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Biomedical subjects

S Luby

Publications and source records attributed to S Luby.

At least 19 recordsLinked to original sources
PubMed2002

Vulnerability to homicide in Karachi: political activity as a risk factor.

BACKGROUND: Previous studies analysing Karachi ambulance data from 1993 to 1995 identified neighbourhoods in Karachi disproportionately affected by homicide. As a step toward developing intervention programmes to curb violence, we conducted a study to identify risk factors for becoming a homicide victim in a high violence area of Karachi. METHODS: We interviewed families of 35 cases, individuals intentionally killed through acts of violence between January 1994 and January 1997, and 85 community-based controls frequency matched by sex, from Orangi, a high violence area of Karachi. RESULTS: Most of our cases and controls were male (97% and 92%, respectively) and had similar socioeconomic and ethnic backgrounds. All the victims were killed by firearms; 4 (11%) had been tortured prior to death. Most of the victims were killed in the streets (n = 25, 71%). Of these, 7 (36%) had been killed by law-enforcement officers, while 6 (24%) died from indiscriminate firing. People who were killed were 34 times more likely to have attended all political processions (29% versus 1%, odds ratio [OR] = 34; 95% CI: 4-749, P < 0.001), 19 times more likely to have attended political meetings (31% versus 2%, OR = 19; 95% CI: 4-136, P < 0.001), and 17 times more likely to have held an important position in a political party (29% versus 2%, OR = 17; 95% CI: 3-120, P < 0.001) than controls. CONCLUSIONS: Homicide in Orangi was political. Efforts to improve trust between ethnic groups and to build legitimacy for non-violent forms of conflict resolution are important steps to limit future violence.

Adolescent↗
PubMed2001

Is drinking water in Abidjan, Côte d'Ivoire, safe for infant formula?

OBJECTIVE: To survey knowledge, attitudes, and practices regarding water use and infant feeding in the Koumassi District of Abidjan, Côte d'Ivoire, and to evaluate the microbiologic quality of source and stored drinking water. DESIGN: Random-cluster household survey. METHODS: We randomly selected 20 clusters, each comprising six households with at least 1 child aged < or =3 years. In each household, we administered a questionnaire and collected source and stored drinking water samples and tested these for chlorine levels and for total coliform and fecal bacteria count ( Escherichia coli ). RESULTS: Municipal water was used for drinking in 112 (93%) of 120 households, and in 99 (83%), it was stored for later use. By 1 month of age, 97 (90%) of 108 infants given drinking water were given stored water for drinking. In 8 (66%) of 12 households where children were receiving artificial feeding, formula was prepared from municipal water without additional treatment. Stored water had lower levels of free chlorine than source water (median of 0.05 versus 0.2 mg/dl; p <.001), and E. coli was detected in 36 (41%) of 87 stored water samples and 1 (1%) of 108 source water samples ( p <.001). CONCLUSIONS: In the Koumassi District of Abidjan, where municipal water is widely available and of good quality, drinking water is stored in most households, is often contaminated with E. coli, and is given to children at a young age. If replacement feeding is to be more widely used to prevent postnatal transmission of HIV-1, communities using stored water need interventions to make stored water safer.

Chlorine↗
PubMed2001

A low-cost intervention for cleaner drinking water in Karachi, Pakistan.

OBJECTIVE: To pilot test an inexpensive, home-based water decontamination and storage system in a low-income neighborhood of Karachi. METHODS: Fifty households received a 20-L plastic water storage vessel with a high-quality spout and a regular supply of diluted hypochlorite solution. Twenty-five control households were recruited. Water samples were collected at baseline and during unannounced follow-up visits 1, 3, 6, and 10 weeks later. RESULTS: Baseline drinking water samples among intervention households were contaminated with a mean 9397 colony-forming units (cfu)/100 mL of thermotolerant coliforms compared with a mean 10,990 cfu/100 mL from controls. After intervention the mean concentration of thermotolerant coliforms decreased by 99.8% among the intervention households compared with an 8% reduction among controls. Two years after vessel distribution, 34 (68%) of the families were still using the vessel. Thirteen of the households had stopped using their vessel because it had broken after more than 6 months of use, a pattern most consistent with ultraviolet radiation-induced degradation of the plastic. CONCLUSIONS: In a highly contaminated environment, a specifically designed water storage container and in-home water chlorination was acceptable and markedly improved water quality. Where plastic water vessels will be exposed to substantial sunlight, ultraviolet light stabilizers should be incorporated into the plastic.

