Family Medicine Commons^™

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 …

Availability, Affordability, And Consumption Of Fruits And Vegetables In 18 Countries Across Income Levels: Findings From The Prospective Urban Rural Epidemiology (Pure) Study., Victoria Miller, Salim Yusuf, Clara K. Chow, Mahshid Dehgha, Daniel J. Corsi, Karen Lock, Barry Popkin, Sumathy Rangarajan, Rasha Khatib, Scott A. Lear, Prem Mony, Manmeet Kaur, Viswanathan Mohan, Krishnapillai Vijayakumar, Rajeev Gupta, Annamarie Kruger, Lungiswa Tsolekile, Noushin Mohammadifard, Omar Rahman, Annika Rosengren, Alvaro Avezum, Andrés Orlandini, Noorhassim Ismail, Patricio Lopez-Jaramillo, Afzalhussein Yusufali, Kubilay Karsidag, Romaina Iqbal, Jephat Chifamba, Solange Martinez Oakley, Farnaza Ariffin, Katarzyna Zatonska, Paul Poirier, Li Wei, Bo Jian, Chen Hui, Liuxu Xu, Bai Xiulin, Koon Teo, Andrew Mente

Community Health Sciences

BACKGROUND:

Several international guidelines recommend the consumption of two servings of fruits and three servings of vegetables per day, but their intake is thought to be low worldwide. We aimed to determine the extent to which such low intake is related to availability and affordability.

METHODS:

We assessed fruit and vegetable consumption using data from country-specific, validated semi-quantitative food frequency questionnaires in the Prospective Urban Rural Epidemiology (PURE) study, which enrolled participants from communities in 18 countries between Jan 1, 2003, and Dec 31, 2013. We documented household income data from participants in these communities; we also recorded the diversity …

Burden And Associated Factors For Caregivers Of The Elderly In A Developing Country, S Sabzwari, A Munir Badini, Z Fatmi, T Jamali, S Shah

Department of Family Medicine

The elderly population in South Asia is growing. In Pakistan trained caregivers are scarce and culturally not acceptable. This study assessed the level of stress experienced by caregivers of the elderly and determined the association of care giving burden with different characteristics of the elderly. A cross-sectional, questionnaire based study was conducted using nonprobability purposive sampling. All consenting participants aged 60 years and above needing help with at least one activity of daily living or two instrumental activities of daily living were included. 350 participants were assessed for perceived care giver burden. Care providers were mostly female (68.9%). Half (50.3%) …

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 …

Ischemic Strokes: Observations From A Hospital Based Stroke Registry In Bangladesh., Nirmalenduk Bikash Bhowmik, Aamir Abbas, Mohammad Saifuddin, Md. Rashedul Islam, Rumana Habib, Aminur Rahman, Md. Amirul Haque,, Zahid Hassan, Mohammad Wasay

Department of Medicine

Background. Stroke is an important morbidity for low and middle income countries like Bangladesh. We established the first stroke registry in Bangladesh. Methods. Data was collected from stroke patients who were admitted in Department of Neurology of BIRDEM with first ever stroke, aged between 30 and 90 years. Patients with intracerebral hemorrhage, subarachnoid and subdural hemorrhage, and posttrauma features were excluded. Results. Data was gathered from 679 stroke patients. Mean age was 60.6 years. Almost 68% of patients were male. Small vessel strokes were the most common accounting for 45.4% of all the patients followed by large vessel getting affected …

Association Of Tobacco Use And Other Determinants With Pregnancy Outcomes: A Multicentre Hospital-Based Case-Control Study In Karachi, Pakistan., Shafquat Rozi, Zahid Ahmad Butt, Nida Zahid, Saba Wasim, Kashif Shafique

Community Health Sciences

OBJECTIVES:

The study aimed to identify the effects of maternal tobacco consumption during pregnancy and other factors on birth outcomes and obstetric complications in Karachi, Pakistan.

DESIGN:

A multicentre hospital-based case-control study.

SETTING:

Four leading maternity hospitals of Karachi.

PARTICIPANTS:

A random sample of 1275 women coming to the gynaecology and obstetric department of selected hospitals for delivery was interviewed within 48 hours of delivery from wards. Cases were women with adverse birth outcomes and obstetric complications, while controls were women who had normal uncomplicated delivery.

