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PubMed1998

Suicide and attempted suicide in Pakistan.

Suicide and attempted suicide are understudied subjects in Pakistan, an Islamic country where they are considered criminal offenses. National suicide statistics are not compiled nor are suicide mortality statistics reported to the World Health Organization (WHO). Although there are strong religious sanctions against suicide, there are no clear principles against attempted suicide in Islam. Despite this, Pakistan, like many other Islamic countries, has punitive laws against attempted suicide. This has led to both suicide and attempted suicide being underdiagnosed and underreported. Data on suicide and attempted suicide are also difficult to obtain. This article gives an overview of the current state of suicide and attempted suicide in Pakistan, in the context of existing religious and legal factors, high-lighting the main findings of the few studies carried out over the last 50 years. It is important that researchers in Islamic countries like Pakistan not be deterred by the apparent low rates of suicide in these countries, but conduct further research in this important yet neglected public-health problem.

Humans↗
PubMed2003

Prevalence and correlates of stunting among children in rural Pakistan.

BACKGROUND: Protein-energy malnutrition remains an important underlying cause of death among preschool children in Pakistan. The present study aimed to estimate the prevalence of stunting and its correlates and to explore the role of sex bias in remote rural villages of south Pakistan. METHODS: We selected 1878 children less than 3 years of age through stratified random sampling from 64 villages having the number of children enrolled proportionate to the size of each village, in rural Sindh, Pakistan. Trained investigators completed child physical measurements and a maternal interview. The Z-scores for the distribution of height-for-age (stunting) and weight-for-height (wasting) were estimated relative to those of the National Center for Health Statistics/Center for Disease Control (NCHS/CDC) reference population. RESULTS: A total of 483 (26%) of the 1878 children were wasted, 977 (55%) were stunted and 259 (15%) were both wasted and stunted. Mothers who were illiterate were more likely to have children who were stunted (odds ratio (OR) = 1.27, 95% confidence interval (CI) 1.11-1.61). Fathers who earn less than Rs. 1000 (US $20) per month (OR = 1.35, 95% CI 1.12-1.66) were more likely to have children who were stunted. Children living in an overcrowded house were more likely to be stunted (OR = 1.44, 95% CI 1.18-1.75). Male children compared to females were equally likely to be stunted (57 vs 55%, OR 1.03, 95% CI 0.86-1.25). CONCLUSIONS: In this region of lower Sindh, stunting is more common than wasting. Female illiteracy, poor household income and overcrowding are important risk factors for stunting. The prevalent belief that in rural Pakistan, parents pay attention to feeding male children at the cost of female children is not proven by these data.

Cross-Sectional Studies↗
PubMedDate not supplied

Behind the mud walls: the role and practice of lady health visitors in Pakistan.

Lady health visitors (LHVs), as a specific cadre of health care provider, have existed in Pakistan since 1951. They provide a variety of services to urban and rural communities, including basic nursing care, maternal child health services, and training of community workers. Our purpose in conducting this study was to provide a broad description of LHVs and their practice in Pakistan. A descriptive exploratory design using the qualitative technique of interviewing was considered the most appropriate choice for the study given the lack of literature related to LHVs. A purposive sample of 52 LHVs were interviewed located in both rural and urban areas of the four provinces in Pakistan along with the Northern Areas. The major theme emerging from this study was that of "marginalization." LHVs aligned their practice with medicine yet were originally registered with the Pakistan Nursing Council and had 1 year of midwifery training. LHVs also differentiated their practice from nursing by clearly demarcating the role of registered nurses (RNs) to the hospital, whereas they as LHVs served the community. Confidence that they were making an impact within the communities was apparent. However, frustration at the lack of career mobility was evident along with the desire for strengthening their basic 2-year LHV education.

Adult↗
PubMed2002

Contribution of BRCA1 and BRCA2 mutations to breast and ovarian cancer in Pakistan.

