BackgroundTo reduce morbidity and mortality, awareness regarding diabetes and its complications is necessary. This study aimed at assessing the level of knowledge, attitude, and practices (KAP) regarding complications of diabetes mellitus among patients with type 2 diabetes in Dhaka, Bangladesh.MethodsA cross-sectional study was carried out recruiting patients with diabetes from the outpatient department of BIRDEM hospital in Dhaka. Overall, 425 patients with diabetes were enrolled in this study. A pretested questionnaire was filled by the interviewer with face to face interview. Levels of KAP were determined by calculating the scores. Multivarable linear regression was used to determine significant predictors for knowledge, attitude, and practices.ResultsOn average, the level of knowledge, attitude, and practices were 9.2 (out of 14), 7.9 (out of 13), and 16.9 (out of 27), respectively. Age and gender were significant predictors of knowledge and attitude. Females had better level of knowledge and attitude compared to males (βs = 0.55 and 1.24, respectively). Patients with graduate degrees and above compared to illiterates reported significantly greater knowledge and practice (βs = 1.27 and 1.44, respectively), after adjustments for covariates. Educational program was the most important significant predictor of KAP. Higher duration of diabetes (β = 0.07) and positive marital status (β = 1.21) had influenced better practice.ConclusionsLack of knowledge, poor attitude, and inadequate practice were found in this surveyed communinty. Level of education and educational program on diabetes were the most significant contributing factors. The current study suggests the need of structured educational programs on diabetes and its complications on a regular basis to assist patients in living a productive life.

Background Each year nearly 7.7 million children under five years die around the world; out of which approximately 3.1 million of the newborns die during the neonatal period and almost all these (99%) deaths occur in the developing countries. According to the World Health Organization’s estimation neonatal deaths account for 45% of the under-five deaths. More than one-third of these deaths occur in the first 24 h of birth, whereas three-quarter of the neonatal deaths takes place in the first seven days of birth. The purpose of this study is to assess the knowledge, attitude, and practices (KAP) among mothers about newborns’ care and its related factors in district Badin Sindh province of Pakistan. Methods A community-based cross-sectional study was conducted from July 2017 to August 2017 to assess the Knowledge, Attitude, and Practices (KAP) in mothers regarding newborn care. A structured questionnaire was administered, after pretest, for data gathering through face to face interview. All survey participants were identified using multi-stage cluster sampling. A scoring system was used to calculate the level of KAP among participants. Independent sample t-test, ANOVA, and GLM were applied to identify the statistical difference between the means of various groups. Result A total of 518 survey participants were interviewed. Among the study sample, more than half of the newborns were bathed within six hours of delivery. Around 50% started breastfeeding after 1 h of birth. A substantial proportion (45%) of mothers gave pre-lacteal feeding and 44.8% of them did not feed colostrum to their newborns. Among those who administered pre-lacteal to their newborn babies included animal/formula milk (15.4%), honey (24.5%) and fresh butter/ghee (5.2. %). Mothers with no education had less significant KAP score about newborn care as compared to those who had higher education ( p < 0.05). Conclusion This study revealed that high-risk factors such as immediate bathing, application of traditional substances on the cord, delayed initiation of breastfeeding, discarding colostrum and giving pre-lacteal feed to newborns were highly prevalent. This requires urgent attention of Maternal, Newborn and Child Health (MNCH) programs and health care delivery system to prevent harmful care practices and adopt healthy practices especially in the rural settings.

Background Advantages and disadvantages associated with joint and nuclear family systems can affect quality of life (QOL). However, there is scarcity of literature about QOL among joint and nuclear family systems. This study aimed to assess the factors associated with QOL in joint and nuclear family systems. Methods We conducted a population based cross sectional study in all 52 Union Councils (UCs) of District Abbottabad, Khyber Pakhtunkhwa province, Pakistan from March 2015 to August 2015. Multistage cluster sampling technique was used to select participants from both nuclear and joint family houses. The validated Urdu version of World Health Organization Quality of Life Questionnaire-Brief Version (WHOQOL-BREF) was used to assess quality of life among participants. Univariate and multivariate analyses were performed to explore the associations of different socio demographic variables with QOL among both family systems. Also a multilevel linear regression using backward analysis to obtain final model for each domain was performed to find out the variables that are associated with QOL score in each of family systems. Results A total of 2063 participants were included in this study (51.0% joint family, 49.0% nuclear family) with the response rate of 97.4%. In multiple linear regression analysis of each domain for joint and nuclear family systems, rural residence compared to urban (p < 0.001), being female (p < 0.001), older age (p < 0.001), having comorbidity (p < 0.001) and lower socioeconomic status (p < 0.001) were found to be a strong predictor of poorer QOL. Furthermore, social capital (p < 0.001) had a positive effect on joint and nuclear family QOL scores. Conclusion This study was the first of its kind which determined the factors of QOL in joint and nuclear families using the validated Urdu version of WHOQOL-BREF in Pakistan. Male gender, urban residence, younger age, higher socioeconomic status and social capital were positive predictors of QOL score while older age and presence of illness were associated with lower QOL scores among both family systems.

