Digital Commons Network^™

International Consortium On Mammographic Density: Methodology And Population Diversity Captured Across 22 Countries, Valerie A. Mccormacka, Anya Burton, Isabel Dos-Santos-Silva, John H. Hipwell, Caroline Dickens, Dorria Salem, Rasha Kama, Mikael Hartman, Charmaine Pei Ling Lee, Kee-Seng Chia, Vahit Ozmen, Mustafa Erkin Aribal, Anath Arzee Flugelman, Martín Lajous, Ruy Lopez-Riduara, Megan Rice, Isabelle Romieu, Giske Ursin, Samera Qureshi, Huiyan Ma, Eunjung Lee, Carla H. Van Gils, Johanna O.P. Wanders, Sudhir Vinayak, Rose Ndumia, Steve Allen, Sarah Vinnicombe, Sue Moss, Jong Won Lee, Jisun Kim, Ana Pereira, Maria Luisa Garmendia, Reza Sirous, Mehri Sirous, Beata Peplonska, Agnieszka Bukowska, Rulla M. Tamimi, Kimberly Bertrand, Chisato Nagata, Ava Kwong, Celine Vachon, Christopher Scott, Beatriz Perez-Gomez, Marina Pollan, Gertraud Maskarinec, Graham Giles, John Hopper, Jennifer Stone, Nadia Rajaram, Soo-Hwang Teo, Shivaani Mariapun, Martin J. Yaffe, Joachim Schüz, Anna M. Chiarelli, Linda Linton, Norman F. Boyd

Imaging & Diagnostic Radiology, East Africa

Mammographic density (MD) is a quantitative trait, measurable in all women, and is among the strongest markers of breast cancer risk. The population-based epidemiology of MD has revealed genetic, lifestyle and societal/environmental determinants, but studies have largely been conducted in women with similar westernized lifestyles living in countries with high breast cancer incidence rates. To benefit from the heterogeneity in risk factors and their combinations worldwide, we created an International Consortium on Mammographic Density (ICMD) to pool individual-level epidemiological and MD data from general population studies worldwide. ICMD aims to characterize determinants of MD more precisely, and to evaluate whether …

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.

Frequency Of Birth Defects And Its Relationship To Parents Having Interfamily Marriages At A Tertiary Care Hospital, Tufail Soomro, Shiyam Sunder Tikmani

Community Health Sciences

Background: Inter family cousin marriages carries a risk of increased birth defects. The exact contribution of interfamily to birth defects risk is controversial. The aims of this study were to determine the frequency of birth defects in in relation to interfamily or outside family marriages.
Methods: This cross sectional study was conducted in the Civil hospital Sukkur from 9th November 2013 to 13th December 2015. Mothers giving birth to babies married in interfamily or outside family with their consent obtained were included in the study. Mothers not giving consent for study and having any known major illnesses were excluded from …

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.

Challenges In Implementing A Community Based Trial In A Rural Pakistani District: Lessons Learnt From Project Nigraan, F. Rabbani, Imran Naeem, Shipton Leah, Mehboob Beenish, Zahidie Aysha, Sangrasi Kashif, Aftab Wafa, Perveen Shagufta, Qazi Shamim Ahmad

Community Health Sciences

No abstract provided.

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 …

Evaluation Of The Uptake And Impact Of Neonatal Vitamin A Supplementation Delivered Through The Lady Health Worker Programme On Neonatal And Infant Morbidity And Mortality In Rural Pakistan: An Effectiveness Trial, Sajid Soofi, Shabina Ariff, Kamran Sadiq, Atif Habib, Zaid Bhatti, Imran Ahmad, Masawar Hussain, Nabeela Ali, Simon Cousens, Zulfiqar A Bhutta

Department of Paediatrics and Child Health

Background: Despite evidence for the benefits of vitamin A supplementation (VAS) among children 6 to 59 months of age, the feasibility of introduction and potential benefit of VAS in the neonatal period in public health programmes is uncertain. Objective: The primary objective was to evaluate the feasibility and effectiveness of early neonatal VAS (single dose of 50 000 international units within 48–72 hours after birth) delivered through the public sector Lady Health Worker (LHW) programme in rural Pakistan and to document its association with a reduction in mortality at 6 months of age.
Methods: A community-based, cluster randomised, …

