Medicine and Health Sciences Commons^™

Prevalence And Possible Factors Associated With Anaemia, And Vitamin B 12 And Folate Deficiencies In Women Of Reproductive Age In Pakistan: Analysis Of National-Level Secondary Survey Data, Sajid Bashir Soofi, Gul Nawaz Khan, Kamran Sadiq, Shabina Ariff, Atif Habib, Sumra Kureishy, Imtiaz Hussain, Muhammad Umer, Zamir Suhag, Arjumand Rizvi, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Objective: To determine the prevalence and possible factors associated with anaemia, and vitamin B12 and folate deficiencies in women of reproductive age (WRA) in Pakistan.
Methods: A secondary analysis was conducted on data collected through the large-scale National Nutrition Survey in Pakistan in 2011. Anaemia was defined as haemoglobin levels <12 g/dL, vitamin B12 deficiency as serum vitamin B12 levels of <203 pg/mL (150 pmol/L) and folate deficiency as serum folate levels <4 ng/mL (10 nmol/L).
Results: A total of 11751 blood samples were collected and analysed. The prevalence of anaemia, vitamin B12 deficiency and folate deficiency was 50.4%, 52.4% and 50.8%, respectively. After adjustment, the following factors were positively associated with anaemia: living in Sindh province (RR 1.07; 95%CI 1.04 to 1.09)P<0.00, food insecure with moderate hunger (RR 1.03; 95%CI 1.00 to 1.06)P=0.02, four or more pregnancies (RR 1.03; 95%CI 1.01 to 1.05)P<0.00, being underweight (RR 1.03; 95%CI 1.00 to 1.05)P=0.02, being overweight or obese (RR 0.95; 95%CI 0.93 to 0.97)P<0.00 and weekly intake of leafy green vegetables (RR 0.98; 95%CI 0.95 to 1.00)P=0.04. For vitamin B12 deficiency, a positive association was observed with rural population (RR 0.81; 95%CI 0.66 to 1.00)P=0.04, living in Khyber Pakhtunkhwa province (RR 1.25; 95%CI 1.11 to 1.43)P<0.00 and living in Azad Jammu and Kashmir (RR 1.50; 95%CI 1.08 to 2.08)P=0.01. Folate deficiency was negatively associated with daily and weekly intake of eggs (RR 0.89; 95%CI 0.81 to 0.98)P=0.02 and (RR 0.88; 95%CI 0.78 to 0.99)P=0.03.
Conclusions: In Pakistan, …

High Burden Of Subclinical Lead Toxicity After Phase Out Of Lead From Petroleum In Pakistan, Hafsa Majid, Aysha Habib, Nadeem Ullah Khan, Imran Siddiqui, Farooq Ghani, Lena Jafri

Department of Pathology and Laboratory Medicine

OBJECTIVE:
To evaluate the frequency of subclinical lead toxicity.
STUDY DESIGN:
Cross-sectional study.
PLACE AND DURATION OF STUDY:
Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, from January 2011 to December 2014.
METHODOLOGY:
Analysis of laboratory data for blood lead levels (BLL) was performed. Lead was tested by atomic absorption spectrometer. For all subjects, only initial test results were included while the results of repeated testing were excluded. Exemption was sought from institutional ethical review committee. BLL of 2-10 ug/dl and 10-70 ug/dl in children and adults, respectively were taken as subclinical lead toxicity.
RESULTS:
Amongst …

Identifying Constraints For Hospital Infection Control Management Via Mckinsey 7s Framework In Pakistan, Shagufta Perveen, Shifa Salman Habib

Community Health Sciences

Background: In Pakistan, structured guidelines for hospital infection control and prevention are deficient in most public sector facilities. There is dearth of literature available on management of hospital-care acquired infections and related issues. This study aims to understand infection control management as a proxy measure for quality of health care provided at a public sector tertiary care hospital in Karachi, Pakistan. In this study, we identify barriers to implementation of infection control measures and highlight key areas for quality improvement.
Methods: A cross sectional study was carried out in 2008 using qualitative research methods. In-depth interviews were conducted with hospital …

