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PubMed1988

Epidemic non-A non-B hepatitis in urban Karachi, Pakistan.

An outbreak of icteric non-A non-B (NANB) hepatitis occurred in a residential community of urban Karachi, Pakistan, from August 1986 through October 1986. Of the 114 cases reported from this community during the 1986 calendar year, a clustering of 85 cases was seen during the above period. Twenty-seven percent of 226 households and 9% of 1,250 individuals were affected. Five persons were hospitalized and 1 death occurred in a young pregnant woman. Cases occurred predominantly in the less than or equal to 29-year-old age group (72%), with a male:female ratio of 1.8:1. Thirty-four cases occurred singly within households, while in 28 households multiple cases were seen. Analysis of the epidemic curve and intervals of onset of multiple cases within households suggested prolonged common source exposure rather than secondary person-to-person transmission. No single water source was implicated but a contaminated municipal supply was presumed. Information collected from several other communities and from a university hepatitis reference laboratory suggested that the outbreak was part of a larger urban epidemic of NANB hepatitis. Based upon this investigation and data from recently published reports, it is concluded that NANB hepatitis is endemic in Pakistan.

Adolescent↗

PubMed1989

An outbreak of enterically transmitted non-A, non-B hepatitis in Pakistan.

An epidemic of enterically transmitted non-A, non-B hepatitis occurred at a college in Sargodha, Pakistan in early 1987. There were 133 clinical cases, an attack rate of approximately 20%. Though the disease was relatively mild, all clinical cases required hospitalization and prolonged convalescence. Nearly all cases were associated with a single water source. The epidemic ended when the water supply was improved. This is the 4th described epidemic of non-A, non-B hepatitis in Pakistan.

Acute Disease↗

PubMed2026

Epidemiological overview of Cryptosporidium infection in Capra hircus from southern Khyber Pakhtunkhwa, Pakistan.

Objectives: Cryptosporidium is a protozoan parasite that commonly infects livestock, including Capra hircus, causing diarrhea, dehydration, and sometimes mortality. These infections lead to substantial economic losses in the farming industry. This study aimed to determine the prevalence and associated risk factors, such as region, season, age, and sex, of Cryptosporidium infection in C. hircus in southern Khyber Pakhtunkhwa, Pakistan. Materials and Methods: A total of 360 fecal samples were collected from C. hircus from the Kohat, Bannu, and Lakki Marwat Districts of Khyber Pakhtunkhwa, Pakistan. Fecal smears were stained using the modified Ziehl-Neelsen method, and statistical analysis, including chi-square tests, was employed to assess the association between Cryptosporidium infection prevalence and various factors. Results: The overall Cryptosporidium infection prevalence was 20.55% (74/360). District-wise analysis revealed the highest prevalence in Kohat (23.33%), followed by Bannu (20%) and Lakki Marwat (18.33%). Monthly examination identified August as the peak prevalence month (36.67%), displaying non-significant monthly variations (p = 0.075). Seasonal disparity indicated a significantly higher prevalence in the summer (30%) compared to other seasons (p = 0.008). Age-wise prevalence demonstrated susceptibility in kids aged ≤ 15 days (≤ 33.93%), with significant overall age-based differences (p = 0.001). Female kids exhibited a slightly higher prevalence at 22.22% compared to males (19.19%), with no significant gender-based difference (p = 0.479). Conclusions: This study highlights the influence of geographic, seasonal, and demographic factors on Cryptosporidium prevalence in goat populations. The findings emphasize the importance of implementing targeted preventive measures. Recommended strategies include farmer education programs, seasonal deworming schedules, early screening for infection, and strict hygiene and water sanitation practices to reduce transmission risks effectively.

Cryptosporidiosis↗

PubMed2004

Outbreak of rove beetle (Staphylinid) pustular contact dermatitis in Pakistan among deployed U.S. personnel.

