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Biomedical subjects

I H Thaver

Publications and source records attributed to I H Thaver.

At least 19 recordsLinked to original sources
PubMed2001

Knowledge, attitudes and practices of general practitioners in Karachi District Central about tetanus immunization in adults.

OBJECTIVE: To assess the knowledge, attitude and practices of general practitioners regarding tetanus immunization in adults. SETTING: The study was conducted in District Central, Karachi. STUDY DESIGN: This was a Knowledge, Attitude and practices (KAP) survey. METHODS: From a list of 1050 general practitioners (GPs), 100 were selected through simple random sampling and interviewed through a written questionnaire. RESULTS: Only 25% general practitioners had adequate knowledge about pre-exposure and 13% both pre- and post-exposure tetanus immunization. All were ready to participate in any program to update their knowledge. Ninety seven percent were practicing only post-exposure immunization. In unimmunized patients with history of road side/street injury, 55% started tetanus immunization with tetanus toxoid (TT) only, 43% with Anti Tetanus Serum/Tetanus Immunoglobin (ATS/TIG) and only 2% with both TT and ATS/TIG. Only 13% GPs advised their patients to complete three doses of tetanus toxoid after initial contact. CONCLUSION: As majority of GPs had poor knowledge and incorrect practices so interventions like seminars and display of immunization protocols in the clinics are recommended.

Female↗
PubMed1998

Private practitioners in the slums of Karachi: what quality of care do they offer?

Private health services have expanded in many developing countries over the last 10 yr. Qualified private practitioners provide basic health care for poorer groups in urban areas, although health care planners frequently criticize them for providing poor quality of care, charging high fees and failing to provide preventive health advice. In Karachi, a large city with more than 400 slums, private practitioners are important providers of care to the poor. This study assessed the nature and quality of care provided by 201 practitioners selected from four districts of the city. Vignettes of specific medical problems were used to assess their knowledge and their practice was measured by observing 658 doctor-patient contacts. The results show that knowledge was closer to accepted medical management than was their actual prescribing practice. On the other hand, their manners and interpersonal behaviour were good. Thus poor prescribing practice, which might equally stem from market influences as lack of knowledge, is the cause of low standards of care. In these circumstances, didactic in-service training to improve prescribing practice is unlikely to be successful.

Adult↗
PubMed1997

Do workshops make a difference in improving the capability of physicians?

Continuing medical education (CME) activities have been shown to improve the capability and capacity of physicians for appropriate management of their patients. However, doubts have been raised about the role of workshops and seminars. This study is an attempt to find out whether workshops can improve the knowledge (capability) of practicing physician. Participants of 10 randomly selected workshops conducted in whole of Sindh were included for this study. A pre-test followed by post-test methodology used for 214 participants demonstrated that physicians' knowledge increased for some of the basic facts after attending the workshop. However, when their knowledge was assessed with some problem-solving approach, no significant (P < 0.05) change could be noted. It is recommended that workshops should be designed and conducted more carefully. Besides, some innovative approaches for CME should be compared with 'workshops' approach to determine their effectiveness.

Adult↗
PubMed1995

Self medication or self care: implication for primary health care strategies.

To determine the frequency of self-medication, a cross-sectional study was conducted in a Karachi district by selecting households through systematic random sampling. Health seeking behaviour for childhood illnesses and assessment of the magnitude and reasons for self-medication were done by interviewing mothers/caretakers. Five hundred households were visited, of which 158 fulfilled the criteria of having one sick child in the previous month. Medication without prescription was given to 51.3% children, mostly consisting of unidentified drugs or analgesics/antipyretics. Good past experience (61.3%) with the medicine was the main reason for self-medication. The use of medicines by health professionals was the main reason influencing parents for self-medication to their children. Self-medication is difficult to eliminate, but interventions can be made to discourage use of inappropriate and harmful drugs.

Child↗
PubMed1994

Anaemia in children: Part I. Can simple observations by primary care provider help in diagnosis?

