Digital Commons Network^™

Genomic Diversity Of Epec Associated With Clinical Presentations Of Differing Severity, Tracy H. Hazen, Michael S. Donnenberg, Sandra Panchalingam, Martin Antonio, Anowar Hossain, Inacio Mandomando, John Benjamin Ochieng, Shahida Qureshi, Farheen Quadri, Anita K. M. Zaidi

Department of Paediatrics and Child Health

Enteropathogenic Escherichia coli (EPEC) are diarrhoeagenic E. coli, and are a significant cause of gastrointestinal illness among young children in developing countries. Typical EPEC are identified by the presence of the bundle-forming pilus encoded by a virulence plasmid, which has been linked to an increased severity of illness, while atypical EPEC lack this feature. Comparative genomics of 70 total EPEC from lethal (LI), non-lethal symptomatic (NSI) or asymptomatic (AI) cases of diarrhoeal illness in children enrolled in the Global Enteric Multicenter Study was used to investigate the genomic differences in EPEC isolates obtained from individuals with various clinical outcomes. A …

Simplified Paper Format For Detecting Hiv Drug Resistance In Clinical Specimens By Oligonucleotide Ligation, Nuttada Panpradist, Ingrid A. Beck, Michael Chung, James N. Kiarie, Lisa M. Frenkel, Barry R. Lutz

Internal Medicine, East Africa

Human immunodeficiency virus (HIV) is a chronic infection that can be managed by antiretroviral treatment (ART). However, periods of suboptimal viral suppression during lifelong ART can select for HIV drug resistant (DR) variants. Transmission of drug resistant virus can lessen or abrogate ART efficacy. Therefore, testing of individuals for drug resistance prior to initiation of treatment is recommended to ensure effective ART. Sensitive and inexpensive HIV genotyping methods are needed in low-resource settings where most HIV infections occur. The oligonucleotide ligation assay (OLA) is a sensitive point mutation assay for detection of drug resistance mutations in HIV pol. The current …

The Diagnostic Accuracy Of Determine™ Tb Lam Antigen In Detection Of Extra Pulmonary Tuberculosis (Eptb), Fatimah Osman Juma

Master of Medicine in Internal Medicine

Background: TB remains a key global health challenge; particularly Extra pulmonary Tuberculosis (EPTB) and is also a major cause of morbidity and mortality in sub-Saharan Africa. The increasing incidence of EPTB compounded by difficulties in making a timely diagnosis portends to poor prognosis and increased mortality. Delays in diagnosis and misdiagnosis of EPTB in suspected patients account for mortality as well. Challenges in diagnosis of EPTB are mainly due to disease related factors, the paucibacillary nature of disease and challenges with sample collection and processing. Reference standard test such as TB culture, geneXpert and histology which are used in the …

Effect Of Provision Of An Integrated Neonatal Survival Kit And Early Cognitive Stimulation Package By Community Health Workers On Developmental Outcomes Of Infants In Kwale County, Kenya: Study Protocol For A Cluster Randomized Trial, Lisa G. Pell, Diego G. Bassani, Lucy Nyaga, Isaac Njagi, Catherine Wanjiku, Thulasi Thiruchselvam, William Macharia, Ripudaman S. Minhas, Patricia Kitsao-Wekulo, Amyn Lakhani, Zulfiqar Ahmed Bhutta, Robert Armstrong, Shaun K. Morris

Paediatrics and Child Health, East Africa

Background: Each year, more than 200 million children under the age of 5 years, almost all in low- and middle-income countries (LMICs), fail to achieve their developmental potential. Risk factors for compromised development often coexist and include inadequate cognitive stimulation, poverty, nutritional deficiencies, infection and complications of being born low birthweight and/or premature. Moreover, many of these risk factors are closely associated with newborn morbidity and mortality. As compromised development has significant implications on human capital, inexpensive and scalable interventions are urgently needed to promote neurodevelopment and reduce risk factors for impaired development.