Costs and Cost Analysis↗
PubMed2001

Restaurant-associated outbreak of Salmonella typhi in Nauru: an epidemiological and cost analysis.

Typhoid fever is endemic in the South Pacific. We investigated an outbreak in Nauru. Through interviews and medical records, we identified 50 persons with onset between 1 October 1998 and 10 May 1999, of fever lasting > or = 3 days and one other symptom. Salmonella Typhi was isolated from 19 (38%) cases. Thirty-two (64%) patients were school-aged children, and 17 (34%) were in four households. Case-control studies of (a) culture-confirmed cases and age- and neighbourhood-matched controls; and (b) household index cases and randomly selected age-matched controls implicated two restaurants: Restaurant M (matched OR [MOR] = 11, 95% confidence interval [CI] = 1.3-96) and Restaurant I (MOR = 5.8, 95% CI = 1.2-29). Food-handlers at both restaurants had elevated anti-Vi antibody titres indicative of carrier state. The annual incidence was 5.0/1000 persons. Outbreak-associated costs were $46,000. Routine or emergency immunization campaigns targeting school-aged children may help prevent or control outbreaks of typhoid fever in endemic disease areas.

Adolescent↗
PubMed2001

Hypertension and its determinants among adults in high mountain villages of the Northern Areas of Pakistan.

We studied the prevalence and determinants of hypertension among adults in mountainous rural villages in the Ghizar district Northern Areas of Pakistan, an area that recently has undergone substantial economic development. We selected a stratified random sample of 4203 adults (age > 18 years) from 16 villages in Punial Valley of Ghizar district where the number of study subjects from each village was proportionate to the size of the village. We obtained blood pressure (BP) records by taking the mean of the second and third BP measurement, using a standard mercury sphygmomanometer, and assessed risk factors for hypertension in the study subjects. The mean +/- s.d. blood pressures (mm Hg) were 125 +/- 19 systolic and 80 +/- 12 diastolic in men and 125 +/- 22 systolic and 78 +/- 14 diastolic in women. The 125 +/- 22 systolic and 78 +/- 14 diastolic in women. The mm Hg, or systolic BP > or = 140 mm Hg or currently taking antihypertensive medication) was 15%, increasing from 4% in the 18-29 year age group to 36% among persons 60 years of age or older. The age-standardised prevalence of hypertension was 14% (12.5% among men and 14% among women). There was no significant difference in prevalence of hypertension in males, and in females. Multivariate analysis revealed that age, and higher body mass index (overweight and obesity) were independently associated with higher prevalence of hypertension. People with hypertension were more likely to have a first-degree relative with physician-diagnosed hypertension (OR = 1.90, 95% CI 1.49, 2). Hypertension is a significant health problem in rural northern Pakistan. The primary health care programme in the Northern Areas of Pakistan needs to address this problem, especially identifying people at risk.

Adolescent↗
PubMed2001

Management trend and safety of vaginal delivery for term breech fetuses in a tertiary care hospital of Karachi, Pakistan.

AIM: To investigate the safety of vaginal delivery for term breech fetuses in a tertiary-care hospital of Pakistan. METHODS: We reviewed the medical records of all live singleton breech deliveries at or beyond 37 weeks of gestation, at the Aga Khan University Hospital, Karachi, from January 1988 to December 1995. RESULTS: Rate of cesarean section increased from 48% (1988) to 74% (1995). Out of 287 subjects, 158 underwent elective cesarean section while 129 received a trial of labor, 77% of which delivered vaginally. There was no neonatal or maternal death. Compared to babies delivered by emergency or elective cesarean section, those delivered vaginally had significantly more neonatal intensive-care unit admissions (none and 5% versus 13%) and higher rates of birth trauma (none and 0.6% versus 7%). However, there was no significant difference in the Apgar score at 5 minutes and the risk of maternal complications by delivery mode. CONCLUSION: Allowing trial of labor to carefully selected mothers can result in vaginal delivery in 77% of the cases. However, the risk of trauma and neonatal intensive-care unit admissions, among vaginal births may favor the decision of elective cesarean section, unless rigorous pre-delivery assessment and conduct of delivery by adequately trained obstetricians is performed.

