… Background: Various anthropometric tools employed to assess obesity include body mass index (BMI) and waist to hip ratio (WHR) and waist circumference (WC) among others. An increased prevalence of central obesity in Asians calls for evaluation of WHR, WC and BMI as screening tools for obesity among them so as to give a clue about performance of these screening measures in detection of obesity. Study Design: Cross sectional analytical study. Setting: Allied Teaching Hospital Faisalabad. Study Period: December, 2014 to November, 2015. Methods: 377 patients of essential hypertension screened for obesity, using BMI, WHR and WC as screening tools and analyzed and compared their performance in detecting obesity among study subjects. Taking BMI as gold standard, the sensitivity and specificity of WHR and WC was measured along with their positive and negative predictive values. Study subjects were also categorized according to "BMI trigger points for public health consideration" risk categories suggested by WHO for Asian populations. Results: Among 377 study subjects, 239 (63.39%) were categorized as obese by WHR measurements and 254 (67.33%) individuals were labelled as obese by WC measurements compared to 209 by BMI (p-value 0.00 in both cases). This showed a trend towards abdominal pattern of obesity among study subjects. The difference was significant among male as well as female portions of study population, where out of 249 study subjects of male gender, 145 (58.23%) were categorized as obese according to WHR and 156 (62.65%) were labelled as obese according to WC, compared to 125 overweight or obese by BMI (p-value 0.00). Females showed a similar trend with 98 (76.56%) out of 128 labelled as obese by WC and 94 (73.43%) by WHR compared to 84 (65.62%) by BMI. The difference between WHR and BMI in detecting obesity among females was a less significant compared to males. Out of 377 total subjects, 335 fell into increased, high or very high risk categories according to "BMI trigger points for public health consideration". WC showed a sensitivity of 97.13% and specificity of 69.64% whereas WHR showed a sensitivity of 96.65% and specificity of 77.98% when compared as screening tools with BMI as gold standard. Conclusions: WC performed better as a screening tool for obesity when compared with WHR among hypertensive patients. Higher number of obese patients detected by both WC and WHR than BMI showed tendency towards central obesity among study subjects. This difference underscores the relevance of using WC or WHR as measures of obesity especially among Pakistani population.Article Citation: Ghafoor MU, Mahmood-ur-Rehman, Irshad F. Screening tools for obesity; evaluation of waist hip ratio, waist circumference and BMI among hypertensive patients in a tertiary care hospital. Professional Med J 2016;23 (7):844-857.

Objectives: To assess the knowledge of dengue disease cause, symptoms, prevention and management in Paramedical students of Independent School of Paramedics. Study Design: Descriptive cross sectional study Setting: Independent School of Paramedics Faisalabad. Period: From February till May 2018. Material & Methods: There were total of 140 paramedical students and all 140 paramedical students of Independent School of Paramedics were selected through convenience sampling technique. Data was collected through self-administered structured questionnaire after taking informed consent from all the participants. Questionnaire was adapted from already published studies. Knowledge of dengue was categorized as adequate (>80%), moderate (60-80%) and inadequate (<60%) depending upon the correct response for a particular question by study participants. Results: Knowledge on the transmission, symptoms of dengue and methods to prevent dengue was found to be adequate that is, 130 (92.9%), 113 (80.7%) and 122 (87.1%) respectively. Knowledge on cause of dengue 16 (11.4%), species of mosquito involved in transmission 30 (21.4%), likely time for mosquito to bite 32 (22.9%), dengue is preventable 77 (55%), and where to refer a dengue patient 77 (55%) was found to be inadequate. Moderate knowledge was found for route of transmission of dengue 109 (77.9%), natural habitat of mosquito 105 (75%) and medication for dengue 90 (64.3%). Conclusion: Overall knowledge on dengue symptoms and dengue prevention was found to be better than knowledge on cause of dengue and dengue management. This necessitates the comprehensive dengue educational program especially for dengue cause and dengue management for the paramedics.