High Burden Of Subclinical Lead Toxicity After Phase Out Of Lead From Petroleum In Pakistan, Hafsa Majid, Aysha Habib, Nadeem Ullah Khan, Imran Siddiqui, Farooq Ghani, Lena Jafri

Department of Pathology and Laboratory Medicine

Objective: To evaluate the frequency of subclinical lead toxicity.
Study design: Cross-sectional study.
Place and duration of study: Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, from January 2011 to December 2014.
Methodology: Analysis of laboratory data for blood lead levels (BLL) was performed. Lead was tested by atomic absorption spectrometer. For all subjects, only initial test results were included while the results of repeated testing were excluded. Exemption was sought from institutional ethical review committee. BLL of 2-10 ug/dl and 10-70 ug/dl in children and adults, respectively were taken as subclinical lead toxicity.
Result: Amongst …

Societal Costs Of Micronutrient Deficiencies In 6- To 59-Month-Old Children In Pakistan, Simon Wieser, Beatrice Brunner, Christina Tzogiou, Rafael Plessow, Michael B. Zimmermann, Jessica Farebrother, Sajid Bashir Soofi, Zaid Ahmad Bhatti, Imran Ahmed, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: In Pakistan, nearly half of children younger than 5 years are stunted, and 1 in 3 is underweight. Micronutrient deficiencies, a less visible form of undernutrition, are also endemic. They may lead to increased morbidity and mortality as well as to impaired cognitive and physical development.
Objective: To estimate the lifetime costs of micronutrient deficiencies in Pakistani children aged between 6 and 59 months.
Methods: We develop a health economic model of the lifetime health and cost consequences of iodine, iron, vitamin A, and zinc deficiencies. We assess medical costs, production losses in terms of future incomes lost, and …

Primary Headache Disorders In The Adult General Population Of Pakistan – A Cross Sectional Nationwide Prevalence Survey, Herekar Aa, Ahmad A, Uqaili Ul, Ahmed B, Effendi J, Alvi Sz, Shahab Ma, Javed U, Herekar Ad, Khanani R, Steiner Tj

Section of Neurology

Back Ground: The large geographical gaps in our knowledge of the prevalence and burden of headache disorders include almost all of Eastern Mediterranean Region (EMR). We report a nationwide population-based study in Pakistan, an EMR country with the sixth largest population in the world, conducted as a project within the Global Campaign against Headache.

Methods: We surveyed six locations from the four provinces of Pakistan: Punjab, Sindh, Khyber Pakhtunkhwa and Baluchistan. We randomly selected and visited rural and urban households in each. One adult member (18-65 years) of each household, also randomly selected, was interviewed by a trained non-medical interviewer …

Risk Factors Of Cardiovascular Disease And Its Recommendations In Pakistani Context., Rubina Barolia, Amber Hussain Sayani

School of Nursing & Midwifery

Cardiovascular diseases possess a major cause for fatality and disability the world over. Since last several decades, the rates of cardiovascular diseases-related deaths have decreased in a number of high-income countries but increased in low- and middle-income countries with around 80% of the burden. Despite the seriousness of cardiovascular diseases in low- and middle-income countries, minimal attention is given to the prevention of cardiovascular diseases risk factors in South Asia, particularly in Pakistan. In addition, economic and political instability is accelerating the rates of cardiovascular diseases in the country. Practical efforts are required to enhance the understanding of cardiovascular diseases …

Burden Of Zinc (Zn) Deficiency: A High Volume Clinical Laboratory Data Analysis, Hafsa Majid, Shabnum Khawaja, Aysha Habib Khan, Imran Siddqui, Farooq Ghani, Lena Jafri