Birth Injuries↗
PubMed2001

Injection safety.

Explore the source record for details and available documents.

Blood-Borne Pathogens↗
PubMed2000

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

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

Blood Banks↗
PubMed2000

Knowledge, attitudes, and practices regarding sexually transmitted infections among general practitioners and medical specialists in Karachi, Pakistan.

OBJECTIVES: To determine the knowledge, attitudes, and practices regarding diagnosis and treatment of sexually transmitted infections (STIs) among specialists--that is, dermatologists, gynaecologists and urologists, and general practitioners (GPs) in Karachi, Pakistan. METHODS: Interviewers administered structured questionnaires to doctors conducting outpatient clinics at tertiary hospitals and/or private clinics in Karachi. All private clinics within a 10 km radius of the Aga Khan University, and all tertiary hospitals having more than 100 inpatient beds were included in the study. RESULTS: 100 doctors (54 specialists and 46 GPs) responded. 80 doctors reported seeing at least one STI patient/month. The most commonly diagnosed STI the doctors reported was urethritis/cervicitis syndrome. 50% of the doctors knew the recommended antibiotics for gonorrhoea though only 46% of these knew the correct dosage. Specialists were three times more likely to recognise the clinical presentation of herpes and twice as likely to treat chlamydia, syphilis, and herpes with appropriate antimicrobials than GPs. 85% of the doctors advised their STI patients regarding condom usage; 36% thought that STI patients had loose sexual morals; 43% believed STI patients were drug addicts. Over 90% of the physicians were willing to attend educational sessions and follow a national STI treatment protocol. CONCLUSION: Doctors in Karachi, especially GPs, are deficient in appropriately managing and counselling STI patients. Among the specialists, urologists and dermatologists were more likely to manage STIs correctly than gynaecologists. Karachi doctors should be educated in the correct management and counselling of STIs to prevent further spread of STIs including AIDS.

Attitude of Health Personnel↗
PubMed2000

Effectiveness of health education in promoting the use of iodized salt in Lotkoh, tehsil Chitral, Pakistan.

INTRODUCTION: We evaluated the effect of health education on the use of iodized salt in a remote region. METHODS: We randomly selected 31 villages in teh Lotkoh tehsil of district Chitral in the North West Frontier Province of Pakistan. We then randomly selected 7 households from each village and inteviewed the eldest women of the family. We also tested samples of salt for iodine concentration at the user's level. RESULTS: Eighty-five percent of families (184/217) used iodized salt exclusively. Among the samples population, the Aga Khan Health Services (AKHS) informed 67% about the importance of iodized salt. Shopkeepers and neighbors informed 25%. People informed by AKHS were more likely to know the volatile nature of iodine (76% vs 55%, p < 0.001) and the advantages of iodized salt (91% vs. 75%, p = 0.001) than persons informed by other sources. People who could name any single advantage of iodized salt were more likely to use iodized salt (97%) compared to those who could not name any advantages (62%) (p < 0.001) Iodine concentration in 78% (141/183) samples was acceptable (> or = 15 ppm). One specific brand of salt consistently had sufficient iodine concentration (91%) compared to all others (47%) (p < 0.001). CONCLUSION: Health education has been effective in promoting the use of iodized salt in these isolated rural communities. A joint effort by the government, local NGOs and the community can substitute the role of mass media in such areas. Regular evaluation of iodized salt brands should be considered.

Chi-Square Distribution↗
PubMed1999

Risky behavior of bus commuters and bus drivers in Karachi, Pakistan.

