Pediatrics Commons^™

Childhood Obesity, A Public Health Crisis: Narrative Review Of Public Health Interventions For Childhood Obesity, Sumera Aziz Ali, Savera Aziz Ali, Nadir Suhail, Shiyam Sunder Tikmani, Gulshan Bano

Community Health Sciences

Introduction: Child obesity is the major pediatric public health crisis of the current century and its trend is increasing in the developing countries due to nutrition and epidemiologic transition. Considering the burden of childhood obesity and its associated outcomes need for obesity prevention in children has become priority both for government and researchers.
Objective: The objective of this review is to provide the updated knowledge and evidence from various research studies, designed to provide interventions either in school or at home.
Methodology: Electronic databases like Google scholar, PubMed and Sciencedirect were used as search engines. Key terms used during the …

Evaluation Of Solar Disinfection Of Water Intervention Delivered Through Lady Health Workers In Reduction Of Diarrheal Episodes In Under Five Children, Shabina Ariff, Ubaidullah Khan, Ali Turab, Imtiaz Hussain, Atif Habib, Tarab Mansoor, Dania Mallick, Zamir Suhag, Zaid Bhatti, Imran Ahmed, Sajid Bashir Soofi, Zulfiqar A Bhutta

Department of Paediatrics and Child Health

Background: Solar Water Disinfection (SODIS) is a simple, inexpensive and sustainable means of daily household treatment for drinking and storage of water. Globally, over a billion people lack access to safe drinking water. As many as half million under five children die annually due to diarrheal illnesses. Most of these deaths are concentrated in Africa and South Asia. Unsafe water is one of the most critical risk factors for diarrhoea. Systematic reviews indicate that interventions to improve the microbial quality of drinking water in households are effective at reducing diarrhoea illnesses and thereby contribute significantly in reducing deaths due to …

Effect Of Mobile Phone Text Messages Reminders On Uptake Of Routine Immunization Among Children In Pakistan- Study Protocol For A Randomized Clinical Trial, Abdul Momin Kazi, Murtaza Ali, Khurram Zubair, Hussain Kalimuddin, Syed Asad Ali

Department of Paediatrics and Child Health

Introduction: Routine Immunization (RI) is considered one of the best public health interventions to decrease child morbidity and mortality. The RI coverage in Pakistan is still well below the desired level, leading to continued polio transmission, large measles outbreaks and thousands of deaths from vaccine-preventable illnesses. Different innovative and cost effective strategies are required to look into for enhancement in vaccination uptake and coverage. We plan to test the effectiveness of reminders to parents/caregivers on cell phones through short messaging system (SMS) in improving vaccine uptake and on-time routine immunization for children in Pakistan.
Methods and Analysis: A parallel-randomized controlled …

A Histopathological Outlook On Nephrotic Syndrome: A Pediatric Perspective, M K. Arif, M Arif, N Amjad

Department of Paediatrics and Child Health

The developing world is observing changing histopathological patterns of idiopathic nephrotic syndrome (INS). However, the true burden of non-minimal change disease (non-MCD) presenting as INS remains unestimated owing to a paucity of data on renal biopsies. Data were collected from January 2006 to June 2014 on 75 children up to 16 years of age who underwent renal biopsies for INS. Mean age at biopsy was 11.2 ± 3.7 years. The male to female ratio was 1.5:1. A total of 25 (33.3%) children were steroid sensitive, 36 (48%) were steroid resistant, 10 (13.3%) were steroid dependent and 4 (5.3%) came with …

Hyperlactetemia And Its Trends In Critically Ill Children Admitted In Pediatric Intensive Care Unit Of A Developing Country, Qalab Abbas, Muhammad Tariq Jamil, Leena Jafri, Anwar Ul Haque, Vivek Khetpal

Department of Paediatrics and Child Health

Background: There is increasing evidence that in setting of critical ailments clinical signs lag biomarkers like Lactate and hyperlactetemia can be the only marker for this disorder. This study was conducted to describe the incidence of hyperlactatemia in critically ill children and its association with outcome.Methods: Retrospective review of medical records of all children who had their lactic acid (LA) levels measured during their admission in PICU from January 2014 to December 2015 was done. Demographic and clinical variables were recorded along with PICU therapies, outcome (Survived or expired) and development of multi-organ dysfunction. Results are presented as frequency with …

