Educational Intervention among Barbers to Improve Their Knowledge regarding HIV/AIDS: A Pilot Study from a South Asian Country.

One of the Millennium Development Goals is to combat HIV, the burden of which continues to increase in developing countries, like Pakistan. The prevalence is high among the high-risk population, and the use of unsterilized surgical instruments, traditional straight razors, and blades adds to the spread of this disease. This study assesses the effect of an educational intervention on the knowledge of 70 barbers practising in a suburban community in Pakistan regarding HIV and its symptoms and transmission. At baseline, only 10% of the barbers reported that they had ever heard about HIV compared to 49% after the intervention. Similarly, 4% and 6% of them had good knowledge at baseline about symptoms and transmission of the disease, increasing to 39% and 43% respectively, after the intervention (p<0.001). The results of this educational intervention warrant consideration of activation of mass campaigns to increase public awareness about bloodborne diseases and to educate personnel who might harm the persons in their communities by unsafe practices.

Impact of postpartum anxiety and depression on child's mental development from two peri-urban communities of Karachi, Pakistan: a quasi-experimental study.

BACKGROUND: Postpartum anxiety and depression has detrimental effects on the overall mental development of children. This study aims to assess the impact of postpartum anxiety and depression on children's mental development on all sub-scales in a Pakistani population. METHODS: A quasi-experimental study was conducted in two peri-urban communities of Karachi, a mega city of Pakistan, to assess the impact of postpartum anxiety and depression on children's growth and mental development. A total of 420 women were enrolled, who had given consent out of 651 pregnant women identified, during February 2004 to December 2005. Data for socio-demographic, home environment and family relationship variables were collected between 36 weeks of pregnancy and within 10 days of childbirth. Mother's levels of anxiety and depression were assessed at 1, 2, 6, 12, 18, 24, and 30 months of childbirth. An indigenous, validated screening instrument- Aga Khan University Anxiety and Depression scale was used and diagnostic confirmation was done through a psychologist's interview, based on DSM IV criteria. Children's growth and development was monitored in the same sequence using an Early Childhood Development tool that consists of five subscales; socio emotional, language, cognitive, gross motor and fine motor development. Physical growth was monitored by measuring height and weight of the child. Data was analyzed using SAS 9.2. Multivariable Generalized Estimating Equations (GEE) logistic regression was conducted to identify association of postpartum anxiety and depression with each early childhood development indicator, adjusting for parental and child factors. RESULTS: A significant association of postpartum anxiety and depression with delayed development on all five subscales of children's mental development was found in our study. Interestingly, our study found that higher maternal age had adverse effects on child's emotional whereas positive impact on child's cognitive development. Children's stunting had an adverse impact on all five subscales of children's development. Male children were at higher risk for delayed language and gross motor development relative to female children. CONCLUSIONS: Our study found that postpartum anxiety and depression is associated with adverse outcomes regarding children's mental development on all sub-scales. The impact was accentuated by low family income or child's increasing age.

Preventable lifestyle risk factors for non-communicable diseases in the Pakistan Adolescents Schools Study 1 (PASS-1).

OBJECTIVES: The rising burden of preventable risk factors for non-communicable diseases (NCDs) among adolescents is a major public health challenge worldwide. We identified the preventable risk factors for NCDs in adolescents. METHODS: In a school-based study, pre-tested structured questionnaires were completed by 414 adolescents (14 to 17 years) at six schools in three cities in Pakistan. The chi-squared test and adjusted odds ratio (aOR) with 95% confidence interval (CI) were calculated in a multinomial logistic regression analysis. RESULTS: Over 80% of the adolescents had unhealthy diets, and 54% were physically inactive. Most adolescents were exposed to passive smoking, and 14% were also current smokers. More than one-third of participants chewed betel nut, and one-quarter used oral tobacco. More girls were physically inactive (OR, 4.07; 95% CI, 2.69 to 6.17), whereas a greater proportion of boys were current smokers (OR, 2.17; 95% CI, 1.19 to 3.91), exposed to passive smoking (OR, 2.57; 95% CI, 1.72 to 3.83), and using betel nut (OR, 2.03; 95% CI, 1.34 to 3.06). Only 3.1% of the participants were without any preventable lifestyle risk factor for NCDs, and over 80% had ≥2 factors. Co-existence of risk factors was independently associated with fathers being blue-collar workers (aOR, 3.57; 95% CI, 1.07 to 11.92) and parents not treating their child fairly (aOR, 5.05; 95% CI, 1.29 to 19.78). CONCLUSIONS: Most of the adolescents studied had preventable risk factors for NCDs. These results warrant comprehensive and integrated interventions to prevent lifestyle risk factors, and parents are front-line stakeholders.