The population of Pakistan has been reported to have the highest rate of breast cancer of any Asian population (excluding Jews in Israel) and one of the highest rates of ovarian cancer worldwide. To explore the contribution that genetic factors make to these high rates, we have conducted a case-control study of 341 case subjects with breast cancer, 120 case subjects with ovarian cancer, and 200 female control subjects from two major cities of Pakistan (Karachi and Lahore). The prevalence of BRCA1 or BRCA2 mutations among case subjects with breast cancer was 6.7% (95% confidence interval [CI] 4.1%-9.4%), and that among case subjects with ovarian cancer was 15.8% (95% CI 9.2%-22.4%). Mutations of the BRCA1 gene accounted for 84% of the mutations among case subjects with ovarian cancer and 65% of mutations among case subjects with breast cancer. The majority of detected mutations are unique to Pakistan. Five BRCA1 mutations (2080insA, 3889delAG, 4184del4, 4284delAG, and IVS14-1A-->G) and one BRCA2 mutation (3337C-->T) were found in multiple case subjects and represent candidate founder mutations. The penetrance of deleterious mutations in BRCA1 and BRCA2 is comparable to that of Western populations. The cumulative risk of cancer to age 85 years in female first-degree relatives of BRCA1-mutation-positive case subjects was 48% and was 37% for first-degree relatives of the BRCA2-mutation-positive case subjects. A higher proportion of case subjects with breast cancer than of control subjects were the progeny of first-cousin marriages (odds ratio [OR] 2.1; 95% CI 1.4-3.3; P=.001). The effects of consanguinity were significant for case subjects with early-onset breast cancer (age <40 years) (OR=2.7; 95% CI 1.5-4.9; P=.0008) and case subjects with ovarian cancer (OR=2.4; 95% CI 1.4-4.2; P=.002). These results suggest that recessively inherited genes may contribute to breast and ovarian cancer risk in Pakistan.

Adult↗
PubMed1999

Injuries in Pakistan: directions for future health policy.

Injuries result in major financial and productivity losses to nations while inflicting tremendous personal burden on the injured and their families. Two-thirds of the global deaths from injuries occur in the developing world, consuming substantial health sector resources. Pakistan is a developing country with a population of 136 million and no reported estimate of the national impact of injuries. This study presents a profile of injuries in Pakistan, estimates the impact on the country and recommends strategies to further delineate this important public health problem. A methodical review of published, unpublished and government literature was undertaken and data collected for all types of injuries principally over the 1982-1994 period. Motor vehicle injuries, homicides, assaults, work-related injuries, poisonings and risk factors have been included. Selected epidemiological estimates have been generated and the WHO motorization index has been used to assess road-side accident risk. The lack of reliable data and under-reporting of work-related injuries is revealing. The rising time trend in all injuries, the significant loss of life from injuries and the age of those injured have a critical impact on the national economy and health system. Data on injuries in Pakistan are primarily recorded by police authorities and used for legal purposes. Pakistan must institute an information system to evaluate the true impact of injuries and develop national safety standards. Implementation of such standards is especially important for road traffic safety and occupational health in industrial units within the country.

Accidents, Traffic↗
PubMed2003

Capacity development for health research in Pakistan: the effects of doctoral training.

Capacity development for health research has been promoted in developing countries for many years, especially by international aid agencies. In Pakistan the government has been investing substantial funds in the development of a critical mass of scientists in the country. This paper represents the first attempt in Pakistan to assess the impact of capacity development efforts in health research. The study surveyed 54 Pakistani researchers who were sent for doctoral training to institutions out of the country on funded programmes in the past three decades. The 50 male and four female respondents had an average of 5.7 years of job experience prior to being sent for training and the average duration of training per person was 4 years. The average reported expenditure directly given to the trainees was US dollars 35300 (1995 US dollars) per person. These researchers had an average of 15 publications per person, while they have trained an average of nine students per researcher since return to Pakistan. The respondents indicated a lack of academic liberty and incentives to sustain their research efforts, and recommended autonomy in work and provision of facilities to stimulate their contributions. This study reflects the complex issues facing highly trained researchers who have returned to Pakistan and are attempting to pursue their careers. Their contributions in terms of writing papers, teaching students and policy involvement are important for assessing capacity development efforts. Comparative data from other developing nations is severely lacking for cross-country analysis. Such evaluations are critical to develop plans for the reduction of the 10/90 gap in health research investments.

