Digital Commons Network^™

Burden Of Care As Perceived By Informal Caregivers Of The Patients Receiving Chemotherapy In Tertiary Care Hospital Of Karachi, Pakistan, Asher Ghori, Rubina Barolia, Naghma Rizvi, Ghulam Qadir

School of Nursing & Midwifery

Background: Almost 32.5 million people are diagnosed with cancer annually. The huge number of cancer patients with deteriorating health renders a far greater number of informal caregivers bearing the burden of care in different forms and magnitude. The main purpose of the study was to explore the types of burden perceived by the informal caregivers and the factors associated with the caregiving burden.
Methods: A quantitative descriptive cross-sectional study design was adopted to answer the research questions from April to May 2016. Around 200 informal caregivers were recruited from one of the tertiary hospitals of Karachi, Pakistan. The modified ZBIS …

Burden Of Ileal Perforations Among Surgical Patients Admitted In Tertiary Care Hospitals Of Three Asian Countries: Surveillance Of Enteric Fever In Asia Project (Seap), September 2016-September 2019, Saqib Hamid Qazi, Mohammad Tahir Yousafzai, Irum Fatima Dehraj, Rozina Thobani, Afshan Akhtar, Abdul Momin Kazi, Aneeta Hotwani, Najeeb Rahman, Junaid Mehmood, Farah Naz Qamar

Section of Paediatric Surgery

Background: Typhoid fever is caused by Salmonella enterica subspecies enterica serovar Typhi (S. Typhi) and can lead to systemic illness and complications. We aimed to characterize typhoid-related ileal perforation in the context of the population-based Surveillance of Enteric Fever in Asia Project (SEAP) in Bangladesh, Nepal and Pakistan.
Methods: Between September 2016 and September 2019, all cases of nontraumatic ileal perforation with a clinical diagnosis of typhoid were enrolled from 4 tertiary care hospitals in Karachi, 2 pediatric hospitals in Bangladesh, and 2 hospitals in Nepal. Sociodemographic data were collected from patients or their caregivers, and clinical and outcome data …

Validation Of A Swahili Version Of The 9-Item Patient Health Questionnaire (Phq-9) Among Adults Living With Hiv Compared To A Community Sample From Kilifi, Kenya, Paul Mwangi, Moses K. Nyongesa, Hans M. Koot, Pim Cuijpers, Charles R.J.C. Newton, Abubakar Abdillah

Institute for Human Development

Background: Depression remains under-investigated in people living with HIV in sub-Saharan Africa due to paucity of adequately validated measures. This study aimed to validate an adapted version of the 9-item Pa- tient Health Questionnaire (PHQ-9) among adults living with HIV compared to those from the community in Kilifi, Kenya.

Methods: Analysis of data from 450 adults living with HIV and 337 adults from the community was conducted examining the reliability, factorial structure, measurement invariance and discriminant validity of interviewer- administered PHQ-9, Swahili version.

Results: Internal consistency of the Swahili PHQ-9 was good overall, in adults living with …

Evolving Nurse Leadership Role In 2020, Nasreen Rafiq, Farida Bibi Mughal

School of Nursing & Midwifery

No abstract provided.

Nursing Education Amidst Covid-19: Obstacles And Way Forward, Farida Bibi Mughal, Nasreen Rafiq, Bibi Hajira Irshad Ali

School of Nursing & Midwifery

No abstract provided.

