Health and Immune Boosting Techniques of General Adult Pakistani Population: A KAP Study.

OBJECTIVE: To discover Pakistani adult population's perception about their general health, immune status and knowledge regarding immunity, and to highlight their efforts to improve it. METHODS: The knowledge-attitude-practice study was conducted from January to May 2021, after approval ethics review committee of the Islamic International Medical College, Rawalpindi, Pakistan, and comprised individuals of either gender from the community aged 18 years or more and not suffering from any physical disability or mental illness. Data was collected using a pre-tested, self-administered questionnaire that was disseminated through online platforms. The collected data was analysed using SPSS 25. RESULTS: All the 455(100%) individuals approached responded to the questionnaire. The mean age of the subjects was 22.6±7.579 years. There were 256(56.3%) female respondents, 283(62.2%) were aged 20-21 years, and 359(78.9%) hailed from the Sindh province. Most participants perceived their general health as 'good' 197(43.3%). The immune system function was reported 'good' by 200(44%), and the perception of general knowledge of immunity was reported 'good' by 189(41.5%) subjects. Inverse relationships were identified between stress levels and self-perceived health, and between receiving effective homeopathic treatment and 'very good' self-perceived immune status (p<0.05). People willing to take non-obligatory vaccines had a positive opinion about their self-perceived knowledge on immunity that produced a direct relationship (p<0.05). CONCLUSIONS: The findings provide a framework of practices that should be promoted to improve health status of adult population in Pakistan.

A comparative study of the common complaints and secondary complications in patients of osteoarthritis on allopathic, homeopathic and herbal system of medicines.

Osteoarthritis is the most common form of arthritis worldwide and progression of arthritis may lead to secondary complications. Osteoarthritis is the degradation of joint tissues from the effects of injury, grinding sensation and inflammation. There are three main systems of medicine including allopathic, homeopathic and herbal system for the treatment of osteoarthritis. Plants are the basis for traditional medicine which is still widely practiced today. The objective of the present study is to find out the complaints and secondary complications in patients of osteoarthritis on allopathic, homeopathic and herbal system of medicine. This study was conducted in Karachi from January 2019 to January 2020. Allopathic, Homeopathic and Herbal practitioners were consulted in the study (n=600, with= 200 in each study group). Data was analyzed by SPSS 22 version. Finding of the study suggest that after the treatment with allopathic medicines orthopaedician, family physician or rheumatologist / internal medicine specialist, there was no significant difference in complaints (Chi-square =0.598, p=0.742). Moreover, there was no significant difference in complications (Chi-square = 0.039, p=0.981). While treatment with homeopathic medicines either by orthologist or family physician significant difference in complaints were observed (Chi-square =4.86, p=0.027). The patient visiting family physicians have higher number of complications than orthologists. While treatment with herbal medicines either by orthologists or family physician there was significant difference in complaints. (Chi-square =5.404, p=0.020). The study reveals that there is no significant difference of complaints and complications in allopathic systems of medicine when treating osteoarthritis, while it is significant for homeopathic and herbal medicine.

Determinants of patients preferring Complementary and Alternative medicine attending public hospitals in Lahore, Pakistan.

OBJECTIVE: To find the frequency and determinants of patients preferring complementary and alternative medicine over registered medical doctors.. METHODS: This cross-sectional study was conducted at Services Hospital, Mayo Hospital and Jinnah Hospital in Lahore, Pakistan, from June 8 to August 20, 2017.A pre-tested self-administered questionnaire was used to collect data. SPSS 20 was used for data analysis. . RESULTS: Of the 385 subjects, 200(51.9%) had visited at least one complementary and alternative medicine healer in their life. Besides, 166(83%) subjects confirmed positive outcome of such therapies. When asked about reasons behind their choice,227(59%)subjects mentioned cost effectiveness, 99(25.7%) better understanding, 131(34%) guidance about disease by such healers, 198(51.4%) harmless therapies, 198(51.4%) natural ingredients of medicines, 154(40%) accessibility, 161(41.8%) psychological satisfaction, 221(57.4%) said fewer appointments, 222(57.7%) said diagnosis without laboratory tests, 131(34%)family influence, 52(13.5%) had surgical fears, 101(26.2%) said faith in spiritual exercises, 63(16.4%) were addicted to complementary and alternative medicine products, 122(31.7%) said better communication) while183(47.5%) said sparing more time for consultation. CONCLUSIONS: There were a variety of beliefs and reasons behind patients preferring complementary and alternative medicine providers over medical doctors.

