Medicine and Health Sciences Commons^™

Simplified Antibiotic Regimens For Treatment Of Clinical Severe Infection In The Outpatient Setting When Referral Is Not Possible For Young Infants In Pakistan (Simplified Antibiotic Therapy Trial [Satt]): A Randomised, Open-Label, Equivalence Trial, Fatima Mir, Imran Nisar, Shiyam S. Tikmani, Benazir Baloch, Sadia Shakoor, Fyezah Jehan, Imran Ahmed, Simon Cousens, Anita K M Zaidi

Department of Paediatrics and Child Health

Background: Parenteral antibiotic therapy for young infants (aged 0–59 days) with suspected sepsis is sometimes not available or feasible in countries with high neonatal mortality. Outpatient treatment could save lives in such settings. We aimed to assess the equivalence of two simplified antibiotic regimens, comprising fewer injections and oral rather than parenteral administration, compared with a reference treatment for young infants with clinical severe infection.
Methods: We undertook the Simplified Antibiotic Therapy Trial (SATT), a three-arm, randomised, open-label, equivalence trial in five communities in Karachi, Pakistan. We enrolled young infants (aged 0–59 days) who either presented at a primary health-care …

Epidemiology And Prevalence Of Deep Venous Thrombosis In Patients With Spinal Cord Injury, Aatik Arsh, Haider Darain, Syed Muhammad Ilyas

Pakistan Journal of Neurological Sciences (PJNS)

Pressure ulcers in patients with spinal cord injury (SCI) are associated with incredible financial cost and human sufferings. The aim of this retrospective study was to determine prevalence of pressure ulcers amongst patients with different levels of SCI.

Neurological Health Profile In Pakistan – A Health Systems Based Needs Assessment, Tauhid Awan, Arsalan Ahmad, Ather Javed, Mohammad Wasay, Muhammad Babar Khan, Haroon Awan

Pakistan Journal of Neurological Sciences (PJNS)

The aims of our study were to develop a neurological health profile in Pakistan from a health systems perspective, ascertain the readiness of neurology with regards to Sustainable Development Goals, and proffer recommendations for policy advocacy and planning in neurology.

Establishment Of Site Specific Multi Disciplinary Tumour Boards In Pakistan -Is It Really Necessary To Discuss All Cancer Cases In Multidisciplinary Tumour Board Meetings?, Ahmed Nadeem Abbasi

Department of Radiation Oncology

No abstract provided.

Sociodemographic Factors Associated With Igg And Igm Seroprevalence For Human Cytomegalovirus Infection In Adult Populations Of Pakistan: A Seroprevalence Survey, Saira Ibrahim, Anwar Ali Siddiqui, Amna Siddiqui, Waquaruddin Ahmed, Paul A. H. Moss, El Nasir Lalani

Department of Biological & Biomedical Sciences

Background: The seroprevalence of human cytomegalovirus (HCMV) infection ranges from 30 to 90 % in developed countries. Reliable estimates of HCMV seroprevalence are not available for Pakistan. This study determined the seroprevalence and sociodemographic factors associated with HCMV infection in adult populations of Karachi, Pakistan.
Methods: A seroprevalence survey was conducted on 1000 adults, including residents of two semi-urban communities, and visitors to a government and a private hospital. Questionnaire-based interviews were conducted. Sera were analysed for HCMV-specific IgG and IgM. Chi-square or Fisher’s exact test was used for comparing sociodemographic variables against seropositivity of HCMV-IgG or IgM. Multiple logistic …

Establishment And Maintenance Of Quality Of Site-Specific Multidisciplinary Tumor Boards In Pakistan, Ahmed Nadeem Abbasi

Department of Radiation Oncology

No abstract provided.

Nutritional Status And Physical Abuse Among The Children Involved In Domestic Labour In Karachi Pakistan: A Cross-Sectional Survey., Saima Zainab, Muhammad Masood Kadir

Community Health Sciences

OBJECTIVE:

To determine the prevalence of physical abuse among domestic child labours and to assess the nutritional status by calculating the Body Mass Index of children involved in domestic labour in Karachi.

