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Soomro M.H.,Shaheed Mohtarma Benazir Bhutto Medical University | Soomro M.H.,University of Bergen | Qadeer E.,National TB Control Program | Khan M.A.,Association for Social Development | Morkve O.,University of Bergen
Tanaffos | Year: 2012

Background: Tuberculosis (TB) is a major cause of mortality affecting millions of people in third world countries. In DOTS monitoring of patients is facility-based and treatment supporter-based; by these two ways patients' compliance to treatment is monitored. The aim of this study was to evaluate the role of treatment supporters and their impact on patients' treatment outcomes. Materials and Methods: The study was a cross-sectional survey in the routine TB control program operational context. All sputum smear positive TB patients that were diagnosed and registered by the public sector in the urban and rural diagnostic centers in 2008 with available outcomes were included in the study. Data of 451 patients were collected during August-October 2010 from 15 health facilities. Results: The majority of patients (89.6%) were provided with treatment supporters. Of 404 (89.6%) cases with treatment supporters, in 203 (50.2%) the supporters were lady health workers, in 46 (11.4%) were community health workers and health facility workers, and in 155 (38.4%) were family members and community volunteers. A total of 384 (85.1%) were categorized as "treatment success", 31 (6.9%), as "transferred out", 17 (3.8%), as "expired", 16 (3.5%) as "defaulted" and three (0.7%) as "treatment failure". The treatment success rates in patients supervised by Lady health workers, community health workers and health facility workers, and family members and community volunteers were 93.1%, 89.1% and 73.5%, respectively. Conclusion: We found a significantly higher treatment success rate (93.1%) in patients supervised by lady health workers compared to others. The overall treatment success rate was 85.1%. © 2012 NRITLD. Source

Ahmed A.,Association for Social Development | Ahmed A.,Pmas Arid Agriculture University | Chaudhry A.G.,Pmas Arid Agriculture University | Farooq H.,Pmas Arid Agriculture University
Medical Forum Monthly | Year: 2014

Objective: objective of the study was to explore the Stigma, attitude and practices with special reference to TB in Urban areas. Study Design: Descriptive study Place and Duration of Study: This study was conducted in UC-49. Tehsil Malikwal District Mandi Bahawaldin from Jan-2013 to March-2013. Materials and Methods: To gather the data on set objective a structured questionnaire was implemented. To collect the data a sample of 70 was interviewed after verbal consent. Tool was refined as per the highlighted suggestions of pre-testing under similar environment. Data was entered in EpiData software and analyzed in SPSS. Results: Tables show the participation of both male and female as 70:30% respectively. In case of TB symptoms; Doctor or other medical worker was consulted for sharing by 91.4% respondents, 71.4% respondents would like to visit health facility (Government or Private), 14.3% visit the pharmacy for treatment, 30% were those who visit the health facility when they observed TB signs especially duration of cough, 65.7% urban residents visit the care center as soon they realize they had TB, 8.6% hate TB patients, 30% response friendly but avoid TB patients, 40% show sympathy toward TB patients, and 60% were said that the life of Tb patients were poor. Conclusion: In spite of health interventions aimed at awareness, treatment and rehabilitation of TB in Pakistan, the country still stands distinctively among the nations where TB is sky rising. The government and civil society need to move ahead from policy level to practical implementation of measures to prevent TB. At cultural perception level, there is a need to remove misconceptions about TB being the one that severely bars the social life mingling. Source

Dogar O.,University of York | Jawad M.,Imperial College London | Shah S.K.,University of York | Newell J.N.,Nuffield Center for International Health and Development | And 3 more authors.
Nicotine and Tobacco Research | Year: 2014

Introduction: We explored the differential effect of cessation interventions (behavioral support sessions with [BSS+] and without [BSS] bupropion) between hookah and cigarette smokers. Methods: We reanalyzed the data from a major cluster-randomized controlled trial, ASSIST (Action to Stop Smoking In Suspected Tuberculosis), which consisted of 3 conditions: (a) behavioral support sessions (BSS), (b) behavioral support sessions plus 7 weeks of bupropion therapy (BSS+), and (c) controls receiving usual care. The trial originally recruited 1,955 adult smokers with suspected tuberculosis from 33 health centers in the Jhang and Sargodha districts of Pakistan between 2010 and 2011. The primary endpoint was continuous 6-month smoking abstinence, which was determined by carbon monoxide levels. Subgroup-specific relative risks (RRs) of smoking abstinence were computed and tested for differential intervention effect using log binomial regression (generalized linear model) between 3 subgroups (cigarette-only: 1,255; mixed: 485; and hookah-only: 215). Results: The test result for homogeneity of intervention effects between the smoking forms was statistically significant (p-value for BSS+: .04 and for BSS: .02). Compared to the control, both interventions appeared to be effective among hookah smokers (RR = 2.5; 95% CI = 1.3-4.7 and RR = 2.2; 95% CI = 1.3-3.8, respectively) but less effective among cigarette smokers (RR = 6.6; 95% CI = 4.6-9.6 and RR = 5.8; 95% CI = 4.0-8.5), respectively. Conclusions: The differential intervention effects on hookah and cigarette smokers were seen (a) because the behavioral support intervention was designed primarily for cigarette smokers; (b) because of differences in demographic characteristics, behavioral, and sociocultural determinants; or (c) because of differences in nicotine dependency levels between the 2 groups. © Advance Access publication December 27, 2013. © The Author 2013. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. Source

