Digital Commons Network^™

Building Up A Genomic Surveillance Platform For Sars-Cov-2 In The Middle Of A Pandemic: A True North-South Collaboration, Waqasuddin Khan, Furqan Kabir, Samiah Kanwar, Fatima Aziz, Sahrish Muneer, Adil Kalam, Mehdia Ali, Nadia Ansari, Fyezah Jehan, Muhammad Imran Nisar

Department of Paediatrics and Child Health

Next-generation sequencing technology has revolutionised pathogen surveillance over the last two decades. However, the benefits are not equitably distributed, with developing countries lagging far behind in acquiring the required technology and analytical capacity. Recent declines in the cost associated with sequencing-equipment and running consumables have created an opportunity for broader adoption. During the COVID-19 pandemic, rapid diagnostics development and DNA sequencing revolutionised the ability to diagnose and sequence SARS-CoV-2 rapidly. Socioeconomic inequalities substantially impact the ability to sequence SARS-CoV-2 strains and undermine a developing country's pandemic preparedness. Low- and middle-income countries face additional challenges in establishing, maintaining and expanding genomic …

Antimicrobial Resistance And Rational Prescription Practices: Knowledge, Perceptions And Confidence Of Health Profession Interns In Uganda, Shamim Nabidda, Rogers Ssennyonjo, Joseph Atwaru, Andrew Marvin Kanyike, Shiellah Baryayaka, Kennedy Pangholi, Jonans Tusiimire

School of Nursing & Midwifery, East Africa

Background

Antimicrobial resistance (AMR) is significantly driven by misuse and overuse of antibiotics. Graduate health profession interns often prescribe antimicrobials under minimum supervision.

Objectives

This study explored the knowledge, perceptions and confidence of health profession interns in Uganda regarding AMR and rational prescription practices.

Methods

This was a cross-sectional survey employing quantitative techniques carried out between October and November 2022 at six tertiary hospitals in Uganda. Health profession interns including doctors, nurses, midwives and pharmacists were recruited as study participants. Data were collected using online Kobo toolbox software. Data analysis was performed using STATA (StataCorp) version 16. Bivariate analysis and …

Quality & Patient Safety Gazette : Volume 2, Issue 3 - 2023, The Aga Khan University Hospital, Karachi

Quality and Patient Safety Archives

• Safe Care Certification-Garden and Kharadar
• Workshop on Developing and Monitoring Clinical Practice Guide-Pathways/Protocols
• JCIA Made Easy Video Series-Prevention & Control of Infection (PCI) Standards on Finger Tips
• JCI Standards for Clinical Care Program Certification (CCPC)
• Blast from the Past
• Learn with Fun!
• Stay Tuned with Us…..

Reducing The Rate Of Central Line-Associated Bloodstream Infections; A Quality Improvement Project, David Odada, Hellen Munyi, Japhet Gatuiku, Ruth Thuku, Jared Nyandigisi, Anne Wangui, Emilie Ashihundu, Beatrice Nyakiringa, Jemimah Kimeu, Martin Musumbi, Rodney Adam

Internal Medicine, East Africa

Background The burden of central line-associated bloodstream infections is significant and has negative implications for healthcare, increasing morbidity and mortality risks, increasing inpatient hospital stays, and increasing the cost of hospitalization. Efforts to reduce the incidence of central line-associated bloodstream infections have utilized quality improvement projects that implement, measure, and monitor outcomes. However, variations in location, healthcare organization, patient risks, and practice gaps are key to the success of interventions and approaches. This study aims to evaluate interventions of a quality improvement project on the reduction of central line-associated bloodstream infection rates at a university teaching hospital.

Methods This was …

P16 Expression And Recurrent Cervical Intraepithelial Neoplasia After Cryotherapy Among Women Living With Hiv, Daniel Maina, Michael H. Chung, Marleen Temmerman, Zahir Moloo, Jonathan Wawire, Sharon A. Greene, Elizabeth Unger, Shahin Sayed, Samah Sakr, Nelly Mugo

Pathology, East Africa

Background: The expression of p16 protein, a surrogate marker for high-risk human papillomavirus (hrHPV), is associated with cervical dysplasia. We evaluated correlates of p16 expression at treatment for high-grade cervical lesions and its utility in predicting the recurrence of cervical intraepithelial lesions grade 2 or higher (CIN2+) following cryotherapy among women with HIV.