Background: The present study was conducted to translate and validate the World Health Organization’s Quality-of-Life Scale - BREF into local language of Pakistan. Methods: A forward- backward translation procedure was followed to develop the Pakistani version of the questionnaire. Through a multi- stage clustered sampling technique, a sample of individuals aged 18 years and above completed the questionnaire in Abbottabad district, Pakistan. Psychometric properties of the instrument including reliability (internal consistency and test-retest analysis), validity (known group comparison and items’ correlation) and their domains were assessed. Satisfactory results were also shown in the correlation matrix in all domains. Results: A total of 2060 participants were recruited in this study. Participants’ mean age was 35.51 (SD= 14.31) years in healthy individuals and 39.29 (SD= 14.31) years in diseased individuals. The internal consistency of the WHOQOL-BREF (Pakistani Version) was 0.86. Moreover, the physical, psychological, and environmental domains had acceptable reliability (alpha= 0.78, 0.75, and 0.73, respectively), but reliability was low (alpha= 0.56) in the social domain. Reproducibility of the WHOQOL-BREF was as follows: ICC range: 0.72–0.92 at 2-week retest interval. After performing comparison analysis, the results indicated that the questionnaire significantly segregated the study groups in all QoL domains, except for social relationship. Conclusion: The study provided strong exploratory evidence for the reliability and validity of the WHOQOL-BREF for use in Pakistan. However, more exploration is needed to improve the reliability results in the social domain.

BackgroundPre-hospital emergency care is a vital and integral component of health systems particularly in the resource constrained countries like Uganda. It can help to minimize deaths, injuries, morbidities, disabilities and trauma caused by the road traffic incidents (RTIs). This study identifies the weaknesses and capacities affecting the pre-hospital emergency care for the victims of RTIs in the Greater Kampala Metropolitan Area (GKMA).MethodsA cross-sectional study was conducted in the GKMA using a three-part structured questionnaire. Data related to the demographics, nature of RTIs and victims’ pre-hospital experience and existing Emergency Medical Services (EMS) were collected from victims and EMS specialists in 3 hospitals and 5 EMS institutions respectively. Data was descriptively analyzed, and after the principal component analysis was employed to identify the most influential weaknesses and capacities affecting the pre-hospital emergency care for the victims of RTI in the GKMA.ResultsFrom 459 RTI victims (74.7% males and 25.3% females) and 23 EMS specialists (91.3% males and 8.7% females) who participated in the study between May and June 2016, 4 and 5 key weaknesses and capacities respectively were identified to affect the pre-hospital emergency care for RTI victims in the GKMA. Although some strengths exist like ambulance facilitation, EMS structuring, coordination and others), the key weaknesses affecting the pre-hospital care for victims were noted to relate to absence of predefined EMS systems particularly in the GKMA and Uganda as a whole. They were identified to involve poor quality first aid treatment; insufficient skills/training of the first responders; inadequate EMS resources; and avoidable delays to respond and transport RTI victims to medical facilities.ConclusionsThough some strengths exist, the weaknesses affecting prehospital care for RTI victims primarily emanate from the absence of predefined and well-organized EMS systems in the GKMA and Uganda as a whole.Electronic supplementary materialThe online version of this article (10.1186/s12873-017-0137-2) contains supplementary material, which is available to authorized users.

