Hepatitis E is a classic water-borne disease in developing countries. Detection of anti-HEV IgM and IgG antibodies, in addition to HEV RNA are useful epidemiological markers in diagnosis of hepatitis E. This study was conducted to investigate an outbreak of acute viral hepatitis in South-Pakistan. Anti-HEV IgM and IgG were assessed comparatively with serological kits manufactured by Abbott, Cosmic, TGH, and Wantai, selecting HEV RNA as reference assay. Molecular evolutionary analysis was performed by phylogeny and HEV spread time analysis by Bayesian Coalescent Theory approach. Of the 89 patients, 24 (26.9%) did not have acute hepatitis viral marker. Of the remaining 65 cases, 4 (6.1%) were positive for anti-HAV IgM, one (1.5%) for anti-HBc IgM, 2 (3%) for HCV, 53 (81.5%) for anti-HEV IgM, and 5 (7.7%) were hepatitis-negative. The Wantai test was 100% sensitive and specific followed by Cosmic (98.1% and 100%), TGH (98.1% and 97.2%) and Abbott (79.2% and 83.3%). Two HEV variant strains were detected by phylogeny responsible for this acute hepatitis outbreak. Estimates on demographic history of HEV showed that HEV in Pakistan has remained at a steady nonexpanding phase from around 1970 to the year 2005, in which it expanded explosively with the emergence of new HEV variants. In conclusion, the limited sensitivity of available assay (Abbott anti-HEV EIA) may be a concern in HEV diagnosis in Pakistan. This study cautions that the dissemination of the variant strains to other areas of Pakistan may lead to explosive HEV outbreaks. PMID:21328376
Khan, Anis; Tanaka, Yasuhito; Kurbanov, Fuat; Elkady, Abeer; Abbas, Zaigham; Azam, Zahid; Subhan, Amna; Raza, Sajjad; Razza, Sajjad; Hamid, Saeed; Jafri, Wasim; Shih, James; Xia, Ningshao; Takahashi, Kazuaki; Mishiro, Shunji; Mizokami, Masashi
We report 13 cases of Naegleria fowleri primary amebic meningoencephalitis in persons in Karachi, Pakistan, who had no history of aquatic activities. Infection likely occurred through ablution with tap water. An increase in primary amebic meningoencephalitis cases may be attributed to rising temperatures, reduced levels of chlorine in potable water, or deteriorating water distribution systems.
Shakoor, Sadia; Beg, Mohammad Asim; Bandea, Rebecca; Sriram, Rama; Noman, Fatima; Ali, Farheen; Visvesvara, Govinda S.; Zafar, Afia
We report 13 cases of Naegleria fowleri primary amebic meningoencephalitis in persons in Karachi, Pakistan, who had no history of aquatic activities. Infection likely occurred through ablution with tap water. An increase in primary amebic meningoencephalitis cases may be attributed to rising temperatures, reduced levels of chlorine in potable water, or deteriorating water distribution systems. PMID:21291600
Shakoor, Sadia; Beg, Mohammad Asim; Mahmood, Syed Faisal; Bandea, Rebecca; Sriram, Rama; Noman, Fatima; Ali, Farheen; Visvesvara, Govinda S; Zafar, Afia
Accepted 16 September 1996? OBJECTIVES—To determine the incidence of insulin dependent diabetes mellitus (IDDM) among children aged up to 16 years residing in the city of Karachi, Pakistan, during the five years from 1989 to 1993.?DESIGN—Retrospective study of incidence using hospital and clinic records.?SETTING—The city of Karachi, Pakistan.?SUBJECTS—Children satisfying standard criteria for the diagnosis of IDDM, attending treatment facilities for the first time during the study period.?MAIN OUTCOME MEASURES—The incidence of IDDM in this population and its variation by age and sex.?RESULTS—The incidence of IDDM in this population is 1.02/100 000 per year, which is one of the lowest incidence rates yet reported.?CONCLUSIONS—The very low incidence of IDDM, contrasted with the substantially higher incidence among migrants, supports the view that environmental factors are the major determinants of variations in the incidence of this condition between populations.??
Staines, A; Hanif, S; Ahmed, S; McKinney, P; Shera, S; Bodansky, H
Background Karachi is the largest metropolis of Pakistan and its economic hub attracting domestic migrants for economic opportunities. It is also the epicenter of HIV epidemic in the country. Since 2004, one pilot study and four behavioral and biological surveillance rounds have been conducted in Karachi. In addition many student research projects have also focused on key risk groups including injection drug users (IDUs). As a result of this extra ordinary exposure of same kind of questions, IDUs know how to respond to high value questions related to sharing of needles or unsafe sexual practices. The purpose of the study was to explore the element of research fatigue among IDUs in Karachi, Pakistan. Methods The study was conducted on 32 spots in Karachi, selected on the basis of estimate of IDUs at each spot. A trained field worker (recovered IDU) visited each spot; observed sharing behavior of IDUs and asked questions related to practices in January 2009. Verbal consent was obtained from each respondent before asking questions. Results On average 14 IDUs were present at each spot and out of 32 selected spots, 81% were active while more than two groups were present at 69% spots. In each group three to four IDUs were present and everyone in the group was sharing. One dose of injecting narcotics was observed. Sharing of syringes, needles and distilled water was observed at 63% spots while professional injector/street doctor was present at 60% spots. Conclusion There is a need to check internal consistency in surveillance research. It is highly likely that IDUs and other risk groups know how to respond to key questions but their responses do not match with the practices.
Objective: To study the perceptions on bioethics among patients presenting to family physicians at a teaching hospital in Karachi, Pakistan Study design: Questionnaire based cross sectional survey Settings: The study was carried out at the family practice center, the Aga Khan University Hospital, Karachi Main outcome measures: Perceptions on the broad principles of bioethics Results: Majority of the respondents were
Waris Qidwai; Hafeez Qureshi; Syed Sohail Ali; Mahboob Alam; Syed Iqbal Azam
The causes of conjunctivitis and keratoconjunctivitis in 388 patients who attended eye casualty departments in Karachi, Pakistan, during a 5 month period were investigated. Most of these infections were diagnosed as adenovirus (291, 75%) or bacterial (71, 18.3%). Of the remainder, 9 cases (2.3%) were caused by herpes simplex virus and 7 (1.8%) by Chalmydia trachomatis. There was no evidence of typical active trachoma in this urban population. Bacteria or Candida albicans were also grown from 44 of the adenovirus cases (15%). Many of the bacteria grown from eyes in this study were resistant to antibiotics, probably because of inadequate and/or inappropriate self-medication with antibiotics in this community. PMID:1412664
Woodland, R M; Darougar, S; Thaker, U; Cornell, L; Siddique, M; Wania, J; Shah, M
Cancer registries play a major role in providing the data to justify establishment, implementation and monitoring of cancer control programs, therefore stability in cancer registration is of pivotal importance. An erroneous assessment of the cancer burden can have long-term negative implications for the limited health resources of a country. Thus, registries starting simultaneously with cancer control programs clearly cannot be adequate for the purpose. The Karachi Cancer Registry (KCR) is the first population-based registry of Pakistan, with 9 years proven data stability (1995-2003) for Karachi South (KS), a location with a population distribution similar to that for the country in general as regards age, gender, and religion. It also has the distinction of being the only district in the country with representation of all ethnic and socio-economic groups of the country. The primary recommended strategy for the 'National Cancer Control Program' (NCCP), Pakistan based on the assessment of eight common cancers in Karachi and the WHO estimates would be identical. A curb on the epidemic levels of tobacco and areca nut use would reduce malignancies in males by 43.7% and in females by 17.8%. WHO estimates put these figures at 45% and 18.5% for males and females respectively. Primary prevention in the form of diet control, checks on preservatives, dyes, and pesticides; protection from occupational hazards, control of biological agents and solar UV protection would help control of another half of the malignancies. Resource restrictions put high technology methods beyond the scope of Pakistan today. Early detection of cancers of accessible sites, though not an urgent requirement, would be warranted for oral, cervical and breast cancer, after sufficient capacity building, initially in the high-risk groups. In females, this could help target 47.6% (approximately half) of the malignancies and in men 13% of the total. Establishment of equitable pain control and a palliative care network throughout the country is an urgent and essential measure as more than 70% of cancer patients report with very advanced stages of malignancy. The estimated annual incident cancer cases for Pakistan, year 2000 on the basis of KCR data were 138,343 for males and 135,054 for females; approximately twice the number cited by WHO for the same year. The argument that higher KCR estimates reflect an urban catchment population may be justified, the urban: rural ratio being 2:1 in Pakistan. Evidence-based strategies, however,support the counter argument, that the rising incidence of cancer in Pakistan is primarily attributable to risk factors equally prevalent in the rural and urban areas viz. increasing tobacco use, low socio-economic conditions, dietary deficiencies and prevalence of oncogenic viruses. Pakistan has a significant cancer burden and rising trends of risk factors - it is a country in dire need of a Cancer Control Program. KCR data along with WHO estimates can form the initial framework of a NCCP in Pakistan; the lack of a national cancer registration should not deter initiatives. Benefits of an immediate, prompt and targeted implementation established today will be realized after 20-30 years. Otherwise the country should be prepared to face epidemic proportions of the disease in the next decade or two. Prerequisite 'qualification criteria' or 'sincerity of intent test' for NCCP funding by international donors should be legislation against tobacco and areca nuts in Pakistan and stringent evaluative criteria. PMID:15075010
Objective: To determine the trends of academic misconduct in undergraduate students of different private and government section medical institutes. Methodology: This cross sectional study was conducted at three medical colleges of Karachi, Pakistan. The students were evaluated by giving a self reported questionnaire containing various questions assessing their educational dishonesty and cheating behaviors. Results: A total of 274 students from different years completed the questionnaire. Mean age was 21.48 ± 1.89 years. Most of the students were in 4th year (n=86; 31.3%). There were 182 (66.5%) females and 92 (33.5%) males. Majority of the students (n=155; 55.1%) accepted that they have cheated at least once. There was no significant difference regarding acceptance of cheating among different years of study (p=0.23) however females were found to accept cheating more as compared to males (p=0.036). First year students were found more to ask teachers for answers during OSCE (p=0.01). A large number of students accepted that they mark proxy for their friends (85.7%) and also ask their friends to mark proxy for them (85.03%). Nearly half (44.02%) of the students rotating in wards also admitted to write fake histories. Conclusion: A large number of medical students admitted cheating and involvement in other academic misconduct. We need to improve our educational system, formally add professional session and strict disciplinary action should be taken against those who are found guilty.
Hafeez, Kamran; Laiq-uz-Zaman Khan, Muhammad; Jawaid, Masood; Haroon, Saroona
The Health Education and Literacy Project (HELP) set up a primary health care (PHC) project in the urban slum of Naleem Colony in Karachi, Pakistan, in 1992. The project integrated preventive health, literacy, sanitation, and income generation. Its focus was the community health worker (CHW). Its motto was self-sustainability. A rotating fund allowed the community to contribute towards maintaining the CHW. A community grass-roots organization had administrative control of the project. Researchers had conducted a baseline survey and one year later a knowledge, attitude, and practices survey of 150 households that had received health education and of 150 other households that did not receive health education. The two groups were located in geographically distinct areas. At follow-up, the intervention group consistently was more likely to have good hygienic health practices than the control group (garbage covered, garbage disposal in the garbage drum, washing hands before feeding, and wash hands and child after defecation; p 0.05). Mothers in the intervention group were significantly more likely to know about the vaccinations children needed than those in the control group (for all vaccinations, 76% vs. 21%; p 0.0001). They were also more likely to know how to make oral rehydration solution (ORS) at home than their counterparts (65% vs. 15%). Among intervention mothers, 27% of their children had had diarrhea and 92% of the mothers had used ORS during an episode of diarrhea. The knowledge of correct dietary sources of protein among the intervention group improved significantly between baseline and follow-up (23% vs. 55%; p 0.05), while it did not for the controls (23% vs. 30%; p 0.05). These findings suggest that the project was on the right track towards overall community development by providing health education, sanitation, literacy, and income generation services to the people of the squatter settlement. PMID:12291610
Agboatwalla, M; Akram, D S
Objective: To determine the trends of academic misconduct in undergraduate students of different private and government section medical institutes. Methodology: This cross sectional study was conducted at three medical colleges of Karachi, Pakistan. The students were evaluated by giving a self reported questionnaire containing various questions assessing their educational dishonesty and cheating behaviors. Results: A total of 274 students from different years completed the questionnaire. Mean age was 21.48 ± 1.89 years. Most of the students were in 4(th) year (n=86; 31.3%). There were 182 (66.5%) females and 92 (33.5%) males. Majority of the students (n=155; 55.1%) accepted that they have cheated at least once. There was no significant difference regarding acceptance of cheating among different years of study (p=0.23) however females were found to accept cheating more as compared to males (p=0.036). First year students were found more to ask teachers for answers during OSCE (p=0.01). A large number of students accepted that they mark proxy for their friends (85.7%) and also ask their friends to mark proxy for them (85.03%). Nearly half (44.02%) of the students rotating in wards also admitted to write fake histories. Conclusion: A large number of medical students admitted cheating and involvement in other academic misconduct. We need to improve our educational system, formally add professional session and strict disciplinary action should be taken against those who are found guilty. PMID:24353611
Hafeez, Kamran; Laiq-Uz-Zaman Khan, Muhammad; Jawaid, Masood; Haroon, Saroona
BACKGROUND: Household-level geographic information systems (GIS) database are usually constructed using the geographic positioning system (GPS). In some research settings, GPS receivers may fail to capture accurate readings due to structural barriers such as tall buildings. We faced this problem when constructing a household GIS database for research sites in Karachi, Pakistan because the sites are comprised of congested groups
Mohammad Ali; Shahid Rasool; Jin-Kyung Park; Shamoon Saeed; Rion Leon Ochiai; Qamaruddin Nizami; Camilo J Acosta; Zulfiqar Bhutta
Objective: In many developing-country urban areas, municipally supplied water is not microbiologically safe. This study evaluated drinking water quality and effect of home water purification efforts in Karachi, Pakistan.Methods: Members of 300 households, including 100 households who used the Aga Khan University Hospital Laboratory and 200 of their neighbors were interviewed. In 293 consenting households, structured observations were performed and
Stephen E. Luby; Amber H. Syed; Naureen Atiullah; Mohammad K. Faizan; Susan Fisher-Hoch
Menstruation is a normal physiological process that is managed differently according to various social and cultural understandings. Therefore, this cross-sectional study was conducted to explore the menstrual practices among 1275 female adolescents of urban Karachi, Pakistan from April to October 2006 by using interviews. Data was entered and…
Ali, Tazeen Saeed; Rizvi, Syeda Naghma
The cause of this investigation was to identify the main reasons which decline the educational standards at secondary level in Karachi, Pakistan. It was carried out through survey. The population of the study was both "government and private" schools students and teachers. The views of male and female students and teachers were sought out. One…
Faizi, Waqar-un-Nisa; Shakil, Anila Fatima; Lodhi, Farida Azim
Observations were made of 996 encounters between children with diarrhoea and practitioners (28 paediatricians, 62 general practitioners) in Karachi, Pakistan. Oral rehydration salt (ORS) was prescribed in more than 50% of encounters by 53% of general practitioners (GPs) and 61% of paediatricians. Sixty-six percent of GPs and 50% of paediatricians prescribed antibacterials, 60% of GPs and 28% of paediatricians prescribed
S. Q. Nizami; I. A. Khan; Z. A. Bhutta
The purpose of the research was to understand the process of implementation of inquiry teaching strategies in lower secondary mathematics classroom in Pakistan. The research methodology was action research (Kemmis, 2004) in which I played the dual role of teacher and researcher, and taught Mathematics to class seven in a private English medium school in Karachi. The inquiry teaching strategies
Abdul Wali Khan
General practitioners (GPs) could have an important role in early diagnosis of autism. There have been no studies evaluating the knowledge of GPs regarding autism in Pakistan. We aimed to fill that gap by assessing knowledge and attitude of GPs in Karachi regarding autism. We conducted a cross-sectional survey of 348 GPs; only 148 (44.6%) had…
Rahbar, Mohammad Hossein; Ibrahim, Khalid; Assassi, Parisa
OBJECTIVE: To determine awareness of cancer risk factors in the patients and attendants of Out-patient Clinics at a University Hospital in Karachi, Pakistan.METHODS: A cross-sectional survey was conducted on 315 respondents reporting to a tertiary care hospital in Karachi, Pakistan, to assess their level of awareness regarding risk factors of cancer.RESULTS: The respondents belonged to an urban population with the
Hadi Bhurgri; Saqib Ali Gowani; Ahmed Itrat; Saira Samani; Akbar Zuberi; Momin Saulat Siddique; Waris Qidwai; Yasmin Bhurgri
Background Depression in elderly is a major global public health concern. There has been no population-based study of depression in the elderly in Pakistan. The aim of the study was to estimate the prevalence of depression and its association with family support of elderly (age 60 years and above) in Karachi, Pakistan. Methods A population based cross-sectional study was carried out in Karachi from July-September 2008. Questionnaire based interviews were conducted with individuals (n?=?953) recruited through multi-stage cluster sampling technique, using the 15- item Geriatric Depression Scale (GDS). Results Prevalence of depression was found to be 40.6%, with a higher preponderance in women than men (50% vs. 32%). Elderly currently not living with their spouses were 60% more depressed than those living with their spouses (Adjusted OR?=?1.6, 95% CI?=?1.3-2.1). Elderly who did not consider their children as future support were twice as likely to be depressed as those considering their children to be old age security (Adjusted OR?=?2.1, 95% CI?=?1.4-3.1). An increase in one male adult child showed 10% decrease in depression after adjusting for other variables (Adjusted OR?=?0.9, 95% CI?=?0.8-0.9). Conclusion A relatively high prevalence of depression was found in the elderly in Karachi. There appeared to be a strong association between depression and family support variables such as living with spouse, considering children as future security and number of male adult children in the sample studied. Mental wellbeing of the elderly in Pakistan needs to be given consideration in the health policy of the country. In collectivistic societies like Pakistan family support plays an important part in mental health of the elderly that needs to be recognized and supported through various governmental and non-governmental initiatives. Keypoints Assessment of depression in elderly, Cross-sectional study in Karachi-Pakistan
General practitioners (GPs) could have an important role in early diagnosis of autism. There have been no studies evaluating\\u000a the knowledge of GPs regarding autism in Pakistan. We aimed to fill that gap by assessing knowledge and attitude of GPs in\\u000a Karachi regarding autism. We conducted a cross-sectional survey of 348 GPs; only 148 (44.6%) had heard of “autism.” Our
Mohammad Hossein Rahbar; Khalid Ibrahim; Parisa Assassi
Toxic compounds such as heavy metals exert chronic and lethal effects in animals, plants, and human health. With the rapid industrialization, urbanization, and economic development in Karachi, heavy metals are continuing to be introduced to estuarine and coastal environment through rivers, runoff and land-based point sources. Pollution in the Karachi coastal region (167 km long) is mainly attributed to Lyari and Malir Rivers flowing through the city of Karachi. Both rivers are served by various channels of domestic and industrial wastes carrying more than 300 million gallons per day untreated effluent of 6000 industries and ultimately drain into the beaches of Arabian Sea. Concentrations of selected heavy metals (Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, and Zn) in surface sediments from eighty-eight sites in Karachi coastal region were studied in order to understand metal contamination due to industrialization, urbanization, and economic development in Karachi. Sediment samples were collected in 2005 and 2006. We have found that heavy metal concentrations in surface sediments varied from 0.006 to 24.3 ug/g for Cd, 5.1 to 95 ug/g for Co, 2.9 to 571 ug/g for Cr, 6.9 to 272 ug/g for Cu, 0.55 to 6.5% for Fe, 1.2 to 318 ug/g for Mn, 7.5 to 75 ug/g for Ni, 6.3 to 121 ug/g for Pb, and 3.3 to 389 ug/g for Zn. Enrichment factors (EFs) were calculated to assess whether the concentrations observed represent background or contaminated levels. The highest levels of metals were found to be at the confluence of the Lyari and Malir River streams at the Arabian Sea, indicating the impact of the effluents of the highly urbanized and industrialized city of Karachi. Furthermore, this study assessed heavy metal toxicity risk with the application of Sediment Quality Guideline (SQG) indices (effect range low/effect range median values, ERL/ERM). Results indicated that the potential toxicity of marine environment can cause adverse biological effects to the biota directly and the human health indirectly through food web chain.
Siddique, A.; Mumtaz, M.; Zaigham, N. A.; Mallick, K. A.; Saied, S.; Khwaja, H. A.
Background Tuberculosis (TB) is endemic in Pakistan which ranks fifth amongst the twenty two countries designated to be highly burdened by TB according to the World Health Organization. However, there is paucity of data regarding the knowledge of diagnosis of TB and its management amongst public and private practitioners. In this study, we endeavor to identify this gap in knowledge regarding the diagnosis and management of TB between public and private doctors and the factors affecting these knowledge scores in urban Pakistan. Methods This cross sectional survey was conducted between June and December 2011. Doctors from public hospitals, private hospitals and private clinics scattered in all eighteen towns of Karachi were included in the study. Qualified MBBS doctors working in any specialty were eligible to participate whereas doctors working in both the public and private sectors were excluded from the study. Vignette based clinical scenarios were given to assess the knowledge score regarding the diagnosis and management of TB. Results A total of 196 doctors participated in the study. There was a significant difference between private and public physicians in terms of age and years of practice (p-value <0.05). Significant differences in the proportion of knowledge scores were observed between the public and private doctors and National TB Control Program trained and untrained doctors in Karachi. Factors associated with inadequate knowledge scores were being female gender [OR: 2.76 (95% CI: 1.418-5.384)], private employment status [OR: 1.50 (95% CI: 1.258-2.439)], and not trained by NTP [OR: 2.98 (95% CI: 1.286-3.225)] on multivariate logistic regression analysis. Conclusion It is concluded that a knowledge gap exists between the public and private doctors in Karachi. Strengthening of currently implemented public private mix model along with improvement in the trainings of public and private practitioners is highly recommended to control TB in Pakistan.
Background Psychiatric disorders affect about 450 million individuals worldwide. A number of treatment modalities such as psychotropic medications, psychotherapy and electroconvulsive therapy can be used to treat these disorders. Attitudes of general public play a pivotal role in effective utilization of mental health services. We explored the perceptions of general public of Karachi, Pakistan regarding psychotherapy. Methods A cross-sectional study was conducted in Karachi, Pakistan during July-August, 2008. A three-step sampling strategy and a structured questionnaire were employed to survey knowledge and perceptions of adult general public about psychotherapy. Descriptive statistics were used for baseline characteristics. Logistic regression models were used to investigate any significant associations between baseline characteristics of the participants and their perceptions. Results The study sample comprised of 985 individuals (536 males; 531 financially independent) with an average age of 36.7 years (SD 13.54 years) and 12.5 years (SD 3.09 years) of education were included. Majority (59.4%; n = 585) claimed to be aware of psychotherapy as a treatment option for psychiatric disorders but 47.5% of these (n = 278/585) failed to identify its correct definition. Concerns voiced by the participants about psychotherapy included stigma (48.7%) and breech in confidentiality (39.5%); 60.7% opined it cost effective and 86.5% favored its use as an adjuvant modality. A preference for psychotherapy as the treatment strategy for psychiatric disorders was demonstrated by 46.6% (n = 459/985). Younger, more educated, financially independent and female participants were more likely to prefer psychotherapy as were those who deemed it cost effective. Conclusion Positive attitudes regarding the acceptability, clinical utility and cost-effectiveness of psychotherapy were observed in a sample representative of general public of Karachi, Pakistan. These findings highlight its potential utility for devising pragmatic mental health strategies in the face of limited resources.
Zafar, Abdul Mueed; Jawaid, Ali; Ashraf, Hiba; Fatima, Ambreena; Anjum, Rubina; Qureshi, Salah U
Objective To determine the factors associated with retaining the vaccination card among care takers of 12-59 months old children in Karachi, Pakistan. Methods This was an analytical cross-sectional study in Karachi. Households were randomly selected throughout a multistage cluster sampling technique. Data was collected for 504 children of 12- 59 months of age. Questionnaire was administered to caretakers to gather information regarding the children’s vaccination status, socio-demographic characteristics and reviewing their vaccination cards. Statistical analysis was done by SPSS 19 using logistic regression. Results: Among 462 vaccinated children, caretakers of 33% provided vaccination cards. Odds of card retention decrease if the caretaker has a large household i.e., >5 people sharing one room (AOR 0.277, 95% CI: 0.096, 0.797) and if the child is of four to five years of age (AOR 0.544, 95% CI: 0.305, 0.970). Gender of the child, and the caretaker’s education and access to electronic media were not significant predictors of vaccination card retention in our study. Conclusion Our study showed that vaccination card retention for children 12-59 months of age was low (33%) in Karachi. There is a need to educate caretakers of young children regarding the importance of keeping vaccination card and to disseminate this information through healthcare providers. Improving vaccination card retention is one of the key measures which will help towards accurately estimating coverage and to inform health policy decisions.
Sheikh, Sana Sadiq; Ali, Syed Asad
Background Diabetes Mellitus (DM) is a growing epidemic and the cost of treating diabetes is largely increasing. The objective of this study was to estimate the cost-of-illness of DM among attendees of out-patient clinics in Karachi, Pakistan. This is the first study conducted from a societal perspective to estimate the cost of managing diabetes in Pakistan. Methods A prevalence-based 'Cost-of-Illness' study for diabetes care was conducted in six different out-patient clinics of Karachi, Pakistan from July to September 2006. A pre-tested questionnaire was administered to collect the data from 345 randomly selected persons with diabetes. Results The annual mean direct cost for each person with diabetes was estimated to be Pakistani rupees 11,580 (US$ 197). Medicines accounted for the largest share of direct cost (46%), followed by laboratory investigations (32%). We found that increased age, the number of complications and longer duration of the disease significantly increase the burden of cost on society (p < 0.001). Comparing cost with family income it was found that the poorest segment of society is spending 18% of total family income on diabetes care. Conclusion This study concluded that substantial expenditure is incurred by people with diabetes; with the implication that resources could be saved by prevention, earlier detection and a reduction in diabetes co-morbidities and complications through improved diabetes care. Large scale and cost-effective prevention programs need to be initiated to maximise health gains and to reverse the advance of this epidemic.
Khowaja, Liaquat A; Khuwaja, Ali K; Cosgrove, Peter
Background Substantial amount of time is lost before initiation of treatment in Schizophrenia. The delay in treatment is labelled as Duration of Untreated Psychosis (DUP). Most of these estimates come from western countries, where health systems are relatively better developed. There is dearth of information on pathway to care from developing countries. Methods and Results Patients with ICD-10 based diagnosis of Schizophrenia were enrolled by convenient method of sampling. The pathway to care was explored through a semi-structured questionnaire. Onset, course and symptoms of psychosis were assessed using Interview for the Retrospective Assessment of the Onset of Schizophrenia (IRAOS). Ethical approval of the project was taken from The Aga Khan University, Ethics Review Committee. Of the enrolled 93 subjects, 55 (59%) were males and 38 (41%) were females. In our sample, 1.56 mean (median, 2) attempts were made prior to successful help seeking. The duration of untreated psychosis was 14.8 months (St. Deviation; 29.4). DUP was 16.8 months (St. Deviation; 34.9) for males and 11.8 months (St. Deviation; 18.9) for females. In the pathway to care, psychiatrists featured prominently as initial care providers. In the first attempt at help-seeking, 43% patients were initially taken to psychiatrists. After the initial consultation, 45% were prescribed psychotropic medication while 7% were hospitalized. Only 9% subjects were given the diagnosis of schizophrenia initially. When participants were inquired about the reasons for delay, 29% reported financial difficulties as the barrier to care. Positive symptoms of psychosis were present in 57% subjects while negative symptoms were present in 30% subjects. There was a statistically significant difference (Chi-square; 7.928, df: 1, Sig 0.005) between DUP and the positive and negative symptoms category. Conclusion In the absence of well developed primary care health system in Pakistan, majority of patients present to psychiatrists as a first contact. DUP, as a measurement of help seeking behaviour, tends to be shorter with positive symptoms of Schizophrenia. Substantial amount of time is lost due to non recognition of disease and subsequently, inadequate treatment. Secondary prevention strategies should focus on families, which play an important role in the treatment-seeking process of psychotic patients.
Naqvi, Haider A.; Hussain, Sajjad; Zaman, Muhammad; Islam, Mohammad
Objectives Sexually transmitted infections are thought by some to be rare in socially conservative Muslim countries. Little is known about prevalence of syphilis in Pakistani women from the general population. We determined syphilis prevalence in a multi-center cross-sectional study of low risk pregnant women in Karachi, Pakistan. Methods We administered a structured questionnaire and obtained a blood sample for syphilis serology (rapid plasma reagin test with Treponema pallidum hemagglutination assay confirmation) from all women giving informed consent over six weeks in 2007. Results The prevalence of confirmed syphilis was less than one percent (0.9%; 95%CI: 0.4, 1.8) in a sample size of 800 women recruited from three urban sites (?1% refusal rate). Women who lived in an area where male drug use is prevalent (Ibrahim Hyderi Hospital) had 1% (1.5%) higher prevalence rates than women from the other two sites 0.5%. Conclusions We documented higher-than-expected syphilis seroprevalence rates in a low risk population of antenatal clinic attendees in Pakistan. Bridge populations for syphilis may include drug users, who are usually married, and Hijras or their clients. Hijras are transgender and/or transvestite men who may provide sex for money to men. In accordance with our results, the national policy for syphilis control in Pakistan should be modified to include universal syphilis screening in antenatal clinics with subsequent partner notification.
Shah, SA; Kristensen, S; Memon, MA; Usman, G; Ghazi, A; John, R; Sathiakumar, N; Vermund, SH
Mixing ratios of carbon monoxide (CO), carbon dioxide (CO2), methane (CH4), and 47 nonmethane hydrocarbons - NMHCs - (19 alkanes, 13 alkenes, ethyne, and 14 aromatics) were determined for ground level whole air samples collected during the winter of 2006 in Karachi, Pakistan. Pakistan is among the fastest growing economies in Asia, and Karachi is one of the largest cities in the world with a rapidly expanding population of over 14 million in the whole metropolitan area, and a large industrial base. Samples were collected in January 2006 throughout the urban area to characterize the overall air composition of the city, and along the busiest road to determine the traffic signature of Karachi. This sampling campaign follows a previous study carried out in the winter of 1998-1999 in the same city, when elevated concentrations of many NMHCs were observed. Exceptionally high levels of methane were still observed in 2006 with an average mixing ratio of 5.0 ppmv (6.3 ppmv were observed in 1999). The overall air composition of the Karachi urban environment characterized during this 2006 sampling is compared to 1999 aiming to highlight any possible change in the main VOC sources present throughout the city. In particular, we want to evaluate the impact of the heavy usage of natural gas on the overall air quality of Karachi and the recently increased use of liquefied petroleum gas (LPG) as alternative source of energy. We also compare the composition of the urban troposphere of Karachi to other major urban centers worldwide such as Guangzhou (China), Mexico City (Mexico), and Milan (Italy).
Barletta, B.; Meinardi, S.; Khwaja, H. A.; Beyersdorf, A. J.; Baker, A. K.; Zou, S.; Rowland, F.; Blake, D. R.
The ability of pathogenic free-living amoebae to produce infections is a growing concern. In this study, we investigated the presence of free-living amoebae (Acanthamoeba spp., Naegleria fowleri, Balamuthia mandrillaris) in drinking water supplies in Karachi, Pakistan. Fifty-two domestic tap water samples were examined. Amoebae were identified by morphological characteristics and polymerase chain reaction. Thirty percent of the examined samples were positive for Acanthamoeba spp., 8% for N. fowleri while B. mandrillaris were not recovered. Additionally we examined secretory IgA antibody to Acanthamoeba and B. mandrillaris. Acanthamoeba antibody prevalence rate was 100% in both males and females, while B. mandrillaris antibody prevalence rate was 5.5% in males only (females were negative). Our findings suggest that free-living amoebae are a potential health hazard in domestic water supplies in Karachi, Pakistan. PMID:23708583
Yousuf, Farzana Abubakar; Siddiqui, Ruqaiyyah; Subhani, Faysal; Khan, Naveed Ahmed
ObjectiveTo assess the burden and factors associated with highway work-zone (HWZ) crashes.DesignHistorical cohort.SettingSection of the Karachi–Hala Road, Pakistan (196 km).DataPolice-reported crashes and traffic statistics from January 2006 to December 2008.AnalysisCrash and death risk between the HWZ and other zones for a 50 km section were compared. Crash locations were described for a further 146 km section on which factors associated
Junaid Ahmad Bhatti; Junaid Abdul Razzak; Emmanuel Lagarde; L Rachid Salmi
This paper explores local knowledge and perceptions about clubfoot in the Indus Hospital’s catchment population in Karachi, Pakistan. Data was collected through seven focus group discussions with community members and Lady Health Workers, nine in-depth interviews with parents of children with treated or untreated clubfoot, and one interview with an adult with untreated clubfoot. We found that participants were unable to distinguish clubfoot from other disabilities. Moreover, participants had a number of beliefs about the causes of clubfoot, which included lunar and solar eclipses, religious explanations, the health status and behaviours of parents, and genetics. While participants were aware of surgery and other allopathic treatments for clubfoot, many also believed in traditional and religious treatments or were unaware that clubfoot is a treatable condition. This study is the first of its kind in Pakistan and provides important insights that clubfoot programs need comprehensive strategies to raise awareness about clubfoot amongst community members, health providers, and religious leaders in order to be successful.
Burfat, Aziza; Mohammed, Shama; Siddiqi, Osman; Samad, Lubna; Mansoor, Ali Khan; Mohammad Amin, Chinoy
Lead is a widespread environmental contaminant worldwide and is associated with adverse outcomes in children, including impaired neurobehavioral development and learning difficulties. A cross-sectional survey of 53 young children was conducted in a fishing village on an island adjacent to Karachi, Pakistan. Whole blood from each individual was tested for lead levels. Also tested were samples of cooked food, house dust, and drinking water from 36 households. Laboratory determinations were made by the Pakistan Council for Scientific and Industrial Research with quality control by the United States Centers for Disease Control and Prevention. Fifty-two subjects (98%) had blood lead levels above 10 microg/dl (mean 21.60 microg/dl), an internationally recognized threshold for potential neurotoxicity. The mean concentration was 3.90 microg/g in cooked food, 4.02 microg/l in drinking water, and 91.30 microg/g in house dust. These findings indicate possible major health concerns and suggest significant environmental contamination in this community as well as the need to identify locally relevant early childhood exposures. PMID:16053208
Hozhabri, Siroos; White, Franklin; Rahbar, Mohammad Hossein; Agboatwalla, Mubina; Luby, Stephen
Background Surveillance data of Sindh AIDS Control Programme, Pakistan suggest that HIV infection is rapidly increasing among IDUs in Karachi and has reached 9% in 2004–5 indicating that the country has progressed from nascent to concentrated level of HIV epidemic. Findings of 2nd generation surveillance in 2004–5 also indicate 104/395 (26.3%) IDUs HIV positive in the city. Methods We conducted a cross sectional study among registered IDUs of a needle exchange and harm reduction programme in Karachi, Pakistan. A total of 161 IDUs were included in the study between October–November 2003. A detailed questionnaire was implemented and blood samples were collected for HIV, hepatitis B & C and syphilis. HIV, hepatitis B and C antibody tests were performed using Enzyme Linked Immunosorbent Assay (ELISA) method. Syphilis tests (RPR & TPHA) were performed on Randox kit. Besides calculating frequencies univariate analysis was performed using t tests for continuous variables as age, age at first intercourse and average age of initiation of addiction and chi square for categorical variables like paid for sex or not to identify risk factors for hepatitis B and C and syphilis. Results Average age of IDU was 35.9 years and average age of initiation of drugs was 15.9 years. Number of drug injections per day was 2.3. Shooting drugs in group sharing syringes was reported by 128 (79.5%) IDUs. Over half 94 (58.3%) reported paying for sex and 64% reported never using a condom. Commercial selling of blood was reported by 44 (28%). 1 of 161 was HIV positive (0.6%). The prevalence of hepatitis B was 12 (7.5%), hepatitis C 151 (94.3%) and syphilis 21 (13.1%). IDUs who were hepatitis C positive were more likely to start sexual activity at an earlier age and had never used condoms. Similarly IDUs who were hepatitis B positive were more likely to belong to a younger age group. Syphilis positive IDUs were more likely to have paid for sex and had never used a condom. Conclusion Prudent measures such as access to sterile syringes, rehabilitation and opiate substitution therapies are required to reduce high risk behaviors of IDUs in Pakistan.
Altaf, Arshad; Shah, Sharaf Ali; Zaidi, Najam A; Memon, Ashraf; Nadeem-ur-Rehman; Wray, Norman
Background The demographic transition in South Asia coupled with unplanned urbanization and lifestyle changes are increasing the burden of non-communicable disease (NCD) where infectious diseases are still highly prevalent. The true magnitude and impact of this double burden of disease, although predicted to be immense, is largely unknown due to the absence of recent, population-based longitudinal data. The present study was designed as a unique ‘Framingham-like’ Pakistan cohort with the objective of measuring the prevalence and risk factors for hypertension, obesity, diabetes, coronary artery disease and hepatitis B and C infection in a multi-ethnic, middle to low income population of Karachi, Pakistan. Methods We selected two administrative areas from a private charitable hospital’s catchment population for enrolment of a random selection of cohort households in Karachi, Pakistan. A baseline survey measured the prevalence and risk factors for hypertension, obesity, diabetes, coronary artery disease and hepatitis B and C infection. Results Six hundred and sixty-seven households were enrolled between March 2010 and August 2011. A majority of households lived in permanent structures (85%) with access to basic utilities (77%) and sanitation facilities (98%) but limited access to clean drinking water (68%). Households had high ownership of communication technologies in the form of cable television (69%) and mobile phones (83%). Risk factors for NCD, such as tobacco use (45%), overweight (20%), abdominal obesity (53%), hypertension (18%), diabetes (8%) and pre-diabetes (40%) were high. At the same time, infectious diseases such as hepatitis B (24%) and hepatitis C (8%) were prevalent in this population. Conclusion Our findings highlight the need to monitor risk factors and disease trends through longitudinal research in high-burden transition communities in the context of rapid urbanization and changing lifestyles. They also demonstrate the urgency of public health intervention programs tailored for these transition communities.
Khan, Faisal S.; Lotia-Farrukh, Ismat; Khan, Aamir J.; Siddiqui, Saad Tariq; Sajun, Sana Zehra; Malik, Amyn Abdul; Burfat, Aziza; Arshad, Mohammad Hussham; Codlin, Andrew J.; Reininger, Belinda M.; McCormick, Joseph B.; Afridi, Nadeem; Fisher-Hoch, Susan P.
Background. The prevalence of infertility in Pakistan is 22% with primary infertility at 4% and secondary infertility at 18%. This study explored perceptions and experiences of women in Karachi, Pakistan regarding the causes, treatment-seeking behavior for and consequences of secondary infertility. Methods. Focus group discussions and in-depth interviews with married women explored their perceptions and experiences for issues related to secondary infertility. Results. The knowledge of women about the causes and scientific treatment options for infertility was limited resulting in inclination for traditional unsafe health care. Infertility was stated to result in marital instability, stigmatization and abuse specially for women with no live child. Conclusions. Since infertility can have a serious effect on both the psychological well-being and the social status of women in Pakistan, effective interventions are the need of the day. There is a dire need for health education and counseling to be integrated into infertility management plans.
Sami, Neelofar; Saeed Ali, Tazeen
Background Burn injuries are a major cause of medico legal deaths in Pakistan. The present study was conducted with the aim to assess the mortality rate related to different types of burns injuries. Findings This was an observational prospective cross sectional study conducted in Burns Ward of Civil Hospital, Karachi during a period of two years from January 1st 2010 to December 31st, 2011. Data was collected over a questionnaire containing demographic variables as well as date of burn, date of the death (if patient expired), total body surface area involved, cause and manner of burn. The data was statistically analyzed by SPSS v. 16. A total of 1979 patients were admitted to the department during the study period. Out of them, 715 died, hence a mortality rate of 36.12%. Out of the 715 patients, 380 (53.1%) were males and 335 (46.9%) were females. Mortality was highest in age-group 16–30 years (n = 395, 55.2%). Majority of the deaths were accidental (n = 685, 95.8%). Fire burns was found to be the most common cause of death (n = 639, 89.3%). 35% (n = 252) of the patients who died had more than 60% of total body surface area involved in burns. Conclusion Measures must be taken to inform the general population of the possible causes of these injuries, and to enable the people to be prepared to face any such circumstances.
Background: This study explored how married women perceive situations which create family conflicts and lead to different forms of violence in urban Pakistan. In addition, it examines perceptions of consequences of violence, their adverse health effects, and how women resist violence within marital life. Methods: Five focus group discussions were conducted with 28 women in Karachi. Purposive sampling, aiming for variety in age, employment status, education, and socioeconomic status, was employed. The focus group discussions were conducted in Urdu and translated into English. Manifest and latent content analysis were applied. Results: One major theme emerged during the analysis, ie, family violence through the eyes of females. This theme was subdivided into three main categories. The first category, ie, situations provoking violence and their manifestations, elaborates on circumstances that provoke violence and situations that sustain violence. The second category, ie, actions and reactions to exposure to violence, describes consequences of ongoing violence within the family, including those that result in suicidal thoughts and actions. The final category, ie, resisting violence, describes how violence is avoided through women’s awareness and actions. Conclusion: The current study highlights how female victims of abuse are trapped in a society where violence from a partner and family members is viewed as acceptable, where divorce is unavailable to the majority, and where societal support of women is limited. There is an urgent need to raise the subject of violence against women and tackle this human rights problem at all levels of society by targeting the individual, family, community, and societal levels concurrently.
Ali, Tazeen S; Krantz, Gunilla; Mogren, Ingrid
Background Several recent studies have recommended that ophthalmologists must be aware of the visual sensations (and their associated anxiety/fear) experienced by patients undergoing cataract surgery. We assessed the knowledge of a group of eye doctors in Pakistan regarding these phenomena. Methods This was a cross-sectional survey. Eye doctors (ophthalmologists, residents and medical officers) attending the Ophthalmological Society of Pakistan Annual Conference 2011, in Karachi were invited to participate in the study. A self-administered structured questionnaire was used to examine their knowledge of visual sensations and their associated anxiety/fear experienced by patients during cataract surgery. Simple frequencies and proportions were calculated to describe the data. Results A total of 150 ophthalmologists, residents and medical officers were invited to participate in the study. Of these, 68 (45.3%) responded. The mean age (±SD) of the participants was 42.9 (13.2) years. The proportion of participants who thought that patients could experience visual sensations during cataract surgery under regional anaesthesia was 89.7% and that under topical anaesthesia was 73.5%. The most frequently cited sensations included: light perception, changes in light brightness, movements, instruments and surgeon’s hands or fingers. The eye doctors estimated that 38.9% and 64.3% patients would see at least something during cataract surgery under regional anaesthesia and topical anaesthesia, respectively. They also believed that 24.2%-36.9% of patients may experience anxiety/fear as a result of visual sensations during such surgery. Approximately half of the eye doctors did not think that retained vision was a source of fear or anxiety for the patients. While most of them acknowledged the importance of preoperative counselling in helping to alleviate such fear/anxiety, the majority of them did not regularly counsel their patients on what to expect during the surgery. Conclusion Our study reveals that a significant proportion of eye doctors do not have adequate knowledge of the visual phenomenon and their associated anxiety or fear, that patients can experience during cataract surgery. Targeted educational interventions are needed to increase awareness of this phenomenon among eye care professionals.
There are limited studies examining risk factors associated with child mental health problems in developing countries. To explore the association between social and educational factors and child mental health problems among primary school age children in Karachi, children aged 5–11 years were randomly selected from 27 mainstream schools in Karachi. The Strengths and Difficulties Questionnaire and a socio-demographic checklist were
Sajida Abdul Hassan; Panos Vostanis; John Bankart
There are limited studies examining risk factors associated with child mental health problems in developing countries. To explore the association between social and educational factors and child mental health problems among primary school age children in Karachi, children aged 5–11 years were randomly selected from 27 mainstream schools in Karachi. The Strengths and Difficulties Questionnaire and a socio-demographic checklist were
Sajida Abdul Hassan; Panos Vostanis; John Bankart
ABSTRACT: OBJECTIVE: To determine the safety and logistic feasibility of a mass immunization strategy outside the local immunization program in the pediatric population of urban squatter settlements in Karachi, Pakistan. METHODS: A cluster-randomized double blind preventive trial was launched in August 2003 in 60 geographic clusters covering 21,059 children ages 2 to 16 years. After consent was obtained from parents
Mohammad Imran Khan; Rion Leon Ochiai; Hasan Bin Hamza; Shah Muhammad Sahito; Muhammad Atif Habib; Sajid Bashir Soofi; Naveed Sarwar Bhutto; Shahid Rasool; Mahesh K Puri; Mohammad Ali; Shafi Mohammad Wasan; Mohammad Jawed Khan; Remon Abu-Elyazeed; Bernard Ivanoff; Claudia M Galindo; Tikki Pang; Allan Donner; Lorenz von Seidlein; Camilo J Acosta; John D Clemens; Shaikh Nizami; Zulfiqar A Bhutta
Food is an important factor in the fish biology, to the extent of governing their growth, maturity and migratory movements. Therefore, this research was aimed to investigate the feeding habits of marine edible fish Sphyraena forsteri (Cuvier, 1829) collected during February 2006 to July 2007 from fresh landing at fish harbor, Karachi coast, Pakistan. The gut analysis of 120 fish
Y. AKHTAR; F. M. BILQEES
Background It is well established that low levels of 25(OH) Vitamin D (<30 ng/dL) are a common finding world over, affecting over a billion of the global population. Our primary objective was to determine the prevalence of vitamin D deficiency and insufficiency in the asymptomatic adult population of Karachi, Pakistan and the demographic, nutritional and co-morbidity characteristics associated with serum vitamin D levels. Methods A cross-sectional population survey was conducted at two spaced out densely populated areas of the city. Serum levels of 25OHVitamin D were measured and GFR as renal function was assessed by using 4 variable MDRD formula. Results Our sample of 300 had a median age of 48(interquartile range 38–55) years. The median level of serum vitamin D was 18.8 (IQ range 12.65–24.62) ng/dL. A total of 253 (84.3%) respondents had low levels (<30 ng/dL) of 25OH vitamin D. Serum PTH and vitamin D were negatively correlated (r?=??0.176, p?=?0.001). The median PTH in the vitamin D sufficiency group was 38.4(IQ range28.0–48.8)pg/mL compared with 44.4(IQ range34.3–56.8) pg/mL in the deficiency group (p?=?0.011).The median serum calcium level in the sample was 9.46(IQ range 9.18–9.68) ng/dL. Low serum levels of vitamin D were not associated with hypertension (p?=?0.771) or with an elevated spot blood pressure (p?=?0.164).In our sample 75(26%) respondents had an eGFR corresponding to stage 2 and stage 3 CKD. There was no significant correlation between levels of vitamin D and eGFR (r?=??0.127, p-value?=?0.277).Respondents using daily vitamin D supplements had higher 25 OH vitamin D levels (p-value?=?0.021). Conclusion We observed a high proportion of the asymptomatic adult population having low levels of vitamin D and subclinical deterioration of eGFR. The specific cause(s) for this observed high prevalence of low 25OH vitamin D levels are not clear and need to be investigated further upon.
Sheikh, Adil; Saeed, Zeb; Jafri, Syed Ali Danial; Yazdani, Iffat; Hussain, Syed Ather
Background To determine the behavior of physicians regarding medical literature reading and participation in research activities at one of the largest teaching hospitals in Pakistan. Method This descriptive, cross-sectional study was conducted by interviewing the house officers, residents and fellows of six major specialties (Medicine, Surgery, Pediatrics, Psychology, Obstetrics & Gynecology and Anesthesia) in Civil Hospital, Karachi between August and December, 2011. The questionnaire elicited responses regarding the reading habits of physicians, preferred sources of information, their participation in research activities (publication & supervision) and views regarding journal club. SPSS 17.0 was used for data entry and analysis. Result A total of 259 completely filled questionnaires were returned with a response rate of 85.19%. Mean age of the participants was 29.67?±?7.65?years. Books were selected by 71.4% doctors as their preferred source of information, regardless of their clinical specialties. (p?0.05). E-journals were preferred by 75.7% of the doctors over printed journals. This holds true for doctors from all specialties (p?0.05). The ease of searching for relevant articles was the major contributor (50.5%) in preference of e-journals. 137 (52.9%) doctors read 5 or less articles per week. 30 (11.6%) doctors have subscription of journals (printed or electronic). At least one research paper has been published by 151 (58.3%) of the physicians interviewed. Most common reason for not participating in research activities was busy schedule (56.4%). Almost half (49.4%) doctors reported lack of journal club in their units. Of these, majority (88.35%) wanted a journal club in their respective units. Conclusion Urgent intervention is required to promote healthcare literature reading and writing practice in our physicians. Easy access to workplace computers with internet and subscription of paid journals will facilitate physicians. Lack of supervisors and busy schedule were reported to be important contributors for not participating in research. Addressing these issues will encourage doctors to participate more in research activities.
