Khabir Ahmad

Publications of Khabir Ahmad

• Corneal swapping in a bomb blast victim.

  Authors: Tanveer Anjum Chaudhry, Tahreem Aman, Farheen Shaikh, Khabir Ahmad

  JPMA. The Journal of the Pakistan Medical Association. 01/2012; 62(1):67-8.

  The case of a 40-year-old-man who presented to our clinic with bilateral blindness as a consequence of bomb blast injuries is reported. He had a completely opaque cornea, partially damaged posteriorThe case of a 40-year-old-man who presented to our clinic with bilateral blindness as a consequence of bomb blast injuries is reported. He had a completely opaque cornea, partially damaged posterior segment and perception of light in the right eye, while a clear cornea, totally damaged posterior segment and no light perception in the fellow eye. His corneas were successfully swapped which gave him navigational vision.

• Contact lens-related visual loss--a case series from Karachi.

  Authors: Tanveer Anjum Chaudhry, Sarah Sarfraz, QaziAssad Khan, Khabir Ahmad

  JPMA. The Journal of the Pakistan Medical Association. 12/2011; 61(12):1246-8.

  All cases of corneal ulcers, presenting at the Aga Khan University Hospital, Karachi between January 2006 and December 2010 were reviewed. Information was obtained regarding socio-demography, theAll cases of corneal ulcers, presenting at the Aga Khan University Hospital, Karachi between January 2006 and December 2010 were reviewed. Information was obtained regarding socio-demography, the cause of ulcer, prior treatment and visual acuity. Afterwards, contact-lens specific information such as the type of lens and purpose and duration of lens usage was obtained from the participants by phone interviews. There were 59 persons with unilateral ulcers and 4 had bilateral presentation. The mean age of the study participants was 27.79 +/- 14.51 years while the median age as 24 years. Of these, 87 %had a visual acuity less than <3/60 at presentation. Even after rigorous treatment, the visual acuity remained poor. In all 41 (68.4%) of the 60 eyes, for which follow up data were available, had visual acuity of less than 3/60 at their last follow up visit.Contact lens accounted for the majority of ulcerative eyes among women while trauma among men. Contact-lens related corneal ulcers are resulting in serious visual disability. Targeted education is necessary to address this avoidable cause of visual loss.

• An evaluation of referral system for retinopathy of prematurity in leading health centers across Karachi, Pakistan.

  Authors: Farzeen Khalid Hashmi, Tanveer Anjum Chaudhry, Khabir Ahmad

  JPMA. The Journal of the Pakistan Medical Association. 10/2010; 60(10):840-4.

  Retinopathy of prematurity (ROP) is emerging as a significant avoidable cause of childhood blindness in developing countries. This study was conducted to assess the referral system for ROP in theRetinopathy of prematurity (ROP) is emerging as a significant avoidable cause of childhood blindness in developing countries. This study was conducted to assess the referral system for ROP in the leading health care centers involved in the provision of services to newborns in Karachi, and to assess the awareness of this condition among health care workers in these centers. A purposeful sampling technique was employed to select ten health care centers in Karachi, Pakistan, which had the highest number of deliveries per year. Key informants interviews were held with the health care providers involved in the decision-making at these centers. A content analysis was performed on their responses. A total of 20 physicians (5 neonatologists and 15 pediatricians) were interviewed. Most of the surveyed centers did not have any referral system for ROP. The two centers that did have a referral system were not following standard protocol for such referrals. Most interviewees had inadequate knowledge of ROP. Only 2 out of 20 physicians were aware that ROP can lead to blindness. There was no referral system for ROP screening at most of the surveyed centers. The few centers that did have a referral system were not following international screening guidelines for such referrals. There is lack of recognition of ROP as a sight-threatening condition as shown by the inadequate knowledge of ROP among the concerned staff.

• Early experience with intravitreal bevacizumab combined with laser treatment for retinopathy of prematurity.