Deployed military personnel are often faced with a variety of exposures unfamiliar to U.S. physicians. This is the first report to describe an outbreak of a pustular disease among U.S. personnel deployed to Pakistan in support of Operation Enduring Freedom. Up to 10% of the base population was afflicted with a pustular eruption and an accompanying halo of erythema. A retrospective chart review and ongoing patient care resulted in 191 cases. Various therapies were used, including "watchful waiting." Gradual resolution occurred with residual area(s) of hypo- or hyperpigmentation. An irritant contact dermatitis was suspected based upon clinical presentation; staphylinid (rove) beetles were implicated. Rove beetle dermatitis from a pederin toxin has occurred in other parts of the world but has not been previously reported in Pakistan. We discuss the nature and progression of the dermatitis, treatments, outcomes, measures to control exposures, and the implications of such outbreaks.

Animals↗

PubMed1987

Epidemic non-A, non-B hepatitis in patients from Pakistan.

Epidemic non-A, non-B hepatitis was diagnosed in three young Pakistani men during a 10-month period at the Los Angeles County-University of Southern California Medical Center. All three patients had recently visited or lived in Karachi, Pakistan. None had serologic markers of hepatitis B virus infection or IgM antibody (acute-phase) to hepatitis A virus. A liver biopsy from one patient showed marked cholestasis and cholangiolar transformation of hepatocytes, a pattern previously described in patients with epidemic non-A, non-B hepatitis. Immune electron microscopy of a stool specimen obtained from this patient 10 days after the onset of symptoms showed virus-like particles, 27 nm in diameter, that were specifically aggregated by antibody contained in acute-phase sera from the three Pakistani patients, from patients with non-A, non-B hepatitis in Burma and Nepal, and from an experimentally infected marmoset. Recognition of three separate cases of probable epidemic-type non-A, non-B hepatitis in patients at one institution during such a short time suggests that Pakistan is endemic for this infection and that the disease may be more commonly spread to the United States than is now presumed.

Adult↗

PubMed2006

Knowledge and attitudes regarding AIDS among female commercial sex workers at Hyderabad City, Pakistan.

OBJECTIVE: To determine the level of knowledge and attitudes regarding AIDS among female commercial sex workers (FCSWs) in Hyderabad City, Sindh, Pakistan. DESIGN: A cross-sectional survey. PLACE AND DURATION OF STUDY: Red light area of Hyderabad City, Sindh, Pakistan, from March to July 2004. SUBJECTS AND METHODS: A pre-designed questionnaire was administered to see the level of knowledge and attitudes regarding AIDs among FCSWs. In this regard, a total of 61 FCSWs were interviewed after getting informed consent. RESULTS: Mean age of the FCSWs was 27 years. Majority was uneducated and unmarried. All respondents had heard the word AIDS but no one knew about the word HIV as well as its meaning. All respondents believed that AIDS is a preventable disease and they knew some method of prevention. Television was most common source of knowledge. FCSWs had inadequate knowledge in terms of signs and symptoms and the treatment of disease. CONCLUSION: FCSWs of the Hyderabad city had insufficient knowledge and various misconceptions regarding AIDS. Therefore, there is a need for their education and improvement in socioeconomic status. There is also the need of further studies with substantial statistical work to generate more accurate data in this regard.

Acquired Immunodeficiency Syndrome↗

PubMed2006

The cost of unsafe injections in pakistan and challenges for prevention program.

The burden of disease associated with unsafe therapeutic injection practices in Pakistan is very high. The number of injection per person per year has been estimated to be in the range of 8.2 to 13.6, one of the highest in developing world. Extrapolating this number to the whole country would result in 1.5 billion injections per year. Approximately 4% (75 million) of these are administered for immunization while the remainders are used for therapeutic use. Of these, 94.2% are unnecessary. Average price of an injection (not the complete prescription) is Rs. 20.6 (0.34 US dollars). Under conservative estimate, over three billion rupees or 500 million dollars out-of-pocket healthcare resources may be wasted each year. Appropriate use of injections would be highly cost effective. According to adjusted analysis, safe and appropriate use of injection in Pakistan would cost 92 million US dollars each year with a high proportion that would be injection devices paid through out-of-pocket expenses. Behaviour change for reduction in number of injections require long-term multidimentional efforts. Interventions in the form of phasing out of convention disposable injection equipment and switching to reuse prevention devices for all injections could prevent the common practice of reuse, hence reducing the transmission of infections.

