Public Health Commons^™

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 …

Countdown To 2015 Country Case Studies: What Can Analysis Of National Health Financing Contribute To Understanding Mdg 4 And 5 Progress?, Carlyn Mann, Courtney Ng, Nadia Akseer, Zulfiqar Ahmed Bhutta, Josephine Borghi, Tim Colbourn, Patricia Hernández-Peña, Luis Huicho, Muhammad Ashar Malik, Melisa Ashar Martinez-Alvarez, Spy Munthali, Ahmad Shah Salehi, Mekonnen Tadesse, Mohammed Yassin, Peter Berman

Community Health Sciences

Background

Countdown to 2015 (Countdown) supported countries to produce case studies that examine how and why progress was made toward the Millennium Development Goals (MDGs) 4 and 5. Analysing how health-financing data explains improvements in RMNCH outcomes was one of the components to the case studies.

Methods

This paper presents a descriptive analysis on health financing from six Countdown case studies (Afghanistan, Ethiopia, Malawi, Pakistan, Peru, and Tanzania), supplemented by additional data from global databases and country reports on macroeconomic, health financing, demographic, and RMNCH outcome data as needed. It also examines the effect of other contextual factors presented in …

Important Steps To Maintain The Privacy Of Patients In The Hospital, Savera Aziz Ali, Minaz Mawani, Gulshan Bano, Sumera Aziz Ali

School of Nursing & Midwifery

Women are considered as vulnerable groups in our society in spite of their defined women rights by various laws. This shows that unfortunately these laws are not implemented practically in the real life. Society is shaped by the individuals and everyone should be responsible for advocating their own rights as well as the right of others especially of the vulnerable groups within the population.

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 …

Available Interventions For Prevention Of Cotton Dust-Associated Lung Diseases Among Textile Workers, Asaad Ahmed Nafees, Zafar Fatmi

Community Health Sciences

The authors reviewed literature on interventions for cotton dust-associated lung diseases among textile workers. Internet sources (PubMed, Cochrane Library, Google and Google Scholar) were accessed and interventions were categorized into: Engineering or administrative controls, or personal protective equipment (PPE). Ten relevant articles were shortlisted, five related to engineering controls (pre-processing, bactericidal treatment of cotton, improved workplace design, machinery and dust control measures). Administrative controls may involve setting standards, environmental surveillance, periodic medical examinations, and workers training. Although specific guidelines are available regarding the use of PPEs, but there was little literature on their effectiveness. It was concluded that there is …

Acceptability And Feasibility Of Point-Of-Care Cd4 Testing On Hiv Continuum Of Care In Low And Middle Income Countries: A Systematic Review, Minh D. Pham, Paul A. Agius, Lorena Romero, Peter Mcglynn, David Anderson, Suzanne M. Crowe, Stanley Luchters

Population Health, East Africa

Background: CD4 testing is, and will remain an important part of HIV treatment and care in low and middle income countries (LMICs). We report the findings of a systematic review assessing acceptability and feasibility of POC CD4 testing in field settings.

Methods: Electronic databases were searched for studies published in English between 2005 and 2015 that describe POC CD4 platforms. Studies conducted in LMICs and under field conditions outside a laboratory environment were eligible. Qualitative and descriptive data analysis was used to present the findings.

Results: Twelve studies were included, 11 of which were conducted in sub-Saharan countries and used …

Peer Pressure And Family Smoking Habits Influence Smoking Uptake In Teenage Boys Attending School: Multilevel Modeling Of Survey Data., Shafquat Rozi, Sadia Mahmud, Gillian Lancaster, Nida Zahid

Community Health Sciences

Introduction:

Among young teens, about one in five smokes worldwide. Adolescents spend a considerable amount of their time in school, and the school environment is therefore important for child health practices and outcomes.

Objectives:

We aimed to investigate the impact on smoking behavior of the school environment and the personal characteristics of male teenage students attending schools in Pakistan, taking into account the survey sampling structure.

Methods:

A two-stage cluster sampling with stratification was employed, and we interviewed 772 male secondary school students. We adopted random effect and generalizing estimating equation models.

Results:

Peer pressure in particular had a strong …

Important Strategies For Effective Family Planning Counseling, Savera Aziz Ali, Minaz Mawani, Gulshan Bano, Sumera Aziz Ali

School of Nursing & Midwifery

No abstract provided.

