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Health Systems Changes After Decentralisation: Progress, Challenges And Dynamics In Pakistan, Shehla Zaidi, Maryam Bigdeli, Etienne V. Langlois, Atif Riaz, David W. Orr, Nasir Idrees, Jesse B. Bump

Community Health Sciences

Decentralisation is widely practised but its scrutiny tends to focus on structural and authority changes or outcomes. Politics and process of devolution implementation needs to be better understood to evaluate how national governments use the enhanced decision space for bringing improvements in the health system and the underlying challenges faced. We use the example of Pakistan's radical, politically driven provincial devolution to analyse how national structures use decentralisation opportunities for improved health planning, spending and carrying out transformations to the health system. Our narrative draws on secondary data sources from the PRIMASYS study, supplemented with policy roundtable notes from Pakistan. …

Applying Quality Improvement Methods To Neglected Conditions: Development Of The South Asia Burn Registry (Sabr), Nukhba Zia Nukhba Zia, Asad Latif, Saidur Rahman Mashreky, Ehmer Al-Ibran, Madiha Hashmi, A. K. M. Fazlur Rahman, Sazzad Khondoker, Mohammed Saeed Quraishy, Adnan A. Hyder

Department of Anaesthesia

Objective: South Asia has the highest mortality rate from burns in the world. Application of quality improvement methods to burn care can help identify health system gaps. Our overall aim is to introduce a sustainable hospital-based burn registry for resource-constrained settings to assess health outcomes of burn injury patients presenting to dedicated burn injury centers in South Asia.
Results: The South Asia Burn Registry (SABR) is implemented through collaborative approach in selected burn centers in Bangladesh and Pakistan. Th registry collects data on burn injury events, the care provided, and the functional status of patients at discharge from burn centers. …

Multidisciplinary Care In Motor Neuron Disease, Sara Khan

Pakistan Journal of Neurological Sciences (PJNS)

Motor neuron disease (MND) is a progressive degenerative disorder of the motor neurons, resulting in progressive limb, bulbar and respiratory muscle weakness. No definitive disease modifying treatment is available at this time. The mainstay of management remains multidisciplinary care, which has shown to improve quality of life, prevents complications and may also increase life span. In this review, different medical specialties necessary to offer complete multidisciplinary care are discussed. Symptomatic management of individual symptoms commonly experienced by patients with MND is elaborated on.

Evaluation Of The Cost-Effectiveness Of The Treatment Of Uncomplicated Severe Acute Malnutrition By Lady Health Workers As Compared To An Outpatient Therapeutic Feeding Programme In Sindh Province, Pakistan, Eleanor Rogers, Saul Guerrero, Deepak Kumar, Sajid Bashir Soofi, Shahid Fazal, Karen Martínez, Jose Luis Alvarez Morán, Chloe Puett

Department of Paediatrics and Child Health

Background: Due to the limited evidence of the cost-effectiveness of Community Health Workers (CHW) delivering treatment for severe acute malnutrition (SAM), there is a need to better understand the costs incurred by both implementing institutions and beneficiary households. This study assessed the costs and cost-effectiveness of treatment for cases of SAM without complications delivered by government-employed Lady Health Workers (LHWs) and complemented with non-governmental organisation (NGO) delivered outpatient facility-based care compared with NGO delivered outpatient facility-based care only alongside a two-arm randomised controlled trial conducted in Sindh Province, Pakistan.
Methods: An activity-based cost model was used, employing a societal perspective …

Integrating Nutrition Into Health Systems: What The Evidence Advocates, Rehana Salam, Jai K. Das, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

There is considerable evidence of positive health and nutrition outcomes resulting from integrating nutrition-specific interventions into health systems; however, current knowledge on establishing and sustaining effective integration of nutrition into health systems is limited. The objective of this review is to map the existing types of integration platforms and review the evidence on integrated health and nutrition programmes' impacts on specific nutrition outcomes. A literature search was conducted, and integrated nutrition programmes were examined through the lens of the six World Health Organization (WHO) building blocks, including the demand side. Forty-five studies were included in this review, outlining the integration …

Oral Polio Vaccine Response In The Mal-Ed Birth Cohort Study: Considerations For Polio Eradication Strategies, William K. Pan, Jessica C. Seidman, Syed Asad Ali, Christel Hoest, Carl Mason, Dinesh Mondal, Stacey L. Knobler, Pascal Bessong, Mal-Ed Network Investigators

