Gender perspectives on knowledge and practices regarding tuberculosis in urban and rural areas in Pakistan.

We investigated gender differences in knowledge of and attitude towards tuberculosis (TB) in urban and rural communities in Sindh province, Pakistan. Knowledge of symptoms was generally deficient, particularly in rural females. Regarding TB prevention, 22.4% of rural and 14.4% of urban males said completing treatment was important; only 9.8% of rural and 7.1% of urban females agreed. Doctors were an important source of information in rural areas and 60.9% of rural males said they would only stop treatment on a doctor's advice. In contrast, > 65% of respondents in urban areas said they would stop treatment when symptoms ended. Our study highlights the need to increase population awareness about TB in Sindh.

Gender perspectives on knowledge and practices regarding tuberculosis in urban and rural areas in Pakistan

We investigated gender differences in knowledge of and attitude towards tuberculosis [TB] in urban and rural communities in Sindh province, Pakistan. Knowledge of symptoms was generally deficient, particularly in rural females. Regarding TB prevention, 22.4% of rural and 14.4% of urban males said completing treatment was important; only 9.8% of rural and 7.1% of urban females agreed. Doctors were an important source of information in rural areas and 60.9% of rural males said they would only stop treatment on a doctor's advice. In contrast, > 65% of respondents in urban areas said they would stop treatment when symptoms ended. Our study highlights the need to increase population awareness about TB in Sindh

A low-cost intervention for cleaner drinking water in Karachi, Pakistan.

OBJECTIVE: To pilot test an inexpensive, home-based water decontamination and storage system in a low-income neighborhood of Karachi. METHODS: Fifty households received a 20-L plastic water storage vessel with a high-quality spout and a regular supply of diluted hypochlorite solution. Twenty-five control households were recruited. Water samples were collected at baseline and during unannounced follow-up visits 1, 3, 6, and 10 weeks later. RESULTS: Baseline drinking water samples among intervention households were contaminated with a mean 9397 colony-forming units (cfu)/100 mL of thermotolerant coliforms compared with a mean 10,990 cfu/100 mL from controls. After intervention the mean concentration of thermotolerant coliforms decreased by 99.8% among the intervention households compared with an 8% reduction among controls. Two years after vessel distribution, 34 (68%) of the families were still using the vessel. Thirteen of the households had stopped using their vessel because it had broken after more than 6 months of use, a pattern most consistent with ultraviolet radiation-induced degradation of the plastic. CONCLUSIONS: In a highly contaminated environment, a specifically designed water storage container and in-home water chlorination was acceptable and markedly improved water quality. Where plastic water vessels will be exposed to substantial sunlight, ultraviolet light stabilizers should be incorporated into the plastic.

Microbiologic effectiveness of hand washing with soap in an urban squatter settlement, Karachi, Pakistan.

We conducted a study in a squatter settlement in Karachi, Pakistan where residents report commonly washing their hands to determine if providing soap, encouraging hand washing, and improving wash-water quality would improve hand cleanliness. We allocated interventions to 75 mothers and collected hand-rinse samples on unannounced visits. In the final model compared with mothers who received no hand-washing intervention, mothers who received soap would be expected to have 65% fewer thermotolerant coliform bacteria on their hands (95% CI 40%, 79%) and mothers who received soap, a safe water storage vessel, hypochlorite for water treatment, and instructions to wash their hands with soap and chlorinated water would be expected to have 74% fewer (95% CI 57%, 84%). The difference between those who received soap alone, and those who received soap plus the safe water vessel was not significant (P = 0.26). Providing soap and promoting hand washing measurably improved mothers' hand cleanliness even when used with contaminated water.

Community growth monitoring.

BACKGROUND: For a decade the effectiveness of growth charts has been questioned. Along with the purpose of assessing the growth patterns of children, growth charts were considered to be an educational tool. With low levels of literacy in developing countries, and consequently a minimum understanding of growth charts by mothers, they have had limited effectiveness, The practice is also time-consuming and resource intensive. OBJECTIVE: In wake of the importance of monitoring the growth of children, yet keeping in mind the ineffectiveness of growth charts, a novel method of monitoring the growth of children has been demonstrated in this article. SETTING: Urban squatter settlement covering a population of 10,000 people of low-income families. METHODS: Secondary school educated females were trained to give primary health care to their neighboring families and they were paid by a 'Health Insurance' system devised locally. As part of the PHC program a novel method of growth monitoring was tried in the form of "Community Growth Monitoring". CONCLUSION: Community Growth Monitoring requires less time and is effective in measuring the growth of children of a community as a whole, rather than the individual child. This is demonstrated as a process indicator of nutrition counseling, used as an intervention in the community.

