Pediatrics Commons^™

Amoebic Liver Abscess: Outcomes Of Percutaneous Needle Aspiration Vs Drain Placement In Paediatric Population, Areej Saleem, Saqib Hamid Qazi, Waseem Mirza, Sarah Masroor Jeelani

Section of Paediatric Surgery

Objective: To compare the effectiveness of percutaneous catheter drain placement with percutaneous needle aspiration in terms of hospital stay, time to resolution of symptoms and cost of intervention performed.
Methods: The retrospective cohort study was conducted at Aga Khan University Hospital, Karachi, and comprised data of patients with amoebic liver abscess from, January 2006 to December 2016 which was collected using non-probability purposeful sampling. Primary outcome included length of hospital stay, time to resolution of symptoms and cost of intervention. Secondary outcomes included development of complications, need for re-intervention and abscess resolution. SPSS 22 was used for data analysis. . …

Neurodevelopmental Milestones And Associated Behaviours Are Similar Among Healthy Children Across Diverse Geographical Locations, José Villar, Michelle Fernandes, Manorama Purwar, Eleonora Staines-Urias, Paola Di Nicola, Leila Cheikh Ismail, Roseline Ochieng, Fernando Barros, Maria Carvalho, Elaine Albernaz

Paediatrics and Child Health, East Africa

It is unclear whether early child development is, like skeletal growth, similar across diverse regions with adequate health and nutrition. We prospectively assessed 1307 healthy, well-nourished 2-year-old children of educated mothers, enrolled in early pregnancy from urban areas without major socioeconomic or environmental constraints, in Brazil, India, Italy, Kenya and UK. We used a specially developed psychometric tool, WHO motor milestones and visual tests. Similarities across sites were measured using variance components analysis and standardised site differences (SSD). In 14 of the 16 domains, the percentage of total variance explained by between-site differences ranged from 1.3% (cognitive score) to 9.2% …

Health Systems Changes After Decentralisation: Progress, Challenges And Dynamics In Pakistan, Shehla Zaidi, Maryam Bigdeli, Etienne V. Langlois, Atif Riaz, David W. Orr, Nasir Idrees, Jesse B. Bump

Community Health Sciences

Decentralisation is widely practised but its scrutiny tends to focus on structural and authority changes or outcomes. Politics and process of devolution implementation needs to be better understood to evaluate how national governments use the enhanced decision space for bringing improvements in the health system and the underlying challenges faced. We use the example of Pakistan's radical, politically driven provincial devolution to analyse how national structures use decentralisation opportunities for improved health planning, spending and carrying out transformations to the health system. Our narrative draws on secondary data sources from the PRIMASYS study, supplemented with policy roundtable notes from Pakistan. …

Evaluation Of The Cost-Effectiveness Of The Treatment Of Uncomplicated Severe Acute Malnutrition By Lady Health Workers As Compared To An Outpatient Therapeutic Feeding Programme In Sindh Province, Pakistan, Eleanor Rogers, Saul Guerrero, Deepak Kumar, Sajid Bashir Soofi, Shahid Fazal, Karen Martínez, Jose Luis Alvarez Morán, Chloe Puett

Department of Paediatrics and Child Health

Background: Due to the limited evidence of the cost-effectiveness of Community Health Workers (CHW) delivering treatment for severe acute malnutrition (SAM), there is a need to better understand the costs incurred by both implementing institutions and beneficiary households. This study assessed the costs and cost-effectiveness of treatment for cases of SAM without complications delivered by government-employed Lady Health Workers (LHWs) and complemented with non-governmental organisation (NGO) delivered outpatient facility-based care compared with NGO delivered outpatient facility-based care only alongside a two-arm randomised controlled trial conducted in Sindh Province, Pakistan.
Methods: An activity-based cost model was used, employing a societal perspective …

Integrating Nutrition Into Health Systems: What The Evidence Advocates, Rehana Salam, Jai K. Das, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

There is considerable evidence of positive health and nutrition outcomes resulting from integrating nutrition-specific interventions into health systems; however, current knowledge on establishing and sustaining effective integration of nutrition into health systems is limited. The objective of this review is to map the existing types of integration platforms and review the evidence on integrated health and nutrition programmes' impacts on specific nutrition outcomes. A literature search was conducted, and integrated nutrition programmes were examined through the lens of the six World Health Organization (WHO) building blocks, including the demand side. Forty-five studies were included in this review, outlining the integration …

