Psychiatric morbidity and perceptions on psychiatric illness among patients presenting to family physicians, in April 2001 at a teaching hospital in Karachi, Pakistan

Objective: To assess psychiatric morbidity and the perceptions about psychiatric illness, among patients presenting to family physicians, at a teaching hospital in Karachi, Pakistan. Methods: A questionnaire based survey was developed to collect demographic data, information on psychiatric morbidity and perceptions on psychiatric illness. It was administered to 400 patients, against a sample size of 347. The study objective was explained, written consent was taken and confidentiality was assured. Results: There were more women then men in the study, with a mean age of 37 years. The majority was married, better educated and socioeconomically placed then the rest of the population. A total of 175 (43.75%) subjects reported psychiatric illness in the family. A psychiatrist or a family physician diagnosed the illness in 110 (62.85%) and 37 (21.14%) of the cases, respectively. A total of 68 (38.85%) subjects reported reluctance in accepting a diagnosis of psychiatric illness. A total of 296 (74%) of the respondents thought that psychiatric illness is stigmatized and therefore treatment is not sought for it. Alternate treatment for psychiatric illness were quoted as seeking treatment from a Hakim (49 subjects, 12.3%), spiritual healers (49 subjects, 12.3%) and family support (10 subjects, 2.5%). A total of 121 (30%) subjects thought that psychiatric illness is caused by supernatural powers and spirits. A total of 109 (27.3%) subjects felt a need to seek psychiatric help, but did not visit a psychiatrist because of reluctance.Conclusion: Considerable psychiatric morbidity exists among our patient population and is stigmatized. We recommend improvement in psychiatric services, as well as patient education programs

Knowledge, attitude and practice regarding obesity among patients, at Aga Khan University Hospital, Karachi

BACKGROUND: Obesity is a major public health problem and responsible for significant morbidity and mortality among our patients. It is important to study the knowledge, attitude and practices with regard to obesity among patients, in order to devise interventional strategies. METHODS: Patients visiting the out-patient clinics of Aga Khan University Hospital, Karachi, were included in the study. The interview was questionnaire-based and recorded the demographic profile of the patients and questions relevant to the objective of the study. The ethical requirements for the study were met. SPSS computer software was used for data management. A hundred patients were surveyed.RESULTS: Women (55%) were more than men (45%), under 39 years (73%), married (55%), with graduate or more education (65%), in private service (44%) and housewives (19%). A substantial number of respondents (75%) understood the meaning of obesity and considered it a major health problem (90%). More respondents felt the need to reduce weight (52%), despite the fact that lesser number considered themselves to be overweight or obese (34%). A majority of the respondents did exercise (59%) but a minority did it more than five times a week (17%) and more than 30 minutes on each occasion (31%). A substantial proportion of the respondents stated their preference for oily food (34%), sweets (34%), fried food (40%), red meat (21%), fast food (37%), butter, cheese and cream (31%). CONCLUSIONS: We have found a significant level of understanding about obesity among our patients. Physical exercise and dietary measures to control body weight are lacking despite the desire to have appropriate body weight. There is a need and we strongly recommend patient education programs to control obesity

Factors associated with geriatric morbidity and impairment in a megacity of Pakistan

Background: The elderly population is increasing globally. In Pakistan, the elderly comprise 6% of the population that is predicted to triple by 2050. Non-communicable diseases are common health problems of the elderly in Pakistan, however, resulting geriatric impairments and disability are unknown. This study was conducted to determine geriatric impairments and identify associated socio-demographic factors and comorbidities among community dwelling elderly in Karachi, Pakistan.Methods: A cross-sectional study was conducted during 2013-2014. Community clusters were selected from all sub-districts of Karachi, the largest city of Pakistan. Data was collected from systematically selected households within these clusters from individuals, aged ≥60 years, using standardized questionnaires. Geriatric impairment was assessed through validated questions and tools. We screened for depression, dementia, mobility and functional status. Descriptive statistics were computed for socio-demographic factors. We estimated the prevalence and 95% CI for geriatric impairments and comorbidities.Results: A total of 1200 community-dwelling elderly participated in this study. More than half (n = 663, 55.3%) were females. The average age of the participants was 68.7 (SD = 7.8) years. Two-thirds suffered from chronic illness and the most common impairments were psychological and cognitive. Females were 2.45 times more at risk of developing three or more geriatric impairments. Participants with no formal education had the highest proportion (43.8%) of geriatric impairments. Participants living with more children were more likely to have three or more impairments.Conclusion: A high burden of non-communicable diseases and associated impairments were identified among elderly in Karachi, Pakistan. High rates of psychological and cognitive impairments require urgent attention for resources and strategic planning in anticipation of a growing geriatric population

Frequency of poor quality of life and predictors of health related quality of life in cirrhosis at a tertiary care hospital Pakistan

