Shafquat Rozi

Correlates of cigarette smoking among male college students in Karachi, Pakistan

BackgroundAbout 1.3 billion people are regular smokers world wide and every day between 8,200 and 9,900 young people start to smoke, risking rapid addiction to nicotine. Transition from high school to college is a critical period to adopt healthy habits and life style. Therefore, it is important to understand the factors that might influence their smoking habit. Our study aims to assess the influence of factors that encourage college students to smoke cigarettes.MethodsThe data used in this survey were obtained from a representative sample of registered colleges of Karachi. A random sample of 576 male college students of ages ranging from 15–30 years was interviewed using a questionnaire administered by survey officers, by applying multi stage cluster sampling during the academic year 2004–2005.ResultsIn this study, we found 26.7% of students had ever tried smoking, whereas 24%(95% CI: 21.0%–28.0%) of college students reported current smoking (that is whether one had smoked a cigarette in past 30 days). Among different age groups, prevalence of current smoking was 19.2% in 15–17 years, 26.5% in 18–20 years and 65% in 21 years and above. After adjusting for age of respondent, students in public schools were more likely to smoke as compared to students in private schools (adjusted OR = 2.3; 95% CI: 1.3–4.2). Students whose friends are smokers were 5 times more likely to smoke compared to those whose friends are non-smokers (adjusted OR = 4.8; 95%CI: 3.1 – 7.4). Those students having fathers with no formal schooling were more likely to smoke (adjusted OR = 2.2; 95% CI: 1.1–4.2) as compared to those whose fathers had some degree of education. Students having non-working mothers were more likely to smoke as compared to students with working mothers (adjusted OR = 2.8; 95% CI: 0.9–9.1). Students belonging to Bin Qasim (adjusted OR = 2.1; 95% C.I: 1.1–4.1) and Gadap town (adjusted OR = 2.1; 95%C.I) were more likely to smoke as compared to students residing in other towns.ConclusionThis study shows that smoking is strongly associated with age, which may suggest social tolerance to smoking in this setting and that social and educational variables appear to play a significant role in smoking among college students. Our study suggests that such factors should be taken into account when designing effective tobacco control programs among college students. This is an effort which has been done to reduce tobacco consumption among college students and introduce awareness programs to amend their health risk behavior.

Poor knowledge – predictor of nonadherence to universal precautions for blood borne pathogens at first level care facilities in Pakistan

BackgroundWe conducted an assessment of knowledge about blood borne pathogens (BBP) and use of universal precautions at first level care facilities (FLCF) in two districts of Pakistan.MethodsWe conducted a cross-sectional survey and selected three different types of FLCFs ; public, general practitioners and unqualified practitioners through stratified random sampling technique. At each facility, we interviewed a prescriber, a dispenser, and a housekeeper for knowledge of BBPs transmission and preventive practices, risk perception, and use of universal precautions. We performed multiple linear regression to assess the effect of knowledge score (11 items) on the practice of universal precautions score (4 items- use of gloves, gown, needle recapping, and HBV vaccination).ResultsWe interviewed 239 subjects. Most of the participants 128 (53%) were recruited from general practitioners clinics and 166 (69.5%) of them were dispensers. Mean (SD) knowledge score was 3.8 (2.3) with median of 4. MBBS prescribers had the highest knowledge score while the housekeepers had the lowest. Mean universal precautions use score was 2.7 ± 2.1. Knowledge about mode of transmission and the work experience alone, significantly predicted universal precaution use in multiple linear regression model (adR2 = 0.093).ConclusionKnowledge about mode of transmission of blood borne pathogens is very low. Use of universal precautions can improve with increase in knowledge.

