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A Qualitative Study Using Traditional Community Assemblies To Investigate Community Perspectives On Informed Consent And Research Participation In Western Kenya, Rachel Vreeman, Eunice Kamaara, Allan Kamanda, David Ayuku, Winstone Nyandiko, Lukoye Atwoli, Samuel Ayaya, Peter Gisore, Michael Scanlon, Paula Braitstein

Paediatrics and Child Health, East Africa

Background: International collaborators face challenges in the design and implementation of ethical biomedical research. Evaluating community understanding of research and processes like informed consent may enable researchers to better protect research participants in a particular setting; however, there exist few studies examining community perspectives in health research, particularly in resource-limited settings, or strategies for engaging the community in research processes. Our goal was to inform ethical research practice in a biomedical research setting in western Kenya and similar resource-limited settings.

Methods: We sought to use mabaraza, traditional East African community assemblies, in a qualitative study to understand community perspectives on …

Intestinal, Airway, And Cardiovascular Relaxant Activities Of Thymoquinone, Muhammad Nabeel Ghayur, Anwar Hussain Gilani, Luke Jeffrey Janssen

Department of Biological & Biomedical Sciences

Thymoquinone (TQ) is a bioactive component found in many medicinal herbs. In this study, we report the smooth and cardiac muscle relaxant activities of this compound. TQ concentration dependently suppressed spontaneously contracting rabbit jejunum while also relaxed high K+-(80 mM) induced contractions in jejunum and guinea-pig ileum, indicating activity at voltage-operated Ca++ channels (VOCC). Further, TQ displaced Ca++ concentration-response curves, obtained in a Ca++-free environment, to the right, showing blockade of VOCC. Similar activity was observed with verapamil, a standard VOCC blocker. TQ also exhibited nonadrenergic relaxation of agonist-induced contractions in guinea-pig trachea. When tested in fluo-4-loaded mouse lung slices, …

Evaluation Of Gut Modulatory And Bronchodilator Activities Of Amaranthus Spinosus Linn, Mueen Ahmad Chaudhary, Imran Imran, Samra Bashir, Hassan Mehmood, Najeeb-Ur Rehman, Anwarul-Hassan Gilani

Department of Biological & Biomedical Sciences

Background: The aqueous-methanolic extract of Amaranthus spinosus (A. spinosus Linn.,) whole plant, was studied for its laxative, spasmolytic and bronchodilator activities to validate some of its medicinal uses.
Methods: The crude extract of A. spinosus was studied in-vivo for bronchodilator and laxative activities and in-vitro using isolated tissue preparations which were mounted in tissue baths assembly containing physiological salt solutions, maintained at 37°C and aerated with carbogen, to assess the spasmolytic effect and to find out the possible underlying mechanisms.
Results: In the in-vivo experiments in mice, the administration of A. spinosus increased fecal output at doses of 100 …

Community Perspectives On Research Consent Involving Vulnerable Children In Western Kenya, Rachel Vreeman, Eunice Kamaara, Allan Kamanda, David Ayuku, Winstone Nyandiko, Lukoye Atwoli, Samuel Ayaya, Peter Gisore, Michael Scanlon, Paula Braitstein

Paediatrics and Child Health, East Africa

Involving vulnerable pediatric populations in international research requires culturally appropriate ethical protections. We sought to use mabaraza, traditional East African community assemblies, to understand how a community in western Kenya viewed participation of children in health research and informed consent and assent processes. Results from 108 participants revealed generally positive attitudes towards involving vulnerable children in research, largely because they assumed children would directly benefit. Consent from parents or guardians was understood as necessary for participation while gaining child assent was not. They felt other caregivers,community leaders, and even community assemblies could participate in the consent process. Community members believed …

Childhood Unintentional Injuries: Need For A Community-Based Home Injury Risk Assessments In Pakistan., Adnan A. Hyder, Aruna Chandran, Uzma R. Khan, Nukhba Zia, Cheng-Ming Huang, Sarah Stewart De Ramirez, Junaid Razzak

Department of Emergency Medicine

Background. A substantial proportion of the annual 875,000 childhood unintentional injury deaths occur in the home. Very few printed tools are available in South Asia for disseminating home injury prevention information. Methods. Three tools were planned: an injury hazard assessment tool appropriate for a developing country setting, an educational pamphlet highlighting strategies for reducing home injury hazards, and an in-home safety tutorial program to be delivered by a trained community health worker. Results. The three tools were successfully developed. Two intervention neighborhoods in Karachi, Pakistan, were mapped. The tools were pretested in this local setting and are now ready for …