PRIMARY AND SECONDARY OUTCOME MEASURES:

Adverse birth outcomes (preterm delivery, low birth weight, stillbirth, …

Economic Burden Of Mental Illnesses In Pakistan., Ashar Muhammad Malik, Murad Moosa Khan

Community Health Sciences

BACKGROUND:

The economic consequences of mental illnesses are much more than health consequences. In Low and Middle Income Countries (LMIC) the economic impact of mental illnesses is rarely analyzed. This paper attempts to fill the gap in research on economics of mental health in LMIC. We provide economic burden of mental illness in Pakistan that can serve as an argument for reorienting health policy, resource allocation and priority settings.

AIM:

To estimate economic burden of mental illnesses in Pakistan.

METHODS:

The study used prevalence based cost of illnesses approach using bottom-up costing methodology. We used Aga Khan University Hospital, Psychiatry …

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 …

Effectiveness Of An Interventional Program For The Management Of Hypertension Through Strengthening Of The Health Care Delivery System : A Pilot Study, Waris Qidwai, Khawar Kazmi, Kashmira Nanji, Sana Anees

Department of Family Medicine

Background: The aim of the study was to assess the effectiveness of an interventional program to improve hypertension management through strengthening of the health care delivery system.
Methods: A pilot study was conducted from February to December 2014 in two off-site Family Medicine clinics of the Aga Khan Hospital Karachi, Pakistan. Patients aged > 40 years, with known hypertension were included. At the intervention site, Family Physicians were trained; individual and group education sessions were conducted for catchment population, while usual care was provided at the control site. Referral system between primary, secondary and tertiary levels of care was …

Motivation And Retention Of Physicians In Primary Healthcare Facilities: A Qualitative Study From Abbottabad, Pakistan, Sayed Masoom Shah, Shehla Zaidi, Jamil Ahmed, Shafiq Ur Rehman

Community Health Sciences

BACKGROUND:

Workforce motivation and retention is important for the functionality and quality of service delivery in health systems of developing countries. Despite huge primary healthcare (PHC) infrastructure, Pakistan's health indicators are not impressive; mainly because of under-utilization of facilities and low patient satisfaction. One of the major underlying issues is staff absenteeism. The study aimed to identify factors affecting retention and motivation of doctors working in PHC facilities of Pakistan.

METHODS:

An exploratory study was conducted in a rural district in Khyber Puktunkhwa (KP) province, in Pakistan. A conceptual framework was developed comprising of three organizational, individual, and external environmental …

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 …

Peer Pressure And Family Smoking Habits Influence Smoking Uptake In Teenage Boys Attending School: Multilevel Modeling Of Survey Data., Shafquat Rozi, Sadia Mahmud, Gillian Lancaster, Nida Zahid

Community Health Sciences

Introduction:

Among young teens, about one in five smokes worldwide. Adolescents spend a considerable amount of their time in school, and the school environment is therefore important for child health practices and outcomes.

Objectives:

We aimed to investigate the impact on smoking behavior of the school environment and the personal characteristics of male teenage students attending schools in Pakistan, taking into account the survey sampling structure.

Methods:

A two-stage cluster sampling with stratification was employed, and we interviewed 772 male secondary school students. We adopted random effect and generalizing estimating equation models.

Results:

Peer pressure in particular had a strong …

Professional Practices Promoting Health Of Healthcare Workers: Comparison Of Public And Private Hospitals In Pakistan, Nourin Jivany, Javed Yakoob, Shazia Bana, Asima Faisa, Humeira Jawed

Section of Gastroenterology

Background and Objectives: Health and safety of healthcare workers (HCWs) is a determinant of the quality of healthcare delivered to the population at large. This study aimed at comparing various dimension of HCWs’ health and safety between public and private hospitals (PHs) in the Pakistan context.

Methods: A sample of 1146 HCWs from 2 public and 2 PHls in a metropolitan city were invited to response to a structured questionnaire, assessing various aspects of health and safety promotion practices in their hospital. Categorical data were compared using chi-square test or Fisher exact test or likelihood ratio tests.

Findings: According to …

Use Of Antenatal Corticosteroids At Health Facilities And Communities In Low-And-Middle Income Countries., Mabel Berrueta, Jennifer Hemingway-Foday, Vanessa R. Thorsten, Robert L. Goldenberg, Waldemar A. Carlo, Ana Garces, Archana Patel, Sarah Saleem, Omrana Pasha, Elwyn Chomba, Patricia L. Hibberd, Nancy F. Krebs, Shivaprasad Goudar, Richard J. Derman, Fabian Esamai, Edward A. Liechty, Janet L. Moore, Elizabeth M. Mcclure, Marion Koso-Thomas, Pierre M. Buekens, José M. Belizán, Fernando Althabe

Community Health Sciences

BACKGROUND:

Antenatal corticosteroids (ACS) for women at high risk of preterm birth is an effective intervention to reduce neonatal mortality among preterm babies delivered in hospital settings, but has not been widely used in low-middle resource settings. We sought to assess the rates of ACS use at all levels of health care in low and middle income countries (LMIC).

