Public Health Commons^™

Prenatal Exposure To Wood Fuel Smoke And Low Birth Weight, Amna R. Siddiqui, Ellen B. Gold, Xiaowei Yang, Kiyoung Lee, Kenneth H. Brown, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Maternal exposure to wood fuel smoke may lead to impaired fetal growth due to hypoxia and or oxidative stress from smoke constituents such as carbon monoxide and particulate matter. Objectives: We studied the risk of low birth weight (LBW) and reduced mean birth weight in relation to reported use of wood for cooking during the prenatal period, compared with natural gas (NG).
Methods: We studied a historical cohort of women who had a singleton live birth in the years 2000-2002, from a semirural area of Pakistan. Infant's birth weight was obtained from records, and prenatal records had data for …

Film Retakes In Digital And Conventional Radiography, Waseem Akhtar Mirza, Mubashir Aslam, Arif Ali, Kashif Mirza, Nadeem Ahmad

Department of Radiology

Objective: To determine the film-retake rates and causes in digital radiography comparison to conventional X-rays method.
Study design: Comparative study.
Place and duration of study: Radiology Department, Aga Khan University Hospital, Karachi, from January 2004 to December 2006.
Patients and methods: X-rays of different body parts, conducted during the year 2004, with conventional radiography (n=170300), and in 2006 with digital radiography (n=174550), were included in this study. Measurements were done for number of X-rays re-take due to different quality control reasons for both the conventional and digital radiography. Quality control reasons included underexposure, overexposure, positioning errors, patient movements, portable X-rays, …

Sehat-1: Pehli Class: Asatza Aur Sehat Ke Karkuno Ke Liye Aik Gaed, Tashmin Kassam-Khamis, Farah Shivji, Sadia Muzaffar Bhutta

Books

No abstract provided.

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

Department of Radiology

No abstract provided.

Depression In The Elderly: Does Family System Play A Role? A Cross-Sectional Study, Ather M. Taqui, Ahmed Itrat, Waris Qidwai, Zeeshan Qadri

Department of Family Medicine

Background

The most common geriatric psychiatric disorder is depression. The role of family systems in depression among the elderly has not been studied extensively. It has been suggested that urbanization promotes nucleation of family systems and a decrease in care and support for the elderly. We conducted this study in Karachi, a large urban city of Pakistan, to determine the relationship between the type of family system and depression. We also determined the prevalence of depression in the elderly, as well as correlation of depression with other important socio-demographic variables.

Methods

A cross-sectional study was carried out in the premises …

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 …

Incidence, Patterns And Severity Of Reported Unintentional Injuries In Pakistan For Persons Five Years And Older: Results Of The National Health Survey Of Pakistan 1990–94, Zafar Fatmi, Wilbur C. Hadden, Junaid A. Razzak, Huma Qureshi, Adnan A. Hyder, Gregory Pappas

Community Health Sciences

Background

National level estimates of injuries are not readily available for developing countries. This study estimated the annual incidence, patterns and severity of unintentional injuries among persons over five years of age in Pakistan.

Methods

National Health Survey of Pakistan (NHSP 1990–94) is a nationally representative survey of the household. Through a two-stage stratified design, 18, 315 persons over 5 years of age were interviewed to estimate the overall annual incidence, patterns and severity of unintentional injuries for males and females in urban and rural areas over the preceding one year. Weighted estimates were computed adjusting for complex survey design …

Eight Key Household Practices Of Integrated Management Of Childhood Illnesses (Imci) Amongst Mothers Of Children Aged 6 To 59 Months In Gambat, Sindh, Pakistan, Ajmal Agha, Muhammad Younus, Muhammed Masood Kadir, Sajid Ali, Zafar Fatmi

Community Health Sciences

Objective:

To determine Knowledge, Attitudes and Practices (KAP) regarding eight key integrated management of childhood illness (IMCI) suggested practices and the association of these key practices with stunting as outcome.