Exploring Teacher Leadership Development In A Public Secondary School In Uganda, Stephen Olukor

Master of Education

Effective school leadership is currently associated with school improvement that enhances teaching and learning processes. School improvement is believed to be possible with teacher participation in leadership at the classroom and school organizational levels. To create a culture of reflective teaching and learning in a school requires a shift in perception of school leadership as actions of an individual called a head teacher to a process of collective influence. Schools need to put in place effective leadership development programmes for teachers. This study on teacher leadership development was conducted in one public secondary school in Uganda to explore how teacher …

Influence Of Secondary School Students’ Prior Conceptions On Learning Outcomes: A Case Of Hiv And Aids Education In A Secondary School In Kenya, Grace Wanjiru Kimotho

Master of Education

The secondary HIV and AIDS education in Kenya is aimed at bringing about behavior change among the students through enabling them make informed decisions on issues regarding their sexuality to control the spread of the pandemic. An increase in case of sexually transmitted diseases, among secondary school students, pregnancy and abortions implies that secondary school students are engaging in unprotected sex predisposing themselves to HIV infection. Learners come to class with already formed ideas that explain the world around them. Some of these ideas are contrary to what is scientifically known about HIV and AIDS and have been referred to …

Risks To Early Childhood Health And Development In The Postconflict Transition Of Northern Uganda, Theresa A. Mcelroy, Stella Atim, Charles P. Larson, Robert Armstrong

Paediatrics and Child Health, East Africa

Research from numerous fields of science has documented the critical importance of nurturing environments in shaping young children’s future health and development. We studied the environments of early childhood (birth to 3 years) during postconflict, post displacement transition in northern Uganda. The aim was to better understand perceived needs and risks in order to recommend targeted policy and interventions. Methods. Applied ethnography (interview, focus group discussion, case study, observational methods, document review) in 3 sites over 1 year. Results. Transition was a prolonged and deeply challenging phase for families. Young children were exposed to a myriad of risk factors. Participants …

Retrospective Analysis Of Metabolic Syndrome: Prevalence And Distribution In Executive Population In Urban Pakistan., Niloufer Sultan Ali, Ali Khan Khuwaja, Adnan Ur Rahman, Kashmira Nanji

Department of Family Medicine

Background. Metabolic Syndrome (MetS) is a major public health concern.

Objective. The aim of this study was to estimate the frequency of MetS, its components, and factors associated with MetS amongst apparently healthy individuals in Pakistan.

Methods. A retrospective cross-sectional study was conducted at the executive Clinics of Aga Khan Hospital, Pakistan. Medical records of patients aged ≥18 years visiting the clinics from July 2011 to December 2011 were consecutively reviewed. Records in which either MetS components data or 10% of overall data was missing were excluded. A total of 1329 participants’ records was included in final analysis. Data was …

Fiber And Bulking Agents For The Treatment Of Chronic Constipation, Kashmira Nanji, Bilal Ahmed, Safia Awan, Waris Qidwai, Saeed Hamid

Department of Family Medicine

No abstract provided.

Awareness And Practive Of Health Promotion For Women In Calabar, Cross River State, Nigeria, P. E. Samson-Akpan, I. Akpabio, Ekaete Asuquo, O. B. Edet

School of Nursing & Midwifery, East Africa

Aim: A descriptive survey was undertaken to ascertain nurses’ awareness and level of practice of health promotion among women in Calabar.

Background: Women’s health is affected by array of factors; nurses could have a major impact in increasing women’s capacity to exercise increased control over their lives and determinants of health.

Method: One hundred and thirty six nurses drawn from the ante-natal clinics of primary, secondary and tertiary health facilities in Calabar participated in the study. A questionnaire with a content validity index of 0.91 was used for data collection. The test-retest reliability coefficient of the questionnaire was (r) 0.79. …

Aga Khan University, Report 2012, Aga Khan University

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Sindh Health Sector Strategy 2012 – 2020, Shehla Zaidi

Community Health Sciences

No abstract provided.