Prevalence and predictors of depression among an elderly population of Pakistan

Objective: To assess the magnitude and risk factors of the problem of depression in an elderly population of Pakistan. Method: A cross-sectional study was conducted using a sample of 402 people aged 65 and above visiting the Community Health Center of the Aga Khan University, Karachi. Questionnaire based interviews were conducted for data collection and the 15-Item Geriatric Depression Scale was used to screen for depression. Univariate and multivariate logistic regression analyses were performed to identify factors associated with depression. Results: Of the 402 participants; 69.7% (95% CI = ±4.5%) were men, 76.4% (95% CI = ±4.2%) were currently married, 36.8% (95% CI = ±5%) had received 11 or more years of education and 24.4% (95% CI = ±4.2%) were employed. The mean age was 70.57 years (SD = ±5.414 years). The prevalence of depression was found to be 22.9% (95% CI = ±4.1%) and multiple logistic regression analysis indicated that higher number of daily medications (p-value = 0.03), total number of health problems (p-value = 0.002), financial problems (p-value < 0.001), urinary incontinence (p-value = 0.08) and inadequately fulfilled spiritual needs (p-value = 0.067) were significantly associated with depressive symptoms. Conclusion: We have identified several risk factors for depression in the elderly which need to be taken into account by practicing family physicians and health care workers.

Hyperendemic pulmonary tuberculosis in peri-urban areas of Karachi, Pakistan

BackgroundCurrently there are very limited empirical data available on the prevalence of pulmonary tuberculosis among residents of marginalized settings in Pakistan. This study assessed the prevalence of pulmonary tuberculosis through active case detection and evaluated predictors of pulmonary tuberculosis among residents of two peri-urban neighbourhoods of Karachi, Pakistan.MethodsA cross-sectional study was conducted in two peri-urban neighbourhoods from May 2002 to November 2002. Systematic sampling design was used to select households for inclusion in the study. Consenting subjects aged 15 years or more from selected households were interviewed and, whenever possible, sputum samples were obtained. Sputum samples were subjected to direct microscopy by Ziehl-Neelson method, bacterial culture and antibiotic sensitivity tests.ResultsThe prevalence (per 100,000) of pulmonary tuberculosis among the subjects aged 15 years or more, who participated in the study was 329 (95% confidence interval (CI): 195 – 519). The prevalence (per 100,000) of pulmonary tuberculosis adjusted for non-sampling was 438 (95% CI: 282 – 651). Other than cough, none of the other clinical variables was significantly associated with pulmonary tuberculosis status. Analysis of drug sensitivity pattern of 15 strains of Mycobacterium tuberculosis revealed that one strain was resistant to isoniazid alone, one to streptomycin alone and one was resistant to isoniazid and streptomycin. The remaining 12 strains were susceptible to all five drugs including streptomycin, isoniazid, rifampicin, ethambutol, and pyrazinamide.ConclusionThis study of previously undetected tuberculosis cases in an impoverished peri-urban setting reveals the poor operational performance of Pakistans current approach to tuberculosis control; it also demonstrates a higher prevalence of pulmonary tuberculosis than current national estimates. Public health authorities may wish to augment health education efforts aimed at prompting health-seeking behaviour to facilitate more complete and earlier case detection. Such efforts to improve passive case-finding, if combined with more accessible DOTS infra-structure for treatment of detected cases, may help to diminish the high tuberculosis-related morbidity and mortality in marginalized populations. The economics of implementing a more active approach to case finding in resource-constrained setting also deserve further study.

High HIV Incidence among Persons Who Inject Drugs in Pakistan: Greater Risk with Needle Sharing and Injecting Frequently among the Homeless

Background The incidence of HIV among persons who inject drugs (PWIDU) has fallen in many nations, likely due to successes of clean needle/syringe exchange and substance abuse treatment and service programs. However in Pakistan, prevalence rates for PWID have risen dramatically. In several cities, prevalence exceeded 20% by 2009 compared to a 2003 baseline of just 0.5%. However, no cohort study of PWID has ever been conducted. Methods We enrolled a cohort of 636 HIV seronegative PWID registered with three drop-in centers that focus on risk reduction and basic social services in Karachi. Recruitment began in 2009 (March to June) and PWID were followed for two years. We measured incidence rates and risk factors associated with HIV seroconversion. Results Incidence of HIV was 12.4 per 100 person-years (95% exact Poisson confidence interval [CI]: 10.3–14.9). We followed 474 of 636 HIV seronegative persons (74.5%) for two years, an annual loss to follow-up of <13 per 100 person years. In multivariable Cox regression analysis, HIV seroconversion was associated with non-Muslim religion (Adjusted risk ratio [ARR] = 1.7, 95%CI:1.4, 2.7, p = 0.03), sharing of syringes (ARR = 2.3, 95%CI:1.5, 3.3, p<0.0001), being homeless (ARR = 1.7, 95%CI:1.1, 2.5, p = 0.009), and daily injection of drugs (ARR = 1.1, 95%CI:1.0, 1.3, p = 0.04). Conclusions Even though all members of the cohort of PWID were attending risk reduction programs, the HIV incidence rate was very high in Karachi from 2009–2011. The project budget was low, yet we were able to retain three-quarters of the population over two years. Absence of opiate substitution therapy and incomplete needle/syringe exchange coverage undermines success in HIV risk reduction.