  Authors: Ayesha E Ahmed, Roomasa Channa, Jibran Durrani, Azam Ali, Khabir Ahmad

  Middle East African journal of ophthalmology. 07/2010; 17(3):264-7.

  This study was designed to present our early experience with intravitreal bevacizumab combined with laser treatment for retinopathy of prematurity (ROP) at a single institution over aThis study was designed to present our early experience with intravitreal bevacizumab combined with laser treatment for retinopathy of prematurity (ROP) at a single institution over a 13-month-period. A retrospective case series of eight children with ROP who received intravitreal bevacizumab combined with laser treatment between June 2007 and July 2008 were reported. A chart review was conducted to evaluate if stability of the ROP lesion had been achieved. Main information collected included data on demographics, gestational age, birth weight, length of stay in neonatal intensive care unit, and stage of ROP. Fifteen eyes of eight subjects were treated. One eye did not receive any treatment due to complete retinal detachment. The median age at treatment was 8 weeks (range, 6 weeks to 1 year). The most common stage of ROP was 3+. All eyes remained stable at 1 year or later after treatment. Intravitreal bevacizumab in conjunction with laser treatment had promising results at our institution. We recommend prospective, randomized, controlled clinical trials to compare the effect of laser treatment alone, of bevacizumab treatment alone (at different doses), and of combined bevacizumab and laser treatment.

• Prevalence of allergic conjunctivitis in school children of Karachi.

  Authors: Rashid Baig, Asma Wilayat Ali, Tuba Ali, Azam Ali, Mahnaz Naveed Shah, Adeel Sarfaraz, Khabir Ahmad

  JPMA. The Journal of the Pakistan Medical Association. 05/2010; 60(5):371-3.

  To determine the prevalence of allergic conjunctivitis in children in selected schools in Karachi, Pakistan. This cross-sectional study was conducted in September and October 2008 as part of theTo determine the prevalence of allergic conjunctivitis in children in selected schools in Karachi, Pakistan. This cross-sectional study was conducted in September and October 2008 as part of the School Eye Health Initiative launched by the Aga Khan University, Karachi and the Adamjee Eye Hospital, Karachi. Children in the selected schools underwent vision assessment and a slit lamp examination by an ophthalmologist. The main objective was to detect allergic conjunctivitis which was ascertained by the presence of papillae in the upper tarsal conjunctiva, redness of the eyes, and presence or history of itching and burning. A total of 818 children aged 5-19 years were examined. Of these, 19.2% (95% CI 16.5% to 21.9%) had allergic conjunctivitis. There was a significant association between increasing age and allergic conjunctivitis (Odds ratio: 1.19, 95% CI: 1.12, 1.26; P < 0.001). Boys had a higher burden of allergic conjunctivitis than girls; however this difference was not statistically significant (Odds ratio: 1.31, 95% CI: 0.90, 1.91, p = 0.153). There is a very high prevalence of allergic conjunctivitis in children in the selected schools in Karachi. Further research is needed to identify factors that contribute to such a high burden of this condition and to assess whether a similar pattern is also observed elsewhere.

• Blepharophimosis-ptosis-epicanthus inversus syndrome in a Pakistani pedigree.

  Authors: Tanveer Anjum Chaudhry, Mirza Umair Khalid, Taimur Saleem, Khabir Ahmad

  Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. 04/2010; 20(4):285-6.

  Blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) is a rare developmental ocular disorder. We report this condition affecting 4 members of a Pakistani family across three generations. ABlepharophimosis-ptosis-epicanthus inversus syndrome (BPES) is a rare developmental ocular disorder. We report this condition affecting 4 members of a Pakistani family across three generations. A 2-year-old girl was brought to the clinic by her father for the correction of her shortened palpebral fissures. Examination findings were consistent with BPES. The girl's father, paternal grandfather and paternal aunt also had identical features. The distance between the medial canthi of the index case was 30 mm, and the lengths of vertical and horizontal palpebral fissure were 6 mm and 20 mm, respectively. BPES must be considered an important differential diagnosis in patients presenting with blepharoptosis and blepharophimosis.