Methods: This is a subgroup analysis of women with HIV in Kenya with baseline cervical biopsy-confirmed CIN2+ who were randomized to receive cryotherapy and followed every six-months for two-years for biopsy-confirmed recurrence of CIN2+. P16 immunohistochemistry was performed on the baseline cervical biopsy with a positive result …

Renin As A Biomarker Of Acute Kidney Injury And Mortality In Children With Severe Malaria Or Sickle Cell Disease, Daniel Adan, Anthony Batte, Ruth Namazzi, Ivan Mufumba, Caroline Kazinga, Kagan Mellencamp, Caitlin Bond, Robert Opoka, Chandy John, Andrea Conroy

Paediatrics and Child Health, East Africa

Background: Globally, a very high percentage of acute kidney injury (AKI) occurs in low- and middle-income countries (LMICs) where late recognition contributes to increased mortality. There are challenges with using existing biomarkers of AKI in LMICs. Emerging evidence suggests renin may serve as a biomarker of kidney injury that can overcome limitations in creatinine-based diagnostics.

Methods: Two study populations in Uganda were assessed. Cohort #1 was a two-site, prospective cohort study enrolling 600 children with severe malaria (SM). Cohort #2 was a prospective cohort study enrolling 185 children with sickle cell disease (SCD) hospitalized with a vaso-occlusive crisis. Plasma or …

Outpatient Management Of Urinary Tract Infections By Medical Officers In Nairobi, Kenya: Lack Of Benefit From Audit And Feedback On Adherence To Treatment Guidelines, Florence Mbatia, James Orwa, Mary B. Adam, Gulnaz Mohamoud, Rodney Adam

Family Medicine, East Africa

Introduction: Acute uncomplicated urinary tract infections are common in outpatient settings but are not treated optimally. Few studies of the outpatient use of antibiotics for specifc diagnoses have been done in sub-Saharan Africa, so little is known about the prescribing patterns of medical ofcers in the region.

Methods: Aga Khan University has 16 outpatient clinics throughout the Nairobi metro area with a medical ofcer specifcally assigned to that clinic. A baseline assessment of evaluation and treatment of suspected UTI was performed from medical records in these clinics. Then the medical ofcer from each of the 16 clinics was recruited from …

Research Nexus : Volume 5 - 2023, Office Of Research And Graduate Studies

Office of Research and Graduate Studies

• Researcher Spotlight: Dr Sajid Soofi, CoE-WCH
• Research Office Launches Pure: Revolutionizing Research Grant Management
• AKU ISMC Achieves UKRI Accreditation: Opening New Doors for Research
• Student Research Forum Unites AKU and UBC for Climate Change Study
• LevelUp: Elevating Research Administration and Grants Management Skills

Clinic Bulletin H1 - 2023, Outpatient Services

AKUH Outpatient Services Archives

• Special Message Series
• Clinic Statistics
• New Doctors
• Health Hub
• Connect, Compete, And Conquer
• Corporate Engagements
• Sparkling Festivities
• Stay Tuned

Perceptions And Experiences Of Nursing Students And Faculty Members Regarding Implementation Of The Bs-Nursing Program, Abdul Karim, Yasmin Amarsi, Yasmin Parpio, Laila Akber Cassum, Munira Amirali, Shakir Rehman

School of Nursing & Midwifery

Objective: To explore the perceptions and experiences of nursing students and faculty members regarding the implementation of the baccalaureate nursing programme in public-sector setting.
Methods: The descriptive, exploratory, qualitative study was conducted at the Khyber Medical University, Peshawar, Pakistan, from April 15, 2020 to April 15, 2021, and comprised undergraduate nursing students and faculty members. Because of the coronavirus disease-2019 pandemic, the subjects were interviewed through telephonic call using a semi-structured interview guide. Data was analysed using the Creswell's analysis approach.
Results: Of the 15 subjects, 10(66.6%) were students aged 21-24 years; 7(70%) males and 3(30%) females. The remaining 5(33.3%) …