Introduction:Prehospital emergency care is a vital and integral component of health systems, particularly in resource-constrained countries like Uganda. It can help to minimize deaths, injuries, morbidities, disabilities, and trauma caused by road traffic incidents (RTIs). This study identifies the weaknesses and capacities affecting the prehospital emergency care for the victims of RTIs in the Greater Kampala Metropolitan Area (GKMA).Methods:A cross-sectional study was conducted in the GKMA using a three-part structured questionnaire. Data related to the demographics, nature of RTIs and victims’ pre-hospital experience and existing Emergency Medical Services (EMS) were collected from victims and EMS specialists in 3 hospitals and 5 EMS institutions, respectively. Data were descriptively analyzed, and a principal component analysis was employed to identify the most influential weaknesses and capacities affecting the prehospital emergency care for the victims of RTI in the GKMA.Results:From 459 RTI victims (74.7% males and 25.3% females) and 23 EMS specialists (91.3% males and 8.7% females) who participated in the study between May and June 20164. key weaknesses and 5 key capacities were identified to affect the prehospital emergency care for RTI victims in the GKMA. Although some strengths exist, (e.g., ambulance facilitation, EMS structuring, and coordination), the key weaknesses affecting the pre-hospital care for victims were noted to relate to the absence of predefined EMS systems, particularly in the GKMA and Uganda as a whole. They were identified to involve poor quality first aid treatment, insufficient skills/training of the first responders, inadequate EMS resources, and avoidable delays to respond and transport RTI victims to medical facilities.Discussion:Though some strengths exist, the weaknesses affecting prehospital care for RTI victims primarily emanate from the absence of predefined and well-organized EMS systems in the GKMA and Uganda as a whole.

BackgroundChildhood immunization is one of the most cost-effective interventions for child health. Still, many children are not able to receive completed immunization status. Wealth – related inequality in immunization is considered a major reason for equitable coverage of immunization in Pakistan. Therefore, we examine wealth-related inequality in completed childhood immunization and to assess achievement indices across geographical regions in Pakistan.MethodsThe analysis was based on a nationally representative demographic and health survey (DHS) of Pakistan, conducted in 2012–13. We examined completed childhood (12–23 months) immunization in the various regions of the country and we used concentration, extended concentration and achievement indices to demonstrate inequality across geographical regions in Pakistan.ResultsInequality in completed childhood immunization was seen in Pakistan with concentration index (CI) of 0.181 (95% CI: 0.164–0.209). Regions with high average of complete immunization showed lower inequality except for Sindh. Despite having better average immunization coverage in Kyber Pakhtunkhwa, the relative change of 128% in concentration index (CI) from C2 (standard CI) to C5 (when poorer quantile received highest weights) shows this to be also the most inequitable regions. Four parameters of inequality aversion (v = 2, 3, 4 & 5) demonstrated that ‘dis – achievement’ in completed immunization is densely concentrated among the poorer regions. Balochistan, Sindh and Gilgit Baltistan exhibited broader inequality gaps (93.75%, 83.35%, and 54.93%, respectively) at higher aversion parameter.ConclusionsAs hypothesized, achievement index uncovers ‘penalized’ immunization coverage amongst the poorest population. Thus any policy that stringently focuses on improving average immunization rate without any strategy to deal with inequality will only improve immunization rate within wealthier groups. Based on these results, it is advisable to public health policy makers to use both aspect of information: average and degree of inequality in immunization coverage.Electronic supplementary materialThe online version of this article (10.1186/s12939-018-0837-6) contains supplementary material, which is available to authorized users.

BackgroundUse of helmets plays a major role in preventing injuries or decreasing injury severity among motorcycle riders. Use of helmets may depend on personal factors such as psychological factors.ObjectivesThe aim of this study was to independently assess the association between helmet use among motorcycle riders and ADHD scores, with controlling the accident history and was taken more sensitive measures if helmet use was different between motorcycle riders, according to their ADHD scores.Patients and MethodsA cross-sectional study was done on 205 motorcycle riders referred to Kerman Referral Injury Hospital after a motorcycle traffic accident. Friends and family members possessing motorcycles who visited the patient in this facility were included in our sample. The Persian version of the Conner’s Adult ADHD Rating Scale (CAARS) self-report (screening version) was used in order to screen for adult ADHD. CAARS scores were compared between those who usually used helmets and those who did not.ResultsUnivariable analysis showed the mean of the age variable was significantly higher in the helmeted group, 26.94 ± 7.72 vs. 23.08 ± 7.7.32, (P < 0.001). The majority of the non-helmeted group was single (P < 0.001). Subjects with secondary educational level were more often in the helmeted group (P = 0.007). Daily and weekly driving hours were higher in the non-helmeted group (P = 0.002 and P = 0.004). Most of the subjects in the helmeted group had a driving license in comparison with the other group (P < 0.001). There was not a significant association between SES and having hyperactive children and helmet use (P = 0.159). In all ADHD subscales, a significant association was found and scores were higher in the non-helmeted group (P < 0.05). Nevertheless, multivariable analysis did not confirm the association of the ADHD screening score with helmet use.ConclusionsThe result of this study did not find an independent association between ADHD and helmet use.