Medicine and Health Sciences Commons^™

Risk Factors For Depression Among Married Women Belonging To Higher And Lower Socioeconomic Status In Karachi, Pakistan, Saima Zainab, Zafar Fatmi, Ambreen Kazi

Community Health Sciences

OBJECTIVES: To determine the risk factors for depression among married women belonging to low and high socioeconomic status in Karachi.METHODS: The study design was cross-sectional. The data was collected from 128 adult married women during July to September 2005. The women were selected from different socioeconomic classes from five hospitals/institutes in Karachi. The Centre for Epidemiology Studies-Depression (CES-D) scale was used to screen the subjects for depression and a structured questionnaire was used to identify the factors for depression.RESULT: According to the CES-D scale, 65% of the study population was found to be depressed. Among the women from high socioeconomic …

Perceptions And Experiences Of Women In Karachi, Pakistan Regarding Secondary Infertility: Results From A Community-Based Qualitative Study, Neelofar Sami, Tazeen S. Ali

Community Health Sciences

Background: The prevalence of infertility in Pakistan is 22% with primary infertility at 4% and secondary infertility at 18%. This study explored perceptions and experiences of women in Karachi, Pakistan regarding the causes, treatment-seeking behavior for and consequences of secondary infertility.
Methods: Focus group discussions and in-depth interviews with married women explored their perceptions and experiences for issues related to secondary infertility.
Results: The knowledge of women about the causes and scientific treatment options for infertility was limited resulting in inclination for traditional unsafe health care. Infertility was stated to result in marital instability, stigmatization and abuse specially for women …

Determining The Factors Associated With Unmet Need For Family Planning: A Cross-Sectional Survey In 49 Districts Of Pakistan, Waqas Hameed, Syed Khurram Azmat, Mohsina Bilgrami, Muhammad Ishaqe

Community Health Sciences

Introduction & Background: Around 137 million women in the developing world who would like to avoid childbearing are unable to do so, despite a huge increase in contraceptive access and use globally. Ironically, the prevalence of unmet need in Pakistan is among the highest in the world despite being one of the first countries in South Asia to launch national family planning program. The aim of this paper is to estimate the prevalence of unmet need for contraception and to indentify the factors associated with it.
Methods: A cross-sectional survey was conducted in forty nine districts of Pakistan across all …

Gender Roles And Their Influence On Life Prospects For Women In Urban Karachi, Pakistan: A Qualitative Study, Tazeen S. Ali, Gunilla Krantz, Raisa Gul, Nargis Asad, Eva Johansson, Ingrid Mogren

School of Nursing & Midwifery

BACKGROUND: Pakistan is a patriarchal society where men are the primary authority figures and women are subordinate. This has serious implications on women's and men's life prospects.
OBJECTIVE: The aim was to explore current gender roles in urban Pakistan, how these are reproduced and maintained and influence men's and women's life circumstances.
DESIGN: Five focus group discussions were conducted, including 28 women representing employed, unemployed, educated and uneducated women from different socio-economic strata. Manifest and latent content analyses were applied.
FINDINGS: TWO MAJOR THEMES EMERGED DURING ANALYSIS: 'Reiteration of gender roles' and 'Agents of change'. The first theme included perceptions …

The Association Between Parity, Infant Gender, Higher Level Of Paternal Education And Preterm Birth In Pakistan: A Cohort Study, Kiran Shaikh, Shahirose Sadrudin Premji, Marianne S. Rose, Ambreen Kazi, Shaneela Khowaja, Suzanne Tough

School of Nursing & Midwifery

Background:

High rates of antenatal depression and preterm birth have been reported in Pakistan. Self reported maternal stress and depression have been associated with preterm birth, however findings are inconsistent. Cortisol is a biological marker of stress and depression, and its measurement may assist in understanding the influence of self reported maternal stress and depression on preterm birth.

Methods:

In a prospective cohort study pregnant women between 28 to 30 weeks of gestation from the Aga Khan Hospital for Women and Children completed the A-Z Stress Scale and the Centre for Epidemiology Studies Depression Scale to assess stress and depression …

The Risk Factor Profile Of Women With Secondary Infertility: An Unmatched Case-Control Study In Kigali, Rwanda, Nathalie Dhont, Stanley Luchters, Claude Muvunyi, Joseph Vyankandondera, Ludwig De Naeyer, Marleen Temmerman, Janneke Van De Wijgert

Population Health, East Africa

Background: Secondary infertility is a common, preventable but neglected reproductive health problem in resource-poor countries. This study examines the association of past sexually transmitted infections (STIs) including HIV, bacterial vaginosis (BV) and factors in the obstetric history with secondary infertility and their relative contributions to secondary infertility.

