Medicine and Health Sciences Commons^™

Cardiac Surgery In Octogenarians, Asmatullah Khan, Hassan Khan, Saulat H. Fatimi, Asadullah Khan

Saulat Fatimi

In Europe and North America, cardiac surgery can be done successfully on octogenarians, but differences in patient selection, surgical and bypass techniques prevent us from concluding similarly in Pakistan. This study investigated the short and long-term outcomes of cardiac surgery in octogenarians operated over a 5 years period at The Aga Khan University Hospital, from January 2001 to December 2006. Seventeen octogenarians, (mean age 81.7 ± 2.3) underwent coronary artery bypass graft (CABG). Thirty-days hospital mortality was reported in only 1 patient. Surgical complication of any kind was reported in 13 (76.5%) patients with pleural effusion being the commonest in …

Rhesus And Kell Phenotyping Of Voluntary Blood Donors: Foundation Of A Donor Data Bank, Farheen Karim, Bushra Moiz, Fahmida Jan Muhammad, Fatima Ausat, Mohammad Khurshid

Mohammad Khurshid

OBJECTIVE: To assess the Rhesus (Rh) and Kell (K) phenotype of voluntary blood donors and lay foundation of a data bank of voluntary blood donors. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Blood Bank, The Aga Khan University Hospital, Karachi, in the year 2014. METHODOLOGY: Voluntary blood donors were inducted after taking written informed consent. Three -5cc of EDTA anticoagulated blood sample was taken to phenotype red cells for C, c, E, e, and Kell antigens using antisera. [DiaMedSwitzerland]. RESULTS: Hundred blood donors were included in the study. ABO blood groups of the donors were: O [37%], B …

Residual Barriers For Utilization Of Maternal And Child Health Services: Community Perceptions From Rural Pakistan., Zahid Memon, Shehla Zaidi, Atif Riaz

Zahid Ali Memon

Low utilization of maternal and child care services in rural areas has constrained Pakistan from meeting targets of Millennium Development Goals (MDGs) 4 and 5. This study explores community barriers in accessing Maternal and Child Health (MCH) services in ten remote rural districts of Pakistan. It further presents how the barriers differ across a range of MCH services, and also whether the presence of Community Health Workers (CHWs) reduces client barriers. Qualitative methods were used involving altogether sixty focus group discussions with mothers, their spouses and community health workers. Low awareness, formidable distances, expense, and poorly functional services were the …

The Minds Of Mothers: Maternal Mental Health In An Urban Squatter Settlement Of Karachi., Fauziah Rabbani, Furqan Farooq Raja

Fauziah Rabbani

BACKGROUND:

Community-based information on maternal mental health in developing countries is meager and nearly non-existent in Pakistan.

OBJECTIVE:

To determine the proportion of probable cases of women with mental disorders and examine the associated conditions and risk factors which contribute to maternal mental ill-health.

METHODS:

With convenient sampling 260 mothers in an urban squatter settlement of Karachi were interviewed. The tools consisted of a household questionnaire collecting information on basic demographic and other characteristics and the Aga Khan University Anxiety and Depression Scale (AKUADS), an instrument to assess psychiatric morbidity.

RESULTS:

The proportion of probable cases of mental disorder was …

Motivating And Demotivating Factors For Community Health Workers Engaged In Maternal, Newborn And Child Health Programs In Low And Middle-Income Countries: A Systematic Review., Leah Shipton, Aysha Zahidie, F. Rabbani

Fauziah Rabbani

This systematic review aimed to synthesize primary research on motivating factors of community health workers (CHWs) for maternal, neonatal, and child health (MNCH) in low and middle-income countries (LMICs). Peer-reviewed literatures were systematically searched in five databases. Identified studies were then screened and selected for inclusion. The eligibility criteria were reported primary qualitative, quantitative, or mixed methods research, with participants being CHWs in LMICs who address MNCH, which investigated motivation or related concepts of retention, attrition, and performance. A thematic synthesis process was used to analyze findings of motivating factors, reported by included studies. Seventeen qualitative, quantitative, or mixed methods …

Inspiring Health Worker Motivation With Supportive Supervision: A Survey Of Lady Health Supervisor Motivating Factors In Rural Pakistan, Fauziah Rabbani, Leah Shipton, Wafa Aftab, Kashif Sangrasi, Shagufta Perveen, Aysha Zahidie

Fauziah Rabbani

BACKGROUND: Community health worker motivation is an important consideration for improving performance and addressing maternal, newborn, and child health in low and middle-income countries. Therefore, identifying health system interventions that address motivating factors in resource-strained settings is essential. This study is part of a larger implementation research project called Nigraan, which is intervening on supportive supervision in the Lady Health Worker Programme to improve community case management of pneumonia and diarrhea in rural Pakistan. This study explored the motivation of Lady Health Supervisors, a cadre of community health workers, with particular attention to their views on supportive supervision. METHODS: Twenty-nine …