Evaluation Of The Uptake And Impact Of Neonatal Vitamin A Supplementation Delivered Through The Lady Health Worker Programme On Neonatal And Infant Morbidity And Mortality In Rural Pakistan: An Effectiveness Trial, Sajid Soofi, Shabina Ariff, Kamran Sadiq, Atif Habib, Zaid Bhatti, Imran Ahmad, Masawar Hussain, Nabeela Ali, Simon Cousens, Zulfiqar A Bhutta

Department of Paediatrics and Child Health

Background: Despite evidence for the benefits of vitamin A supplementation (VAS) among children 6 to 59 months of age, the feasibility of introduction and potential benefit of VAS in the neonatal period in public health programmes is uncertain. Objective: The primary objective was to evaluate the feasibility and effectiveness of early neonatal VAS (single dose of 50 000 international units within 48–72 hours after birth) delivered through the public sector Lady Health Worker (LHW) programme in rural Pakistan and to document its association with a reduction in mortality at 6 months of age.
Methods: A community-based, cluster randomised, …

Right-Sided Congenital Diaphragmatic Hernia And Myelomeningocele: A Rare Association, Syed Rehan Ali, Shakeel Ahmed

Department of Paediatrics and Child Health

Congenital diaphragmatic hernia (CDH) is a rare birth defect with a prevalence of < 0.5 per 1,000 live births. Majority of these defects are left-sided as most studies suggest that frequency of right-sided CDH was 10% of the total. The association of CDH with myelomeningocele (MMC) is extremely rare; as in Sweed's study of 116 consecutive cases of CDH, the incidence of associated MMC with CDH was stated as 4.3%. There has been one previous case report of leftsided CDH, MMC and hydrocephalus prenatally diagnosed; but to the best of authors' knowledge, this is the first reported case of the above constellation with a right-sided CDH diagnosed prenatally.

Atrial Thrombus In A Premature Newborn Following Cardio-Pulmonary Resuscitation, Syed Rehan Ali, Shakeel Ahmed, Nadeem Aslam, Heeramani Lohana

Department of Paediatrics and Child Health

Critically ill newborns, whether term or preterm, are at great risk for developing symptomatic thromboembolic disease. Comorbidities like inflammation, DIC, fluctuations in cardiac output, congenital heart disease, as well as central venous or arterial catheters, are the predisposing risk factors. Clinically symptomatic or asymptomatic cases are usually picked up by echocardiography, usually done for other indications. Management usually comprises of observation, heparin therapy, thrombo-embolectomy, and catheter directed revascularization. We present a case of premature neonate who developed thrombus at inter-atrial septum as a possible consequence of cardiopulmonary resuscitation, detected by echocardiography. Conversely, there is always a possibility of paradoxical emboli …

The Pediatric Disease Spectrum In Emergency Departments Across Pakistan: Data From A Pilot Surveillance System, Huba Atiq, Emaduddin Siddiqui, Surraya Bano, Asher Feroze, Sayyeda Ghazala Kazi, Jabeen Fayyaz, Shivam Gupta, Junaid A. Razzak, Adnan A Hyder, Asad Mian

Department of Emergency Medicine

Background: There is an increasing number of urgently ill and injured children being seen in emergency departments (ED) of developing countries. The pediatric disease burden in EDs across Pakistan is generally unknown. Our main objective was to determine the spectrum of disease and injury among children seen in EDs in Pakistan through a nationwide ED-based surveillance system.
Methods: Through the Pakistan National Emergency Department Surveillance (Pak-NEDS), data were collected from November 2010 to March 2011 in seven major tertiary care centers representing all provinces of Pakistan. These included five public and two private hospitals, with a collective annual census of …

Uncovering The Burden Of Intentional Injuries Among Children And Adolescents In The Emergency Department, Uzma R. Khan, Butool Hisam, Nukhba Zia, Mohammed Umer Mir, Olakunle Alonge, Seemin Jamali, Adnan Hyder, Junaid Abdul Razzak

