Medicine and Health Sciences Commons^™

Bangladesh To Take Over The Training Of Midwifery Educators: A Commentary Paper, Kerstin Erlandsson, Ulrika Byrskog, Catrin Borneskog Sinclair, Christina Pedersen

Journal of Asian Midwives (JAM)

While Bangladesh has made gains in maternal health provisions, there are still gaps and unmet need for services. Bangladesh has trained over 7 000 midwives, and many more midwifery educators are needed to serve the country’s population of 140 million with midwifery services. In April 2016 the first nursing faculty teaching midwifery students at nursing institutes across Bangladesh were enrolled in a blended online and onsite master’s programme with the Dalarna University, Sweden. The programme content focused the subject sexual, reproductive and perinatal health and was the first of its kind in Asia. The graduating faculty members were expected to …

A Peculiar Case Of Dengue Hemorrhagic Fever: A Case Report Of Radical Outcomes: A Case Study, Neelam Ubaid-Ur-Raheem

Journal of Asian Midwives (JAM)

Dengue is the arthropod-borne flavivirus infection, its severity increases during pregnancy, and results in worst maternofetal outcomes, which is an alarming issue. Dengue fever (DF) is the most common cause for preterm delivery and abortion. Dengue-related thrombocytopenia increases the risk of bleeding during pregnancy and delivery and can also leads to high maternal mortality rates. Globally 3.9 billion people are at risk of dengue fever, especially in Asia.
This case study focuses on a 22-years old pregnant woman from Pakistan without known co-morbidities. She presented in an emergency department with high fever, nausea, vomiting, and bleeding gum. She was positive …

Is It Safe To Have Sexual Intercourse During Pregnancy? A Commentary Paper, Misbah Zafar, Mehreen Aslam

Journal of Asian Midwives (JAM)

Sexuality is an expression of love, care, and intimacy between couples but pregnancy, and the early postnatal period can have a significant impact on sexual health. Numerous physiological and psychological changes take place during pregnancy^[1]. These changes may have a deep influence on the sexual lives of married couples in a variety of ways. ^[2]

The degree of sexual health awareness, myths, rituals, and beliefs about sexual activity during pregnancy are some of the contributing factors which promote or hinders the sexual relationships during pregnancy ^[3]. The most common fear related …

Strengthening Midwifery Response: Implementing Updated Who Guidelines In Birthing Centers In Northern Pakistan, Rafat Jan, Marina Baig, Sadia Karimi, Farzana Yameen, Kiran Mubeen, Arusa Lakhani

Journal of Asian Midwives (JAM)

No abstract provided.

A Step To Improve Maternal Health In Mountain Region Of Pakistan, Rafat Jan, Farzana Yameen, Marina Baig, Sadia Karimi, Kiran Mubeen, Arusa Lakhani

Journal of Asian Midwives (JAM)

No abstract provided.

International Day Of Midwives: Honoring Midwives' Dedication And Zeal In Gilgit Baltistan, Pakistan, Arusa Lakhani, Rafat Jan, Sadia Karimi, Mehreen Aslam

Journal of Asian Midwives (JAM)

No abstract provided.

Harvesting Health: Indigenous Mothers’ Resilience In The Face Of Climate Change And Maternal Nutrition Challenges In Rural Bajaur, Pakistan: A Study Protocol, Ihsan Ullah, Rafat Jan, Dilshad Begum, Kiran Mubeen, Laila Amir Ali Lalji

Journal of Asian Midwives (JAM)

No abstract provided.

A Health Systems Approach To Critical Care Delivery In Low-Resource Settings: A Narrative Review, Stephen A. Spencer, Faustina Excel Adipa, Tim Baker, Ana Maria Crawford, Paul Dark, Dingase Dula, Stephen B. Gordon, David Oliver Hamilton, Dawit Kebede Huluka, Wangari Siika

Anaesthesiology, East Africa

There is a high burden of critical illness in low-income countries (LICs), adding pressure to already strained health systems. Over the next decade, the need for critical care is expected to grow due to ageing populations with increasing medical complexity; limited access to primary care; climate change; natural disasters; and conflict. In 2019, the 72nd World Health Assembly emphasised that an essential part of universal health coverage is improved access to effective emergency and critical care and to “ensure the timely and effective delivery of life-saving health care services to those in need”. In this narrative review, we examine critical …

Organisation, Staffing And Resources Of Critical Care Units In Kenya, Wambui Mwangi, Ronnie Kaddu, Carolyne Njoki Muiru, Nabukwangwa Simiyu, Vishal Patel, Demet Sulemanji, Dorothy Otieno, David Misango, Wangari Siika, Rashan Haniffa

Anaesthesiology, East Africa

Objective: To describe the organisation, staffing patterns and resources available in critical care units in Kenya. The secondary objective was to explore variations between units in the public and private sectors.