METHODS:

We assessed rates of ACS in 7 sites in 6 LMIC participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development's Global Network for Women and Children's Health Research Antenatal Corticosteroids Trial (ACT), a cluster-randomized trial …

The Antenatal Corticosteroids Trial (Act): A Secondary Analysis To Explore Site Differences In A Multi-Country Trial., Karen Klein, Elizabeth M. Mcclure, Daniela Colaci, Vanessa Thorsten, Patricia L. Hibberd, Fabian Esamai, Ana Garces, Archana Patel, Sarah Saleem, Omrana Pasha, Elwyn Chomba, Waldemar A. Carlo, Nancy F. Krebs, Shivaprasad Goudar, Richard J. Derman, Edward A. Liechty, Marion Koso-Thomas, Pierre M. Buekens, José M. Belizán, Robert L. Goldenberg, Fernando Althabe

Community Health Sciences

BACKGROUND:

The Antenatal Corticosteroid Trial (ACT) assessed the feasibility, effectiveness, and safety of a multifaceted intervention to increase the use of antenatal corticosteroids (ACS) in mothers at risk of preterm birth at all levels of care in low and middle-income countries. The intervention effectively increased the use of ACS but had no overall impact on neonatal mortality in the targeted <5(th) percentile birth weight infants. Being in the intervention clusters was also associated with an overall increase in neonatal deaths. We sought to explore plausible pathways through which this intervention increased neonatal mortality.

METHODS:

We conducted secondary analyses to assess site differences in outcome and potential explanations for the differences in outcomes if found. By site, and in the intervention and control clusters, we evaluated characteristics of the mothers and care systems, the …

The Antenatal Corticosteroids Trial (Act)'S Explanations For Neonatal Mortality - A Secondary Analysis., Fernando Althabe, Vanessa Thorsten, Karen Klein, Elizabeth M. Mcclure, Patricia L. Hibberd, Robert L. Goldenberg, Waldemar A. Carlo, Ana Garces, Archana Patel, Omrana Pasha, Elwyn Chomba, Nancy F. Krebs, Shivaprasad Goudar, Richard J. Derman, Fabian Esamai, Edward A. Liechty, Nellie I. Hansen, Sreelatha Meleth, Dennis D. Wallace, Marion Koso-Thomas, Alan H. Jobe, Pierre M. Buekens, José M. Belizán

Community Health Sciences

BACKGROUND:

The Antenatal Corticosteroid Trial assessed the feasibility, effectiveness, and safety of a multifaceted intervention to increase the use of antenatal corticosteroids (ACS) in mothers at risk of preterm birth at all levels of care in low and middle-income countries. The intervention effectively increased the use of ACS but was associated with an overall increase in neonatal deaths. We aimed to explore plausible pathways through which this intervention increased neonatal mortality.

METHODS:

We conducted a series of secondary analyses to assess whether ACS or other components of the multifaceted intervention that might have affected the quality of care contributed to …

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 …

Descriptive Epidemiology Of Somatising Tendency: Findings From The Cupid Study., Sergio Vargas-Prada, David Coggon, Georgia Ntani, Georgia Ntani, Karen Walker-Bone, Keith T. Palmer, Vanda E. Felli, Raul Harari, Lope H. Barrero, Sarah A. Felknor, David Gimeno, Anna Cattrell, Matteo Bonzini, Eleni Solidaki, Eda Merisalu, Rima R. Habib, Farideh Sadeghian, Muhammad Masood Kadir, Sudath S. P. Warnakulasuriya, Ko Matsudaira, Busisiwe Nyantumbu, Malcolm R. Sim, Helen Harcombe, Ken Cox, Leila M. M. Sarquis, Maria H. Marziale, Florencia Harari, Rocio Freire, Natalia Harari, Magda V. Monroy, Leonardo A. Quintana, Marianela Rojas, E. Clare Harris, Consol Serra, J. Miguel Martinez, George Delclos, Fernando G. Benavides, Michele Carugno, Marco M. Ferrario, Angela C. Pesatori, Leda Chatzi, Panos Bitsios, Manolis Kogevinas, Kristel Oha, Tiina Freimann, Ali Sadeghian, Roshini J. Peiris-John, Nalini Sathiakumar, A. Rajitha Wickremasinghe, Noriko Yoshimura, Helen L. Kelsall, Victor C. W. Hoe, Donna M. Urquhart, Sarah Derrett, David Mcbride, Peter Herbison, Andrew Gray, Eduardo J. Salazar Vega

