Medical Specialties Commons^™

Newborn Care In Indonesia, Lao People’S Democratic Republic And The Philippines: A Comprehensive Needs Assessment, Els Duysburgh, Birgit Kerstens, Melissa Diaz, Vini Fardhdiani, Katherine Ann Reyes, Khamphong Phommachanh, Marleen Temmerman, Basil Rodriques, Nabila Zaka

Obstetrics and Gynaecology, East Africa

Background: Between 1990 and 2011, global neonatal mortality decline was slower than that of under-five mortality. As a result, the proportion of under-five deaths due to neonatal mortality increased. This increase is primarily a consequence of decreasing post-neonatal and child under-five mortality as a result of the typical focus of child survival programmes of the past two decades on diseases affecting children over four weeks of age. Newborns are lagging behind in improved child health outcomes. The aim of this study was to conduct a comprehensive, equity-focussed newborn care assessment and to explore options to improve newborn survival in Indonesia, …

Risk Factors Associated With Birth Asphyxia In Rural District Matiari, Pakistan: A Case Control Study, Farhana Tabassum, Arjumand Rizvi, Shabina Ariff, Sajid Bashir Soofi, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: During the past two decades there has been a sustained decline in child mortality; however, neonatal mortality has remained stagnant. Each year approximately 4 million babies are born asphyxiated resulting in 2 million neonatal deaths and intrapartum stillbirths. Almost all neonatal deaths occur in developing countries, where the majority is delivered at homes with negligible antenatal care and poor perinatal services.
Objectives: To identify socio-demographic and clinical risk factors associated with birth asphyxia in Matiari District of Sindh Province, Pakistan.
Method: A matched case control study was conducted in Matiari District with 246 cases and 492 controls. Newborn deaths …

Multi-Drug Resistant Gram Negative Infections And Use Of Intravenous Polymyxin B In Critically Ill Children Of Developing Country: Retrospective Cohort Study, Naveed-Ur-Rehman Siddiqui, Farah Naz Qamar, Humaira Jurair, Anwarul Haque

Department of Paediatrics and Child Health

Background: Patients in pediatric intensive care Units (PICU) are susceptible to infections with antibiotic resistant organisms which increase the morbidity, mortality and cost of care. To describe the clinical characteristics and mortality in patients with Multi-Drug Resistant (MDR) gram negative organisms. We also report safety of Polymyxin B use in these patients.
Methods: Files of patients admitted in PICU of Aga Khan University Hospital, from January 2010 to December 2011, one month to 15 years of age were reviewed. Demographic and clinical features of patients with MDR gram negative infections, antibiotic susceptibility pattern of isolates, discharge disposition and adverse effects …

Vascular Ehlers-Danlos Syndrome: A Rare Disorder Presenting With Focal Convulsions, Shakeel Ahmed, Syed Rehan Ali, Naila Nadeem, Muhammad Hamid

Department of Paediatrics and Child Health

Vascular Ehlers-Danlos Syndrome (VEDS), previously called Ehlers-Danlos syndrome type-IV, is a heterogeneous group of heritable connective tissue disorders characterized by thin, translucent skin, easy bruising, arterial, intestinal, and/or uterine fragility. There is large vessel involvement that leads to arterial rupture often preceded by aneurysm, arteriovenous fistulae, or dissection. Noninvasive imaging studies such as CT angiography and MR angiography are preferred as diagnostic studies for this condition. We are reporting a 4 years old girl who was presented with right sided unilateral convulsions and hypertension. CT angiogram showed stenosis with post-stenotic dilatation of coeliac and superior mesenteric arteries. There were extensive …

Provider Cost Analysis Supports Results-Based Contracting Out Of Maternal And Newborn Health Services: An Evidence-Based Policy Perspective, Peter Hatcher, Shiraz Shaikh, Hassan Fazli, Shehla Zaidi, Atif Riaz

Community Health Sciences

Background

There is dearth of evidence on provider cost of contracted out services particularly for Maternal and Newborn Health (MNH). The evidence base is weak for policy makers to estimate resources required for scaling up contracting. This paper ascertains provider unit costs and expenditure distribution at contracted out government primary health centers to inform the development of optimal resource envelopes for contracting out MNH services.