Materials and methods: An online cross-sectional survey was used to collect data on organisational characteristics (model of care, type of unit, quality- related activities, use of electronic medical records and participation in the national ICU registry), staffing and available resources for monitoring, ventilation and general critical care.

Results: The survey included 60 of 75 identified units (80% response rate), with 43% (n = 23) located in government facilities. A …

Cost-Effectiveness Of Hydroxyurea For Sickle Cell Anemia In A Low-Income African Setting: A Model-Based Evaluation Of Two Dosing Regimens, David Teigen, Robert Opoka, Phillip Kasirye, Catherine Nabaggala, Heather A. Hume, Bjørn Blomberg, Chandy John, Russell Ware, Bjarne Robberstad

Paediatrics and Child Health, East Africa

Background and Objective: The disease burden of sickle cell anemia (SCA) in sub-Saharan African (SSA) countries is substantial, with many children dying without an established diagnosis or proper treatment. The global burden of SCA is increasing each year, making therapeutic intervention a high priority. Hydroxyurea is the only disease-modifying therapy with proven feasibility and efcacy suitable for SSA; however, no one has quantifed the health economic implications of its use. Therefore, from the perspective of the health care provider, we estimated the incremental cost-efectiveness of hydroxyurea as a fxed-dose regimen or maximum tolerated dose (MTD) regimen, versus SCA care without …

The Meaning Of Caring For Patients With Cancer Among Traditional Medicine Practitioners In Uganda: A Grounded Theory Approach, John Baptist Asiimwe, Prakash B. Nagendrappa, Esther C. Atukunda, Grace Nambozi, Casim U. Tolo, Martin Ogwang, Mauda M. Kamatenesi

School of Nursing & Midwifery, East Africa

Traditional medicine practitioners (TMPs) are a critical part of healthcare systems in many sub-Saharan African countries and play vital roles in caring for patients with cancer. Despite some progress in describing TMPs’ caring experiences in abstract terms, literature about practice models in Africa remains limited. This study aimed to develop a substantive theory to clarify the care provided by TMPs to patients with cancer in Uganda. This study adhered to the principal features of the modified Straussian grounded theory design. Participants were 18 TMPs caring for patients with cancer from 10 districts in Uganda, selected by purposive and theoretical sampling …

Developing And Testing A Clinical Care Bundle Incorporating Caffeine Citrate To Manage Apnoea Of Prematurity In A Resource-Constrained Setting: A Mixed Methods Clinical Feasibility Study Protocol, Grace Irimu, Ferdinand Okwaro, Jesse Coleman, Mary Waiyego, Dorothy Chomba, Millicent Parsimei, Cynthia Shitote, Roseline Ochieng, Jasmit Shah, William Macharia

Paediatrics and Child Health, East Africa

Background Apnoea of prematurity (AOP) is a common condition among preterm infants. Methylxanthines, such as cafeine and aminophylline/theophylline, can help prevent and treat AOP. Due to its physiological benefts and fewer side efects, cafeine citrate is recommended for the prevention and treatment of AOP. However, cafeine citrate is not available in most resource-constrained settings (RCS) due to its high cost. Challenges in RCS using caffeine citrate to prevent AOP include identifying eligible preterm infants where gestational age is not always known and the capability for continuous monitoring of vital signs to readily identify apnoea. We aim to develop an evidencebased …

Pregnancy-Related Mortality Up To 1 Year Postpartum In Sub-Saharan Africa: An Analysis Of Verbal Autopsy Data From Six Countries, Ursula Gazeley, Georges Reniers, Julio E. Romero- Prieto, Clara Calvert, Momodou Jasseh, Kobus Herbst, Sammy Khagayi, David Obor, Daniel Kwaro, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Objective: To compare the causes of death for women who died during pregnancy and within the first 42 days postpartum with those of women who died between >42 days and within 1 year postpartum.

Design: Open population cohort (Health and Demographic Surveillance Systems).

Setting: Ten Health and Demographic Surveillance Systems (HDSS) in The Gambia, Kenya, Malawi, Tanzania, Ethiopia and South Africa.

Population: 2114 deaths which occurred within 1 year of the end of pregnancy where a verbal autopsy interview was conducted from 2000 to 2019.