Method/Design: This cluster randomized trial aims at …

Setting Research Priorities To Improve Global Newborn Health And Prevent Stillbirths By 2025, Sachiyo Yoshida, José Martines, Peter Gisore, Joy E. Lawn, Stephen Wall, Joăo Paulo Souza

Paediatrics and Child Health, East Africa

Background: In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013–2025.

Methods: We used adapted Child …

A Lost Tribe In The City: Health Status And Needs Of African Asylum Seekers And Refugees In Hong Kong, William Chi Wai Wong, Sealing Cheng, Eleanor Holroyd, Julie Chen, Kelley Ann Loper, Lynn Tran, Heidi Yin Hai Miu

School of Nursing & Midwifery, East Africa

Background: Hong Kong’s resistance to be a signatory of the 1951 Geneva Convention and lack of domestic policies in this area has resulted in restrictions on access to healthcare amongst asylum seekers and refugees (ASRs). Using social determinants of health framework this study sought to identify health practices, problems and needs of African ASRs in Hong Kong.

Methods: A cross-sectional survey comprising of six domains including health status, health-seeking behaviour and social experience targeted at adult African ASRs in Hong Kong was conducted through three local non-governmental organisations between February and April 2013. Outpatient care and inpatient care in the …

Reference Intervals For Thyroid Stimulating Hormone And Free Thyroxine Derived From Neonates Undergoing Routine Screening For Congenital Hypothyroidism At A University Teaching Hospital In Nairobi, Kenya: A Cross Sectional Study, Geoffrey Omuse, Ali Kassim, Francis Kiigu, Syeda Hussain, Mary Limbe

Pathology, East Africa

Background: In order to accurately interpret neonatal thyroid function tests (TFTs), it is necessary to have population specific reference intervals (RIs) as there is significant variation across different populations possibly due to genetic, environmental or analytical issues. Despite the importance of RIs, globally there are very few publications on RIs for neonatal TFTs primarily due to ethical and technical issues surrounding recruitment of neonates for a prospective study. To the best of our knowledge, this is the first report from Africa on neonatal RIs for TFTs.

Methods: We used hospital based data largely derived from neonates attending the wellness clinic …

Flaviviruses As A Cause Of Undifferentiated Fever In Sindh Province, Pakistan: A Preliminary Report, Erum Khan, Joveria Q. Farooqi, Kelli L. Barr, Dhani Prakoso, Amna Nasir, Akbar Kanji, Sadia Shakoor, Faisal Riaz Malik, Rumina Hasan, John A. Lednicky

Department of Pathology and Laboratory Medicine

Arboviral diseases are expanding worldwide, yet global surveillance is often limited due to diplomatic and cultural barriers between nations. With human encroachment into new habitats, mosquito-borne viruses are also invading new areas. The actual prevalence of expanding arboviruses is unknown in Pakistan due to inappropriate diagnosis and poor testing for arboviral diseases. The primary objective of this study was to document evidence of flavivirus infections as the cause of undifferentiated fever in Pakistan. Through a cooperative effort between the USA and Pakistan, patient exposure to dengue virus (DENV), West Nile virus (WNV), and Japanese encephalitis virus (JEV) was examined in …

Evidence And Evidence Gaps In Adolescent Health, George Patton, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

The momentum to bring adolescents and young adults to center stage in global health and international development is palpable. Adolescents are increasingly seen as a crucial group for the success of the newly adopted Agenda for Sustainable Development [1]. Sitting within the Agenda for Sustainable Development framework, the 2030 Global Strategy for Women's, Children's and Adolescents' Health has extended the Every Woman, Every Child agenda to adolescence [2]. The strategy articulates the need for adolescent responsive health systems as well as social determinants, a focus that extends to legal and policy environments [3]. Countries seeking to adopt this more holistic …

Vitamin D Levels In Black African Adults At The Aga Khan University Hospital Nairobi, Elizabeth Muringa Kagotho