Buses account for a disproportionate number of road traffic accident fatalities in Karachi, Pakistan and other developing countries. Potentially dangerous bus driving and commuting practices that increase risk of road accidents and the effect of traffic police on bus behavior are evaluated. A total of 250 episodes each of disembarking and embarking commuters, buses stopping and moving on the road at ten of Karachi's highest risk intersections for traffic injuries were observed. Of the disembarking passengers, 33% did not wait for the bus to stop; 54% stepped off in the center of the road and 84% did not look out for traffic. Among the embarking commuters, 38% got on moving buses; 73% climbed on buses filled to their outer foot boards and 83% waited for buses on the street. Males were more likely than females to jump off a moving bus (43% versus 1.6%, P < 0.001), get on a moving bus (49% versus 12%, P < 0.001), and run to catch a bus (45% versus 8%, P < 0.001). At the bus stops, 30% of the buses did not stop completely; 46% stopped away from the stop and 79% stopped in the center of the road. Where traffic police were present buses were more likely to race (9% versus 3%, P = 0.05) and to cut off other vehicles (13% versus 2%, P = 0.001) than where police were absent. Risky behavior is common among both Karachi bus drivers and bus commuters. The traditional efforts to regulate bus traffic through traffic police is ineffective.

Accidents, Traffic↗
PubMed1999

Pedestrian environment and behavior in Karachi, Pakistan.

Pedestrian road traffic accidents (RTAs) are responsible for a substantial number of injuries and deaths in Karachi. To better understand the situations facing pedestrians we selected ten of Karachi's highest risk locations for pedestrian RTAs and observed 250 pedestrians for each of three activities--crossing the street, walking on the street, and walking on the sidewalk. We also observed the extent and effect of street and sidewalk encroachments. A total of 35% of the pedestrians crossing the street caused traffic to swerve to avoid them. Pedestrians crossing one lane at a time were 2.9 times more likely to cause the traffic to swerve than pedestrians who crossed the whole street at once (53 vs. 18%, RR = 2.9, 95% CI = 1.9-4.3). Pedestrians crossing in a group were 1.8 times more likely to cause traffic to swerve compared to those crossing singly (49 vs. 28%, RR = 1.8, 95% CI = 1.3-2.5, P = 0.001). A total of 36% ran while crossing and were 1.8 times more likely to cause traffic to swerve than those who walked (48 vs. 27%, RR = 1.8, 95% CI = 1.3-2.5). An average of 77% of the sidewalk width was blocked by encroachments which forced pedestrians to step on the road resulting in vehicles swerving. An average 33% of the street width was blocked by illegally parked vehicles. Pedestrians in Karachi indulge in risky behaviors. Encroachments on streets and sidewalks compound the problem. Piloting efforts to modify pedestrian behavior and the environment they negotiate should be considered to reduce pedestrian deaths.

Accidents, Traffic↗
PubMed1999

Survey of surgical emergencies in a rural population in the Northern Areas of Pakistan.

OBJECTIVE: To determine the incidence of specific surgical emergencies in a mountainous rural community in the Northern Areas of Pakistan and to assess use of existing health services, and outcomes related to acute surgical illness events. METHOD: A cross-sectional population-based survey was conducted. Interviewers visited each of 118 villages in the study area (population 100000), selected a random sample from a total of 9900 households, and interviewed the oldest premenopausal female member (n = 836). Questions were focused on injury, acute abdomen, and/or maternal morbidity occurring in the past year. Cases were included as surgical emergencies when one or more index clinical features indicating a potential for surgical intervention were present. Mortality from a wider range of surgical emergencies was also elicited based on the respondent's lifetime knowledge of the household. RESULTS: The incidence rates were 1531/100000 persons per year for injuries; 1364/100000 for acute abdomen, and 16462/100000 for maternal morbidity. The rate of injuries was 2.7 times higher and that of acute abdomen twice as high in males as in females. The injury rate decreased with advancing age, being 13 times higher in children < 5 years than in adults > 40. By contrast, the rate for acute abdomen showed a rise with advancing age, being 8 times higher in the > 40 age group than in under-fives. Burns, falls and road accidents, in that order, were the commonest forms of injury accounting for 82% of 138 cases. Of 43 burn casualties, 46% were in the age group < 5 years; there was no gender bias. Of 71 casualties from falls and road accidents, 85% were aged 6-40 years; there was 6 : 1 male predominance. The maternal morbidity rate was highest in the age group 25-35 years and may be attributed to the high pregnancy rate in this age bracket. Of 408 patients with acute surgical illness, 85% were managed initially at home or close to home in a health centre, dispensary or civil hospital; 32% eventually sought specialist surgical care. The overall rate for minor and major surgical procedures was 411/100000 persons per year (lowest estimate), and appeared to be low. The rate of operative deliveries at 11.8/1000 deliveries (lowest estimate) was particularly low. The mortality rates were correspondingly high: 55/100000 persons per year for injuries and for acute abdomen (lowest estimates). The maternal mortality ratio was particularly high at 8.9/1000 deliveries (lowest estimate). Annual mortality rates derived from deaths recalled during the respondent's lifetime in the household (mean period = 26 years), tended to corroborate the results of the 1-year survey. CONCLUSION: The incidence rates for broad categories of serious acute surgical illness in the study population far exceeded the rates of acute surgical intervention. Mortality rates were correspondingly high. Such evidence points to a large unmet surgical need and ought to spur improvements in the health service.

