Medicine and Health Sciences Commons^™

Household Food Access And Child Malnutrition: Results From The Eight-Country Mal-Ed Study, Zulfiqar Ahmed Bhutta, Maled Network Investigators, Anita K. M. Zaidi, Sajid Bashir Soofi, Ali Turab, Didar Alam, Shahida Qureshi, Aisha Khizar Yousafzai, Syed Asad Ali, Imran Ahmed, Sajad Memon, Muneera Rasheed

Woman and Child Health

Background: Stunting results from decreased food intake, poor diet quality, and a high burden of early childhood infections, and contributes to significant morbidity and mortality worldwide. Although food insecurity is an important determinant of child nutrition, including stunting, development of universal measures has been challenging due to cumbersome nutritional questionnaires and concerns about lack of comparability across populations. We investigate the relationship between household food access, one component of food security, and indicators of nutritional status in early childhood across eight country sites.
Methods: We administered a socioeconomic survey to 800 households in research sites in eight countries, including a …

Fiberoptic Intubation In A Paediatric Patient With Severe Temporomandibular Joint (Tmj) Ankylosis, Ali Asghar, Faisal Shamim, Asiyah Aman

Department of Anaesthesia

Craniofacial abnormalities are associated with mandibular hypoplasia, reduced mandibular space with overcrowding of soft tissues and maxillary hypoplasia. Decreased mouth opening and limitation in jaw protrusion are independent predictors of difficult airway in such patients. The relative difficult problem becomes even graver in the paediatric age group because of their small mouth opening and un-cooperativeness. A child with severe temporomandibular joint (TMJ) ankylosis presented with negligible mouth opening and required surgical correction under general anaesthesia. Successful intubation was performed with endotracheal tube size 5.5 mm using an adult 4.3 mm fiberoptic bronchoscope under inhalational as well as topical anaesthesia.

Omphalocoele, Ten Years Experience At A Tertiary Care Hospital, Anila Haroon, Akhtar Amin Memon, Rehan Ali

Department of Paediatrics and Child Health

Omphalocoele is a rare congenital anterior abdominal wall defect. We present 12 cases of Omphalocoele seen in our hospital. Further, we have discussed the clinical presentation, antenatal diagnosis, associated abnormalities and final outcome of the cases.

Situation Analysis Of Child Labour In Karachi, Pakistan: A Qualitative Study, Asaad Ahmed Nafees, Kausar S. Khan, Zafar Fatmi, Mubashir Aslam

Community Health Sciences

In Karachi, large employment opportunities, burgeoning population and the availability of cheap labour might be the contributing factors for the increasing prevalence of child labour. A literature review was conducted in 2007 that included published and unpublished literature since 2000. Various organizations working in the field were also covered, while the perception of the child labourers was covered through three focus group discussions. Common health issues among the child labourers in Karachi included respiratory illnesses, fever and generalised pains, as well as drug and sexual abuse. Organisations working for child labour could be broadly categorised into those working for legal …

Antenatal Care And The Occurrence Of Low Birth Weight Delivery Among Women In Remote Mountainous Region Of Chitral, Pakistan, Z. Ahmed, S. Khoja, Suha S. Tirmizi

Obstetrics and Gynaecology, East Africa

Objective: Low birth weight (LBW) is closely associated with perinatal morbidity and bears an increased risk for subsequent infant morbidity. The study aimed to assess low birth weight delivery factors among women in Chitral, Pakistan.

Methodology: Mixed Methodology was adopted. Structured data collection tool was used to collect information from medical records of 1316 mothers, followed by interviews and focus group discussions to understand the causes and their remedies. The main outcome measure was infants born with low birth weight LBW (<2.5kg).

