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 …

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. …

Landscape Analysis Of The Family Planning Situation In Pakistan—District Profile: Faisalabad, Population Council

Reproductive Health

This district profile of Faisalabad is part of the Landscape Analysis of the Family Planning Situation in Pakistan. The factsheet provides a detailed picture of the use of antenatal and delivery care services; use of family planning; other socioeconomic indicators; availability of health facilities, pharmacies, and lady health workers; distribution of public static and private facilities by cadre;, provision of specific family planning methods by sector; and presence and provision of family planning services/products. The factsheet concludes with a review of consumers’ perspectives on barriers to use of family planning. The analysis, conducted by the Population Council, was supported by …

Landscape Analysis Of The Family Planning Situation In Pakistan—District Profile: Rawalpindi, Population Council

Reproductive Health

This district profile of Rawalpindi is part of the Landscape Analysis of the Family Planning Situation in Pakistan. The factsheet provides a detailed picture of use of family planning and other socioeconomic indicators. It covers consumers’ perspectives on barriers to use of family planning noting the lack of information among men and women, especially migrants; problems of access among poor rural women; and difficulty in affording services, among poor couples. The factsheet concludes with a chart listing district-specific donors, projects, and implementing partners. The analysis, conducted by the Population Council, was supported by the Bill & Melinda Gates Foundation.

Landscape Analysis Of The Family Planning Situation In Pakistan—District Profile: Lahore, Population Council

Reproductive Health

This district profile of Lahore is part of the Landscape Analysis of the Family Planning Situation in Pakistan. The factsheet provides a detailed picture of contraceptive use and unmet need; use of antenatal and delivery care services; other socioeconomic indicators; availability of health facilities, pharmacies, and lady health workers; distribution of public static and private facilities by cadre; provision of specific family planning methods by sector; and presence and provision of family planning services/products. The factsheet concludes with a review of consumers’ perspectives on barriers to use of family planning and a chart listing district-specific donors, projects, and implementing partners. …

Landscape Analysis Of The Family Planning Situation In Pakistan—District Profile: Sukkur, Population Council

Reproductive Health

This district profile of Sukkur is part of the Landscape Analysis of the Family Planning Situation in Pakistan. The factsheet provides a detailed picture of use of antenatal and delivery care services; use of family planning; other socioeconomic indicators; availability of health facilities, pharmacies, and lady health workers; distribution of public static and private facilities by cadre; provision of specific family planning methods by sector; and presence and provision of family planning services/products. The factsheet concludes with a review of consumers’ perspectives on barriers to use of family planning and a chart listing district-specific donors, projects, and implementing partners. The …

Landscape Analysis Of The Family Planning Situation In Pakistan—District Profile: Peshawar, Population Council

Reproductive Health

This district profile of Peshawar is part of the Landscape Analysis of the Family Planning Situation in Pakistan. The factsheet provides a detailed picture of use of antenatal and delivery care services; other socioeconomic indicators; availability of health facilities, pharmacies, and lady health workers; distribution of public static and private facilities by cadre; provision of specific family planning methods by sector; and presence and provision of family planning services/products. The factsheet concludes with a review of consumers’ perspectives on barriers to use of family planning and a chart listing district-specific donors, projects, and implementing partners. The analysis, conducted by the …

Landscape Analysis Of The Family Planning Situation In Pakistan—District Profile: Karachi, Population Council

Reproductive Health

This district profile of Karachi is part of the Landscape Analysis of the Family Planning Situation in Pakistan. The factsheet provides a detailed picture of the use of family planning; use of antenatal and delivery care services; other socioeconomic indicators; availability of health facilities and lady health workers; distribution of public static and private facilities by cadre; provision of specific family planning methods by sector; and presence and provision of family planning services. The factsheet concludes with a review of consumers’ perspectives on barriers to use of family planning. The analysis, conducted by the Population Council, was supported by the …

Youth In Pakistan: Priorities, Realities And Policy Responses, Zeba Sathar, Iram Kamran, Maqsood Sadiq, Sabahat Hussain

Poverty, Gender, and Youth

Youth is a pivotal stage during which the right policies and interventions in the health, social, educational, and economic sectors can protect young people against risks, and turn the trajectories of their lives toward a safe and productive path of growth. This report explores some of the key issues facing youth in Pakistan, in the main spheres marking their transition to adult roles. It also presents the results of an age-based segmentation analysis capturing where youth in Pakistan stand in terms of school enrollment, work force participation, and marriage, with a view to identifying the broad developmental priorities for each …

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 …

Landscape Analysis Of The Family Planning Situation In Pakistan, Population Council

Reproductive Health

Pakistan faces a number of challenges to increasing modern contraceptive use. Although there are encouraging signs, such as improved male participation, the addition of about four million current FP users, from 2007 to 2013, and a responsive policy environment with demonstrated political and financial commitment to meeting the country’s FP2020 goals, the task that lies ahead is still huge. This report presents the findings of a landscape analysis of family planning (FP) in Pakistan by the Population Council in 2015 and 2016, with support from the Bill & Melinda Gates Foundation. This landscape analysis assesses both demand and supply side …

Do Dietary Patterns Explain High Prevalence Of Cardiovascular Risk Factors Among Pakistani Urban Adults? A Cross-Sectional Study, Nilofer F. Safdar, Elizabeth Bertone-Johnson, Lorraine Cordeiro, Tazeen H. Jafar, Nancy L. Cohen

Nutrition Department Faculty Publication Series

Background

The prevalence of cardiovascular disease (CVD) in South Asia is higher than in any other developing countries. The diversity of diets in populations among developing countries may be one explanation for the differences in CVD. This study was carried out to explore the association between dietary patterns and the presence of cardiovascular risk factors among Pakistani low income urban adults.

Methods

Socio demographic, physical activity and dietary information was collected from 1546 Pakistani subjects aged ≥40 years from the Control of Hypertension and Risk Attenuation (COBRA) study. Anthropometric, clinical and biomarker measures were assessed. Cluster analysis was used to …

A Systematic Review Of The Treatment And Management Of Pre-Eclampsia And Eclampsia In Pakistan, Saleem Shaikh, Ali M. Mir

Reproductive Health

Pakistan is one of the six countries that account for more than 50 percent of the world’s maternal deaths. According to Population Council estimates, each year nearly 8.6 million women become pregnant in the country. Of these, 1.2 million women are likely to face obstetric complications. Each year, there are nearly 14,000 pregnancy-related deaths. Information is lacking on context-specific health-system barriers that prevent optimal use of the lifesaving medicine magnesium sulfate (MgSO4) in Pakistan. Although efforts in Pakistan both at the national and subnational level are ongoing on the prevention and treatment of pre-eclampsia and eclampsia (PE/E), results are generally …

Landscape Analysis Report On Pre-Eclampsia And Eclampsia In Pakistan, Ali M. Mir, Saleem Shaikh, Mumraiz Khan, Irfan Masood, Karen Kirk, Amy Dempsey, Charlotte E. Warren

Reproductive Health

This report presents the findings of a landscape analysis of the policy, programming, and service environment around prevention and treatment of pre-eclampsia and eclampsia (PE/E) in Pakistan. The primary aim of the landscape analysis was to identify the policy and program level of activities, as well as gaps and challenges around prevention and treatment of PE/E and the use of magnesium sulphate at the provincial and district levels in Pakistan. The study was carried out by the Population Council in 2016, with the support of the United States Agency for International Development (USAID) as part of the Project entitled “Ending …