Department of Pathology and Laboratory Medicine

A cross-sectional survey was done at the Section of Chemical Pathology, Department of Pathology and Laboratory Medicine, AKUH, Karachi, to determine frequency of Zn deficiency, the second major micronutrient deficiency in developing countries, in subjects coming for investigations. Data of plasma Zn, from Jan 2013 to Dec 2014 was analyzed and deficiency was labeled at <65ug/dl. Total 469 subjects were tested for plasma Zn levels over the period of 24 months and complete information was available for 422 subjects, included in final analysis. Median age of subjects was 13 yrs (IQR 7-35) and 57% were male. Mean plasma Zn levels of the total subjects were 105±42.6ug/dl. Out of the total subjects 13.5% (n=57) had Zn deficiency (mean plasma Zn 52±11 ug/dl), and most of them were of age group 6-16yrs. These findings advocate that diet of Pakistani children should be revised in order to provide sufficient amounts of Zn.

Cost-Effectiveness Of A Family Planning Voucher Program In Rural Pakistan, Edward Ivor Broughton, Waqas Hameed, Xaher Gul, Shabnum Sarfraz, Imam Yar Baig, Monica Villanueva

Community Health Sciences

Introduction: This study reports on the effectiveness and efficiency from the program funder's perspective of the Suraj Social Franchise (SSF) voucher program in which private health-care providers in remote rural areas were identified, trained, upgraded, and certified to deliver family planning services to underserved women of reproductive age in 29 districts of Sindh and 3 districts of Punjab province, Pakistan between October 2013 and June 2016.
Method: A decision tree compared the cost of implementing SSF to the program funder and its effects of providing additional couple years of protection (CYPs) to targeted women, compared to business-as-usual. Costs included vouchers …

Post-Traumatic Stress Disorder And Its Predictors In Emergency Medical Service Personnel: A Cross-Sectional Study From Karachi, Pakistan, Salima Kerai, Uzma R. Khan, Muhammad Islam, Nargis Asad, Junaid Razzak, Omrana Pasha

Department of Paediatrics and Child Health

Background: Emergency medical service (EMS) personnel who work to provide emergency medical care at the scene and during transportation are exposed to various kinds of stressors and are particularly susceptible to developing stress-reactions. This study assesses symptoms of post-traumatic stress disorder and its predictors among the personnel of a selected EMS in Karachi, Pakistan.
Methods: Data were gathered from 518 personnel working in an EMS setting from February to May 2014. Participants were screened for post-traumatic stress symptoms using the Impact of Event Scale-Revised (IES-R). Demographic and work-related characteristics, coping styles and the social support systems of the participants were …

Peer Violence Perpetration And Victimization: Prevalence, Associated Factors And Pathways Among 1752 Sixth Grade Boys And Girls In Schools In Pakistan, Rozina Karmaliani Professor, Judith Mcfarlane, Rozina Somani, Hussain Maqbool Ahmed Khuwaja, Shireen Shehzad Bhamani, Tazeen Saeed Ali, Saleema A. Gulzar, Yasmeen Hassan Somani, Esnat D. Chirwa, Rachel Jewkes

School of Nursing & Midwifery

Background: Child peer violence is a global problem and seriously impacts health and education. There are few research studies available in Pakistan, or South Asia. We describe the prevalence of peer violence, associations, and pathways between socio-economic status, school performance, gender attitudes and violence at home.
Methods: 1752 children were recruited into a cluster randomized controlled trial conducted on 40 fairly homogeneous public schools (20 for girls and 20 for boys), in Hyderabad, Pakistan. This was ranging from 20-65 children per school. All children were interviewed with questionnaires at baseline.
Results: Few children had no experience of peer violence in …

Emergence Of Fluoroquinolone Resistance Among Drug Resistant Tuberculosis Patients At A Tertiary Care Facility In Karachi, Pakistan, Syed Mohammad Asad Zaidi, Abdul Haseeb, Shifa Salman Habib, Amyn Malik, Saira Khowaja, Nausheen Saifullah, Nadeem Rizvi

