Identifying needs and barriers to diabetes education in patients with diabetes

Objective: To assess the needs, awareness and barriers to diabetes education for self management and to facilitate the initiation of an education programme promoting self care among diabetics and their families.Methods: A qualitative study was conducted among adult diabetics attending outpatient clinics in a tertiary care teaching hospital in Karachi, Pakistan. Semi-structured interviews were conducted on 27 subjects (11 men; 16 women) to identify dominant themes and priority issues.Results: Participants displayed great deal of variation with respect to level of knowledge and motivation for education. Most believed that diabetes was caused by stress. Family was perceived to be a source of positive support. Relative ease of adherence to pharmacological regimens as compared to diet and exercise was reported. Participants expressed frustration at chronicity of disease and fear of developing certain specific complications and inheritance by their children. Barriers to enhancing knowledge included \u27No need for further information\u27, distance from training institutions and other priorities.CONCLUSION: Knowledge, beliefs and fears about diabetes, family influence and accessibility of healthcare, affects management behaviours and learning. Understanding needs and expectations of people with diabetes is essential in initiating and improving the outcomes of education programme for diabetes self care

Childhood Injuries in Pakistan: Results from Two Communities

The study aimed at determining the incidence, nature, and extent of childhood injuries in two suburban and rural communities of Pakistan. The findings of the study are based on a cross-sectional survey of 2,292 children aged 1-8 years. Information was sought retrospectively from the primary caregiver on the occurrence of injury that required formal or informal medical consultation during the past three months. The incidence rate of non-fatal injuries that required care outside home for children aged 1-8 years was 19.7 injuries per 100 person (child)-years of exposure [95% confidence interval (CI) 16.41-23.51]: 26.5 injuries per 100 person (child)-years of exposure (95% CI 21.31-32.63) in the suburban area and 12.1 injuries per 100 person (child)-years of exposure (95% CI 8.68-16.66) in the rural area. The most common non-fatal injuries were falls (10.5 fall injuries per 100 person (child)-years of exposure), burns and scalds (3.5 burn injuries per 100 person (child)-years of exposure), and road traffic injuries (RTIs) (2 RTIs per 100 person (child)-years of exposure). One fatality due to drowning was also reported during the study period. The difference among sex was highly significant (p=0.03). Boys (60%) were at a higher risk of injuries compared to girls (40%). The data also revealed that 61% of the injuries took place inside the home. The magnitude of childhood injuries in the two communities was significant compared to the findings of the National Health Survey of Pakistan (1990–1994). The fact that the majority (61%) of the injuries occurred inside the home raises many questions in relation to the household hazards and adequacy of safety and child-proofing measures in these households. There is a need to develop community-based interventions, creating awareness about the consequences of childhood injuries and educating families about preventive measures to reduce the incidence of injuries during early and middle childhood

Non fatal injuries among infants: A pilot study

Objective: To determine the incidence, nature and the extent of infant injuries in two suburban and rural communities of Pakistan.Methods: The cross-sectional study was conducted on a cohort of 310 infants in suburban and rural communities of Pakistan in September 2007. The information was collected from primary care-givers based on any injury that had occurred to their infants during the preceding 3 months that required treatment at home or in a hospital.Result: The incidence of non-fatal injury for infants up to 1-year-old was found to be 19 injuries per 100 person (child) years of exposure (95% CI 9.90 - 27.21). In suburban area, the rate was 26 injuries/100 person (child) years (95 % CI 15.37 - 35.71), while in rural area, it was 13 injuries/100 person (child) years of exposure (95 % CI 4.79-18.39). Altogether, 13 episodes of injury were reported among infants in both the communities. The male to female infant ratio for injury was 1:2.2. Suburban area had more than double injuries compared to the rural area.Conclusion: The magnitude of infant injuries was quite significant, especially among suburban and female children. There is a dire need to develop community-based interventions creating awareness on the matter

The Effect of Breastfeeding on the Cognitive and Language Development of Children Under 3 Years of Age: Results of Balochistan-Early Childhood Development Project

Background: Breastfeeding is known to be an important factor in the overall growth and development of children. Breastfeeding is thought to lead to enhance cognitive and language development of a child. However, this association has not yet been scientifically and statistically established. This study aimed to explore this association in children under 3 years of age.Methods: This was a secondary data-analysis of the baseline data of “Balochistan – Early Childhood Development Project”. The final sample comprised of 604 children less than 3 years of age. The children were selected by three-stage stratified random sampling from three districts of Balochistan province; Gwadar, Quetta and Qilla Saifullah. The data for the duration of breastfeeding was categorized as less than 6 months, from 6 months to 12 months and greater than 12 months. The age appropriate language and cognitive development of children was assessed through the CDA (Care for development Appraisal) tool. We applied multivariate logistic regression model for the analysis.Results: In unadjusted analysis, children breastfed for more than 12 months were at an advantage for cognitive and language development (cOR=2.91, cOR=2.8; p\u3c0.05; respectively). After adjusting for a range of co-variates this developmental advantage decreased to aOR=2.42 for cognition and aOR=2.44 for language respectively (p\u3e\u3c0.05).Conclusions: The duration for which the child is breast-fed is integral for his language and cognitive development. Based on our findings we recommend that breastfeeding should be promoted for more than 12 months to bring out the maximum benefit in the language and cognitive development of a child

Missing Dimensions in Addressing Child Malnutrition in Pakistan: Lessons from the Tawana Experience

