J Ayub Med Coll Abbottabad 2003;15(1)

ARE OUR PEOPLE HEALTH CONSCIOUS? RESULTS OF A PATIENTS SURVEY IN KARACHI, PAKISTAN

Waris Qidwai, Danish Saleheen, Sadia Saleem, Marie Andrades, Syed Iqbal Azam

Community Health Sciences, Family Medicine Division,  The Aga Khan University, Karachi, Pakistan

Background: Life style is known to influence health and may be responsible for certain diseases. There is a need to document the life style on health among the Pakistani population. Methods: The study was conducted on patients visiting the Family Practice Center, the Aga Khan University, Karachi. A questionnaire was used to collect information on the demographic profile, and the life style on health. The ethical requirements for conducting the study were met. Results: 393 patients were surveyed. The majority were young married men, in either private or government service. Preference for consumption of fats/oils, sweets, spicy foods, salt, fruits/ vegetables, tea, coffee, cola drinks and alcohol was found among 103 (26%), 84 (22%), 86 (22%), 110 (28%), 239 (61%), 319 (81%), 117 (30%), 253 (64%) and 13 (03%) respondents respectively. Hand washing after defecation, before eating food and after work was seen among 341 (87%), 296 (75%) and 256 (65%) respondents respectively. Brushing of teeth after eating food, before breakfast and bedtime was seen in 56 (14%), 346 (88%) and 176 (45%) respondents respectively. Preventive dental check-up was practiced by 102 (26%) of the respondents. Sleep of less than 6 hours per day among 74 (19%), water consumption of less than 1 liter daily among 84 (21%) and fish consumption on once a week basis among 173 (44%) respondents was found. Tobacco and betel nuts use was found among 69 (17%) and 79 (20%) respondents. Conclusions: We have documented a clear need to raise public awareness on the issue of life style on health. There is a need and we strongly recommend debate and further research, along with interventional strategies in line with the available evidence on healthy life style.

Key-words: Health behavior, Life style, Physical fitness, Diet

INTRODUCTION

‘Health’ is defined as a state of the organism when it functions optimally without evidence of disease or abnormality¹. Habits and customs influenced by the lifelong process of socialization, including social use of alcohol and tobacco, dietary habits, and exercise, all of which have important implications for health, are considered part of the life-style².

An unhealthy life style has been blamed for a considerable morbidity and mortality in Pakistan. A higher prevalence of insulin-dependent diabetes mellitus and heart disease has been reported in Pakistan^3,4, and an unhealthy life style may be partly responsible⁵. Tobacco chewing has been implicated as a cause, for a higher incidence of head and neck cancers in Pakistan⁶.

Therefore, a need was identified to study the life style on health among our patients.

MATERIAL AND METHODS

A questionnaire-based cross sectional survey was carried out at the Family Practice Center, the Aga Khan University hospital in Karachi, Pakistan, from March to July 2002. It is a tertiary level teaching facility, in the private sector manned by ten family physicians. On an average, 24 patients consult each family physician daily.

A questionnaire was developed in keeping with the study objectives and included the demographic profile of the respondents.

Questions were directed at finding the preference for consumption of various food items, hand washing practices, brushing of teeth, preventive dental check-up, sleep in 24 hours, consumption of water, consumption of fish and the status of tobacco and betel nut chewing.

A process of convenience sampling was used, whereby available patients in the waiting area, were requested to participate in the study. The investigators administered the questionnaires, and the interviews were conducted all along the study period.

The objectives of the study were explained to the patient who signed the consent form, after assurance of confidentiality was provided.

Since we used a convenience sample, a sample size was not determined. EPI-info and SPSS computer software were used for analysis of the results.

RESULTS

A total of 393 patients were surveyed. The majority were young married men, in either private or government service (Table-I). Respondents’ preference for consumption or otherwise, of fats and oils, sweets, spicy foods, salt, fruits and vegetables, tea, coffee, cola drinks and alcohol are listed (Table-2).

Table-1: Demographic Profile of the Study Population (n=393)

Table-2: Respondents’ attitude towards consumption of food and drink items (n=393)

Respondents’ practices with regard to hand washing, brushing of teeth, preventive dental check-up, duration of sleep, water consumption and eating of fish are listed (Table-3) Respondent’s status with regard to chewing of tobacco and betel nuts is listed (Table-4).

DISCUSSION

The demographic profile of the study population shows, that the majority of the respondents were well educated and better placed socio-economically, then the rest of the population in general. This is a limitation in the study since the more affluent and better educated people use the facility.