Adult↗
PubMed2005

Prevalence and determinants of blood pressure screening in Pakistan.

OBJECTIVE: We analysed data collected during a nationwide cross-sectional household survey to estimate the prevalence of, and to identify factors associated with, blood pressure screening in Pakistan. DESIGN: A population-based cross-sectional survey (National Health Survey of Pakistan 1990-1994). METHODS: During 1990-1994, 18 135 people aged at least 6 months were surveyed across Pakistan. We restricted this analysis to individuals aged 18 years or older (n = 9442). Our primary outcome measure was self-reported blood pressure screening, which was assessed using the question: 'Have you ever had your blood pressure taken?' Individuals answering affirmatively or otherwise to this question were categorized as screened or unscreened for high blood pressure. Logistic regression analysis was performed to identify the factors independently associated with the primary outcome. RESULTS: Overall, 35.6% [95% confidence interval (CI), 33.9-37.3%] of participants - 41.3% (95% CI, 39.9-42.7%) women versus 29.0% (95% CI, 27.6-30.4%) men - reported ever having had their blood pressure checked. The independent determinants of blood pressure screening identified in the multivariate logistic regression analysis [adjusted odds ratio (95% CI)] included age [26-35 years, 1.58 (1.37-1.81); 36-50 years, 2.18 (1.89-2.51); > 50 years, 2.29 (1.96-2.66)], female sex [2.25 (2.02-2.50)], socio-economic status [lower, 0.54 (0.47-0.63) and middle, 0.70 (0.61-0.80) versus high], province of residence [Punjab, 0.45 (0.39-0.51); Sindh, 0.80 (0.68-0.93); Balochistan, 0.47 (0.39-0.57) versus North West Frontier Province], rural dwelling [0.42 (0.38-0.47)] versus urban dwelling, and educational attainment [less than matriculation, 1.47 (1.27-1.69); matriculation, 1.69 (1.41-2.04); graduation and above, 2.50 (1.81-3.44) versus no education]. CONCLUSIONS: The rates of blood pressure screening in Pakistan are worryingly low, calling for the establishment of a nationwide programme to improve detection, awareness and treatment of hypertension.

Adolescent↗
PubMed2005

Helicobacter pylori colonization in infants in a peri-urban community in Karachi, Pakistan.

BACKGROUND: The prevalence and incidence of Helicobacter pylori in children in Pakistan is not known. OBJECTIVES: To measure the prevalence and age of acquisition of Helicobacter pylori infection/colonization in infants in a peri-urban community in Karachi, Pakistan. SETTING: Field based epidemiologic study in a peri-urban community in Karachi, Pakistan. METHODS: Infants aged 1 to 3 months were recruited from a birth cohort from the community. C-urea breath test (C-UBT) was performed on recruitment, and the test was repeated at 2, 3, 6, and 9 months of age. RESULTS: One hundred forty-eight infants were recruited and had C-UBT on 319 occasions over a period of 2 years. Two hundred thirty-one=(72%) tests were positive: 80% (49/61) infants at 1 month of age, 79% (33/42) at 2 month of age, 76% (92/121) at 3 month of age, 58% (37/64) at 6 months of age, and 67% (20/30) at 9 months of age. CONCLUSIONS: The study reveals an early colonization/infection of infants and a high prevalence of Helicobacter pylori in a peri-urban community in Karachi, Pakistan.

Age Distribution↗
PubMed2004

Epidemiology of cleft lip and cleft palate in Pakistan.