Community Health Sciences

Background: Pakistan is classified as one of the high multi-drug resistant tuberculosis (MDR-TB) burden countries. A poorly regulated private sector, over-prescription of antibiotics and self-medication has led to augmented rates of drug-resistance in the country. Pakistan's first national anti-tuberculosis drug resistance survey identified high prevalence of fluoroquinolone resistance among MDR-TB patients. Further institutional evidence of fluoroquinolone drug-resistance can support re-evaluation of treatment regimens as well as invigorate efforts to control antibiotic resistance in the country.
Findings: In this study, data for drug-susceptibility testing (DST) was retrospectively analyzed for a total of 133 patients receiving MDR-TB treatment at the Chest Department …

Prevalence And Characteristics Of Resistant Hypertensive Patients In An Asian Population, Rabia Naseem, Arsalan Majeed Adam, Fiza Khan, Adiya Dossal, Ibrahim Khan, Ammara Khan, Hannah Paul, Hafsa Jawed, Aisha Aslam, Faez Muhammad Syed, Muhammad Ahsen Niazi, Shehzeen Nadeem, Aruba Khan, Amber Zia, Mohammad Hussham Arshad

Department of Medicine

Background: Resistant hypertension is a well-recognized clinical challenge yet there are no reported data on its prevalence in Pakistan. These patients are subjected to a higher risk of developing hypertensive complications. The objective of our study was to evaluate the prevalence and determinants of resistant hypertension in an Asian cohort of hypertensive patients.
Methods: This cross-sectional study was carried out among hypertensive patients visiting a tertiary care hospital in Karachi from September-December 2015. Patient data and characteristics were recorded using a pre-coded questionnaire. Morisky and Berlin questionnaires were used to assess compliance to medications and determine the risk of developing …

Rsv Associated Hospitalizations In Children In Karachi, Pakistan: Implications For Vaccine Prevention Strategies, Syed Asad Ali, Mohammad Tahir Yousafzai, Rabbia Waris, Fatima Jafri, Fatima Aziz, Imran Naeem Abbasi, Anita K. M. Zaidi

Department of Paediatrics and Child Health

Major progress is being made in vaccines against Respiratory Syncytial Virus (RSV), with multiple vaccine candidates currently in the clinical phase of development. Making an investment case for public sector financing of RSV vaccine will require estimation of burden, cost-effectiveness, and impact. The aim of this study is to determine the proportion, age distribution and clinical spectrum of RSV associated hospitalizations in children in Karachi, Pakistan. A three years prospective study was conducted at the Aga Khan University Hospital in Karachi, a city of 20 million in south Pakistan, from August 2009 to June 2012. Children less than five years …

Impact Of Caregiving On Various Aspects Of The Lives Of Caregivers, Babar Irfan, Omar Irfan, Ahmed Ansari, Waris Qidwai, Kashmira Nanji

Department of Family Medicine

Objective: This study was designed to assess the impact of caregiving on the lives of the caregivers.

Methods: A cross-sectional study was conducted between July and September 2015 at a teaching hospital in Karachi, Pakistan. Participants who were more than 18 years old and were involved in caregiving (former or current) of a family member were invited to participate in the study. The participants were recruited through consecutive sampling technique. A total of 400 caregivers were interviewed. Written informed consent was obtained from all the participants. A pretest structured questionnaire was used for data collection and included sections …

Adaptation Of The Recent Life Changes Questionnaire (Rlcq) To Measure Stressful Life Events In Adults Residing In An Urban Megapolis In Pakistan, Azmina Artani, Shireen Shehzad, Iqbal Azam Syed, Moiz Abdul Sultan, Adeel Khoja, Ayeesha Kamran Kamal

Section of Neurology

Background: Contextually relevant stressful life events are integral to the quantification of stress. None such measures have been adapted for the Pakistani population.