Background Cirrhosis produces variety of symptoms which eventually lead to a negative impact on Health Related Quality of Life (HRQOL). The general aim of this study was to evaluate the magnitude of poor HRQOL and to assess factors related with HRQOL in patients with CLD in Pakistan. Findings This was a cross sectional study conducted in gastroenterology outpatient clinics of Aga Khan University Hospital, Karachi on adult patients with cirrhosis. In this study chronic liver disease questionnaire (CLDQ) was used to assess HRQOL of these patients and CLDQ score was used as an outcome measure to determine factors related with HRQOL. 273 participants were recruited in the study; 155 (57%) were males. Mean age of participants was 49 ± 11 years. The most common cause for cirrhosis was viral infection 247(91.5%). Mean Model for End Stage Liver Disease (MELD) score was 12.6 ± 6.8 and 2/3 of patients 209 (76.6%) had advanced cirrhosis in Child Turcot Pugh (CTP) B or C stage. Poor HRQOL was seen in 187(69%; 95% C.I.: 63%, 74%) of the participants. Mean CLDQ score was 4.36 ±1.1. Amongst all of the domains, fatigue domain had lower CLDQ score. Hemoglobin (β = 0.09 [SE = 0.04]), Albumin (β = 0.32[SE = 0.09]), Diastolic Blood Pressure (DBP) (β = 0.01[0.005) prior history of decompensation (β = 0.98[SE = 0.39] were significant factors associated with HRQOL in patients with liver cirrhosis. Conclusion Frequency of poor health related quality of life determined by CLDQ score is high in patients with liver cirrhosis. Hemoglobin, serum albumen, prior history of decompensation (like encephalopathy and upper gastro intestinal bleed), are associated with health related quality of life

School Excellence: Principals’ Perceptions

It was generally believed that the education system of Pakistan, in general, and Khyber Pakhtunkhwa, in particular, was in shambles. Barring a few exceptions, the schools in Khyber Pakhtunkhwa direly needed improvement. Turning schools into Centres of Excellence required identification of factors that promoted effectiveness and excellence. The study was carried out to identify factors promoting excellence in schools in Khyber Pakhtunkhwa, Pakistan. The population of the study included all the boys’ high Schools of Peshawar city. The sample comprised 30 principals/headmasters of boys’ high schools (26 from private sector and 4 from public sector). The tool of the study was an opinionnaire, which was fielded to principals/headmasters of both sectors. The opinionnaire contained items and statements of multi-dimensional nature. The data analysis was given both quantitative and qualitative treatment. In order to be logical and scientific in approach the analysis was further made meaningful with the application of statistical measures. The outcome of the study revealed a number of factors that could help convert a school into a centre of excellence. Keywords: Excellence, Effective, Public and private schools, Opinionnaire, Factor

Lack of association of statin use with vitamin D levels in a hospital based population of type 2 diabetes mellitus patients

Objective: To investigate the relationship of statins (drug given to reduce serum levels of LDL-cholesterol) on vitamin D levels of Pakistani type 2 diabetes mellitus (DM) patients in a hospital in Karachi.Methods: In a cross-sectional survey, 312 consecutive patients with type 2 DM (219 males and 93 females, age 22-70 years) were recruited with informed consent. A questionnaire was administered to find out whether they were statin users or non-users. Serum was analyzed for concentrations of 25(OH) vitamin D [25(OH)D] and other related biomarkers such as serum cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, phosphate and calcium using kit methods. Multiple Linear Regression was used to evaluate association of statin use with serum levels of vitamin D while adjusting for related covariates including duration of statin use, duration of type 2 DM and smoking.Results: Mean concentrations of serum cholesterol, and LDL-cholesterol were lower among statin users compared to statin non-users (P \u3c 0.01), while HDL-cholesterol levels were higher (P\u3c0.01). No relationship was observed between statin use and serum levels of vitamin D (P=0.768), when adjusted for age, gender, BMI, duration of type 2 DM, smoking, serum cholesterol and LDL-cholesterol. The adjusted regression coefficient (β) and standard error [SE(β)] for statin use duration were 0.012 (0.042), when serum levels of vitamin D was taken as an outcome.Conclusion: Lack of association was found between statin use and vitamin D levels in a hospital-based population of Pakistani patients with type 2 DM

Myths regarding treatment of hepatitis: the vicious cycle of increasing morbidity

Viral hepatitis has high prevalence rates in Pakistan. It is a potentially serious condition with associated high morbidity and mortality. Studies from neighboring regions document significant utilization of the services of faith healers for the treatment of patients with hepatitis. This article is a short communicatio

Association of vitamin D binding protein polymorphism with risk of type 2 diabetes mellitus in a Pakistani urban population: A case control study