• Central corneal thickness of Pakistani adults.

  Authors: Roomasa Channa, Fazia Mir, Mahnaz Naveed Shah, Azam Ali, Khabir Ahmad

  JPMA. The Journal of the Pakistan Medical Association. 05/2009; 59(4):225-8.

  OBJECTIVE: To determine the average central corneal thickness (CCT) of healthy adults in the ophthalmology clinic of a tertiary care hospital of Pakistan. METHODS: This was a cross-sectional studyOBJECTIVE: To determine the average central corneal thickness (CCT) of healthy adults in the ophthalmology clinic of a tertiary care hospital of Pakistan. METHODS: This was a cross-sectional study conducted in the ophthalmology clinics of Aga Khan University Hospital, Karachi Pakistan. One hundred normal subjects (200 eyes) were studied. An ultrasound pachymeter was used to measure CCT. RESULTS: The mean (+/- SD) age of the study population was 44.29 +/- 15.18 years with a median of 47 years (range: 16-73). Twenty three percent of the subjects had diabetes mellitus, 29% hypertension and 6% had history of ischaemic heart disease. The mean (SD) CCT measurements were 531.08 +/- 33.37) and 531.29 +/- 33.33 micrometers in the right and left eyes respectively and were not significantly different from each other. There was no statistically significant correlation between CCT and IOP (r = 0.158, p = 0.12). We did not find a significant association between CCT and other independent variables like age, sex, presence of co-morbidity i.e. Diabetes Mellitus (DM), Hypertension (HTN), Ischaemic Heart Disease (IHD), myopia, hypermetropia, systemic and eye medication use. CONCLUSIONS: The average CCT values obtained in the hospital-based study closely match those of the African Americans. A population-based study would be needed to provide unbiased CCT estimate in Pakistani population.

• Gender differences and delay in presentation of childhood squint.

  Authors: Tanveer A Chaudhry, Aziz Khan, Muhammad Bilal Salman Khan, Khabir Ahmad

  JPMA. The Journal of the Pakistan Medical Association. 04/2009; 59(4):229-31.

  OBJECTIVE: To assess gender differences and delay in presentation of childhood squint in a tertiary care hospital. METHODS: It was a series of children presenting with squint at the Aga KhanOBJECTIVE: To assess gender differences and delay in presentation of childhood squint in a tertiary care hospital. METHODS: It was a series of children presenting with squint at the Aga Khan University Hospital, Karachi, Pakistan. We retrospectively studied the cases presenting between February 2000 and July 2007. RESULTS: Atotal of 107 children with squint were seen. Of these, 55 (52.4%) were girls. A statistically significant difference was observed between the mean age at presentation (+/- SD) of boys and girls (3 years and 5 months vs 4 years and 5 months p: < 0.05). Girls had a greater mean (SD) and median (range) delay in squint presentation than had boys (2 year 4 months +/- 3 years vs 3 years +/- 2 year 8 months) and 2 year 3 months (1 month to 12 years) vs 1 year 3 months (1 month to 14 years), respectively. Overall amblyopia was present in 25.3% (23/91) children. Girls also had a higher burden of amblyopia compared with their male counterparts though the difference was not statistically significant (P = 0.09). CONCLUSION: There was a significant gender difference in age at presentation of childhood squint in our study. Further research is recommended to explore the reasons for this.

• Retinopathy of prematurity: frequency and risk factors in a tertiary care hospital in Karachi, Pakistan.

  Authors: Ather M Taqui, Reema Syed, Tanveer A Chaudhry, Khabir Ahmad, Muhammad S Salat

  JPMA. The Journal of the Pakistan Medical Association. 04/2008; 58(4):186-90.

