Sleep and its relation with academic performance among adolescents: An analytical cross sectional study in Gulshan Town, Karachi.

OBJECTIVE: To determine the prevalence of sleep patterns and their relationship with academic performance among adolescents. METHODS: The analytical cross-sectional study was conducted from March to August 2015 in Gulshan Town of Karachi and comprised students in grades 6 to 8 who were selected from six government and private schools. Data was collected regarding their sleeping time, wake-up time, sleep latency and total sleep duration. Paediatric Daytime Sleepiness Scale was administered to calculate daytime sleepiness. Academic performance of students was taken from school academic records. Data was analysed using SPSS 22. RESULTS: Of the 440 subjects, 234 (53.2%) were boys and 206 (46.8%) were girls. The overall age range was 11-16 years. A total of 280 (63.6%) students had abnormal sleep patterns, 182(41.4%) suffered from daytime sleepiness, 41 (9.3%) had abnormal sleep latency and 201 (45.7%) scored below 60% in their exams. Among poor sleepers, 157 (56.1%) scored below 60% in their exams. CONCLUSIONS: More than half the subjects were found to be sleeping less than required, which eventually affected their academic performance.

Knowledge regarding calcium contained in food amongst secondary school going adolescents in Karachi.

OBJECTIVE: To determine the knowledge regarding calcium contained in food among secondary school-going children. METHODS: The cross-sectional study was conducted from February to May 2013 in two public and two private schools of Jamshed Town, Karachi. Stratified random sampling was used to raise the study sample. A pre-coded, piloted questionnaire was used for data collection. Data was analysed using SPSS 19. RESULTS: Of the 153 participants, 27(18.3%) had adequate knowledge while 126(81.7%) had inadequate knowledge about calcium contained in food. The mean age of the participants was 13.52±1.725 years. Statistically significant association was present between knowledge regarding calcium and mother's and father's educational level (p=0.039 and p=0.012, respectively), mother's and father's working status (p=0.002 and p=0.015, respectively) and acquisition of knowledge from parents (p=0.020), teachers (p=0.039) and via television (p=0.034). CONCLUSIONS: Most adolescents did not have knowledge about calcium contained in food.

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.

Impact of postpartum anxiety and depression on child's mental development from two peri-urban communities of Karachi, Pakistan: a quasi-experimental study.

BACKGROUND: Postpartum anxiety and depression has detrimental effects on the overall mental development of children. This study aims to assess the impact of postpartum anxiety and depression on children's mental development on all sub-scales in a Pakistani population. METHODS: A quasi-experimental study was conducted in two peri-urban communities of Karachi, a mega city of Pakistan, to assess the impact of postpartum anxiety and depression on children's growth and mental development. A total of 420 women were enrolled, who had given consent out of 651 pregnant women identified, during February 2004 to December 2005. Data for socio-demographic, home environment and family relationship variables were collected between 36 weeks of pregnancy and within 10 days of childbirth. Mother's levels of anxiety and depression were assessed at 1, 2, 6, 12, 18, 24, and 30 months of childbirth. An indigenous, validated screening instrument- Aga Khan University Anxiety and Depression scale was used and diagnostic confirmation was done through a psychologist's interview, based on DSM IV criteria. Children's growth and development was monitored in the same sequence using an Early Childhood Development tool that consists of five subscales; socio emotional, language, cognitive, gross motor and fine motor development. Physical growth was monitored by measuring height and weight of the child. Data was analyzed using SAS 9.2. Multivariable Generalized Estimating Equations (GEE) logistic regression was conducted to identify association of postpartum anxiety and depression with each early childhood development indicator, adjusting for parental and child factors. RESULTS: A significant association of postpartum anxiety and depression with delayed development on all five subscales of children's mental development was found in our study. Interestingly, our study found that higher maternal age had adverse effects on child's emotional whereas positive impact on child's cognitive development. Children's stunting had an adverse impact on all five subscales of children's development. Male children were at higher risk for delayed language and gross motor development relative to female children. CONCLUSIONS: Our study found that postpartum anxiety and depression is associated with adverse outcomes regarding children's mental development on all sub-scales. The impact was accentuated by low family income or child's increasing age.

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.

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.

Smokeless tobacco use among adult patients who visited family practice clinics in Karachi, Pakistan.

