Risk behaviours associated with urethritis and genital ulcer disease in prison inmates, Sindh, Pakistan

We evaluated the epidemiological differences with respect to demographics, drug use and sexual behaviours associated with lifetime risk of urethritis, genital ulcer disease (GUD) and urethritis and GUD together among 3395 male prisoners in Sindh. Factors associated with urethritis and GUD alone were sex with multiple females, sex with men, and ethnicity. Additional factors associated with urethritis alone were sex with prostitutes, sex with partners having multiple partners and sex with partners believed to be injecting drugs. Behaviours associated with lifetime risk for urethritis and GUD together were sex with multiple females, sex with prostitutes, sex with men, sex with partners believed to be injecting drugs and ethnicity. These relationships were consistently stronger compared to urethritis or GUD alone

Multivariate analysis of risk factors associated with genital ulcer disease among incarcerated males in Sindh

Objective: To evaluate the potential risk behaviors associated with the lifetime risk of self reported genital ulcer disease (GUD) among prison inmates.SETTING: Prison inmates from 14 prisons of Sindh Province.Methods: A cross-sectional study was conducted on 3395 prison inmates during July to December, 1994. A questionnaire was used to assess the lifetime risk of self-reported GUD (whether or not the subject was ever affected with GUD up to present age) and to investigate demographic markers and risk behaviors for their possible association with lifetime risk of GUD using logistic regression analysis.Results: The reported lifetime risk of GUD in the study sample was 11.4% (386/3395). In final multivariate logistic regression model the sexual behaviors which were independently associated with GUD were having sexual intercourse with female (adjusted OR = 1.7; 95% CI: 1.3-2.3, P = 0.0002), sexual intercourse with a prostitute (adjusted OR = 1.5; 95% CI: 1.2-2.0, P = 0.0008), sexual intercourse with man (adjusted OR = 2.2; 95% CI: 1.7-2.7, P = \u3c 0.001) and sexual intercourse with man during current incarceration (adjusted OR = 1.9; 95% CI: 1.2-2.9, P = 0.0071).CONCLUSION: Health education needs to re-enforce monogamous relationship for high risk groups such as in our study. Although infrequent condom use was not a risk factor for GUD in this study, yet based on the results of previous studies, promotion of condom use should be the component of health education program

Risk behaviours associated with urethritis in prison inmates, Sindh

Objective: To identify sexual risk behaviours associated with lifetime risk of urethritis in prison inmates.Design: A cross-sectional study using a pre-designed questionnaire.SETTING: Fourteen prisons throughout the Sindh Province, Pakistan.SUBJECTS: Three thousand three hundred ninety-five prison inmates incarcerated during July, 1994.MAIN OUTCOME MEASURE: Lifetime risk of urethritis occurrence (whether or not the subject was ever affected with urethritis up to his present age)Results: Lifetime risk of urethritis occurrence in the study population was 20.8% (706/3395). The final multivariate logistic regression model indicated that risk behaviours associated with lifetime risk of urethritis in this population were \u27sexual intercourse with a female\u27 (adjusted OR = 2.18; 95% CI 1.60, 2.95), \u27multiple female sexual partners\u27 (adjusted OR = 1.67; 95% CI 1.28, 2.18) and \u27sexual intercourse with man\u27 (adjusted OR = 2.75; 95% CI 2.29, 3.31).CONCLUSION: The prevalence of urethritis in this population was very high. High prevalence of various risky sexual behaviours among inmates indicates, their unawareness as to what precautions they might take to avoid risk of acquiring STDs including HIV. The study subjects meet the characteristics of a core group of STDs transmitters and provides short window of opportunity for STD/HIV control programs to intervene, while they are in detention to reduce the risk not only for this group but also for general population

Recall errors in a weekly survey of diarrhoea in Guatemala: determining the optimal length of recall

We measured the recall error, optimal recall length and factors associated with diarrhoea in a weekly survey. Data was taken from a year-long randomized controlled trial in which characteristics of diarrhoeal episodes were recorded weekly. We labelled the recall period as days 1-6, day I being the day before the visit. Recall error was the percentage difference between the number of episodes reported to begin on a particular day and the mean for days I and 2. Generalized estimating equations were used to determine associations. Recall error was 37% on day 3 and 51% on day 5. The error was less in younger children (by 10%), severe episodes (by 29%) and when blood was present in the stool (by 18%). Diarrhoea was underreported when the recall period extended beyond 2 days. Surveys that use longer recall periods risk underestimating diarrhoea incidence and selectively capturing more severe episodes

Prevalence of plasmodium slide positivity among the children treated for malaria, Jhangara, Sindh

Objective: The aim of the study was to estimate the prevalence of malaria amongst the children with fever or history of fever.SETTING: Rural Health Centre (RHC), Jhangara, a town near the Manchhar Lake in Taluka Sehwan, District Dadu, Sindh.SUBJECTS: Four hundred and thirty eight children of 6 months to 10 years of age, who attended above described RHC during August through October 1997.Methods: A Sindhi-translated standard questionnaire was used to record symptoms and duration of child\u27s illness. Each child was physically examined, had their axillary temperature measured; and blood samples were collected from which Giemsa stained thick and thin blood films were examined for presence of Plasmodium parasites.Results: The median age of the studied children was 24 months and 57% (250/438) were boys. Fifty three percent (231) of the study subjects were from Jhangara Town, 40% (177) and 7% (30) came from other villages and villages near to the Manchhar Lake respectively. The prevalence of Plasmodium slide positivity was 5.9% (26/438). Among Plasmodium slide positive children, 65% (17/26) were positive for P. falciparum and 35% (9/26) for P. vivax. Among the P. falciparum positive children, 88% (15/26) had scanty (MP, 1-10/100 fields) and 12% (2/26) had moderate density (MP, 10-100/100 fields) of infection. Seventeen percent (6/30) of the children from villages close to Manchhar Lake were Plasmodium slide positive compared to 7% (17/53) and 3% (5/177) from Jhangara town and other villages respectively. Cough, diarrhea, abdominal distention and vomiting were the commonly reported symptoms among the children of all ages at the time of interview. Guardians reported fever as part of the illness in all children, although during physical examination only 128 (29%) had axillary temperature \u3e or = 37.5 degrees C. Pallor as an indicator for anemia, rash and prickly heat were the major recorded observations.CONCLUSION: The Prevalence of Plasmodium positivity was higher in children who attended from villages close to Manchhar lake, therefore especial measure needs to be considered for this area. In addition, the health care workers in rural Sindh need to adopt appropriate guidelines to differentiate the clinical malarial patients from patients with other potential infectious diseases, which may need other treatment

