Q Iqbal

Crimean-Congo haemorrhagic fever in Pakistan

Pakistan is faced with a quadruple burden of communicable and noncommunicable diseases (infectious diseases; high maternal, neonatal, of zoonotic diseases, coordination and closer integration of health departments, collaboration with intergovernmental organisations such as the World Organization for Animal Health (OIE), implementation and monitoring of policies for effective surveillance, fostering of collaboration among infectious disease researchers, informative campaigns that target the general public or animal handlers in the weeks before the festival, and vector control programmes. Moreover, collaborative efforts among endemic countries will further strengthen the CCHF virus control programme.

Assessment of medication adherence among type 2 diabetic patients in Quetta city, Pakistan

ABSTRACT Objectives: Type 2 diabetes (T2DM) is a growing burden among all countries including Pakistan, with medication adherence very important to improve care. However, little is known about medication adherence in Pakistan and potential predictors among T2DM patients to provide future guidance. This needs to be addressed. Consequently, the present study sought to assess medication adherence among type 2 diabetic patients in Quetta city, Pakistan. Methods: Questionnaire based, descriptive study among 300 Pakistani patients attending public and private hospitals aged 18 years and above, having a confirmed diagnosis of T2DM, without additional co-morbidities were targeted. Descriptive statistics were used to describe demographic and disease characteristics. The association between socio-demographic data and study variables was compared through the Mann Whitney/Kruskal Wallis test (where applicable). The factors that were significantly associated with medication adherence were further assessed by logistic regression analysis. Results: 55.6% of patients had high adherence although overall patients reported moderate adherence. Age, gender, education, diabetes-related knowledge and treatment satisfaction were significantly associated with medication adherence. Older males with only primary education and with poor diabetes-related knowledge had the lowest adherence. Conclusions: This study presents a model that is associated with medication adherence among T2DM patients, with disease-related knowledge as a significant predictor of likely adherence. Results of the current study revealed that improved diabetes related knowledge plays a significant role in improving medication adherence. Healthcare practitioners and the system should formalize and acknowledge patient education as a key component to treat patients with T2DM. This should include a greater role for pharmacists and other professionals.

Frequency and evaluation of the perceptions towards caesarean section among pregnant women attending public hospitals in Pakistan and the implications

ABSTRACT Objectives: There is increasing prevalence of caesarean sections (CS) worldwide; however, there are concerns about their rates in some countries, including potential fears among mothers. Consequently, we aimed to determine the frequency of CS, and explore patient’s perception towards CS attending public hospitals in Pakistan, to provide future guidance. Methods: A two-phased study design (retrospective and cross sectional) was adopted. A retrospective study was conducted to assess the frequency of CS over one year among four public hospitals. A cross sectional study was subsequently conducted to determine patients’ perception towards CS attending the four tertiary care public hospitals in Quetta city, Pakistan, which is where most births take place. Results: Overall prevalence of CS was 13.1% across the four hospitals. 728 patients were approached and 717 responded to the survey. Although 78.8% perceived CS as dangerous, influenced by education (p = 0.004), locality (p = 0.001) and employment status (p = 0.001), 74.5% of patients were in agreement that this is the best approach to save mother’s and baby’s lives if needed. 62% of respondents reported they would like to avoid CS if they could due to post-operative pain, and 58.9% preferred a normal delivery. There was also a significant association with education (p = 0.001) and locality (p = 0.001) where respondents considered normal vaginal delivery as painful. Conclusion: The overall frequency of CS approximates to WHO recommendations, although there is appreciable variation among the four hospitals. When it comes to perception towards CS, women had limited information. There is a need to provide mothers with education during the antenatal period, especially those with limited education, to accept CS where needed.

Uncontrollable medicine prices in Pakistan

2602 www.thelancet.com Vol 388 November 26, 2016 Furthermore, a subsidy of medicines that had increased in price was proposed. The price hike was strongly condemned and the Senate’s Standing Committee on National Health Services, Regulations and Coordination instructed that no second chances should be given to these companies. However, no action was taken and patients were left at the mercy of the pharmaceutical companies, so they had no choice but to pay exorbitant prices for medicines that were aff ordable just a few months before. Within this context, surely pharmaceutical companies in Pakistan are using various tactics to avoid scrutiny from the regulatory authorities. At the same time, the leniency of the regulatory authorities is also evident. It is time for health authorities in Pakistan to start learning from past experiences. An amendment in the relevant schedule appended to the Drug and Pricing Act is needed that will allow the government to place stern policies on price control, and actions to be taken in case of illegitimate price hikes. Instead of listening to the demands of the pharmaceutical industry, the Pakistani Government should start listening to the people, who are now faced with unaff ordable medicines.

Effect of Educational Intervention on Osteoporosis Knowledge among University Female Students in Quetta, Pakistan

Objective: The study intended to assess the impact of educational intervention on knowledge of osteoporosis among female university students of Quetta. Methods: This interventional study was conducted on female university students by using convenience sampling technique. A total of 163 female students were enrolled for the study, these are those female students who did not heard about the disease named as osteoporosis. These subjects were provided with a selfexplanatory brochure that contains basic information regarding osteoporosis. The intervention was completely theoretical in nature. After two days interval participants were contacted again and asked to complete a pre-validated questionnaire containing 20 questions related to osteoporosis knowledge. Descriptive analysis was used to demonstrate the demographic characteristics of the study population. Inferential statistics (Mann-Whitney U test and Kruskal Wallis tests and Wilcoxon mean rank test, p<0.05) were used to assess the significance among study variables and to assess the impact of educational intervention on knowledge. Results: Average score of knowledge was 14.18 ± 2.7. Although educational intervention had a significant effect on knowledge scores of the respondents (Wilcoxon rank test p<0.005) (considering the pre-intervention knowledge score as zero) certain demographic characteristics (academic degree and living status) does affect knowledge scores of the study respondents. Conclusion: Although adequate improvement of knowledge scores of osteoporosis was reported after educational intervention, yet efforts should be made to bring change in the attitudes and practices of the female students by the help of intensive educational programs based on behavioral learning theories for better disease knowledge and prevention.

Quality of Life in Patients with Skin Diseases Attending a Public Healthcare Institute of Quetta City, Pakistan

Background: The current study is aimed to document the Dermatology Life Quality Index (DLQI) of patients with skin disorders attending a public healthcare institute in Quetta city, Pakistan. Methods: A questionnaire based, cross-sectional study was planned for this research. The study was conducted at Bolan Medical Complex Hospital, Quetta. A response based, double design sampling method was used to identify the sample required for the study. Patients were asked to answer the Dermatology Life Quality Index (DLQI) for the assessment of QoL. SPSS v. 20 was used for data analysis. The Chi Square test was used for cross tabulation analysis and p Key words: Quality of life, Skin diseases, Public healthcare institute, Quetta city, Pakistan.