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PubMed2003

Depressive disorder: diagnosis and management in general practice in Pakistan.

OBJECTIVE: To formulate guidelines for diagnosis and management of depressive illness in general practice in Pakistan. METHODS: Using guidelines developed through research in primary care, this article explains how depressive illness could be diagnosed using diagnostic and statistical manual (DSM) criteria and managed systematically at general practice level in Pakistan. RESULTS: Diagnosing depression accurately and choosing the right anti-depressant and giving it for adequate length of time are crucial factors in effective management of depression. CONCLUSION: Depressive illness can be diagnosed and managed effectively in general practice in Pakistan and only a minority of patients would need to be referred to psychiatrists.

Antidepressive Agents↗
PubMed2003

Epidemiology of epilepsy in Pakistan: review of literature.

OBJECTIVE: To review literature pertinent to the epidemiology of epilepsy in developing countries with special reference to Pakistan. METHODS: All the studies published in medical journals related to epilepsy in Pakistan were systematically reviewed. Important findings from various studies are summarized. RESULTS: Overall prevalence of epilepsy in Pakistan is estimated to be 9.99 per 1000 population. Highest prevalence is seen in people younger than 30 years of age. A slight decrease in prevalence is noted between the ages of 40 and 59. Higher prevalence is observed in rural population. Etiology of epilepsy is more commonly identified in pediatric population. Epilepsy was considered idiopathic in 21 to 76% cases. Only 27.5% epileptic persons in urban areas and 1.9% in the rural areas were treated with AEDs. The burden of epilepsy is not fully evaluated and understood. Generalized seizures were the most common seizure type noted. Knowledge about epilepsy and its care is extremely low. CONCLUSION: Epilepsy is a common medical problem in Paksitan, more prevalent is rural population. The majority of people with epilepsy are treated inadequately or inappropriately.

Adolescent↗
PubMed2004

Prevalence of exercise-induced bronchospasm in national hockey players of Pakistan.

OBJECTIVE: To determine prevalence of Exercise-induced Bronchospasm (EIB) in hockey players, who had represented or were aspiring to represent Pakistan at international level. METHOD: An observational, cross-sectional study was done on the prevalence of EIB in national hockey players of Pakistan. All participants of the training camp (n = 27) players were included in this study, after obtaining permission from the Pakistan Hockey Federation. An acquaintance session was conducted to introduce the study, and for the correct recording of Peak Expiratory Flow (PEF) rate. On field-testing day, pulse and PEF rates were measured first without any exercise and warm up (pre-exercise PEF rate). After competitive 6 minute (6-min) field free running, pulse rate was measured to ensure that players heart rate has reached 70% of the predicted maximum heart rate. PEF and pulse rates were measured at 5-min, 15-min and 30-min post exercise. A player was considered EIB positive based on a post exercise decrement in PEF rate > or = 15% at any defined point of time. RESULTS: Twenty-seven players participated in our study out of which 5 players (19%) had EIB. CONCLUSION: Our findings indicate that a significant number of cases of EIB exist among national field hockey players. We suggest that active screening for EIB should be made part of training sessions, so that performance of players could be enhanced. Diagnosed cases should be treated as per the guidelines laid down by International Olympic Committee Medical Commission.

Adult↗
PubMedDate not supplied

Determinants of therapeutic injection overuse among communities in Sindh, Pakistan.

BACKGROUND: Unsafe injections including reuse of disposable syringe is very common in developing countries including Pakistan. Healthcare providers unnecessarily prescribe injections to patients suggesting that patients ask for injections. We conducted this qualitative study to determine the reasons of overuse of therapeutic injections by the communities in Sindh province of Pakistan. METHODS: Using field-tested focus group guides of World Health Organization, eighteen focus group discussions (FGDs) were conducted with community members of rural Sindh, peri-urban and urban Karachi during January-February 2001. RESULTS: Injections are overused in Sindh, Pakistan, because patients prefer them, believing that they provide quick relief, and perceive them as a therapeutic norm and standard practice. According to community members initiative of prescription of injections are taken by doctors. Overuse of injections is of particular concern as patients are not aware of the risks associated with reuse of injection equipment. Doctors and television are considered as the most credible source of providing healthcare information. CONCLUSION: There is a need to educate communities regarding rationale use of therapeutic injections. Open discussion and frequent communication between doctors and patient should be encouraged. Mass media could play a vital role in educating communities about risks of unsafe injections.

