Digital Commons Network^™

The Effect Of Folic Acid, Protein Energy And Multiple Micronutrient Supplements In Pregnancy On Stillbirths, Aamer Imdad, Mohammad Yawar Yakoob, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background:Pregnancy is a state of increased requirement of macro-and micronutrients, and malnourishment or inadequate dietary intake before and during pregnancy, can lead to adverse perinatal outcomes including stillbirths. Many nutritional interventions have been proposed during pregnancy according to the nutritional status of the mother and baseline risk factors for different gestational disorders. In this paper, we have reviewed three nutritional interventions including peri-conceptional folic acid supplementation, balanced protein energy supplementation and multiple micronutrients supplementation during pregnancy. This paper is a part of a series to estimate the effect of interventions on stillbirths for input to Live Saved Tool (LiST) …

Care During Labor And Birth For The Prevention Of Intrapartum-Related Neonatal Deaths: A Systematic Review And Delphi Estimation Of Mortality Effect, Anne C. C. Lee, Simon Cousens, Gary L. Darmstadt, Hannah Blencowe, Robert Pattinson, Neil F. Moran, G. Justus Hofmeyr, Rachel A. Haws, Shereen Zulfiqar Bhutta, Joy E. Lawn

Department of Obstetrics & Gynaecology

Background: Our objective was to estimate the effect of various childbirth care packages on neonatal mortality due to intrapartum-related events ("birth asphyxia") in term babies for use in the Lives Saved Tool (LiST).

Methods: We conducted a systematic literature review to identify studies or reviews of childbirth care packages as defined by United Nations norms (basic and comprehensive emergency obstetric care, skilled care at birth). We also reviewed Traditional Birth Attendant (TBA) training. Data were abstracted into standard tables and quality assessed by adapted GRADE criteria. For interventions with low quality evidence, but strong GRADE recommendation for implementation, an expert …

T-Tube Management Of Late Esophageal Perforation, Irfan Qadir, Hasnain Zafar, Mubashir Zareen Khan, Hasanat Mohammad Sharif

Section of General Surgery

Esophageal perforation is a serious condition with a high mortality rate. Management strategy of such a patient depends on the extent of perforation and the time interval between perforation and diagnosis. The use of a T tube to treat delayed esophageal perforation with complete resolution and no need for future definitive surgery has been less frequently described. We adapted this principle in successful management of a 73 year old patient with four days history of fever, shortness of breath, chest pain and radiological evidence of perforation.

Aku Newsletter : Spring 2011, Volume 12, Issue 1, Aga Khan University

The Aga Khan University Newsletters

No abstract provided.

Can We Stop The Stroke Epidemic In Pakistan?, Ismail A. Khatri, Mohammad Wasay

Department of Medicine

No abstract provided.

Intimate Partner Violence In Urban Pakistan: Prevalence, Frequency, And Risk Factors, Tazeen S. Ali, Nargis Asad, Ingrid Mogren, Gunilla Krantz

School of Nursing & Midwifery

Background: Intimate partner violence (IPV) is an important public health issue with severe adverse consequences. Population-based data on IPV from Muslim societies are scarce, and Pakistan is no exception. This study was conducted among women residing in urban Karachi, to estimate the prevalence and frequency of different forms of IPV and their associations with sociodemographic factors.
Methods: This cross-sectional community-based study was conducted using a structured questionnaire developed by the World Health Organisation for research on violence. Community midwives conducted face-to-face interviews with 759 married women aged 25-60 years.
Results: Self-reported past-year and lifetime prevalence of physical violence was 56.3 …

Lady Health Workers Programme In Pakistan: Challenges, Achievements And The Way Forward, Assad Hafeez, Bile Khalif Mohamud, Mobasher Riaz Shiekh, Syed Ayyaz Imran Shah, Rashid Jooma

Section of Neurosurgery

Objectives: To review the Lady Health Workers programme and critically explore various aspects of the process to extract tangible implications for other similar situations.
Methods: A descriptive study was carried out over a period of one year (2007-08). A detailed desk review of project documents, interaction with relevant stakeholders, performance validation and extensive feedback from the community were collected. The data so obtained was analyzed and evaluated against predetermined benchmarks.
Results: Each LHW serves a population of 1,000 people in the community and extends her services in the catchment population through monthly home visits. The scope of work includes over …

An Analysis Of The Clinical Practice Of Emergency Medicine In Public Emergency Centres In Kenya, Benjamin W. Wachira

