Community Health and Preventive Medicine Commons^™

Improving Pregnancy Outcomes In Low- And Middle-Income Countries, Robert L. Goldenberg, Elizabeth M. Mcclure, Sarah Saleem

Community Health Sciences

This paper reviews the very large discrepancies in pregnancy outcomes between high, low and middle-income countries and then presents the medical causes of maternal mortality, stillbirth and neonatal mortality in low-and middle-income countries. Next, we explore the medical interventions that were associated with the very rapid and very large declines in maternal, fetal and neonatal mortality rates in the last eight decades in high-income countries. The medical interventions likely to achieve similar declines in pregnancy-related mortality in low-income countries are considered. Finally, the quality of providers and the data to be collected necessary to achieve these reductions are discussed. It …

Does Courtesy Bias Affect How Clients Report On Objective And Subjective Measures Of Family Planning Service Quality? A Comparison Between Facility- And Home-Based Interviews, Waqas Hameed, Muhammad Ishaque, Xaher Gul, Junaid-Ur-Rehman Siddiqui, Sharmeen Hussain, Wajahat Hussain, Aftab Ahmed, Asma Balal

Community Health Sciences

Purpose: Despite a general understanding that exit interviews being conducted at service providers' facilities may influence clients' responses favorably to health professionals, there is very little evidence available that demonstrates the extent to which this problem exists. This study aimed at assessing and comparing clients' perceptions of the quality of family planning services and their satisfaction levels between facility- and home-based interviews.
Methods: A cross-sectional survey was conducted among clients receiving family planning services across three service delivery channels - nongovernmental organization (NGO) clinics, social franchise (SF) centers, and outreach camps. The survey took place from December 2015 to January …

Expression Of Androgen Receptor And Cancer Stem Cell Markers (Cd44 +/Cd24 - And Aldh1 +): Prognostic Implications In Invasive Breast Cancer, Nazia Riaz, Romana Idress, Sadia Habib, Iqbal Azam Syed, El Nasir Lalani

Section of General Surgery

Background: Androgen receptor (AR) has emerged as a significant prognostic marker in early breast cancer (BCa). Association of AR with cancer stem cell (CSC) markers in BCa is unknown. Aim of the present study was to evaluate the immunohistochemical expression of AR, CD44, CD24 and ALDH1 in a cohort of Pakistani patients diagnosed with invasive BCa and to correlate the expression with 5- year disease free survival.
Patients and methods: We evaluated immunohistochemical expression AR, CD44, CD24 and ALDH1 in formalin fixed paraffin embedded archival blocks of 166 cases of primary invasive BCa (stage I-III) and correlated the expression with …

Routine Antenatal Ultrasound In Low- And Middle-Income Countries: First Look - A Cluster Randomised Trial, Robert L. Goldenberg, Robert O. Nathan, David Swanson, Sarah Saleem, Waseem Mirza, Fabian Esamai, David Muyodi, Ana L. Garces, Lester Figueroa, Elwyn Chomba

Community Health Sciences

Objective: Ultrasound is widely regarded as an important adjunct to antenatal care (ANC) to guide practice and reduce perinatal mortality. We assessed the impact of ANC ultrasound use at health centers in resource-limited countries.
Design: Cluster randomized trial.
Settings: Clusters within five countries (Democratic Republic of Congo, Guatemala, Kenya, Pakistan and Zambia).
Methods: Clusters were randomized to standard ANC or standard care plus two ultrasounds and referral for complications. The study trained providers in intervention clusters to perform basic obstetric ultrasounds.
Main Outcome Measures: The primary outcome was a composite of maternal mortality, maternal near-miss mortality, stillbirth, and neonatal mortality. …

Exploring Health Care Seeking Knowledge, Perceptions And Practices For Childhood Diarrhea And Pneumonia And Their Context In A Rural Pakistani Community, Wafa Aftab, Leah Shipton, Fauziah Rabbani, Kashif Sangrasi, Shagufta Perveen, Aysha Zahidie, Imran Naeem, Shamim Qazi

Community Health Sciences

BACKGROUND:

Where access to facilities for childhood diarrhea and pneumonia is inadequate, community case management (CCM) is an effective way of improving access to care. In Pakistan, utilization of CCM for these diseases through the Lady Health Worker Program remains low. Challenges of access to facilities persist leading to delayed care and poor outcomes. Estimating caregiver knowledge, understanding their perceptions and practices, and recognizing how these are related to care seeking decisions about childhood diarrhea and pneumonia is crucial to bring about coherence between supply and demand-side practices.