Clinical and epidemiologic studies of defined geographic populations can serve as a means of establishing data important for the diagnosis, treatment, and counseling of patients with cleft lip and cleft palate. Several descriptive epidemiologic studies have been carried out in many countries worldwide; however, no such study has ever been performed in Pakistan. Population-based data on the incidence of cleft lip and palate were obtained from birth registry information in northern Pakistan. A total of 117 cases from 61,156 live births reported were identified. The incidence for cleft lip and/or cleft palate was 1.91 per 1000 births (one per 523 births). Cleft lip alone (42 percent) was noted more frequently than isolated cleft palate (24 percent) and combined cleft lip and palate deformities (34 percent). Boys were more commonly affected by cleft lip and cleft lip with cleft palate, whereas girls predominated in the isolated cleft palate cases. Consanguineous marriages were observed in 32 percent of parents versus 18 percent in matched controls. Only 32 percent of cleft mothers received formal prenatal counseling, monthly examinations, and regular laboratory testing during the entirety of the pregnancy. Nutritional and vitamin supplements were given to only 28 percent of mothers of cleft children versus 59 percent in matched controls. Descriptive statistics were used to assess pertinent risk factors associated with cleft lip and palate. The acquisition of incidence and associated data has generated baseline information on the magnitude of cleft lip and cleft palate in Pakistan. It is hoped that this information can be used for appropriate resource use, cleft lip and cleft palate prevention programs, and counseling programs with Pakistan-specific data.

Adult↗
PubMed2005

HLA analysis of the Parsi (Zoroastrian) population in Pakistan.

The Parsis of Pakistan are descendants of Zoroastrians from Iran who fled to Gujarat in India after the Arab invasion in 900 AD. A small group eventually migrated from India to Karachi in Pakistan. In this study, the Parsis from Pakistan were analyzed at the HLA-B, -C, -DRB1 and -DQB1 loci using the polymerase chain reaction with sequence-specific primers (PCR-SSP). The most common alleles at the HLA loci were HLA-B*35 (15.9%), HLA-Cw*0602 (21.4%), HLA-DRB1*11 (23.0%), and HLA-DQB1*02 (24.7%). Data analysis suggests that the Parsis of Pakistan and India descended from the same stock and may have the closest ancestry with Jewish and Italian populations.

Ethnicity↗
PubMed2005

Self-rated health in Pakistan: results of a national health survey.

BACKGROUND: Self-rated health (SRH) is a robust predictor of mortality. In UK, migrants of South Asian descent, compared to native Caucasian populations, have substantially poorer SRH. Despite its validation among migrant South Asian populations and its popularity in developed countries as a useful public health tool, the SRH scale has not been used at a population level in countries in South Asia. We determined the prevalence of and risk factors for poor/fair SRH among individuals aged > or =15 years in Pakistan (n = 9442). METHODS: The National Health Survey of Pakistan was a cross-sectional population-based survey, conducted between 1990 and 1994, of 18,135 individuals aged 6 months and above; 9442 of them were aged > or =15 years. Our main outcome was SRH which was assessed using the question: "Would you say your health in general is excellent, very good, good, fair, or poor?" SRH was dichotomized into poor/fair, and good (excellent, very good, or good). RESULTS: Overall 65.1% respondents -- 51.3 % men vs. 77.2 % women -- rated their health as poor/fair. We found a significant interaction between sex and age (p < 0.0001). The interaction was due to the gender differences only in the ages 15-19 years, whereas poor/fair SRH at all older ages was more prevalent among women and increased at the same rate as it did among men. We also found province of dwelling, low or middle SES, literacy, rural dwelling and current tobacco use to be independently associated with poor/fair SRH. CONCLUSION: This is the first study reporting on poor/fair SRH at a population-level in a South Asian country. The prevalence of poor/fair health in Pakistan, especially amongst women, is one of the worst ever reported, warranting immediate attention. Further research is needed to explain why women in Pakistan have, at all ages, poorer SRH than men.

Adolescent↗
PubMed1998

Aneurysm surgery in Pakistan.

