Medicine and Health Sciences Commons^™

Provider Cost Analysis Supports Results-Based Contracting Out Of Maternal And Newborn Health Services: An Evidence-Based Policy Perspective, Peter Hatcher, Shiraz Shaikh, Hassan Fazli, Shehla Zaidi, Atif Riaz

Community Health Sciences

Background

There is dearth of evidence on provider cost of contracted out services particularly for Maternal and Newborn Health (MNH). The evidence base is weak for policy makers to estimate resources required for scaling up contracting. This paper ascertains provider unit costs and expenditure distribution at contracted out government primary health centers to inform the development of optimal resource envelopes for contracting out MNH services.

Methods

This is a case study of provider costs of MNH services at two government Rural Health Centers (RHCs) contracted out to a non-governmental organization in Pakistan. It reports on four selected Basic Emergency Obstetrical …

Choledochal Cyst--A Different Disease In Newborns And Infants, Zafar Nazir, Munira Abdul Aziz

Department of Surgery Docs

Abstract

We report experience of managing Choledochal Cyst (CC) in different paediatric ages. Eleven neonates and infants (aged 0-8 months) and 24 paediatric cases (aged 2.5 - 18 years) were managed over 24 years (1988 to 2012). Neonates and infants presented with jaundice, acholic stools and abdominal mass whereas most of the paediatric cases presented with intermittent non-specific abdominal pain. Morphology of CC was mostly cystic in neonates whereas it was fusiform in majority (62%) of paediatric cases. Biliary amylase was high and correlated with the presence of abnormal pancreaticobiliary junction (PBJ) in 20 /24 paediatric patients. Obstruction at the …

Plaque Index In Multi-Bracket Fixed Appliances, Zafar Ul Islam, Attiya Shaikh, Mubassar Fida

Section of Dental-Oral Maxillofacial Surgery

Objective: To compare the plaque index in patients receiving multi-bracket fixed orthodontic treatment for various factors like age, gender, socio-economic status, brushing practices, meal habits, types of brackets, types of ligations, use of mouthwash and duration of treatment.
Study Design: Cross-sectional analytical study.
Place and Duration of Study: Orthodontics Clinic, The Aga Khan University Hospital, from September to November 2011.
Methodology: Socio-demographic and clinical modalities were defined and recorded for 131 patients having multi-bracket fixed appliances. The plaque index of subjects were recorded according to the Silness and Loe plaque index method. Independent sample t-test was used to see difference …

Epidemiology, Determinants And Dynamics Of Cholera In Pakistan: Gaps And Prospects For Future Research., Maliha Naseer, Tanzil Jamali

Community Health Sciences

Cholera is one of the notifiable endemic diseases in Pakistan, but the reporting of cholera cases is still unsatisfactory. Most of the diagnosed cases are never reported to the relevant authorities. In the year 1993 - 2005, the country did not report any single case of cholera to the WHO. The objectives of this review were to understand the epidemiology and to identify the possible determinants of cholera infection in Pakistan. Medscape, Medline, PakMedinet and PubMed, was searched, using key words, epidemiology and determinants of cholera infection in Pakistan during 1995 - 2010. Morbidity and mortality due to cholera infection …

Integration Of Non-Communicable Diseases Into Primary Health Care: A Snapshot From Eastern Mediterranean Region, Shehla Zaidi, Abdul Latif Khan, Aftab Ali Mukhi, Yousuf Memon, Slim Slama, Samer Jabbour

Community Health Sciences

No abstract provided.

A Unique Mri Presentation Of Fungal Infection In The Brain, Muhammad Bilal Salman Khan, Saad Shafqat, Ather Enam

Section of Neurology

Fungal infections of CNS are common in certain geographic locations. MRI with or without contrast is a useful prediagnostic tool. However, the findings may sometimes be misleading. In this case report, the authors present unusual imaging findings in the MRI of fungal infection in an immunocompetent host, whereby hyper-intense signals were seen on T2-weighted images and patchy post-contrast enhancement was observed with surrounding edema. These findings were suggestive of a neoplastic lesion but it was identified as aspergillosis on subsequent histopathology. This unusual MRI finding of CNS highlights the need to consider fungal infection as a differential diagnosis of all …

Non Communicable Diseases In Pakistan: Burden, Challenges And Way Forward For Health Care Authorities, Mohammad Wasay, Shehla Zaidi, Maria Khan, Rashid Jooma

Section of Neurology

No abstract provided.