Methods: Between November 2007 and May 2009 a research infertility clinic was set up at the Kigali University Teaching Hospital in Rwanda. Cases were defined as sexually-active women aged 21-45 years presenting with secondary infertility (n = 177), and controls as multiparous women in the same age groups who recently delivered …

Food For Thought: Eathing For The Baby & You, Cassandra Fernandes Faria

Institute for Educational Development, Karachi

No abstract provided.

Prevalence Of Head Lice And Hygiene Practices Among Women Over Twelve Years Of Age In Sindh, Balochistan, And North West Frontier Province: National Health Survey Of Pakistan, 1990-1994., Sadia Mahmud, Gregory Pappas, Wilbur C Hadden

Community Health Sciences

Background: Head lice infestation is an infection of the scalp and skin which causes blood loss, discomfort, and social and psychological distress with the possibility of secondary bacterial infections occurring at scratch sites. In Pakistan, although some small scale studies have been conducted to investigate prevalence of head lice in school children and the general population, no population based estimates have been reported. The National Health Survey of Pakistan (NHSP 1990 - 94) was a nationally representative health examination survey of the Pakistani population. The NHSP is the first population based household survey to collect data on the prevalence of …

Concurrent Sexual And Substance-Use Risk Behaviours Among Female Sex Workers In Kenya's Coast Province: Findings From A Behavioural Monitoring Survey, Simon Pierre Tegang, S. Abdallah, G. Emukule, Stanley Luchters, Nzioka Kingola, M. Barasa, Stephen Mucheke, P. Mwarogo

Population Health, East Africa

While many studies confirm the association between HIV, alcohol and injecting drug use by female sex workers (FSWs), little is known about their use of marijuana, khat and other substances and the association of these substances with HIV, risky sexual behaviour, and sexual violence. To better understand this association, data were analysed from a cross-sectional, behavioural survey of 297 FSWs in Mombasa, a well-known tourist destination and the second largest port in Africa and capital city of the Coast Province in Kenya. Among the FSWs, lifetime use of different substances was reported by 91% for alcohol, 71% for khat, 34% …

A Multicentre Matched Case Control Study Of Risk Factors For Preeclampsia In Healthy Women In Pakistan., Uzma Shamsi, Juanita Hatcher, Azra Shamsi, Nadeem Zuberi, Zeeshan Qadri, Sarah Saleem

Community Health Sciences

Background: Preeclampsia is one of the leading causes of maternal and perinatal morbidity and mortality world-wide. The risk for developing preeclampsia varies depending on the underlying mechanism. Because the disorder is heterogeneous, the pathogenesis can differ in women with various risk factors. Understanding these mechanisms of disease responsible for preeclampsia as well as risk assessment is still a major challenge. The aim of this study was to determine the risk factors associated with preeclampsia, in healthy women in maternity hospitals of Karachi and Rawalpindi. Methods: We conducted a hospital based matched case-control study to assess the factors associated with preeclampsia …

Father's Support And Literacy--Factors Associated With Child Mortality In Gambat, Sindh-Pakistan, Ajmal Agha, Fozia Ajmal, Azam Iqbal, Franklin White

Community Health Sciences

Objectives: To determine Under Five Mortality Rate (U5MR) in Gambat and to identify causes of and factors associated with it.
Methods: The study was conducted in taluka Gambat of Sindh, Pakistan from December 2002 to August 2003. The sample of at least 510 mothers was needed to capture expected 1020 live births. We interviewed mothers to elicit information about live births in the past five years, under-five mortality and its cause. Additionally, the mothers were also asked about their mobility and availability of husband's support in child's rearing, other than economic support. Approval was sought from Aga Khan University's Ethical …

Association Of Various Reproductive Rights, Domestic Violence And Marital Rape With Depression Among Pakistani Women, Faridah A. Ali, Syed M. Israr, Badar S. Ali, Naveed Z. Janjua

Community Health Sciences

Background: Depression among women is common in developing countries. Gender inequality can contribute to women's risk for depression. Lack of reproductive and sexual rights is an important marker of gender inequality and women do not have the freedom to express their reproductive and sexual needs in many parts of the world. Therefore we designed this study to determine the association of depression with lack of various reproductive rights and domestic violence among married women in Karachi, Pakistan. Methods: A case-control study with 152 cases and 152 controls, which included women 15-48 years, recruited from two teaching hospitals from 1(st) June …

Breast Cancer In Pakistan - Awareness And Early Detection, Saba Sohail, Shams Nadeem Alam

Department of Radiology

No abstract provided.