Prevalence And Predictors Of Iron Deficiency Anemia In Children Under Five Years Of Age In Pakistan, A Secondary Analysis Of National Nutrition Survey Data 2011–2012, Atif Habib, Kirsten Black, Sajid Bashir Soofi, Imtiaz Hussain, Zaid Bhatti, Zulfiqar A. Bhutta, Camille Raynes- Greenow

Department of Paediatrics and Child Health

Background: Iron deficiency Anemia (IDA) in children is a recognized public health problem that impacts adversely on child morbidity, mortality and impairs cognitive development. In Pakistan information on the true prevalence and predictors of IDA is limited. This study sought to investigate IDA in children under five years of age using data from a nationally representative stratified cross-sectional survey.
Methods: Secondary analysis was performed on the National Nutrition Survey in Pakistan 2011–2012. We used a pre-structured instrument to collect socio demographic and nutritional data on mothers and children. We also collected Anthropometric measurements and blood samples for micronutrient deficiencies. …

Uncovering The Burden Of Intentional Injuries Among Children And Adolescents In The Emergency Department, Uzma R. Khan, Butool Hisam, Nukhba Zia, Mohammed Umer Mir, Olakunle Alonge, Seemin Jamali, Adnan Hyder, Junaid Abdul Razzak

Department of Emergency Medicine

Introduction: In low- and middle-income countries, injuries are a leading cause of mortality in children. Much work has been done in the context of unintentional injuries but there is limited knowledge about intentional injuries among children. The objective of this paper was to understand the characteristics of children with intentional injuries presenting to emergency departments in Pakistan.
Methods: The data was from the Pakistan National Emergency Departments Surveillance (Pak-NEDS), conducted from November 2010 to March 2011 in seven major emergency departments of Pakistan. Data on 30,937 children under 18 years of age was collected. This paper reports frequency of intentional …

Ambulance Use In Pakistan: An Analysis Of Surveillance Data From Emergency Departments In Pakistan., Nukhba Zia, Hira Shahzad, Syed Muhammad Baqir, Shahab Shaukat, Haris Ahmad, Courtland Robinson, Adnan Ali Hyder, Junaid Razzak

Department of Emergency Medicine

Background:

The utilization of ambulances in low- and middle-income countries is limited. The aim of this study was to ascertain frequency of ambulance use and characteristics of patients brought into emergency departments (EDs) through ambulance and non-ambulance modes of transportation.

Methods:

The Pakistan National Emergency Departments Surveillance (Pak-NEDS) was a pilot active surveillance conducted in seven major tertiary-care EDs in six main cities of Pakistan between November 2010 and March 2011. Univariate and multivariate logistic regression was performed to investigate the factors associated with ambulance use.

Results:

Out of 274,436 patients enrolled in Pak-NEDS, the mode of arrival to the …

Pattern Of Presenting Complaints Recorded As Near-Drowning Events In Emergency Departments: A National Surveillance Study From Pakistan., Siran He, Jeffrey C. Lunnen, Nukhba Zia, Uzma Rahim Khan, Khusro Shamim, Adnan Ali Hyder

Department of Emergency Medicine

Background:

Drowning is a heavy burden on the health systems of many countries, including Pakistan. To date, no effective large-scale surveillance has been in place to estimate rates of drowning and near-drowning in Pakistan. The Pakistan National Emergency Department Surveillance (Pak-NEDS) study aimed to fill this gap.

Method:

Patients who presented with a complaint of “near-drowning” were analyzed to explore patterns of true near-drowning (unintentional) and intentional injuries that led to the “near-drowning” complaint. Bivariate analysis was done to establish patterns among patients treated in emergency departments, including socio-demographic information, injury-related information, accompanying injuries, and emergency department resource utilization.

Result: …

Effect Of Diabetes Self-Management Education On Glycemic Control, Compared To Usual Care In Type 2 Diabetic Patients At The Family Medicine Clinic, Aga Khan University Hospital Nairobi, Catherine Wanjiku Gathu

Master of Medicine in Family Medicine

Background: Globally, the magnitude of disease burden associated with diabetes is high. Poor glycemic control contributes greatly to this burden, especially in the occurrence of related complications. The value of Diabetes Self-Management Education (DSME) is evident in literature, and has been recommended as a way of optimizing glycemic and metabolic control and averting early onset of diabetes complications. Usual care involves spontaneous sharing of information during medical consultations without planned structure or defined time frame. In the African setting, the effect of DSME, and how it compares to usual care, is yet to be fully explored. Objective: To compare the …