Master of Medicine in Internal Medicine

Objectives: To describe the case mix, interventions, procedures and management of patients in public accident and emergency departments (A&Es) in Kenya. Methods: This was an observational study of patients who presented to 15 A&Es from 1 October to 31 December 2010. The study was conducted across Kenya in two national referral hospitals, five secondary level hospitals, and eight primary level hospitals. All patients presenting alive to the A&E during the 24 hour study period that were seen by a doctor or clinical officer were included in the study. A data collection form was completed by the primary investigator at the …

Complementary Feeding: A Global Network Cluster Randomized Controlled Trial, Nancy F. Krebs, K. Michael Hambidge, Manolo Mazariegos, Jamie Westcott, Norman Goco, Linda L. Wright, Marion Koso-Thomas, Antoinette Tshefu, Carl Bose, Omrana Pasha, Robert Goldenberg, Elwyn Chomba, Waldemar Carlo, Mark Kindem, Abhik Das, Ty Hartwell, Elizabeth Mcclure

Community Health Sciences

Background: Inadequate and inappropriate complementary feeding are major factors contributing to excess morbidity and mortality in young children in low resource settings. Animal source foods in particular are cited as essential to achieve micronutrient requirements. The efficacy of the recommendation for regular meat consumption, however, has not been systematically evaluated. Methods/Design: A cluster randomized efficacy trial was designed to test the hypothesis that 12 months of daily intake of beef added as a complementary food would result in greater linear growth velocity than a micronutrient fortified equi-caloric rice-soy cereal supplement. The study is being conducted in 4 sites of the …

Thoracolumbar Tuberculosis: Implications For Appropriate Management Based On Disease Location And Proposal Of A Novel Scoring System, Shahryar Noordin, Salim Allana, Tashfeen Ahmad, Zafar Sajjad, Khabir Ahmad, Ather Enam, Riaz Hussain Lakdawala

Section of Orthopaedic Surgery

Objective: To identify factors indicating disease severity in patients with thoracolumbar tuberculosis requiring surgical intervention.
Design: Medical charts of patients who underwent surgery for thoracic and lumbar spinal tuberculosis from 1990-2005 were reviewed. Patients with different levels of disease were compared in terms of neurological deficits, duration of symptoms, previous antituberculous therapy, nutritional status and associated co-morbids.
Results: Ninety-three patients aged 7-77 years (mean age 40 years) were included. Thoracic spine was involved in 80% of operated patients, and lumbar spine in 20%. Severe neurological impairment (Frankel A to C) was present in 68% of patients with thoracic disease, as …

Requirement Of Argininosuccinate Lyase For Systemic Nitric Oxide Production, Ayelet Erez, Sandesh Cs. Nagamani, Oleg A. Shchelochkov, Muralidhar H. Premkumar, Philippe M. Campeau Campeau, Yuqing Chen, Harsha K. Garg, Li Li, Asad Mian, Terry K. Bertin, Jennifer O. Black, Heng Zeng, Yaoping Tang, Anilkumar K. Reddy, Marshall Summar, William E. O’Brien, David G. Harrison, William E. Mitch, Juan C. Marini, Judy L. Aschner, Nathan S. Bryan, Brendan Lee

Department of Emergency Medicine

Nitric oxide (NO) is crucial in diverse physiological and pathological processes. We show that a hypomorphic mouse model of argininosuccinate lyase (encoded by Asl) deficiency has a distinct phenotype of multiorgan dysfunction and NO deficiency. Loss of Asl in both humans and mice leads to reduced NO synthesis, owing to both decreased endogenous arginine synthesis and an impaired ability to use extracellular arginine for NO production. Administration of nitrite, which can be converted into NO in vivo, rescued the manifestations of NO deficiency in hypomorphic Asl mice, and a nitric oxide synthase (NOS)-independent NO donor restored NO-dependent vascular reactivity in …

Setting Research Priorities To Reduce Almost One Million Deaths From Birth Asphyxia By 2015, Joy E. Lawn, Rajiv Bahl, Staffan Bergstrom, Zulfiqar Ahmed Bhutta, Gary L. Darmstadt, Matthew Ellis, Mike English, Jennifer J. Kurinczuk, Anne C. C. Lee, Mario Merialdi, Mohamed Mohamed, David Osrin, Robert Pattinson, Vinod Paul, Siddarth Ramji, Ola D. Saugstad, Lyn Sibley, Nalini Singhal, Steven N. Wall, Dave Woods, John Wyatt, Kit Yee Chan, Igor Rudan

Woman and Child Health

No abstract provided.

