Ethics In Health Care Settings: Practices Of Healthcare Professionals And Perceptions Of Patients Regarding Informed Consent, Confidentiality And Privacy At Two Tertiary Care Hospitals Of Islamabad, Pakistan.

BACKGROUND: Medical profession works within thin lines of professionalism and trust. Faith of the patients often breached but less reported among the Low and Middle-Income Countries (LMICs). In Pakistan, though the Pakistan Medical and Dental Council (PMDC) have its own code of medical ethics but there isn't much evidence on regulating ethical misconducts. Apart from the gross violations of the code of conduct, the "insensible" misuse of informed consent, confidentiality and privacy is very common. This study is an effort to explore practices of informed consent, confidentiality and privacy among health care providers along with assessment of perceptions of patients about ethical practices in two tertiary care hospitals of Islamabad, Pakistan. METHODS: We conducted eight homogenous Focus Group Discussions (FGDs), four each in both the public and private sector hospitals till the saturation was achieved. RESULTS: Informed consent, in clinical practice, was found not being practiced. Confidentiality was not being uniformly applied in practices. Patients perceived the practices being contrary to the ethics. According to patients, ethical measures were found satisfactory in private hospitals. However, patients were not gratified fully with both the systems of healthcare delivery. CONCLUSIONS: There is insufficient adherence to the ethical principles in clinical practice, in both public and private sector hospitals in Islamabad, Pakistan. Informed consent, privacy and confidentiality are time and time again unheeded due to lack of robust system of monitoring and penalties by the responsible authorities.

Prevalence of hepatitis B among Afghan refugees living in Balochistan, Pakistan.

OBJECTIVE: Continued civil war and political instability in Afghanistan have lead to a huge influx of refugees into the neighboring provinces in Pakistan. This study was conducted to estimate seroprevalence of hepatitis B and to identify potential risk factors for hepatitis B virus (HBV) transmission among the refugees living in the camps of Balochistan Province, Pakistan. METHODS: A cross-sectional survey of hepatitis B surface antigen (HBsAg) was conducted during October 2003. We obtained the registration list to select families randomly from the refugee camps. A husband, wife and one of their children, selected at random, were enrolled in the study. Study subjects with positive laboratory results for HBsAg were compared with those who were negative for HBsAg. RESULTS: Field workers interviewed 301 families with a total of 903 study subjects. Blood specimens of 75 study subjects (8.3%, 95% CI 6.6-10.3) were positive for HBsAg. There were 37 husbands (12.3%, 95% CI 7.2-14.4) and 21 wives (7.0%, 95% CI 4.5-10.6) positive for HBsAg. Out of 301 children, 17 (5.6%, 95% CI 3.4-9.1) were positive for HBsAg. Receiving more than ten injections during the previous year increased the risk of HBV infection (OR 3.5, 95% CI 1.8-6.7). A child positive for HBsAg was more likely to have a positive parent compared to an HBsAg negative child (OR 5.7, 95% CI 2.0-16.5). CONCLUSION: Hepatitis B is highly endemic among Afghan refugees living in these camps. Unsafe injection practices will continue to cause a steady increase in the magnitude of this health problem until appropriate control measures are taken. The possibility of mother-to-child transmission underscores the need to include vaccination against hepatitis B as part of routine immunization in this population.