Methods: InterVA5 and InSilicoVA verbal autopsy algorithms were used to at-tribute the most likely underlying …

Design And Implementation Of A Community-Based Mother-To-Mother Peer Support Programme For The Follow-Up Of Low Birthweight Infants In Rural Western Kenya, Jemma Wright, Florence Achieng, Linda Tindi, Manasi Patil, Mwanamvua Boga, Mary Kimani, Hellen Barsosio, Dan Juma, Helen Nabwera, Laura Kiige

Obstetrics and Gynaecology, East Africa

Background: Globally, low birthweight (LBW) infants (

Methods: Key informant interviews were conducted with 10 mothers of neonates (infants days) from two rural communities in western Kenya. These data informed the identification of key characteristics required for mother-to-mother peer supporters (peer mothers) following up LBW infants post discharge. Forty potential peer mothers were invited to attend a 5-day training programme that focused on three main themes: supportive care using appropriate communication, identification of severe illness, and recommended care strategies for LBW infants. Sixteen peer mothers were mentored to conduct seven community follow-up visits to each mother-LBW infant pair with fifteen …

Strategies For Improving Mental Health And Wellbeing Used By Adults Ageing With Hiv From The Kenyan Coast: A Qualitative Exploration, Peter Mwangala, Ryan G. Wagner, Charles R. Newton, Amina Abubakar

Institute for Human Development

Background: Physical and mental health problems are common among older adults living with HIV (OALWH). Adaptive coping strategies play a vital role in improving these adults' mental health and well-being despite the deleterious effects of HIV and ageing. However, in sub-Saharan Africa, limited evidence exists on the commonly utilized coping strategies in this population. We explore the coping strategies used by Kenyan OALWH to improve their mental health and wellbeing.

Methods: Semi-structured in-depth interviews were conducted between October and December 2019 with 56 participants: 34 OALWH (53% female), 11 healthcare providers (63% female) and 11 primary caregivers (73% female) in …

Healthy Eating And Physical Activity: Analysing Soweto’S Young Adults’ Perspectives With An Intersectionality Lens, Gudani Mukoma, Edna Bosire, Sonja Klingberg, Shane A. Norris

Brain and Mind Institute

Background and objectives: Non-communicable diseases (NCDs) are taking a toll on Africa’s youth at younger ages than in other regions. These are attributed to risk factors that usually advance in adolescence, such as unhealthy diets and reduced physical activity. Young adults in South Africa, particularly women, tend to be sedentary, consume energy-dense diets low in micronutrients, and are more likely to develop NCDs much earlier in life than those in high-income countries. With an intersectionality perspective, this study explored young adults’ barriers and solutions to addressing these risk factors in Soweto.

Setting: Soweto, Johannesburg, South Africa, is one …

A Qualitative Inquiry Of Experiences Of Hiv-Related Stigma And Its Effects Among People Living With Hiv On Treatment In Rural Kilifi, Kenya, Stanley Wechuli Wanjala, Moses Nyongesa, Rachael Mapenzi, Stanley Luchters, Amina Abubakar

Institute for Human Development

Background: The pervasiveness of HIV-related stigma and discrimination, and its consequences on HIV prevention and treatment, have been well documented. However, little is known about the lived experiences of HIV-related stigma and its effects among the general adult population living with HIV in rural African settings. This study set out to explore this knowledge gap.

Methods: From April to June 2018, we conducted in-depth interviews with a convenience sample of 40 adults living with HIV aged 18–58 years in Kilifi, Kenya. A semi-structured interview guide was used to explore experiences of HIV-related stigma and its impact on these adults. …

In The Name Of Riwaj: An Ethnographic Study To Explore The Notion Of Women Empowerment Among Bisp Recipients In Rural Sakhro-Sindh, Pakistan, Qurratulain Nasiruddin, Rozina Karmaliani, Nasim Zahid Shah, Tazeen Saeed Ali

School of Nursing & Midwifery

Women empowerment is a national agenda for Pakistan and, one of its manifestations is the nationwide cash transfer program namely Benazir Income Support Programme (BISP). With the help of Bourdieu methodological paradigm of “habitus” this paper analyses empowerment among BISP recipients in their social settings where various social actors such as her husband and wadera of the village dominate her agency but, at the same time, women herself submits her agency to these social actors under the veil of riwaj (social customs). This ethnographic study reveals that the performance of submission among women follows an inner drive for conformation to …

Sexual Violence And Associated Factors Among Women Of Reproductive Age In Rwanda: A 2020 Nationwide Cross-Sectional Survey, Lilian Nuwabaine, Joseph Kawuki, Earnest Amwiine, John Baptist Asiimwe, Quraish Sserwanja, Ghislaine Gatasi, Elorm Donkor, Humphrey Atwijukiire

School of Nursing & Midwifery, East Africa

Background; Sexual violence against women is a global public health issue with both short- and long-term effects on the physical and mental health of women. This study aimed to determine the prevalence of sexual violence and its associated factors among women of reproductive age in Rwanda.