Methods: The RLCQ developed by Richard Rahe measures stress of an individual through recording the experience of life changing events. We used qualitative methodology in order to identify contextually relevant stressors in an open ended format, using serial in-depth interviews until thematic saturation of reported stressful life events was achieved. In our next phase of adaptation, our objective was to scale each item on the questionnaire, so as to weigh each of these identified events, in terms …

Road Traffic Crash Related Injured And Fatal Victims In Karachi From 2007 To 2014: A Time-Series Analysis, Rashid Jooma, Masood Ali Shaikh

Section of Neurosurgery

Injuries and deaths due to road traffic crashes (RTC) are major public health concern. The Road Traffic Injury Research and Prevention Center, collects RTC data on injuries and fatalities from five emergency departments in Karachi. Data generating process (DGP) for RTC from 2007 to 2014, for monthly number of fatal and injured victims were analyzed using autoregressive integrated moving average and vector auto regression, time series models. Results provide strong evidence that the DGP for the current levels of the number of fatalities and injured owing to RTCs are significantly influenced by the own past history of the two series. …

Selective Screening For Organic Acidurias And Amino Acidopathies In Pakistani Children, Noreen Abbas Sherazi, Aysha Habib Khan, Lena Jafri, Azeema Jamil, Nasir Ali Khan, Bushra Afroze

Department of Pathology and Laboratory Medicine

Objective: To determine the frequency of organic acidurais (OA) and amino acidopathies (AA) in selected high-risk patients screened in two years.
Study Design: Retrospective Observational study.
Place and Duration of Study: The Aga Khan University Hospital (AKUH), Karachi, from January 2013 to December 2014.
Methodology: Patients with OA and AA were included in the study and patients with IMDs other than OA and AA were excluded. Amino acids and organic acids were analyzed on high performance liquid chromatography and gas chromatography-mass spectrometry respectively. Clinical data and chromatograms of patients screened for IMDs were reviewed by chemical pathologist and metabolic physician. …

Bomb Blast In A Tertiary Care Hospital, The Challenges Faced During Management Of Victims In A Resource Limited Country, Rizwan Sultan, Hasnain Zafar, Umar B, Khabir Ahmed

Department of Surgery

Abstract Introduction: A bomb blast in a hospital results in a many fold increase in the casualties. The affected health care in the region is the next challenge faced by the administration of the city. We discuss the challenges faced after a bomb blast in the civil hospital of Quetta, Pakistan on 8 August 2016. Methods: A retrospective review of the medical records of patients who were transferred by air to the Aga Khan University Hospital Karachi over a period of 86 h after the blast in Quetta. Results: Seventy-five patients were received in three separate waves; those received in …

Lead Exposure Assessment Among Pregnant Women, Newborns, And Children: Case Study From Karachi, Pakistan., Zafar Fatmi, Ambreen Sahito, Akihiko Ikegami, Atsuko Mizuno, Xiaoyi Cui, Nathan Mise, Mai Takagi, Yayoi Kobayashi, Fujio Kayama

Community Health Sciences

Lead (Pb) in petrol has been banned in developed countries. Despite the control of Pb in petrol since 2001, high levels were reported in the blood of pregnant women and children in Pakistan. However, the identification of sources of Pb has been elusive due to its pervasiveness. In this study, we assessed the lead intake of pregnant women and one- to three-year-old children from food, water, house dust, respirable dust, and soil. In addition, we completed the fingerprinting of the Pb isotopic ratios (LIR) of petrol and secondary sources (food, house-dust, respirable dust, soil, surma (eye cosmetics)) of exposure within …

Preventing Peer Violence Against Children: Methods And Baseline Data Of A Cluster Randomized Controlled Trial In Pakistan, Judith Mc Farlane, Rozina Karmaliani Professor, Hussain Maqbool Ahmed Khuwaja, Saleema A. Gulzar, Rozina Somani, Tazeen Saeed Ali, Yasmeen Hassan Somani, Shireen Shehzad Bhamani, Ryan D. Krone, Rene M. Paulson, Atta Muhammad, Rachel Jewke