Department of Emergency Medicine

Introduction: In low- and middle-income countries, injuries are a leading cause of mortality in children. Much work has been done in the context of unintentional injuries but there is limited knowledge about intentional injuries among children. The objective of this paper was to understand the characteristics of children with intentional injuries presenting to emergency departments in Pakistan.
Methods: The data was from the Pakistan National Emergency Departments Surveillance (Pak-NEDS), conducted from November 2010 to March 2011 in seven major emergency departments of Pakistan. Data on 30,937 children under 18 years of age was collected. This paper reports frequency of intentional …

Overcrowding In The Emergency Departments: Challenges And Opportunities For Improvement, Muhammad Akbar Baig, Asad Mian, Fatima Najeeb, Hira Shahzad

Department of Emergency Medicine

With the advent of Emergency Medicine, one can observe an increase in the number of Emergency Departments (ED) across the country. However, most EDs struggle due to an overwhelming number of patients. Overcrowding can lead to delays in patient care. For a city like Karachi which is an active disaster zone, preemptive preparedness is required in the face of terror threats and such overcrowding needs to be decreased to a bare minimum. The most frequent causes of prolonged length of stay (LOS) in the ED include non-availability of in-hospital beds, delays in response to subspecialty consultations and escalating medical expenses. …

Developing Paediatric Emergency Medicine—An Opinion From A Developing Country Tertiary Care Center, Emaduddin Siddiqui, Shahan Waheed, Irum Qamar Khan

Department of Emergency Medicine

No abstract provided.

Systematic Review Of The Global Epidemiology, Clinical And Laboratory Profile Of Enteric Fever, Asma Azmatullah, Farah Naz Qamar, Durrane Thaver, Anita Km Zaidi, Zulfiqar A. Bhutta

Department of Paediatrics and Child Health

Background: Children suffer the highest burden of enteric fever among populations in South Asian countries. The clinical features are non-specific, vary in populations, and are often difficult to distinguish clinically from other febrile illnesses, leading to delayed or inappropriate diagnosis and treatment. We undertook a systematic review to assess the clinical profile and laboratory features of enteric fever across age groups, economic regions, level of care and antibiotic susceptibility patterns.
Methods: We searched PubMed (January 1964-December 2013) for studies describing clinical features in defined cohorts of patients over varying time periods. Studies with all culture-confirmed cases or those with at …

Postnatal Growth Standards For Preterm Infants: The Preterm Postnatal Follow-Up Study Of The Intergrowth-21st Project, José Villar, Francesca Giuliani, Zulfiqar A. Bhutta, Enrico Bertino, Eric O. Ohuma, Leila Cheikh Ismail, Fernando C. Barros, Douglas G. Altman, Cesar Victora, Julia A. Noble, Michael G. Gravett, Manorama Purwar, Ruyan Pang, Ann Lambert, Aris T. Papageorghiou, Roseline Ochieng, Yasmin A. Jaffer, Stephen H. Kennedy

Paediatrics and Child Health, East Africa

Background: Charts of size at birth are used to assess the postnatal growth of preterm babies on the assumption that extrauterine growth should mimic that in the uterus.

Methods: The INTERGROWTH-21st Project assessed fetal, newborn, and postnatal growth in eight geographically defined populations, in which maternal health care and nutritional needs were met. From these populations, the Fetal Growth Longitudinal Study selected low-risk women starting antenatal care before 14 weeks’ gestation and monitored fetal growth by ultrasonography. All preterm births from this cohort were eligible for the Preterm Postnatal Follow-up Study, which included standardised anthropometric measurements, feeding practices based on …

Congenital Factor Vii Deficiency In Children At Tertiary Health Care Facility In Pakistan, Muhammad Matloob Alam, Bushra Moiz, Karim Abdur Rehman, Priyanka Jethwani, Zehra Fadoo

