Knowledge, attitude and practice of private practitioners regarding TB-DOTS in a rural district of Sindh, Pakistan

BACKGROUND: Tuberculosis is prevailing in both urban and rural areas of Pakistan. Knowledge, attitude and practice (KAP) of private practitioners (PPs) regarding tuberculosis management have been reported only in urban areas of Pakistan. This survey was conducted for the first time in a rural area of Sindh, Pakistan.METHODS: This survey was conducted in January 2007 at Thatta, a rural district of Sindh, Pakistan. Study subjects were twenty-two allopathic qualified (MBBS) doctors of district Thatta, who were practicing in private setups for at least last one year. Before TB-DOTS training PPs had filled the KAP questionnaire regarding tuberculosis (TB) diagnosis and management through DOTS. Survey data was analysed through SPSS version 11.05 software.RESULTS: On average, five TB suspects per month were seen by each PP. Only 14% of PPs advised sputum microscopy solely for pulmonary TB diagnosis, while 86% of PPs used different combination of tests (chest x-ray/sputum microscopy/ESR/tuberculin test) for TB diagnosis. Over 40% PPs did not prescribe TB treatment regimen according to TB-DOTS category. Majority PPs (85%) did not follow the treatment through sputum microscopy and instead relied on clinical improvement and x-ray clearance. Nearly 60% of TB patients at PPs clinic did not show compliance to the TB treatment and none of PPs were following the retrieval of default cases.CONCLUSIONS: A gross lack of PPs knowledge and right practice regarding TB diagnosis and management through DOTS was identified and needed to be addressed through providing DOTS training

Public private mix model in enhancing tuberculosis case detection in District Thatta, Sindh, Pakistan

To enhance the TB case detection through Public Private Mix (PPM) model by involving private practitioners in collaboration with National TB Control Program, (NTP) in district Thatta. Private practitioners (PPs) of district Thatta involved in treatment of TB cases were requested to participate in the study. All consenting physicians were provided with training on Directly Observed Treatment Short course (DOTS) module. In addition to routine cases, TB cases diagnosed by private practitioners through sputum microscopy were also registered with the district TB control program and medicines were provided by NTP. After intervention of PPM-DOTS change in Case Detection Rate (CDR) were estimated. An increased number of sputum smear positive cases were found in the intervention period--the third quarter of 2007, from 188 to 211 and CDR from 69% to 77%. The improvement in case detection rate was significant as this moderately added to the total number of cases detected from the whole of the district Thatta during the study period. Public private mix (PPM) model was effective in increasing the CDR of TB cases in district Thatta. It is recommended that the public private partnership model in Tuberculosis case detection needs to be taken on a larger scale so as to reduce the heavy TB burden in the country

Knowledge, attitude and practice regarding emergency contraceptive pills among female health workers of a tertiary care hospital in Karachi

Background: Unsafe abortion is a major public health problem in low-and-middle income countries. Young and unmarried women constitute a high risk group for unsafe abortions. Use of emergency contraceptive pills (ECPs) may significantly reduce the abortion-related morbidity and mortality. The purpose of this study was to evaluate the knowledge, attitudes and practice (KAP) about ECPs among female health workers of a tertiary care hospital in Karachi.Methods: In this hospital based cross-sectional study, 187 female health workers (nurses and midwives) were participated. A predesigned, 26-item questionnaire was used to collect participants’ responses regarding knowledge, attitude and practice of ECP. Descriptive analysis of data was done by using SPSS-version 16.Results: Total 187 female health workers (95 nurses and 92 midwives) were participated in the study. Mean age of study participants was 23.5±7.31. Mean knowledge score of the study participants was 3.7±2.18 (Out of score: 1-10). Majority participants 151 (80.7%) had inadequate knowledge (score ≤50%) about ECP. The mean attitude score of the study participants was 20.9±2.68 (Out of score: 8-32). Significant number 84 (45 %) of participants had negative (score ≤50%) attitudes towards ECPs.Conclusions: There was gap in knowledge and negative attitude towards ECP were identified among female health workers. There was a need to bridge the gap of knowledge on ECP and remove the misconception about the use and safety of ECP among female health workers

Surgical correction of aorto-pulmonary window: a rare and lethal cause of pulmonary hypertension

Aorto-pulmonary window is a relatively rare congenital cardiac malformation with an overall incidence of 0.1%. Pulmonary hypertension develops quickly if the lesion is left untreated hence early surgical intervention is warranted after diagnosis. The surgery for correction of APW has evolved over years, currently an open repair on cardiopulmonary bypass (CPB) with a single patch technique yields good results. Mortality is affected by association of pulmonary hypertension and other cardiac malformations. We present a case of an infant with a large type II APW with a relatively low pulmonary vascular resistance. Hospital stay was complicated because of pulmonary arterial disease making it an important reason for correction in the first few months of life

Myocardial Echinococcosis: Rare Manifestation of a Common Parasitic Disease in Northern Tanzania

Hydatid (Echinococcal) disease often involves the liver and lungs but in sporadic cases, it can involve cardiac structures. A 24-year-old male was referred with symptoms of cough and shortness of breath and a provisional diagnosis of metastatic disease of unknown primary to the lung, which was based on a chest X-ray (CXR). Incidentally, on echocardiogram, he was found to have right ventricular (RV) and myocardial multiseptated cysts, which were compatible with cardiac echinococcosis, as the patient had multiple bilateral lung cysts as well. Imaging with ultrasound, computed tomography (CT) scan, and magnetic resonance imaging (MRI) has ameliorated the diagnosis of hydatid disease location in various body parts. However, for earlier and accurate diagnosis, a high index of suspicion is required in endemic areas, especially in vulnerable populations such as pastoralists

