Nutritional status and physical abuse among the children involved in domestic labour in Karachi Pakistan: a cross-sectional survey.

OBJECTIVE: To determine the prevalence of physical abuse among domestic child labours and to assess the nutritional status by calculating the Body Mass Index of children involved in domestic labour in Karachi. METHODS: A cross sectional study was conducted in the squatter settlements of Karachi. Questionnaire based interviews were conducted to capture physical abuse with 385 children who worked as domestic labour in the household of their employer. The ages of the children were between 10 to 14 years belonging to both genders. The children were enrolled in study by snow-ball sampling technique. RESULTS: The overall prevalence of physical abuse among domestic child labour in Karachi was found to be 8.3 %. Over 9 % had low weight and about 90% were stunted. This study also highlighted that 95% of the children involved in domestic labour perform overtime work in their employer\u27s home, more than once per week. CONCLUSIONS: There is high burden of physical abuse among the domestic child labour and these children are malnourished. There is a need to recognize and regulate this form of labour in Pakistan

Gender differences and clustering pattern of behavioural risk factors for chronic non-communicable diseases: community-based study from a developing country.

Objectives: This study estimates the burden of behavioural risk factors for chronic non-communicable diseases (CNDs) to evaluate the degree of clustering and the differential of these factors by gender in adults. Methods: In a community-based survey, information was obtained about behavioural risk factors for CNDs among 534 adults in Karachi, Pakistan. Chi-square test and odds ratio (OR) with 95% confidence interval (CI) were calculated to evaluate the differences of these factors by gender. Results: Overall, 22.5% of adults had anxiety/depression, 47.8% did not have adequate intake of fruits and vegetables, 60.1% were physically inactive while 49.8% were overweight/obese. More women had anxiety/ depression (OR = 2.1, 95% CI = 1.4-3.1), were physically inactive (OR=2.1, 95% CI = 1.5-3.1) and overweight/ obese (OR= 6.2, 95% CI = 4.3-9.1). On the contrary, greater number of men were found to have inadequate fruit and vegetable consumption (OR = 1.8, 95% CI = 1.3-2.5). Only 1.1% of study subjects had none of the studied risk factors, 16.9% had one while 82% had \u3e or =2 factors. The clustering of these risk factors was significantly higher in women (

Resource allocation within the National AIDS Control Program of Pakistan: a qualitative assessment of decision maker\u27s opinions

Background: Limited resources, whether public or private, demand prioritisation among competing needs to maximise productivity. With a substantial increase in the number of reported HIV cases, little work has been done to understand how resources have been distributed and what factors may have influenced allocation within the newly introduced Enhanced National AIDS Control Program of Pakistan. The objective of this study was to identify perceptions of decision makers about the process of resource allocation within Pakistan\u27s Enhanced National AIDS Control Program. Methods: A qualitative study was undertaken and in-depth interviews of decision makers at provincial and federal levels responsible to allocate resources within the program were conducted. Results: HIV was not considered a priority issue by all study participants and external funding for the program was thought to have been accepted because of poor foreign currency reserves and donor agency influence rather than local need. Political influences from the federal government and donor agencies were thought to manipulate distribution of funds within the program. These influences were thought to occur despite the existence of a well-laid out procedure to determine allocation of public resources. Lack of collaboration among departments involved in decision making, a pervasive lack of technical expertise, paucity of information and an atmosphere of ad hoc decision making were thought to reduce resistance to external pressures. Conclusion: Development of a unified program vision through a consultative process and advocacy is necessary to understand goals to be achieved, to enhance program ownership and develop consensus about how money and effort should be directed. Enhancing public sector expertise in planning and budgeting is essential not just for the program, but also to reduce reliance on external agencies for technical support. Strengthening available databases for effective decision making is required to make financial allocations based on real, rather than perceived needs. With a large part of HIV program funding dedicated to public-private partnerships, it becomes imperative to develop public sector capacity to administer contracts, coordinate and monitor activities of the non-governmental sector

Use of fresh parental fibular allograft for reconstruction of skeletal defects after limb salvage surgery

Abstract OBJECTIVE: To share early experience with paediatric patients having undergone skeletal reconstruction after limb salvage surgery. METHODS: A reterorespective audit study was conducted at Aga Khan University Hospital, Karachi, from 1994 to 2011 An audit of the institutional tumour registry was done and relevant cases of paediatric patients having undergone skeletal reconstruction after limbsalvage surgery were tracked. Outcomes were objectively assessed through Musculoskeletal Tumour Society score. International Society of Limb Salvage grading was used to measure union of the graft to the host bone. RESULTS: Of the total 9 patients, 5(55.6%) were males and 4(44.4%) were females with an overall mean age of 11±3 SD years (range: 7-14 years). Six (66.7%) cases involved lower limbs, while 2(22.2%) cases involved upper limbs. The mean follow-up was 41±3SD months (range: 14-204 months). There was no tissue reaction observed locally or systemically. No local recurrence was seen. Mean Musculoskeletal Tumor Society score was 21.2±3 SD and International Society Of Limb Salvage grading was excellent in 5(55.5%) patients and good in 2(22.2%). One (11.1%) fibula fractured due to non-union at the proximal site. One (11.1%) patient died of the disease. Donor site morbidity was minimum except a big toe drop in 1(11%) case. CONCLUSIONS: Parental fresh fibular allografts provide a good alternative for skeletal reconstruction. Donor site morbidity was minimal

Health systems readiness for adopting mhealth interventions for addressing non-communicable diseases in low- and middle-income countries: A current debate

