Prevalence of Depression in Caregivers of Stroke Patients in Karachi, Pakistan

ABSTRACT Background and Objective: Caregivers of patients with chronic debilitating illnesses are at risk of developing mental health problems. The objective of this study is to determine the frequency of depression in caregivers of stroke patients at a tertiary care teaching hospital in Karachi, Pakistan. Methods: A cross-sectional study was conducted among caregivers of stroke, who were recruited from the Aga Khan University Hospital between January 2018 to October 2018. Data was collected through the Urdu Hamilton rating scale for depression (HAM-D-U) and it was analyzed using descriptive and inferential statistics. Results: A total of 136 caregivers participated in the study. Among them, 44.1 % were male and 55.9% were female. The mean age of caregivers was 45.38 ± 10.33 years. Using the HAM-D-U scale, depression was present in 64 (47.1%) of caregivers. Out of them (n=64), 46 (33.8%) had mild depression whereas 18 (13.2%) had moderate depression. Depression was found to have a significant relationship with the age of the patient (p=0.002), education level of caregiver (p= 0.012), employment status of caregiver (p=0.012), being a sole caregiver (p=0.039), and monthly family income (p=0.016). Conclusion: Caring for patients with neurological disorders is highly challenging and demanding. The need for this role may arise unexpectedly in one’s life leaving little space for adjustment and coping. Caregiver depression can be debilitating especially if moderate to severe in intensity. Depression in stroke caregivers can be missed as patients are the center of management . Hence, strategies should be designed and reinforced to screen caregivers for depression with a pathway for easy and timely referral

Suicides by pesticide ingestion in Pakistan and the impact of pesticide regulation

Introduction: Suicide is a major public health problem in Pakistan, accounting to approximately 19,331 deaths every year. Many are due to consumption of acutely toxic pesticides; however, there is a lack of national suicide data, limiting knowledge and potential for intervention. In this paper, we aimed to review the literature on pesticide self-poisoning in Pakistan to identify the most problematic pesticides in relation to national pesticide regulations. Methods: Information on the currently registered and banned pesticides was obtained from Ministry of National Food Security and Research while data on pesticide import and use was extracted from FAOSTAT. We searched the following sources for articles and research papers on poisoning in Pakistan: Cumulative Index to Nursing and Allied Health (CINAHL), Google Scholar, Applied Social Sciences Index and Abstracts (ASSIA), Excerpta Medica (EMBASE), National Library of Medicine\u27s MEDLINE (PUBMED), PS102YCHINFO and Pakmedinet.com using the search terms \u27self-poisoning\u27, \u27deliberate self-harm\u27, \u27suicide\u27, \u27methods and means of suicide\u27, \u27organophosphate\u27, \u27wheat pill\u27, \u27aluminium phosphide\u27, \u27acute poisoning\u27, OR \u27pesticides\u27, AND \u27Pakistan\u27. Results: As of May 2021, 382 pesticide active ingredients (substances) were registered in Pakistan, of which five were WHO hazard class Ia (extremely hazardous) and 17 WHO hazard class Ib (highly hazardous). Twenty-six pesticides, four formulations, and seven non-registered pesticides had been banned, of which two were WHO class Ia and five Ib. We identified 106 hospital-level studies of poisoning conducted in Pakistan, of which 23 did not mention self-poisoning cases and one reported no suicidal poisoning cases. We found no community or forensic medicine studies. Of 52,323 poisoning cases identified in these papers, 24,546 [47%] were due to pesticides. The most commonly identified pesticide classes were organophosphorus (OP) insecticides (13,816 cases, 56%) and the fumigant aluminium phosphide (3 g 56% tablets, often termed \u27wheat pills\u27; 686 cases, 2.7%). Few studies identified the particular pesticides involved or the resulting case fatality. Conclusion: We found pesticide poisoning to be a major cause of poisoning in Pakistan, with OP insecticides and the fumigant aluminium phosphide the main pesticides identified. Withdrawal of Class I pesticides (as proposed to occur nationally in 2022) and high concentration aluminium phosphide tablets should rapidly reduce suicidal deaths by reducing the case fatality for low-intention poisoning cases. National cause of death data and forensic toxicology laboratory data identifying the pesticides responsible for deaths will be important to assess impacts of the proposed national ba