Spatial Heterogeneity Of Enteric Fever In 2 Diverse Communities In Nepal, Dipesh Tamrakar, Krista Vaidya, Alexander T. Yu, Kristen Aiemjo, Shiva Ram Naga, Yanjia Cao, Caryn Bern, Rajeev Shrestha, Biraj M. Karmacharya, Farah Naz Qamar

Department of Paediatrics and Child Health

Background: Typhoid fever is endemic in the urban Kathmandu Valley of Nepal; however, there have been no population-based studies of typhoid outside of this community in the past 3 decades. Whether typhoid immunization should be prioritized in periurban and rural communities has been unclear.
Methods: We performed population-based surveillance for enteric fever in 1 urban catchment (Kathmandu) and 1 periurban and rural catchment (Kavrepalanchok) as part of the Surveillance for Enteric Fever in Asia Project (SEAP). We recruited individuals presenting to outpatient and emergency departments at 2 study hospitals with suspected enteric fever and performed blood cultures. Additionally, we conducted …

Response To Comments On Aisha Sheikh Et Al (J Pak Med Assoc. 70: 1477, 2020) Changing Prevalence Of Gestational Diabetes Mellitus During Pregnancy Over More Than A Decade, Aisha Sheikh, Lumaan Sheikh

Section of Diabetes, Endocrinology and Metabolism

No abstract provided.

Change In The Spectrum Of Orthopedic Trauma: Effects Of Covid-19 Pandemic In A Developing Nation During The Upsurge; A Cross-Sectional Study, Pervaiz Mahmood Hashmi, Marij Zahid, Syed Arif Ali, Hammad Naqi Khan, Anum Sadruddin Pidani, Alizah Pervaiz Hashmi, Shahryar Noordin

Section of Orthopaedic Surgery

Background: The COVID-19 pandemic has caused a great impact on orthopedic surgery with a significant curtailment in elective surgeries which is the major bread and butter for orthopedic surgeons. It was also observed that the spectrum of orthopedic trauma injuries has shifted from more severe and frequent road traffic accidents (high energy trauma) to general, low energy house-hold injuries like low energy fractures in the elderly, pediatric fractures, house-hold sharp cut injuries and nail bed lacerations. The aim of this study is to appraise the effect of the COVID-19 pandemic on orthopedic surgical practice, both inpatient and outpatient facility.
Materials …

Efter Jobbet: En Inledande Diskussion Om Studiet Av Fritid, Leif Stenberg, Anders Ackfeldt

Faculty & Staff Publications

No abstract provided.

Longitudinally Extensive Transverse Myelitis: A Sub-Saharan Conundrum, Antonina Obayo, Sylvia Mbugua, Sayed Karar

Internal Medicine, East Africa

Spinal cord schistosomiasis is a rare, underdiagnosed manifestation of schistosomiasis. We present the case of a 36-year-old male who presented to our institution with a one-week history of low back pain with rapidly progressive lower limb weakness, loss of sensation, and flaccid paraparesis. An MRI of the spine showed a longitudinally extensive transverse myelitis from T6 to L1, with enhancement at the cauda equina region. Further review of the images and serological tests eventually led to diagnosis of spinal schistosomiasis. He was treated with praziquantel and high-dose steroids, with minimal improvement in his symptoms.

Multiomics Characterization Of Preterm Birth In Low- And Middle-Income Countries, Fyezah Jehan, Muhammad Imran Nisar, Muhammad Ilyas, Usma Mehmood, Aneeta Hotwani, Ambreen Nizar, Sajid Muhammad, Waqasuddin Khan, Javairia Khalid, Furqan Kabir

Department of Paediatrics and Child Health

Importance: Worldwide, preterm birth (PTB) is the single largest cause of deaths in the perinatal and neonatal period and is associated with increased morbidity in young children. The cause of PTB is multifactorial, and the development of generalizable biological models may enable early detection and guide therapeutic studies.
Objective: To investigate the ability of transcriptomics and proteomics profiling of plasma and metabolomics analysis of urine to identify early biological measurements associated with PTB.
Design, setting, and participants: This diagnostic/prognostic study analyzed plasma and urine samples collected from May 2014 to June 2017 from pregnant women in 5 biorepository cohorts in …