METHODS:

A cross sectional study was conducted in the squatter settlements of Karachi. Questionnaire based interviews were conducted to capture physical abuse with 385 children who worked as domestic labour in the household of their employer. The ages of the children were between 10 to 14 years belonging to both genders. The children were enrolled in study by snow-ball sampling technique.

RESULTS:

The overall prevalence of physical abuse …

Comparing Effectiveness Of Active And Passive Client Follow-Up Approaches In Sustaining The Continued Use Of Long Acting Reversible Contraceptives (Larc) In Rural Punjab: A Multicentre, Non-Inferiority Trial, Waqas Hameed, Syed Khurram Azmat, Moazzam Ali, Muhammad Ishaque, Ghazunfer Abbas, Erik Munroe, Rebecca Harrison, Wajahat Hussain Shamsi, Ghulam Mustafa, Omar Farooq Khan

Community Health Sciences

Background: The use of long-acting reversible contraceptive (LARC) methods is very low in Pakistan with high discontinuation rates mainly attributed to method-related side effects. Mixed evidence is available on the effectiveness of different client follow-up approaches used to ensure method continuation. We compared the effectiveness of active and passive follow-up approaches in sustaining the use of LARC-and within 'active' follow-up, we further compared a telephone versus home-based approach in rural Punjab, Pakistan.
Methods: This was a 12-month multicentre non-inferiority trial conducted in twenty-two (16 rural- and 6 urban-based) franchised reproductive healthcare facilities in district Chakwal of Punjab province, between November …

Health Care Provider Knowledge And Routine Management Of Pre-Eclampsia In Pakistan, Sana Sheikh, Rahat Najam Qureshi, Asif Raza Khowaja, Rehana Salam, Marianne Vidler, Diane Sawchuck, Peter Von Dadelszen, Shujat Zaidi, Zulfiqar Bhutta

Department of Paediatrics and Child Health

Background: Maternal mortality ratio is 276 per 100,000 live births in Pakistan. Eclampsia is responsible for one in every ten maternal deaths despite the fact that management of this disease is inexpensive and has been available for decades. Many studies have shown that health care providers in low and middle-income countries have limited training to manage patients with eclampsia. Hence, we aimed to explore the knowledge of different cadres of health care providers regarding aetiology, diagnosis and treatment of pre-eclampsia and eclampsia and current management practices.
Methods: We conducted a mixed method study in the districts of Hyderabad and Matiari …

Obesity, An Emerging Epidemic In Pakistan-A Review Of Evidence., Sana Tanzil, Tanzil Jamali

Community Health Sciences

BACKGROUND:

In Pakistan, the disease pattern is facing a huge changeover from acute and communicable diseases to the non-communicable diseases. Moreover, an emerging epidemic of obesity is still under recognized in Pakistan. A detailed review and dissemination of the existing knowledge to determine the extent of burden of obesity can help understand this important public health issue.

METHODS:

A detailed literature review was conducted through PubMed search engines, regarding obesity burden in Pakistan. The original peer reviewed research articles, reports of WHO in English language, non-government organizations reports were included in the review. "Obesity AND Pakistan" were used as a …

Health Workers’ Perspectives, Knowledge And Skills Regarding Community Case Management Of Childhood Diarrhoea And Pneumonia: A Qualitative Inquiry For An Implementation Research Project “Nigraan” In District Badin, Sindh, Pakistan, Fauziah Rabbani, Shagufta Perveen, Wafa Aftab, Aysha Zahidie, Kashif Sangrasi, Shamim Ahmad Qazi Ahmad Qazi

Community Health Sciences

BACKGROUND:

Pakistan's Lady Health Worker Programme aims to provide care to children sick with pneumonia and diarrhoea, which continues to cause 27 % under-five mortality in Pakistan. The quality of supervision received by Lady Health Workers (LHWs) in the programme influence their knowledge and skills, in turn impacting their ability to provide care.