Enhancement Of Knowledge And Skills Of Community Midwives In Sindh, Pakistan, Sadia Abbas Ali, Arusa Lakhani, Rafat Jan, Shahnaz Shahid, Marina Baig, Farzana Adnan

Journal of Asian Midwives (JAM)

With a maternal mortality rate of 276 deaths per 100,000 live births, Pakistan is one of the countries with a large share in the percentage of world’s maternal mortality. As an intervention for the Millennium Development Goals (MDG) 4 and 5, the World Health Organization (WHO) strongly suggests that skilled care before, during, and after childbirth can save the lives of women and newborn babies. One of the interventions to ensure care to mothers and babies by skilled care providers is the capacity building training of Community Midwives (CMWs) aiming to improve their midwifery competency.

One such training intervention was …

Effect Of Raised Body Fat On Vitamin D, Leptin And Bone Mass, Syeda Sadia Fatima, Saad Farooq, Maaida Asif Tauni, Omar Irfan, Faiza Alam

Department of Biological & Biomedical Sciences

Objective: To estimate leptin, vitamin D and bone mineral density levels in individuals with high fat mass, and to assess any correlation.Methods: The cross-sectional study was conducted at the Basic Medical Sciences Institute, Jinnah Post Graduate Medical Centre, Karachi, and Aga Khan University, Karachi, from August 2012 to July 2014, and comprised healthy male volunteers between the ages of 18-60 years. Body fat percentage was determined using bioelectrical impedance analysis and the participants were classified as: Group A (15-21.9); Group B (22-27.9); and Group C ( > 28). Bone mineral density was calculated by ultrasound bone densitometer (T-score between +1 and …

Knowledge And Perceptions Regarding Sexual And Reproductive Health Among High School Students In Kathmandu, Nepal, Magdalena Mattebo, Rebecka Elfstrand, Ulrika Karlsson, Kerstin Erlandsson

Journal of Asian Midwives (JAM)

Background: Nepal recently began teaching sexual education in the school system and has established youth friendly services in order to meet the need of increased sexual and reproductive knowledge among the youth.
Objective: To examine the sexual and reproductive knowledge and perceptions among young people attending schools in Kathmandu.
Method: A written questionnaire was distributed to 160 students, in a classroom environment, in four schools in Kathmandu.
Results: Two thirds of the females and nearly 60% of the males knew that it was possible to get sexually transmitted infection (STI) during one sexual encounter and more than half of the …

Prevalence Of Hypertension In Low- And Middle-Income Countries: A Systematic Review And Meta-Analysis., Ahmed Sarki, Chidozie U. Nduka, Saverio Stranges, Ngianga-Bakwin Kandala, Olalekan A. Uthman

School of Nursing & Midwifery, East Africa

We aimed to obtain overall and regional estimates of hypertension prevalence, and to examine the pattern of this disease condition across different socio-demographic characteristics in low-and middle-income countries. We searched electronic databases from inception to August 2015. We included population-based studies that reported hypertension prevalence using the current definition of blood pressure ≥140/90 mm Hg or self-reported use of antihypertensive medication. We used random-effects meta-analyses to pool prevalence estimates of hypertension, overall, by World Bank region and country income group. Meta-regression analyses were performed to explore sources of heterogeneity across the included studies. A total of 242 studies, comprising data …

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 …

Comparison Of Frequency Of Insulin Resistance In Patients With Chronic Obstructive Pulmonary Disease With Normal Controls, Zareen Kiran,, Numan Majeed, Bader Faiyaz Zuberi

Section of Diabetes, Endocrinology and Metabolism

Objective: To compare mean homeostatic model assessment of insulin resistance (HOMA-IR) in patients with and without chronicobstructive pulmonary disease (COPD).

Methods: A Case control analytic study was conducted in medical outpatient department of Medial Unit-II of Dow University of Health Sciences from April 2013 to September 2013. All patients with the diagnosis of COPD were included as cases. Controls were age match healthy individuals with minor illnesses. Age, weight, height and forced expiratory volume in one second to forced vital capacity (FEV1/FVC) ratio were documented. Fasting blood glucose and fasting insulin levels were done. Body mass index (BMI) …

Factors That Lead To Sustainability Of School-Feeding Programs In Rural Community Secondary Schools: A Case Study Of Two Secondary Schools In Nachingwea District, Lindi – Southern Tanzania, Yahaya Jafari Mbembe

