Economic burden of thalassemia on parents of thalassemic children: a multi-centre study

Objectives To determine the economic burden of thalassemia on parents of thalassemic children

Study design, settings and duration: Descriptive nonprobability, purposive sampling done in PHRC Research Centres of Multan, Lahore, Islamabad, Karachi, Peshawar and Quetta from July 2013 to June 2014

Patients and Methods: After taking informed written consent, parents/guardians of thalassemia major children were interviewed. All information was recorded on the pre-tested questionnaire. Data was entered and analyzed using SPSS version 11

Results: A total of 600 guardians/ parents of the thalassemic children were included in the study. There were 57% boys and 43% girls with a mean age of 9.40 +/- 5.66 years. Among them, 47.8% were from rural and 52.2 % from urban areas. Almost 71% children were transfusion dependent. The family history of cousin/interfamilial marriage was present in 78.2% while parental consanguinity was present in 72.8%. Only 1.7% parents got premarital screening for thalassemia. In private sector 56.8% had to pay nothing while others had to pay from Rs. 500 to Rs. 2000 per visit. Expenditure per month in private thalassemia centres showed that 57% had to bear no cost at all, 12.2% had to spend up to Rs. 1000, while 24.8% Rs. 1001 to 5000 and 6% had to pay more than Rs. 5000. In the government sector cost per visit in 35.5% was up to Rs. 500 while others had to pay between Rs. 501 to more than Rs. 2000. Monthly cost at government sector almost doubled. Total expenditure [private and government sector] per month was Rs. 9626 for each patient

Conclusion: Total cost [both direct and indirect] for the management of thalassemia was quite high and this cost puts significant economic burden on the affected thalassemic families. This disease puts social, financial and psychological impacts on suffering families, so prevention-based strategies like premarital screening, prenatal diagnosis and genetic counseling should be adopted in Pakistan. A national screening project for thalassemia is the need of the day

Hepatitis E virus seroprevalence in pregnant women in Pakistan: maternal and fetal outcomes

Hepatitis E virus [HEV] is endemic in Pakistan. Although otherwise asymptomatic, HEV infection becomes fatal in pregnancy, with considerable maternal and fetal morbidity and mortality. We conducted a descriptive study from April to October 2015 in 10 tertiary care hospitals throughout Pakistan to determine maternal and fetal morbidity and mortality in HEV-positive pregnant women with acute jaundice or raised liver function tests. Twenty-one of 135 women were HEV positive and in 3rd trimester except for 1 in 1st trimester. Overall prevalence of HEV in pregnancy was 0.19%. Ten women were artificially induced, 3 had premature labour, 4 delivered spontaneously [full term], 3 died and there was 1 intrauterine death. One woman had a home abortion before coming to hospital. There were 7 perinatal infant deaths: 4 intrauterine, 3 stillbirths and 1 abortion. Maternal mortality was significantly associated with delivery, as 17 mothers who lived went into labour spontaneously or were artificially induced, whereas 3 women who continued their pregnancy and did not deliver, died. Case fatality rate of HEV infection in pregnancy was 14.2%

Screening for tuberculosis among household contacts of index patients

Household contacts of sputum positive pulmonary TB cases are at a high risk of getting infected with tuberculosis therefore symptomatic or vulnerable individuals should be screened and treated early. To determine the prevalence of pulmonary tuberculosis in the households contacts of index patients having pulmonary tuberculosis infection using standard diagnostic tests and refer the positive cases to DOTS program for treatment. This national descriptive study was conducted in seven Centers of PMRC throughout Pakistan form November 2010 to March 2012. A total of 580 index adult patients suffering from pulmonary tuberculosis, being treated at DOTs Centers of major tertiary care hospitals of Karachi, Lahore, Multan, Peshawar and Quetta living within 5-8 kilometers of the hospital, who consented to participate in the study were selected from the DOTs centres. Generally one but occasionally two close contacts of these index patients [spouses, parents or siblings] were called to the hospital for screening of TB using chest Xray, smear microscopy and tuberculin skin test. Out of 800 contacts screened, 125 [15.6%] were positive on sputum smear examination while 113 had infiltration on X-rays along with positive tuberculin skin test [Indurations of >10 mm] making a definitive diagnosis of TB. Calcified lesions were seen on X-rays in another 91 cases giving evidence of past infection, however 26 of these were AFB positive indicating either the relapse of disease or active lesion. Low grade fever and weight loss were the most significant findings in contacts that were positive on sputum smear and radiology. Almost 15.6% household contacts of pulmonary tuberculosis patients have pulmonary tuberculosis. Health care providers in general and DOTs staff in particular should be trained to inform all index cases that their close contacts especially those suffering from weight loss and fever should be screened for tuberculosis and treated if required