Situation analysis of child labour in Karachi, Pakistan: A qualitative study

In Karachi, large employment opportunities, burgeoning population and the availability of cheap labour might be the contributing factors for the increasing prevalence of child labour. A literature review was conducted in 2007 that included published and unpublished literature since 2000. Various organizations working in the field were also covered, while the perception of the child labourers was covered through three focus group discussions. Common health issues among the child labourers in Karachi included respiratory illnesses, fever and generalised pains, as well as drug and sexual abuse. Organisations working for child labour could be broadly categorised into those working for legal advice and advocacy; those generating statistics; and those that are providing interventions. Discussion with children showed that irrespective of the immediate cause, the underlying determinant for child labour was poverty. The best practices identified included evening schools and drop-in centers for working children with provision for skill-based education and basic health facilities. There is need to have more such centres

Engaging general practitioners in public–private mix tuberculosis DOTS program in an urban area in Pakistan need for context-specific approach

A public–private mix tuberculosis (TB) DOTS project was implemented to enhance coverage and collaboration between the public and private sectors, with an objective to increase case detection and to improve TB case management in a large urban area. General practitioners (GPs) were trained to provide DOTS services. Patients were diagnosed and treated as per national guidelines and outcomes were reported to national TB control program. Treatment and sputum microscopy were provided free of cost. A total of 94 GPs were trained. In all, 57.4% of trained GPs remained actively involved in the project. Overall treatment success rate of the patients enrolled with the project was 86.3% with 8.7% default patients. Experience suggests that a more stringent selection criteria need to be followed for inclusion of GPs in the program to improve the success of the program. A multifaceted context specific approach is needed while working with private health care providers

Socio-demographic determinants of pregnancy induced hypertension

Background: Pregnancy induced hypertension is a major health problem affecting the maternal and neonatal health, this serious obstetric problem occurs in women with pre-existing primary or secondary hypertension or women who are not having hypertension before pregnancy.Methods: A cross-sectional study was carried out among the women suffering from pregnancy induced hypertension, admitted in the gynaecology wards of Lal-Ded hospital, Srinagar from May 2021 to July 2021. A total of 100 sample patients were taken and data was collected using structured questionnaire. Data was analyzed by using SPSS 16.0.Results: Women suffering from PIH were having the mean age of 28 years with the mean gestation period being 36 weeks+6 days. Their mean systolic blood pressure was 150 mmHg and mean diastolic blood pressure was 98 mmHg. Out of 100 women, 75% were multigravida and 25% were primigravida and 40% were having a history of hypertension before pregnancy. Only 48% had a history of PIH in previous pregnancies while 52% had no such history. In 14% of PIH patients, there was an associated systemic disease. Out of 100, 48% belonged to rural areas, 15% were living in urban areas while 37% resided in semi-urban district. 46% of the patients were illiterate while 54% were educated, be it primary, secondary or higher level. Only 8% were employed while the rest were house wives. 11% had not been to a gynaecologist during their pregnancy while 13% had one visit done, 30% two and 46% had three or more antenatal visits. 67% had a history of hypertension among blood relatives.Conclusions: Pregnancy induced hypertension and socio-demographic determinants like the age of mother, blood pressure, history of hypertensive disorders in blood relatives,do show correlation Among these, history of PIH and chronic hypertensive disorders in blood relatives and high BP seemed to be the strongest risk factors among these 100 women

Knowledge, attitude and practices regarding HIV/AIDS among adult fishermen in coastal areas of Karachi.

BACKGROUND: Migrant populations are at high risk of Human Immuno Deficiency Virus infection (HIV) and Acquired Immunodeficiency Syndrome (AIDS). Studies of HIV/AIDS knowledge, attitudes and practices among fishermen in developing countries have shown gaps in knowledge and fear of contagion with ambivalent attitudes towards HIV/AIDS and inconsistent universal precautions adherence. The aim of this study was to determine the knowledge, attitude and practices regarding HIV/AIDS among adult fishermen in a coastal area of Karachi, Pakistan. METHODS: Community based cross sectional study was conducted among fishermen in coastal area of Karachi from June to September 2012. A total of 297 adult fishermen were selected by using simple random sampling technique from different sectors of coastal village. Data were collected using a structured validated questionnaire. The frequency distribution of both dependent and independent variables were worked out. Comparisons of knowledge, attitude and practices regarding HIV/AIDS by socio-demographic characteristics were made using logistic regression. RESULTS: Out of 297 fishermen, majority had in-appropriate knowledge (93.6%), negative attitude (75.8%) and less adherent sexual practices (91.6%). In univariate analysis, lower education and higher income were significantly associated (OR 2.25, 95% CI, 1.11, 4.55), (OR = 3.04 CI 1.03-9.02, p value 0.04) with negative attitude and un-safe practices towards HIV/AIDS respectively, whereas no significant association of socio-economic characteristics with knowledge, attitude and practices were observed in multivariate analysis. CONCLUSIONS: This study suggests that fishermen had very poor knowledge, negative attitudes towards HIV and AIDS and had unsafe sexual practices which suggest that they lack the basic understanding of HIV/AIDS infection. Extensive health education campaign should be provided to the vulnerable sections of the society for the control of HIV/AIDS