Evaluation of blood bank practices in Karachi, Pakistan, and the government's response.

BACKGROUND: National legislation in Pakistan regulating blood banks has been introduced several times, but has never been passed. To support provincial-level efforts to develop legislation we conducted a study to evaluate blood-banking practices in Karachi, Pakistan, to identify areas that could be improved. METHODS: Thirty-seven blood banks were randomly selected from a list of 87 Karachi blood banks. The research team interviewed blood bank personnel, inspected available facilities and equipment, and observed blood collection using structured questionnaires and observation forms. RESULTS: Of the 37 selected facilities, 25 were operational and 24 agreed to participate. Twelve (50%) of the facilities reported regularly utilizing paid blood donors, while only six (25%) activity recruited volunteer donors. During observation only 8% of facilities asked donors about injecting drug use, and none asked donors any questions about high-risk sexual behaviour. While 95% of blood banks had appropriate equipment and reagents to screen for hepatitis B, only 55% could screen for HIV and 23% for hepatitis C. Twenty-nine percent of the facilities were storing blood products outside the WHO recommended temperature limits. IMPLICATIONS: Practices at most Karachi blood banks fell well below WHO standards. Findings from this study were instrumental in developing and passing legislation to regulate blood transfusion throughout Sindh Province, and suggest a method for improving blood transfusion practices in other developing countries.

Frequency of parenteral exposure and seroprevalence of HBV, HCV, and HIV among operation room personnel.

A study was designed to determine the frequency of needle-stick injuries, immunization status for hepatitis B virus (HBV) and sero-prevalence of HBV, hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections among operation room personnel. Self-assessment questionnaires were completed and blood tested for HBsAg, anti-HBc (total), anti-HCV and anti-HIV. Of 114 operation room personnel studied, the majority (58.8%) reported more than four needle-stick injuries per year, 36.8% one to three needle-stick injuries per year, while 4.4% reported no needle-stick injury in the last five years. Thirty-six percent of personnel had received a complete course of hepatitis B vaccination. There was serological evidence of hepatitis HBV virus and/or HCV infections in 31% of the studied population. Four percent were reactive for HCV infection, 7.5% for HBsAg infection and 25.43% for anti-HBc (total); none was HIV positive. Eighty percent of the HCV positive and 55% of the anti-HBc (total) positive personnel had more than four needle-stick injuries per year in the last five years, while 75% HBsAg-reactive personnel had received one to three needle-stick injuries per year. This study indicates a need for continued efforts to minimize the risk of blood-borne infection by enhancing the compliance of operation room personnel with HBV vaccination and adherence to infection control measures.

Prevalence of hepatitis B surface antigen and HCV antibodies in hepatocellular carcinoma cases in Karachi, Pakistan.

Hepatocellular carcinoma (HCC) is a common cancer the world over. In Pakistan it has an incidence of 8/ 100,000 per annum. To assess the prevalence of Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections in biopsy proven cases of HCC a serological study was conducted at Screening Laboratory of Blood Transfusion Services, Jinnah Postgraduate Medical Centre. Of 54 sera of HCC tested for HBV and HCV infections, 67% showed HBV infection, and 33% HCV infection. Among them 24% were positive for both HBV and HCV infections. No HBV and HCV infection was found in 24% cases of HCC. Our findings suggest viral association for most of the HCC cases reported in the country. We suggest an immediate intervention strategy to prevent the spread of HBV and HCV infections by mandatory screening of blood for HBV and HCV infections, and the use of disposable/sterilized needles, instruments for all invasive procedures. For the prevention of vertical transmission of HBV infections all pregnant women should be screened and vaccinated and HBV vaccination should also be included in EPI (expanded programme for immunization).

Knowledge and attitudes of medical students to people with HIV and AIDS.

PIP: 244 fourth- and fifth-year medical students of Sindh Medical College, Karachi, completed questionnaires during November-December 1994 designed to assess their knowledge and attitudes toward HIV/AIDS. 96.7% correctly answered survey questions on the cause of AIDS. 87.7% correctly responded on the existence of HIV transmission through blood transfusion, 96.3% on transmission through sexual contact, and 77% on mother-to-child transmission. 25% of respondents believed that people with AIDS should not be allowed to use common toilets and that health personnel should attend such patients only while wearing special clothing. 72.1% were aware of the HIV antibody test for diagnosis. Further, 85% had correct knowledge on counseling to family members of HIV-infected individuals to avoid blood and body secretions, sexual activity, and condom use. 27% incorrectly believed that HIV-infected children should be removed from school and 34% did not know that HIV-infected persons remain healthy for a long period of time.^ieng

AIDS -- diagnosis and management.