Oral Polio Vaccine Response In The Mal-Ed Birth Cohort Study: Considerations For Polio Eradication Strategies, William K. Pan, Jessica C. Seidman, Syed Asad Ali, Christel Hoest, Carl Mason, Dinesh Mondal, Stacey L. Knobler, Pascal Bessong, Mal-Ed Network Investigators

Department of Paediatrics and Child Health

Background: Immunization programs have leveraged decades of research to maximize oral polio vaccine (OPV) response. Moving toward global poliovirus eradication, the WHO recommended phased OPV-to-IPV replacement on schedules in 2012. Using the MAL-ED prospective birth cohort data, we evaluated the influence of early life exposures impacting OPV immunization by measuring OPV response for serotypes 1 and 3.
Methods: Polio neutralizing antibody assays were conducted at 7 and 15 months of age for serotypes 1 and 3. Analyses were conducted on children receiving ≥3 OPV doses (n = 1449). History of vaccination, feeding patterns, physical growth, home environment, diarrhea, enteropathogen detection, …

Knowledge, Attitudes, Practices And Barriers In Use Of Evidence-Based Medicine Among Resident Physicians In Aga Khan University Hospital, Nairobi., Megha Unadkat

Master of Medicine in Paediatrics and Child Health

Background: Evidence based medicine (EBM) helps clinicians to integrate latest research evidence into their daily clinical practice. There is a need for all healthcare professions to adopt it in order to provide scientific, safe, efficient and most cost-effective care. Postgraduate residents are at the frontline of healthcare delivery and all medical institutions should strive to produce practitioners of EBM. Studies have shown that physicians are still struggling to adapt to this paradigm shift in the practice of medicine, especially in Sub Saharan Africa (SSA). However, very few studies have been done in SSA and none in East Africa to explore …

Fmic Annual Report 2019 | Pashto (پشتو), French Medical Institute For Mothers And Children

French Medical Institute for Mothers and Children (FMIC) Archives

No abstract provided.

Fmic Annual Report 2019 | Dari (دری), French Medical Institute For Mothers And Children

French Medical Institute for Mothers and Children (FMIC) Archives

No abstract provided.

Fmic Annual Report 2019 | English, French Medical Institute For Mothers And Children

French Medical Institute for Mothers and Children (FMIC) Archives

No abstract provided.

Where Are The Paediatricians? An International Survey To Understand The Global Paediatric Workforce, Beth D. Harper, Waceke Nganga, Robert Armstrong, Kevin D. Forsyth, Hazen P. Ham, William J. Keenan, Christiana M. Russ

Paediatrics and Child Health, East Africa

Objective: Our primary objective was to examine the global paediatric workforce and to better understand geographic differences in the number of paediatricians globally. Secondary objectives were to describe paediatric workforce expectations, who provides children with preventative care and when children transition out of paediatric care.

Design: Survey of identified paediatric leaders in each country.

Setting: Paediatric association leaders worldwide.

Main outcome measures: Paediatrician numbers, provision of primary care for children, age of transition to adult care.

Results: Responses were obtained from 121 countries (73% of countries approached). The number of paediatricians per 100 000 children ranged from a median of …

Common Alternative Diagnoses Among A Pediatric Hospital-Based Cohort Evaluated For Tuberculosis In Karachi, Pakistan: The Need For Facilitated Referral In Tuberculosis Clinics, Sadia Shakoor, Fatima Mir, Rumina Hasan

Department of Pathology and Laboratory Medicine

Background: Children evaluated for tuberculosis (TB) are often diagnosed with miscellaneous conditions that mimic TB. Knowledge of differentials informs policy on service provision through liaison with referral centers offering definitive diagnosis and treatment for common alternative disorders.
Methods: We reviewed medical records of children who were offered diagnostic testing for TB (culture or Xpert MTB/RIF) at a tertiary care hospital in Karachi, Pakistan to identify common alternative diagnoses among children who are evaluated for TB.
Results: From January 2014 to December 2015, of 126 culture or Xpert MTB/RIF negative children presenting with chronic symptoms, 31 were diagnosed and treated for …

Socio-Anthropological Methods To Study The Feasibility And Acceptability Of The Minimally Invasive Autopsy From The Perspective Of Local Communities: Lessons Learnt From A Large Multi-Centre Study, Maria Maixenchs, Rui Anselmo, Guillermo Martínez Pérez, Kelvin Oruko, Selidji Todagbe Agnandji, Pamela Catherine Angoissa Minsoko, Kounandji Diarra, Mahamane Djiteye, Zulfiqar Ahmed Bhutta, Shujaat Zaidi