BACKGROUND: Use of smokeless tobacco (SLT) is significantly associated with poor oral health and cancers. The objectives of this study were to estimate the proportion of use and the knowledge about SLT in relation to oral cancer and its differentials by socio-demographic and patient's diagnostic categories. This study also aimed to assess the SLT user's attitude and practices for its use. METHODS: In a cross-sectional study, 502 adult patients (> or =15 years) were randomly interviewed in family practice clinics in Karachi, Pakistan. SLT use was considered as usage of any of the following: betel quid (paan) with tobacco, betel nuts with tobacco (gutkha), and snuff (naswar). RESULTS: Overall, 52.4% subjects had used SLT at least in one form. More males were using SLT than females (P = 0.03). Similarly, higher proportion of patients with gastro-intestinal diseases were using SLT compared with other diagnostic categories (P = 0.004). Knowledge about the oral carcinogenic effect of SLT was higher among men and those who had schooling of >10 years (P < 0.001). This knowledge was also higher in patients with non-communicable and infectious diseases. Among SLT users, 31.3% tried to quit this habit but failed. The majority of users started using SLT before the age of 15 years; 40.2% and 30.8% started after being inspired by media advertisements and friends/peer pressure, respectively. CONCLUSIONS: In this study, over half of the patients were using SLT in various forms and had poor knowledge about its hazards. We suggest that there is a need for socially and culturally acceptable educational and behavioral interventions for control of SLT usage.

Characteristics of patients using psychoactive drugs in Karachi, Pakistan.

OBJECTIVES: To assess the distribution of various characteristics related to use of psychoactive drugs and the differences by gender. METHOD: A case-series study was conducted at the out-patient clinic affiliated with a teaching hospital in Karachi, Pakistan. After taking consent to participate, 118 adult patients who visited these clinics for consultation for any reason and were taking psychoactive drug(s) were interviewed. RESULTS: Over 40% of the study subjects were taking psychoactive drugs without an advice from their doctor. In all, 78% were taking psychoactive drugs for >6 months and 67% were using these drugs on a regular basis. Over 85% were using these for induction of sleep and 59% for relaxation. Seventy-five percent of study participants reported that they can afford these pills and over 46% were able to get these drugs easily; significantly more men compared to women (58% vs. 39%; difference of proportion = -19.7; 95% CI = -37, -1.5). All other studied characteristics were equally distributed among men and women. CONCLUSION: In this study a substantial number of cases were using psychoactive drugs without doctors' advice. Patient education and health awareness sessions may be helpful in preventing inappropriate use of psychotropic drugs.

Cost effectiveness of screening of all newly recruited employees for diabetes at a tertiary care hospital.

BACKGROUND: Diabetes Mellitus is a disease which remains asymptomatic for long duration of time and usually diagnosed either when gets complicated or by routine or opportunistic screening. The practice of universal screening is not recommended, particularly in constraint resources. However, we embarked with a study to assess the yield of recommended screening for Type 2 diabetes in all the newly recruited employees at a tertiary care hospital in Karachi. METHODS: All the information required for this study was collected from medical records of all newly recruited employees of nursing services department of a tertiary care hospital of Karachi, Pakistan, over a period of 5 months (August 2004 to December 2004). Out of 360 subjects, 326, whose information was found to be complete, were included for final analysis. RESULTS: Mean age of the study subjects was 25.3 +/- 4.7 years and their mean casual plasma glucose level was 99.1 +/- 16.3 mg/dl. 315 (96.6%) study subjects had casual plasma glucose level of 139 mg/dl or less. Only 10 (3.1%) study subjects had casual plasma glucose levels between 140 to 199 mg/dl. Just one employee, 41 years old, was found to have casual plasma glucose level of 213 mg/dl. CONCLUSION: In this study, screening of all individuals for diabetes had a very low yield. Recommendation of universal screening for diabetes does not represent a good use of resources and perhaps not cost-effective. However, periodic screening of high risk individuals should be warranted.

Hepatitis B vaccination status and identification of risk factors for hepatitis B in health care workers.

OBJECTIVE: To assess the vaccination status of health care workers and to identify the risk factors for hepatitis B at a tertiary care hospital. DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi from March 2003 to May 2003. PATIENTS AND METHODS: Three hundred and ninety-three health care workers were interviewed after taking verbal consent using a self-administered questionnaire by convenience sampling. A sample size of 385 was calculated, using 5% level of significance, margin of error as 5% and an expected prevalence of 50%. Descriptive statistics like percentages, mean and range were obtained. RESULTS: A total of 393 respondents, (age range 19-59 years) were interviewed. Amongst them 86% were completely vaccinated, 12% had incomplete vaccination and 2% didn't have even a single dose. Needle stick injuries were highest amongst those health care workers who had complete vaccination. CONCLUSION: Despite the availability of free vaccination, a target of 100% coverage has not yet been achieved. All health care workers should be motivated and ensured for vaccination. Regular educational campaigns for health care workers are needed to increase vaccination compliance.