Evaluation of an enzyme-linked immunosorbent assay based on binding inhibition for type-specific quantification of poliovirus neutralization-relevant antibodies.

To detect neutralization-relevant antibodies against 3 types of poliovirus (PV) without using tissue cultures and live viruses, an enzyme-linked immunosorbent assay (ELISA) based on monoclonal antibody-binding inhibition was evaluated using sera from 80 vaccinated Japanese children and 60 Pakistani poliomyelitis patients. Compared with the neutralization test, the sensitivity of the inhibition ELISA was 100% (111/111) for detection of anti-PV1 antibody, 98.3% (118/120) for anti-PV2, and 96.5% (82/85) for anti-PV3, and the specificity was 93.1% (27/29), 100% (20/20), and 92.7% (51/55), respectively. Thus, the inhibition ELISA showed excellent potential as a seroepidemiologic tool in both vaccinated and naturally-infected populations.

Impact of health education on mothers' knowledge of preventive health practices.

A prospective community-based intervention study was conducted in a slum area of Karachi, Pakistan, with the objective of evaluating the impact of health education on the knowledge of mothers. One hundred and fifty households were studied in the intervention and the same in the non-intervention group. The post intervention knowledge scores of the mothers showed a significant difference of P < 0.05. Nearly 50.7% mothers in the intervention group knew of at least four diseases against which vaccination is given as compared to the non-intervention group (P < 0.05). Similarly, mothers in the intervention group were more aware about the advantages of breast feeding, signs of dehydration, measures for prevention of measles and tuberculosis as compared to the non-intervention group (P < 0.05). Finally, a comparison was made between the pre- and post-intervention scores between the two groups. The score in the non-intervention group changed from 11.5 to 16.1 (P > 0.05) as compared to the intervention group in which it changed from 10.2 to 32.2 (P < 0.05).

PIP: A prospective community-based intervention study was conducted in a slum area of Karachi, Pakistan, with the objective of evaluating the impact of health education on the knowledge of mothers. 150 households were studied in the intervention as well as the nonintervention group. The post-intervention knowledge scores of the mothers showed a significant difference (P 0.05). Nearly 50.7% of mothers in the intervention group knew of at least four diseases against which vaccination is given as compared to the nonintervention group (P 0.05). Similarly, mothers in the intervention group were more aware about the advantages of breast feeding, signs of dehydration, measures for prevention of measles and tuberculosis as compared to the nonintervention group (P 0.05). Finally, a comparison was made between the pre- and post-intervention scores between the two groups. The score in the nonintervention group changed from 11.5 to 16.1 (P 0.05) as compared to the intervention group, in which it changed from 10.2 to 32.2 (P 0.05).

Effect of intervention on promotion of exclusive breast feeding.

A community-based intervention study was conducted in a Katchi Abadi (slum area) of Karachi with the objective of improving optimal breast feeding practices, including promotion of exclusive breast feeding and giving of colostrum to newborns. Sixty-seven mothers were registered in the intervention group and 53 in the control group. Health education to promote exclusive breast feeding was provided in the form of flip-charts, videos and photographs. Sixty-six percent mothers in the control group gave prelacteals as compared to 31% in the intervention group (P < .0001). Colostrum was given by 97% mothers in the intervention group and 3% in the control group. Majority (94%) of intervention group mothers continued exclusive breast feeding till four months of age against 7% in the control group. It was concluded that health education programmes in the antenatal period as well as after birth can promote exclusive breast feeding practices.

Genetic divergence of poliovirus strains isolated in the Karachi region of Pakistan.

Seventy-seven wild poliovirus strains isolated from poliomyelitis cases in the Civil Hospital of Karachi in Pakistan in 1989-1993 were selected for partial sequence analysis covering the VP1/2A junction region of the viral genome to study the genetic relationships and epidemiological links between strains. Viral RNA was partially amplified by RT-PCR and sequenced by a solid phase method. Computer analysis revealed genetic divergence of the strains within each serotype. Most of the nucleotide differences between strains were silent: only a few specific amino acid substitutions were seen in the sequenced region. Three genotypes of poliovirus type 1 and two of poliovirus type 3 were co-circulating, while type 2 strains were represented by a single genotype. Representatives of all the genotypes present have been found among previously or concurrently characterized stains isolated elsewhere, but direct epidemiological links were found only in the case of serotype 1. Many of the epidemics caused by poliovirus type 1 in other countries were genetically linked to Pakistan. This study clearly shows the endemic circulation and wide variation of all three poliovirus serotypes in southern Pakistan and indicates the need for more effective vaccination programmes to prevent the further spread of these wild viruses.