Master of Education

School feeding programs (SFPs) have increasingly received a considerable attention as instruments for improving students‟ academic and nutritional developments in rural community secondary schools. This demands the programs to have certain qualities to be able to achieve their intended goals and objectives. Amongst these is sustainability to guarantee students in the schools with food in regular bases conditional on school attendance and the programs‟ contributions. Many studies have been conducted on SFPs in Tanzania but not in Lindi region and the Nachingwea district in particular. This is different with culture which has been extensively examined in the area. However, these …

The Effect Of Teachers’ Qualification On Children’S Learning Outcome In Early Childhood Education In Northern Uganda, Brenda Apeta

Master of Education

This study examined the effect of teachers’ qualification on the children’s learning outcome in nursery schools in Northern Uganda. Twenty lessons were observed from five teachers in two rural nursery schools. The findings indicated that three of the teachers were of low qualifications while the remaining two had no qualifications in ECD. The teachers’ low qualification or the lack of it, affected children’s learning outcome in such a way that the untrained teachers to a greater extent used classroom practices that encouraged rote learning as compared to the qualified teachers. The teachers’ perception on how their qualification shaped their classroom …

Postnatal Growth Standards For Preterm Infants: The Preterm Postnatal Follow-Up Study Of The Intergrowth-21st Project, José Villar, Francesca Giuliani, Zulfiqar A. Bhutta, Enrico Bertino, Eric O. Ohuma, Leila Cheikh Ismail, Fernando C. Barros, Douglas G. Altman, Cesar Victora, Julia A. Noble, Michael G. Gravett, Manorama Purwar, Ruyan Pang, Ann Lambert, Aris T. Papageorghiou, Roseline Ochieng, Yasmin A. Jaffer, Stephen H. Kennedy

Paediatrics and Child Health, East Africa

Background: Charts of size at birth are used to assess the postnatal growth of preterm babies on the assumption that extrauterine growth should mimic that in the uterus.

Methods: The INTERGROWTH-21st Project assessed fetal, newborn, and postnatal growth in eight geographically defined populations, in which maternal health care and nutritional needs were met. From these populations, the Fetal Growth Longitudinal Study selected low-risk women starting antenatal care before 14 weeks’ gestation and monitored fetal growth by ultrasonography. All preterm births from this cohort were eligible for the Preterm Postnatal Follow-up Study, which included standardised anthropometric measurements, feeding practices based on …

Application Of Multimodal Pedagogical Approach In Developing Literacy At Lower Primary: Action Research, Nampeera Lydia Victoria

Master of Education

Literacy development at lower primary demands diversity in communication if learners are to successfully navigate its landscape. In this study, we sought to understand how multimodal pedagogy can be applied at lower primary for literacy development in Uganda and the benefits and challenges involved in using the pedagogy. To support the study a review of literature on the value and challenge of, as well as studies related to, multimodal leaning, literacy development, classroom practices and communication in Uganda and the sub Saharan Africa as a whole was done. The methodology that informed the study was a qualitative participatory action research …

Residential Proximity To Major Roadways Is Associated With Increased Levels Of Ac133+ Circulating Angiogenic Cells, Natasha Dejarnett, Ray Yeager, Daniel J. Conklin, Jongmin Lee, Timothy E. O’Toole, James Mccracken, Wes Abplanalp, Sanjay Srivastava, Daniel W. W. Riggs, Jasmit Shah

Brain and Mind Institute

OBJECTIVES: Previous studies have shown that residential proximity to a roadway is associated with increased cardiovascular disease risk. Yet, the nature of this association remains unclear, and its effect on individual cardiovascular disease risk factors has not been assessed. The objective of this study was to determine whether residential proximity to roadways influences systemic inflammation and the levels of circulating angiogenic cells.

APPROACH AND RESULTS: In a cross-sectional study, cardiovascular disease risk factors, blood levels of C-reactive protein, and 15 antigenically defined circulating angiogenic cell populations were measured in participants (n=316) with moderate-to-high cardiovascular disease risk. Attributes of roadways surrounding …

Trends In Management Of Neck Of Femur Fracture, Tashfeen Ahmad, Umair Ashraf, Omar Irfan, Zehra Abdul Muhammad

Department of Surgery Docs

Abstract

OBJECTIVE:

To identify trends related to surgical procedure for the management of neck of femur fracture to see how the choice is changing over time in relation to different age groups.