Department of Paediatrics and Child Health

This study presents the demographics, clinical spectrum, and outcome of patients with congenital factor VII (FVII) deficiency at a tertiary care center over a period of 12 years. Of the 49 patients, 27 (55%) patients were males. Consanguinity was found in 92% of the patients. The median age of symptom onset was 2.4 (interquartile range [IQR]: 1.1-6.5) years with a median age of 5.8 (IQR: 3.1-10) years at diagnosis. Life-threatening complications like intracranial bleeding (ICB) and intra-abdominal bleeding (IAB) were observed in 8 (16.4%) patients. We found that 11 (55%) of the 20 patients with FVII coagulant activity (FVIIc) 5% …

Hereditary Sensory Autonomic Neuropathy Ii, A Rare Disease In A Large Pakistani Family, Fazal M. Arain, Prem Chand

Department of Paediatrics and Child Health

Hereditary Sensory Autonomic Neuropathy II (HSAN II) is a rare genetic disorder, characterized by severe loss of pain, temperature and touch sensation. Injuries in these patients can progress to necrosis and shedding of digits and limbs. Here we report two cases of HSAN II belonging to a Pakistani family. Individual 1, a forty five year old man, had complete loss of pain sensation since birth. Self-mutilation and complication of injuries resulted in the shedding of all the digits and right foot and surgical amputation of left leg. Individual 2, a five year old girl,had delay in healing of wounds and …

Pathogen-Specific Burdens Of Community Diarrhoea In Developing Countries: A Multisite Birth Cohort Study (Mal-Ed), Sadia Shakoor, Shahida Qureshi, Furqan Kabir, Anita K. M. Zaidi, Zulfiqar Ahmed Bhutta, Imran Ahmed, Didar Alam, Syed Asad Ali, Muneera Rasheed, Sajid Bashir Soofi, Ali Turab, Aisha Khizar Yousafzai

Department of Pathology and Laboratory Medicine

Background: Most studies of the causes of diarrhoea in low-income and middle-income countries have looked at severe disease in people presenting for care, and there are few estimates of pathogen-specific diarrhoea burdens in the community.
Methods: We undertook a birth cohort study with not only intensive community surveillance for diarrhoea but also routine collection of non-diarrhoeal stools from eight sites in South America, Africa, and Asia. We enrolled children within 17 days of birth, and diarrhoeal episodes (defined as maternal report of three or more loose stools in 24 h, or one loose stool with visible blood) were identified through …

Diagnostic Utility Of Who Defined Sepsis Syndromic Criteria With Procalcitonin In Identification Of Sepsis In Children With Suspected Infections, Samuel Owuor Akech

Master of Medicine in Paediatrics and Child Health

Title: Diagnostic Utility of WHO Defined Sepsis syndromic Criteria with Procalcitonin in Identification of Sepsis in Children with Suspected Infections Background: Bacterial infections are a major cause of morbidity and mortality in children but accurate and timely diagnosis remains a challenge to the frontline clinicians. Cultures of sterile bodily specimens are considered the gold standard but are insensitive and results are delayed. Procalcitonin (PCT) has recently emerged as a biomarker with high sensitivity and specificity making it superior to culture based techniques performed in non-ideal circumstances which prevail in resource poor settings. This study investigated the diagnostic utility World Health …

Screening For G6pd Deficiency Among Neonates With Neonatal Jaundice Admitted To Tertiary Care Center: A Need In Disguise, Kishwer Kumar, Arjumand Sohaila, Shiyam Sunder Tikmani, Iqtidar Ahmed Khan, Anila Zafar

Department of Paediatrics and Child Health

This study was conducted to determine the association of Glucose-6-Phosphate Dehydrogenase (G-6-PD) deficiency among neonates admitted with jaundice at the neonatal intensive care unit, well baby nursery and neonatal step down nursery of the Aga Khan University Hospital, Karachi, Pakistan, from January to June 2010. A total of 205 neonates following the selection criteria were included. All selected neonates have their venous blood drawn, saved in EDTA bottle and sent to laboratory of The Aga Khan University Hospital (AKUH). The laboratory results of whether G-6-PD deficiency was present or not was recorded in the proforma. G-6-PD was deficient in 19 …

