Management and treatment outcomes of MDR-TB: results from a setting with high rates of drug resistance.

SETTINGS: Although Pakistan has a high burden of multidrug-resistant tuberculosis (MDR-TB), little is known about the management and treatment outcomes of MDR-TB patients in Pakistan. OBJECTIVE: To evaluate management and predictors of unsuccessful treatment outcomes among MDR-TB patients. METHODS: In this observational cohort study, 196 MDR-TB patients enrolled at the Programmatic Management Unit for drug-resistant TB of Lady Reading Hospital, Peshawar, Pakistan, between 1 January 2012 and 28 February 2013 were included. Patients were followed until an outcome was recorded or 31 January 2015. RESULTS: Extensive concurrent resistance to ofloxacin (OFX) and pyrazinamide (54.6%) was observed. Among 181 patients for whom treatment outcome was available, 135 (74.6%) were cured, 1 (0.6%) completed treatment, 35 (19.3%) died, 8 (4.4%) failed treatment and 2 (1.1%) defaulted. In multivariate analysis, predictors of unsuccessful treatment outcome (death, failure and default) were age >40 years (OR 3.412, P = 0.009), baseline body weight <40 kg (OR 2.966, P = 0.020), concurrent comorbidity (OR 3.785, P = 0.023), resistance to OFX (OR 2.777, P = 0.023), lung cavitations at baseline chest X-ray (OR 5.253, P < 0.001) and regimen modification due to adverse events (OR 3.492, P = 0.037). CONCLUSION: The treatment outcome results were encouraging. Patients with identifiable predictors of poor treatment outcome should receive enhanced clinical management. Early detection and management of mild adverse effects can help prevent regimen modification and may improve treatment outcomes.

The environmental profile of a community's health: a cross-sectional study on tobacco marketing in 16 countries

To examine and compare tobacco marketing in 16 countries while the Framework Convention on Tobacco Control requires parties to implement a comprehensive ban on such marketing.METHODS:Between 2009 and 2012, a kilometre-long walk was completed by trained investigators in 462 communities across 16 countries to collect data on tobacco marketing. We interviewed community members about their exposure to traditional and non-traditional marketing in the previous six months. To examine differences in marketing between urban and rural communities and between high-, middle- and low-income countries, we used multilevel regression models controlling for potential confounders.FINDINGS:Compared with high-income countries, the number of tobacco advertisements observed was 81 times higher in low-income countries (incidence rate ratio, IRR: 80.98; 95% confidence interval, CI: 4.15-1578.42) and the number of tobacco outlets was 2.5 times higher in both low- and lower-middle-income countries (IRR: 2.58; 95% CI: 1.17-5.67 and IRR: 2.52; CI: 1.23-5.17, respectively). Of the 11,842 interviewees, 1184 (10%) reported seeing at least five types of tobacco marketing. Self-reported exposure to at least one type of traditional marketing was 10 times higher in low-income countries than in high-income countries (odds ratio, OR: 9.77; 95% CI: 1.24-76.77). For almost all measures, marketing exposure was significantly lower in the rural communities than in the urban communities.CONCLUSION:Despite global legislation to limit tobacco marketing, it appears ubiquitous. The frequency and type of tobacco marketing varies on the national level by income group and by community type, appearing to be greatest in low-income countries and urban communities.

Study on child labour in automobile workshops of Peshawar, Pakistan.

To determine the characteristics of children working in car workshops in Peshawar, a descriptive survey was conducted from June to November 2005 of 200 boys (6-15 years) randomly selected from 32 workshops. A questionnaire was used to collect socioeconomic and work-related data. The majority of the boys had no or little education, had started work before the age of 10 years and earned <700 rupees/month. Most of their fathers had little education and were in poorly paid jobs, unemployed or deceased. About 40% of the boys were engaged in mechanical work. Watery eyes (31%), chronic cough (29%) and diarrhoea (22%) were the commonest symptoms reported by the boys and 38% had had a major injury.

Study on child labour in automobile workshops of Peshawar, Pakistan

To determine the characteristics of children working in car workshops in Peshawar, a descriptive survey was conducted from June to November 2005 of 200 boys [6-15 years] randomly selected from 32 workshops. A questionnaire was used to collect socioeconomic and work-related data. The majority of the boys had no or little education, had started work before the age of 10 years and earned < 700 rupees/month. Most of their fathers had little education and were in poorly paid jobs, unemployed or deceased. About 40% of the boys were engaged in mechanical work. Watery eyes [31%], chronic cough [29%] and diarrhoea [22%] were the commonest symptoms reported by the boys and 38% had had a major injury

Programme development of drug abuse control in Baluchistan, Pakistan.

The drug abuse control programme in Baluchistan is inter-disciplinary and progressive. Its main thrust consists of constant vigilance on border check-points by law enforcement agencies, developing in-patient and out-patient facilities for treatment and rehabilitation of addicted persons, and a preventive education programme using the mass media and students from higher educational institutions.