In low-and-middle-income countries, epidemiologic transition is taking place very rapidly from communicable diseases to non-communicable diseases. NCDs mortality rates are increasing faster and nearly 80% of NCDs deaths occur in LMICs. Existing weak health systems of LMICs are undergoing a devastating human and economic toll as a result of increasing treatment costs and losses to productivity from NCDs. At the same time, the increasing penetration of mobile phone technology and the spread of cellular network and infrastructure have led to the introduction of the mHealth field. While mHealth field offers a great promise to prevent and control non-communicable diseases in low-and-middle-income countries: there is a great debate going on to explore health systems readiness for adopting mHealth technology to address NCDs in LMICs. There are a number of factors which determine health systems readiness and response for adoption of mHealth technology including preparedness of healthcare institutions, availability of the resources, willingness of healthcare providers and communities. We have discussed these factors to understand health systems preparedness to adopt mHealth field for prevention and control of NCDs. To adequately integrate mobile-phone-based health interventions into existing health systems, these factors should be dealt up-front through constant effort to improve health systems response for NCDs. Currently, there is insufficient empirical and policy evidence on this research area and therefore future research and policy dialogue should be directed to assess the health systems willingness for mHealth adoption principally to address NCDs in the context of LMICs

Thirty years of Alma Ata pledges: is devolution in Pakistan an opportunity for rekindling primary health care?

The 1978 Alma Ata Conference presented the manifesto to attain global health for the next century by providing basic health care aimed at the urban and rural poor of the developing world. While the goals of Alma Ata were noble, they were untenable. Today, developing countries face serious issues of equity in health care delivery and fairness in health care management with even a greater need to transform the management systems and practice. Primary health care remains a cornerstone of building the capacity of health systems. Devolution in health sector in Pakistan seems like a chance to re-exert Alma Ata agenda. To achieve the millennium development goals by 2015, revitalization and effective implementation of primary health care will be a vital reform

Knowledge and beliefs of adolescents regarding sexually transmitted infections and HIV/AIDS in a rural district in Pakistan

Objective: To assess the knowledge and beliefs of adolescents (15-19 years girls and boys) regarding sexually transmitted infections (STIs) and HIV/AIDS. Methods: A community based cross-sectional survey was conducted in October 2002 in a rural district (Mirpurkhas) of Sindh province, Pakistan. Results: A total of 428 adolescent girls and boys were interviewed. Only 44% correctly named at least one STI, while 55% knew at least two modes of transmission for HIV/AIDS. Adolescents with education greater than or equal to secondary level, those who were able to read the newspaper, possessed electricity in their homes and were allowed to meet their friends once in six months had significantly more HIV/AIDS knowledge. Conclusion: We conclude that rural adolescents of Sindh need more knowledge regarding STIs including HIV/AIDS. There is a need to formulate strategies to raise the levels of awareness and knowledge among adolescents regarding these conditions. Our findings indirectly support the use of mass media and peer education strategies to provide factual information to adolescent

Prevalence of hepatitis B virus infection among barbers and their knowledge, attitude and practices in the district of Sukkur, Sindh .

Abstract OBJECTIVES: Several occupations in developing countries lag behind in ensuring the safety of their workers in occupational settings. Lack of implementation of safety guidelines at workplaces can expose workers to health risks. In Pakistan, barbers are one of the un-regulated occupational groups. Low literacy, increased frequency of direct skin contact and blade/razors use can expose barbers to body fluids including blood of the customers. We conducted this study in order to determine hepatitis B virus (HBV) prevalence among barbers and their knowledge, attitude and practices in a peri-urban district of Sindh. MATERIAL AND METHODS: Three hundred eighty-five barbers from the Sukkur district were interviewed using a structured questionnaire. Blood samples were collected and tested for HBsAg. A scale was built to determine the proportions of responses to knowledge, attitude and practice items. RESULTS: The prevalence of HBV among barbers was 2.1%. The barbers\u27 knowledge on HBV and its transmission routes was poor. The response to attitude items was good, except that only 35.1% of the participants agreed to have vaccination against HBV. The overall performance on the knowledge and practice scales was poor compared to the attitude scale on which 80% of the barbers performed well. CONCLUSION: The prevalence of HBV among barbers was lower compared to the available national figures for the prevalence among the general population

Chronic bronchitis and chronic obstructive pulmonary disease (COPD) among textile workers in Karachi, Pakistan

Objective: To determine the frequency and predictors of chronic bronchitis and COPD among textile workers in Karachi, Pakistan.Study design: Cross-sectional survey.Place and duration of study: Karachi, Pakistan, from October to December 2009.Methodology: Male textile workers from 15 mills of Karachi were inducted. Data was collected using American Thoracic Society respiratory questionnaire (ATS-DLD-78-a) and spirometry.Results: Out of 372 participants, 29 (7.8%) workers had chronic bronchitis (4, 9.1% aged ≥40 years) and 25 (6.7%) had COPD (12, 27.2% aged ≥40 years). Workers with chronic bronchitis had significantly decreased lung function compared to the healthy workers. Those reporting severe self-perceived dust exposure at work, ≥ 10 pack years of smoking, uneducated, longer duration of work (≥11 years), and ever smokers were more likely to have chronic bronchitis or COPD. In the multivariate analyses, severe self-perceived dust exposure at work (AOR = 7.4; 95% CI: 1.9, 28.0), family history of respiratory illness/symptoms (AOR = 4.8; 95% CI: 1.1, 20.9) and lack of education (AOR = 4.2; 95% CI: 1.1, 16.9) were significant predictors of chronic bronchitis. Duration of work ≥11 years (AOR = 5.5; 95% CI: 1.5, 19.7) and pack years of smoking ≥10 years (AOR = 3.5; 95% CI: 1.1, 11.7) were strong predictors for COPD.Conclusion: There is a high frequency of chronic bronchitis and COPD among textile workers. Multiple important predictors for prevention are identified