Inspire : Vol 6, Issue 9, Department Of Medicine

INSPIRE – Department of Medicine Archives

• Message from the Chair
• Medicine at National and International Forums Dermatology & the Journey of Education
• Risk Management training
• Nuts and Bolts of Research Administration training research program
• Pitfalls of Harmful Cosmetics and Skincare Trends
• In-depth- featuring Dr Zeba Rasmussen | Visiting Faculty By Zahrah Rahmatullah & Shahnoor Ahmed
• Featured Faculty | Dr Nashiz Inayet | Gastroenterology Section “…everyday, life brings its own challenges and with every challenge, an opportunity
• What Academics Are Reading?
• Poem

Ultrastructure For The Diagnosis Of Primary Ciliary Dyskinesia In South Africa, A Resource-Limited Setting, Monica Birkhead, Samuel Otido, Theodore Mabaso, Keketso Mopeli, Dorcas Tlhapi, Charl Verwey, Ziyaad Dangor

Paediatrics and Child Health, East Africa

Introduction: International guidelines recommend a multi-faceted approach for successful diagnoses of primary ciliary dyskinesia (PCD). In the absence of a gold standard test, a combination of genetic testing/microscopic analysis of structure and function/nasal nitric oxide measurement is used. In resourcelimited settings, often none of the above tests are available, and in South Africa, only transmission electron microscopy (TEM) is available in central anatomical pathology departments. The aim of this study was to describe the clinical and ultrastructural findings of suspected PCD cases managed by pediatric pulmonologists at a tertiary-level state funded hospital in Johannesburg.

Methods: Nasal brushings were …

Role Of Hospital Leadership In Pandemic Preparedness: Experience At A Tertiary Hospital In Kenya During The Covid-19 Pandemic, Lucy Mwangi, William Macharia, Benjamin Wachira, Jemimah Kimeu, Boniface Mativa, Lukoye Atwoli

Paediatrics and Child Health, East Africa

Introduction: Pandemic preparedness refers to being ready for, responding to and recovering from public health crises, and is integral for health security. Hospital leadership is a critical building block of an effective healthcare system, providing policy, accountability and stewardship in a health crisis.

Objectives and methods: We aimed to describe the leadership and governance structures put in place at the Aga Khan University Hospital, Nairobi, a private not-forprofit tertiary healthcare facility, following the COVID-19 pandemic. We reviewed over 200 hospital documents archived in the COVID-19 repository including those received from the Kenya Ministry of Health, emails, memos, bulletins, meeting minutes, …

Who O2cov2: Oxygen Requirements And Respiratory Support In Patients With Covid-19 In Low-And-Middle Income Countries—Protocol For A Multicountry, Prospective, Observational Cohort Study, Pryanka Relan, Srinivas Murthy, John Marshall, Djillali Annane, Sylvie Chevret, Yaseen Arabi, Wangari Siika, Sara Dominguez Rodriguez, Pauline Convocar, Janet Diaz

Anaesthesiology, East Africa

Introduction: SARS-CoV-2 has been identified as the cause of the disease officially named COVID-19, primarily a respiratory illness. COVID-19 was characterised as a pandemic on 11 March 2020. It has been estimated that approximately 20% of people with COVID-19 require oxygen therapy. Oxygen has been listed on the WHO Model List of Essential Medicines List and Essential Medicines List for Children for almost two decades. The COVID-19 pandemic has highlighted, more than ever, the acute need for scale-up of oxygen therapy. Detailed data on the use of oxygen therapy in low-and-middle income countries at the patient and facility level are …

Development, Roll-Out And Implementation Of An Antimicrobial Resistance Training Curriculum Harmonizes Delivery Of In-Service Training To Healthcare Workers In Kenya, Josiah Njeru, Joshua Odero, Sheilla Chebore, Mungai Ndung’U, Emmanuel Tanui, Evelyn Wesangula, Romona Ndanyi, Susan Githii, R Gunturu, Willy Mwangi

Pathology, East Africa

Background: Antimicrobial resistance (AMR) is an increasingly severe threat to global public health that requires action across different sectors. Selection of appropriate antimicrobials is an urgent challenge due to the emergence of drug resistance. In 2017, Kenya developed an AMR policy and National Action Plan to drive prevention and containment of AMR. A priority activity under AMR surveillance strategic objective was to develop a national AMR training curriculum for in-service healthcare workers. In this paper we discuss the development process, gains achieved through implementation across the country and lessons learned.

