Ghazala Rafique

Prevalence and Factors Associated with Intestinal Parasitic Infection among Children in an Urban Slum of Karachi

Background Intestinal parasitic infections are endemic worldwide and have been described as constituting the greatest single worldwide cause of illness and disease. Poverty, illiteracy, poor hygiene, lack of access to potable water and hot and humid tropical climate are the factors associated with intestinal parasitic infections. The study aimed to estimate prevalence and identify factors associated with intestinal parasitic infections among 1 to 5 years old children residing in an urban slum of Karachi Pakistan. Methods and Principal Findings A cross sectional survey was conducted from February to June 2006 in Ghosia Colony Gulshan Town Karachi, Pakistan. A simple random sample of 350 children aged 1–5 years was collected. The study used structured pre-tested questionnaire, anthropometric tools and stool tests to obtain epidemiological and disease data. Data were analyzed using appropriate descriptive, univariate and multivariable logistic regression methods. The mean age of participants was 2.8 years and 53% were male. The proportions of wasted, stunted and underweight children were 10.4%, 58.9% and 32.7% respectively. The prevalence of Intestinal parasitic infections was estimated to be 52.8% (95% CI: 46.1; 59.4). Giardia lamblia was the most common parasite followed by Ascaris lumbricoides, Blastocystis hominis and Hymenolepis nana. About 43% children were infected with single parasite and 10% with multiple parasites. Age {Adjusted Odds Ratio (aOR) = 1.5; 95% CI: 1.1; 1.9}, living in rented households (aOR = 2.0; 95% CI: 1.0; 3.9) and history of excessive crying (aOR = 1.9; 95% CI: 1.0; 3.4) were significantly associated with intestinal parasitic infections. Conclusions Intestinal parasites are highly prevalent in this setting and poverty was implicated as an important risk factor for infection. Effective poverty reduction programmes and promotion of deworming could reduce intestinal parasite carriage. There is a need for mass scale campaigns to create awareness about health and hygiene.

Validating MOSPA questionnaire for measuring physical activity in Pakistani women

BackgroundPrecise measurements of activity at a population level are important for monitoring trends and evaluating health promotion strategies. Few studies have assessed the measurement of physical activity in developing countries. The aim of this study was to validate the MOSPA (Monica Optional Study of Physical Activity) questionnaire which was developed for the WHO-Monitoring trends and determinants of cardiovasculr disease (MONICA) study sites.MethodsThe MOSPA questionnaire assesses energy expendtiture (EE) related to physical activity (employment, household work, transportation, and leisure time) over a one year period. This questionnaire has been described in the manuscript as the long term (LT) questionnaire. An adapted short term (ST) 5 day questionnaire was developed to assess convergent validity. Questionnaire data were compared with physical activity EE estimates from a Caltrac accelerometer and with body composition measures (height, weight and bioelectrical impedance) in 50 women from the Aga Khan University (AKU) hospital antenatal clinics, Pakistan. Other forms of EE i.e. resting EE and thermic effect of food were not assessd in this study.ResultsSubjects were aged 26 ± 3.8 years and were 16.1 ± 6.7 weeks pregnant. Their average weight was 58.8 ± 10.7 Kg. The average EE/day assessed by the Caltrac accelerometer, was 224 kcal and by MOSPA LT questionnaire it was 404 kcal. The questionnaires and Caltrac data were reasonably well correlated: r = 0.51 and r = 0.60 (P < 0.01) for LT and ST questionnaires respectively. Energy expenditure from questionnaire data was not correlated with body composition measures.ConclusionThe MOSPA questionnaire is useful in assessing physical activity levels in a sedentary population over a one year period.

Association of depression with newly diagnosed type 2 diabetes among adults aged between 25 to 60 years in Karachi, Pakistan.

