Medicine and Health Sciences Commons^™

A Study Protocol: Using Demand-Side Financing To Meet The Birth Spacing Needs Of The Underserved In Punjab Province In Pakistan, Syed Khurram Azmat, Moazzam Ali, Waqas Hameed, Ghulam Mustafa, Ghazanfer Abbas, Muhammad Ishaque, Mohsina Bilgrami, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: High fertility rates, unwanted pregnancies, low modern contraceptive prevalence and a huge unmet need for contraception adversely affect women’s health in Pakistan and this problem is compounded by limited access to reliable information and quality services regarding birth spacing especially in rural and underserved areas. This paper presents a study protocol that describes an evaluation of a demand-side financing (DSF) voucher approach which aims to increase the uptake of modern contraception among women of the lowest two wealth quintiles in Punjab Province, Pakistan.

Methods/Design: This study will use quasi-experimental design with control arm and be implemented in: six government …

Improving Community Case Management Of Diarrhoea And Pneumonia In District Badin, Pakistan Through A Cluster Randomised Study--The Nigraan Trial Protocol, Fauziah Rabbani, Aftab A. Ali Mukhi, Shagufta Perveen, Xaher Gul, Saleem Iqbal Perwaiz, Shamim Ahmed Qazi, Iqbal Azam Syed, Khalid Hussain Shaikh, Wafa Aftab

Community Health Sciences

BACKGROUND:

Diarrhoea and pneumonia contribute 30% of deaths in children under 5 in Pakistan. Pakistan's Lady Health Workers Programme (LHW-P) covers about 60% of the population but has had little impact in reducing morbidity and mortality related to these major childhood killers. An external evaluation of the LHW-P suggests that lack of supportive supervision of LHWs by lady health supervisors (LHSs) is a key determinant of this problem. Project NIGRAAN aims to improve knowledge and skills of LHWs and community caregivers through supervisory strategies employed by LHSs. Ultimately, community casemanagement (CCM) of childhood pneumonia and diarrhoea will improve.

METHODS/DESIGN:

NIGRAAN …

Non Communicable Diseases In Pakistan: Burden, Challenges And Way Forward For Health Care Authorities, Mohammad Wasay, Shehla Zaidi, Maria Khan, Rashid Jooma

Section of Neurology

No abstract provided.

Epidemiology, Determinants And Dynamics Of Cholera In Pakistan: Gaps And Prospects For Future Research., Maliha Naseer, Tanzil Jamali

Community Health Sciences

Cholera is one of the notifiable endemic diseases in Pakistan, but the reporting of cholera cases is still unsatisfactory. Most of the diagnosed cases are never reported to the relevant authorities. In the year 1993 - 2005, the country did not report any single case of cholera to the WHO. The objectives of this review were to understand the epidemiology and to identify the possible determinants of cholera infection in Pakistan. Medscape, Medline, PakMedinet and PubMed, was searched, using key words, epidemiology and determinants of cholera infection in Pakistan during 1995 - 2010. Morbidity and mortality due to cholera infection …

Women's Empowerment And Contraceptive Use: The Role Of Independent Versus Couples' Decision-Making, From A Lower Middle Income Country Perspective, Waqas Hameed, Syed Khurram Azmat, Moazzam Ali, Muhammad Ishaque Sheikh, Ghazunfer Abbas, Marleen Temmerman, Bilal Iqbal Avan

Community Health Sciences

Introduction: There is little available evidence of associations between the various dimensions of women's empowerment and contraceptive use having been examined--and of how these associations are mediated by women's socio-economic and demographic statuses. We assessed these phenomena in Pakistan using a structured-framework approach.
Methods: We analyzed data on 2,133 women who were either using any form of contraceptive or living with unmet need for contraception. The survey was conducted during May - June 2012, with married women of reproductive age (15-49 years) in three districts of Punjab. The dimensions of empowerment were categorized broadly into: economic decision-making, household decision-making, and …

Lumbar Morphometry: A Study Of Lumbar Vertebrae From A Pakistani Population Using Computed Tomography Scans, Muhammad M. Alam, Muhammad Waqas, Hussain Shallwani, Gohar Javed

