Family Medicine Commons^™

Factors Associated With Geriatric Morbidity And Impairment In A Megacity Of Pakistan, Saniya Sabzwari, Romaina Iqbal, Zafar Fatmi, Iqbal Azam Syed

Department of Family Medicine

Background: The elderly population is increasing globally. In Pakistan, the elderly comprise 6% of the population that is predicted to triple by 2050. Non-communicable diseases are common health problems of the elderly in Pakistan, however, resulting geriatric impairments and disability are unknown. This study was conducted to determine geriatric impairments and identify associated socio-demographic factors and comorbidities among community dwelling elderly in Karachi, Pakistan.
Methods: A cross-sectional study was conducted during 2013-2014. Community clusters were selected from all sub-districts of Karachi, the largest city of Pakistan. Data was collected from systematically selected households within these clusters from individuals, aged ≥60 …

Regional Variation In Comorbid Prediabetes And Diabetes And Associated Factors Among Hypertensive Individuals In Rural Bangladesh, Pakistan, And Sri Lanka, Liang Feng, Aliya Naheed, H. Asita De Silva, Imtiaz Jehan, Rubhana Raqib, Md Tauhidul Islam, Nathasha Luke, Anuradhani Kasturiratne, Hamida Farazdaq, Sahar Senan, Tazeen Jafar, Cobra-Bps Study Group

Community Health Sciences

We aimed to explore the cross-country variation in the prevalence of comorbid prediabetes or diabetes and determine the sociodemographic, lifestyle, and clinical factors, especially body mass index (BMI) and waist circumference, associated with comorbid diabetes in individuals with hypertension in rural South Asia. We analyzed cross-sectional data of 2426 hypertensive individuals of ≥40 years from 30 randomly selected rural communities in Bangladesh, Pakistan, and Sri Lanka. Prediabetes was defined as fasting plasma glucose (FPG) between 100 and 125 mg/dL without use of antidiabetic treatment and diabetes as FPG ≥126 mg/dL or use of antidiabetic medication. The prevalence (95% CI) of …

The Minds Of Mothers: Maternal Mental Health In An Urban Squatter Settlement Of Karachi., Fauziah Rabbani, Furqan Farooq Raja

Fauziah Rabbani

BACKGROUND:

Community-based information on maternal mental health in developing countries is meager and nearly non-existent in Pakistan.

OBJECTIVE:

To determine the proportion of probable cases of women with mental disorders and examine the associated conditions and risk factors which contribute to maternal mental ill-health.

METHODS:

With convenient sampling 260 mothers in an urban squatter settlement of Karachi were interviewed. The tools consisted of a household questionnaire collecting information on basic demographic and other characteristics and the Aga Khan University Anxiety and Depression Scale (AKUADS), an instrument to assess psychiatric morbidity.

RESULTS:

The proportion of probable cases of mental disorder was …

Motivating And Demotivating Factors For Community Health Workers Engaged In Maternal, Newborn And Child Health Programs In Low And Middle-Income Countries: A Systematic Review., Leah Shipton, Aysha Zahidie, F. Rabbani

Fauziah Rabbani

This systematic review aimed to synthesize primary research on motivating factors of community health workers (CHWs) for maternal, neonatal, and child health (MNCH) in low and middle-income countries (LMICs). Peer-reviewed literatures were systematically searched in five databases. Identified studies were then screened and selected for inclusion. The eligibility criteria were reported primary qualitative, quantitative, or mixed methods research, with participants being CHWs in LMICs who address MNCH, which investigated motivation or related concepts of retention, attrition, and performance. A thematic synthesis process was used to analyze findings of motivating factors, reported by included studies. Seventeen qualitative, quantitative, or mixed methods …

Inspiring Health Worker Motivation With Supportive Supervision: A Survey Of Lady Health Supervisor Motivating Factors In Rural Pakistan, Fauziah Rabbani, Leah Shipton, Wafa Aftab, Kashif Sangrasi, Shagufta Perveen, Aysha Zahidie