Result: There was a significant association between the occurrence of low birth weight and maternal education, paternal education, …

The Study Of Hiv And Antenatal Care Integration In Pregnancy In Kenya: Design, Methods, And Baseline Results Of A Cluster-Randomized Controlled Trial, Janet M. Turan, Rachel L. Steinfeld, Maricianah Onono, Elizabeth A. Bukusi, Meghan Woods, Starley B. Shade, Sierra Washington, Reson Marima, Jeremy Penner, Marta L. Ackers, Dorothy Mbori-Ngacha, Craig R. Cohen

Pathology, East Africa

Background: Despite strong evidence for the effectiveness of anti-retroviral therapy for improving the health of women living with HIV and for the prevention of mother-to-child transmission (PMTCT), HIV persists as a major maternal and child health problem in sub-Saharan Africa. In most settings antenatal care (ANC) services and HIV treatment services are offered in separate clinics. Integrating these services may result in better uptake of services, reduction of the time to treatment initiation, better adherence, and reduction of stigma.

Methodology/Principal Findings: A prospective cluster randomized controlled trial design was used to evaluate the effects of integrating HIV treatment into ANC …

Non Fatal Injuries Among Infants: A Pilot Study, Seema Zainulabdin Lasi, Ghazala Rafique, Habib Peermohammad

Human Development Programme

Objective: To determine the incidence, nature and the extent of infant injuries in two suburban and rural communities of Pakistan.
Methods: The cross-sectional study was conducted on a cohort of 310 infants in suburban and rural communities of Pakistan in September 2007. The information was collected from primary care-givers based on any injury that had occurred to their infants during the preceding 3 months that required treatment at home or in a hospital.
Result: The incidence of non-fatal injury for infants up to 1-year-old was found to be 19 injuries per 100 person (child) years of exposure (95% CI 9.90 …

Idiopathic Pulmonary Haemosiderosis Presenting As Severe Iron Deficiency Anaemia--A Case From Pakistan, Noureen Afzal, Ammara Mushtaq, Arshalooz Rahman, Sonia Qureshi

Department of Paediatrics and Child Health

Idiopathic pulmonary haemosiderosis is an uncommon disorder, which is characterized by iron deficiency, recurrent haemoptysis and diffuse parenchymal infiltration on chest radiograph. We report an 8 year old child who had past history of multiple blood transfusions with diagnosis of iron deficiency anaemia and recurrent chest infection since the age of 21/2 year. At the age of 8 years, the child presented with fever and severe respiratory distress requiring intubation and ventilation. On Chest X-ray, bilateral white out was found and CT scan lung showed diffuse alveolar involvement. Lung biopsy confirmed haemosiderin-laden macrophages. Child was put on steroids and despite …

Acute Lymphoblastic Leukemia In A Child With Fanconi’S Anemia, Naureen Mushtaq, Rabia Wali, Zehra Fadoo, Ali Faisal Saleem

Department of Paediatrics and Child Health

No abstract provided.

Cardiac Involvement In Kawasaki Disease In Pakistani Children, Saleem Akhtar, Muhammad Matloob Alam, Mehnaz Atiq Ahmed

Department of Paediatrics and Child Health

Introduction: Coronary artery involvement is the most dreaded long-term complication of Kawasaki disease. Our aim was to look at the pattern of cardiovascular involvement in Pakistani children admitted with Kawasaki disease.
Methods: This study included children admitted with Kawasaki disease at the Aga Khan University Hospital Karachi over a period of 14 years from January 1997 to December 2010. Information gathered included patient demographics, clinical features, investigations, echocardiographic findings, treatment and follow-up. Those with coronary artery involvement on initial echocardiogram remained on long-term follow-up with clinical examination and echocardiogram.
Results: A total of 56 patients were admitted. (Mean age at …

Urinary Tract Infection Presenting As Jaundice In Neonates, Noureen Afzal, Maqbool Qadir, Sonia Qureshi, Rehan Ali, Shakeel Ahmed, Khalil Ahmad

Department of Paediatrics and Child Health

Neonatal Hyperbilirubinaemia is a common finding during the first postnatal week. Physiological jaundice occurs in first week of life in 60% of term and 80% of premature neonates. Non physiologic or pathologic jaundice occurs in 5-10% of newborns which require intervention. According to AAP guidelines laboratory investigation for jaundice include total serum bilirubin, blood Type and coombs test and if the baby has an elevation of direct reacting or conjugated bilirubin, there should be a urine analysis and urine culture. Here we are presenting 5 cases that developed indirect hyperbilirubinaemia and routine workup done according to AAP guidelines were normal. …