METHODS:

This study is part of an implementation research project titled "Nigraan" (an Urdu word meaning supervisor), and explores LHW and Lady Health Supervisor (LHS) perspectives regarding the role of supervision in improving LHWs performance and motivation in district Badin, Sindh, Pakistan. Their knowledge and skills regarding …

Inspiring Health Worker Motivation With Supportive Supervision: A Survey Of Lady Health Supervisor Motivating Factors In Rural Pakistan, Fauziah Rabbani, Leah Shipton, Wafa Aftab, Kashif Sangrasi, Shagufta Perveen, Aysha Zahidie

Community Health Sciences

BACKGROUND:

Community health worker motivation is an important consideration for improving performance and addressing maternal, newborn, and child health in low and middle-income countries. Therefore, identifying health system interventions that address motivating factors in resource-strained settings is essential. This study is part of a larger implementation research project called Nigraan, which is intervening on supportive supervision in the Lady Health Worker Programme to improve community case management of pneumonia and diarrhea in rural Pakistan. This study explored the motivation of Lady Health Supervisors, a cadre of community health workers, with particular attention to their views on supportive supervision.

METHODS:

Twenty-nine …

Tobacco Control Laws In Pakistan And Their Implementation: A Pilot Study In Karachi, Javaid Ahmed Khan, Abdul Malik Amir Humza Sohail, Muhammad Arslan Arif Maan

Section of Pulmonary & Critical Care

Objective: In order to limit the high prevalence of tobacco use in Pakistan various tobacco control laws have been implemented. The objective of this study is to serve as a pilot study to assess the implementation of these laws in the largest city of Pakistan, Karachi.

Methods: A cross-sectional study was conducted in Karachi. The implementation of tobacco control laws in 'smoke-free' places, the adherence of tobacco companies to these laws, the regulation of cigarette sale, and the awareness and views of the general public regarding tobacco control laws were assessed via direct observation by visits and through self-administered …

Health Care Seeking Behaviours In Pregnancy In Rural Sindh, Pakistan: A Qualitative Study, Rahat Najam Qureshi, Sana Sheikh, Asif Raza Khowaja, Zahra Hoodbhoy, Shujaat Zaidi, Diane Sawchuck, Marianne Vidler, Zulfiqar A. Bhutta, Peter Von Dadeslzen

Department of Paediatrics and Child Health

Background: Pakistan has alarmingly high numbers of maternal mortality along with suboptimal care-seeking behaviour. It is essential to identify the barriers and facilitators that women and families encounter, when deciding to seek maternal care services. This study aimed to understand health-seeking patterns of pregnant women in rural Sindh, Pakistan.
Methods: A qualitative study was undertaken in rural Sindh, Pakistan as part of a large multi-country study in 2012. Thirty three focus group discussions and 26 in-depth interviews were conducted with mothers [n=173], male decision-makers [n=64], Lady Health Workers [n=64], Lady Health Supervisors [n=10], Women Medical Officers [n=9] and Traditional Birth …

Chronic Bronchitis And Chronic Obstructive Pulmonary Disease (Copd) Among Textile Workers In Karachi, Pakistan, Asaad Ahmed Nafees, Zafar Fatmi, Muhammad Masood Kadir, Nalini Sathiakumar

Community Health Sciences

Objective: To determine the frequency and predictors of chronic bronchitis and COPD among textile workers in Karachi, Pakistan.
Study design: Cross-sectional survey.
Place and duration of study: Karachi, Pakistan, from October to December 2009.
Methodology: Male textile workers from 15 mills of Karachi were inducted. Data was collected using American Thoracic Society respiratory questionnaire (ATS-DLD-78-a) and spirometry.
Results: Out of 372 participants, 29 (7.8%) workers had chronic bronchitis (4, 9.1% aged ≥40 years) and 25 (6.7%) had COPD (12, 27.2% aged ≥40 years). Workers with chronic bronchitis had significantly decreased lung function compared to the healthy workers. Those reporting severe …

Long-Tunneled Versus Short-Tunneled External Ventricular Drainage: Prospective Experience From A Developing Country, Muhammad Zubair Tahir, Zain A. Sobani, Muhammed Murtaza, Ather Enam