Cost-Benefit Analysis↗

PubMed1999

Intrauterine growth restriction: a perspective for Pakistan.

BACKGROUND: Intrauterine growth restriction (IUGR) is the second leading contributor to the prevailing perinatal mortality and morbidity. It affects 23.8% of newborns around the world and 75% of these affected infants are born in Asia. In Pakistan the incidence of IUGR is around 25%, more than the WHO criteria for triggering a public health action. INTRODUCTION: IUGR is implicated with profound long-term impacts in adult life; like coronary heart disease, NIDDM and abnormal cortisol levels. The effects of the short and long term sequelae are reviewed. ETIOLOGY: IUGR is associated with a wide variety of etiological factors. But the factor unique in its importance to Pakistan is maternal malnutrition. The fetal gene expression is under the influence of nutrition. Growth projection curves showing the interaction between the genetic and environmental factors are discussed. SURVEILLANCE: Identification of IUGR baby in a primary care setting and the options in diagnosis in secondary and tertiary care settings are overviewed. CONCLUSION: The roots of this problem, with multi factorial causes are in the socioeconomic infrastructure. This calls for a synergistic approach of reducing this public health issue. Women empowerment can help us to get out of this intergenerational cycle of growth failure. Availability of resources aside, it is also a matter of political will to change things for the better.

Fetal Growth Retardation↗

PubMed1999

Perceived gynecological morbidity among young ever-married women living in squatter settlements of Karachi, Pakistan.

BACKGROUND: Community-based information on obstetric and gynecological morbidity in developing countries is meager and nearly non-existent in Pakistan. OBJECTIVES: To estimate the prevalence of specific gynecological morbidities and investigate the predictors of pelvic inflammatory disease. METHODS: Users [404] and non-users [313] of modern contraceptives were identified from eight squatter settlements of Karachi, Pakistan and detailed information on basic demographics, contraceptive use, female mobility, decision-making and gynecological morbidities were elicited. RESULTS: The perceived prevalence of menstrual disorders were 45.3%, uterine prolapse 19.1%, pelvic inflammatory disease 12.8% and urinary tract infection 5.4%. The magnitude of gynecological morbidity was high with about 55% of women reporting at least one gynecological morbidity though fewer [20%] reported at least two gynecological morbidities. Significant predictors of pelvic inflammatory disease were intrauterine contraceptive device users (OR = 3.1; 95% CI 1.7-5.6), age < or = 20 years (OR = 2.3; 95% CI 1.1-4.8) and urban life style (OR = 2.1; 95% CI 1.0-4.6). CONCLUSION: There is an immense burden of reproductive ill-health and a significant association between ever users of intrauterine contraceptive device and pelvic inflammatory disease. We therefore suggest improvement in the quality of reproductive health services generally, but specifically for family planning services.

Adolescent↗

PubMed1999

Demographic aspects of hepatitis C in northern Pakistan.

OBJECTIVE: To find out the prevalence of hepatitis C in various, age, sex and ethnic groups in Pakistan. SETTING: Specimens obtained from military/civil hospitals and General Practitioners of Rawalpindi Islamabad, region and other areas of Northern Pakistan, in vicinity. SUBJECTS: Serum of 1710 patients of hepatitis C, diagnosed at Armed Forces Institute of Pathology (AFIP), Rawalpindi between 1st July 1996 and Dec 31, 1997, tested for Anti HCV by 3rd generation Murex Elisa. Required information was collected on a proforma filled for each patient. RESULTS AND CONCLUSION: The majority of the cases were between 30-60 years of age. There was male preponderance. The infection was more common in Urdu speaking fraction of the patients as compared with others.