Adolescent↗
PubMed2005

Adherence of private practitioners with the National Tuberculosis Treatment Guidelines in Pakistan: a survey report.

OBJECTIVE: In Pakistan, over 80% of the patients suffering from TB consult a private practitioner for the initial evaluation. A cross-sectional survey was conducted in seven thickly populated urban communities of Rawalpindi district to evaluate the adherence of private practitioners with TB treatment guidelines as laid down by National Tuberculosis Control Programme (NTP) in Pakistan. The data was collected over 30 days. METHODS: A young lean man was simulated to act as a TB patient and was provided with a chest X-ray suggestive of TB and two Acid-Fast Bacilli (AFB) positive sputum reports. Only those prescriptions were included for analysis which either had recognized the patient having TB or had any TB drug written in the prescription. RESULTS: A total of 77 practitioners were visited. Prescriptions of 53 general practitioners fulfilled the inclusion criteria and were analyzed. Only 2 (3.7%) prescriptions out of 53 met the required standard for TB patients as laid down by NTP. Eighty three percent (n = 44) favored a combination drug for the treatment while the rest preferred individual preparations. CONCLUSIONS: The study reflects the lack of knowledge about standardized TB treatment protocols amongst the private practitioners in Pakistan. Public Private Partnerships between government public health departments and non-governmental organizations working in public health can be a valuable tool in generating mass awareness campaigns.

Antitubercular Agents↗
PubMed2004

Smoking among adult males in an urban community of Karachi, Pakistan.

Smoking is the single most important avoidable cause of premature morbidity and mortality in the world. It is a major public health problem in Pakistan. The objectives of this study were to assess smoking status and its relationship to socio-demographic characteristics, and to determine the behavior of male smokers in an urban community in Karachi, Pakistan. A cross-sectional, household survey was conducted among 396 males, aged 15 years and above in January and February 2002. The overall prevalence of current smokers was 34%. By univariate analysis, the factors associated with smoking were younger age (15-29 years) (OR=4.2, 95% CI 2.1-7.3) as compared to older age (> 45 years), unmarried as compared to married (OR=3.1, 95% CI 1.9-5.4), educated for > 12 years compared to those with an education of 0-5 years (OR=2.0, 95% CI 1.2-3.3), and being student as compared to being an office/business worker (OR=3.2, 95% CI 1.8-5.4). The majority of smokers (55%) began smoking when younger than 25 years, smoked for more than 5 years (53%), smoked more than 10 cigarettes a day (55%) and smoked in public places (82%). Forty-two percent of the smokers used tobacco in other forms as well. Fifty-eight percent of smokers smoked to relieve anger and frustration and 30% smoked due to friend or peer pressure. In conclusion, smoking is a major problem in especially in younger age groups. There is an urgent need for health promotion and anti-tobacco education in combating the epidemic of smoking in Pakistan.

Adolescent↗
PubMedDate not supplied

Recommendations to strengthen the role of lady health workers in the national program for family planning and primary health care in Pakistan: the health workers perspective.

BACKGROUND: This study was planned to assess the strengths and weakness of the National Program for Family Planning and Primary from the Lady Health Workers (LHIW) perspective. We conducted this study in order to develop recommendations for strengthening LHWs' role in Primary Health Care (PHC) in Pakistan in consultation with the health workers. METHODS: A qualitative study, based on key informant interviews, was carried out in Karachi, Pakistan. A total of 20 workers were interviewed. Analysis was carried out by grouping similar responses in a matrix and then analysis with reference to context. RESULTS: Motivations for joining program included financial benefits, convenient timings and an opportunity to serve humanity. Training was deemed satisfactory but clinical training was resented because of doctors' attitudes. Further training needs identified included basic information about common ailments, reproductive issues and basic clinical skills. Major strengths of the program mentioned included provision of services at grass root level, reinforcement of health messages and the community acceptability of workers. Weaknesses mentioned included the contractual nature of job, low salaries, irregularity of payment, no career development and poor logistical support. CONCLUSION: Giving LHWs permanent government employee status and a raise in salary may strengthen the workers functions. Eligible LHWs should be given incentives (skills, career development, financial). The community must be educated about assigned role and responsibilities of LHWs and patient referral system by the LHW needs to be strengthened. The valuable role of LHWs in PHC in Pakistan must be acknowledged and further improvements pursued.