Oral Hygiene Kap Assessment And Dmft Scoring Among Children Aged 11-12 Years In An Urban School Of Karachi, Farhan Vakani, Nadia Basaria, Shahjahan Katpar

Department of Continuing Professional Education

Objective:To assess the oral hygiene knowledge, attitude and practices among school children and evaluate their DMFT (Decayed/Missing/Filled Teeth) scores.

Study Design:

Cross-sectional study.

Place and Duration of Study:

A private school of Karachi from March to April 2008.

Methodology:

Convenient sample comprising 300 students of grade 6 within the age group of 11-12 years was selected. A knowledge, attitude and practices survey questionnaire based on quantitative indicators was filled by the students. Clinical examination was done for DMFT. Data analysis was done by using SPSS version 11. Associations were assessed using chi-square test and a p-value of < 0.001 was considered significant.

Results:

There …

Fmic Annual Report 2011 | English, French Medical Institute For Mothers And Children

French Medical Institute for Mothers and Children (FMIC) Archives

No abstract provided.

Anthropometric Measurements As A Risk For Hypertensive Disorders In Pregnancy: A Hospital Based Study In South Asian Population, Ferha Saeed, Ahmed Jawad, Asma Azmat, Iqbal Azam Syed, Safdar Kagazwala

Department of Obstetrics & Gynaecology

Objectives: To determine the relationship between pregnancy induced hypertensive diseases and obesity.

Methods: A retrospective case controlled study was performed at Aga Khan University Hospital including records from July 2000 to June 2005. All women developing hypertension with or without proteinuria after 20 weeks of pregnancy (n = 218) were included. Categories of pregnancy induced hypertensive diseases (PIHD) were defined according to National high blood pressure working group and ACOG committee bulletin. Controls were selected randomly with a ratio of 1:1.7 between cases and controls.

Results: The estimated prevalence of pre-eclampsia in our institution is 1.9%. Earlier reports suggested mostly …

Bridging Culture, Research, And Practice In Early Childhood Development: The Madrasa Resource Centers In East Africa, Peter Mwaura, Kofi Marfo

Institute for Human Development, East Africa

The Madrasa Resource Centers in East Africa have adapted features of Euro-American theory and practice into a service delivery system responding to local cultural and socioeconomic realities. After 25 years of implementation in predominantly Muslim communities with high poverty and low literacy rates, the program could serve as a model for other parts of the continent with similar population profiles. This article examines some of the program’s key features and discusses the prospects that the program’s integration of research into service delivery holds for developmental research in the region. It proposes that university partnerships with such programs could yield productive …

Palliative Care For People Living With Hiv/Aids In Uganda: An Investigation Of Patients & Caregiver’S Outcome And Professional Perspectives, Wesley Too

School of Nursing & Midwifery, East Africa

Background: Although antiretroviral treatment is expanding in sub-Saharan Africa, the World Health Organization advocates for integration of palliative care with HAART because pain, other distressing symptoms and complex psychosocial challenges persist throughout the HIV trajectory. Palliative care improves the outcome for patients with HIV and may complement antiretroviral treatment by increasing adherence through better management of side effects from the treatment, providing patient and family-centred holistic care, and giving end-of-life care when necessary. However, integrating what have become two disciplines is challenging. Aim: To study the implications for palliative care provision in the context of changing policy to universal access …

Bacterial Vaginosis Is Associated With Uterine Cervical Human Papillomavirus Infection: A Meta-Analysis, Evy Gillet, Joris Fa Meys, Hans Verstraelen, Carolyne Bosire, Philippe De Sutter, Marleen Temmerman, Davy Vanden Broeck

Obstetrics and Gynaecology, East Africa

Background: Bacterial vaginosis (BV), an alteration of vaginal flora involving a decrease in Lactobacilli and predominance of anaerobic bacteria, is among the most common cause of vaginal complaints for women of childbearing age. It is well known that BV has an influence in acquisition of certain genital infections. However, association between BV and cervical human papillomavirus (HPV) infection has been inconsistent among studies. The objective of this meta-analysis of published studies is to clarify and summarize published literature on the extent to which BV is associated with cervical HPV infection.