Elective Tracheostomy In Mechanically Ventilated Children, Prem Kumar Maheshwari, Muhammad Rehan Khan, Anwarul Haque

Department of Paediatrics and Child Health

Tracheostomy is an important procedure in children requiring prolonged mechanical ventilation. We conducted a retrospective study to assess the frequency, indications, postoperative course and short-term outcome of elective tracheostomy in a Paediatric Intensive Care Unit (PICU) of Pakistan. Twenty-five patients underwent tracheostomy in last 5 years (2.2 % of all PICU admissions). Mean age of patients was 6 years and 60% were male. The most common indication for tracheostomy was prolonged mechanical ventilation secondary to neurological disease (60%), followed by upper airway obstruction (40%). Major complications included accidental decannulation (20%) and tube obstruction (20%). Three patients (12%) developed ventilator-associated pneumonia …

Spinal Muscular Atrophy:Clinical Spectrum And Genetic Mutations In Pakistani Children, S. H. Ibrahim, Tariq Moatter, Ali Faisal Saleem

Department of Paediatrics and Child Health

Background: In Pakistan the rate of consanguineous marriages is high, thus, the chance of incidence of autosomal recessive disorders is likely to be high. The aim of this study is to investigate the clinical characteristics and genetics of spinal muscular atrophy (SMA) in children who presented to Aga Khan University, Karachi.
Materials and Methods: This study was a retrospective review of the medical charts of children (neonate: 15 years) with discharge diagnosis of SMA during last 10 years. Demographic features, consanguinity, and diagnostic analysis (including genetic analysis) were noted.
Results: During the study period 67 children had a discharge diagnosis …

Malnutrition In Young Pakistani Children, Shela Akbar Ali Hirani

School of Nursing & Midwifery

Background: Pakistan is a developing country with the second highest infant and child mortality rate in South Asia. In this region, malnutrition underlies much of the high infant and under five child morbidity and mortality rates. Although struggle to tackle the issue of malnutrition among young Pakistani children has been going on since many decades, till yet a realistic solution for this growing problem has not been found.

Objective: This paper aims at reviewing literature to analyse the biological, maternal, socio-cultural, environmental, and politico-economical determinants of malnutrition among young children in Pakistan so that need based interventions can …

Biotinidase Deficiency In Pakistani Children; What Needs To Be Known And Done, Bushra Afroze, Mohammad Wasay

Department of Medicine

No abstract provided.

Patient Safety In Developing Countries: Retrospective Estimation Of Scale And Nature Of Harm To Patients In Hospital, R. M. Wilson, P. Michel, S. Olsen, R. W. Gibberd, C. Vincent, R. El-Assady, O. Rasslan, S. Qsous, William Macharia, A. Sahel, S. Whittaker, M. Abdo-Ali, M. Letaief, N. A. Ahmed, A. Abdellatif, I. Larizgoitia

Paediatrics and Child Health, East Africa

Objective: To assess the frequency and nature of adverse events to patients in selected hospitals in developing or transitional economies.

Design: Retrospective medical record review of hospital admissions during 2005 in eight countries.

Setting: Ministries of Health of Egypt, Jordan, Kenya, Morocco, Tunisia, Sudan, South Africa and Yemen; the World Health Organisation (WHO) Eastern Mediterranean and African Regions (EMRO and AFRO), and WHO Patient Safety.

Participants: Convenience sample of 26 hospitals from which 15 548 patient records were randomly sampled.