Objective: To assess if genotypes/diplotypes of vitamin D binding protein have any association with type 2 diabetes mellitus.Methods: This case-control study was conducted from January 2013 to July 2015 at the endocrinology clinics of the Aga Khan University Hospital, Karachi, and comprised adult patients with type 2 diabetes and their age- and gender-matched healthy controls. Venous blood was obtained and assessed for serum/plasma 25 hydroxyvitamin D, parathyroid hormone, calcium, alkaline phosphatase and creatinine. Deoxyribonucleic acid was isolated and genotyping was done by polymerase chain reaction-restriction fragment length polymorphismprocedures.Results: Of the 330 participants, there were 165(50%) cases and as many controls. There were 116(70.3%) males and 49(29.7%) females in each group. The mean age of the patients was 48.82±9.23 years and that of the controls was 46.27±8.77 years (range: 22-70 years) (p=0.010) Mean serum concentration of 25 hydroxy vitamin D was significantly higher among the patients compared to the controls (p\u3c0.001), but not significantly different by genotypes or diplotypes (p\u3e0.05). Multiple conditional logistic regression revealed an associationof group-specific 1-2 genotype with patients when adjusted for age, body mass index, and serum levels of 25 hydroxy vitamin D with matched adjusted odds ratio (95% confidence interval) being 3.1(1.22-7.88).Conclusions: Group-specific 1-2 genotype of vitamin D binding protein gene was associated with the risk of type 2 diabetes

Is Chaalia/Pan Masala harmful for health? practices and knowledge of children of schools in Mahmoodabad and Chanesar Goth, Karachi

OBJECTIVE: To determine the practices and knowledge of harmful effects regarding use of Chaalia and Pan Masala in three schools of Mahmoodabad and Chanesar Goth, Jamshed Town, Karachi, Pakistan. METHODS: To achieve the objective a cross-sectional design was used in three government schools of Mahmoodabad and Chanesar Goth, Jamshed Town, Karachi. Students of either gender drawn from these schools fulfilling the inclusion and exclusion criteria were interviewed using a pre-coded structured questionnaire. Along with demographic data, questions regarding frequency of Chaalia and Pan Masala use, practices of this habit in friends and family and place of procurement of these substances, were inquired. Knowledge was assessed about harmful effects and its source of information. In addition, practices in relation to that knowledge were assessed. RESULTS: A total of 370 students were interviewed over a period of six weeks, of which 205 (55.4%) were boys. The ages of the students were between 10 and 15 years. Thirty one percent of the fathers and 62% of the mothers were uneducated. The frequency of use of any brand of Chaalia was found to be 94% and that of Pan Masala was 73.8%. Eighty five percent of them were regular users. A large majority (88%) procured the substances themselves from near their homes. Ninety five percent of the children had friends with the same habits. Eighty four percent were using the substances in full knowledge of their families. Chaalia was considered harmful for health by 96% and Pan Masala by 60%. Good taste was cited as a reason for continuing the habit by 88.5% of the children and use by friends by 57%. Knowledge about established harmful effects was variable. Knowledge about harmful effects was high in both daily and less than daily users . CONCLUSION: The frequency of habits of Chaalia and Pan Masala chewing, by school children in lower socio-economic areas is extremely high. The probable reasons for this high frequency are taste, the widespread use of these substances by family members and friends, low cost and easy availability

Socio-economic determinants of out-of-pocket Payments on healthcare in Pakistan

BACKGROUND: Out-of-pocket (OOP) payment on healthcare is dominant mode of financing in developing countries. In Pakistan it is 67% of total expenditure on healthcare. Analysis of determinants of OOP health expenditure is a key aspect of equity in healthcare financing. It helps to formulate an effective health policy. Evidence on OOP in Pakistan is sparse. This paper attempts to fill this research gap. METHODS: We estimated determinants of OOP payments on healthcare in Pakistan. We used data sets of Pakistan Household Integrated Economic Survey (HIES) and Pakistan Standard of Living Measurement (PSLM) Survey for the year 2004-05. We developed a multiple regression model for the determinants of OOP payments using methods of Ordinary Least Square (OLS). We mainly used social, economic, demographic and health variables in our analysis. RESULTS: Median household OOP healthcare in the year 2004-05 was Pakistani Rupees (PKR) 2500 (US$ 41.99) in 2004-05. Household non-food expenditure was the single highest significant predictor of household OOP health expenditure. Household features like literate head and spouse, at least one obstetric delivery in last three years, unsafe water, unhygienic toilet and household belonging to Khyber Pukhtonkhwa (KPK) province were significant positive predictors of OOP payments. Households with male head, bricks used in housing construction, household with at least one child and no elderly, and head of household in a white collar profession were negative predictors of OOP payments. CONCLUSION: Our analysis confirms earlier findings that economic status and number of old aged members are significant positive predictors of OOP payments. This association can direct government to enhance allocations to healthcare and to include program focusing on non-communicable diseases. Our findings suggest further research to explore beneficiaries of government healthcare programs and determinants of high OOP payments by household residing in KPK province than other province. The interaction between white collar profession and their economic status in predicting OOP payments is also an area for further research