Cost of diabetes care in out-patient clinics of Karachi,Pakistan

Background  

Diabetes Mellitus (DM) is a growing epidemic and the cost of treating diabetes is largely increasing. The objective of this study was to estimate the cost-of-illness of DM among attendees of out-patient clinics in Karachi, Pakistan. This is the first study conducted from a societal perspective to estimate the cost of managing diabetes in Pakistan.     

Evaluation of blood bank practices in Karachi, Pakistan, and the government's response

BACKGROUND: National legislation in Pakistan regulating blood banks has been introduced several times, but has never been passed. To support provincial-level efforts to develop legislation we conducted a study to evaluate blood-banking practices in Karachi, Pakistan, to identify areas that could be improved. METHODS: Thirty-seven blood banks were randomly selected from a list of 87 Karachi blood banks. The research team interviewed blood bank personnel, inspected available facilities and equipment, and observed blood collection using structured questionnaires and observation forms. RESULTS: Of the 37 selected facilities, 25 were operational and 24 agreed to participate. Twelve (50%) of the facilities reported regularly utilizing paid blood donors, while only six (25%) activity recruited volunteer donors. During observation only 8% of facilities asked donors about injecting drug use, and none asked donors any questions about high-risk sexual behaviour. While 95% of blood banks had appropriate equipment and reagents to screen for hepatitis B, only 55% could screen for HIV and 23% for hepatitis C. Twenty-nine percent of the facilities were storing blood products outside the WHO recommended temperature limits. IMPLICATIONS: Practices at most Karachi blood banks fell well below WHO standards. Findings from this study were instrumental in developing and passing legislation to regulate blood transfusion throughout Sindh Province, and suggest a method for improving blood transfusion practices in other developing countries.     

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

OBJECTIVES: There is a dearth of knowledge regarding Pakistani women's perceptions and treatment seeking behavior for infertility. We conducted this study to explore the contextual factors that influence the health-seeking behavior of infertile women in the lower socio-economic group. METHODS: In-depth interviews were conducted with 17 women, identified from clinics and community using pre-tested interview guidelines covering issues as the chronological sequence of the number and types of the health care providers consulted for infertility, household dynamics regarding decision making, perceived causes and social and psychological effects of infertility on the woman and her family. RESULTS: 14 of the 17 women interviewed presented with primary infertility and three with secondary infertility. Reasons reported for seeking treatment for primary infertility were: someone to carry on the family name, feeling alone and akhrat par maan bap bun kar uthna (getting up as a parent on judgment day). Two of the three women suffering from secondary infertility were seeking treatment because they did not have any male offspring. Of the 14 women, 11 initially sought treatment within the first two years of marriage; one woman reported that she was "coerced" by her mother-in-law to seek treatment following the first week of marriage. On average, a woman went to three health care providers (general practitioners, gynecologists and Traditional Birth Attendants) in her quest for assistance. The effects that infertility had on these women ranged from social pressure, coercion by in-laws and/or social isolation. Only one woman reported being put off by sex because it was not giving her what she 'desired'. CONCLUSION: Women in Pakistan seek care for infertility early and go to various types of health care providers. Infertility is usually treated as a clinical disease by the health care providers without considering its social ramifications.     

Nosocomial buffalopoxvirus infection, Karachi, Pakistan

During 5 months in 2004-2005, buffalopoxvirus infection, confirmed by virus isolation and limited nucleic acid sequencing, spread between 5 burns units in Karachi, Pakistan. The outbreak was related to movement of patients between units. Control measures reduced transmission, but sporadic cases continued due to the admission of new patients with community-acquired infections.     

Emergence of vancomycin-resistant Enterococcus faecium at a tertiary care hospital in Karachi,Pakistan

Vancomycin-resistant enterococcus (VRE) has not been reported previously in Pakistan. This is the first report where in vancomycin-resistant Enterococcus faecium was isolated from the clinical specimens of six patients admitted to the intensive care unit (ICU) and neonatal intensive care unit (NICU) of the Aga Khan University Hospital, Karachi. To identify the extent of the outbreak, rectal swabs were obtained from all the patients admitted to the ICU and NICU at that time. A total of 10 strains of vancomycin-resistant Enterococcus faecium were isolated. All the strains showed high-level resistance to both glycopeptides (vancomycin and teicoplanin) with a vancomycin minimum inhibitory concentration greater than 256 mg/L. All isolates had the vanA gene detected by polymerase chain reaction. The contour-clamped homogeneous electric field (CHEF) pattern demonstrated that all but one of the isolates were of a single clone, suggesting that they were derived from common source. Use of vancomycin and prolonged hospitalization were common features in all cases investigated.     

