An audit of the quality of care indicators for the management of diabetes in family practice clinics in Karachi, Pakistan

BACKGROUND: Management of diabetes is a painstaking and careful approach. This study was aimed to evaluate the quality of care for the management of diabetes provided by family practitioners to their patients having diabetes. This is a retrospective audit of medical records conducted in a tertiary care teaching hospital of private sector in Karachi for one month. METHODS: For this study, 150 medical records of patients with type 2 diabetes that visited family practice clinics for their diabetes care were examined. A total of 88 patient\u27s medical records were selected and analyzed who attended the studied clinics for at least one year and had minimum of four out-patient visits. Majority (68%) of the audited medical records were of females. RESULTS: Of the total medical records analyzed, only one-quarter of the cases qualified the criteria of \u27excellent\u27 or \u27good\u27 diabetes care. Monitoring of body weight of the patient was only one indicator which was according the recommendations in 100% case at every visit. The other nearest quality of care indicator documented was blood glucose advice at every visit in 79.5% (95% CI: 71.1-87.9) of cases. Physical activity advised/reinforced at every visit was least observed (27.3%; 95% CI: 18.0-36.6). In addition, blood sugar control was reported in less than a quarter (23.9%) with 95% CI of 15.0-32.8. CONCLUSION: This work has identified a big gap in the management of type 2 diabetes provided by family practitioners. In addition, majority of the patients found to have poor glycemic control. Interventions are suggested to improve the quality of diabetes care. More such audits and research are recommended at the larger scale

Anxiety and depression among outpatients with type 2 diabetes: A multi-centre study of prevalence and associated factors.

Background: Anxiety and depression contribute to poor disease outcomes among individuals with diabetes. This study aimed to assess the prevalence of anxiety and depression and to identify their associated factors including metabolic components among people with type 2 diabetes. Methods: We conducted a cross-sectional, multi-center study in four out-Patient clinics in Karachi, Pakistan. In all, 889 adults with type-2 diabetes were included in this study. Anxiety and depression were measured by using the Hospital Anxiety and Depression Scale (HADS). Multivariable analysis using multiple logistic regression was carried out to evaluate the combined effect of various factors associated with anxiety and depression, while adjusting for confounding variables. Results: Overall, 57.9% (95% CI = 54.7%, 61.2%) and 43.5% (95% CI = 40.3%, 46.8%) study participants had anxiety and depression respectively. Factors found to be independently associated with anxiety were physical inactivity, having hypertension and ischemic heart disease. For depression, being female, of older age, having hypertension and ischemic heart disease were significantly associated. Metabolic components found to be independently associated with both anxiety and depression were systolic blood pressure, fasting blood glucose and fasting blood triglycerides. Body mass index was independently associated with depression but not with anxiety. Conclusion: This study identified that a large proportion of adults with diabetes had anxiety and/or depression, and identified factors associated with these entities. These results alert clinicians to identify and treat anxiety and depression as common components of diabetes care. Additional studies are needed to establish the directional nature of this relationship and to test interventions

Cardiovascular Disease-Related Lifestyle Factors among People with Type 2 Diabetes in Pakistan: A Multicentre Study for the Prevalence, Clustering, and Associated Sociodemographic Determinants

Background. We evaluated the prevalence and clustering pattern of cardiovascular disease (CVD) related lifestyle factors and their association with CVD among patients with type 2 diabetes. We also examined the association of these factors with various socio-demographic characteristics. Methods. A total of 1000 patients with type 2 diabetes were interviewed in a cross-sectional, multi-center study in out-patient clinics in Karachi, Pakistan. Results. In this study 30.3% study participants had CVD. Majority of the patients were physically inactive and had adverse psychosocial factors. Forty percent of the study participants were exposed to passive smoking while 12.7% were current smokers. Only 8.8% of study subjects had none of the studied lifestyle factor, 27.5% had one, while 63.7% had two or three factors. CVDs were independently associated with physical inactivity, adverse psychosocial factors, passive smoking and clustering of two or three lifestyle factors. Physical inactivity was more prevalent among females and patients with no/less education. Proportion of adverse psychosocial factors were higher among females, elders and patients with no/less education. Clustering of these lifestyle factors was significantly higher among females, elderly and no/less educated patients. Conclusion. These results suggest the need of comprehensive and integrated interventions to reduce the prevalence of lifestyle factors