Space-time clustering of childhood leukaemia cases in Karachi, Pakistan

The incidence rate of childhood leukaemia varies internationally (about 4–40/106 per year) with the lowest rates being recorded in black African children.1 The data from population based studies on the incidence of childhood leukaemia in South Asia, including Pakistan, are lacking. The development of leukaemia has been considered as an infectious process.2 However, the epidemiological evidence for the existence of childhood leukaemia virus has been regarded as naive. Also, the question whether childhood leukaemias have a tendency to occur in cluster remains un-answered.3 We conducted this study to determine if clustering of cases of childhood leukaemia at diagnosis in time and time and space if observed was more common than could be expected. Data collection was carried out between March 2002 and November 2002. All children diagnosed between 1 January 1995 and 30 May 2002 as having any form of leukaemia before their 15th birthday and were born and resident of Karachi, were included in the …

Association of tobacco use and other determinants with pregnancy outcomes: a multicentre hospital-based case–control study in Karachi, Pakistan

Objectives The study aimed to identify the effects of maternal tobacco consumption during pregnancy and other factors on birth outcomes and obstetric complications in Karachi, Pakistan. Design A multicentre hospital-based case–control study. Setting Four leading maternity hospitals of Karachi. Participants A random sample of 1275 women coming to the gynaecology and obstetric department of selected hospitals for delivery was interviewed within 48 hours of delivery from wards. Cases were women with adverse birth outcomes and obstetric complications, while controls were women who had normal uncomplicated delivery. Primary and secondary outcome measures Adverse birth outcomes (preterm delivery, low birth weight, stillbirth, low Apgar score) and obstetric complications (antepartum haemorrhage, caesarean section, etc). Results Final multiple logistic regression analysis revealed that with every 1 year increase in age the odds of being a case was 1.03 times as compared with being a control. Tobacco use (adjusted OR (aOR): 2.24; 95% CI 1.56 to 3.23), having no slits in the kitchen (proxy indicator for indoor air pollution) (aOR=1.90; 95% CI 1.05 to 3.43), gravidity (aOR=0.83; 95% CI 0.73 to 0.93), non-booked hospital cases (aOR=1.87; 95% CI 1.38 to 2.74), history of stillbirth (aOR=4.06; 95% CI 2.36 to 6.97), miscarriages (aOR=1.91; 95% CI 1.27 to 2.85) and preterm delivery (aOR=6.04; 95% CI 2.52 to 14.48) were significantly associated with being a case as compared with control. Conclusions This study suggests that women who had adverse pregnancy outcomes were more likely to have exposure to tobacco, previous history of adverse birth outcomes and were non-booked cases. Engagement of stakeholders in tobacco control for providing health education, incorporating tobacco use in women in the tobacco control policy and designing interventions for tobacco use cessation is warranted. Prenatal care and health education might help in preventing such adverse events.

