Showing papers by "Syed Iqbal Azam published in 2002"

Time to focus child survival programmes on the newborn: assessment of levels and causes of infant mortality in rural Pakistan

Abstract: OBJECTIVE: Population-based surveys were conducted in selected clusters of Pakistan's least developed provinces, Balochistan and North-West Frontier Province (NWFP), including the Federally Administered Tribal Areas (FATA), to assess levels and causes of neonatal and postneonatal mortality. METHODS: Interviews were conducted in a total of 54 834 households: Balochistan, 20 486; NWFP, 26 175; and FATA, 8173. Trained interviewers administered questionnaires after obtaining verbal informed consent from the respondents. Verbal autopsy interviews were conducted for infant deaths reported for the previous year. FINDINGS: The infant mortality rate based on combined data from the different sites was 99.7 per 1000 live births (range 129.0-70.1). The contribution of neonatal deaths to all infant deaths was much higher for NWFP (67.2%), where the overall rate was lowest, than for Balochistan (50.8%) and FATA (56.8%). Around 70% of all neonatal deaths occurred in the early neonatal period. The three main clinical causes of infant deaths were diarrhoea syndrome (21.6%), tetanus (11.7%) and acute respiratory infections (11.6%). In the neonatal period, however, tetanus (18.3%), small size for gestational age or low birth weight (15.3%), and birth injury (12.0%) accounted for nearly half (45.6%) of all deaths, while the contributions of diarrhoea syndrome (5.1%) and acute respiratory infections (6.0%) were less significant (11.1%). Tetanus was the cause of death for 21.7% and 17.1% of all infant deaths in FATA and NWFP respectively. CONCLUSION: The results suggest that there should be a shift in child survival programmes to give greater emphasis to maternal and neonatal health, in particular to maternal tetanus immunization, safe delivery and cord care.

Prevalence and risk factors associated with tuberculin skin test positivity among household contacts of smear-positive pulnionary tuberculosis cases in Umerkot, Pakistan.

Abstract: Study population and setting Household contacts of acid-fast bacilli (AFB) sputum smear-positive tuberculosis patients in the Umerkot Taluka, Sindh, Pakistan. Objective To estimate the prevalence of and identify risk factors associated with tuberculin skin test (TST) positivity among household contacts of acid-fast bacilli (AFB) sputum smear-positive pulmonary tuberculosis cases. Design A cross-sectional study of household contacts of AFB sputum smear-positive tuberculosis cases, registered at the Umerkot Anti-Tuberculosis Association clinic from August 1999 to September 1999. The contact's Mycobacterium tuberculosis infection status was assessed using TST. On the day of the TST, a pre-designed questionnaire was administered to collect data on putative risk factors for TST positivity among contacts. The data were analysed using a marginal logistic regression model by the method of generalised estimating equations (GEE) to determine risk factors independently associated with TST positivity. Results The prevalence of TST positivity among household contacts of AFB sputum smear-positive index patients was 49.4%. The final multivariate GEE model showed that contact's age and sleeping site relative to the index case, the intensity of the index case's AFB sputum-smear positivity and the contact's BCG scar status were independent predictors of TST positivity among household contacts of AFB sputum smear-positive index cases. Conclusions The results suggest that the household contacts of AFB sputum smear-positive tuberculosis patients in a poor neighbourhood of rural Sindh had a high prevalence of M. tuberculosis infection as determined by TST. Poor housing conditions seem to contribute to the spread of M. tuberculosis infection. Early diagnosis of pulmonary TB through evaluation of TST-positive household contacts, followed by appropriate therapy, may prevent further spread of M. tuberculosis infection. We recommend an awareness programme to prevent household contacts from acquiring M. tuberculosis infection from smear-positive pulmonary TB cases.

The utilization of services of health care providers among patients presenting to family physicians at a teaching hospital in Karachi, Pakistan.

Abstract: OBJECTIVE To study the utilization of services of Health care providers among patients presenting to Family Physicians in a teaching hospital in Karachi. METHODOLOGY It was a cross sectional study. A questionnaire was developed to collect patient's utilization of services of health care providers. The investigators administered the questionnaire to 387 patients, after purpose of the study was explained, written consent was taken and confidentiality was assured. RESULTS The study population included more females than males, with average age of 32.6 years. The majority were married, well educated, in private and government service, were students or housewives. We found that 383(99%), 141(36.4%), 88(22.7%) and 45(11.6%) of the respondents had used services of allopaths, homeopaths, hakims and spiritual healers respectively. It is important to consider that these patients had come for allopathic treatment, thus exhibiting preference for it. The five main ailments for consulting health care providers differed, suggesting the perception in the mind of patients that certain ailments are better treated by particular system of treatment than the others. Studies are needed to explore this area further. The main reasons for consultation with particular health care provider were the recommendation of others or the perceived effectiveness of the practitioners. The reasons cited for non-consultation with health care providers were the lack of belief in them or lack of effectiveness of their treatment. Three hundred seventy nine (98%), 259 (67%), 174 (45%) and 249 (64.4%) of patients were willing to consult allopaths, homeopaths, hakims and spiritual healers again respectively, if unwell in future. CONCLUSION We found a substantial utilization of services of complimentary medicine practitioners among patients seeking allopathic treatment. Further study on the utilization and organization of services offered by health care providers is required.