Effects Of Polypharmacy On Adverse Drug Reactions Among Geriatric Outpatients At A Tertiary Care Hospital In Karachi: A Prospective Cohort Study., Bilal Ahmed, Kashmira Nanji, Rakshinda Mujeeb, Muhammad Junaid Patel

Department of Medicine

Background: Adverse drug reactions (ADRs) present a challenging and expensive public health problem. Polypharmacy is defined according to the WHO criteria as the, ‘‘concurrent use of five or more different prescription medication’’. Elderly are more prone to adverse reactions due to comorbid conditions, longer lists of medications and sensitivity to drug effects. The aim of the study is to estimate the incidence and strength of association of ADRs due to polypharmacy among the geriatric cohort attending outpatient clinics at a tertiary care center.

Methods: A hospital based prospective cohort study was conducted at ambulatory care clinics of Aga Khan University …

Motivation Of Clinical Faculty Towards Teaching And Learning., M. Tariq, Syed Ahsan Ali

Department of Medicine

No abstract provided.

Outcomes Of Splenectomy For Idiopathic Thrombocytopenic Purpura In Adults: A Developing Country Perspective., Amyn Pardhan, Aamir Hameed, Hasnain Zafar, Samia Mazahir, Ghulam Murtaza

Department of Medicine

Objective: to determine the outcome of splenectomy done in adult patients of Idiopathic Thrombocytopenic Purpura over a period of 10 years and, secondarily, to determine the predictors of complete response to therapy.

Methods: The retrospective review comprised of adult patients over 14 years of age who underwent open or laparoscopic splenectomy for Idiopathic Thrombocytopenic Purpura at Aga Khan University Hospital, Karachi, from January 2000 to December 2010. Data was reviewed in January 2011 by a surgical resident. Outcome was the response to splenectomy as per new definition of response set by the American Society of Haematology 2011 evidence based practice …

Clinical Course And Outcome Of Acute Severe Asthma (Status Asthmaticus) In Adults., Ali Khawaja, Hira Shahzad, Murtaza Kazmi, Ali Bin Sarwar Zubairi

Department of Medicine

Objective: To evaluate the clinical course and outcomes in patients with acute severe asthma in a tertiary care setting.
Methods: The retrospective cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of patients of age 16 and above who were admitted with a diagnosis of acute severe asthma from January 2000 to December 2013.These patients had undergone clinical evaluation to assess the severity of illness as well as the complications and eventual outcomes. SPSS 16 was used for statistical analysis.
Results: Of the 50 patients in the study, 41 (82%) were females. The overall mean …

Vascular Ehlers-Danlos Syndrome: A Rare Disorder Presenting With Focal Convulsions, Shakeel Ahmed, Syed Rehan Ali, Naila Nadeem, Muhammad Hamid

Department of Paediatrics and Child Health

Vascular Ehlers-Danlos Syndrome (VEDS), previously called Ehlers-Danlos syndrome type-IV, is a heterogeneous group of heritable connective tissue disorders characterized by thin, translucent skin, easy bruising, arterial, intestinal, and/or uterine fragility. There is large vessel involvement that leads to arterial rupture often preceded by aneurysm, arteriovenous fistulae, or dissection. Noninvasive imaging studies such as CT angiography and MR angiography are preferred as diagnostic studies for this condition. We are reporting a 4 years old girl who was presented with right sided unilateral convulsions and hypertension. CT angiogram showed stenosis with post-stenotic dilatation of coeliac and superior mesenteric arteries. There were extensive …

Public Health Service Options For Affordable And Accessible Noncommunicable Disease And Related Chronic Disease Prevention And Management, Sharon Brownie, Andrew P. Hills, Rachel Rossiter

School of Nursing & Midwifery, East Africa

Globally, nations are confronted with the challenge of providing affordable health services to populations with increasing levels of noncommunicable and chronic disease. Paradoxically, many nations can both celebrate increases in life expectancy and bemoan parallel increases in chronic disease prevalence. Simply put, despite living longer, not all of that time is spent in good health. Combined with factors such as rising levels of obesity and related noncommunicable disease, the demand for health services is requiring nations to consider new models of affordable health care. Given the level of disease burden, all staff, not just doctors, need to be part of …

Cervical Vertebral Anomalies In Skeletal Malocclusions: A Cross-Sectional Study On Orthodontic Patients At The Aga Khan University Hospital, Pakistan, Saman Faruqui, Mubassar Fida, Attiya Shaikh

Section of Orthopaedic Surgery

Introduction: Morphological deviations of the cervical vertebral column have been described in relation to craniofacial aberrations and syndromes. Furthermore, it has recently been shown that abnormal morphology of upper cervical vertebrae is associated with malformation of the jaws and occlusion. Accordingly, it is relevant to focus on similar associations in patients with skeletal malocclusions. Therefore, the objectives of this study are to: (a) Identify the anomalies of the cervical column in patients with skeletal malocclusions (b) Determine the association between cervical vertebral anomalies and skeletal malocclusions.
Materials and Methods: This cross-sectional study was conducted on a total of 90 subjects …

