Age at menopause, and knowledge of and attitudes to menopause, of women in Karachi, Pakistan.

OBJECTIVES: The objectives of the study were to identify the average age at menopause in Karachi and to assess knowledge of and attitudes to the menopause among Pakistani women in different social strata. STUDY DESIGN: A population-based cross-sectional study of 960 women aged over 35 years was conducted. RESULTS: As insufficient data were available for 35 women, 925 interviews were analysed. There were 287 menopausal women, whose mean (SD) age at menopause was 47.1 (4.7) years (95% CI 46.8 to 47.6). Of these 287 women, 135 (47%) wanted their menses to continue and 235 (82%) had consulted a physician after the menopause. Of all 925 women, 58% knew the correct definition of the menopause, all had consulted a physician for various symptoms related to the menopause and 53% said that women should consult a physician premenopausally. Symptoms experienced by premenopausal women included lack of sleep (25%), fear of infertility (13%) and urinary incontinence (18%). The majority of the overall sample (52%) were sexually active. Of the sexually active women, 16% had marital problems, compared with 44% of sexually inactive women, and this difference was statistically significant (P < 0.0001). Source of knowledge about the menopause included relatives (35%), television (18%), neighbours (17%), friends (17%) and health-care providers (14%). CONCLUSIONS: Evidence-based information about the menopause should be provided for Pakistani women.

Child labour a reality: results from a study of a squatter settlement of Karachi.

INTRODUCTION: Pakistan's exports have suffered heavy losses due to its denunciation for use of children in the industry on the premise that it destroys their childhood and desires for progress. The international community has not realized the root cause of child employment and imposed harsh economic sanctions that have harmed Pakistan's economy leading to further deterioration of health and well being of these unprivileged children. OBJECTIVES: To identify the reasons behind child labour and to asses the occupational, health and related problems faced by the working children. METHODS: This study was done in a section of a squatter settlement Bhutta village near the seaport called Accora with a population of 10000 (approx.). It was a cross-sectional study using a structured questionnaire with questions regarding occupation, eating habits, health, hopes and aspirations. Respondents were 150 male working children permanent residents of Bhutta Village (Accora) selected by systematic sampling. RESULTS: The children were between the ages of 12-14 years (mean = 13.91 yrs). The average family size of these children was 7.4 members and the average family income was Pak Rupees 2,884/month. Fifty seven percent said they get no time to rest whereas the remaining got half to one hour of rest during the day. The usual foods consumed included pulses (46%), vegetables (39%) and meat (15%). Eighty seven percent were not suffering from any disease at the time of interview. The children had an average income of Pak Rupees 615/month (range: 200-1200). Forty five percent were helpers in shops the rest were employed in other businesses. The reasons given for job included family support (89%), parent's pressure (5%), fond of work (4%), learning skills (1%) and self support (1%). The majority (56%) was working for more than 7 hours per-day and 79% said that they do not like to work. Majority of the children wanted to study, play, be born in another family and become doctors, engineers and officers. CONCLUSION: The children in this area were deprived and were trapped between work for family and the desire of living the life of a child with hopes dreams and aspiration for a better future. Making them jobless is only going to aggravate their health and financial problems and will not improve their social and economic status. A policy for supporting these children has to be worked out which caters to their need for financial support and at the same time provides them with learning opportunities.

Predictive validity of the medical college admission criteria for academic performance: results from the four MBBS batches of Karachi Medical and Dental College.

OBJECTIVE: To assess the predictive validity of the secondary school certificate (SSC), higher secondary certificate (HSC) and IBA admission test for academic performance of MBBS students at KMDC. METHODOLOGY: Data based study using the results of first four batches of KMDC, which graduated in 1997, 1998, 1999 and 2000. Data was entered on SPSS-8, ANOVA, correlation and step-wise linear regression analysis was done using effect models. A total of 166 students record were used for analysis. RESULTS: The average IBA score was 65 for all the batches with a significant difference (p = 0.000) amongst the four batches of KMDC. Similarly the scores of all the four batches varied significantly for HSC (p = 0.002), first professional (p = 0.002), third professional (p = 0.000) and the final professional (p = 0.001) exams. The IBA scores had significantly positive weak correlation with second (p = 0.009) and third (p = 0.003) professional marks of the medical students. When the scores of HSC were combined with the IBA test scores, the predictive ability increased for first (p = 0.031) second (p = 0.032) and third (p = 0.011) professional academic performance of medical students. The results of SSC had no effect on the academic performance of medical students. CONCLUSION: IBA scores combined with HSC marks can predict academic achievement of medical students for the first three to four years. It however does not predict the performance in the final year, which is where the exit competencies are acquired by the graduates necessary for practicing medicine. The admission criteria lacks the testing of non-cognitive attributes and learning abilities necessary for a medical graduate to practice skillfully. Hence a valid instrument for testing the positive attributes, which could predict good performance of medical doctors, should be designed.

Are the elderly in Pakistan getting their due share in health services? Results from a survey done in the peri-urban communities of Karachi.

