Herekar Arif D, Herekar Akbar A, Ahmad Ali, Uqaili Umer L, Ahmed Bilal, Effendi Jahanzeb, Alvi Syed Z, Steiner Timothy J
J Headache Pain. 2013 Aug 22;14(1):73. doi: 10.1186/1129-2377-14-73.
Large geographical gaps in our knowledge of the prevalence and burden of headache disorders include Pakistan, a country with major problems of poverty, illiteracy and security. We report implementation in this country of standard methods developed by Lifting The Burden (LTB) for population-based burden-of-headache studies.
We surveyed six locations from the four provinces: Lahore and Multan (Punjab), Karachi and Sukkur (Sindh), Abbottabad (Khyber Pakhtunkhwa) and Gwadar (Baluchistan). We randomly selected rural and urban households in each, which were visited by trained non-medical interviewers from the same locations. One randomly selected adult member (18-65 years) of each household was interviewed using LTB's structured questionnaire translated into Urdu, the national language. Validation was performed among patients and accompanying attendants in three (urban and rural) medical facilities. After responding to the questionnaire, these participants were re-interviewed and diagnosed by a neurologist (gold standard).
The survey was completed by 4,223 respondents (1,957 [46.3%] male, 2,266 [53.7%] female, 1,443 [34.2%] urban, 2,780 [65.8%] rural, mean age 34.4 ± 11.0 years). The participation rate was 89.5%. There were 180 participants (46.1% male, 53.9% female, 41.7% urban, 58.3% rural, mean age 39.4 ± 14.2 years) in the validation sample, of whom 147 (81.7%) reported headache in the last year. The questionnaire was 100% sensitive in screening for headache and for headache on ≥15 days/month, and showed good agreement with the gold-standard diagnoses (kappa = 0.77). It was relatively insensitive for TTH. The questionnaire's default diagnosis of probable MOH when medication overuse accompanied headache on ≥15 days/month was not supported by evidence of causation in most cases seen by the neurologist. In public-health terms, precise diagnosis in these cases matters less than reliably detecting the coexistence of these disorders.
In conclusion, the methods developed by LTB were applied successfully in Pakistan, despite problems unique to this country.
在我们对头痛疾病的患病率和负担的认知方面，存在很大的地域差距，其中包括巴基斯坦，该国面临着贫困、文盲和安全等重大问题。我们报告了在该国实施由“减轻负担”（LTB）组织开发的基于人群的头痛负担研究标准方法的情况。
我们从四个省份的六个地点进行了调查：拉合尔和木尔坦（旁遮普省）、卡拉奇和苏库尔（信德省）、阿伯塔巴德（开伯尔-普赫图赫瓦省）和瓜达尔（俾路支省）。我们在每个地点随机选择农村和城市家庭，由来自同一地点的经过培训的非医学访员进行走访。使用翻译成该国国语乌尔都语的LTB结构化问卷，对每个家庭中随机选择的一名成年成员（18 - 65岁）进行访谈。在三个（城市和农村）医疗机构的患者及其陪同人员中进行了验证。在回答问卷后，这些参与者由神经科医生（金标准）进行再次访谈和诊断。
4223名受访者完成了调查（男性1957名[46.3%]，女性2266名[53.7%]，城市居民1443名[34.2%]，农村居民2780名[65.8%]，平均年龄34.4±11.0岁）。参与率为89.5%。验证样本中有180名参与者（男性46.1%，女性53.9%，城市居民41.7%，农村居民58.3%，平均年龄39.4±14.2岁），其中147名（81.7%）报告在过去一年中有头痛症状。该问卷在筛查头痛以及每月≥15天头痛方面的敏感度为100%，并且与金标准诊断显示出良好的一致性（kappa = 0.77）。对于紧张性头痛，该问卷相对不敏感。当药物过度使用且每月≥15天伴有头痛时，问卷默认的可能的药物过量使用性头痛诊断在神经科医生所见的大多数病例中没有因果关系的证据支持。从公共卫生角度来看，在这些病例中进行精确诊断的重要性低于可靠地检测这些疾病的共存情况。
总之，尽管巴基斯坦存在独特的问题，但LTB开发的方法在该国成功得到了应用。
