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Rozi S, Zahid N, Roome T, Lakhdir MPA, Sawani S, Razzak A, Butt ZA. Effectiveness of a School Based Smokeless Tobacco Intervention: A Cluster Randomized Trial. J Community Health 2020; 44:1098-1110. [PMID: 31267293 DOI: 10.1007/s10900-019-00689-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
To assess the effectiveness of intervention in improving knowledge, attitude and perception regarding smokeless tobacco (SLT) use and its harmful effects and intention to quit SLT among school going adolescents. A school-based cluster randomized control trial was carried out in 18 secondary schools targeting male and female students from grades 6 to 10 in Karachi. Primary outcome was knowledge about hazards of smokeless tobacco (SLT) and secondary outcomes were attitude and Perception about hazards of SLT, and intention to quit SLT. We enrolled 738 participants in intervention group and 589 in the control group. Mean score of knowledge significantly improved in intervention as compared to control group (P value < 0.01). Intention to quit was found to be proportionately higher (33%) in the intervention group as compared to control group. Generalized estimating equations were used to assess the association of factors with knowledge regarding harmful effects of SLT use. Significant predictors of increase in knowledge score were found in children: who had seen any anti SLT messages on social media in the past 30 days, who were getting information regarding harmful effects of SLT use in school or textbooks and who had friends using SLT. A school-based intervention was effective in increasing knowledge regarding the harmful effects of SLT use and intention to quit SLT use among school adolescents. Introduction of such educational programmes on a regular basis in schools or as part of school curriculum can have an impact on reducing prevalence of SLT use.Trial Registration NCT03418506. https://register.clinicaltrials.gov/NCT03418506 .
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Affiliation(s)
- Shafquat Rozi
- Department of Community Health Sciences, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.
| | - Nida Zahid
- Department of Surgery, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Talat Roome
- Department of Pathology, Dow University of Health Sciences, University Road, Karachi, 75270, Pakistan
| | - Maryam Pyar Ali Lakhdir
- Department of Community Health Sciences, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Sobiya Sawani
- Department of Community Health Sciences, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Anam Razzak
- Department of Pathology, Dow University of Health Sciences, University Road, Karachi, 75270, Pakistan
| | - Zahid Ahmad Butt
- School of Population and Public Health, University of British Columbia, Vancouver, V6T 1Z4, Canada
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Panezai J, Ali A, Ghaffar A, Benchimol D, Altamash M, Klinge B, Engström PE, Larsson A. Upregulation of circulating inflammatory biomarkers under the influence of periodontal disease in rheumatoid arthritis patients. Cytokine 2020; 131:155117. [PMID: 32403006 DOI: 10.1016/j.cyto.2020.155117] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/11/2020] [Accepted: 04/28/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Periodontal disease (PD) and rheumatoid arthritis (RA) are chronic immuno-inflammatory conditions with osteolysis being a hallmark feature. The influence of PD on RA's systemic inflammatory status and disease activity remains unclear. The objective of this study was to assess the systemic inflammation and disease activity of RA under the influence of PD. METHODS In this case-control study, 38 RA patients (19 with PD and 19 without PD) were compared to 38 non-RA patients and 12 healthy controls. Periodontal parameters (bleeding on probing (BOP), probing pocket depth (PPD), PPD Total, PPD Disease and marginal bone loss (MBL) were determined. Serological analyses included quantification of 92 inflammatory biomarkers using a multiplex proximity extension assay, anti-citrullinated protein antibodies (ACPA), rheumatoid factor (IgM-RF) and erythrocyte sedimentation rate (ESR). RA disease activity was determined using Disease Activity Score for 28 joints (DAS28). All RA patients were on medication. RESULTS IgM-RF was higher in RA patients with PD. PD conditions were more severe in the non-RA group. Inflammatory biomarkers (IL-10RB, IL-18, CSF-1, NT-3, TRAIL, PD-L1, LIF-R, SLAMF1, FGF-19, TRANCE, CST5, STAMPB, SIRT2, TWEAK, CX3CL1, CXCL5, MCP-1) were significantly higher in RA patients with PD than RA without PD. DAS28 associated with twice as many inflammatory biomarkers in RA patients with PD whereas IgM-RF and ACPA associated more frequently with biomarkers in the RA without PD group. IgM-RF correlated inversely with BOP. CONCLUSION Periodontal disease augments systemic inflammation in RA. A profound influence exists independent of autoimmune status.
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Affiliation(s)
- Jeneen Panezai
- Altamash Institute of Dental Medicine, Department of Periodontology, Karachi, Pakistan; Karolinska Institutet, Department of Dental Medicine, Division of Oral Diseases, Section of Periodontology, Huddinge, Sweden; Balochistan University of Information Technology, Engineering and Management Sciences, Department of Microbiology, Faculty of Life Sciences and Informatics, Quetta, Pakistan.