Measles susceptibility in children in Karachi, Pakistan

Measles, despite being vaccine preventable is still a major public health problem in many developing countries. We estimated the proportion of measles susceptible children in Karachi, the largest metropolitan city of Pakistan, one year after the nationwide measles supplementary immunization activity (SIA) of 2007-2008. Oral fluid specimens of 504 randomly selected children from Karachi, aged 12-59 months were collected to detect measles IgG antibodies. Measles antibodies were detected in only 55% children. The proportion of children whose families reported receiving a single or two doses of measles vaccine were 78% and 12% respectively. Only 3% of parents reported that their child received measles vaccine through the SIA. Among the reported single dose measles vaccine recipients, 58% had serologic immunity against measles while among the reported two dose measles vaccine recipients, 64% had evidence of measles immunity. Urgent strengthening of routine immunization services and high quality mass vaccination campaigns against measles are recommended to achieve measles elimination in Pakistan.     

Dengue outbreak in Karachi, Pakistan, 2006: experience at a tertiary care center

This is the first report of the largest epidemic of dengue hemorrhagic fever (DHF) virus infection (2006) with IgM-confirmed cases from Karachi, Pakistan. Medical records of 172 IgM-positive patients were reviewed retrospectively for demographic, clinical and laboratory data. Patients were categorized into dengue fever (DF) and DHF according to the WHO severity grading scale. The mean+/-SD age of the patients was 25.9+/-12.8 years, 55.8% were males and the hemoconcentration was recorded in a small number of patients [10 (7.0%)]. Male gender [odds ratio (OR)=14.7, P=0.003), positive history of vomiting (OR=4.3, P=0.047), thrombocytopenia at presentation (OR=225.2, P<0.001) and monocytosis (OR=5.8, P=0.030) were independently associated with DHF, but not with DF. Five cases (2.9%) had a fatal outcome, with a male-to-female ratio of 1:4. Three were from a pediatric group (<15 years). Pulmonary hemorrhages, disseminated intravascular coagulation and cerebral edema preceded death in these patients. The results have highlighted significant findings, such as adult susceptibility to DHF, pronounced abdominal symptoms and lack of hemoconcentration at time of presentation in the study population. These findings may play an important role in the case definitions of future studies from this part of the world.     

Determinants of childhood mortality in slums of Karachi,Pakistan

Pakistan has an infant mortality rate (IMR) of 90.5/1000 live births, and the country's child mortality level of 117.5 is worse than in other South Asian countries. Rapid population growth combined with rural-to-urban migration has led to the creation of urban slums in which morbidity levels are usually higher than in rural populations. A study was conducted in January 1993 in 6 slums of Karachi where the Aga Khan University has operated primary health care programs since 1985. Researchers recorded the deaths of 347 children under age 5 years old due to diarrhea and acute respiratory infections (ARI) during 1989-93. 235 mothers of these children were interviewed. The following are discussed as risk factors for under-5 child mortality: the use of traditional healers, poor nutritional status, incomplete or no immunization, the quick change of healers, inappropriate child care arrangements, mother's literacy, who decides about outside treatment, short birth interval, bottle feeding, and nuclear family structure. Maternal autonomy, appropriate health-seeking behavior, and child-rearing processes identified in the study point to the need for intervention strategies which go beyond the usual primary health care initiatives and involve communities in developing social support systems for mothers.     

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

Background  

Currently 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.     

Causes of conjunctivitis and keratoconjunctivitis in Karachi, Pakistan.