Fauziah Rabbani

BACKGROUND: Community health worker motivation is an important consideration for improving performance and addressing maternal, newborn, and child health in low and middle-income countries. Therefore, identifying health system interventions that address motivating factors in resource-strained settings is essential. This study is part of a larger implementation research project called Nigraan, which is intervening on supportive supervision in the Lady Health Worker Programme to improve community case management of pneumonia and diarrhea in rural Pakistan. This study explored the motivation of Lady Health Supervisors, a cadre of community health workers, with particular attention to their views on supportive supervision. METHODS: Twenty-nine …

Improving Community Case Management Of Diarrhoea And Pneumonia In District Badin, Pakistan Through A Cluster Randomised Study--The Nigraan Trial Protocol, Fauziah Rabbani, Aftab A. Ali Mukhi, Shagufta Perveen, Xaher Gul, Saleem Iqbal Perwaiz, Shamim Ahmed Qazi, Iqbal Azam Syed, Khalid Hussain Shaikh, Wafa Aftab

Fauziah Rabbani

BACKGROUND:

Diarrhoea and pneumonia contribute 30% of deaths in children under 5 in Pakistan. Pakistan's Lady Health Workers Programme (LHW-P) covers about 60% of the population but has had little impact in reducing morbidity and mortality related to these major childhood killers. An external evaluation of the LHW-P suggests that lack of supportive supervision of LHWs by lady health supervisors (LHSs) is a key determinant of this problem. Project NIGRAAN aims to improve knowledge and skills of LHWs and community caregivers through supervisory strategies employed by LHSs. Ultimately, community casemanagement (CCM) of childhood pneumonia and diarrhoea will improve.

METHODS/DESIGN:

NIGRAAN …

Health Workers’ Perspectives, Knowledge And Skills Regarding Community Case Management Of Childhood Diarrhoea And Pneumonia: A Qualitative Inquiry For An Implementation Research Project “Nigraan” In District Badin, Sindh, Pakistan, Fauziah Rabbani, Shagufta Perveen, Wafa Aftab, Aysha Zahidie, Kashif Sangrasi, Shamim Ahmad Qazi Ahmad Qazi

Fauziah Rabbani

BACKGROUND: Pakistan's Lady Health Worker Programme aims to provide care to children sick with pneumonia and diarrhoea, which continues to cause 27 % under-five mortality in Pakistan. The quality of supervision received by Lady Health Workers (LHWs) in the programme influence their knowledge and skills, in turn impacting their ability to provide care. METHODS: This study is part of an implementation research project titled "Nigraan" (an Urdu word meaning supervisor), and explores LHW and Lady Health Supervisor (LHS) perspectives regarding the role of supervision in improving LHWs performance and motivation in district Badin, Sindh, Pakistan. Their knowledge and skills regarding …

Economic Development And Health Status Among The Poor In Squatter Settlements Of Karachi., Fauziah Rabbani, Anwer T. Merchant

Fauziah Rabbani

OBJECTIVE:

Socioeconomic status is an important determinant of health outcome measures. This study examines and presents some of the important health outcomes amongst the higher and lower socioeconomic groups within the urban poor.

SETTING:

Data analysis is based on a Health and Demographic Survey conducted in urban squatter settlements of Karachi in 1996.

METHODS:

A structured questionnaire was administered to all households in the catchment area. The indicator used to assess economic status is ownership of assets.

RESULTS:

Comparison between the two economic levels shows that the lower socio-economic group was more likely to experience child mortality, (CI; 1.02-1.29, p …

Behind The Counter: Pharmacies And Dispensing Patterns Of Pharmacy Attendants In Karachi., Fauziah Rabbani, F. H. Cheema, N. Talati, S. Siddiqui, S. Syed, S. Bashir, L. Z. Zuberi, A. Shamim, Q. Mumtaz

Fauziah Rabbani

BACKGROUND:

There is little literature available on dispensing patterns and unsupervised sale of medicines from pharmacies in developing countries.