Family Planning Services↗
PubMed2005

Blood pressure and hypertension distribution in a lower middle class urban community in Pakistan.

OBJECTIVE: To determine the awareness level, blood pressure profile and its correlates in Metroville Health Study and to compare the results with those of Pakistan National Health Survey and National Health and Nutrition Examination Survey of USA. METHODS: Sample consisted of 400 households of Metroville, included after informed consent. Demographic data was collected and Blood pressure, Cholesterol, Blood Glucose, Height and weight were measured. Obesity was calculated as BMI. The results were compared with those of the Pakistan National Health Survey and National Health and Nutrition Examination Survey of USA. RESULTS: For both sexes and all age groups, hypertension was more prevalent in MHS than Pakistan National Health Survey (PNHS) and U.S. MHS hypertensives were more likely to be aware of and treated for their condition than hypertensives of PNHS, but less likely than U.S. hypertensives. Systolic and diastolic blood pressure (DBP) rose with increased age in all three populations. Blood pressure also rose with increased body mass index (BMI) in MHS as well as PNHS and NHANES, with little differences in the degree of rise among them. A one-kg/Height (in m approximately) increment in BMI was associated with a 0.40-0.67 mmHg increment in systolic pressure in men and a 0.56-0.74 mmHg increment in women. The main difference between USA and two Pakistani surveys was the level of DBP, which was significantly higher in Pakistani Surveys than NHANES, for both men and women. CONCLUSIONS: The prevalence of Hypertension in Metroville was high. It showed a quantitative relationship to increasing age and BMI. Hypertension and obesity were the major public health problems in the lower middle class community of Metroville. It is recommended that awareness should be increased and preventive measures implemented.

Adolescent↗
PubMedDate not supplied

Cancer profile of Hyderabad, Pakistan 1998-2002.

Hyderabad is the third largest city of Pakistan, the second largest city of Sindh Province and one of the oldest cities of the sub-continent. This administrative headquarter is located just east of the River Indus and is an important commercial and industrial center. Once a provincial capital, it is at a distance of approximately 200-km from Karachi. This present study was conducted with the objective of providing the cancer profile of Hyderabad, which has an urban population of 2,840,653 (52.2% M, 47.8% F) annual growth rate 1.13. The city is inhabited by all ethnicities of the country, however the predominant ethnicity is Sindhi, followed by Mohajirs (post-partition immigrants from India), and a lesser extent other ethnicities of Pakistan viz. Baluchs, Punjabis and Pathans. The study includes two sets of patients. First the incident cancer cases, residents of Hyderabad, who reached Karachi for diagnosis or treatment. Second the incident cancer cases registered at the Aga Khan University Pathology-based Cancer Registry (APCR) Pathology collection points at Hyderabad and subsequently registered at APCR, during 1st January 1998 to 31st December 2002. The pathology department of the AKU has 3 centers in Hyderabad, which provide diagnostic pathology especially oncopathology services to the city. The age-standardized rates (ASR) for cancer (all sites) 1998 to 2002 in Hyderabad were 91.6/100,000 in males and 96.0/100,000 in females. The most common malignancies (ASR per 100,000) in males were oral cavity (11.8), lymphoma (10.6), lung (8.0), urinary bladder (6.8), prostate (4.8), liver (4.4), pharynx (4.2), colo-rectum (3.6), larynx (3.2), and skin (3.2). The cancers in females (ASR per 100,000) were breast (22.4), oral cavity (11.5), gall bladder (4.8), esophagus (4.2), cervix (3.6), ovary (3.4), colo-rectum (3.4), lymphoma (3.4), uterus (3.4), and thyroid (2.4). Tobacco-associated cancers were responsible for approximately 40.0% of the tumors in males and 20.0% in females. Histological confirmation remained 96.3%, with 44.5% presenting in grade II or I, 55.5% presenting as stage III and IV. Information on grade and stage of malignancy was available in 70% and 50% of the cases respectively. Males comprised 53.1%, and females 46.9% of the cases. The mean age of cancer all sites, both genders was 45.2 years (95% CI 44.4; 45.9), males 45.4 years (95% CI 44.3; 46.5); females 44.9 years (95% CI 43.9; 45.9). Conclusions drawn from this database must be interpreted with care, as it may be identified as data from selected medical institutions. Chances of selective collection bias are minimized as the data of the AKU pathology is collected from multiple centers in the city of Hyderabad, dispersed at distances, which allows adequate sampling from the entire city. There is a slight preponderance of lymphomas in males which we feel is a true higher risk, yet it may indicate an over representation of easily accessible sites in pathology based-data. Nonetheless, this is the first attempt to determine the cancer incidence pattern of Hyderabad, and should serve as a guideline for estimation of the cancer burden and risk assessment statistics of Pakistan and the cancer control program of the country.