Background In Pakistan, like many Asian countries, a large proportion of healthcare is provided through the private sector. We evaluated a systematic screening strategy to identify people with tuberculosis in private facilities in Karachi and assessed the approaches' ability to diagnose patients earlier in their disease progression. Methods and Findings Lay workers at 89 private clinics and a large hospital outpatient department screened all attendees for tuberculosis using a mobile phone-based questionnaire during one year. The number needed to screen to detect a case of tuberculosis was calculated. To evaluate early diagnosis, we tested for differences in cough duration and smear grading by screening facility. 529,447 people were screened, 1,010 smear-positive tuberculosis cases were detected and 942 (93.3%) started treatment, representing 58.7% of all smear-positive cases notified in the intervention area. The number needed to screen to detect a smear-positive case was 124 (prevalence 806/100,000) at the hospital and 763 (prevalence 131/100,000) at the clinics; however, ten times the number of individuals were screened in clinics. People with smear-positive TB detected at the hospital were less likely to report cough lasting 2–3 weeks (RR 0.66 95%CI [0.49–0.90]) and more likely to report cough duration >3 weeks (RR 1.10 95%CI [1.03–1.18]). Smear-positive cases at the clinics were less likely to have a +3 grade (RR 0.76 95%CI [0.63–0.92]) and more likely to have +1 smear grade (RR 1.24 95%CI [1.02–1.51]). Conclusions Tuberculosis screening at private facilities is acceptable and can yield large numbers of previously undiagnosed cases. Screening at general practitioner clinics may find cases earlier than at hospitals although more people must be screened to identify a case of tuberculosis. Limitations include lack of culture testing, therefore underestimating true TB prevalence. Using more sensitive and specific screening and diagnostic tests such as chest x-ray and Xpert MTB/RIF may improve results.
Creswell, Jacob; Khowaja, Saira; Codlin, Andrew; Hashmi, Rabia; Rasheed, Erum; Khan, Mubashir; Durab, Irfan; Mergenthaler, Christina; Hussain, Owais; Khan, Faisal; Khan, Aamir J.
Concentrations of 12 metals (Fe, Mn, Cr, Mo, Ni, Pb, Se, Sr, U, V, Zn, and Zr) in surface sediments of Karachi Coast, Pakistan were determined to evaluate their distribution and pollution assessment. The measured metals in the sediments were found to be in the range of Fe, 0.84-6.96 %; Mn, 300-1,300 ?g/g; Cr, 12.0-319.84 ?g/g; Mo, 0.49-2.03 ?g/g; Ni, 1.53-58.86 ?g/g; Pb, 9.0-49.46 ?g/g; Se, 0.25-.86 ?g/g; Sr, 192-1185 ?g/g; U, 0.19-1.66 ?g/g; V, 15.80-118.20 ?g/g; Zn, 15.60-666.28 ?g/g; and Zr, 44.02-175.26 ?g/g. The mean contents of the metal studied were: Fe, 3.07 %, Mn, 0.05 %; Cr, 96.75 ?g/g; Mo, 1.34 ?g/g; Ni, 31.39 ?g/g; Pb, 23.24 ?g/g; Se, 0.61 ?g/g; Sr, 374.83 ?g/g; U, 0.64 ?g/g; V, 61.75 ?g/g; Zn, 204.75 ?g/g; and Zr:76.27 ?g/g, and arrangement of the metals from higher to lower mean content in this area is: Fe > Zn > Mn > Sr > Zn > Cr > Zr > V > Ni > Pb > Mo > U > Se. There is no significant correlation among most of these metals, indicating different anthropogenic and natural sources. To assess ecotoxic potential of marine sediments, Numerical Sediment Quality Guidelines were also applied. The concentration of Pb in all the sediments except one was lower than the threshold effect concentration (TECs) showing that there are no harmful effects to marine life from Pb. On the other hand, the concentrations of Cr, Ni, and Zn exceeded TEC in three stations, indicating their potential risk. The degree of pollution in sediments for metals was assessed by calculating enrichment factor (EF) and pollution load index (PLI). The results indicated that sediments of Layari River Mouth Area, Fish Harbour, and KPT Boat Building Area are highly enriched with Cr and Zn (EF > 5). Sediments of Layari River Outfall Zone were moderately enriched with Ni and Pb (EF > 2). The pollution load index was found in the range of 0.98 to 1.34. Lower values of PLI (? 1) at most of sampling locations imply no appreciable input from anthropogenic sources. However, relatively higher PLI values (>1) at Layari River Mouth Area, Fish Harbour, and KPT Boat Building Area are attributed to increased human activity in the area. PMID:22580789
Mashiatullah, Azhar; Chaudhary, Muhammad Zaman; Ahmad, Nasir; Javed, Tariq; Ghaffar, Abdul
OBJECTIVES: To confirm whether blood lead concentrations in Karachi were as high as reported in 1989 and to identify which types of exposure to lead contribute most to elevated blood lead concentrations in children in Karachi. METHODS: A total of 430 children aged 36-60 months were selected through a geographically stratified design from the city centre, two suburbs, a rural community and an island situated within the harbour at Karachi. Blood samples were collected from children and a pretested questionnaire was administered to assess the effect of various types of exposure. Cooked food, drinking-water and house dust samples were collected from households. FINDINGS: About 80% of children had blood lead concentrations 10 g/dl, with an overall mean of 15.6 g/dl. At the 5% level of significance, houses nearer to the main intersection in the city centre, application of surma to children's eyes, father's exposure to lead at workplace, parents' illiteracy and child's habit of hand- to-mouth activity were among variables associated with elevated lead concentrations in blood. CONCLUSION: These findings are of public health concern, as most children in Karachi are likely to suffer some degree of intellectual impairment as a result of environmental lead exposure. We believe that there is enough evidence of the continuing problem of lead in petrol to prompt the petroleum industry to take action. The evidence also shows the need for appropriate interventions in reducing the burden due to other factors associated with this toxic element.
Rahbar, Mohammad Hossein; White, Franklin; Agboatwalla, Mubina; Hozhabri, Siroos; Luby, Stephen
This study assessed to what extent an enforcement campaign influenced seat-belt and helmet wearing on a Pakistani highway. The study setting was the Karachi-Hala highway where a traffic enforcement campaign was conducted from Dec 2009 to Feb 2010. Seat-belt and helmet wearing were observed in Nov 2009 and Apr 2010 at Karachi toll plaza. Differences in wearing rates as a function of occupants’ age, sex, and vehicle type were compared between the two periods. On average, 9 119 (Standard deviation=1 896) traffic citations were issued per month from Aug 2009 to Feb 2010; 4.2% of which were for not wearing helmet. A 22.5% increase in citations was observed for Dec 2009 to Feb 2010 periods compared with Aug 2009 to Oct 2009 periods. Nearly six thousand four-wheeled and four hundred two-wheeled motorized vehicle occupants were observed in Nov 2009 and Apr 2010. Overall, two of the five drivers and one of the five front seat occupants wore seat belts. This proportion was significantly higher in drivers and front-seat occupants of cars than those of heavier vehicles. Similarly, one of two motorcyclists used a helmet but this proportion was 5.8% for pillion riders in Nov 2009. The increased enforcement had a limited influence on belt wearing in drivers (+4.0%; 95% Confidence Interval [95%CI]=1.8–6.1) and occupants (+6.2%; 95%CI=4.2–8.2). A higher increase was observed for motorcyclists (+9.8%; 95%CI=2.6–16.8) and pillion riders (+12.8%; 95%CI=5.4, 20.5). These results suggested that serious efforts are required to increase seat-belt and helmet use on Pakistani highways. Improving enforcement resources, increased fines, not allowing such vehicles on roads, and awareness campaigns targeting drivers of heavy vehicles might increase wearing rates in Pakistan.
Bhatti, Junaid A.; Ejaz, Kiran; Razzak, Junaid A.; Tunio, Israr Ali; Sodhar, Irshad
This study assessed to what extent an enforcement campaign influenced seat-belt and helmet wearing on a Pakistani highway. The study setting was the Karachi-Hala highway where a traffic enforcement campaign was conducted from Dec 2009 to Feb 2010. Seat-belt and helmet wearing were observed in Nov 2009 and Apr 2010 at Karachi toll plaza. Differences in wearing rates as a function of occupants' age, sex, and vehicle type were compared between the two periods. On average, 9 119 (Standard deviation=1 896) traffic citations were issued per month from Aug 2009 to Feb 2010; 4.2% of which were for not wearing helmet. A 22.5% increase in citations was observed for Dec 2009 to Feb 2010 periods compared with Aug 2009 to Oct 2009 periods. Nearly six thousand four-wheeled and four hundred two-wheeled motorized vehicle occupants were observed in Nov 2009 and Apr 2010. Overall, two of the five drivers and one of the five front seat occupants wore seat belts. This proportion was significantly higher in drivers and front-seat occupants of cars than those of heavier vehicles. Similarly, one of two motorcyclists used a helmet but this proportion was 5.8% for pillion riders in Nov 2009. The increased enforcement had a limited influence on belt wearing in drivers (+4.0%; 95% Confidence Interval [95%CI]=1.8-6.1) and occupants (+6.2%; 95%CI=4.2-8.2). A higher increase was observed for motorcyclists (+9.8%; 95%CI=2.6-16.8) and pillion riders (+12.8%; 95%CI=5.4, 20.5). These results suggested that serious efforts are required to increase seat-belt and helmet use on Pakistani highways. Improving enforcement resources, increased fines, not allowing such vehicles on roads, and awareness campaigns targeting drivers of heavy vehicles might increase wearing rates in Pakistan. PMID:22105384
Bhatti, Junaid A; Ejaz, Kiran; Razzak, Junaid A; Tunio, Israr Ali; Sodhar, Irshad
In Karachi, large employment opportunities, burgeoning population and the availability of cheap labour might be the contributing factors for the increasing prevalence of child labour. A literature review was conducted in 2007 that included published and unpublished literature since 2000. Various organizations working in the field were also covered, while the perception of the child labourers was covered through three focus group discussions. Common health issues among the child labourers in Karachi included respiratory illnesses, fever and generalised pains, as well as drug and sexual abuse. Organisations working for child labour could be broadly categorised into those working for legal advice and advocacy; those generating statistics; and those that are providing interventions. Discussion with children showed that irrespective of the immediate cause, the underlying determinant for child labour was poverty. The best practices identified included evening schools and drop-in centers for working children with provision for skill-based education and basic health facilities. There is need to have more such centres. PMID:23866451
Nafees, Asaad Ahmed; Khan, Kausar Saeed; Fatmi, Zafar; Aslam, Mubashir
Background Electroconvulsive therapy (ECT) is shown to be effective in many psychiatric illnesses, but its distorted projection by the Pakistani media and its unregulated use by many physicians across the country have adversely affected its acceptability. Given this situation we aimed to assess the awareness and perceptions regarding ECT as a treatment modality among the psychiatric patients. Methods This was a questionnaire based cross-sectional study carried out at 2 tertiary care hospitals in Karachi, Pakistan. Results We interviewed 190 patients of which 140 were aware of ECT. The study showed that the level of education had a significant impact on the awareness of ECT (p = 0.009). The most common source of awareness was electronic and print media (38%), followed by relatives (24%) and doctors (23%). Physical injuries (42%) and neurological (12%) and cognitive disturbances (11%) were the commonly feared side effects. The most popular belief about ECT was that it was a treatment of last resort (56%). Thirty-nine percent thought that ECT could lead to severe mental and physical illness and 37% considered it inhumane. Patients' willingness to receive ECT was dependant on whether or not they were convinced of its safety (p = 0.001) and efficacy (p = 0.0001). Conclusion We identified a serious lack of dissemination of information regarding ECT by the psychiatrists and the mental health care providers. This may be the result of an inadequate postgraduate training in Pakistan or just a lack of concern about the mentally ill patients. The media seemed to be the major source of information for our patients. We also saw the prevalence of a variety of myths regarding ECT in our society, which we feel may be responsible for the patients' adverse attitudes. Given the widespread applicability of ECT there is a dire need to dispel these misconceptions and improve its acceptability.
Arshad, Mehreen; Arham, Ahmad Zafir; Arif, Mansoor; Bano, Maria; Bashir, Ayisha; Bokutz, Munira; Choudhary, Maria Maqbool; Naqvi, Haider; Khan, Murad Moosa
Objective: Patients' attitude towards medical students' presence during treatment depends on the cultural values of the society. This study was conducted to find out the patients' receptiveness in our society to be involved in teaching process for medical students during consultation in out patient department of a teaching hospital in Karachi Pakistan. Methodology: This cross sectional study was conducted in the surgical Out Patient Department (OPD) at Dow University Hospital from May 2012 to June 2012. Four hundred and eleven patients consented for participation through non probability purposive sampling, in which 279 patients were from morning clinics in the presence of students for clinical teaching, while 132 patients participated through evening clinics of surgery, when students were not present for comparison in specific dimensions of care for patients' satisfaction. Results: Majority of patients 293 (71%) agreed with the teaching of students during consultation and they feel they are contributing in future doctor's teaching, only 24% patients disagreed. Fifty two percent of patients who disagreed reported interference in privacy, 34% reported interference in consultation and 43% felt it resulted in prolong waiting time due to teaching. Conclusion: Majority of the patients agree to be part of teaching for medical students and this study can be used to assess the educational interventions designed to improve the patient based teaching. PMID:24353555
Laiq-Uz-Zaman Khan, Muhammad; Jawaid, Masood; Hafeez, Kamran
Diarrhea causes 16% of all child deaths in Pakistan. We assessed patterns of healthcare use among caretakers of a randomly selected sample of 959 children ages 0-59 months in low-income periurban settlements of Karachi through a cross-sectional survey. A diarrheal episode was reported to have occurred in the previous 2 weeks among 298 (31.1%) children. Overall, 280 (80.3%) children sought care. Oral rehydration solution and zinc were used by 40.8% and 2%, respectively; 11% were admitted or received intravenous rehydration, and 29% sought care at health centers identified as sentinel centers for recruiting cases of diarrhea for a planned multicenter diarrheal etiology case-control study. Odds ratios for independent predictors of care-seeking behavior were lethargy, 4.14 (95% confidence interval = 1.45-11.77); fever, 2.67 (1.27-5.59); and stool frequency more than six per day, 2.29 (1.03-5.09). Perception of high cost of care and use of home antibiotics were associated with reduced care seeking: odds ratio = 0.28 (0.1-0.78) and 0.29 (0.11-0.82), respectively. There is a need for standardized, affordable, and accessible treatment of diarrhea as well as community education regarding appropriate care in areas with high diarrheal burden. PMID:23629928
Quadri, Farheen; Nasrin, Dilruba; Khan, Asia; Bokhari, Tabassum; Tikmani, Shiyam Sunder; Nisar, Muhammad Imran; Bhatti, Zaid; Kotloff, Karen; Levine, Myron M; Zaidi, Anita K M
Globally, suicide remains one of the leading causes of death among individuals aged 10 to 64 years and it ranks between second and fourth among those age 10 to 45 years. Data on suicidal behavior from Pakistan is sparse, especially for children and adolescents. A retrospective descriptive case note study was carried out of all patients under the age of
Ehsan Ullah Syed; Murad M. Khan
Over the past several decades in Pakistan, an increasing number of women with young children are joining the workforce, which is one of the biggest social changes in the later half of the twentieth century. More children are being raised in households where mothers work for pay as compared with the scenario a generation ago. This change has…
Meherali, Salima Moez; Karmaliani, Rozina; Asad, Nargis
Objective: Attitudes of medical students toward a specialty is strongly related to their future choice of specialty. In developing countries like Pakistan, where there is a shortage of psychiatrists, there is a need to assess the effect of exposure to psychiatry on medical students. Methods: The authors conducted a survey of fourth-year medical…
Sajid, Ayesha; Khan, Murad M.; Shakir, Murtaza; Moazam-Zaman, Riffat; Ali, Asad
Background: Cigarette smoking is the largest preventable risk factor for morbidity and mortality in developed countries where at least one in four adults smoke cigarettes. Healthcare providers who smoke are less likely to advise patients to quit smoking. The aim of this study is to find out the frequency of tobacco smoking among medical professionals in tertiary care hospitals of Karachi, and to identify the common factors responsible for the continuation of smoking among healthcare providers. Methods: This descriptive cross-sectional study was carried out at public and private tertiary Care Hospitals/Institutes at Karachi. A self-administered questionnaire was used to collect data from 180 subjects. An informed consent was obtained from all the subjects. The data were analyzed using SPSS version 16.0. Results: Prevalence of smoking was 29%. High prevalence of smoking was among male doctors as compared to female doctors. Sixty-eight per cent of smokers started smoking between 20 to 30 years of age. Age less than 35 years, male and public sectors hospitals were more likely OR 1.23, CI (0.98-2.41), 6.40 CI (4.48-10.52) and 2.61 CI (2.20-3.78) respectively. Conclusions: The Result of the study suggests that while healthcare smoking habits appear to be high, they are not uniformly low when compared from an international perspective. Health promotion programs focused on self-efficacy may be an effective tool for reducing the initiation, frequency, and amount of cigarette smoking among healthcare providers.
Background Chronic kidney disease (CKD) is increasing being recognized as a global public health problem. However, there is dearth of information on the prevalence, determinants, and management of CKD from low- and middle-income countries. The objectives of the study were to determine the 1) prevalence of CKD; 2) socio-demographic and clinical factors associated with CKD; and 3) the existing management of these patients with regards to blood pressure control, and use of antihypertensive medications. Methods We conducted a cross-sectional study on 2873 participants aged ?40 years in 12 representative communities in Karachi, Pakistan. The primary outcome was clinically significant CKD defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 estimated by CKD-EPI (CKD Epidemiology Collaboration) Pakistan equation (0.686?×?CKD-EPI1.059) or urinary albumin to creatinine ratio ?3 mg/mmol (i.e. KDOQI CKD stage G3, A2 or worse). Results The overall prevalence (95% CI) of CKD was 12.5% (11.4 – 13.8%). The factors independently associated with CKD were older age, hypertension, diabetes, elevated systolic blood pressure, raised fasting plasma glucose, raised triglycerides, and history of stroke (p?0.05 for each). About 267 (74.4%, 69.5 – 78.8%) adults with CKD had concomitant hypertension. Of these, 130 (48.7%, 42.6 – 54.9%) were on antihypertensive medications, and less than 20% had their BP controlled to conventional target of ?140/90 mm Hg, and only 16.9% (12.6 – 21.9%) were on blockers of renin-angiotensin system alone or in combination with other drugs. Conclusions Clinically significant CKD is common among Pakistani adults. The conventional risk factors for CKD and poor control of blood pressure among patients with CKD highlight the need to integrate CKD prevention and management in the primary care infrastructure in Pakistan, and possibly neighbouring countries.
Background Mistreatment or belittlement of medical students either by faculty or fellow students has often been reported. Perception of mistreatment has also been associated with increased degree of psychological morbidity. There is a lack of such studies being conducted amongst the medical students of Pakistan. The aim of this study was to determine the prevalence and forms of perceived mistreatment and presence of mental health morbidity in a private medical school in Pakistan. Also, any association between mental health morbidity and mistreatment was to be identified. Methods A cross sectional study was carried out on medical students from Aga Khan University Hospital, Karachi, Pakistan during the period of June–September 2007. A self administered questionnaire, adapted from Frank et al and Baldwin et al was distributed to a total of 350 students. The questionnaire consisted of three parts: the first dealing with the demographics of the population, the second concerning the various forms of mistreatment, while the third assessed the mental health of students using the General Health Questionnaire 12(GHQ12). Descriptive statistics were performed. The Chi-square test and Fisher's exact tests were applied. Results A total of 350 students were approached out of which 232 completed the questionnaire giving a response rate of 66.2%. Mistreatment was reported by 62.5% (145/232) of the respondents. Of these, 69.7% (83/145) were males and 54.9% (62/145) were females. There was a significant relationship between gender, year division, stress at medical school and possible use of drugs/alcohol and reported mistreatment but no statistical relationship was seen with psychiatric morbidity. The overall prevalence of psychological morbidity was 34.8% (77/221). Conclusion This study suggests high prevalence of perceived mistreatment and psychological morbidity among Pakistani medical students. However, no association was found between these two aspects of medical student education. There is a need to bring about changes to make the medical education environment conducive to learning. Increased student feedback, support systems and guidance about progress throughout the year and the provision of adequate learning resources may provide help with resolving both of these issues.
Shoukat, Sana; Anis, Mariam; Kella, Danesh K.; Qazi, Fahad; Samad, Fatima; Mir, Faizia; Mansoor, Maryah; Parvez, Mohammad B.; Osmani, Bushra; Panju, Sukaina A.; Naqvi, Haider
Background An increased interest in professionalism has been reported in the field of medical education due to concerns regarding deterioration of humanism and professional values in the teaching and practice of medicine. The primary aim of this study was to assess attitudes of Pakistani and Pakistani heritage students at a medical college in Pakistan about important elements of professionalism that an ideal medical doctor should possess. A further objective of the study was to determine students’ preferred ways of learning professionalism. Methods A written survey was distributed to undergraduate medical students at a public sector medical college at Karachi, Pakistan in 2011. Using the Penn State College of Medicine (PSCOM) Professionalism Questionnaire, attitudes of medical students of semester 1, 5, and 8 regarding professionalism were assessed anonymously. Results The mean age of the students was 21.11?±?2.72 years. Forty-three percent of the respondents were male. Forty percent of the students held Pakistani citizenship. Thirty-five percent students were US citizens with Pakistani parents and twenty-five percent were Pakistani heritage students that had dual citizenships. No significant differences in the elements of professionalism (Accountability, Altruism, Duty, Excellence, Honesty & Integrity and Respect) mean scores or in the overall mean score of professionalism among the various classes were found. The total overall Cronbach alpha value for all elements of the professionalism in the selected classes was above 0.9. The most preferred methods for learning professionalism were role modeling by faculty, case based scenarios and role plays. Conclusion The students rated all the attributes of professionalism as important and there was no difference across the study years. The overall internal consistency of each element of professionalism was high in different classes. Faculty role models, case based scenarios and role plays may be used to teach professionalism. As a great majority of students were having a Pakistani heritage rather than complete Pakistani born and bred background, hence findings of the survey may not be taken as representative of typical Pakistani medical students.
Due to lack of adequate number of formally trained nephrologists, many patients with chronic kidney disease (CKD) are seen by general practitioners (GPs). This study was designed to assess the knowledge of the GPs regarding identification of CKD and its risk factors, and evaluation and management of risk factors as well as complications of CKD. We conducted a cross-sectional survey of 232 randomly selected GPs from Karachi during 2011. Data were collected on a structured questionnaire based on the kidney disease outcomes and quality initiative recommendations on screening, diagnosis, and management of CKD. A total of 235 GPs were approached, and 232 consented to participate. Mean age was 38.5 ± 11.26 years; 56.5% were men. Most of the GPs knew the traditional risk factors for CKD, i.e., diabetes (88.4%) and hypertension (80%), but were less aware of other risk factors. Only 38% GPs were aware of estimated glomerular filtration rate in evaluation of patients with CKD. Only 61.6% GPs recognized CKD as a risk factor for cardiovascular disease. About 40% and 29% GPs knew the correct goal systolic and diastolic blood pressure, respectively. In all, 41% GPs did not know when to refer the patient to a nephrologist. Our survey identified specific gaps in knowledge and approach of GPs regarding diagnosis and management of CKD. Educational efforts are needed to increase awareness of clinical practice guidelines and recommendations for patients with CKD among GPs, which may improve management and clinical outcomes of this population.
Yaqub, S.; Kashif, W.; Raza, M. Q.; Aaqil, H.; Shahab, A.; Chaudhary, M. A.; Hussain, S. A.
This study describes the experiences of 10 young feminised men in Pakistan. They face high levels of stigma, violence and sexual abuse. The average age of first sex was 11 years old and all reported having been been raped during childhood and early adolescence, often several times. While some mothers and siblings were quietly supportive, young feminised men often end up running away from home, finding support as a member of a hijra dera, a 'pseudo-household' led by an older feminised man or guru, in which they find employment as dancers or sex workers. After their entry into sex work there is little or no opportunity to use condoms. The hijra dera offer an important entry point for improved social support and sexual health programmes, including efforts to ensure young feminised men postpone their sexual debut and/or improve their sexual health, retain access to education, explore alternative forms of employment and improve access to health care. PMID:23157327
de Lind van Wijngaarden, Jan W; Schunter, Bettina T; Iqbal, Qasim
Background Gallstones have been regarded as one of the most expensive diseases in Gastroenterology, posing a great economic burden on developing nations. The majority of Pakistani people live in rural areas where healthcare facilities are not available or are very primitive. We aim to assess the characteristics among cholelithiasis patients from rural Karachi so that a prevention campaign can be launched in rural underprivileged settings to reduce the economic burden of this preventable disease. Method A total of 410 patients were included in the study after giving verbal consent as well as written consent. Variables such as age, weight, height, body mass index (BMI), blood pressure, waist circumference, number of children, monthly family income, number of siblings, and number of family members, were considered in this questionnaire. All data was analysed by SPSS ver. 16.0. Mean and standard deviation (SD) were calculated for continuous variables. Frequency and percentages were calculated for categorical variables. Results Nearly 85.4% of the participants were female. The mean?±?S.D. for age was 43.8?±?9.59. Nearly 61% of the patients were illiterate. All of our patients were from low socioeconomic status and their mean salary?±?S.D. was 6915?±?1992 PKR (1 US $?=?90.37PKR). 75% of them were smokers with mean consumption?±?S.D. of 7.5?±?10 cigarettes per day. Fibre in diet was not used by 83.65% of patients. 40.2% were living in combined families. 61% were living in purchased homes. A positive history of diabetes mellitus was given by 45.1%, family history of cholelithiasis by 61% and history of hypertension by 31.7% of subjects. Soft drink consumption was given by 45.1% of patients; while only 8.5% used snacked daily. Tea was consumed by 95.1% of the subjects. Daily physical activity for 30 minutes was reported by only 13.4% of participants. Conclusion In conclusion, rural dwellers from low socioeconomic strata are neglected patients and illiteracy further adds fuel to the fire by decreasing the contact with the health professionals. Assessment of the characteristics are very important because considering the great socio-economic burden, an intervention strategy in the form of mass media campaign as well as small group discussions in such rural areas can be formulated and applied to high risk populations to reduce the burden and complications of gallstone disease.
Background About 1.3 billion people are regular smokers world wide and every day between 8,200 and 9,900 young people start to smoke, risking rapid addiction to nicotine. Transition from high school to college is a critical period to adopt healthy habits and life style. Therefore, it is important to understand the factors that might influence their smoking habit. Our study aims to assess the influence of factors that encourage college students to smoke cigarettes. Methods The data used in this survey were obtained from a representative sample of registered colleges of Karachi. A random sample of 576 male college students of ages ranging from 15–30 years was interviewed using a questionnaire administered by survey officers, by applying multi stage cluster sampling during the academic year 2004–2005. Results In this study, we found 26.7% of students had ever tried smoking, whereas 24%(95% CI: 21.0%–28.0%) of college students reported current smoking (that is whether one had smoked a cigarette in past 30 days). Among different age groups, prevalence of current smoking was 19.2% in 15–17 years, 26.5% in 18–20 years and 65% in 21 years and above. After adjusting for age of respondent, students in public schools were more likely to smoke as compared to students in private schools (adjusted OR = 2.3; 95% CI: 1.3–4.2). Students whose friends are smokers were 5 times more likely to smoke compared to those whose friends are non-smokers (adjusted OR = 4.8; 95%CI: 3.1 – 7.4). Those students having fathers with no formal schooling were more likely to smoke (adjusted OR = 2.2; 95% CI: 1.1–4.2) as compared to those whose fathers had some degree of education. Students having non-working mothers were more likely to smoke as compared to students with working mothers (adjusted OR = 2.8; 95% CI: 0.9–9.1). Students belonging to Bin Qasim (adjusted OR = 2.1; 95% C.I: 1.1–4.1) and Gadap town (adjusted OR = 2.1; 95%C.I) were more likely to smoke as compared to students residing in other towns. Conclusion This study shows that smoking is strongly associated with age, which may suggest social tolerance to smoking in this setting and that social and educational variables appear to play a significant role in smoking among college students. Our study suggests that such factors should be taken into account when designing effective tobacco control programs among college students. This is an effort which has been done to reduce tobacco consumption among college students and introduce awareness programs to amend their health risk behavior.
Rozi, Shafquat; Butt, Zahid A; Akhtar, Saeed
Backgroun and Objective: Resistance to multiple antimicrobials is the major cause of debility and death due to infectious diseases around the world. Our objective was to determine the frequency and antimicrobial susceptibility pattern of aerobic microbial isolates in a clinical laboratory. Methodology: All culture specimens of tissue, pus, urine, bone, blood, fluid, stool, sputum, and high vaginal swab received in the Microbiology Department of Clinical & Research Laboratory, Baqai Institute of Diabetology and Endocrinology from May 2010 to January 2011 were included in the present study. Bacterial isolates were identified and their antimicrobial susceptibility pattern was determined. Results: Out of 312 cultured specimens, 272 (87.17%) were found infected with 437 microbial organisms (412 bacteria and 25 Candida isolates). A total of 90 (20.59%) multi-drug resistant (MDR) isolates were found. MDR Escherichia coli was isolated in 40 (34.19%) out of 117 culture specimens which showed the growth of Escherichia coli, Pseudomonas aeruginosa in 17 (22.08%), Methicillin-resistant Staphylococcus aureus in 13 (11.50%), Klebsiella pneumoniae in 7 (22.58%), Proteus species in 6 (31.58%), Acinetobacter species in 3 (33.33%), Enterobacter species in 2 (28.57%), Coliform (Escherichia coli) in 1 (16.67%) and Enterococcus species were isolated in 1 (50%) culture specimen. Conclusions: High prevalence of multi-drug resistant bacteria was found in the present study. Emergence of antimicrobial resistance has become a major challenge in infectious disease medicine. Antimicrobial resistance may be due to misuse of antimicrobials by physicians and self medication in Pakistan. Further large scale studies are needed to validate our findings.
Sabir, Rubina; Danish Alvi, S. Faraz; Fawwad, Asher
Objective: To determine the prevalence of Hepatitis-B, Hepatitis-C and Human Immunodeficiency infections in replacement blood donors. Materials and Methods: From January 2004 to December 2011, 108,598 apparently healthy donors donated blood at our Blood Bank. Screening was done by Microparticle Enzyme Immuno Assay (MEIA) method on Axsym System (Abbott Diagnostic, USA) and in year 2011 by Chemiluminescent Immunoassay (CIA) method on Architect i2000 (Abbott Diagnostic, USA). From 2010 onward, HIV reactive donors were advised for confirmatory tests and reported back with the results. Results: Of the 108,598 total donors, 108,393 (99.8%) were replacement donors with a mean age of 28.92 (17-55) years. Of this, only 164 (0.15%) were females. Among the replacement donors, 4,906 (4.5%) were found to be reactive for Hepatitis-B, C and Human Immunodeficiency Virus. All the reactive patients, except one, were males. HbsAg was positive in 2,068 (1.90%) and anti-HCV in 2832 (2.61%) donors, while 111 (0.10%) were positive for Human Immunodeficiency Virus. Co-infectivity was observed in 103 (0.09%) cases. The prevalence appeared to be higher in younger age group (17-30 yrs). Only 16.6% cases should be patients returned with results of the confirmatory tests for HIV and were found positive. Conclusion: Hepatitis-B and C sero-prevalence in our series of replacement donors appears high compared to most studies from neighboring countries and relatively low in comparison to earlier studies from Pakistan. Prevalence of HIV, however, appears low and turn out of HIV positive cases for confirmatory tests is low. Conflict of interest:None declared. PMID:24385780
Irfan, Syed Mohammad; Uddin, Jamal; Zaheer, Hasan Abbas; Sultan, Sadia; Baig, Amjad
Background Rhinitis can cause a heavy toll on patients because of its bothersome effects on productivity. This retrospective study was conducted to explore the clinical profile, outcomes and improvement in the symptoms and productivity resulting from treatment of allergic rhinitis in Pakistan. Methods We carried out a retrospective file review of all allergic rhinitis patients who presented to the Ear, Nose, Throat Consulting Clinic from January, 2006 to June, 2008 using a structured proforma especially designed for this purpose. Data was entered and analyzed using SPSS v. 16.0. Results The charts of 169 patients were reviewed. The mean age of the patients was 35.2 ± 9.1 years. Sixty percent patients were male. Ninety eight patients (58%) reported allergy symptoms to be present at both home and work. One hundred and two patients (60.4%) had symptoms severe enough to cause absence from work or academic activities. Up to seventy one percent patients were spending between 1000 - 3000 Pakistani Rupees (1 US$= 83.3 Pakistani rupees) on the treatment of allergic rhinitis per year. One hundred and fifty one patients (89.3%) reported an improvement in rhinitic symptoms and productivity while 18 patients (10.7%) didn't. This improvement was significantly associated with satisfaction with treatment (p < 0.001). Conclusion Allergic rhinitis, a ubiquitous disease, was seen to cause a strain on patients in the form of recurrent treatment-related expenses as well as absenteeism from work or other daily activities. Symptoms and productivity improved significantly after treatment.
Background Postpartum anxiety and depression is a major public health concern because of its adverse effects on the cognitive and social development of the infant. Globally postpartum depression has been widely investigated but as anxiety is a more prominent feature of postpartum depression we assessed the prevalence of anxiety and depression and their associated factors in post partum women. Methods A quasi-experimental study investigating the impact of postpartum anxiety and depression on child growth and development was conducted in two peri-urban, multiethnic, communities of Karachi, a mega city of Pakistan. A house to house questionnaire based survey was done by trained field workers; 420 consenting pregnant women were identified and data for socio-demographic, home environment and family relationship variables was collected between 36 weeks of pregnancy and within 10 days of childbirth. Mother's levels of anxiety and depression were assessed after one month, two months, six months and twelve months of childbirth; this was two step process: initially 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. Women found to be anxious and depressed at least once out of four assessments were considered for the computation of overall prevalence of postpartum anxiety and depression as well as its risk factors. However, point prevalence's of postpartum anxiety and depression were also reported at each assessment time. Two sixty seven women could be followed for one year. Data was analyzed using SPSS. Chi-square test, simple and multiple logistic regression were used to see the association of different factors. Results The overall prevalence of postpartum anxiety and depression was found to be 28.8 percent. Domestic violence, difficulty in breast feeding at birth and unplanned current pregnancy were found to be significantly associated with postpartum anxiety and depression. Conclusion Domestic violence and not having the right to plan pregnancy are related to the patriarchal culture and lack of empowerment of women. The association with difficulties in breast feeding needs to be further explored in future studies
Ali, Niloufer S; Ali, Badar S; Azam, Iqbal S
A spectacular view of the Makran Range of Pakistan (27.0N, 65.5E) looking north with the Arabian Sea and the city of Karachi in the foreground. In the center, the Indian sub-continent moving slowly north into the Asian continent has caused the folded sedimentary Makran Range to bend from east-west to north-south as well as the uplift forming The Great Himalaya Range and the high Tibetan Plateau to the north.
Background Head and neck cancers are a major cancer burden in Pakistan. They share a common risk factor profile including regular consumption of products of betel, areca and tobacco. Use of paan, chaalia, gutka, niswar and tumbaku is acceptable in Pakistan and is considered a normal cultural practice. This cross-sectional study was carried out to understand the relation of socio-demographic factors for the consumption of paan, chaalia, gutka, niswar and tumbaku in Pakistani population. Through systematic sampling, 425 subjects from a squatter settlement in Karachi were interviewed using a structured questionnaire. High risk behavior was defined as Daily use of any of the above products. Results Daily use of all the substances except chaalia was higher among males compared to females. Chaalia use was higher among adolescents than adults while non-married consumed both chaalia and gutka more than married. Mohajir ethnicity had higher prevalence of paan, gutka and tumbaku use while Pathans had higher prevalence of niswar use. Conclusion Prevalence of use of chewable products is high in Pakistan with particularly high use of certain substances related with socio-demographic profiles. Industrially prepared products, chaalia and gutka, are gaining popularity among youth. Policies and focused interventions can be developed taking into consideration the preferred use of products among different socio-demographic groups.
Mazahir, Samia; Malik, Rabia; Maqsood, Maria; Merchant, Kanwal AliRaza; Malik, Farida; Majeed, Atif; Fatmi, Zafar; Khawaja, Muhammad Rizwanulhaq; Ghaffar, Shehzad
The effects of soil extracts from Khan Towel, Tanveer Garment, One Tech Rubber, and One Tech Ply Board factories in the vicinity of Korangi and Landhi industrial areas on seed germination and growth of cultivated plants like Albizia lebbeck, Leucaena leucocephala, Thespesia populnea, and Peltophorum pterocarpum and naturally growing plants such as Prosopis juliflora (Karachi University and Korangi and Landhi
Syed Atiqur Rehman; Muhammad Zafar Iqbal
Endocrine disrupting chemicals (EDCs) are introduced into the aquatic environment through industrial and municipal effluents along with urban and agricultural runoffs. Exposure of aquatic organisms to EDCs may lead to hormonal disruption and adverse health effects. The goals of our study were: to collect anchovy and mussel samples from the coastal region of Karachi, to use the yeast estrogen screen (YES) bioassay in estimating xeno-estrogen content in these samples, and to investigate if the bioassay could be used to quantify known amounts of 17?-estradiol (E2) injected into cod and salmon fillets. Results of the studies showed that mussel estrogenic activity in Karachi decreased in the order of Buleji point 1 (8.91 ± 4.77, mean ± SD) > Paradise point 1 (1.72 ± 0.81) > Paradise point 2 (0.61 ± 0.84) ng E2 equivalents/g wet wt (p < 0.05). By comparison, anchovy estrogenic activity at Korangi/Phitti Creek was much higher than at Manora. Together, these results confirmed previous reports that both Buleji point 1 and Korangi/Phitti Creek were the most contaminated areas of Karachi. The YES bioassay was only a semi-quantitative method in determining the contents of xeno-estrogens in aquatic organisms; it consistently overestimated the amounts of E2 injected into cod and salmon fillets due to additive and/or non-additive interactions between E2 and endogenous estrogens. Nevertheless, the YES bioassay was able to identify the contaminated sites in the coastal region of Karachi. PMID:22983728
Hunter, Sarah; Khan, M Z; Shieh, Ben H H; Doerr, Barbara; Ali, Sara; Law, Francis C P
Abstract Objective To assess parent’s knowledge and perceptions surrounding polio and polio vaccination, self-reported participation in polio supplementary immunization activities (SIAs) targeting children aged 5 years, and reasons for non-participation. Methods The mixed methods study began with a cross-sectional survey in Karachi, Pakistan. A structured questionnaire was administered to assess parental knowledge of polio and participation in polio SIAs conducted in September and October 2011. Additionally, 30 parents of Pashtun ethnicity (a high-risk group) who refused to vaccinate their children were interviewed in depth to determine why. Descriptive and bivariate analyses by ethnic and socioeconomic group were performed for quantitative data; thematic analysis was conducted for qualitative interviews with Pashtun parents. Findings Of 1017 parents surveyed, 412 (41%) had never heard of polio; 132 (13%) did not participate in one SIA and 157 (15.4%) did not participate in either SIA. Among non-participants, 34 (21.6%) reported not having been contacted by a vaccinator; 116 (73.9%) reported having refused to participate, and 7 (4.5%) reported that the child was absent from home when the vaccinator visited. Refusals clustered in low-income Pashtun (43/441; 9.8%) and high-income families of any ethnic background (71/153; 46.4%). Low-income Pashtuns were more likely to not have participated in polio SIAs than low-income non-Pashtuns (odds ratio, OR: 7.1; 95% confidence interval, CI: 3.47–14.5). Reasons commonly cited among Pashtuns for refusing vaccination included fear of sterility; lack of faith in the polio vaccine; scepticism about the vaccination programme, and fear that the vaccine might contain religiously forbidden ingredients. Conclusion In Karachi, interruption of polio transmission requires integrated and participatory community interventions targeting high-risk populations.
Khowaja, Asif Raza; Khan, Sher Ali; Nizam, Naveeda; Omer, Saad Bin
Objective: To assess the degree of applicability of bone age calculated by Greulich & Pyle Atlas in estimation of chronological age for therapeutic and medico legal purposes. Methods: Two Hundred and Twenty children (139 males, 81 females) between ages of 56 and 113 months (4.5 to 9.5 years) were randomly selected from 4 primary schools of Shireen Jinnah & Clifton, Karachi. Digital images of hand and wrist radiographs were obtained by a computed radiography at Ziauddin Hospital Clifton. Bone ages were computed using Greulich & Pyle Atlas by radiologists at Ziauddin Hospital, North Nazimabad, Karachi. Results: On average, the Greulich & Pyle Atlas underestimates chronological age by 6.65 ± 13.47 months in females and 15.78 ± 12.83 months in males (p-values < 0.001). High correlation was found between chronological age and bone age in both genders (Females r=0.778; p-value< 0.001, Males r=0.816; p-value < 0.001). Conclusion: Bone age calculated by Greulich & Pyle Atlas should not be used for estimating chronological age in children of ages 56-113 months in situations where high accuracy is required (e.g. medicolegal cases). However, serial measurements of bone age by this atlas can be used in management of growth related endocrine disorders in these children.
Manzoor Mughal, Arsalan; Hassan, Nuzhat; Ahmed, Anwar
BACKGROUND: HIVAIDS is spreading globally, hitting the younger generations. In Pakistan, the prevalence of HIV in high-risk subpopulations is five per cent or higher. This poses a serious threat of a generalised epidemic especially among the younger population. In the wake of HIVAIDS epidemic this is worrying as a well informed younger generation is crucial in restricting the spread of
Syed Farid-ul-Hasnain; Eva Johansson; Gunilla Krantz
Chewing lice of the species Afrimenopon waar (Eichler) were collected from captive budgerigar Melopsittacus undulatus (Shaw) in Pakistan. This is the first record of amblyceran lice from this host. It is also the first record of the genus Afrimenopon from Pakistani region. The primary host species of Afrimenopon waar is the rosy-faced lovebird Agapornis roseicollis (Vieillot). The finding of A. waar on budgerigars is, most likely, a result of a contamination in captivity. Morphological variation and origin of these lice are discussed. PMID:17334969
Sychra, Oldrich; Naz, Saima; Rizvi, S Anser
Objective To determine the safety and logistic feasibility of a mass immunization strategy outside the local immunization program in the pediatric population of urban squatter settlements in Karachi, Pakistan. Methods A cluster-randomized double blind preventive trial was launched in August 2003 in 60 geographic clusters covering 21,059 children ages 2 to 16 years. After consent was obtained from parents or guardians, eligible children were immunized parenterally at vaccination posts in each cluster with Vi polysaccharide or hepatitis A vaccine. Safety, logistics, and standards were monitored and documented. Results The vaccine coverage of the population was 74% and was higher in those under age 10 years. No life-threatening serious adverse events were reported. Adverse events occurred in less than 1% of all vaccine recipients and the main reactions reported were fever and local pain. The proportion of adverse events in Vi polysaccharide and hepatitis A recipients will not be known until the end of the trial when the code is broken. Throughout the vaccination campaign safe injection practices were maintained and the cold chain was not interrupted. Mass vaccination in slums had good acceptance. Because populations in such areas are highly mobile, settlement conditions could affect coverage. Systemic reactions were uncommon and local reactions were mild and transient. Close community involvement was pivotal for information dissemination and immunization coverage. Conclusion This vaccine strategy described together with other information that will soon be available in the area (cost/effectiveness, vaccine delivery costs, etc) will make typhoid fever control become a reality in the near future.
Khan, Mohammad Imran; Ochiai, Rion Leon; Hamza, Hasan Bin; Sahito, Shah Muhammad; Habib, Muhammad Atif; Soofi, Sajid Bashir; Bhutto, Naveed Sarwar; Rasool, Shahid; Puri, Mahesh K; Ali, Mohammad; Wasan, Shafi Mohammad; Khan, Mohammad Jawed; Abu-Elyazeed, Remon; Ivanoff, Bernard; Galindo, Claudia M; Pang, Tikki; Donner, Allan; von Seidlein, Lorenz; Acosta, Camilo J; Clemens, John D; Nizami, Shaikh Qamaruddin; Bhutta, Zulfiqar A
Background: Infection in young infants is a major cause of morbidity and mortality in low-middle income countries, with high neonatal mortality rates. Timely case management is lifesaving, but the current standard of hospitalization for parenteral antibiotic therapy is not always feasible. Alternative, simpler antibiotic regimens that could be used in outpatient settings have the potential to save thousands of lives. Methods: This trial aims to determine whether 2 simplified antibiotic regimens are equivalent to the reference therapy with 7 days of once-daily (OD) intramuscular (IM) procaine penicillin and gentamicin for outpatient management of young infants with clinically presumed systemic bacterial infection treated in primary health-care clinics in 5 communities in Karachi, Pakistan. The reference regimen is close to the current recommendation of the hospital-based intravenous ampicillin and gentamicin therapy for neonatal sepsis. The 2 comparison arms are (1) IM gentamicin OD and oral amoxicillin twice daily for 7 days; and (2) IM penicillin and gentamicin OD for 2 days, followed by oral amoxicillin twice daily for 5 days; 2250 “evaluable” infants will be enrolled. The primary outcome of this trial is treatment failure (death, deterioration or lack of improvement) within 7 days of enrollment. Results are expected by early 2014. Discussion: This trial will determine whether simplified antibiotic regimens with fewer injections in combination with high-dose amoxicillin are equivalent to 7 days of IM procaine penicillin and gentamicin in young infants with clinical severe infection. Results will have program and policy implications in countries with limited access to hospital care and high burden of neonatal deaths.
Background Pakistan is a patriarchal society where men are the primary authority figures and women are subordinate. This has serious implications on women's and men's life prospects. Objective The aim was to explore current gender roles in urban Pakistan, how these are reproduced and maintained and influence men's and women's life circumstances. Design Five focus group discussions were conducted, including 28 women representing employed, unemployed, educated and uneducated women from different socio-economic strata. Manifest and latent content analyses were applied. Findings Two major themes emerged during analysis: ‘Reiteration of gender roles’ and ‘Agents of change’. The first theme included perceptions of traditional gender roles and how these preserve women's subordination. The power gradient, with men holding a superior position in relation to women, distinctive features in the culture and the role of the extended family were considered to interact to suppress women. The second theme included agents of change, where the role of education was prominent as well as the role of mass media. It was further emphasised that the younger generation was more positive to modernisation of gender roles than the elder generation. Conclusions This study reveals serious gender inequalities and human rights violations against women in the Pakistani society. The unequal gender roles were perceived as static and enforced by structures imbedded in society. Women routinely faced serious restrictions and limitations of autonomy. However, attainment of higher levels of education especially not only for women but also for men was viewed as an agent towards change. Furthermore, mass media was perceived as having a positive role to play in supporting women's empowerment.