METHODS:

Data was collected from family caregivers to explore their knowledge, perceptions …

Frequency And Factors Associated With Adult Immunization In Patients Visiting Family Medicine Clinics At A Tertiary Care Hospital, Karachi, Samar Zaki, Asma Usman, Swaleha Tariq, Sameena Shah, Iqbal Azam Syed, Waris Qidwai, Kashmira Nanji

Department of Family Medicine

Objective: The goal of this study was to determine the frequency and factors associated with adult immunization in patients visiting family medicine clinics at a tertiary care hospital in Karachi.
Methods: A cross-sectional study was conducted from March 2014 to March 2015 in a tertiary care hospital in Karachi, Pakistan. Participants more than 18 years were invited to participate in the study. A pretested questionnaire was used to collect information. Data were entered and analyzed using IBM SPSS Statistics for Windows, version 19.0 (Armonk, NY: IBM Corp).
Results: A total of 340 patients were surveyed. The majority of patients …

Albuminuria And Kidney Function As Prognostic Marker Of Left Ventricular Mass Among South Asians With Hypertension, Liang Feng, Aamir Hameed, Imtiaz Jehan, John Allen, Tazeen Jafar

Section of Cardiology

We aimed to evaluate the association of albuminuria and estimated glomerular filtration rate (eGFR) at baseline and changes in these parameters with left ventricular mass index (LVMI) at 7 years in adults with hypertension from communities in Pakistan. A nested cohort of 539 hypertensives aged 40 years and older from a community-living population in Karachi, Pakistan, followed up for 7 years in the Control of Blood Pressure and Risk Attenuation trial. Urine spot albumin-to-creatinine ratio (UACR) and serum creatinine-based eGFR were assessed at baseline and 7 years, and echocardiography at 7 years. Mean age of participants was 50.9 ± 9.1 …

Why Women Suffer Domestic Violence In Silence: Web-Based Responses To A Blog, Salima Farooq, Tazeen Saeed Ali, Yasmin Parpio, Nasreen Lalani, Muecke Marjorie

School of Nursing & Midwifery

Background & Aim: Domestic violence (DV) is a global socio-cultural concern faced by a majority of women. DV has a negative impact on women’s social, physical, and psychological wellbeing. Objective was to explore perceptions regarding contributing factors to domestic violence among women.
Methods & Materials: A qualitative descriptive exploratory method was applied for the study. Purposive sampling was used to select participants through emails to respond to the web based blog created for the study. 41 worldwide participants shared their perceptions through the blogs in the study. The data were collected using a web-based discussion forum on the Urban Women …

Ventricular Depolarisation Vectors In Exercise Induced Myocardial Ischaemia, Cameruddin W. Vellani, Mohammad Yusuf, Sadia Mahmud, Satwat Hashmi

Section of Cardiology

Ischaemia reduces membrane excitability and conduction of myocardial depolarisation. This would alter the synergy of electromotive forces that contribute to a resultant force at any instant. Changes in magnitude and direction of resultant forces are reflected in electrocardiographic signals. Here we show a method for obtaining the coordinates of resultant electrical forces during exercise derived from a bipolar orthogonal lead system for calculation of electrical vectors in three planes. In a trial, analysis of changes in vectors indicated that the extent of reduction in magnitude with exercise was significantly greater in groups of patients categorized by impaired effort tolerance and …

Health-Related Quality Of Life Variations By Sociodemographic Factors And Chronic Conditions In Three Metropolitan Cities Of South Asia: The Carrs Study, Kavita Singh, Dimple Kondal, Roopa Shivashankar, Mohammed K. Ali, Rajendra Pradeepa, Vamadevan S. Ajay, Viswanathan Mohan, Muhammad Masood Kadir, Mark Daniel Sullivan, Nikhil Tandon, K M Venkat Narayan, Dorairaj Prabhakaran

Community Health Sciences

Objectives: Health-related quality of life (HRQOL) is a key indicator of health. However, HRQOL data from representative populations in South Asia are lacking. This study aims to describe HRQOL overall, by age, gender and socioeconomic status, and examine the associations between selected chronic conditions and HRQOL in adults from three urban cities in South Asia.
Methods: We used data from 16 287 adults aged ≥20 years from the baseline survey of the Centre for Cardiometabolic Risk Reduction in South Asia cohort (2010-2011). HRQOL was measured using the European Quality of Life Five Dimension-Visual Analogue Scale (EQ5D-VAS), which measures health status …