This article uses the Tawana Pakistan Project (TPP) as a case study of how to promote self?sustaining improvements in nutrition status. The programme used a participatory approach to mobilisation around malnutrition, had a transparent information system for monitoring resources, and brought a focus on deeper structural issues to the analysis of malnutrition. We argue that Tawana was cancelled because it did not provide sufficient opportunities for leakage and diversion. This amply illustrates the political nature of nutrition. Yet efforts to reduce malnutrition continue to focus primarily on technical fixes. For long?term change researchers and programme implementers will need to understand the political space they operate within. Tawana was not perfect but it offered a glimpse of a different way forward, one that struck a balance between inclusiveness and action; transparency and accountability; and health and social science perspectives. It affected politics and was undone by them. It is not too late to include these concepts and approaches in future nutrition policies and interventions

ENTREPRENEURIAL INTENTION OF BUSINESS STUDENTS IN PAKISTAN: MOTIVATIONS AND OBSTACLES

The aim of this study is to examine the entrepreneurial intention of Pakistani business students and the influence of motivators and obstacles of it. Total 637 final year graduates and post graduates business student of Hyderabad and Jamshoro districts participated in the survey. The data was accumulated through self-administrated questionnaires. To measure the reliability, Cronbach’s alpha and Kolmogorov-Smirnov test for normality were employed. Descriptive statistics, principal component analysis, varimax orthogonal rotation method were used to analyze the data. The result showed low degree of entrepreneurial intention amongst business students in Pakistan. They prefer jobs as compare to establish their own business in near future but at the same time they have good intention to start their own business someday. Furthermore, the key motivators recognized by this study are autonomy and employment, whereas capital and risk are significant obstacles. Â

ENTREPRENEURIAL INTENTION OF BUSINESS STUDENTS IN PAKISTAN: MOTIVATIONS AND OBSTACLES

The aim of this study is to examine the entrepreneurial intention of Pakistani business students and the influence of motivators and obstacles of it. Total 637 final year graduates and post graduates business student of Hyderabad and Jamshoro districts participated in the survey. The data was accumulated through self-administrated questionnaires. To measure the reliability, Cronbach’s alpha and Kolmogorov-Smirnov test for normality were employed. Descriptive statistics, principal component analysis, varimax orthogonal rotation method were used to analyze the data. The result showed low degree of entrepreneurial intention amongst business students in Pakistan. They prefer jobs as compare to establish their own business in near future but at the same time they have good intention to start their own business someday. Furthermore, the key motivators recognized by this study are autonomy and employment, whereas capital and risk are significant obstacles. 

Bonded amalgam as a fissure sealant in low-income setting: A randomised controlled trial

Objectives: To compare one year retention rate of bonded amalgam sealants (BAS) with that of conventional resin-based sealant (RBS). Methods: It was a parallel group, equivalence, randomised controlled trial done during March 2018 to December 2019 at the dental clinics of Dow University of Health Sciences, and the Jinnah Sind Medical University, Karachi, Pakistan on children aged 12-16 years, who were randomly assigned to one of the two treatment groups (BAS vs. RBS). Complete retention of the sealant at one year follow-up was labeled as success. Multi-level mixed effect logistic regression model was employed. Study was registered at www.clinicaltrials.gov # NCT NCT03130725. Results: There were 137 teeth (23 subjects) in the BAS and 128 teeth (15 subjects) in the RBS group that were evaluated for sealant retention at 12 months follow-up. Among the BAS group, 100/137 (73%) sealants were completely retained whereas 110/128 (86%) were fully retained in the RBS group. Nearly, 22/137 (16%) BAS and 10/128 (7.8%) RBS were completely dislodged. In multivariable analysis, subject age \u3e15 years and male gender were found to be significantly associated with the dislodgement of sealants. Conclusions: At 12 months follow-up, the retention of bonded amalgam sealant (BAS) was significantly lower than that of the resin-based sealant (RBS)

Anxiety and depression among outpatients with type 2 diabetes: A multi-centre study of prevalence and associated factors.

Background: Anxiety and depression contribute to poor disease outcomes among individuals with diabetes. This study aimed to assess the prevalence of anxiety and depression and to identify their associated factors including metabolic components among people with type 2 diabetes. Methods: We conducted a cross-sectional, multi-center study in four out-Patient clinics in Karachi, Pakistan. In all, 889 adults with type-2 diabetes were included in this study. Anxiety and depression were measured by using the Hospital Anxiety and Depression Scale (HADS). Multivariable analysis using multiple logistic regression was carried out to evaluate the combined effect of various factors associated with anxiety and depression, while adjusting for confounding variables. Results: Overall, 57.9% (95% CI = 54.7%, 61.2%) and 43.5% (95% CI = 40.3%, 46.8%) study participants had anxiety and depression respectively. Factors found to be independently associated with anxiety were physical inactivity, having hypertension and ischemic heart disease. For depression, being female, of older age, having hypertension and ischemic heart disease were significantly associated. Metabolic components found to be independently associated with both anxiety and depression were systolic blood pressure, fasting blood glucose and fasting blood triglycerides. Body mass index was independently associated with depression but not with anxiety. Conclusion: This study identified that a large proportion of adults with diabetes had anxiety and/or depression, and identified factors associated with these entities. These results alert clinicians to identify and treat anxiety and depression as common components of diabetes care. Additional studies are needed to establish the directional nature of this relationship and to test interventions