Adolescent↗
PubMed2006

Critical evaluation of the claims made by pharmaceutical companies in drug promotional material in Pakistan.

BACKGROUND: In Pakistan, there is no mechanism to monitor the drug promotional campaign by pharmaceutical industry despite the fact that there is enough evidence that irrational pharmacotherapy is increasingly encountered even in the developed countries due to unethical practices of pharmaceutical promotion. Objectives. To audit the drug promotional claims made by the pharmaceutical companies in Pakistan. METHODS: Drug promotional pamphlets and brochures containing claims for the drugs, which were circulated by the pharmaceutical representatives were collected from 122 general practitioners (GPs) from Karachi and Larkana cities of the Sindh Province. The claims were critically analyzed and audited with the help of currently available evidence in the medical literature. RESULTS: 345 distinct advertisements covering 182 drugs from different manufacturers were critically analyzed for information content. Sixty two out of 345 (18%) of the reviewed advertisements were adjudged to be misleading / unjustifiable, which were again classified as, exaggerated (32%), ambiguous (21%), false (26%), and controversial (21%). The primary source of information (approximately 78%) about the newly launched drugs for the GPs was found to be the pharmaceutical representatives followed by hospital doctors (5%) and colleagues (5%). Furthermore, 110 (90%) GPs were of the view that the drug promotion has definitely an influence on their prescribing pattern. CONCLUSIONS: Since GPs in Pakistan rate pharmaceutical companies as their primary source of information regarding drugs, it can be anticipated that inappropriate advertisement claims would lead to irrational prescribing if physicians had no any other information to follow.

Advertising↗
PubMed2006

Development of standardized Midwifery Nursing Reproductive Health Data Set (MN-RHDs) for Pakistan.

UNLABELLED: Pakistan has a marked discrepancy between reported and unreported maternal mortality, morbidity and reproductive health figures. Pakistan's figures are listed in the "E" category by the World Health Organization meaning there is no official means of data collection and reporting. PURPOSE: The purpose of this study was to develop the standardized "Midwifery Nursing Reproductive Health Data Set (MN-RHDS)" to provide systematic information about Pakistan's maternal mortality, morbidity, reproductive health, midwifery practices, and patient outcomes. METHOD: The descriptive data elements and definitions were generated and validated through Delphi survey and consensus conference of 25 experts. DATA COLLECTION: The experts rated each element on necessity, clarity of definition, and collectability. FINDINGS: Elements were categorized as follows: 1) Antenatal, 2) Labor and Delivery, 3) Postnatal, 4) Demographics, 5) Service Data, 6) Maternal Death, 7) Referral, and 8) Maternal Status. Elements related to task work compared to psychosocial nursing care achieved higher means with lower standard deviation. CONCLUSIONS: The MN-RHDS impacts data collection, storage, retrieval, and linkage of standardized information about reproduction interventions and outcomes in developing nations.

Female↗
PubMed1991

Update: dracunculiasis eradication--Pakistan, 1990.

Dracunculiasis (guinea worm disease) is a disabling infection that affects an estimated 10 million persons in 17 African countries and parts of India and Pakistan each year. In 1987, the Pakistan Dracunculiasis Eradication Program was established with the goal of eradicating dracunculiasis from Pakistan by 1990. This report summarizes progress toward that goal.

Communicable Disease Control↗
PubMed1990

Uses and abuses of biostatistics in medical research in Pakistan.

Medical research in Pakistan has gained momentum over the past several years. However, the logical conclusions based on information and data are rarely witnessed. This could be due to the fact that medical researchers and doctors are unaware of Biostatistics, its logic, use and inferences to be obtained. Most researches are based on the pattern of works already done elsewhere. Following others blindly generates various snags. In the present study, research articles published during 1986 in the Journal of Pakistan Medical Association (JPMA) and Pakistan Journal of Medical Research (PJMR) are being reviewed with respect to use and abuse of Statistical Methods.