Ali, Tazeen S.; Krantz, Gunilla; Gul, Raisa; Asad, Nargis; Johansson, Eva; Mogren, Ingrid
The geometric mean concentration (GMC) and the proportion maintaining a protective level (150 enzyme-linked immunosorbent assay (ELISA) units [ELU]/ml) 2 years following a single dose of 25 ?g of injectable Vi capsular polysaccharide typhoid vaccine was measured against that of the control hepatitis A vaccine in children 2 to 16 years old in cluster randomized trials in Karachi and Kolkata. The GMC for the Vi group (1,428 ELU/ml) was statistically significantly different from the GMC of the control hepatitis A vaccine group (86 ELU/ml) after 6 weeks. A total of 117 children (95.1%) in the Vi group and 9 (7.5%) in the hepatitis A group showed a 4-fold rise in Vi IgG antibody concentrations at 6 weeks (P < 0.01). Protective antibody levels remained significantly different between the two groups at 2 years (38% in the Vi vaccine groups and 6% in the hepatitis A group [P < 0.01]). A very small proportion of younger children (2 to 5 years old) maintained protective Vi IgG antibody levels at 2 years, a result that was not statistically significantly different compared to that for the hepatitis A group (38.1% versus 10.5%). The GMCs of the Vi IgG antibody after 2 years were 133 ELU/ml for children 2 to <5 years old and 349 ELU/ml for children 5 to 16 years old. In conclusion, Vi capsular polysaccharide typhoid vaccine is immunogenic in children in settings of South Asia where typhoid is highly endemic. The antibody levels in children who received this vaccine remained higher than those in children who received the control vaccine but were significantly reduced at 2 years of follow-up. PMID:24599532
Ochiai, R Leon; Khan, M Imran; Soofi, Sajid B; Sur, Dipika; Kanungo, Suman; You, Young A; Habib, M Atif; Sahito, Shah Muhammad; Manna, Byomkesh; Dutta, Shanta; Acosta, Camilo J; Ali, Mohammad; Bhattacharya, Sujit K; Bhutta, Zulfiqar A; Clemens, John D
Background Dropping out of school\\/college not only impedes economic prosperity but may also result in poor knowledge and awareness about\\u000a sexually transmitted diseases (STDs).\\u000a \\u000a \\u000a \\u000a \\u000a Purpose This study investigated, among young adults in Karachi, Pakistan, the risk factors associated with involuntary school\\/college\\u000a dropout and the implications for awareness about HIV\\/AIDS and STDs.\\u000a \\u000a \\u000a \\u000a \\u000a Method A population-based, cross-sectional study of 1,650 young males and females, aged
Syed Farid-ul-Hasnain; Gunilla Krantz
BACKGROUND: Head and neck cancers are a major cancer burden in Pakistan. They share a common risk factor profile including regular consumption of products of betel, areca and tobacco. Use of paan, chaalia, gutka, niswar and tumbaku is acceptable in Pakistan and is considered a normal cultural practice. This cross-sectional study was carried out to understand the relation of socio-demographic
Samia Mazahir; Rabia Malik; Maria Maqsood; Kanwal AliRaza Merchant; Farida Malik; Atif Majeed; Zafar Fatmi; Muhammad Rizwanulhaq Khawaja; Shehzad Ghaffar
This information sheet about Pakistan, by the U.S. State Dept., summarizes its geography, political history, government, economy and international relations. Pakistan, lying on the Arabian Sea between Iran and India, and neighboring Afghanistan and China, has been independent from British control since 1947. Her people, 98 million, come from several Indo-European ethnic groups, but are 97% Muslim. Most live in the fertile Indus river valley; 53% work in agriculture; 13% in industry; mean per capita income is $331. The infant mortality rate is about 119/1000; life expectancy around 51 years. The country is endowed with resources, besides farmland, of oil, gas, coal, iron and hydroelectric power. It produces cotton, rice, fruits and vegetables as well for export. Pakistan's history is filled with strife, armed or political, marked by the independence of East Pakistan, now Bangladesh, in 1970, and rivalry for power by military and democratic factions, ending with a real election of Benazir Bhutto in 1986. Despite basic resources and a net export of food and textiles, the country has a significant debt and runs a deficit, and supports a rapidly growing young population (3.1% growth rate). Pakistan partakes in a complicated net of international relations due to the alignment of countries on her borders. Religious and ethnic conflicts with India, ideological difficulties and millions of refugees flowing from Afghanistan, but good relations with Iran and China make up this pattern. PMID:12177945
OBJECTIVE: To elucidate predictors of non-adherence among psychiatric patients presenting at a tertiary care hospital of Pakistan, for follow-up with consultant psychiatrist.\\u000aMETHODS: A convenient sampleof psychiatric patients from Aga Khan University Hospital was enrolled between April and May, 2005. An interviewer assisted, standardized questionnaire was used for data collection. Patients with cognitive deficit or psychosis and those presenting for
Fawad Taj; Mansoor Tanwir; Zarmeneh Aly; Ameer Ali Khowajah; Asma Tariq; Fahd Khalid Syed; Fahd Waqar; Khezar Shahzada
The objective of the study was to provide an overview of the demographics of cancer of the oral cavity and pharynx in Karachi South (1995-2001), and identify potential risk factors. Cases recorded for Karachi South, at Karachi Cancer Registry during 1(st) January 1995 to 31(st) December 2002 were analysed. For maximum completion of data cancer cases, recorded from 1(st) January 1995 to 31(st) December 2001 were included for final analysis. The age standardized incidence rates per 100000 population (ASIRs) for cancer of the oral cavity (excluding salivary gland) in Karachi South were 17.1 and 16.5 in males and females whereas the ASIRs for cancer of the pharynx (excluding nasopharynx) were 7.1 and 2.4 in males and females, respectively. The oral pharyngeal ratios were 2.4 and 6.9 for males and females and gender ratios (M F) were 1.04 for the oral cavity and 3.0 for the pharynx. The mean ages were 51 years (95% CI 49.6; 52.2) and 56.1 years (95% CI 54.4; 57.8) respectively. Cancer of the oral cavity ranked 2(nd) in Karachi in both genders. Cancer of the pharynx ranked 7(th) in males and 14(th) in females. Approximately 97% of the oral cavity and pharyngeal cancers were histologically confirmed. The majority of the oral (47.1%) and pharyngeal (51.9%) cancer cases presented as grade II lesions, and were discovered at advanced stages. Of the cancers reported during 1995-2001, 60.4% of the oral and 78.1% of the pharyngeal lesions had spread to a distant site at the time of diagnosis. Squamous cell carcinoma comprised 96.5% and 91.8% of the totals. The incidences of these cancers are comparable to the highest risk regions of the world. As distinct from other geographical areas oral cancer is as common in females as in males, which may reflect the pattern of exposure to known risk factors such as betal quid, arecanut and tobacco and the absence of alcohol as a risk factor in both genders. Apergillus contamination of arecanut could also be a risk factor but no confirmation studies or quantification is available. Despite the common risk factors, incidence of pharyngeal cancer is three times higher in men as compared with women. The keys to reducing the incidence and mortality due to oral and pharyngeal cancers are prevention and control, emphasizing cessation of tobacco use and cancer screening. However a targeted cancer and tobacco control program does not presently exist in Pakistan. PMID:12875625
Bhurgri, Yasmin; Bhurgri, Asif; Hussainy, Akbar Shah; Usman, Ahmed; Faridi, Naveen; Malik, Jawaid; Zaidi, Zubair Ahmed; Muzaffar, Suhail; Kayani, Naila; Pervez, Shahid; Hasan, Sheema H
Violence in today’s cities limits the scope for effective urban governance. It also destroys opportunities for collective action conducive to political and economic development, thus jeopardizing the regional competitiveness of these cities. A myriad of causal factors have been suggested, including urbanization, ethnic diversity, social fragmentation and widespread poverty. The cases of Kabul in Afghanistan and Karachi in Pakistan illustrate
Eleven microsatellite markers were used to determine the genetic population structure and spread of Aedes aegypti (Stegomyia aegypti) (Diptera: Culicidae) in Pakistan using mosquitoes collected from 13 different cities. There is a single genetic cluster of Ae. aegypti in Pakistan with a pattern of isolation by distance within the population. The low level of isolation by distance suggests the long-range passive dispersal of this mosquito, which may be facilitated by the tyre trade in Pakistan. A decrease in genetic diversity from south to north suggests a recent spread of this mosquito from Karachi. A strong negative correlation between genetic distance and the quality of road connections shows that populations in cities connected by better road networks are less differentiated, which suggests the human-aided passive dispersal of Ae. aegypti in Pakistan. Dispersal on a large spatial scale may facilitate the strategy of introducing transgenic Ae. aegypti or intracellular bacteria such as Wolbachia to control the spread of dengue disease in Pakistan, but it also emphasizes the need for simple measures to control container breeding sites. PMID:23662926
Rasheed, S B; Boots, M; Frantz, A C; Butlin, R K
This volume is a collection of papers presented at the first US-Pakistan workshop in marine science held in Karachi, Pakistan, in November 1982. Of the twenty-four contributions in this book, fourteen cover topics specific to the Arabian Sea-coastal Pakistan region. These include six papers on the geology, tectonics, and petroleum potential of Pakistan, four papers on sedimentary processes in the Indus River delta-fan complex, and four papers on the biological oceanography of the Arabian Sea and coastal Pakistan. The additional ten papers are overviews of shelf sedimentation processes, paleoceanography, the marine nutrient cycle, and physical and chemical oceanography.
Haq, B.U.; Milliman, J.D. (eds.)
The burden of coronary heart disease (CHD) is increasing at a greater rate in South Asia than in any other region globally, but there is little direct evidence about its determinants. The Pakistan Risk of Myocardial Infarction Study (PROMIS) is an epidemiological resource to enable reliable study of genetic, lifestyle and other determinants of CHD in South Asia. By March
Danish Saleheen; Moazzam Zaidi; Asif Rasheed; Usman Ahmad; Abdul Hakeem; Muhammed Murtaza; Waleed Kayani; Azhar Faruqui; Assadullah Kundi; Khan Shah Zaman; Zia Yaqoob; Liaquat Ali Cheema; Abdus Samad; Syed Zahed Rasheed; Nadeem Hayat Mallick; Muhammad Azhar; Rashid Jooma; Ali Raza Gardezi; Nazir Memon; Abdul Ghaffar; Asad Ali Shah; Maria Samuel; Farina Hanif; Madiha Yameen; Sobia Naz; Aisha Sultana; Aisha Nazir; Shehzad Raza; Muhammad Shazad; Sana Nasim; Muhammad Ahsan Javed; Syed Saadat Ali; Mehmood Jafree; Muhammad Imran Nisar; Muhammad Salman Daood; Altaf Hussain; Nadeem Sarwar; Ayeesha Kamal; Panos Deloukas; Muhammad Ishaq; Philippe Frossard; John Danesh
The objective of the study was to provide an overview of the demographics of lung cancer, the number one cancer killer of men in Karachi South (1995-2002). Lung cancer cases recorded at Karachi Cancer Registry during 1st January 1995 to 31st December 2004 were analyzed. To allow for maximum data completion, cases recorded from 1st January 1995 to 31st December
Yasmin Bhurgri; Asif Bhurgri; Ahmed Usman; Nassar Sheikh; Naveen Faridi; Jawaid Malik; Rasheeda Ahmed; Naila Kayani; Shahid Pervez
BACKGROUND: Liver injury due to dengue viral infection is not uncommon. Acute liver injury is a severe complicating factor in dengue, predisposing to life-threatening hemorrhage, Disseminated Intravascular Coagulation (DIC) and encephalopathy. Therefore we sought to determine the frequency of hepatitis in dengue infection and to compare the outcome (length of stay, in hospital mortality, complications) between patients of Dengue who
Om Parkash; Aysha Almas; SM Wasim Jafri; Saeed Hamid; Jaweed Akhtar; Hasnain Alishah
As part of a quality assurance programme at the Aga Khan University Medical Centre, Karachi, Pakistan, all hysterectomy specimens were reviewed from January 1986 to December 1989. Adenomyosis was found in 237 of the 419 (56.5%) specimens studied. Of these 237 patients, 232 (97.9%) were parous and 196 (82.8%) were in the fourth and fifth decades of life. This high
H Shaikh; K S Khan
To explore traditional beliefs and practices, to assess puerperal morbidity, and to understand care-seeking behaviors, a qualitative and quantitative study was conducted in low socio-economic settlements of Karachi, Pakistan. Five focus group discussions and 15 in-depth interviews were conducted in July and August 2000. 525 Muslim women, who were 6–8 weeks post-partum, were then interviewed at home. Maternal care was
Fariyal F. Fikree; Tazeen Ali; Jill M. Durocher; Mohammad H. Rahbar
This study aims to explore the inquiry-based teaching strategies employed by mathematics teachers in lower secondary classrooms. The inquiry-based teaching strategy provides an opportunity for learners to learn mathematical concepts by 'exploring', 'conjecturing', 'reasoning', and 'evaluating' (Arendas, 1994; Jaworski,1994; Borasi, 1992). The study was conducted in a government and a private school in Karachi, Pakistan. The research participants were mathematics
Ali Ahmad Khan
The recent floods in Pakistan have had a devastating effect on the Pakistani population. The Office for the Coordination of Humanitarian Affairs (OCHA 2010) estimates that, as of early September 2010, more than 20 million people had been displaced by the flood and by some estimates the damage to crops, housing, other buildings, roads, and irrigation infrastructure now reaches $6.5
Paul Dorosh; Sohail Malik; Marika Krausova
Background Obesity is an emerging problem in Pakistan. The authors sought to determine prevalence of obesity and malnutrition in school-going children, from grades 6th to 8th of different schools of Karachi and assess associations that affect the weight of the children. Methodology/Principal Findings A cross sectional study design with children studying in grades 6th to 8th grade, in different schools of Karachi. We visited 10 schools of which 4 consented; two subsidized government schools and two private schools. A questionnaire was developed in consultation with a qualified nutritionist. Height and weight were measured on calibrated scales. A modified BMI criterion for Asian populations was used. Data was collected from 284 students. Of our sample, 52% were found to be underweight whereas 34% of all the children were normal. Of the population, 6% was obese and 8% overweight. Of all obese children, 70% belonged to the higher socio-economic status (SES) group, while of the underweight children, 63.3% were in the lower SES. Amongst obese children in our study, 65% ate meat every day, compared to 33% of normal kids. Conclusion Obesity and undernutrition co-exist in Pakistani school-children. Our study shows that socio-economic factors are important since obesity and overweight increase with SES. Higher SES groups should be targeted for overweight while underweight is a problem of lower SES. Meat intake and lack of physical activity are some of the other factors that have been highlighted in our study.
Warraich, Haider Javed; Javed, Faisal; Faraz-ul-Haq, Mohammed; Khawaja, Fariha Batool; Saleem, Sarah
A study was undertaken to compare Pediatric Malignancy at Kurume (Japan) and Karachi (Pakistan) with reference to international data collected over the years, in order to identify essential differences between developed and developing conditions and factors influencing the etio-pathogenesis of pediatric cancer. The study was retrospective encompassing all types of cancer in children over a period of three years i-e 1988-1990. Essential factors related to present study were: 1. Population: The population of Karachi is about 10 million while that of Kurume is only half a million. 2. Socio-economic conditions: The average socio-economic condition of people in Karachi is poor while in Kurume it appears to be good. 3. Educational status: Only 25% people in Karachi are educated beyond middle class while Kurume reveals a 100% education up to high school level. 4. Environmental conditions: The environmental conditions of Kurume and surrounding areas are very clean and free from pollution, sewage problems and traffic hazards. Karachi and its surroundings on the other hand pose very serious air and water industries! It was concluded that whereas genetic predisposition predominates, the environmental conditions, educational and socio-economic status of a society immensely influence the pattern and trends of pediatric carcinogenesis. PMID:1664009
Shakoor, A; Murakami, T; Yamashita, F
ObjectivePoisoning is the fourth leading cause of unintentional injury and a common paediatric emergency in children under 5 years of age. The objective of this study was to determine the factors associated with unintentional poisoning among children under 5 years of age presenting to emergency rooms at tertiary care hospitals in Karachi, Pakistan.SettingChildren were recruited from the emergency rooms of
Bilal Ahmed; Zafar Fatmi; Amna R Siddiqui; Abdul L Sheikh
Since 1960, South Asia has emerged as the largest user of groundwater in irrigation in the world. Yet, little is known about this burgeoning economy, now the mainstay of the region's agriculture, food security and livelihoods. Results from the first socio-economic survey of its kind, involving 2,629 well-owners from 278 villages from India, Pakistan, Nepal Terai and Bangladesh, show that groundwater is used in over 75% of the irrigated areas in the sample villages, far more than secondary estimates suggest. Thanks to the pervasive use of groundwater in irrigation, rain-fed farming regions are a rarity although rain-fed plots within villages abound. Groundwater irrigation is quintessentially supplemental and used mostly on water-economical inferior cereals and pulses, while a water-intensive wheat and rice system dominates canal areas. Subsidies on electricity and canal irrigation shape the sub-continental irrigation economy, but it is the diesel pump that drives it. Pervasive markets in tubewell irrigation services enhance irrigation access to the poor. Most farmers interviewed reported resource depletion and deterioration, but expressed more concern over the high cost and poor reliability of energy supply for groundwater irrigation, which has become the fulcrum of their survival strategy.
Shah, Tushaar; Singh, O. P.; Mukherji, Aditi
Background The percentage of unintentional childhood poisoning cases in a given population attributable to specific risk factors (i.e., the population attributable risk) which can be calculated; determination of such risk factors associated with potentially modifiable risk factors, are necessary to focus on the prevention strategies. Methods We calculated PARs, using 120 cases with unintentional poisoning and 360 controls in a hospital based matched case- control study. The risk factors were accessibility to hazardous chemicals and medicines due to unsafe storage, child behavior reported as hyperactive, storage of kerosene and petroleum in soft drink bottles, low socioeconomic class, less education of the mother and the history of previous poisoning. Results The following attributed risks were observed: 12% (95% confidence interval [CI]?=?8%–16%) for both chemicals and medicines stored unsafe, 19% (15%–23%) for child reported as hyperactive, 40% (38%–42%) for storage of kerosene and petroleum in soft drink bottles, 48% (42%–54%) for low socioeconomic status, 38% (32%–42%) for no formal mothers education and 5.8% (2%–10%) for history of previous poisoning. 48% of cases for overall study population which could be attributed to at least one of the six risk factors. Among girls, this proportion was 23% and 43% among boys. About half of the unintentional childhood poisoning cases in this Pakistani population could be avoided. Conclusion Exposure to potentially modifiable risk indicators explained about half of the cases of unintentional poisoning among children under five years of age in this Pakistani population, indicating the theoretical scope for prevention of the disease.
Ahmed, Bilal; Fatmi, Zafar; Siddiqui, Amna R.
Objective: To identify students' perceptions about the practices of provision and utilization of written feedback in the nursing degree programmes in Karachi. Study Design: Cross-sectional descriptive study. Place and Duration of Study: Nine Nursing Institutions in Karachi, Pakistan were selected for the study, from February to October 2011. Methodology: The sample consisted of 379 second year nursing students from nine institutions in Karachi. The data was collected through a modified Assessment Experience Questionnaire (AEQ) developed by Gibbs and Simpson. The data obtained through AEQ was analyzed in the SPPS. Results: Students reported wide variations in the practices related to written assignments, and the provision of written feedback. Although 80% of the students, reported receiving written feedback with or without oral feedback, 20% of them, received only verbal feedback on their assignments. For 44 - 46% of the students, the quality, quantity, timing, and utilization of feedback was below the reference scores, which is indicative of negative perceptions. Only 40% reported receiving feedback on regular basis. Assignment guidelines were not always provided in a written form. In most cases, the guidelines were ambiguous as well as the feedback was not always reflective of the guidelines. Conclusion: The findings have implications for teachers, students, and institutions similar to the context of this study. Teachers need to be aware of the role and the impact of written feedback on students' learning and develop competence for giving effective feedback. Finally, institutional commitment and policies are needed to promote the practices of written feedback. PMID:24709235
Khowaja, Amina Aijaz; Gul, Raisa B; Lakhani, Arusa; Rizvi, Nusrat Fatima; Saleem, Faiza
This article focuses on an early childhood programme that has been initiated by the Institute for Educational Development at the Aga Khan University in Karachi, Pakistan. The programme is a Certificate in Education and involves training teachers so as to enable them to understand early childhood education and development, and to become effective practitioners in their classrooms. The early childhood
The study explores how a teacher of Early Childhood teaches young children creative writing skills in a community-based school in Karachi, Pakistan. A qualitative case study method was used to examine the practices of the teacher and four early years’ learners (seven to eight years). Data was generated through semi-structured interviews; classroom observations and document analysis. Findings reveal that current
Nilofar Vazir; Shairoz Ismail
Background Body weight and its perception play an important role in the physical and mental well-being of a person. Weight perception is found to be a better predictor of weight management behaviour as compared to actual weight. In Pakistan, studies have been done on the prevalence of weight status but weight perception is still unexplored. The study was done to examine relationships between body weight perception, actual weight status, and weight control behaviour among the female university students of Karachi. Methods A cross sectional study was carried out during Sep-Nov 2009 on female students in four universities of Karachi, Pakistan. Our final sample size included 338 female university students. Height and weight were measured on calibrated scales. A modified BMI criterion for Asian populations was used. Results Based on measured BMI; the prevalence of underweight, normal weight and overweight females was 27.2%, 51.5% and 21.3% respectively. As a whole, just over one third (33.73%) of the sample misclassified their weight status. Among underweight (n=92), 45.70% thought they were of normal weight. No one who was truly underweight perceived them self as overweight. Among the normal weight (n= 174), 9.8% thought they were underweight and 23.6% considered themselves overweight. Among the overweight (n=72); 18.3% considered themselves normal. Only one female student thought she was underweight despite being truly overweight. Conclusions Our study shows that among female university students in Karachi, the prevalence of being underweight is comparatively high. There is a significant misperception of weight, with one third of students misclassifying themselves. Underweight females are likely to perceive themselves as normal and be most satisfied with their weight. Health policy makers should implement these findings in future development of health interventions and prevention of depression, social anxiety and eating disorders associated with incorrect weight perception among young females. Studies that employ a longitudinal approach are needed to validate our findings.
The Indus offshore basin, located in the south of the Karachi trough and Thar slope, between Murray Ridge and the Indian border (23 to 25/sup 0/N lat.; 66 to 68/sup 0/E long.) has been investigated geologically from the point of view of hydrocarbon potential. Nine wells were drilled in the area: two onshore wells (Karachi 1,2), three wells near the Karachi shore (Dabbo creek, Patiani Creek, and Korangi Creek), one well on the offshore platform (Karachi South A-1), and three wells in offshore depressions (Indus Marine A-1, B-1, and C-1). No oil or gas deposit was discovered, but gas shows and traces were recorded. However, considering the large area (7,700 mi/sup 2/; 20,000 km/sup 2/) the number of wells drilled represents an insufficient effort of exploration and drilling. Tectonically, the Indus offshore basin can be divided into three units: (1) an ofshore depression on the west, between Murray Ridge and the hinge line; (2) the offshore Karachi trough platform in the middle between the hinge and the Karachi shoreline; and (3) offshore Thar slope platform or Indus River deltaic area on the east. The hinge-line zone and the outer margin of the carbonate platform, where there is a possibility of reef buildups, seem to be potential areas for hydrocarbons, and further investigation and drilling for suitable structural traps should be pursued.
New in-situ U-Pb, Hf and oxygen data indicate that the Baltoro plutonic unit in the southern part of the Karakoram axial batholith was formed by partial melting of pre existing igneous sources with some input from supra-crustal rocks. This is consistent with the previous interpretations emphasizing partial melting of mafic lower crust beneath the Karakoram during the early Miocene 26-21Ma. The Baltoro batholith is mainly composed of biotite monzogranites and garnet two-mica leucogranites. Our zircon U-Pb ages corroborate the previous geochronology ranging from 26.3-17.3Ma., Cretaceous ages (97-72Ma) have also been observed in some zircons. Inherited ages are ranging from 553-2605Ma similar to those reported for the Lhasa block, confirming the westward continuation of south Tibet. The weighted mean ?Hf(0) for each sample varies from -8.7 to -4.0 and ranges from -17.1 to +4.4. These values are similar to the whole rock Hf data from the same rocks and are indistinguishable from those reported for the Cretaceous calc-alkaline magmatic rocks along the east-west transect of the Karakoram Terrane. Also, Miocene two-mica granites in the Darbuk area, eastern Karakoram show the comparable Hf composition. These values are significantly more evolved than the southward juvenile oceanic Cretaceous-Paleogene Kohistan-Ladakh Arc (+5to+16). The initial ?Hf(t) values of the Cretaceous zircons (+0.9 to +4.7) are more correlated to the Cretaceous calc-alkaline basement of Karakoram Batholith than the Kohistan-Ladakh Arc. The Hf composition of inherited cores is significantly different than the magmatic zircons with ?Hf(0) ranging from -58.6 to -14.3 comparable to the mid-crustal migmatitic gneisses southward in the Karakoram Metamorphic Complex. Both Miocene granites and Cretaceous zircons share similar and homogenous igneous type ?18O with mean ?18O range from 7.2 to 9.4‰ (2?). The mean ?18O of the core domain has a mixed signature ranging from 6.9 ‰ to 9.2 ‰. We suggest that the granites were formed by partial melting of pre existing igneous sources with some input from supracrustal rocks. The intermediate Hf composition of the magmatic zircons between highly evolved inherited core (similar to the mid- upper crustal Dassu migmatite) and calc-alkaline Cretaceous granodiorites suggests possible mixing between the two sources. Possible involvement of upper crust is also evident by the few more evolved Hf composition and slight increase in the observed oxygen composition than typical igneous zircons (> 8‰). This may have resulted by the interaction of the magma with the supracrustal material during the final ascent and emplacement at shallow depths beneath the Karakoram. Our zircon oxygen data did not show evidence of a juvenile (< 6‰) component. Moreover, the Hf compositions observed in Kohistan-Ladakh Arc are too radiogenic ((+6 to +16) than what we observe in the Baltoro granites. Therefore, mixing of such magma with the adjacent juvenile Kohistan-Ladakh batholiths or any direct contribution from juvenile mantle derived magma is unlikely. However this does not exclude the role of mantle melts in providing the additional heat to melt lower crust beneath the Karakoram. Our Hf data is significantly evolved than the Karakoram shear zone leucogranites (+1 to +9) where unlike to Baltoro region, magmas were strongly influenced by the juvenile Ladakh batholith.
Mahar, M.; Maheo, G.; Goodell, P.; Pavlis, T. L.
Continued advances in the field of histo-pathology (and cyto-pathology) over the past two decades have resulted in dramatic changes in the manner in which these disciplines are now practiced. This is especially true in the setting of a large university hospital where the role of pathologists as clinicians (diagnosticians), undergraduate and postgraduate educators, and researchers has evolved considerably. The world around us has changed significantly during this period bringing about a considerable change in our lifestyles and the way we live. This is the world of the internet and the world-wide web, the world of Google and Wikipedia, of Youtube and Facebook where anyone can obtain any information one desires at the push of a button. The practice of histo (and cyto) pathology has also evolved in line with these changes. For those practicing this discipline in a poor, developing country these changes have been breathtaking. This is an attempt to document these changes as experienced by histo (and cyto) pathologists practicing in the biggest center for Histopathology in Pakistan, a developing country in South Asia with a large (180 million) and ever growing population. The Section of Histopathology, Department of Pathology and Microbiology at the Aga Khan University Hospital (AKUH) in Karachi, Pakistan's largest city has since its inception in the mid-1980s transformed the way histopathology is practiced in Pakistan by incorporating modern methods and rescuing histopathology in Pakistan from the primitive and outdated groove in which it was stuck for decades. It set histopathology in Pakistan firmly on the path of modernity and change which are essential for better patient management and care through accurate and complete diagnosis and more recently prognostic and predictive information as well. PMID:24935563
Ahmad, Zubair; Idrees, Romana; Fatima, Saira; Arshad, Huma; Din, Nasir-ud; Memon, Aisha; Minhas, Khurram; Ahmed, Arsalan; Fatima, Syeda Samia; Arif, Muhammad; Ahmed, Rashida; Haroon, Saroona; Pervez, Shahid; Hassan, Sheema; Kayani, Naila
Childhood iron deficiency has a high incidence in Pakistan. Some but not all studies have shown that dietary iron deficiency may cause increased absorption of lead as both compete for the same transporters in the small intestine. Therefore, children in Pakistan, residing in heavily polluted cities like Karachi may be prone to lead poisoning. This hypothesis was tested by investigating blood and hair lead concentrations in children from Karachi who were divided into four groups of iron status; normal, borderline iron deficiency, iron deficiency and iron deficiency anaemia. A prospective observational study was conducted where 269 children were categorized into four groups of iron status using the World Health Organization criteria and one based on soluble transferrin receptor measurements. Blood iron status was determined using a full blood count, serum iron, ferritin, transferrin saturation and soluble transferrin receptor measurements. Blood lead was determined by graphite atomic absorption spectroscopy, whereas hair lead was assessed using an inductively coupled plasma atomic emission spectroscopy technique. Blood lead concentrations were significantly higher in children with iron deficiency anaemia (mean [95% confidence intervals] were 24.9 [22.6-27.2] ?g/dL) compared to those with normal iron status (19.1 [16.8-21.4] ?g/dL) using WHO criteria. In contrast, hair lead content was not significantly different in children of different iron status. Our findings reinforce the importance of not only reducing environmental lead pollution but also the development of national health strategies to reduce childhood iron deficiency in Pakistan. PMID:22917764
Rahman, Muhammad Ataur; Rahman, Bushra; Ahmad, Muhammad Saeed; Blann, Andrew; Ahmed, Nessar
India's Indo Rama Synthetics (Bombay) is planning a $186-million integrated polyester fiber and filament complex at Nagpur, Maharashtra. The complex will have annual capacities for 38,000 m.t. of polyester chips by polycondensation, 25,000 m.t. of polyester staple fiber, and 12,000 m.t. of polyester blended yarn. The company is negotiating with the main world suppliers of polycondensation technology. The first stage of the project is slated to begin production by the end of this year and be fully completed by 1994. In Pakistan, National Fibers Ltd. (PNF; Karachi) has signed a deal with Zimmer (Frankfurt) for technology, procurement, construction, and support work to expand polyester staple fiber capacity from 14,000 m.t./year to 52,000 m.t./year. The technology involves a continuous polymerization process. The project also calls for improvements to PNF's existing batch plant. It is scheduled for completion by the end of 1994. Total cost of the project is estimated at Rs1.745 billion ($70 million), out of which the foreign exchange component is Rs1.05 billion. The Islamic Development Bank (Jeddah; Saudi Arabia) has already approved a $27-million slice of the financing, while the balance of the foreign exchange loan is being arranged through suppliers credit. Local currency loans will be provided by other financial institutions in Pakistan.
The burden of coronary heart disease (CHD) is increasing at a greater rate in South Asia than in any other region globally, but there is little direct evidence about its determinants. The Pakistan Risk of Myocardial Infarction Study (PROMIS) is an epidemiological resource to enable reliable study of genetic, lifestyle and other determinants of CHD in South Asia. By March 2009, PROMIS had recruited over 5,000 cases of first-ever confirmed acute myocardial infarction (MI) and over 5,000 matched controls aged 30–80 years. For each participant, information has been recorded on demographic factors, lifestyle, medical and family history, anthropometry, and a 12-lead electrocardiogram. A range of biological samples has been collected and stored, including DNA, plasma, serum and whole blood. During its next stage, the study aims to expand recruitment to achieve a total of about 20,000 cases and about 20,000 controls, and, in subsets of participants, to enrich the resource by collection of monocytes, establishment of lymphoblastoid cell lines, and by resurveying participants. Measurements in progress include profiling of candidate biochemical factors, assay of 45,000 variants in 2,100 candidate genes, and a genomewide association scan of over 650,000 genetic markers. We have established a large epidemiological resource for CHD in South Asia. In parallel with its further expansion and enrichment, the PROMIS resource will be systematically harvested to help identify and evaluate genetic and other determinants of MI in South Asia. Findings from this study should advance scientific understanding and inform regionally appropriate disease prevention and control strategies.
Misconceptions about epilepsy may explain the considerable stigma accompanying it. We aimed to identify such fallacies through questionnaire-based interviews of 487 adult residents of a slum area in Karachi, Pakistan. Of those interviewed, 25% believed that epilepsy was caused by evil spirits, black magic and envy by others - those without a school education were more likely to hold these views (P < 0.05). Perceived complications included impotence and cancer. Shoe-sniffing was considered a treatment modality by 13%. It appears that misconceptions abound regarding epilepsy's causes, complications and methods of treatment. However, those who had received a school education were less likely to link epilepsy with supernatural phenomena. PMID:18302862
Shafiq, Majid; Tanwir, Mansoor; Tariq, Asma; Saleem, Ayesha; Zafar, Monaa; Khuwaja, Ali Khan
Objective: To evaluate the current practices of segregation approaches, storage arrangements, collection and disposal systems in the teaching hospitals of Karachi. Methods: A cross-sectional survey was conducted in eight teaching hospitals of Karachi, using convenient sam- pling technique. The instrument of research was a self administered questionnaire, with four sections, relating to the general information of the institution, administrative information,
Shahida Rasheed; Saira Iqbal; Lubna A. Baig; Kehkashan Mufti
The US raid that killed Osama bin Laden has raised concerns about the security of Pakistan’s nuclear arsenal. In the process of building two new plutonium production reactors and a new reprocessing facility to fabricate more nuclear weapons fuel, Pakistan is also developing new delivery systems. The authors estimate that if the country’s expansion continues, Pakistan’s nuclear weapons stockpile could
Hans M. Kristensen; Robert S. Norris
Zygophyllum simplexL. is a succulent annual that grows on the coastal and inland saline flats around Karachi, Pakistan. The seeds are moderately salt tolerant during germination. Germination ofZygophyllum simplexseeds under various salinity, proline, betaine, GA and kinetin treatments was determined. Proline (0.1 and 1 mm) and betaine (0.1 and 1 mm) alleviated the innate dormancy of seeds, and germination reached
M. AJMAL KHAN; IRWIN A UNGAR
OBJECTIVE: To identify the strengths and weaknesses of the devolved district health system from the experiences of different stakeholders, and recommend direction for reforms in the existing system.METHODS: Using qualitative exploratory design, the study was conducted in 3 cities of the province of Sindh in Pakistan--Karachi, Khairpur and Larkana--from January to March 2010. Nine in-depth interviews were conducted with multiple
Shiraz Shaikh; Imran Naeem; Asaad Nafees; Aysha Zahidie; Zafar Fatmi; Ambreen Kazi
Aflatoxin B1 (AFB1) levels were evaluated in betel nuts (Areca catechu L.) being imported to Pakistan during 2010-2011. In total, 278 betel nut samples (India = 21, Indonesia = 51, Sri-Lanka = 34 and Thailand = 172) were received from the Department of Customs and were analysed by thin layer chromatography (TLC). All Indian origin betel nuts showed AFB1 contamination ranging from 11.7-262.0 µg kg(-1) with a mean of 92.5 µg kg(-1). Among Indonesian and Sri Lankan shipments, 80.4% and 73.5% betel nuts were contaminated with AFB1 ranging between 3.3-39.2 and 6.5-103.4 µg kg(-1) with a mean of 11.6 and 35.0 µg kg(-1), respectively. However, only 30.2% of Thailand origin samples showed AFB1 contamination ranging 3.3-77.0 µg kg(-1) with a mean of 6.6 µg kg(-1). The widespread occurrence of AFB1 increases the hazard associated with betel nuts. Thus, strict control is a pre-requisite for the production and import/export of psychoactive substances as betel nuts. PMID:25029400
Asghar, Muhammad Asif; Iqbal, Javed; Ahmed, Aftab; Khan, Mobeen Ahmed; Shamsuddin, Zuzzer Ali
Road traffic injuries (RTIs) are one of the leading causes of death among productive age group. Using systems approach framework (SAF), current preventive strategies for RTI control were reviewed in Pakistan. A review of the literature was done using four international search engines. Only ten studies on preventive strategies for RTI stemming from Pakistan were found. The first Road Traffic Injuries Research Network (RTIRN) surveillance system for road traffic injuries was established in urban city (Karachi) in Pakistan has shown promise for injury control and should be scaled up to other cities. Enforcement of traffic laws on seat-belt and helmet wearing is poor. National Highway and Motorway Police Ordinance (2000) was one of the few legislative measure so far taken in Pakistan. Using SAF, efforts are required to implement interventions targeting human, vehicle design and also making environment safer for road users. PMID:24848396
Khan, Adeel Ahmed; Fatmi, Zafar
Incorporating ethics education in curriculum of medical technology students and highlighting the importance of teaching the subject to this particular population in this part of world are our aims. At SIUT we have a school with name of “Zain ul Abidin” school of Biomedical Technology, which is supposed to award B.S. degree in 5 sub-specialties that is hemodialysis, radiology, laboratory sciences, operation theater technology and intensive care technology. This school is affiliated by Karachi University. The students entering in school have done fellow in science (F.Sc.)with pre-medical group, thus have background knowledge of biology, physics, chemistry, languages, religion and Pakistan studies. Here for B.S. included in their curriculum are the subjects of anatomy, physiology, biochemistry, microbiology, pharmacology, pathology, Islamiat and English for all and then related sub-specialty topics to each group for example student in hemodialysis group more exposed to nephrology topics etc. I planned to add ethics with subjects, which are common to all specialties and designed curriculum. Curriculum was approved (after minor changes), from Karachi University and I started teaching ethics to these students. This paper highlights methods and tools of teaching and evaluation and results observed. This will be the first examination in bioethics from medical technologists, at university level in the history of country. This is a great achievement in country to start teaching bioethics to medical technologists. Karachi University has implemented the same curriculum to other medical technology schools affiliated with University.
The impacts of an early South Asian dust storm that originated over the western part of the Middle East and engulfed northwest parts of India during the third week of March 2012 have been studied at four different stations covering India and Pakistan. The impacts of this dust storm on aerosol optical properties were studied in detail at Delhi, Jodhpur, Lahore and Karachi. The impact could also be traced up to central Himalayan foothills at Manora Peak. During dust events, the aerosol optical depth (AOD) at 500nm reached a peak value of 0.96, 1.02, 2.17 and 0.49 with a corresponding drop in Ångström exponent (AE for 440-870nm) to 0.01, -0.02, 0.00 and 0.12 at Delhi, Jodhpur, Lahore and Karachi, respectively. The single scattering albedo (SSA) at 675nm was relatively lower at Delhi (0.87) and Jodhpur (0.86), with absorption Ångström exponent (AAE) less than 1.0, but a large value of SSA was observed at Lahore (0.98) and Karachi (0.93), with AAE value greater than 1.0 during the event. The study of radiative impact of dust aerosols revealed a significant cooling at the surface and warming in the atmosphere (with corresponding large heating rate) at all the stations during dust event. The effect of this dust storm was also seen at Manora Peak in central Himalayas which showed an enhancement of ~28% in the AOD at 500nm. The transport of dust during such events can have severe climatic implications over the affected plains and the Himalayas. PMID:24973722
Srivastava, A K; Soni, V K; Singh, Sachchidanand; Kanawade, V P; Singh, N; Tiwari, S; Attri, S D
Background Migrant populations are at high risk of Human Immuno Deficiency Virus infection (HIV) and Acquired Immunodeficiency Syndrome (AIDS). Studies of HIV/AIDS knowledge, attitudes and practices among fishermen in developing countries have shown gaps in knowledge and fear of contagion with ambivalent attitudes towards HIV/AIDS and inconsistent universal precautions adherence. The aim of this study was to determine the knowledge, attitude and practices regarding HIV/AIDS among adult fishermen in a coastal area of Karachi, Pakistan. Methods Community based cross sectional study was conducted among fishermen in coastal area of Karachi from June to September 2012. A total of 297 adult fishermen were selected by using simple random sampling technique from different sectors of coastal village. Data were collected using a structured validated questionnaire. The frequency distribution of both dependent and independent variables were worked out. Comparisons of knowledge, attitude and practices regarding HIV/AIDS by socio-demographic characteristics were made using logistic regression. Results Out of 297 fishermen, majority had in-appropriate knowledge (93.6%), negative attitude (75.8%) and less adherent sexual practices (91.6%). In univariate analysis, lower education and higher income were significantly associated (OR 2.25, 95% CI, 1.11, 4.55), (OR = 3.04 CI 1.03-9.02, p value 0.04) with negative attitude and un-safe practices towards HIV/AIDS respectively, whereas no significant association of socio-economic characteristics with knowledge, attitude and practices were observed in multivariate analysis. Conclusions This study suggests that fishermen had very poor knowledge, negative attitudes towards HIV and AIDS and had unsafe sexual practices which suggest that they lack the basic understanding of HIV/AIDS infection. Extensive health education campaign should be provided to the vulnerable sections of the society for the control of HIV/AIDS.
The Makran Accretionary Belt covers vast areas of the south-western Makran, Pakistan and extends westwards into coastal Iran. In Pakistan this belt is dominated by an overall regressive succession comprising the Siahan/Hoshab shale (a valley-forming claystone/siltstone-dominant facies) and the ridge-forming, sandstone-dominant facies of the Panjgur Formation, a very thick cyclic succession of Oligocene-Early Miocene turbidites. These formations form part of the "Khojak-Panjgur Submarine Fan Complex". The Panjgur Formation comprises nine distinct facies, which are organized into seven facies associations distinguished by their constituent facies, vertical organizations and lateral geometries. Facies associations include: (1) mid-fan channels, (2) overbank/levee, (3) crevasse-splays, (4) inter-channel, (5) outer-fan-lobes, (6) fan-fringe, and (7) trench floor/basin-plain. The formation displays a hierarchy of 1st, 2nd and 3rd order sedimentary cycles. The 1st order cycles range in thickness from 60 m to 450 m and conceptually correspond to "sequences" or "depositional sequences" formed mainly in response to sea-level fluctuations. Their boundaries are characterized by gradual or abrupt replacement of claystone/siltstone facies of the basin-plain by thin- to thick-bedded mid- to outer-fan turbidites, representing a basinward shift of the facies. The 1st order cycles generally start with thick- to very thick-bedded sandstones of channelized mid-fan facies, passing upwards into a middle part consisting of thin- to thick-bedded sandstone and claystone facies of the outer-fan-lobes and capped by claystone/siltstone-dominant facies of the basin-plain association. These three parts of the 1st order cycles correspond to the lowstand systems tracts (LST), transgressive systems tracts (TST) and highstand systems tract (HST) of the full depositional sequence. The 2nd order cycles, which are generally thinning-up and thickening-up cycles, range in thickness from 4 to 65 m, and occur both as isolated and composite packages, are characterized by mid-fan channelized and outer-fan-lobe associations, respectively. We interpret the 2nd order cycles as parasequences, which formed in response to marine flooding events of relatively short duration. The 3rd order cycles are very small-scale (1-4 m thick), mostly thickening-up cycles, which generally represent compensation cycles of the outer-fan-lobes. Sedimentary logs from the measured sections display significant differences in the character of facies, facies associations and cyclicity style but exhibit sufficient similarities to demonstrate that all these sequences formed parts of the same very large submarine fan complex. The succession has been strongly deformed, as attested by the prevalence of asymmetrical/overturned folding, thrusting and imbrication, resulting in great thickening due to tectonic duplication, as well as disruption of the cycles.
Kassi, Akhtar Muhammad; Khan, Abdul Salam; Kelling, Gilbert; Kasi, Aimal Khan
This report discusses how the US can play a productive mediating role in South Asia by engaging India and Pakistan in an international forum to manage nuclear weapons, as Edward Teller advocated. India and Pakistan have developed their nuclear capabilitie...
Carbon monoxide (CO) is one of the six criteria air pollutants related to urbanization and has a wide range of health effects.\\u000a The study measured and compared the exhaled CO levels among commuters and roadside vendors in potentially heavy and low traffic\\u000a volume areas of Karachi, a megacity in Pakistan. Saddar town [areas of M. A. Jinnah Road (Tibet Center,
Saniya R. Sabzwari; Zafar Fatmi
The World Health Organization encourages hospitals to become Health Promoting Hospitals (HPH) but adapting this concept to Pakistan has not been investigated. We explore perceptions of healthcare stakeholders about strategies and a priority action-plan to encourage HPHs in Pakistan. We conducted a qualitative study in 2007 where key-informant interviews and focus group discussions were held with healthcare stakeholders in Karachi. Thematic analysis was done and emerging themes were categorized. The HPH core components were perceived as the "standard framework"; however more emphasis was placed on priority actions as to satisfy "basic needs" of patients, staff and the community. This included basic facilities of comfort, health, hygiene, safety, security and emotional support. A change in the traditional mindset from cure to care and identification of key personnel, awareness-raising and cooperation would strengthen advocacy efforts for HPH in Pakistan. PMID:22256406
Khowaja, A R; Karmaliani, R; Mistry, R; Agha, A
Relations between Pakistan and Afghanistan have remained estranged mainly due to Afghanistan's revanchist claim made about Pakistan's western province and its non-recognition of the Durand Line as the international border. With a hostile India to the East...
Next to the global economic meltdown, the implosion of Pakistan tops the list of urgent problems demanding immediate attention. A new strategy for Pakistan is long overdue in light of the continued expansion of terrorism and nuclear weapons production in ...
Z. S. Davis
Although biomethanation is a mature technology, its implementation is only partly a success in Pakistan. Biogas plants on family farms can be economical but are seldom so in Pakistan. Either the investment cost has been high or satisfactory performance of...
In Pakistan, societal attitudes and norms, as well as cultural practices (Karo Kari, exchange marriages, dowry, etc.), play a vital role in women's mental health. The religious and ethnic conflicts, along with the dehumanizing attitudes towards women, the extended family system, role of in-laws in daily lives of women, represent major issues and stressors. Such practices in Pakistan have created the extreme marginalisation of women in numerous spheres of life, which has had an adverse psychological impact. Violence against women has become one of the acceptable means whereby men exercise their culturally constructed right to control women. Still, compared to other South Asian countries, Pakistani women are relatively better off than their counterparts.
Background We sought to describe the characteristics and operational dynamics of male sex workers (MSW) and hijra sex workers (HSWs) in 11 cities across Pakistan in 2011. Methods We report descriptive statistics of self-reported sexual behaviour data from cross-sectional mapping and biological and behavioural surveys conducted among 1431 MSWs and 1415 HSWs in four cities across Pakistan in 2011. Results While Karachi had the largest numbers of MSWs and HSWs, Quetta had the largest relative population sizes, with 3.6?MSWs per 1000 male adults and 3.3?HSWs per 1000 male adults. There was considerable variability in the proportion of HSWs who operate through deras, ranging from 2.2% in Peshawar to 62.7% in Karachi. The number of HSWs per guru varies by city, from 1.5 in Quetta to 16.5?HSWs per guru in Karachi. Among HSWs, the use of mobile phones for solicitation ranged from 37.6% in Quetta to 83% in Peshawar and among MSWs the use of mobile phones ranged from 27% in Karachi to 52% in Quetta. In Quetta, a large proportion of HSWs (41%) find clients through gurus. Client volume tended to be higher among HSWs and among both MSWs and HSWs in Quetta and Peshawar. Condom use with clients was most consistent in Quetta, with 31% of MSWs and 41% of HSWs reporting always using condoms with clients. Peshawar had the greatest proportion reporting never using condoms. Conclusions There is considerable geographic heterogeneity in the characteristics and operational dynamics of MSWs and HSWs across Pakistan.
Thompson, Laura H; Salim, Momina; Baloch, Chaker Riaz; Musa, Nighat; Reza, Tahira; Dar, Nosheen; Arian, Shahzad; Blanchard, James F; Emmanuel, Faran
This article aims to assess the pattern of road traffic injuries (RTIs) and fatalities in Karachi metropolis. Assessing the pattern of RTIs in Karachi at this juncture is important for many reasons. The rapid motorisation in the recent years due to the availability of credit has significantly increased the traffic volume of the city. Since then, the roads of Karachi have continuously developed at a rapid pace. This development has come with a high human loss, because the construction of multilevel flyovers, signal-free corridors and the resulting high-speed traffic ultimately increase the severity of injuries. The reasons for this high proportion are inadequate infrastructure, poor enforcement of safety regulations, high crash severity index and greater population of vulnerable road user groups (riders and pedestrians). This research is the first of its kind in the country to have a geocoded database of fatalities and injuries in a geographical information system for the entire city of Karachi. In fact, road crashes are both predictable and preventable. Developing countries should learn from the experience of highly motorised nations to avoid the high burden of RTIs by adopting road safety and prevention measures. PMID:20589551
Lateef, Muhammad U
This paper aims at analyzing and assessing the evolution and outcomes of Pakistan's urban policies during 1947-97. One-third of Pakistan's population live in urban areas, and the level of urbanization increased from 18% in 1951 to 32% in 1991. The rapid rate of urbanization has produced two megacities, Karachi with a population of 8-10 million and Lahore with a population of about 5 million, and 6 other cities with populations of 1 million or more. Pakistan is one of the pioneering countries in implementing physical planning and planned housing; this is reflected in its urban policies as constituted by the Five-Year Plan and national development budgets. The programs through which the policies were implemented are divided into three phases. Phase 1 (1947-70) involved the resettlement of refugees and laying of the institutional framework; core housing schemes (consisting of 1- to 2-room quarters) were the key element of the urban strategy in this period. Phase 2 (1971-78) policies were guided by the promise of mass housing, particularly for the working and lower classes. At this time, too, a set of squatter settlements known as Katchi Abadis emerged, and international organizations started funding Pakistan's urban development programs. Phase 3 (1980-95) saw the steady "privatization" of the housing and land markets and improved housing conditions, while urban policy continued to concentrate on public works, plots and construction. Despite the improvements, urban crises persist, and policies are shifting towards more complex issues of quality and the provision of new collective goods. In general, the achievements of Pakistan's urban policies have outweighed its failures, as both the rich and the poor have benefitted from them. PMID:12294610
Qadeer, M A
Stroke is a major public health problem in developing countries of South Asia. In this paper, we review the epidemiology of stroke in Pakistan. Most of the available data are based on hospital-centred case series addressing established stroke risk factors, stroke-related mortality and disability, functional status, and case fatality rates. There are limited population-based data regarding the prevalence of established stroke risk factors in the general population, and no epidemiologic studies have been conducted to specifically identify potential stroke risk factors unique to the region. The limited data that are available from Pakistan indicate that stroke epidemiology differs between Pakistan and Western populations - in Pakistan first stroke occurs at a younger age, particularly among women, and there is a higher proportion of haemorrhagic strokes. Besides the established stroke risk factors (e.g. hypertension, smoking, and diabetes) some potentially unique stroke risk factors related to life style and dietary habits such as huqqa smoking, use of dalda and desi ghee, and orally consumed forms of tobacco, may exist in Pakistan, and warrant further investigation. The shortage of trained stroke epidemiologists is a major limiting factor to the conduct of epidemiological stroke studies in Pakistan. Epidemiologic data are essential to guide health policy development aimed at decreasing the mortality and morbidity from stroke in Pakistan. To facilitate this process, medical professionals in Pakistan could participate in the World Health Organization's STEPwise approach to stroke surveillance, which provides a framework for data collection and comparison between and within populations. PMID:19765127
Farooq, M U; Majid, A; Reeves, M J; Birbeck, G L
Why have Pakistani workers failed to transform their evident street power into sustained influence in formal politics? Throughout South Asia, worker' organi- zations formed alliances with political parties, political parties formed workers' or- ganizations, and governments incorporated worker' organizations into state con- sultation machinery. With the exception of Pakistan, in each of the countries of South Asia, representatives at these
India and Pakistan launched their respective nuclear programs in the 1940s and 1950s with considerable foreign technical support, especially from the United States Atoms for Peace Program. The technology and training that was acquired served as the platform for later nuclear weapon development efforts that included nuclear weapon testing in 1974 and in 1998 by India, and also in 1998 by Pakistan - which had illicitly acquired uranium enrichment technology especially from Europe and received assistance from China. As of 2013, both India and Pakistan were continuing to produce fissile material for weapons, in the case of India also for nuclear naval fuel, and were developing a diverse array of ballistic and cruise missiles. International efforts to restrain the South Asian nuclear build-up have been largely set aside over the past decade as Pakistani support became central for the U.S. war in Afghanistan and as U.S. geopolitical and economic interests in supporting the rise of India, in part as a counter to China, led to India being exempted both from U.S non-proliferation laws and international nuclear trade guidelines. In the absence of determined international action and with Pakistan blocking the start of talks on a fissile material cutoff treaty, nuclear weapon programs in South Asia are likely to keep growing for the foreseeable future.