Community Health Sciences

Somatising tendency, defined as a predisposition to worry about common somatic symptoms, is importantly associated with various aspects of health and health-related behaviour, including musculoskeletal pain and associated disability. To explore its epidemiological characteristics, and how it can be specified most efficiently, we analysed data from an international longitudinal study. A baseline questionnaire, which included questions from the Brief Symptom Inventory about seven common symptoms, was completed by 12,072 participants aged 20-59 from 46 occupational groups in 18 countries (response rate 70%). The seven symptoms were all mutually associated (odds ratios for pairwise associations 3.4 to 9.3), and each contributed …

Understanding Health Seeking Behavior Of Health Care Professionals In Tertiary Care Hospitals In Pakistan, Shazia Bana,, Javed Yakoob, Nourin Jivany, Asima Faisal, Humeira Jawed, Safia Awan

Section of Gastroenterology

Background: Health seeking behaviour refers to the behaviour of people towards seeking their own health through provided health services. The medical professionals are at a higher risk of avoiding health seeking behaviour because they believe they are aware of the diseases and their symptoms as well as the pharmaceutical management of the disease. The aim of this study was to understand the healthcare seeking behaviour of nurses and doctors as well as the factors affecting it in hospitals of a major city in a developing country. Methods: A cross-sectional study was designed and a self-report questionnaire was distributed to …

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 …

Geographic Access To Working Family Planning Centers And Unintended Pregnancies Among Married Women: A Community Based Nested Case Control Study., Sumera Aziz Ali, Sarah Saleem, Neelofar Sami, Mir Shabbar, Muhammad Ahmed, Shafquat Rozi, Robert L. Goldenberg, Margo S. Harrison, Omrana Pasha

Community Health Sciences

Background:

Unintended pregnancies pose substantial risk to mothers and children. In Pakistan, unintended pregnancies account for 46% of all pregnancies. Lack of geographic access to open and well-supplied family planning (FP) centers may be related to the occurrence of such pregnancies, particularly in rural areas.

Objective:

The objective of this analysis is to determine if geographic access to family planning centers in the Thatta district of Pakistan is related to unintended pregnancy rates among married women.

Methods:

We conducted a community-based, nested case-control study of 800 pregnant women identified from the database of an active surveillance system, which registers and …

Translating Knowledge For Action Against Stroke--Using 5-Minute Videos For Stroke Survivors And Caregivers To Improve Post-Stroke Outcomes: Study Protocol For A Randomized Controlled Trial (Movies4stroke)., Ayeesha Kamran Kamal, Adeel Khoja, Bushra Usmani, Nargis Asad, Asma Ahmed, Iqbal Azam, Sarah Saleem, Saleem Sayani

Department of Medicine

Background: Two thirds of the global mortality of stroke is borne by low and middle income countries (LMICs). Pakistan is the world’s sixth most populous country with a stroke-vulnerable population and is without a single dedicated chronic care center. In order to provide evidence for a viable solution responsive to this health care gap, and leveraging the existing >70 % mobile phone density, we thought it rational to test the effectiveness of a mobile phone-based video intervention of short 5-minute movies to educate and support stroke survivors and their primary caregivers.

Methods: Movies4Stroke will be a randomized control, outcome assessor …

Primary Healthcare Policy Implementation In South Asia, Chris Van Weel, Ryuki Kassai, Waris Qidwai, Raman Kumar, Kanu Bala, Pramendra Prasad Gupta, Ruvaiz Haniffa Haniffa, Neelamani Rajapaksa Hewageegana, Thusara Ranasinghe, Michael Kidd, Amanda Howe

Department of Family Medicine

Primary healthcare is considered an essential feature of health systems to secure population health and contain costs of healthcare while universal health coverage forms a key to secure access to care. This paper is based on a workshop at the 2016 World Organization of Family Doctors (WONCA) South Asia regional conference, where the health systems of Bangladesh, India, Nepal, Pakistan and Sri Lanka were presented in relation to their provision of primary healthcare. The five countries have in recent years improved the health of their populations, but currently face the challenges of non-communicable diseases and ageing populations. Primary healthcare should …

Translational Research And Complexity Of Clinical Practice: Issues, Challenges, And Way Forward, Waris Qidwai

Department of Family Medicine

No abstract provided.