Psychiatric morbidity and perceptions on psychiatric illness among patients presenting to Family Physicians, in April 2001 at a teaching hospital in Karachi, Pakistan

Abstract: Objective: To assess psychiatric morbidity and the perceptions about psychiatric illness, among patients presenting to family physicians, at a teaching hospital in Karachi, Pakistan. Methods: A questionnaire based survey was developed to collect demographic data, information on psychiatric morbidity and perceptions on psychiatric illness. It was administered to 400 patients, against a sample size of 347. The study objective was explained, written consent was taken and confidentiality was assured. Results: There were more women then men in the study, with a mean age of 37 years. The majority was married, better educated and socioeconomically placed then the rest of the population. A total of 175 (43.75%) subjects reported psychiatric illness in the family. A psychiatrist or a family physician diagnosed the illness in 110 (62.85%) and 37 (21.14%) of the cases, respectively. A total of 68 (38.85%) subjects reported reluctance in accepting a diagnosis of psychiatric illness. A total of 296 (74%) of the respondents thought that psychiatric illness is stigmatized and therefore treatment is not sought for it. Alternate treatment for psychiatric illness were quoted as seeking treatment from a Hakim (49 subjects, 12.3%), spiritual healers (49 subjects, 12.3%) and family support (10 subjects, 2.5%). A total of 121 (30%) subjects thought that psychiatric illness is caused by supernatural powers and spirits. A total of 109 (27.3%) subjects felt a need to seek psychiatric help, but did not visit a psychiatrist because of reluctance. Conclusion: Considerable psychiatric morbidity exists among our patient population and is stigmatized. We recommend improvement in psychiatric services, as well as patient education programs. © 2002 Blackwell Publishing Asia

Nécessité d'axer les programmes de survie de l'enfant sur les nouveau-nés : évaluation des taux et des causes de mortalité infantile dans des zones rurales du Pakistan

Abstract: Objectif Des enquetes en population ont ete realisees dans des groupes choisis de provinces les moins developpees du Pakistan, a savoir le Beloutchistan et la province frontiere du nord-ouest (NWFP), y compris les zones tribales sous administration federale (FATA), afin d’evaluer les taux et les causes de mortalite neonatale et postneonatale. Methodes Au total, des entretiens ont ete menes dans 54 834 menages : 20 486 au Beloutchistan, 26 175 dans la NWFP et 8173 dans les FATA. Des enqueteurs experimentes ont distribue des questionnaires apres avoir obtenu verbalement le consentement eclaire des interesses. Concernant les deces de nourrissons rapportes au cours de l’annee precedente, des autopsies verbales ont ete realisees. Resultats Le taux de mortalite infantile calcule d’apres les donnees cumulees des differents sites est de 99,7 pour 1000 naissances vivantes (intervalle 129,0–70,1). La part representee par les deces neonatals dans l’ensemble des deces infantiles est beaucoup plus elevee dans la NWFP (67,2 %), ou le taux de mortalite generale est le plus bas, qu’au Beloutchistan (50,8 %) et dans les FATA (56,8 %). Pres de 70 % de l’ensemble des deces neonatals surviennent au debut de la periode neonatale. Les trois principales causes cliniques de deces infantiles sont le syndrome diarrheique (21,6 %), le tetanos (11,7 %) et les infections respiratoires aigues (11,6 %). En revanche, pendant la periode neonatale, le tetanos (18,3 %), la petite taille pour l’âge gestionnel ou le faible poids de naissance (15,3 %) et les traumatismes a la naissance (12,0 %) representent pres de la moitie de tous les deces (45,6 %), tandis que la part imputable au syndrome diarrheique (5,1 %) et aux infections respiratoires aigues (6,0 %) est moins importante (11,1 %). Le tetanos est responsable de 21,7 % de l’ensemble des deces infantiles dans les FATA et de 17,1 % dans la NWFP. Conclusion Ces resultats laissent a penser qu’il faudrait modifier les programmes axes sur la survie de l’enfant afin de mettre davantage l’accent sur la sante maternelle et neonatale, en particulier sur la vaccination antitetanique des femmes enceintes, l’accouchement sans risque et les soins du cordon ombilical.