Methods

This is a case study of provider costs of MNH services at two government Rural Health Centers (RHCs) contracted out to a non-governmental organization in Pakistan. It reports on four selected Basic Emergency Obstetrical …

Frequency Of Cardiorenal Syndrome Type-I In Hospitalized Children With Acute Heart Failure In A Tertiary-Care Hospital, Mehjabeen Zaidi, Arshalooz Jamila Rehman, Anwarul Haque, Saleem Akhtar, Prem Kumar Maheshwar

Department of Paediatrics and Child Health

Objective: To determine the frequency of cardiorenal syndrome in hospitalized children with acute heart failure.

Study Design: Descriptive study.

Place and Duration of Study: Paediatric Intensive Care Unit, The Aga Khan University Hospital, Karachi, from December 2010 to December 2011.

Methodology: Sixty eight (68) children with acute heart failure fulfilling the selection criteria were evaluated for worsening of renal function (WRF). Serum creatinine was done at baseline and repeated at 72 hours to see the worsening of renal function. Estimated serum creatinine clearance was calculated by Schwartz formula.

Results: Mean age of patients was 43.6 ± 55.2 months. There were …

Subacute Sclerosing Panencephalitis: Clinical And Demographic Characteristics, Arshad Rafique, Nida Amjad, Prem Chand, Syed Sohail Zahoor Zaidi, Muhammad Suleman Rana, Khalid Ahmed, Shahnaz Ibrahim

Department of Paediatrics and Child Health

Objective: To determine the clinical and demographic characteristics of children diagnosed with Subacute sclerosing panencephalitis (SSPE).

Study Design: Case series.

Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January 2000 to June 2012.

Methodology: A retrospective analysis was done, regarding medical charts of 43 children under the age of 16 years with a discharge diagnosis of SSPE. Demographic and clinical characteristics were recorded. Results were expressed as percentages.

Results: Most of the 43 patients were male (72%). The average age at presentation was 8.7 years with average duration of symptoms being 100.6 days. History of …

Empyema Thoracis In Children: Clinical Presentation, Management And Complications, Ali Faisal Saleem, Abdul Sattar Shaikh, Reema Sajjad Khan, Fazal Khan, Ahmad Vaqas Faruque, Muhammad Arif Mateen Khan

Department of Paediatrics and Child Health

Objective: To determine the etiology, clinical manifestation, management (medical and surgical) and complications of children with empyema thoracis in a tertiary care hospital from Karachi, Pakistan.

Study Design: Descriptive, analytical study.

Place and Duration of Study: Department of Surgery, The Aga Khan University Hospital, Karachi, from January 1996 to December 2010.

Methodology: Medical records of admitted children aged > a month to 15 years with discharge diagnosis of empyema thoracis and data was collected on demographic features, clinical manifestation, management and complications. Children managed medically were compared with those managed surgically by using interquartile range and median comparison. Mann-Whitney U test …

Frequency Of Retinopathy Of Prematurity In Premature Neonates With A Birth Weight Below 1500 Grams And A Gestational Age Less Than 32 Weeks: A Study From A Tertiary Care Hospital In A Lower-Middle Income Country, Arjumand Sohaila, Shiyam Sunder Tikmani, Iqtidar Ahmed Khan, Huba Atiq, Ali Syed Muhammad Akhtar, Prem Kumar, Kishwer Kumar

Department of Emergency Medicine

Introduction: Retinopathy of prematurity (ROP) is a treatable cause of blindness in neonates. In Pakistan, ROP is often not recognized early because screening and treatment programs are not yet in place in most neonatal units, even in tertiary care hospitals. It is hoped that this report will help inform medical professionals of the magnitude of the problem and help to design appropriate management strategies.

Objectives: The aim was to determine the frequency of ROP in premature and very low birth weight (BW) neonates (BW(GA)weeks).

Study Design: Cross-sectional study.

Study Setting : Neonatal intensive care unit (NICU) of a tertiary care …

Ct Scan In Children With Acute Bacterial Meningitis: Experience From Emergency Department Of A Tertiary-Care Hospital In Karachi, Pakistan, Jabeen Fayyaz, Arshalooz Rehman, Akhter Hamid, Munawar Khursheed, Nukhba Zia, Asher Feroze, Uzma R. Khan

Department of Emergency Medicine

Objective: To determine the role of computed tomography scan in children presenting to emergency department with symptoms and signs of suspected acute bacterial meningitis.