Use Of Smokeless Tobacco In Medical Students And Hypertension, Sumera Aziz Ali

Community Health Sciences

No abstract provided.

Male Involvement In Reproductive, Maternal And Child Health: A Qualitative Study Of Policymaker And Practitioner Perspectives In The Pacific, Jessica Davis, Joseph Vyankandondera, Stanley Luchters, David Simon, Wendy Holmes

Population Health, East Africa

Background: The importance of involving men in reproductive, maternal and child health programs is increasingly recognised globally. In the Pacific region, most maternal and child health services do not actively engage expectant fathers and fathers of young children and few studies have been conducted on the challenges, benefits and opportunities for involving fathers. This study explores the attitudes and beliefs of maternal and child health policymakers and practitioners regarding the benefits, challenges, risks and approaches to increasing men's involvement in maternal and child health education and clinical services in the Pacific.

Methods: In-depth interviews were conducted with 17 senior maternal …

A Novel Point-Of-Care Testing Strategy For Sexually Transmitted Infections Among Pregnant Women In High-Burden Settings: Results Of A Feasibility Study In Papua New Guinea, Steven G. Badman, Lisa M. Vallely, Pamela Toliman, Grace Kariwiga, Bomesina Lote, William Pomat, Caroline Holmer, Rebecca Guy, Stanley Luchters, Chris Morgan

Population Health, East Africa

Background: Sexually transmitted and genital infections in pregnancy are associated with an increased risk of adverse maternal and neonatal health outcomes. High prevalences of sexually transmitted infections have been identified among antenatal attenders in Papua New Guinea. Papua New Guinea has amongst the highest neonatal mortality rates worldwide, with preterm birth and low birth weight major contributors to neonatal mortality. The overall aim of our study was to determine if a novel point-of-care testing and treatment strategy for the sexually transmitted and genital infections Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and Bacterial vaginosis (BV) in pregnancy is …

Cost Of Management Of Severe Pneumonia In Young Children: Systematic Analysis, Shanshan Zhang, Peter M. Sammon, Isobel King, Ana Lucia Andrade, Cristiana M. Toscano, Sheila N. Araujo, Anushua Sinha, Shabir A. Madh, Gulam Khandaker, Jiehui Kevin Yin, Robert Booy, Tanvir M. Huda, Qazi S. Rahman, Shams El Arifeen, Angela Gentile, Norberto Giglio, Mejbah U. Bhuiyan, Katharine Sturm Ramirez, Bradford D. Gessner, Mardiati Nadjib, Phyllis J. Carosone– Link, Eric Af Simões, Jason A. Child, Imran Ahmed, Zulfiqar Ahmed Bhutta, Sajid Bashir Soofi

Department of Paediatrics and Child Health

Background: Childhood pneumonia is a major cause of childhood illness and the second leading cause of child death globally. Understanding the costs associated with the management of childhood pneumonia is essential for resource allocation and priority setting for child health.
Methods: We conducted a systematic review to identify studies reporting data on the cost of management of pneumonia in children younger than 5 years old. We collected unpublished cost data on non–severe, severe and very severe pneumonia through collaboration with an international working group. We extracted data on cost per episode, duration of hospital stay and unit cost of interventions …

Use Of Antenatal Corticosteroids At Health Facilities And Communities In Low-And-Middle Income Countries., Mabel Berrueta, Jennifer Hemingway-Foday, Vanessa R. Thorsten, Robert L. Goldenberg, Waldemar A. Carlo, Ana Garces, Archana Patel, Sarah Saleem, Omrana Pasha, Elwyn Chomba, Patricia L. Hibberd, Nancy F. Krebs, Shivaprasad Goudar, Richard J. Derman, Fabian Esamai, Edward A. Liechty, Janet L. Moore, Elizabeth M. Mcclure, Marion Koso-Thomas, Pierre M. Buekens, José M. Belizán, Fernando Althabe

Community Health Sciences

BACKGROUND:

Antenatal corticosteroids (ACS) for women at high risk of preterm birth is an effective intervention to reduce neonatal mortality among preterm babies delivered in hospital settings, but has not been widely used in low-middle resource settings. We sought to assess the rates of ACS use at all levels of health care in low and middle income countries (LMIC).