School of Nursing & Midwifery

Background: Violence against and among children is a global public health problem that annually affects 50% of youth worldwide with major impacts on child development, education, and health including increased probability of major causes of morbidity and mortality in adulthood. It is also associated with the experience of and perpetration of later violence against women. The aim of this article is to describe the intervention, study design, methods, and baseline findings of a cluster randomized controlled trial underway in Pakistan to evaluate a school-based play intervention aiming to reduce peer violence and enhance mental health.
Methods: A cluster randomized controlled …

Assessing Decision Of Inpatient Or Outpatient Care In Community Acquired Pneumonia: Apt Care Study, Saleem Ullah, Javaid Khan, Amanullah Khan, Irfan Hashemy

Section of Pulmonary & Critical Care

Objective: To estimate the proportion of community-acquired pneumonia patients with disagreement between Confusion, Uraemia, Respiratory rate, Blood pressure, age > 65 years recommendation and physician\\\'s decision to hospitalise or not.
Methods: This cross-sectional nation-wide, non-interventional, cross-sectional study was carried out across 10 cities of Pakistan from December 2011 to May 2012, and recruited consenting adult patients with confirmatory diagnosis of community-acquired pneumonia on chest X-ray. Confusion, Uraemia, Respiratory rate, Blood pressure, age > 65 years recommendation for each patient was determined at the time of analysis. This recommendation was compared with treatment decision made by the physician. Disagreement was considered when the …

Motivating And Demotivating Factors For Community Health Workers Engaged In Maternal, Newborn And Child Health Programs In Low And Middle-Income Countries: A Systematic Review., Leah Shipton, Aysha Zahidie, F. Rabbani

Community Health Sciences

This systematic review aimed to synthesize primary research on motivating factors of community health workers (CHWs) for maternal, neonatal, and child health (MNCH) in low and middle-income countries (LMICs). Peer-reviewed literatures were systematically searched in five databases. Identified studies were then screened and selected for inclusion. The eligibility criteria were reported primary qualitative, quantitative, or mixed methods research, with participants being CHWs in LMICs who address MNCH, which investigated motivation or related concepts of retention, attrition, and performance. A thematic synthesis process was used to analyze findings of motivating factors, reported by included studies. Seventeen qualitative, quantitative, or mixed methods …

Validation Of Bioelectrical Impedance Analysis For Assessing Dry Weight Of Dialysis Patients In Pakistan, Huma Asmat, Romaina Iqbal, Fatima Sharif, Aamer Mahmood, Aamir Abbas, Waqar Kashif

Department of Medicine

Accurate dry weight estimation (DW) to achieve euvolemia is one of the key objectives of hemodialysis (HD). While conventionally DW is estimated by clinical examination, bioelectrical impedance analysis (BIA) has been proposed as an objective method to determine DW and has been tested extensively in the Western population. We aim to validate BIA for determining DW in a Pakistani population against the conventional clinician's method. This is a single-center validation study conducted at two outpatient HD units of Aga Khan Hospital, Karachi. One hundred and forty-eight DW readings of patients who were on maintenance HD were taken both by BIA …

Barriers And Perceptions Regarding Code Status Discussion With Families Of Critically Ill Patients In A Tertiary Care Hospital Of A Developing Country: A Cross-Sectional Study, Ahsan A. Syed, Aysha Almas, Quratulain Naeem, Umer F. Malik, M. Tariq