Methods: An initial stakeholders’ forum was convened to …

Community Centred Co-Design Methodology For Designing And Implementing Socio-Behavioural Interventions To Counter Covid-19 Related Misinformation Among Marginalized Population Living In The Squatter Settlements Of Karachi, Pakistan: A Methodology Paper, Rubina Qasim, Waqas Ahmed Farooqui, Atiya Rahman, Rukhsana Haroon, Madiha Saleem, Muhammad Rafique, Fiza Noor, Afifa Ghani, Muhammad Yaqoob, Mohammad Tahir Yousafzai

Community Health Sciences

Background: Misinformation regarding COVID-19 pandemic and vaccination is damaging COVID-19 vaccine trust and acceptance in Low- and Middle-Income Countries (LMIC). Identification of misinformation and designing locally acceptable solutions are needed to improve COVID-19 vaccine acceptance. This study aimed to utilize community-led co-design methodology to evaluate misinformation regarding COVID-19 and develop contextual interventions to address misinformation in a marginalized peri urban slum communities of Landhi town Karachi, Pakistan.
Methods: This study was conducted between January and December 2021, in marginalized peri-urban slum dwellers of Muslimabad Colony, Landhi Town Karachi, Pakistan. We used a community-centred co-design methodology embedded within mixed study design …

Inspire : Vol 6, Issue 7, Department Of Medicine

INSPIRE – Department of Medicine Archives

• Message from the Chair
• Medicine at National and International Forums
• Centre for Impact | Way forward
• 3rd European Congress of Clinical Microbiology & Infectious Diseases (ECCMID)
• 60th annual European Renal Association (ERA) Congress
• CPSP Provincial Faculty Member
• Smoking cessation skills building workshop
• World No-Tobacco Day
• Employee of the Month - Shahzad Vasaya
• Featured Faculty – Dr Sana Sheikh– Faculty member – Data Science Team
• Poem Section
• What Academics are Reading?
• Publications

Pregnancy-Related Mortality Up To 1 Year Postpartum In Sub-Saharan Africa: An Analysis Of Verbal Autopsy Data From Six Countries, Ursula Gazeley, Georges Reniers, Julio E. Romero- Prieto, Clara Calvert, Momodou Jasseh, Kobus Herbst, Sammy Khagayi, David Obor, Daniel Kwaro, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Objective: To compare the causes of death for women who died during pregnancy and within the first 42 days postpartum with those of women who died between >42 days and within 1 year postpartum.

Design: Open population cohort (Health and Demographic Surveillance Systems).

Setting: Ten Health and Demographic Surveillance Systems (HDSS) in The Gambia, Kenya, Malawi, Tanzania, Ethiopia and South Africa.

Population: 2114 deaths which occurred within 1 year of the end of pregnancy where a verbal autopsy interview was conducted from 2000 to 2019.

Methods: InterVA5 and InSilicoVA verbal autopsy algorithms were used to at-tribute the most likely underlying …

A Peculiar Case Of Dengue Hemorrhagic Fever: A Case Report Of Radical Outcomes: A Case Study, Neelam Ubaid-Ur-Raheem

Journal of Asian Midwives (JAM)

Dengue is the arthropod-borne flavivirus infection, its severity increases during pregnancy, and results in worst maternofetal outcomes, which is an alarming issue. Dengue fever (DF) is the most common cause for preterm delivery and abortion. Dengue-related thrombocytopenia increases the risk of bleeding during pregnancy and delivery and can also leads to high maternal mortality rates. Globally 3.9 billion people are at risk of dengue fever, especially in Asia.
This case study focuses on a 22-years old pregnant woman from Pakistan without known co-morbidities. She presented in an emergency department with high fever, nausea, vomiting, and bleeding gum. She was positive …

Healthy Eating And Physical Activity: Analysing Soweto’S Young Adults’ Perspectives With An Intersectionality Lens, Gudani Mukoma, Edna Bosire, Sonja Klingberg, Shane A. Norris

Brain and Mind Institute

Background and objectives: Non-communicable diseases (NCDs) are taking a toll on Africa’s youth at younger ages than in other regions. These are attributed to risk factors that usually advance in adolescence, such as unhealthy diets and reduced physical activity. Young adults in South Africa, particularly women, tend to be sedentary, consume energy-dense diets low in micronutrients, and are more likely to develop NCDs much earlier in life than those in high-income countries. With an intersectionality perspective, this study explored young adults’ barriers and solutions to addressing these risk factors in Soweto.