Adolescent↗

PubMed2000

The role of son preference in reproductive behaviour in Pakistan.

The sex of surviving children is an important determinant of reproductive behaviour in South Asia in general and Pakistan in particular. This cohort study evaluates the role of the sex of children on reproductive intentions and subsequent behaviour of women in urban slums of Karachi, Pakistan. The analysis is based on two rounds of surveys conducted in 1990-91 and 1995 of a cohort of married women aged 15-49 years. The results show that pregnancies became increasingly unwanted as the number of surviving sons increased. The sex of surviving children was strongly correlated with subsequent fertility and contraceptive behaviour. However, rather than an exclusive son preference, couples strove for one or more sons and at least one surviving daughter. The policy implications of the link between overt son preference and low status of women are discussed.

Adolescent↗

PubMed2000

Prenatal diagnosis of beta-thalassaemia in Pakistan: experience in a Muslim country.

A service for prenatal diagnosis of beta-thalassaemia was introduced in Pakistan in May 1994. Two renowned Islamic scholars, consulted before the service was introduced, ruled that a pregnancy can be terminated if the fetus is affected by a serious genetic disorder, and if termination is before 120 days (17 weeks) of gestation. During the first 3(1/2) years of the service 300 couples requested the test. Almost all the couples had been informed by their treating doctors. Most diagnoses were made between 10 and 16 weeks of gestation, and only 15 (5%) were reached after the 16th week. DNA analysis was by the amplification refractory mutation system (ARMS). A multiplex ARMS was developed in which three primer combinations identified the mutations in 91.5% of the couples. In 13 couples (4. 3%) linkage analysis was required for the fetal diagnosis. In 47/53 (88.7%) women carrying an affected fetus the pregnancy was terminated. In six cases it was declined principally on religious grounds. Postnatal confirmation of the prenatal diagnosis was possible in 117 unaffected children. One year after the start of the service, interviews with 141 couples with an affected child showed that 72% knew of the availability of prenatal diagnosis. Thirty-two of the informed couples had had a pregnancy, but only 18 (56%) used prenatal diagnosis. The main reasons for non-utilization of prenatal diagnosis were the cost of the test and fear of undergoing the test, though some gave no clear explanation. This study demonstrates that prenatal diagnosis is feasible and acceptable in a Muslim country such as Pakistan.

Attitude↗

PubMed2000

Unsafe injections and the transmission of hepatitis B and C in a periurban community in Pakistan.

Following reports of frequent deaths associated with jaundice and chronic liver disease among adults in a periurban community of Karachi, Pakistan, an investigation was conducted to evaluate the relationship between injections and viral hepatitis infections, to identify the reasons why patients received frequent injections, and to observe the injection practices employed in clinics. Two hundred and three adult patients were interviewed as they left each of the 18 area clinics. Practitioners were interviewed and three consecutive injections were observed at each clinic. Eighty-one per cent of patients received an injection on the day of the interview. Of the 135 patients who provided a serum sample, 59 (44%) had antibodies against hepatitis C virus and 26 (19%) had antibodies against hepatitis B virus. Patients who received more injections were more likely to be infected with hepatitis C. If oral and injected medications were equally effective, 44% of patients preferred injected medication. None of the practitioners knew that hepatitis C could be transmitted by injections. Non-sterile syringes and needles that had been used earlier in the day on other patients were used for 94% of the observed injections. Interventions to limit injections to those which are safe and clinically indicated are needed to prevent injection-associated infections in Pakistan and other low-income countries.

Adult↗

PubMed2001

Tropical pulmonary eosinophilia and filariasis in Pakistan.