A Review Related To Midwifery Led Model Of Care, Shahnaz Shahid, Rafat Jan, Rahat Najam Qureshi, Salma Rattani

School of Nursing & Midwifery

Background: Midwifery led care (MLC) is a model of care in which perinatal care is provided to women throughout different phases of childbirth by a midwife.
Objective: This paper aims to provide a literature review on MLC.
Methods: A variety of databases and reports were considered to do the literature review on MLC. The search was limited from 1991 to 2011 by using keywords. A total of 50 articles were critically appraised for this review.
Findings: The main theme that emerged was women ^’s satisfaction with MLC. Satisfaction was integrated with midwife ^’s presence throughout childbirth, experience to …

Effect Of Age On Uterine And Ovarian Morphology With Polycystic Ovaries, Ambreen Usmani, Rehana Rehman, Aisha Qamar

Department of Biological & Biomedical Sciences

Abstract

Objective: To measure the outcome of age on ovarian and uterine morphology in primary infertile women with

polycystic ovaries.

Methods: The observational cross-sectional study was conducted from January 2009 to March 2010, and the

subjects were recruited from Ziauddin Hospital, Nazimabad, Karachi. The primary infertile subjects with polycystic

ovaries were subdivided into two age groups:20-30 years (group I), and 31-40 years (group II). Both groups had equal

number of subjects. The ovarian volume, follicles count and size, uterine area and endometrial thickness were

determined by transabdominal and transvaginal scans. Shapiro-Wilk's test and Mann-Whitney test were applied,

with p<0.05 being significant.

Results: …

Magnetic Resonance Spectroscopy Of Enhancing Cerebral Lesions: Analysis Of 78 Histopathology Proven Cases, Muhammad Shahbaz Alam, Humera Ahsan, Zafar Sajjad, Madiha Beg, Umer Bhatti, Ather Enam, Mohammad Wasay

Department of Radiology

Objectives: To investigate the efficacy of magnetic resonance spectroscopy in differentiating various types of neoplastic and non-neoplastic enhancing cerebral lesions.
Methods: The prospective study was conducted from January 2007 to December 2009 at the Department of Radiology, Aga Khan University Hospital, Karachi. All patients with enhancing brain lesions on magnetic resonance imaging who underwent magnetic resonance spectroscopy and a biopsy with histopathological analysis were included in study. The lesions were categorised into neoplastic and non-neoplastic lesions on the basis of spectroscopy findings. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of magnetic resonance spectroscopy were calculated. …

Leishmania Donovani Bodies In Bone Marrow, Natasha Ali, Shabneez Hussain

Department of Pathology and Laboratory Medicine

We report a case of a 5-year-old female, resident of Afghanistan, who presented with fever and massive splenomegaly. Bone marrow revealed Leishmania donovani bodies (LD bodies) in macrophages characterized by a kinetoplast and characteristic double dot appearance. She was diagnosed as visceral leishmaniasis which is transmitted by sandflies (Phlebotomus).

Agreement Between Serology And Histology For Detection Of Helicobacter Pylori Infection, Javed Yakoob, Zaigham Abbas

Section of Gastroenterology

No abstract provided.

Association Between Sella Turcica Bridging And Palatal Canine Impaction, Batool A. Haider, Attiya Shaikh, Mubassar Fida

Section of Dental-Oral Maxillofacial Surgery

Introduction: The association of sella turcica bridging and various dental anomalies has been an area of interest for researchers. Based on the evidence of a common embryologic origin between sella turcica and the teeth, the objectives of this study were to measure the dimensions of sella turcica and to test whether an association exists between sella bridging and impacted canines.
Methods: Orthodontic records comprising standard-quality lateral cephalograms and dental panoramic radiographs were selected. Thirty-one patients with palatally impacted canines (20 female, 11 male; mean age, 18.4 ± 8.9 years) and 70 controls with erupted canines (35 male, 35 female; mean …

Intimate Partner Violence After Disclosure Of Hiv Test Results Among Pregnant Women In Harare, Zimbabwe, Simukai Shamu, Christina Zarowsky, Tamara Shefer, Marleen Temmerman, Naeemah Abrahams

Obstetrics and Gynaecology, East Africa

Background: HIV status disclosure is a central strategy in HIV prevention and treatment but in high prevalence settings women test disproportionately and most often during pregnancy. This study reports intimate partner violence (IPV) following disclosure of HIV test results by pregnant women.

Methods: In this cross sectional study we interviewed 1951 postnatal women who tested positive and negative for HIV about IPV experiences following HIV test disclosure, using an adapted WHO questionnaire. Multivariate regression models assessed factors associated with IPV after disclosure and controlled for factors such as previous IPV and other known behavioural factors associated with IPV.