Association of awareness about hepatitis C infection with patterns of health seeking behavior among hepatitis C patients in Karachi, Pakistan

Background: Hepatitis C infection is one of the significant causes of morbidity and mortality throughout the world. In Pakistan, hepatitis C infection rate is 4.8%, which is the second highest prevalence rate among all developing countries. This study aimed to identify the association between awareness about hepatitis C infection and pattern of health seeking behavior among patients living with hepatitis C in Karachi, Pakistan. Methods: A descriptive, cross-sectional study was conducted among 250 hepatitis C patients who were recruited from the Aga Khan University Hospital and the Civil Hospital Karachi, Pakistan between March and May 2013. Data were collected through a modified questionnaire on ‘awareness about hepatitis C and patterns of health seeking behavior among hepatitis C patients’. Results: We did not find any association between participants’ awareness of hepatitis C infection and their primary contact with a health care provider. However, this study found that only half of the study participants (52%) had correct knowledge of hepatitisC. The patterns of health seeking behavior showed that a majority of the study participants approached a medical doctor (n=368), followed by spiritual healers (n=206), and a few participants approached traditional healers (n=39) and homeopaths (n=11). Conclusions: The study did not find any association between the patients’ level of awareness about hepatitis C infection and their primary contact with health careproviders. However, it has been found that patterns of health seeking behavior are strongly related to the patients’ cultural practices and beliefs, which affect their choiceof health care providers. This study has provided a basis for planning interventional studies aimed at improving patients’ level of awareness about hepatitis C and their health seeking behavior

The patterns of health seeking behavior among patients with hepatitis C in Karachi, Pakistan

Background: The study aimed to assess the patterns of health seeking behavior and the level satisfaction with the health care providers among hepatitis C patients in Karachi, Pakistan. Methodology: A descriptive, cross-sectional study was conducted among 250 hepatitis C patients, who were recruited from the Aga Khan University Hospital and the Civil Hospital Karachi, Pakistan, between March and May 2013. Results: The patterns of health seeking behavior showed that a majority of the study participants approached a medical doctor (n=359), followed by spiritual healers (n=103), and a few participants approached traditional healers (n=38) and homeopaths (n=11). The pattern of health seeking behavior also revealed that the participants were taking treatment from more than one health care provider at the same time. Participants who visited doctors had effective treatment outcomes and they were satisfied with their doctors. However, those participants who visited homeopaths, traditional healers and spiritual healers had ineffective treatment outcomes and they were not satisfied with these health care providers. Conclusion: The patterns of health seeking behavior are strongly related to the patients\u27 cultural practices and beliefs, which affect their choice of health care providers. This study has provided a basis for planning interventional studies aimed at improving patients\u27 health seeking behaviors

Patterns of suicide and self-harm in Pakistan: a retrospective descriptive study protocol

Introduction Suicide is a major global public health problem. Low-income and middle-income countries contribute 78% of all suicidal deaths. Pakistan, a South Asian country, lacks official statistics on suicides at national level. Statistics on suicide are neither collected nationally nor published in the annual national morbidity and mortality surveys. Medicolegal reports on suicides and self-harm are extremely rich and important source of information but greatly underused in Pakistan. We aim to examine the patterns of suicides and self-harm retrospectively in patients who were registered with medicolegal centres (MLCs) in Karachi, during the period January 2017 to December 2021. Methods and analysis Using retrospective descriptive design, the data will be collected from the medical records maintained at the main office of the Karachi police surgeon. Data from all nine MLCs of Karachi are collated and stored at the main office of Police surgeon. Information on suicide and self-harm cases will be extracted from records of all MLCs. The data will be collected using structured proforma and it will be analysed using descriptive and inferential analysis. Ethics and dissemination The study was approved for exemption from Aga Khan University, Ethical Review Committee. The findings of the study will be disseminated by conducting seminars for healthcare professionals and stakeholders including psychiatrists, psychologists, counsellors, medicolegal officers, police surgeons, mental health nurses, general and public health physicians and policy makers. Findings will be published in local and international peer-reviewed scientific journals