Department of Paediatrics and Child Health

Background: Immunization programs have leveraged decades of research to maximize oral polio vaccine (OPV) response. Moving toward global poliovirus eradication, the WHO recommended phased OPV-to-IPV replacement on schedules in 2012. Using the MAL-ED prospective birth cohort data, we evaluated the influence of early life exposures impacting OPV immunization by measuring OPV response for serotypes 1 and 3.
Methods: Polio neutralizing antibody assays were conducted at 7 and 15 months of age for serotypes 1 and 3. Analyses were conducted on children receiving ≥3 OPV doses (n = 1449). History of vaccination, feeding patterns, physical growth, home environment, diarrhea, enteropathogen detection, …

Prevalence And Correlates Of Comorbid Depression In Patients With Type 2 Diabetes Attending Clinic At Aga Khan University Hospital, Nairobi, Alamin Suleiman

Master of Medicine in Family Medicine

Introduction: Type 2 diabetes affects 500,000 people in Kenya and is a single cause of morbidity and mortality. It also co-exists with depression, increasing the disease severity and the likelihood of a lower quality of life. Objectives: The primary aim of this study was to examine the depression prevalence as well as factors associated with depression among patients with Type 2 diabetes attending clinic at Aga Khan University Hospital Nairobi (AKUHN). The study also assessed the differences in depression severity with Type 2 diabetes alone and with Type 2 diabetes and other comorbid conditions. Methodology: An analytic cross-sectional methodology was …

The Effect Of Premedication With Intravenous Lornoxicam On Propofol Injection Pain At Induction Of General Anaesthesia In Adults: A Randomised Placebo-Controlled Trial, Dennis Omari Onyancha

Master of Medicine in Anaesthesiology

Background: Propofol is widely used for the induction and maintenance of general anaesthesia and offers many key attractive pharmacological qualities that make it suitable for these indications. However, pain on injection is one of its major drawbacks and can be very distressing to patients. There is a paucity of studies that have looked at the effect of lornoxicam on propofol injection pain either as a sole intervention or in combination with any other method. Primary objective: To determine whether premedication with intravenous lornoxicam had any effect on the intensity of propofol injection pain at induction of general anaesthesia in adult …

The Rural Livelihood Impacts Of East Africa’S New Development Corridors, Charis Enns, Brock Bersaglio, Ramson Karmushu, Masalu Luhula, Alex Awiti

East Africa Institute

Background and rationale: Africa is experiencing a surge of investment in new development corridors, which are networks of transport infrastructure intended to open isolated parts of the continent for investment and socio-economic development. Proponents of development corridors – including governments, bilateral development agencies and multilateral development banks – present these massive infrastructure projects as a solution to the obstacles created by uneven development. Development corridors are promoted as a way of correcting the spatial disparities that exist between different regions as they are promised to intensify agricultural and industrial production, increase economic diversification, create new employment opportunities and improve access …

Fmic Annual Report 2019 | English, French Medical Institute For Mothers And Children

French Medical Institute for Mothers and Children (FMIC) Archives

No abstract provided.

Where Are The Paediatricians? An International Survey To Understand The Global Paediatric Workforce, Beth D. Harper, Waceke Nganga, Robert Armstrong, Kevin D. Forsyth, Hazen P. Ham, William J. Keenan, Christiana M. Russ

Paediatrics and Child Health, East Africa

Objective: Our primary objective was to examine the global paediatric workforce and to better understand geographic differences in the number of paediatricians globally. Secondary objectives were to describe paediatric workforce expectations, who provides children with preventative care and when children transition out of paediatric care.

Design: Survey of identified paediatric leaders in each country.

Setting: Paediatric association leaders worldwide.

Main outcome measures: Paediatrician numbers, provision of primary care for children, age of transition to adult care.

Results: Responses were obtained from 121 countries (73% of countries approached). The number of paediatricians per 100 000 children ranged from a median of …

Ultrastructural Studies Of Acrosomal Formation In The Testis Of Male Greater Cane Rat (Thryonomys Swinderianus), A. O. Adebayo, A. K. Akinloye, Amadi O. Ihunwo, V. O. Taiwo, B. O. Oke

Brain and Mind Institute

Purpose:

In furthering the understanding of the process of spermatogenesis in the greater cane rat, this study describes the ultrastructural spermiogenic transformation and acrosomal formation in the testes of this hystricomorphic rodent that is currently undergoing domestication in parts of West Africa.