Methods: The retrospective analysis was done on children who were admitted through the Emergency Department at Aga Khan University Hospital, Karachi, from September 2009 to September 2011 with the diagnosis of acute bacterial meningitis. Information related to age, gender, presenting complaints, clinical signs and symptoms, computed tomography scan findings and final outcome of patients was gathered from the medical records. SPSS 19 was used for statistical analysis.

Results: A total of 192 patients were admitted with …

Readmission To Paediatric Intensive Care Unit: Frequency, Causes And Outcome, Muhammad Rehan Khan, Prem Kumar, Sumaira Iram, Anwarul Haque

Department of Paediatrics and Child Health

Readmission to intensive care units is considered to be an important quality indicator in ICU settings. This study was carried out at the paediatric intensive unit (PICU) and step down units of paediatric ward at the Aga Khan University Hospital, Karachi, Pakistan, to assess the frequency, common causes and outcome of patients readmitted in PICU within 48 hours after discharge from unit. During the study period, 1022 patients were admitted in PICU, out of which 24 (2.34%) patients required readmission. Male to female ratio was 1.2:1. The mean length of stay on paediatric floor before readmission was 24 hours. Fifteen …

Age Related Clinical Manifestation Of Acute Bacterial Meningitis In Children, Jabeen Fayyaz, Arshalooz Rehman, Akhter Hamid, Munawar Khursheed, Nukhbha Zia, Asher Feroze

Department of Emergency Medicine

Objective: To determine the signs and symptoms of acute bacterial meningitis (ABM) in different age grops of a paediatric population.

Methods: The retrospective study comprised patients who had been admitted through the Emergency Department of Aga Khan University Hospital, Karachi with the relevant diagnosis from September 2009 to September 2011. Case record forms were used to collect data from patient files. Data was collected using variables such as age, gender, presenting complaints, clinical signs and symptoms, computed tomography scan findings and final outcome of patients. There was a minimal risk of breach in patient confidentiality. SPSS 19 was used for …

Rota Virus Diarrhea In Hospitalized Children, Muhammad Irfan Habib, Sayyeda Ghazala Kazi, Khalid Mehmood Ahmed Khan, Nukhba Zia

Department of Emergency Medicine

Objective: To determine the frequency and clinical features of Rota virus diarrhea in children presenting in a tertiary care hospital.

Study Design: A cross-sectional, observational study.

Place and Duration of Study: National Institute of Child Health, Karachi, from January to June 2007.

Methodology: A total of three hundred children of either gender aged 1 month to 5 years, who presented with diarrhea of < 7 days as a primary illness were enrolled. Children with bloody diarrhea or nosocomial gastroenteritis acquired duringhospitalization for other disease were not included. Detection of Rota virus in stool was done by enzyme linked immunoassay.

Results: Out of 300 children, 188 (63%) tested positive and 112 (37%) tested negative for Rota virus. Positive Rota virus cases in 7 – 12 months of age was (n = 34, 18.08%). Overall, 151 (80.3%) children …

Fmic Annual Report 2014 | English, French Medical Institute For Mothers And Children

FMIC Reports

No abstract provided.

Pediatric Cerebral Palsy In Africa: Where Are We?, Kirsten A. Donald, Angelina M. Kakooza, Robinson D. Wammanda, Macpherson Mallewa, Pauline Samia, Haydar Babakir, David Bearden, Annette Majnemer, Darcy Fehlings, Michael Shevell, Harry Chugani, Jo M. Wilmshurst

Paediatrics and Child Health, East Africa

Cerebral palsy is the most common cause of physical disability in children worldwide. However, little is reported on this condition in the African context. Doctors from 22 countries in Africa, and representatives from a further 5 countries outside Africa, met to discuss the challenges in the evaluation and management of children with cerebral palsy in Africa and to propose service needs and further research. Basic care is limited by the poor availability of diagnostic facilities or medical personnel with experience and expertise in managing cerebral palsy, exacerbated by lack of available interventions such as medications, surgical procedures, or even regular …

