Incidence, patterns and associated factors for occupational injuries among agricultural workers in a developing country

Background: Injuries are common among agricultural workers, and a large section of the population is employed in agriculture worldwide. We aimed to determine the incidence, patterns and associated risk factors of occupational injuries among the agricultural workers in a developing country. Methods: A cross-sectional study in Hyderabad, Pakistan was conducted from December 2012 to February 2013. Information was collected about incidence, pattern and associated risk factors of occupational injuries from 472 agricultural workers. Injury incidence and patterns for place, severity, type, agent, parts of body affected and work activity were calculated. Analysis was performed using SPSS version 19.0. Multivariate logistic regression was performed to calculate the adjusted odds ratio (OR) with 95% confidence interval, to identify the putative risk factors for occupational injuries. Results: Incidence of occupational injuries was 35.0 per 100 per year (95% CI: 28.9 - 42.7). Cuts (70%) and hand tools (71%) were the most common type and agent for injury, respectively. Majority of injuries occurred during harvesting (55%). Increasing age [AOR 1.03 (95% CI: 1.01 - 1.05)], income \u3c6000PKR/month [AOR 2.27 (95% CI: 1.08 - 4.76)] and driving tractor [AOR 2.58 (95% CI: 1.25 -5.33)] increase the risk for injuries. Conclusion: There was a high burden of injuries among the agricultural workers in Pakistan. Large-scale studies are required to further characterize the risk of injuries and develop preventive strategies to protect agricultural workers

Inculcating health awareness in Karachi, Pakistan: How innovative, socially acceptable methods can help combat communicable diseases of poverty

In the megacity of Karachi, which has a population of more than 24 million, more than 9.2 million people (approximately 40 per cent) live in squatter settlements. Communities here are characterised by low socioeconomic settings, crowded living conditions, inadequate water and sanitation facilities, and poor health-related behaviours. Such conditions create an environment favourable to the spread of communicable diseases like tuberculosis (TB), hepatitis and dengue. Since 1985, the Department of Community Health Sciences at the Aga Khan University, Karachi, Pakistan has run the Urban Health Program (UHP), a community-campus partnership operating in these disadvantaged squatter settlements. Recent explosive increases in the spread of dengue, hepatitis and TB, however, necessitated special attention and activities on a scale and pace that was greater than could be accommodated as part of UHP’s core work. Thus, having an already well-established collaborative model with social accountability measures in place, a dedicated mass awareness program was initiated over the course of one year, from mid 2015: the AGAHI project. This article describes AGAHI’s innovative, low-cost, collaborative activities conducted in partnership with two squatter communities, Sultanabad and Rehri Goth, to build health awareness, improved care-seeking and compliance to treatment. Activities ranged from school sessions, role plays and awareness walks to laneway meetings, training of health care workers, door-to-door campaigns and collaboration with local religious leaders, public sector groups and NGOs. Building on the collaborative work of the UHP, in just 12 months AGAHI was able to conduct 80 health awareness sessions with 4000 participants. Moreover, high-risk and vulnerable populations were identified and referred for further treatment. A comparative cross-sectional survey afterwards revealed a significant increase in knowledge among Sultanabad residents as compared to the neighbouring settlement of Hijrat Colony. As a result, this article suggests that the need for and efficacy of targeted health awareness campaigns against the major infectious diseases of poverty cannot be overemphasised. By adopting community-based participatory models, couched in a framework of social accountability, activities that are low cost, innovative and scientifically robust hold real potential for improving health awareness in vulnerable megacities like Karachi

Unintended Pregnancies among Married Women in Sindh Pakistan: Role of Lady Health Workers

Background: Unintended pregnancies, which pose substantial risks to both mothers and children, account for 24% of all pregnancies in Pakistan. Door to door visits and service provision by lady health workers (LHWs) may be related to the reduction of such pregnancies, particularly in rural areas. This study aimed to determine the association of knowledge about Lady Health Visitors (LHWs) and door to door visits by LHWs with unintended pregnancies among rural women.Methods: We conducted a community-based, nested case-control study of 800 pregnant women, identified from the database of an active surveillance mechanism, which registers and follows all pregnant women in the catchment area. Women who were enrolled during the first trimester and reported their pregnancy to be unintended were selected as cases from the database (n=200). Women whose pregnancies were intended served as controls (n=600). Logistic regression was used for analysis.Results: Knowledge about LHWs and door to door visits by LHWs had no significant association with unintended pregnancies OR=1.11(95%CI: 0.74-1.66) and OR=1.03 (95%CI: 0.67-1.58) respectively. Other factors associated with unintended pregnancy were higher knowledge and use of family planning, maternal age, having at least one son, spousal opposition to family planning and limited spousal education.Conclusion: Results suggest that Family planning strategies need to target old aged women and address the role of men in addition to improving coverage and quality of Family planning services