Biometry↗
PubMed1990

Sickle cell anaemia in Pakistan.

The sickle cell gene is found predominantly in Equatorial Africa and amongst the negro population in the United States. It has also been reported in Saudi Arabia, the Middle East, Southern India and Iran. Despite human migration from the Middle East, Iran and India to Pakistan, there have to date been no reported cases of sickle cell disease in Pakistan to the best of our knowledge. But unfortunately there has been no population screening to find out the true incidence of the disease. Our study demonstrates that the disease is not totally non-existent in Pakistan: over a two-year period we have collected eight cases in our department. Electrophoretic screening is obviously needed to find out the true incidence of the disease/trait.

Adolescent↗
PubMed1977

The role of drug information centres for improving patient care in Pakistan and other developing countries.

Relevant and uptodate information about drugs in common use is either unavailable or scarce, in Pakistan and other developing countries. Developed countries inspite of all the facilities available for learning have recognised the limitation of human memory. Drug information centres have therefore been established for repeated reminder and continued education for the practicing doctors in prescribing drugs and early recognition of adverse reactions to them. The proposal for establishing such drug information centres in Pakistan and other developing countries for further improving the patient care and early reporting of adverse reaction to drugs in this paper is based on the encouraging response to and beneficial experience by such centres in the western world. There is every reason that it will succeed in improving the health of the people of Pakistan.

Developing Countries↗
PubMed1995

Fenitrothion intoxication during spraying operations in the malaria programme for Afghan refugees in North West Frontier Province of Pakistan.

During the experimental use of fenitrothion to replace malathion for the control of malaria in North West Frontier Province of Pakistan, serious intoxication of Afghan refugee spraymen occurred. A few weeks after commencement of the spraying operations, cholinesterase levels had fallen to 43.8% in personnel mixing the insecticide, and to 60.7% in spraymen, as measured by tintometry. Most of the personnel reported symptoms of overexposure and the spraying operations had to be discontinued. Intoxication of personnel resulted in poor coverage of the target area. High ambient temperatures during Pakistan's spray season discourage the use of full-protective clothing. Fenitrothion intoxication observed in the Afghan refugee programme, and similar experiences in Pakistan in the past, suggest that this insecticide is too toxic for routine use, when the compliance with safety precautions cannot be effectively supervised.

Afghanistan↗
PubMed1998

Gender differences in nonfatal suicidal behavior in Pakistan: significance of sociocultural factors.

Suicidal behavior is an understudied subject in Pakistan. A variety of social, legal, and religious factors make reporting and data collection on suicide and nonfatal suicidal behavior difficult. To study the problem, a retrospective case-note analysis was carried out in which the sociodemographic and clinical characteristics of 262 female and 185 male suicidal individuals admitted to a university hospital in Karachi, Pakistan, are compared. Three quarters of the suicidal persons were under the age of 30 years. Compared to men, women were younger and more often married. Both women and men tended to use self-poisoning with benzodiazepines, but more women used organophosphate insecticides. In Pakistani society, legal, social, and economic discrimination predisposes women to psychological distress and subsequent suicidal behavior. The study highlights the need for culture-specific research on suicidal behavior in Pakistan.

Adult↗
PubMed1998

Prescribing practices: an overview of three teaching hospitals in Pakistan.

The extent and nature of irrational prescribing of drugs has not been explored in Pakistan A pilot study was therefore undertaken in three major teaching hospitals located in the twin cities of Rawalpindi/Islamabad. Six hundred and one prescriptions from medical, paediatrics and psychiatry units of these hospitals were analyzed to study the prescribing pattern. The mean number of drugs per prescription was found to be 2.97. Only 23.6% drugs were prescribed by their generic names. About 80% of the prescribed drugs were from the National Essential Drug List of Pakistan. Use of injectable preparations was 17.1%. Antimicrobials constituted 20.4% of the drugs prescribed, frequently for cases of acute respiratory infections and gastroenteritis. The average cost of treatment per day was Rupees 26.10 in the outdoors and Rs. 88.36 in indoors. Treatment did not correlate to the diagnosis in 24.6% of the cases. Doses of drugs were inappropriate in 30.6% prescriptions. Duration of treatment was not specified on a vast majority (73.4%) of the prescriptions. The data highlights the need for educational, managerial and regulatory interventions to rationalize the drug use in Pakistan.

Drug Utilization↗