Oral submucous fibrosis (OSF) is an oral pre?cancerous condition characterized by symptoms such as intolerance to spicy food, altered salivation, progressive difficulty in opening the mouth, and signs like vesiculation, ulceration, blanching, rigidity, and stiffening of the oral mucosa and depapillation and altered mobility of the tongue. It is seen mostly among people of Indian subcontinent origin. The major structural
Rehana Maher; Perin Aga; Newell W. Johnson; Rengaswamy Sankaranarayanan; Saman Warnakulasuriya
Social unrest represents a major challenge for policy makers around the globe, as it can quickly escalate from small scale disturbances to highly public protests, riots and even civil war. This research was motivated by a need to understand social instability and to unpack the comments made during a spring 2013 conference hosted by Pacific Northwest National Laboratory’s Center for Global Security and the U.S. Institute for Peace, where policymakers noted that models considering social instability are often not suitable for decision-making. This analysis shows that existing state level models of instability could be improved in spatial scale to the city level, even without significantly improved data access. Better data would make this analysis more complete and likely improve the quality of the model. Another challenge with incorporating modeling into decision-making is the need to understand uncertainty in a model. Policy makers are frequently tasked with making decisions without a clear outcome, so characterization of uncertainty is critical. This report describes the work and findings of the project. It took place in three phases: a literature review of social stability research, a “hindsight scan” that looked at historical data, and a “foresight scan” looking at future scenarios.
Olson, Jarrod; Kurzrok, Andrew J.; Hund, Gretchen; Fagley, Erik M.
BACKGROUND: Infections with hepatitis B virus (HBV) and hepatitis C virus (HCV) can lead to chronic liver disease and hepato-cellular carcinoma (HCC). This cross-sectional study estimated the prevalence and identified risk factors associated with Hepatitis B surface antigen (HBsAg) and HCV antibody (anti-HCV) sero-positivity among children 1 to 15 years of age. METHODS: The study targeted the low to middle
Wasim Jafri; Nadim Jafri; Javed Yakoob; Muhammad Islam; Syed Farhan Ali Tirmizi; Tazeen Jafar; Saeed Akhtar; Saeed Hamid; Hasnain Shah; Sheikh Nizami
Domperidone is an anti-dopaminergic drug used for the treatment of nausea, vomiting and dyspepsia. It has also been used in Parkinson's disease. In this study, five different brands of Domeperidone tablets were selected from the local market for evaluation of their quality as the local market is occupied of many competitors for a single generic. The evaluation of Domperidone tablets was done using various pharmacopoeial and non-pharmacopoeial tests. All the test results fell within BP specified limits for all the selected brands i.e. the results for Brands A to E for weight variation, thickness and diameter were satisfactory and within limits. For Brands A to E, the results for hardness and friability were also satisfactory i.e. 4-10kg/cm2and 0.1-0.6% respectively. The results for Brands A to E for disintegration were 2-6 minutes; for dissolution and assay, the results were 89-92% and 95-99% respectively. The results of similarity factor (f2) also showed that all brands of Domperidone have comparative dissolution profiles. PMID:25015463
Khan, Muhammad Qamar; Razvi, Nighat; Anjum, Fakhsheena; Ghazal, Lubna; Siddiqui, Saeed Ahmed; Shoaib, Muhammad Harris
Objectives. (1) To determine the indications, frequency, and types of antibiotics used in hospitalized paediatric patients at tertiary care hospital and (2) to evaluate whether the prescribed antibiotics were based on the isolation of organism and their sensitivity. Study Design. Descriptive observational hospital based study. Results. A total of 131 patients were included over 6 months of study period, in whom antibiotics were prescribed at the time of admission. The majority were between 1 and 5 years of age. M?:?F ratio was 1?:?1. Fever was the commonest symptom (in 84% of cases) followed by gastroenteritis. Blood culture was done in 114 cases (87%) and was positive only in 10 (8.8%). The commonest organism isolated from blood was Salmonella Typhi. Ceftriaxone was found to be the most frequently prescribed antibiotic as an empirical therapy. 102 (77.86%) patients received Ceftriaxone, followed by ampicillin. The antibiotics were probably used on the basis of clinical condition rather than the result of blood culture, as yield of blood culture was quite low. Conclusion. Our study showed an unjustified use of antibiotics regardless of the admission and discharge diagnosis in acute febrile illnesses. Further on, inappropriate practice of using Ceftriaxone was noted in LRTI and pneumonia. Efforts are needed to educate physicians about the rational use of antibiotics.
Ali, Syed Rehan; Ahmed, Shakeel; Lohana, Heeramani
The development of essential services including water and sanitation in many megacities of the economically developing countries of Asia cannot keep pace with their rapidly growing population and accompanying urban and industrial development. The inadequate water supply and poor sanitation services lead to contamination of their water supply. It also leads to the input of sewage water into the groundwater.
A. Rahman; H. K. Lee; M. A. Khan
This study was designed to establish the burden of head and neck cancers (HNCA) in public sector based cancer centres of Pakistan. Data were obtained from the central body governing all the cancer centres in the country. The frequency of treated HNCAs out of the total body cancers treated across Pakistan was found to be 14.5%. Highest prevalence rates amongst all cancers were noted in Sind, notably in Karachi and Jamshoro, followed by Multan in Punjab and a much lower frequency in Peshawar in the North West Frontier Province. This variation presumably reflects levels of betel quid consumption but more data are needed to be gathered in a comprehensive way if the findings are to be applicable for improvement of the national cancer control program. PMID:18990033
Chaudhry, Saima; Khan, Ayyaz Ali; Mirza, Kamran Masood; Iqbal, Hafiz Aamer; Masood, Yasmeen; Khan, Nauman Rauf; Izhar, Faisal
Carbon monoxide (CO) is one of the six criteria air pollutants related to urbanization and has a wide range of health effects. The study measured and compared the exhaled CO levels among commuters and roadside vendors in potentially heavy and low traffic volume areas of Karachi, a megacity in Pakistan. Saddar town [areas of M. A. Jinnah Road (Tibet Center, Denso Hall) and Empress Market] was selected to represent an area of high traffic volume and the suburban town of Gadap (Gadap and Gulshan-e-Maymar) was selected to represent an area of no or low traffic volume. The study compared the CO exposure of commuters and roadside vendors in high and low traffic volume in Karachi. CO exposure was measured in expired air using the breath analyzer module of Bacharach Monoxor-II, USA. A total of 326 individuals (115 commuters and 211 stationary roadside vendors) from Saddar town (n?=?193) and Gadap town (n?=?133) were selected. In addition, CO levels in ambient air in the same areas, using portable CO analyzer (Bacharach, Monoxor-II, USA), were measured. The mean ambient CO level at Saddar town was 15.6 (SE ± 2.6) ppm compared to 3.3 (SE ± 0.3) ppm at Gadap town. The mean CO level in expired air was significantly higher among nonsmokers at Saddar town (12.8 ± 0.5 ppm) compared to the nonsmokers at Gadap town (7.8 ± 0.4 ppm). The mean CO level in expired air among smokers was twice that of nonsmokers (21.6 vs. 10.6 ppm). CO in expired air was greater among high traffic volume commuters and roadside stationary population in Karachi, Pakistan. The population in Karachi is exposed to high concentration of air pollutants. These pollutants need to be characterized for health effects and interventions needs to be developed. PMID:21120689
Sabzwari, Saniya R; Fatmi, Zafar
In this review, we evaluate and summarize the available data that addresses the levels of HM that exist in aquatic species, mainly fish, of Pakistan. Data on this topic were collected from the literature of the last two decades (1990-2012). Results revealed that the highest number (>50%) of studies addressing HM-contaminated fish have occurred in the Punjab province, followed by the Sindh and Khyber Pakhtunkhwa provinces. Our review disclosed that the HM concentrations in Pakistani fish species varied considerably with location. Generally, the level of HM residues detected in fish species had the following descending order: Fe>Zn>Pb>Cd>Hg>Ni>Cu>Ag>Cr>Mn>As. Fish samples collected from the Kabul River near the Nowshera district, Stretch of Ravi River, Indus River near Mainwali district, and Arabian Sea at Karachi revealed extremely high HM concentrations (range: 0.34-8,381.30 jlg/g), compared to other fresh water bodies, such as the Llyold Barrage, Guddu Barrage, Jinnah Barrage, and Chashma Barrage (0.01-2.13 jlg/g). As a reference point, we also reviewed selected data on HM fish residues that exist in countries that neighbor Pakistan. With the exception of fish collected in India, the majority of fish analyzed for HM residues in neighboring countries displayed lower residues than did fish from Pakistan. We concluded from reviewing the available published data that the most probable sources for the HM contaminants found in Pakistani water and fish were release of domestic sewage, agricultural runoff, and industrial effluents. We strongly recommend that action be taken to better control the discharges of unregulated waste that enters the Pakistani aquatic environment, with the intent to mitigate any continuing future damage to the aquatic ecosystem. We also recommend intensifying research programs that address the toxicity of HM to the aquatic environment, so that a better understanding of metal effects on fish can be achieved that will lead to a sustainable ecological harmony in Pakistan. PMID:24609520
Hussain, Majid; Muhammad, Said; Malik, Riffat N; Khan, Muhammad U; Farooq, Umar
Rapid urbanization, and lack of efficient monitoring and control of pollution, along with phenomena like Asian Brown Haze or prolonged episodes of winter fog, makes the South Asian atmospheric chemistry a very complex one. The anthropogenic aerosols released from this region are projected to become the dominant component of anthropogenic aerosols worldwide in the next 25 years (Nakicenovic and Swart, 2000). The region is one of the most densely populated in the world, with present population densities of 100-500 persons km-2. There are six big cities, namely, Delhi, Dhaka, Karachi, Kolkata, Lahore, and Mumbai, each housing a population around or above 10 million. There is now a real concern about the sustainability of the region's ability to support the population due to air pollution, loss of biodiversity and soil degradation. Therefore, we conducted several extensive campaigns over last 10 years in Lahore, Karachi, and Islamabad in Pakistan to (1) chemically characterize the aerosols (PM2.5 mass, concentrations of trace elements, ions, black and organic carbon), and gaseous pollutants (concentrations of NH3, SO2, HONO, HNO3, HCl and (COOH)2, and (2) identify the major emission sources in this region. Exceedingly high concentrations of all species, relative to major urban areas of US and Europe, were observed. Concentrations of PM2.5, BC, Pb, SO42-, NH4+, HONO, NH3 respectively, up to 476, 110, 12, 66, 60, 19.6 and 50 ?gm-3 were observed in these cities, which were far in excess of WHO and US EPA air quality standard (Biswas et al., 2008). We use air parcel back trajectories, intercomponent relationships and meteorological observations to explain chemistry and emission sources of aerosol constituents. Carbonaceous aerosols contributed up to 69% of the PM2.5 mass (Husain et al., 2007). Source apportionment was conducted using positive matrix factorization. The analysis has classified six emission sources of aerosol components, namely, industrial activities, wood burning, secondary aerosols, metal processing, vehicular emissions, and crustal and road dust. Findings of our study will play a vital role in adopting a strategy to regulate emissions, and to mitigate the long-term climate change in the region. References: Nakicenovic, N. and Swart, R., 2000. In: N. Nakicenovic and R. Swart, Eds, Emissions Scenarios 2000. Special Report of the Intergovernmental Panel on Climate Change, Cambridge University Press, Cambridge. Biswas, K.F., Ghauri, B.M., Husain, L., 2008. Gaseous and aerosol pollutants during fog and clear episodes in South Asian urban atmosphere. Atmospheric Environment, 42, 7775-7785. Husain, L., Dutkiewicz, V.A., Khan, A.J., Ghauri, B.M., 2007. Characterization of carbonaceous aerosols in urban air. Atmospheric Environment, 41, 6872-6883.
Biswas, K. F.; Husain, Liaquat
Typhoid fever remains a major public health problem in developing countries such as Pakistan. A great majority of cases occur in children living in poor sanitary conditions in squatter settlements in large cities. We conducted a case-control study to identify risk factor for typhoid fever in children under the age of 16 years residing in squatter settlements of Karachi. We enrolled 88 typhoid fever patients, diagnosed by positive blood culture or Typhidot test, between June 1999 and December 2001. Simultaneously, we enrolled 165 age-matched neighborhood controls. Multivariate analysis done through conditional binary logistic regression analysis technique showed that increasing number of persons in the household (odds ratio [OR]=1.9; 95% confidence interval [CI] 1.2-3.1), non-availability of soap near hand washing facility (OR=2.6; 95% CI 1.1-6.3), non-use of medicated soap (OR=11.2; 95% CI 1.3-97.6) and lack of awareness about contact with a known case of typhoid fever (OR=3.7; 95% CI 1.6-8.4) were independent risk factors of the disease. Health education with emphasis on hand washing may help decrease the burden of typhoid fever in developing countries. PMID:20701852
Siddiqui, Fahad Javaid; Haider, Syed Rizwan; Bhutta, Zulfiqar Ahmed
For the purpose of making a thorough grasp of the present oil situation of China and the south Asia countries, an investigational analysis was made. As for China, an investigation was summed up on oil related organization structure, changes of processed c...
T. Shimokawa Y. Kakuta
This article compares the lives of women and explores dimensions of their autonomy in different regions of South Asia-Punjab in Pakistan, and Uttar Pradesh in north India and Tamil Nadu in south India. It explores the contextual factors underlying observed differences and assesses the extent to which these differences could be attributed to religion, nationality, or north-south cultural distinctions. Findings
Shireen J. Jejeebhoy; Zeba A. Sathar
There are no official data on suicide from Pakistan, a conservative South Asian Islamic country with traditionally low suicide rates. Both suicide and attempted suicide are illegal acts, as well as socially and religiously condemned, making research in this area difficult. Recent reports suggest an increase in suicide rates. In this study, police…
Khan, Murad Moosa; Hyder, Adnan Ali
Before 1953 almost no barite deposits were known in Pakistan. Discovery of such deposits relatively close to oil fields in northern Pakistan in 1953 led to increased barite production from 1957 to 1961 and to doubling of production in 1962, firmly establishing new industry for the country. During 1962 and 1963, most of the known barite deposits in Pakistan were geologically mapped, and minimum reserves were estimated to be 1,423,000 short tons. The largest single deposit, Ehuzdar, is estimated to contain more than 1,100,000 short tons of barite. Barite has been found in Pakistan principally in the Hazara, Khuzdar, and Las Bela districts. Although several vein deposits contain good quality barite, 90 percent of estimated reserves are in replacement deposits concordant to bedding in sedimentary rocks. Host rocks range in age from Precambrian to Pleistocene, but the periods of barite deposition are probably Jurassic or younger. Some barite concentrated in sandstone may be of detrital origin. In late 1962, demand for barite in Pakistan was estimated at about 8,000 tons annually. Although domestic barite resources exceed this figure, less than 40 percent of demand was being supplied by domestic nines in 1963. Transportation costs and limited production facilities are partly responsible for output, but the lack of quality control is a major obstacle. Producers are not generally familiar with commercial specifications for barite and have net recognized that their products are too impure to be successfully marketed without installing the necessarycontrol procedures of sampling and beneficiation.
Klinger, F. L.; Richards, R. L.
Background Worldwide the proportion of elderly people in the population is increasing. Currently in Pakistan 7.3 million people (5.6% of total population) are more than 60 years old. This age shift has emerged as an important health issue and is associated with an increased utilization of emergency services by the elderly. We carried out this study to assess the pattern of elderly patients (>60 years) who visit emergency departments in comparison to young adults (18–60 years). Methods Data was collected retrospectively of patients aged 18 years or more who visited the Emergency Department (ED) of Aga Khan University Hospital, Karachi (AKUH) during September, 2009 to September, 2011. The data collection sheet included patient’s demographic information, triage category, reason for visit, clinical presentation, ED length of stay, day and time of presentation and their disposition. Data was entered and analyzed using SPSS version 19.0. Descriptive statistics were used to describe patient’s demographics. Chi-square (?2) test was used as a test of significance to compare differences between groups for categorical data and t-test for continuous data. Multiple logistic regression analysis was done to find out the association between the patient characteristics and outcomes (admission and expiry). Results Almost 24% (n = 13014) of all adults (n = 54588) presenting to the ED were over the age of 60 years. More than 57% of elderly patients belonged to the high priority triage category compared to 35% in younger patients. Most of the elderly patients ( 27%) presented with nonspecific complaints followed by shortness of breath (13%) and fever (9%). The median length of stay (LOS) in the ED for elderly was 379 minutes (252 min in under-60 yrs patients) and they were more likely to get admitted to in-patient departments compared to younger patients (OR 1.7 95% CI 1.6-1.8). A high proportion of those admitted (20%) required intensive or special care. Mortality in elderly patients was 2.3% as compared to 0.7% in young adults. This was accompanied by a higher mortality risk in the elderly with an odds ratio of 2.3 (CI 2–2.5). Conclusion Elderly ED users differ significantly from younger adults in terms of criticality on presentation, ED LOS and final disposition.
Shigellosis is communicated when the pathogen is swallowed down through the factors like stool or polluted hands with dust. Inappropriate hygienic conditions may reach such clinical manifestations. Shigellosis is frequently originated in crowded places and where hygienic conditions are insufficient and sanitation is poor. Infections easily transmissible from person to person like family members or infected playmates. The disease can easily transmit through infected food handlers with inappropriate hygienic conditions, crops nurturing in contaminated water with sewage line system, swimming in contaminated pool water. Similarly houseflies can also form an important vector for its transmission. In this study, Ecological factors were also the causative indicators for the disease. The issue was the water contamination of the different areas of Karachi mainly the Pehlwan Goth, Safora Goth. Then another area we focused was Patel Para in which Salmonella species were present. Other indicator was the individual-to-individual transfer that was common in Safora Goth. PMID:24577930
Qureshi, Tasneem; Saeed, Aftab; Usmanghani, Khan
Mangroves ecosystems consist of inter tidal flora and fauna found in the tropical and subtropical regions of the world. Mangroves forest is a collection of halophytic trees, shrubs, and other plants receiving inputs from regular tidal flushing and from freshwater streams and rivers. A global reduction of 25 % mangroves' area has been observed since 1980 and it is categorized as one of to the most threatened and vulnerable ecosystems of the world. Forest resources in Pakistan are being deteriorating both quantitatively and qualitatively due to anthropogenic activities, climatic v and loose institutional management. According to the FAO (2007), extent of forest cover of Pakistan in 2005 is 1,902,000 ha, which is 2.5% of its total land area. Annual change rate during 2000-2005 was -2.1% which is highest among all the countries in Asia. The Indus delta region contains the world's fifth-largest mangrove forest which provides a range of important ecosystem services, including coastal stabilisation, primary production and provision of nursery habitat for marine fish. Given their ecological importance in coastal settings, mangroves receive special attention in the assessment of conservation efforts and sustainable coastal developments. Coastline of Pakistan is 1050km long shared by the provinces, Sind (350km) and Baluchistan (700 km). The coastline, with typical arid subtropical climate, possesses five significant sites that are blessed with mangroves. In the Sindh province, mangroves are found in the Indus Delta and Sandspit. The Indus Delta is host to the most extensive mangroves areas and extends from Korangi Creek in the West to Sir Creek in the East, whereas Sandspit is a small locality in the West of Karachi city. In the Balochistan province, mangroves are located at three sites, Miani Hor, Kalmat Khor and Jiwani. Contemporary methods of Earth observation sciences are being incorporated as an integral part of environmental assessment related studies in coastal areas. GIS and Remote Sensing based technologies and methods are in use to map forest cover since the last two decades in Pakistan. The national level forest cover studies based upon satellite images include, Forestry Sector Master Plan (FSMP) and National Forest & Range Resources Assessment Study (NFRRAS). In FSMP, the mangrove forest extent was visually determined from Landsat images of 1988 - 1991, and was estimated to be 155,369 ha; whereas, in NFRRAS, Landsat images of 1997 - 2001 were automated processed and the mangroves areas was estimated to be 158,000 ha. To our knowledge, a comprehensive assessment of current mangroves cover of Pakistan has not been made over the last decade, although the mangroves ecosystems have become the focus of intention in context of recent climate change scenarios. This study was conducted to support the informed decision making for sustainable development in coastal areas of Pakistan by providing up-todate mangroves forest cover assessment of Pakistan. Various types of Earth Observation satellite images and processing methods have been tested in relation to mangroves mapping. Most of the studies have applied classical pixel - based approached, there are a few studies which used object - based methods of image analysis to map the mangroves ecosystems. Object - based methods have the advantage of incorporating spatial neighbourhood properties and hierarchical structures into the classification process to produce more accurate surface patterns recognition compared with classical pixel - based approaches. In this research, we applied multi-scale hierarchical approach of object-based methods of image analysis to ALOS - AVNIR-2 images of the year 2008-09 to map the land cover in the mangroves ecosystems of Pakistan. Considering the tide height and phonological effects of vegetation, particularly the algal mats, these data sets were meticulously chosen. Incorporation of multi-scale hierarchical structures made it easy to effectively discriminate among the land cover classes, particularly the mudflats from sparse mangroves, at their r
Abbas, S.; Qamer, F. M.; Hussain, N.; Saleem, R.; Nitin, K. T.
Pakistan is located at the converging boundaries of the Indian, Arabian, and Eurasian plates. Evolution of this tectonic setting has provided an array of environmental habitats for deposition of petroleum source rocks and development of structural forms. The potential Cretaceous source rocks in Central and South Indus Basin are spread over an area of about 300,000 km[sup 2]. With 2% cutoff on Total Organic Carbon, the average source rock thickness is 30-50 m, which is estimated to have generated more than 200 billion bbl of oil equivalent. To date, production of more than 30,000 bbl of oil and about 1200 million ft[sup 3] of gas per day can be directly attributed to Cretaceous source. This basin was an area of extensional tectonics during the Lower to Middle Cretaceous associated with slightly restricted circulation of the sea waters at the north-western margin of Indian Plate. Lower Cretaceous source rocks (Sembar Formation) were deposited while the basin was opening up and anoxia was prevailing. Similarly Middle to Upper Cretaceous clastics were deposited in setting favorable for preservation of organic matter. The time and depth of burial of the Cretaceous source material and optimum thermal regime have provided the requisite maturation level for generation of hydrocarbons in the basin. Central Indus basin is characterized by Cretaceous source rocks mature for gas generation. However, in South Indus Basin Cretaceous source rocks lie within the oil window in some parts and have gone past it in others.
Kari, I.B. (Pakistan Petroleum Limited, Sindh (Pakistan))
Since September 11, 2001, Pakistan's madrassas have come under scrutiny as sources for the interpretation and propagation of militant versions of Islam. The madrassas are not unique to Pakistan, but are found throughout the Muslim world. However, Pakistan...
P. M. Bell
Modern Methods in Seismic Hazard Assessment; Nagarkot, Nepal, 8-12 June 2009; The M7.6 Muzaffarabad, Pakistan, earthquake struck the Pakistani Kashmir on 8 October 2005, claiming more than 80,000 lives. The earthquake underscored two points about earthquake hazard in Pakistan: first, that it is high, and, second, that it is poorly understood. In Karachi, for example, hazard is generally considered to be low, yet this rapidly growing megacity is as close to a major strike-slip fault system as Los Angeles is to the San Andreas fault. The Pakistani engineering community has sought guidance from seismologists on improved characterization of seismic hazard. This requires both improved hazard assessment methodology and improved constraints on the critical inputs to seismic hazard maps, for example, assessment of fault slip rates and geological site characterization. These inputs are currently unavailable. Efforts to map seismicity and attenuation and to estimate fault slip rates have been hampered by political instability. Yet there is no shortage of intellectual energy—Pakistan boasts an eager community of trained earthquake professionals.
Hough, Susan E.; Yong, Alan
A profile of Pakistan is sketched in this paper. Emphasis is placed on the nature, scope, and accomplishments of population activities in the country. Topics and sub-topics include: location and description of the country; population (size, growth patterns, age structure, urban/rural distribution, ethnic and religious composition, migration,…
Hardee, J. Gilbert; Satterthwaite, Adaline P.
This study focuses on the dengue transmission in different regions of Pakistan. For this purpose, the data of dengue cases for 2009-2012 from four different cities (Rawalpindi, Islamabad, Lahore, and Karachi) of the country is collected, evaluated, and compiled. To identify the reasons and regions of higher risk of Dengue transmission, land use classification, analysis of climate covariates and drainage patterns was done. Analysis involves processing of SPOT 5 10 m, Landsat TM 30 m data sets, and SRTM 90 m digital elevation models by using remote sensing and GIS techniques. The results are based on the change in urbanization and population density, analysis of temperature, rainfall, and wind speed; calculation of drainage patterns including stream features, flow accumulation, and drainage density of the study areas. Results suggest that the low elevation areas with calm winds and minimum temperatures higher than the normal, rapid increase in unplanned urbanization, low flow accumulation, and higher drainage density areas favor the dengue transmission.
Khalid, Bushra; Ghaffar, Abdul
Bladder carcinoma is most common urological malignancy in Pakistan. The objective of the study was to determine the clinico-pathological\\u000a characteristics of histologically confirmed bladder carcinoma at a tertiary care hospital of South Punjab, Pakistan. Methods: In two hundreds and twenty one patients (172 male and 49 female) bladder carcinoma was diagnosed from Jan 1998 to June 2005.\\u000a All patients were
Muhammad Rafique; Abrar A. Javed
Background: Intimate partner violence (IPV) is an important public health issue with severe adverse consequences. Population-based data on IPV from Muslim societies are scarce, and Pakistan is no exception. This study was conducted among women residing in urban Karachi, to estimate the prevalence and frequency of different forms of IPV and their associations with sociodemographic factors. Methods: This cross-sectional community-based study was conducted using a structured questionnaire developed by the World Health Organisation for research on violence. Community midwives conducted face-to-face interviews with 759 married women aged 25–60 years. Results: Self-reported past-year and lifetime prevalence of physical violence was 56.3 and 57.6%, respectively; the corresponding figures for sexual violence were 53.4% and 54.5%, and for psychological abuse were 81.8% and 83.6%. Violent incidents were mostly reported to have occurred on more than three occasions during the lifetime. Risk factors for physical violence related mainly to the husband, his low educational attainment, unskilled worker status, and five or more family members living in one household. For sexual violence, the risk factors were the respondent’s low educational attainment, low socioeconomic status of the family, and five or more family members in one household. For psychological violence, the risk factors were the husband being an unskilled worker and low socioeconomic status of the family. Conclusion: Repeated violence perpetrated by a husband towards his wife is an extremely common phenomenon in Karachi, Pakistan. Indifference to this type of violence against women stems from the attitude that IPV is a private matter, usually considered a justifiable response to misbehavior on the part of the wife. These findings point to serious violations of women’s rights and require the immediate attention of health professionals and policymakers.
Ali, Tazeen S; Asad, Nargis; Mogren, Ingrid; Krantz, Gunilla
Purpose Pakistan is a patriarchal society in which male opinion leaders play an important role in determining health-seeking behaviors pertaining to family planning (FP) among their respective communities. This research focuses on cataloguing the perceptions of opinion leaders (clergymen, health professionals, and social workers) about the barriers for using services and practical solutions for promoting FP in the slums of Karachi, Pakistan. Materials and methods A qualitative study using an open-ended, semistructured interview schedule with hypothetical scenarios and in-depth interviews with a purposive sample of 45 opinion leaders (25 mosque imams/clergymen, 12 nonallopathic health professionals, and eight social workers/activists) was conducted in 2006–2007 in Karachi, Pakistan. Transcripts were coded thematically utilizing NVivo by using an adapted constant comparison analysis process as described by Strauss and Corbin. Results Seven key themes were derived from the in-depth interviews. Five themes provide insight into the opinion leaders’ perceptions of barriers to FP and modern contraception methods. Among the barriers religious taboos and cultural pressures were particularly note-worthy. Two themes offered opportunities for more effective development and implementation of FP programs. Conclusion It is evident from the study that opinion leaders in the community and the clergy lack the understanding of the importance of birth spacing. However, because they have a great deal of influence on the community at large, it is imperative to interact with them to build their capacity in order to propagate the messages of FP and improve maternal health and reproductive health in general.
Azmat, Syed Khurram
Objectives: (1) To determine frequency of urinary tract infection among pyuric diabetic patients. (2) To determine sterile pyuria frequency among pyuric diabetic patients. (3) To determine factors predisposing to urinary tract infection. Methods: This is a non randomized, prospective observational study done in tertiary care set up of Dow University of Health Sciences, Karachi. Data collection done from June 2013 till August 2013. Sampling was done by convenient method, sample size of 97. Inclusion criteria was all adult (above 16) patients with diabetes mellitus and pyuria (more than 4 pus cells /HPF) whose urine culture report was also available. Verbal consent was sought from patients. All data was collected on a Performa. Data was maintained and analyzed on SPSS version 16. Results: Total number of pyuric diabetic patients in study was 97. Frequency of Urinary tract infection was 59/97 (60.82%), prevalence of culture negative sterile pyuria was found 38/97 (39.17%). Urinary tract infection was found to be more in females with lower urinary tract symptoms and flank pains. Stone disease, obstructed pelvicalyceal system, proteinuria, high serum creatinine and positive nitrites were found more in culture positive patients than in culture negative pyuric patients. Conclusions: Pyuric diabetic patients in our study population were found to have culture positive UTI in 60.82% and culture negative sterile pyuria among 39.17% of patients. UTI was found more in females, in symptomatic patient and with abnormal urinary tract anatomy and function.
Mamun Mahmud, Huma; Qureshi, Sobia; Kumar, Darshan; Farman, Syed
Background Exposure to airborne fungi has been related with exacerbation of asthma in adults and children leading to increased outpatient, emergency room visits, and hospitalizations. Hypersensitivity to these airborne fungi may be an important initial predisposing factor in the development and exacerbation of asthma. Objective This study was conducted to determine an association between fungal types and spore concentrations with the risk of asthma exacerbation in adults. Methods This cross-sectional study was conducted from May 2008 to August 2009 at the Aga Khan University Hospital Karachi, Pakistan. All adult (age?16 years) patients presenting to the hospital with acute asthma exacerbation were enrolled after informed consent. A home survey was conducted for each patient to assess their environmental characteristics. Indoor air samples were also obtained from the patient's home to determine the type and spore concentration of fungi within the week of their enrollment in the study. Results Three hundred and ninety-one patients with an acute asthma exacerbation were enrolled during the study period. The mean age of participants was 46 years (standard deviation, ±18 years) and 247 (63.2%) were females. A trend of higher asthma enrollment associated with higher Aspergillus concentrations was found in two consecutive summers. A total of nineteen types of fungi were found in air samples. Aspergillus spp. was the most frequently isolated fungus with acute asthma exacerbation. Conclusion An association of higher concentration of indoor Aspergillus spp. with asthma exacerbation in adults was observed in this study.
Zubairi, Ali Bin Sarwar; Azam, Iqbal; Awan, Safia; Zafar, Afia
In 49 samples of groundwater, sampled in Muzaffargarh District of south-western Punjab, central Pakistan, concentrations of As exceeded the World Health Organisation provisional guideline value, and United States Environmental Protection Agency (USEPA) Maximum Contaminant Level (MCL), of 10 ?gL?1 in 58% of samples and reached up to 906 ?gL?1. In this semi-arid region canal irrigation has lead to widespread water-logging,
R. T. Nickson; J. M. McArthur; B. Shrestha; T. O. Kyaw-Myint; D. Lowry
Suicide is now considered a major public health problem, especially in low income countries. A systematic review was conducted to identify risk factors and causes of deliberate self-harm and suicide in Pakistan – a Muslim, South Asian nation. In addition, the role of emergency department-based surveillance is explored. Four electronic databases (PubMed, CINAHL Plus, MDConsult, PakMediNet) were searched and 23
Muhammad Shahid; Adnan A. Hyder
Background Plasmodium vivax is the prevalent malarial species accounting for 70% of malaria burden in Pakistan; however, there is no baseline data on the circulating genotypes. Studies have shown that polymorphic loci of gene encoding antigens pvcsp and pvmsp1 can be used reliably for conducting molecular epidemiological studies. Therefore, this study aimed to bridge the existing knowledge gap on population structure on P. vivax from Pakistan using these two polymorphic genes. Methods During the period January 2008 to May 2009, a total of 250 blood samples were collected from patients tested slide positive for P. vivax, at the Aga Khan University Hospital, Karachi, or its collection units located in Baluchistan and Sindh Province. Nested PCR/RFLP was performed, using pvcsp and pvmsp1 markers to detect the extent of genetic diversity in clinical isolates of P. vivax from southern Pakistan. Results A total of 227/250 (91%) isolates were included in the analysis while the remainder were excluded due to negative PCR outcome for P.vivax. Pvcsp analysis showed that both VK 210 (85.5%, 194/227) and VK 247 type (14.5%, 33/227) were found to be circulating in P. vivax isolates from southern Pakistan. A total of sixteen and eighty-seven genotypes of pvcsp and pvmsp-1 were detected respectively. Conclusion This is the first report from southern Pakistan on characterization of P. vivax isolates confirming that extensively diverse pvcsp and pvmsp1 variants are present within this region. Results from this study provide valuable data on genetic diversity of P. vivax that will be helpful for further epidemiological studies.
A study was carried out in a specially designed settling column to investigate the settling characteristics of effluents arising from Karachi tanneries. The Jar-tests were conducted to determine the optimum dosage of coagulants such as potash alum and ferric chloride to maximize the removal of suspended solids (S.S) from the wastes. For alum, the optimum dosage was found to be
Waseem Akhtar; Muhammad Rauf; Iqbal Ali; Nayeemuddin
A study was carried out in a specially designed settling column to investigate the settling characteristics of effluents arising from Karachi tanneries. The Jar-tests were conducted to determine the optimum dosage of coagulants such as potash alum and ferric chloride to maximize the removal of suspended solids (S.S) from the wastes. For alumn, the optimum dosage was found to be
Waseem Akhtar; Muhammad Rauf; Iqbal Ali
Objectives: To determine the dietary habits and life style of the students of a private medical university in Karachi. Methodology: A cross-sectional study was conducted at Baqai Medical University, from August 2005 to September 2005. A total of 384 medical students from the batches of 2002 to 2005 participated in this study. A pre-tested semi structured questionnaire was self administered
Nighat Nisar; Majid Hafeez Qadri; Kiran Fatima; Shakeela Perveen
Limited literature exists on the quality and availability of treatment and care of sexually transmitted infections (STIs) in Pakistan. This article aims to document existing services for the care and treatment of STIs available in Pakistan's public and private sectors to high risk groups (HRG), particularly the transgendered population. We conducted a cross-sectional survey to document STI services in Lahore, Karachi, Rawalpindi, Peshawar, and Quetta. Seventy-three interviews were administered with health service providers at the 3 largest public sector hospitals in each city, as well as with general physicians and traditional healers in the private sector. Twenty-five nongovernmental organizations (NGO) providing STI services were also interviewed. Fewer than 45% of private and public sector general practitioners had been trained in STI treatment after the completion of their medical curriculum, and none of the traditional healers had received any formal training or information on STIs. The World Health Organization (WHO) syndromic management guidelines were followed for STI management by 29% of public and private sector doctors and 5% of traditional healers. STI drugs were available at no cost at 44% of NGOs and at some public sector hospitals. Our findings show that although providers do treat HRGs for STIs, there are significant limitations in their ability to provide these services. These deterrents include, but are not limited to, a lack of STI training of service providers, privacy and adherence to recommended WHO syndromic management guidelines, and costly diagnostic and consultation fees. PMID:19856743
Rahimtoola, Minal; Hussain, Hamidah; Khowaja, Saira N; Khan, Aamir J
BACKGROUND: Postpartum anxiety and depression is a major public health concern because of its adverse effects on the cognitive and social development of the infant. Globally postpartum depression has been widely investigated but as anxiety is a more prominent feature of postpartum depression we assessed the prevalence of anxiety and depression and their associated factors in post partum women. METHODS:
Niloufer S Ali; Badar S Ali; Iqbal S Azam
Introduction: Administering medication is one of the high risk areas for any health professional. It is a multidisciplinary process, which begins with the doctor’s prescription, followed by review and provision by a pharmacist, and ends with preparation and administration by a nurse. Several studies have highlighted a high medication incident rate at several healthcare institutions. Methods: Our study design was exploratory and evaluative and used methodological triangulation. Sample size was of two types. First, a convenient sample of 1000 medication dosages to estimate the medication error (95% CI). We took another sample from subjects involved in medication usage processes such as physicians, nurses, pharmacists, and patients. Two sets of instruments were designed via extensive literature review: a medication tracking error form and a focus group interview questionnaire. Results: Our study findings revealed 100% compliance with a computerized physician order entry (CPOE) system by physicians, nurses, and pharmacists. The main error rate was 5.5% and pharmacists contributed an higher error rate of 2.6% followed by nurses (1.1%) and physicians (1%). Major areas for improvement in error rates were identified: delay in medication delivery, lab results reviewed electronically before prescription, dispension, and administration.
Khowaja, Khurshid; Nizar, Rozmin; Merchant, Rashida J; Dias, Jacqueline; Bustamante-Gavino, Irma; Malik, Amina
BACKGROUND: The use of omega-3 fatty acids is a currently proven strategy for secondary prevention of heart disease. The prescription practices for this important nutraceutical is not currently known. It is imperative to assess the knowledge of cardiologists regarding the benefits of omega-3 fatty acids and to determine the frequency of its prescription. The aim of the study was to
Saqib A Gowani; Sana Shoukat; Ather M Taqui; Hashim M Hanif; Wasiq F Rawasia; Zeeshan Qadri; Sajid H Dhakam
BACKGROUND: Postpartum hemorrhage (PPH) remains a major killer of women worldwide. Standard uterotonic treatments used to control postpartum bleeding do not always work and are not always available. Misoprostol's potential as a treatment option for PPH is increasingly known, but its use remains ad hoc and available evidence does not support the safety or efficacy of one particular regimen. This
Nadeem F Zuberi; Jill Durocher; Rozina Sikander; Neelofur Baber; Jennifer Blum; Gijs Walraven
Background Although unintentional injuries are major causes of morbidity and mortality in less developed countries, they have received\\u000a scant attention, and injury prevention policies and programs have just begun to be addressed systemically.\\u000a \\u000a \\u000a \\u000a \\u000a Aims To reduce hazards associated with home injuries due to falls and ingestions through an injury prevention program administered\\u000a by home visitors.\\u000a \\u000a \\u000a \\u000a \\u000a Methods Non-blinded randomized controlled trial design of two
Rifat Rehmani; John C. LeBlanc
BACKGROUND: Electroconvulsive therapy (ECT) is shown to be effective in many psychiatric illnesses, but its distorted projection by the Pakistani media and its unregulated use by many physicians across the country have adversely affected its acceptability. Given this situation we aimed to assess the awareness and perceptions regarding ECT as a treatment modality among the psychiatric patients. METHODS: This was
Mehreen Arshad; Ahmad Zafir Arham; Mansoor Arif; Maria Bano; Ayisha Bashir; Munira Bokutz; Maria Maqbool Choudhary; Haider Naqvi; Murad Moosa Khan
The occurrence of rich Albian ammonite faunas in what is now northern Pakistan has been known for more than 80 years, but there has been no comprehensive account of the assemblages present. A total of 36 taxa are described below. The middle part of the Lumshiwal Formation yields Upper Aptian ammonites south of the Samana Range. Elsewhere, it yields Douvilleiceras leightonense Casey, 1962, of the lower Lower Albian Leymeriella regularis Zone and the Sonneratia perinflata and S. kitchini Subzones of the Sonneratia chalensis Zone of the northwest European sequence. The top one to two metres of the Lumshiwal yields an abundant fauna of rolled and phosphatised ammonites that includes elements from much of the Albian. Of these, Prolyelliceras gevreyi (Jacob, 1907) first appears in the lower Lower Albian Leymeriella tardefurcata Zone. The commonest ammonite is Douvilleiceras mammillatum (Schlotheim, 1813) sensu lato, which ranges from the perinflata Subzone of the chalensis Zone to the Otohoplites bulliensis Subzone of the O. auritiformis Zone of the Lower Albian. The presence of Lyelliceras pseudolyelli (Parona and Bonarelli, 1897) indicates the uppermost, pseudolyelli Subzone of the auritiformis Zone. The presence of Lyelliceras lyelli (d'Orbigny, 1841) indicates the basal Middle Albian lyelli Subzone of the Hoplites dentatus Zone. There is no evidence for the higher parts of the Middle Albian. Dipoloceras (Rhytidoceras ) sp. indicates the presence of lower Upper Albian, possibly the pricei Zone. There is evidence, in the form of specifically indeterminate Mortoniceras (Mortoniceras) sp., of a level within the inflatum to fallax Zone inteval from a single locality, but no evidence of the succeeding parts of the upper Upper Albian. The base of the Kawagarth Formation that succeeds the Lumshiwal yields lower Upper Albian Mortoniceras (M.) geometricum Spath, 1932 of the Mortoniceras pricei Zone, northwest of Darmasand in the Samana range.
Kennedy, William James; Fatmi, Ali N.
Breaking bad news can be an intimidating task for any physician. The aim of this study was to record the practices of breaking bad news to the patients by Pakistani radiologists and trainees. The radiologists and trainees attending the 26th National Radiological Conference in October 2010 in Karachi, Pakistan, were surveyed. The response rate was 76%. The respondents included residents (51%), private practicing radiologists (28%), academic radiologists (13%), and other trainees (8%). Most of the academic radiologists communicated with their patients. The daily frequency of breaking bad news by residents was noted, which was highest in the public teaching hospitals (71%). For severe abnormalities such as malignancy, 50% residents, 55% of the academic radiologists and 74% of the private practicing radiologists were very uncomfortable in disclosure of results. Differences in frequency of communication with patients were noticed with both different training levels, and different settings of practice in a developing country. PMID:24112271
Ali Khawaja, Ranish Deedar; Akhtar, Waseem; Khawaja, Ali; Irfan, Hira; Naeem, Mohammad; Memon, Mukhtiar
To understand Pakistan's complex challenges in this volatile region, an observer must not only analyze Pakistan but also their historical relationship with Afghanistan to intrinsically understand the root causes associated with Pakistani motivations and c...
C. L. Budihas
Since 2001, the West has focused on the insurgency along the Afghan- Pakistani border. The minimal achievements of Pakistan's counterinsurgency operations drew U.S. scrutiny. Skeptics accused Pakistan of not being serious about eliminating Islamic militan...
C. M. Lowe
Background During the 1980s, approximately three million people migrated from Afghanistan to Pakistan and sought refuge in several cities including the city of Karachi. After the initial settlement of the refugees, the international organizations transitioned the health care of these refugees to the two local non-profit service agencies in Karachi. One of these agencies subsidized health care to the refugees under their care and the other agency encouraged the refugees under their care to utilize governmental and non-governmental private health resources at the disposal of general public. Our objective was to measure the effect of health subsidy on the uptake of contraception among Afghan refugee women and compare them to the group of Afghan women without such a subsidy. Methodology/Principal Findings A randomly selected group of 650 married Afghan women-325 women in each group-participated in a detailed survey regarding the knowledge, attitude and practices of family planning and contraceptive use. 90 percent of the women in the health subsidy group had had heard of family planning, compared to the 45 percent in the non-subsidized group. The use of contraceptives was greater than two-fold in the former versus the latter. Results of logistic regression analysis revealed that the refugee women who had had access to subsidized healthcare were significantly more likely to use the contraceptive methods with advancing age as compared to the women in the non-health subsidy group. The difference remained significant after adjusting for other variables. Conclusions/Significance Refugee women who are provided subsidized healthcare are more inclined to use contraceptives. It is therefore important that Afghan refugee women living elsewhere in Pakistan be provided healthcare subsidy, whereby their reproductive health indicators could improve with reduced fertility. We strongly encourage facilities introducing such subsidies to refugees in resource poor settings to assess the impact through similar inquiry.
Raheel, Hina; Karim, Mehtab S.; Saleem, Sarah; Bharwani, Sulaiman
Background In Pakistan, Plasmodium vivax and Plasmodium falciparum co-exist and usage of sulphadoxine-pyrimethamine (SP) against P. falciparum exposes P. vivax to the drug leading to generation of resistant alleles. The main aim of this study was to investigate frequency distribution of drug resistance associated mutations in pvdhfr, pvdhps genes and provide baseline molecular epidemiological data on SP-associated resistance in P. vivax from southern Pakistan. Methods From January 2008 to May 2009, a total of 150 samples were collected from patients tested slide-positive for P. vivax, at the Aga Khan University Hospital, Karachi, or its collection units located in Baluchistan and Sindh Province. Nested PCR using pvdhfr and pvdhps specific primers was performed for all samples.91.3% (137/150) of the samples were tested PCR positive of which 87.3% (131/137) were successfully sequenced. Sample sequencing data was analysed and compared against wild type reference sequences. Results In dhfr, mutations were observed at codons F57L, S58R and S117N/T. Novel non-synonymous mutations were observed at codon positions N50I, G114R and E119K while a synonymous mutation was observed at codon position 69Y. In dhps, mutations were observed at codon position A383G and A553G while novel non-synonymous mutations were observed at codon positions S373T, E380K, P384L, N389T, V392D, T393P, D459A, M601I, A651D and A661V. Conclusion This is the first report from southern Pakistan on SP resistance in clinical isolates of P. vivax. Results from this study confirm that diverse drug resistant alleles are circulating within this region.
A retrospective study of 14,018 malignant tumours from northern Pakistan is presented. The data reflects the pattern of cancer distribution in this region. Among males most common sites are lymphnode, leukemia, skin, prostate, colorectal, bone and stomach and in females breast, skin, ovary, leukemia, gall-bladder, thyroid and bone. The distribution of malignant tumours in various districts of northern Pakistan and different ethnic groups like Pathans, Punjabis and Urdu speaking have also been outlined. Age standardized cancer ratio (ASCAR) was calculated to compare the data from the neighbouring countries of the region. Prostatic cancer in males and gall-bladder carcinoma in females is more frequent in our material as compared to other countries of the region. Comparison of the pattern of malignant tumours in North and South has also been highlighted. PMID:1766068
Ahmad, M; Khan, A H; Mansoor, A
Mercury concentrations in ten fish species harvested from twenty sites in the South West Coast of Pakistan, are reported. The following fish, within a limited weight range, were included in this study: Picnic seabream, Indian scad, Indian ariomma, Bigeye scad, Threadfins, Cornet fish, Lefteye flounder, Gold band goatfish, Smooth dwarf monocle bream and Half?mourning coraker. Comparative estimations were also made
Jaleel Tariq; M. Jaffar
STUDY OBJECTIVE: The objectives of this review were to: (1) assess the nature and comprehensiveness of information regarding HIV/AIDS in Pakistan; (2) to evaluate the extent of HIV/AIDS in Pakistan by epidemiological estimates; (3) to indicate the implications of the results for health policy in Pakistan and other regions at a similar stage in the epidemic. DESIGN: A structured review of published, unpublished, and government literature was undertaken to collate all available information and present a descriptive epidemiological profile of HIV/AIDS in the country. SETTING: Pakistan, a developing country in the South Asian region. National and regional information and analysis are presented in so far as the data allowed. Sample sizes varied from 1.35 million people screened at the national level to smaller studies of fewer than 100 screened. RESULTS: Data pertaining to HIV/AIDS in Pakistan showed the best national estimates of HIV prevalence as 64 per 100,000 (0.064%). Within patients with sexually transmitted diseases the seroprevalence was as high as 6100 per 100,000 (6.1%); in men with extramarital contacts, 5400 per 100,000 (5.4%) and was as low as zero in some studied populations as well. The average age of onset was reported as 30 years. It is estimated that if all incident cases of AIDS were to die, there would be at least 5000 deaths annually attributable to HIV/AIDS. CONCLUSION: Coupled with the extremely low awareness of HIV/AIDS in Pakistan, as well as growing number of cases, the AIDS epidemic is poised to take a hold in Pakistan. The presence of additional risk factors such as unscreened blood, and low condom use rates make the situation fertile for AIDS to become a major public health issue. Pakistan's health policy must be proactive in tackling this emerging health threat.