Methods:

Sampling proportionate to sub-population sizes was employed to ensure representation from all the Union Councils of taluka Gambat-Sindh.

Results:

Low female education and mobility show the status of child's first care provider in a typical rural community. Few women knew about giving more food to a child suffering from diarrhoea. Moreover, very few exclusively breastfed their children for first 4-6 months, got their children completely immunized, washed hands before …

Cost Effectiveness Of Screening Of All Newly Recruited Employees For Diabetes At A Tertiary Care Hospital, Niloufer Sultan Ali, Ali Khan Khuwaja

Department of Anaesthesia

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 …

Family Systems: Perceptions Of Elderly Patients And Their Attendents Presenting At A University Hospital In Karachi, Pakistan, Ahmed Itrat, Ather Mohammed Taqui, Fahd Qazi, Waris Qidwai

Department of Family Medicine

Objective:

To know the present status of family systems in Pakistan, changes they are undergoing and implications of such trends on health of the elderly population.

Methods:

A cross-sectional study was carried out at the out-patient clinics, AgaKhan University Hospital, using convenience sampling method. Verbal informed consent was taken from the participants. The questions included demographic profile, satisfaction with current family system, opinions about changing trends of family systems, and their implications on health. Analysis was done using SPSS 13.0.

Results:

Four hundred subjects aged 65 and above were interviewed, out of which 226 (56.5%) were living in the …

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 …

Knowledge And Beliefs Of Adolescents Regarding Sexually Transmitted Infections And Hiv/Aids In A Rural District In Pakistan, Hafsa Raheel, Franklin White, Muhammad Masood Kadir, Zafar Fatmi

Community Health Sciences

Objective:

To assess the knowledge and beliefs of adolescents (15-19 years girls and boys) regarding sexually transmitted infections (STIs) and HIV/AIDS.

Methods:

A community based cross-sectional survey was conducted in October 2002 in a rural district (Mirpurkhas) of Sindh province, Pakistan.

Results:

A total of 428 adolescent girls and boys were interviewed. Only 44% correctly named at least one STI, while 55% knew at least two modes of transmission for HIV/AIDS. Adolescents with education greater than or equal to secondary level, those who were able to read the newspaper, possessed electricity in their homes and were allowed to meet their …

Correlates Of Cigarette Smoking Among Male College Students In Karachi, Pakistan, Shafquat Rozi, Zahid A. Butt, Saeed Akhtar

Community Health Sciences

Background: About 1.3 billion people are regular smokers world wide and every day between 8,200 and 9,900 young people start to smoke, risking rapid addiction to nicotine. Transition from high school to college is a critical period to adopt healthy habits and life style. Therefore, it is important to understand the factors that might influence their smoking habit. Our study aims to assess the influence of factors that encourage college students to smoke cigarettes.Methods: The data used in this survey were obtained from a representative sample of registered colleges of Karachi. A random sample of 576 male college students of …

Resource Allocation Within The National Aids Control Program Of Pakistan: A Qualitative Assessment Of Decision Maker's Opinions, Sara Husain, Masood Kadir, Zafar Fatmi

Community Health Sciences

Background:

Limited resources, whether public or private, demand prioritisation among competing needs to maximise productivity. With a substantial increase in the number of reported HIV cases, little work has been done to understand how resources have been distributed and what factors may have influenced allocation within the newly introduced Enhanced National AIDS Control Program of Pakistan. The objective of this study was to identify perceptions of decision makers about the process of resource allocation within Pakistan's Enhanced National AIDS Control Program.

Methods:

A qualitative study was undertaken and in-depth interviews of decision makers at provincial and federal levels responsible to …

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 …

Knowledge And Attitudes About Health Research Amongst A Group Of Pakistani Medical Students, Hassan Khan, Muhammad Rizwanulhaq Khawaja, Abdul Waheed, Muhammad Ameen Rauf, Zafar Fatmi

Community Health Sciences

Background

Health research training is an important part of medical education. This study was conducted to assess the level of knowledge and attitudes regarding health research in a group of Pakistani medical students at Aga Khan University, Karachi.