Section of Neurosurgery

Background: External ventricular drains (EVD) are commonly utilized for temporary diversion of cerebrospinal fluid (CSF). Many neurosurgeons prefer long-tunneled EVDs in their routine practice. However, it is still unclear whether this extended tunneling helps in reducing CSF infection. Keeping this in mind, we decided to compare infection rates in long-tunneled versus short-tunneled EVDs in the setting of a developing country.
Materials and methods: A prospective study of 60 patients was conducted. Consenting patients who underwent short-tunneled (Group A) or long-tunneled (Group B) EVDs between January 2008 and June 2009 were followed during the course of their inpatient care. All operational …

Paucity Of Trauma Literature From A Highly Burdened Developing Country, Rizwan Sultan, Hasnain Zafar

Department of Surgery

Abstract Introduction: Trauma is the leading cause of death among a younger population not only in USA but in Pakistan as well. The high prevalence of disease should result in a larger amount of data and a larger number of publications resulting in the ability to explore improvements in the field. This study aimed to review the trauma literature generated from Pakistan. Methods: Journals indexed with PubMed from January 2010 to December 2014 were searched using the search term ‘‘Trauma AND Pakistan’’ filtering for relevant dates and human reports only. The abstracts and articles were reviewed by the authors to …

Imparting Research Ethics In Emergency Medicine-A Perspective From The Developing World, Shahan Waheed, Muhammad Akbar Baig, Asad Mian

Department of Emergency Medicine

No abstract provided.

The Role Of Micro Health Insurance In Providing Financial Risk Protection In Developing Countries- A Systematic Review., Shifa Salman Habib, Shagufta Perveen, Hussain Maqbool Ahmed Khuwaja

Community Health Sciences

BACKGROUND:

Out of pocket payments are the predominant method of financing healthcare in many developing countries, which can result in impoverishment and financial catastrophe for those affected. In 2010, WHO estimated that approximately 100 million people are pushed below the poverty line each year by payments for healthcare. Micro health insurance (MHI) has been used in some countries as means of risk pooling and reducing out of pocket health expenditure. A systematic review was conducted to assess the extent to which MHI has contributed to providing financial risk protection to low-income households in developing countries, and suggest how the findings …

Diagnostic Methods To Determine Microbiology Of Postpartum Endometritis In South Asia: Laboratory Methods Protocol Used In The Postpartum Sepsis Study: A Prospective Cohort Study, Sadia Shakoor, Megan E. Reller, Amnesty Lefevre, Aneeta Hotwani, Shahida M. Qureshi, Farheen Yousuf, Mohammad Shahidul Islam, Nicholas Connor, Iftekhar Rafiqullah, Fatima Mir

Department of Paediatrics and Child Health

Background: The South Asian region has the second highest risk of maternal death in the world. To prevent maternal deaths due to sepsis and to decrease the maternal mortality ratio as per the World Health Organization Millenium Development Goals, a better understanding of the etiology of endometritis and related sepsis is required. We describe microbiological laboratory methods used in the maternal Postpartum Sepsis Study, which was conducted in Bangladesh and Pakistan, two populous countries in South Asia.
Methods/Design: Postpartum maternal fever in the community was evaluated by a physician and blood and urine were collected for routine analysis and culture. …

Integration Of Health Promotion Into Nursing Practice: A Case Study In Pakistan., Muneerah Vastani, Rozina Karmaliani Professor, Pammla M. Petrucka

School of Nursing & Midwifery

The purpose of this study was to understand the concept of health promotion and perceptions related to the integration of health promotion in nursing practice in Pakistan. The study utilized the qualitative single case study approach to explore and describe the concept of health promotion, its significance and ways to integrate health promotion strategies in nursing practice. The data were collected from three different sources; focus group discussion among final year Post-RN BScN students, key informant interviews of practicing nurses, faculty, and MScN students, as well as a document review of the Post-RN BScN curriculum. Data analysis included a content …

Present And Future Of Neurology In Pakistan, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Neurology started as a department in early nineteen sixties in Dow Medical College and King Edward Medical College and initially having a separate department of neurology was not mandated in medical colleges by Pakistan Medical and Dental Council¹. Some neurology training programs do not give exposure to subspecialties and training is focused on adult neurology². From 2015 to 2016, several conferences were held on neurology including an Annual Meeting in Quetta, movement disorder conference in Lahore.