Species Identification Of Invasive Yeasts Including Candida In Pakistan: Limitations Of Phenotypic Methods, Joveria Farooqi, Kauser Jabeen, Noureen Saeed, Afia Zafar, Mary Eleanor Brandt, Rumina Hasan

Department of Pathology and Laboratory Medicine

Objective: To compare phenotypic and genotypic methods of yeast identification. Methods: The in-vitro cross-sectional study was conducted from January 2006 to May 2009. Invasive yeasts isolated at the clinical microbiology laboratory at the Aga Khan University (AKU), Karachi, Pakistan, were identified. Speciation by phenotypic and molecular methods was compared. All yeasts isolated during the study period from blood and other invasive sites were identified using standard methods. Isolates were shipped to Mycotic Diseases Branch, Centres for Disease Control and Prevention, Atlanta, Georgia, USA, for identification by Luminex flow cytometric multianalyte profiling (xMAP) system. Ribosomal ITS2 DNA sequencing was performed …

Peripheral (Limb) Myokymic Discharges In Motor Neuron Disease, Javeria Rauf, Junaid Akhtar, Bhojo Assumal Khealani, Liaquat Ali

Section of Neurology

We present the case of a 28-year-old gentleman who presented with weakness and wasting in the right arm. He complained about painful cramps in his left leg but there were no sensory, visual or swallowing problems. Neurological examination was significant for asymmetric weakness of both upper and lower limbs and deep tendon reflexes were asymmetrically brisk. Initial laboratory investigations, MRI brain and MRI spine were normal. Electromyography revealed active denervation and chronic neurogenic motor unit action potential. Myokymic discharges were noted in the left deltoid muscle.

Aku Newsletter : Winter 2012, Volume 13, Issue 1, Aga Khan University

The Aga Khan University Newsletters

No abstract provided.

Outbreak Of Beriberi Among African Union Troops In Mogadishu, Somalia, John T. Watson, Hassan El Bushra, Emmaculate J. Lebo, Godfrey Bwire, James Kiyengo, Gideon Emukule, Victor Omballa, John Tole, Muvunyi Zuberi, Robert F. Breiman, Mark A. Katz

Internal Medicine, East Africa

Context and Objectives: In July 2009, WHO and partners were notified of a large outbreak of unknown illness, including deaths, among African Union (AU) soldiers in Mogadishu. Illnesses were characterized by peripheral edema, dyspnea, palpitations, and fever. Our objectives were to determine the cause of the outbreak, and to design and recommend control strategies.

Design, Setting, and Participants: The illness was defined as acute onset of lower limb edema, with dyspnea, chest pain, palpitations, nausea, vomiting, abdominal pain, or headache. Investigations in Nairobi and Mogadishu included clinical, epidemiologic, environmental, and laboratory studies. A case-control study was performed to identify risk …

Sonographic Fetal Biometry Charts For A Pakistani Cohort., W. Akhtar, A. Ali, M. A. Arain, F. Saeed, S. Siddiqui, A Memon

Department of Radiology

This study aimed to develop growth centiles at different gestational weeks for fetal biparietal diameter, abdominal circumference, femur length and head circumference in a Pakistani cohort. Data were collected at a tertiary referral hospital from pregnant women at gestational ages 13-40 weeks referred for obstetric ultrasound as a part of routine antenatal care. A total of 1599 fetal sonographic biometric measurements were collected after screening for the inclusion criteria. For each measurement, separate regression models were derived to estimate the mean, standard deviation and reference percentiles at each week of gestational age for this cohort. The best fitting model for …

Integration Of Geriatrics Into A Spiral Undergraduate Medical Curriculum In Pakistan: Evaluation And Feedback Of Third-Year Medical Students., S. R. Sabzwari, S. Bhanji, Rukhsana W. Zuberi

Department of Family Medicine

Background: In the last decades there has been a sharp rise in the elderly population throughout the world. The unique needs of the elderly require a multidisciplinary and comprehensive medical approach. None of the 50 medical schools in Pakistan teach geriatrics in their undergraduate or postgraduate training. This paper discusses the development and implementation of the first geriatric curriculum in a medical school of Pakistan and its effect on knowledge and attitudes of third-year medical students.
Methods: The curriculum was designed through collaboration and approval of various academic departments at the Aga Khan University in Karachi Pakistan. After a review …