Abdomen, Acute↗
PubMed1999

Does use of a government service depend on distance from the health facility?

To reduce mortality from common childhood illnesses such as diarrhoea and upper respiratory infections, it is important that health services are available and used appropriately. Physical accessibility to a health facility may influence its use, particularly in rural areas. We assessed whether use of government services for treatment of the three most common acute childhood illnesses (fever, diarrhoea and upper respiratory infections) was influenced by the physical accessibility of the government primary health care centres. We analyzed data from a household survey which was collected between November 1992 and January 1993, from 139 randomly selected villages located around 14 government facilities in Thatta, a rural district of Pakistan. There were 691 children under 5 years of age who suffered from the three acute illnesses; 85% of these children used either a government or a private service. Children living at less than 4 km from a government facility made 22% less use of that facility than those living 4 km or more away. After controlling for the effects of distance from a private facility and treatment cost in a multiple logistic regression model, children living less than 4 km from a government facility were no more likely to use the facility than those living 4 km or more away (Adjusted Odds Ratio: 1.01, 95% Confidence Interval: 0.68-1.50). These results suggest that factors other than distance are the primary determinants of use of government services for treating children in the Thatta district. To increase the use of government health services, policymakers should assess carefully the factors determining the use of existing facilities, before they plan the building of more health facilities. Further studies are needed to examine the management of health facilities and the clients' perception of health-care providers.

Catchment Area, Health↗
PubMed1998

Outbreak of Crimean-Congo haemorrhagic fever in Quetta, Pakistan: contact tracing and risk assessment.

In December 1994 in a private hospital in Quetta, Pakistan, 3 health-workers contracted Crimean-Congo haemorrhagic fever (CCHF) after surgery on a bleeding patient who later died. We conducted a retrospective study to determine transmission risks among contacts. Fifty contacts gave blood for antibody tests and answered questions about exposure. Two of four people exposed percutaneously and one of five with cutaneous exposure contracted CCHE The person with cutaneous exposure was a surgeon who tore his glove during surgery and noted blood on his hand but no cut. There were no anti-CCHF antibodies or CCHF cases among persons whose skin came into contact with body fluids other than blood (0/4), who had skin-to-skin contact (0/16) with patients or were physically close to them (0/21). Three index case relatives reported that although 10 family members had cutaneous exposure, none developed CCHF. The family refused blood tests. CCHF transmission in resource-constrained settings can be limited by focusing on avoiding health worker contact with blood.

Disease Outbreaks↗
PubMed1998

Postexposure treatment of rabies in Pakistan.

To evaluate compliance with current World Health Organization (WHO) guidelines for postexposure treatment (PET) of rabies, we interviewed all animal bite victims seeking treatment on the same day of each week from 28 December 1994 through 18 January 1995 at the Civil Hospital of Karachi (Pakistan), a major referral center. Of the 143 patients studied, 109 (76%) sustained bleeding transdermal bites (WHO category III). Overall, wounds were not washed with soap or an antiseptic in 69% of victims. All victims received 5% sheep brain-derived vaccine, and only three of the 109 victims with category III bites received rabies immune globulin. PET of rabies in Karachi was deficient by all WHO standards. Although there is a great urgency to improve PET, it will remain a costly and inefficient method of controlling rabies. Reduction of rabies reservoirs is required to decrease human deaths due to rabies in Pakistan and other developing countries in which canine rabies is endemic.

Adolescent↗