Gastrointestinal bleed pathway documentation by nurses and physicians in Pakistan: a literature gap

BackgroundUpper gastrointestinal bleed is the serious medical condition which needs immediate interventions to prevent patients from serious complications. Nurses and physicians neglect gastrointestinal bleed pathway documentation which results in improper patient care management. Aim of the studyThe aim of this paper is to overview the reviews on gastrointestinal bleed pathway documentation and also to identify the barriers of gastrointestinal bleed pathway documentation among physicians and nurses. MethodologyLiterature search was undertaken in a systematic way to explore and review the existing literature related to documentation in GI bleed pathway and the barriers of documentation among nurses and physicians. For literature search, four major databases, CINHAL plus with full text, PUBMED, Cochrane library and JSTOR were used. Other search engine like Google scholar was also used to find the relevant literature. These databases were searched for the time period between 2000 and 2012. ResultsThe literature review reveals studies on effectiveness of gastrointestinal bleed pathway on patient’s outcome, effect of clinical pathway on documentation, and barriers of documentation in Clinical Pathway. However, none of the study focused specifically on gastrointestinal bleed pathway documentation among nurses and physicians in Pakistan. ConclusionThere is a gap in literature regarding physicians and nurses’ practice towards documentation of gastrointestinal bleed pathway in Pakistan. It is recommended that base line study is needed to overcome the issue of managing gastrointestinal bleed patients and to improve patients’ quality of care.  Key Words: GI bleed, clinical pathway, documentation, Pakista

Awareness about hepatitis C and patterns of health seeking behavior among hepatitis C patients in Karachi, Pakistan

Objective: The study aimed to assess the level of awareness about hepatitis C, the patterns of health seeking behavior, and the satisfaction with the health care providers among hepatitis C patients in Karachi, Pakistan. This study also intended to identify the participants\u27 reported exposure to risk factors and the causative agents of hepatitis C. Moreover, this study also aimed to identify association between patients\u27 sociodemographic characteristics and pattern of health seeking behavior, and also the association between participants\u27 awareness about hepatitis C and their primary contact with health care providers. Methodology: A descriptive, cross-sectional study was conducted among 250 hepatitis C patients, who were recruited from the Aga Khan University Hospital and the Civil Hospital Karachi, Pakistan, between March and May 2013. Data was collected through a modified questionnaire on \u27Awareness about hepatitis C and patterns of health seeking behavior among hepatitis C patients\u27, and it was analyzed using descriptive and inferential statistics. Results This study found that only half of the study participants (52%) had correct knowledge about hepatitis C; in fact, most of the study participants had incorrect knowledge about transmission of HCV infection, such as sharing towel/clothes (76.8%), coughing (75.2%), tattooing (66.4%), kissing (66%), sexual intercourse (54.4%), ear and nose piercing (53.6%), and eating utensils (53.6%). Moreover, 90.8% participants had misconceptions that preventive vaccine for hepatitis C infection is available. This study also found that 61% participants had exposure to needles/syringes and 22% participants perceived the use of medical instruments as their cause of hepatitis C. The participants (19.11%) also reported food and water as their cause of hepatitis C. The patterns of health seeking behavior showed that a majority of the study participants approached a medical doctor (n=368), followed by spiritual healers (n=206), and a few participants approached traditional healers (n=39) and homeopaths (n=11). In contrast to participants who visited traditional healers, homeopaths, or spiritual healers, the participants who visited doctors had effective treatment outcomes and they were satisfied with doctors. The study findings showed that there was no association between participants\u27 awareness about hepatitis C and their primary contact with a health care provider. However, significant differences were identified between participants\u27 occupation and first visit to spiritual healers (P=0.01), their education and first visit to traditional healers (P=0.02), and spiritual healers (P=0.006). Moreover, significant association was identified between the participants\u27 number of children and their second visit to doctors (P=0.007), and family members belonging to the medicine field and their first visit to doctors (P=0.05) and spiritual healers (P=0.05). Conclusion: This study concluded that participants had misconceptions regarding HCV transmission, risk factors, and preventive vaccine for hepatitis C. Further, it concluded that patterns of health seeking behavior are strongly related to the patients\u27 cultural practices and beliefs, which affect their choice of health care providers. Finally, this study has provided a basis for planning interventional studies aimed at improving patients\u27 level of awareness about hepatitis C and their health seeking behaviors