| | - Azra Ali
- Habib Medical Centre, Rheumatology Clinic, Karachi, Pakistan, Karachi, Pakistan
| | - Ambereen Ghaffar
- Habib Medical Centre, Rheumatology Clinic, Karachi, Pakistan, Karachi, Pakistan
| | - Daniel Benchimol
- Karolinska Institutet, Department of Dental Medicine, Division of Oral Diagnostics and Rehabilitation, Section of Oral Diagnostics and Surgery, Huddinge, Sweden
| | - Mohammad Altamash
- Altamash Institute of Dental Medicine, Department of Periodontology, Karachi, Pakistan
| | - Bjӧrn Klinge
- Karolinska Institutet, Department of Dental Medicine, Division of Oral Diseases, Section of Periodontology, Huddinge, Sweden; Malmö University, Faculty of Odontology, Department of Periodontology, Malmö, Sweden
| | - Per-Erik Engström
- Karolinska Institutet, Department of Dental Medicine, Division of Oral Diseases, Section of Periodontology, Huddinge, Sweden
| | - Anders Larsson
- Uppsala University, Department of Medical Sciences, Uppsala, Sweden
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Saqib MAN, Rafique I, Qureshi H, Munir MA, Bashir R, Arif BW, Bhatti K, Ahmed SAK, Bhatti L. Burden of Tobacco in Pakistan: Findings From Global Adult Tobacco Survey 2014. Nicotine Tob Res 2019; 20:1138-1143. [PMID: 29059338 DOI: 10.1093/ntr/ntx179] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 08/14/2017] [Indexed: 11/13/2022]
Abstract
Introduction The Global Adult Tobacco Survey (GATS) is the global standard for systematically monitoring adult tobacco use and tracking key tobacco control indicators. Methods Using a multistage stratified cluster design, 9856 households were sampled, and one individual was randomly selected from each household. Standard GATS questionnaire was used to collect information on tobacco use, cessation, second-hand smoke, knowledge, attitudes, and perceptions. Data were analyzed per standard GATS protocol. Results Of 9856 individuals, 7831 individuals completed the interview. The response rate was 81%. Overall, 19.1% adults were currently using tobacco products and among them, 12.4% smoked tobacco, and 7.7% smokeless tobacco. Exposure to second-hand smoke was seen in 86% in a restaurant while it was 76% on public transportation. A total of 24.7% smokers made a quit attempt in the past 12 months. Anticigarette smoking information was observed by 37.7% adults, while 29.7% current smokers thought about quitting after reading health warning labels on cigarette packages. Most (85%) adults favored no smoking in public places, and 74.8% favored increasing taxes on tobacco products. Current cigarette smokers spent Pakistani Rupees 767.3 per month (7.78 USD) on manufactured cigarettes and consumed 4500 cigarette sticks (225 packs) annually. Conclusions Besides 19.1% tobacco users, the majority (86%) were exposed to second-hand smoke at public places indicating that ban on tobacco use in public places is not being followed. A quarter of current smokers wants to quit smoking who may be provided assistance to reduce tobacco burden. Implications This study provides national-level data about tobacco use and its burden and also indicates weak implantation of tobacco control laws. There is need to devise a strategy for proper implementation of these laws to reduce the tobacco burden in the country.
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Affiliation(s)
| | - Ibrar Rafique
- Pakistan Health Research Council, Head Office, Islamabad, Pakistan
| | - Huma Qureshi
- Pakistan Health Research Council, Head Office, Islamabad, Pakistan
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Amir Khan M, Ahmar Khan M, Walley JD, Khan N, Imtiaz Sheikh F, Ali S, Salahuddin E, King R, Ellahi Khan S, Manzoor F, Jehangir Khan H. Feasibility of delivering integrated COPD-asthma care at primary and secondary level public healthcare facilities in Pakistan: a process evaluation. BJGP Open 2019; 3:bjgpopen18X101632. [PMID: 31049412 PMCID: PMC6480853 DOI: 10.3399/bjgpopen18x101632] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/20/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND In Pakistan,the estimated prevalence of chronic obstructive pulmonary disease (COPD) and asthma are 2.1% and 4.3% respectively, and existing care is grossly lacking both in coverage and quality. An integrated approach is recommended for delivering COPD and asthma care at public health facilities. AIM To understand how an integrated care package was experienced by care providers and patients, and to inform modifications prior to scaling up. DESIGN & SETTING The mixed-methods study was conducted as part of cluster randomised trials on integrated COPD and asthma care at 30 public health facilities. METHOD The care practices were assessed by analysing the clinical records of n = 451 asthma and n = 313 COPD patients. Semi-structured interviews with service providers and patients were used to understand their care experiences. A framework approach was applied to analyse and interpret qualitative data. RESULTS Utilisation of public health facilities for chronic lung conditions was low, mainly because of the non-availability of inhalers. When diagnosed, around two-thirds (69%) of male and more than half (55%) of female patients had severe airway obstruction. The practice of prescribing inhalers differed between intervention and control arms. Patient non-adherence to follow-up visits remained a major treatment challenge (though attrition was lower and slower in the intervention arm). Around half of the male responders who smoked at baseline reported having quit smoking. CONCLUSION The integrated care of chronic lung conditions at public health facilities is feasible and leads to improved diagnosis and treatment in a low-income country setting. The authors recommend scaling of the intervention with continued implementation research, especially on improving patient adherence to treatment.