Opium trade and the spread of HIV in the Golden Crescent.

The Golden Crescent region of South Asia-comprising Afghanistan, Iran, and Pakistan-is a principal global site for opium production and distribution. Over the past few decades, war, terrorism, and a shifting political landscape have facilitated an active heroin trade throughout the region. Protracted conflict has exacerbated already dire socio-economic conditions and political strife within the region and contributed to a consequent rise in opiate trafficking and addiction among the region's inhabitants. The worsening epidemic of injection drug use has paralleled the rising incidence of HIV and other blood-borne infections in the region and drawn attention to the broader implications of the growing opiate trade in the Golden Crescent. The first step in addressing drug use is to recognize that it is not a character flaw but a form of mental illness, hence warranting humane treatment of drug users. It is also recommended that the governments of the Golden Crescent countries encourage substitution of opium with licit crops and raise awareness among the general public about the perils of opium use.

Spatial distribution of health consultations in the past two weeks by provider type and district: Pakistan Social and Living Standards Measurement Survey 2014-15.

Place is a nexus between epidemiology and Geographic Information System. In this study, the Pakistan Social and Living Standards Measurement survey 2014-15 data on percent distribution of health consultations, in the past 2-weeks by type of healthcare provider were mapped cumulatively, as well as disaggregated by urban and rural areas, using a GIS programme to visualize spatial distribution in the country by district. Private sector is the main and preferred provider for healthcare services when Pakistanis get sick or injured. Differences between and within provinces - at the district level - exist, but in spite of significant investment by the government in public sector health and nutrition services; most people prefer going to private dispensaries and hospitals. Harnessing the visualization power of GIS for better decision making in health sector is contingent upon easy availability of up-to-date GIS shapefiles to analyze and depict health data on maps.

Self-management of headache: a cross-sectional survey in the General Public of Islamabad.

OBJECTIVES: To quantify the frequency of self-management for headache by adult population aged >18 years in urban and rural Islamabad. METHODS: The cross-sectional study using systematic sampling of households was conducted in I-8 sector of Islamabad and its outskirts (in Nurpur Shahan) from March to September 2011. It comprised 248 individuals above 18 years of age who were interviewed using a structured questionnaire. SPSS 16 was used for data analysis. RESULTS: Of the total, 136 (54.8%) were males and 112 (45.2%) were females. The overall mean age was 32 +/- 12.5 years, and 218 (87.9%) suffered from headache. Out of those suffering from headaches, 178 (81.7%) employed self-management. Pharmaceutical drugs (n = 155; 87.1%) were the commonest modality employed, while vitamins (n = 6; 3.4%), massage (n = 8; 4.5%), herbal remedies (n = 4; 2.2%) and homeopathic medicines (n = 5; 2.8%) were infrequently utilised. Acetaminophen (panadol) was the commonest pharmaceutical drug used (n = 91; 58.7%), followed by salicylic acid (aspirin) (n = 46; 29.7%). Self-management was slightly more frequent among males (n = 95; 53.37%) and in the above-matriculation group (n = 103; 57.8%). A total of 151 (84.7%) people claimed to be satisfied with their self-management. CONCLUSION: Self-management of headaches is highly prevalent among the general public. The majority opts for pharmaceutical drugs, mostly preferring acetaminophen. Most are satisfied with their self-management.

Attitude and practice of patients and doctors towards complementary and alternative medicine.

