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Biomedical subjects

F F Fikree

Publications and source records attributed to F F Fikree.

15 recordsLinked to original sources
PubMed1998

An epidemiologic study of cystitis among Muslim women attending an out-patients clinic in Karachi.

Cystitis is considered to be one of the most common infections afflicting women of all age groups. It has been suggested that personal hygiene customs may influence the prevalence of cystitis. In this study, 130 women of child bearing age attending the out-patients clinic were interviewed in order to determine the frequency of cystitis and its associated risk factors including personal hygiene practices. Twenty seven percent of the women reported suffering from cystitis atleast once in the past, comparable to reported studies from the United States but higher than reported from other Muslim countries. Sixty-three percent of women reported their first episode during pregnancy and a significant relationship was observed between parity and cystitis (p value < 0.000). However, personal hygiene practices following micturition or sexual intercourse bore no significant association with cystitis. Cystitis, commonly reported among Pakistani married women, occurs primarily during pregnancy. Preventive measures during pregnancy are suggested.

Adult↗
PubMed1997

Increased severity of oral submucous fibrosis in young Pakistani men.

OBJECTIVE: To investigate the influence of age and sex on the incidence of severe oral submucous fibrosis (mouth opening 15 mm or less). DESIGN: Case (severe disease) control (mild disease) study. SETTING: University hospital, Pakistan. SUBJECTS: 147 patients with severe (mouth opening 15 mm or less) and 83 with mild disease (mouth opening 20 mm or more). MAIN MEASURES: Influence of sex and age on severity of oral submucous fibrosis. RESULTS: Men were twice as likely as women to have severe disease (odds ratio (OR) 2.0, 95% confidence interval (CI) of OR 1.15 to 3.47, P=0.02). Men in the 20-39 year age group were 4.8 times as likely as women to have severe disease (OR 5.8, 95% CI 2.15 to 15.5, P=0.00004). Men aged 40 years or more were 40% less likely to have severe disease than women (OR 0.6, 95% CI 0.19 to 1.88, P=0.39). CONCLUSIONS: Smoking increases the carcinogenic potential of submucous fibrosis. As men in this population smoke more than women, men with severe oral submucous fibrosis may develop oral cancer and die younger. Alternatively, young men may consume more areca nut than women.

Adolescent↗
PubMed1997

Maternal mortality in different Pakistani sites: ratios, clinical causes and determinants.

BACKGROUND: Population-based estimates of maternal mortality from Pakistan are inadequate to define the magnitude of the problem or provide information on clinical causes and determinants. METHODS: Surveys were conducted in selected clusters in Karachi, Balochistan and North West Frontier Province from 1989-1992. Pre-coded questionnaires were administered to 38,563 households to ascertain household characteristics, complete pregnancy histories and deaths of household members in the five years preceding the survey. Verbal autopsy questionnaires were then conducted to establish cause of death to women in the reproductive age group. Descriptive, bivariate and multivariable analyses were carried out to determine the association between the background variables, biological and women's status indicators and maternal mortality using a nested case-control design. RESULTS: Overall, the estimated maternal mortality ratio combining the data from the different sites was 433 per 100,000 livebirths. The estimated maternal mortality ratios per 100,000 livebirths ranged from a low of 281 in Karachi to a high of 673 in Khuzdar [Balochistan]. Hemorrhage (52.9%), puerperal sepsis (16.3%) and eclampsia (14.4%) were the leading causes for direct maternal deaths. Logistic regression identified the important risk factors as poor housing construction material (OR = 2.1; 95% CI = 1.3,3.2), distance of 40 or more miles from nearest hospital (OR = 1.3; 95% CI = 0.9,1.8), grandmultigravidity (OR = 1.6; 95% CI = 1.1,2.4) and prior fetal losses (OR = 5.3; 95% CI = 3.8,7.4). CONCLUSION: Focusing on special groups of pregnant women with targeted programs such as training, monitoring and supervision of birth attendants for the provision of oxytocics, will go a long way in decreasing the proportion of maternal deaths attributed to direct, avoidable causes.

Adult↗
PubMed1996

Demographic survey of the level and determinants of perinatal mortality in Karachi, Pakistan.

A demographic survey was used to estimate the level and determinants of perinatal mortality in eight lower socio-economic squatter settlements of Karachi, Pakistan. The perinatal mortality rate was 54.1 per 1000 births, with a stillbirth to early neonatal mortality ratio of 1:1. About 65% of neonatal deaths occurred in the early neonatal period, and early neonatal mortality contributed 32% of all infant deaths. Risk factor assessment was conducted on 375 perinatal deaths and 6070 current survivors. Poorer socio-economic status variables such as maternal and paternal illiteracy, maternal work outside the home and fewer household assets were significantly associated with perinatal mortality as were biological factors of higher parental age, short birth intervals and poor obstetric history. Multivariable logistic analysis indicated that some socio-economic factors retained their significance after adjusting for the more proximate biological factors. Population attributable risk estimates suggest that public health measures for screening of high-risk women and use of family planning to space births will not improve perinatal mortality substantially without improvement of socio-economic conditions, particularly maternal education. The results of this study indicate that an evaluation of perinatal mortality can be conducted using pregnancy histories derived from demographic surveys.