Womens' beliefs and practices regarding food restrictions during pregnancy and lactation: a hospital based study.

BACKGROUND: Maternal diet is an important determinant of outcomes of pregnancy. Malnutrition during pregnancy and its consequences maximally affect the health and long-term outcomes of the population. Low birth weight accounts for almost 30% of all births; with maternal malnutrition as a dominant risk factor. This study aims to investigate the existing beliefs and practices regarding food restrictions during pregnancy and lactation and also to assess whether there is any relationship with education level of the respondent and their beliefs and practices. METHODS: A cross-sectional survey was conducted at Community Health Center (CHC) of The Aga Khan University Hospital, Karachi from July-September 2000. Four hundred adult female respondents, who came to the outpatient services as a patient or as an attendant, were interviewed after taking verbal consent. A self administered pre-coded and pre-tested questionnaire was filled by the respondent. RESULTS: More than three fourths of respondents were literate. Twelve percent believed in restricting some food item during pregnancy and about 25% believed the same during lactation. No statistically significant association was found between belief about food restriction during pregnancy or during lactation and education level of the respondent. CONCLUSION: Undue food restrictions during pregnancy and lactation do exist in our culture. To assess the true picture we need to conduct larger studies in the community. The information obtained from the studies will help us in addressing these issues for improvement of nutritional knowledge and dietary practices and to avoid undue food restrictions.

Women s perception about food properties in a tertiary care hospital.

OBJECTIVE: To understand the existing food beliefs regarding hot, cold and badi (gas-producing) properties of different food items and also to assess whether there is any relationship with education of women and these beliefs. DESIGN: A cross-sectional study. PLACE AND DURATION OF STUDY: Community Health Center (CHC), The Aga Khan University Hospital, Karachi from July to September 2000. SUBJECTS AND METHODS: Four hundred adult female respondents, who came to CHC as a patient or as an attendant, were interviewed after taking verbal consent. A self-administered pre-coded and pre-tested questionnaire was filled by the respondent. Descriptive frequencies and cross tabulation were computed to assess the existing food beliefs. Chi-square test was used to assess the association between education level of women and belief regarding these food items. RESULTS: More than three-fourth of respondents were literate. The percentages of respondents saying that certain foods were hot, cold and badi were 71%, 55% and 80% respectively. Meat, either beef or mutton, fish, egg, chicken, was perceived as hot by majority of the respondents. Majority of vegetables was perceived as cold foods in our study. The other foods like rice, yogurt, banana, watermelon, milk and cold drink were also thought to be cold by many of the respondents. Cabbage, cauliflower, potato, rice, gram and mash pulses (chane and mash-ki-dal) were highly rated as badi foods. Level of education of women didn t show any statistically significant difference in keeping beliefs regarding hot, cold and badi properties of food items. CONCLUSION: A significant concept of different properties of food exists in our culture. We recommend future studies to explore scientific basis for classifying hot, cold or badi foods and also to look into its impact on health by their restriction based on their beliefs.

Women's beliefs regarding food restrictions during common childhood illnesses: a hospital based study.

BACKGROUND: Malnutrition continues to be a major problem in Pakistan. Inadequate nutrition contributes substantially to childhood death and disease. Restriction of diet during common childhood illnesses further compromises the nutritional status of the child. The present study aims to determine the beliefs and practices regarding food restrictions during common childhood illnesses. METHODS: A cross-sectional survey was conducted at Community Health Centre (CHC), of The Aga Khan University Hospital, Karachi to understand the beliefs and practices regarding food restrictions in common childhood illnesses. Four hundred adult females were interviewed from July-September 2000. A self-administered questionnaire was filled by the respondent. RESULTS: Major sources of information about restriction of various foods during different illnesses were relatives. Sixty five percent of the respondents believed that heavy food should be restricted during diarrhoea and oily food during jaundice. Sixty six percent of the respondents believed that cold food should be restricted during cold/cough and twenty three percent believed that oily food should be restricted during typhoid. CONCLUSION: Beliefs' regarding food restrictions during illnesses plays a very important role on the nutrition status. Surprisingly, medical doctors and other health care givers were also the source of information for advising food restrictions in certain childhood illnesses. Therefore there is a need for educating the physicians and other health care workers along with the mothers about food concepts and feeding practices during health and diseases. Protein energy malnutrition can be reduced to some extent if wrong dietary beliefs about child feeding practices in a community can be removed with health education programme.