PIP: HIV infection causes AIDS, a fatal disease. Viral types HIV-1 and HIV-2 have thus far been identified, the latter form presenting mainly in West Africa. HIV-1 is in countries throughout the world, demonstrating a pattern of infection which varies by region. 960 HIV-positive cases have been detected in Pakistan, 52 of which had progressed to AIDS. HIV can be transmitted either horizontally by blood and semen or vertically through the placenta. However, transmission is most common in individuals involved in risk activities or who belong to high-risk groups. Once infected with HIV, people may remain healthy for several years. Clinical progression and the criteria for the diagnosis of AIDS are discussed. Except for the recently exposed, individuals infected with HIV have antibodies which can be detected through laboratory assays. ELISA, polymerase chain reaction, and virus culturing are ways of diagnosing the presence of HIV. The laboratory diagnosis of HIV/AIDS infection, treatment, the prevention of HIV infection, and the need for a practical vaccine against HIV infection are discussed.^ieng

Rehabilitation of grade III protein energy malnutrition on out patients basis.

Malnutrition is an important yet preventable and curable cause of morbidity and mortality. One hundred and thirty-five children suffering from grade III Protein Energy Malnutrition (PEM) from a poor urban population of Karachi city were enrolled for rehabilitation by health education and growth monitoring as out patient. Of these, 89% showed satisfactory recovery during a mean follow-up period of 3.2 months. Mainstay of this study was simple health messages adapted according to local cultural practices in native language. This simple strategy can go a long way in prevention and treatment of PEM in all the developing countries.

Beta-lactamase producing Neisseria gonorrhea strains in Karachi.

Urethral or cervical swab of 255 patients attending Skin and Social Hygiene Centre and found positive for gram negative intracellular diplococci on direct microscopy were inoculated on Modified New York City (MNYC) medium and chocolate (heated blood) agar for isolation of neisseria gonorrhea. Growth of N. gonorrhea was obtained in 134 (52.5%) cases. These strains were tested for penicillin susceptibility by disc diffusion method and for the production of beta-lactamase by rapid penicillinase paper strip test and rapid chromogenic cephalosporin method. Penicillin resistance was found in 31 (23%) strains, of which twelve (9%) were beta-lactamase producers (PPNG), the remaining 19 (14%) strains were penicillin resistant beta-lactamase negative (Pen RB Neg). We conclude that PPNG as well as other penicillin resistant strains (Pen RB Neg) of neisseria gonorrhea are prevalent in our country and appropriate changes in the conventional therapeutic regime are desirable.

AIDS and HIV associated disorders in Karachi.

In a seroepidemiological study for the prevalence of HIV infection in Pakistan, individuals from different groups were tested for HIV antibodies using ELISA. Positive results were confirmed by western blot. Out of 413 individuals screened four were found positive by ELISA, of these three were confirmed by western blot. Two cases were foreign nationals visiting Pakistan, one of them died of full blown AIDS, the other did not show any AIDS related condition. The third case was a Pakistani national who presented with full blown AIDS with toxoplasmosis. To our knowledge this is the first case of full blown AIDS reported in a Pakistani national. The fourth case was an asymptomatic promiscuous lady who could not be traced further. Blood transfusions abroad and sexual contacts were responsible for HIV infection in these cases.

Human immunodeficiency virus-associated disorders in Pakistan.

We have documented evidence of the human immunodeficiency virus (HIV) infection in four individuals including a blood donor and three members of a family (husband, wife, and a child) in Karachi, Pakistan. Our data indicate that HIV has been transmitted to the wife of the seropositive male, a drug abuser, in the recent past and that she has passed the virus to her newborn child perinatally/transplacentally. The two seropositive males (blood donor and drug abuser) were diagnosed clinically as having persistent generalized lymphadenopathy, an AIDS-related condition (ARC), and the child presented with developmental disorders and neurologic manifestations. This is the first report of AIDS/ARC cases from Pakistan that can be directly related to HIV infection and its heterosexual transmission.