Hyder, A. A.; Khan, O. A.
Pakistan's low sociodemographic profile has changed dramatically since the 1994 International Conference on Population and Development, said the Minister for Population Welfare and Science and Technology, HE Begum Sayda Abida Hussain, during her statement at the Forum. Based on the population census of 1998, Pakistan has an annual population growth rate of 2.3%, she said. The decline may be attributed to changes in married patterns and a rapid reduction in marital fertility, she added. The contraceptive prevalence rate has gone up from only 2% in the early 1990s to about 27% in 1998. Meeting the demand for reproductive health services, reducing maternal, infant and child mortality, and promoting gender equality are high priorities for her government, she informed the participants in the Forum. In line with this priority, the Government of Pakistan has developed a new population and development policy and is working to improve the education and status of women, lower fertility, increase contraceptive prevalence, and reduce infant and maternal mortality, she told the meeting. Pakistan is expanding reproductive health services in the rural and urban areas through community-based organizations, she said. Some 50,000 women workers now provide counseling and other services to women at their doorstep. Before concluding her address, she called on donors' increased support for ICPD implementation. "The full implementation of the ICPD agenda requires resources that are beyond the capacity of a developing country like Pakistan," she said. PMID:12157873
Objective: To determine the level of awareness about five common diseases, namely: Tuberculosis (TB), Typhoid, Hepatitis B, Hepatitis C and HIV\\/AIDS among college female students of Karachi. Methods: A cross-sectional survey of female students aged 16-21 years from three colleges selected by con- venient sampling method was conducted from January to May 2004. Data was collected through a self-admin- istered
Sabeena Jalal Khan; Qudsia Anjum; Najib Ullah Khan; Faiza Ghulam Nabi
We investigated whether differences in quality of firm-level corporate governance can explain the firm-level performance in a cross-section of companies listed at Karachi Stock Exchange. Therefore, we analysed the relationship between firm-level value as measured by Tobins Q and total Corporate Governance Index (CGI) and three sub-indices : Board, Shareholdings and Ownership, and Disclosures and Transparency for a sample of
Attiya Y. Javed; Robina Iqbal
Objective: To study the awareness of 'Informed Consent', among patients presenting to Family Physicians. Method: A cross-sectional study was carried out at the Community Health Centre, Aga Khan University Hospital, Karachi in July 2002. Written Consent was taken and confidentially was assured Results: Out of the 100 patients interviewed, 80 agreed to participate in the study, forty-four men and thirty-six
H. Bhurgri; W. Qidwai
Synopsis The study deals with the entrapment of fishes in the intake of Karachi Nuclear Power Plant. A total of 62 species of marine\\u000a fishes belonging to 43 genera were observed entrapped in the seawater intake. Therapon puta, Liza waigiensis, Abudefduf septemfasciatus, and Lagoceptalus inermis were the most common. Mass mortalities of the juveniles of Sardinella sindensis were recorded in September
Mohammad Moazzam; Syed H. Niaz Rizvi
In April 1996 at the senior officials' segment of the 52nd Session of the Economic and Social Commission for Asia and the Pacific (ESCAP), a representative of Pakistan informed participants that population well-being efforts are part of the means used in implementing Pakistan's Social Action Programme. The Minister of State for Parliamentary Affairs noted that US$3 billion has been allocated to the Programme for implementation during the Eighth Five-Year Plan (1993-1998). The Programme aims to develop human resources and to improve the quality of life of the population, using life expectancy, access to primary health care, and literacy as indicators of quality of life. A key target group of the Programme is women. The Programme includes education, health, nutrition, training, and employment projects. In Pakistan, the mass media are contributing greatly in effecting the social change required to increase participation of women in economic activities. PMID:12291136
The geological setting of Pakistan in the framework of the modern concept of plate tectonics is unique in the sense that, within an area of about 800,000 km 2, critical tectonic junctions of different interacting plates and microplates are present in an environment where field exposures are excellent. Here we discuss the dynamics of these various plate boundaries. Two types of active plate boundaries are conspicuous: (1) convergent boundaries characterized by continent-continent collision, obduction, and thrusting in the northern region of the Himalaya and by oceanic crust subduction with a volcanic arc and a wide accretionary wedge in the southern region of Chagai and Makran; (2) a transform boundary, the Chaman transform zone, characterized by very large strike-slip and lesser thrusting. The Chaman transform zone connects the Makran convergence zone, where oceanic lithosphere is being subducted beneath the Lut and Afghan microplates, with the Himalayan convergence zone, where the Indo-Pakistan lithosphere is underthrusting Eurasia. The Chaman zone is at present an intracontinental plate boundary with oblique motion, characterized by north-south strike-slip faults and eastward thrusting and folding in the Kirthar-Sulaiman mountain belt. This mountain belt, the northwestern margin of the Indo-Pak subcontinent, was an Atlantic-type margin from the late Paleozoic until the Cretaceous. In the Cretaceous, the continental margin became a plate boundary; a thrust belt was formed in the Paleocene, and fragments of the oceanic crust were obducted, either as thrust sheets (Muslimbagh) or as an ophiolitic melange (Bela and Waziristan).
Farah, Abul; Abbas, Ghazanfar; De Jong, Kees A.; Lawrence, Robert D.
Beta-thalassemia is one of the most common inherited hemoglobin disorders in Pakistan. The carrier frequency is estimated to be 5.4%. To determine the spectrum of beta-globin gene defects causing beta-thalassemia, we have analyzed a representative sample of 602 alleles from six ethnic groups in Pakistan; 99.2% alleles were characterized, while 0.8% remained unidentified. The spectrum of mutations is heterogeneous and we have found 19 different mutations in all ethnic groups. The four most common mutations, IVS-I-5 (G-->C) (37.7%), codons 8/9 (+G) (21.1%), the 619 bp deletion (12.4%), and IVS-I-1 (G-->T) (9.5%), account for 80.7% of the alleles. There are differences between the ethnic groups and also between provinces. In the four provinces of Pakistan, the IVS-I-5 (G-->C) mutation is more prevalent in Sindh and Balochistan, bordering India in the south and Iran in the southwest, while the codons 8/9 (+G) mutation is more common in the Punjab and the North West Frontier Province, bordering India in the northeast and Afghanistan, respectively. The 619 bp deletion is high (46%) in Gujratis and Memons residing in the Province of Sindh, neighboring the Indian Gujrat. PMID:9730364
Khan, S N; Riazuddin, S
Pakistan's contiguity to the Gulf endows it with a strategic significance of its own that is hard to overemphasize. It has historically long-standing political, cultural, and economic relations with all the littoral states of the Gulf, which further place...
The extreme polymorphism found at some loci of the HLA system has made it an invaluable tool for population genetic analyses. In this study eight diverse ethnic groups from Pakistan were analyzed at the HLA-A locus using sequence specific primers for polymerase chain reaction (PCR-SSP) and then further typed to the allele level using a two-stage sequence specific oligonucleotide probe (SSOP) strategy. Four of these ethnic groups (Burusho, Hazara, Kalash, Pathan) were from the north and four (Baloch, Brahui, Sindhi and Parsi) were from the south of Pakistan. Nine alleles were identified as unique to a particular ethnic group within Pakistan. Maximum variation was seen in the HLA-A*02 allele family for which 11 alleles were detected in the eight Pakistani ethnic groups. The alleles that showed significant variation between the Pakistani ethnic groups include A*0101, A*0206, A*0209, A*0207, A*0217, A*1101, A*2402/09 N/11 N, A*2902, A*3301 and A*3001. A phylogenetic tree based on DA distances for HLA-A allele frequencies separated the Pakistani populations from other world populations and also separated the only Dravidian speaking population of Pakistan, the Brahui, from the remaining Indo-European speaking ethnic groups of Pakistan. PMID:12753666
Mohyuddin, A; Williams, F; Mansoor, A; Mehdi, S Q; Middleton, D
The characteristic variations of postnoon bite-out in foF2 were studied by using f-plots obtained at Karachi (geog. coord. 24.95 deg N, 67.14 deg E; mag. dip 36 deg N) from March 1976 to February 1978. It has been found that the percent occurrence of bite-out was minimum in June and maximum in February. The development of bite-out during magnetically quiet and disturbed days was also studied. The percent occurrence of bite-out was found to be greater during magnetically quiet days but the depression of foF2 was larger during magnetically disturbed days.
Aspects of the social environment, including social conditions (socio-economic status, household situations, chronic illnesses) and social relations (attitude and behaviors of relations) are major determinants of depression among women. This study evaluates the relative power of social relations and social conditions in predicting depression among pregnant women in Pakistan. In the qualitative phase of the study, social environmental determinants were identified through literature search, and experts' opinions from psychologists, psychiatrists, gynecologists, sociologists and researchers. Along with this, 79 in-depth interviews were conducted with pregnant women drawn from six hospitals (public and private) and two communities in Karachi, Pakistan. Identified determinants of depression were grouped into themes of social conditions and social relations and pregnancy-related concerns. In the study's quantitative phase, the relative power of the identified themes and categories, based on their scores for predicting depression (determined by the Center for Epidemiological Studies-Depression Scale (CES-D scale)), was determined through multivariate linear regression. Social environmental determinants of pregnant women were described under the themes and categories of (1) social relations: involving husband, in-laws and children; (2) social conditions: involving the economy, illness, life events, household work, environmental circumstances and social problems; and (3) pregnancy-related concerns i.e. symptoms of pregnancy, changes during pregnancy, dependency and concern for unborn baby. Multivariate analysis found that among these themes, social relations and pregnancy-related concerns were significantly associated with total CES-D scores. Among the categories besides increasing age and less education, husband, in-laws, household work and pregnancy symptoms were significantly associated with total CES-D scores. The study highlights the importance of social relations compared to social conditions for determining depression in pregnant women. PMID:16797813
Kazi, Ambreen; Fatmi, Zafar; Hatcher, Juanita; Kadir, Muhammad Masood; Niaz, Unaiza; Wasserman, Gail A
Introduction There is a misconception that cardiovascular disease (CVD) is the burden of wealthy nations, but, in fact, it is the leading cause of death and disability-adjusted life worldwide. Healthy diets are an essential factor in the prevention of CVD. However, promoting healthy diet is challenging, particularly for people with low-socioeconomic status (SES), because poverty is linked with many risk behaviours such as smoking, unhealthy eating and obesity. Multiple factors, cultural values and beliefs interact and make healthy eating very challenging. The effects of these factors in the context of low-SES populations with CVD are largely unknown. To address this gap, this study will examine the factors that affect decisions about consuming healthy diet in Pakistanis with low SES who suffer from CVD. Methods and analysis A qualitative method of interpretive description will be used. 25 participants will be selected from two cardiac rehabilitation (CR) centres in Karachi, Pakistan. Face-to-face interviews using a critical realist framework will be used to understand individual and contextual factors in the food choices of people with low SES and CVD. ATLAS.ti qualitative data analysis software will be used to identify themes and patterns in the interview data. Ethics and discussion Ethical approvals were received from the Ethics Review board of University of Alberta, Canada and Aga Khan University, Karachi Pakistan. The findings will generate new knowledge about which and how factors influence the food choices of Pakistanis with CVD and low SES to provide an insight into the development of an operational framework for designing interventions for prevention of CVD. For knowledge-translation purposes, we will publish the findings in highly accessed, peer-reviewed scientific and health policy journals at the national and international level. This research protocol received IRDC (International Development Research Centre) doctoral award from International Development Research Centre, Ottawa, Canada.
Barolia, Rubina Iqbal; Clark, Alexander M; Higginbottom, Gina M A
Polychlorinated naphthalenes (PCNs) are now under review by the Stockholm Convention as candidates for persistent organic pollutants (POPs) due to their persistence, toxicity, bioaccumulation, and long-range atmospheric transport. Data on PCN levels are sparse in South Asia. Atmospheric PCNs in India and Pakistan were monitored during the winter by polyurethane foam disk passive air samplers (PUF-PAS). The average concentrations were 29 pg/m(3) and 7.7 pg/m(3) in the Indian and Pakistani samples, respectively. Those concentration levels were relatively lower than the previously reported values in other Asian countries, but still considerably higher than in other sites in the world. Tri-CNs and tetra-CNs were the dominant homologues in the air, especially in India. Spatially, the PCNs were ubiquitous in the target areas, and local distribution was generally impacted by the proximity to potential sources. Major sources of PCNs in this study were the re-emission of Halowax and industrial thermal processes. Biomass burning influenced some sites in Pakistan. However, the enrichment of tri-CNs in Indian cities cannot be ascribed to either the signature of a specific source or the preferential volatilization and/or photodegradation in tropical areas. Despite this unclear issue in South Asia, the present study indicates that the potential health impact was generally comparable to that in non-urban sites worldwide. PMID:23988747
Xu, Yue; Li, Jun; Chakraborty, Paromita; Syed, Jabir Hussain; Malik, Riffat Naseem; Wang, Yan; Tian, Chongguo; Luo, Chunling; Zhang, Gan; Jones, Kevin C
Pakistan’s agriculture is almost wholly dependent on irrigation and irrigated land supplies more than 90 percent of agricultural production. Irrigation is central to Pakistan’s economy. Massive investments in irrigation contributed to the development of one of the largest Indus Basin Irrigation System. Despite heavy budgetary inputs in irrigation system, it is facing shortage of resources and suffering from operational problems.
Background: Poor care and hygiene of contact lens (CL) results in eye problems and infections. Healthcare workers have an important role in advocating correct lens care. Objectives: To determine the practices of CL care and the adverse consequences of poor CL care among healthcare workers. Setting and Design: A cross-sectional study in one public and three private sector hospitals in Karachi, Pakistan, in 2009–2010. Materials and Methods: We questioned 500 healthcare workers of all ages and both sexes, who wore CL, about compliance with advice on care and any complications due to improper hygiene practices. Ethical approval was obtained. Chi-square tests were used to determine significance and p-value less than 0.05 was considered statistically significant. Results: Of the total CL users, 385 (77%) were females. Most (75%) respondents wore CL to correct myopia, whereas 54% wore CL only occasionally. Surprisingly, only 24% knew the CL cleaning protocol. Lens solution was changed daily by 33% of users and after more than 2 weeks by 42%. Although 412 (82%) participants practised reasonable hand hygiene before inserting CL, 88 (18%) did not. Infection and eye dryness were statistically significantly (P < 0.01) associated with sex, hand-washing, and frequency of CL use. Conclusion: Noncompliance with the CL protocol was common among healthcare workers in our society. This behavior calls for targeted health education and awareness programs for healthcare workers.
Khan, Muhammed Hamza; Mubeen, Syed Muhammed; Chaudhry, Tanveer Anjum; Khan, Shaharyar Ahmed
Hi-vol air sampling equipment was run at three sites (representative of "city", "industrial" and "rural" sampling locations) in Lahore, Pakistan, for over a year. The extraction and quantitative analyses of all Lahore air samples was completed for a suite of metals, various anions, ammonium, elemental and organic carbon, as well as particle-associated polycyclic aromatic hydrocarbons (PAHs). A comparison of Lahore yearly mean pollutant concentrations with those obtained in Birmingham, U.K., shows that airborne metal levels in the Pakistani city are greater by at least one order of magnitude. The concentrations in Lahore obtained from this study are broadly in line with similar studies in Karachi as well as Calcutta and Bombay. Concentrations of particle-associated PAH are also around one order of magnitude higher than in U.K. samples, and, given the difference in ambient temperature, vapour-to-particle ratios of PAH are expected to be far higher in the hotter climate of Lahore. Minerals identified by X-ray diffraction (XRD) in the Lahore air samples were broadly in line with those determined at locations in other parts of the world.
Smith, D. J. T.; Harrison, Roy M.; Luhana, L.; Pio, Casimiro A.; Castro, L. M.; Tariq, Mohammad Nawaz; Hayat, S.; Quraishi, T.
Aims To examine the effect of the daily use of micronutrients (including zinc) or the same micronutrients plus heat inactivated lactic acid bacteria (LAB), on diarrhoea in children compared to placebo. Methods A triple blind randomised clinical trial in an urban slum of Karachi, Pakistan. Micronutrients (including zinc), micronutrients (including zinc and LAB), or placebo, were provided daily for two months to 75 young children (aged 6–12?months) identified at high risk for diarrhoea related mortality on the basis of history of at least one episode of diarrhoea in the preceding two weeks. The longitudinal prevalence of diarrhoea was defined as the percentage of days a child had diarrhoea out of the days the child was observed. Results Mean longitudinal prevalence of diarrhoea in the micronutrient–zinc group was 15% (SD?=?10%) child?days compared to 26% (SD?=?20%) child?days in the placebo group and 26% (SD?=?19%) child?days in the micronutrient–zinc–LAB group. The difference between the micronutrient–zinc–LAB and placebo groups was not significant. Conclusion The daily provision of micronutrients (including zinc) reduces the longitudinal prevalence of diarrhoea and thus may also reduce diarrhoea related mortality in young children; heat inactivated LAB has negative effects in these children.
Sharieff, W; Bhutta, Z; Schauer, C; Tomlinson, G; Zlotkin, S
This study analyzes seasonal and temporal variations in aerosol optical depth (AOD), and the impact of these variations on the properties of clouds over five cities in Pakistan, using Moderate Resolution Imaging Spectroradiometer (MODIS) data, obtained from the Terra satellite during the period (2001-2011). The obtained results indicated seasonal variation in AOD, with a high value of 2.3, in summer and low values of 0.2, in winter for the costal part of the region. The relationship between AOD and other cloud parameters, namely water vapor (WV), cloud fraction (CF), cloud optical thickness (COT), cloud liquid water path (CLWP), cloud top temperature (CTT), and cloud top pressure (CTP) were analyzed. On a temporal scale, latitudinal variations of both WV and AOD produce high correlations (>0.6) in some regions, and moderate correlations (0.4-0.6) in the other regions. An increasing trend in CF with AOD was found over urban regions in the period of observations. The CF values were higher for Lahore than the other selected regions during the whole period. During autumn and winter seasons the correlation was found to be positive between AOD and CLWP, while negative correlation was observed during the other seasons for all the selected regions. COT showed negative correlation with AOD at all locations except Karachi during spring and summer seasons.
Alam, Khan; Khan, Rehana; Blaschke, Thomas; Mukhtiar, Azam
A total of 560 samples from three areas in northeastern Baluchistan (the southern Sulaiman Range, the central Loralai Range, and the northern Kirthar Range) were analyzed using thermal demagnetization techniques. Thirteen formations of late Palaeozoic to early Tertiary age were studied palaeomagnetically. Inclinations of the obtained results show a general affinity with the Indian apparent polar wander path. Deviating declinations from the Loralai Range indicate a clockwise rotation over 50° with respect to the Indian shield. Secondary magnetization components probably of late Palaeocene to early Eocene age were consistently present in the samples from the Kirthar Range and the Sulaiman Range but were not observed in samples from the Loralai Range. Acquisition of these components is attributed to crustal upwarping during the Palaeocene, which is tentatively related to initial collision of continental Indo-Pakistan with an island arc off south central Asia. The Baluchistan data support recent palaeomagnetic results from the Indus-Tsangpo suture zone in Ladakh (NW Himalaya), which indicate that such an initial collision took place at very low northern palaeolatitudes.
Klootwijk, Chris T.; Nazirullah, Russel; de Jong, Kees A.; Ahmed, Habib
Over the past fifty years, the Pakistan Navy has developed an effective naval strategy and capability to counter the threat posed by the superior Indian Navy. It has adopted an offensive sea denial strategy that dictates primacy of submarines and maritime aircraft equipped with missiles as the main instruments of waging war at sea. The Pakistan Navy has taken lead
Staff development is very significant for the achievement of overall goals of higher education in Pakistan. The success of innovations depends largely upon the skills of instructors; but in Pakistan, the people with a simple masters degree (without any pedagogical training) are inducted as teaching staff at the university level, so it is time to…
Ullah, Muhammad Hameed; Khan, Muhammad Naeem Ullah; Murtaza, Ali; Ud Din, Muhammad Naseer
This paper summarises the findings of a 2005 doctoral study by Malik which explored to what extent participation in higher education offers empowerment to women in Pakistan. A survey instrument was used to question female faculty members and female students from 10 public universities in Pakistan; 1290 students and 290 faculty members responded.…
Malik, Samina; Courtney, Kathy
Developing countries are in critical energy crisis. Pakistan spends almost 7 billion US$ on import of fossil fuels annually to congregate its energy needs. The renewable and sustainable energy resources are best substitute to the conventional fuels and energy sources. Pakistan takes the opportunity to have almost 159 million animals producing almost 652millionkg of manure daily from cattle and buffalo
Syed S. Amjid; Muhammad Q. Bilal; Muhammad S. Nazir; Altaf Hussain
Abstract:Using a new census of private educational institutions in Pakistan together withthe population census, we present evidence that private schooling, particularly at the primary level is indeed a large and increasingly important factor in education in Pakistan both in absolute terms and relative to public schooling. While the rural-urban gap still remains, the growth trends showed a marked improvement in
Tahir Andrabi; Jishnu Das; Asim Ijaz Khwaja
A significant proportion of groundwater in south Asia is contaminated with arsenic. Pakistan has low levels of arsenic in groundwater compared with China, Bangladesh and India. A representative multi-stage cluster survey conducted among 3874 persons ?15 years of age to determine the prevalence of arsenic skin lesions, its relation with arsenic levels and cumulative arsenic dose in drinking water in
Zafar Fatmi; Iqbal Azam; Faiza Ahmed; Ambreen Kazi; Albert Bruce Gill; Muhmmad Masood Kadir; Mubashir Ahmed; Naseem Ara; Naveed Zafar Janjua
4 Abstract: Dietary trends have been found to be related with metabolic syndrome in various studies. To identify dietary patterns and study associations between the dietary patterns of subjects with high and low risk of metabolic syndrome in a Karachi based community. A group of 871 men and women were selected randomly from 532 households. Data about consumption of specific
M. Zafar; Iqbal Hydrie; Abdul Basit; A. Samad Shera; Rubina Hakeem; Akhtar Hussain; Raana Liaqat; Ali Khan
This study has been carried out employing the ionospheric data of Karachi (24.950 N, 67.140 E) for a complete Solar Cycle (1986- 96), acquired by means of Digisonde DGS-256. The visual observations of data as shown that some times Nocturnal Ionospheric Stratification at Karachi do occur. However, Nocturnal Ionospheric Stratification is very rare in middle and lower latitudes (TAN and HUANG, 1985).Therefore, the present study is undertaken. Only the night-time F-layer Stratification cases have been included in this study. It is revealed that the Nocturnal Stratification in F-layer at Karachi is mainly a post-midnight phenomenon, under both magnetically quite and disturbed condition. Though it may occur on pre and post- midnight periods, its occurrence in all seasons is frequent (95 %) in post-midnight period 0215- 0500 LT. Only 5% cases were observed in pre-midnight 0200-000 LT. Its occurrence during Solar Maximum (1989-90) is significantly greater than two Solar Minimum i.e. 1986-87 and 1995-96. However, its maximum occurrence is observed in 1992 i.e. 2 years after the Solar Maximum. The seasons in order of its maximum occurrence are Winter, Equinoxes and Summer. Nocturnal Stratification occurrence even in Winter is observed to be the highest in the month of January. Nocturnal Ionospheric Stratification at Karachi may and may not occur on a TID (Traveling Ionospheric Disturbances) night, irrespective of the fact whether the night is magnetically quite and disturbed. This shows that the Nocturnal Stratification is not caused by a TID as reported b TAN and HUANG (1985) over Wuchang (30.50 N, 11.40 E), China. Moreover, Karachi dose not lie under any of the zones of precipitation described by BOSS and SMITH (1980). Therefore, a future study on the cause of Nocturnal Ionospheric Stratification is clearly required.
Kanwal, Ambreen; Shahrukh Zaidi, Syed; Ara Zafar, Husan
An estimated 400,000 infant and 16,500 maternal deaths occur annually in Pakistan. These translate into an infant mortality rate and maternal mortality ratio that should be unacceptable to any state. Disease states including communicable diseases and reproductive health (RH) problems, which are largely preventable account for over 50% of the disease burden.The analysis of Pakistan’s maternal and child health (MCH)
S. Siddiqi; I. U. Haq; A. Ghaffar; T. Akhtar; R. Mahaini
Background The duty of a doctor to take care presumes the person who offers medical advice and treatment to unequivocally possess the skills and knowledge to do so. However, a sense of responsibility cannot be guaranteed in the absence of accountability, which in turn requires a comprehensive medical law system to be in place. Such a system is almost non-existent in Pakistan. Keeping the above in mind, we designed this study to assess the knowledge, attitudes and practices of surgeons regarding malpractice at a tertiary care center in Pakistan. Methods This was an observational, cross-sectional, questionnaire-based study conducted during a three month period from 31st March, 2012 to 30th June, 2012 at Civil Hospital, Karachi. Surgeons who were available during the period of our study and had been working in the hospital for at least 6 months were included. Self-administered questionnaires were distributed after seeking informed, written consent. The specialties included were general surgery, cardiothoracic surgery, neurosurgery, ophthalmology, otolaryngology, plastic surgery, pediatric surgery, orthopedic surgery, oral and maxillofacial surgery and gynecology and obstetrics. The study questionnaire comprised of four sections. The first section was concerned with the demographics of the surgeons. The second section analyzed the knowledge of the respondents regarding professional negligence and malpractice. The third section assessed the attitudes surgeons with regard to malpractice. The last section dealt with the general and specific practices and experiences of surgeons regarding malpractice. Results Of the 319 surgeons interviewed, 68.7% were oblivious of the complete definition of malpractice. Leaving foreign objects inside the patient (79.6%) was the most commonly agreed upon form of malpractice, whereas failure to break news in entirety (43.9%) was most frequently disagreed. In the event of a medical error, majority (67.7%) were ready to disclose their error to the patient. The most common perceived reason for not disclosing the error was threat of a claim or assault (90.9%). Majority (68.3%) believed that malpractice had a negative effect on reputation. Only 13(4.1%) had received at least one legal claim for damages. Only about three-fourths (75.5%) had the habit of frequently obtaining informed consent from the patients. 83(26.0%) expressed reluctance in accepting a case that was deemed to be difficult. Financial gains and liabilities were responsible for biased approach in 8.5% and 12.2% of the respondents respectively. Conclusion There is a dire need of programs aimed at increasing awareness among practicing surgeons in our setup. Proactive measures are required for the formulation of an efficient system of litigation. Physician accountability will not only arouse a greater sense of responsibility in them, but will also augment the confidence placed by patients on the healthcare system.
Knowledge about hepatitis B and C was assessed in a cross-sectional study of 300 adults aged 18 or older attending family medicine clinics at The Aga Khan University Hospital, Karachi. Most knew that hepatitis B and C are viral diseases that primarily affect the liver, but knowledge about risk factors for disease transmission was poor. Approximately 70% knew that hepatitis B is vaccine preventable; 60% had the misconception that hepatitis C is also vaccine preventable. The majority incorrectly believed that people with hepatitis B or C should follow the diet 'parhaiz'. Generally women knew more than men about the diseases. This study suggests that health education about these infections should be provided to the public. Family physicians can play an important role in educating people about the prevention of these diseases. PMID:15568456
Khuwaja, A K; Qureshi, R; Fatmi, Z
Background Weight misperception is the discordance between an individual’s actual weight status and the perception of his/her weight. It is a common problem in the youth population as enumerated by many international studies. However data from Pakistan in this area is deficient. Methods A multi-center cross-sectional survey was carried out in undergraduate university students of Karachi between the ages of 15–24. Participants were questioned regarding their perception of being thin, normal or fat and it was compared with their Body Mass Index (BMI). Measurements of height and weight were taken for this purpose and BMI was categorized using Asian cut offs. Weight misperception was identified when the self-perceived weight (average, fat, thin) did not match the calculated BMI distribution. Chi square tests and logistic regression tests were applied to show associations of misperception and types of misperception (overestimation, underestimation) with independent variables like age, gender, type of university and faculties. P-value of <0.05 was taken as statistically significant. Results 42.4% of the total participants i.e. 43.3% males and 41% females misperceived their weight. Amongst those who misperceived 38.2% had overestimated and 61.8% had underestimated their weight. Greatest misperception of was observed in the overweight category (91%), specifically amongst overweight males (95%). Females of the underweight category overestimated their weight and males of the overweight category underestimated their weight. Amongst the total participants, females overestimated 8 times more than males (OR 8.054, 95% CI 5.34-12.13). Misperception increased with the age of the participants (OR 1.114, 95% CI 1.041-1.191). Odds of misperception were greater in students of private sector universities as compared to public (OR 1.861, 95% CI: 1.29-2.67). Odds of misperception were less in students of medical sciences (OR 0.693, 95% CI 0.491-0.977), engineering (OR 0.586, 95% CI 0.364-0.941) and business administration (OR 0.439, 95% CI 0.290-0.662) as compared to general faculty universities. Conclusion There was marked discrepancy between the calculated BMI and the self-perceived weight in the youth of Karachi. Better awareness campaigns need to be implemented to reverse these trends.
The extreme polymorphism found at some of the loci of the HLA system has made it an invaluable tool for population genetic analyses. In this study the genetic polymorphism of six Pakistani ethnic groups was investigated at the HLA-A, -B, -C, -DRB and DQB1 loci using polymerase chain reaction with sequence specific primers. The groups included in this study are the Baloch, Brahui and Sindhi from the south and the Burusho, Kalash and Pathan from the north of Pakistan. The allele frequencies, three-locus haplotype frequencies for HLA-A, -C, -B and HLA-A, -B, -DRB1 are given. Variation in the allele and haplotype distribution between the six Pakistani ethnic groups was observed. A phylogenetic tree and correspondence analysis based on HLA-A, -B, -C, -DRB1 and -DQB1 allele frequencies revealed the Kalash population to be distinct from the remaining Pakistani populations. The Baloch and Brahui were closely related to one another. The Sindhi were closer to the Pathan and Burusho populations than to the neighboring Baloch and Brahui populations, indicating admixture between the northern and southern populations of Pakistan. A phylogenetic tree and correspondence analysis comparing the Pakistani populations with various other world populations showed that the Pakistani ethnic groups lie within the cluster of Asian Indian populations. The three-locus haplotypes found in the Pakistani populations suggest an influence from Caucasian and Oriental populations. PMID:12445319
Mohyuddin, A; Ayub, Q; Khaliq, S; Mansoor, A; Mazhar, K; Rehman, S; Mehdi, S Q
Explains innovations taking place in large English-as-a-foreign-language classrooms in Pakistan. Describes a pilot project that investigated ways of bringing out effective learning in large classes. (Author/VWL)
The present study is an effort to document bio-geographical distribution for Zygoptera of Pakistan. Damselflies were collected throughout the country and territory of Azad Jammu and Kashmir during 2004-2009. A total of 2692 specimens were collected yielding 9 families, 21 genera, and 48 species and subspecies. Three of these species, Libellago lineata lineata (Burmeister), Elattoneura atkinsoni (Selys), and Elattoneura souteri (Fraser), are recorded for the first time from Pakistan. Distribution, habitats, previous records, and Zoogeographic affiliation for all collected taxa are discussed. Help was also taken from published literature on Zygoptera of Pakistan, and specimens housed at National Insect Museum were also studied. In total, 53 species are accounted for providing an updated record for all modern taxa of damselfly fauna of Pakistan. PMID:22221175
Zia, Ahmed; Naeem, Muhammad; Rafi, Muhammad Ather; Naz, Falak; Afsheen, Sumera; Ilyas, Muhammad
The present study is an effort to document bio-geographical distribution for Zygoptera of Pakistan. Damselflies were collected throughout the country and territory of Azad Jammu and Kashmir during 2004–2009. A total of 2692 specimens were collected yielding 9 families, 21 genera, and 48 species and subspecies. Three of these species, Libellago lineata lineata (Burmeister), Elattoneura atkinsoni (Selys), and Elattoneura souteri (Fraser), are recorded for the first time from Pakistan. Distribution, habitats, previous records, and Zoogeographic affiliation for all collected taxa are discussed. Help was also taken from published literature on Zygoptera of Pakistan, and specimens housed at National Insect Museum were also studied. In total, 53 species are accounted for providing an updated record for all modern taxa of damselfly fauna of Pakistan.
Zia, Ahmed; Naeem, Muhammad; Rafi, Muhammad Ather; Naz, Falak; Afsheen, Sumera; Ilyas, Muhammad
The book presents detailed and exhaustive information about the universities of Pakistan in the public and the private sectors. It provides basic information on the brief history of each university; its jurisdiction; names of principal officers and facult...
Background The rationale for use of drugs during pregnancy requires a careful assessment as in addition to the mother, the health and life of her unborn child is also at stake. Information on the use of drugs during pregnancy is not available in Pakistan. The aim of this study was to evaluate the patterns of drug prescriptions to pregnant women in tertiary care hospitals of Pakistan. Methods This was a cross-sectional study conducted at five tertiary care hospitals of Pakistan. Copies of outpatient medicinal prescriptions given to pregnant patients attending the antenatal clinics were collected. The drugs were classified according to the pharmacological class and their teratogenic potential. Results All the pregnant women attending the antenatal clinics received a prescription containing at least one drug. A total of 3769 distinct prescriptions given to different women were collected. Majority of the women who received the prescriptions belonged to third trimester (55.4%) followed by second (33.6%) and first trimester (11.0%). On an average, each prescription contained 1.66 ± 0.14 drugs. The obstetricians at Civil Hospital, Karachi and Chandka Medical College Hospital, Larkana showed a tendency of prescribing lesser number of drugs compared to those in other hospitals. Anti-anemic drugs including iron preparations and vitamin and mineral supplements (79.4%) were the most frequently prescribed drugs followed by analgesics (6.2%) and anti-bacterials (2.2%). 739 women (19.6%) received prescriptions containing drugs other than vitamin or mineral supplements. Only 1275 (21.6%) of all the prescribed drugs (n = 6100) were outside this vitamin/mineral supplement class. Out of these 1275 drugs, 29 (2.3%) drugs were prescribed which are considered to be teratogenic. Misoprostol was the most frequently prescribed (n = 6) among the teratogenic drugs followed by carbimazole (n = 5) and methotrexate (n = 5). Twenty nine pregnant women (0.8% of all the women studied) were prescribed these teratogenic drugs. Conclusion Less than one percent of the pregnant women attending tertiary care hospitals in Pakistan are prescribed teratogenic drugs. The prescribing practices of Pakistani physicians are similar to those in western countries.
Rohra, Dileep K; Das, Nirmal; Azam, Syed I; Solangi, Nazir A; Memon, Zahida; Shaikh, Abdul M; Khan, Nusrat H
The earthquake of 8 October, 2005, severely affected the existing drinking water-supply and sanitation systems in five districts of Pakistan. Wells and springs reported significant reduction in yield with water sources buried under land slides along with considerable damage of sewerage networks, drains, and related infrastructure. In response to the tragedy, the Government of Pakistan, in collaboration with international development
M. T. Amin; M. Y. Han
Background & Aims There is a paucity of data on the impact of hepatitis D virus (HDV) in patients with hepatitis B virus (HBV) infection from South Asia. We studied the impact of HDV co-infection on virological and clinical characteristics. Methods We collected data of 480 patients with HBsAg positive and a detectable HBV DNA PCR, who presented to the Aga Khan University, Karachi and Isra University in Hyderabad, Pakistan in the last 5 years. HDV co-infection was diagnosed on the basis of anti-HDV. ALT, HBeAg, HBeAb and HBV DNA PCR quantitative levels were checked in all patients. We divided all patients into two groups based on anti-HDV, and compared their biochemical, serological & virological labs and clinical spectrum. Clinical spectrum of disease included asymptomatic carrier (AC), chronic active hepatitis (CAH), immuno-tolerant phase (IP), and compensated cirrhosis (CC). Results HDV co-infection was found in 169 (35.2%). There were 164 (34.6%) HBeAg positive and 316 (65.4%) HBeAg negative patients. Mean ALT level was 66 ± 73 IU. 233 (48.5%) had raised ALT. HBV DNA level was ? 10e5 in 103(21.5%) patients. Overall, among HBV/HDV co-infection, 146/169 (86.4%) had suppressed HBV DNA PCR as compared to 231/311 (74.3%) patients with HBV mono-infection; p-value = 0.002. Among HBeAg negative patients 71/128(55.5%) had raised ALT levels among HBV/HDV co-infection as compared to 71/188 (37.8%) with HBV mono-infection (p-value = 0.002); levels of HBV DNA were equal in two groups; there were 27/128 (21%) patients with CC among HBV/HDV co-infection as compared to 23 (12%) in HBV mono-infection (p-value = 0.009); there were less AC (p-value = 0.009) and more CAH (p-value = 0.009) among HBV/HDV co-infection patients. Among HBeAg positive patients, serum ALT, HBV DNA levels and the spectrum of HBV were similar in the two groups. Conclusions HBV/HDV co-infection results in the suppression of HBV DNA. A fair proportion of HBV/HDV co-infected patients with HBeAg negative have active hepatitis B infection and cirrhosis as compared to those with mono-infection.
A magnitude 7.6 earthquake that shook the western Himalayas on 8 October killed at least 23,000 in Pakistan and 1,400 in India, injured more than 50,000 people, and left more 2.5 million people homeless across the Kashmir region. The official death toll could exceed 30,000, placing this among most deadly earthquakes to have ever occurred on the Indian subcontinent.Scientists warn that, given the lack of development and poor construction in the area, future earthquakes in more densely populated areas could be devastating. David Simpson, president of the Incorporated Research Institutes for Seismology, said the 8 October quake ‘was a terrible disaster, but not to the level of what could happen in the future. This is yet again another warning message of things to come.”
Mesozoic to Cenozoic biostratigraphy of NW Pakistan has been conducted in order to document the temporal and spatial relationship between different marine strata with the help of remote sensing and Geographic Information Systems (GIS). These relationships were then used to help distinguish different tectonostratigraphic units in the Waziristan and the Kurram areas located at the northwestern margin of the Indo-Pakistani craton. Extensive biostratigraphic work in the Waziristan and Kurram areas enabled to distinguish five tectonostratigraphic units and two significant unconformities in the study area. Different foraminiferal zones from Early Jurassic to Middle Eocenewere developed, although due to random samples these zones are not continuous in the sedimentary record. However continuous biozonation from the Late Paleocene P4 to the Early Eocene P9 (Bolli, 1985) biozone was observed. It is observed that the Santonian stage is generally missing in the sedimentary sequence, and it is only found in the olistoliths. This implies that during the Campanian stage there was instability in the shelf due to ophiolite obduction, which caused the displacement of the Santonian strata. The absence of Early Paleocene (Zone P1--P3) microfauna is suggested by rapid subsidence of the NW Indian shelf beginning in the early Paleocene. Moreover, index fossils for the Palpha, P1a, b, c, d, P2 and P3 biozones are absent in the melange of the Thal area suggesting regional uplift during the Paleocene. The presence of Planorotalites pseudomenardii P4 zone microfauna above the unconformable Upper Cretaceous Kahi melange strata suggest the India-Asia collision age between 58 Ma--56 Ma. Foraminiferal biostratigraphy of upper Cretaceous olistoliths was conducted from the Mughal Kot gorge, Baluchistan, Pakistan in order to reveal the depositional history of Late Santonian aged (Dicarinella asymmetrica zone) olistoliths and associated upper Cretaceous to early Tertiary Indo-Pakistani shelf strata. These olistoliths are embedded in uppermost Campanian strata of the Mughal Kot Formation. Similar olistostromes are found at approximately the same stratigraphic level across a broad region of NW Pakistan. These olistostromes are similar in age to radiometrically constrained deformation in the Zhob and Waziristan ophiolites 50 and 90 km to the west and northwest respectively and may record incipient underthrusting of the NW Indo Pakistani craton beneath oceanic crust now in Waziristan and northern Baluchistan. This Campanian event precedes stratigraphically constrained Paleocene and Early Eocene deformation in Parachinar, Orakzai and the Attock-Cherat Ranges, which is interpreted as the collision of NW Indo-Pakistan with Asia and the Kabul Block. A turbiditic depositional environment of the Mughal Kot Formation was developed due to the regional collapse of the NW Indo-Pakistani shelf margin during the Late Campanian (G. calcarata zone ˜80--74 Ma), possibly as a result of ophiolite obduction as the Indo-Pakistani plate moved beneath Tethyan oceanic crust.
Shafique, Naseer Ahmed
A stable, democratic, prosperous Pakistan is considered vital to U.S. interests. U.S. concerns regarding Pakistan include regional and global terrorism, Afghan stability, democratization and human rights protection, the ongoing Kashmir problem and Pakista...
K. A. Kronstadt
Background The aims of this study were to evaluate the awareness of and attitudes towards the 2005 European Society of Cardiology (ESC) guidelines for Heart Failure (HF) of the cardiologists in Pakistan and assess barriers to adherence to guidelines. Methods A cross-sectional survey was conducted in person from March to July 2009 to all cardiologists practicing in 4 major cities in Pakistan (Karachi, Lahore, Quetta and Peshawar). A validated, semi-structured questionnaire assessing ESC 2005 Guidelines for HF was used to obtain information from cardiologists. It included questions about awareness and relevance of HF guidelines (See Additional File 1). Respondents' management choices were compared with those of an expert panel based on the guidelines for three fictitious patient cases. Cardiologists were also asked about major barriers to adherence to guidelines. Results A total of 372 cardiologists were approached; 305 consented to participate (overall response rate, 82.0%). The survey showed a very high awareness of CHF guidelines; 97.4% aware of any guideline. About 13.8% considered ESC guidelines as relevant or very relevant for guiding treatment decisions while 92.8% chose AHA guidelines in relevance. 87.2% of respondents perceived that they adhered to the HF guidelines. For the patient cases, the proportions of respondents who made recommendations that completely matched those of the guidelines were 7% (Scenario 1), 0% (Scenario 2) and 20% (Scenario 3). Respondents considered patient compliance (59%) and cost/health economics (50%) as major barriers to guideline implementation. Conclusion We found important self reported departures from recommended HF management guidelines among cardiologists of Pakistan.
This paper evaluates possible scenarios for Pakistan's uranium enrichment and plutonium production programs since the late 1970s by using Pakistan's supply of natural uranium as a constraint. Since international sanctions have prevented Pakistan from importing uranium for decades, it has had to rely on domestic uranium production—currently estimated as approximately 40 tons a year. The paper divides the development of
ZIA MIAN; A. H. NAYYAR; R. RAJARAMAN
Over the past four years, Pakistan's higher-education budget has increased more than sevenfold, to about $449-million. While that amounts to only 0.5 percent of Pakistan's gross domestic product, it is a big improvement from the days of barely enough to pay "measly salaries and basic bills." But for students, along with many of Pakistan's most…
Baseline for Monitoring Water Resources Along Kabul and Indus Rivers of Pakistan for Potential Terrorist Contamination Terrorism has temporarily constrained the dynamism of the world it was enjoying before September 11, 2001, but also has opened avenues for people of all ethnicities, creeds, and professions to join hands in combating it. Scientific efforts to combat terrorism are likely to lead to better use of existing scientific knowledge as well as to discoveries that will increase world organization, interconnectivity, and peace promotion. Afghanistan and surrounding regions are major focal points for current anti-terrorist activities of the USA and its allies, including Pakistan. The United States, Pakistan, and Afghanistan have shared many similar political objectives, as well as differences, in cold war and post-cold-war eras, reflected by variable provisions of material aid. It is well recognized that understanding Afghanistan requires comprehension of the Pakistan situation as well, especially for common resources. Water is paramount because it is absolutely vital, but can be contaminated by internal or cross-border terrorism. The Kabul and Indus rivers originate in the Hindu Kush - Himalaya ranges. The Kabul River flows from Afghanistan into Pakistan, and after irrigating Peshawar basin, joins the Indus. The Indus, after its origin in Tibet and flow through the Indian Himalaya, enters Pakistan and flows south as the irrigation lifeblood of the country. Any terroristic addition of radioactive nuclides or contaminants to either river could dramatically impact the dependent riverine ecologies. Monitoring cells thus need to be established at locations in Afghanistan and Pakistan to assess base-line river variances for possible future contamination by terrorists. This paper presents a general view and the physical and chemical parameters of parts of the two rivers, and of the surrounding underground water in Peshawar Basin, including pH, conductivity, total dissolved solids, major elements, trace elements, heavy metals and oxygen isotopes. Data are mostly within allowed limits of US-EPA for surface and underground water. Oxygen isotopes confirm the dangers of contamination from the Kabul River to underground water. Heavy metals were determined through spectrophotometery, however, modern geophysical methods are cheaper and quicker and can be applied at monitoring stations. With Kabul river and its surroundings as examples, similar theory and practice can be applied to rivers within the United States and other parts of the world.
Hamidullah, S.; Tariq, S.; Shah, M. T.; Bishop, M. P.; Kamp, U.; Olsenholler, J.
Background and Objective: Co-existence of myeloproliferative disorders (MPD) and Janus associated kinase 2 mutation (JAK2 V617F) is a well-established fact. Only few case reports are available showing presence of JAK2 V617F mutation in chronic myeloid leukemia (CML). Purpose of this study was to determine the frequency of JAK2 V617F mutation in Philadelphia Chromosome positive (Ph (+)) CML patients in Pakistan. Methods: The study was conducted from August 2009 to July 2010 at Civil Hospital and Baqai Institute of Hematology (BIH) Karachi. Blood samples from 25 patients with CML were collected. Multiplex reverse transcription polymerase chain reaction (RT-PCR) was performed for Breakpoint Cluster Region - Abelson (BCR-ABL) rearrangement. Conventional PCR was performed for JAK2 V617F mutation on BCR-ABL positive samples. Results: All 25 samples showed BCR-ABL rearrangement. Out of these 11 samples (44%) had JAK2 V617F mutation; the remaining 14 (56%) cases showed JAK2 617V wild type. Conclusion: It is concluded that the co-existence of Ph (+)CML and JAK2 V617F mutation is possible. PMID:24639858
Tabassum, Najia; Saboor, Mohammed; Ghani, Rubina; Moinuddin, Moinuddin
Background Physician migration, also known as “brain drain,” results from a combination of a gap in the supply and demand in developed countries and a lack of job satisfaction in developing countries. Many push and pull factors are responsible for this effect, with media and internet playing their parts. Large-scale physician migration can pose problems for both the donor and the recipient countries, with a resulting reinforcement in the economic divide between developed and developing countries. The main objectives of our study were to determine the prevalence of migration intentions in medical undergraduates, to elucidate the factors responsible and to analyze the attitudes and practices related to these intentions. Methods This was a cross-sectional, observational, questionnaire-based study, conducted at Dow Medical College of Dow University of Health Sciences, Karachi, between January, 2012 and May, 2012. A total of 323 students responded completely. The questionnaire consisted of 3 sections, and was aimed at collecting demographic details, determining students’ migratory intentions, evaluating reasons for and against migration and assessing attitudes and practices of students related to these intentions. Results Out of 323 respondents, 195 wanted to pursue their careers abroad, giving a prevalence rate of 60.4% in our sample. United States was the most frequently reported recipient country. The most common reasons given by students who wished to migrate, in descending order, were: lucrative salary abroad followed by quality of training, job satisfaction, better way of life, relatives, more opportunities, better working environment, terrorism in Pakistan, harassment of doctors in Pakistan, desire to settle abroad, more competition in Pakistan, better management, peer pressure, longer working hours in Pakistan, religious reasons, parent pressure, political reasons and favoritism in Pakistan. A considerable number of respondents had already started studying for licensing examinations, and were also planning of gaining clinical experience in their desired country of interest. Conclusion Physician migration is a serious condition that requires timely intervention from the concerned authorities. If considerable measures are not taken, serious consequences may follow, which may pose a threat to the healthcare system of the country.