Antimicrobial Resistance In Typhoidal Salmonella: Surveillance For Enteric Fever In Asia Project, 2016-2019, Farah Naz Qamar, Mohammad Tahir Yousafzai, Irum Fatima Dehraj, Sadia Shakoor, Seema Irfan, Aneeta Hotwani, Muhammad J. Hunzai, Rozina Thobani, Najeeb Rahman, Junaid Mehmood, Ashraf M. Memon

Department of Paediatrics and Child Health

Background: Clinicians have limited therapeutic options for enteric as a result of increasing antimicrobial resistance, and therefore typhoid vaccination is recommended as a preventive measure. As a part of the Surveillance for Enteric Fever in Asia Project (SEAP), we investigated the extent measured the burden of antimicrobial resistance (AMR) among confirmed enteric fever cases in Bangladesh, Nepal, and Pakistan.
Methods: From September 2016-September 2019, SEAP recruited study participants of all age groups from its outpatient, inpatient, hospital laboratory, laboratory network, and surgical sites who had a diagnosis of febrile illness that was either suspected or blood culture confirmed for enteric …

Early Marriage And Early Childbearing In South Asia: Trends, Inequalities, And Drivers From 2005 To 2018, Samuel Scott, Phuong Hong Nguyen, Sumanta Neupane, Priyanjana Pramanik, Priya Nanda, Zulfiqar Ahmed Bhutta, Kaosar Afsana, Purnima Menon

Woman and Child Health

Early marriage (EM) and early childbearing (ECB) have far-reaching consequences. This study describes the prevalence, trends, inequalities, and drivers of EM and ECB in South Asia using eight rounds of Demographic and Health Survey data across 13 years. We report the percentage of ever-married women aged 20-24 years (n = 105,150) married before 18 years (EM) and with a live birth before 20 years (ECB). Relative trends were examined using average annual rate of reduction (AARR). Inequalities were examined by geography, marital household wealth, residence, and education. Sociodemographic drivers of changes for EM were assessed using regression decomposition analyses. We …

Rigorous Hand Hygiene Practices Among Health Care Workers Reduce Hospital-Associated Infections During The Covid-19 Pandemic, Rozina Roshan, Anam Shahil Feroz, Zohra Rafique, Nazleen Virani

Section of Internal Medicine

The experiences of these recent months have left us with as many new questions as they have given us new solutions. The main question that infection prevention and control department is having these days is "Why have hospital-associated infections (HAIs) reduced during COVID-19 pandemic?" What is the one unique strategy that has brought decline in increasing HAIs? Would it be appropriate to say that rigorous hand hygiene practices among health care workers (HCWs) have reduced HAIs in a tertiary care hospital of Pakistan? This commentary is written to understand the effect of rigorous hand hygiene among HCWs on number of …

A Bibliometric Analysis Of The Aga Khan University Research Contribution In Early Child Development, Peter Gatiti, Anil Khamis

Libraries

The research contribution of the Aga Khan University to the Sustainable Development Goals (SDGs) has been explored through a bibliometric analysis. The analysis shows exponential growth of research across the SDGs undertaken by AKU-affiliated researchers. The analysis identified areas of interdisciplinary research, with a significant focus on societal development of interest to AKU, as per its mandate, and reflective of the work of the Aga Khan Development Network (AKDN) of which AKU is an integral part. Building on the bibliometric analysis, this paper focuses on early childhood development and early childhood education with reference to the SDGs. A specific query …

Covid-19 Pandemic: Economic Burden On Patients With Musculoskeletal Injuries In A Tertiary Care Hospital Of Lmic; Retrospective Cross Sectional Study, Pervaiz Hashmi, Shah Fahad, Hammad Naqi Khan, Marij Zahid, Anum Sadruddin Pidani, Shahryar Noordin

Section of Orthopaedic Surgery

Covid-19 has adversely impacted the health care organizations by over burdening with Covid patients and suspending the elective surgeries and clinics. Hospitalization during pandemic may increase health cost of patients for elective and emergency procedure due to extra cost of covid testing and isolation. A single center retrospective study was conducted to quantify losses due to postponement of elective surgeries and extra cost for procurement of PPEs. The secondary objective was to see the effect of Covid -19 on the total costs of inpatient care during Covid era.
Patient and method: We included all the patients admitted in orthopedic section …