Methods: Medline and Web of Science were systematically searched for …

Labrad : Vol 36, Issue 1 - January 2011, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Routine and Special Liver Function Tests
• Management of Coagulopathy Associated with Liver Disease
• Significance of Clinical and Laboratory Scoring System in Diagnosis of Disseminated Intravascular Coagulation in Chronic Liver Disease
• Laboratory Diagnosis of Hydatid Disease
• Laboratory Diagnosis of Amoebiasis
• Improvement of Bacteriological Yield of Liver Abscess by use of Anaerobic Chambers
• Radiofrequency Ablation of Liver Tumours
• HER2 in Breast Cancer: Frequently Asked Questions
• Clinical Laboratory Continuing Medical Education (CME) Seminar
• World Blood Donor Day at Aga Khan University Blood Bank

Girls' Secondary Education In Uganda: Assessing Policy Within The Women's Empowerment Framework, Shelley Jones

Institute for Educational Development, East Africa

This paper makes the case that policies, such as the National Strategy for Girls' Education in Uganda (NSGE), intended to achieve gender equity in education for girls in developing countries, have limited relevance to, and impact on girls' actual educational experiences. Recent considerations of girls' education acknowledge that gender equity within education is more than access to schooling; it entails the cultivation of capabilities necessary for girls to participate fully, actively and equally in all aspects of their societies. Drawing on a longitudinal, ethnographic policy research case study with 15 Ugandan schoolgirls in rural Masaka District, Uganda, from August 2004 …

Aku-Nama : Winter 2011, Volume 4, Issue 2, Aga Khan University Alumni Association

The Aga Khan University Newsletter and Magazine for Alumni (AKU-NAMA)

No abstract provided.

Pakistan National Nutrition Survey, 2011, Zulfiqar A Bhutta, Sajid Bashir Soofi, S. Shujaat H Zaidi, Atif Habib, Imtiaz Hussain

Department of Paediatrics and Child Health

No abstract provided.

Perception And Practices Of Breastfeeding Of Infants 0-6 Months In An Urban And A Semi-Urban Community In Pakistan: A Cross-Sectional Study, Sumera Ali, Syed Faizan Ali, Ayesha Mallick Imam, Samia Ayub, Abdul Gaffar Billoo

Department of Paediatrics and Child Health

OBJECTIVE: To investigate mother's perception and practices about breastfeeding and their socio-demographic correlate in infants equal to or less than 6 months.

METHODS: A cross-sectional study was carried out on 200 mother-infant pairs who visited the health care centers, Bilal Colony (semi-urban) and the Aga Khan University (urban), for their well baby follow-ups and vaccination using convenient sampling. Frequencies and percentages were computed and Chi-square was used to find associations between socio-demographics of mothers and their perception and practices about breastfeeding.

RESULTS: Exclusive breastfeeding was reported by about 54% of the mothers. Thirty-five percent of the mothers gave prelacteal feed, …

Communities, Birth Attendants And Health Facilities: A Continuum Of Emergency Maternal And Newborn Care (The Global Network's Emonc Trial), Omrana Pasha, Robert L. Goldenberg, Elizabeth M. Mcclure, Sarah Saleem, Shivaprasad S. Goudar, Fernando Althabe, Archana Patel, Fabian Esamai, Ana Garces, Elwyn Chomba, Manolo Mazariegos, Bhala Kodkany, Jose M. Belizan, Richard J. Derman, Patricia L. Hibberd, Waldemar A. Carlo, Edward A. Liechty, K. Michael Hambidge, Pierre Buekens, Dennis Wallace, Lisa Howard-Grabman, Suzanne Stalls, Marion Koso-Thomas, Alan H. Jobe, Linda L. Wright

Community Health Sciences

Background: Maternal and newborn mortality rates remain unacceptably high, especially where the majority of births occur in home settings or in facilities with inadequate resources. The introduction of emergency obstetric and newborn care services has been proposed by several organizations in order to improve pregnancy outcomes. However, the effectiveness of emergency obstetric and neonatal care services has never been proven. Also unproven is the effectiveness of community mobilization and community birth attendant training to improve pregnancy outcomes. Methods/Design: We have developed a cluster-randomized controlled trial to evaluate the impact of a comprehensive intervention of community mobilization, birth attendant training and …

Vitamin A Supplementation For Preventing Morbidity And Mortality In Children From 6 Months To 5 Years Of Age, Aamer Imdad, Kurt Herzer, Evan Mayo-Wilson, Mohammad Yawar Yakoob, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background: Vitamin A deficiency (VAD) is a major public health problem in low and middle income countries affecting 190 million children under 5. VAD can lead to many adverse health consequences, including death.
Objectives: To evaluate the effect of vitamin A supplementation (VAS) for preventing morbidity and mortality in children aged 6 months to 5 years.
Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2010 Issue 2), MEDLINE (1950 to April Week 2 2010), EMBASE (1980 to 2010 Week 16), Global Health (1973 to March 2010), Latin American and Caribbean Health Sciences (LILACS), metaRegister of Controlled …