Infiltrating Ductal Carcinoma Breast With Central Necrosis Closely Mimicking Ductal Carcinoma In Situ (Comedo Type): A Case Series, Shahid Pervez, Hassan Khan

Department of Pathology and Laboratory Medicine

Here we present a series of infiltrative ductal carcinoma breast cases (infiltrative ductal carcinoma with central necrosis) so closely mimicking 'DCIS with central comedo necrosis' that on initial morphological analysis these foci of tumors were labeled as DCIS (high grade, comedo). However on further histological work up and by using immunohistochemistry (IHC) for myoepithelial markers it was later confirmed that these were foci of infiltrative ductal carcinoma breast with central necrosis. This case series gives the realization that a breast carcinoma may be partly or entirely DCIS like yet invasive. In such a dilemma IHC especially for assessment of myoepithelial …

Adults' Perceived Prevalence Of Enteric Fever Predicts Laboratory-Validated Incidence Of Typhoid Fever In Children, Xinguang Chen, Bonita Stanton, Al Pach, Andrew Nyamete, R. Leon Ochiai, Linda Kaljee, Baiqing Dong, Dipika Sur, S.K. Bhattacharya, Siti Sapardiyah Santoso, Magdarina Agtini, Zahid Memon, Zulfiqar Ahmed Bhutta, Canh Gia Do, Lorenz Von Seidlein, John Clemens

Centre of Excellence in Women and Child Health

This study was undertaken to develop a model to predict the incidence of typhoid in children based on adults’ perception of prevalence of enteric fever in the wider community. Typhoid cases among children, aged 5-15 years, from epidemic regions in five Asian countries were confirmed with a positive Salmonella Typhi culture of the blood sample. Estimates of the prevalence of enteric fever were obtained from random samples of adults in the same study sites. Regression models were used for establishing the prediction equation. The percentages of enteric fever reported by adults and cases of typhoid incidence per 100,000, detected through …

Comparative Predictive Value Of Three Prognostic Markers--S-Phase Fraction, Pcna And Mitotic Count On Axillary Lymph Node Metastasis In Carcinoma Breast, Shahid Pervez, Muhammad Nadeem Khan, Muhammad Israr Nasir

Department of Pathology and Laboratory Medicine

Background: Axillary lymph node metastasis is the single most important prognostic factor in carcinoma of the breast. Therefore, prognostic markers that may reliably predict probability of lymph node (LN) metastases are of great value. This study was conducted to compare the predictive value of two novel prognostic / proliferative markers i.e. S-phase fraction (SPF) and proliferating cell nuclear antigen (PCNA) in parallel with mitotic index.

Methods: Data of consecutive cases of infiltrating ductal carcinoma (IDC) breast diagnosed from July 2003 to July 2004 at the section of the Histopathology, The Aga Khan University Hospital, Karachi, were reviewed. A total of …

Women’S Health In Developing Countries, Javed Rizvi, Nadeem F. Zuberi

Department of Obstetrics & Gynaecology

Healthcare priorities are different in developing and developed countries. A more effective resource allocation, complemented by efforts to implement only those practices that are effective, should be a priority for improving reproductive health services in developing countries. A large burden of gynaecological disease exists in developing countries and it is difficult to envisage serious reforms and improvements without an increase in public-sector spending. However, communities themselves could assume some responsibility for women's health in ways that prioritize women's own perceptions and primary needs. In this chapter we have compiled existing evidence regarding various gynaecological problems faced by women in developing …

Frequency And Characteristics Of Breast Lymphomas Presenting To A Tertiary Care Hospital, Pakistan, Nausheen Yaqoob, Shahid Pervez, Naila Kayani, Rashida Ahmed, Zubair Ahmed, Sheema Hasan

Department of Pathology and Laboratory Medicine

Objective: To assess the relative frequency of (primary and secondary) mammary lymphomas presenting to a tertiary care hospital, Pakistan and its categorization according to WHO classification of lymphoid neoplasms.