Methods

It was a cross-sectional pilot study conducted among a group of Pakistani medical students. Through stratified random sampling, a pre-tested, structured and validated questionnaire was administered to 220 medical students. Knowledge and attitudes were recorded on a scale (graduated in percentages).

Results

Mean scores of students were 49.0% on knowledge scale and 53.7% on attitude scale. Both knowledge and attitudes improved …

Health And Needs Assessment Of Geriatric Patients: Results Of A Survey At A Teaching Hospital In Karachi, Syed Nabeel Zafar, Hammad Ashraf Ganatra, Sarah Tehseen, Waris Qidwai

Department of Family Medicine

Objective: To study the health and needs of geriatric patients

Methods: A questionnaire based survey of patients visiting the out-patient department of Aga Khan University was carried out. Ethical requirements were met and included administration of informed consent and provision of confidentiality to patients. Convenience sampling was used without any randomization for interviews. Epi-info and SPSS software were used for data management.

Results: Four hundred and two (402) subjects above the age of 65 were surveyed. Most of the subjects were retired (40.5%) married (76.4%) men (69.7%). Ages ranged from 65 to 90 years, the mean being 70.57 years and …

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 …

Geographic Data On Health Inequities: Understanding Policy Implications, Gregory Pappas

Community Health Sciences

No abstract provided.

Hepatitis B And C: Prevalence And Risk Factors Associated With Seropositivity Among Children In Karachi, Pakistan, Wasim Jafri, Nadim Jafri, Javed Yakoob, Muhammad Islam, Syed Farhan Ali Tirmizi, Tazeen Jafar, Saeed Akhtar, Saeed Hamid, Hasnain Ali Shah, Sheikh Qamaruddin Nizami

Section of Gastroenterology

Background

Infections with hepatitis B virus (HBV) and hepatitis C virus (HCV) can lead to chronic liver disease and hepato-cellular carcinoma (HCC). This cross-sectional study estimated the prevalence and identified risk factors associated with Hepatitis B surface antigen (HBsAg) and HCV antibody (anti-HCV) sero-positivity among children 1 to 15 years of age.

Methods

The study targeted the low to middle socioeconomic population that comprises 80% to 85% of the population. Consent was obtained from parents of the eligible children before administering questionnaire and collected a blood sample for anti-HCV and HBsAg serology.

Results

3533 children were screened for HBsAg and …

Knowledge, Attitude And Misconceptions Regarding Tuberculosis In Pakistani Patients, Javaid Ahmed Khan, Muhammad Irfan, Amna Zaki, Madiha Beg, Syed Fayyaz Hussain, Nadeem Rizvi

Section of Pulmonary & Critical Care

Objective:

To assess knowledge of patients with tuberculosis; about their disease and misconceptions regarding TB.

Methods:

A cross sectional study was conducted at Out-patient clinics of two teaching hospitals (private and public) in Karachi, Pakistan. A questionnaire was filled for the purpose.

Results:

A total of 170 patients were interviewed, 112 from private and 58 from a public sector hospital. Cough, fever, bloody sputum and chest pain were recognized as the common symptoms of TB. Eleven (7%) patients thought TB was not an infectious disease and 18 (10.6%) did not consider it a preventable disease. Contaminated food was considered the …

Acute Health Effects Of The Tasman Spirit Oil Spill On Residents Of Karachi, Pakistan, Naveed Zafar Janjua, Pashtoon Murtaza Kasi, Haq Nawaz, Sadia Zohra Farooqui, Urooj Bakht Khuwaja, Najam-Ul-Hassan, Syed Nadim Jafri, Shahid Ali Lutfi, Muhammad Masood Kadir, Nalini Sathiakumar