Zinc Supplementation For The Prevention Of Pneumonia In Children Aged 2 Months To 59 Months, Zohra S. Lassi, Batool A. Haider, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background:Pneumonia is a leading cause of morbidity and mortality in children younger than five years of age. Most deaths occur during infancy and in low-income countries. Daily regimens of zinc have been reported to prevent acute lower respiratory tract infection and reduce child mortality.
Objectives: To evaluate the effectiveness of zinc supplementation in the prevention of pneumonia in children aged two to 59 months.
Search Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 2), which contains the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to January Week 2, 2010), EMBASE …

Microdiscectomy For Lumbosacral Disc Herniation And Frequency Of Failed Disc Surgery, Muhammad Shahzad Shamim, Maria Adnan Parekh, Muhammad Ehsan Bari, Ather Enam, Faraz Khursheed

Section of Neurosurgery

Background: Microdiscectomy for lumbosacral disc herniations is one of the most commonly performed neurosurgical procedures. The Patient demographics, symptomatology, and recovery are highly variable, and surgical outcomes depend on several factors, including Patient demographics. Failed disc surgery refers to failure of improvement in Patient's symptoms following microdiscectomy, and has been observed to occur in up to 12% of Patients. To date, no study form Pakistan has looked into Patient demographics and failed disc surgery rates within the local context.
Objective:The aim of this study was to review the demographics of the Patient population presenting for surgical treatment of lumbosacral …

Biliary Stones: An Atypical Cause Of Abdominal Pain In Paediatric Age Group, Amber Mehmood, M. Arif Mateen Khan

Department of Emergency Medicine

OBJECTIVE: To identify Paediatric patients with biliary stone disease presenting to a tertiary care hospital in order to determine the etiology, presentation and management.

METHODS: Retrospective study of all cases of ultrasonographically proven biliary stones under the age of 15 years from January 1988 to December 2008. Data included their risk factors, complications, management and outcome.

RESULTS: Total 32 patients were identified with biliary stones, treated in the hospital. Mean age at presentation was 8.25 +/- 3.33 years. Sixteen patients underwent cholecystectomy.

CONCLUSION: Paediatric cholelithiasis is an atypical and under-diagnosed cause of abdominal pain in childhood. True prevalence of the …

Self-Glucose Monitoring And Glycaemic Control At A Tertiary Care University Hospital, Karachi, Pakistan, Khurshid Khowaja, Humaira Waheed

Section of Diabetes, Endocrinology and Metabolism

OBJECTIVE: To explore the association between Self Monitoring of Blood Glucose (SMBG) levels and improved glycemic control (HbA1c level) among type 2 diabetic patients, receiving oral hypoglycaemic agents and insulin, and to ascertain the factors influencing SMBG.

METHOD: Using Comparative cross sectional study design five hundred Type 2 diabetes patients through convenient sampling between 30-70 years were interviewed through a structured questionnaire in year 2006 and 2007 at AKUH Ambulatory setting. These 500 subjects were divided as 250 in case (doing SMBG) and 250 in control (not doing SMBG) groups.

RESULTS: We identified that HbA1c value was maintained at good …

Homozygous Frame Shift Mutation In Ecm1 Gene In Two Siblings With Lipoid Proteinosis., Azam J. Samdani, Abid Azhar, Syed M. Shahid, Syeda N. . Nawab, Rozeena Shaikh, Shah A. Qader, Qaisar Mansoor, Bahram K. Khoso, Muhammad Ismail

Department of Medicine

Background: The extracellular matrix protein 1 (ECM1) is a glycoprotein, expressed in skin and other tissues. Loss-of-function mutation in ECM1 causes a rare autosomal recessive disorder called lipoid proteinosis. Lipoid proteinosis is presented by varying degrees of skin scars, beaded papules along the eyelid margins, variable signs of hoarseness of voice and respiratory disorders. More than 250 cases of this disorder have been described in the literature, but occurrence of lipoid proteinosis in siblings is very rare. This study was designed to investigate the possible mutation causing lipoid proteinosis in a Pakistani family and to elaborate the scope of possible …