Table-3: Respondent’s status of healthy practices (n=393 )

Table–4: Respondent’s status of chewing tobacco and betel nuts (n=393)

According to the American Academy of Family Physicians, a diet high in fat and cholesterol can contribute to heart disease⁷. It is indeed a matter of grave concern, that a high proportion of the respondents (26%) have shown their preference for fats and oils in their diet, while a small proportion (16%) has expressed their intention of avoiding them.

The association between consumption of sweets and diseases including dental caries is well known⁸. It is again a matter of concern that 22% of the respondents have expressed a preference for sweets in their diets, while just 18% avoid them.

The association between high blood pressure and salt intake is well known⁹. It is again a matter of grave concern that only 7% of the respondents have said that they avoid salt in their diet while 28% expressed their preference for it.

The role of fruits and vegetables in the prevention of cancers^10,11 and heart disease¹² are well known. It is encouraging to see that 61% respondents have shown a preference for fruits and vegetables in their diet in comparison to 16% who haven’t.

The role of tea consumption in the prevention of cancer and rheumatoid arthritis has being quoted in literature^13-15, while there are concerns about the possible adverse effects¹⁶. An overwhelming majority among the respondents (81%), have expressed their preference for tea drinking.

Caffeine consumption could contribute to an increased risk of coronary heart disease¹⁷, while it could have a preventive role in the risk of development of Parkinson’s disease¹⁸. A preference of coffee and cola drinks among 30% and 64% of the respondents respectively, speaks for an overwhelming trend in favor of their consumption.

Alcohol consumption is considered part of an unhealthy lifestyle¹⁹, but fortunately preference for its consumption was minimal among the respondents.

Hand washing is considered an essential component of a healthy life style²⁰. It is a matter of grave concern that 13% of the respondents are not washing hands after defecation.

Dental care including brushing of teeth and preventive dental check-ups are considered part of a healthy life style¹⁹. The status of dental care among the respondents needs improvement.

A significant number of respondents (19%) are getting less then six hours of sleep daily, which is a cause for concern and further enquiry²¹.

A decreased fluid intake and consequent urine concentration are among the most important factors influencing stone formation²². The climate of Karachi is warm and it is a cause for concern that 21% of the respondent’s intake of water is less than a liter a day.

Consumption of fish and fish oils has been shown to have a favorable influence on the lipid metabolism^23-25. We have found that still 10% respondents do not consume fish.

Tobacco chewing is common in South Asia²⁶, and has been implicated in the causation of head and neck cancers⁶ and sub-mucous fibrosis²⁷. We have found a high prevalence of tobacco chewing (17%) in our study sample, and interventional strategies are required.

Areca nut (Betel nut) has been chewed since ancient times, but the habit is discouraged because of its oncogenic, addictive and dysaesthetic properties, in addition to having adverse effects on the mucosa, gums and teeth²⁸. The fact that we have found a high prevalence of betel nut chewing (20%) among the respondents in our study, points towards a need for preventive strategies in this area.

Interventions have been found to be successful for life style modification in the general population¹⁹. Over two decades back, changes in life styles were reported to have lead to a decline in mortality from cardiovascular diseases in the developed world²⁹. Substantial evidence is available in favor of life style interventions leading to a better health outcome³⁰.

CONCLUSION

We have documented the life style on health among patients in Karachi, Pakistan.

A need is established for interventional strategy in order to promote healthy life style among our patients.

Further debate and research on the issue is strongly recommended.

REFERENCES

1.        Stedman’s concise medical and allied health dictionary. Illustrated third edition. Baltimore: Williams & Wilkins; 1997. Health; p. 382-83

2.        Stedman’s concise medical and allied health dictionary. Illustrated third edition. Baltimore: Williams & Wilkins;1997. Life-style; p. 491

3.        Rankin J, Bhopal R. Understanding of heart disease and diabetes in a South Asian community: cross-sectional study testing the’snowball’ sample method. Public health 2001; 115:253-60:

4.        Abate N, Chandalia M. Ethnicity and type 2 diabetes: focus on Asian Indians. J Diabetes Complications 2001;15:320-7

5.        Hakeem R, Thomas J, Badruddin SH. Urbanization and coronary heart disease risk factors in South Asian children. J Pak Med Assoc 2001; 51:22-8

6.        Bhurgri Y, Bhurgri A, Hassan SH, Zaidi SH, Rahim A, Sankaranarayanan R, Parkin DM. Cancer incidence in Karachi, Pakistan: first result from Karachi Cancer Registry. Int J Cancer 2000; 85:325-9

7.        American Academy of Family Physicians and American Heart Association. Diet and exercise: Healthy balance for a healthy heart. 1997 [Cited 2003, Jan 10] Available from http://www.aafp.org/acf/cvho/balance.html

8.        Gabris K, Nyarasdy I, Banoczy J. Significance of assessing risk factors for caries in their prevention. Orv Hetil 2002; 16:1467-73

9.        Vesely J. Determination of blood pressure sensitivity to salt. Unitv Lek 2002; 48:241-7

10.     Broadhurst CL, Polansky MM, Anderson RA. Insulin-like biological activity of culinary and medicinal plant aqueous extracts in vitro. J Agric Food Chem. 2000;48:849-52.