  To determine the frequency of Retinopathy of Prematurity (ROP) in the premature infants born in a tertiary care hospital and to determine the risk factors associated with it. This was a retrospectiveTo determine the frequency of Retinopathy of Prematurity (ROP) in the premature infants born in a tertiary care hospital and to determine the risk factors associated with it. This was a retrospective analysis of premature infants with birth weight < or = 1500 grams or gestational ago < or = 32 weeks, admitted to the Neonatal Intensive Care Unit of a tertiary care hospital in a three year period. The infants underwent eye examinations between their 4th and 7th week of life. Univariate and multiple logistic regression analysis were performed to determine the association between risk factors and ROP development. Sixty eight infants were included in the analysis. Out of these, 22 (32.4%) developed ROP (inclusive of all stages) and 14 (20.6%) developed threshold disease. Multiple logistic regression analysis revealed that low gestational age, sepsis and respiratory distress syndrome were independent predictors for the development of ROP. The frequency of ROP in our hospital was on the higher side of the range reported in neighbouring developing countries. Low gestational age, sepsis and respiratory distress syndrome were independent predictors of ROP development. Our results suggest that ROP is an important emerging cause of preventable childhood blindness in urban areas of Pakistan like Karachi.

• Prevalence of vitamin A deficiency in socioeconomically disadvantaged localities in Quetta, Pakistan.

  Authors: Zulfiqar Ali Shah, Mohammed Babar Qureshi, Muhammad Aman Khan, Tanveer Anjum Chaudhry, Khabir Ahmad, Mohammad Daud Khan

  Tropical doctor. 11/2007; 37(4):210-1.

• Pattern of health care utilization and determinants of care-seeking from GPs in two districts of Pakistan.

  Authors: Naveed Z Janjua, Mohammad I Khan, Hussain R Usman, Iqbal Azam, Moazzam Khalil, Khabir Ahmad

  The Southeast Asian journal of tropical medicine and public health. 11/2006; 37(6):1242-53.

  The aims of the study were to describe the pattern of health care utilization and out-of-pocket expenses incurred in seeking health care, and to identify the determinants of care-seeking from privateThe aims of the study were to describe the pattern of health care utilization and out-of-pocket expenses incurred in seeking health care, and to identify the determinants of care-seeking from private general practitioners (GP) in two districts of Pakistan. During July-September 2001, we conducted a cross-sectional study in two districts in the Sindh Province of Pakistan. We selected 1,150 participants age > or = 3 months through a two-stage cluster sampling technique. Information was collected about contacts with healthcare providers during the past three months, presenting complaints, type of treatment received, and cost of the latest visit. Of 1,150 participants, 967 (84%) had at least one contact with health care providers during past three months. The mean number of contacts was 1.7. Most of the contacts (66.8%) were with private GPs. The average cost per visit was Pak Rs 106 (US dollar 1.7) and Rs 38 (US dollar 0.6) for GPs and public sector providers, respectively. A multiple logistic regression model revealed those living in urban areas, with monthly household income > Rs 2,500 (US dollar 39.7), an education level > 5 years, and who received both injections and oral drugs were more likely to visit private general practitioners.

• Population beliefs about the efficacy of injections in Pakistan's Sindh province.

  Authors: Naveed Z Janjua, Yvan J Hutin, Saeed Akhtar, Khabir Ahmad

  Public health. 10/2006; 120(9):824-33.