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Affiliation(s)
- Muhammad Amir Khan
- Chief Coordinating Professional, Association for Social Development, Islamabad, Pakistan
| | - Muhammad Ahmar Khan
- Research Coordinator, Association for Social Development, Islamabad, Pakistan
| | - John D Walley
- Professor of International Public Health, Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Nida Khan
- Project Coordinator, Association for Social Development, Islamabad, Pakistan
| | | | - Saima Ali
- Research Coordinator, Association for Social Development, Islamabad, Pakistan
| | - Ehsan Salahuddin
- Research Coordinator, Association for Social Development, Islamabad, Pakistan
| | - Rebecca King
- Lecturer, Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Shaheer Ellahi Khan
- Assistant Professor, Humanities and Social Sciences Department, Bahria University, Islamabad, Pakistan
| | - Farooq Manzoor
- Provincial Manager, Non-Communicable Disease Control Program, Punjab, Pakistan
| | - Haroon Jehangir Khan
- Director, NCD & Mental Health, Directorate General of Health Services, Lahore, Pakistan
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Khan MA, Khan N, Walley JD, Khan MA, Hicks J, Ahmed M, Sheikh FI, Ali M, Manzoor F, Khan HJ. Effectiveness of delivering integrated COPD care at public healthcare facilities: a cluster randomised trial in Pakistan. BJGP Open 2019; 3:bjgpopen18X101634. [PMID: 31049414 PMCID: PMC6480856 DOI: 10.3399/bjgpopen18x101634] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 11/21/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND In Pakistan chronic obstructive pulmonary disease (COPD) prevalence is 2.1% in adults aged >40 years. Despite being a health policy focus, integrated COPD care has remained neglected, with wide variation in practice. AIM To assess whether enhanced care at public health facilities resulted in better control of COPD, treatment adherence, and smoking cessation. DESIGN & SETTING A two-arm cluster randomised controlled trial was undertaken in 30 public health facilities (23 primary and 7 secondary), across three districts of Punjab, between October 2014-December 2016. Both arms had enhanced diagnosis and patient recording processes. Intervention facilities also had clinical care guides; drugs for COPD; patient education flipcharts; associated staff training; and mobile phone follow-up. METHOD Facilities were randomised in a 1:1 ratio (sealed envelope independent lottery method), and 159 intervention and 154 control patients were recruited. The eligibility criteria were as follows: diagnosed with COPD, aged ≥18 years, and living in the catchment area. The primary outcome was change in BODE (Body mass index, airway Obstruction, Dyspnoea, Exercise capacity) index score from baseline to final follow-up visit. Staff and patients were not blinded. RESULTS Six-month primary outcomes were available for 147/159 (92.5%) intervention and 141/154 (91.6%) control participants (all clusters). The primary outcome results cluster-level analysis were as follows: mean intervention outcome = -1.67 (95% confidence intervals [CI] = -2.18 to -1.16); mean control outcome = -0.66 (95% CI = -1.09 to -0.22); and covariate-adjusted mean intervention-control difference = -0.96 (95% CI = -1.49 to -0.44; P = 0.001). CONCLUSION The findings of this trial and a separate process evaluation study support the scaling of this integrated COPD care package at primary and secondary level public health facilities in Pakistan and similar settings.
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Affiliation(s)
- Muhammad Amir Khan
- Chief Coordinating Professional, Association for Social Development, Islamabad, Pakistan
| | - Nida Khan
- Project Coordinator, Association for Social Development, Islamabad, Pakistan
| | - John D Walley
- Professor of International Public Health, Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Muhammad Ahmar Khan
- Research Coordinator, Association for Social Development, Islamabad, Pakistan
| | - Joseph Hicks
- Senior Medical Statistician, Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Maqsood Ahmed
- Senior Professional, Association for Social Development, Islamabad, Pakistan
| | | | - Muhammad Ali
- Research Assistant, Association for Social Development, Islamabad, Pakistan
| | - Farooq Manzoor
- Provincial Manager, Non-Communicable Disease Control Program, Directorate General of Health Services, Punjab, Pakistan
| | - Haroon Jehangir Khan
- Director, NCD & Mental Health, Directorate General of Health Services, Punjab, Pakistan
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Allen L, Williams J, Townsend N, Mikkelsen B, Roberts N, Foster C, Wickramasinghe K. Socioeconomic status and non-communicable disease behavioural risk factors in low-income and lower-middle-income countries: a systematic review. Lancet Glob Health 2017; 5:e277-e289. [PMID: 28193397 PMCID: PMC5673683 DOI: 10.1016/s2214-109x(17)30058-x] [Citation(s) in RCA: 358] [Impact Index Per Article: 51.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/24/2016] [Accepted: 12/12/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Non-communicable diseases are the leading global cause of death and disproportionately afflict those living in low-income and lower-middle-income countries (LLMICs). The association between socioeconomic status and non-communicable disease behavioural risk factors is well established in high-income countries, but it is not clear how behavioural risk factors are distributed within LLMICs. We aimed to systematically review evidence on the association between socioeconomic status and harmful use of alcohol, tobacco use, unhealthy diets, and physical inactivity within LLMICs. METHODS We searched 13 electronic databases, including Embase and MEDLINE, grey literature, and reference lists for primary research published between Jan 1, 1990, and June 30, 2015. We included studies from LLMICs presenting data on multiple measures of socioeconomic status and tobacco use, alcohol use, diet, and physical activity. No age or language restrictions were applied. We excluded studies that did not allow comparison between more or less advantaged groups. We used a piloted version of the Cochrane Effective Practice and Organisation of Care Group data collection checklist to extract relevant data at the household and individual level from the included full text studies including study type, methods, outcomes, and results. Due to high heterogeneity, we used a narrative approach for data synthesis. We used descriptive statistics to assess whether the prevalence of each risk factor varied significantly between members of different socioeconomic groups. The study protocol is registered with PROSPERO, number CRD42015026604. FINDINGS After reviewing 4242 records, 75 studies met our inclusion criteria, representing 2 135 314 individuals older than 10 years from 39 LLMICs. Low socioeconomic groups were found to have a significantly higher prevalence of tobacco and alcohol use than did high socioeconomic groups. These groups also consumed less fruit, vegetables, fish, and fibre than those of high socioeconomic status. High socioeconomic groups were found to be less physically active and consume more fats, salt, and processed food than individuals of low socioeconomic status. While the included studies presented clear patterns for tobacco use and physical activity, heterogeneity between dietary outcome measures and a paucity of evidence around harmful alcohol use limit the certainty of these findings. INTERPRETATION Despite significant heterogeneity in exposure and outcome measures, clear evidence shows that the burden of behavioural risk factors is affected by socioeconomic position within LLMICs. Governments seeking to meet Sustainable Development Goal (SDG) 3.4-reducing premature non-communicable disease mortality by a third by 2030-should leverage their development budgets to address the poverty-health nexus in these settings. Our findings also have significance for health workers serving these populations and policy makers tasked with preventing and controlling the rise of non-communicable diseases. FUNDING WHO.