Adolescent↗
PubMed1996

Critical appraisal by reading for medical students--a case study from Pakistan.

Doctors read literature to keep abreast of medical advances. A recommendation from the 1993 World Summit for Medical Education is that medical schools should teach medical students to critically appraise scientific reports. The Department of Community Health Sciences of Aga Khan University Medical College teaches basic research methods to medical students. This is now supplemented with "Critical Reading". Critical reading was first taught to 67 third year students between October, 1993 and May, 1994. A "validity check-list for critical readers" was introduced in a two week orientation consisting of three one-hour classroom sessions and four one-hour small group sessions. Thereafter, small groups met monthly to critique clinical epidemiological reports relevant to current organ system teaching. The students reading attitudes and critical appraisal skills were assessed through continuous assessment and a written final examination with questionnaire. All but three students passed the final examination (mean score (74%, standard deviation 12%). Sixty-four of 67 (96%) completed questionnaires. All (73% strongly) agreed that critical reading skills were essential, but only 30% strongly agreed that they had, indeed, mastered the skills. Ninety-seven percent (56% strongly) disagreed that year three was too early to start critical reading. Clinical teaching staff expressed interest in learning these skills. Students benefited from and enjoyed this first critical reading course. It strengthened ties between clinical and community health sciences teaching staff. The critical reading skills of the clinical teaching staff is being addressed in seminars to strengthen institutional research capacity.

Education, Medical, Undergraduate↗
PubMed1995

Pakistan: the Faisalabad Obstetric Flying Squad.

The Faisalabad Obstetric Flying Squad was established in 1988 and provides access to emergency obstetric services for the poor women of Faisalabad. The service is highly appreciated by both women and participating dais. The latter receive training from the Mother and Child Welfare Association of Faisalabad and form an integral part of the obstetric care team. While problems in accessing communication facilities exist, the project has made a lasting impact on the provision of emergency obstetric services in the city. Improved recording and reporting mechanisms would permit a more precise assessment of the impact of the service on the reduction of maternal morbidity and mortality. It would also permit an assessment of the operating costs of the service. One of the reasons the service functions effectively is that it is fully integrated into the general operations of the Allied Hospital. If similar institutional mechanisms can be established there is good reason to think that the Faisalabad Obstetric Flying Squad could be replicated in other developing country settings.

Demography↗
PubMed1995

A rapid community based health evaluation of pregnant women in low socioeconomic settlements of Karachi.

A rapid nutritional and health evaluation of a random sample of 163 pregnant women was conducted in low socioeconomic settlements of Karachi, with the objective of determining the morbidity and nutritional status of pregnant women. These data are expected to be used in an ongoing community-based antenatal care programme. Twenty-nine percent of women reported fever, 14 percent diarrhoea and 33 percent respiratory infections in the previous week. Mean weight was 54.8 (+/- 10.6) kg, mean height was 151.6 (+/- 6.0) cm and mean midarm circumference was 25.6 (+/- 3.2) cm. The mean uterine height at gestational ages 8 months and over was 32.1 (+/- 10.2) cm which is below the 10th percentile. These results suggest a chronic, mildly malnourished population with a high rate of infections. Specifically, we suggest that maternal height and uterine height be used to assess women at high risk for low birthweight.

Anthropometry↗
PubMed1994

A community-based nested case-control study of maternal mortality.

OBJECTIVES: Population-based information from Pakistan on maternal mortality is inadequate to define the magnitude of the problem or to contribute information on the distribution of clinical causes and risk factors. A population-based survey was conducted in eight urban squatter settlements of Karachi, Pakistan, to address these key issues. METHODS: Pre-coded questionnaires were administered to the 10,135 households to ascertain deaths of household members in the 5 years preceding the survey (1984-1989). A verbal autopsy questionnaire was administered to the 121 households where a female death between 15 and 49 years of age was reported. RESULTS: The maternal mortality ratio was estimated as 281 per 100,000 livebirths with hemorrhage, eclampsia and puerperal sepsis as the major causes of maternal deaths. Important risk factors identified were maternal employment, paternal unemployment, and poor prior pregnancy history. Women did seek health care but the assistance sought was often inappropriate. CONCLUSION: Intervention programs for improving timely referral and upgrading of hospitals are suggested.

Adolescent↗
PubMed1994

Risk factors for term intrauterine growth retardation: a community-based study in Karachi.