11.     Deneo-Pellegrinitt, Boffetta P, De Stefani E, Ronco A, Brennan P, Mendilaharsu M. Plant foods and differences between colon and rectal cancers. Eur J Cancer Prev.2002; 11:369-75

12.     Lindenaver P, Rastegar DA, Von Goeler D. Fruit and vegetable intake and coronary heart disease. Ann Intern Med. 2002; 16: 144

13.     Woolcott CG, King WD, Marrett LD. Coffee and tea consumption and cancers of the bladder, colon and rectum. Eur J Cancer Prev 2002; 11:137-45

14.     Ke L, Yu P, Zhang ZX, Huang SS, Huang G, Ma XH. Congou tea drinking and esophageal cancer in South China. Br J Cancer 2002; 1:346-7

15.     Mikuls TR, Cerhan JR, Criswell LA, Merlino L, Mudano AS, Burma M, Folsom AR, Saag KG. Coffee, tea, and caffeine consumption and risk of rheumatoid arthritis: results from the Iowa Women’s Health study. Arthritis Rheum 2002; 46:83-91

16.     Temme EH, Van Hoydonck PG. Tea consumption and iron status. Eur J Clin Nutr 2002; 56:379-86

17.     Lane JD, Pieper CF, Phillips-Bute BG, Bryant JE, Kuhn CM. Caffeine affects cardiovascular and neuroendocrine activation at work and home. Psychosom Med 2002; 64:595-603

18.     Ascherio A, Zhang SM, Hernan MA, Kawachi I, Colditz GA, Speizer FE, Willett WC. Prospective study of caffeine consumption and risk of Parkinson’s disease in men and women. Ann Neurol 2001; 50:56-63

19.     Kunitsuka K, Yamatsu K, Adachi Y. A correspondence behavioral approach for 6 lifestyle’s improvements in a workplace. Nippon Koshu Eisei Zasshi 2002; 49:525-34

20.     Little K. Hand-washing key to food safety. Nurs Times 2001; 6:53

21.     Vijay Rajput and steven M Bromley. Chronic Insomnia: A practical Review.  Am Fam Physician. 1999; 60: 1431-38

22.     Andrew J. Portis and Chandru P Sundaran. Diagnosis and initial management of  kidney stones. Am Fam Physician. 2001; 63: 1329-38

23.     McKenney JM. New cholesterol guidelines, new treatment challenges. Pharmacotherapy 2002; 22:853-63

24.     Watts GF, Barrett PH. High-density lipoprotein metabolism in familial hypercholesterolaemia: significance, mechanisms, therapy. Nutr Metab Cardiovasc Dis 2002; 12:36-41

25.     Chan DC, Watts GF, Barrett PH, Beilin LJ, Redgrave TG, Mori TA. Regulatory effects of HMG CoA reductase inhibitor and fish oils on apolipoprotein B-100 kinetics in insulin-resistant obese male subjects with dyslipidemia. Diabetes 2002; 51:2377-86

26.     Croucher R, Islam S, Jarvis M, Garrett M, Rahman R, Shajahan S, Howells G. Tobacco dependence in a UK Bangladesh female population: a cross-sectional study. Nicotine Tob Res 2002; 4:171-6

27.     Hashibe M, Sankaranarayanan R, Thomas G, Kuruvilla B, Mathew B, Somanathan T, Parkin DM, Zhang ZF. Body mass index, tobacco chewing, alcohol drinking and the risk of oral submucous fibrosis in Kerala, India. Cancer causes control 2002; 13:55-64

28.     Yoganathan P. Betel chewing creeps into the New World. N Z Dent J 2002; 98:40-5

29.     Kannel WB. Meaning of the downward trend in cardiovascular mortality. JAMA 1982; 12;:877-80

30.     Anonymous. Evidence mounts that lifestyle interventions have big payback. Dis Manag Advis 2002; 8:81-

Address for correspondence:

Dr. Waris Qidwai, Associate Professor of Family Medicine, The Aga Khan University, Stadium Road, PO Box 3500, Karachi-74800, Pakistan. Tele: +92 21 4930051 /Ext: 4842, Fax: +92 21 4934294, 4932095, Email: waris@akunet.org