Master of Medicine in Clinical Pathology

Introduction: Vitamin D has been known for centuries for its benefits in bone health. Recent observational studies have however demonstrated its benefits in infectious diseases such as tuberculosis and non-communicable diseases such as diabetes mellitus, cardiovascular diseases and cancer. This has led to a dramatic increase in testing among adults. The cut-offs for vitamin D deficiency have been debated for decades and the current cut off is derived from a Caucasian population. Studies done among black African adults in Africa are few and have shown that vitamin D deficiency ranges from 5-91%. In view of the difference in skin colour, …

Supporting Healthy Futures For East Africa: Celebrating 15 Years Of Partnership In Nursing Education. School Of Nursing And Midwifery In East Africa, Aga Khan University, Nairobi, Kenya, Sharon Brownie, Walter Robb, Lyndal Hunter, Cliff Aliga, Isabel Kambo, Atem Machar, Joseph Mwizerwa, Judith Mutyabule, M. Namuguzi, Carolyne Namukwaya, Esther Nderitu, Leah Sande, Victor Skrzypczynski, Muneerah Vastani, Mariana Xavier

Books

This impact evaluation study was designed on the basis of quality and accountability. It focused on sourcing evidence regarding the impact and achievements of a 15-year investment in nursing education and workforce capacity building. The study was also designed to enhance alumni connection and establish sustainable models for monitoring and evaluation.

Frequency And Etiology Of Community-Acquired Bloodstream Infection In Hospitalized Febrile Children, Tufail Soomro, Shiyam Sunder Tikmani, Sumera Aziz Ali

Community Health Sciences

Background: Blood stream infection is a serious problem that needs immediate attention and treatment. We aim to identify the frequency of common organisms in blood culture of febrile pediatric patients so that empirical antibiotic therapy can be started timely.
Methods: This cross-sectional study was conducted in pediatric ward Civil Hospital Sukkur from 1st May 2013 to 31st October 2014. Children of both genders who are between the age of one month to 15 years admitted to the pediatric ward with a fever of > 38.0 c and with a history of fever ˃ two days and whose blood culture has been …

Primary Healthcare Policy Implementation In South Asia, Chris Van Weel, Ryuki Kassai, Waris Qidwai, Raman Kumar, Kanu Bala, Pramendra Prasad Gupta, Ruvaiz Haniffa Haniffa, Neelamani Rajapaksa Hewageegana, Thusara Ranasinghe, Michael Kidd, Amanda Howe

Department of Family Medicine

Primary healthcare is considered an essential feature of health systems to secure population health and contain costs of healthcare while universal health coverage forms a key to secure access to care. This paper is based on a workshop at the 2016 World Organization of Family Doctors (WONCA) South Asia regional conference, where the health systems of Bangladesh, India, Nepal, Pakistan and Sri Lanka were presented in relation to their provision of primary healthcare. The five countries have in recent years improved the health of their populations, but currently face the challenges of non-communicable diseases and ageing populations. Primary healthcare should …

Enteric Fever: A Slow Response To An Old Plague, Carlos Franco- Paredes, M. Imran Khan, Esteban Gonzalez- Diaz, Jose I. Santos- Preciado, Alfonso J. Rodriguez Morales, Eduardo Gotuzzo

Centre of Excellence in Women and Child Health

Man is irremediably embedded in nature with complex interactions with all living organisms. Historically, the establishment of contemporary human societies has been influenced by our coexistence with other microorganisms living in highly interconnected habitats and ecologies. As a result, with the progression from unicellular to multicellular life, bacteria have coexisted with humans. In this biological journey, while there are important benefits provided by bacterial guests to the human host living in complex relationships and becoming part of their microbiome, some organisms are able to cause a wide spectrum of diseases. Among the large Enterobacteriaceae family, the genus Salmonella, a …

Mycobacterium Tuberculosis Lineage 4 Comprises Globally Distributed And Geographically Restricted Sublineages, David Stucki, Daniela Brites, Leïla Jeljeli, Mireia Coscolla, Gunturu Revathi

