Effect of diabetic counseling based on conversation map as compared to routine counseling on diabetes management self-efficacy and diabetic distress among patients with diabetes in Pakistan: a randomized controlled trial (study protocol)

Background: Novel interactive and pictorial health education tool named Diabetes Conversation Map (DCM) might be effective for the improvement of diabetes management self-efficacy (DMSE) and diabetes distress (DD) among diabetic patients in lower middle-income setting. This study protocol will assess the effectiveness of DCM as compared to routine care (RC) to improve DMSE, decrease DD and glycated hemoglobin (HbA1c) among patients with type 2 diabetes (T2DM). Methods: This will be two arms randomized controlled trial, conducted at national institute of diabetes and endocrinology (NIDE) in Karachi, Pakistan. A sample of 120 T2DM patients of age 30–60 years with suboptimal diabetes control will be screened through eligibility criteria and DD screening tool. Patients who fulfill the eligibility criteria and have diabetes distress will be randomized into interventional and control arm. The intervention arm will receive four education sessions (40 min each) using DCM for 4 weeks duration of enrollment. Controlled arm will receive RC. DMSE and DD will be measured using the validated Likert tools at baseline and after 3 months of enrollment. Latest results of HbA1c will be retrieved from the respective medical record files at baseline and 3 months. Change in DMSE, DD scores and HbA1c levels within groups (pre-post) and between the groups after 3 months of enrollment will be compared. Multivariable linear regression will be conducted to adjust for any potential confounders. Discussion: In a study in UK, 70% of the patients with diabetes reported DCM had helped them in controlling their diabetes and recommended this method to teach other patients with diabetes also. In China, a study found that patients with diabetes who received DCM based education had significantly lower DD and significantly higher diabetes empowerment score after six months of the intervention as compared to the traditional counselling. A cross sectional study conducted in Pakistan also demonstrated that teaching based on DCM was useful in improving the knowledge, attitude and practices of patients with T2DM. Besides, no other study has evaluated the effectiveness of these novel tools for DMSE and diabetes distress DD in well-designed, sufficiently powered clinical trials. Trial registration: ClinicalTrials.gov Identifier: NCT03747471. Date of registration: Nov 20. 2018. Version and Date of Protocol: Version 1, IRB Approval date 28 June 2018

Diabetes conversation map - A novel tool for diabetes management self-efficacy among type 2 diabetes patients in Pakistan: A randomized controlled trial

Background: This study aimed to measure the effect of diabetes education using the novel method of diabetes conversation map (DCM) as compared to routine counselling (RC) on diabetes management self-efficacy (DMSE) among patients living with type 2 diabetes in Karachi, Pakistan.Methods: A parallel arm randomized controlled trial among patients with type 2 diabetes aged 30-60 years, with HbA1c \u3e 7%, diagnosed for at least 5 yrs., was conducted at the national institute of diabetes and endocrinology in Karachi, Pakistan. A total 123 type 2 diabetes patients were randomized into DCM (n = 62) or RC (n = 61). Four weekly diabetes control sessions of 40 min each using the DCM or RC was provided. DMSE was measured using a validated Urdu language DMSE tool at baseline and after three months of the randomization. Change in DMSE and HbA1c levels within groups (pre-post) and between the groups after 3 months of enrollment was compared.Results: Baseline characteristics except HbA1c were similar between the two arms. After 3 months of enrollment, there was no change in the DMSE score in the RC arm however, significant increase in DMSE score was noted in the DCM arm (P = \u3c 0.001). The average difference (95% confidence interval) in DMSE score between the DCM and RC arm was 33.7(27.3, 40.0; p = \u3c 0.001) after 3 months of the enrollment. Difference in HbA1c within groups was not significant.Conclusions: DCM significantly improved DMSE among type 2 diabetes patients in a developing country setting like Pakistan. Healthcare workers caring for type 2 diabetes patients need to be trained on DCM to effectively utilize this novel tool for educating diabetes patients.Trial registration: This trial was prospectively registered. ClinicalTrials.gov Identifier: NCT03747471. Date of registration: Nov 20. 2018

identification of pharmacological activities of

The use of medicinal plants for cure, treatment and control of diseases is one of the ancient forms of medical practice in mankind history. The 80% population of underdeveloped nations is still dependent on traditional medicinal remedy for its basic medical needs. Malva neglecta Wallr. is a medicinal plant used for phytotherapy for the treatment of cough, respiratory and digestive problems. The present study was conducted for the identification of pharmacological activity of crude extract of Malva neglecta Wallr. on inflammatory, emesis, and analgesic effect in different In-Vivo moels. For this study we performed hind paw, eddy hot plate, and check emesis methods. In the standard condition methods, 78.05%, 76.75% inhibition in anti-emetic, anti- inflammatory and in analgesic it shows significant effect. Malva neglecta Wallr. crude extract (Mn.Cr) possess anti-inflammatory, analgesic and antiemetic activities