Setting: Soweto, Johannesburg, South Africa, is one …

Chronic Hepatitis B, C, And Stroke; Association And Pathophysiology, Hamza Imran, Adnan Yousuf, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Background and Objectives:

Hepatitis infection may raise the incidence of stroke and other cerebrovascular abnormalities, according to several studies. However, its association is controversial. This review looked to compile the most recent research on the relationship between HBV and HCV, atherosclerosis, and stroke.

Methods:This article reviews the literature on the connection between hepatitis B and C viruses with stroke and atherosclerosis. The search included articles from PubMed, PakMediNet, and Google Scholar, as well as a Medline search using specific keywords and MeSH terms. A total of 2655 articles were identified. Out of these 2655 articles we identified 134 articles …

Mosquito Bed Net Use And Associated Factors Among Pregnant Women In Rwanda: A Nationwide Survey, Joseph Kawuki, Elorm Donkor, Lilian Nuwabaine, Ghislaine Gatasi

School of Nursing & Midwifery, East Africa

Background

In malaria-endemic countries such as Rwanda, the appropriate use of mosquito bed nets is an effective intervention for malaria prevention. Despite being one of the demographics most impacted by malaria, there is a dearth of literature on the usage of mosquito bed nets by pregnant women in Rwanda. The study aimed to assess the prevalence and associated factors for mosquito bed net use among pregnant women in Rwanda

Methods

We used weighted data from the 2020 Rwanda Demographic and Health Survey of 870 pregnant women, and multistage stratified sampling was used to select participants. Multivariable logistic regression was conducted …

The Factors Associated With Caesarean Section At A Rural Hospital In Southwestern Uganda: A Cross-Sectional Study, Lilian Nuwabaine, Mathius Amperiize, Patience Annet Nakalega

School of Nursing & Midwifery, East Africa

Background

Globally, the overall prevalence of caesarean section (CS) is estimated at 18.6%, with 27% in high-income countries and 6% in low- and middle-income countries. There is an increase in trends of CS in Uganda from 8.5% in 2012 to 11% in 2016. No studies have been carried out to account for the high rates of CS at Kisiizi Hospital in Uganda. This study determined the proportion and factors associated with CS delivery at a rural hospital in southwestern Uganda.

Methods

This was a cross-sectional study of 321 immediate postnatal women in a rural hospital in southwestern Uganda. A structured …

A Review Of The Current State Of Global Surgical Oncology And The Role Of Surgeons Who Treat Cancer: Our Profession’S Imperative To Act Upon A Worldwide Crisis In Evolution, Aaron C. Saunders, Miriam Mutebi, T. Subramanyeshwar Rao

General Surgery, East Africa

Worldwide, the capacity of healthcare systems and physician workforce is woefully inadequate for the surgical treatment of cancer. With major projected increases in the global burden of neoplastic disease, this inadequacy is expected to worsen, and interventions to increase the workforce of surgeons who treat cancer and strengthen the necessary supporting infrastructure, equipment, staffing, financial and information systems are urgently called for to prevent this inadequacy from deepening. These efforts must also occur in the context of broader healthcare systems strengthening and cancer control plans, including prevention, screening, early detection, safe and effective treatment, surveillance, and palliation. The cost of …

Association Of Plasma Afatoxin With Persistent Detection Of Oncogenic Human Papillomaviruses In Cervical Samples From Kenyan Women Enrolled In A Longitudinal Study, Yan Tong, Philip Tonui, Elkanah Orang'o, Jianjun Zhang, Titus Maina, Kapten Muthoka, John Groopman, Joshua Smith, Erin Madeen, Aaron Ermel

Obstetrics and Gynaecology, East Africa

Background: Cervical cancer is caused by oncogenic human papillomaviruses (HR-HPV) and is common among Kenyan women. Identifcation of factors that increase HR-HPV persistence is critically important. Kenyan women exposed to afatoxin have an increased risk of HR-HPV detection in cervical specimens. This analysis was performed to examine associations between afatoxin and HR-HPV persistence.