Methods: We used secondary data from the 2020 Rwanda Demographic and Health Survey of 1,700 participants, who were selected using multistage stratified sampling. Multivariable logistic regression was conducted to explore factors associated with sexual violence using SPSS (version 25).

Results: Of the 1,700 women of reproductive age, 12.4% (95%CI: 11.0–14.1) had …

Inspire : Vol 6, Issue 6, Department Of Medicine

INSPIRE

• Message from the Chair
• Medicine at National and International Forums
• Cardiology meets Endocrinology | Dr Hannah Jennings visit to AKU
• Poem Section
• ‘The Guest House
• What Academics are Reading?

Cerebellar Manifestation Secondary To Rectal Neoplasia, Soban Khan, Zaid Waqar, Maryam Khalil, Bushra Khalid, Sajid Ali, Ijaz Ali, Muhammad Tariq, Muhammad Adil

Pakistan Journal of Neurological Sciences (PJNS)

The condition known as paraneoplastic cerebellar degeneration (PCD) is among the most disabling examples of a cancer's remote effects. Serology for paraneoplastic antibodies, clinical suspicion, and a targeted search for malignancy all play a role in the diagnosis. Tests for neuronal autoantibodies aid in diagnosis and point the way for the search for malignancy. Unfortunately, even with an early diagnosis, existing therapeutic approaches only have little success. Here we present the case of a young male who developed cerebellar syndrome secondary to rectal neoplasia.

The Effects Of Height-For-Age And Hiv On Cognitive Development Of School-Aged Children In Nairobi, Kenya: A Structural Equation Modelling Analysis, Rachel Maina, Jia He, Amina Abubakar, Miguel Perez-Garcia, Manasi Kumar, Jelte M. Wicherts

Brain and Mind Institute

Background: Empirical evidence indicates that both HIV infection and stunting impede cognitive functions of school-going children. However, there is less evidence on how these two risk factors amplify each other’s negative effects. This study aimed to examine the direct effects of stunting on cognitive outcomes and the extent to which stunting (partially) mediates the effects of HIV, age, and gender on cognitive outcomes.

Methodology: We applied structural equation modelling to cross-sectional data from 328 children living with HIV and 260 children living without HIV aged 6–14 years from Nairobi, Kenya to test the mediating effect of stunting and predictive …

Determinants Of First‐Ever Stroke Severity In West Africans: Evidence From The Siren Study, Oladimeji Adebayo, Onoja Akpa, Osahon J. Asowata, Adekunle Fakunle, Fred S. Sarfo, Albert Akpalu, Kolawole Wahab, Reginald Obiako, Morenikeji Komolafe, Philip Adebayo

Internal Medicine, East Africa

Background: Baseline stroke severity is probably partly responsible for poor stroke outcomes in sub-Saharan Africa. However, there is a paucity of information on determinants of stroke severity among indigenous Africans. We sought to identify the factors associated with stroke severity among West Africans in the SIREN (Stroke Investigative Research and Educational Networks) study.

Methods and Results: Stroke was diagnosed clinically and confirmed with brain neuroimaging. Severe stroke was defined as a Stroke Levity Scale score of ≤5. A multivariate logistic regression model was constructed to identify factors associated with stroke severity at 95% CI and a nominal cutoff of 5% …

A Review Of The Current State Of Global Surgical Oncology And The Role Of Surgeons Who Treat Cancer: Our Profession’S Imperative To Act Upon A Worldwide Crisis In Evolution, Aaron C. Saunders, Miriam Mutebi, T. Subramanyeshwar Rao

General Surgery, East Africa

Worldwide, the capacity of healthcare systems and physician workforce is woefully inadequate for the surgical treatment of cancer. With major projected increases in the global burden of neoplastic disease, this inadequacy is expected to worsen, and interventions to increase the workforce of surgeons who treat cancer and strengthen the necessary supporting infrastructure, equipment, staffing, financial and information systems are urgently called for to prevent this inadequacy from deepening. These efforts must also occur in the context of broader healthcare systems strengthening and cancer control plans, including prevention, screening, early detection, safe and effective treatment, surveillance, and palliation. The cost of …

Intravenous Thrombolytic Therapies In The Management Of Unknown Onset And Wakeup Strokes: A Scoping Review, Saima Nazish