Objectives: This study was designed to evaluate the frequency of postpartum depression in new mothers at a tertiary care hospital in Faisalabad and identify the factors associated with the condition. Study Design: Cross-sectional study. Setting: Obstetrics and Gynecology Department of Independent University Hospital, Faisalabad. Period: Over a period of three months from February 2018 to May 2018. Material & Methods: Included 213 subjects selected through nonprobability purposive sampling patients who had given birth in the last six months were included in the study. The Punjabi version of Edinburgh Postnatal Depression Scale was used to assess for depression. Socio-demographic and medical information was collected on a pre-designed proforma. Data was analyzed using SPSS version 23. Chi square test was applied to ascertain association. Results: Out of the total 213 participants, 33.8% (n=72) of the study sample were suffering from postnatal depression. The socio-demographic profile of the depressed patients showed that most of them were uneducated (84.72%), housewives (77.78%) living with extended families (68.06%). The difference in the number of depressed women among extended and nuclear families was found to be statistically significant (p-value of 0.004). The study also showed that women suffering from postpartum depression were less likely to breastfeed their babies (p-value 0.046). Conclusion: Postpartum depression was identified in more than one thirds of the females included in this study. This high number should raise an alarm for all health professionals. Detection through mandatory screening and early intervention can prevent the adverse consequences this disorder carries for the mother and the child.

Objectives: To study the pattern of BMI and associated factors in residents of Hussainabad aged 15 years and above. Study Design: Cross-sectional study. Setting: Hussainabad, Faisalabad. Period: 15th April to 23th August 2017. Material & Methods: A sample of 410 was obtained. Participants were selected by convenience sampling. Data was collected by self-administered questionnaire. Results: Out of total 410 study participants, 250 (61%) were males and 160 (39%) were females. 258 (62.9%) participants were found having BMI in the range of overweight and obesity, 6 (1.4%) participants were underweight and the remaining 146 (36%) participants were having normal BMI range. Amongst 258 overweight/obese people, 83 (20.2%) people were overweight, 112 (27.3%) moderate obese, 30 (7.3%) severe obese and 33 (8.1%) very severe obese. Overall 175 (42.7%) people were suffering from obesity. 249 (60.7%) people were in habit of eating in between meals and 161 (39.3%) were not used to eating in between meals. 95 (23.1%) people eat four times a day and 55 (13.4%) people eat more than four times a day. Likeness and increased frequency of rice and meat [136 (33.2%) and (130 (31.7%)] was more than vegetables and pulses [(91 (22.2%) and (53 (12.9%)] respectively. 157 (38.3%) people were having nocturnal eating habits. 194 (47.3%) admitted of liking the sweets and sweet foods and 170 (41.5%) people admitted of eating more under stressful conditions. 130 (31.7%) participants don’t do any kind of physical activity. Conclusion: This study describes a high frequency of obesity among population of Hussainabad. Numerous health risk practices were identified including unhealthy dietary habits, eating sweet foods, increased meal frequency, snacking behavior and lack of physical activity.

Background: Various anthropometric tools employed to assess obesity includebody mass index (BMI) and waist to hip ratio (WHR) and waist circumference (WC) amongothers. An increased prevalence of central obesity in Asians calls for evaluation of WHR, WC andBMI as screening tools for obesity among them so as to give a clue about performance of thesescreening measures in detection of obesity. Study Design: Cross sectional analytical study.Setting: Allied Teaching Hospital Faisalabad. Study Period: December, 2014 to November,2015. Methods: 377 patients of essential hypertension screened for obesity, using BMI, WHRand WC as screening tools and analyzed and compared their performance in detecting obesityamong study subjects. Taking BMI as gold standard, the sensitivity and specificity of WHR andWC was measured along with their positive and negative predictive values. Study subjects werealso categorized according to “BMI trigger points for public health consideration” risk categoriessuggested by WHO for Asian populations. Results: Among 377 study subjects, 239 (63.39%)were categorized as obese by WHR measurements and 254 (67.33%) individuals were labelledas obese by WC measurements compared to 209 by BMI (p-value 0.00 in both cases). Thisshowed a trend towards abdominal pattern of obesity among study subjects. The differencewas significant among male as well as female portions of study population, where out of 249study subjects of male gender, 145 (58.23%) were categorized as obese according to WHR and156 (62.65%) were labelled as obese according to WC, compared to 125 overweight or obeseby BMI (p-value 0.00). Females showed a similar trend with 98 (76.56%) out of 128 labelledas obese by WC and 94 (73.43%) by WHR compared to 84 (65.62%) by BMI. The differencebetween WHR and BMI in detecting obesity among females was a less significant comparedto males. Out of 377 total subjects, 335 fell into increased, high or very high risk categoriesaccording to “BMI trigger points for public health consideration”. WC showed a sensitivity of97.13% and specificity of 69.64% whereas WHR showed a sensitivity of 96.65% and specificityof 77.98% when compared as screening tools with BMI as gold standard. Conclusions: WCperformed better as a screening tool for obesity when compared with WHR among hypertensivepatients. Higher number of obese patients detected by both WC and WHR than BMI showedtendency towards central obesity among study subjects. This difference underscores therelevance of using WC or WHR as measures of obesity especially among Pakistani population.