Department of Paediatrics and Child Health

The minimally invasive autopsy (MIA), an innovative approach for obtaining post-mortem samples of key organs, is increasingly being recognized as a robust methodology for cause of death (CoD) investigation, albeit so far limited to pilot studies and research projects. A better understanding of the real causes of death in middle- and low-income countries, where underlying causes of death are seldom determined, would allow improved health planning, more targeted prioritization of available resources and the implementation of coherent public health policies. This paper discusses lessons learnt from the implementation of a Feasibility and Acceptability (F&A) study evaluating the MIA approach in …

A Systematic Review Of Observational Studies, Demonstrating Smoking Among School Going Adolescents, Shafquat Rozi, Gillian Lancaster, Sadia Mahmud, Zahid Ahmad Butt, Talat Roome, Nida Zahid

Community Health Sciences

Objective: To characterize the methods of design and analysis currently adopted in survey research of school-based observational studies for smoking, and to identify the common pitfalls made by researchers.
Methods: The systematic review was conducted in 2009 and consisted of observational studies in school settings published between January 2005 and January 2009. Smoking status was the main outcome of interest. Following Cochrane style, five steps were followed: setting selection criteria for studies and conducting a literature search; review of abstracts; review of complete articles; data extraction and quality assessment of included studies; and, finally, synthesis of studies.
Results: Of the …

Assessment Of Inequalities In Coverage Of Essential Reproductive, Maternal, Newborn, Child, And Adolescent Health Interventions In Kenya, Emily Catherine Keats, Nadia Akseer, Zaid Bhatt, William Macharia, Anthony Ngugi, Arjumand Rizvi, Zulfiqar Ahmed Bhutta

Paediatrics and Child Health, East Africa

Importance: Previous work has underscored subnational inequalities that could impede additional health gains in Kenya.

Objective: To provide a comprehensive assessment of the burden, distribution, and change in inequalities in reproductive, maternal, newborn, child, and adolescent health (RMNCAH) interventions in Kenya from 2003 to 2014.

Design, Setting, and Participants: This population-based cross-sectional study used data from the 2003, 2008, and 2014 Kenya Demographic and Health Surveys. The study included women of reproductive age (ages 15-49 years) and children younger than years, with national, regional, county, and subcounty level representation. Data analysis was conducted from April 2018 to November 2018.

Exposures: …

Effectiveness Of A Youth-Led Early Childhood Care And Education Programme In Rural Pakistan: A Cluster-Randomised Controlled Trial, Aisha Khizar Yousafzai, Muneera Rasheed, Arjumand Rizvi, Fariha Shaheen, Liliana A. Ponguta, Chin R. Reyes

Department of Paediatrics and Child Health

Background: The United Nation's Sustainable Development Goals encompass lifelong learning from birth to youth to adulthood (Goal 4) and economic opportunities for young people (Goal 8). The targets include improving access to quality early childhood care and education (ECCE) as well as learning and training opportunities for adolescents and youth. Cross-generational models for young children and youth may offer opportunities to address the interconnections between goals and targets for the next generation. We investigated whether an ECCE programme for young children (3.5-6.5 years) delivered by female youth (18-24 years) in rural Pakistan would be effective on children's school readiness.
Methods: …

Fly Control To Prevent Diarrhoea In Children, Jai K. Das, Yousaf Bashir Hadi, Rehana Salam, Mehar Hoda, Zohra S. Lassi, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background:
Diarrhoeal disease accounts for millions of child deaths every year. Although the role of flies as vectors of infectious diarrhoea has been established, fly control is not often mentioned as an approach to decrease childhood diarrhoea. Theoretically, fly control for decreasing diarrhoea incidence can be achieved by intervening at four different levels: reduction or elimination of fly breeding sites; reduction of sources that attract houseflies; prevention of contact between flies and disease-causing organisms; and protection of people, food, and food utensils from contact with flies.
Objectives:
To assess the impact of various housefly control measures on the incidence of …

Business Not As Usual: How Multisectoral Collaboration Can Promote Transformative Change For Health And Sustainable Development, Shyama Kuruvilla, Rachael Hinton, Ties Boerma, Ryan Bunney, Nuria Casamitjana, Rafael Cortez, Patrizia Fracassi, Jennifer Franz-Vasdeki, Daniel Helldén, Joanne Mcmanus, Jai K. Das

Department of Paediatrics and Child Health

No abstract provided.