Models Of Care For Orphaned And Separated Children And Upholding Children's Rights: Cross-Sectional Evidence From Western Kenya, Lonnie Embleton, David Ayuku, Allan Kamanda, Lukoye Atwoli, Samuel Ayaya, Rachel Vreeman, Winstone Nyandiko, Peter Gisore, Julius Koech, Paula Braitstein

Paediatrics and Child Health, East Africa

Background: Sub-Saharan Africa is home to approximately 55 million orphaned children. The growing orphan crisis has overwhelmed many communities and has weakened the ability of extended families to meet traditional care-taking expectations. Other models of care and support have emerged in sub-Saharan Africa to address the growing orphan crisis, yet there is a lack of information on these models available in the literature. We applied a human rights framework using the United Nations Convention on the Rights of the Child to understand what extent children's basic human rights were being upheld in institutional vs. community- or family-based care settings in …

Acute Cerebellitis With Hydrocephalus, Nida Amjad, Anwarul Haque, Khalid Ahmed

Department of Paediatrics and Child Health

We report a case of an 8 years old child who presented with sudden onset of headache and vomiting. He had broad-based gait and intention tremors on admission. MRI brain revealed isointense signals on T1-weighted imaging and hyperintense signals on T2-weighted imaging. Cerebellar swelling was also identified with significant mass effect obliterating the fourth ventricle. CT head showed prominent third and lateral ventricles. He was treated with high dose corticosteroids and required an external ventricular drain (EVD) insertion. He made an uneventful recovery and suffered no neurologic deficit. The clinical and radiologic findings in this boy were consistent with cerebellitis …

Early Recovery In Post Varicella Transverse Myelitis, Prem Chand, Shahnaz Brahim, Syed Sohail Zaidi, Nida Amjad

Department of Paediatrics and Child Health

A two and a half year old Kenyan girl presented with recurrent chest infections and difficulty in swallowing. Her clinical and laboratory workup was suggestive of lower respiratory tract infection for which she received a course of antibiotics; however, she remains symptomatic after the management of her suspected diagnosis. Therefore, further radiological workup including a chest CT scan and barium study were performed. This showed a homogeneous mass surrounded by ascending and descending aorta in the posterior mediastinum that was compressing the middle esophagus. She had a posterolateral thoracotomy which revealed a cystic mass with smooth surfaces (5 x 5 …

Community-Based Interventions For The Prevention And Control Of Helmintic Neglected Tropical Diseases, Rehana A. Salam, Hasina Maredia, Jai K. Das, Zohra S. Lassi, Zulfiqar A. Bhutta

Department of Paediatrics and Child Health

In this paper, we aim to systematically analyze the effectiveness of community-based interventions (CBIs) for the prevention and control of helminthiasis including soil-transmitted helminthiasis (STH) (ascariasis, hookworms, and trichuriasis), lymphatic filariasis, onchocerciasis, dracunculiasis, and schistosomiasis. We systematically reviewed literature published before May 2013 and included 32 studies in this review. Findings from the meta-analysis suggest that CBIs are effective in reducing the prevalence of STH (RR: 0.45, 95% CI: 0.38, 0.54), schistosomiasis (RR: 0.40, 95% CI: 0.33, 0.50), and STH intensity (SMD: -3.16, 95 CI: -4.28, -2.04). They are also effective in improving mean hemoglobin (SMD: 0.34, 95% CI: 0.20, …

Impact Of Community-Based Interventions On Hiv Knowledge, Attitudes And Transmission, Rehana A. Salam, Sarah Haroon, Hashim H. Ahmed, Jai K. Das, Zulfiqar A. Bhutta

Department of Paediatrics and Child Health

In 2012, an estimated 35.3 million people lived with HIV, while approximately two million new HIV infections were reported. Community-based interventions (CBIs) for the prevention and control of HIV allow increased access and ease availability of medical care to population at risk, or already infected with, HIV. This paper evaluates the impact of CBIs on HIV knowledge, attitudes, and transmission. We included 39 studies on educational activities, counseling sessions, home visits, mentoring, women's groups, peer leadership, and street outreach activities in community settings that aimed to increase awareness on HIV/AIDS risk factors and ensure treatment adherence. Our review findings suggest …