The purpose of this study was to find out the incidence and outcome of aneurysms being operated in Pakistan. The data was collected from various neurosurgical centers in Pakistan where facilities for aneurysm surgery are available. The population of Pakistan is 130 million, with 28 neurosurgical centers in the country but only eight are equipped with facilities for performing aneurysm surgery. The period of study extended from January 1994 to December 1996. During this period 350 patients presented with subarachnoid hemorrhage (SAH). Diagnosis of SAH was confirmed by computed tomography (CT) brain scan, diagnostic lumbar puncture was performed in few patients only where CT scan was negative. After angiography, 240 patients had intracranial aneurysms, 79 had arteriovenous malformations, and three had bled in brain tumors. Of the 240 patients with proven intracranial aneurysms, 122 (51%) were male and 118 (49%) were female. The mean age at presentation was 40.5 years with a range from 7 to 68 and a peak incidence between 41 and 50 years. Subarachnoid bleeding was noticed in 179 (74.6%) patients, 52 (21.7%) had SAH associated with intracerebral hemorrhage, and nine (4%) patients presented with the third cranial nerve palsy. Anterior communicating artery was the commonest site for aneurysms (120, 50%), followed by posterior communicating artery (46, 19%) and middle cerebral artery (45, 19%). Aneurysm surgery was performed in 134 (56%) patients. Operative mortality was about 10%. At 3 months follow up 49% patients were in grade I Glasgow Outcome Scale. We conclude that intracranial aneurysms occur with equal frequency in both sexes with a peak incidence between 41-50 years and anterior communicating artery is the commonest site. SAH is the most common mode of presentation and is still a neglected from of stroke in Pakistan. Medical specialists and family physicians require education for early diagnosis and timely referral of patients with SAH to neurosurgical centers.

Adult↗
PubMed1995

Risk factors for drug abuse in Pakistan: a replication.

While a number of risk factors have been identified for drug abuse in the United States, little evidence is available about such factors in some other counties. Among these latter is Pakistan, a nation in which heroin addiction is a major problem. The present study was done to examine those psychosocial characteristics which differentiated 60 heroin addicts from 60 nondrug-using controls in Pakistan. Most of the drug-abuse factors identified earlier were significant in Pakistan as well. Applying cut-off scores previously established for each of 9 variables, the relationship between drug status and number of factors at risk was also examined. Over 98% of the addicts were at risk for five or more factors; only 15% of controls were at risk for 5 variables and none exceeded 5. Precursors for abuse appear to cut across cultural lines. The high-risk individual in Pakistan, as in the United States, is one with ready access to drugs and the social inducements to use them while lacking bonds with societal institutions or value systems which might mitigate against drug use. Because several of the risk factors represent deep and long-standing aspects of the addict's personality, both prevention and treatment confront formidable difficulties.

Adolescent↗
PubMed2000

Short report: phylogenetically distinct hepatitis E viruses in Pakistan.

Hepatitis E, which is enterically transmitted, is the most common cause of acute hepatitis in much of Asia. Phylogenetic analysis of several isolates of hepatitis E virus (HEV) from Asia suggests that transmission of this virus is geographically restricted. In Sarghoda, Pakistan, HEV Sar-55 was isolated from a 1987 outbreak. It belongs to the Central-Asian cluster of the Asian sub-genotype. We now report the complete sequence of a second Pakistan HEV from a 1988 outbreak in Abbottabad. The Abbottabad nucleotide sequence was compared with 15 other complete HEV sequences using statistical methods of phylogenetic analysis. The analysis showed that Abbottabad HEV belongs to the South Asia cluster of the Asian sub-genotype. The sequence differences of the 2 Pakistan isolates recovered only one year apart suggest that HEV of 2 distinct origins circulate in Pakistan.

Base Sequence↗
PubMed2001

Health ethics in Pakistan: a literature review of its present state.

National literature on ethics provides an insight into the nature and development of a dialogue on health issues within a population. This study investigated the health ethics discourse in Pakistan. The purpose was to critically reflect on the nature and level of such discussions with the aim of stimulating an interest in the ethical implications of health and medicine in developing countries. The study evaluated the literature on biomedical and health ethics published in Pakistan during 1988-1999. Overall, there is a dearth of published discourse on healthcare ethics in Pakistan. Values that are considered to stem from religious teachings predominate in discussions relating to medical ethics. A lack of effective policy and legislation concerning the ethical practice of medicine is reported to have negative effects on the profession. Research ethics has not been captured in the published papers in Pakistan. Consideration of ethical issues in health is at an early stage in the country and may reflect the situation in a large part of the developing world.

Developing Countries↗
PubMed2005

Cutaneous leishmaniasis in Pakistan.