Scaling Up Primary Health Services For Improving Reproductive, Maternal, And Child Health: A Multisectoral Collaboration In The Conflict Setting Of Afghanistan, Jai K. Das, Nadia Akseer, Shafiq Mirzazada, Omarwalid Noorzada, Corinne E. Armstrong, Kashif Mukhtar, Ahmed Jan Naeem, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

No abstract provided.

A Comparison Of Maternal And Newborn Health Services Costs In Sindh Pakistan, Asif Raza Khowaja, Craig Mitton, Rahat Qureshi, Stirling Bryan, Laura A. Magee, Peter Von Dadelszen, Zulfiqar A. Bhutta

Department of Paediatrics and Child Health

Pakistani women suffer the highest rate of maternal mortality in South Asia. A lack of comprehensive knowledge about maternal and newborn health (MNH) services costs impedes policy decisions to maximize the benefit from existing, as well as emerging, MNH interventions in Pakistan. We compared MNH service costs at different levels of care. A cross-sectional survey was conducted during January to March 2016 as part of a large economic evaluation in Sindh, Pakistan. Health providers and facilities were selected from a sampling frame, inclusive of public and private sectors. This study utilized a broad perspective (i.e. costs to the health system …

Multiple-Micronutrient Supplementation: Evidence From Large-Scale Prenatal Programmes On Coverage, Compliance And Impact, Cristiana Berti, Michelle F. Gaffey, Zulfiqar Ahmed Bhutta, Irene Cetin

Department of Paediatrics and Child Health

Micronutrient deficiencies during pregnancy pose important challenges for public-health, given the potential adverse outcomes not only during pregnancy but across the life-course. Provision of iron-folic acid (IFA) supplements is the strategy most commonly practiced and recommended globally. How to successfully implement IFA and multiple micronutrient supplementation interventions among pregnant women and to achieve sustainable/permanent solutions to prenatal micronutrient deficiencies remain unresolved issues in many countries. This paper aims to analyse available experiences of prenatal IFA and multiple micronutrient interventions to distil learning for their effective planning and large-scale implementation. Relevant articles and programme-documentation were comprehensively identified from electronic databases, websites …

Ultrasonographic Optic Nerve Sheath Diameter Measurement For Raised Intracranial Pressure In A Tertiary Care Centre Of A Developing Country, Naveed Ur Rehman Siddiqu, Anwarul Haque, Qalab Abbas, Humaira , Jurair, Basit Salam, Raza Sayani

Department of Paediatrics and Child Health

Background:
Intracranial hypertension is not an uncommon life-threatening syndrome, caused by a variety of non-neurological and neurological illnesses, and quick diagnosis, timely treatment of Raised Intracranial Pressure (ICP) is associated with improved outcome. Our aim of study was to determine ultrasonographic measurement of Optic nerve sheath diameter (ONSD) for raised ICP.
Method:
Prospective case series done in Emergency and Paediatric critical care unit of Aga Khan University Hospital. ONSD measurement in millimetres was done by placing linear probe of ultrasound on eye ball.
Result:
Forty-eight patients were included in study with mean age of 7.5±5.0 years with 21/48 …

The Dietary Intake And Practices Of Adolescent Girls In Low- And Middle-Income Countries: A Systematic Review, Emily C. Keats, Aviva I. Rappaport, Shailja Shah, Christina Oh, Reena Jain, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

In many low- and middle-income countries (LMICs) the double burden of malnutrition is high among adolescent girls, leading to poor health outcomes for the adolescent herself and sustained intergenerational effects. This underpins the importance of adequate dietary intake during this period of rapid biological development. The aim of this systematic review was to summarize the current dietary intake and practices among adolescent girls (10⁻19 years) in LMICs. We searched relevant databases and grey literature using MeSH terms and keywords. After applying specified inclusion and exclusion criteria, 227 articles were selected for data extraction, synthesis, and quality assessment. Of the included …

Assessment Of Dental Maturation On Orthopantomograms Among Children With Various Dental Malocclusions At A Tertiary Care Hospital, Hafiz Taha Mahmood, Mubassar Fida

Department of Paediatrics and Child Health

Objectives: To determine and compare the median dental age among males and females and in subjects with dental Class I, II and III malocclusions.
Methods: The retrospective study was conducted at Aga Khan University Hospital and comprised dental records of patients from July to December 2016 who were aged 9-16 years and had complete dentition excluding third molars. The sample was divided according to dental malocclusion which was further categorised according to chronological age groups. SPSS 21 was used for data analysis.
Results: Of the 270 sbjects whose radiographs were studied, 135(50%) each were males and females. Children aged 11-12 …