BackgroundThe combination of depression with type 2 diabetes is a public health problem. If diabetes is managed in its initial phase, the morbidity and mortality due to this combination may be prevented at an early stage. Therefore, we aimed to determine the association of depression with newly diagnosed type 2 diabetes among adults aged between 25 to 60 years in Karachi, Pakistan.MethodsFrom July 2006 to September 2007, a matched case control study (n = 592) was conducted in Civil Hospital, Karachi. Incident cases of type 2 diabetes (n = 296) diagnosed within one month were recruited from diabetic Out Patient Department (OPD) of Civil Hospital, Karachi. They were matched on age and sex with controls (n = 296), who were attendants sitting in the medical out patient department of the same hospital, recruited on the basis of absence of classical symptoms of polyuria and polydispia along with random blood glucose level of <200 mg/dl measured by a glucometer. Depression was identified by the Siddiqui Shah Depression Scale. Conditional logistic regression was applied to examine the association of depression and other independent variables with newly diagnosed type 2 diabetes at 95% C.I. and P < 0.05.ResultsThe study comprised of 592 subjects with 432(73%) males and 160(27%) females. Depression was significantly associated with newly diagnosed type 2 diabetes having mild level (mOR: 3.86; 95%CI: 2.22,6.71) and moderate to severe level (mOR: 3.41; 95%CI: 2.07,5.61). History of (h/o) gestational diabetes (mOR: 2.83; 95%CI: 1.05,7.64), family h/o diabetes (mOR: 1.59; 95%CI: 1.04,2.43), nuclear family (mOR: 1.75; 95%CI: 1.14,2.69), BMI (mOR: 1.62; 95%CI: 1.01,2.60 for obese and mOR: 2.12; 95%CI: 1.19,3.79 for overweight vs healthy to underweight) were also significantly associated with outcome, adjusting for age, sex, marital status, h/o smoking and h/o high BP.ConclusionsDiabetics should be screened simultaneously for depression and concomitant preventive strategies for gestational diabetes, nuclear family and high BMI should also be used to prevent mortality/morbidity among patients between 25 to 60 years of age.

A Nutrition Education Intervention to Combat Undernutrition: Experience from a Developing Country

Introduction. Undernutrition in children is a major public health concern in Pakistan. A number of interventions which focused only on providing nutrient supplementation have failed to change child undernutrition status during the last 2 decades. The present study aimed to assess the impact of nutrition education on the nutritional status of children living in resource-limited environments. Methods. Subjects were 586 children from Tando Jam and Quetta, Pakistan, aged from 6 months to 8 years. Children were characterized as mild, moderate, or severely wasted on Z-scores. Anthropometry and 24-hour dietary recall were used for nutritional assessment. Intervention strategy was nutrition counselling targeting mothers. Primary outcome was decrease in the severity of wasting and changes in the feeding practices. Results. Nearly 36% children in Tando Jam and 32% children in Quetta progressed to a normal nutritional status. There was a significant increase in the number of meals taken per day (Tando Jam—P ≤ 0.000/Quetta—P ≤ 0.025). In Tando Jam, significant increase was reported in the intake of high starch food items, vegetables, and fruits (P ≤ 0.000). In Quetta, significant increase was noted in the intake of plant protein (P ≤ 0.005), dairy foods (P ≤ 0.041), and vegetables (P ≤ 0.026). Conclusion. Nutrition education was successful in reducing undernutrition in food insecure households.

Dietary practices of school children in Sindh, Pakistan

Background: Malnutrition in Pakistan has remained an unresolved issue for decades. Data on nutrient intake and variety in children’s diet is lacking. Aim: This paper describes the dietary practices of school children across eight districts of Sindh. Methods: A school-based survey of dietary practices among 1109 students from classes 2–5 in 36 schools was conducted using a pre-tested interviewer-completed questionnaire. Results: Descriptive and comparative analysis of data showed that more than 75% school children ate breakfast, lunch and dinner regularly. However, 10% children skipped breakfast and nearly one-third of them skipped mid-morning and evening snacks. Skipping breakfast and snacks was related to low socio-economic status and rural residence. Children’s intake of protein-rich food items and fruits also illustrated that urban residence and better socio-economic status have a positive effect on the frequency and variety of daily protein and fruit intake. Though affordability and geographic location were key determinants of children’s dietary practices, significantly higher percentages of children studying in class 2, 3 and 4 consumed different kinds of protein-rich food items, fruits and vegetables more frequently as opposed to children studying in class 5. Junk food consumption was more common in urban areas and better socio-economic strata. Conclusion: Development of school-based nutrition education programmes and behavior change strategies emphasizing the regular intake of meals and nutrient-rich snacks, and encouraging consumption of easily available and affordable food items such as dried seeds, fruits, vegetables, milk and its derivatives is essential for addressing nutrient deficiencies.

Social and Societal Context of Women’s Mental Health, What Women Want, What They Get: Gap Analysis in Pakistan of Mental Health Services, Polices and Research

Introduction: The burden of mental illness is increasing in Pakistan as political instability, violence and terrorism beset the country. Mental health in Pakistan can be examined from three perspectives—services, research and policy. Services are provided in major public sector hospitals and some private institutions. Trained health professionals including psychiatrists and clinical psychologists are limited, and people often access faith healers for mental illnesses. Research on mental health is also being conducted, the focus being on the clinical aspects of mental health. Public health initiatives in Pakistan are yet to develop disease prevention and health promotion programmes. Intervention studies on the social context of women’s mental health are scarce. There is a mental health policy and a mental health Ordinance, Pakistan’s National health policy documents do not integrate mental health as a priority area. Women’s mental health, in contrast, is well recognized as an issue, but no national or provincial programme is to be found.

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.