Muhammad Masood Kadir

Tobacco use and secondhand smoke exposure during pregnancy: An investigative survey of women in 9 developing nations:

OBJECTIVES We examined pregnant womens use of cigarettes and other tobacco products and the exposure of pregnant women and their young children to secondhand smoke (SHS) in 9 nations in Latin America, Asia, and Africa. METHODS Face-to-face surveys were administered to 7961 pregnant women (more than 700 per site) between October 2004 and September 2005. RESULTS At all Latin American sites, pregnant women commonly reported that they had ever tried cigarette smoking (range: 78.3% [Uruguay] to 35.0% [Guatemala]). The highest levels of current smoking were found in Uruguay (18.3%), Argentina (10.3%), and Brazil (6.1%). Experimentation with smokeless tobacco occurred in the Democratic Republic of the Congo and India; one third of all respondents in Orissa, India, were current smokeless tobacco users. SHS exposure was common: between 91.6% (Pakistan) and 17.1% (Democratic Republic of the Congo) of pregnant women reported that smoking was permitted in their home. CONCLUSIONS Pregnant womens tobacco use and SHS exposure are current or emerging problems in several low- and middle-income nations, jeopardizing ongoing efforts to improve maternal and child health.

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)

Descriptive Epidemiology of Somatising Tendency: Findings from the CUPID Study

Somatising tendency, defined as a predisposition to worry about common somatic symptoms, is importantly associated with various aspects of health and health-related behaviour, including musculoskeletal pain and associated disability. To explore its epidemiological characteristics, and how it can be specified most efficiently, we analysed data from an international longitudinal study. A baseline questionnaire, which included questions from the Brief Symptom Inventory about seven common symptoms, was completed by 12,072 participants aged 20–59 from 46 occupational groups in 18 countries (response rate 70%). The seven symptoms were all mutually associated (odds ratios for pairwise associations 3.4 to 9.3), and each contributed to a measure of somatising tendency that exhibited an exposure-response relationship both with multi-site pain (prevalence rate ratios up to six), and also with sickness absence for non-musculoskeletal reasons. In most participants, the level of somatising tendency was little changed when reassessed after a mean interval of 14 months (75% having a change of 0 or 1 in their symptom count), although the specific symptoms reported at follow-up often differed from those at baseline. Somatising tendency was more common in women than men, especially at older ages, and varied markedly across the 46 occupational groups studied, with higher rates in South and Central America. It was weakly associated with smoking, but not with level of education. Our study supports the use of questions from the Brief Symptom Inventory as a method for measuring somatising tendency, and suggests that in adults of working age, it is a fairly stable trait.

CARRS Surveillance study: design and methods to assess burdens from multiple perspectives.

BackgroundCardio-metabolic diseases (CMDs) are a growing public health problem, but data on incidence, trends, and costs in developing countries is scarce. Comprehensive and standardised surveillance for non-communicable diseases was recommended at the United Nations High-level meeting in 2011.Aims: To develop a model surveillance system for CMDs and risk factors that could be adopted for continued assessment of burdens from multiple perspectives in South-Asian countries.MethodsDesign: Hybrid model with two cross-sectional serial surveys three years apart to monitor trend, with a three-year prospective follow-up of the first cohort.Sites: Three urban settings (Chennai and New Delhi in India; Karachi in Pakistan), 4000 participants in each site stratified by gender and age.Sampling methodology: Multi-stage cluster random sampling; followed by within-household participant selection through a combination of Health Information National Trends Study (HINTS) and Kish methods.Culturally-appropriate and methodologically-relevant data collection instruments were developed to gather information on CMDs and their risk factors; quality of life, health-care utilisation and costs, along with objective measures of anthropometric, clinical and biochemical parameters. The cohort follow-up is designed as a pilot study to understand the feasibility of estimating incidence of risk factors, disease events, morbidity, and mortality.ResultsThe overall participant response rate in the first cross-sectional survey was 94.1% (Chennai 92.4%, n = 4943; Delhi 95.7%, n = 4425; Karachi 94.3%, n = 4016). 51.8% of the participants were females, 61.6% < 45years, 27.5% 45–60years and 10.9% >60 years.DiscussionThis surveillance model will generate data on prevalence and trends; help study the complex life-course patterns of CMDs, and provide a platform for developing and testing interventions and tools for prevention and control of CMDs in South-Asia. It will also help understanding the challenges and opportunities in establishing a surveillance system across countries.