OBJECTIVES: To determine the attitude towards complementary and alternative medicine among the doctors and patients. METHODS: The study was carried out at Civil Hospital Karachi and Liaquat National University Hospital, Karachi during April to September 2010. Two sets of questionnaires were developed separately for doctors and patients. Each set consisted of queries regarding demographic data of patients and doctors. The questionnaire for the patients contained questions reflecting the general attitude, mode of complimentary and alternative medicine usage, disease referred and the underlined reasons behind pricking the options. The questionnaires for doctors in general laid focus on the personal opinion about the practice not only for their own use, but also related to their concern towards those patients who used complimentary and alternative medicine. Predictive analysis software statistics 18 was used for statistical analysis. RESULTS: Of the patients, 237 (59.3%) used complimentary and alternative medicine. Herbal medicine followed by homeopathic medicine were the most commonly used therapies. Fever and cough were the most common diseases for which patients used the options. The preference was mainly based on inter-personal communications, reliance on complimentary and alternative medicine, and financial restriction. Concealing from the doctors was common in patients. Only 62 (34.4%) out of 180 doctors used complimentary and alternative medicine themselves. Refusal by other doctors was because they considered the option ineffective, obsolete and unsatisfactory. About half of the doctors forbade the patients to use such therapies, but 31% (n=73) patients ignored the doctor's advice. CONCLUSION: The use of complimentary and alternative medicine is highly prevalent in our society by patients irrespective of their social class. Preference for such therapies, on the other hand, is quite low among medical doctors as they consider allopathic medicine to be effective.

Drug utilization patterns in Rawalpindi and Islamabad, Pakistan.

OBJECTIVES: To assess the prevalence of self medication among Pakistanis in rural and urban settings. METHODS: A door-to-door survey was carried out during June and July 2008 and 2009 after due verbal consent taken from the residents. The houses were randomly selected from ultra posh area, quarters of government employees, residents of Barani Training Institute, low socio-economic population in the surrounding of Adiallah road near Rawalpindi, and a remote village Raye Chak, (population 5000) some 50 kilometers away from the city. RESULTS: There were 2042 dosage forms of drugs from 430 houses; allopathic medicine 89.3%; traditional medicines 6.7%; and homeopathic drugs 4% representation. The top 10 companies had more than 57% market share among 147 firms whose products were reported. The availability of paediatric drugs mixtures/syrups was 24%, and injectiables, 5.5%. Nonsteroidal anti-inflammatory drugs (NSAID) had 38% representation; antimicrobials 25%, multivitamins and haematinics were 1.6% that was contrary to the general perception of the irrational use of this group of medicines. CONCLUSION: Alternative medicine is gaining ground. Overuse of anti-inflammatory drugs suggest higher prevalence of pain, inflammation and infections than systemic disorders in society.

Perception of tuberculosis in Pakistan: findings of a nation-wide survey.

OBJECTIVE: To assess knowledge about symptoms, diagnosis, treatment, transmission, and impact of tuberculosis in Pakistan. METHODS: This nationwide survey was carried out by face to face interviews with 2742 men and women from December 2009 to June 2010. Multiple stage random area probability sampling was used for this purpose. Trained interviewers conducted interviews using structured questionnaire focusing knowledge, diagnosis, treatment, and impact of TB. Data was weighted to correspond with census distribution of population across rural and urban areas of all four provinces. SPSS 10 was used for data analysis. RESULTS: Ninety percent (2478) of the respondents were familiar with the term TB. Common symptoms associated by respondents were cough (59%), haemoptysis (51%) and fever (40%). Majority (61%) mentioned that TB can be diagnosed by clinical examination by a doctor, 45% laboratory analysis of sputum, and 33% Xray chest as a diagnostic modality. Ninety-three percent were of the opinion that TB is treatable; 90% were in favour of treatment by doctor, and 16% by homeopathic or hakim treatment. About 91% favoured to continue TB treatment according to doctor's advice, 4% thought it can be stopped within 1-2 months of resolution of symptoms, while 73% regarded TB as a communicable disease. More than 33% respondents considered that TB affects education, occupation, getting married, and having children. CONCLUSION: Pakistani population has deficient knowledge and misconceptions regarding symptoms, diagnosis, treatment, and impact of TB.