Impact Of Water And Sanitation And Health Education Interventions On Health And Hygiene Behaviors: A Study From A Northern Pakistani Village, Aysha Zahidie, Fauziah Rabbani

Fauziah Rabbani

Introduction: Water and sanitation interventions were delivered in the northern areas of Pakistan as a joint venture of the Aga Khan University and the Aga Khan Health Systems Oshikhandass Diarrhea and Dysentery Project (1989-96) followed by the Aga Khan Water, Sanitation, Health and Hygiene Studies Program (WSHHSP). Through these interventions water treatment plants, new pit latrines along with a component of health education were introduced. Objectives: To explore perceptions, knowledge and practices of inhabitants of Oshikhandass village in Gilgit related to water quality, latrine use and hand washing following the intervention. Methods: Through a cross-sectional study during June-July 2012, six …

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

Fauziah Rabbani

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 …

Health Workers’ Perspectives, Knowledge And Skills Regarding Community Case Management Of Childhood Diarrhoea And Pneumonia: A Qualitative Inquiry For An Implementation Research Project “Nigraan” In District Badin, Sindh, Pakistan, Fauziah Rabbani, Shagufta Perveen, Wafa Aftab, Aysha Zahidie, Kashif Sangrasi, Shamim Ahmad Qazi Ahmad Qazi

Fauziah Rabbani

BACKGROUND: Pakistan's Lady Health Worker Programme aims to provide care to children sick with pneumonia and diarrhoea, which continues to cause 27 % under-five mortality in Pakistan. The quality of supervision received by Lady Health Workers (LHWs) in the programme influence their knowledge and skills, in turn impacting their ability to provide care. METHODS: This study is part of an implementation research project titled "Nigraan" (an Urdu word meaning supervisor), and explores LHW and Lady Health Supervisor (LHS) perspectives regarding the role of supervision in improving LHWs performance and motivation in district Badin, Sindh, Pakistan. Their knowledge and skills regarding …

Economic Development And Health Status Among The Poor In Squatter Settlements Of Karachi., Fauziah Rabbani, Anwer T. Merchant

Fauziah Rabbani

OBJECTIVE:

Socioeconomic status is an important determinant of health outcome measures. This study examines and presents some of the important health outcomes amongst the higher and lower socioeconomic groups within the urban poor.

SETTING:

Data analysis is based on a Health and Demographic Survey conducted in urban squatter settlements of Karachi in 1996.

METHODS:

A structured questionnaire was administered to all households in the catchment area. The indicator used to assess economic status is ownership of assets.

RESULTS:

Comparison between the two economic levels shows that the lower socio-economic group was more likely to experience child mortality, (CI; 1.02-1.29, p …

Behind The Counter: Pharmacies And Dispensing Patterns Of Pharmacy Attendants In Karachi., Fauziah Rabbani, F. H. Cheema, N. Talati, S. Siddiqui, S. Syed, S. Bashir, L. Z. Zuberi, A. Shamim, Q. Mumtaz

Fauziah Rabbani

BACKGROUND:

There is little literature available on dispensing patterns and unsupervised sale of medicines from pharmacies in developing countries.

OBJECTIVE:

This study obtained background information on pharmacies assessed the level of training, knowledge and dispensing patterns of pharmacy attendants in Karachi.

METHODOLOGY:

This is a descriptive cross sectional study with convenient sampling. A structured questionnaire was used to interview pharmacy attendants.

RESULTS:

Of the 219 pharmacies surveyed, 62% reported more than 50 customers daily and 20% also sold items of general provision. Mean operating hours were 13. Only 24 (11%) had a visible license. On an average 3 attendants were …

Psycho-Social Consequences Of Secondary Infertility In Karachi., Neelofar Sami, Tazeen Saeed Ali

Tazeen Ali

OBJECTIVE:

To explore the experiences of social consequences among women suffering from secondary infertility.

METHODS:

Descriptive case series of 400 women with secondary infertility attending tertiary care hospitals in Karachi, Pakistan.