Magnesium, A Drug Of Diverse Use, Mohammad Irfan Akhtar, Hameed Ullah, Mohammad Hamid

Department of Anaesthesia

Magnesium has evolved as a drug with diverse clinical applications. Mg++ is an important caution and its homeostasis is very important for normal body functioning. The physiological role of Mg is due to its calcium channel blocking properties at smooth muscle, skeletal muscle and conduction system levels. The analgesic properties are due to NMDA receptor blocking action. Mg++ is beneficial in acute Myocardial Infarction, protection during open heart surgery and treatment and prevention of heart rhythm disturbances. Mg has an established role in the management of preeclampsia and eclampsia. Magnesium prevents or controls convulsions by blocking neuromuscular transmission and decreasing …

Informal Support To First-Parents After Childbirth: A Qualitative Study In Low-Income Suburbs Of Dar Es Salaam, Tanzania, Columba Mbekenga, Andrea B. Pembe, Kyllike Christensson, Elisabeth Darj, Pia Olsson

School of Nursing & Midwifery, East Africa

Background: In Tanzania, and many sub-Saharan African countries, postpartum health programs have received less attention compared to other maternity care programs and therefore new parents rely on informal support. Knowledge on how informal support is understood by its stakeholders to be able to improve the health in families after childbirth is required. This study aimed to explore discourses on health related informal support to first-time parents after childbirth in low-income suburbs of Dar es Salaam, Tanzania.

Methods: Thirteen focus group discussions with first-time parents and female and male informal supporters were analysed by discourse analysis.

Results: The dominant discourse was …

Frequency And Associated Factors For Care Giving Among Elderly Patients Visiting A Teaching Hospital In Karachi, Pakistan., Waris Qidwai Dr, Mohammad Uzair Abdul Rauf, Seema Sakina, Ayesha Hamid, Sidra Ishaque, Tabinda Ashfaq

Department of Family Medicine

Objective: To study frequency and associated factors for care giving among elderly Patients visiting a teaching hospital in Karachi, Pakistan.
Methodology: A cross sectional questionnaire-based study was conducted at the Community Health Centre (CHC), Aga Khan University Hospital (AKUH) Karachi, Pakistan from September to November 2009. All individuals, visiting the CHC and aged 65 years or above were interviewed after taking written informed consent.
Results: A total of 400 elderly completed the interview. Majority were females, 65-69 years age, More than half of the individuals ie: 227 (85%) had received Care Giver experience for assistance and among these 195(72%) had …

Population Attributable Risk Of Unintentional Childhood Poisoning In Karachi Pakistan, Bilal Ahmed, Zafar Fatmi, Amna R Siddiqui

Department of Medicine

Background: The percentage of unintentional childhood poisoning cases in a given population attributable to specific risk factors (i.e., the population attributable risk) which can be calculated, determination of such risk factors associated with potentially modifiable risk factors, are necessary to focus on the prevention strategies.

Methods: We calculated PARs, using 120 cases with unintentional poisoning and 360 controls in a hospital based matched case- control study. The risk factors were accessibility to hazardous chemicals and medicines due to unsafe storage, child behavior reported as hyperactive, storage of kerosene and petroleum in soft drink bottles, low socioeconomic class, less education of …

Neonatal Vitamin A Supplementation For The Prevention Of Mortality And Morbidity In Term Neonates In Developing Countries, Batool A. Haider, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background:Vitamin A deficiency is a major public health problem in developing countries. Vitamin A supplementation in children greater than six months of age has been found to be beneficial, with no effect of supplementation between one to five months. Supplementation in the neonatal period has been suggested to have an impact by increasing body stores in early infancy.
Objectives: To evaluate the role of vitamin A supplementation in term neonates in developing countries with respect to the prevention of mortality and morbidity.
Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, May …

Zinc Supplementation As An Adjunct To Antibiotics In The Treatment Of Pneumonia In Children 2 To 59 Months Of Age, Batool A. Haider, Zohra S. Lassi, Amina Ahmed, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background:Diarrhoeal disorders and acute respiratory infections (ARIs), especially pneumonia, are the most common causes of death in low-income countries. Studies evaluating the impact of zinc supplementation as an adjunct in the management of pneumonia are limited and have shown variable results.
Objectives: To evaluate zinc supplementation, as an adjunct to antibiotics, in the treatment (clinical recovery) of pneumonia in children aged two to 59 months.
Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1), which contains the Cochrane Acute Respiratory Infections (ARI) Group's and the Cochrane Infectious Diseases Group's Specialised …