Poppy Intoxication in Infants and Children: Hazards of a Folk Remedy.

OBJECTIVE: To study the clinical and laboratory profile in infants and children presented in the tertiary care hospital with poppy intake and to compare the profile between those who survived with those who died. STUDY DESIGN:   Observational study. Study Place and Duration: Department Of Paediatrics, Mardan Medical Complex, Mardan, KPK, Pakistan from January 2019 to January 2020. METHODOLOGY: All the infants and children who reported during research period with signs and symptoms (one or more) of opium poppy intoxication, i.e. meiosis, respiratory depression and decreased consciousness level along with confirmed history of giving poppy at home. RESULTS: A total of 32 cases of opium poppy intoxication were admitted. Their age ranged from one month to 23 months, mean age was 7.22 + 5.43 months. Out of them, 15 (46.87%) infants and children survived, and 17 (53.13%) died, (p<0.001). The children who survived had significantly shorter period of time between poppy over-dose and admission in hospital as compared to those who had died (6.0 + 2.56 hours versus 12.47 + 4.14 hours, p<0.001). There was significantly high mortality in children who were given poppy powder mixed in water, out of 17 cases 13 died and 4 survived. Low respiratory rate, decreased oxygen saturation, aspiration pneumonia, apneic spells, cyanosis and leukocytosis >15000cc had significant effect on mortality. CONCLUSION: Poppy opium is very dangerous and hazardous for infants as it depresses respiration, causes coma; and can be fatal. People need to be educated to curb this harmful practice and authorities need to take necessary actions to stop the sale of poppy at shops and stores. Key Words: Poppy, poisoning/Intoxication, Infants, Meiosis, Apneic spell.

Ethnomedicinal and traditional uses of the Ferns of Khyber Pakhtunkhwa, Pakistan.

Ferns are often used by indigenous people in Khyber Pakhtunkhwa, Pakistan. This study was designed to collect the ethnomedicinal and traditional knowledge of these locals about this group of vascular plants. Forty taxa belong to nineteen genera and ten families are used in the treatment of different diseases. The Pteridaceae was the most representative family with twelve taxa (30%), followed by Athyriaceae and Dryopteridaceae with six taxa each (30%), and Thelypteridaceae with five taxa (12.5%). Regarding the genera, Adiantum, Asplenium and Dryopteris ranked first with four taxa each (30%), followed by Aleuritopteris, Diplazium, Pteris and Equisetum with three taxa each (30%), followed by Athyrium, Oeosporangium, Polystichum and Pseudophegopteris with two taxa each (20%). These taxa were commonly used in the treatment of respiratory disorders i.e. asthma, bronchitis, emphysema, pneumonia; intestinal ulcer, stomach, urinary ailments and skin disorders by the methods of decoction and infusion. Traditional knowledge about ethnomedicinal plants is a valuable and essential source for the discovery of allopathic, herbal and homeopathic medicines.

Integration of informal medical practitioners in DOTS implementation to improve case detection rate.

OBJECTIVE: To integrate informal registered medical practitioners (IRMP) in Directly Observed Therapy Short Course (DOTS) implementation to improve case detection rate. METHODS: This interventional study was conducted in the settlement area of Malir district whereas New Karachi was taken as control, between February to November 2005. All registered healthcare providers within 5 kilometer around Tuberculosis (TB) DOTS center Malir were included. New sputum positive and sputum direct smear negative cases of pulmonary Tuberculosis above 15 years residing in the catchments area were included as target population. Informal registered medical practitioners were trained for the referral of suspected cases to the TB DOTs center where three sputum samples were taken, and X-ray chest was done to confirm if sputum direct smear (D/S) was negative. Demographic data regarding age, gender, address, case number, onset of symptoms, treatment given, response, compliance to treatment was all collected. RESULTS: Out of 64 health care providers there were a drop out of 6 leaving 58 informal registered medical practitioners (36 homeopathic/22 Hakims) who referred 54 cases, of these 16 cases were actual suspects. Two out of these 16 (12.5%) were Tuberculosis positive. One was Sputum D/S positive and the other sputum direct smear negative with X-ray chest positive. Comparison of data (Malir and New Karachi diagnostic center) showed that by incorporating homeopathic and Hakims an increase in the proportion of case identification (0.477) was significantly higher in Malir (intervention area) vs New Karachi (non-intervention area) (0.316). CONCLUSION: Integration of informal registered medical practitioners was found to be effective in DOTS implementation hence they can be incorporated in other national programmes to improve public health.