Main outcome measures: Two stage screening. Initial screening based on 18 explicit criteria. Records that screened positive were then reviewed …

Schools As Potential Vaccination Venue For Vaccines Outside Regular Epi Schedule: Results From A School Census In Pakistan., Sajid Bashir Soofi, Inam-Ul Haq, M. Imran Khan, Muhammad Bilal Siddiqui, Mushtaq Mirani, Rehman Tahir, Imtiaz Hussain, Mahesh K Puri, Zamir Hussain Suhag, Asif R Khowaja, Abdul Razzaq Lasi, John D Clemens, Michael Favorov, R. Leon Ochiai, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Vaccines are the most effective public health intervention. Expanded Program on Immunization (EPI) provides routine vaccination in developing countries. However, vaccines that cannot be given in EPI schedule such as typhoid fever vaccine need alternative venues. In areas where school enrolment is high, schools provide a cost effective opportunity for vaccination. Prior to start of a school-based typhoid vaccination program, interviews were conducted with staff of educational institutions in two townships of Karachi, Pakistan to collect baseline information about the school system and to plan a typhoid vaccination program. Data collection teams administered a structured questionnaire to all schools …

Skeletal Manifestations Of Scurvy: A Case Report From Dubai, Shahryar Noordin, Naveed Baloch, Muhammad Sohail Salat, Abdul Rashid Memon, Tashfeen Ahmad

Section of Orthopaedic Surgery

Introduction: Nutritional deficiencies are rarely reported in developed countries. We report a child of Pakistani origin brought up in Dubai who developed skeletal manifestations of scurvy due to peculiar dietary habits.
Case Presentation: A 4.5 year old boy presented with pain and swelling of multiple joints for three months and inability to walk for two months. Dietary history was significant for exclusive meat intake for the preceding two years. On examination the child's height and weight were below the 5th percentile for his age. He was pale and tachycardic. There was significant swelling and tenderness over the wrist, knee and …

Nitric Oxide Metabolites As Biomarkers For Influenza-Like Acute Respiratory Infections Presenting To The Emergency Room, Asad Mian, Federico R Laham, Andrea T Cruz, Harsha Garg, Charles G Macias, A. Chantal Caviness, Pedro A Piedra

Department of Emergency Medicine

Aims: Nitric oxide (NO) is increased in the respiratory tract in pulmonary infections. The aim was to determine whether nasal wash NO metabolites could serve as biomarkers of viral pathogen and disease severity in children with influenza-like illness (ILI) presenting to the emergency department (ED) during the 2009 influenza A H1N1 pandemic.
Methods: Children ≤18 years old presenting to the ED with ILI were eligible. Nasal wash specimens were tested for NO metabolites, nitrate and nitrite, by HPLC and for respiratory viruses by real-time PCR.
Results: Eighty-nine patients with ILI were prospectively enrolled during Oct-Dec, 2009. In the …

Perspective On Opportunities For Research And Interventions Provided By Community Based Health Information System Illustrated By The Potential Use Of Motivational Interviewing Intervention, Peter Gisore, F Were, D. Ayuku, D. Kaseje

Paediatrics and Child Health, East Africa

Background: With the growth of Community-Based Health Information (CBHIS) for decision making and service provision in the low income settings, innovative models of addressing Maternal and Newborn Health (MNH) morbidity and mortality are necessary. World Health Organization (WHO) estimates that five hundred thousand mothers and about three million newborns die each year in middle and low income countries.

Objectives: To stimulate interest in utilisation CBHIS for research and interventions, with an illustration of potential using on Motivational Interviewing intervention.

Data Source: Literature searched electronically, discussion with behavioural experts, health system researchers, and maternal and Newborn Health (MNH) experts, and book …

A Qualitative Study Using Traditional Community Assemblies To Investigate Community Perspectives On Informed Consent And Research Participation In Western Kenya, Rachel Vreeman, Eunice Kamaara, Allan Kamanda, David Ayuku, Winstone Nyandiko, Lukoye Atwoli, Samuel Ayaya, Peter Gisore, Michael Scanlon, Paula Braitstein

Paediatrics and Child Health, East Africa

Background: International collaborators face challenges in the design and implementation of ethical biomedical research. Evaluating community understanding of research and processes like informed consent may enable researchers to better protect research participants in a particular setting; however, there exist few studies examining community perspectives in health research, particularly in resource-limited settings, or strategies for engaging the community in research processes. Our goal was to inform ethical research practice in a biomedical research setting in western Kenya and similar resource-limited settings.