Caregivers’ Knowledge, Perceptions And Home Management Practices Of Fever In Children Under The Age Of Five Years Presenting With Acute Febrile Illnesses, Katherine Oyieke

Master of Medicine in Paediatrics and Child Health

Background: Fever in children is one of the most common clinical symptoms and a frequent cause of caregiver concern. It is a normal body response to a variety of conditions, the most common of which is infection. Many childhood illnesses are accompanied by fever, which is often treated at home prior to presentation at a health facility. Nearly every child will develop a febrile episode at some point in life. The challenge for caregivers is to know when to be concerned and how to manage such episodes appropriately when they occur. Caregiver knowledge and perceptions regarding fever are an important …

Executive Function And Attention-Deficit/Hyperactivity Disorder In Ugandan Children With Perinatal Hiv Exposure, Matthew Burkey, Robert Opoka

Paediatrics and Child Health, East Africa

Background: Attention-deficit/hyperactivity disorder (ADHD) is among the most commonly diagnosed mental disorders in childhood and is associated with substantial deficits in executive functioning and lost academic and occupational attainment. This study evaluates symptoms of ADHD and their association with neurocognitive deficits in a cohort of rural Ugandan children who were born to HIV-infected mothers.

Methods: We assessed ADHD symptoms and executive function (including memory and attention) in a non-clinical sample of children born to HIV-infected mothers in rural eastern Uganda. Analyses included assessments of the psychometric properties, factor structure, and convergent and discriminant validity of the ADHD measure (ADHD-Rating Scale-IV); …

Effect Of Clopidogrel On Platelet Cd Markers In Normal Individuals And In Patients With Untreated Type 2 Diabetes Mellitus, Muhammad Saboor, Moinuddin, Samina Ilyas

Department of Paediatrics and Child Health

The objective of this study was to evaluate the effect of clopidogrel response in patients with untreated type 2 diabetes mellitus as compared with normal individuals. One hundred and seven subjects i.e. 32 normal and 75 patients with untreated type 2 diabetes mellitus were enrolled in this study. In the first step, normal subjects as well as diabetic patients were selected and tested for various laboratory parameters and platelets flow cytometry. In the second step, an antiplatelet drug (clopidogrel) was administered for 10 days to each individual enrolled in the study. After 10 days blood samples were collected for platelets …

Use Of N-Acetylcysteine In Children With Fulminant Hepatic Failure Caused By Acute Viral Hepatitis, Ali Faisal Saleem, Qalab Abbas, Anwarul Haque

Department of Paediatrics and Child Health

Objective: To determine the efficacy of N-acetylcysteine (NAC) in children aged > 1 month to 16 years admitted with Fulminant Hepatic Failure (FHF) secondary to Acute Viral Hepatitis (AVH) in a tertiary care center of a developing country.

Study Design: Analytical study.

Place and Duration of Study: Department of Paediatrics, The Aga Khan University Hospital, Karachi, Pakistan, from January 2007 to December 2011.

Methodology: Medical records of children (> 1 month - 16 years) with FHF admitted with AVH of known etiology who received NAC were reviewed retrospectively. Liver function tests (mean ± SD) at baseline, 24 hours after NAC and …

Haematological Causes Of Thrombocytopenia In Children At Aga Khan University Hospital, Karachi, Amna Jawaid

Department of Paediatrics and Child Health

Objective: To identify the haematological causes of thrombocytopenia in children admitted at a tertiary care hospital.
Methods: The prospective, descriptive study was carried out at the Aga Khan University Hospital, Karachi, from September 3, 2009 to March 3, 2010, and comprised children between one month and 14 years of age with platelet count less than15000. After reviewing the record, a questionnaire was filled and data was analysed using SPSS 15.
Results: Out of 108 patients in the study, 69(64%) were male and 39(36%) were female. The overall mean age was 69±46.54 months (range: 12-168 months). The mean platelet count was …

Clinical Profiles And Outcomes Of Children Admitted To The Pediatric Intensive Care Unit From The Emergency Department, Anwarul Haque, Naveed Ur Rehman Siddiqui, Sidra Kaleem Jafri, Mehar Hoda, Surraiya Bano, Asad Mian