OBJECTIVE:

This study obtained background information on pharmacies assessed the level of training, knowledge and dispensing patterns of pharmacy attendants in Karachi.

METHODOLOGY:

This is a descriptive cross sectional study with convenient sampling. A structured questionnaire was used to interview pharmacy attendants.

RESULTS:

Of the 219 pharmacies surveyed, 62% reported more than 50 customers daily and 20% also sold items of general provision. Mean operating hours were 13. Only 24 (11%) had a visible license. On an average 3 attendants were …

Psycho-Social Consequences Of Secondary Infertility In Karachi., Neelofar Sami, Tazeen Saeed Ali

Tazeen Ali

OBJECTIVE:

To explore the experiences of social consequences among women suffering from secondary infertility.

METHODS:

Descriptive case series of 400 women with secondary infertility attending tertiary care hospitals in Karachi, Pakistan.

RESULTS:

More than two thirds (67.7%) of women stated that their inability to give live births or give birth to sons had resulted in marital dissonance. The respondents had been threatened for divorce (20%), husband's remarrying (38%) or to be returned to their parent's home (26%) by their in laws or husbands. Majority (68%) of the women threatened did not have any live births. However, those who had live …

Lead Exposure Assessment Among Pregnant Women, Newborns, And Children: Case Study From Karachi, Pakistan., Zafar Fatmi, Ambreen Sahito, Akihiko Ikegami, Atsuko Mizuno, Xiaoyi Cui, Nathan Mise, Mai Takagi, Yayoi Kobayashi, Fujio Kayama

Community Health Sciences

Lead (Pb) in petrol has been banned in developed countries. Despite the control of Pb in petrol since 2001, high levels were reported in the blood of pregnant women and children in Pakistan. However, the identification of sources of Pb has been elusive due to its pervasiveness. In this study, we assessed the lead intake of pregnant women and one- to three-year-old children from food, water, house dust, respirable dust, and soil. In addition, we completed the fingerprinting of the Pb isotopic ratios (LIR) of petrol and secondary sources (food, house-dust, respirable dust, soil, surma (eye cosmetics)) of exposure within …

Motivating And Demotivating Factors For Community Health Workers Engaged In Maternal, Newborn And Child Health Programs In Low And Middle-Income Countries: A Systematic Review., Leah Shipton, Aysha Zahidie, F. Rabbani

Community Health Sciences

This systematic review aimed to synthesize primary research on motivating factors of community health workers (CHWs) for maternal, neonatal, and child health (MNCH) in low and middle-income countries (LMICs). Peer-reviewed literatures were systematically searched in five databases. Identified studies were then screened and selected for inclusion. The eligibility criteria were reported primary qualitative, quantitative, or mixed methods research, with participants being CHWs in LMICs who address MNCH, which investigated motivation or related concepts of retention, attrition, and performance. A thematic synthesis process was used to analyze findings of motivating factors, reported by included studies. Seventeen qualitative, quantitative, or mixed methods …

Nutritional Status And Physical Abuse Among The Children Involved In Domestic Labour In Karachi Pakistan: A Cross-Sectional Survey., Saima Zainab, Muhammad Masood Kadir

Community Health Sciences

OBJECTIVE:

To determine the prevalence of physical abuse among domestic child labours and to assess the nutritional status by calculating the Body Mass Index of children involved in domestic labour in Karachi.

METHODS:

A cross sectional study was conducted in the squatter settlements of Karachi. Questionnaire based interviews were conducted to capture physical abuse with 385 children who worked as domestic labour in the household of their employer. The ages of the children were between 10 to 14 years belonging to both genders. The children were enrolled in study by snow-ball sampling technique.