Hepatitis B vaccination among primary health care workers in Northwest Pakistan

Background: We assessed hepatitis B vaccination and its determinants among health care workers (HCW) in rural Northwest Pakistan.Methods: This cross sectional study was conducted among 485 HCWs from both public and private clinics. Data about hepatitis B vaccination, socio-demographic, knowledge regarding modes of transmission of hepatitis B virus, perceived disease severity and benefits of vaccination was collected through questionnaire. Multivariable logistic regression analysis was performed.Results: Prevalence of complete hepatitis B vaccination was 40% (among Physicians with MBBS/MD qualification; 86% and lowest among non-qualified Dispensers;16%). Also, prevalence was higher among HCWs from public Dispensaries (77%) than those working in private clinics (35%). Being MBBS/MD Physician (Adj. OR 26.60; 95%CI 9.27-73.23), Non-MBBS/MD Physician (Adj.OR 1.89; 95%CI 0.78-4.59), qualified Dispensers (Adj. OR 3.58; 95%CI 1.34-9.54) compared to non-qualified Dispensers, working in public clinics (Adj. OR 2.54; 95%CI 1.13-5.69) as compared to private, perceived disease threat after exposure to blood and body fluids (Adj. OR 1.11; 95%CI 1.03-1.19) and perceived benefits of hepatitis B vaccination (Adj. OR 1.13; 95%CI 1.09-1.19) were significant predictors of complete hepatitis B vaccination.CONCLUSION: Improved perception of disease threat and benefits of vaccination and qualification of HCWs are associated with hepatitis B vaccination among Primary HCWs

Socio-economic effects of COVID-19 – a study of the University students and teachers in Pakistan

Background: Coronavirus Disease-2019 (COVID–19) has appeared as a deadly pandemic affecting most of the countries across the world. The disease has caught humanity unprepared; therefore, there has been a lack of awareness about the causes, and transmission and mortality rates. It has also affected the overall socioeconomics from individual to worldwide levels. COVID-19 is an unprecedented and first-time challenge for Pakistan and a lockdown imposed by the Government of Pakistan has further devastated the economy of the country. This online survey was conducted to know the effects of the Covid-19 pandemic on the social life and economic status of the people of Pakistan. In this article, we mainly focused on teachers and students from different Universities of Pakistan for data generation because they can provide better information due to the use of modern technologies as a source of information.Methods: An online questionnaire survey covering 11 parameters including age, gender, employment status, mortality rate, education, marital status and, information about the pathogen responsible for the disease was filled by 1260 individuals from Pakistan.Results: The results obtained show that 56.6% of the responders were males,43.4% were females, 59.9% were unmarried, 37.7% were graduate students and, 48.7% unemployed. Most of the responders (55.6%) said that COVID-19 negatively affected the jobs of the people. We found (93%) of the responders with good knowledge about COVID-19.Conclusion: We conclude from the results that most of the responders were males, educated and they knew the pathogenic effect of the COVID-19 virus on humans. These results also show that the disease has drastically affected the economy and social life of the people of Pakistan.Keywords: Coronavirus; COVID-19; Knowledge; Socio-economic; Pakistan

Community centred co-design methodology for designing and implementing socio-behavioural interventions to counter COVID-19 related misinformation among marginalized population living in the squatter settlements of Karachi, Pakistan: A methodology paper

Background: Misinformation regarding COVID-19 pandemic and vaccination is damaging COVID-19 vaccine trust and acceptance in Low- and Middle-Income Countries (LMIC). Identification of misinformation and designing locally acceptable solutions are needed to improve COVID-19 vaccine acceptance. This study aimed to utilize community-led co-design methodology to evaluate misinformation regarding COVID-19 and develop contextual interventions to address misinformation in a marginalized peri urban slum communities of Landhi town Karachi, Pakistan.Methods: This study was conducted between January and December 2021, in marginalized peri-urban slum dwellers of Muslimabad Colony, Landhi Town Karachi, Pakistan. We used a community-centred co-design methodology embedded within mixed study design to identify misinformation, co-design, test and implement locally acceptable solutions. The co-design methodology involved five stages of the design thinking model: (1) Empathize, (2) Define, (3) Ideate, (4) Prototype, and (5) Test. The project involved active engagement and participation of wide range of stakeholders and community beneficiaries (end users) including local EPI vaccinators, informal healthcare workers, religious leaders (male and female), schoolteachers (male and female), local government representatives, community leaders, housewives, youth, and general population. To develop a trusting relationship, and understand local culture, values, practices, and traditions, we allowed one month of observation period (observe, engage, watch, and listen) in the beginning, followed by door-to-door survey along with focus group discussions (FGD) and in-depth interviews (IDI) at baseline. Co-design workshops (separate for male and female) were conducted at each stage of co-design methodology to design and test locally acceptable solutions.Conclusion: Community-centred co-design methodology was not only successful in designing, testing, and evaluating locally acceptable solutions but it also actively engaged and empowered the marginalized population living in peri urban slum communities of Karachi, Pakistan