  OBJECTIVE: Reused syringes have been identified as a major risk factor for hepatitis B and C in Pakistan, a country facing a growing epidemic of these infections. We conducted this study to identifyOBJECTIVE: Reused syringes have been identified as a major risk factor for hepatitis B and C in Pakistan, a country facing a growing epidemic of these infections. We conducted this study to identify factors associated with receiving at least one injection during the past 3 months in an urban and a rural area in the Sindh province of Pakistan. METHODS: A population-based cross-sectional study of individuals aged 3 months was conducted in 34 clusters in an urban and a rural setting. Information was obtained on the number of contacts with healthcare providers and the number of injections received during the past 3 months. Beliefs about the efficacy of injections were also tested. Multivariable logistic regression analysis was performed to identify factors associated with receiving at least one injection during the past 3 months. RESULTS: Of 1150 subjects who participated in the study, 848 (74%) reported having received at least one injection during the past 3 months. Seventy-one percent (815/1150) believed that injections act faster than oral drugs and relieve symptoms quickly. There was a lack of risk perception among the participants: 19% (222/1150) believed that injections involve less risk than do oral drugs. Multivariable logistic regression analysis revealed that individuals who had visited unqualified practitioners (adjusted OR=6.1; 95% CI: 2.6-14.1) or general practitioners (adjusted OR=3.4; 95% CI: 1.9-6.0) were more likely to have received an injection. Belief that 'injections act faster and relieve symptoms quickly' had a multiplicative interaction with the area of dwelling: people in rural areas who held this belief were more likely to receive injections than people who did not hold this belief and were living in urban areas. CONCLUSIONS: In Pakistan, people's lack of awareness of risks associated with injections and their strong belief in the fast action of injections are driving injection overuse. These factors are supplemented by general practitioners' and unqualified providers' inclinations to prescribe more injections. Efforts must be made to include the unqualified practitioners in any interventions aimed to reduce injection overuse in Pakistan.

• Glaucoma admissions and surgery in public sector tertiary care hospitals in pakistan: results of a national study.

  Authors: Mohammad Babar Qureshi, Mohammad Daud Khan, Mahnaz Naveed Shah, Khabir Ahmad

  Ophthalmic epidemiology. 05/2006; 13(2):115-9.

  PURPOSE: To assess the annual number of glaucoma operations and admissions in the public sector tertiary care hospitals in Pakistan. METHODS: Eye departments in all 18 public tertiary care centers inPURPOSE: To assess the annual number of glaucoma operations and admissions in the public sector tertiary care hospitals in Pakistan. METHODS: Eye departments in all 18 public tertiary care centers in the country were requested to provide data on the number of glaucoma operations and admissions during 1998. Of these, 13 hospitals agreed to participate. Eye departments' log books or patients' records were used to collect data retrospectively on the total number of eye admissions, the total number of glaucoma admissions, the type of glaucoma, and the total number and type of glaucoma operations. RESULTS: Glaucoma accounted for 8.1% (1,942/23,931) of all eye admissions. Open-angle glaucoma was responsible for 37.6% or 731 glaucoma admissions followed by secondary glaucoma (35.0%) and angle-closure glaucoma (18.2%). During 1998, 1,407 glaucoma-related operations were performed in the selected hospitals. The mean (+/-SD) and the median number of operations performed were 108.2 (+/-59.6) and 112 (range: 17-206), respectively. Trabeculectomies accounted for 1,043 (74.1 %) of all procedures. Their number ranged from 16 to 170 (median: 84) in the selected hospitals. CONCLUSIONS: We believe that the annual number of glaucoma operations performed in the public tertiary care hospitals in Pakistan is far less than required. In-depth research is therefore needed to explain if this is because of gaps in service provision or a genuine shift to medical management of glaucoma on an outpatient basis.

• Perceptions of eye health in schools in Pakistan.

  Authors: Khabir Ahmad, Mohammad Aman Khan, Mohammad Daud Khan, Mohammad Babar Qureshi, Tanveer Anjum Chaudhry, Clare Gilbert

  BMC ophthalmology. 02/2006; 6:8.