RESULTS:

The overall prevalence of physical abuse …

Health Workers’ Perspectives, Knowledge And Skills Regarding Community Case Management Of Childhood Diarrhoea And Pneumonia: A Qualitative Inquiry For An Implementation Research Project “Nigraan” In District Badin, Sindh, Pakistan, Fauziah Rabbani, Shagufta Perveen, Wafa Aftab, Aysha Zahidie, Kashif Sangrasi, Shamim Ahmad Qazi Ahmad Qazi

Community Health Sciences

BACKGROUND:

Pakistan's Lady Health Worker Programme aims to provide care to children sick with pneumonia and diarrhoea, which continues to cause 27 % under-five mortality in Pakistan. The quality of supervision received by Lady Health Workers (LHWs) in the programme influence their knowledge and skills, in turn impacting their ability to provide care.

METHODS:

This study is part of an implementation research project titled "Nigraan" (an Urdu word meaning supervisor), and explores LHW and Lady Health Supervisor (LHS) perspectives regarding the role of supervision in improving LHWs performance and motivation in district Badin, Sindh, Pakistan. Their knowledge and skills regarding …

Obesity, An Emerging Epidemic In Pakistan-A Review Of Evidence., Sana Tanzil, Tanzil Jamali

Community Health Sciences

BACKGROUND:

In Pakistan, the disease pattern is facing a huge changeover from acute and communicable diseases to the non-communicable diseases. Moreover, an emerging epidemic of obesity is still under recognized in Pakistan. A detailed review and dissemination of the existing knowledge to determine the extent of burden of obesity can help understand this important public health issue.

METHODS:

A detailed literature review was conducted through PubMed search engines, regarding obesity burden in Pakistan. The original peer reviewed research articles, reports of WHO in English language, non-government organizations reports were included in the review. "Obesity AND Pakistan" were used as a …

Inspiring Health Worker Motivation With Supportive Supervision: A Survey Of Lady Health Supervisor Motivating Factors In Rural Pakistan, Fauziah Rabbani, Leah Shipton, Wafa Aftab, Kashif Sangrasi, Shagufta Perveen, Aysha Zahidie

Community Health Sciences

BACKGROUND:

Community health worker motivation is an important consideration for improving performance and addressing maternal, newborn, and child health in low and middle-income countries. Therefore, identifying health system interventions that address motivating factors in resource-strained settings is essential. This study is part of a larger implementation research project called Nigraan, which is intervening on supportive supervision in the Lady Health Worker Programme to improve community case management of pneumonia and diarrhea in rural Pakistan. This study explored the motivation of Lady Health Supervisors, a cadre of community health workers, with particular attention to their views on supportive supervision.

METHODS:

Twenty-nine …

Chronic Bronchitis And Chronic Obstructive Pulmonary Disease (Copd) Among Textile Workers In Karachi, Pakistan, Asaad Ahmed Nafees, Zafar Fatmi, Muhammad Masood Kadir, Nalini Sathiakumar

Community Health Sciences

Objective: To determine the frequency and predictors of chronic bronchitis and COPD among textile workers in Karachi, Pakistan.
Study design: Cross-sectional survey.
Place and duration of study: Karachi, Pakistan, from October to December 2009.
Methodology: Male textile workers from 15 mills of Karachi were inducted. Data was collected using American Thoracic Society respiratory questionnaire (ATS-DLD-78-a) and spirometry.
Results: Out of 372 participants, 29 (7.8%) workers had chronic bronchitis (4, 9.1% aged ≥40 years) and 25 (6.7%) had COPD (12, 27.2% aged ≥40 years). Workers with chronic bronchitis had significantly decreased lung function compared to the healthy workers. Those reporting severe …

The Role Of Micro Health Insurance In Providing Financial Risk Protection In Developing Countries- A Systematic Review., Shifa Salman Habib, Shagufta Perveen, Hussain Maqbool Ahmed Khuwaja

Community Health Sciences

BACKGROUND:

Out of pocket payments are the predominant method of financing healthcare in many developing countries, which can result in impoverishment and financial catastrophe for those affected. In 2010, WHO estimated that approximately 100 million people are pushed below the poverty line each year by payments for healthcare. Micro health insurance (MHI) has been used in some countries as means of risk pooling and reducing out of pocket health expenditure. A systematic review was conducted to assess the extent to which MHI has contributed to providing financial risk protection to low-income households in developing countries, and suggest how the findings …

Are Pre-School Girls More Likely To Be Under-Nourished In Rural Thatta, Pakistan?-A Cross-Sectional Study., Rozina Nuruddin, Wilbur C. Hadden

Community Health Sciences

BACKGROUND:

Pakistan ranks third lowest on a global gender index (2013) and 13(th) highest on the prevalence of underweight among under-five children (2010). Through this population-based study, we examined gender differentials in the prevalence of stunting, wasting and under-weight defined by World Health Organization (WHO) Growth Standard among rural pre-school Pakistani children.

METHODS:

We performed secondary analysis of data collected through a cross-sectional survey of Thatta district during 1992-93. Prevalence ratios were calculated for 1051 children aged 0-35 months from 95 randomly selected villages of rural Pakistan using a clustered adjusted log binomial model. Level 1 variables included child and …

Improving Community Case Management Of Diarrhoea And Pneumonia In District Badin, Pakistan Through A Cluster Randomised Study--The Nigraan Trial Protocol, Fauziah Rabbani, Aftab A. Ali Mukhi, Shagufta Perveen, Xaher Gul, Saleem Iqbal Perwaiz, Shamim Ahmed Qazi, Iqbal Azam Syed, Khalid Hussain Shaikh, Wafa Aftab

Community Health Sciences

BACKGROUND:

Diarrhoea and pneumonia contribute 30% of deaths in children under 5 in Pakistan. Pakistan's Lady Health Workers Programme (LHW-P) covers about 60% of the population but has had little impact in reducing morbidity and mortality related to these major childhood killers. An external evaluation of the LHW-P suggests that lack of supportive supervision of LHWs by lady health supervisors (LHSs) is a key determinant of this problem. Project NIGRAAN aims to improve knowledge and skills of LHWs and community caregivers through supervisory strategies employed by LHSs. Ultimately, community casemanagement (CCM) of childhood pneumonia and diarrhoea will improve.

METHODS/DESIGN:

NIGRAAN …

Epidemiology, Determinants And Dynamics Of Cholera In Pakistan: Gaps And Prospects For Future Research., Maliha Naseer, Tanzil Jamali

Community Health Sciences

Cholera is one of the notifiable endemic diseases in Pakistan, but the reporting of cholera cases is still unsatisfactory. Most of the diagnosed cases are never reported to the relevant authorities. In the year 1993 - 2005, the country did not report any single case of cholera to the WHO. The objectives of this review were to understand the epidemiology and to identify the possible determinants of cholera infection in Pakistan. Medscape, Medline, PakMedinet and PubMed, was searched, using key words, epidemiology and determinants of cholera infection in Pakistan during 1995 - 2010. Morbidity and mortality due to cholera infection …

Needle Stick Injuries--Risk And Preventive Factors: A Study Among Health Care Workers In Tertiary Care Hospitals In Pakistan., Asad Ali Khan Afridi, Ameet Kumar, Raza Sayani

Community Health Sciences

BACKGROUND:

Health care workers (HCWs) are at substantial risk of acquiring blood borne infections such as HIV, Hepatitis-B and Hepatitis-C through needle stick injuries (NSIs). This study aimed to assess the proportion of NSIs and their associated factors among HCWs and also to identify the areas in which preventive efforts might be directed to protect against this occupational hazard.