Infantile Spasms: Clinical Profile And Treatment Outcomes, Shazia Kulsoom, S. H. Ibrahim, Sidra Kaleem Jafri, Khemchand N. Moorani, Misbah Anjum

Department of Paediatrics and Child Health

Background and Objective:
Infantile spasm (IS) is one of the severe epileptic encephalopathies which affect children in early two years of life. Our objective was to determine the clinical profile, etiology and outcome of treatment in children with infantile spasms attending tertiary care hospital at Karachi, Pakistan.
Methods:
This is retrospective study of 36 patients out of 94 registered as IS, aged three months to two years, managed and followed up at Aga Khan University Hospital, Karachi, from 2010 to 2015. Data of all children with IS was collected from case record. Details including clinical observations, lab investigations, anti-epileptic medications …

Meconium Stained Liquor And Its Neonatal Outcome, Nadia Mohammad, Hafiz Taha Mahmood, Arjumand Sohaila, Syed Rehan Ali

Department of Paediatrics and Child Health

Objective:
To determine the maternal factors and neonatal outcome of pregnancy complicated by meconium stained amniotic fluid.
Methods:
This one year retrospective study was conducted at the Agha Khan Hospital for Women-Garden Campus, it is a secondary care private teaching hospital. Demographics information included gestational age, gender and birth weight of baby, medical and obstetric complications during pregnancy, mode of delivery, neonatal outcome (Meconium Aspiration Syndrome (MAS) and need for admission in nursery) were recorded on a pre-designed proforma.
Results:
In our study the frequency of meconium stained amniotic fluid (MSAF) was 7.85%, out of them 12 % babies developed …

Advancing Universal Health Coverage In South Asian Cities: A Framework, Alayne M. Adams, Devaki Nambiar, Sameen Siddiqi, Bushra Binte Alam, Srinath Reddy

Department of Paediatrics and Child Health

No abstract provided.

Measuring And Understanding Social-Emotional Behaviors In Preschoolers From Rural Pakistan, Jenna E. Finch, Aisha Khizar Yousafzai, Muneera Rasheed, Jelena Obradović

Department of Paediatrics and Child Health

The Strengths and Difficulties Questionnaire (SDQ) is widely-used to measure symptoms of common childhood behavioral problems that may lead to mental health difficulties. In a sample of 1,302 highly-disadvantaged mothers and their preschoolers, we evaluated the factor structure and reliability of the parent-report version of the SDQ in rural Pakistan. Confirmatory factor analyses suggested that the original structure of the SDQ was not appropriate for our data. We created conceptually- and empirically-coherent measures of children’s externalizing behavior problems and prosocial skills. Child and family correlates of social-emotional behaviors were similar to those found in other countries, supporting the validity of …

“His Mind Will Work Better With Both Of Us”: A Qualitative Study On Fathers’ Roles And Coparenting Of Young Children In Rural Pakistan, Joshua Jeong, Saima Siyal, Günther Fink, Dana Charles Mccoy, Aisha Khizar Yousafzai

Department of Paediatrics and Child Health

Background: Parents are the primary providers of nurturing care for young children’s healthy early development. However, the literature on parenting in early childhood, especially in low- and middle-income countries, has primarily focused on mothers. In this study, we investigate how parents make meaning of fathers’ parenting roles with regards to their young children’s early health and development in rural Pakistan.
Methods: Data were collected between January and March 2017 through in-depth interviews with fathers (N = 33) and their partners (N = 32); as well as separate focus group discussions with fathers (N = 7) and mothers (N = 7). …

His Mind Will Work Better With Both Of Us”: A Qualitative Study On Fathers’ Roles And Coparenting Of Young Children In Rural Pakistan, Joshua Jeong, Saima Siyal, Günther Fink, Dana Charles Mccoy, Aisha Khizar Yousafzai

Department of Paediatrics and Child Health

Background: Parents are the primary providers of nurturing care for young children’s healthy early development. However, the literature on parenting in early childhood, especially in low- and middle-income countries, has primarily focused on mothers. In this study, we investigate how parents make meaning of fathers’ parenting roles with regards to their young children’s early health and development in rural Pakistan.
Methods: Data were collected between January and March 2017 through in-depth interviews with fathers (N = 33) and their partners (N = 32); as well as separate focus group discussions with fathers (N = 7) and mothers (N = 7). …