Evaluation of resistance to fluoroquinolones in clinical isolates of escherichia coli

The evaluation of resistance to ciprofloxacin [CIP] in Escherichia coli [n=1112] isolated from clinical specimens including urine, pus, high vaginal swabs, etc. was carried out at Rawalpindi General Hospital, Rawalpindi during the years 2002- 2005. The isolates were identified by colonial morphology, gram staining, and biochemical tests like indole, citrate and TSI. The antibiotic susceptibility of these isolates was determined by Kirby-Bauer disk diffusion method according to the standard guidelines of Clinical Laboratory Standards Institute [CLSI]. During the year 2002 resistance to ciprofloxacin was 49.19% [n=187], in the year 2003 it was 47.5% [n=297], in year 2004 was 59.03% [n=332], in year 2005 was 46.28% [n=296]. When resistant isolates from different sources were compared E. coli uropathogens varied between 45.2 to 58.53% during the four year. While pus isolates in 2003 were highly resistant [69% resistance] and isolates from high vaginal swab showed peak resistance in 2004 [66%] Fig. 3 table 4. In the year 2002, four fluoroquinolones [FQs] i.e. ofloxacin [OFX], ciprofloxacin [CIP], enoxacin [ENX] and sparfloxacin [SPX] were included in the study while norfloxacin [NOR] was tested against urinary isolates only. During that year 203 isolates were identified as E. coli; 124 from urine, 45 from pus, 21 from high vaginal swabs, and 13 from other sources. Highest resistance was seen in isolates from urine ranging from 54-68% against these FQs

Frequency, causes and outcome of placenta praevia

The objective of the study was to identify and target preventive interventions among women at increased risk of placenta praevia. This is a Descriptive study. All the case records of women with the diagnosis of pregnancy with placenta praevia were reviewed. The frequency of placenta praevia was 1.45% or 1:69 deliveries complicating a singleton pregnancy. Diagnosis of placenta praevia was confirmed by complete history, examination and finally the ultra sound examination, the course of events during antenatal period, their mode of delivery and fetal outcome of all such patients were assessed. Special attention was paid to the past history of dilatation and curettage, previous LSCS and or other forms of uterine surgical procedures. There were 7082 deliveries during the study period. Out of which 103 patients had placenta praevia. The frequency of placenta praevia was found to be 1.45% or 1:69 deliveries. The maximum No. of patients 38 [36.89%] had placenta praevia type III. Highest percentage of the patients with placenta praevia were between 30-35 years. 40 [38.83%] gave history of one or more Gynecological/Obstetrical procedures before the present pregnancy. Incidence of placenta praevia was significantly higher in patients with previous Caesarean Section i.e 15 [15.15%] had previous one or more LSCS. While 18 [17.4%] had history of previous curettage/induced abortion. The poor socioeconomic status illiteracy early marriages, multiparity, long distances from the referral centers, lack of proper health care facilities at the primary and secondary health care centers predisposed the patients in our area to increased incidence and complications of placenta praevia

Prevalence of anemia in Zhob Killi Qamardin Karez, Balochistan

Instead of communicable diseases, developing countries are now seeing serious increase in non-communicable disease and Anemia is one of major problems in developing countries like Pakistan especially in under developed areas like e.g Balochistan. Anemia is prevalent in certain area of this continent. Anemia is little bit prevalent in the Urban area of the Balochistan but rural and high altitude areas are still desire its due attention. The people affected belong to rural areas with low socio-economic status and are unable to afford the even economical iron therapy diagnosis, treatment. In some cases bone marrow aspirates and immunodiagnostic facilities are needed for diagnostic purpose. Results showed that prevalence of anemia was high in more than fifteen years of age group, females suffered more with anemia as compared to males in the area