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Affiliation(s)
- Luke Allen
- British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Julianne Williams
- British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nick Townsend
- British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Bente Mikkelsen
- WHO Global Coordination Mechanisms on the Prevention and Control of Non-communicable diseases, WHO, Geneva, Switzerland
| | - Nia Roberts
- Health Care Libraries, Bodleian Libraries, University of Oxford, Oxford, UK
| | - Charlie Foster
- British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kremlin Wickramasinghe
- British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Khan MT, Hashmi S, Zaheer S, Aslam SK, Khan NA, Aziz H, Rashid N, Shafique K. Burden of waterpipe smoking and chewing tobacco use among women of reproductive age group using data from the 2012-13 Pakistan Demographic and Health Survey. BMC Public Health 2015; 15:1113. [PMID: 26563874 PMCID: PMC4643522 DOI: 10.1186/s12889-015-2433-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 10/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the general decline in cigarette smoking, use of alternative forms of tobacco has increased particularly in developing countries. Waterpipe (WP) and Chewing Tobacco (CT) are two such alternative forms, finding their way into many populations. However, the burden of these alternative forms of tobacco and their socio demographic determinants are still unclear. We assessed the prevalence of WP and CT use among women of reproductive age group in Pakistan. METHODS Data from the most recent Pakistan Demographic and Health Survey 2012-13 (n = 13,558) was used for this analysis. Information obtained from ever married women, aged between 15 and 49 years were analyzed using two separate data subgroups; exclusive WP smokers (total n = 12,995) and exclusive CT users (total n = 12,771). Univariate and Multivariate logistic regression analyses were conducted and results were reported as crude and adjusted Odds Ratio with 95% confidence intervals. RESULTS Prevalence of WP smoking and CT were 4% and 2%, respectively. After multivariate adjustments, ever married women who were: older than 35 years (OR; 4.68 95% CI, 2.62-8.37), were poorest (OR = 4.03, 95% CI 2.08-7.81), and had no education (OR = 9.19, 95% CI 5.10-16.54), were more likely to be WP smokers. Similarly, ever married women who were: older than 35 years (OR = 3.19, 95% CI 1.69-6.00), had no education (OR = 4.94, 95% CI 2.62-9.33), were poor (OR = 1.64, 95% CI 1.07-2.48) and had visited health facility in last 12 months (OR = 1.81, 95% CI 1.22-2.70) were more likely to be CT users as well. CONCLUSION Older women with lower socio-economic profile were more likely to use WP and CT. Focused policies aiming towards reducing the burden of alternate forms of tobacco use among women is urgently needed to control the tobacco epidemic in the country.
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Affiliation(s)
- Muhammad Tahir Khan
- School of Public Health, Dow University of Health Sciences, OJHA Campus, SUPARCO road, Gulzar e Hijri, Karachi, Pakistan.
| | - Shahkamal Hashmi
- School of Public Health, Dow University of Health Sciences, OJHA Campus, SUPARCO road, Gulzar e Hijri, Karachi, Pakistan.
| | - Sidra Zaheer
- School of Public Health, Dow University of Health Sciences, OJHA Campus, SUPARCO road, Gulzar e Hijri, Karachi, Pakistan.
| | - Syeda Kanwal Aslam
- School of Public Health, Dow University of Health Sciences, OJHA Campus, SUPARCO road, Gulzar e Hijri, Karachi, Pakistan.
| | - Naveed Ali Khan
- Department of Surgery, Dow University of Health Sciences, Karachi, Pakistan.
| | - Hina Aziz
- School of Public Health, Dow University of Health Sciences, OJHA Campus, SUPARCO road, Gulzar e Hijri, Karachi, Pakistan.
| | - Nabil Rashid
- School of Public Health, Dow University of Health Sciences, OJHA Campus, SUPARCO road, Gulzar e Hijri, Karachi, Pakistan.
| | - Kashif Shafique
- School of Public Health, Dow University of Health Sciences, OJHA Campus, SUPARCO road, Gulzar e Hijri, Karachi, Pakistan.
- Institute of Health and Wellbeing, Public Health, University of Glasgow, 1-Lilybank Gardens, Glasgow, G12 8RZ, UK.