Department of Medicine

Background: In Asian societies including Pakistan, a complex background of illiteracy, different familial dynamics, lack of patient’s autonomy, religious beliefs, and financial constraints give new dimensions to code status discussion. Barriers faced by physicians during code status discussion in these societies are largely unknown.
Aim: To determine the barriers and perceptions in discussion of code status by physicians.
Design: Questionnaire-based cross-sectional study.
Setting and participants: This study was conducted in the Department of Medicine of The Aga Khan University Hospital, Karachi, Pakistan. A total of 134 physicians who had discussed at least five code statuses in their lifetime were included. …

Exploring The Impact Of Gender Inequities On The Promotion Of Cardiovascular Health Of Women In Pakistan, Rubina Barolia, Alexander M. Clark, Gina M. Higginbottom

School of Nursing & Midwifery

Cardiovascular disease exerts an enormous burden on women's health. The intake of a healthy diet may reduce this burden. However, social norms and economic constraints are often factors that restrain women from paying attention to their diet. Underpinned by critical realism, this study explores how gender/sex influences decision-making regarding food consumption among women of low socioeconomic status (SES). The study was carried out at two cardiac facilities in Karachi, Pakistan, on 24 participants (male and female from different ethnic backgrounds), who had received health education. Using an interpretive descriptive approach, the study identified major barriers to a healthy diet: proscribed …

Neurorobotics In Pakistan, Ather Enam, Muhammad Waqas

Section of Neurosurgery

No abstract provided.

Community Engagement And Integrated Health And Polio Immunisation Campaigns In Conflict-Affected Areas Of Pakistan: A Cluster Randomised Controlled Trial, Atif Habib, Sajid Soofi, Simon Cousens, Saeed Anwar, Najib Ulhaque, Imran Ahmed, Noshad Ali, Rehman Tahir, Zulfiqar A Bhutta

Department of Paediatrics and Child Health

Background: Pakistan faces huge challenges in eradicating polio due to widespread poliovirus transmission and security challenges. Innovative interventions are urgently needed to strengthen community buy-in, to increase the coverage of oral polio vaccine (OPV) and other routine immunisations, and to enhance immunity through the introduction of inactivated polio vaccine (IPV) in combination with OPV. We aimed to evaluate the acceptability and effect on immunisation coverage of an integrated strategy for community engagement and maternal and child health immunisation campaigns in insecure and conflict-affected polio-endemic districts of Pakistan.
Methods: We did a community-based three-arm cluster randomised trial in healthy children …

Tuberculosis Control In Sindh, Pakistan: Critical Analysis Of Its Implementation, Ali H. Khan

Medical College Documents

Tuberculosis (TB) remains one of the main health problems despite preventive and control measures that have been taken in the past few decades. It is responsible for almost 8.8 million cases and 1.4 million deaths around the world. Lack of access to TB services is a barrier for empowering TB patients. In a country like Pakistan, controlling TB has become a challenge because of the lack of private sector involvement in a National Tuberculosis Control Program (NTP). Therefore, collaboration is needed between public, private and government sectors in treating TB as well as in improving the quality of the health …

A Mixed Methods Study To Assess The Effectiveness Of Food-Based Interventions To Prevent Stunting Among Children Under-Five Years In Districts Thatta And Sujawal, Sindh Province, Pakistan: Study Protocol, Sumra Kureishy, Gul Nawaz Khan, Shabina Arrif,, Khizar Ashraf, Angela Cespedes, Atif Habib, Imtiaz Hussain, Asmat Ullah, Ali Turab, Imran Ahmed, Shehla Zaidi, Sajid Bashir Soofi

Department of Paediatrics and Child Health

Background: Maternal and child malnutrition is widely prevalent in low and middle income countries. In Pakistan, widespread food insecurity and malnutrition are the main contributors to poor health, low survival rates and the loss of human capital development. The nutritional status trends among children exhibit a continuous deteriorating with rates of malnutrition exceeding the WHO critical threshold. With the high prevalence of maternal and child malnutrition, it is important to identify effective preventative approaches, especially for reducing stunting in children under-five years of age. The primary aim of this study is to assess the effectiveness of food-based interventions to …