Data of the Pakistan Contraceptive Prevalence Survey of 1984-85 were used to determine whether there are any differentials in fertility levels by age at marriage, educational level, work status, region of residence (province), and place of residence (urban or rural) in Pakistan. Both bivariate and multivariate analyses examined the effects of these factors on fertility. The technique of Multiple Classification Analysis (MCA) was used to determine the net effect of each factor. Among the predictors, age at marriage was the most significant variable, followed by the husband's education, woman's education, husband's occupation, woman's work status, region, and place of residence. Among the demographic variables, age and age at marriage were the most important determinants of fertility. Among the socioeconomic variables, the educational level of both husband and wife were important determinants of cumulative fertility. Age at marriage was inversely related to fertility. The mean number of children ever born was 5.1 for those who married below age 16 vs. 4.1 for age at marriage 16-19, and 3.6 for 20-24. In the multivariate analysis the effect of age at marriage was the strongest as a predictor. Education had a negative effect on fertility. The mean number of children ever born to women with no education was 4.5; to women with primary education, 3.6; to women with secondary education, 3.2; and to women with tertiary education, 2.3. Women working as salaried employees had higher fertility (5.0) compared to women working in family business or at home (4.2). Women whose husbands worked as salaried employees had comparatively lower fertility than those whose husbands were working in their own business or in agriculture. The region of residence did not yield wide differentials. Furthermore, place of residence did not reveal any significant difference in fertility. The mean number of children was marginally higher among urban women (4.4) compared to their rural counterparts (4.2), indicating that the fertility transition has not started yet. PMID:12346202
The study aimed to determine the hazardous health effects of pesticides exposure in the factory workers by measuring plasma cholinesterase (PChE), pesticides residues, and renal and hepatic biochemical markers. In addition, we also assessed the knowledge, attitudes, and safety practices adopted by the industrial workers. The study was conducted in three different sizes of factories located in Lahore (large), Multan (medium), and Karachi (small) in Pakistan. Total 238 adult males consisting of 184 pesticide industrial workers (exposed group) from large-sized (67), medium-sized (61), small-sized (56) industrial formulation factories, and 54 controls (unexposed) were included in the study. All the participants were male of aged 18 to 58 years. PChE levels were estimated by Ellmann's method. Plasma pesticides residue analysis was performed by using reverse phase C-18 on high-performance liquid chromatograph and GC with NPD detector. Plasma alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine, urea, and gamma glutamyltransferase (GGT) were measured on Selectra E auto analyzer. Plasma and C-reactive protein was analyzed by Immulite 1000. The results revealed a significant decrease in plasma post exposure PChE levels (<30%) as compared to baseline in the workers of small (29%) and medium (8%) industrial units (p < 0.001). Plasma cypermethrin, endosulfan, imidacloprid, thiodicarb, carbofuran, and methamidophos levels were found to be higher than allowable daily intake. Serum AST, ALT, creatinine GGT, malondialdehyde, total antioxidant, and CRP were significantly raised among the workers of small and medium pesticide formulation factories as compared to large industrial unit and controls (p < 0.001). The study demonstrated that unsafe practices among small- and medium-sized pesticides industrial workers cause significant increase in pesticide exposure, oxidative stress, and derangement of hepatic and renal function. PMID:19669582
Khan, Dilshad Ahmed; Hashmi, Imran; Mahjabeen, Wajiha; Naqvi, Tatheer A
Background Since a decade, low and middle income countries have a rising trend of contracting their primary healthcare services to NGOs. In Pakistan, public sector often lacks capacity to effectively & equitably manage the healthcare services. It led the government to outsource the administration of primary health care services to a semi-autonomous government entity i.e. Peoples’ Primary Healthcare Initiative (PPHI). This small scale study has assessed the quality of healthcare services at the contracted Basic Health Units (BHUs) with the PPHI and compared it with those managed by the local district government in the province of Sindh. Methods A cross-sectional mix methods survey was conducted in November 2011. Two BHUs of each type were selected from the districts Karachi and Thatta in Sindh province. BHUs were selected randomly and a purposive sampling technique was used to recruit the study participants at the two study sites. Focus group discussions were conducted with patients visiting the facility while in-depth interviews were conducted with service providers. An observation based resource availability checklist was also administered. Results There was a significant difference between the PPHI and the district government administered BHUs with regard to infrastructure, availability of essential medicines, basic medical appliances, mini-lab facilities and vehicles for referrals. These BHUs were found to have sufficient number of trained clinical staff and no punctuality and retention issues whatsoever. The district government administered BHUs presented a dismal picture in all the aspects. Conclusion Out-sourcing of primary healthcare facilities has resulted in significantly improved certain aspects quality and responsiveness of primary healthcare services. This strategy is likely to achieve an efficient and perhaps an equitable healthcare delivery in low and middle income countries where governments have limited capacity to manage healthcare services.
Spectral analysis of the digital data of the Bouguer anomaly of North India including Ganga basin suggest a four layer model with approximate depths of 140, 38, 16 and 7 km. They apparently represent lithosphere-asthenosphere boundary (LAB), Moho, lower crust, and maximum depth to the basement in foredeeps, respectively. The Airy's root model of Moho from the topographic data and modeling of Bouguer anomaly constrained from the available seismic information suggest changes in the lithospheric and crustal thicknesses from ˜126-134 and ˜32-35 km under the Central Ganga basin to ˜132 and ˜38 km towards the south and 163 and ˜40 km towards the north, respectively. It has clearly brought out the lithospheric flexure and related crustal bulge under the Ganga basin due to the Himalaya. Airy's root model and modeling along a profile (SE-NW) across the Indus basin and the Western Fold Belt (WFB), (Sibi Syntaxis, Pakistan) also suggest similar crustal bulge related to lithospheric flexure due to the WFB with crustal thickness of 33 km in the central part and 38 and 56 km towards the SE and the NW, respectively. It has also shown the high density lower crust and Bela ophiolite along the Chamman fault. The two flexures interact along the Western Syntaxis and Hazara seismic zone where several large/great earthquakes including 2005 Kashmir earthquake was reported. The residual Bouguer anomaly maps of the Indus and the Ganga basins have delineated several basement ridges whose interaction with the Himalaya and the WFB, respectively have caused seismic activity including some large/great earthquakes. Some significant ridges across the Indus basin are (i) Delhi-Lahore-Sargodha, (ii) Jaisalmer-Sibi Syntaxis which is highly seismogenic. and (iii) Kachchh-Karachi arc-Kirthar thrust leading to Sibi Syntaxis. Most of the basement ridges of the Ganga basin are oriented NE-SW that are as follows (i) Jaisalmer-Ganganagar and Jodhpur-Chandigarh ridges across the Ganga basin intersect Himalaya in the Kangra reentrant where the great Kangra earthquake of 1905 was located. (ii) The Aravalli Delhi Mobile Belt (ADMB) and its margin faults extend to the Western Himalayan front via Delhi where it interacts with the Delhi-Lahore ridge and further north with the Himalayan front causing seismic activity. (iii) The Shahjahanpur and Faizabad ridges strike the Himalayan front in Central Nepal that do not show any enhanced seismicity which may be due to their being parts of the Bundelkhand craton as simple basement highs. (iv) The west and the east Patna faults are parts of transcontinental lineaments, such as Narmada-Son lineament. (v) The Munghyr-Saharsa ridge is fault controlled and interacts with the Himalayan front in the Eastern Nepal where Bihar-Nepal earthquakes of 1934 has been reported. Some of these faults/lineaments of the Indian continent find reflection in seismogenic lineaments of Himalaya like Everest, Arun, Kanchenjunga lineaments. A set of NW-SE oriented gravity highs along the Himalayan front and the Ganga and the Indus basins represents the folding of the basement due to compression as anticlines caused by collision of the Indian and the Asian plates. This study has also delineated several depressions like Saharanpur, Patna, and Purnia depressions.
Ravi Kumar, M.; Mishra, D. C.; Singh, B.
Background The prevalence of anxiety/depression is quite high during the perinatal period but unfortunately its detection and treatment have been less than satisfactory. Moreover, many women are reluctant to take pharmacotherapy for fear of excretion of drugs into their breast milk. This study assesses the effectiveness of counseling from minimally trained community health workers in reducing anxiety/depression, the rate of recurrence and the interval preceding recurrence in women during first two and a half years after childbirth. Methods In a quasi-experimental study, community women from two under-privileged communities were trained in data gathering, teaching healthy child-rearing practices, basic counseling skills, and screening for anxiety/depression by using an indigenously developed questionnaire, the Aga Khan University Anxiety and Depression Scale (AKUADS). The diagnosis was further confirmed by a clinical psychologist using DSM IV criteria. After obtaining consent, 420 women were screened and 102 were identified as having anxiety/depression. Screening was carried out after 1, 2, 6, 12, 18, 24 and 30 months of a live birth. Only 62 out of 102 agreed to be counseled and received eight weekly sessions. AKUADS was re-administered at 4 weeks and 8 weeks after the beginning of counseling; this was followed by the clinical psychologist's interview for confirmation of response. After recovery, screening was continued every 3 months for detection of recurrence throughout the study period. Out of the women who had declined counseling 12 agreed to retake AKUADS after 4 and 8 weeks of diagnosis. Independent samples t-test, chi-square test, Repeated Measures ANOVA and Kaplan Meier technique were used for the analysis. Results A significant decline in level of anxiety/depression was found in both the counseled and the non-counseled groups at 4 and 8 weeks (p-value < 0.001) but the counseled group fared better than the non-counseled for recovery, reduction in the rate of recurrence and increase in the duration before relapse. Conclusions As our results cannot be generalized; further studies need to be carried out, to assess the benefit of incorporating minimal counseling skills in the training of community health workers.
Project-based learning (PBL) is a teaching and learning strategy, which is gaining popularity rapidly among educators, teachers, parents and students. PBL is not a new concept: it is a well-established teaching strategy in certain parts of the world, but in some it is either alien or newly introduced. This study was conducted in one of the schools in the context
Syed Wali Shah
Agriculture plays an important role in the national economy of Pakistan, where most of the rapidly increasing population resides in rural areas and depends on agriculture for subsistence. Biotechnology has considerable potential for promoting the efficiency of crop improvement, food production, and poverty reduction. Use of modern biotechnology started in Pakistan since 1985. Currently, there are 29 biotech centers/institutes in the country. However, few centers have appropriate physical facilities and trained manpower to develop genetically modified (GM) crops. Most of the activities have been on rice and cotton, which are among the top 5 crops of Pakistan. Biotic (virus/bacterial/insect) and abiotic (salt) resistant and quality (male sterility) genes have already been incorporated in some crop plants. Despite acquiring capacity to produce transgenic plants, no GM crops, either produced locally or imported, have been released in the country. Pakistan is signatory to the World Trade Organization, Convention on Biological Diversity, and Cartagena protocols. Several legislations under the Agreement on Trade-Related Aspects of Intellectual Property Rights have been promulgated in the country. National Biosafety Guidelines have been promulgated in April 2005. The Plant Breeders Rights Act, Amendment in Seed Act-1976, and Geographical Indication for Goods are still passing through discussion, evaluation, and analysis phases. Meanwhile, an illegal GM crop (cotton) has already sneaked into farmer's field. Concerted and coordinated efforts are needed among various ministries for implementation of regulation and capacity building for import/export and local handling of GM crops. Pakistan could easily benefit from the experience of Asian countries, especially China and India, where conditions are similar and the agriculture sector is almost like that of Pakistan. Thus, the exchange of information and experiences is important among these nations. PMID:17955999
Background Chronic kidney disease (CKD) is being increasingly recognized as a leading public health problem. However, there are limited data available with respect to prevalence of CKD in Pakistan, a developing South Asian country. The study presents the baseline findings of prevalence and risk factors for adult kidney disease in a Pakistani community cohort. Methods A total of 667 households were enrolled between March 2010 and August 2011 including 461 adults, aged 15 and older. Mild kidney disease was defined as estimated Glomerular Filtration Rate (eGFR) ?60 ml/min with microalbuminuria ? 30 mg/dl and moderate kidney disease was defined as eGFR <60 ml/min (with or without microalbuminuria). Results The overall prevalence of kidney disease was 16.6% with 8.6% participants having mild kidney disease and 8% having moderate kidney disease. Age was significantly associated with kidney disease (p?0.0001). The frequency of diabetes, hypertension and smoking differed significantly among the three groups, i.e., no kidney disease, mild kidney disease and moderate kidney disease. Conclusion Our study results suggest that the burden of kidney disease in this population is found considerable and comparable to neighboring developing countries. We believe that these results have critical implications on health and economics of these countries and due to the epidemic of diabetes, hypertension, cardiovascular disease, smoking and association with worsening poverty, further rapid growth is expected. There is an urgent need for early recognition and prevention strategies based on risk factors and disease trends determined through longitudinal research.
This study examines the influence of the mid-latitude circulation on the surface heat low (HL) and associated monsoon rainfall over northwestern India and Pakistan using the ERA40 data and high resolution (T106L31) climate model ECHAM5 simulation. Special emphasis is given to the surface HL which forms over Pakistan and adjoining areas of India, Iran and Afghanistan during the summer season. A heat low index (HLI) is defined to depict the surface HL. The HLI displays significant correlations with the upper level mid-latitude circulation over western central Asia and low level monsoon circulation over Arabian Sea and acts as a bridge connecting the mid-latitude wave train to the Indian summer monsoon. A time-lagged singular value decomposition analysis reveals that the eastward propagation of the mid-latitude circumglobal wave train (CGT) influences the surface pressure anomalies over the Indian domain. The largest low (negative) pressure anomalies over the western parts of the HL region (i.e., Iran and Afghanistan) occur in conjunction with the upper level anomalous high that develops over western-central Asia during the positive phase of the CGT. The composite analysis also reveals a significant increase in the low pressure anomalies over Iran and Afghanistan during the positive phase of CGT. The westward increasing low pressure anomalies with its north-south orientation provokes enormous north-south pressure gradient (lower pressure over land than over sea). This in turn enables the moist southerly flow from the Arabian Sea to penetrate farther northward over northwestern India and Pakistan. A monsoon trough like conditions develops over northwestern India and Pakistan where the moist southwesterly flow from the Arabian Sea and the Persian Gulf converge. The convergence in association with the orographic uplifting expedites convection and associated precipitation over northwestern India and Pakistan. The high resolution climate model ECHAM5 simulation also underlines the proposed findings and mechanism.
Saeed, Sajjad; Müller, Wolfgang A.; Hagemann, Stefan; Jacob, Daniela
Background Vaccines are the most effective public health intervention. Expanded Program on Immunization (EPI) provides routine vaccination in developing countries. However, vaccines that cannot be given in EPI schedule such as typhoid fever vaccine need alternative venues. In areas where school enrolment is high, schools provide a cost effective opportunity for vaccination. Prior to start of a school-based typhoid vaccination program, interviews were conducted with staff of educational institutions in two townships of Karachi, Pakistan to collect baseline information about the school system and to plan a typhoid vaccination program. Data collection teams administered a structured questionnaire to all schools in the two townships. The administrative staff was requested information on school fee, class enrolment, past history of involvement and willingness of parents to participate in a vaccination campaign. Results A total of 304,836 students were enrolled in 1,096 public, private, and religious schools (Madrasahs) of the two towns. Five percent of schools refused to participate in the school census. Twenty-five percent of schools had a total enrolment of less than 100 students whereas 3% had more than 1,000 students. Health education programs were available in less than 8% of public schools, 17% of private schools, and 14% of Madrasahs. One-quarter of public schools, 41% of private schools, and 43% of Madrasahs had previously participated in a school-based vaccination campaign. The most common vaccination campaign in which schools participated was Polio eradication program. Cost of the vaccine, side effects, and parents' lack of information were highlighted as important limiting factors by school administration for school-based immunization programs. Permission from parents, appropriateness of vaccine-related information, and involvement of teachers were considered as important factors to improve participation. Conclusions Health education programs are not part of the regular school curriculum in developing countries including Pakistan. Many schools in the targeted townships participated in immunization activities but they were not carried out regularly. In the wake of low immunization coverage in Pakistan, schools can be used as a potential venue not only for non-EPI vaccines, but for a catch up vaccination of routine vaccines.
Enteric fever remains a major health problem in the developing world, including Pakistan. Poor sanitation and hygienic conditions are the major predisposing factors. Salmonella infection with different strains in the same patient has rarely been reported previously. We are reporting two cases of bacteraemia with simultaneous detection of two strains of Salmonella in a single episode of infection. In both the cases, 2 different serotypes of Salmonella were causing bacteraemia leading to fever. In highly endemic area, one must be aware of mixed Salmonella infections as inappropriate diagnosis of such infections may lead to treatment failure. PMID:23905456
Sultan, Binish Arif; Fasih, Naima; Qaiser, Saba; Khan, Erum; Zafar, Afia; Irfan, Seema
This volume contains both literature from South Asia and articles about South Asian literature. The first article consists of an interview with a leading Pakistani poet, N.M. Rashed, who discusses modern Urdu literature. Other articles are: "Five 'Dangerous' Books"--on censorship in East Pakistan--by P. Sarkar; "Baluchi Language and Literature"…
Coppola, Carlo, Ed.
Background Weight loss is known to decrease the health risks associated with being overweight and obese. Awareness of overweight status is an important determinant of weight loss attempts and may have more of an impact on one's decision to lose weight than objective weight status. We therefore investigated the perception of weight among adults attending primary care clinics in Karachi, Pakistan, and compared it to their weight categories based on BMI (Body Mass Index), focusing on the underestimation of weight in overweight and obese individuals. We also explored the factors associated with underestimation of weight in these individuals. Methods This was a cross sectional study conducted on 493 adults presenting to the three primary care clinics affiliated with a tertiary care hospital in Karachi, Pakistan. We conducted face to face interviews to gather data on a pre-coded questionnaire. The questionnaire included detail on demographics, presence of comorbid conditions, and questions regarding weight assessment. We measured height and weight of the participants and calculated the BMI. The BMI was categorized into normal weight, overweight and obese based on the revised definitions for Asian populations. Perception about weight was determined by asking the study participants the following question: Do you consider yourself to be a) thin b) just right c) overweight d) obese. We compared the responses with the categorized BMI. To identify factors associated with underestimation of weight, we used simple and multiple logistic regression to calculate crude odds Ratios (OR) and adjusted Odds Ratios (AOR) with 95% Confidence Intervals. Results Overall 45.8% (n = 226) of the study participants were obese and 18% (n = 89) were overweight. There was poor agreement between self perception and actual BMI (Kappa = 0.24, SE = 0.027, p < 0.001). Among obese participants a large proportion (73%) did not perceive themselves as obese, although half (n = 102) of them thought they may be overweight. Among the overweight participants, half (n = 41) of them didn't recognize themselves as overweight. Factors associated with misperception of weight in overweight and obese participants were age ? 40 years (AOR = 3.4; 95% CI: 1.8-6.4), male gender (AOR = 2.97; 95% CI: 1.6-5.5), being happy with ones' weight (AOR = 6.4; 95% CI: 3.4-12.1), and not knowing one's ideal weight (AOR = 2.45, 95% CI: 1.10-5.47). Conclusion In this cross sectional survey, we observed marked discordance between the actual and perceived weight. Underestimation of individual weight was more common in older participants (? 40 years), men, participants happy with their weight and participants not aware of their ideal weight. Accurate perception of one's actual weight is critical for individuals to be receptive to public health messages about weight maintenance or weight loss goals. Therefore educating people about their correct weight, healthy weights and prevention of weight gain are important steps towards addressing the issue of obesity in Pakistan.
Background A major incident is defined as an event that owing to the number of casualties has the potential to overwhelm the available resources. This paper attempts to describe the incidence and epidemiology of major incidents dealt with by a government-run emergency medical service (EMS) in the Punjab province of Pakistan, a developing country in South Asia. A major incident in this EMS is defined as any incident that produces three or more patients, or any incident in which extraordinary resources are needed. Methods All the calls received by an EMS Rescue 1122 were studied over a 6-month period. Calls that were defined as major incidents were identified, and further details were sought from the districts regarding these incidents. Questions specifically asked were the type of incident, time of the incident, response time for the incident, the resources needed, and the number of dead and injured casualties. Retrospective data were collected from the submitted written reports. Results Road traffic crashes (RTCs) emerged as the leading cause of a major incident in the province of Punjab and also led to the greatest number of casualties, followed by fire incidents. The total number of casualties was 3,380, out of which 73.7% were RTC victims. There was a high rate of death on the scene (10.4%). Certain other causes of major incidents also emerged, including violence, gas explosions and drowning. Conclusion Road traffic crashes are the most common cause of a major incident in developing countries such as Pakistan. Injury prevention initiatives need to focus on RTCs.
The South Asia Panel of the National Council on Foreign Languages and International Studies reports on the need for specialists in the languages and cultures of Afghanistan, Bangladesh, India, Nepal, Pakistan, Sri Lanka, Bhutan, and the Maldives. Two categories of specialists are discussed: (1) individuals in government, mission, etc., in…
National Council on Foreign Language and International Studies, New York, NY.
The lack of summer monsoon sometimes brings severe droughts in many parts of the world including South Asian countries like Pakistan. Human life and economy in Pakistan considerably depends on the summer monsoon. So, an essential question arises "how can we contribute better to manage the water resources during drought conditions for the societal needs". To address the concern as a hydrologist, we need to develop a basis of the scientific understanding of the different contrast of the climatology during extremely dry rainfall events over Pakistan region. However, compared to other regional studies i.e. Indian Summer Monsoon (ISM) and South-East Asian Monsoon (SEAM), the basis of the thermodynamical structure and the processes associated with upper tropospheric conditions during the climatological mean Pakistan Summer Monsoon (PSM) and its extreme events have not been addressed deeply yet and need to be investigated, because it is immensely vital for the hydrologist as a first step to develop the basis of scientific understanding. By data analysis, an attempt has been made to accomplish this objective. Firstly, the climatological tropospheric conditions and the associated processes from pre-monsoon phase to the PSM mature phase are investigated. During the PSM mature phase (mid July), the climatological-mean structure of the atmosphere favors convective activity compared to the pre-monsoon phase (late June) with weakening of the subsidence in the upper troposphere and also with increasing of incoming moisture flux in the lower troposphere from Arabian Sea and Bay of Bengal around Pakistan. Specifically, in the upper troposphere, the upper-level subsidence and convergence observed over Pakistan during pre-monsoon phase shifts and reallocates to the northwest of Pakistan during mature phase, which results in weakening of the subsidence just over Pakistan, and then the PSM mature phase initiated. Secondly, comparing the PSM mature phase climatological mean characteristics, the characteristics of the extremely dry PSM events are investigated by focusing their common anomalous tropospheric conditions observed during the period 1979-2008. We found that the extremely dry PSM events were closely related with the anomalous state of upper tropospheric cyclonic circulation northwest of Pakistan and the associated cold temperature anomaly around Pakistan. This anomalous state of upper tropospheric cyclonic circulation is accompanied with the anomalous upper level convergence around Pakistan, which anomalously weakens the climatological mean PSM trough to suppress the PSM activities. We found two possibilities i.e. Matsuno-Gill type atmospheric response from the tropics and/or the Rossby wave train along the Asian Jet to trigger, reinforce, and maintain the upper-tropospheric cyclonic circulation. In summary, the strong convection anomalies resulting in severe drought events over the PSM region are suggested to be induced by both the tropical and extratropical processes. However what (i.e. source) triggers the circulation anomaly from the tropics and/or extratropics is unknown at the moment, which needs further investigations to reach a definite conclusion. Further, if hydrologist gets a prediction signal in advance, the integrated water resources management (IWRM) will be much more effective for the region.
Ahmad, S.; Koike, T.; Nishii, K.
The widely accepted definition of environmental education as stated by The Tbilisi Declaration of 1978 focuses on developing an environmentally literate citizenry which is capable of working "...individually and collectively toward solutions of current [environmental] problems and the prevention of new ones". The two basic tenets of environmental literacy are further defined in this study as the ability to understand environmental problems and the ability to address those environmental problems in a responsible manner. Acquisition of knowledge has also been considered an important element when developing environmental literacy programs. However, a large sector of the world population is non- or low-literate and communication is through channels other than the written word. The challenge for environmental educators is to reach the low-literate learners who have not had many opportunities to participate in formal education activities through established institutions. The purpose of this study was to describe levels of environmental literacy in communities with varying levels of formal literacy in two cities, Karachi and Islamabad, Pakistan to determine the role formal literacy plays in enhancing environmental literacy and decision making in relation to age, sex, location, number of years spent in formal education, and the socio-economic status (SES) of adult learners. Based on the outcomes, recommendations were made for designing effective programs to ensure involvement of low-literate communities in established decision-making processes through relevant program planning. This study suggested strategies to program planners and environmental educators for designing programs that reach low-literate communities, highlight local environmental concerns, and empower these communities in addressing local environmental issues. A purposive sample was identified from the constituencies of five non-governmental organizations in Karachi and Islamabad, Pakistan. Two instruments, one to measure levels of formal literacy, and the other to assess environmental literacy of the participants at the nominal, functional, and operational levels, were developed for this study. Negligible correlations were found between environmental literacy and the demographic or "external" variables of age, sex, location, number of years participants had spent in formal education institutions, socio-economic status, and formal literacy. However, some low and moderate positive correlations were found between formal literacy and age, sex, location, number of years participants had spent in formal education institutions, and socio-economic status of the participants. No correlations were found between environmental literacy and formal literacy indicating that the ability to read and write did not relate to environmental literacy or awareness in the participants.
Daudi, Sabiha Shafique
The US government appears to be using drones to launch air strikes inside Pakistan. This article details uncertainties regarding the ethical soundness of these strikes and highlights the consequent need for greater official transparency. Available evidence is assessed in the light of traditional ethical requirements that the use of force is beneficial to a legitimate military objective, that it discriminates
Maize is frequently cited as a crop that was bypassed by Pakistan's green revolutions in wheat and rice, and more recently, cotton. While the returns to investments in maize research and extension have been positive, they have not been nearly as great as ...
Emerging contractual delivery systems, collaborative partnerships, new management initiatives, and global product markets require professionals and students to have a broader awareness of construction methods and project management issues. This paper presents the state of the project management education in Pakistan. The analysis is based on…
Arain, Faisal Manzoor; Tipu, Syed Awais Ahmad
This paper addresses the correlation between educational policies and political conditions as an indicator of socialization in the nation and state building process in Pakistan. Because of the discrepancies between official statements and the level of ethnic conflict, this study seeks to analyze the standard national social studies curriculum for…
Kazi, Aftab A.
This study represents the first complete modern account of the Sphingidae of Pakistan and takes the form of an annotated checklist, based on several national collections and those of a number of individuals. Of the 60 species and subspecies found, 14 are new records to the fauna of Pakistan, namely Agnosia orneus, Langia zenzeroides subsp. zenzeroides, Polyptychus trilineatus subsp. trilineatus, Dolbina inexacta, Ambulyx sericeipennis subsp. sericeipennis, Thamnoecha uniformis, Macroglossum belis, Macroglossum stellatarum, Cechetra scotti, Hippotion boerhaviae, Hyles euphorbiae subsp. euphorbiae, Rhagastis olivacea, Rethera brandti subsp. euteles and Theretra latreillii subsp. lucasii. Anambulyx elwesi subsp. kitchingi and Clanis deucalion subsp. thomaswitti are not recognised as valid subspecies and are synonymized with their respective nominotypical subspecies. An additional list is given of 30 taxa which may yet be found in Pakistan as they are present in neighbouring countries close to the border. Of the species/subspecies found, 24 are part of the Palaearctic fauna, 27 are part of the Oriental fauna and nine are Palaeo-Oriental/Palaeotropical. This reconfirms the transitional biogeographical position of the Pakistan fauna. PMID:24870331
Rafi, Muhammad Ather; Sultan, Amir; Kitching, Ian J; Pittaway, Anthony R; Markhasiov, Maxim; Khan, Muhammad Rafique; Naz, Falak
The research on climate change in Pakistan is in its initial stages and has started with the commencement of the new century. Realizing the importance and potential impact of climate change on natural resources and population and their sustainable development, several projects have been initiated in collaboration with international institutions such as APN, ICIMOD, UNEP, START, and others. The focus
This paper discusses the history of civil and military rule in the Pakistani Government and its effect on U.S. foreign policy. It reviews policy making and administrative control in Pakistan during the British Colonial regime, the Indian Civil Service-Civ...
This paper provides a description of the recent decentralization reforms in Pakistan under General Musharraf. In the process, we hope to not only highlight major aspects of this reform, but also to analyze the evolution of this reform in historical context in order to better understand the potential causes behind the current decentralization. Analyzing the evolution of local government reforms
Ali Cheema; Asim Ijaz Khwaja; Adnan Qadir
To compare the severity of Plasmodium vivax malaria with that of P. falciparum malaria, we conducted a retrospective cross-sectional study of 356 adults hospitalized with malaria (2009–2011) in Pakistan. P. vivax and P. falciparum accounted for 83% and 13% of cases, respectively; 79.9% of patients with severe malaria were infected with P. vivax.
Zubairi, Ali Bin Sarwar; Nizami, Sobia; Raza, Afsheen; Mehraj, Vikram; Rasheed, Anita Fazal; Ghanchi, Najia Karim; Khaled, Zahra Nur
Pakistan faces a human resources for health (HRH) crisis. A cross-sectional survey was conducted to overview frontline health workers. A total of 750 health facilities were surveyed across Pakistan. The median estimate of public sector health care workers in the district health system in Pakistan is 417 288, including 46 153 estimate of public sector health care workers in the district health system in Pakistan is 417 288, including 46 153 doctors and 41 032 nurses. Another estimated 20 000 doctors work in public sector tertiary care hospitals across the country. A total of 3549 health care workers were interviewed regarding job satisfaction and work environment. The private sector had better work environment scores compared with the public sector. Policy dimensions showed an absence of robust policies in practice. The public sector is inadequately staffed and job satisfaction and work environment need improvement. HRH crisis countries should share experiences, and developmental partners should support them in overcoming the HRH crisis. PMID:21495600
Hafeez, A; Khan, Z; Bile, K M; Jooma, R; Sheikh, M
This paper studies whether in Pakistan the dynamic behavior of unemployment, inflation, budget deficit and real GDP growth is systematically affected by the timing of elections. We cover the period from 1973-2009. Our results can be summarized as follows: 1. Unemployment tends to be lower in pre-election periods and tends to increase immediately after elections, perhaps as a result of
Irem Batool; Gernot Sieg
Two major disasters in Pakistan and innumerable lesser disasters throughout the Himalaya-Karakoram region in 2010 highlight geologic events and extreme weather (perhaps climate change) in affecting the well being of whole nations and commerce and relations between nations. Two chief events in Pakistan include the Jan. 4 rockslide into the Hunza River and the subsequent formation of a natural dam lake (Lake Gojal); and the monsoon precipitation-fed flooding across the Indus Basin. The first event severed Pakistan’s major land link with China. The second event devastated Pakistan’s national land-based transportation infrastructure and agriculture and displaced millions of people. In a country plagued by monsoon-driven floods, the lack of catastrophic breakout of Lake Gojal is welcome. Satellite-based monitoring shows the spillway to be eroding more rapidly (but not alarmingly) under August’s monsoon peak flow. Similar events have occurred before in the region and will occur again. These mega-events in Pakistan should be an alert for all of South Asia, as climate change increases or shifts the hazard environment, encroaching development and urbanization increases the vulnerabilities, and as improved capacity for trans-national commerce breaks down the Himalayan barrier and both promotes new opportunities and possible conflicts. 2010's natural mega-calamities in Pakistan and widespread landsliding and flooding elsewhere in South Asia underscores the subcontinent’s need for a thorough field-, remote sensing-, and modeling-based assessment of the disaster potential related to landslides, glacier surges, extreme monsoon precipitation events, natural glacier and landslide dam lake outbursts, and unseasonal snow melting. The Himalayan-Karakoram region is remarkable for its heterogeneous responses to climate change. For instance, some areas are undergoing rapid glacier recession and stagnation; others are undergoing glacier growth. We take the instance of the rockslide-formed Lake Gojal and of the region’s glacier dynamics seen by satellite to show the promise of remote sensing to address disaster management and hazard identification. However, the biggest role of remote sensing should be in the identification of hazard-prone situations, such as areas where landslides or the development of dangerous glacier lakes is likely. Increased satellite surveillance and deployment of air- and land surface-borne sensor platforms, and in some cases surface or subsurface watercraft, may aid the characterization of the landscape, identify geologic and climatic instabilities, and identify vulnerabilities among the people and infrastructure. A broad-based remote sensing program should fit within a coherent regional/international approach to the key related issues of natural hazards, water resources, urban planning, food security, hydropower, and environmental conservation. Notably, these issues all are interlinked to transboundary hydrology and climate change.
Kargel, J. S.; Fink, W.; Furfaro, R.; Leonard, G. J.; Patterson, M.; Glims, Gaphaz
Asian tarsiid and sivaladapid primates maintained relictual distributions in southern Asia long after the extirpation of their close Holarctic relatives near the Eocene–Oligocene boundary. We report here the discovery of amphipithecid and eosimiid primates from Oligocene coastal deposits in Pakistan that demonstrate that stem anthropoids also survived in southern Asia beyond the climatic deterioration that characterized the Eocene–Oligocene transition. These fossils provide data on temporal and paleobiogeographic aspects of early anthropoid evolution and significantly expand the record of stem anthropoid evolution in the Paleogene of South Asia.
Marivaux, Laurent; Antoine, Pierre-Olivier; Baqri, Syed Rafiqul Hassan; Benammi, Mouloud; Chaimanee, Yaowalak; Crochet, Jean-Yves; de Franceschi, Dario; Iqbal, Nayyer; Jaeger, Jean-Jacques; Metais, Gregoire; Roohi, Ghazala; Welcomme, Jean-Loup
Oral histories are an important way of telling a community's history, and this intriguing project from the University of Washington Libraries sheds new light on a very interesting aspect of history in the Pacific Northwest. The goal of the South Asian Oral History Project (SAOHP) is "to record pan-South Asian immigrant experiences in the Pacific Northwest using the medium of oral history." The project began in 2005, and the interviews here include immigrants who moved to the area from Bangladesh, India, Pakistan, and Sri Lanka from the 1950s to the present. Visitors can view transcripts of the interviews at their leisure, and good background material can be found in the section titled "A librarian's gift: Oral history project preserves memories of South Asian immigrants". The interviews are quite fascinating, and they include memories of studying at the University of Washington, attending the1962 Seattle World's Fair, and the challenges immigrants faced when they arrived.
Although Baltistan, north east Pakistan, is in a region of iodine deficiency disorders, the distribution of goitre within the district, according to age and sex, has not been clearly defined. To establish the prevalence of the condition and to measure the reported difference in prevalence in the north and south of the district thyroid size was assessed in new patients attending the Aman clinic, Khapalu, and outlying areas between April and September from 1981 to 1986. Samples of potable water collected from villages were analysed for iodine (as iodide) concentrations in Britain. Population weighted prevalences were: in the north in males 20.4%, in females 28.1% and in the south in males 13.9%, in females 21.2%. There was an overall deficiency of iodine in the water (mean iodine (as iodide) concentrations (north) 11.0 nmol/l (1.4 micrograms/l), (south) 11.8 nmol/l (1.5 micrograms/l) (95% confidence interval -0.7 to 0.9). The differences followed the Main Karakoram Thrust, suggesting a geological goitrogen in the north, which might be minerals containing ions such as BF4- and SO3F-, and molybdenite and calcium, which are present in rocks in Baltistan. A new hypothesis for the genesis of endemic goitre is proposed--that is, that continents on crustal plates drift across the earth and collide, one plate sliding under the other and melting, giving rise to characteristic mineral assemblages in the overlying rocks. As the minerals weather out they enter the diet of the local population, where in the presence of iodine deficiency they produce or enhance iodine deficiency disorders. Despite the current iodised oil campaign by the Pakistani government with Unicef a long term working iodisation programme is still urgently needed. PMID:2372605
Stewart, A G
Objective: To compare the disease patterns in two data sets of patients, five years apart, at the National Institute of Cardiovascular Diseases (NICVD), a tertiary care cardiac hospital in Karachi. The underlying objective was to determine any changes in cardiovascular disease patterns at an acute cardiac unit over a period of five years. Methodology: A retrospective descriptive study was conducted
Syed Faraz Kazim; Ahmed Itrat; Naima Waqar Butt; Muhammad Ishaq
The main emphasis of this paper is on the engineering economics and design developments in the field of thermal power generation in Pakistan. Pakistan is rich with coal fields but is making no use of this available natural resource to fulfil its energy demands. The shortage of power is getting worst day by day and to align with the power requirements, Pakistan needs to add 2000 MW each year to national grid. With the increasing prices of natural gas and oil, Pakistan should consider coal, the abundantly available natural resource, as an alternate fuel for its new power plants to overcome the power crises.
Qureshi, S. A.; Javed, M. Adnan
The Southern Indus basin extends approximately between lat. 23/sup 0/ and 28/sup 0/31'N, and from long. 66/sup 0/E to the eastern boundary of Pakistan. Of the 55 exploratory wells drilled (1955-1984), 27 were based on results of multifold seismic surveys. Five commercial oil discoveries and one gas discovery in Cretaceous sands, three gas discoveries in Paleocene limestone or sandstone, and one gas-condensate discovery from lower Eocene limestone prove that hydrocarbons are present. The main hydrocarbon fairways are Mesozoic tilted fault blocks. Tertiary reefal banks, and drape and compressional anticlines. Older reservoirs are accessible toward the east and northeast, and younger mature source rocks are to the west, including offshore, of the Badin block oil field area. The Indus offshore basin reflects sedimentation associated with Mesozoic rifting of the Pakistan-Indian margin, superimposed by a terrigenous clastic depositional system comprised of deltas, shelves, and deep-sea fans of the Indus River.
Quadri, V.U.N.; Shuaib, S.M.
This paper illustrates the experiences of essential medicine management in providing cure and care to victims of Pakistan's 2005 earthquake in a safe, rational and effective mode. The health interventions assured access to essential medicine, sustained supply, inventory control through a computerized logistic support system and rational use of medicines. World Health Organization Pakistan outlined modalities for acceptance of donated medicines, assisted in speedy procurement of medicines and designed customized kits. Proper storage of medicines at controlled temperature was ensured in warehousing facilities in 12 locations. A steady supply of medicines and their consumption without stock-outs in the 56 first-level care facilities of calamity-hit areas helped to ascertain the average consumption and cost of essential medicines and supplies for the catchment population. Tools for quantification and forecasting of medicines and supplies were developed and shared. Medicines and medical supplies were efficiently used resulting in minimum wastage. PMID:21495596
Bukhari, S K S; Qureshi, J A R H; Jooma, R; Bile, K M; Kazi, G N; Zaibi, W A; Zafar, A
Mulloway (Argyrosomus japonicus) occur in estuarine and coastal waters surrounding Australia, Africa, India, Pakistan, China, Korea and Japan, where they are important in fisheries. This study identified that mulloway in south-eastern Australia had similar growth rates, but matured at smaller lengths and younger ages, to those in South Africa and Western Australia. Growth of both sexes was similar to about
V. Silberschneider; C. A. Gray; J. Stewart
In addition to being a major cause of mortality in South Asia, childhood diarrhea creates economic burden for affected households. We used survey data from sites in Bangladesh, India, and Pakistan to estimate the costs borne by households due to childhood diarrhea, including direct medical costs, direct nonmedical costs, and productivity losses. Mean cost per episode was $1.82 in Bangladesh, $3.33 in India, and $6.47 in Pakistan. The majority of costs for households were associated with direct medical costs from treatment. Mean costs understate the distribution of costs, with 10% of cases exceeding $6.61, $8.07, and $10.11 in Bangladesh, India, and Pakistan, respectively. In all countries there was a trend toward lower costs among poorer households and in India and Pakistan there were lower costs for episodes among girls. For both poor children and girls this may reflect rationing of care, which may result in increased risks of mortality.
Rheingans, Richard; Kukla, Matt; Faruque, Abu Syed Golam; Sur, Dipika; Zaidi, Anita K. M.; Nasrin, Dilruba; Farag, Tamer H.; Levine, Myron M.; Kotloff, Karen L.
Flooding is the most devastating natural hazard in Pakistan and the recent flooding has demonstrated its severeness. Floods are common throughout the country. However, their characteristics differ from region to region. Flooding behavior of the major basins and flood management at the national level are investigated in this article. Monsoon rainfalls are the main source of floods in the Indus Basin, while Mediterranean Waves and Cyclones, which are generated over the Arabian Sea, induce flooding in the Kharan Basin and the Makran Coastal Area. Fluvial floods in the Indus Basin have caused major economic losses. Pakistan’s government has spent vast resources on relief operations and flood works since the country came into existence in 1947. A number of provincial and federal acts, ordinances, accords, and treaties shape the national flood policy. Institutional setup for flood hazard and crisis management has evolved over the years. Nevertheless, data show no major reduction in the flood-to-damage ratio. The inter-linkage of structural and non-structural measures and their combined efficiency must be analyzed and optimized for more effective flood management.
Tariq, Muhammad Atiq Ur Rehman; van de Giesen, Nick
Objective. The study was performed to review the complications of surgery for POP with or without surgery for SUI. This included the need for second procedure two years after the primary surgery. Study Design. We conducted a retrospective cross-sectional comparative study at the Aga Khan University, Karachi, Pakistan. International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) was used to identify women who underwent vaginal hysterectomy with anterior/posterior repair alone and those with concomitant tension-free vaginal tape surgery for urodynamic stress incontinence. Results. The 28 cases of VH/repair combined with TVT were compared for complications with 430 cases of VH with repair alone. The basic characteristics like age, BMI, and degree of prolapse showed no statistical difference among two groups. The main comorbidities in both groups were hypertension, diabetes, and bronchial asthma. We observed no significant differences in intraoperative and postoperative complications except for cuff abscess, need for medical intervention, and readmission following discharge from hospital, which were higher in cases with vaginal hysterectomy with concomitant TVT. Conclusions. Vaginal hysterectomy is an efficient treatment for uterovaginal prolapse with a swift recovery, short length of hospital stay, and rare serious complications. The addition of surgery for USI does not appear to increase the morbidity.
Mohsin Rizvi, Raheela; Akhtar, Munnazza; Zuberi, Nadeem Faiyaz
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.
Khuwaja, Ali Khan; Lalani, Saima; Azam, Iqbal Syed; Ali, Badar Sabir; Jabbar, Abdual; Dhanani, Raheem
Background Pakistan is highly vulnerable to climate change due to its geographic location, high dependence on agriculture and water resources, low adaptive capacity of its people, and weak system of emergency preparedness. This paper is the first ever attempt to rank the agro-ecological zones in Pakistan according to their vulnerability to climate change and to identify the potential health repercussions of each manifestation of climate change in the context of Pakistan. Methods A climate change vulnerability index is constructed as an un-weighted average of three sub-indices measuring (a) the ecological exposure of each region to climate change, (b) sensitivity of the population to climate change and (c) the adaptive capacity of the population inhabiting a particular region. The regions are ranked according to the value of this index and its components. Since health is one of the most important dimensions of human wellbeing, this paper also identifies the potential health repercussions of each manifestations of climate change and links it with the key manifestations of climate change in the context of Pakistan. Results The results indicate that Balochistan is the most vulnerable region with high sensitivity and low adaptive capacity followed by low-intensity Punjab (mostly consisting of South Punjab) and Cotton/Wheat Sindh. The health risks that each of these regions face depend upon the type of threat that they face from climate change. Greater incidence of flooding, which may occur due to climate variability, poses the risk of diarrhoea and gastroenteritis; skin and eye Infections; acute respiratory infections; and malaria. Exposure to drought poses the potential health risks in the form of food insecurity and malnutrition; anaemia; night blindness; and scurvy. Increases in temperature pose health risks of heat stroke; malaria; dengue; respiratory diseases; and cardiovascular diseases. Conclusion The study concludes that geographical zones that are more exposed to climate change in ecological and geographic terms- such as Balochistan, Low-Intensity Punjab, and Cotton-Wheat Sindh -also happen to be the most deprived regions in Pakistan in terms of socio-economic indicators, suggesting that the government needs to direct its efforts to the socio-economic uplift of these lagging regions to reduce their vulnerability to the adverse effects of climate change.
This study analyzes the standard Pakistan social studies curriculum to investigate (1) the extent to which it represents ethnic nationalities of Pakistan, and (2) the extent to which it demonstrates its contribution to the process of national cohesion and integration. The findings presented are based on a content analysis (both trend and variable)…
Kazi, Aftab A.
Describes the activities of the Netherlands Library Development Project (NLDP) for the promotion of information technology in Pakistan. During a period of five years, NLDP made great efforts in the fields of manpower training, hardware supply, software development, information networks, and curriculum development in Pakistan. It set up computer training centres for training librarians, introduced electronic mail and CD-ROM technology
The present biogeographic distribution of tiger beetle fauna is an attempt to register all modern taxa from Pakistan. It includes 55 taxa under 14 genera and 11 subgenera. Three species, Cylindera (Eriodera) albopunctata (Chaudoir 1852), Cicindela viridilabris (Chaudoir 1852) and Neocollyris (Neocollyris) redtenbacheri (Horn 1894) are recorded from Pakistan for the first time.
Rafi, Muhammad Ather; Jurgen, Wiesner; Matin, Muhammad Abdul; Zia, Ahmed; Sultan, Amir; Naz, Falak
Virtual education paradigm has been developing as a form of distance education to provide education across the boundaries of a nation and/or country. It imparts education through information and communication technologies. In Pakistan the Virtual University of Pakistan imparts it. The main objective of the study was to evaluate the students'…
This study investigates the economic outcomes of education for wage earners in Pakistan. This is done by analysing the relationship between schooling, cognitive skills and ability, on the one hand, and economic activity, occupation, sectoral choice and earnings, on the other. In Pakistan, an important question remains largely unaddressed: what does the coefficient on ‘schooling’ in conventional earning function estimates
Monazza Aslam; Faisal Bari; Geeta Kingdon
In Pakistan, academic education is a luxury. Instead, education must be geared to production, solving practical problems, and promoting national development. Since 1951, Pakistan has attempted to bring work and education together and to throw off the structural and attitudinal restrictions of a foreign educational system which strangled tradition,…
Federal Ministry of Education, Islamabad (Pakistan).
This study investigates the economic outcomes of education for wage earners in Pakistan. This is done by analysing the relationship between schooling, cognitive skills and ability, on the one hand, and economic activity, occupation, sectoral choice and earnings, on the other. In Pakistan, an important question remains largely unaddressed: what…
Aslam, Monazza; Bari, Faisal; Kingdon, Geeta
The field of biomedical engineering and the engineer is introduced; thereafter the author reviews the present state of the arts of medicine, engineering and their interface area in Pakistan. The importance of biomedical equipment cannot be denied even in an underdeveloped economy such as Pakistan, where the need for biomedical engineers has not been realised, thereby decreasing the usefulness of
N. U. Janjua
The presence of raised beaches and marine terraces along the Makran coast indicates episodic uplift of the continental margin resulting from large-magnitude earthquakes. The uplift occurs as incremental steps similar in height to the 1-3 m of measured uplift resulting from the November 28, 1945 (M 8.3) earthquake at Pasni and Ormara, Pakistan. The data support an E-W-trending, active subduction zone off the Makran coast. The raised beaches and wave-cut terraces along the Makran coast are extensive with some terraces 1-2 km wide, 10-15 m long and up to 500 m in elevation. The terraces are generally capped with shelly sandstones 0.5-5 m thick. Wave-cut cliffs, notches, and associated boulder breccia and swash troughs are locally preserved. Raised Holocene accretion beaches, lagoonal deposits, and tombolos are found up to 10 m in elevation. The number and elevation of raised wave-cut terraces along the Makran coast increase eastward from one at Jask, the entrance to the Persian Gulf, at a few meters elevation, to nine at Konarak, 250 km to the east. Multiple terraces are found on the prominent headlands as far east as Karachi. The wave-cut terraces are locally tilted and cut by faults with a few meters of displacement. Long-term, average rates of uplift were calculated from present elevation, estimated elevation at time of deposition, and 14C and U-Th dates obtained on shells. Uplift rates in centimeters per year at various locations from west to east are as follows: Jask, 0 (post-Sangamon); Konarak, 0.031-0.2 (Holocene), 0.01 (post-Sangamon); Ormara 0.2 (Holocene). ?? 1979.
Page, W. D.; Alt, J. N.; Cluff, L. S.; Plafker, G.