  BACKGROUND: Research exploring children's and their teachers' perceptions of eye health is lacking. This paper reports for the first time on perceptions of primary schoolchildren and their teachersBACKGROUND: Research exploring children's and their teachers' perceptions of eye health is lacking. This paper reports for the first time on perceptions of primary schoolchildren and their teachers of healthy and diseased eyes, things that keep eyes healthy and damage them, and what actions to be taken in case of an eye injury. METHODS: Using draw and write technique, 160 boys and girls (9-12 years old) attending four primary schools in Abbottabad district, northern Pakistan, were invited to draw pictures in response to a set of semi-structured questions and then label them. Sixteen teachers who were currently teaching the selected students were interviewed one-on-one. RESULTS: Analysis of text accompanying 800 drawings and of the interview scripts revealed that most children and teachers perceived healthy eyes to be those which could see well, and diseased eyes to be those which have redness, watering, dirty discharge, pain, and itching; or those which have "weak eyesight" and blindness. Among things that students and teachers thought damage the eyes included sun, television, and sharp pointed objects, particularly pencils. Teachers noted that children with eye problems "have difficulty seeing the blackboard well", "screw up their eyes", and "hold their books too close". CONCLUSION: We conclude that schoolchildren and their teachers had a good knowledge of eye health, but many of them had serious misconceptions e.g., use of kohl, medicines and eye drops keeps eyes healthy. Kohl is an important source of lead and can reduce children's intelligence even at low blood levels. Health education in schools must take into account children's existing knowledge of and misconceptions about various aspects of eye health. Such steps if taken could improve the relevance of eye health education to schoolchildren.

• Perceptions of eye health in schools in Pakistan

  Authors: Khabir Ahmad, Mohammad Khan, Mohammad Qureshi, Tanveer Chaudhry, Clare Gilbert

  BMC Ophthalmology. 01/2006;

  Abstract Background Research exploring children's and their teachers' perceptions of eye health is lacking. This paper reports for the first time on perceptions of primary schoolchildren and theirAbstract Background Research exploring children's and their teachers' perceptions of eye health is lacking. This paper reports for the first time on perceptions of primary schoolchildren and their teachers of healthy and diseased eyes, things that keep eyes healthy and damage them, and what actions to be taken in case of an eye injury. Methods Using draw and write technique , 160 boys and girls (9–12 years old) attending four primary schools in Abbottabad district, northern Pakistan, were invited to draw pictures in response to a set of semi-structured questions and then label them. Sixteen teachers who were currently teaching the selected students were interviewed one-on-one. Results Analysis of text accompanying 800 drawings and of the interview scripts revealed that most children and teachers perceived healthy eyes to be those which could see well, and diseased eyes to be those which have redness, watering, dirty discharge, pain, and itching; or those which have "weak eyesight" and blindness. Among things that students and teachers thought damage the eyes included sun, television, and sharp pointed objects, particularly pencils. Teachers noted that children with eye problems "have difficulty seeing the blackboard well", "screw up their eyes", and "hold their books too close". Conclusion We conclude that schoolchildren and their teachers had a good knowledge of eye health, but many of them had serious misconceptions e.g., use of kohl, medicines and eye drops keeps eyes healthy. Kohl is an important source of lead and can reduce children's intelligence even at low blood levels. Health education in schools must take into account children's existing knowledge of and misconceptions about various aspects of eye health. Such steps if taken could improve the relevance of eye health education to schoolchildren.

• Prevalence and determinants of blood pressure screening in Pakistan.

  Authors: Khabir Ahmad, Tazeen H Jafar

  Journal of hypertension. 11/2005; 23(11):1979-84.