Concepts of homeopathy among general population in Karachi, Pakistan.

OBJECTIVE: To explore the characteristics of patients and their gender influences concerning the use of homeopathic medicine, visiting both homeopathic and conventional medicine (allopathic) clinics. METHODS: This cross sectional study was carried out on 200 patients who attended private and public homeopathic and allopathic clinics or hospitals in Karachi using a pre-tested self-administered questionnaire. Data for demographic variables of frequencies and associations between variables were analyzed on SPSS version 12.0. Significance level was p < 0.05. RESULTS: Out of the total, 64.5% respondents, more among females than males (p < 0.01) believed in homeopathy. Although slightly more than a quarter preferred homeopathic treatment than allopathic treatment, 67.5% participants had had homeopathic consultation and treatment in the past. Amongst participants who had opted for homeopathy in any of their illnesses, the majority had it for chronic conditions which included skin lesions and problems of rheumatology. CONCLUSION: In this modern era, where people have the choice to decide newer and advanced forms of medical treatment and scientific methods, a large proportion of people still rely on alternative forms of treatment like homeopathy. More awareness regarding use of homeopathic treatment is needed among general population.

Ethnomedicinal and traditional uses of the Ferns of Khyber Pakhtunkhwa, Pakistan / Usos etnomedicinais e tradicionais das samambaias de Khyber Pakhtunkhwa, Paquistão

Abstract Ferns are often used by indigenous people in Khyber Pakhtunkhwa, Pakistan. This study was designed to collect the ethnomedicinal and traditional knowledge of these locals about this group of vascular plants. Forty taxa belong to nineteen genera and ten families are used in the treatment of different diseases. The Pteridaceae was the most representative family with twelve taxa (30%), followed by Athyriaceae and Dryopteridaceae with six taxa each (30%), and Thelypteridaceae with five taxa (12.5%). Regarding the genera, Adiantum, Asplenium and Dryopteris ranked first with four taxa each (30%), followed by Aleuritopteris, Diplazium, Pteris and Equisetum with three taxa each (30%), followed by Athyrium, Oeosporangium, Polystichum and Pseudophegopteris with two taxa each (20%). These taxa were commonly used in the treatment of respiratory disorders i.e. asthma, bronchitis, emphysema, pneumonia; intestinal ulcer, stomach, urinary ailments and skin disorders by the methods of decoction and infusion. Traditional knowledge about ethnomedicinal plants is a valuable and essential source for the discovery of allopathic, herbal and homeopathic medicines.

Resumo As samambaias são frequentemente usadas pelos indígenas em Khyber Pakhtunkhwa, Paquistão. Este estudo foi desenhado para coletar o conhecimento etnomedicinal e tradicional desses moradores sobre este grupo de plantas vasculares. Quarenta táxons pertencem a dezenove gêneros, e dez famílias são utilizadas no tratamento de diferentes doenças. Pteridaceae foi a família mais representativa com doze táxons (30%), seguida por Athyriaceae e Dryopteridaceae com seis táxons cada (30%), e Thelypteridaceae com cinco táxons (12,5%). Em relação aos gêneros, Adiantum, Asplenium e Dryopteris ficaram em primeiro lugar com quatro táxons cada (30%), seguidos por Aleuritopteris, Diplazium, Pteris e Equisetum com três táxons cada (30%), e Athyrium, Oeosporangium, Polystichum e Pseudophegopteris com dois táxons cada (20%). Estes táxons foram comumente usados ​​no tratamento de distúrbios respiratórios, isto é, asma, bronquite, enfisema, pneumonia; úlcera intestinal, estômago, doenças urinárias e doenças da pele pelos métodos de decocção e infusão. O conhecimento tradicional sobre plantas etnomedicinais é uma fonte valiosa e essencial para a descoberta de medicamentos alopáticos, fitoterápicos e homeopáticos.