Prevalence And Incidence Of Hypertension: Results From A Representative Cohort Of Over 16,000 Adults In Three Cities Of South Asia, Dorairaj Prabhakaran, Panniyammakal Jeemon, Shreeparna Ghosh, Roopa Shivashankar, Vamadevan S. Ajay, Dimple Kondal, Ruby Gupta, Mohammed K. Ali, Deepa Mohan, Viswanathan Mohan, Muhammad Masood Kadir, Nikhil Tandon, Kolli Srinath Reddy, K.M. Venkat Narayan

Community Health Sciences

Background: Despite high projected burden, hypertension incidence data are lacking in South Asian population. We measured hypertension prevalence and incidence in the Center for cArdio-metabolic Risk Reduction in South Asia (CARRS) adult cohort.
Methods: The CARRS Study recruited representative samples of Chennai, Delhi, and Karachi in 2010/11, and socio-demographic and risk factor data were obtained using a standard common protocol. Blood pressure (BP) was measured in the sitting position using electronic sphygmomanometer both at baseline and two year follow-up. Hypertension and control were defined by JNC 7 criteria.
Results: In total, 16,287 participants were recruited (response rate=94.3%) and two …

Comprehensive Review Of The Evidence Regarding The Effectiveness Of Community-Based Primary Health Care In Improving Maternal, Neonatal And Child Health: 8. Summary And Recommendations Of The Expert Panel, Robert E. Black, Carl E. Taylor, Shobha Arole, Abhay Bang, Zulfiqar Ahmed Bhutta, A Mushtaque R. Chowdhury, Betty R. Kirkwood, Nazo Kureshy, Claudio F. Lanata, James F. Phillips

Department of Paediatrics and Child Health

Background: The contributions that community-based primary health care (CBPHC) and engaging with communities as valued partners can make to the improvement of maternal, neonatal and child health (MNCH) is not widely appreciated. This unfortunate reality is one of the reasons why so few priority countries failed to achieve the health-related Millennium Development Goals by 2015. This article provides a summary of a series of articles about the effectiveness of CBPHC in improving MNCH and offers recommendations from an Expert Panel for strengthening CBPHC that were formulated in 2008 and have been updated on the basis of more recent evidence.
Methods: …

A Description Of The Methods Of The Aspirin Supplementation For Pregnancy Indicated Risk Reduction In Nulliparas (Aspirin) Study, Matthew K. Hoffman, Shivaprasad S. Goudar, Bhalachandra S. Kodkany, Norman Goco, Marion Koso-Thomas, Menachem Miodovnik, Elizabeth M. Mcclure, Dennis D. Wallace, Jennifer J. Emingway-Foday, Antoinette Tshefu, Adrien Lokangaka, Carl L. Bose, Elwyn Chomba, Musaku Mwenechanya, Waldemar A. Carlo, Ana Garces, Nancy F. Krebs, K. Michael Hambidge, Sarah Saleem, Robert L. Goldenberg, Archana Patel, Patricia L. Hibberd, Fabian Esamai, Edward A. Liechty, Robert Silver, Richard J. Derman

Community Health Sciences

Background: Preterm birth (PTB) remains the leading cause of neonatal mortality and long term disability throughout the world. Though complex in its origins, a growing body of evidence suggests that first trimester administration of low dose aspirin (LDA) may substantially reduce the rate of PTB.
Methods: Hypothesis: LDA initiated in the first trimester reduces the risk of preterm birth. Study Design Type: Prospective randomized, placebo-controlled, double-blinded multi-national clinical trial conducted in seven low and middle income countries. Trial will be individually randomized with one-to-one ratio (intervention/control) Population: Nulliparous women between the ages of 14 and 40, with a …

Validation Of Bioelectrical Impedance Analysis For Assessing Dry Weight Of Dialysis Patients In Pakistan, Huma Asmat, Romaina Iqbal, Fatima Sharif, Aamer Mahmood, Aamir Abbas, Waqar Kashif

Department of Medicine

Accurate dry weight estimation (DW) to achieve euvolemia is one of the key objectives of hemodialysis (HD). While conventionally DW is estimated by clinical examination, bioelectrical impedance analysis (BIA) has been proposed as an objective method to determine DW and has been tested extensively in the Western population. We aim to validate BIA for determining DW in a Pakistani population against the conventional clinician's method. This is a single-center validation study conducted at two outpatient HD units of Aga Khan Hospital, Karachi. One hundred and forty-eight DW readings of patients who were on maintenance HD were taken both by BIA …

Validation Of Respiratory Questionnaire For Lung Function Assessment Among An Occupational Group Of Textile Workers In Pakistan, Tanzil Jamali, Asaad Ahmed Nafees