Acute health effects of the Tasman Spirit oil spill on residents of Karachi, Pakistan

BackgroundOn July 27 2003, a ship carrying crude oil run aground near Karachi and after two weeks released 37,000 tons of its cargo into the sea. Oil on the coastal areas and fumes in air raised health concerns among people. We assessed the immediate health impact of oil spill from the tanker Tasman Spirit on residents of the affected coastline in Karachi, Pakistan.MethodsWe conducted a study consisting of an exposed group including adults living in houses on the affected shoreline and two control groups (A and B) who lived at the distance of 2 km and 20 km away from the sea, respectively. We selected households through systematic sampling and interviewed an adult male and female in each household about symptoms relating to eyes, respiratory tract, skin and nervous system, smoking, allergies, beliefs about the effect on their health and anxiety about the health effects. We used logistic regression procedures to model each symptom as an outcome and the exposure status as an independent variable while adjusting for confounders. We also used linear regression procedure to assess the relationship exposure status with symptoms score; calculated by summation of all symptoms.ResultsOverall 400 subjects were interviewed (exposed, n = 216; group A, n = 83; and group B, n = 101). The exposed group reported a higher occurrence of one or more symptoms compared to either of the control groups (exposed, 96% vs. group A, 70%, group B 85%; P < 0.001). Mean summary symptom scores were higher among the exposed group (14.5) than control group A (4.5) and control group B (3.8, P < 0.001). Logistic regression models indicated that there were statistically significant, moderate-to-strong associations (Prevalence ORs (POR) ranging from 2.3 to 37.0) between the exposed group and the symptoms. There was a trend of decreasing symptom-specific PORs with increase in distance from the spill site. Multiple linear regression model revealed strong relationship of exposure status with the symptoms score (β = 8.24, 95% CI: 6.37 – 10.12).ConclusionResults suggest that the occurrence of increased symptoms among the exposed group is more likely to be due to exposure to the crude oil spill.

Status of children's blood lead levels in Pakistan: implications for research and policy.

OBJECTIVES Data on blood lead levels, sources of lead and health effects were reviewed among children in Pakistan. METHODS A systematic review was conducted of published studies found through PubMed, an index of Pakistani medical journals PakMediNet and unpublished reports from governmental and non-governmental agencies in Pakistan. RESULTS With the exception of a few studies that had adequate sample sizes and population-based samples, most studies were small and used convenience sampling methods to select study subjects. Overall, blood lead levels declined from 38 microg/dl in 1989 to 15 microg/dl in 2002. The major sources of lead that directly or indirectly resulted in lead exposure of children included: leaded petrol; fathers occupation in lead-based industry; leaded paint; traditional cosmetics; and remedies. Apart from leaded petrol, there was no information regarding the level of lead in other sources such as paints and the household environment. Very little information was available regarding the adverse health effects of lead among children. CONCLUSION The phasing out of leaded petrol was a commendable mitigation measure undertaken in July 2001 in Pakistan. A comprehensive assessment is now needed urgently to explore other sources of lead contributing to adverse health effects, and to plan intervention options with the ultimate goal of reducing the burden of disease due to lead exposure.

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 > or =2 factors. The clustering of these risk factors was significantly higher in women (p<0.001). DISCUSSION This study shows that almost all of the adults in the study had behavioural risk factors for CNDs and clustering of these factors is very common and significantly higher in women. The tendency of clustering risk factors in individuals provides opportunities to address factors with integrated approaches to prevent/delay the onset of CNDs.

Do community medicine residency trainees learn through journal club? An experience from a developing country