Methods: Kenyan women were enrolled in a prospective study. The analytical cohort for this analysis included 67 HIVuninfected women (mean age 34 years) who completed at least two of three annual study visits and had an available blood sample. Plasma afatoxin was detected using ultra-high pressure liquid …

The Ethical And Validity Conundrum In Epilepsy Research In Lmic Settings, Pauline Samia, Adeel Shah, Archana Patel, Philip Olielo, Lionel Mudave, Samson Gwer

Paediatrics and Child Health, East Africa

In the last few decades, research in epilepsy has significantly improved understanding of risk factors and etiologies associated with epilepsy, promoting greater access to interventions and medications that have improved health-related outcomes for patients. However, these advances and benefits are not being felt evenly on a global scale due to significant inequalities in access to and utilization of research resources and expertise in Low-and Middle-Income Countries (LMICs).

To promote effective research output, and advance evidence-based practices; the context, disease burden, and challenges that hinder good research need to be re-defined and addressed. This is key in facilitating implementation of coherent …

Harnessing Technology And Innovation To Address Emerging Issues: Covid-19 Opportunities And Challenges, Mercy Igoki, Jackson Langat

Institute for Educational Development, East Africa

This study explores the opportunities and challenges presented through harnessing technology and innovation to address COVID-19 as an emerging issue in higher education institutions in Kenya. COVID-19 pandemic has presented unprecedented challenges to higher education institutions in sub-Saharan Africa, specifically in Kenya. The pandemic forced institutions to migrate to online learning, impacting the quality of education, enrollment rates, and mental health challenges students face. The study used a mixed-methods approach, incorporating secondary sources of information and primary data from experts such as Ministry of Education officials, university management, students' counsellors, and teaching staff from Kenyan universities. It focused on teaching …

Cerebrospinal Fluid Biomarkers Provide Evidence For Kidney-Brain Axis Involvement In Cerebral Malaria Pathogenesis, Andrea L. Conroy, Dibyadyuti Datta, Robert Opoka, Anthony Batte, Paul Bangirana, Adnan Gopinadhan, Kagan A. Mellencamp, Ayse Akcan-Arikan, Richard Idro, Chandy C. John

Paediatrics and Child Health, East Africa

Introduction: Cerebral malaria is one of the most severe manifestations of malaria and is a leading cause of acquired neurodisability in African children. Recent studies suggest acute kidney injury (AKI) is a risk factor for brain injury in cerebral malaria. The present study evaluates potential mechanisms of brain injury in cerebral malaria by evaluating changes in cerebrospinal fluid measures of brain injury with respect to severe malaria complications. Specifically, we attempt to delineate mechanisms of injury focusing on blood-brain-barrier integrity and acute metabolic changes that may underlie kidney-brain crosstalk in severe malaria.

Methods: We evaluated 30 cerebrospinal fluid (CSF) markers …

Dengue Virus And Blood Safety: A Mini-Review Of Research Publications, Festus Mulakoli, George Gachara, Eric Ndombi, Samoel Khamadi

School of Nursing & Midwifery, East Africa

The growing demand for donated whole blood and blood products to save lives has both health benefits and health risks for blood recipients at the same time. Dengue virus, a re-emerging viral disease poses a threat to blood safety, and it has spread to over 128 countries in the world. Several studies have documented transfusion-transmitted (TT) dengue, with the first cases being reported in China in 2002 and Singapore in 2008. To understand the magnitude and broader picture of the dengue virus and blood safety, we conducted a mini-review of published literature from the Scopus database. The review focused on …

The Ethical And Validity Conundrum In Epilepsy Research In Lmic Settings, Pauline Samia, Adeel Shah, Archana Patel, Philip Olielo, Lionel Mudave, Samson Gwer

Brain and Mind Institute

In the last few decades, research in epilepsy has significantly improved understanding of risk factors and etiologies associated with epilepsy, promoting greater access to interventions and medications that have improved health-related outcomes for patients. However, these advances and benefits are not being felt evenly on a global scale due to significant inequalities in access to and utilization of research resources and expertise in Low-and Middle-Income Countries (LMICs).

To promote effective research output, and advance evidence-based practices; the context, disease burden, and challenges that hinder good research need to be re-defined and addressed. This is key in facilitating implementation of coherent …