Ahmed A.,Association for Social Development | Ahmed A.,Pmas Arid Agriculture University | Chaudhry A.G.,Pmas Arid Agriculture University | Farooq H.,Pmas Arid Agriculture University
Medical Forum Monthly | Year: 2014

Objective: Specific objective of the study was to determine the level of information and awareness regarding TB among the urban dwellers of Malikwal. Study Design: Descriptive study Place and Duration of Study: This study was conducted in UC-Tehsil Malikwal District Mandi Bahauddin. Duration of study lasts from Jan-2013 to March-2013. Materials and Methods: With the help of structured questionnaire the data of 70 respondents were collected. Quality of questionnaire was improved with the help of recommendations of pretesting activity. After taking verbal consent data was gathered by enumerators. Data was entered in EpiData software and analyzed in SPSS. Results: Data shows the 58.6% participation of age group 20-30 years, 70:30% ratio of male and female representation, 42.9% respondents passed their college level of education, among 70 participants 39 reported cough lasts longer than three weeks as sign & symptom of TB, 61 (n=70) were those who said that through polluted air TB virus effects general population, 59 (n=70) reported that through covering mouth and nose during cough and sneezing is necessary to prevent TB, 66 (n=70) respondents said that anybody will be infected by TB, 77.1% were of the view that by using specific medication TB can be cured by getting the services from government clinic as reported 91.4%, 80% of sample said that TB treatment and diagnosis is free of cost in Pakistan as spread information by TV as reported 64.3%. Conclusion: Government departments along with line departments and private stack holders are required to ensure wider level of implementation of projects about the social awareness on TB containing quality of information while using various means of IC&T tools including media to cover the masses. Source

Khan M.A.,Association for Social Development | Mirza S.,Association for Social Development | Ahmed M.,Association for Social Development | Rasheed A.,Provincial Programme for Family planning and Primary health care | And 3 more authors.
BMC Pregnancy and Childbirth | Year: 2012

Background: Two out of three neonatal deaths occur in just 10 countries and Pakistan stands third among them. Maternal mortality is also high with most deaths occurring during labor, birth, and first few hours after birth. Enhanced access and utilization of skilled delivery and emergency obstetric care is the demonstrated strategy in reducing maternal and neonatal mortality. This trial aims to compare reduction in neonate mortality and utilization of available safe birthing and Emergency Obstetric and Neonatal Care services among pregnant mothers receiving 'structured birth planning', and/or 'transport facilitation' compared to routine care.Methods: A pragmatic cluster randomized trial, with qualitative and economic studies, will be conducted in Jhang, Chiniot and Khanewal districts of Punjab, Pakistan, from February 2011 to May 2013. At least 29,295 pregnancies will be registered in the three arms, seven clusters per arm; 1) structured birth planning and travel facilitation, 2) structured birth planning, and 3) control arm. Trial will be conducted through the Lady Health Worker program. Main outcomes are difference in neonatal mortality and service utilization; maternal mortality being the secondary outcome. Cluster level analysis will be done according to intention-to-treat.Discussion: A nationwide network of about 100,000 lady health workers is already involved in antenatal and postnatal care of pregnant women. They also act as " gatekeepers" for the child birthing services. This gate keeping role mainly includes counseling and referral for skill birth attendance and travel arrangements for emergency obstetric care (if required). The review of current arrangements and practices show that the care delivery process needs enhancement to include adequate information provision as well as informed " decision" making and planned " action" by the pregnant women. The proposed three-year research is to develop, through national technical working group process, and then test a set of arrangements for achieving the enhanced utilization of safe birthing services.Trial registration: Current Controlled Trials ISRCTN86264432. © 2012 Khan et al.; licensee BioMed Central Ltd. Source

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