Comparing lung function of textile workers with the healthy Pakistani population

Background: The purpose of this study was to compare lung function of textile workers with healthy Pakistani population, compare predicted values based on the European Respiratory Society (ERS) equations with those based on the Pakistani equations, and to develop predictor equations for textile workers in Pakistan.Methods: This was a secondary analysis of data from two previous surveys where lung function of textile workers was compared with healthy Pakistani men. Spirometry was performed according to the American Thoracic Society guidelines. Independent sample t-test was used to compare the lung function parameters and multivariate linear regression was used to develop predictor equations.Results: There were significant differences in lung function of textile workers (FVC: 4.1 L, FEV1: 3.3 L and FEV1/FVC: 0.8) compared to healthy Pakistani men (FVC: 3.9 L, FEV1: 4.1 L and FEV1/FVC: 1.04). ERS reference equations tended to under-diagnose abnormal lung function, 16.9% versus 25.3% (p\u3c0.01). Predictor equations for Pakistani textile workers were also developed.Conclusion: Lung function of textile workers was significantly reduced compared to healthy population. Use of ERS reference equations for Pakistani textile workers may not provide appropriate interpretation

Maternal predictors of intrauterine growth retardation

Objective: To identify maternal factors associated with intrauterine growth restriction (IUGR).Study Design: A case-control study. Place and Duration of Study: Neonatal Unit of The Aga Khan Hospital for Women (AKHW), Karimabad, from January 2014 to December 2015.Methodology: Cases were IUGR live born babies (n=90), while control were appropriate-for-gestational age (AGA) babies (n=180). Information recorded in pre-designed proforma included gestational age and birth weight of baby, demographics of mothers, pregnancy related medical and obstetric complications. Data were analysed through SPSS-19. Multivariable logistic regression was used to determine the maternal factors associated with the intrauterine growth restriction.Results: Maternal factors associated with IUGR after adjusting for confounders in the multivariable model included younger age (OR=0.9, CI=0.8-0.9), poor gestational weight gain (OR=3.0, CI=1.6-6.1) and history of previous abortion (OR=3.06, CI=1.1-8.0). Significant interaction was found between pregnancy-induced hypertension (PIH) and parity of mother, primary-para mother with PIH having an increased risk for IUGR babies (OR=10.1, CI=1.0-23.2).Conclusion: Young age, primigravida status, low gestational weight gain, previous history of abortion, PIH and GDM have strong association with IUGR; hence, special consideration is essential to overcome these issues in order to improve maternal and neonatal health

Engaging general practitioners in public–private mix tuberculosis DOTS program in an urban area in Pakistan need for context-specific approach

A public–private mix tuberculosis (TB) DOTS project was implemented to enhance coverage and collaboration between the public and private sectors, with an objective to increase case detection and to improve TB case management in a large urban area. General practitioners (GPs) were trained to provide DOTS services. Patients were diagnosed and treated as per national guidelines and outcomes were reported to national TB control program. Treatment and sputum microscopy were provided free of cost. A total of 94 GPs were trained. In all, 57.4% of trained GPs remained actively involved in the project. Overall treatment success rate of the patients enrolled with the project was 86.3% with 8.7% default patients. Experience suggests that a more stringent selection criteria need to be followed for inclusion of GPs in the program to improve the success of the program. A multifaceted context specific approach is needed while working with private health care providers

Epidemiology of asthma and associated factors in an urban Pakistani population: Adult asthma study-Karachi

