 82.6% of study subjects had an elevated body mass index; this was almost equally prevalent across clinics. CONCLUSION: Many patients with type 2 diabetes do not receive optimal diabetes care in Karachi. Among the different settings, care provided in private health sector clinics was of a better standard. However, our results reveal a need for overall improvement in the quality of diabetes care. Further research is also needed to evaluate the reasons for poor diabetes care, and to identify the most cost-effective means to address these.

Self-examination for breast and testicular cancers: a community-based intervention study.

The prevalence of cancers is growing rapidly in all parts of the word and Pakistan is no exception. Prevention is the best option to tackle this rising epidemic and screening, early detection and health awareness programs are cornerstones in this regard. A community-based interventional study was therefore her conducted to assess the effect of health education intervention about knowledge and practice of self-breast examination (SBE) among women and self-testicular examination (STE) among men. A total of 127 (70 females and 57 males) adults (>or=18 years) from an urban community of Karachi, Pakistan were included after giving informed consent. Interventions were in the local language (Urdu) and included educational and awareness sessions by symposia, lectures and hand-on practice demonstrations about SBE and STE. Informative leaflets and brochure were also employed. Pre-intervention assessment revealed that 57% women had knowledge of SBE and 4% men knew about STE and this proportion increased significantly (p<0.001) after intervention both in women and in men by 83% and 72%, respectively. Similarly, significant post-intervention improvements were reported for SBE and STE practices (p<0.001). Our results suggest that educational interventions at the community level increase the knowledge and practices of women and men for the SBE and STE.

Promoting motivation towards community health care: a qualitative study from nurses in Pakistan.

Based on the extensive health care needs of Pakistani population, the idea of Community Health Nursing was introduced in 1985. The educational nursing institutes adopted nursing curriculum in order to produce competent nurses to meet the rising demands of society. However, very few numbers of nurses choose community health nursing as their career pathway in Pakistan. Based on the current observation, enhancing motivation among graduate nurses has always been viewed as a great challenge for the academic nursing institutions. This study was intended to explore motivating and de motivating factors in nurses towards community Health Nursing. By utilizing self concept based model of motivation, semi structured interviews were conducted with newly graduated nurses, nurse educators and nursing students. The findings revealed that certain traits, values and competencies are required to motivate nurses as well as to build their capacity towards working effectively in the community setting. Moreover, through this study several realistic recommendations by the participants are highlighted that could foster motivation among future nurses towards this field.

Family physicians understanding about Mantoux test: A survey from a high endemic TB country.

BACKGROUND: Tuberculosis is a global health emergency and is a big challenge to diagnose and manage it. Family physicians being first contact health persons should be well competent to diagnose and manage the patients with tuberculosis. AIMS: This study was aimed to assess the level of understanding about Mantoux Test amongst Family Physicians in Karachi, Pakistan and to determine the difference of level of understanding by gender and number of tuberculosis patients seen in a month. METHODS: A cross sectional survey was conducted among 200 Family Physicians working in Karachi; the largest city and economic hub of Pakistan. Family Physicians who attended Continuous Medical Education sessions were approached after taking consent. Pre-tested, self administered questionnaire was filled consisting of: basic demographic characteristics, questions regarding knowledge about Mantoux Test, its application and interpretation. Data of 159 questionnaires was analyzed for percentages, as rest were incomplete. Chi square test was used to calculate the difference of understanding levels between various groups. RESULTS: Almost two thirds of respondents were males and above 35 years of age. Majority of Family Physicians were private practitioners and seeing more than five tuberculosis patients per month. Overall, a big gap was identified about the knowledge of Mantoux Test among study participants. Only 18.8% of Family Physicians secured Excellent (>/= 80% correct responses). This poor level of understanding was almost equally distributed in all comparative groups (Male = 20.8% versus Female = 15.9%; p - 0.69) and (Seen < 5 tuberculosis patients per month = 18.6% versus seen >/= 5 tuberculosis patients per month = 19.3%; p - 0.32). A huge majority of Family Physicians (92%) however, showed keen interest in obtaining further knowledge regarding Mantoux Test and amongst them 72% suggested Continued Medical Education sessions as preferable mode of updating themselves. CONCLUSION: Our study revealed an overall major deficit in understanding and interpretation of Mantoux Test amongst Family Physicians which needs to be addressed. Continues Medical Education sessions for Family Physicians should be organized in regular basis for upgrading their knowledge in this regards.

Gender differences and clustering pattern of behavioural risk factors for chronic non-communicable diseases: community-based study from a developing country.