An experiment in primary health care in Karachi, Pakistan.

PIP: The Health Education and Literacy Project (HELP) set up a primary health care (PHC) project in the urban slum of Naleem Colony in Karachi, Pakistan, in 1992. The project integrated preventive health, literacy, sanitation, and income generation. Its focus was the community health worker (CHW). Its motto was self-sustainability. A rotating fund allowed the community to contribute towards maintaining the CHW. A community grass-roots organization had administrative control of the project. Researchers had conducted a baseline survey and one year later a knowledge, attitude, and practices survey of 150 households that had received health education and of 150 other households that did not receive health education. The two groups were located in geographically distinct areas. At follow-up, the intervention group consistently was more likely to have good hygienic health practices than the control group (garbage covered, garbage disposal in the garbage drum, washing hands before feeding, and wash hands and child after defecation; p 0.05). Mothers in the intervention group were significantly more likely to know about the vaccinations children needed than those in the control group (for all vaccinations, 76% vs. 21%; p 0.0001). They were also more likely to know how to make oral rehydration solution (ORS) at home than their counterparts (65% vs. 15%). Among intervention mothers, 27% of their children had had diarrhea and 92% of the mothers had used ORS during an episode of diarrhea. The knowledge of correct dietary sources of protein among the intervention group improved significantly between baseline and follow-up (23% vs. 55%; p 0.05), while it did not for the controls (23% vs. 30%; p 0.05). These findings suggest that the project was on the right track towards overall community development by providing health education, sanitation, literacy, and income generation services to the people of the squatter settlement.^ieng

Enteric viral infections in pre-school children in Karachi, Pakistan.

A prospective study was conducted in Karachi, Pakistan on the virology of enteropathogens excreted by children with acute gastroenteritis and the results were compared with a control group of healthy children. Rotavirus and Adenovirus detection was done using ELISA techniques, while enterovirus isolation was done by virus culture. In 1990, 12.3% children with acute watery diarrhoea excreted rotavirus, as compared to 24.4% children in 1991. None of the healthy children excreted adenovirus 40 and 41. Preliminary results of 1992 revealed that rotavirus was seen in 13% of children with acute watery diarrhoea and adenovirus in 10% of children. Enteroviruses were isolated in the same frequency in all three groups i.e. children with acute watery diarrhoea, children with poliomyelitis and healthy children. Non-polio enteroviruses were excreted in 50-52% in all the 3 groups. The rate of enterovirus excretion is much higher than seen in other developed countries and is the same in children with diarrhoea and healthy children.

Hepatitis A, B and C seroprevalence in Pakistan.

A cross sectional study was conducted to determine the seroprevalence of Hepatitis A, B, and C virus in healthy Pakistani children. HAV IgG antibody was assayed in 258 subjects and it was found that 94% children by 5 years of age had HAV IgG-antibody. The overall seroprevalence of HAV IgG antibody was 55.8% and IgM 5.3%. HBVsAb levels assayed in 236 healthy children showed a seroprevalence of 2.97%. Similarly, HCV antibody seroprevalence was found to be a low 0.44% in healthy children. HAV is a major cause of Hepatitis, as compared to HBV and HCV which are of low endemicity.

The immune function and measles virus infection in three different socioeconomic child populations in Karachi, Pakistan.

The immune function as well as anti-measles virus antibody level were investigated with 111 children in Karachi who were classified into high-, middle- and low-income groups. No difference in the blood cell counts or the biochemical data among three groups indicates no marked difference in the general health conditions among them. In the low-income group, levels of IgG, IgA and anti-measles virus antibody were significantly higher than those in the other two groups. Although 30% of children of the low-income group kept extremely high levels of immunoglobulin, no significant correlation was observed between IgG levels and anti-measles virus antibody levels. In the high-income group, the level of IgM was significantly lower and the incidence of anti-measles virus antibody-negative children was high (7/38; 18.4%). These antibody-negative children kept lower immunoglobulin levels although they were over four years old. These results suggest that the living environmental conditions of these different socioeconomic groups vary greatly and hygienic conditions must influence the chance of encountering infectious pathogens including measles virus. The relation between living environment and risk of subacute sclerosing panencephalitis (SSPE) in child population of Krachi is discussed.