Ccl2/Mcp-I Genotype-Phenotype Relationship In Latent Tuberculosis Infection, Rabia Hussain, Ambreen Ansari, Najeeha Talat, Zahra Hasan, Ghaffar Dawood

Department of Pathology and Laboratory Medicine

Among the known biomarkers, chemokines, secreted by activated macrophages and T cells, attract groups of immune cells to the site of infection and may determine the clinical outcome. Association studies of CCL-2/MCP-1 -2518 A/G functional SNP linked to high and low phenotypes with tuberculosis disease susceptibility have shown conflicting results in tuberculosis. Some of these differences could be due the variability of latent infection and recent exposure in the control groups. We have therefore carried out a detailed analysis of CCL-2 genotype SNP -2518 (A/G transition) with plasma CCL-2 levels and related these levels to tuberculin skin test positivity in …

Knowledge, Perceptions And Myths Regarding Infertility Among Selected Adult Population In Pakistan: A Cross-Sectional Study, Sumera Ali, Raafay Sophie, Ayesha M. Imam, Faisal I. Khan, Syed F. Ali, Annum Shaikh, Syed Farid-Ul-Hasnain

Community Health Sciences

Background: The reported prevalence of infertility in Pakistan is approximately 22% with 4% primary and 18% secondary infertility. Infertility is not only a medical but also a social problem in our society as cultural customs and perceived religious dictums may equate infertility with failure on a personal, interpersonal, or social level. It is imperative that people have adequate knowledge about infertility so couples can seek timely medical care and misconceptions can be rectified.We aim to assess the knowledge, perception and myths regarding infertility and suggest ways to improve it.
Methods: A cross-sectional survey was carried out by interviewing a sample …

Delayed Surgical Therapy Reduces Mortality In Patients With Acute Necrotizing Pancreatitis, Abdul Rehman Alvi, Ghulam Murtaza Shaikh, Syed Faraz Kazim

Section of General Surgery

Objective: To review the trends in management and analyze the factors influencing outcomes of acute necrotizing pancreatitis.
Methods: It wa a retrospective analytical study. All adult patients with computed tomography with proven necrotizing pancreatitis managed at the department of surgery, Aga Khan University Hospital, Karachi were included in this study extending from January 1998 to January 2008. Outcome variables were hospital stay, complication rate and in-hospital mortality. Data analysis was carried out using SPSS version 16. For comparison, Pearson chi-square test, Fisher's exact test, t-test and ANOVA were used, where applicable. A p-value less than 0.05 was considered statistically significant. …

Developing Child Friendly Environment In Early Childhood Education Classroom In Pakistan, Khush Funer Murtaza

Professional Development Centre, Gilgit

Among all levels of education, Early Childhood Education and Development (ECEd) is considered to be the most critical level for social (relationship to others), emotional (self-image and security), cognitive (thinking and reasoning) and physical development of children. Therefore, the teachers of early years need to play a significant role in the teaching and learning process through providing a friendly environment in their schools. The study employed a case study approach. Information was gathered through a combination of methods, which included classroom observations, field notes, document analysis, focus group and semi structured interviews. The focus group participants and the interviewees were …

Comparison Of Outcomes Of Enteral Feeding Via Nasogastric Versus Gastrostomy Tubes In Post Operative Patients With A Principle Diagnosis Of Squamous Cell Carcinoma Of The Oral Cavity, Zain-Ul-Abedeen Sobani, Shehzad Ghaffar, Beenish Nisar Ahmed

Section of Otolaryngology, Head & Neck Surgery

OBJECTIVES: Squamous cell carcinoma of the oral cavity has a profound impact on a patient's nutritional intake, 40-50% of head and neck cancer patients have a markedly impaired nutritional status at the time of their initial presentation. Studies show that patients who have better nutritional status have fewer complications and a better survival rate. Therefore, enteral nutritional support plays an important part in their management. Due to the lack of relevant data, surgeons help patients make informed decisions regarding their mode of nutritional support and perform gastrostomy or place nasogastric tube depending on the patient's preference. This study addresses the …