Primary care treatment for child and adolescent neuropsychiatric conditions in remote rural Punjab, Pakistan - a cross-sectional survey.

BACKGROUND: Pakistan is one of the most populous regions of the world. Previous work has demonstrated that there is reliance on traditional healthcare systems when seeking psychiatric care; however, there is a lack of information on help seeking for child and adolescent population. The aim of this study was to describe types of treatments and families' perceptions of the effectiveness of those treatments for childhood neuropsychiatric disorders in remote rural Punjab. METHOD: Cross-sectional survey of consecutive attendees at an advertised mental health consultation day in a remote rural area. RESULTS: The effectiveness of these treatments, as rated by patients and their families, was variable, with highest reported effectiveness for general practitioner treatments. In families with a past history of care from a general practitioner, those who had epilepsy reported treatments to be more effective than those with mental retardation. Carers and users described consulting five different types of primary healthcare practitioners that used both physical and psychotherapeutic treatments. CONCLUSIONS: There is considerable variation in treatments available for child and adolescent neuropsychiatric disorders in remote rural areas of Punjab, a large proportion of which are considered ineffective by the users and carers. This highlights the need to develop effective interventions for child and adolescent neuropsychiatric conditions that can be administered by primary health workers. Our data suggest that the need for this is greatest for mental retardation.

Health seeking behavior of couples with secondary infertility.

OBJECTIVE: To determine the factors affecting the health-seeking behavior of couples with secondary infertility in Karachi. DESIGN: A descriptive case series. PLACE AND DURATION OF STUDY: The data was collected from women attending infertility clinics in five tertiary care hospitals in Karachi from March to June 2003. PATIENTS AND METHODS: All currently married women, between the age of 15-35 years, with at least one previous conception, irrespective of outcome, attending an infertility clinic and consenting to participate in the study, were included. Women with corrective surgery on vagina and uterus, and cases of primary infertility, were excluded. Multiple logistic regression models were used to determine the association of various factors, affecting the health-seeking behavior, with statistical significance set at p < 0.05 for the covariates and the interaction terms between various factors. RESULTS: The women consulted multiple health care providers for treatment of secondary infertility. The main reasons for seeking treatment were couple s wish (54.2%), family pressure (22.6%) and want of a son by husbands or in-laws (20.4%). The most commonly sought providers were physicians (74.7%), Traditional Birth Attendants (TBA, 39.5%), Spiritual healers (26%), Hakeems (23%) and Homeopaths (17.2%). Most of the women who consulted non-physicians were illiterate (69.4%) as compared to those who consulted a physician (37.8%, p-value = 0.00). The non-physicians were more commonly consulted by women belonging to low socioeconomic group. The posttreatment complications were more common among women who consulted non-physicians. CONCLUSION: Pressure from husbands and in-laws compels women for consulting multiple providers. Health seeking behavior for infertility is affected by the literacy and socioeconomic status of the women.

The usage of complementary and alternative medicine in gastrointestinal patients visiting the outpatients' department of a large tertiary care centre-views from Pakistan.

