Amanullah Khan

The relationship between therapeutic injections and high prevalence of hepatitis C infection in Hafizabad, Pakistan

To determine the prevalence and routes of transmission of hepatitis C virus (HCV) infection in Hafizabad, Pakistan, we collected sera in 1993 from a geographically based random sample of residents, and in 1994 identified 15 HCV-infected individuals (cases) and 67 age and sex matched uninfected individuals (controls). Initially we approached 504 households, and collected serum from a randomly selected household member in 309 (64%). Twenty persons (6.5%) had anti-HCV antibody; 31% percent had hepatitis B core antibodies, and 4.3% had hepatitis B surface antigen. In the case-control study, persons who received more therapeutic injections (categorized as averaging 1, 2-4, 5-9 or > 10 injections per year in the previous 10 years) were more likely to be infected with HCV (odds ratio 0, 1.5, 2.5 and 6.9 respectively, P = 0.008) compared to persons averaging 0 injections per year. Efforts to limit therapeutic injections to only those that are medically indicated and that use sterile equipment are essential in order to prevent transmission of HCV.

What Influences Contraceptive Use among Young Women in Urban Squatter Settlements of Karachi, Pakistan?

Interviews were conducted in squatter settlements in Karachi Pakistan with Muslim women 30 years old or younger their husbands and their mothers-in-law to explore factors that influence couples contraceptive use. Univariate and multivariate regression analyses were conducted to examine the associations between contraceptive use and several variables including social and demographic characteristics; religious beliefs; communication about family planning (FP) among the three family members; womens mobility and decision-making capability; acceptance of information about FP in the mass media; and exposure to FP messages from health care workers. Univariate analyses indicate that women who reported using modern contraceptive methods were significantly more likely to be literate (odds ratio 1.7) to be exposed to an urban environment (1.8) and to have had at least 5 live births (2.0). According to multivariate analyses women who were literate who were of high economic status whose mother-in-law reported discussing FP with them and who had received FP messages from health care workers were two-three times as likely to use contraceptives as were other women. In addition women who said it was appropriate for FP messages to be delivered through mass media were 50% more likely to use contraceptives. The long-term goals of improving womens education levels and economic status are important for increasing contraceptive prevalence in Pakistan. At the same time policy-makers should initiate short-term interventions such as engaging religious leaders in FP programs encouraging the outreach efforts of community health care workers and targeting mothers-in-law with FP messages as these are likely to be effective in increasing womens contraceptive use. (authors)

Household members of hepatitis C virus-infected people in Hafizabad, Pakistan: infection by injections from health care providers

Household members of people with hepatitis C are at increased risk of HCV infection. The prevalence and routes of transmission of HCV to household members in Hafizabad, Pakistan were investigated. Household members of 24 index cases were given a risk factor questionnaire, tested for HCV infection, and the risk factors between the infected and uninfected were compared. Twelve of 74 household members (16.2%) were seropositive for HCV antibody. This was 2(1/2) times the rate of infection in the general population (OR = 2.8; P = 0.01). None of the routes of transmission studied within the household was associated with an increased risk. Household members who received more than 4 injections per year were 11.9 times more likely to be infected than those who had not (P = 0.016). In Hafizabad, the greatest risk for HCV infection to household members of infected people is injections given by health-care workers rather than household contact with infected persons.

Pneumonia perceptions and management: an ethnographic study in urban squatter settlements of Karachi, Pakistan.

Childhood pneumonia continues to be the second highest contributor to childhood morbidity and mortality in all ethnic groups in Pakistan. Information on community perceptions and management is largely limited to the Punjabi populace. In this study, ethno-specific illness terminologies, recognition and severity indicators and resort to treatment options for childhood pneumonia are explored among the two main ethnic groups in Sindh. Results are based on focus group discussions with 90 caretakers and 16 case history interviews. The findings indicate that pneumonia recognition is almost universal. The main recognition and severity indicator was pasli chalna (chest indrawing) followed by signs and symptoms relating to the quality of breathing and presence of high fever, lethargy and anorexia. Recognition of rapid breathing was low and mostly associated with fever. Exposure to thand (cold) through a variety of mechanisms was perceived to be the dominant causal model. The concept of contagion was virtually non-existent. Despite this, belief in efficacy of allopathic care was very high. Most caretakers reported seeking outside care within one to three days of the onset of symptoms. However, unrealistic expectations of cure often led to change in physicians and treatment regimen, if no improvement was observed by the second day. On the other hand, the quality of care provided by the physicians (both licensed and unlicensed) left much to be desired. Female autonomy and mobility did not appear to be a major constraint in seeking outside care other than for hospitalisation. Implications of these findings for the national acute respiratory infections control programme and future research are discussed

Front-line management of pulmonary tuberculosis: An analysis of tuberculosis and treatment practices in urban Sindh, Pakistan

SETTING Karachi and Hyderabad, Pakistan. OBJECTIVE To describe the level and quality of tuberculosis (TB) case management by non-TB control program (TCP) physicians in urban Sindh, Pakistan. DESIGN We interviewed 152 adults with pulmonary TB confirmed by Karachis TB control program regarding the initial management of their TB symptoms before entering the TCP. We also surveyed 65 general practitioners (GPs) attending continuing education seminars with a multiple choice test to assess their management of suspected pulmonary TB. We compared both results to guidelines from the World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (IUATLD). RESULTS Eighty percent (122/152) of patients first sought GPs. Only 14% of GPs performed any sputum test. At most, 17 (40%) of the 42 patients recalling their GPs treatment, received the recommended 4-drug regimen. However, 68% (45/65) of surveyed GPs chose correct treatment from a multiple choice format. But their initial laboratory investigations, follow-up, and treatment cessation criteria (9%, 9-31%, and 11% correct, respectively) demonstrated under-utilization of sputum tests and over-reliance on unhelpful tests. CONCLUSIONS GPs first saw most of these TCP patients, but their weak management likely hinders TB control. A partnership between TB control programs and GPs could improve case management and hasten TB control.

Household Costs for Treatment of Severe Pneumonia in Pakistan

Current World Health Organization (WHO) guidelines for severe pneumonia treatment of under-5 children recommend hospital referral. However, high treatment cost is a major barrier for communities. We compared household costs for referred cases with management by lady health workers (LHWs) using oral antibiotics. This study was nested within a cluster randomized trial in Haripur, Pakistan. Data on direct and indirect costs were collected through interviews and record reviews in the 14 intervention and 14 control clusters. The average household cost/case for a LHW managed case was

Cholera in a developing megacity; Karachi, Pakistan

1.46 compared with

DO MOTHERS-IN-LAW MATTER? FAMILY DYNAMICS AND FERTILITY DECISION-MAKING IN URBAN SQUATTER SETTLEMENTS OF KARACHI, PAKISTAN

7.60 for referred cases. When the cost of antibiotics provided by the LHW program was excluded from the estimates, the cost/case came to

The quest of infertile women in squatter settlements of Karachi, Pakistan: a qualitative study

0.25 and

Predictors of in-hospital mortality for intracerebral hemorrhage: A hospital-based study in Pakistani adults *

7.51 for the community managed and referred cases, respectively, a 30-fold difference. Expanding severe pneumonia treatment with oral amoxicillin to community level could significantly reduce household costs and improve access to the underprivileged population, preventing many child deaths.