METHODS:

We assessed rates of ACS in 7 sites in 6 LMIC participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development's Global Network for Women and Children's Health Research Antenatal Corticosteroids Trial (ACT), a cluster-randomized trial …

The Antenatal Corticosteroids Trial (Act)'S Explanations For Neonatal Mortality - A Secondary Analysis., Fernando Althabe, Vanessa Thorsten, Karen Klein, Elizabeth M. Mcclure, Patricia L. Hibberd, Robert L. Goldenberg, Waldemar A. Carlo, Ana Garces, Archana Patel, Omrana Pasha, Elwyn Chomba, Nancy F. Krebs, Shivaprasad Goudar, Richard J. Derman, Fabian Esamai, Edward A. Liechty, Nellie I. Hansen, Sreelatha Meleth, Dennis D. Wallace, Marion Koso-Thomas, Alan H. Jobe, Pierre M. Buekens, José M. Belizán

Community Health Sciences

BACKGROUND:

The Antenatal Corticosteroid Trial assessed the feasibility, effectiveness, and safety of a multifaceted intervention to increase the use of antenatal corticosteroids (ACS) in mothers at risk of preterm birth at all levels of care in low and middle-income countries. The intervention effectively increased the use of ACS but was associated with an overall increase in neonatal deaths. We aimed to explore plausible pathways through which this intervention increased neonatal mortality.

METHODS:

We conducted a series of secondary analyses to assess whether ACS or other components of the multifaceted intervention that might have affected the quality of care contributed to …

The Antenatal Corticosteroids Trial (Act): A Secondary Analysis To Explore Site Differences In A Multi-Country Trial., Karen Klein, Elizabeth M. Mcclure, Daniela Colaci, Vanessa Thorsten, Patricia L. Hibberd, Fabian Esamai, Ana Garces, Archana Patel, Sarah Saleem, Omrana Pasha, Elwyn Chomba, Waldemar A. Carlo, Nancy F. Krebs, Shivaprasad Goudar, Richard J. Derman, Edward A. Liechty, Marion Koso-Thomas, Pierre M. Buekens, José M. Belizán, Robert L. Goldenberg, Fernando Althabe

Community Health Sciences

BACKGROUND:

The Antenatal Corticosteroid Trial (ACT) assessed the feasibility, effectiveness, and safety of a multifaceted intervention to increase the use of antenatal corticosteroids (ACS) in mothers at risk of preterm birth at all levels of care in low and middle-income countries. The intervention effectively increased the use of ACS but had no overall impact on neonatal mortality in the targeted <5(th) percentile birth weight infants. Being in the intervention clusters was also associated with an overall increase in neonatal deaths. We sought to explore plausible pathways through which this intervention increased neonatal mortality.

METHODS:

We conducted secondary analyses to assess site differences in outcome and potential explanations for the differences in outcomes if found. By site, and in the intervention and control clusters, we evaluated characteristics of the mothers and care systems, the …

Effect Of Body Mass Index On Outcome Of Labour Induction, Farheen Yousuf, Tahira Naru, Sana Sheikh

Department of Obstetrics & Gynaecology

The retrospective study to explore the adverse effect of obesity on pregnancy and labour was conducted at Aga Khan University Hospital, Karachi, Pakistan, and comprised data of all patients booked between 12-14 weeks and required induction of labour from January 1 to December 31, 2012. Women were grouped into two body mass index categories: normal weight (23 kg/m2). Obesity increased the risk of development of gestational hypertension and diabetes. Therefore obese women were more likely to be induced due to medical indication whether primiparous or multiparous adjusted odds ratio =2.89(95% confidence interval 1.29-6.48) and 2.77 (95% confidence interval 1.07-7.19) respectively. …

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 …

Stop Stunting: Situation And Way Forward To Improve Maternal, Child And Adolescent Nutrition In Afghanistan, Ariel Higgins Steele, Piyali Mustaphi, Sherin Varkey, Humayoun Ludin, Najibullah Safi, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

No abstract provided.