Methods: We sought to use mabaraza, traditional East African community assemblies, in a qualitative study to understand community perspectives on …

Community Based Weighing Of Newborns And Use Of Mobile Phones By Village Elders In Rural Settings In Kenya: A Decentralised Approach To Health Care Provision, Peter Gisore, Evelyn Shipala, Kevin Otieno, Betsy Rono, Irene Marete, Constance Tenge, Hillary Mabeya, Sherri Bucher, Janet Moore, Edward Liechty, Fabian Esamai

Paediatrics and Child Health, East Africa

Background: Identifying every pregnancy, regardless of home or health facility delivery, is crucial to accurately estimating maternal and neonatal mortality. Furthermore, obtaining birth weights and other anthropometric measurements in rural settings in resource limited countries is a difficult challenge. Unfortunately for the majority of infants born outside of a health care facility, pregnancies are often not recorded and birth weights are not accurately known. Data from the initial 6 months of the Maternal and Neonatal Health (MNH) Registry Study of the Global Network for Women and Children’s Health study area in Kenya revealed that up to 70% of newborns did …

Risks To Early Childhood Health And Development In The Postconflict Transition Of Northern Uganda, Theresa A. Mcelroy, Stella Atim, Charles P. Larson, Robert Armstrong

Paediatrics and Child Health, East Africa

Research from numerous fields of science has documented the critical importance of nurturing environments in shaping young children’s future health and development. We studied the environments of early childhood (birth to 3 years) during postconflict, post displacement transition in northern Uganda. The aim was to better understand perceived needs and risks in order to recommend targeted policy and interventions. Methods. Applied ethnography (interview, focus group discussion, case study, observational methods, document review) in 3 sites over 1 year. Results. Transition was a prolonged and deeply challenging phase for families. Young children were exposed to a myriad of risk factors. Participants …

Influence Of Perceived Racial Discrimination On Health And Behaviour Of Immigrant Children In British Columbia, Anne George, Cherylynn Bassani, Robert Armstrong

Paediatrics and Child Health, East Africa

This study examines the influence of perceived discrimination on the health and behaviour of ethnic minority immigrant children in British Columbia, Canada. Using data from the New Canadian Children and Youth Study, we examine perceived discrimination experienced by the parent, family, and cultural group in Canada to test the influence of micro-, meso-, and macrolevels of discrimination on children. Families from 6 ethnic backgrounds participated in the study. Parents’ perceptions of the child’s health and six behavioral scales (hyperactivity, prosocial behaviour, emotional problems, aggression, indirect aggression, and a general combined behaviour scale) were examined as outcome variables. After controlling for …

Community Perspectives On Research Consent Involving Vulnerable Children In Western Kenya, Rachel Vreeman, Eunice Kamaara, Allan Kamanda, David Ayuku, Winstone Nyandiko, Lukoye Atwoli, Samuel Ayaya, Peter Gisore, Michael Scanlon, Paula Braitstein

Paediatrics and Child Health, East Africa

Involving vulnerable pediatric populations in international research requires culturally appropriate ethical protections. We sought to use mabaraza, traditional East African community assemblies, to understand how a community in western Kenya viewed participation of children in health research and informed consent and assent processes. Results from 108 participants revealed generally positive attitudes towards involving vulnerable children in research, largely because they assumed children would directly benefit. Consent from parents or guardians was understood as necessary for participation while gaining child assent was not. They felt other caregivers,community leaders, and even community assemblies could participate in the consent process. Community members believed …

Pseudomonas Necrotizing Fasciitis In An Otherwise Healthy Infant, Shakeel Ahmed, Syed Rehan Ali, Zahra Aziz Samani

Department of Paediatrics and Child Health

Necrotizing fasciitis is an uncommon rapidly progressing infection of soft tissue characterized by a severe inflammation of the fascia and soft tissue. The disease is associated with necrosis and subcutaneous gangrene of the inflamed tissue with systemic toxicity that carries a significant mortality unless timely diagnosed and aggressively treated. Monomicrobial necrotizing fasciitis caused by Pseudomonas aeruginosa is an exceptionally uncommon condition with only few cases reported in the literature so far. We are reporting a six-month-old female infant who was previously healthy and who presented with necrotizing fasciitis and isolates Pseudomonas aeruginosa both from the blood and tissue. The child …