RESULTS:

More than two thirds (67.7%) of women stated that their inability to give live births or give birth to sons had resulted in marital dissonance. The respondents had been threatened for divorce (20%), husband's remarrying (38%) or to be returned to their parent's home (26%) by their in laws or husbands. Majority (68%) of the women threatened did not have any live births. However, those who had live …

Symptomatic Surgically Treated Non-Neoplastic Cysts Of The Central Nervous System: A Clinicopathological Study From Pakistan, Nasir Ud Din, Huma Arshad, Zubair Ahmad, Sheema H Hasan, Mohammad Ehsan Bar

Zubair Ahmad

Objective: To report clinicopathologic features of symptomatic surgically removed non-neoplastic cysts of the central nervous system (CNS). Study Design: Case series. Place and Duration of Study: The Aga Khan University Hospital, Karachi, from 2003 to 2012. Methodology: All non-neoplastic CNS cysts reported during the study period were retrieved and reviewed. Age, gender, location, histologic type and clinical features were noted. Results: A total of 124 cysts were diagnosed in the study period. These included 44 epidermoid cysts (mean age 30.5 ± 13.8 years), 35 colloid cysts (mean age 31 ± 13.2 years), 32 arachnoid cysts (mean age 24.8 ± 20.2 …

Distribution Of Helicobacter Pylori Virulence Markers In Patients With Gastroduodenal Diseases In Pakistan, Javed Yakoob, Shahab Abid, Zaigham Abbas, Wasim Jafri, Zubair Ahmad, Rashida Ahmed, Muhammad Islam

Zubair Ahmad

Background: Helicobacter pylori (H. pylori) infection is known to be associated with a spectrum of gastroduodenal diseases. We studied the association of H. pylori virulence markers cytotoxin-associated gene (cagA) and vacuolating associated cytotoxin gene (vacA) alleles in Patients with non ulcer dyspepsia (NUD), gastric ulcer (GU), gastric carcinoma (GC) and duodenal ulcer (DU). Methods: H. pylori infection established by both rapid urease test and histology were studied. The cagA and vacA allelic status was determined by polymerase chain reaction (PCR). Sequencing of vacA i1 and i2 PCR product was carried out. Results: Two hundred and twenty-four Patients were included, 141 …

Designing The First Ever Health Insurance For The Poor In Pakistan–A Pilot Project, Rashid Jooma, Sabeena Jalal

Rashid Jooma

Abstract Several developing countries lack a medical insurance system with universal coverage, so access to medical services is not easy, principally for people living in poverty. One of the biggest issues for designing healthcare systems in developing countries is how to include those not formally employed. Therefore, it is important to implement targeted interventions so that the most in need are not left out. The World Health Report 2000 distinguishes four functions for the health system to fulfill: (i) the provision of health services; (ii) the creation of the necessary investment and training resources for health; (iii) health financing; and …

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

Rashid Jooma

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.

Distribution Of Helicobacter Pylori Virulence Markers In Patients With Gastroduodenal Diseases In Pakistan, Javed Yakoob, Shahab Abid, Zaigham Abbas, Wasim Jafri, Zubair Ahmad, Rashida Ahmed, Muhammad Islam

Rashida Ahmed

Background: Helicobacter pylori (H. pylori) infection is known to be associated with a spectrum of gastroduodenal diseases. We studied the association of H. pylori virulence markers cytotoxin-associated gene (cagA) and vacuolating associated cytotoxin gene (vacA) alleles in Patients with non ulcer dyspepsia (NUD), gastric ulcer (GU), gastric carcinoma (GC) and duodenal ulcer (DU). Methods: H. pylori infection established by both rapid urease test and histology were studied. The cagA and vacA allelic status was determined by polymerase chain reaction (PCR). Sequencing of vacA i1 and i2 PCR product was carried out. Results: Two hundred and twenty-four Patients were included, 141 …

Bomb Blast In A Tertiary Care Hospital, The Challenges Faced During Management Of Victims In A Resource Limited Country, Rizwan Sultan, Hasnain Zafar, Umar B, Khabir Ahmed

Khabir Ahmed

Abstract Introduction: A bomb blast in a hospital results in a many fold increase in the casualties. The affected health care in the region is the next challenge faced by the administration of the city. We discuss the challenges faced after a bomb blast in the civil hospital of Quetta, Pakistan on 8 August 2016. Methods: A retrospective review of the medical records of patients who were transferred by air to the Aga Khan University Hospital Karachi over a period of 86 h after the blast in Quetta. Results: Seventy-five patients were received in three separate waves; those received in …

Prevalence Of Diabetic Retinopathy Among Individuals Screened Positive For Diabetes In Five Community Based Eye Camps In Northern Karachi Pakistan, Jamal-U- Din, Mohammad Babar Qureshi, Akhtar Jamal Khan, Mohammad Daud Khan, Khabir Ahmed

Khabir Ahmed

Background: Population-based data on the prevalence of diabetic retinopathy in Pakistan are lacking. We determined the prevalence of diabetic retinopathy among individuals screened positive for diabetes in five community-based eye camps in northern Karachi, Pakistan. Methods: In summer 2002, five community-based eye camps were set up in Karachi, Pakistan’s largest city. All individuals aged 30 years or older who visited the camps were requested to participate in the study. Those who agreed were screened for diabetes and those found to have the disease were referred to an eye hospital for diabetic retinopathy screening. Verbal informed consent was obtained from all …