The causes of conjunctivitis and keratoconjunctivitis in 388 patients who attended eye casualty departments in Karachi, Pakistan, during a 5 month period were investigated. Most of these infections were diagnosed as adenovirus (291, 75%) or bacterial (71, 18.3%). Of the remainder, 9 cases (2.3%) were caused by herpes simplex virus and 7 (1.8%) by Chalmydia trachomatis. There was no evidence of typical active trachoma in this urban population. Bacteria or Candida albicans were also grown from 44 of the adenovirus cases (15%). Many of the bacteria grown from eyes in this study were resistant to antibiotics, probably because of inadequate and/or inappropriate self-medication with antibiotics in this community.     

Cholera in a developing megacity; Karachi,Pakistan.

Despite rapid urbanization and increasing affluence in Karachi, cases of cholera are frequent. We analysed computerized isolation data from the AKUH Clinical Microbiology Laboratory, Karachi, from 1990-6 to examine microbiological, temporal and demographic trends in Vibrio cholerae infections. During this period 888 strains of V. cholerae (566 V. cholerae serogroup O1, and 204 V. cholerae serogroup O139) were isolated from specimens from 886 patients; 214/464 were adult inpatients, and 250/464 paediatric inpatients, the remaining 422 outpatients. Isolations peaked between June and August. Overlapping epidemics occurred in 1993 and 1994 of serogroup O1 (May to August), and serogroup O139 (August to October). All ages and social and economic strata were affected. Forty-four percent of all isolates were from children under the age of 5 years. The mean age of all patients with serogroup O1 infections was 19.6 years (+/-0.9) compared with 367 (+/-1.7) for serogroup O139 infections (P < 0.0001, t test). More than a quarter (27%) of all serogroup O1 isolates were from babies under 2 years of age. One patient had a serogroup O1 infection followed by a serogroup O139 infection 1 year later. Another patient was infected with serogroup O1 strains 5 years apart. Emergence of resistant strains was observed, but by 1996 serogroup O139 had disappeared. An aquatic organism, cholera nevertheless continues to take its toll in this city of 11 million situated in a desert.     

Intra-household clustering of hepatitis C virus infection in Karachi, Pakistan

Transmission rates of hepatitis C virus (HCV) infection through non-sexual household contacts have been considered to be very low. This study evaluated intra-household clustering of cases of HCV infection in a low socio-economic community in Karachi, Pakistan. Serum samples from 341 household contacts of 86 thalassaemic HCV-seropositive children were evaluated for antibodies to HCV using an ELISA. Spatial analysis of data was carried out to test for intra-household clustering. Seventy of 341 (20.5%) household contacts were HCV-seropositive. Of the households studied, 44.2% (38/86) had one or more contacts who tested HCV-seropositive. Ecological analysis of variables at household level showed that in households where HCV-seropositive index thalassaemic children were male HCV tended to be transmitted to one or more familial contacts. Spatial analysis with an asymptotic score test of the null hypothesis of no extra within-family infectivity revealed that there was a significant tendency of HCV infection to cluster within a household (score statistic = 19.44, P=0.032). The results showed that non-sexual household exposure may play a role in efficient HCV spread to household contacts of HCV-infected persons and needs further evaluation.     

Prevalence of byssinosis in spinning and textile workers of Karachi, Pakistan

The authors measured prevalence of byssinosis in spinning and textile workers of Karachi, Pakistan, and examined association of the disease with demographic and environmental factors. This was a cross-sectional study conducted in 3 spinning and textile mills and 3 colonies inhabited by spinning and textile workers. A precoded questionnaire was administered to the workers and followed by physical and clinical examination. Among 362 textile workers, the authors found the prevalence of byssinosis to be 35.6%. Educational status of the workers and section of the mill were significantly associated with prevalence of the disease. The authors conclude that there is a high prevalence of byssinosis in spinning and textile workers of Karachi. Furthermore, low education level and work in the spinning section of the mill appear to contribute significantly to the high prevalence of the disease in Pakistan.     

Primary amebic meningoencephalitis caused by Naegleria fowleri, Karachi, Pakistan

We report 13 cases of Naegleria fowleri primary amebic meningoencephalitis in persons in Karachi, Pakistan, who had no history of aquatic activities. Infection likely occurred through ablution with tap water. An increase in primary amebic meningoencephalitis cases may be attributed to rising temperatures, reduced levels of chlorine in potable water, or deteriorating water distribution systems.