The commonest and reliable method of diagnosing anaemia is by determining haemoglobin levels, which is an invasive technique. This cross-sectional study aims to detect the validity of diagnosing anaemia by simple non-invasive clinical techniques. This study screened 951 children (6-60 months) residing in a squatter settlement of Karachi. Every child was first labelled anaemic or normal by a clinical scoring system and then his/her haemoglobin was tested by finger prick method on a Hemocue. Mean age was 31.1 +/- 15.3 months (n = 945) and median was 32 months. The prevalence of anaemia by Hemocue was 78% (Anaemia = Hb < 11 gms%) and by clinical examinations 68%. Conjunctivae alone had the highest sensitivity (74%) and nails alone highest specificity (96%). Nails alone had the highest positive predictive value and conjunctivae alone highest negative predictive value (43.2%). Combinations of conjunctivae with either nails, palm or tongue yielded the highest validity. The results indicate that in PHC settings with no laboratory facilities, anaemia can be detected by pallor of conjunctivae associated with pallor of either nails, palm or tongue.

Anemia, Iron-Deficiency↗
PubMed1994

Anaemia in children: Part II. Should primary health care providers prescribe iron supplements by the observation and presence of assumed symptoms?

The dilemma of private practitioners is whether to prescribe or not to prescribe iron supplements on suspicion of anaemia. This cross sectional study was done in an urban squatter settlement with a primary health care centre to assess the significance of symptoms and a history of associated diseases in the diagnosis of anaemia. A total of 321 children were sampled from 1800 children < 5 years of age in a population of 11,000, by systematic random sampling. Mothers were asked about the presence of assumed associated symptoms and diseases which were listlessness, irritability, anaemia, pica, poor weight gain, diarrhoea, acute respiratory infection and malaria in last 3 months. There was significant association between anaemia (Hb < 11 gms%) and irriability (P < .02), anorexia for solid foods (P < .04), pica (P < .001), episode of diarrhoea (P < .001) and poor weight gain (P < .006). There was no significant association between malaria, cold, cough and anaemia. Children with these symptoms complex should receive iron supplements.

Anemia, Iron-Deficiency↗
PubMed1994

Whither GPs...

Explore the source record for details and available documents.

Pakistan↗
PubMed1993

The value of intermittent growth monitoring in primary health care programmes.

The objective of growth monitoring is to detect early growth faltering before the child becomes severely malnourished. It has been found in many large projects in the private sector and in Government run Primary Health Care (PHC) programmes that monthly weighing is not feasible which makes it impossible to develop a functional outreach programme on a sustainable basis. This study is an attempt to propose an intermittent growth monitoring which is operationally feasible for large scale PHC programmes in the public sector. A historical prospective study was conducted to find out the correlation of weights of children at different ages with weights at subsequent months. Two hundred and ninety-two growth cards of children were selected from two squatter settlements of Karachi which are having a PHC programme through the Aga Khan University. At six months, about 71% of children were within the normal range, with increasing age from 10% to 39% of these children shifted to grade I Protein Energy Malnutrition (PEM). When weights of children for each month were correlated with weights at all other months up to 24 months, it was found that correlation coefficient at 6th and 9th month were significant (P value < 0.001). Probability of developing malnutrition at different weights and ages were also calculated. The results indicate that malnutrition starts appearing at 6 months and weights at 6 months and to a lesser extent at 9 months are better prognostic indices of future malnutrition. Intermittent weighing of children can help in early identification of "high risk" children who can then be managed and even be prevented from developing future malnutrition.

Body Weight↗
PubMed1993

The "P" in GMP--a major shift in growth monitoring program of a primary health care project.