Section of Neurosurgery

Study design: A cross-sectional study.
Purpose: To describe the characteristics of lumbar vertebrae of Pakistani patients reporting at a tertiary care hospital and compare with studies from other populations.
Overview of literature: Several studies have been conducted to determine morphometry of lumbar vertebrae. Most of the studies involve Caucasian populations, still data on other populations still sparse. This is the first study describing lumbar morphometry of a Pakistani population.
Methods: An observational study was conducted based on a review of thin-cut (3 mm) computed topographic images of lumbar vertebrae. Two-hundred and twenty vertebrae from forty-nine patients were studied, and various …

Factors Associated With Intimate Partner Violence Against Women In A Mega City Of South-Asia: Multi-Centre Cross-Sectional Study, Niloufer S. Ali, Farzana N. Ali, Ali K. Khuwaja, Kashmira Nanji

Department of Family Medicine

Objectives: To assess the proportion of women subjected to intimate partner violence and the associated factors, and to identify the attitudes of women towards the use of violence by their husbands. Design: Cross-sectional study.
Setting: Family practice clinics at a teaching hospital in Karachi, Pakistan.
Participants: A total of 520 women aged between 16 and 60 years were consecutively approached to participate in the study and interviewed by trained data collectors. Overall, 401 completed questionnaires were available for analysis. Multivariate logistic regression analysis was used to identify the association of various factors of interest.
Results: In all, 35% of …

Polio Travel Restrictions: A Sledgehammer To Crack A Nut?, Rashid Jooma

Section of Neurosurgery

Imposition by WHO of mandatory vaccination for international travelers from Pakistan has caused confusion and panic amongst travelers besides the adverse effect on the country's image from the widely reported statement. It is felt that the announced measure is not primarily supported by science but is rather a response to disillusionment in the donors about the repeatedly missed eradication targets set by WHO. In the past few years, exportation of poliovirus from Pakistan has caused outbreaks in China, Iraq and Syria besides the ongoing two way transmission with Afghanistan, but the carriers in these spreads are mainly land route travelers. …

Cost-Effective Practice Of Neurology: An Idea Whose Time Has Come, Rashid Jooma

Pakistan Journal of Neurological Sciences (PJNS)

Pakistanis spent $ 7.2 billion on healthcare in 2013 (3.1% of our Gross Domestic Product), representing a per capita expenditure of $ 39.4. The government contribution to this was no more than 31.4% ($ 12.4 per capita). The public allocations to health thus represent a paltry 4.7% of total government expenditure and are just shy of 1% of our GDP.

Cramp Fasciculation Syndrome: A Peripheral Nerve Hyperexcitability Disorder, Bhojo A. Khealani

Pakistan Journal of Neurological Sciences (PJNS)

Cramp fasciculation syndrome is mildest among all the peripheral nerve hyperexcitability disorders, which typically presents with cramps, body ache and fasciculations. The diagnosis is based on clinical grounds supported by electrodiagnostic study. We report a case of young male with two months’ history of body ache, rippling, movements over calves and other body parts, and occasional cramps. His metabolic workup was suggestive of impaired fasting glucose, radiologic work up (chest X-ray and ultrasound abdomen) was normal, and electrodiagnostic study was significant for fasciculation and myokymic discharges. He was started on pregablin and analgesics. To the best of our knowledge this …

Clippers (Chronic Lymphocytic Inflammation With Pontine Perivascular Enhancement Responsive To Steroids)–Case Report With Neuroimaging, Abdul Salam, Farah Sana, Rashed Nazir, M. Azhar Saeed, Yasir Iqbal, Arsalan Ahmad

Pakistan Journal of Neurological Sciences (PJNS)

Background: CLIPPERS syndrome (chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids) is an inflammatory disease process primarily involving the pons and adjacent structures. Clinically, the patient may present with cerebellar signs such as dysarthria, gait ataxia and with cranial nerve palsies. It shows good response to steroids / immunosuppressive therapy. Pathologically, there is infiltration of T lymphocytes into the perivascular spaces of brainstem. The disease follows a relapsing and a remitting course and the earlier the treatment is started with high dose steroids and the more prolonged it is, the better the clinical outcome will be.