Pathology, East Africa

Generalist and specialist species differ in the breadth of their ecological niches. Little is known about the niche width of obligate human pathogens. Here we analyzed a global collection of Mycobacterium tuberculosis lineage 4 clinical isolates, the most geographically widespread cause of human tuberculosis. We show that lineage 4 comprises globally distributed and geographically restricted sublineages, suggesting a distinction between generalists and specialists. Population genomic analyses showed that, whereas the majority of human T cell epitopes were conserved in all sublineages, the proportion of variable epitopes was higher in generalists. Our data further support a European origin for the most …

The Epidemiology Of Traumatic Event Exposure Worldwide: Results From The World Mental Health Survey Consortium, Corina Benjet, E Bromet, E G. Karam, R C. Kessler, K A. Mclaughlin, A M. Ruscio, V Shahly, D J. Stein, M Petukhova, E Hill, J Alonso, Lukoye Atwoli, B Bunting, R Bruffaerts, J M. Caldas-De-Almeida

Internal Medicine, East Africa

Background: Considerable research has documented that exposure to traumatic events has negative effects on physical and mental health. Much less research has examined the predictors of traumatic event exposure. Increased understanding of risk factors for exposure to traumatic events could be of considerable value in targeting preventive interventions and anticipating service needs.

Method: General population surveys in 24 countries with a combined sample of 68 894 adult respondents across six continents assessed exposure to 29 traumatic event types. Differences in prevalence were examined with cross-tabulations. Exploratory factor analysis was conducted to determine whether traumatic event types clustered into interpretable factors. …

Implementation Of Hiv Drug Resistance Testing In Kenya, Horacio Duarte, Ingrid Beck, James Munyao, Molly Levine, Catherine Kiptinness, Bhavna Chohan, Samah Sakr, Michael Chung, Lisa Frenkel

Internal Medicine, East Africa

Background: Testing for HIV drug resistance prior to antiretroviral therapy (ART) is standard of care in the United States but is rarely performed in Africa due to its high cost. The prevalence of HIV drug resistance is increasing in resource-limited settings (RLS). An affordable and feasible strategy is needed in RLS to identify individuals with drug resistance and prescribe effective ART. Our group developed a low-cost oligonucleotide ligation assay (OLA) that detects mutations conferring resistance. Little data exists on implementing HIV drug resistance testing in RLS. Here, we describe the implementation of OLA in one laboratory in Kenya and discuss …

A Case Of Refractory Thrombotic Thrombocytopenic Purpura Treated With Plasmapheresis And Rituximab, Nicholas Kirui, Ahmed Sokwala

Internal Medicine, East Africa

Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening disorder with no prevalence or incidence studies in sub-Saharan Africa. Acquired TTP has several causes, all of which lead to decreased activity of von Willebrand factor cleaving protease (ADAMTS13) due to autoantibodies that are directed towards ADAMTS13. We report a case of a 46-year-old man who presented with most of the classic clinical manifestations of TTP.

Short Communication: Analysis Of Minor Populations Of Human Immunodeficiency Virus By Primer Identification And Insertion-Deletion And Carry Forward Correction Pipelines, Paul Hughes, Wenjie Deng, Scott C. Olson, Robert W. Coombs, Michael Chung, Lisa M. Frenkel

Internal Medicine, East Africa

Accurate analysis of minor populations of drug-resistant HIV requires analysis of a sufficient number of viral templates. We assessed the effect of experimental conditions on the analysis of HIV pol 454 pyrosequences generated from plasma using (1) the ‘‘Insertion-deletion (indel) and Carry Forward Correction’’ (ICC) pipeline, which clusters sequence reads using a nonsubstitution approach and can correct for indels and carry forward errors, and (2) the ‘‘Primer Identification (ID)’’ method, which facilitates construction of a consensus sequence to correct for sequencing errors and allelic skewing. The Primer ID and ICC methods produced similar estimates of viral diversity, but differed in …

