Injection practices among practitioners in private medical clinics of Karachi, Pakistan.

The aim of this study was to determine the frequency and determinants of sharps injuries among private health practitioners in slum areas of Karachi, Pakistan. All practitioners with at least 1 year of experience in a private medical clinic were asked to complete a self-administered, structured questionnaire (317/397 responded). Only 7.9% of practitioners were qualified from medical school, 12.3% were registered nurses and 8.8% lacked any professional qualifications. At least 1 sharps injury in the previous 12 months was reported by 26.7%, mostly due to needle recapping. Only 25.2% reported using a new syringe for each patient. In multivariate regression analysis shorter work experience, < 14 years of schooling, > 20 patients per day, administering > or = 30 injections per day, reuse of syringes and needle recapping after use were significantly associated with sharps injury in the past year. Better awareness and training on standard precautions is needed for private practitioners in slum areas of Karachi.

Seasonal, nontoxigenic Vibrio cholerae O1 Ogawa infections in the Eastern Region of Saudi Arabia.

BACKGROUND: Surveillance for Vibrio cholerae in the Eastern Region of Saudi Arabia has been ongoing since 1985 to detect and prevent local proliferation of imported cholera. In 1996 and 1997 the authors performed additional microbiologic and epidemiologic assessment of V. cholerae surveillance to better characterize a recurrent summertime pattern of V. cholerae infections in the Eastern Region of Saudi Arabia. METHODS: All health facilities routinely submitted stool or rectal swab specimens for isolation of V. cholerae from patients with gastroenteritis. In addition, specimens were taken from expatriate workers and household contacts of persons with confirmed V. cholerae infection. Forty-two isolates were evaluated for cholera enterotoxin by enzyme-linked immunosorbent assay, cholera toxin polymerase chain reaction, and Y1 adrenal cell assay; 12 isolates also were characterized by pulsed-field gel electrophoresis (PFGE). Interviews about potential exposures were done for all V. cholerae infections. RESULTS: Vibrio cholerae O1 serotype Ogawa biotype El Tor was identified in 113 gastroenteritis patients (6.0 per 100,000 population per year), 28 asymptomatic expatriate workers, and 16 of 982 household contacts of index patients. All symptomatic infected persons had mild illness that was not typical of cholera, and all 42 isolates evaluated were nontoxigenic. All 12 isolates evaluated by PFGE had an indistinguishable pattern (pattern 81). Infections appeared in late May, decreased in mid-July through August, increased again in September, and disappeared from December through April. Infections had a uniform geographic distribution and affected all ages. No linkage was identified between affected households, or between community cases and food-handlers or domestic servants. DISCUSSION: Surveillance in the Eastern Region of Saudi Arabia has identified a novel strain of nontoxigenic V. cholerae O1 Ogawa. This strain probably has a local environmental reservoir. Since cholera toxin is the primary virulence factor involved in the cause of cholera, assays for cholera toxin should be included in cholera surveillance.

Breastfeeding practice in dammam area of saudi arabia.

OBJECTIVES: The main objective of this study was to determine the breastfeeding status for children under 24 months and assess the causes of breastfeeding failure among those mothers who do not breastfeed their babies. METHODOLOGY: This study was conducted on a sampled population of 1185 children under 24 months of age, using breastfeeding indicators recommended by World Health Organization, for assessing breastfeeding practices within a recall period of 24 hours, in the Dammam area of Saudi Arabia. RESULTS: The exclusive breastfeeding rate and predominantly breastfeeding rates were 33% and 11.5%, respectively, under 4 months of age among these children. The timely complementary feeding rate was 31.7% only. All the values were far behind those recommended. The reasons given in order of their frequencies by the mothers for failure to breastfeed were insufficient milk, advice and example of other mothers and formula milk advertisement. CONCLUSION: This study recognizes the low level of exclusive breastfeeding among children under 4 months of age and lays emphasis on changing the behavior of mothers towards exclusive breastfeeding. This can be achieved by special integrated community-based approaches among potential mothers by supporting them after delivery and proper follow-up, to prevent failure of milk formation and discontinuation of breastfeeding.

Asymptomatic salmonella, Shigella and intestinal parasites among primary school children in the eastern province.

OBJECTIVE: The main objective of this study was to determine the prevalence of some potential entropathogens among primary school children. METHODOLOGY: This study was conducted, on a sampled population of3258 primary school going children in the age group of 6-11 years. They were investigated for the presence of some potential enteropathogens in their stools. RESULTS: The overall prevalence of enteropathogens was 10.44 percent. Salmonella and Shigella species were found among 114 percent children. Multiple drug resistance was common in the isolated species of Salmonella and Shigella with ma exception of Nalidixic acid and cephalothin in Shigella. The prevalence rate of parasitic infection was 9.30%. The most common parasite found was giardia lambia, 8.16 percent, and next most common was Entamoeba histolytica 0.74%, followed by other parasites: (Hemenolepis nana, Ascaris lumbricoides, Trichuris trichuira and Enterobious vermicularis, in order of their frequencies). CONCLUSION: This study lays emphasis on the importance of asymptomatic carriers as a potential source of infection and demonstrates the emergence of resistance in salmonella and Shigella species.

A study on diarrheal diseases in children under five years of age.

A cross sectional house-to-house survey on diarrheal disease in children less than five-years-of-age was conducted in the Eastern Province of Saudi Arabia. The main objective was to determine diarrheal disease morbidity and its relationship with different variable factors and management practices during the episode of diarrhea. The survey population included 1,105 households with 2,005 children under five-years-of-age selected from the entire Eastern Province. The prevalence observed was 7.6% during a two-week period giving an annual incidence of two episodes per child per year. Diarrheal morbidity was less prevalent among with age, water storage, and feeding patterns. Diarrhea morbidity was less prevalent among children receiving breast milk. The majority of cases with diarrhea were treated in health facilities where 27% were given drugs only. A solution containing sugar and salt in addition to home fluids were given to 46.4% while 23% received oral rehydration solution (ORS).