Exploring leadership challenges in a primary school for under-privileged working children in Karachi

Primary education, a basic human right, is universally recognized as being among the most critical life chances due to its functional importance. The situation of the country\u27s basic or primary level education, as reflected in high levels of illiteracy and innumeracy, is a matter of great concern. In relation to it, Pakistan has not been able to actualize the much desired targets concerning an increase in primary level enrollment and decrease in drop out rates. Consequently, it is imperative to examine the alternatives to public education through the civil society; the ability of Non-governmental organizations (NGOs) to bring about social transformation through grass root mobilization is undoubted. Certainly, many NGOs in the past and present contributed to work as a helping hand to the government in this noble cause. This study was also carried out in one of the schools of an NGO which particularly caters to a category of under-privileged working children. The study discloses that while working for a noble cause, the school leadership faces a number of administrative, academic and resource challenges during its move. However, at the same time, it strategizes its activities in such a way that the challenges are resolved to a great extent. The study also offers some recommendations to the school, the senior management and the school leadership who actually look after the day to day activities of the school. This report also includes the lessons learned from the study. The findings would be not only beneficial for the researcher, but for the educational world which has to give a major contribution to assist these under-privileged working children through researches in other related areas

Predictors of oral tobacco use among young adult patients visiting family medicine clinics in Karachi, Pakistan.

Prevalence of cancers associated with the use of oral tobacco (OT) is rising very rapidly and prevention of use is the best option to tackle this scenario. This cross-sectional study estimated the proportion of OT use and predictors associated with its initiation and determined the knowledge, attitude and practices of OT users. A total of 231 young adult Patients (15-30 years age) were interviewed by medical students in family practice clinics in Karachi, Pakistan. OT use was considered as usage of any of the following: betel quid (paan) with tobacco, betel nuts with tobacco (gutkha), and snuff (naswar). Overall, 49.8% (95% CI=43.3-56.2) subjects had used OT at least in one form. Multivariable analysis demonstrated independent association of OT users with secondary education level (adjusted OR=3.6, 95% CI=1.6-8.1) and use of OT by a family member (OR=2.3, 95% CI=1.3-4.0). Among OT users, 37.4% started after being inspired by friends/peer pressure, 60% using for more than 5 years, 53.2 % users reported getting physical/mental comfort from the use of OT while 31.6% tried to quit this habit but failed. We suggest socially and culturally acceptable educational and behavioral interventions for control of OT usage and hence to prevent its associated cancers

Anxiety and depression among outpatients with type 2 diabetes: A multi-centre study of prevalence and associated factors

Abstract Background Anxiety and depression contribute to poor disease outcomes among individuals with diabetes. This study aimed to assess the prevalence of anxiety and depression and to identify their associated factors including metabolic components among people with type 2 diabetes. Methods We conducted a cross-sectional, multi-center study in four out-patient clinics in Karachi, Pakistan. In all, 889 adults with type-2 diabetes were included in this study. Anxiety and depression were measured by using the Hospital Anxiety and Depression Scale (HADS). Multivariable analysis using multiple logistic regression was carried out to evaluate the combined effect of various factors associated with anxiety and depression, while adjusting for confounding variables. Results Overall, 57.9% (95% CI = 54.7%, 61.2%) and 43.5% (95% CI = 40.3%, 46.8%) study participants had anxiety and depression respectively. Factors found to be independently associated with anxiety were physical inactivity, having hypertension and ischemic heart disease. For depression, being female, of older age, having hypertension and ischemic heart disease were significantly associated. Metabolic components found to be independently associated with both anxiety and depression were systolic blood pressure, fasting blood glucose and fasting blood triglycerides. Body mass index was independently associated with depression but not with anxiety. Conclusion This study identified that a large proportion of adults with diabetes had anxiety and/or depression, and identified factors associated with these entities. These results alert clinicians to identify and treat anxiety and depression as common components of diabetes care. Additional studies are needed to establish the directional nature of this relationship and to test interventions.</p