Department Of Community Health Sciences Medical College (Report 2009 - 2016), Department Of Community Health Sciences, Medical College

Department of Community Health Sciences Archives

This report comprehensively documents the academic, research, and service accomplishments of the Department of Community Health Sciences (CHS) at the Aga Khan University from 2009 to 2016. It highlights the department’s mission to strengthen public health education and systems through innovative programs, strategic partnerships, and impactful research. Topics covered include CHS faculty profiles, educational programs, strategic initiatives, community outreach, grant-funded projects, and the vision for establishing a School of Public Health.

Childhood Obesity, A Public Health Crisis: Narrative Review Of Public Health Interventions For Childhood Obesity, Sumera Aziz Ali, Savera Aziz Ali, Nadir Suhail, Shiyam Sunder Tikmani, Gulshan Bano

Community Health Sciences

Introduction: Child obesity is the major pediatric public health crisis of the current century and its trend is increasing in the developing countries due to nutrition and epidemiologic transition. Considering the burden of childhood obesity and its associated outcomes need for obesity prevention in children has become priority both for government and researchers.
Objective: The objective of this review is to provide the updated knowledge and evidence from various research studies, designed to provide interventions either in school or at home.
Methodology: Electronic databases like Google scholar, PubMed and Sciencedirect were used as search engines. Key terms used during the …

Effect Of Mobile Phone Text Messages Reminders On Uptake Of Routine Immunization Among Children In Pakistan- Study Protocol For A Randomized Clinical Trial, Abdul Momin Kazi, Murtaza Ali, Khurram Zubair, Hussain Kalimuddin, Syed Asad Ali

Department of Paediatrics and Child Health

Introduction: Routine Immunization (RI) is considered one of the best public health interventions to decrease child morbidity and mortality. The RI coverage in Pakistan is still well below the desired level, leading to continued polio transmission, large measles outbreaks and thousands of deaths from vaccine-preventable illnesses. Different innovative and cost effective strategies are required to look into for enhancement in vaccination uptake and coverage. We plan to test the effectiveness of reminders to parents/caregivers on cell phones through short messaging system (SMS) in improving vaccine uptake and on-time routine immunization for children in Pakistan.
Methods and Analysis: A parallel-randomized controlled …

Naegleria Fowleri Meningoencephalitis Associated With Public Water Supply, Pakistan, 2014, Najia Ghanchi, Erum Khan, Azam Khan, Wali Muhammad, Faisal Riaz Malik, Afia Zafar

Department of Pathology and Laboratory Medicine

No abstract provided.

The Pediatric Disease Spectrum In Emergency Departments Across Pakistan: Data From A Pilot Surveillance System, Huba Atiq, Emaduddin Siddiqui, Surraya Bano, Asher Feroze, Sayyeda Ghazala Kazi, Jabeen Fayyaz, Shivam Gupta, Junaid A. Razzak, Adnan A Hyder, Asad Mian

Department of Emergency Medicine

Background: There is an increasing number of urgently ill and injured children being seen in emergency departments (ED) of developing countries. The pediatric disease burden in EDs across Pakistan is generally unknown. Our main objective was to determine the spectrum of disease and injury among children seen in EDs in Pakistan through a nationwide ED-based surveillance system.
Methods: Through the Pakistan National Emergency Department Surveillance (Pak-NEDS), data were collected from November 2010 to March 2011 in seven major tertiary care centers representing all provinces of Pakistan. These included five public and two private hospitals, with a collective annual census of …

Validity Of Brighton Criteria In The Diagnosis Of Guillain–Barré Syndrome (Gbs) In Pakistan, Safia Bano, Ahsan Numan, Abubakar Siddique

Pakistan Journal of Neurological Sciences (PJNS)