Fear Of Covid-19 Among Pregnant Women In Pakistan: A Cross-Sectional Study, Sidrah Nausheen, Shelina Bhamani, Areeba Makhdoom, Lumaan Sheikh

Department of Obstetrics & Gynaecology

Background: The emergence of COVID-19 and its pandemic nature has exacerbated fears worldwide. Pregnant women are considered a vulnerable group during the COVID-19 pandemic because the physiological changes make them more susceptible to infections. Pregnant women are found expressing much of the fear related to their course of pregnancy, the in-utero transmission of the disease, and questions related to infection control in healthcare settings. Hence, the purpose of this paper was to explore the fears faced by pregnant women related to COVID.
Methods: It was a cross-sectional survey among 201 pregnant women attending antenatal clinics of Aga Khan University Hospital. …

Training Needs Assessment Of Health Care Professionals In Reproductive, Maternal And Newborn Health In A Low-Income Setting In Tanzania, Columba Mbekenga, Eunice Pallangyo, Tumbwene Mwansisya, Kahabi Isangula, Loveluck Mwasha, James Orwa, Micheal Mugerwa, Michaela Mantel, Leonard Subi, Secilia Mrema, David Siso, Edna Selestine, Marleen Temmerman, Grace Edwards

School of Nursing & Midwifery, East Africa

Background: Healthcare delivery globally and particularly in low-income setting is challenged by multiple, complex and dynamic problems. The reproductive, maternal and newborn health (RMNH) care is among the most affected areas resulting into high maternal and neonatal mortality and morbidity across the Sub Saharan region and Tanzania in particular. However, under-investment in adequate education and training of health care providers (HCPs) is reported worldwide and contributes to the critical shortages, and lack of adequate knowledge and skills among HCPs. The aim of this study was to assess the training needs among HCPs of RMNH care in selected health facilities …

Epidemiology Of Staphylococcus Aureus Infections In Kenya: Current State, Gaps And Opportunities, Justin Nyasinga, Geoffrey Omuse, John Njenga, Andrew Nyerere, Shima Abdulgader, Mae Newton, Andrew Whitelaw, Gunturu Revathi

Pathology, East Africa

Staphylococcus aureus has maintained its clinical relevance as a major cause of hospital and community acquired infections globally with a high burden of antimicrobial resistance (AMR). Though reported, the burden of infection, antimicrobial resistance and molecular epidemiology of S. aureus are not well defined in Kenya. This descriptive review evaluated reported data on the detection and characterization of S. aureus infections in Kenya. Published data between 2000 and 2020 were evaluated. S. aureus isolation frequencies varied from 1% in blood specimens to 52.6% among skin and soft tissues infections while MRSA rates ranged from 1% to 84.1%. While penicillin resistance …

Long-Term Neurocognitive And Educational Outcomes Of Neonatal Insults In Kilifi, Kenya, Dorcas N. Magai, Hans M. Koot, Paul Mwangi, Esther Chongwo, Charles R. Newton, Amina Abubakar

Institute for Human Development

Background: There is little data on the long-term neurocognitive and educational outcomes among school-aged survivors of neonatal jaundice (NNJ) and hypoxic-ischemic encephalopathy (HIE) in Africa. This study investigates the long-term neurocognitive and educational outcomes and the correlates of these outcomes in school-aged survivors of NNJ or HIE in Kilifi, Kenya.

Methods: We conducted a cross-sectional study on neurocognitive and educational outcomes among school-aged survivors (6–12 years) of NNJ (n = 134) and HIE (n = 107) and compared them to a community comparison group (n = 134). We assessed nonverbal intelligence, planning, working memory, attention, syntax, pragmatics, wordfinding, …

Towards Pragmatic Adaptations: Orthopedic Surgery Amidst The Coronavirus Disease 2019 Pandemic, Maryam Ehtesham, Talal Almas, Muhammad Ali Niaz, Absam Akbar

Medical College Documents

No abstract provided.