Descriptive Epidemiology Of Somatising Tendency: Findings From The Cupid Study., Sergio Vargas-Prada, David Coggon, Georgia Ntani, Georgia Ntani, Karen Walker-Bone, Keith T. Palmer, Vanda E. Felli, Raul Harari, Lope H. Barrero, Sarah A. Felknor, David Gimeno, Anna Cattrell, Matteo Bonzini, Eleni Solidaki, Eda Merisalu, Rima R. Habib, Farideh Sadeghian, Muhammad Masood Kadir, Sudath S. P. Warnakulasuriya, Ko Matsudaira, Busisiwe Nyantumbu, Malcolm R. Sim, Helen Harcombe, Ken Cox, Leila M. M. Sarquis, Maria H. Marziale, Florencia Harari, Rocio Freire, Natalia Harari, Magda V. Monroy, Leonardo A. Quintana, Marianela Rojas, E. Clare Harris, Consol Serra, J. Miguel Martinez, George Delclos, Fernando G. Benavides, Michele Carugno, Marco M. Ferrario, Angela C. Pesatori, Leda Chatzi, Panos Bitsios, Manolis Kogevinas, Kristel Oha, Tiina Freimann, Ali Sadeghian, Roshini J. Peiris-John, Nalini Sathiakumar, A. Rajitha Wickremasinghe, Noriko Yoshimura, Helen L. Kelsall, Victor C. W. Hoe, Donna M. Urquhart, Sarah Derrett, David Mcbride, Peter Herbison, Andrew Gray, Eduardo J. Salazar Vega

Community Health Sciences

Somatising tendency, defined as a predisposition to worry about common somatic symptoms, is importantly associated with various aspects of health and health-related behaviour, including musculoskeletal pain and associated disability. To explore its epidemiological characteristics, and how it can be specified most efficiently, we analysed data from an international longitudinal study. A baseline questionnaire, which included questions from the Brief Symptom Inventory about seven common symptoms, was completed by 12,072 participants aged 20-59 from 46 occupational groups in 18 countries (response rate 70%). The seven symptoms were all mutually associated (odds ratios for pairwise associations 3.4 to 9.3), and each contributed …

Engaging With Community-Based Public And Private Mid-Level Providers For Promoting The Use Of Modern Contraceptive Methods In Rural Pakistan: Results From Two Innovative Birth Spacing Interventions, Syed Khurram Azmat, Waqas Hameed, Hasan Bin Hamza, Ghulam Mustafa, Muhammad Ishaque, Ghazunfer Abbas, Omar Farooq Khan, Jamshaid Asghar, Erik Munroe, Safdar Ali

Community Health Sciences

Background: Family planning (FP) interventions aimed at reducing population growth have negligible during the last two decades in Pakistan. Innovative FP interventions that help reduce the growing population burden are the need of the hour. Marie Stopes Society--Pakistan implemented an operational research project--'Evidence for Innovating to Save Lives', to explore effective and viable intervention models that can promote healthy timing and spacing of pregnancy in rural and under-served communities of Sindh, Punjab and Khyber Pakhtunkhwa provinces of Pakistan.
Methods: We conducted a quasi-experimental (pre- and post-intervention with control arm) study to assess the effectiveness of each of the two intervention …

Clinical Presentation Of Ovarian Tumors, Qamarunissa Muhabat, Fakharunissa Waheed, Waqar Unissa, Nigar Jabeen

Department of Obstetrics & Gynaecology

Ovarian malignancy is a serious disease affecting women of all ages, more so above 50 years, and they are still difficult to treat, partly because no truly effective therapy has yet been developed although presentation is often vague and non-specific, the symptoms are definitely present. It is important to recognize the symptoms so far, there is no test yet available, which is truly specific and suitable for screening and early detection of epithelial ovarian carcinoma. So, it is concluded that for prognosis and patient survival, early detection and treatment is mandatory.

Monitoring Intra-Abdominal Pressure : Should It Be A Routine For Critically Ill?, Madiha Hashmi

Department of Anaesthesia

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 …

Safety Netting Through The Prevention And Detection Of Child Abuse In Low And Middle Income Countries: Lessons From Pakistan, Kanwal Nayani, Muhammad Akbar Baig, Nick Brown, Asad Mian

Department of Paediatrics and Child Health

No abstract provided.