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Abstract
BACKGROUND Smoking is a risk factor not only for the development of cancer and coronary heart disease but also for tuberculosis (TB). The aim of this study was to determine the prevalence of smoking in patients with TB, identify demographic and clinical characteristics associated with smoking and to evaluate TB treatment outcomes in the smokers. METHOD A retrospective cohort study of patients with TB was conducted at Khyber Teaching Hospital, Peshawar, Pakistan. All patients with pulmonary and extrapulmonary TB and those coinfected with HIV, hepatitis or diabetes mellitus were included in the study. The patients were categorized into smokers and nonsmokers. Treatment outcomes were evaluated by smear testing at the end of the treatment. RESULTS Of 472 enrolled subjects, 68 (14.4%) were smokers. The prevalence of smoking among male and female patients with TB was 11.8% and 2.5%, respectively. Univariate analysis indicated that the gender, age group and marital status of patients with TB were associated with smoking. The results indicated that patient gender (P = 0.05), age: 15 to 24 years (P = 0.05) and age >55 years (P = 0.004) were risk factors associated with smoking among TB patients. Of the 68 smokers with TB, the treatment outcomes among 54 patients (79.4%) were unsuccessful. The treatment outcomes was statistically significantly associated with smoking (odds ratio: 2.58, P = 0.004). CONCLUSIONS Findings from the current study proved smoking to be one of the main factors associated with the occurrence of TB and significantly reducing the outcomes of TB therapy.
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Berg CJ, Ajay VS, Ali MK, Kondal D, Khan HM, Shivashankar R, Pradeepa R, Mohan D, Fatmi Z, Kadir MM, Tandon N, Mohan V, Narayan KMV, Prabhakaran D. A cross-sectional study of the prevalence and correlates of tobacco use in Chennai, Delhi, and Karachi: data from the CARRS study. BMC Public Health 2015; 15:483. [PMID: 25958327 PMCID: PMC4432508 DOI: 10.1186/s12889-015-1817-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 05/04/2015] [Indexed: 11/29/2022] Open
Abstract
Background Tobacco burdens in India and Pakistan require continued efforts to quantify tobacco use and its impacts. We examined the prevalence and sociodemographic and health-related correlates of tobacco use in Delhi, Chennai (India), and Karachi (Pakistan). Methods Analysis of representative surveys of 11,260 participants (selected through multistage cluster random sampling; stratified by gender and age) in 2011 measured socio-demographics, tobacco use history, comorbid health conditions, and salivary cotinine. We used bivariate and multivariate regression analyses to examine factors associated with tobacco use. Results Overall, 51.8 % were females, and 61.6 % were below the age of 45 years. Lifetime (ever) tobacco use prevalence (standardized for world population) was 45.0 %, 41.3 %, and 42.5 % among males, and 7.6 %, 8.5 %, and 19.7 % among females in Chennai, Delhi, and Karachi, respectively. Past 6 month tobacco use prevalence (standardized for world population) was 38.6 %, 36.1 %, and 39.1 % among males, and 7.3 %, 7.1 %, and 18.6 % among females in Chennai, Delhi, and Karachi, respectively. In multivariable regression analyses, residing in Delhi or Karachi versus Chennai; older age; lower education; earning less income; lower BMI; were each associated with tobacco use in both sexes. In addition, semi-skilled occupation versus not working and alcohol use were associated with tobacco use in males, and having newly diagnosed dyslipidemia was associated with lower odds of tobacco use among females. Mean salivary cotinine levels were higher among tobacco users versus nonusers (235.4; CI: 187.0-283.8 vs. 29.7; CI: 4.2, 55.2, respectively). Conclusion High prevalence of tobacco use in the South Asian region, particularly among men, highlights the urgency to address this serious public health problem. Our analyses suggest targeted prevention and cessation interventions focused on lower socioeconomic groups may be particularly important. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1817-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carla J Berg
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, 1518 Clifton Rd NE, 30322, Atlanta, Georgia, USA.
| | - Vamadevan S Ajay
- Public Health Foundation of India, Plot No 47, Sector 44, 122002, Gurgaon, Haryana, India. .,Centre for Chronic Disease Control, Plot No 47, Sector 44, 122002, Gurgaon, Haryana, India.
| | - Mohammed K Ali
- Hubert Department of Global Health, Emory University Rollins School of Public Health, 1518 Clifton Rd NE, 30322, Atlanta, Georgia, USA.
| | - Dimple Kondal
- Public Health Foundation of India, Plot No 47, Sector 44, 122002, Gurgaon, Haryana, India. .,Centre for Chronic Disease Control, Plot No 47, Sector 44, 122002, Gurgaon, Haryana, India.
| | - Hassan M Khan
- Aga Khan University, Stadium Road, P.O. Box 3500, 74800, Karachi, Pakistan.
| | - Roopa Shivashankar
- Public Health Foundation of India, Plot No 47, Sector 44, 122002, Gurgaon, Haryana, India. .,Centre for Chronic Disease Control, Plot No 47, Sector 44, 122002, Gurgaon, Haryana, India.
| | - Rajendra Pradeepa
- Madras Diabetes Research Foundation, No 4, Conran Smith Road, Gopalapuram, 600 086, Chennai, India.
| | - Deepa Mohan
- Madras Diabetes Research Foundation, No 4, Conran Smith Road, Gopalapuram, 600 086, Chennai, India.
| | - Zafar Fatmi
- Aga Khan University, Stadium Road, P.O. Box 3500, 74800, Karachi, Pakistan.
| | - Muhammad M Kadir
- Aga Khan University, Stadium Road, P.O. Box 3500, 74800, Karachi, Pakistan.
| | - Nikhil Tandon
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences (AIIMS), Ansari, New, Nagar, 110029, Delhi, India.