Sporadic Cjd And Retinitis Punctata Albescansa Case Report And Literature Review, Quratulain Khan, Yusra Hanif Khan

Pakistan Journal of Neurological Sciences (PJNS)

Introduction Sporadic Creutzfeldt-Jakob disease (sCJD) is the most common form of CJD causing 85% of all cases. Various phenotypes of sCJD have been identified including Heidenhain variant which has early and predominant visual symptoms with most pronounced neuropathological changes in occipital lobe. Methodology. We are reporting a case of sCJD with Retinitis Punctata Albescens (RPA), a variant of Retinitis Pigmentosa (RP), which to our knowledge has not been reported before. A 51 year old, married, right handed, Pakistani woman presented with dementia and gait problems for 3 months and visual hallucinations for 2 months. Ophthalmological examination 3 years prior to …

Mycobacterium Tuberculosis Central Asian Strain (Cas) Lineage Strains In Pakistan Reveal Lower Diversity Of Miru Loci Than Other Strains, Asho Ali, Zahra Hasan, Sana Jafri, Raunaq Inayat, Rumina Hasan

Department of Pathology and Laboratory Medicine

Mycobacterium tuberculosis (MTB) Central Asian Strain (CAS) lineage strains are predominant in South Asia. Mycobacterial interspersed repetitive units-variable number of tandem repeats (MIRU-VNTR) typing is an effective way of determining genetic diversity of strains. A maximum of 24 loci-based MIRU-VNTR typing can be used, however, it is important to investigate the relevance of specific MIRU loci for regional strains for more cost-effective MIRU typing. MIRU-VNTR typing was performed on MTB strains from Pakistan. Strains were comprised of CAS (n=113) and non-CAS lineages (n=87) - both multi-drug resistant (MDR) and drug susceptible. Hunter Gaston Discriminatory Index (HGDI) for each MIRU loci …

A Study Protocol: Using Demand-Side Financing To Meet The Birth Spacing Needs Of The Underserved In Punjab Province In Pakistan, Syed Khurram Azmat, Moazzam Ali, Waqas Hameed, Ghulam Mustafa, Ghazanfer Abbas, Muhammad Ishaque, Mohsina Bilgrami, Marleen Temmerman

Community Health Sciences

Background: High fertility rates, unwanted pregnancies, low modern contraceptive prevalence and a huge unmet need for contraception adversely affect women's health in Pakistan and this problem is compounded by limited access to reliable information and quality services regarding birth spacing especially in rural and underserved areas. This paper presents a study protocol that describes an evaluation of a demand-side financing (DSF) voucher approach which aims to increase the uptake of modern contraception among women of the lowest two wealth quintiles in Punjab Province, Pakistan.
Methods/design: This study will use quasi-experimental design with control arm and be implemented in: six government …

Rationale, Design, And Cohort Enrolment Of A Prospective Observational Study Of The Clinical Performance Of The New Contraceptive Implant (Femplant) In Pakistan, Syed Khurram Azmat, Waqas Hameed, Anja Lendvay, Babar Tasneem Shaikh, Ghulam Mustafa, Muhammad Ahmed Siddiqui, Sajid Brohi, Asif Karim, Muhammad Ishaque, Wajahat Hussain

Community Health Sciences

Introduction: The use of hormonal implants has gained positive traction in family planning programs in recent times. Compared to other popular methods, such as long-term reversible intrauterine devices, the use of hormonal implants as a family planning method has distinct advantages in terms of long-term efficiency and better user compliance and availability. This paper presents a study protocol to document and evaluate the efficacy, safety, and acceptability of Femplant (contraceptive implant) in Pakistan during the first year of its use among married women of reproductive age (18-44 years) at clinics in two provinces of Pakistan (Sindh and Punjab).
Materials and …