Guillain–Barré syndrome (GBS) case definitions have been developed in recent past for its quick diagnosis. However, they have not been adopted worldwide especially in developing countries like Pakistan. In this study, we validated the sensitivity of Brighton working group case definitions for GBS at Services Hospital Lahore. Methods: A total of 30 cases of GBS with available clinical history, neurological examination,cerebrospinal fluid(CSF) and nerve conduction studies (NCS) results, and exclusion of related diagnoses were selected (2014–2015). Sensitivity of the Brighton criteria for GBS for level 3 of diagnostic certainty which requires no clinical laboratory testing, level 2 which employs CSF …

Are Pre-School Girls More Likely To Be Under-Nourished In Rural Thatta, Pakistan?-A Cross-Sectional Study., Rozina Nuruddin, Wilbur C. Hadden

Community Health Sciences

BACKGROUND:

Pakistan ranks third lowest on a global gender index (2013) and 13(th) highest on the prevalence of underweight among under-five children (2010). Through this population-based study, we examined gender differentials in the prevalence of stunting, wasting and under-weight defined by World Health Organization (WHO) Growth Standard among rural pre-school Pakistani children.

METHODS:

We performed secondary analysis of data collected through a cross-sectional survey of Thatta district during 1992-93. Prevalence ratios were calculated for 1051 children aged 0-35 months from 95 randomly selected villages of rural Pakistan using a clustered adjusted log binomial model. Level 1 variables included child and …

Systematic Review Of The Global Epidemiology, Clinical And Laboratory Profile Of Enteric Fever, Asma Azmatullah, Farah Naz Qamar, Durrane Thaver, Anita Km Zaidi, Zulfiqar A. Bhutta

Department of Paediatrics and Child Health

Background: Children suffer the highest burden of enteric fever among populations in South Asian countries. The clinical features are non-specific, vary in populations, and are often difficult to distinguish clinically from other febrile illnesses, leading to delayed or inappropriate diagnosis and treatment. We undertook a systematic review to assess the clinical profile and laboratory features of enteric fever across age groups, economic regions, level of care and antibiotic susceptibility patterns.
Methods: We searched PubMed (January 1964-December 2013) for studies describing clinical features in defined cohorts of patients over varying time periods. Studies with all culture-confirmed cases or those with at …

Mode Of Delivery And Risk Of Asthma In Children 5-14 Years Old In Tabriz, Iran, Roya Sahebi, Leyla Sahebi, Amir Hossein Jafari-Rouhi, Ahmad Jafari-Javid, Stanley Luchters, Chad Hughes

Population Health, East Africa

Introduction: It has been suggested that a cesarean section increases risk of developing asthma due to lack of exposure to maternal microflora during birth. To investigate the association between the mode of delivery and the risk of asthma in children aged 5-14 years in Tabriz, Iran.

Methods: A case-control study was performed on 233 (case = 81, control = 152) children aged 5-14 years referred to outpatient clinics of Tabriz Children’s Hospital and Sheikhorrais Clinic in 2014. Clinical asthma diagnosis was done according to Global Initiative for Asthma Criteria. A questionnaire was administered to obtain a demographic, environmental, and clinical …

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

Community Health Sciences

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 …

Anemia In A Middle Aged Female With Aortitis: A Case Report., Shabneez Hussain, Salman Naseem Adil, Shahid Ahmed Sami

Department of Surgery Docs

Abstract

BACKGROUND:

Idiopathic aortitis is among the most common causes of non-infectious aortitis, which rarely presents with anemia.

CASE PRESENTATION:

Here we report a case of a 49-year-old muhajir female who presented with shortness of breath and easy fatigability for the past 6 months. Physical examination revealed pallor and a diastolic murmur in the aortic region. Echocardiography showed thickened and calcified aortic and mitral valves, severe aortic regurgitation and dilatation of ascending aorta. She was advised aortic valve replacement and was referred to a haematologist due to concomitant anemia. Complete blood counts revealed haemoglobin: 7.7 gm/dl, mean corpuscular volume (MCV): …