Factors Influencing Antiepileptic Drug Non-Compliance In Epileptic Patients Of Pakistan, Safia Bano, Ahsan Numanb

Pakistan Journal of Neurological Sciences (PJNS)

Failure to comply with drug regimes is prevalent amongst patients with epilepsy and the consequence of this is often an increased risk of further seizures and other associated harms including increased health care costs. Contributing factors leading to non-compliance of anti-epileptic drugs has not been examined in Pakistan. We investigated the factors influencing non-compliance to prescribed antiepileptic drugs (AEDs). A cross-sectional study was employed for a total of 53 epileptic patients with non-compliance of anti-epileptic drugs. The data-collection tools were a questionnaire and structured interview for this study. Results showed that males were more liable to non-compliance of AEDs as …

Neurocutanoussarcoidosis: A Rare Entity, Muslim Ali Lakhiar, Manzoor Lakhiar, Abdul Hafeez Bughio

Pakistan Journal of Neurological Sciences (PJNS)

Neurosarcoidosis is a granulomatous disorder considered to be a great imitator. We report a case of young lady who presented with gradual onset flexed posturing of fingers of left hand for four years, followed by similar pattern of weakness involving the right hand for three years along with slipping of slippers for one year. Neurologic examination showed distal wasting & weakness in upper limbs with normal jerks and sensory impairment in gloves and stocking distribution. On skin examination there were hypopigmented macules over face, neck and back. Electro diagnostic studies showed sensory motor axonal polyneuropathy, while skin biopsy reported as …

Mental Health Is Not A Luxury In Pakistan, Salma Kerai

Pakistan Journal of Neurological Sciences (PJNS)

A day with a fever is taken serious enough to get off from work in contrast to a day with emotional distress. World health organization defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. However, mental health is not seen as an integral part of overall well-being in many cultures.

Clinico-Pathological Profile And Outcomes Of Patients With Polycythaemia Vera, Essential Thrombocythaemia And Idiopathic Myelofibrosis: A Tertiary Care Center Experience From Southern Pakistan, Muhammad Shariq Shaikh, Mohammad Usman Shaikh, Salman Naseem Adil, Mohammad Khurshid, Zeeshan Ansar Ahmed

Department of Pathology and Laboratory Medicine

Background: The “Philadelphia Negative Classic Myeloproliferative Neoplasms” include polycythaemia vera (PV), essential thrombocythaemia (ET) andidiopathic myelofibrosis (IMF). These three disorders share several clinical and laboratory features including JAK2 V617F mutation. Our objectives were to determine the clinicoat hological profile and outcomes of Pakistani patients with polycythaemia vera (PV), essential thrombocythaemia (ET) and idiopathic myelofibrosis (IMF) in order to have an insight regarding behaviour of these conditions.
Methods: A retrospective analysis of all the cases of PV, ET and IMF diagnosed at our institute from January 1995 to December 2013 was performed.Age, gender, clinical presentation, laboratory investigations, treatment provided and …

Depression And Anxiety: A Snapshot Of The Situation In Pakistan, Bilaal Ahmed, Syed Faaiz Enam, Zafar Iqbal, Ghulam Murtaza, Shahid Bashir

Medical College Documents

Background: Depression is a great cause of morbidity around the world. Not one person seems to escape the hollow dread that the disease can bring forth.
Aims: Although living in a large extended family which serves as a social support is common in Pakistan, why we still suffer from anxiety and depression just as often if not more than those in other countries?
Method: We checked studies conducted in different localities of Pakistan over the past 10 years to find prevalence values of anxiety and depression. Results: The values of anxiety and depression ranging from 22% to as high as …