Growth monitoring and promotion (GMP) is the monitoring of a child's growth to promote, maintain and restore health. The "P" in GMP relates to the promotive, preventive and curative actions which accompany the monitoring process. Data from two of the Primary Health Care field sites of The Aga Khan University, Essa Nagri and Azam Basti (squatter settlements), in Karachi for May 1989 was analyzed to determine the relationship between weight change and nutritional status. 21% of 2,838 children had a decrease in weight from April to May 1989. Children in Grade I malnutrition (n = 274) contributed much more to this decrease than children with Grades II and III (54 and 5, respectively). By focusing attention only on those with Grades II and III malnutrition, the obvious ones, we have been missing the opportunity to prevent a deterioration of those in Grade I, though it is easier and less time consuming to reverse this trend in early stages of malnutrition. To ensure more quality-time for community health workers' focus on the at-risk population, three alternative "high-risk" groups are proposed. Promotion of growth and weight change needs to be stressed more, instead of the nutritional status only in GMP programs.

Body Weight↗
PubMed1991

Alma Ata and health for all by the year 2000. The roles of academic institutions.

The title of this article raises a complex set of questions. To begin, what happened at Alma Ata and the goal that emanated from it-Health for All by the Year 2000--are themselves controversial matters. At least there are some who are strongly critical of those events and ideas. Even without linking academic institutions with Alma Ata and HFA/2000, a controversy is spawned when one asks about the roles of such institutions in dealing with societal problems--which problems should a university address, and how deeply does a university become engaged in them, particularly if it carries the university out of the cloister into the trenches of societal conflict? Linking academic institutions with Alma Ata and HFA/2000 deepens the controversy but also provides a framework for examining the basic principles on which each is based, and for testing those principles against the realities of real world problems of health development. This article draws on recent critical assessments of both sides of the equation: a recent Consultative Committee to the Director General of WHO that analyzes the successes and failures of PHC development to date, and lays out conditions for greater effectiveness in the future; and the Technical Discussions of WHO on the Roles of Universities in the Strategy for Health for All that review traditional and progressive arguments about the roles of universities in their societies, and how HFA can be seen as fitting into that debate. The thinking contained in these documents provides ample opportunity to examine whether or not academic institutions should have a role that relates to Alma Ata and Health for All, and, in the end, takes the position that, indeed, this is an appropriate role for those universities prepared to make the commitment. The point is also made that such involvement cannot be effective if the scale of the institutional commitment is marginal--it must be substantial and institution-wide. An example is given of the Aga Khan University in Karachi, Pakistan, an institution avowedly committed to a community orientation and to health services development. The Network of Community-Oriented Educational Institutions for Health Sciences can be considered a movement of educational institutions in this direction. It is functioning with considerable creative initiative in addressing issues having to do with problem-based teaching methods, community orientation, and partnerships with governmental health services.(ABSTRACT TRUNCATED AT 400 WORDS)

Academic Medical Centers↗
PubMed1990

Infant mortality and undernutrition in the squatter settlements of Karachi.

The socio-demographic and biological processes contributing to infant mortality and undernourishment were studied in five urban squatter settlements of Karachi. All those families who had experienced an infant death in the past 2 years (N = 106) were recruited into the study. Comparative children were selected by random numbers with geographical matching from families with at least one live infant and without a history of infant deaths in the past 2 years. The comparison children were weighed and those found underweight (27 per cent) were studied for the presence of risk factors. Forty-one per cent of all deaths were in the neonatal period, and in 47 per cent of cases deaths had occurred in infants with a birth order of 5 and above. Age, duration of breast feeding, birth interval, and the live/dead status of the previous sibling were significant biological variables accounting for 23 per cent of the variance for survival. Socio-economic status accounted for 22 per cent of the variance and health-seeking behaviour (antenatal care, immunization, etc.) for 28 per cent. Sixty-eight per cent of those underweight were more than 6 months old. Age, female sex, birth interval less than 24 months, duration of breast feeding, adolescent mother, alive/dead status of the previous child were significant influences accounting for 12 per cent of the variance. Socio-economic status and health seeking behaviour were also important determinants, but not to the same extent as in the case of infant death.

Adolescent↗