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Articles 61 - 90 of 254
Full-Text Articles in Community Health and Preventive Medicine
Examining The Relationships Between Early Childhood Experiences And Adolescent And Young Adult Health Status In A Resource-Limited Population: A Cohort Study, Zeba A. Rasmussen, Wasiat H. Shah, Chelsea L. Hansen, Syed Iqbal Azam, Ejaz Hussain, Barbara A. Schaefer, Nicole Zhong, Alexandra A. Jamison, Khalil Ahmed, Benjamin J J. Mccormick
Examining The Relationships Between Early Childhood Experiences And Adolescent And Young Adult Health Status In A Resource-Limited Population: A Cohort Study, Zeba A. Rasmussen, Wasiat H. Shah, Chelsea L. Hansen, Syed Iqbal Azam, Ejaz Hussain, Barbara A. Schaefer, Nicole Zhong, Alexandra A. Jamison, Khalil Ahmed, Benjamin J J. Mccormick
Department of Medicine
Background: Adolescence is a critical point in the realization of human capital, as health and educational decisions with long-term impacts are made. We examined the role of early childhood experiences on health, cognitive abilities, and educational outcomes of adolescents followed up from a longitudinal cohort study in Pakistan, hypothesizing that early childhood experiences reflecting poverty would manifest in reduced health and development in adolescence.
Methods and findings: Adolescents/young adults previously followed as children aged under 5 years were interviewed. Childhood data were available on diarrhea, pneumonia, and parental/household characteristics. New data were collected on health, anthropometry, education, employment, and languages …
Exploring Digital Health Interventions To Support Community Health Workers In Low-And-Middle-Income Countries During The Covid-19 Pandemic: A Scoping Review Protocol, Anam Shahil Feroz, Komal Valliani, Hajra Khwaja, Sehrish Karim
Exploring Digital Health Interventions To Support Community Health Workers In Low-And-Middle-Income Countries During The Covid-19 Pandemic: A Scoping Review Protocol, Anam Shahil Feroz, Komal Valliani, Hajra Khwaja, Sehrish Karim
Community Health Sciences
Introduction: COVID-19 has significantly affected community health workers' (CHWs) performance as they are expected to perform pandemic-related tasks along with routine essential healthcare services. A plausible way to optimise CHWs' functioning during this pandemic is to couple the efforts of CHWs with digital tools. So far, no systematic evidence is available on the use of digital health interventions to support CHWs in low-middle-income countries (LMICs) amid the COVID-19 pandemic. The article describes a protocol for a scoping review of primary research studies that aim to map evidence on the use of unique digital health interventions to support CHWs during COVID-19 …
Duration Of Cessation Of Smoking Before Elective Surgery: Impact On Intraoperative Hemodynamics And Early Postoperative Pain In Developing Country, Mohsin Nazir, Gauhar Afshan, Muslima Ejaz, Amir Raza
Duration Of Cessation Of Smoking Before Elective Surgery: Impact On Intraoperative Hemodynamics And Early Postoperative Pain In Developing Country, Mohsin Nazir, Gauhar Afshan, Muslima Ejaz, Amir Raza
Department of Anaesthesia
Aim and Background: It is estimated that up to 20% of patients coming for elective surgery are smokers and carry a risk of perioperative complications. Though smoking cessation and its impact on perioperative outcome are widely investigated worldwide we were unable to find any data in Pakistan. The objective of the study is to determine the impact of the duration of smoking cessation before elective surgery on intraoperative hemodynamics and postoperative pain in Pakistani population.
Methods: It was a prospective cohort study conducted at the Aga Khan University Hospital Karachi, Pakistan, for one-year duration. A total of 260 patients scheduled …
Risk Factors Leading To Pulmonary Exacerbation In Patients With Cystic Fibrosis: A Systematic Review, Danish Abdul Aziz, Syeda Khadija Fatima, Hasan Nawaz Tahir
Risk Factors Leading To Pulmonary Exacerbation In Patients With Cystic Fibrosis: A Systematic Review, Danish Abdul Aziz, Syeda Khadija Fatima, Hasan Nawaz Tahir
Department of Paediatrics and Child Health
Objective: To ascertain major risk factors associated with pulmonary exacerbation and pulmonary function decline in cystic fibrosis.