Materials and Methods:

Testicular samples were obtained from ten sexually mature cane rats that were perfused-fixed using Karnovsky's fixative (phosphate buffered 2% paraformaldehyde – 2.5% glutaraldehyde fixative at pH 7.4). The samples were processed for ultrastructural analysis and examined under the transmission electron microscope.

Results:

The testes of the cane rat showed uniqueness in its cellular associations and …

Assessment Of Factors Affecting Quality Of Life In Oral Squamous Cell Carcinoma Patients Using University Of Washington Quality Of Life Questionnaire, Syed Abbas, Muhammad Usman Tariq, Abdul Rehman, Javeria Saeed, Syed S. Hashmi, Musa Karim, Mazhar Ali

Section of Otolaryngology, Head & Neck Surgery

Introduction Post-treatment Quality of Life (QOL) is considered an important outcome in cancer patients. A number of questionnaire tools have been designed for its assessment. University of Washington Quality of Life (UW QOL) questionnaire version four is a reliable tool for assessment of post-treatment QOL in oral squamous cell carcinoma (OSCC) patients. Our aim was to identify the post-treatment problems faced by OSCC patients and to assess the impact of clinical factors affecting post-treatment QOL by using UW QOL (version four) questionnaire. Methods The study was conducted on 59 patients with OSCC who were treated with curative intent at Patel …

Assessing Nutritional Status Of Critically Ill Patients Using Serum Prealbumin Levels, Khushbakht Arbab, Hafsa Majid, Lena Jafri, Aysha Habib, Ahmed Raheem, Bushra Jamil, Bushra Akram, Madiha Hashmi

Department of Pathology and Laboratory Medicine

Background: Malnutrition in hospitalized patients, contributes to poor outcomes. Biomarker serum prealbumin, can prevent the complications by commencement of nutritional support to improve clinical outcomes. This study was designed to assess the association between low serum prealbumin level (<18 mg/dl), with length of stay and all cause intensive care unit mortality.
Methods: This cross-sectional study was conducted from July 2016 to July 2017 at Aga Khan University Hospital Karachi Pakistan. All consecutive patients, aged between 18 to 70 years, admitted in medical or surgical intensive care unit were included. Demographic, clinical history and blood samples for analysing serum prealbumin were obtained on first day of admission. Patients were categorized into two groups …

Relationship Of Sociodemographic Factors With Serum Levels Of Vitamin D In A Healthy Population Of Pakistan, Khalida Iqbal, Najmul Islam, Naseema Mehboobali, Ali Asghar, Saleem Perwaiz Iqbal, Mohammad Perwaiz Iqbal

Department of Biological & Biomedical Sciences

High prevalence of vitamin D deficiency has been reported from Pakistan. Association of sociodemographic factors with vitamin D status has received little attention in this region. Therefore, we embarked on investigating the relationship of sociodemographic factors with vitamin D levels in a healthy Pakistani population. Venous blood from 226 healthy participants (age range 19-69 years) was collected and analyzed for serum concentrations of 25(OH) vitamin D [25(OH)D] and other related biomarkers. Demographic characteristics of the study participants were collected. Vitamin D deficiency (25(OH)D levels less than 20 ng/ml) was found to be 75% in this cohort. Gender, sunlight exposure and …

Assessment Of Inequalities In Coverage Of Essential Reproductive, Maternal, Newborn, Child, And Adolescent Health Interventions In Kenya, Emily Catherine Keats, Nadia Akseer, Zaid Bhatt, William Macharia, Anthony Ngugi, Arjumand Rizvi, Zulfiqar Ahmed Bhutta

Paediatrics and Child Health, East Africa

Importance: Previous work has underscored subnational inequalities that could impede additional health gains in Kenya.

Objective: To provide a comprehensive assessment of the burden, distribution, and change in inequalities in reproductive, maternal, newborn, child, and adolescent health (RMNCAH) interventions in Kenya from 2003 to 2014.

Design, Setting, and Participants: This population-based cross-sectional study used data from the 2003, 2008, and 2014 Kenya Demographic and Health Surveys. The study included women of reproductive age (ages 15-49 years) and children younger than years, with national, regional, county, and subcounty level representation. Data analysis was conducted from April 2018 to November 2018.