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. …

Factors Affecting Depression Among Married Women Living In Urban Squatter Settlements Of Karachi, Pakistan, Shireen Shehzad, Salima Farooq, Yasmin Parpio, Rozina Karmaliani Professor, Nargis Asad, Iqbal Azam Syed, Omrana Pasha

School of Nursing & Midwifery

Background: Depression is one of the growing public health concerns among women worldwide. This is one of the most under-recognized and under-treated mental illnesses worldwide. Women of developing countries are inexplicably affecting with depression. Purpose: The purpose of study is to assess the prevalence and associative factors of depression among women of aged 20 to 40 years living in urban squatter settlements of Karachi, Pakistan. The identification of all the potential determinants will potentially help in formulating preventive strategies in order to decline the prevalence of depression among women and improve the well being of women.
Methods: An analytical cross-sectional …

Geographic Access To Working Family Planning Centers And Unintended Pregnancies Among Married Women: A Community Based Nested Case Control Study., Sumera Aziz Ali, Sarah Saleem, Neelofar Sami, Mir Shabbar, Muhammad Ahmed, Shafquat Rozi, Robert L. Goldenberg, Margo S. Harrison, Omrana Pasha

Community Health Sciences

Background:

Unintended pregnancies pose substantial risk to mothers and children. In Pakistan, unintended pregnancies account for 46% of all pregnancies. Lack of geographic access to open and well-supplied family planning (FP) centers may be related to the occurrence of such pregnancies, particularly in rural areas.

Objective:

The objective of this analysis is to determine if geographic access to family planning centers in the Thatta district of Pakistan is related to unintended pregnancy rates among married women.

Methods:

We conducted a community-based, nested case-control study of 800 pregnant women identified from the database of an active surveillance system, which registers and …

Genomic Diversity Of Epec Associated With Clinical Presentations Of Differing Severity, Tracy H. Hazen, Michael S. Donnenberg, Sandra Panchalingam, Martin Antonio, Anowar Hossain, Inacio Mandomando, John Benjamin Ochieng, Shahida Qureshi, Farheen Quadri, Anita K. M. Zaidi

Department of Paediatrics and Child Health

Enteropathogenic Escherichia coli (EPEC) are diarrhoeagenic E. coli, and are a significant cause of gastrointestinal illness among young children in developing countries. Typical EPEC are identified by the presence of the bundle-forming pilus encoded by a virulence plasmid, which has been linked to an increased severity of illness, while atypical EPEC lack this feature. Comparative genomics of 70 total EPEC from lethal (LI), non-lethal symptomatic (NSI) or asymptomatic (AI) cases of diarrhoeal illness in children enrolled in the Global Enteric Multicenter Study was used to investigate the genomic differences in EPEC isolates obtained from individuals with various clinical outcomes. A …

Blood, Donors And Dollars: Rethinking Financial Sustainability Of Safe Blood Services In Tanzania, Kahabi Isangula, Sharon Brownie, Abela Mahimbo, Solomon Kibona, Abdu Juma, Deus Mogela

School of Nursing & Midwifery, East Africa

Introduction: Collection, processing and distribution of safe blood in Tanzania occurs within a free-for-service context, that is, a collection from non-remunerated blood donors and distributing freely to the needy people through health facilities. The safe blood services in the country appear to be crippled with many challenges and cannot meet the demand for blood and its products. As such, a need for rethinking collection methods, financial models and possible mechanisms for donor remuneration is evident.

Methods: In this paper, we venture on multi-stakeholder meetings and ongoing discussions regarding the internal mechanisms of safe blood transfusion financing. The intent is to …

Low Self-Esteem Leads To Depression Among Elderly: Case Study Of Nursing Home, Savera Aziz Ali, Nadir Suhail, Sumera Aziz Ali

School of Nursing & Midwifery

Background: Self-esteem is defined as “how we value our self”; it affects our trust and relationships in every part of life. Person with low self-esteem may feel powerless and incompetent about himself/herself. Moreover, low self-esteem operates as a risk factor for depression, which is most common disorder among elderly people both in developed and developing countries, causing multiple behavioral changes as well as may increase the chances of depression and suicide among the elderly people. Objective: The objective of this case study was to understand the problems faced by elderly people in the nursing home and to relate the self-esteem …