Pneumococcal Serotypes And Serogroups Causing Invasive Disease In Pakistan, 2005-2013, Sadia Shakoor, Furqan Kabir, Asif R. Khowaja, Shahida M. Qureshi, Fyezah Jehan, Farah Qamar, Cynthia G. Whitney, Anita K M Zaidi

Department of Paediatrics and Child Health

While pneumococcal conjugate vaccines have been implemented in most countries worldwide, use in Asia has lagged in part because of a lack of data on the amount of disease that is vaccine preventable in the region. We describe pneumococcal serotypes elicited from 111 episodes of invasive pneumococcal disease (IPD) from 2005 to 2013 among children and adults in Pakistan. Seventy-three percent (n = 81) of 111 IPD episodes were cases of meningitis (n = 76 in children 0-15 years and n = 5 among adults). Serotypes were determined by target amplification of DNA extracted from pneumococcal isolates (n = 52) …

Randomised Double Blind Study To Compare Effectiveness Of Honey, Salbutamol And Placebo In Treatment Of Cough In Children With Common Cold, Adil Waris, William Macharia, E. K. Njeru, F. Essajee

Paediatrics and Child Health, East Africa

Background: Acute upper respiratory infection is the most common childhood illness and presents with cough, coryza and fever. Available evidence suggests that cough medicines may be no more effective than honey-based cough remedies.

Objective: To compare effectiveness of honey, salbutamol and placebo in the treatment of cough in children with acute onset cough.

Design: Randomised control trial

Setting: Aga Khan University Hospital Paediatric Casualty

Subjects: Children between ages one to twelve years presenting with a common cold between December 2010 and February 2012 were enrolled.

Outcome measures: Frequency, severity and extent to which cough bothered and disturbed child and parental …

Prevalence And Outcomes Of Acute Kidney Injury In Term Neonates With Perinatal Asphyxia, Dan Alaro, Bashir Admani, Lucy Wainaina, Rachel Musoke

Paediatrics and Child Health, East Africa

Background: The kidney is the most damaged organ in asphyxiated full-term infants. The severity of its damage is corre­lated with the severity of neurological damage. We determined the prevalence of perinatal asphyxia-associated acute kidney injury (AKI).

Methods: We conducted a prospective cohort study including 60 full-term neonates admitted at the Kenyatta National Hospital newborn unit (NBU) in Nairobi with hypoxic ischaemic encephalopathy (HIE) from June 2012 to November 2012. Renal function was assessed by measuring serum creatinine on day 3 of life. AKI was defined by a level of creatinine above 133 μmol/l. The degree of neurological impairment was determined …

Pediatric Cerebral Palsy In Africa: A Systematic Review, Kirsten A. Donald, Pauline Samia, Angelina Kakooza-Mwesige, David Bearden

Paediatrics and Child Health, East Africa

Cerebral palsy is a common neurologic problem in children and is reported as occurring in approximately 2-2.5 of 1000 live births globally. As is the case with many pediatric neurologic conditions, very little has been reported on this condition in the African context. Resource-limited settings such as those found across the continent are likely to result in a different spectrum of etiologies, prevalence, severity as well as management approaches. This review aims to establish what has been reported on this condition from the African continent so as to better define key clinical and research questions.

Implementation And Evaluation Of The Helping Babies Breathe Curriculum In Three Resource Limited Settings: Does Helping Babies Breathe Save Lives? A Study Protocol, Akash Bang, Roopa Bellad, Peter Gisore, Patricia Hibberd, Archana Patel, Shivaprasad Goudar, Fabian Esamai, Norman Goco, Sreelatha Meleth, Richard J. Derman, Edward A. Liechty, Elizabeth Mcclure, Waldemar A. Carlo, Linda L. Wright

Paediatrics and Child Health, East Africa

Background: Neonatal deaths account for over 40% of all under-5 year deaths; their reduction is increasingly critical for achieving Millennium Development Goal 4. An estimated 3 million newborns die annually during their first month of life; half of these deaths occur during delivery or within 24 hours. Every year, 6 million babies require help to breathe immediately after birth. Resuscitation training to help babies breathe and prevent/manage birth asphyxia is not routine in low-middle income facility settings. Helping Babies Breathe (HBB), a simulation-training program for babies wherever they are born, was developed for use in low-middle income countries. We evaluated …