Exposures: …

Effectiveness Of A Youth-Led Early Childhood Care And Education Programme In Rural Pakistan: A Cluster-Randomised Controlled Trial, Aisha Khizar Yousafzai, Muneera Rasheed, Arjumand Rizvi, Fariha Shaheen, Liliana A. Ponguta, Chin R. Reyes

Department of Paediatrics and Child Health

Background: The United Nation's Sustainable Development Goals encompass lifelong learning from birth to youth to adulthood (Goal 4) and economic opportunities for young people (Goal 8). The targets include improving access to quality early childhood care and education (ECCE) as well as learning and training opportunities for adolescents and youth. Cross-generational models for young children and youth may offer opportunities to address the interconnections between goals and targets for the next generation. We investigated whether an ECCE programme for young children (3.5-6.5 years) delivered by female youth (18-24 years) in rural Pakistan would be effective on children's school readiness.
Methods: …

Assessment Of Patient-Centered Approaches To Collect Sexual Orientation And Gender Identity Information In The Emergency Department: The Equality Study, Adil H. Haider, Rachel R. Adler, Eric Schneider, Tarsicio Uribe Leitz, Anju Ranjit, Christina Ta, Adele Levine, Omar Harfouch, Danielle Pelaez, Lisa Kodadek

Section of General Surgery

Importance: Health care and government organizations call for routine collection of sexual orientation and gender identity (SOGI) information in the clinical setting, yet patient preferences for collection methods remain unknown.
Objective: To assess of the optimal patient-centered approach for SOGI collection in the emergency department (ED) setting.
Design, setting, and participants: This matched cohort study (Emergency Department Query for Patient-Centered Approaches to Sexual Orientation and Gender Identity [EQUALITY] Study) of 4 EDs on the east coast of the United States sequentially tested 2 different SOGI collection approaches between February 2016 and March 2017. Multivariable ordered logistic regression was used to …

Business Not As Usual: How Multisectoral Collaboration Can Promote Transformative Change For Health And Sustainable Development, Shyama Kuruvilla, Rachael Hinton, Ties Boerma, Ryan Bunney, Nuria Casamitjana, Rafael Cortez, Patrizia Fracassi, Jennifer Franz-Vasdeki, Daniel Helldén, Joanne Mcmanus, Jai K. Das

Department of Paediatrics and Child Health

No abstract provided.

Scaling Up Primary Health Services For Improving Reproductive, Maternal, And Child Health: A Multisectoral Collaboration In The Conflict Setting Of Afghanistan, Jai K. Das, Nadia Akseer, Shafiq Mirzazada, Omarwalid Noorzada, Corinne E. Armstrong, Kashif Mukhtar, Ahmed Jan Naeem, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

No abstract provided.

Frontoethmoidal Encephalocele Presenting In Concert With Schizencephaly, Asra Tanwir, Syed Sarmad Bukhari, Muhammad Shahzad Shamim

Section of Neurosurgery

Background: Schizencephaly is a rare defect which is identified as clefts that are lined with grey matter extending from the ependyma of the cerebral ventricles to the pia mater. An encephalocele occurs due to failure of neural tube closure resulting in a gap through which cerebrospinal fluid and meninges can bulge into a pouch. There have been rare instances when these two defects have presented simultaneously.
Case description: We report a case of a 17-year-old child who was brought by his parents with complaint of swelling over his nose and forehead and aggressive behavior since birth. Magnetic resonance imaging findings …

Exploring Teachers’ Interventions In Enhancing Grade One School Readiness, Rawa Ghaleb Afara

Master of Education

This study investigates first-grade teacher’s intervention to support learners in grade one who are not yet ready for school. It was undertaken to give a clear insight into the intervention that grade-one teachers do to assist learners for a smooth transition in grade one. In addition it looked at the challenges that affect teacher education practices. Most research studies examined readiness by focusing on the skills which children should have before going to school. Limited studies investigated ‘readiness’ by examining the role of teachers in handling children in grade one especially those who were not ready emotionally, cognitively and behaviorally. …

Multi-Disciplinary And Shared Decision-Making Approach In The Management Of Organ-Confined Prostate Cancer, Syed M. Nazim, Mohamed Fawzy, Christian Bach, Hammad Ather

Section of Urology

Decision-making in the management of organ-confined prostate cancer is complex as it is based on multi-factorial considerations. It is complicated by a multitude of issues, which are related to the patient, treatment, disease, availability of equipment(s), expertise, and physicians. Combination of all these factors play a major role in the decision-making process and provide for an interactive decisionmaking preferably in the multi-disciplinary team (MDT) meeting. MDT decisions are comprehensive and are often based on all factors including patients’ biological status, disease and its aggressiveness, and physician and centres’ expertise. However, one important and often under rated factor is patient-related factors. …