Background Large geographical gaps in our knowledge of the prevalence and burden of headache disorders include Pakistan, a country with major problems of poverty, illiteracy and security. We report implementation in this country of standard methods developed by Lifting The Burden (LTB) for population-based burden-of-headache studies. Methods We surveyed six locations from the four provinces: Lahore and Multan (Punjab), Karachi and Sukkur (Sindh), Abbottabad (Khyber Pakhtunkhwa) and Gwadar (Baluchistan). We randomly selected rural and urban households in each, which were visited by trained non-medical interviewers from the same locations. One randomly selected adult member (18–65 years) of each household was interviewed using LTB’s structured questionnaire translated into Urdu, the national language. Validation was performed among patients and accompanying attendants in three (urban and rural) medical facilities. After responding to the questionnaire, these participants were re-interviewed and diagnosed by a neurologist (gold standard). Results The survey was completed by 4,223 respondents (1,957 [46.3%] male, 2,266 [53.7%] female, 1,443 [34.2%] urban, 2,780 [65.8%] rural, mean age 34.4?±?11.0 years). The participation rate was 89.5%. There were 180 participants (46.1% male, 53.9% female, 41.7% urban, 58.3% rural, mean age 39.4?±?14.2 years) in the validation sample, of whom 147 (81.7%) reported headache in the last year. The questionnaire was 100% sensitive in screening for headache and for headache on ?15 days/month, and showed good agreement with the gold-standard diagnoses (kappa?=?0.77). It was relatively insensitive for TTH. The questionnaire’s default diagnosis of probable MOH when medication overuse accompanied headache on ?15 days/month was not supported by evidence of causation in most cases seen by the neurologist. In public-health terms, precise diagnosis in these cases matters less than reliably detecting the coexistence of these disorders. Conclusion In conclusion, the methods developed by LTB were applied successfully in Pakistan, despite problems unique to this country.
Due to the lack of bioturbation, the varve-laminated muds from the oxygen minimum zone (OMZ) off Pakistan provide a unique opportunity to precisely determine the vertical and lateral sediment fluxes in the nearshore part of the northeastern Arabian Sea. West of Karachi (Hab area), the results of two sediment trap stations (EPT and WPT) were correlated with 16 short sediment cores on a depth transect crossing the OMZ. The top of a distinct, either reddish- or light-gray silt layer, 210Pb-dated as AD 1905 ± 10, was used as an isochronous stratigraphic marker bed to calculate sediment accumulation rates. In one core, the red and gray layer were separated by a few (5-10) thin laminae. According to our varve model, this contributes < 10 years to the dating uncertainty, assuming that the different layers are almost synchronous. We directly compared the accumulation rates with the flux rates from the sediment traps that collected the settling material within the water column above. All traps on the steep Makran continental slope show exceptionally high, pulsed winter fluxes of up to 5000 mg m-2 d-1. Based on core results, the flux at the seafloor amounts to 4000 mg m-2 d-1 and agrees remarkably well with the bulk winter flux of material, as well as with the flux of the individual bulk components of organic carbon, calcium carbonate and opal. However, due to the extreme mass of remobilized matter, the high winter flux events exceeded the capacity of the shallow traps. Based on our comparisons, we argue that high-flux events must occur regularly during winter within the upper OMZ off Pakistan to explain the high accumulations rates. These show distribution patterns that are a negative function of water depth and distance from the shelf. Some of the sediment fractions show marked shifts in accumulation rates near the lower boundary of the OMZ. For instance, the flux of benthic foraminifera is lowered but stable below ~1200-1300 m. However, flux and sedimentation in the upper eastern Makran area are dominated by the large amount of laterally advected fine-grained material and by the pulsed nature of the resuspension events at the upper margin during winter.
Schulz, H.; von Rad, U.
Prolonged breastfeeding, apart from being beneficial to a child's health, helps keep the birth rate low. 1 of the effects of malnutrition in developing countries is the reduction in the period of lactation. In Pakistan, where the birth rate is already very high and the use of contraceptives limited, any reduction in the breastfeeding period may result in an increase in the birth rate. This study was undertaken to find out the recent changes in the breastfeeding pattern and their potential impact on the fertility levels in Pakistan. The data for this study are based on 2 National Fertility Surveys, the 1975 Pakistan Fertility Survey and the 1979 Population, Labor Force, and Migration Survey. The estimation of the mean duration of breastfeeding is based on a measure developed by Mosley (1982), given by the formula Y-BIN. where Y=estimate of duration of breastfeeding, B=total number of children currently being breastfed, and N=the average number of births/month. Taking maternal age, parity, place of residence, education, and occupation as background variables, the findings are a follows. 1) There was a decline of about 4 months in the average length of lactation. 2) The age of the mother is positively associated with duration of breastfeeding. 3) Urban women have shorter periods of breastfeeding. 4) Women working on farms have longer periods of breastfeeding. 5) A slight increase in fertility is due to a decline in breastfeeding and a decrease in the use of contraceptives. It is suggested that breastfeeding may be promoted among Pakistani mothers in order to reduce the birth rate. PMID:12285106
Some critical comments are made on a paper entitled "Factors Affecting Fertility in Pakistan." The 60-page paper is considered too long and taxing for the reader with 20 tables and 8 appendix tables. The extensive literature review needs to be updated to refer to the objective of the study. Only conventional sociodemographic variables were considered, omitting information on the supply side and contraceptive use. The results on work status and fertility were ambiguous, indicating that salaried employees with higher education had higher fertility than those with lower education engaged in family business. The statement that perhaps a trend of declining fertility started in Baluchistan based on the mean number of children was contradicted by the figure for children ever born standardized by age, which indicated a slightly higher number. No substantial difference was found in urban and rural fertility, yet the author kept referring to this marginal difference by age in a detailed table. The rationale of running four separate models for four dependent variables when mean desired and ideal number of children do not differ much from each other was questioned. It would be more useful to present the results of only one dependent variable. The variation explained by the independent variables was as low as 8% in the model on children ever born and between 25% and 50% in the other 3 models. This suggests that when there is little variation in fertility, the analysis of factors explaining fertility differentials is not of much value. The conclusion that fertility transition has not started yet in Pakistan is also debatable in view of some recent evidence of fertility decline in the Pakistan Demographic and Health Survey of 1990-91 indicating that urban, educated groups of women are in the vanguard. A more precise discussion of the results would have made the study more meaningful. PMID:12346203
Multi-sensor precipitation datasets including two products from the Tropical Rainfall Measuring Mission (TRMM) Multi-satellite Precipitation Analysis (TMPA) and estimates from Climate Prediction Center Morphing Technique (CMORPH) product were quantitatively evaluated to study the monsoon variability over Pakistan. Several statistical and graphical techniques are applied to illustrate the nonconformity of the three satellite products from the gauge observations. During the monsoon season (JAS), the three satellite precipitation products captures the intense precipitation well, all showing high correlation for high rain rates (>30 mm/day). The spatial and temporal satellite rainfall error variability shows a significant geo-topography dependent distribution, as all the three products overestimate over mountain ranges in the north and coastal region in the south parts of Indus basin. The TMPA-RT product tends to overestimate light rain rates (approximately 100%) and the bias is low for high rain rates (about ±20%). In general, daily comparisons from 2005 to 2010 show the best agreement between the TMPA-V7 research product and gauge observations with correlation coefficient values ranging from moderate (0.4) to high (0.8) over the spatial domain of Pakistan. The seasonal variation of rainfall frequency has large biases (100-140%) over high latitudes (36N) with complex terrain for daily, monsoon, and pre-monsoon comparisons. Relatively low uncertainties and errors (Bias ±25% and MAE 1-10 mm) were associated with the TMPA-RT product during the monsoon-dominated region (32-35N), thus demonstrating their potential use for developing an operational hydrological application of the satellite-based near real-time products in Pakistan for flood monitoring.
Khan, Sadiq Ibrahim; Hong, Yang; Gourley, Jonathan J.; Khattak, Muhammad Umar Khan; Yong, Bin; Vergara, Humberto J.
Pakistan is home to many varieties of minerals, some of which make it prominent in the mineral world. The exploration of Pakistan's mineral wealth is far from complete and has rarely been conducted in the north and northwest of the country. This article presents the newest exploration and examination of minerals from an unexploited area in Pakistan. Several materials characterization techniques were carried out to examine and identify the phase and structure of the minerals, including x-ray diffraction, energy dispersive x-ray spectroscopy, scanning electron microscopy, and transmission electron microscopy. In this study, several commonly found minerals are identified, including calcite, dolomite, quartz, talc, and fluorapatite.
Iqbal, Yaseen; Leu, Lii-Cherng; Fahad, Muhammad; Ubic, Rick
Mountainous areas in the northern Pakistan are blessed by numerous rivers that have great potential in water resources and hydropower production. Many of these rivers are unexploited for their water resource potential. If the potential of these rivers are explored, hydropower production and water supplies in these areas may be improved. The Indus is the main river originating from mountainous area of the Himalayas of Baltistan, Pakistan in which most of the smaller streams drain. In this paper, the hydrology of the mountainous areas in northern Pakistan is studied to estimate flow pattern, long-term trend in river flows, characteristics of the watersheds, and variability in flow and water resource due to impact of climate change. Eight watersheds including Gilgit, Hunza, Shigar, Shyok, Astore, Jhelum, Swat, and Chitral, Pakistan have been studied from 1960 to 2005 to monitor hydrological changes in relation to variability in precipitation, temperature and mean monthly flows, trend of snow melt runoff, analysis of daily hydrographs, water yield and runoff relationship, and flow duration curves. Precipitation from ten meteorological stations in mountainous area of northern Pakistan showed variability in the winter and summer rains and did not indicate a uniform distribution of rains. Review of mean monthly temperature of ten stations suggested that the Upper Indus Basin can be categorized into three hydrological regimes, i.e., high-altitude catchments with large glacierized parts, middle-altitude catchments south of Karakoram, and foothill catchments. Analysis of daily runoff data (1960-2005) of eight watersheds indicated nearly a uniform pattern with much of the runoff in summer (June-August). Impact of climate change on long-term recorded annual runoff of eight watersheds showed fair water flows at the Hunza and Jhelum Rivers while rest of the rivers indicated increased trends in runoff volumes. The study of the water yield availability indicated a minimum trend in Shyok River at Yogo and a maximum trend in Swat River at Kalam. Long-term recorded data used to estimate flow duration curves have shown a uniform trend and are important for hydropower generation for Pakistan which is seriously facing power crisis in last 5 years. PMID:22109645
Ahmad, Zulfiqar; Hafeez, Mohsin; Ahmad, Iftikhar
There is much concern about the capacity of the health system of Pakistan to meet its goals and obligations. Historically, the political thrust has been absent from the health policy formulation and this is reflected in the low and stagnant public allocations to health. Successive political leaderships have averred from considering healthcare is a common good rather than a market commodity and health has not been recognized as a constitutional right. Over 120 of world’s nation states have accepted health as a constitutional right but the 1973 Constitution of Pakistan does not mandate health or education as a fundamental right and the recently adopted 18th constitutional amendment missed the opportunity to extend access to primary health care as an obligation of the State. It is argued in this communication that missing from the calculations of policy formulation and agenda setting is the political benefits of providing health and other social services to underserved populations. Across the developing world, many examples are presented of governments undertaking progressive health reforms that bring services where none existed and subsequently reaping electoral benefit. The political determinant of healthcare will be realized when the political leaders of poorly performing countries can be convinced that embracing distributive policies and successfully bringing healthcare to the poor can be major factors in their re-elections.
Jooma, Rashid; Sabatinelli, Guido
Carbonate buildups including reefs and banks have proven to be prolific hydrocarbon reservoirs in the US, Canada, Mexico, North Africa, Southeast Asia, and the Middle East. Seismic interpretation, particularly of high quality marine data, and geological analyses, including petrographic studies of selected formations, reveal a broad spectrum of possible reefal prospects in formations of different ages in Pakistan. However, the region with good seismic that provides good recognition of possible reefal buildups remains to date devoid of well confirmation. Oil and Gas Development Corp. of Pakistan formed the technical services department in 1976 for a systematic scientific review of all exploration data and basin analysis. In 1985 this department was renamed offshore department, with responsibility for all offshore exploration. This article is based on the department`s work in collaboration with geoscientists from Russia, the US, Norway, and Canada covering the area shown. Four major types of carbonate buildups, easily recognized from seismic interpretation, include: barrier buildups that are linear with relatively deep water on both sides during deposition; pinnacle buildups that are roughly equidimensional and were surrounded by deep water during deposition; shelf margin buildups that are linear with deep water on one side and shallow water on the other; and patch buildups that form in shallow water either in close proximity to shelf margins, or over broad shallow seas.
Quadri, V.N.; Quadri, S.M.G.J.
There is much concern about the capacity of the health system of Pakistan to meet its goals and obligations. Historically, the political thrust has been absent from the health policy formulation and this is reflected in the low and stagnant public allocations to health. Successive political leaderships have averred from considering healthcare is a common good rather than a market commodity and health has not been recognized as a constitutional right. Over 120 of world's nation states have accepted health as a constitutional right but the 1973 Constitution of Pakistan does not mandate health or education as a fundamental right and the recently adopted 18th constitutional amendment missed the opportunity to extend access to primary health care as an obligation of the State. It is argued in this communication that missing from the calculations of policy formulation and agenda setting is the political benefits of providing health and other social services to underserved populations. Across the developing world, many examples are presented of governments undertaking progressive health reforms that bring services where none existed and subsequently reaping electoral benefit. The political determinant of healthcare will be realized when the political leaders of poorly performing countries can be convinced that embracing distributive policies and successfully bringing healthcare to the poor can be major factors in their re-elections. PMID:24948958
Jooma, Rashid; Sabatinelli, Guido
According to the World Health Organization and the United Nations Children's Fund, developing countries carry a large share of neonatal mortality in the world. According to UNICEF, almost 450 newborn children die every hour, mostly from preventable causes. Restricted access to quality and hygienic delivery services and limited knowledge about handling the newborn aggravate the situation. South Asia, and Pakistan in particular, have reduced their child and infant mortality during the last decade; however, neonatal mortality still remains unacceptably high. There are multiple reasons, mainly related to practices and behaviours of communities and traditional birth attendants. Rural and poor populations suffer most in Pakistan, where three out of five deliveries still occur at home. Traditional community practices and conservative norms drastically affect neonatal health outcomes. Preventing sepsis at the umbilical cord, keeping the baby at the correct temperature after birth and early initiation of exclusive breastfeeding are three simple strategies or messages that need to be disseminated widely to prevent many neonatal mortalities and morbidities. Since inappropriate practices in handling newborns are directly linked with persistent and unremitting behaviours among health providers and the community at large, we suggest doing robust "social marketing" for saving newborn lives. The objective of the paper is to present a social-marketing strategy and a marketing mix that will help address and surmount actual barriers and promote alternative behaviours in early neonatal care. PMID:20357556
Ejaz, Iram; Shaikh, Babar Tasneem
Maximum entropy (Maxent) modeling was used to predict the potential climatic niches of three medicinally important Asclepiad species: Pentatropis spiralis, Tylophora hirsuta, and Vincetoxicum arnottianum. All three species are members of the Asclepiad plant family, yet they differ in ecological requirements, biogeographic importance, and conservation value. Occurrence data were collected from herbarium specimens held in major herbaria of Pakistan and two years (2010 and 2011) of field surveys. The Maxent model performed better than random for the three species with an average test AUC value of 0.74 for P. spiralis, 0.84 for V. arnottianum, and 0.59 for T. hirsuta. Under the future climate change scenario, the Maxent model predicted habitat gains for P. spiralis in southern Punjab and Balochistan, and loss of habitat in south-eastern Sindh. Vincetoxicum arnottianum as well as T. hirsuta would gain habitat in upper Peaks of northern parts of Pakistan. T. hirsuta is predicted to lose most of the habitats in northern Punjab and in parches from lower peaks of Galliat, Zhob, Qalat etc. The predictive modeling approach presented here may be applied to other rare Asclepiad species, especially those under constant extinction threat.
Khanum, Rizwana; Mumtaz, A. S.; Kumar, Sunil
Summary Background Gram-negative Enterobacteriaceae with resistance to carbapenem conferred by New Delhi metallo-?-lactamase 1 (NDM-1) are potentially a major global health problem. We investigated the prevalence of NDM-1, in multidrug-resistant Enterobacteriaceae in India, Pakistan, and the UK. Methods Enterobacteriaceae isolates were studied from two major centres in India—Chennai (south India), Haryana (north India)—and those referred to the UK's national reference laboratory. Antibiotic susceptibilities were assessed, and the presence of the carbapenem resistance gene blaNDM-1 was established by PCR. Isolates were typed by pulsed-field gel electrophoresis of XbaI-restricted genomic DNA. Plasmids were analysed by S1 nuclease digestion and PCR typing. Case data for UK patients were reviewed for evidence of travel and recent admission to hospitals in India or Pakistan. Findings We identified 44 isolates with NDM-1 in Chennai, 26 in Haryana, 37 in the UK, and 73 in other sites in India and Pakistan. NDM-1 was mostly found among Escherichia coli (36) and Klebsiella pneumoniae (111), which were highly resistant to all antibiotics except to tigecycline and colistin. K pneumoniae isolates from Haryana were clonal but NDM-1 producers from the UK and Chennai were clonally diverse. Most isolates carried the NDM-1 gene on plasmids: those from UK and Chennai were readily transferable whereas those from Haryana were not conjugative. Many of the UK NDM-1 positive patients had travelled to India or Pakistan within the past year, or had links with these countries. Interpretation The potential of NDM-1 to be a worldwide public health problem is great, and co-ordinated international surveillance is needed. Funding European Union, Wellcome Trust, and Wyeth.
Kumarasamy, Karthikeyan K; Toleman, Mark A; Walsh, Timothy R; Bagaria, Jay; Butt, Fafhana; Balakrishnan, Ravikumar; Chaudhary, Uma; Doumith, Michel; Giske, Christian G; Irfan, Seema; Krishnan, Padma; Kumar, Anil V; Maharjan, Sunil; Mushtaq, Shazad; Noorie, Tabassum; Paterson, David L; Pearson, Andrew; Perry, Claire; Pike, Rachel; Rao, Bhargavi; Ray, Ujjwayini; Sarma, Jayanta B; Sharma, Madhu; Sheridan, Elizabeth; Thirunarayan, Mandayam A; Turton, Jane; Upadhyay, Supriya; Warner, Marina; Welfare, William; Livermore, David M; Woodford, Neil
Three different satellite-borne sensors, namely the Total Ozone Mapping Spectrometer (TOMS), the Moderate Resolution Imaging Spectroradiometer (MODIS), and the Multi-angle Imaging Spectroradiometer (MISR), were used to investigate the spatial and temporal variations of aerosols over several cities in Pakistan. A Hybrid Single Particle Lagrangian Integrated Trajectory (HYSPLIT) model was used for trajectory analysis in order to reconstruct the origins of air masses and understand the spatio-temporal variability of aerosol concentrations. Recent MODIS aerosol data (2002-2008) and earlier TOMS data (1979-2001) revealed increasing concentrations of aerosols over Pakistan and adjacent areas. Validation of MODIS and MISR derived aerosol optical depths (AODs) with Aerosol Robotic Network (AERONET) data for 2007 demonstrated that the MISR data was more accurate when close to the ocean, while the MODIS was more accurate over vegetated areas. The relationship between MODIS and MISR AOD data from 2002 to 2008 was analyzed, revealing a strong correlation between the two datasets. An assessment of seasonal variability in AOD for industrial, urban, semi-urban, rural, and semi-arid areas revealed maximum AOD values during the summer over all the areas investigated. Back trajectory analyses indicated that while winter air masses reaching Pakistan had travelled long distances, summer air masses had travelled only short distances. The higher aerosol concentrations during the summer are interpreted to be a result of the air masses spending more time over land during the summer than they do during the winter. While monsoonal rainfall tends to reduce aerosol concentrations by washing aerosols out of the atmosphere, this effect is mainly restricted to the eastern and south-eastern parts of Pakistan.
Alam, Khan; Qureshi, Salman; Blaschke, Thomas
Objective To determine the causes of blindness and visual impairment in adults (?30 years old) in Pakistan, and to explore socio?demographic variations in cause. Methods A multi?stage, stratified, cluster random sampling survey was used to select a nationally representative sample of adults. Each subject was interviewed, had their visual acuity measured and underwent autorefraction and fundus/optic disc examination. Those with a visual acuity of <6/12 in either eye underwent a more detailed ophthalmic examination. Causes of visual impairment were classified according to the accepted World Health Organization (WHO) methodology. An exploration of demographic variables was conducted using regression modeling. Results A sample of 16?507 adults (95.5% of those enumerated) was examined. Cataract was the most common cause of blindness (51.5%; defined as <3/60 in the better eye on presentation) followed by corneal opacity (11.8%), uncorrected aphakia (8.6%) and glaucoma (7.1%). Posterior capsular opacification accounted for 3.6% of blindness. Among the moderately visually impaired (<6/18 to ?6/60), refractive error was the most common cause (43%), followed by cataract (42%). Refractive error as a cause of severe visual impairment/blindness was significantly higher in rural dwellers than in urban dwellers (odds ratio (OR) 3.5, 95% CI 1.1 to 11.7). Significant provincial differences were also identified. Overall we estimate that 85.5% of causes were avoidable and that 904?000 adults in Pakistan have cataract (<6/60) requiring surgical intervention. Conclusions This comprehensive survey provides reliable estimates of the causes of blindness and visual impairment in Pakistan. Despite expanded surgical services, cataract still accounts for over half of the cases of blindness in Pakistan. One in eight blind adults has visual loss from sequelae of cataract surgery. Services for refractive errors need to be further expanded and integrated into eye care services, particularly those serving rural populations.
Dineen, B; Bourne, R R A; Jadoon, Z; Shah, S P; Khan, M A; Foster, A; Gilbert, C E; Khan, M D
Pakistan experienced extraordinary rainfall in mid-July 2010, which continued until September 2010. The result was unprecedented floods affecting the entire length of the country. The floods have been assessed to be the worst since 1929. According to the ...
This thesis examines the prospects of conflict caused by water scarcity in China, India, and Pakistan. The thesis uses indicators of water tensions, including water quality, water quantity, the management of water, state institutions, and national water p...
J. F. Brennan
Gift of the Indus: The Arts and Culture of Pakistan, presented by ARTSEDGE, the Kennedy Center's arts education network, introduces the arts and culture of Pakistan to young people and teenagers in the US, Pakistan, and all over the world, in the hope of fostering greater understanding. The site has three broad sections: The Nation, with information about the people and the land; Culture & Daily Life; and Arts of Pakistan, the most extensive section, encompassing music, theater, dance, and the visual arts. Video is used extensively on the site; allowing visitors to watch both folk and classical dance, see masters and students creating Arabic calligraphy, or sculptors working with wood, glass, and metal. There is also a weblog called Mehfil: A Gathering Place, a "one-year experiment in cultural conversation" constructed to allow teens to communicate while protecting their privacy.
Pakistan is a federal republic with a population of approximately 176 million. In 2008 democratic rule was restored in the country through elections that international observers deemed competitive and reflective of the people's will. Asif Ali Zardari, the...
This paper comprises of two sections. The first section describes challenges in the Carboniferous-Permian Gondwanan stratigraphic palynology, and progress in techniques such as presence of the `rare-marine intervals', and `radiometric dating' in some Gondwanan successions, e.g., South Africa, Australia and South America, as tools to confidently calibrate these palynozones. The second section describes developments in the palynological work on the Carboniferous-Permian Nilawahan Group of the Salt Range, Pakistan, and summarises their correlation with the coeval succession of the Gondwana continents and with the Russian/International stages.
Jan, Irfan U.
Abstract The paper reviews the trend of seigniorage earningsby State Bank of Pakistan and commercial,banks. It is found that seigniorage revenue of the SBP has declined overtime which indicates autonomy,of the central bank as well as less reliance of the government,on SBP’s resources for budget financing. In general, a direct relationship has been observed between seigniorage and inflation in Pakistan.
The first military coup in Pakistan in 1958, led by General Ayub Khan, started a precedent that continues four decades later, and also created an institutional path for three subsequent military coups. Today in Pakistan most policies, domestic and foreign...
Pakistan and the western Himalaya is a region of high seismic activity located at the triple junction between the Arabian, Eurasian and Indian plates. Four devastating earthquakes have resulted in significant numbers of fatalities in Pakistan and the surrounding region in the past century (Quetta, 1935; Makran, 1945; Pattan, 1974 and the recent 2005 Kashmir earthquake). It is therefore necessary to develop an understanding of the spatial distribution of seismicity and the potential seismogenic sources across the region. This forms an important basis for the calculation of seismic hazard; a crucial input in seismic design codes needed to begin to effectively mitigate the high earthquake risk in Pakistan. The development of seismogenic source zones for seismic hazard analysis is driven by both geological and seismotectonic inputs. Despite the many developments in seismic hazard in recent decades, the manner in which seismotectonic information feeds the definition of the seismic source can, in many parts of the world including Pakistan and the surrounding regions, remain a subjective process driven primarily by expert judgment. Whilst much research is ongoing to map and characterise active faults in Pakistan, knowledge of the seismogenic properties of the active faults is still incomplete in much of the region. Consequently, seismicity, both historical and instrumental, remains a primary guide to the seismogenic sources of Pakistan. This study utilises a cluster analysis approach for the purposes of identifying spatial differences in seismicity, which can be utilised to form a basis for delineating seismogenic source regions. An effort is made to examine seismicity partitioning for Pakistan with respect to earthquake database, seismic cluster analysis and seismic partitions in a seismic hazard context. A magnitude homogenous earthquake catalogue has been compiled using various available earthquake data. The earthquake catalogue covers a time span from 1930 to 2007 and an area from 23.00° to 39.00°N and 59.00° to 80.00°E. A threshold magnitude of 5.2 is considered for K-means cluster analysis. The current study uses the traditional metrics of cluster quality, in addition to a seismic hazard contextual metric to attempt to constrain the preferred number of clusters found in the data. The spatial distribution of earthquakes from the catalogue was used to define the seismic clusters for Pakistan, which can be used further in the process of defining seismogenic sources and corresponding earthquake recurrence models for estimates of seismic hazard and risk in Pakistan. Consideration of the different approaches to cluster validation in a seismic hazard context suggests that Pakistan may be divided into K = 19 seismic clusters, including some portions of the neighbouring countries of Afghanistan, Tajikistan and India.
Rehman, Khaista; Burton, Paul W.; Weatherill, Graeme A.
Objective: The purpose was to study the impact of anthropometrical parameters on portal vein diameter and liver size by ultrasound in a subset of Karachi population. Methods: Four hundred and fifty nine apparently healthy subjects were included in this cross sectional study. After recording weight and height of each subject, Portal vein diameter and both liver lobes were measured by gray scale ultrasonography. Students T test and ANOVA were applied for statistical analyses. Results: With increasing age, portal vein diameter and right lobe of liver increased significantly (p value < 0.001). Increase in portal vein diameter was also observed with rise in body mass index (0.8 cm in underweight - 1.1 cm in obese subjects). Sizes of right and left liver lobes also increased with a rise in body mass index (p value < 0.001 and 0.001). Gender, however, did not have any effect on portal vein diameter and liver size. Conclusion: Age and body mass index are reliable parameters to consider for avoiding false positive diagnosis of hepatomegaly and portal hypertension. Knowing the right and left liver size with respect to anthropometrical measurements also assist a clinician in selecting a subject for liver transplantation. PMID:24772148
Raza Siddiqui, Tanya; Hassan, Nuzhat; Gul, Pashmina
Objective: The purpose was to study the impact of anthropometrical parameters on portal vein diameter and liver size by ultrasound in a subset of Karachi population. Methods: Four hundred and fifty nine apparently healthy subjects were included in this cross sectional study. After recording weight and height of each subject, Portal vein diameter and both liver lobes were measured by gray scale ultrasonography. Students T test and ANOVA were applied for statistical analyses. Results: With increasing age, portal vein diameter and right lobe of liver increased significantly (p value < 0.001). Increase in portal vein diameter was also observed with rise in body mass index (0.8 cm in underweight - 1.1 cm in obese subjects). Sizes of right and left liver lobes also increased with a rise in body mass index (p value < 0.001 and 0.001). Gender, however, did not have any effect on portal vein diameter and liver size. Conclusion: Age and body mass index are reliable parameters to consider for avoiding false positive diagnosis of hepatomegaly and portal hypertension. Knowing the right and left liver size with respect to anthropometrical measurements also assist a clinician in selecting a subject for liver transplantation.
Raza Siddiqui, Tanya; Hassan, Nuzhat; Gul, Pashmina
Mountainous areas of higher altitudes in the northern Pakistan have numerous rivers of great surface runoff during the rainy months and glaciers melt seasons that play a significant role in water resources and hydro-power production. Many of these rivers are unexploited for their water resource potential. If the potential of these rivers are explored, hydro-power production and water supplies in these areas may be improved. The Indus is the mighty river in the Asian countries originating from mountainous area of the Himalayas of Baltistan, Pakistan in which most of the smaller streams and four main rivers drain. Under the larger interest of the economic development of the country, hydrology of these mountainous in northern Pakistan is studied in the perspective of climate change, which includes eight watersheds namely Gilgit, Hunza, Shigar, Shyok, Astore, Jhelum, Swat and Chitral. Available historic data from1960-2005 have been precisely utilized to study the hydrological changes with respect to variability in precipitation, temperature and mean monthly flows, trend of snow melt runoff, daily hydrographs of selected periods (1990 to 1999), water yield and runoff relationship, and flow duration curves. Precipitation from ten meteorological stations in mountainous area of northern Pakistan has not shown uniform distribution of rains but variability in the winter and summer rains is noticed. Review of mean monthly temperature of ten stations suggested that the Upper Indus Basin can be categorized into three hydrological regimes i.e., high altitude catchments with large glacierized parts, middle altitude catchments south of Karakoram, and foothill catchments. A 3-D finite element model (Feflow) has also been used for regional groundwater flow modeling of the Upper Chaj Doab in Indus Basin, Pakistan.
Interprovenance variation was examined in the composition of Moringa oleifera oilseeds from Pakistan. The hexane-extracted oil content of M. oleifera seeds harvested in the vicinity of the University of Agriculture, Faisalabad (Punjab, Pakistan), Bahauddin Zakariya University\\u000a (Multan, Pakistan), and the University of Sindh, Jamshoro (Sindh, Pakistan), ranged from 33.23 to 40.90%. Protein, fiber,\\u000a moisture, and ash contents were found to
Farooq Anwar; Muhammad Ashraf; Muhammad Iqbal Bhanger
The link of betel, areca and chewable tobacco with head and neck cancers is clearly established. Fifty eight percent of the global head and neck cancers occur in South and Southeast Asia, where chewing of betel, areca and tobacco are common. This study was carried out to establish the pattern of use of Paan, Chaalia, Gutka, Niswar, Tumbaku and Naas among population of squatter settlement of Karachi and to determine the perceptions and knowledge regarding their role in the etiology of head and neck cancers. It was a cross-sectional study, performed at Bilal colony in Karachi. Through systematic sampling, 425 subjects [a male and female from a household] were interviewed with a structured questionnaire. Knowledge regarding etiology of head and neck cancers was classified in ordinals of "good", "some" and "poor", for each substance separately, while practices were classified into "daily user", "occasional user" and "never user". About 40% of the participants were chewing at least one item [betel, areca or tobacco products] on daily basis. This prevalence was 2.46 times higher among males than females and 1.39 times higher among adolescents than adults. At least 79% of the participants were classified as having poor knowledge about the carcinogenicity of each of these items. Knowledge increased with age and level of education. Health hazards of these items were poorly recognized and about 20% perceived at least one of these items to be beneficial. Positive attitudes were seen regarding the steps to curb the production, business and consumption of these substances. In conclusion, prevalence of chewing of betel, areca and tobacco among adults and adolescents is high. Deficiency in knowledge and wrong perception of favorable effect of chewing products is common. Besides curtailing the availability of chewing products, correct knowledge regarding its ill-effects should be inculcated among population to decrease the burden of head and neck cancers. PMID:16629524
Khawaja, Muhammad RizwanulHaq; Mazahir, Samia; Majeed, Atif; Malik, Farida; Merchant, Kanwal AliRaza; Maqsood, Maria; Malik, Rabia; Ghaffar, Shehzad; Fatmi, Zafar
The process of digitization in libraries of Pakistan is at a very initial stage. Pakistan is lagging behind developed countries due to many reasons such as: funding, computer illiteracy and expertise in digitization. However, some institutions like the Higher Education Commission, the Punjab University Library, the National Library of Pakistan and some private organizations are doing digitization. In social sciences,
This paper explores the demand for child schooling in Pakistan, using the Pakistan Integrated Household Survey (1991). There have been few such studies for Pakistan, a country with relatively low enrollment rates and education levels, high illiteracy, and large disparity between male and female education. Additionally, this study focuses on two potential sources of bias in the estimation of the
The North West Frontier Province of Pakistan plans to improve services and facilities for handicapped children and is encouraging expatriates to bring their skills to Pakistan. Staff of current institutions are either untrained or have received short courses of training within Pakistan. There are currently about five expatriates working in the…
Seasonally-changes in wind pattern, monsoon, sometimes results in severe droughts and intense flooding in many parts of the world including South Asian countries like Pakistan. The livelihood of a vast population in Pakistan depends on agriculture and land use is strongly influenced by water-based ecosystems that depend on the monsoon rains. Furthermore, climate change studies undertaken so far reveal that action is essential in order to prevent long term damage to water cycle and thus of great concern to the community and stakeholders. Pakistan Summer Monsoon (PSM) is generally affected by both the disturbances from the tropical and the extratropical regions; however there is lack of understanding of physical mechanisms of PSM compared to other regional studies i.e. Indian Summer Monsoon (ISM) and South-East Asian Monsoon (SEAM). In our study, we applied heat and vorticity budgets and wave train analysis to reveal the mechanisms of the extremely dry and wet PSM events associated with the anomalous upper tropospheric circulation. We found that the extremely dry (wet) PSM events are closely related with the strengthening(weakening) of the upper-tropospheric central Asian high. We also found that in addition to Rossby-wave (Matsuno-Gill) type atmospheric response, the Rossby wave train along the Asian Jet originating from northwestern Europe or North Atlantic Ocean strengthened(weakened) the upper-tropospheric central Asian high. Therefore strong convection anomalies resulting in severe flooding (drought) events over the PSM region are induced by both the tropical and extratropical processes. Key Words: Pakistan, Extremes Monsoon Events, Physical Processes, Heat Budget, Vorticity, Wave Train
Ahmad, S.; Koike, T.; Nishii, K.
Ephedra, also known as "ma huang", is a dioecious, drought- and frost-resistant, perennial, evergreen shrub with compelling medicinal value. The genus is represented by 42 species around the world, 9 of which were provisionally reported from Pakistan. Species of the genus have a controversial taxonomy due to their overlapping morphological features. Conventional tools alone are not sufficient for characterizing the species. The objective of present study was to assess the genetic variability present in different biotypes of Ephedra growing in Pakistan using molecular markers. A total of six genotypes collected from diverse geographic zones of Pakistan were used. The DNA of all genotypes was amplified using nine randomly amplified polymorphic DNA (RAPD) primers to study genetic variability at the molecular level. The dissimilarity coefficient matrix based on the data of 9 RAPD primers was used to construct a dendrogram which was then used to group the genotypes in clusters. Based on the dendrogram and dissimilarity coefficient matrix, the RAPD markers used here revealed a moderate to high level of genetic polymorphism (6 to 49%) among the genotypes. It was found that the collection of genotype accessions from Swat Valley in northwestern Pakistan was most distantly related to the other five collections. More molecular markers including functional genes and ribosomal spacer regions are suggested to find a better estimate of the genetic diversity present in Ephedra growing in Pakistan. The information provided here is useful for identifying valuable Ephedra variants which will be used for medicinal purposes and earning foreign currency. PMID:18273806
Ghafoor, S; Shah, M M; Ahmad, H; Swati, Z A; Shah, S H; Pervez, A; Farooq, U
The data of the Population Labour Force and Migration (PLM) Survey of 1979-1980 was analyzed in order to study spacing between births as well as differentials in urban and rural areas, differentials by age at marriage, urbanization, education, work pattern, and contraceptive use. The median intervals from PLM Survey of 1979-80 and Pakistan Fertility Survey (PFS) of 1975 birth histories were compared by urban and rural residence for each parity in order to analyze trends in birth spacing. Findings indicate only a slight increase in child spacing, the 1st birth interval of urban females has increased consistently by 1 month from 1st parity to 4th parity according to PLM 1979-80. Urban women had shorter spacing of births than rural females in both surveys. In addition, the Pakistan Demographic Survey of 1985-86 showed that the medium of the 1st birth interval declined to 18.09 months compared to the 22.46 months of PLM. Women in urban areas had a higher rate of fertility than women in rural areas where the interval between marriage and 1st birth increased. Urban females also had shorter duration of breastfeeding and tended to have shorter median birth intervals at higher ages at marriage. Longer intervals were attributed to subfecundity or delayed cohabitation. In rural areas women do not space their births deliberately. The medium birth interval of women in urban centers was 4 months shorter than those for rural females with the same education increasing by 7 months in case of no female education. Educated females in major urban areas achieved their family size faster than women residing in other urban and rural areas. Educated urban females with high parity (4+) had longer intervals due to greater contraceptive use and a diminished desire to have more children. In the urban areas of Punjab and Sind longer birth spacing was recorded than in the rural areas but differences disappeared after the 2nd parity. Obviously, women engaged in economic activity want to complete their family size earlier, thus the birth interval is shorter. Among contraceptive users, ever users had shorter median intervals, as this small group was more educated and wanted to complete family size in a short time. There are certain associations between variables, but the impact of changes of birth spacing on marital fertility in inconclusive. PMID:12283410
Kiani, M F; Nazli, S
North Korea contributes to instability in the Middle East and South Asia through its proliferation of missiles and other weapons systems used as delivery platforms for chemical (and the production of chemical munitions) or biological weapons, including long-range artillery. Evidence also shows that North Korea has collaborated in the nuclear programs of Syria, Iran, Libya, and Pakistan and has provided
Bruce E. Bechtol Jr
Due to the lack of bioturbation, the laminated muds from the oxygen-minimum zone (OMZ) off Pakistan provide a unique opportunity to precisely determine the vertical and lateral sediment fluxes in the near shore part of the northeastern Arabian Sea, and to explore the effects of the margin topography and the low oxygen conditions on the accumulation of organic matter and other particles. West of Karachi, in the Hab river area of EPT and WPT (Eastern and Western PAKOMIN Traps), 16 short sediment profiles from water depths between 250 m and 1970 m on a depth transect crossing the OMZ (~ 120 to ~ 1200 m water depth) were investigated, and correlated on the basis of a thick, light-gray- to reddish-colored turbidite layer. Varve counting yielded a date for this layer of AD 1905 to 1888. We adopted the young age which agrees with 210Pb- dating, and used this isochronous stratigraphic marker bed to calculate sediment accumulation rates, that we could directly compare with the flux rates from the sediment traps installed within the water column above. All traps in the area show exceptionally high, pulsed winter fluxes of up to 5000 mg m-2 d-1 in this margin environment. The lithic flux at the sea floor is as high as 4000 mg m-2 d-1 , and agrees remarkably well with the bulk winter flux of material. This holds as well for the individual bulk components (organic carbon, calcium carbonate, opal, lithic fraction). However, the high winter flux events (HFE) by their extreme mass of remobilized matter terminated the recording in the shallow traps by clogging the funnels. Based on our comparisons, we argue that HFE for the past 5000 yr most likely occurred as regular events within the upper OMZ off Pakistan. Coarse fraction and foraminiferal accumulation rates from sediment surface samples along the Hab transect show distribution patterns that seem to be a function of water depth and distance from the shelf. Some of these sediment fractions show sudden shifts at the lower boundary of the OMZ. However, the potential effect of the OMZ on carbon preservation in the area would by masked by high mass of fine-grained matter laterally advected, and by the pulsed nature of the resuspension events.
Schulz, H.; von Rad, U.
Based in Switzerland, South Centre is a multi-national organization which promotes the global organization of its 46 member nations in order to become "effective in mobilizing its considerable combined expertise and experience or its bargaining power." The site contains a large number of current working papers, South Centre's quarterly newsletter South Letter, and relevant links.
Opinions of university students about euthanasia were studied in 4 cities in Pakistan using convenience sampling. A total of 836 students (316 males and 520 females) completed a questionnaire in which euthanasia was defined as deliberate administration of an overdose of a drug by a doctor to relieve pain and suffering of a dying patient at his/her explicit request to end his/her life. Only 25.6% of students agreed that euthanasia should be legalized in Pakistan. The most common reason cited for legalization of euthanasia was to relieve patient's suffering but only when a committee of physicians agreed to recommend it. Students who opposed legalization (74.4%) cited impediments to future medical research as the most common reason, followed by the risk of misuse by physicians or family members. Only 8.9% of students cited religious beliefs as a reason against legalization. There is a need in Pakistan for more debate about euthanasia. PMID:22256415
Shaikh, M A; Kamal, A
We report physicochemical characteristics of various kinds of liquid milk commercially available in Pakistan in comparison with those of fresh natural milk from animals. Milk samples were collected from local markets at Peshawar, Pakistan, and analyzed for their physical features, including moisture, total solids, specific gravity, conductivity, viscosity and titratable acidity (lactic acid equivalent), and chemical components and macro-minerals, including total protein, casein, lactose, ash and minerals (Na, K and Mg). These items were compared with the physicochemical characteristics of the fresh natural milk samples from buffalo, cow and goat. The results were also compared with reported nutritional quality of milk from various countries and World Health Organization (WHO) standards. We found that all the physical features and chemical components of commercially available milk in Pakistan markets meet WHO's requirements, except for Na, K, Ca and Mg, which are below the standards. PMID:18600784
Imran, Mohammad; Khan, Hamayun; Hassan, Syed Shah; Khan, Rasool
Information based on field observations of Veterinary Officers in nine districts of Punjab, Pakistan showed 11% incidence, 9% mortality and 78% case fatality rates of haemorrhagic septicaemia in buffalo, whereas these values were 4%, 2.5% and 62% in cattle. Disease incidence was higher in 0-24-month-old animals and groups of less than 10 animals. The disease was seasonal, occurring only in rainy seasons of the year, and victims were only cattle and buffalo. The clinical course of the disease was generally 1-2 days. symptoms included high temperature, salivation, swelling of the throat and difficulty in breathing and could result in death. Successful treatment was reported if antibiotics were given at the initial stages of the disease. Various combinations of sulphur drugs and antibiotics were considered more effective. The results of the questionnaire survey suggest that a favourable response was obtained using clamoxyl LA, farmox 15%, vesulong, gentakel and chloramphenicol. Previous vaccination of livestock with the alum-precipitated formalinized broth culture of Pasteurella multocida vaccine (bacterin) was not considered to protect against field outbreaks. PMID:8779811
Sheikh, M A; Anzam, M; Shakoori, A R
The Khewra Salt Mines, the second largest salt mines in the world, are located 160 km south of Islamabad, the capital of Pakistan. Around 1000 workers are involved in the removal of salt from these mines. More than 40,000 visitors come annually to see the mines. The visitors and workers are directly exposed to the internal and external radiological hazards of radon and gamma rays in these mines. The general public is affected by the intake of the salt containing the naturally occurring radionuclides. Therefore the concentration of radon (²²²Rn) in the Khewra Salt Mines and activity concentrations of the naturally occurring radionuclides in the salt samples from these mines were measured. Both active and passive techniques were employed for the measurement of radon with Radon Alpha Detector (RAD-7) and SSNTD respectively. The concentration of ²²²Rn was 26 ± 4 Bq m?³ measured by the active method while 43 ± 8 Bq m?³ was measured by the passive method. The activity concentration of the radionuclides was measured using gamma ray spectrometry with HPGe detector. The mean activity of ??K in salt samples was found to be 36 ± 20 Bq kg?¹ and the concentration of ²²?Ra and ²³²Th in the salt samples was below the detection limits. Gamma radiation hazard was assessed in terms of the external gamma dose from salt slabs and the rooms made of salt and the annual effective dose due to gamma radiation. The exposure to radon daughters, annual effective dose and excessive lifetime cancer risk due to radon in the mines were estimated. The mean annual effective dose due to an intake of ??K from the salt was calculated as 20.0 ± 11.1 µSv, which is lower than the average annual effective dose rate of 0.29 mSv, received by the ingestion of natural radionuclides. Due to the low concentration values of primordial radionuclides in the salt and radon ²²²Rn) in the mines, a 'low level activity measurement laboratory' is suggested to be established in these mines. PMID:22739011
Baloch, Muzahir Ali; Qureshi, Aziz Ahmed; Waheed, Abdul; Ali, Muhammad; Ali, Nawab; Tufail, Muhammad; Batool, Saima; Akram, Muhammad; Iftikhar, Poonam; Qayyum, Hamza; Manzoor, Shahid; Khan, Hameed Ahmed
Objective To determine the present status of plant communities and their possible association with the habitat in Malam Jabba, Swat, Pakistan. Methods A study on the phytoecology was conducted in various ecologically important sites of Malam Jabba, Swat, Pakistan from 2002 to 2004. The altitude of these sites ranged from 1?200 m to 3?200 m. Quadrat method was used for evaluation of plants communities and the data on these attributes was converted to relative values. The plant communities were named after 3 leading species with highest importance values. Biological spectrum of the flora based on the life form was prepared by following Raunkiar's life form classes. Results The floristic composition and structure of the study area were found to be 200 species belonging to 75 families. Asteraceae, Lamiaceae and Poaceae were important families in the study area. The biological spectrum showed that therophytic and hemicrytophytic life form and micro-nonophyllous leaf sizes were dominant in the area. The air and soil temperatures were decreasing with increasing elevation. Both the air and soil temperatures were relatively higher in south slopes than on the northeast slopes. The vegetation analysis of the area indicated eleven plant communities around the area. The present vegetation is the relics of moist temperate coniferous forest in the area. The communities reflect highly deteriorated conditions. Both the structure and composition of the surrounding vegetation were associated with the types of habitats. Conclusions The conservation of the remaining populations of the reported communities will be best achieved by proper time of sustainable harvesting. It is only possible with the participation of local communities.
Rashid, Abdur; Swati, Mohammad Farooq; Sher, Hassan; Al-Yemeni, Mohammad N
This report describes a mathematical model used to test the feasibility of achieving universal primary education in Pakistan. Background information is given on proposals from the Pakistani Commission on National Education that attempted to increase the percentage of children in primary schools, the most recent of these aimed at 100% enrollment by…
Our objectives are to evaluate the potential financial success of an unsubsidized, private sector coal briquetting venture in Pakistan, based on financial competitiveness in market niches, market size, and consumer acceptance; to examine private sector interest and potential business arrangements; to examine potential effects of government policies on such an undertaking; and to make recommendations to the private sector, USAID,
G. G. Stevenson; T. D. Willson
Isotope hydrology, including the development of related instrumentation, methodology of isotopic analysis for (2)H, (13)C, (15)N, (18)O and (34)S and applications in selected areas in Pakistan, are presented. Up-grading of a Varian Mat GD-150 mass spectro...
M. I. Sajjad
Despite the enormous demand for early childhood education care and education, it remains a privilege for young children in most of the world's nine high population countries, known as the E-9 group (Bangladesh, Brazil, China, Egypt, India, Indonesia, Mexico, Nigeria and Pakistan), according to a report published by UNESCO (2003). The World…
Hunzai, Zohra Nisar
This article traces how the concept of educational inspection has evolved in Pakistan, especially in the province of Sindh, and discusses whether the existing inspection system helps to improve quality and establish accountability. The inspection system that originated in colonial days has evolved to incorporate the notion of using supervision to…
Weed management studies in transplanted onion were conducted during 2004 and 2005 at the National Agricultural Research Centre, Islamabad, Pakistan. Pendimethalin and oxadiazon were applied post-emergence 2 days and 4 week after transplanting and their efficacy alone and in combination with one manual weeding was evaluated to reduce weed competition and its effects on marketable bulb yield. Hand weeded and
Khalid Mahmood Khokhar; Tariq Mahmood; Muhammad Shakeel; M. Farooq Chaudhry
Age, gender, and cross-national differences of children ages 9 through 16 in Pakistan (n = 463) and the United States (n = 500) are examined on four bipolar temperament styles: Extroversion-introversion, practical-imaginative, thinking-feeling, and organized-flexible. In general, Pakistani children prefer extroverted over introverted, practical…
Oakland, Thomas; Callueng, Carmelo; Rizwan, Muhammad; Aftab, Sobia
It is common to find well-crafted and coherent policy designs failing to attain desired results in developing counties. Pakistan is no exception. Despite having taken a significant number of initiatives in a quest to further its Teacher Professional Development (TPD) objectives, progress remains less than satisfactory. While a number of studies…
US Agency for International Development, 2006
This report details a situation analysis of children working in football stitching around Sialkot, Pakistan. The analysis (1) examined the reasons that children work and the probable impact of eradicating children's involvement and phasing out home-based production and (2) determined a baseline for monitoring changes in children's and families'…
Marcus, Rachel; Husselbee, David; Shah, Faiz; Harper, Annie; Ali, Bahar
This paper examines the efficiency of small manufacturing firms in Gujranwala, Pakistan. In the first step of the study, we construct measures of technical and scale efficiency for a sample of 153 small manufacturing firms from nine industries. The second step includes Tobit regressions of these measures on attributes of the firm and entrepreneur to examine sources of firm efficiency.