Prevention of delay in the patient discharge process: an emphasis on nurses\u27 role.

Planning for a Patient\u27s postdischarge needs care does not begin on the day when decision is made to release the Patient from the hospital. It is generally accepted that discharge planning should start before admission (for a planned admission) or at the time of admission (for an unplanned admission). A combination of individual factors, most notably age, medical factors such as presence of multiple pathology, and organizational factors such as lack of alternative forms of care facilities put Patients at risk of delayed discharge. Moreover, lack of nurses\u27 participation also contributes toward the delaying of discharge. In this article, the author provides strategies to improve nurses\u27 participation in discharge planning and discusses the importance of involving Patients and their caretakers in decision making

Suicide and self-harm by burns in Pakistan: A scoping review protocol

Introduction: Suicide is a global public health problem. Self-inflicted burns are one of the most severe methods of suicide, with high morbidity and mortality. Low-income and middle-income countries contribute 40% of all suicidal burns. Pakistan lacks comprehensive burns surveillance data, which prevents an understanding of the magnitude of the problem. This scoping review aims to understand the scope of the problem of suicide and self-harm burns in Pakistan and to identify knowledge gaps within the existing literature related to this specific phenomenon.Methods and analysis: This scoping review will follow the methodological framework proposed by Arksey and O\u27Malley. We will search electronic databases (PubMed, Cochrane, Google Scholar and Pakmedinet), grey literature and a reference list of relevant articles to identify studies for inclusion. We will look for studies on self-inflicted burns as a method of suicide and self-harm in Pakistan, published from the beginning until December 2023, in the English language. Two independent reviewers will screen all abstracts and full-text studies for inclusion. The data will be collected on a data extraction form developed through an iterative process by the research team and it will be analysed using descriptive statistics.Ethics and dissemination: Ethical exemption for this study has been obtained from the Institutional Review Board Committee of Aga Khan University Karachi, Pakistan. The findings of the study will be disseminated by conducting workshops for stakeholders, including psychiatrists, psychologists, counsellors, general and public health physicians and policymakers. The findings will be published in national and international peer-reviewed journals

Caregiver strain and its associated factors in autism spectrum disorder in Karachi, Pakistan

Objective: To determine the frequency of caregiver strain and its associated factors in Autism Spectrum Disorder (ASD) at a tertiary care teaching hospital in Karachi, Pakistan. Study design: An analytical cross-sectional study. Place and Duration of the Study: Psychiatry inpatient and outpatient units at The Aga Khan University Hospital, Karachi, Pakistan, from December 2018 to December 2019. Methodology: The study participants were caregivers of ASD. Data were collected from the inpatient and outpatient departments using Caregiver Strain Questionnaire (CGSQ), and a demographic questionnare. Data were analysed using descriptive and inferential analysis. Results: A total of 76 caregivers participated in the study. Among them, 61 (80.3%) were females and 15 (19.7%) were males, with mean age of 37.09±6.91 years. The overall caregiver strain (both subjective and objective) was reported to be severe by 11.8%, moderate by 47.4% and low by 40.8%. About 50% of the participants had a low objective strain on CGSQ whereas 59.2% of the participants subjectively felt the strain to be at moderate level. An association was found between the gender of the participants and subjective strain (p=0.016), and gender with internalised subjective strain (p =0.002). Conclusion: Parenting of a child with ASD involves challenges and demands support. This study supports the recommendation that the caregivers need access to appropriate means to channelize their strain and manage their role productively