  OBJECTIVE: We analysed data collected during a nationwide cross-sectional household survey to estimate the prevalence of, and to identify factors associated with, blood pressure screening inOBJECTIVE: We analysed data collected during a nationwide cross-sectional household survey to estimate the prevalence of, and to identify factors associated with, blood pressure screening in Pakistan. DESIGN: A population-based cross-sectional survey (National Health Survey of Pakistan 1990-1994). METHODS: During 1990-1994, 18 135 people aged at least 6 months were surveyed across Pakistan. We restricted this analysis to individuals aged 18 years or older (n = 9442). Our primary outcome measure was self-reported blood pressure screening, which was assessed using the question: 'Have you ever had your blood pressure taken?' Individuals answering affirmatively or otherwise to this question were categorized as screened or unscreened for high blood pressure. Logistic regression analysis was performed to identify the factors independently associated with the primary outcome. RESULTS: Overall, 35.6% [95% confidence interval (CI), 33.9-37.3%] of participants - 41.3% (95% CI, 39.9-42.7%) women versus 29.0% (95% CI, 27.6-30.4%) men - reported ever having had their blood pressure checked. The independent determinants of blood pressure screening identified in the multivariate logistic regression analysis [adjusted odds ratio (95% CI)] included age [26-35 years, 1.58 (1.37-1.81); 36-50 years, 2.18 (1.89-2.51); > 50 years, 2.29 (1.96-2.66)], female sex [2.25 (2.02-2.50)], socio-economic status [lower, 0.54 (0.47-0.63) and middle, 0.70 (0.61-0.80) versus high], province of residence [Punjab, 0.45 (0.39-0.51); Sindh, 0.80 (0.68-0.93); Balochistan, 0.47 (0.39-0.57) versus North West Frontier Province], rural dwelling [0.42 (0.38-0.47)] versus urban dwelling, and educational attainment [less than matriculation, 1.47 (1.27-1.69); matriculation, 1.69 (1.41-2.04); graduation and above, 2.50 (1.81-3.44) versus no education]. CONCLUSIONS: The rates of blood pressure screening in Pakistan are worryingly low, calling for the establishment of a nationwide programme to improve detection, awareness and treatment of hypertension.

• Prevalence and predictors of smoking in Pakistan: results of the National Health Survey of Pakistan.

  Authors: Khabir Ahmad, Fahim Jafary, Imtiaz Jehan, Juanita Hatcher, Abdul Qayum Khan, Nish Chaturvedi, Tazeen H Jafar

  European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology. 07/2005; 12(3):203-8.

  OBJECTIVE: We analysed data collected during a nationwide cross-sectional household survey to estimate the prevalence of and identify factors associated with smoking in Pakistan. DESIGN:OBJECTIVE: We analysed data collected during a nationwide cross-sectional household survey to estimate the prevalence of and identify factors associated with smoking in Pakistan. DESIGN: Population-based, cross-sectional survey [National Health Survey of Pakistan (NHSP) 1990-1994]. METHODS: A population-based survey was carried out in Pakistan during 1990-1994. A nationally representative sample of 18,135 individuals aged 6 months and older was surveyed. We restricted this analysis to individuals aged 15 years or older (n=9442). The main outcome measure was self-reported smoking. Smokers were defined as individuals who reported current smoking and having smoked at least 100 cigarettes or 'beddies' during their lifetime. RESULTS: Overall prevalence of smoking was 15.2% [95% confidence interval (CI), 14.5-15.9%]. It was 28.6% (27.3-29.9%) among men and 3.4% (2.9-3.9%) among women. The highest prevalence was reported in men aged 40-49 years (40.9%). The independent predictors of smoking identified in the multivariate logistic regression analysis included age, male gender, ethnicity and illiteracy. CONCLUSIONS: One out of every two to three middle-aged men in Pakistan smoke cigarettes. Our findings suggest that ethnically sensitive smoking control programmes that include measures for improving literacy rates are needed in Pakistan.

• Self-rated health in Pakistan: results of a national health survey.

  Authors: Khabir Ahmad, Tazeen H Jafar, Nish Chaturvedi

  BMC public health. 05/2005; 5(1):51.