Background: This study was conducted in order to determine the prevalence of asthma and associated risk factors in the adult population of Karachi, Pakistan.Methods: This multi-stage, cross-sectional survey was conducted from May 2014-August 2015; comprising 1629 adults in 75 randomly selected clusters in Karachi, Pakistan. Definitions included: \u27self-reported asthma\u27, \u27reversibility in FEV1\u27 and \u27respiratory symptoms and reversibility in FEV1\u27.Results: Prevalence of asthma was 1.8% (self-reported) (95% CI: 1.0-2.6), 11.3% (reversibility in FEV1) (95% CI: 9.4-13.3) and 6.6% (symptoms and reversibility in FEV1) (95% CI: 5.1-8.1). Asthmatics were more likely to belong to the age group ≥38 years according to \u27reversibility in FEV1\u27 and \u27respiratory symptoms and reversibility in FEV1\u27 (AOR: 1.9, 95% CI: 1.2-3.3) and (AOR: 2.1, 95% CI: 1.1-4.2), respectively. Asthmatics were more likely to report history of allergies (AOR: 1.9, 95% CI: 1.2-2.9) and (AOR: 2.8, 95% CI: 1.7-4.8); and were exposed to environmental tobacco smoke (AOR: 1.6, 95% CI: 1.1-2.5) and (AOR: 1.9, 95% CI: 1.1-3.3) according to \u27reversibility in FEV1\u27 and \u27respiratory symptoms and reversibility in FEV1\u27, respectively. Asthmatics were more likely to report pack years of smoking ≥5 (AOR: 2.3, 95% CI: 1.1-4.7) according to \u27respiratory symptoms and reversibility in FEV1\u27.Conclusion: This study reports a high prevalence of asthma among Pakistani adults and calls for developing appropriate public health policies for prevention and control of asthma in the country. Further studies should be conducted to determine the national prevalence as well as follow-up studies to identify preventable causes for adult asthma

Preablation Stimulated Thyroglobulin/TSH Ratio as a Predictor of Successful I(131)Remnant Ablation in Patients with Differentiated Thyroid Cancer following Total Thyroidectomy

Background. About 90% of thyroid cancers are differentiated thyroid cancers. Standard treatment is total thyroidectomy followed by radioactive I(131)remnant ablation and TSH suppression with thyroxine. Unsuccessful ablation drastically affects the prognosis of patients with DTC particularly high risk individuals; therefore, identifying the factors that affect the success of ablation is important in the management of patients with DTC. sTg is a good predictor of successful ablation in DTC. Its levels can be influenced by tumor staging and TSH values, as well as other factors. Therefore, we did this study using TSH to correct the predictive value of sTg in success of RRA. Methods. We retrospectively reviewed the records of 75 patients with DTC, who underwent total thyroidectomy followed by RRA and TSH suppression. Results. Preablation sTg and sTg/TSH ratio are significantly associated with ablation outcome. Cutoff value for sTg to predict successful and unsuccessful ablation was 18ng/mL with 76.7% sensitivity and 79.1% specificity, while for sTg/TSH cutoff was 0.35 with 81.4% sensitivity and 81.5% specificity (P \u3c 0.001). Association was stronger for sTg/TSH ratio with adjusted odds ratio (AOR) 11.64 (2.43-55.61) than for sTg with AOR 5.42 (1.18-24.88). Conclusions. Preablation sTg/TSH ratio can be considered as better predictor of ablation outcome than sTg, tumor size, and capsular invasion

Prevalence and Risk Factors of Falls Among the Elderly in Unaizah City, Saudi Arabia

Objectives: Falls and fall-related consequences are a major public health problem in the elderly. This study aimed to measure the prevalence of falls and fall-related risk factors among elderly individuals in Saudi Arabia. Methods: This cross-sectional study was conducted between January and October 2019 among 280 elderly patients aged >60 years old attending 10 randomly selected primary healthcare centres in Unaizah City, Qassim Province, Saudi Arabia. Data were collected using the validated 10-item Missouri Alliance for Home Care (MAHC-10) fall risk assessment tool. Results: A total of 269 participants were included in the study (response rate: 96.1%). The prevalence of falls over the preceding year was 31.6%. Females fell more frequently than males (34.5% versus 28.5%) and most falls occurred indoors (84.7%). Various risk factors were associated with fall risk including being aged >80 years (adjusted odds ratio [aOR]: 5.17, 95% confidence interval [CI]: 1.66–16.14), polypharmacy (aOR: 2.40, 95% CI: 1.01–5.71) and environmental factors (aOR: 2.79, 95% CI: 1.24–6.28). However, more educated participants had a lower risk of falling (aOR: 0.26, 95% CI: 0.09–0.77). There was also a significant association with the MAHC-10 fall risk score (P = 0.043). Conclusion: There was a high prevalence of falls among the elderly in Unaizah City. Various factors were associated with falls including advanced age, polypharmacy, age-related changes and environmental factors. As the majority of fall events occurred indoors, home safety improvements are recommended. Moreover, additional larger-scale research is necessary regarding fall-related risk factors and fall prevention initiatives among elderly individuals in Saudi Arabia.   KEYWORDS Elderly; Falls; Geriatrics; Public Health; Prevalence; Risk Factors; Saudi Arabia