Department of Paediatrics and Child Health

The aim of this study was to describe clinical profiles and outcomes of children admitted directly from the Emergency Room (ER) to the Pediatric Intensive Care Unit (PICU) of academic hospital. The medical records of all children (1 month to 16 years) admitted in PICU from ER, from January 2011 to December 2012 were reviewed. Of the 26,774 patients seen in the ER during the study period, 468 (1.7%) were admitted to the PICU which constituted about 41.5% (468/1127) of all the total PICU admissions. Sixty three percent (n=294) were under-five; males were 60.9% (285), 82.3% (385) were in medical …

Isoniazid Induced Acute Pancreatitis In A Young Girl, Ali Faisal Saleem Dr, Saba Arbab, Farah Qamar Naz

Department of Paediatrics and Child Health

Isoniazid (INH) is the mainstay of management against Mycobacterium tuberculosis. INH-induced acute pancreatitis is an uncommon association and with dearth of literature on it. We are reporting a case of an 11 years old girl who developed acute pancreatitis after 2 weeks of antituberculous therapy. An INH free regimen was started. She was discharged and followed without complications.

Nail As A Foreign Body In A Neonate, An Unusual Presentation At An Unusual Age, Sayyeda Ghazala Irfan Kazi, Muhammad Irfan Habib, Badar Afzal, Irum Qamar Khan, Emaduddin Siddiqui, Maryam Aftab

Department of Emergency Medicine

Children are prone to ingest substances due to their exploratory nature and tendency to put everything in the mouth. Commonly ingested foreign bodies are coins, batteries and buttons. Foreign body ingestion in neonates is a very rare presentation and always needs important consideration as it can be a part of child abuse and can lead to serious life threatening consequences

Mortality Patterns Among Critically Ill Children In A Pediatric Intensive Care Unit Of A Developing Country, Naveed-Ur-Rehman Siddiqui, Zohaib Ashraf, Humaira Jurair, Anwarul Haque

Department of Paediatrics and Child Health

Background and Aim: Advances in biomedical technology have made medical treatment to be continued beyond a point, at which it does not confer an advantage but may increase the suffering of patients. In such cases, continuation of care may not always be useful, and this has given rise to the concept of limitation of life-sustaining treatment. Our aim was to study mortality patterns over a 6-year period in a Pediatric Intensive Care Unit (PICU) in a developing country and to compare the results with published data from other countries.
Materials and Methods: Retrospective cohort study was conducted in a PICU …

Prevalence Of Vitamin D Deficiency In Exclusively Breastfed Infants At The Aga Khan University Hospital, Nairobi, Nusrat. A. Said

Master of Medicine in Paediatrics and Child Health

Introduction: Vitamin D deficiency in infants is a recognized cause of rickets. In the last few years, evidence has emerged of its association with lower respiratory tract infections, food allergy, type 1 diabetes, schizophrenia and various other extra skeletal health effects. Exclusively breastfed infants are especially vulnerable to vitamin D deficiency due to their dependence on previous trans-placental transfer of vitamin D from the mother, dietary vitamin D from breast milk and cutaneous synthesis of vitamin D on exposure to sunlight. The worldwide epidemic of Vitamin D deficiency in pregnancy and the low content of vitamin D in breast milk …

Parental Understanding Of Tuberous Sclerosis Complex, Pauline Samia, Kirsten A. Donald, Birgit Schlegel, Jo M. Wilmshurst

Paediatrics and Child Health, East Africa

Tuberous sclerosis complex is a genetic disorder with multisystem involvement that poses significant challenges to the affected child and family. Caregiver knowledge in the South African population has not previously been reported. A prospective study of the parents of 21 children with tuberous sclerosis complex was undertaken. Median parental age was 38 (interquartile range 34.5-45) years. Parents were randomly allocated to receive written information about the condition, or to receive verbal counselling already established in clinic. A significant difference (P ¼ .001) was observed in the change in the mean knowledge scores for the parent group that received written information …