OBJECTIVE: To assess the health, activity and social status of the elderly. METHODS: This Cross-sectional study with qualitative and quantitative designs was conducted in two areas of Karachi; one was a peri-urban squatter settlement and other a middle income community. The students of second year at Jinnah Medical College were trained to collect data, which was then entered on database IV and analyzed on the SPSS statistical package. RESULTS: The average age of peri-urban respondents was 66 and urban was 69 years. Majority of the senior citizens were independent and 69% had active daily life (ADL), power of decision making for adults was related to their status in the family (p < 0.000), majority were alert, happy and satisfied with life with no difference between urban and peri-urban residents. Fifty-three percent of peri-urban and 25% of the urban residents wanted to be employed and 13% of peri-urban and 22% of the urban wanted to continue working at the time of retirement. Fifty-two percent were suffering from hypertension and out of these 81% were on medication and of these 33% could not take drugs due to economic reasons. Their ailments included diabetes (15.6%), difficulty in walking (46.7%), vision disturbances (71.3%) and hearing loss. Seventy-three percent said that the health care services are present, but insufficient to deal with geriatric care (50%) and unsatisfactory (53%). There was a total lack of social services for elderly in the community. CONCLUSION: In the present cultural set up of Pakistan although the elderly are taken care of by their families but the majority want to continue working and be more independent. Most of the study population had one or the other form of ailment related to ageing which impaired their ADL indicator. There is extreme deficiency of health and social care services for the elderly hence the health care providers should start allocating and improvising for the specialized needs of the elderly. The social structure for elderly should be developed and jobs should also be created for the ones willing to continue working.

Decline in breast feeding, who is to be blamed?!! A study of knowledge, attitude and practice of breast feeding amongst nurses.

OBJECTIVES: Breast-feeding is on the decline. Very often the first introduction to bottle-feeding is facilitated in the maternity units. This reduces the chances for the mother to breast feed successfully. The objective of the study was to evaluate the knowledge, attitude and practices of breast-feeding amongst the nurses working in the maternity units. SUBJECTS: Nurses working in the maternity units of North Nazimabad, Karachi. DESIGN/METHODOLOGY: A cross-sectional study was conducted in the maternity units of North Nazimabad, Karachi. The Nurses were interviewed through a structured questionnaire. RESULTS: Out of 110 nurses working in the units, interviews of 70 nurses were obtained. The survey reveals that out of 70 nurses only 16 were qualified. The result shows that the nurses know little about successful lactation management and their role in the promotion and support of breast-feeding. There was a significant difference (P < 0.00) between qualified and non-qualified nurses as regards management of different aspects of breast-feeding. CONCLUSION: There is a huge gap between what is desired and what is available. Intensive training programs should be organized to enhance nursing activities for the required services in order to promote and support breast-feeding.

Does training affect quality of diarrhoea case management.

Improvement in diarrhoea case management through training of health care providers in the government and the private sector was the key element of diarrhoea policy in Pakistan in 1989. Numerous training sessions were organized by the Child Survival project. The aim of this project was to look at the effect of training on quality of diarrhoea case management at the oral rehydration therapy (ORT) corners and diarrhoea treatment units (DTUs) of Sindh. A systematic random sample of 62 ORT corners and DTUs in Sindh was assessed using the WHO drafted Health Facility Survey manual. It was observed that the trained health providers were better in taking history for blood in stools (P < 0.004) and other illnesses (p < 0.000). For assessment of dehydration, no significant difference (p < 0.933), was found between trained and untrained health providers. Trained were better than untrained (p < 0.035) only in treatment "Plan A" and correct rehydration (p < 0.004) of child at facility. Training did not influence advising mothers for home case management. Thus diagnosis was good and training did improve the quality of assessment of child but treatment (inclusive of advice giving) was not significantly affected by training, except for a child with no dehydration. It is recommended that on the job training should emphasize on skills for management of diarrhoea. Further studies are needed to identify why inspite of training. Health providers do not offer better treatment than the untrained ones.

Supervision for diarrhoea case management at the oral rehydration therapy corners and diarrhoea training units in Sindh.

The role of supervisors in diarrhoea case management at the Oral Rehydration Therapy (ORT) corners of Sindh was assessed by a random sample of 62 ORT corners in rural and urban areas of Sindh. The supervisors at each facility included, Medical Superintendents, District Health Officers, Senior Medical Officers, Civil Surgeons and Medical Officers. In 65% cases the supervisors were working at the same facility and in 35% the supervisors were based elsewhere. In 33.7% cases, there had been no meeting with the supervisor in the past 3 months which incidently was the diarrhoea season. In 6.5% cases there had been only 1 meeting, in 8.5% there had been 2-3 meetings and in the remaining 41.3% cases there had been more than 3 meetings with the supervisor. In majority of the cases the supervisors did not do anything related to improvement of diarrhoea case management. Supervisors had given some importance to case management in the urban areas and the Diarrhoea Training Units (DTU). The supervision at ORT facilities was found to be at a rudimentary level and it is suspected that this might be adversely affecting the quality of diarrhoea case management.