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation, No 4, Conran Smith Road, Gopalapuram, 600 086, Chennai, India.
| | - K M Venkat Narayan
- Hubert Department of Global Health, Emory University Rollins School of Public Health, 1518 Clifton Rd NE, 30322, Atlanta, Georgia, USA.
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, Plot No 47, Sector 44, 122002, Gurgaon, Haryana, India. .,Centre for Chronic Disease Control, Plot No 47, Sector 44, 122002, Gurgaon, Haryana, India.
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Heshmati H, Charkazi A, Asnaashari R, Koohsar F. Prevalence of Smoking and the Related Factors Among the Elderly in Kashmar, Iran. HEALTH SCOPE 2014. [DOI: 10.17795/jhealthscope-13996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gilani SI, Leon DA. Prevalence and sociodemographic determinants of tobacco use among adults in Pakistan: findings of a nationwide survey conducted in 2012. Popul Health Metr 2013; 11:16. [PMID: 24004968 PMCID: PMC3850735 DOI: 10.1186/1478-7954-11-16] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 08/29/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smoking is one of the leading causes of preventable mortality. The World Health Organization recommends that countries should monitor tobacco use regularly. In Pakistan, the last national study on smoking in the general population was conducted in 2002 to 2003. METHODS We conducted a cross-sectional survey of a nationally representative sample of men and women living in rural and urban areas of four main provinces of Pakistan from March through April 2012. Face-to-face in-house interviews were undertaken using a pre-tested structured questionnaire that asked about smoking and other forms of tobacco use. Multistage stratified random area probability sampling was used. To determine the national prevalence of tobacco use, the sample was weighted to correspond to rural-urban population proportions in each of the four provinces as in the 1998 census conducted by Pakistan's Population Census Organization. Associations between sociodemographic variables and tobacco use were investigated using multivariable robust regression. RESULTS Out of 2,644 respondents (1,354 men and 1,290 women), 354 men and 4 women reported being current cigarette smokers. The weighted prevalence of current cigarette smoking was 15.2% (95% confidence interval [CI]; 11.2, 19.3) overall, 26.6% (95% CI: 19.1, 34.1) among males, and 0.4% (95% CI: -0.2, 1.0) among females. Among females, 1.8% (95% CI: 0.4, 3.1) used any smoked tobacco and 4.6% (95% CI: 1.8, 7.4) used any smokeless tobacco daily or on some days of the week. Among males, odds of current cigarette smoking decreased with increasing level of education (OR = 0.75; 95% CI: 0.68, 0.84) and increased with having a father who used tobacco (OR = 2.11; 95% CI: 1.39, 3.22) after adjusting for other sociodemographic characteristics. Lower household income was associated with current cigarette smoking among rural males only (odds ratio [OR] = 0.67; 95% CI: 0.48, 0.92 per category increase in monthly household income). CONCLUSION A large proportion of males smoked cigarettes. Cigarette use was negligible among females, but they used other forms of tobacco. Low education was a determinant of cigarette smoking among males irrespective of socioeconomic status and area of residence. Tobacco control campaigns should target uneducated and rural poor men and monitor all forms of tobacco used by the population.
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Affiliation(s)
| | - David A Leon
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Almas A, Godil SS, Lalani S, Samani ZA, Khan AH. Good knowledge about hypertension is linked to better control of hypertension; a multicentre cross sectional study in Karachi, Pakistan. BMC Res Notes 2012; 5:579. [PMID: 23095492 PMCID: PMC3534478 DOI: 10.1186/1756-0500-5-579] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 10/16/2012] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND According to the National Health survey only 3% of the population has controlled hypertension. This study was designed to elucidate the knowledge about hypertension in hypertensive patients at three tertiary care centers in Karachi. Secondly we sought to compare the knowledge of those with uncontrolled hypertension and controlled hypertension. METHODS It was a cross-sectional study conducted at The Aga Khan University hospital (AKUH), Ziauddin Hospital (ZH) and Civil hospital, Karachi (CHK. All diagnosed Hypertensive patients (both inpatients and outpatients) coming to a tertiary care hospital in Pakistan aged > 18 years were included. Patients were categorized into 2 groups: controlled and uncontrolled hypertension based on their initial BP readings on presentation Uncontrolled Hypertension was defined as average BP ≥ 140/90 mm Hg in patients on treatment. Controlled Hypertension (HTN) was defined as average BP <140/90 mm Hg in patients on treatment. Standardized methods were used to record BP in the sitting position. Knowledge was recorded as a15 item question. Primary outcome was knowledge about hypertension. RESULTS A total of 650 participants were approached and consented 447 were found eligible. 284(63.5%) were from Aga Khan University, 101(22.6) from Dow University of health sciences and 62(13.9) were from Ziauddin University. Mean (SD) age of participants was 57.7(12) years, 50.1(224) were men. Controlled hypertension was present in 323(72.3) and uncontrolled hypertension was present in 124(27.4). The total mean (SD) Knowledge score was 20.97(4.93) out of a maximum score of 38. On comparison of questions related to knowledge between uncontrolled and controlled hypertension, there was statistically significant different in; meaning of hypertension (p <0.001), target SBP(p0.001), target DBP(p 0.001), importance of SBP versus DBP, improvement of health with lowering of blood pressure (p 0.002), high blood pressure being asymptomatic (p <0.001), changing lifestyle improves blood pressure(p 0.003),hypertension being a lifelong disease (<0.001), lifelong treatment with antihypertensives(<0.001) and high blood pressure being part of aging(<0.001). On comparison of knowledge as a composite score between uncontrolled and controlled hypertensive; Mean (SD) score was 21.85(4.74) v18.67 (4.70) (p value: < 0.001). On multivariate analysis; gender β (95% CI) 1.67(0.75, 2.59) p <0.001, uncontrolled blood pressure; -2.70(-3.76,-1.67) p <0.001, Sindhi ethnicity; -1.79(-3.25,-3.27) p 0.01 and pukhtoon ethnicity; -2.72(-4.13,-1.32) p <0.001 were significantly associated with knowledge score. CONCLUSION Knowledge about hypertension in hypertensive patients is not adequate and is alarmingly poor in patients with uncontrolled hypertension. More emphasis needs to be made on target blood pressure and need for taking antihypertensives for life to patients by physicians.