Child Road Traffic Crash Injuries At The Red Cross War Memorial Children’S Hospital In Cape Town South Africa In 1992, 2002 And 2012, Isaac Kihurani, Ashley Van Niekerk, Arjan Bastiaan Van As

Paediatrics and Child Health, East Africa

Road traffic crashes are a significant cause of the disease burden among children, with the highest mortality in low- and middle-income countries. This observational study explores such injuries in Cape Town, South Africa through an analysis of data for cases in 1992, 2002 and 2012 at the Red Cross War Memorial Children's Hospital, a referral paediatric hospital for children younger than 13 years. Descriptive and time trend analysis of demographic data as well as of the causes, severity and place of injury was conducted. Logistic regression and generalised linear models described factors influencing hospital admission. In the years 1992, 2002 …

Toward The Development Of The International Classification Of Functioning Core Sets For Children With Cerebral Palsy: A Global Expert Survey, Veronica Schiariti, Louise C. Masse, Alarcos Cieza, Anne F. Klassen, Karen Sauve, Robert Armstrong, Maureen O’Donnell

Paediatrics and Child Health, East Africa

The goal of the International Classification of Functioning is to standardize the classification of health and function of children around the world. To facilitate the application of this classification, International Classification of Functioning-based tools like the "Core Sets" are being developed. We conducted an international survey of professional experts to identify the most relevant areas of functioning in children with cerebral palsy. The questionnaire covered each component of the classification. In total, 193 professionals completed the survey (response rate 78%). Overall, 9706 answers were linked to the classification (pediatric version) by 2 professionals. From the experts' perspective, movement-related areas and …

Immunization Manual For Medical And Nursing Students ''Hepatitis B Disease'', Rose Kamenwa

Paediatrics and Child Health, East Africa

Approximately 350 – 400 million people worldwide are chronically infected with the hepatitis B virus (HBV ), and approximately 1 million die annually of HBV -related disease. The worldwide prevalence of hepatitis B virus ranges from 0.1% to 20%). This wide range is largely due to differences in age at the time of infection. Following acute HBV infection, the risk of developing chronic infection varies inversely with age: 90% for perinatal infection, 25–35% for infection at age 1–5 years and less than 10% for adults. About 45% of the world population live in areas where chronic HBV is highly endemic …

Community Based Interventions For The Prevention And Control Of Tuberculosis, Ahmed Arshad, Rehana A. Salam, Zohra S. Lassi, Jai K. Das, Imama Naqvi, Zulfiqar A. Bhutta

Department of Paediatrics and Child Health

In 2012, an estimated 8.6 million people developed tuberculosis (TB) and 1.3 million died from the disease. With its recent resurgence with the human immunodeficiency virus (HIV); TB prevention and management has become further challenging. We systematically evaluated the effectiveness of community based interventions (CBI) for the prevention and treatment of TB and a total of 41 studies were identified for inclusion. Findings suggest that CBI for TB prevention and case detection showed significant increase in TB detection rates (RR: 3.1, 95% CI: 2.92, 3.28) with non-significant impact on TB incidence. CBI for treating patients with active TB showed an …

Culturable Aerobic And Facultative Anaerobic Intestinal Bacterial Flora Of Black Cobra (Naja Naja Karachiensis) In Southern Pakistan, Junaid Iqbal, Mehwish Sagheer, Nazneen Tabassum, Ruqaiyyah Siddiqui, Naveed Ahmed Khan

Department of Biological & Biomedical Sciences

Using morphological analysis and biochemical testing, here for the first time, we determined the culturable gut bacterial flora (aerobes and facultative anaerobes) in the venomous Black Cobra (Naja naja karachiensis) from South Asia. The findings revealed that these snakes inhabit potentially pathogenic bacteria including Serratia marcescens, Pseudomonas aeruginosa, Shewanella putrefaciens, Aeromonas hydrophila, Salmonella sp., Moraxella sp., Bacillus sp., Ochrobactrum anthropi, and Providencia rettgeri. These findings are of concern, as injury from snake bite can result in wound infections and tissue necrosis leading to sepsis/necrotizing fasciitis and/or expose consumers of snake meat/medicine in the community to infections.