Community Health Sciences

Objective: To determine the association of spirometric lung pattern with respiratory symptoms and to validate the American Thoracic Society respiratory questionnaire for lung function assessment among textile workers.
Methods: This cross-sectional survey was conducted from August to December 2009 among adult textile workers of Karachi. Data was collected through the American Thoracic Society Division of Lung Disease respiratory questionnaire and the lung function was assessed by using a spirometer. Results of three acceptable readings of spirogram were recorded and the best of the three readings was used for analysis. SPSS 19 was used for data analysis.
Results: There were 372 …

Role Of Mhealth Applications For Improving Antenatal And Postnatal Care In Low And Middle Income Countries: A Systematic Review, Anam Shahil Feroz, Shagufta Perveen, Wafa Aftab

Community Health Sciences

Background: From 1990 to 2015, the number of maternal deaths globally has dropped by 43%. Despite this, progress in attaining MDG 5 is not remarkable in LMICs. Only 52% of pregnant women in LMICs obtain WHO recommended minimum of four antenatal consultations and the coverage of postnatal care is relatively poor. In recent years, the increased cellphone penetration has brought the potential for mHealth to improve preventive maternal healthcare services. The objective of this review is to assess the effectiveness of mHealth solutions on a range of maternal health outcomes by categorizing the interventions according to the types of mHealth …

Barriers Or Gaps In Implementation Of Misoprostol Use For Post-Abortion Care And Post-Partum Hemorrhage Prevention In Developing Countries: A Systematic Review, Amirali Samnani, Narjis Rizvi, Tazeen Ali, Farina Abrejo

Community Health Sciences

Background: Around 303,000 maternal deaths occur every year; most of these are preventable (World Health Organization), ICD-10: International classification of diseases and related health problems, 10th revision. Volume 2: Instruction manual, 2010). Ninety-nine percent of these maternal deaths occur in developing countries. PPH contributed 35 % (35%) of total maternal. Several interventions being done to reduce the number of maternal deaths. It has been noted that a simple low cost intervention of providing misoprostol timely could prevent these deaths.
Objectives: The objectives of this systematic review was to identify barriers/gaps in the implementation of misoprostol use for prevention of …

Recent Strategies To Improve Community Case Management Of Diarrhea Among Children Under Five In Developing Countries, Fauziah Rabbani, Aysha Zahidie

Community Health Sciences

No abstract provided.

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 …

Low Prevalence Of Asthma Among Textile Workers In Karachi, Pakistan, Sana Tanzil, Asaad A. Nafees

Community Health Sciences

Objective: To determine the prevalence of asthma in textile workers through post-bronchodilator spirometry and to compare the differences in prevalence based on different criteria used to assess asthma.
Methods: The cross-sectional study was conducted between July and December 2013 in Karachi, Pakistan, and comprised workers from15 textile mills in the city and its outskirts. Asthma and associated respiratory symptoms were assessed using the American Thoracic Society Division of Lung Diseases Questionnaire, and post-bronchodilator spirometry. SPSS 19 was used for statistical analysis.
Results: Among the 372 workers in the study, asthma was found in 19(5%) as diagnosed on post-bronchodilator spirometry. The …

Association Of Obesity With Infertility Among Pakistani Men: A Case Control Study, Nida Zahid, Sarah Saleem, Syed Iqbal Azam, Tariq Moatter

Community Health Sciences

Background: The reported prevalence of infertility in Pakistan is 21% of which 35% is contributed by male factor. Male infertility has multifactorial etiologies ranging from modifiable to genetic risk factors. Among all the risk factors that may account for male infertility, obesity is one of the emerging public health problems. Therefore, the aim of the study was to determine the association of obesity with infertility in Pakistani men.
Methods: We conducted a case control study. Cases were men with impaired semen parameters and controls did not have impaired semen parameters.
Results: The final multivariable logistic regression model after adjusting for …

Accidental Phosphine Gas Poisoning With Fatal Myocardial Dysfunction In Two Families, Saleem Akhtar, Arshalooz Rehman, Surraya Bano, Anwarul Haque

Department of Emergency Medicine

ABSTRACT Aluminum phosphide is commonly used as a rodenticide and insecticide and is one of the most fatal poisons. The active ingredient is Phosphine gas which inhibits cytochrome oxidase and cellular oxygen utilization. The clinical symptoms are due to multiorgan involvement including cardiac toxicity which is the most common cause of mortality. Severity of clinical manifestations depends upon the amount of the gas to which a person is exposed. There is no specific antidote available. High index of suspicion and early aggressive treatment is the key to success. We report 2 cases of aluminum phosphide toxicity in 2 families due …

Comparing Lung Function Of Textile Workers With The Healthy Pakistani Population, Unaib Rabbani, Asaad Ahmed Nafees