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Affiliation(s)
- Aysha Almas
- Department of Medicine, Aga Khan University, Stadium road, Karachi, Pakistan.
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Musharraf S, Shoaib M, Najam-ul-Haq. TLC-densitometric method development and validation for the quantification of nicotine in tobacco smoked, sniffing, dipping, and chewing products. JPC-J PLANAR CHROMAT 2011. [DOI: 10.1556/jpc.24.2011.5.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Wasay M, Khealani B, Yousuf A, Azam I, Rathi SL, Malik A, Haq A. Knowledge Gaps in Stroke Care: Results of a Survey of Family Physicians in Pakistan. J Stroke Cerebrovasc Dis 2011; 20:282-6. [DOI: 10.1016/j.jstrokecerebrovasdis.2010.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 01/01/2010] [Accepted: 01/04/2010] [Indexed: 11/29/2022] Open
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Lee ACK, Siddiqi K, Khan MA, Ahmed M, Shafiq-Ur-Rehman, Shams N, Nazir A. Local Determinants of Tobacco Use in Pakistan and the Importance of Context. J Smok Cessat 2010. [DOI: 10.1375/jsc.5.2.145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AbstractIntroduction:The tobacco epidemic is surging in developing countries. While the determinants of tobacco use are well known, it is less certain whether they are similar in developed and developing countries. This has important ramifications for the implementation of interventions locally. This qualitative study explored the determinants and importance of context on tobacco use in Pakistan.Methods:Focus group discussions were conducted in two districts with doctors, nurses and patients from local tuberculosis clinics.Results:Peer influence, social acceptability, affordability and visibility of tobacco, public understanding and personal perception of risks influence tobacco use. Individual factors, such as personal curiosity, adversity and stress, also affected tobacco uptake and use. Patients were willing to pay for effective cessation treatment provided the costs were comparable to their expenditure on tobacco.Discussion:Factors such as peer and social influences are similar to those reported elsewhere. However, local variations exist in the degree of sociocultural acceptability, visibility of tobacco use, public understanding of risks and individual situational factors that influence tobacco use. Patients are prepared to pay for treatment, but there are gender differences in what can be afforded. For tobacco cessation interventions to be effective, local adaptations are essential to ensure cultural and contextual appropriateness.
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Colbeck I, Nasir ZA, Ali Z. The state of indoor air quality in Pakistan--a review. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2010; 17:1187-1196. [PMID: 20162371 DOI: 10.1007/s11356-010-0293-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 12/30/2009] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND PURPOSE In Pakistan, almost 70% of the population lives in rural areas. Ninety-four percent of households in rural areas and 58% in urban areas depend on biomass fuels (wood, dung, and agricultural waste). These solid fuels have poor combustion efficiency. Due to incomplete combustion of the biomass fuels, the resulting smoke contains a range of health-deteriorating substances that, at varying concentrations, can pose a serious threat to human health. Indoor air pollution accounts for 28,000 deaths a year and 40 million cases of acute respiratory illness. It places a significant economic burden on Pakistan with an annual cost of 1% of GDP. Despite the mounting evidence of an association between indoor air pollution and ill health, policy makers have paid little attention to it. This review analyzes the existing information on levels of indoor air pollution in Pakistan and suggests suitable intervention methods. METHODS This review is focused on studies of indoor air pollution, due to biomass fuels, in Pakistan published in both scientific journals and by the Government and international organizations. In addition, the importance of environmental tobacco smoke as an indoor pollutant is highlighted. RESULTS Unlike many other developing countries, there are no long-term studies on the levels of indoor air pollution. The limited studies that have been undertaken indicate that indoor air pollution should be a public health concern. High levels of particulate matter and carbon monoxide have been reported, and generally, women and children are subject to the maximum exposure. There have been a few interventions, with improved stoves, in some areas since 1990. However, the effectiveness of these interventions has not been fully evaluated. CONCLUSION Indoor air pollution has a significant impact on the health of the population in Pakistan. The use of biomass fuel as an energy source is the biggest contributor to poor indoor air quality followed by smoking. In order to arrest the increasing levels of indoor pollution, there is a dire need to recognize it as a major health hazard and formulate a national policy to combat it. An integrated effort, with involvement of all stakeholders, could yield promising results. A countrywide public awareness campaign, on the association of indoor air pollution with ill health, followed by practical intervention would be an appropriate approach. Due to the current socioeconomic conditions in the country, development and adoption of improved cooking stoves for the population at large would be the most suitable choice. However, the potential of biogas as a fuel should be explored further, and modern fuels (natural gas and LPG) need to be accessible and economical. Smoking in closed public spaces should be banned, and knowledge of the effect of smoking on indoor air quality needs to be quantified.