  BACKGROUND: Self-rated health (SRH) is a robust predictor of mortality. In UK, migrants of South Asian descent, compared to native Caucasian populations, have substantially poorer SRH. Despite itsBACKGROUND: Self-rated health (SRH) is a robust predictor of mortality. In UK, migrants of South Asian descent, compared to native Caucasian populations, have substantially poorer SRH. Despite its validation among migrant South Asian populations and its popularity in developed countries as a useful public health tool, the SRH scale has not been used at a population level in countries in South Asia. We determined the prevalence of and risk factors for poor/fair SRH among individuals aged > or =15 years in Pakistan (n = 9442). METHODS: The National Health Survey of Pakistan was a cross-sectional population-based survey, conducted between 1990 and 1994, of 18,135 individuals aged 6 months and above; 9442 of them were aged > or =15 years. Our main outcome was SRH which was assessed using the question: "Would you say your health in general is excellent, very good, good, fair, or poor?" SRH was dichotomized into poor/fair, and good (excellent, very good, or good). RESULTS: Overall 65.1% respondents -- 51.3 % men vs. 77.2 % women -- rated their health as poor/fair. We found a significant interaction between sex and age (p < 0.0001). The interaction was due to the gender differences only in the ages 15-19 years, whereas poor/fair SRH at all older ages was more prevalent among women and increased at the same rate as it did among men. We also found province of dwelling, low or middle SES, literacy, rural dwelling and current tobacco use to be independently associated with poor/fair SRH. CONCLUSION: This is the first study reporting on poor/fair SRH at a population-level in a South Asian country. The prevalence of poor/fair health in Pakistan, especially amongst women, is one of the worst ever reported, warranting immediate attention. Further research is needed to explain why women in Pakistan have, at all ages, poorer SRH than men.

• Prevalence and causes of blindness and low vision in a rural setting in Pakistan.

  Authors: Khabir Ahmad, Mohammad Daud Khan, Mohammad Babar Qureshi, Shahnawaz Munami, Raza Ali Shah, Haroon Rasheed, Barkat Jamali, Aziz Baluch, Mohammad Aman Khan

  Ophthalmic epidemiology. 02/2005; 12(1):19-23.

  PURPOSE: To determine the prevalence and causes of blindness and visual impairment in people 40 years of age and older in Budni, Peshawar, Pakistan. METHODS: A population-based cross-sectional studyPURPOSE: To determine the prevalence and causes of blindness and visual impairment in people 40 years of age and older in Budni, Peshawar, Pakistan. METHODS: A population-based cross-sectional study was carried out involving 1,106 men and women 40 years of age and older in a rural area in Pakistan's North West Frontier Province (NWFP). All subjects with a presenting visual acuity < 6/18 in either eye were referred to a centralized clinic for a standardized eye examination that included refraction and dilated fundal examination. The main outcome was blindness (presenting visual acuity < 3/60 in the better eye) and low vision (presenting VA < 6/18-3/60 in the better eye). RESULTS: Of 1,106 people examined, 21 (1.9%; 95% CI: 1.1-2.7%) were blind, while another 27 (2.4%) and 62 (5.5%) subjects had severe visual impairment (< 6/60-3/60) and visual impairment (< 6/18-6/60), respectively. Women, as compared to men, had a higher prevalence of visual impairment and severe visual impairment; but they had a lower prevalence of blindness (1.6 vs. 2.2%); however, the difference was not statistically significant (0.6%; 95% CI: -0.9-2.1%). Similarly farmers had the highest prevalence of blindness. The leading cause of blindness and low vision was cataract, which accounted for 14 of 21 (66.6%) cases of blindness and 49 of 89 (55.5%) cases of low vision. The second leading cause of blindness was uncorrected aphakia. CONCLUSION: Much of the blindness was due to unoperated cataract and uncorrected aphakia. Thus, there is an urgent need to develop ways in which cataract surgical output could be increased, and glasses provided to those who need them.

• Blinding trachoma: a disease of poverty.

  Authors: Pashtoon M Kasi, Ahmed I Gilani, Khabir Ahmad, Naveed Z Janjua

  PLoS medicine. 12/2004; 1(2):e44.