Smoking among males in a low socioeconomic area of Karachi

Approximately half of the families in Pakistan reported having at least one smoker in 1992. Smokers were less educated, poorer and more likely to come from a rural background than non-smokers. The proportion of family earnings in poor families with marginal incomes, may be substantial. We conducted this survey to determine the prevalence of cigarette smoking in males over 15 years of age in Azam Basti, an urban squatter settlement of Karachi where 31% of the children less than 5 years old were malnourished. A pretested, structured questionnaire was administered to males aged fifteen years and above, from randomly selected homes in Azam Basti. In our sample of 102 persons the respondents were 38 years old on average, and earned about Rs. 4,500 (US $130) per month. Persons with 10 or more years of education were thrice as likely to have never smoked as compared to those with less than ten years of schooling, (OR = 3.6, 95$140) (OR = 2.4, 95% confidence interval 0.8, 7.3). Smoking is common in urban squatter settlements in Pakistan. Parental smoking and its relationship with malnutrition in children under five is not well documented or publicized, even though there is evidence that it has a contribution. We propose that primary health care programs consider smoking prevention and cessation as community based interventions

Out-of-pocket expenses borne by the users of obstetric services at government hospitals in Karachi, Pakistan

Objective: Financing health services is a challenge for health policy makers world over, especially in developing countries. Alternate mechanisms such as user fees are being proposed. However, there is a feeling that in developing countries, users of government hospitals spend appreciable personal income to obtain free services at these facilities.Methods: This study aimed to measure the extent and the factors associated with of out-of-pocket expenses borne by the users of obstetric care at government hospitals. It also aimed to determine willingness of consumers to bear out of pocket expenses. It was conducted in three government hospitals in Karachi.Results: Seven hundred cases were registered in the study. Sixty-five percent of them had a monthly household income of less than Rupees (Rs.) 3000. Overall, users spent mean of Rs. 590 as out-of-pocket expenses for obstetric services. Of this Rs. 330 was spent on drugs and Rs. 24 on user fees. Thirty-nine percent of the patients were willing to spend out of pocket for services provided at government hospital and 39% declined to do so. Of the patients indicating willingness to spend, 98% agreed to do so for drugs.CONCLUSION: The results suggest that considerable expenses are borne out of pocket by the users of government hospitals for supposedly free services . If user fees are to be increased the government needs to provide services for which the people will pay, such as drugs, otherwise increase in this fees will simply add to financial burden on the users

Patients\u27 perceptions of blood transfusion risks in Karachi, Pakistan

Objective: To evaluate the understanding of and attitudes toward risks of blood transfusions among transfusion recipients in Karachi.Methods: One hundred forty-one transfusion recipients from 13 major Karachi hospitals were interviewed. Indications for transfusion were obtained by reviewing the patients\u27 medical records.Results: The most common indications for transfusion were surgical complications (n = 77, 55%), anemia (n = 34, 24%), and generalized weakness (n = 15, 11%). Most recipients (n = 103, 80%) had never heard of viral hepatitis, and 44 (31%) had never heard of acquired immunodeficiency syndrome (AIDS). Ninety-four recipients (66%) believed that generalized weakness was a valid indication for blood transfusion. Sixty-nine recipients (49%) were not willing to pay an increased price for blood that was screened for blood-borne pathogens.CONCLUSIONS: Blood recipients in Karachi are unaware of the risks of transfusions, and the reasons given by the ordering physician for many of the transfusions were not consistent with international guidelines. Steps to educate the public about the risks of transfusions and practitioners about the indications for transfusion could prevent blood-borne virus transmission in Karachi

Expansion of epidemic dengue viral infections to Pakistan

Objectives: Antibodies to dengue viruses have occasionally been reported in individuals in Pakistan, but the frequency of occurrence of dengue infection in Pakistan is unclear. The first confirmed dengue hemorrhagic fever outbreak in Pakistan occurred in 1994. In October 1995, the authors investigated an outbreak of a febrile illness among employees of a construction contractor at a power generation plant in Baluchistan, Pakistan, to determine the cause of illness and recommend appropriate preventive measures.Methods: The work site and living arrangements were inspected, a questionnaire was administered, and serum samples were collected from all consenting contractor employees and their families if they lived at the camp. Sera were analyzed for IgM against dengue virus, using an enzyme-linked immunosorbent assay.Results: Interviews were conducted with 76 persons (mean age, 42y); 95% were men. Forty-two persons (55%) reported having experienced fever, headache, or myalgia in the preceding 6 weeks. Fifty-seven subjects (75%) had IgM antibodies against at least one dengue serotype; 45 subjects (59%) had IgM antibodies against dengue serotype 2.CONCLUSION: This was an outbreak of dengue fever due to multiple serotypes of dengue virus. This confirms that epidemic dengue infection was present in southern Pakistan for 2 consecutive years