Leishmaniasis is a major health problem worldwide. It is also a particular problem in the rural areas of Pakistan. The disease occurs in varying presentations, from the self-limited and even self-healing cutaneous forms to fatal systemic disease. Lesions of cutaneous leishmaniasis may occur anywhere on the body but the most likely sites are the exposed parts. The initial papule rapidly gives rise to an ulcer. Systemic leishmaniasis is rarer in Pakistan and invariably fatal if not treated promptly. It affects the internal body organs, particularly the spleen and the liver. Leishmaniasis is transmitted by an infected female sandfly. Cutaneous lesions are usually single and often self-healing, but a presentation with multiple ulcers resulting from multiple bites from the sandfly is not rare in Pakistan. The disease has a very long history and lesions like leishmaniasis have been described dating back to the ninth century (Balkan sore). Cutaneous leishmaniasis has been given various names in different civilizations such as "Delhi boil" in India, "Baghdad boil" in Iraq, and "saldana" in Afghanistan. The organism responsible for leishmaniasis was discovered 100 years ago but the disease has not been eradicated; rather it is on rise in many parts of the world. If control measures are not taken, it might emerge as a major health problem. Pakistan has a burden of cutaneous and visceral leishmaniasis, the mucocutaneous form being almost nonexistent. The physicians need to know the diagnostic criteria as well as the treatment of the disease. Because of a scarcity of dermatologists in the rural areas, most of these cases present to general practitioners. Control of this disease is further complicated by an inadequate supply of appropriate drugs.

Animals↗
PubMed2005

Knowledge regarding management of tuberculosis among general practitioners in northern areas of Pakistan.

OBJECTIVE: To assess the knowledge of General Practitioners (GPs)in NWFP and northern areas of Pakistan regarding diagnosis and management of tuberculosis. METHODS: A cross-sectional survey of general practitioners (GPs) from North West Frontier Province (NWFP) and northern areas of Pakistan was done. The sampling strategy was convenience sampling. The data was collected on a structured questionnaire after taking verbal consent. RESULTS: Out of 88 GPs 43% regarded sputum microscopy and 22% chest radiograph as confirmatory tests for the diagnosis of pulmonary TB. During follow up of pulmonary TB patients, 32% doctors considered chest radiograph as the best investigation while sputum microscopy was chosen by only 28%. Eighty seven percent of GPs correctly identified TB as a droplet infection but 6% considered sexual contact to be the main mode of spread of this disease. Two third of the prescriptions, written for a 60 kg man with newly diagnosed smear-positive pulmonary TB, were not in line with national guidelines. Only 3% of the GPs knew all the five components of DOTS. CONCLUSION: Severe deficiencies were seen in the management of TB by GPs of Northern areas of Pakistan. National TB control Program must take appropriate measures to educate and train the GPs in TB management. Without involving the GPs, TB control will remain a problem in Pakistan).

Cross-Sectional Studies↗
PubMedDate not supplied

Psychiatric morbidity among Afghan refugees in Peshawar, Pakistan.

BACKGROUND: A review of the literature shows that refugees in different parts of the world have high rates of psychological and emotional problems. However, psychiatric morbidity among Afghan refugees in Pakistan has been poorly studied. Most of the studies of psychiatric disorders come from western countries. However, these studies may not be representative of the Afghan refugees in Pakistan. This study was carried out to measure psychiatric morbidity among a group of Afghan refugees attending a psychiatric clinic in Peshawar, Pakistan. METHODS: This is a cross sectional study, to measure prevalence of psychiatric morbidity among the residents of Afghan refugee camps in Peshawar, Pakistan, who attended a psychiatric clinic between November 2003 and February 2004. Data were collected using Mini International neuropsychiatry Interview Schedule (MINI), and a form specifically developed for the study. RESULTS: Nearly 80% of our patients had a diagnosis of Post Traumatic Stress Disorder. Nearly half (47.9%) reported family history of mental illness, while almost a quarter (23.3%) had a physical disability or long term illness. Only 13.7% (106) had contacted health services prior to seeking help for their psychiatric illness. CONCLUSIONS: A high number of patients presenting with PTSD is not an unusual finding when one considers the traumatic experiences faced by the general population of Afghanistan. Only a small number of the patients had been in contact with the health services prior to their contact with the psychiatric service. This study highlights the importance of health education among Afghan refugees and to establish the mental health services for them.

Adolescent↗