BackgroundJournal clubs are an internationally recognized teaching tool in many postgraduate medical education fields. In developing countries lack of funds for current print materials may have limited journal club use. But with advancing information technology trainees in developing countries increasingly have more access to high quality journals online. However, we are aware of no studies describing journal club existence and effectiveness in postgraduate medical training in Pakistan. Also we have found no published effectiveness studies of this teaching modality in Community Medicine (Public Health) in any country. This study evaluated the effectiveness of Community Medicine (Public Health) Resident Journal Club (CMR-JC) in Aga Khan University, Pakistan using international criteria for successful journal clubs (2 years continuous existence and more than 50% attendance) and examining resident and alumni satisfaction.MethodsJournal club effectiveness criteria were searched using electronic search databases. Departmental records were reviewed from September1999–September 2005. Ninety percent of residents and alumni of Community Medicine Residency Programme participated voluntarily in a confidential survey.ResultsThe CMR-JC was regularly conducted. More than 95% of residents attended. (Total residents in the CMR-Programme: 32). Twenty-seven out of 29 current residents/alumni responded to the anonymous questionnaire. Acquisition of critical appraisal skills (23 respondents) and keeping up with current literature (18 respondents) were the two most important objectives achieved. Respondents recommended improved faculty participation and incorporating a structured checklist for article review.ConclusionCMR-JC fulfils criteria for effective journal clubs. Residents and alumni agree CMR-JC meets its objectives. Incorporating suggested recommendations will further improve standards. The journal club learning modality should be included in residency training programs in developing countries. Effective use of online resources to support journal clubs is demonstrated as a successful alternative to excessive expenditure for obtaining print journals. Those trying to start or improve journal clubs can benefit from our experience.

Weight patterns and perceptions among female university students of Karachi: a cross sectional study

BackgroundBody weight and its perception play an important role in the physical and mental well-being of a person. Weight perception is found to be a better predictor of weight management behaviour as compared to actual weight. In Pakistan, studies have been done on the prevalence of weight status but weight perception is still unexplored. The study was done to examine relationships between body weight perception, actual weight status, and weight control behaviour among the female university students of Karachi.MethodsA cross sectional study was carried out during Sep-Nov 2009 on female students in four universities of Karachi, Pakistan. Our final sample size included 338 female university students. Height and weight were measured on calibrated scales. A modified BMI criterion for Asian populations was used.ResultsBased on measured BMI; the prevalence of underweight, normal weight and overweight females was 27.2%, 51.5% and 21.3% respectively. As a whole, just over one third (33.73%) of the sample misclassified their weight status. Among underweight (n=92), 45.70% thought they were of normal weight. No one who was truly underweight perceived them self as overweight. Among the normal weight (n= 174), 9.8% thought they were underweight and 23.6% considered themselves overweight. Among the overweight (n=72); 18.3% considered themselves normal. Only one female student thought she was underweight despite being truly overweight.ConclusionsOur study shows that among female university students in Karachi, the prevalence of being underweight is comparatively high. There is a significant misperception of weight, with one third of students misclassifying themselves. Underweight females are likely to perceive themselves as normal and be most satisfied with their weight. Health policy makers should implement these findings in future development of health interventions and prevention of depression, social anxiety and eating disorders associated with incorrect weight perception among young females. Studies that employ a longitudinal approach are needed to validate our findings.

Exposure of pregnant women to indoor air pollution: a study from nine low and middle income countries

Objective. We studied exposure to solid fuel and second‐hand tobacco smoke among pregnant women in south Asia, Africa and Latin America. Design. Prospective cross‐sectional survey. Setting. Antenatal clinics in Argentina, Brazil, Ecuador, Guatemala, Uruguay, Democratic Republic of Congo, Zambia, India and Pakistan. Sample. A total of 7,961 pregnant women in ten sites in nine countries were interviewed between October 2004 and September 2005. Methods. A standardized questionnaire on exposure to indoor air pollution (IAP) and second‐hand smoke was administered to pregnant women during antenatal care. Main outcome measures. Exposure to IAP and second‐hand tobacco smoke. Results. South Asian pregnant women commonly reported use of wood (49.1–89.7%), crop residue and animal dung as cooking and heating fuel. African pregnant women reported higher use of charcoal (85.4–93.5%). Latin American pregnant women had greater use of petroleum gas. Among south Asian women, solid fuel use and cooking on an open flame inside the home were common. There was a significant association between solid fuel use and allowing smoking within the home at the Asian sites and in Zambia (p < 0.05). Conclusions. Pregnant women from low/middle income countries were commonly exposed to IAP secondary to use of solid fuels. Among these populations, exposure to second‐hand tobacco smoke was also common. This combination of exposures likely increases the risk of poor pregnancy outcomes among the most vulnerable women. Our study highlights the importance of further research on the combined impact of IAP and second‐hand tobacco smoke exposures on adverse maternal and perinatal outcomes.