Cardiovascular Disease-Related Lifestyle Factors among People with Type 2 Diabetes in Pakistan: A Multicentre Study for the Prevalence, Clustering, and Associated Sociodemographic Determinants.

Background. We evaluated the prevalence and clustering pattern of cardiovascular disease (CVD) related lifestyle factors and their association with CVD among patients with type 2 diabetes. We also examined the association of these factors with various socio-demographic characteristics. Methods. A total of 1000 patients with type 2 diabetes were interviewed in a cross-sectional, multi-center study in out-patient clinics in Karachi, Pakistan. Results. In this study 30.3% study participants had CVD. Majority of the patients were physically inactive and had adverse psychosocial factors. Forty percent of the study participants were exposed to passive smoking while 12.7% were current smokers. Only 8.8% of study subjects had none of the studied lifestyle factor, 27.5% had one, while 63.7% had two or three factors. CVDs were independently associated with physical inactivity, adverse psychosocial factors, passive smoking and clustering of two or three lifestyle factors. Physical inactivity was more prevalent among females and patients with no/less education. Proportion of adverse psychosocial factors were higher among females, elders and patients with no/less education. Clustering of these lifestyle factors was significantly higher among females, elderly and no/less educated patients. Conclusion. These results suggest the need of comprehensive and integrated interventions to reduce the prevalence of lifestyle factors.

Educational intervention among barbers about liver cancer-inducing viruses: a pilot study from a developing country.

Liver cancer is among the most prevalent cancers in the world and it is mainly related to the hepatitis B virus (HBV) and hepatitis C virus (HCV). This study evaluated the effectiveness of educational intervention on knowledge and practices regarding hepatitis B and hepatitis C among barbers. After completion of baseline interviews of 70 barbers in Karachi, Pakistan, a 30-min educational session was conducted. The same sessions were repeated twice for all barbers at an interval of 1 month each for reinforcement. Post-intervention interviews were conducted after 1 month of the last session. Before intervention, only 11.4% of the study participants had scored "good" about the knowledge of HBV, which improved to 74.3% after intervention (p < 0.001). Similarly, for HCV, significant improvement was observed after intervention. Regarding the safe practices to prevent HBV and HCV infections, <2% had scored to the level of "good" at baseline, which improved to 48.6% after intervention (p < 0.001). Educational interventions to prevent cancer-induced viruses are highly effective even in illiterate/low-educated people.

An audit of the quality of care indicators for the management of diabetes in family practice clinics in Karachi, Pakistan.

BACKGROUND: Management of diabetes is a painstaking and careful approach. This study was aimed to evaluate the quality of care for the management of diabetes provided by family practitioners to their patients having diabetes. This is a retrospective audit of medical records conducted in a tertiary care teaching hospital of private sector in Karachi for one month. METHODS: For this study, 150 medical records of patients with type 2 diabetes that visited family practice clinics for their diabetes care were examined. A total of 88 patient's medical records were selected and analyzed who attended the studied clinics for at least one year and had minimum of four out-patient visits. Majority (68%) of the audited medical records were of females. RESULTS: Of the total medical records analyzed, only one-quarter of the cases qualified the criteria of 'excellent' or 'good' diabetes care. Monitoring of body weight of the patient was only one indicator which was according the recommendations in 100% case at every visit. The other nearest quality of care indicator documented was blood glucose advice at every visit in 79.5% (95% CI: 71.1-87.9) of cases. Physical activity advised/reinforced at every visit was least observed (27.3%; 95% CI: 18.0-36.6). In addition, blood sugar control was reported in less than a quarter (23.9%) with 95% CI of 15.0-32.8. CONCLUSION: This work has identified a big gap in the management of type 2 diabetes provided by family practitioners. In addition, majority of the patients found to have poor glycemic control. Interventions are suggested to improve the quality of diabetes care. More such audits and research are recommended at the larger scale.

The effectiveness of counseling on anxiety and depression by minimally trained counselors: a randomized controlled trial.

OBJECTIVE: To assess if eight counseling sessions conducted by women minimally trained as community counselors could reduce the mean level of anxiety and/or depression in women of their own community. DESIGN: A randomized controlled trial. SETTING: A lower-middle-class, semi-urban community in Karachi, Pakistan. PARTICIPANTS: 366 anxious and/or depressed women providing informed consent. METHOD: Through systematic sampling, 1226 women were screened using an indigenous instrument. Out of these, 366 women were found to have anxiety and/or depression and were randomized to intervention and control groups. Women from the same community were trained in 11 sessions as counselors. Subjects in the intervention group were counseled once weekly for eight weeks by the trained community counselors. After the 8th session, the screening questionnaire was re-administered to both the groups. RESULTS: A significant reduction was found between the mean anxiety and depression scores of the two groups (p value = 0.000). CONCLUSION: Counseling by minimally trained community counselors reduced levels of anxiety and/or depression in women of their own community.