Results: Over …

How To Write An Introduction And Methods Of A Systematic Review Of Literature, Ashar Muhammad Malik

Community Health Sciences

No abstract provided.

Prevalence Of Hepatitis B Virus Infection Among Barbers And Their Knowledge, Attitude And Practices In The District Of Sukkur, Sindh ., Imran Naeem Abbasi, Zafar Fatmi, Muhammad Masood Kadir, Nalini Sathiakumar

Community Health Sciences

Abstract

OBJECTIVES:

Several occupations in developing countries lag behind in ensuring the safety of their workers in occupational settings. Lack of implementation of safety guidelines at workplaces can expose workers to health risks. In Pakistan, barbers are one of the un-regulated occupational groups. Low literacy, increased frequency of direct skin contact and blade/razors use can expose barbers to body fluids including blood of the customers. We conducted this study in order to determine hepatitis B virus (HBV) prevalence among barbers and their knowledge, attitude and practices in a peri-urban district of Sindh.

MATERIAL AND METHODS:

Three hundred eighty-five barbers from …

Case Report-Maternal Death Due To Rupture Of The Uterus, Sumia Bari

Journal of Asian Midwives (JAM)

Objective: To present the case report of a woman who died during her third delivery due to the mismanagement of her labour. The woman had had one previous caesarean section and tried for vaginal delivery with injudicious use of oxytocin, leading to a rupturing of the uterus and death.
Methods & Result: During a maternal death audit it was found that a 28-years old woman (para 2) Meena (name changed to maintain anonymity) had died. Meena had one previous normal vaginal delivery and a second delivered by caesarean section. In her third pregnancy she did not take have any antenatal …

Birth Centre Management And Business Skill Training For Community Midwives Of Pakistan, Laila Lalji, Laila Akbar Ali, Marina Baig, Rozina Sewani, Arusa Lakhani, Karyn Kaufman, Rafat Jan

Journal of Asian Midwives (JAM)

The Community Midwifery program was introduced in 2007 across Pakistan with the idea that the trained Community Midwives (CMWs) will be deployed back to their ‘native’ rural communities. Hence, they are not employed by government rather they must earn their income by charging fees for their services. It is expected from them to attract clients, establish birth clinics and operate as a small business to support and sustain them financially. However, the CMW training program only teaches students about antenatal, intranatal, postnatal and newborn care, family planning services and awareness of community dynamics and does not include content about setting …

Midwifery In India And Its Roadmap, Manju Chhugani

Journal of Asian Midwives (JAM)

Healthy women are the key to the health of any nation. Midwifery in India has climbed up the ladder of progression from before independence till the present day. In the pre-independence era, maternal and newborn care was given by indigenous dais who not only helped during childbirth but also acted as consultants for any condition of the mother related to birth. They were midwives in the literal sense. Over the time, midwifery in India has broadened to the presence of a skilled birth attendant during childbirth. The maternal health status of women and maternal mortality are closely related to the …

Exploring Adolescent Reproductive Health Knowledge, Perceptions, And Behavior, Among Students Of Non-Government Secondary Schools Supported By Brac Mentoring Program In Rural Bangladesh, Bachera Aktar, Malabika Sarker, Andrew Jenkins

Journal of Asian Midwives (JAM)

Adolescence is the transition period from childhood to adulthood. Since Bangladesh is such a conservative society, reproductive health education for adolescents has not been widely introduced. Very small adolescent health components are included in the secondary and higher secondary school curricula. The BRAC Mentoring Program provides mentorship training to secondary school pupils to develop them as peer leaders. However, this program does not provide adolescent reproductive health education. Therefore, a study, supported by BRAC Education Program in rural Bangladesh, was conducted to explore the current status of reproductive health knowledge, perceptions and practice among the students of secondary schools. This …

Provision Of Mentorship Services For Midwives Working In Remote Areas In The Workplaces Of Afghanistan, Sabera Turkmani, Fatima Gohar, Pashtoon A. Zyaee, Mursal Musawi, Mahmood Azimi

Journal of Asian Midwives (JAM)

Background: Midwives working in remote facilities have little opportunity to receive technical support and coaching services. To close this gap and support rural midwives the Afghan Midwives Association (AMA) designed a field-based mentorship program for midwives working in remote areas.
Methods: The process included five stages:
1. Conduct base line assessment of mentees (midwives) and health facilities.
2. Identify and select of mentees through competitive process.
3. Provide on-the-job coaching and mentoring services to the mentees.
4. Assess the progress of the midwives regularly using existing quality assurance performance standards.
5. End-line / final evaluation
Results: That results of assessments …

News & Events

Journal of Asian Midwives (JAM)

No abstract provided.

Welcome To The First Journal Of Asian Midwives, Rafat Jan

Journal of Asian Midwives (JAM)

No abstract provided.