Impact Of Cable Television On Lives Of Patients Visiting A Teaching Hospital In Karachi, Pakistan, Waris Qidwai, Kashmira Nanji, Madeeha Anwar Adam

Department of Family Medicine

A cross sectional survey was conducted during August 2014 to October 2014, to identify the impact of cable television channels on lives of the people, in Karachi, Pakistan. Three hundred participants were selected through convenience sampling and a pre-tested structured questionnaire was used for data collection. Data was analyzed in SPSS version 19.0. About 15% of participants were more than 40 years. About 62% were females in the study sample. Regression analysis showed that viewing television at night impacts work performance (OR: 1.39; 95% CI: 0.81-2.37), sleep (OR: 1.07; 95% CI: 0.63-1.81), family life (OR: 1.52; 95% CI: 0.89-2.60) and …

Effect Of Diabetes Self-Management Education On Glycemic Control, Compared To Usual Care In Type 2 Diabetic Patients At The Family Medicine Clinic, Aga Khan University Hospital Nairobi, Catherine Wanjiku Gathu

Master of Medicine in Family Medicine

Background: Globally, the magnitude of disease burden associated with diabetes is high. Poor glycemic control contributes greatly to this burden, especially in the occurrence of related complications. The value of Diabetes Self-Management Education (DSME) is evident in literature, and has been recommended as a way of optimizing glycemic and metabolic control and averting early onset of diabetes complications. Usual care involves spontaneous sharing of information during medical consultations without planned structure or defined time frame. In the African setting, the effect of DSME, and how it compares to usual care, is yet to be fully explored. Objective: To compare the …

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 …

The Environmental Profile Of A Community’S Health: A Cross-Sectional Study On Tobacco Marketing In 16 Countries., Emily Savell, Anna B. Gilmore, Michelle Sims, Prem K. Mony, Teo Koon, Khalid Yusoff, Scott A. Lear, Pamela Seron, Noorhassim Ismail, K Burcu Tumerdem Calik, Annik Rosengren, Ahmad Bahonar, Rajesh Kumar, Krishnapillai Vijayakumar, Annamarie Kruger, Hany Swidan, Rajeev Gupta, Ehimario Igumbor, Asad Ali Khan Afridi, Omar Rahman, Jephat Chifamba, Katarzyna Zatonska, V Mohan, Deepa Mohan, Patricio Lopez-Jaramillo, Alvaro Avezum, Paul Poirier, Andres Orlandini, Wei Li, Martin Mckee, Sumathy Rangarajan, Salim Yusuf, Clara K. Chow

Community Health Sciences

OBJECTIVE:

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, …

Hip Fragility Fractures: Anaemia, Calcium And Vitamin D Supplementation, Iqra Khan, Ambreen Jawaid, Khabir Ahmad, Shahryar Noordin

Department of Family Medicine

Objective: To assess the burden of anaemia and osteoporosis in hip fracture patients, to determine the rate of blood transfusion per-operatively, to assess the use of calcium and vitamin D supplements and the use of anti-osteoporotic medications postoperatively.
Methods: A retrospective study was conducted at Aga Khan University and Hospital (AKUH) between June 2009 and May 2011, and comprised record of patients treated for intertrochanteric and femur neck fractures. Patients with associated pathological, open or long bone fractures were excluded. The main study outcome measures were the use of pre-operative and post-operative calcium, vitamin D, bisphosphonates and management of anaemia …

Residual Barriers For Utilization Of Maternal And Child Health Services: Community Perceptions From Rural Pakistan., Zahid Memon, Shehla Zaidi, Atif Riaz

Community Health Sciences

Low utilization of maternal and child care services in rural areas has constrained Pakistan from meeting targets of Millennium Development Goals (MDGs) 4 and 5. This study explores community barriers in accessing Maternal and Child Health (MCH) services in ten remote rural districts of Pakistan. It further presents how the barriers differ across a range of MCH services, and also whether the presence of Community Health Workers (CHWs) reduces client barriers. Qualitative methods were used involving altogether sixty focus group discussions with mothers, their spouses and community health workers. Low awareness, formidable distances, expense, and poorly functional services were the …