Community Health Sciences

Background: On July 27 2003, a ship carrying crude oil ran aground near Karachi and after two weeks released 37,000 tons of its cargo into the sea. Oil on the coastal areas and fumes in air raised health concerns among people. We assessed the immediate health impact of oil spill from the tanker Tasman Spirit on residents of the affected coastline in Karachi, Pakistan.Methods: We conducted a study consisting of an exposed group including adults living in houses on the affected shoreline and two control groups (A and B) who lived at the distance of 2 km and 20 km …

Socio-Demographic Correlates Of Betel, Areca And Smokeless Tobacco Use As A High Risk Behavior For Head And Neck Cancers In A Squatter Settlement Of Karachi, Pakistan, Samia Mazahir, Rabia Malik, Maria Maqsood, Kanwal Aliraza Merchant, Farida Malik, Atif Majeed, Zafar Fatmi, Muhammad Rizwanulhaq Khawaja, Shehzad Ghaffar

Community Health Sciences

Background

Head and neck cancers are a major cancer burden in Pakistan. They share a common risk factor profile including regular consumption of products of betel, areca and tobacco. Use of paan, chaalia, gutka, niswar and tumbaku is acceptable in Pakistan and is considered a normal cultural practice. This cross-sectional study was carried out to understand the relation of socio-demographic factors for the consumption of paan, chaalia, gutka, niswar and tumbaku in Pakistani population. Through systematic sampling, 425 subjects from a squatter settlement in Karachi were interviewed using a structured questionnaire. High risk behavior was defined as Daily use of …

Pakistan - Country Profile Of Cancer And Cancer Control 1995-2004, Yasmin Bhurgri, Asif Bhurgri, Sania Nishter, Ashfaq Ahmed, Ahmed Usman, Shahid Pervez, Naila Kayani, Rashida Ahmed, Sheema H. Hassan, Ahmed Riaz, Hadi Bhurgri, Imtiaz Bashir

Department of Pathology and Laboratory Medicine

No abstract provided.

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 …

Living With Globalization: A Menace Or A Chance?, Fauziah Rabbani, Babar T Shaikh, Sarah Wamala

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 …

Cancer Esophagus Karachi 1995-2002:Epidemiology, Risk Factors And Trends, Y. Bhurgri, N. Faridi, L. A.G. Kazi, S. K. Ali, H. Bhurgri, A. Usman, J. Malik, A. Bhurgri, R. Ahmed, S. Muzaffar, N. Kayani, Shahid Pervez, S. H. Hasan

Department of Pathology and Laboratory Medicine

Objective: To study the trends of cancer esophagus in Karachi South during 1995-2002 and identify risk factors.

Methods: Incident esophageal cancer cases recorded at the Karachi Cancer Registry for Karachi South, during 1st January 1995 to 31st December 2003 were reviewed. For maximum completion of data, incident cases registered from 1st January 1995 to 31st December 2002 were included for final analyses.

Results: The Age Standardized Incidence Rates (ASIRs) of cancer esophagus in Karachi South for males were 6.5/100,000 (1995-1997) and 6.4/100,000 (1998-2002). In females the observed rates were 7.0/100,000 (1995-1997) and 8.6/100,000 (1998-2002).

Conclusion: In the moderately high incidence, …

Socio-Economic And Demographic Factors Associated With Injecting Drug Use Among Drug Users In Karachi, Pakistan, A. Agha, S. Parviz, M. Younus, Zafar Fatmi

Community Health Sciences

Objective: To identify the socio-economic and demographic factors associated with injecting drug users (IDUs) in Karachi.

Methods: We recruited 242 IDUs (taking drugs through sub-dermal routes) and 231 non-IDUs (taking drugs other than sub-dermal routes) from February through June 1996. IDUs were interviewed regarding sociodemographic factors, economic condition, and social network (marital status, living with spouse). In addition, information regarding location of drug users within the city (districts of Karachi) and current history of sexually transmitted diseases (STDs) were gathered. Moreover, blood samples were also obtained for HIV testing

.Results: Multivariate analysis showed that the income generation via illegal …