This article introduces a conflict resolution framework to address the Kashmir conflict. Firstly, Kashmir is mapped out as a multi-dimensional dispute between various parties: besides the interstate dispute between India and Pakistan, Kashmir is also an armed conflict both between India and the Kashmiris over the right of self-determination and between India and the religious militants who are waging a
This paper estimates linear structural models using LISREL and employs MIMIC models to find out factors determining child health in Pakistan. A distinction has been made in permanent and transitory health states that lend support to Grossman's (1972) stock and flow concepts of health. The paper addresses the issue of health unobservability and…
The changing environment of academic libraries in Pakistan demands new competencies for future academic librarians. This study defines and validates competencies for entry-level professionals keeping in view the needs of the next five years. Top-level library managers of selected universities and post-graduate level colleges participated in the…
The customary consanguineous nuptials in Pakistan underlie the frequent occurrence of autosomal recessive inherited disorders, including retinal dystrophy (RD). In many studies, homozygosity mapping has been shown to be successful in mapping susceptibility loci for autosomal recessive inherited disease. RDs are the most frequent cause of inherited blindness worldwide. To date there is no comprehensive genetic overview of different RDs in Pakistan. In this review, genetic data of syndromic and non-syndromic RD families from Pakistan has been collected. Out of the 132 genes known to be involved in non-syndromic RD, 35 different genes have been reported to be mutated in families of Pakistani origin. In the Pakistani RD families 90% of the mutations causing non-syndromic RD and all mutations causing syndromic forms of the disease have not been reported in other populations. Based on the current inventory of all Pakistani RD-associated gene defects, a cost-efficient allele-specific analysis of 11 RD-associated variants is proposed, which may capture up to 35% of the genetic causes of retinal dystrophy in Pakistan.
Khan, Muhammad Imran; Azam, Maleeha; Ajmal, Muhammad; Collin, Rob W. J.; den Hollander, Anneke I.; Cremers, Frans P. M.; Qamar, Raheel
In Pakistan, there are 7,000 children in 70 jails. From observations on why children commit crime, the author offers that the core cause is poverty; 99 per cent of young prisoners belong to deprived sections of society. They do not have access to education; living in prison is difficult; the degrading and harsh treatment adversely affects the…
The level of educational development in Pakistan is low. A decentralisation reform was introduced in 2000 to improve the delivery of basic education by designating the local government body with primary responsibility for administering it. A qualitative field study on local education administration at the North West Frontier Province found…
In Pakistan, the self-serving use of Islam by more secular elements alongside politico-religious ones facilitated the latter's increasing influence and the conflation and intricate interweaving of Islam and Pakistani nationhood. A paradigm shift under Zia's martial law revamped society as much as state laws, producing both religiously defined militias and aligned civil society groups. Examining the impact on women of
In urban squatter settlements and rural villages of Pakistan, human breastmilk is regarded as a potential source of destruction as well as of nurturance. Though it is highly valued as crucial for infant survival, it is also thought susceptible to becoming tainted in many ways: by a 'shadow' from the spirit world; by 'evil eye' or black magic due to
Dorothy S. Mull
The customary consanguineous nuptials in Pakistan underlie the frequent occurrence of autosomal recessive inherited disorders, including retinal dystrophy (RD). In many studies, homozygosity mapping has been shown to be successful in mapping susceptibility loci for autosomal recessive inherited disease. RDs are the most frequent cause of inherited blindness worldwide. To date there is no comprehensive genetic overview of different RDs in Pakistan. In this review, genetic data of syndromic and non-syndromic RD families from Pakistan has been collected. Out of the 132 genes known to be involved in non-syndromic RD, 35 different genes have been reported to be mutated in families of Pakistani origin. In the Pakistani RD families 90% of the mutations causing non-syndromic RD and all mutations causing syndromic forms of the disease have not been reported in other populations. Based on the current inventory of all Pakistani RD-associated gene defects, a cost-efficient allele-specific analysis of 11 RD-associated variants is proposed, which may capture up to 35% of the genetic causes of retinal dystrophy in Pakistan. PMID:24705292
Khan, Muhammad Imran; Azam, Maleeha; Ajmal, Muhammad; Collin, Rob W J; den Hollander, Anneke I; Cremers, Frans P M; Qamar, Raheel
The article explores perspectives on academic activities in public sector universities in Pakistan. Seven Pakistani universities yielded 290 teachers and 568 students in the sample. Factor analysis indicated five main factors in both teacher and student data sets. Both teachers and students were dissatisfied with the performance of the…
Ali, Akhtar; Tariq, Riaz H.; Topping, Keith J.
A project on the chromosome survey of the flora of West Pakistan is in progress and chromosome counts of a large number of species from this region have been reported earlier (Baquar et al. 1965, 1966, 1967). The present paper is a part of this project. Morphological and cytological behaviour of 29 species distributed over 12 genera of the familySolanaceae
S. R. Baquar
The paper reviews the trend of seigniorage earnings by State Bank of Pakistan and commercial banks. It is found that seigniorage revenue of the SBP has declined overtime which indicates autonomy of the central bank as well as less reliance of the government on SBP’s resources for budget financing. In general, a direct relationship has been observed between seigniorage and
M. Farooq Arby
Purpose – The paper aims to: assess the situation of rural population in Pakistan and information facilities available to them including telecommunications, computers and public libraries; document the community information initiatives in terms of objectives, institutional framework, staff, services, use, finance, technology and lessons learned; understand challenges and opportunities regarding the establishment of multipurpose community telecenters (MCTs) in rural areas
Analysis of reactivity induced accidents in Pakistan Research Reactor-1 (PARR-1) utilizing low enriched uranium (LEU) fuel, has been carried out using standard computer code PARET. The present core comprises of 29 standard and five control fuel elements. Various modes of reactivity insertions have been considered. The events studied include: start-up accident; accidental drop of a fuel element on the core;
I. H Bokhari; M Israr; S Pervez
Objective: To determine the prevalence of hypovitaminosis D and its predictors in healthy adult Pakistanis. This study was conducted at various hospitals in Karachi from April 2007 to September 2007. Methodology: In this study 244 healthy adults 16-62 years of age, visited hospital as an attendant of the patients and fulfilled the inclusion and exclusion criteria has been enrolled. After
Khalid Mahmood; Syed Tehseen Akhtar; Abu Talib; Iftikhar Haider
Relatively little systematic research has been undertaken on the role of the principal\\/headteacher in developing countries. In this study six headteachers of government and non-government secondary schools in Karachi were interviewed in depth and five completed diaries of their activities for one week. The study drew upon Rosemary Stewart's analysis of management roles in terms of the demands and constraints
Tim Simkins; Viv Garrett; Muhammad Memon; Rana Nazir Ali
The scope of formal population education in Pakistan covers the entire academic system, beginning from the primary level to the university and professional colleges. The government initiated action in 1980 to integrate population education in the formal and nonformal education sectors. General as well as specific behavioral objectives for population education were developed by the National Committee on Population Education. These objectives were further broken down for primary, middle, and lower and higher secondary school levels. The National Committee on Population Education prepared a curriculum for the training of primary, middle, and lower secondary school teachers which was used in training the master trainers. Textbooks in Pakistan were written in 1975 following the concepts and guidelines provided in the new curricula. Curriculum development specialists prepared model lessons on the integration of population education with social studies, Pakistan studies, Urdu, health and physical education, and nursing and general science for the guidance of textbook writers and teachers. The Allama Iqbal Open University has developed a 24-unit course to orientate primary school teachers in the philosophy and content of new curricula provided for in the new education policy of Pakistan. The Population Planning Division of Pakistan and the Family Planning Association of Pakistan periodically develop materials which serve as supplementary readers; an orientation program for teachers began on a limited scale following the inception of population education in Pakistan. Some research and evaluation projects have been undertaken periodically to study the effectiveness of some of the family planning programs. To ensure systematic and comprehensive coverage of population education through the existing formal and nonformal education programs the government is planning to undertake in collaboration with the UN Fund for Population Activities (UNFPA) and other bilateral and multilateral funding agencies. The broad strategies for implementation cover the following areas: identification of the target group; instructional strategies; and federal and provincial implementation strategies. Problems have included perception as another name for family planning, lack of systematic and consistent planning for integrating population education, and a lack of funds. PMID:12265645
BACKGROUND: There have been no previous studies conducted in Pakistan comparing the concordance of any well established Western anxiety\\/depression screening instrument with an indigenous scale, in a community based setting. METHODS: Participants (n = 1040) in the present study were recruited from the six villages of our interest from the district Gujarat of Pakistan, using a convenient sampling technique. Interview
Hammad Raza Syed; Henrik Daae Zachrisson; Odd Steffen Dalgard; Ingvild Dalen; Nora Ahlberg
BACKGROUND: National level estimates of injuries are not readily available for developing countries. This study estimated the annual incidence, patterns and severity of unintentional injuries among persons over five years of age in Pakistan. METHODS: National Health Survey of Pakistan (NHSP 1990–94) is a nationally representative survey of the household. Through a two-stage stratified design, 18, 315 persons over 5
Zafar Fatmi; Wilbur C Hadden; Junaid A Razzak; Huma I Qureshi; Adnan A Hyder; Gregory Pappas
This study explores the association between working capital management and the profitability of textile firms in Pakistan. The efficiency of working capital management is reflected by three variables: cash conversion efficiency, days operating cycle, and days of working capital. We use return on assets, economic value added, return on equity, and profit margin on sales as proxies for profitability. A
Child marriage (before 18 years) is prevalent in Pakistan, which disproportionately affects young girls in rural, low income and low education households. Our study aims to determine the association between early marriage and high fertility and poor fertility health indicators among young women in Pakistan beyond those attributed to social vulnerabilities. Nationally representative data from Pakistan Demographic and Health Survey, 2006-2007, a cross-sectional observational survey, were limited to ever-married women aged 20-24 years (n = 1,560; 15% of 10,023) to identify differences in poor fertility outcomes [high fertility (three or more childbirths); rapid repeat childbirth (<24 months between births); unwanted pregnancy (any ever); pregnancy termination (any stillbirth, miscarriage or abortion ever)] by early (<18) versus adult (?18) age at marriage. Associations between child marriage and fertility outcomes were assessed by calculating adjusted odds ratios (AORs) using logistic regression models after controlling for demographics, social equity indicators (education, wealth index, rural residence), contraception use, marriage duration and culture-specific factors (husband's desire for more children, son preference). Overall, 50% of ever-married women aged 20-24 years in Pakistan were married before the age of 18 years. Girl child marriage was significantly (p < 0.001) associated with low social equity indicators (poverty, rural residence, and no formal education). Adjusted logistic regression models showed that girl child marriage was significantly associated with high fertility (AOR 6.62; 95% CI 3.53-12.43), rapid repeat childbirth (AOR 2.88; 95% CI 1.83-4.54), unwanted pregnancy (AOR 2.90; 95% CI 1.75-4.79), and pregnancy termination (AOR 1.75; 95% CI 1.10-2.78). Girl child marriage affects half of all ever-married women aged 20-24 years in Pakistan, and increases their risk for high fertility and poor fertility health indicators, highlighting the need of increasing the age of marriage among women in Pakistan. Efforts to eliminate girl child marriage by strict law enforcement, promoting civil, sexual and reproductive health rights for women can help eliminate girl child marriage in Pakistan. PMID:23580067
Nasrullah, Muazzam; Muazzam, Sana; Bhutta, Zulfiqar A; Raj, Anita
The Upper Indus Basin (UIB) is home to three of the world's mightiest mountain ranges. The Karakoram in north and the Himalaya in northeast while the Hindukush in the northwest of Pakistan. The Indus River emerges from the Tibetan Plateau and flows toward northern areas of Pakistan where it changes its direction toward the south and flows into the Arabian Sea. The catchment area of Indus River is located in Pakistan, China and India, but most part covered in Pakistan. The Upper Indus Basin lies within the variable influence of three major weather systems: the sub-Mediterranean regime of mainly winter, westerly storms; the summer monsoon; and the Tibetan anticyclone. The Upper Indus River Basin has a total catchment area of approx. 206,000 km2. The UIB includes the Hunza, Gilgit, Astore, Shigar and Shyok sub-basins. Nearly 11.5% (22,000 km2) of the total area of the UIB is covered by perennial glacial ice (including most of the largest valley glaciers) making it the largest area outside the polar and Greenland regions (Hewitt, 2007). UIB has a mean elevation of 4750 m with almost 60% of its total area above an elevation of 4500 m and 12% of its area (almost the same area is glacier covered) above 5500 m. Glacial melt is one of the major sources of inflow in the Upper Indus Basin, 44.8% of its river flow depends upon glacial melting. Its mean discharge at Tarbela dam is 5533 m3/s (IUCN, IWMI). Most of the annual precipitation in the UIB falls in the winter and spring and originates from the west (Young and Hewitt, 1990). Several researchers reported that 80% of the flow of the Upper Indus River is contributed by less than 20% of its area, essentially from the zones of heavy snowfall and glaciated basins above 3500m in elevation. Under the Framework of TPE Program, observational researches have been lunched since last year. The project aim to the objective of hydrological consequence of snow cover in UIB; impact of glacier dynamic to basin drainage and response of discharge to climatic changes during past 50 years. The presentation will highlight the research including field expedition in 2011, objective and strategies, and request to cooperation as well.
Background Globally 7.6 million children died in 2010 before reaching their fifth birthday and 40% of these deaths occur in the neonatal period. Pakistan has the third highest rate of neonatal mortality globally. To implement evidence-based interventions for the reduction of neonatal mortality, it is important to investigate factors associated with neonatal mortality. The aim of the current study was to identify determinants of neonatal mortality in Pakistan. Methods Data was derived from the Pakistan Demographic and Health Survey 2006–07. All singleton live births between 2002 and 2006 were selected for the current analyses. Data was analysed by using STATA 13 and adjusted for the cluster sampling design. Multivariate Cox proportional hazard models were performed using step-wise backward elimination procedures to identify the determinants of neonatal mortality. Results A total of 5,702 singleton live births in the last five years preceding the survey were selected. Multivariate analyses showed that living in Punjab province (Adj HR?=?2.10, p?=?0.015), belonging to the poorest household wealth index quintile (Adj HR?=?1.95, p?=?0.035), male infants (Adj HR?=?1.57, p?=?0.014), first rank baby (Adj HR?=?1.59, p?=?0.049), smaller than average birth size (Adj HR?=?1.61, p?=?0.023) and mothers with delivery complications (Adj HR?=?1.93, p?=?0.001) had significantly higher hazards of neonatal death in Pakistan. Conclusions To reduce neonatal mortality, there is a need to implement interventions focusing on antenatal care, effective referral system and retraining of healthcare providers to manage delivery complications and smaller than average birth size babies in resource poor communities of Pakistan.
The Indus River is the major source of water for the more than 180 million people of Pakistan. A rapidly increasing population over the past 60 years has created new pressures on water that was once a plentiful resource for the health and development of the country. Rising tensions between India and Pakistan, which share the Indus flow, may lead to violent confrontation in an already volatile part of the globe. The recent flooding, which affected more than 20 million people, drew attention to poor management of the rivers of Pakistan. Public health has the scientific knowledge and professional capacity to help develop water management practices that could improve population health in Pakistan.
The National Security Archive at The George Washington University is dedicated to providing key diplomatic documents that describe the world of political relationships and other key areas of government relations between the United States and other nations. This electronic briefing book released in December 2010 takes a look at the attempts by the Carter administration to roll back Pakistan's nuclear program in the late 1970s. These recently declassified U.S. government documents shed light on the "critical period when Washington discovered that Pakistan, a Nuclear Nonproliferation Treaty hold-out, had acquired key elements of a nuclear weapons capability." This collection contains 40 documents that highlight some of the behind-the-scenes negotiating that went on from 1978 to 1980. There's a brief synopsis of each document, and a fine introduction that provides some good context on this series of communiques and related exchanges.
Cancer is the second leading cause of death in Pakistan. There is increasing evidence that patients are using a range of (biomedical and nonbiomedical) therapeutic options for cancer treatment. To date there has been no sociologically informed research into the engagement of cancer patients in Pakistan with available modalities. In this article, the authors present findings from the first such study. They purposively sampled 46 cancer patients from four hospitals in Lahore and conducted semistructured interviews with them. They argue that individuals are actively mediating therapeutic possibilities by drawing on, and at times being constrained by, personal, social, and cultural resources. It is the authors' contention that this can be conceptualized by an appreciation of individuals' active engagement with three temporally and spatially specific dimensions: structural and practical constraint; pragmatic experimentation; and cultural and religious affiliation. The negotiation (and varying power) of these dimensions is crucial to the process. PMID:17478647
Tovey, Philip; Broom, Alex
This study looked at the comprehensiveness of the primary health care approach being applied in Pakistan's National Maternal, Newborn and Child Health (MNCH) Programme launched in 2005. The methods included a review of the programme's guideline documents, in-depth interviews with managers/advisors and focus group discussions with community groups and service providers. The MNCH Programme is applying a selective primary care model. Programme advisors and managers were concerned about the quality of training, political interference and incomplete implementation. Service providers were not working together as envisioned. Community midwives complained about the community's perceptions of them. Community members were unaware of MNCH Programme implementation in their areas. Pakistan's primary health care programme needs to be reviewed and revised according current thinking on community participation and inter-sectoral collaboration to accelerate progress towards achievement of Millennium Development Goals 4 and 5. PMID:24932928
Akhtar, T; Khan, Z; Raoof, S
From 2004 to 2011, the Canada-Pakistan HIV/AIDS Surveillance Project (HASP) worked with government and non-government partners in Pakistan to design and implement an HIV second generation surveillance (SGS) system. Insights into the development of scalable cost effective surveillance methodologies, implementation, use of data for HIV prevention and human rights were gained over the course of HASP. An ideal SGS system would be affordable, able to be implemented independently by local partners and produce data that could be readily applied in policy and programmes. Flexibility in design and implementation is important to ensure that any SGS system is responsive to information needs, political changes and changes in key population dynamics and HIV epidemics. HASP's mapping methodology is innovative and widely accepted as best practice, but sustainability of the SGS system it developed is a challenge.
Munro, Michelle; Holte-McKenzie, Merydth; Ahmed, Sadia; Archibald, Chris P; Blanchard, James F; Thompson, Laura H
Grain legumes are an important source of dietary protein across southern Asia, but they suffer extensive losses due to several viruses that are members of the genus Begomovirus (family Geminiviridae), which are collectively known as legume yellow mosaic viruses (LYMVs). Despite their economic importance, little attention has been paid to LYMVs in Pakistan and only partial sequences of virus isolates originating from this country are available in the databases. Here, a survey of LYMVs occurring across Pakistan is described. Complete sequences of 44 components (23 DNA-A, 19 DNA-B and 2 betasatellites) were determined. The results show that only the mungbean yellow mosaic India virus (MYMIV) is of agricultural significance in Pakistan having been isolated from all cultivated grain legumes examined. Mungbean yellow mosaic virus, a significant crop pathogen in India, was only identified in a weed, which together with a novel species of LYMV we reported earlier, represents the first LYMV identified in non-cultivated plants. MYMIV was shown to occur as two types in Pakistan that show phylogeographical segregation. Additionally, two begomovirus species not considered pathogens of legumes and a betasatellite were isolated. This is of grave concern since it suggests that the presumed genetic isolation of the LYMVs in legumes may be being breached. LYMVs show little, if any, evidence of interspecific recombination with non-legume infecting begomoviruses. Thus, either recombination with non-legume viruses or interaction with betasatellites, which are host range and pathogenicity determining satellites of begomoviruses, could lead to the appearance of more aggressive virus variants/strains affecting legumes. PMID:20375225
Ilyas, Muhammad; Qazi, Javaria; Mansoor, Shahid; Briddon, Rob W
Weed management studies in transplanted chilies were conducted during 2004 and 2005 at the National Agricultural Research Centre, Islamabad, Pakistan. Pendimethalin and oxadiazon at 0.825 and 0.240l a.i.ha?1, respectively were applied 1 week before and 2 days after transplanting and their efficacy alone and in combination with one manual weeding was evaluated to reduce weed competition and its effects on
Khalid Mahmood Khokhar; Tariq Mehmood; Muhammad Shakeel
Venous thromboembolism (VTE) is an important cause of in-hospital mortality. A local understanding of disease burden, occurrence, etiology and successful preventive and therapeutic interventions is of vital import. We aimed to review the current literature of VTE originating from Pakistan to determine gaps in knowledge in order to prioritize future research. An electronic search was performed using Pakmedinet, Pubmed and Google Scholar to retrieve research articles on thrombosis, deep vein thrombosis and pulmonary thromboembolism in Pakistan. The search included all years and no limits were applied. All original research articles presenting primary data from Pakistan were selected. Full texts were reviewed and information synthesized and summarized in our review. Eighty-one studies were found, out of which we were able to retrieve and review 77 (95%) full texts. A total of 6,501 patients are included in this review. Among the studies, we found 25 case reports/series, 1 case-control, 3 cohort, 20 cross-sectional, 1 quasi-experimental, 2 randomized controlled trials, 4 retrospective file reviews and 21 review articles. Most of these were small studies with only eight having a patient population above 100. Six studies presented incidence of DVT which ranged from 2.6 to 12.82% depending on the population under study. Two articles studied risk factors for DVT. Six looked at different treatment modalities, often comparing one modality to the other, while another 15 articles assessed diagnostic strategies. Preventive aspects of VTE were addressed by only three studies and all found the rates of thrombo-prophylaxis grossly inadequate. There is a dearth of quality research on venous thromboembolism in Pakistan. We describe key areas of neglect and recommend prioritizing research on epidemiological and preventive aspects. PMID:22915351
Khan, Abdul Ahad; Zafar, Syed Nabeel
Objective. To estimate the proportion of pharmacies meeting licensing requirements and to identify factors associated with these pharmacies in urban Rawalpindi, Pakistan. Design. Cross-sectional questionnaire survey conducted during July-September 2001, of 311 pharmacies selected from a drug company list of 506. Setting. Free-standing licensed and unlicensed pharmacies in urban Rawalpindi. Study participants. A pharmacist or (if unavailable) the most experienced
ZAHID A. BUTT; ANWAR H. GILANI; DEBRA NANAN; ABDUL L. SHEIKH; FRANK WHITE
Zusammenfassung Auf einer beigegebenen Karte wird der Verlauf von aktiven und von vermutlichen Hauptverwerfungen in Afghanistan, Pakistan und im Iran gezeigt, wie er anhand von Luftbild-Mosaikkarten und Luftaufnahmen bestimmt wurde. Die fünf wichtigsten aktiven Dislokationen sind die Herat-, Chaman-, Sharud-, Doruneh- und die Zagros-Verwerfung.Die deutlich sichtbare Herat-Verwerfung erstreckt sich in ENE-Richtung über 800 km durch den Nordteil Afghanistans zur chinesischen Grenze.
H. W. Wellman
Fuel-failure detection in nuclear reactors is important from the safety point of view. After the conversion and upgrading of Pakistan Research Reactor-1 (PARR-1), it was decided to install a fuel-failure detection system to confirm the performance and integrity of the new fuel elements. The fuel-failure detection is based on monitoring of delayed neutrons emitted from fission products leaking into the
S. K. Ayazuddin; Tariq Hayat; A. A. Qureshi; H. A. Khan
During the last 30 years, Pakistan has undergone extreme transformations with respect to population and economic conditions. As a hazard-prone country with more people living in high-risk areas than ever before it is increasingly important to pro-actively address natural and man-made hazards and the cumulative risks that they pose at multiple spatial and temporal scales. In this study an assessment
Lubna Rafiq; Thomas Blaschke
This paper examines the magnitude of public\\/private wage differentials in Pakistan using data drawn from the 2001-02 Labour Force Survey. Pakistan Labour Force Survey is a nationwide survey containing micro data from all over the country containing demographic and employment information. As in many other countries, public sector workers in Pakistan tend to have higher average pay and educational levels
The influence of siblings on the socialization of the individual has been recognized as a fact by both psychology and sociology. The significance of sibling order for the outbreak of psychiatric diseases on the other hand is still discussed controversially. In our study, we compared the expected values and the positions actually found in the sibling order of 379 (233 males, 146 females) Austrian and 144 (101 males, 43 females) Pakistani patients diagnosed with schizophrenia according to DSM-IV (295). The position in the sibling order had no influence on the outbreak of schizophrenia in Austria; with Austrian schizophrenics, the results found were very near to the expected values. In Pakistan on the other hand, the eldest brothers from families with 2-4 siblings had a significantly higher risk of falling ill. The investigation of the composition of the sibships of schizophrenic patients also showed a high overrepresentation of men in the firstborn position in Pakistan. These facts seem to exercise influences that may either protect against the outbreak or encourage it. The differences found agree well with the fact that in Pakistan, both the gender of a child and the position in the sibling order entail different ways of treatment and different scopes of responsibility. Socialization in Austria on the other hand, at least in the recent decades, has become very uniform for both sexes, regardless of the sibling position. PMID:10575326
Stompe, T; Ortwein-Swoboda, G; Friedmann, A; Chaudhry, H R
Background Both Plasmodium vivax and Plasmodium falciparum are prevalent in Pakistan, yet up-to-date data on the epidemiology of malaria in Pakistan are not available. This study was undertaken to determine the current prevalence and distribution of Plasmodium species across the country. Methods A malariometric population survey was conducted in 2011 using blood samples collected from 801 febrile patients of all ages in four provinces and the capital city of Islamabad. Microscopically confirmed Plasmodium-positive blood samples were reconfirmed by polymerase chain reaction (PCR). Confirmed parasite-positive samples were subjected to species-specific PCR capable of detecting four species of human malaria. Results Of the 707 PCR-positive samples, 128 (18%) were P. falciparum, 536 (76%) were P. vivax, and 43 (6%) were mixed P. falciparum and P. vivax. Ninety-four microscopy-positive samples were PCR-negative, and Plasmodium malariae and Plasmodium ovale were not detected. Prevalence of P. vivax ranged from 2.4% in Punjab Province to 10.8% in Sindh Province and prevalence of P. falciparum ranged from 0.1% in Islamabad to 3.8% in Balochistan. Conclusions Plasmodium infections in Pakistan are largely attributed to P. vivax but P. falciparum and mixed species infections are also prevalent. In addition, regional variation in the prevalence and species composition of malaria is high.
Our objectives are to evaluate the potential financial success of an unsubsidized, private sector coal briquetting venture in Pakistan, based on financial competitiveness in market niches, market size, and consumer acceptance; to examine private sector interest and potential business arrangements; to examine potential effects of government policies on such an undertaking; and to make recommendations to the private sector, USAID, and the Government of Pakistan on further work. Our results show that coal briquettes potentially can compete against firewood in some markets, particularly in certain urban areas of Punjab and most urban markets of the NWFP. Salt Range or Makerwal coal would be used for these briquettes. Coal briquettes will also compete against charcoal and kerosene in many areas of Pakistan. The most promising briquette is a coal/biomass mixture not requiring carbonization. A limited opportunity may also exist for a carbonized briquette using Makerwal coal. Smoky briquettes for space heating also are competitive in certain areas, but market size is limiting. The total penetrable residential market for coal briquettes in the Punjab and NWFP of 440,000 to 545,000 tonnes of briquettes per year replacing firewood is sufficiently large to support one or more plants of 50,000 tonnes per year. Charcoal, kerosene, and commercial uses of briquettes could add to this market. 9 refs., 20 figs., 39 tabs.
Stevenson, G.G.; Willson, T.D.
Background Peste des petits ruminants (PPR) is an endemic and highly contagious disease in small ruminants of Pakistan. Despite the fact that an effective vaccine is available, outbreaks are regularly occurring in the country. Thus so far, the diagnosis has primarily been made based on clinical outcome or serology. This study was carried out to characterize PPRV from an emerging wave of outbreaks from Punjab, Pakistan. Results A total of 32 blood samples from five different flocks were tested with real-time PCR for the presence of PPRV genome. The samples detected positive in real-time PCR (n?=?17) were subjected to conventional PCR for the amplification of the nucleoprotein (N) gene. Phylogenetic analysis of the sequenced N genes (n?=?8) indicated the grouping of all the sequences in lineage IV along with PPRV strains from Asian and Middle East. However, interestingly sequences were divided into two groups. One group of viruses (n?=?7) clustered with previously characterized Pakistani isolates whereas one strain of PPRV was distinct and clustered with Saudi Arabian and Iranian strains of PPRV. Conclusions Results demonstrated in this study expanded the information on the genetic nature of different PPRV population circulating in small ruminants. Such information is essential to understand genetic nature of PPRV strains throughout the country. Proper understanding of these viruses will help to devise control strategies in PPRV endemic countries such as Pakistan.
Subsurface structure in the Pakistan Himalaya is poorly known despite its geological importance in understanding the trend and growth of the Himalaya. In this paper, we compute receiver functions from a broadband seismic network in northern Pakistan and construct crustal structure beneath the stations. P to S converted phases at the Moho are clearly observed on stacked receiver functions. We model the conversions from the Moho and shallower interfaces using the trial and error method. Assuming a Vp/Vs ratio of 1.75, the modeled crustal thickness is 52-53 km in the Peshawar Basin, 55-62 km in the Lesser Himalaya, and 65-76 km in the Higher Himalaya. The variation of the Moho depth correlates well with surface topography, indicating an Airy type of isostasy in the Pakistan Himalaya. A large negative phase before the Moho conversion is consistently observed at all three stations to the north of the India-Asia suture, which is best modeled by a low velocity layer in the lower crust. The slow lower crust is likely caused by partial melt resulted from crust thickening. Volatile in the crust of the Kohistan island arc and the subduction and melting of the Indian upper crust may also contribute to the low velocity layer. Like the weak middle-lower crust in Tibet, this slow lower crust probably has an important role in the formation and growth of the western Himalaya.
Li, Aibing; Mashele, Bongani
Preference for children of either sex is considered a constraint on fertility decline as it induces many couples to keep adding on surviving children in the hope of having a desired sex composition of children. However, preferences for children of a particular sex may differ in relation to demographic and socioeconomic characteristics of women, traditional values and cultural practices, such as propagating a family name, providing economic advantages, and obtaining a medium of social and economic security in times of illness, unemployment and old age. Utilizing the Pakistan Integrated Household Survey (2001-02), this paper aims at investigating the existence of sex preference and examines sex preference differentials by different attributes of women in Pakistan. The results reveal that there is a desire to have another child in the presence of all children of one sex, either sons or daughters. The desire to have a son with only or mostly daughters, however, is stronger than the desire to have a daughter with only or mostly sons. This behaviour will retard fertility decline unless there is a shift in the desire to have children of both sexes in Pakistan. PMID:18647438
Pakistan ranks 125th out of 169 countries on the Gender Development Index and has high prevalence rates of Violence against Women (VAW). Contributing factors toward gender based violence at the micro, meso and macro levels include the acceptability of violence amongst both men and women, internalization of deservability, economic disempowerment, lack of formal education, joint family systems, entrenched patriarchal norms and values, and a lack of awareness of legal and other support systems. These factors have a long-lasting impact on the health of women and children. The gender disparities in the experience of women seeking health care in Pakistan are well-recognized and documented. In the past, common government policy responses to these disparities have included developing the role of community health workers (CHWs) and lady health visitors (LHVs). Despite being commendable initiatives, these too have been unsuccessful in addressing these multi-faceted disparities. Within this complex scenario, new interventions to address VAW and its impact on health in Pakistan include Group Counselling, Economic Skills Building, Health-Based Microfinance, and Family-Based models that increase male involvement, especially at the primary health care level. The purpose of this article is to outline key contributing factors to VAW, explore tested and new interventions, and highlight the opportunities that exist in implementing them. PMID:23215983
Karmaliani, Rozina; Pasha, Aneeta; Hirani, Saima; Somani, Rozina; Hirani, Shela; Asad, Nargis; Cassum, Laila; McFarlane, Judith
This is an attempt to study the effects of migration of earning member (to Gulf States) on the family, specially children left behind. Twenty five families who sought psychiatric help for one of their members were included. A control group (of non-migrant family) attending the out-patient's department was selected for comparison. The wife and children left behind experienced considerable emotional hardship. Twenty two families (88%) reported statistically significant recent maladjustment in 35 children (30%) as compared to control group of twelve families (48%) in 15 children (10%). Undoubtedly the major brunt is faced by the wives but the damage done to children is much less appreciated. This study identifies the current disturbance but the future effects on the personality of other children could manifest much later. PMID:1900543
Ahmed, S H; Zainulabdin, F
Asymmetrical monsoons during the recent past have resulted into spatially variable and devastating floods in South Asia. Analysis of historic precipitation extremes record may help in formulating mitigation strategies at local level. Eleven indices of precipitation extremes were evaluated using RClimDex and daily time series data for analysis period of 1981-2010 from five representative cities across Punjab province of Pakistan. The indices include consecutive dry days, consecutive wet days, number of days above daily average precipitation, number of days with precipitation ?10 mm, number of days with precipitation ?20 mm, very wet days, extremely wet days, simple daily intensity index, maximum 1-day precipitation quantity, maximum 5 consecutive day precipitation quantity, and annual total wet-day precipitation. Mann-Kendall test and Sen's slope extremes were used to detect trends in indices. Droughts and excessive precipitation were dictated by elevation from mean sea level with prolonged dry spells in southern Punjab and vice versa confirming spatial trends for precipitation extremes. However, no temporal trend was observed for any of the indices. Summer in the region is the wettest season depicting contribution of monsoons during June through August toward devastating floods in the region.
Abbas, Farhat; Ahmad, Ashfaq; Safeeq, Mohammad; Ali, Shafaqat; Saleem, Farhan; Hammad, Hafiz Mohkum; Farhad, Wajid
This paper discusses ways in which the navies of both India and Pakistan can cooperate on issues of maritime and naval significance. Although the militaries and navies of the two countries have traditionally seen each other as rivals, international economic developments make cooperation imperative. South Asia requires an approach that can alter the existing hostile images and perceptions. This can be achieved through developing an incremental approach towards confidence building that would allow consistency and help build confidence gradually. The aim is to make confidence building a sustainable activity that would help transform hostile images and build cooperative and nonhostile relationships. This paper proposes a five-step model to suggest what the two navies can do jointly to build confidence, with the ultimate goal of naval arms control. The steps include (1) the Signaling Stage to initiate communication between the two navies, (2) the Warming-Up Stage to build confidence through nonmilitary joint ventures, (3) the Handshake Stage to build confidence between the two navies through military joint ventures, (4) the Problem-Solving Stage to resolve outstanding disputes, and (5) the Final Nod Stage to initiate naval arms control. This model would employ communication, navigation, and remote sensing technologies to achieve success.
Smokeless tobacco is commonly used in south Asia. In addition to causing oral and pharyngeal cancers, its harmful effects are comparable to smoking tobacco. A cross-sectional survey with systematic sampling was conducted in 2010-2011 to investigate smokeless tobacco use in a multi-ethnic, semi-urban population in Islamabad, Pakistan (n = 2030). The prevalence of smokeless tobacco use was 16.0% (21.6% among males and 8.8% among females); 51.7% of smokeless tobacco users were also cigarette smokers. The rate of smokeless tobacco use was comparatively high among Pakhtun males (38.2%) and Sindhi females (22.4%). The associations between smokeless tobacco use and ethnicity, age group, income level and cigarette smoking were statistically significant among male smokeless tobacco users. Of the sample 41.4% (840/2030) had inadequate knowledge about the health problems associated with smokeless tobacco. Appropriate interventions are needed to raise awareness of the health risks and to prevent smokeless tobacco use. PMID:24960515
Abbas, S M; Alam, A Y; Usman, M; Siddiqi, K
Eight Newcastle disease virus isolates from Pakistan were sequenced and characterized. A PCR matrix gene assay, designed to detect all avian paramyxovirus 1, did not detect four of the isolates. A new matrix gene test that detected all isolates was developed. Phylogenetic analysis and pathotyping confirmed that virulent viruses of different genotypes are circulating in Pakistan.
Khan, Taseer Ahmed; Rue, Cary A.; Rehmani, Shafqat Fatima; Ahmed, Ayaz; Wasilenko, Jamie L.; Miller, Patti J.; Afonso, Claudio L.
This investigation reports the amount of radioactivity in the barren soil of Lahore, Pakistan. For this purpose, an area of about 60 hectares of saline soil was selected in Rakh Dera Chal near the city of Lahore in the Punjab province of Pakistan. The technique of gamma ray spectrometry was applied using HPGe (high purity germanium) gamma ray detector and
Nasim Akhtar; M. Tufail; M. Ashraf Chaudhry; Mohsin Iqbal
Pakistani pharmaceutical industry is synchronized by various legal perspectives to make certain the health of people of Pakistan but unfortunately rising population, inflation and people's wish to have money to burn leads to unethical practices so as in Pharmaceutical companies of Pakistan. Keeping in view the rising trend of unethical drug promotional activities in Pharmaceutical industry, a prior study was
Saeed Abbas Shah; Hyder Ali Khawaja
The Polio Eradication Initiative, the largest coordinated public health project in history, is currently facing serious difficulties. For years, it has tried and failed to eliminate polio from its last strongholds in Afghanistan, Pakistan, India, and Nigeria. Drawing on document analysis as well as participant observation and interviews in Pakistan, Atlanta, Geneva, and Montreal, I explore how officials in the
The purpose of this study was to explore general job satisfaction of elementary school head teachers in Pakistan with respect to their age and gender. One hundred and eighty head teachers were sampled from government elementary schools of Toba Tek Singh, Punjab, Pakistan, to collect the relevant data using a modified version of the Minnesota…
Ghazi, Safdar Rehman; Maringe, Felix
This paper outlines a joint Asian Bank/Pakistan Ministry of Education project designed to upgrade the state of teacher education and to improve the quality, status, and professional self-esteem of Pakistan's teachers. The main strategies identified by the Project for priority attention include: structural changes through the creation of four new…
Abbasi, M. Hashim; Millar, Alex C.
Purpose – The purpose of this paper is to provide a long-term assessment of Pakistan's electricity policy in the context of both environmental and resource constraints. To increase the sustainability of energy supply, the Government of Pakistan introduced a series of reforms in the electricity supply sector during 1990-1995. In response to these policy incentives, most of the independent power
Hassan Qudrat-Ullah; Mustafa Karakul
This article documents the coping strategies adopted by women victims of spousal violence in Pakistan. By drawing on 21 in-depth interviews conducted in Lahore and Sialkot (Pakistan), we found that the women tried to cope with violence by using various strategies, both emotion focused (e.g., use of religion, placating the husband, etc.) and…
Zakar, Rubeena; Zakar, Muhammad Zakria; Kramer, Alexander
A wide-ranging study of the centrality of the mosque to Islamic education in Pakistan emphasizes Islamic educational traditions, the historical background of such education, the obstacles to educational improvement in Pakistan, and the attempt to provide universal primary education. Traditionally, the Prophet Mohammad and the Holy Quran have been…
Khan, K. A.
The theory and evidence of the consequences of high fertility in Pakistan are reviewed in this paper. Several data sets are analyzed to examine the effects of the number of children on school participation and labor participation in urban Pakistan. Other data are utilized to examine the effects of children on savings in urban and rural areas.…
Cochrane, Susan Hill; And Others
This paper attempts to present the findings of a study carried out in Pakistan that explored English-language teachers' professional development in developing countries. The main guiding question for the study was: How do English-language teachers at secondary schools learn to teach and develop professionally in Syria and Pakistan? Two cases were…
Dayoub, Ruba; Bashiruddin, Ayesha
Mangoes are one of Pakistan’s mostimportant fruits; the country is the world’s fourth largest producer and exporter of mangoes. Integrated markets are those where price signals are transferred from one to another, allowing physical arbitrage to adjust any disturbances in these markets; integrated markets are thus a sign of efficiency. From this viewpoint, we investigate domestic integration amongten major mango
Abdul Ghafoor; Khalid Mustafa; Khalid Mushtaq; Abedullah
Objective To determine the incidence of pneumonia and severe pneumonia among children living at high altitudes in Pakistan. Methods A longitudinal cohort study was conducted in which 99 female government health workers in Punial and Ishkoman valleys (Ghizer district, Northern Areas of Pakistan) enrolled children at home, conducted home visits every 2 weeks and actively referred sick children to 15
Aamir J Khan; Hamidah Hussain; Saad B Omer; Sajida Chaudry; Sajid Ali; Adil Khan; Zayed Yasin; Imran J Khan; Rozina Mistry; Imam Yar Baig; Franklin White; Lawrence H Moulton; Neal A Halsey
Hospitals in Pakistan generate a large quantity of waste which is mainly managed by burning in incinerators. Burning of medical waste pollutes the environment by fly ash and toxic metals in the incinerated ash. Information regarding generation of heavy metals from incineration of medical waste is rare in Pakistan. The infectious waste generated in the hospitals of Islamabad (the capital
Sabiha-Javied; M. Tufail; Sofia Khalid
Abstract Climate change is a global phenomenon manifested mainly through global warming. The International Panel on Climate Change (IPCC) has reported its negative consequences on natural resources, anthropogenic activities, and natural disasters. The El Nino and La Nina have affected hydrologic regimes and ecosystems. It has been observed that the average temperature in 1995 was 0.4°C higher than that in 1895. By the end of the 21st century, 10% of the area of Bangladesh is likely to be submerged by the sea. Most of the islands of Pacific Ocean will disappear. A major part of Maldives will be submerged. The sea level is expected to rise by 30-150 cm. Extreme events such as floods, cyclones, tsunamis, and droughts have become regular phenomena in many parts of the world. Other adverse impacts are proliferation of water-borne diseases, sea water intrusion, salinization of coastal areas, loss of biodiversity, eco-degradation of watersheds and global glacial decline, and haphazard snow melts/thaws. In turn, these factors have serious effect on water resources. Pakistan is confronting similar climate change. Meteorological data reveal that winter temperatures are rising and summers are getting cooler. Temperature is expected to increase by 0.9°C and 1.5°C by years 2020 and 2050, respectively. Water resources in Pakistan are affected by climate change as it impacts the behavior of glaciers, rainfall patterns, greenhouse gas emissions, recurrence of extreme events such as floods and droughts. Severe floods have occurred in the years 1950, 1956, 1957, 1973, 1976, 1978, 1988, 1992, 2010, 2011, and 2012. Pakistan has faced the worst-ever droughts during the period from 1998 to 2004. Pakistan has surface water potential of 140 million acre feet (MAF) and underground water reserve of 56 MAF. It is one of the most water-stressed countries in the world. The per capita annual availability of water has reduced from 5140 m3 in 1950 to 1000 m3 now. It is fast approaching towards water scarcity. To minimize adverse impacts of climate change on the water crisis in Pakistan, the preparation of integrated national, provincial, and local level master plans encompassing technical, social, environmental, administrative, and financial considerations is necessary. It is imperative to implement two simultaneous approaches of adaptation (living with climate change) and mitigation (addressing negativities of climate change). Salient features are integrated management of watersheds/catchments/water bodies, optimum exploitation of present sources, development of new sources, water conservation, adequate drainage, efficient design of water storage, conveyance, distribution and supply systems, utilization of waste water, and regulation of water quality. PMID:24695031
Hussain, Mumtaz; Mumtaz, Saniea
In the Hazara arc region of northern Pakistan, some of the active basements structures buried below a thick, detached sedimentary layer are inferred from the distribution of lineaments and the drainage patterns, as viewed in Landsat satellite imagery and from river profiles. A prominent set of NW-trending lineaments seen on satellite imagery, coincides approximately with the southwest or updip side of the Indus—Kohistan seismic zone (IKSZ) —the most active basement structure of the region, even though this structure is buried beneath and decoupled from a 12 km thick sedimentary layer. The IKSZ has been interpreted as an extension of the Himalayan Basement Thrust, and is also associated with a prominent topographic "step". Knickpoints on major rivers in the region lie on or north of the IKSZ. All Indus River tributaries, examined north of the IKSZ, show prominent knickpoints, while two tributaries draining south of the IKSZ have no knickpoints. These results suggest ongoing uplift above and north of the IKSZ, and are consistent with the tectonic model obtained from the seismic data. Another prominent lineament set is detected along the north—south section of the Indus River. This set is probably related to the Indus River horst—anticline and associated reentrant. One of the two highest lineament concentrations occurs at the intersection between the NW-trending IKSZ lineament and the N-trending Indus River lineament. The other is along the west bank of the Indus Valley, 25 km north of Tarbela Dam. A topographic ridge (Swabi—Nowshera ridge) appears to be forming along the west side of the Indus River, in the Peshawar Basin. The rising ridge is ponding the Kabul River upstream of Nowshera, where the drainage is braided.
Gornitz, Vivien; Seeber, Leonard
This paper reviews research published in recent years concerning the effects of zinc deficiency, its consequences, and possible solutions. Zinc is an essential trace element necessary for over 300 zinc metalloenzymes and required for normal nucleic acid, protein, and membrane metabolism. Zinc deficiency is one of the ten biggest factors contributing to burden of disease in developing countries. Populations in South Asia, South East Asia, and sub-Saharan Africa are at greatest risk of zinc deficiency. Zinc intakes are inadequate for about a third of the population and stunting affects 40% of preschool children. In Pakistan, zinc deficiency is an emerging health problem as about 20.6% children are found in the levels of zinc, below 60 ?g/dL. Signs and symptoms caused by zinc deficiency are poor appetite, weight loss, and poor growth in childhood, delayed healing of wounds, taste abnormalities, and mental lethargy. As body stores of zinc decline, these symptoms worsen and are accompanied by diarrhea, recurrent infection, and dermatitis. Daily zinc requirements for an adult are 12-16 mg/day. Iron, calcium and phytates inhibit the absorption of zinc therefore simultaneous administration should not be prescribed. Zinc deficiency and its effects are well known but the ways it can help in treatment of different diseases is yet to be discovered. Improving zinc intakes through dietary improvements is a complex task that requires considerable time and effort. The use of zinc supplements, dietary modification, and fortifying foods with zinc are the best techniques to combat its deficiency. PMID:24499152
Khalid, Nauman; Ahmed, Anwaar; Bhatti, Muhammad Shahbaz; Randhawa, Muhammad Atif; Ahmad, Asif; Rafaqat, Rabab
Soil and water quality is greatly affected by environmental pollution due to the increasing trend of urbanization and industrialization. In many developing countries, including Pakistan, the situation is more alarming as no preventive measures are still taken to tackle the problem. Although in developed countries, many techniques are used to remediate the environment including phytoremediation. It is the most eco-friendly technique in which plants are used to remove pollutants from the environment. Pakistan has also a great diversity of plants which could be used for the remediation of environmental pollutants. To our knowledge, few studies from Pakistan were reported about the use of flora for phytoremediation. According to recent literature, 50 plant species from Pakistan are studied for remediation purposes. In this review, the potential of different plant species for phytoremediation from Pakistan has been discussed along with their comparison to other countries to relate future perspectives. PMID:24091528
Kamran, Muhammad Aqeel; Amna; Mufti, Rabia; Mubariz, Nadia; Syed, Jabir Hussain; Bano, Asghari; Javed, Muhammad Tariq; Munis, Muhammad Farooq Hussain; Tan, Zhiyuan; Chaudhary, Hassan Javed
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Background In 2005, Pakistan was first labeled as a country with concentrated epidemic of Human Immunodeficiency Virus (HIV). This was revealed through second generation surveillance conducted by HIV/AIDS Surveillance Project (HASP). While injection drug users (IDUs) were driving the epidemic, subsequent surveys showed that Hijra (transgender) sex workers (HSWs) were emerging as the second most vulnerable group with an average national prevalence of 6.4%. An exceptionally high prevalence (27.6%) was found in Larkana, which is a small town on the right bank of river Indus near the ruins of Mohenjo-Daro in the province of Sindh. This paper presents the risk factors associated with high prevalence of HIV among HSWs in Larkana as compared to other cities of the country. Methods Data were extracted for secondary analysis from 2008 Integrated behavioral and biological survey (IBBS) to compare HSWs living in Larkana with those living in other cities including Karachi and Hyderabad in Sindh; Lahore and Faisalabad in Punjab; and Peshawar in Khyber Pakhtunkhwa provinces. After descriptive analysis, univariate and multivariate analyses were performed to identify risk factors. P value of 0.25 or less was used to include factors in multivariate analysis. Results We compared 199 HSWs from Larkana with 420 HSWs from other cities. The average age of HSWs in Larkana was 26.42 (±5.4) years. Majority were Sindhi speaking (80%), uneducated (68%) and unmarried (97%). In univariate analysis, factors associated with higher prevalence of HIV in Larkana included younger age i.e. 20–24 years (OR: 5.8, CI: 2.809–12.15), being unmarried (OR: 2.4, CI: 1.0–5.7), sex work as the only mode of income (OR: 5.5, CI: 3.70–8.2) and longer duration of being involved in sex work 5–10 years (OR: 3.3, CI: 1.7–6.12). In multivariate logistic regression the HSWs from Larkana were more likely to lack kno