“We Have A Lot Of Home Deliveries” A Qualitative Study On The Impact Of Covid-19 On Access To And Utilization Of Reproductive, Maternal, Newborn And Child Health Care Among Refugee Women In Urban Eastleigh, Kenya, Adelaide Lusambili, Michela Martini, Faiza Abdirahman, Abena Asante, Sharon Ochieng, Joseph N. Guni, Rose Maina, Stanley Luchters

Population Health, East Africa

Background: Little is known about how pregnant refugee women, and the frontline health care workers who serve them, are affected by the COVID-19 pandemic in terms of health, and health service access. Women refugees are classified as a vulnerable group with regard to pregnancy outcomes and access to maternal care, and may be disproportionally at risk for COVID-19 infection as they are likely to face unique barriers to information and access to reproductive health services during the pandemic. Few studies identify gaps that could inform potential interventions to improve service uptake for refugee women, particularly in the context of …

Loss To Follow Up Of Pregnant Women With Hiv And Infant Hiv Outcomes In The Prevention Of Maternal To Child Transmission Of Hiv Programme In Two High-Burden Provinces In Papua New Guinea: A Retrospective Clinical Audit, Angela Kelly-Hanku, Claire Elizabeth Nightingale, Minh Duc Pham, Agnes Mek, Primrose Homiehombo, Mary Bagita, Justine Nankinga, Andrew Vallely, Lisa Vallely, Stanley Luchters

Population Health, East Africa

Introduction Despite early adoption of the WHO guidelines to deliver lifelong antiretroviral (ARV) regimen to pregnant women on HIV diagnosis, the HIV prevention of mother to child transmission programme in Papua New Guinea remains suboptimal. An unacceptable number of babies are infected with HIV and mothers not retained in treatment. This study aimed to describe the characteristics of this programme and to investigate the factors associated with programme performance outcomes.

Methods We conducted a retrospective analysis of clinical records of HIV-positive pregnant women at two hospitals providing prevention of mother to child transmission services. All women enrolled in the prevention …

Contraceptive And Reproductive Health Practices Of Unmarried Women Globally, 1999 To 2018: Systematic Review And Meta-Analysis, Meng-Yao Wang, Marleen Temmerman, Wei-Hong Zhang, Yu Fan, Yi Mu, Si-Ping Mo, Ai Zheng, Jin-Ke Li

Obstetrics and Gynaecology, East Africa

Background: Premarital sex practices and contraceptive prevalence rate (CPR) among unmarried women worldwide remain unclear, even though unmarried women tend to have multiple sex partners over time, which makes their sexual behaviors particularly important to the sexual and reproductive health of society more broadly.

Methods: We searched the MEDLINE, PubMed, and Google Scholar databases for relevant articles published between January 1, 1999 and December 31, 2018. Data on prevalence of premarital sexual intercourse, use of highly prevalent contraceptive methods, as well as CPR overall and at first sexual intercourse were extracted and estimated using a DerSimonian- Laird random effects model. …

Gender Difference In Mortality Among Pulmonary Tuberculosis Hiv Co-Infected Adults Aged 15-49 Years In Kenya, Rose J. Kosgei, Steven Callens, Peter Gichangi, Marleen Temmerman, Anne-Beatrice Kihara, Gathara David, Eunice Nyaboe Omesa, Enos Masini, E. Jane Carter

Obstetrics and Gynaecology, East Africa

Setting: Kenya, 2012–2015

Objective: To explore whether there is a gender difference in all-cause mortality among smear positive pulmonary tuberculosis (PTB)/ HIV co-infected patients treated for tuberculosis (TB) between 2012 and 2015 in Kenya.