Reported are the results of a community-based prospective study in four urban squatter settlements in Karachi that was carried out to assess the incidence of and risk factors for intrauterine growth retardation. The incidence of term intrauterine growth retardation was 24.4% among 738 singleton births. The socioeconomic and biological risk factors that were found to be statistically significant in a bivariate analysis were included in a logistic regression model to assess their independent effects. The major risk factors were low level of maternal education, paternal unemployment, consanguinity, short birth-to-conception intervals, short maternal stature, and low maternal weight. The population risk estimates suggest the desirability of public health interventions to improve maternal weight and birth spacing and of improvements in socioeconomic conditions, especially maternal education. Public education programmes to discourage consanguineous marriages should also be considered.

Anthropometry↗
PubMed1994

Risk factors for intrauterine growth retardation: results of a community-based study from Karachi.

There is a serious lack of community-based information on low birthweight or intrauterine growth retardation from Pakistan. A community based prospective study was conducted in four squatter settlements of Karachi, to examine the prevalence and risk factors for adverse pregnancy outcome. This paper reports on the prevalence and risk factors for intrauterine growth retardation (<10th percentile birthweight gestational age) among 755 singleton births. The incidence of intrauterine growth retardation was 25.4% (192 intrauterine growth retarded and 563 appropriate for gestational age). Major socioeconomic risk factors identified were low maternal education (RR = 1.4, 95% CI = 1.0,2.1) and poor housing material (RR = 1.7, 95% CI = 1.0,3.0). Among the significant biologic factors, primiparity (RR = 1.9, 95% CI = 1.4,2.7), consanguinity (RR = 1.4, 95% CI = 1.4,2.7), consanguinity (RR = 1.4, 95% CI = 1.1,1.8), short birth to CI = 1.1,2.1), short stature (RR = 2.2, 95% CI = 1.6,3.0), low maternal weight (RR = 2.0, 95% CI = 1.6,2.5) and non-vegetarian diet (RR = 2.3, 95% CI = 1.3,4.2) were especially important. Investigations to assess the adverse mortality and morbidity effects of intrauterine growth retardation are ongoing.

Adult↗
PubMed1993

Can men be trusted? A comparison of pregnancy histories reported by husbands and wives.

Agreement between pregnancies and pregnancy outcomes reported by husbands and wives was assessed in a sample of 857 couples interviewed between June 1989 and July 1990. The respondents were men employed in a semiconductor manufacturing plant in Burlington, Vermont, and their wives. The wives' reports were used as the standard against which the husbands' reproductive histories were evaluated. Measures included sensitivity, specificity, and percentage of agreement. Reports were considered to be congruent if an outcome reported by the husband agreed with the outcome reported by the wife within a period of +/- 6 months. Although men and women reported similar numbers of livebirths (1,478 and 1,500, respectively), men tended to misreport the timing of events; therefore, complete agreement on the numbers and dates of births was only 88.5%. Men also misreported the prevalence of low birth weight (sensitivity, 74%). Specificity was poorer for the younger (< 35 years) and less educated (< or = 12 years) respondents. Husbands' reports of spontaneous abortions had lower sensitivity (71.2%) than their reports of livebirths, particularly among the better educated (66.9%). Induced abortions were frequently omitted by the husbands (sensitivity, 35.1%), and events such as stillbirths or tubal pregnancies were too few in number to permit meaningful analysis. It is concluded that husbands' misreporting of their wives' reproductive histories may be substantial and sufficient to compromise the validity of epidemiologic studies. It would, therefore, be prudent to avoid the use of husbands as proxy informants of their wives' reproductive histories.

Adult↗
PubMed1993

Causes of reproductive age mortality in low socioeconomic settlements of Karachi.

The Maternal and Infant Mortality Survey (MIMS) was conducted in eight squatter settlements of Karachi. The female mortality rate was 151.0 per 100,000 women aged 10-49 years and the maternal mortality ratio was 281 per 100,000 livebirths. The leading causes of deaths among women were complications of pregnancy (28.1%), infectious diseases (24.8%), cardiovascular diseases (20.7%), neoplasia (10.7%) and trauma (10.7%). Hemorrhage (47.1% of all maternal deaths), tuberculosis (40.0% of all infectious disease deaths), oropharyngeal cancer (23.1% of all neoplastic deaths), and burns (61.5% of all trauma deaths) were among the major causes identified. Maternal deaths were associated with young age and nulliparity (p-value < 0.01), and a higher proportion occurred in the hospital or on the way to the hospital as compared to non-maternal deaths.

Adolescent↗
PubMed1993

Crowding--a risk factor for perinatal mortality?

Crowding is known to be associated with an increased risk of infant and child morbidity and mortality particularly due to infections. We examined the association of crowding with perinatal mortality. Our results indicated a paradoxical relationship with the least crowded households showing the highest perinatal mortality (7.7% as compared to 4.7%). However, further analysis indicated that the observed paradoxical relationship is a spurious one, largely explained by the confounding effect of gravidity.

Cross-Sectional Studies↗