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Affiliation(s)
- Ian Colbeck
- Department of Biological Sciences, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, UK.
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Alam AY, Iqbal A, Mohamud KB, Laporte RE, Ahmed A, Nishtar S. Investigating socio-economic-demographic determinants of tobacco use in Rawalpindi, Pakistan. BMC Public Health 2008; 8:50. [PMID: 18254981 PMCID: PMC2268929 DOI: 10.1186/1471-2458-8-50] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Accepted: 02/07/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the socio-economic and demographic determinants of tobacco use in Rawalpindi, Pakistan. METHODS Cross sectional survey of households (population based) with 2018 respondent (1038 Rural; 980 Urban) was carried out in Rawalpindi (Pakistan) and included males and females 18-65 years of age. Main outcome measure was self reported daily tobacco use. RESULTS Overall 16.5% of the study population (33% men and 4.7% women) used tobacco on a daily basis. Modes of tobacco use included cigarette smoking (68.5%), oral tobacco (13.5%), hukka (12%) and cigarette smoking plus oral tobacco (6%). Among those not using tobacco products, 56% were exposed to Environmental tobacco smoke. The adjusted odds ratio of tobacco use for rural residence compared to urban residence was 1.49 (95% CI 1.1 2.0, p value 0.01) and being male as compared to female 12.6 (8.8 18.0, p value 0.001). Illiteracy was significantly associated with tobacco use. Population attributable percentage of tobacco use increases steadily as the gap between no formal Education and level of education widens. CONCLUSION There was a positive association between tobacco use and rural area of residence, male gender and low education levels. Low education could be a proxy for low awareness and consumer information on tobacco products. As Public health practitioners we should inform the general public especially the illiterate about the adverse health consequences of tobacco use. Counter advertisement for tobacco use, through mass media particularly radio and television, emphasizing the harmful effects of tobacco on human health is very much needed.
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Affiliation(s)
- Ali Yawar Alam
- Community Health Sciences, Shifa College of Medicine, Pitrus Bukhari Road, Sector H-8/4, Islamabad, Pakistan.
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Jafary FH, Aslam F, Mahmud H, Waheed A, Shakir M, Afzal A, Qayyum MA, Akram J, Khan IS, Haque IU. Cardiovascular health knowledge and behavior in patient attendants at four tertiary care hospitals in Pakistan--a cause for concern. BMC Public Health 2005; 5:124. [PMID: 16309553 PMCID: PMC1318493 DOI: 10.1186/1471-2458-5-124] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2005] [Accepted: 11/25/2005] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Knowledge about coronary heart disease (CHD) and its risk factors is an important pre-requisite for an individual to implement behavioral changes leading towards CHD prevention. There is scant data on the status of knowledge about CHD in the general population of Pakistan. The objective of this study was to assess knowledge of CHD in a broad Pakistani population and identify the factors associated with knowledge. METHODS Cross sectional study was carried out at four tertiary care hospitals in Pakistan using convenience sampling. Standard questionnaire was used to interview 792 patient attendants (persons accompanying patients). Knowledge was computed as a continuous variable based on correct answers to fifteen questions. Multivariable linear regression was conducted to determine the factors independently associated with knowledge. RESULTS The mean age was 38.1 (+/- 13) years. 27.1% had received no formal education. The median knowledge score was 3.0 out of a possible maximum of 15. Only 14% were able to correctly describe CHD as a condition involving limitation in blood flow to the heart. Majority of respondents could identify only up to two risk factors for CHD. Most commonly identified risk factors were stress (43.4%), dietary fat (39.1%), smoking (31.9%) and lack of exercise (17.4%). About 20% were not able to identify even a single risk factor for CHD. Factors significantly associated with knowledge included age (p = 0.023), income (p < 0.001), education level (p < 0.001), residence (p < 0.001), a family history of CHD (p < 0.001) and a past history of diabetes (p = 0.004). Preventive practices were significantly lacking; 35%, 65.3% and 84.6% had never undergone assessment of blood pressure, glucose or cholesterol respectively. Only a minority felt that they would modify their diet, stop smoking or start exercising if a family member was to develop CHD. CONCLUSION This is the first study assessing the state of CHD knowledge in a relatively diverse non-patient population in Pakistan. There are striking gaps in knowledge about CHD, its risk factors and symptoms. These translate to inadequate preventive behavior patterns. Educational programs are urgently required to improve the level of understanding of CHD in the Pakistani population.
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Affiliation(s)
- Fahim H Jafary
- Department of Medicine, Section of Cardiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Fawad Aslam
- Department of Medicine, Section of Cardiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Hussain Mahmud
- Department of Medicine, Section of Cardiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Abdul Waheed
- Department of Medicine, Section of Cardiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Murtaza Shakir
- Department of Medicine, Section of Cardiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Atif Afzal
- Department of Medicine, Section of Cardiology, Aga Khan University Hospital, Karachi, Pakistan
| | | | | | - Iqbal S Khan
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
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