Methods: All NHLs (nodal and extra nodal) diagnosed in the section of histopathology during 1992-2004 were retrieved and reviewed. All patients (n=30) diagnosed with lymphomatous involvement of the breast were selected. Distinction between primary and secondary breast lymphomas was not made owing to lack of availability of clinical information.

Results: A total of 5637 breast malignancies were diagnosed in our department during the study period of 10 years and the total …

Enhanced Disease Surveillance Through Private Health Care Sector Cooperation In Karachi, Pakistan: Experience From A Vaccine Trial, M. Imran Khan, Shah Muhammad Sahito, Mohammad Javed Khan, Shafi Mohammad Wassan, Abdul Wahab Shaikh, Ashok Kumari Maheshwari, Camilo J. Acosta, Claudia M. Galindo, Rion Leon Ochia, Shahid Rasool, Sheeraz Peerwan, Mahesh K. Puri, Mohammad Ali, Afia Zafar, Rumina Hasan, Lorenz Von Seidlein, John D. Clemens, Shaikh Qamaruddin Nizami, Zulfiqar Ahmed Bhutta

Centre of Excellence in Women and Child Health

INTRODUCTION: In research projects such as vaccine trials, accurate and complete surveillance of all outcomes of interest is critical. In less developed countries where the private sector is the major health-care provider, the private sector must be included in surveillance systems in order to capture all disease of interest. This, however, poses enormous challenges in practice. The process and outcome of recruiting private practice clinics for surveillance in a vaccine trial are described.
METHODS: The project started in January 2002 in two urban squatter settlements of Karachi, Pakistan. At the suggestion of private practitioners, a phlebotomy team was …

Breast Diseases: A Histopathological Analysis Of 3279 Cases At A Tertiary Care Center In Pakistan, M. S. Siddiqui, Naila Kayani, Shahid Pervez, S. A. Aziz, S. Muzaffar, Z. Setna, M. Israr, S. H. Hasan, M. S. Gill

Department of Pathology and Laboratory Medicine

Objective: To know the frequency of breast diseases in Pakistani females.

Methods: A retrospective analysis of 3279 breast specimens received over a period of 4 years (1 993-1996) at the department of pathology, the Aga Khan University Hospital.

Results: Out of a total of 3279 breast specimens, common breast lesions included infiltrating duct carcinoma 37%, followed by fibro adenoma 16.95%, fibrocystic change13.96%, mastitis 6.83% and duct ectasia 5.33%. Majority of the cases of infiltrating duct carcinoma were encountered in the 5th and 6th decades of life. Tumour size was 2 or >2 cms. in 93% of cases and 40% of …

Clinical, Pathological And Molecular Factors Predicting Axillary Node Involvement In Primary Breast Cancer In Pakistani Women, T. Siddiqui, A. Salam, S. Khan, N. Kayani, Shahid Pervez

Department of Pathology and Laboratory Medicine

Background:

Axillary lymph node involvement in primary breast cancer is one of its most important prognostic features. Thus any factors that may predict axillary lymph node involvement in this setting could be potentially helpful in treatment planning and other interventions.

Objective:

The objective of this study was to evaluate clinical, pathological and immuno-histochemical markers in univariate and multivariate analysis, which may be helpful predictors of axillary lymph node involvement in breast cancer.

Method:

A retrospective analysis of 555 cases. Of these 58% had axillary nodal positivity and 42% were negative.

Conclusion:

Factors of no significance included patient’s age, height, weight, …

Epidermal Growth Factor Receptor (Egfr) As A Prognostic Marker: An Immunohistochemical Study On 315 Consecutive Breast Carcinoma Patients, S. A. Aziz, Shahid Pervez, N. Kayani, M. H. Rahbar, S. Khan

Department of Pathology and Laboratory Medicine

Objective: To assess the independent and interdependent prognostic value of epidermal growth factor receptor (EGFR) in carcinoma of breast in female population. The Type I family of growth factor receptors includes epidermal growth factor receptor (EGFR also known as EGFRI).

Methods: The expression of EGFR protein was analysed immunohistochemically on 315 tumour specimens of infiltrating ductal carcinoma of breast. These patients also had axillary lymph nodes sampling.