Radiosurgery: Current Recommendations For Intracranial Lesions And Practices In Pakistan, Hussain Shallwani, Sohaib Tariq, Muhammad E Bari

Pakistan Journal of Neurological Sciences (PJNS)

Radiosurgery is defined as the use of high-dose ionizing radiation for precise and total destruction of a chosen target, avoiding concomitant or delayed harm to adjacent tissues. The three types of radiations include gamma rays (GammaKnife) by Cobalt-60, X8 rays using linear accelerator (LINAC) system, and charged-particles generated from synchocyclotron. Recommendations: Based on current evidence, radiosurgery has proven benefits as the treatment of certain brain metastases, vestibular schwannomas, meningiomas, and some skull base tumors. Conclusion: This review describes the current recommendations for use of radiosurgery for intracranial pathologies. Radiosurgery is a relatively newer modality in the developing country of Pakistan. …

Early Psychosis Symptoms, Haider A. Naqvi, Sajjad Hussain, Muhammad Islam, Shafqat Huma

Department of Psychiatry

Objective: To determine the prodromal symptoms of schizophrenia in the pathways to help-seeking.STUDY Design: A cross-sectional study.PLACE AND DURATION OF STUDY: The Department of Psychiatry, the Aga Khan University, Karachi, from 2008 to 2009.METHODOLOGY: A total of 93 patients were interviewed in the pathways to care of schizophrenia. The diagnosis was based on ICD-10 criteria. The pathways to care were assessed through a semi-structured questionnaire. The onset, course and symptoms of psychosis were assessed through Interview for Retrospective Assessment at Age at Onset of Psychosis (IROAS).Results: Fifty five (59%) participants were male while 41% (n=38%) were female. Using IROAS, 108 …

Leadership In Healthcare Is A Neglected Issue: A Call For Action, Waris Qidwai

Department of Family Medicine

Healthcare and medical profession stands at crossroads today. Unprecedented technological advances as a result of ongoing scientific research has revolutionized healthcare around the world. Despite these developments, we are still faced with a huge burden of communicable diseases, an ever rising burden of noncommunicable diseases, coupled with an increasing load of mental health diseases and accidents in healthcare. There are several reasons for our failure to address healthcare issues of our populations, including a desperate need to revamp existing medical and health care related curriculum. In addition to considering curriculum change, perhaps single most needed change we need to address …

Heart Valve Surgery: Euroscore Vs. Euroscore Ii Vs. Society Of Thoracic Surgeons Score, Muhammad Sharoz Rabbani, Irfan Qadir, Yasir Ahmed, Marrium Gul, Hasanat Sharif

Section of Cardiothoracic Surgery

Background: This is a validation study comparing the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II with the previous additive (AES) and logistic EuroSCORE (LES) and the Society of Thoracic Surgeons' (STS) risk prediction algorithm, for patients undergoing valve replacement with or without bypass in Pakistan.PATIENTS AND Methods: Clinical data of 576 patients undergoing valve replacement surgery between 2006 and 2013 were retrospectively collected and individual expected risks of death were calculated by all four risk prediction algorithms. Performance of these risk algorithms was evaluated in terms of discrimination and calibration.Results: There were 28 deaths (4.8%) among 576 patients, …

Clinical And Biochemical Characteristics Of Children With Juvenile Idiopathic Arthritis, Shakeel Ahmed, Syed Rehan Ali, Sidra Ishaque, Nabil Sami

Department of Paediatrics and Child Health

Objective: To determine the clinical and biochemical characteristics of children with Juvenile Idiopathic Arthritis (JIA) at a tertiary care centre in Karachi, Pakistan.

Study Design: A descriptive study.

Place and Duration of Study: Paediatric Rheumatology Clinic of The Aga Khan University Hospital (AKUH), Karachi, from January 2008 to December 2011.

Methodology: Clinical and laboratory profile and outcome of children less than 15 years of age attending the Paediatric Rheumatology Clinic of the Aga Khan University, Karachi with the diagnosis of Juvenile Idiopathic Arthritis according to International League against Rheumatism were studied. These children were classified into different types of JIA; …