METHODS:

The retrospective audit was conducted at Aga Khan University Hospital, Karachi, and comprised data of all patients who presented with neck of femur fracture from 1995 to 2014. Patients with open fractures and those having external fixators were excluded. Data was retrieved from the hospital database, and analysed using SPSS 17.

RESULTS:

Records of 1039 patients were reviewed. The proportion of patients in the 70+ years age …

Role Of Acute Pain Service In Optimizing Postoperative Pain Relief In A Tertiary Care Teaching Hospital, Aliya Ahmed, Muhammad Yasir

Department of Anaesthesia

Objective: To assess the frequency and types of adjustments that acute pain service makes to postoperative analgesic regimes to improve pain relief or treat side effects.Methods: The prospective observational study was conducted at the Aga Khan University Hospital, Karachi, from December 1, 2012, to March 31, 2013. Data was collected from Acute Pain Service register four hours after the pain rounds by a Service member not involved in rounds. Data was collected on a standardised form and analysed using SPSS 19.Results: Of the 323 patients, 209(65%) were receiving epidural infusions and 114(35%) were receiving intravenous patient-controlled analgesia. Overall, 114(35%) required …

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 …

Can Contracted Out Health Facilities Improve Access, Equity, And Quality Of Maternal And Newborn Health Services? Evidence From Pakistan., Shehla Zaidi, Atif Riaz, F. Rabbani, Iqbal Azam Syed, Syeda Nida Imran, Nousheen Pradhan, Gul Nawaz Khan Nawaz Khan

Community Health Sciences

BACKGROUND:

The case of contracting out government health services to non-governmental organizations (NGOs) has been weak for maternal, newborn, and child health (MNCH) services, with documented gains being mainly in curative services. We present an in-depth assessment of the comparative advantages of contracting out on MNCH access, quality, and equity, using a case study from Pakistan.

METHODS:

An end-line, cross-sectional assessment was conducted of government facilities contracted out to a large national NGO and government-managed centres serving as controls, in two remote rural districts of Pakistan. Contracting out was specific for augmenting MNCH services but without contractual performance incentives. A …

What Can Pakistan Do To Address Maternal And Child Health Over The Next Decade?, Zulfiqar Ahmed Bhutta, Assad Hafeez

Department of Paediatrics and Child Health

Pakistan faces huge challenges in meeting its international obligations and agreed Millennium Development Goal targets for reducing maternal and child mortality. While there have been reductions in maternal and under-5 child mortality, overall rates are barely above secular trends and neonatal mortality has not reduced much. Progress in addressing basic determinants, such as poverty, undernutrition, safe water, and sound sanitary conditions as well as female education, is unsatisfactory and, not surprisingly, population growth hampers economic growth and development across the country. The devolution of health to the provinces has created challenges as well as opportunities for action. This paper presents …

Dietary Almonds Increase Serum Hdl Cholesterol In Coronary Artery Disease Patients In A Randomized Controlled Trial., Humaira Jamshed, Fateh Ali Tipoo Sultan, Romaina Iqbal, Anwar Gilani

Section of Cardiology

Background: More than one-half of coronary artery disease (CAD) patients have low HDL cholesterol despite having well-managed LDL cholesterol. Almond supplementation has not been shown to elevate circulating HDL cholesterol concentrations in clinical trials, perhaps because the baseline HDL cholesterol of trial subjects was not low.

Objective: This clinical trial was designed to test the effect of almond supplementation on low HDL cholesterol in CAD patients.

Methods: A total of 150 CAD patients (50 per group), with serum LDL cholesterol ≤100 mg/dL and HDL cholesterol ≤40 mg/dL in men and ≤50 mg/dL in women, were recruited from the Aga Khan …

Isoniazid Induced Motor-Dominant Neuropathy, Rabeeya Arsalan, Saniya Sabzwari

Department of Family Medicine

Isoniazid though a very effective treatment for tuberculosis can cause severe motor-dominant neuropathy which can be reversible with pyridoxine supplementation. A 45-year-old female diagnosed with psoas abscess, culture positive for mycobacterium tuberculosis, was started on anti- tuberculous treatment with four drugs, including isoniazid at a dose of 5 mg/kg/day. Three months later she developed severe motor weakness of lower limbs with loss of ankle and knee reflexes. She was treated with vitamin B6 injections and isoniazid treatment was continued. Her motor weakness gradually improved in a few months, but mild sensory impairment persisted even after two years. There is need …