METHODOLOGY:

A cross-sectional study was conducted in two tertiary care hospitals of Pakistan representing both private and public health sector. A total of 497 HCWs (doctors and nurses) were interviewed using a structured questionnaire. Data was collected from January to May …

Respiratory Symptoms And Illnesses Among Brick Kiln Workers: A Cross Sectional Study From Rural Districts Of Pakistan, Shiraz Shaikh, Asaad Ahmed Nafees, Vikash Khetpal, Abid Ali Jamali, Abdul Manan Arain, Akram Yousuf

Community Health Sciences

Background: Occupational risk factors are one of the major causes of respiratory illnesses and symptoms, and account for 13% of chronic obstructive pulmonary disease and 11% of asthma worldwide. Majority of brick kilns in Pakistan use wood and coal for baking the bricks which makes the brick kiln workers susceptible to high exposure of air pollution. This study was designed to describe frequency of chronic respiratory symptoms and illnesses and study the association between these symptoms and different types of work.
Methods: This was a questionnaire based cross sectional survey conducted among the brick kiln workers in Larkana and Dadu …

National Health Accounts: Lessons For Pakistan., Ashar Muhammad Malik

Community Health Sciences

No abstract provided.

Psycho-Social Consequences Of Secondary Infertility In Karachi., Neelofar Sami, Tazeen Saeed Ali

Community Health Sciences

OBJECTIVE:

To explore the experiences of social consequences among women suffering from secondary infertility.

METHODS:

Descriptive case series of 400 women with secondary infertility attending tertiary care hospitals in Karachi, Pakistan.

RESULTS:

More than two thirds (67.7%) of women stated that their inability to give live births or give birth to sons had resulted in marital dissonance. The respondents had been threatened for divorce (20%), husband's remarrying (38%) or to be returned to their parent's home (26%) by their in laws or husbands. Majority (68%) of the women threatened did not have any live births. However, those who had live …

Behind The Counter: Pharmacies And Dispensing Patterns Of Pharmacy Attendants In Karachi., Fauziah Rabbani, F. H. Cheema, N. Talati, S. Siddiqui, S. Syed, S. Bashir, L. Z. Zuberi, A. Shamim, Q. Mumtaz

Community Health Sciences

BACKGROUND:

There is little literature available on dispensing patterns and unsupervised sale of medicines from pharmacies in developing countries.

OBJECTIVE:

This study obtained background information on pharmacies assessed the level of training, knowledge and dispensing patterns of pharmacy attendants in Karachi.

METHODOLOGY:

This is a descriptive cross sectional study with convenient sampling. A structured questionnaire was used to interview pharmacy attendants.

RESULTS:

Of the 219 pharmacies surveyed, 62% reported more than 50 customers daily and 20% also sold items of general provision. Mean operating hours were 13. Only 24 (11%) had a visible license. On an average 3 attendants were …

The Minds Of Mothers: Maternal Mental Health In An Urban Squatter Settlement Of Karachi., Fauziah Rabbani, Furqan Farooq Raja

Community Health Sciences

BACKGROUND:

Community-based information on maternal mental health in developing countries is meager and nearly non-existent in Pakistan.

OBJECTIVE:

To determine the proportion of probable cases of women with mental disorders and examine the associated conditions and risk factors which contribute to maternal mental ill-health.

METHODS:

With convenient sampling 260 mothers in an urban squatter settlement of Karachi were interviewed. The tools consisted of a household questionnaire collecting information on basic demographic and other characteristics and the Aga Khan University Anxiety and Depression Scale (AKUADS), an instrument to assess psychiatric morbidity.

RESULTS:

The proportion of probable cases of mental disorder was …

Economic Development And Health Status Among The Poor In Squatter Settlements Of Karachi., Fauziah Rabbani, Anwer T. Merchant

Community Health Sciences

OBJECTIVE:

Socioeconomic status is an important determinant of health outcome measures. This study examines and presents some of the important health outcomes amongst the higher and lower socioeconomic groups within the urban poor.

SETTING:

Data analysis is based on a Health and Demographic Survey conducted in urban squatter settlements of Karachi in 1996.

METHODS:

A structured questionnaire was administered to all households in the catchment area. The indicator used to assess economic status is ownership of assets.

RESULTS:

Comparison between the two economic levels shows that the lower socio-economic group was more likely to experience child mortality, (CI; 1.02-1.29, p …