Community Health Sciences

Background: The purpose of this study was to compare lung function of textile workers with healthy Pakistani population, compare predicted values based on the European Respiratory Society (ERS) equations with those based on the Pakistani equations, and to develop predictor equations for textile workers in Pakistan.
Methods: This was a secondary analysis of data from two previous surveys where lung function of textile workers was compared with healthy Pakistani men. Spirometry was performed according to the American Thoracic Society guidelines. Independent sample t-test was used to compare the lung function parameters and multivariate linear regression was used to develop predictor …

Knowledge, Attitude And Practices Regarding Respiratory Symptoms Among Textile Workers Of Karachi, Pakistan: A Cross-Sectional Survey, Aneeta Khoso, Asaad Ahmed Nafees

Community Health Sciences

Objectives: To determine the prevalence and predictors of good knowledge, appropriate attitude and appropriate protective practices regarding respiratory symptoms among textile workers, and to determine the association of knowledge, attitude and practices with respiratory symptoms.
Methods: The cross-sectional study was conducted in 2009 and comprised male workers from 15 textile mills in and around Karachi. A structured and pre-tested questionnaire was used which included questions to explore the knowledge, attitude and practices regarding respiratory symptoms. SPSS 19 was used for statistical analysis.
Results: The study had a sample size of 372 and found prevalence of good knowledge to be in …

Prevalence Of Hepatitis B Virus Infection Among Barbers And Their Knowledge, Attitude And Practices In The District Of Sukkur, Sindh ., Imran Naeem Abbasi, Zafar Fatmi, Muhammad Masood Kadir, Nalini Sathiakumar

Community Health Sciences

Abstract

OBJECTIVES:

Several occupations in developing countries lag behind in ensuring the safety of their workers in occupational settings. Lack of implementation of safety guidelines at workplaces can expose workers to health risks. In Pakistan, barbers are one of the un-regulated occupational groups. Low literacy, increased frequency of direct skin contact and blade/razors use can expose barbers to body fluids including blood of the customers. We conducted this study in order to determine hepatitis B virus (HBV) prevalence among barbers and their knowledge, attitude and practices in a peri-urban district of Sindh.

MATERIAL AND METHODS:

Three hundred eighty-five barbers from …

Strategies For Prevention Of Road Traffic Injuries (Rtis) In Pakistan: Situational Analysis., Adeel Ahmed Khan, Zafar Fatmi

Community Health Sciences

Road traffic injuries (RTIs) are one of the leading causes of death among productive age group. Using systems approach framework (SAF), current preventive strategies for RTI control were reviewed in Pakistan. A review of the literature was done using four international search engines. Only ten studies on preventive strategies for RTI stemming from Pakistan were found. The first Road Traffic Injuries Research Network (RTIRN) surveillance system for road traffic injuries was established in urban city (Karachi) in Pakistan has shown promise for injury control and should be scaled up to other cities. Enforcement of traffic laws on seat-belt and helmet …

Emerging Challenges And Health System Capacity: The Case Of Non- Communicable Diseases In Pakistan; A Review, Mubashir Zafar, Muhammad Ashar Malik

Community Health Sciences

Background: Pakistan is facing double burden of disease and the contribution of mortality by non-communicable diseases has over numbered the communicable diseases. The focus of health system of Pakistan is inclined more towards communicable disease and maternal & child health. Therefore, there is a need to review health policy, health sector budgeting and health setup in order to meet the needs of healthcare in context of non-communicable disease.

Objective: To review the health system capacity to manage the emerging challenge of non-communicable diseases in Pakistan.

Methodology: A thorough literature search on PubMed and Google Scholar was done. Reports from W.H.O, …

Healthcare Delivery System Improvements: A Way Forward To Improve Health In Developing Countries And Pakistan, Waris Qidwai

Department of Family Medicine

No abstract provided.

Increasing Health Care Costs And Its Adverse Impact On Healthcare, Waris Qidwai

Department of Emergency Medicine

No abstract provided.

Role Of Garlic Usage In Cardiovascular Disease Prevention: An Evidence-Based Approach, Waris Qidwai, Tabinda Ashfaq

Department of Family Medicine

Introduction:.Rapidly growing prevalence of cardiovascular disease is a major threat for the developed as well as developing world warranting urgent need of intervention. Complementary and alternative medicines are gaining popularity among general population because of their safety profile and easy administration. Garlic, in particular, is considered to be one of the best disease-preventive foods because of its potent and widespread effects. This study was done to find out the role of garlic usage in cardiovascular disease prevention.

Methodology : .Major databases including Google, PubMed,MEDLINE, and Cochrane library view were used for the literature search. Clinical trials conducted on humans assessing …