OBJECTIVES: This study estimates the burden of behavioural risk factors for chronic non-communicable diseases (CNDs) to evaluate the degree of clustering and the differential of these factors by gender in adults. METHODS: In a community-based survey, information was obtained about behavioural risk factors for CNDs among 534 adults in Karachi, Pakistan. Chi-square test and odds ratio (OR) with 95% confidence interval (CI) were calculated to evaluate the differences of these factors by gender. RESULTS: Overall, 22.5% of adults had anxiety/depression, 47.8% did not have adequate intake of fruits and vegetables, 60.1% were physically inactive while 49.8% were overweight/obese. More women had anxiety/ depression (OR = 2.1; 95% CI = 1.4-3.1), were physically inactive (OR=2.1; 95% CI = 1.5-3.1) and overweight/ obese (OR= 6.2; 95% CI = 4.3-9.1). On the contrary, greater number of men were found to have inadequate fruit and vegetable consumption (OR = 1.8; 95% CI = 1.3-2.5). Only 1.1% of study subjects had none of the studied risk factors, 16.9% had one while 82% had > or =2 factors. The clustering of these risk factors was significantly higher in women (p<0.001). DISCUSSION: This study shows that almost all of the adults in the study had behavioural risk factors for CNDs and clustering of these factors is very common and significantly higher in women. The tendency of clustering risk factors in individuals provides opportunities to address factors with integrated approaches to prevent/delay the onset of CNDs.

Quit smoking for life--social marketing strategy for youth: a case for Pakistan.

Smoking is the single most avoidable risk factor for cancers. Majority of smokers know about this fact but it is difficult for them to give it up mainly in the face of widespread smoking advertisements by the tobacco industries. To reduce the prevalence of smoking and its associated cancers, immediate actions are required by public health authorities. Social marketing is an effective strategy to promote healthy attitudes and influence people to make real, sustained health behavior change by transiting through different stages which include precontemplation, contemplation, preparation, action, and maintenance. Social marketing can influence smokers to voluntarily accept, reject, modify, or abandon their smoking behavior. In Pakistan, the smoking prevalence has been increasing, necessitating effective measures. The trend of its usage has been going upwards and, according to the World Health Organization, in Pakistan, the usage of cigarette smoking is increased by 30% compared to 1998 figures. The Pakistan Pediatrics Association has estimated 1,000 to 1,200 school-going children between the ages of 6 and 16 years take up smoking every day. In Pakistan, ex-smokers in the low socioeconomic group reported spending 25% of the total household income on this habit. This paper focuses on the antismoking social marketing strategy in Pakistan with an aim to reduce smoking prevalence, especially among the youth.

Educational intervention among barbers about liver cancer-inducing viruses: a pilot study from a developing country.

Liver cancer is among the most prevalent cancers in the world and it is mainly related to the hepatitis B virus (HBV) and hepatitis C virus (HCV). This study evaluated the effectiveness of educational intervention on knowledge and practices regarding hepatitis B and hepatitis C among barbers. After completion of baseline interviews of 70 barbers in Karachi, Pakistan, a 30-min educational session was conducted. The same sessions were repeated twice for all barbers at an interval of 1 month each for reinforcement. Post-intervention interviews were conducted after 1 month of the last session. Before intervention, only 11.4% of the study participants had scored "good" about the knowledge of HBV, which improved to 74.3% after intervention (p < 0.001). Similarly, for HCV, significant improvement was observed after intervention. Regarding the safe practices to prevent HBV and HCV infections, <2% had scored to the level of "good" at baseline, which improved to 48.6% after intervention (p < 0.001). Educational interventions to prevent cancer-induced viruses are highly effective even in illiterate/low-educated people.

Screening of hepatitis B and C among people visiting general practice clinics in a rural district of Sindh, Pakistan.

BACKGROUND: Hepatitis B (HB), Hepatitis C (HC) and their risk factors are amongst the major health problems in developing countries including Pakistan. This study aimed to screen for HB and HC among people who visited General Practice clinics and also to identify the differences of screening positive cases by age and sex. METHODS: This was a retrospective study conducted in Tando Muhammad Khan city, one of the rural districts of Sindh. All together we reviewed 5989 laboratory reports of people for hepatitis B and C on consecutive basis from two laboratories. A pre-designed and structured perform was used to collect the required information. Chi-squared test and univariate analysis was calculated to assess the difference in HB and HC proportion by age groups and sex. RESULTS: One-fourth of reports were positive for at least one entity whereas 8% and 17% of reviewed reports of adults (> 18 years and above) were screened positive for HB and HC respectively. Positive screened tests were higher among older age group compared to young age group (HB: older age group = 56.6% vs. younger age group = 43.4%; OR = 1.07) and (HC: older age group = 58.3% vs. younger age group = 41.7%; OR = 1.08). In the same way, positive screened tests were higher among men compared to women (HB: men = 67.0% vs. women = 33.0%; OR = 1.2) and (HC: men = 62.0% vs. women = 38.0%; OR = 1.3), CONCLUSION: A large proportion of people were screened positive for HB and HC inthis study. Prevention and screening are suggested at larger scale for urgent planning and implementation of intervention strategies in this regard. Further research is also recommended to explore this important health issue at large scale.