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT Background: The efficacy and safety of intravenous recombinant tissue plasminogen activator (IV rt-PA) for the management of unknown time onset stroke (UTOS) and wake-up stroke (WUS) are in a debate. Objective:The objective of this review is to discuss the UTOS and its management with intravenous thrombolytic therapies. Data Sources: Databases searched included PubMed and Cochrane electronic databases and manual search. Study Selection and Data Extraction: 45 articles of potential relevance were selected. Results: 14 relevant papers were included. Most of studies including recent trials using Magnetic resonance imaging diffusion-weighted imaging fluid-attenuated inversion recovery (MRIDWI FLAIR) mismatch or Computed tomography …

Association Of Hyperuricemia With Ischemic Stroke In Adult Population, Ijaz Ali, Zaid Waqar, Bushra Khalid, Maryam Naseem, Soban Khan, Sajid Ali, Muhammad Tariq, Muhammad Adil, Hira Badar Abbasi, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Background and Objective:

Stroke is the second most prevalent cause of dementia, the third biggest cause of mortality, and the top cause of disability globally. Hyperuricemia is frequently seen in patients with vascular risk factors. The objective of this study was to determine the association of hyperuricemia with ischemic stroke in adult patients presenting to neurology department of a tertiary care hospital.

Methods:This was a case-control study of 200 patients, 100 patients with stroke and 100 unmatched controls were accessed for vascular risk factors and hyperuricemia. The setting was Pakistan Institute of Medical Sciences, Islamabad and study duration was …

Frequency Of Depression Among Patients With Parkinson Disease, Mohammad Lateef, Wasim Ikram Alvi, Abdul Malik, Neelum Jamal, Muhammad Umair, Muhammad Athar Khan

Pakistan Journal of Neurological Sciences (PJNS)

Background and Objective:

Parkinson's disease is a degenerative neurological condition that affects a large number of individuals worldwide. One of the common non-motor symptoms associated with this disease is depression, which can pose challenges for both patients and their caregivers. The main objective of this research was to determine the frequency of depression among patients with Parkinson disease.

Methods:This was a cross-sectional study that was conducted in Karachi, Pakistan, between March 26, 2022, and September 30, 2022. Male and female patients diagnosed with Parkinson's disease according to the UK Parkinson's Disease Society Brain Bank Clinical Diagnostic Criteria, who were …

Clinical Presentation, Evaluation, And Management Of Patients With Myasthenia Gravis At A Tertiary Care Center In Pakistan, Aziz Sonawalla, Shafaq Saleem, Salim Allana, Rabia Qaiser, Rohma Shamsi

Pakistan Journal of Neurological Sciences (PJNS)

Background and objectives:

Little is known about the clinical profile and outcome of myasthenia gravis in Pakistan. The objective of this study is to review the clinical characteristics of patients with myasthenia gravis in Pakistan, and the outcome of investigations and treatment.

Methods: The study comprised a retrospective review of charts of patients diagnosed with myasthenia gravis at Aga Khan University Hospital in Karachi, Pakistan, over a period of 16 years from 1987 to 2003. The following features were reviewed: (i) clinical presentation, (ii) investigations especially nerve conduction studies, acetylcholine receptor antibodies, and imaging studies of the thorax, (iii) treatments …

Neurobehavioral And Biochemical Effects Of Choline Chloride Administration In Rats, Lubna Anis, Irfan Sajid, Shoaib Ahmad, Saida Haider

Pakistan Journal of Neurological Sciences (PJNS)

Background and Objective:

Choline is an essential nutrient related to vitamin B complex activity. It can be received through different food sources. It is an important component of acetylcholine which is involved in different brain functions. The present study is designed to assess the behavioral effects of choline chloride in animal models.

Methods:This case-control study was performed in the Department of Biochemistry, Federal Urdu University, Karachi for eight months from May 2022 to December 2022. Twenty-four adult male albino Wister rats were divided into four groups, one control and three test groups. Choline chloride dissolved in saline was given …

Frequency Of Hyperlipedemia In Patients Coming With Ischemic Stroke In Tertiary Care Hospital Karachi, Bushra Ammad, Abdul Malik, Rabia Sana Muhammad, Maryam Javed, Hina Imtiaz

Pakistan Journal of Neurological Sciences (PJNS)

Background and objective:

Stroke is the second leading cause of death and the third leading cause of disability. This study was designed to determine the frequency of hyperlipidemia in patients with ischemic stroke visiting at a tertiary care hospital in Karachi.

Methods:This was a descriptive cross-sectional study and was done in Department of Medicine, LCMD/ Dar-ul-Sehat Hospital Karachi, Pakistan. A total of 184 patients were studied during the study period of six months and all the consecutive patients were recruited who presented with acute stroke in the department of medicine from the duration April 1st 2022 to September 30th, …