Multiple-Micronutrient Supplementation: Evidence From Large-Scale Prenatal Programmes On Coverage, Compliance And Impact, Cristiana Berti, Michelle F. Gaffey, Zulfiqar Ahmed Bhutta, Irene Cetin

Department of Paediatrics and Child Health

Micronutrient deficiencies during pregnancy pose important challenges for public-health, given the potential adverse outcomes not only during pregnancy but across the life-course. Provision of iron-folic acid (IFA) supplements is the strategy most commonly practiced and recommended globally. How to successfully implement IFA and multiple micronutrient supplementation interventions among pregnant women and to achieve sustainable/permanent solutions to prenatal micronutrient deficiencies remain unresolved issues in many countries. This paper aims to analyse available experiences of prenatal IFA and multiple micronutrient interventions to distil learning for their effective planning and large-scale implementation. Relevant articles and programme-documentation were comprehensively identified from electronic databases, websites …

The Dietary Intake And Practices Of Adolescent Girls In Low- And Middle-Income Countries: A Systematic Review, Emily C. Keats, Aviva I. Rappaport, Shailja Shah, Christina Oh, Reena Jain, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

In many low- and middle-income countries (LMICs) the double burden of malnutrition is high among adolescent girls, leading to poor health outcomes for the adolescent herself and sustained intergenerational effects. This underpins the importance of adequate dietary intake during this period of rapid biological development. The aim of this systematic review was to summarize the current dietary intake and practices among adolescent girls (10⁻19 years) in LMICs. We searched relevant databases and grey literature using MeSH terms and keywords. After applying specified inclusion and exclusion criteria, 227 articles were selected for data extraction, synthesis, and quality assessment. Of the included …

Effect Of Psychological Distress On The Emerging Cause Of Infertility, Faiza Kausar

Journal of Asian Midwives (JAM)

Background: Infertility is a growing issue of the recent era, and it represents significant crises for most couples. Psychological distress has often been suggested as a cause of unexplained infertility. Male infertility accounts for 40% of all infertility problems, while female infertility accounts for 40% of all infertility problems; others are unexplained. Previous studies have indicated that stress and depression negatively impact various infertility parameters in both partners. To determine the relationship between infertility and psychological distress and the level of different types of stress among infertile couples, and to relate the significant stressors responsible for worsening infertility or …

Impact Of Sepsis And Non-Communicable Diseases On Prognostic Models To Predict The Outcome Of Hospitalized Chronic Liver Disease Patients, Fakhar Qazi, Shahab Abid, Preet Ayoub Shaikh, Safia Awan

Section of Gastroenterology

AIM: To evaluate the impact of sepsis and non-communicable diseases (NCDs) on the outcome of decompensated chronic liver disease(CLD) patients.

Methods: In this cross-sectional study, medical records of patients with CLD admitted to the Gastroenterology unit at the Aga Khan University Hospital were reviewed. Patients older than 18 years with decompensation of CLD (i.e., jaundice, ascites, encephalopathy, and/or upper gastrointestinal bleed) as the primary reason for admission were included, while those who were admitted for reasons other than decompensation of CLD were excluded. Each patient was followed for 6 wk after index admission to assess mortality, prolonged hospital …

Challenges Faced By Pakistani Healthcare System: Clinician's Perspective, Faran Khalid, Ahmed Nadeem Abbasi

Department of Radiation Oncology

Abstract are not provided by the author/publisher

Assessment Of Dental Maturation On Orthopantomograms Among Children With Various Dental Malocclusions At A Tertiary Care Hospital, Hafiz Taha Mahmood, Mubassar Fida

Department of Paediatrics and Child Health

Objectives: To determine and compare the median dental age among males and females and in subjects with dental Class I, II and III malocclusions.
Methods: The retrospective study was conducted at Aga Khan University Hospital and comprised dental records of patients from July to December 2016 who were aged 9-16 years and had complete dentition excluding third molars. The sample was divided according to dental malocclusion which was further categorised according to chronological age groups. SPSS 21 was used for data analysis.
Results: Of the 270 sbjects whose radiographs were studied, 135(50%) each were males and females. Children aged 11-12 …

Advancing Universal Health Coverage In South Asian Cities: A Framework, Alayne M. Adams, Devaki Nambiar, Sameen Siddiqi, Bushra Binte Alam, Srinath Reddy

Department of Paediatrics and Child Health

No abstract provided.