Results: Overexpression and/or amplification of EGFR was observed in 70 (22.00%) tumours. Eleven (16%) were grade I, 43 (61%) grade II and 16 (23%) grade Ill tumours. Axillary lymph node metastasis had significant …

Dna Ploidy Analysis Of Borderline Epithelial Ovarian Tumours, Saba Lodhi, Sabeen Najam, Shahid Pervez

Department of Pathology and Laboratory Medicine

Objective: Borderline epithelial ovarian tumors not uncommonly pose a great difficulty to surgical pathologists as morphologically they may show very similar features as those of malignant epithelial tumors except invasion. However it is important to separate these from their invasive counterparts because of their superior prognosis. Recently, attention has been focussed on the prognostic value of flow cytometric analysis of DNA ploidy in borderline epithelial ovarian tumors. The purpose of this study is to investigate whether flow cytometric analysis of cellular DNA content acts as a useful adjunct to the histopathological diagnosis of borderline malignancy.

Materials and Methods: Fifteen histologically …

Center-Based Prevalence Of Anxiety And Depression In Women Of The Northern Areas Of Pakistan, Sunita Dodani, Rukhsana Wamiq Zuberi

Department for Educational Development

Objective: To estimate the prevalence of anxiety and depression in women of the Northern areas. Methods: A cross-sectional center-based study was conducted at Singal Medical Center (SNIC), Gilgit, in the Northern Areas of Pakistan, using the Hospital Anxiety and Depression Scale (HADS).

Results: One hundred and twenty women, between the ages of 16 and 60, attended the SMC over a two month period and were included in the study. Using HADS, it was found that 50% of the women had anxiety and/or depression; 25% suffered only from anxiety, 8% from depression and 17% had features of both.

Conclusion: This study …

Diagnostic Evaluation Of Fine Needle Aspiration Cytology In The Management Of Palpable Breast Lesions, S. H. Shah, Naila Kayani, S. H. Hasan, I. N. Soomro, Shahid Pervez, A. S. Hussainy

Department of Pathology and Laboratory Medicine

A total of 113 fine needle aspirates of the breast masses were evaluated in which the subsequent biopsy or mastectomy specimen were also available for histological examination. The age ranged from 16 to 80 years with a mean of 42 years. In benign conditions the mean age was 34.7 years while in malignant cases it was 48 years. The cytological diagnoses were compared with the histological results which revealed that the specificity and sensitivity of fine needle aspiration cytology in the palpable breast lesions was 86.1% and 89.2% respectively with a positive predictive value of 93% and efficiency of 88.2%. …

Immunohistochemical Estrogen Receptor Determination In Human Breast Carcinoma: Correlation With Histologic Differentiation And Age Of The Patients, Shahid Pervez, S. Shaikh, F. Aijaz, S. A. Aziz, M. Naqvi, Sheema H. Hasan

Department of Pathology and Laboratory Medicine

An immunohistochemical assay for the measurement of estrogen receptor (ER) has been evaluated on 290 consecutive human breast biopsy and mastectomy specimens in the year 1992 at The Aga Khan University Hospital laboratories. Immunohistochemical localization of estrogen receptor on frozen/paraffin section was scored in a semi-quantitative fashion incorporating both the intensity and the distribution of specific staining. Histologic grading of the tumour was performed according to Bloom’s method. In this study, 21% of the tumours were estrogen receptor negative, 15% were weak positive, 25% intermediate positive and 39% strong positive. Fifty percent of the well differentiated tumours showed strong ER …

Aggressive Angiomyxoma Of Vulva, Farrukh Aijaz, Shahid Pervez, Shehnaz Wasti, Sheema H. Hassan

Department of Pathology and Laboratory Medicine

No abstract provided.

Chloramphenicol Therapy Of Typhoid Fever, Z A. Bhutta, S H. Naqvi, S Durrani, A Suria

Department of Paediatrics and Child Health

In a prospective study we compared two different dosage regimens of IV chloramphenicol succinate (100 mg/kg/day and 75 mg/kg/day) in children with culture proven typhoid. Trough and peak blood samples, obtained at 48 hrs, were analysed for free chloramphenicol by high pressure liquid chromatography (HPLC). Although the mean trough (8.8 +/- 7.7 versus 5.4 +/- 2.6 mcg/ml) and peak (19.9 +/- 12.2 versus 15.4 +/- 6.1 mcg/ml) chloramphenicol concentrations were comparable in both groups, a significantly wider range was found in the group receiving 100 mg/kg/day. Potentially toxic levels (greater than 30 mcg/ml) developed in two patients with liver dysfunction. …