Quality of life after stroke in Pakistan

BackgroundThere is very little information about the quality of life (QOL) of stroke survivors in LMIC countries with underdeveloped non communicable health infrastructures, who bear two thirds of the global stroke burden.MethodologyWe used a sequential mix methods approach. First, a quantitative analytical cross-sectional study was conducted on 700 participants, who constituted 350 stroke survivor and their caregiver dyads. QOL of stroke survivor was assessed via Stroke Specific Quality of Life Scale (SSQOLS) whereas QOL of caregivers was assessed through RAND-36. In addition; we assessed complications, psychosocial and functional disability of stroke survivors. Following this quantitative survey, caregivers were qualitatively interviewed to uncover contextually relevant themes that would evade quantitative surveys. Multiple linear regression technique was applied to report adjusted β-coefficients with 95% C.I.ResultsThe QOL study was conducted from January 2014 till June 2014, in two large private and public centers. At each center, 175 dyads were interviewed to ensure representativeness. Median age of stroke survivors was 59(17) years, 68% were male, 60% reported depression and 70% suffered post-stroke complications. The mean SSQOLS score was 164.18 ± 32.30. In the final model severe functional disability [adjβ -33.77(-52.44, -15.22)], depression [adjβ-23.74(-30.61,-16.82)], hospital admissions [adjβ-5.51(-9.23,-1.92)] and severe neurologic pain [adjβ -12.41(-20.10,-4.77)] negatively impacted QOL of stroke survivors (P < 0.01).For caregivers, mean age was 39.18 ± 13.44 years, 51% were female and 34% reported high stress levels. Complementary qualitative study revealed that primary caregivers were depressed, frustrated, isolated and also disappointed by health services.ConclusionThe QOL of Stroke survivors as reported by SSQOLS score was better than compared to those reported from other LMIC settings. However, Qualitative triangulation revealed that younger caregivers felt isolated, depressed, overwhelmed and were providing care at great personal cost. There is a need to develop cost effective holistic home support interventions to improve lives of the survivor dyad as a unit.Trial registrationNCT02351778 (Registered as Observational Study).

356 Is ADHD associated with unintentional injuries among children? a matched case control study Pakistan

Background ADHD and unintentional injuries are common among young children. However, epidemiological data investigating association between ADHD and unintentional injuries is scarce, both from developed and developing countries. Method A hospital based case control study was conducted. A total of 300 children, 4–11 years of age with unintentional injuries (case) and 600 children with health conditions other than unintentional injuries (two controls for each case), matched for age and gender, were recruited from the emergency room (ER) of three tertiary care hospitals of Karachi: on each belonging to public and private sector. Unintentional injuries (cases) were falls, burns, drowning, poisoning and road traffic injuries, as defined by the consulting physician in the ER. Children with complaints and diagnosis other than injuries (controls) were selected from the same hospital ER within a week of case recruitment. ADHD was defined by administering strength and difficulty questionnaire (SDQ), a validated instrument for screening of ADHD, to the primary care givers of the children (parents or guardians). Conditional logistic regression was conducted to determine association of ADHD with unintentional injuries, adjusting for potential confounders. Results Children with ADHD were twice likely (mOR = 2.2, 95% CI: 1.5–3.0) to have unintentional injury. In addition, children with low socio-economic status (mOR = 1.7, 95% CI: 1.1–2.4), more than two siblings (mOR = 2.1, 95% CI: 1.1–4.4), low mother education (mOR = 2.0, 95% CI: 1.3–3.0) and history of previous injuries (mOR = 1.9, 95% CI: 1.4–2.7) were independently related to unintentional injuries. Conclusion Screening of ADHD among young age children along with parental counselling for the prevention of injuries would help in decreasing the disease burden. Prevention plans focusing on low socio-economic background children and with children of mother with low education may further reduce the incidence of unintentional injuries.

P1-506 Multilevel modelling of survey data

Introduction Presently, about five million people worldwide die yearly from tobacco related diseases. The WHO currently estimates that there are 1.3 billion people who are regular smokers. Objectives of data analysis To develop two level random effects logistic regression model for the analysis of clustered binary responses to identify factors associated with smoking among school going male adolescents. To assess if the variability between schools is different for the public and private schools using a random coefficient model. Two random effects will account for the variability between public and private schools respectively. To fit a contrasting Generalising Estimating Equation model to deal with two level clustered data for binary outcome. To compare and evaluate the results from the above mentioned models with a conventional logistic regression model as used in the original study. Methods A two-stage cluster sampling with stratification based on school type was employed for the selection of schools and students. We interviewed 772 male secondary school students. The outcome variable is smoking status of the students. We have two level data with a single level of clustering. Results Final multilevel random effect model showed that between cluster variance is significantly different from zero (p value of likelihood ratio test =0.01), which indicates that there is variability between schools and we need to take between cluster variation into account by using multilevel modelling. The Intra-class Correlation quantifies consistencies among observations within each cluster and it is also greater than zero (ICC =0.15).