INTRODUCTION: The use of complementary and alternative medicine (CAM) has increased over the last few years, and an emergent data suggests that some CAM modalities may be helpful in addressing gastrointestinal (GI) conditions. Our aim was to find out the prevalence of such practices for GI condition amongst patients visiting an OPD of a large tertiary care centre of Karachi, Pakistan. METHODS: Patients visiting outpatient department of Hepatogastroenterology department at SIUT, Pakistan from March 2014 to March 2015, were included in this cross sectional study. A pre designed questionnaire was used that included the demographic data, primary disease of the patient, CAM modality used, reason for the use of CAM therapy and reasons for stopping it. Frequencies of different variables were computed using SPSS version 18. RESULTS: 906 patients were interviewed, out of which 52% (471) were males. The mean age at presentation was 39.81±12.4 years. 234 (25.8%) of the participants used one of the CAM modalities; Herbal medicine being most common one, seen in 122 (52.13%) followed by spiritual 61 (26%), and homeopathy 33 (14%). The duration of therapy was limited to six months in 161(68%), whereas 7 patients (2.9%) had prolonged duration of use of more than five years. Reasons for using CAM therapy included advice by family and friends in 66 patients (28%), personal will in 42 (17.94%), no benefit from allopathic treatment in 34 (14.5%), while high cost was the reason of use in 3(5%) of the patients. The most common reason for discontinuation of CAM was no benefit, seen in 113 patients (48.30%), followed by physician's advice in 32 (17%) patients, and side effects in 19 (8%). On the other hand 44 patients (18.80%) reported benefit from the therapy while 14 (5.9%) were still continuing with CAM modality. Among the CAM users 140 (60.09%) were un-educated or had primary education while CAM nonusers had 328 (47%) were either uneducated or had primary education only correlation reveals P value 0.004. CONCLUSION: Significant numbers of patients used CAM therapy. A lower level of education was associated with increased usage of CAM while cost had no major impact on its usage.

Bed wetting in school children of Karachi.

OBJECTIVES: To estimate the frequency of primary nocturnal enuresis (PNE) in Pakistani children and to examine the factors associated with it. METHODS: A randomly selected cross-sectional study was conducted in five elementary schools, one in each of five districts of Karachi. The parents of 5000 children age between 3-13 years were asked to complete a questionnaire which included items about the frequency of daytime wetting and nocturnal enuresis, family history, urinary tract infection, parents and child's own concern about this problem and acquisition of treatments. RESULTS: Over all corrected response rate to the questionnaire was 69% (3395). Enuresis was present in 9.1% (308). There were 166 (53.9%) boys and 142 (46%) girls with a median age of 7 years. Only 54% (166) children sought help for their problem of which 26% consulted doctors, 16% visited homeopaths while 11% used hakeems and home remedies. Of the bed wetters, 30% were wet every night, 30% for more than three nights a week and 40% for less than three nights every week. Parents of 68.5% (211) children reported concern for the problem while 69.8% (215) children were also anxious about their enuresis. Among the concerned children group, 22% parents were not concerned about their child's problem. Family history of enuresis was present in 25.6% (79) children. CONCLUSION: The frequency of enuresis among the school going children in Karachi is 9.1% and is similar to that reported in European countries and other Asian countries including Korea and Taiwan. Enuresis causes concern to both parents and children, but only a small percentage of parents seek medical help for this problem.

Women and health care in rural Pakistan.

The provision of medical facilities to rural areas is a major objective of development in Pakistan and the government has undertaken several programs to train and deploy auxiliary health workers on a large scale. Programs to train lady health visitors, dispensers and sanitary inspectors, have been in operation for decades and their graduates have a place in the workforce. Currently the Government is developing a Basic Health Program to train auxiliary health workers and to establish a network of rural health facilities throughout the country. The research here reported was meant to help plan this program. The 4 week study was conducted in four districts of the Punjab and North West Frontier Provinces. We first interviewed women patients of rural dispensaries in the four districts to determine their views of their needs and of the constraints of the purdah system when seeking health care. We then interviewed principals of medical colleges and training institutes, who were in a position to assess the availability of women to enter the medical workforce and female mid-level health workers who were currently serving in their posts. Finally, since allopathic medical institutions compete with indigenous medical specialists, we interviewed two hakims and a homeopathic physician to obtain their view of rural health needs, as well as their potential for contributing to a broad based rural health care system.

The pattern of postoperative analgesic administration in non-English speaking Asian women following caesarean section.

A survey of postoperative analgesic administration to non-English speaking Asian women following Caesarean section has shown significant differences when compared to English speaking Caucasian women. The main differences demonstrated were that analgesia was utilised for a shorter period (mean of 16 hours) and that a smaller number of doses were given to the Asian group.