Filariasis is a major health problem in South Asia, particularly India, Sri Lanka and Bangladesh. Pakistan was presumed to be not affected. We report for the first time confirmed cases of tropical pulmonary eosinophilia (TPE) in indigenous patients as a result of infection with Wuchereria bancrofti. Following clinical examination, total leukocyte and eosinophil counts were recorded. Parasitological examinations included blood for microfilariae and stool and urine for eggs of intestinal parasites. Total immunoglobulin (Ig) E and specific antifilarial IgG were measured. Suspected cases of TPE were treated with diethylcarbamazine, 6 mg/kg for four weeks and were followed up to 2 and 4 weeks after treatment. Four persons fulfilled the criteria for TPE. Their response to treatment was marked with clinical improvement, reduction in eosinophil count and reduced titers of specific antifilarial antibodies. Two persons had W. bancrofti antigen in their sera confirmed by filariasis antigen detection test. Tropical pulmonary eosinophilia due to Wuchereria. bancrofti, although rare, is present in Pakistan.

Adolescent↗

PubMed2001

Infection control policies and practice in Pakistan.

OBJECTIVE: Infectious diseases in Pakistan are one of the main contributors to the burden of disease. The objectives of this article were to examine the various facets of the issue and suggest relatively inexpensive improvements. SETTINGS: The status of infections/infectious diseases both in hospitals and community were considered. METHODS: Studies on infectious diseases from Pakistan published in national and international journals were reviewed and compared with those from more advanced countries. Anecdotal observation and common experience provided bases for some of the points made. RESULTS: The article argues for some cost-effective and readily workable infection control measures in hospital and community. Government department and other organizations that can be mobilized to develop policies on the relevant issues have been identified. CONCLUSION: The article highlights the need for establishing surveillance system for infections and antibiotics on which to base further policies. As with some other development in the country, a culture of accountability in healthcare might provide sound basis for future developments.

Cross Infection↗

PubMed2000

Progress toward poliomyelitis eradication--Pakistan, 1999-June 2000.

In 1988, the World Health Assembly resolved to eradicate poliomyelitis globally by the end of 2000. Although polio remains endemic in Pakistan, which reported 60% of all polio cases in the World Health Organization's (WHO) Eastern Mediterranean Region during 1999, substantial progress has been made, particularly in acute flaccid paralysis (AFP) surveillance. This report summarizes progress toward polio eradication in Pakistan.

Adolescent↗

PubMed2002

Progress toward poliomyelitis eradication--Pakistan and Afghanistan, January 2000-April 2002.

Since 1988, when the World Health Assembly resolved to eradicate poliomyelitis worldwide, the estimated global incidence of polio has decreased 99%. Pakistan began polio eradication activities in 1994 and Afghanistan in 1997. Although polio remains endemic in the two countries, both the incidence and the geographic distribution of poliovirus have been reduced substantially. This report summarizes progress toward eradicating polio in Pakistan and Afghanistan during January 2000-April 2002. Both countries aim to stop transmission of poliovirus by the end of 2002; however, the unstable security situation in the region might threaten this success.

Acute Disease↗

PubMed1987

Variations in demographic behaviour by levels of living in Pakistan.

This paper utilizes data from the Population, Labour Force, and Migration Survey of 1979 which collected information from about 10,000 households in Pakistan. Poverty was directly related to household size and also to the average number of children under 15, which meant higher dependency ratios for the poor. Poorer ever-married women had higher fertility rates than richer women. However, the association between fertility and levels of living was not monotonically inverse. Schooling rates of 5-9 year olds varied positively with levels of living and, conversely, labor force participation rates for boys aged 10-14 were generally higher in the poorer deciles. The value of children and their utility varies across the deciles. Data from Pakistan show only broad negative associations between infant mortality and standard of living. It could be argued that relatively higher mortality is experienced by those at lower standards of living, which leads at 1st to diminished household size, but eventually to higher fertility and larger household size. Out-migration, particularly to the Middle East, seems to have occurred in reasonably well-off households, or at least has not affected the poorest strata of society. Remittances have further enhanced the standard of living of out-migrants' households. The fertility of migrant households may also be lower than that of nonmigrants and may explain smaller household size. However, internal migration to urban areas tends to increased size as rural migrants live jointly in households away from their families.

Asia↗