Design: Retrospective cohort of 9,026 smear-positive patients aged 15–49 years. All-cause mortality during TB treatment was the outcome of interest. Time to start of antiretroviral therapy (ART) initiation was considered as a proxy for CD4 cell count. Those who took long to start of ART were assumed to have high CD4 cell count.

Results: Of the 9,026 observations analysed, 4,567(51%) and 4,459(49%) were women and men, …

Imagining A Lean And Agile Digital Health Ecosystem - A Measure Of Pandemic Responsiveness, Zainab Samad, Sana Mahmood, Sameen Siddiqi, Zulfiqar Ahmed Bhutta

Section of Cardiology

No abstract provided.

A Way To Track Governments’ Response And People’S Mobility Changes In Response To Covid-19 Pandemic, Dongshan Zhu, Shiva Raj Mishra, Salim S. Virani

Office of the Provost

No abstract provided.

A Cluster-Based, Spatial-Sampling Method For Assessing Household Healthcare Utilization Patterns In Resource-Limited Settings, Alexander T. Yu, Rajani Shakya, Bikram Adhikari, Dipesh Tamraka, Krista Vaidya, Stace Maples, Kashmira Date, Isaac I. Bogoch, Farah Naz Qamar, Mohammad Tahir Yousafzai

Department of Paediatrics and Child Health

Background: Implementation of population-based surveys is resource intensive and logistically demanding, especially in areas with rapidly changing demographics and incomplete or no enumeration of the underlying population and their residences. To remove the need for pre-enumeration and to simplify field logistics for the population healthcare utilization survey used for the Surveillance for Enteric Fever in Asia Project in Nepal, we incorporated a geographic information system-based geosurvey and field mapping system into a single-stage cluster sampling approach.
Methods: A survey was administered to ascertain healthcare-seeking behavior in individuals with recent suspected enteric fever. Catchment areas were based on residential addresses of …

Utilization Of Blood Culture In South Asia For The Diagnosis And Treatment Of Febrile Illness, Caitlin Hemlock, Stephen P. Luby, Shampa Saha, Farah Naz Qamar, Jason R. Andrews, Samir K. Saha, Dipesh Tamrakar, Kashmira Date, Ashley T. Longley, Denise O. Garrett, Isaac I. Bogoch

Department of Paediatrics and Child Health

Background: Blood culture is the current standard for diagnosing bacteremic illnesses, yet it is not clear how physicians in many low- and middle-income countries utilize blood culture for diagnostic purposes and to inform treatment decisions.
Methods: We screened suspected enteric fever cases from 6 hospitals in Bangladesh, Nepal, and Pakistan, and enrolled patients if blood culture was prescribed by the treating physician. We used generalized additive regression models to analyze the probability of receiving blood culture by age, and linear regression models to analyze changes by month to the proportion of febrile cases prescribed a blood culture compared with the …

Effect Of A Mobile Phone Intervention For Female Sex Workers On Unintended Pregnancy In Kenya (Whisper Or Shout): A Cluster-Randomised Controlled Trial, Frances H. Ampt, Megan S. C. Lim, Paul A. Agius, Kelly L'Engle, Griffins Manguro, Caroline Gichuki, Peter Gichangi, Walter Jaoko, Marleen Temmerman, Stanley Luchters

Obstetrics and Gynaecology, East Africa

Background: Female sex workers in low-income and middle-income countries face high risks of unintended pregnancy. We developed a 12-month, multifaceted short messaging service intervention (WHISPER) for female sex workers in Kenya who had the potential to become pregnant, to improve their contraceptive knowledge and behaviours. The aim of this study was to assess the effectiveness of the intervention to reduce the incidence of unintended pregnancy among sex workers in Kenya compared with an equal-attention control group receiving nutrition-focused messages (SHOUT).

Methods: Our two-arm, cluster-randomised controlled trial was done in sex-work venues in two subcounties of Mombasa, Kenya (Kisauni and Changamwe). …