Infection remains a leading cause of neonatal mortality among infants delivered at a tertiary hospital in Karachi, Pakistan.

INTRODUCTION: The current cohort study was conducted to determine the frequency and compare the mortality rate with associated characteristics among low birth weight and normal birth weight infants during the neonatal period at a tertiary healthcare facility, Karachi. METHODOLOGY: Close-ended structured questionnaires were used to collect information from the parents of 500 registered neonates at the time of birth. Follow-ups by phone on the 28th day of life were done to determine the mortality among low birth weight and normal birth weight babies during the neonatal period. RESULTS: The neonatal mortality rate ranged from as low as 2.4% in the normal birth weight and 16.4% in the low birth weight categories to as high as 96% in the very low birth weight category. Respiratory distress syndrome (24.2%) and sepsis (18.2%) were reported as the leading causes of neonatal deaths. The babies' lengths of stay ranged from 2 to 24 hours, and around 90% of neonatal deaths were reported in the first seven days of life. More than 6% of neonates died at home, and 7.6% of the deceased babies did not visit any healthcare facility or doctor before their death. In the 12-15 hours before their deaths, 13.6% of the deceased babies had been unattended. Around 90% of the deceased babies were referred from a doctor or healthcare facility. CONCLUSIONS: The present estimates of neonatal mortality are very high among low birth weight and very low birth weight categories. Infectious diseases, including respiratory distress syndrome (24.2%) and sepsis (18.2%), were leading causes of neonatal deaths.

Insight and educational intervention concerning hepatitis among roadside barbers and their clients in Karachi, Pakistan.

INTRODUCTION: This study aimed to determine perceptions of hepatitis and make available an educational intervention session regarding the infection among roadside barbers and their clients. METHODOLOGY: A cross-sectional study using convenience random sampling technique was conducted on all barbers and one each of their clients during January to June, 2011, in Karachi, Pakistan.  After informed consent was taken and confidentiality ensured, respondents answered an anonymous questionnaire of closed-ended questions regarding hepatitis. The interview was followed by an educational intervention session. Data was analyzed using SPSS version 17. RESULTS: About 51% and 32% of the barbers and clients respectively had knowledge regarding hepatitis. Razors were recognized as agents for transmitting the infection by 12% and 42% of the barbers and clients respectively. Most (96%) barbers disinfected the razor before use and 49% of the clients confirmed that the razor was sterilized before shaving, while 79% insisted on new blade. Though 50% and 30% of the barbers and clients respectively knew that hepatitis is a preventable disease, only 2% and 7% of the respective barbers and clients were vaccinated against Hepatitis B. Reasons for not being vaccinated were non-awareness and cost of the HBV vaccine. Only half of the barbers and clients considered themselves to be at risk for hepatitis. CONCLUSIONS: In Karachi, barbers and clients have poor knowledge of hepatitis and the means of transmissions, as well as low vaccination rates against HBV infection. Hence barbers and their clients must be educated about hepatitis and its prevention.

Biosafety perspective of clinical laboratory workers: a profile of Pakistan.

INTRODUCTION: Biosafety during lab work is an important concern in developing countries. Some critical issues concerning biosafety are lack of training, exceeding workload, working too fast, deciding not to follow safe practices, and skepticism about biohazards. This study aimed to determine biosafety perception and practices of laboratory technicians during routine work in clinical laboratories of Pakistan. METHODOLOGY: A total of 1,782 laboratory technicians were interviewed from major public sector hospitals and a few private hospital laboratories throughout Pakistan. RESULTS: A total of 1,647 (92.4%) males and 135 (7.6%) females participated in the study, with over half (59.7%) having more than five years of work experience. Results showed that 28.4% of the laboratory technicians from Punjab, 35.7% from Sindh, 32% from Balochistan and 38.4% from Khyber Pakhtoon Khawa (KPK) did not use any personal protective equipment. Almost 46% of the respondents (34.2% from Punjab, 61.9% from Sindh, 25.2% from Balochistan and 85% from KPK) said they reused syringes either occasionally or regularly. Furthermore, 30.7% of the respondents said they discard used syringes directly into municipal dustbins. The majority (66.7%) claimed there are no separate bins for sharps, so they throw these in municipal dustbins. Mouth pipetting was reported by 28.3% technicians. Standard operating procedures were not available in 67.2% labs, and accident records were not maintained in 83.4%. No formal biosafety training had been provided to 84.2% of the respondents. CONCLUSION: Laboratory technicians in Pakistan lack awareness of good laboratory practices and biosafety measures, and also face a lack of resources.

Exposure to risk factors for hepatitis B and C viruses among primary school teachers in Karachi.

INTRODUCTION: The study aimed to determine hepatitis B vaccination status and assess the exposure of risk factors for hepatitis B and C among primary schoolteachers in Karachi, Pakistan. METHODOLOGY: In two hundred school teachers from 30 primary schools in Karachi participated in the study between January and June 2008 by completing an anonymous, self-administered questionnaire. Exposure to and knowledge of hepatitis B and C were assessed, as well as mode of transmission and prevention. The percentage of vaccinated and non-vaccinated teachers was also estimated. RESULTS: Only 73 (36.5%) respondents were vaccinated against HBV. Nine percent (17) of the teachers had received more than 10 therapeutic injections while about 56% (101) took between 5-10 injections per annum. Fifteen (8%) of the teachers confirmed they had been injected with re-used syringes. More than 8% (17) of participants' family members were suffering from hepatitis B or C, while 10% (20) of family members had died of liver diseases without any known history. More than 13% (27) of participants shared razors, brushes, cigarettes and hukahs. Statistically significant difference was also observed in risk factors of hepatitis B and C among male and female respondents. CONCLUSION: Hepatitis B vaccination among school teachers of Karachi was around 37% with a high use of therapeutic injections and syringe reuse. Health awareness programs and educational workshops are needed for teachers, who can later educate the children.