Methods: The systematic review was conducted at Aga Khan University, Karachi, in September 2018, and comprised electronic search of PubMed, Ovid, Science Direct and Cumulative Index of Nursing and Allied Health Literature databases of studies conducted from January 1990 to September 2018 which were categorised into 3 sets; 1990-98, 1999-2007 and 2008-18. Studies included for review focussed on articles with pulmonary exacerbation as the health outcome indicator, and had diagnosis of cystic fibrosis as the inclusion criteria, while risk factors were the exposure …
The Double Burden Of Malnutrition And Associated Factors Among South Asian Adolescents: Findings From The Global School-Based Student Health Survey, Sara Estecha Querol, Romaina Iqbal, Laura Kudrna, Lena Al-Khudairy, Paramijit Gill
The Double Burden Of Malnutrition And Associated Factors Among South Asian Adolescents: Findings From The Global School-Based Student Health Survey, Sara Estecha Querol, Romaina Iqbal, Laura Kudrna, Lena Al-Khudairy, Paramijit Gill
Community Health Sciences
The health and nutrition of the global adolescent population have been under-researched, in spite of its significant size (1.2 billion). This study investigates the prevalence and associated factors of malnutrition (stunting, thinness and overweight) among adolescents living in South Asia. The sample analysed was 24,053 South Asian schooled adolescents aged 12-15 years that participated in the cross-sectional Global School-Based Student Health Survey (GSHS) between 2009 and 2016. The prevalence of stunting, thinness and overweight was calculated using the World Health Organization (WHO) Child Growth Reference 2007. Associations between the three forms of malnutrition and their possible associated factors were assessed …
Does Supportive Supervision Intervention Improve Community Health Worker Knowledge And Practices For Community Management Of Childhood Diarrhea And Pneumonia? Lessons For Scale-Up From Nigraan And Nigraan Plus Trials In Pakistan, Wafa Aftab, Suneel Piryani, Fauziah Rabbani
Does Supportive Supervision Intervention Improve Community Health Worker Knowledge And Practices For Community Management Of Childhood Diarrhea And Pneumonia? Lessons For Scale-Up From Nigraan And Nigraan Plus Trials In Pakistan, Wafa Aftab, Suneel Piryani, Fauziah Rabbani
Community Health Sciences
Background: Lack of programmatic support and supervision is one of the underlying reasons of the poor performance of Pakistan's Lady Health Worker Program (LHWP). This study describes the findings and potential for scale-up of a supportive supervision intervention in two districts of Pakistan for improving LHWs skills for integrated community case management (iCCM) of childhood diarrhea and pneumonia.
Methods: The intervention comprised an enhanced supervision training to lady health supervisors (LHSs) and written feedback to LHWs by LHSs, implemented in Districts Badin and Mirpur Khas (MPK). Clinical skills of LHWs and LHSs and supervision skills of LHSs were assessed before, …
Concentrations Of Lead, Mercury, Arsenic, Cadmium, Manganese, And Aluminum In The Blood Of Pakistani Children With And Without Autism Spectrum Disorder And Their Associated Factors, Mohammad H. Rahbar, Shahnaz H. Ibrahim, Syed Iqbal Azam, Manouchehr Hessabi, Fatima Karim, Sori Kim, Jing Zhang, Nasreen Gulzar Ali, Katherine A. Loveland
Concentrations Of Lead, Mercury, Arsenic, Cadmium, Manganese, And Aluminum In The Blood Of Pakistani Children With And Without Autism Spectrum Disorder And Their Associated Factors, Mohammad H. Rahbar, Shahnaz H. Ibrahim, Syed Iqbal Azam, Manouchehr Hessabi, Fatima Karim, Sori Kim, Jing Zhang, Nasreen Gulzar Ali, Katherine A. Loveland
Department of Paediatrics and Child Health
Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder with early onset in utero or childhood. Environmental exposure to six metals (Pb, Hg, As, Cd, Mn, Al) is believed to be associated with ASD directly or interactively with genes. Objective: To assess the association of ASD among Pakistani children with the six metals and genotype frequencies of three GST genes (GSTP1, GSTM1, GSTT1).
Methods: We enrolled 30 ASD cases, age 2-12 years old, and 30 age- and sex-matched typically developing (TD) controls in Karachi, Pakistan. We assessed associations of ASD status with various factors using …
Exploring Community Perceptions, Attitudes And Practices Regarding The Covid-19 Pandemic In Karachi, Pakistan, Anam Shahil Feroz, Naureen Akber Ali, Ridah Feroz, Noshaba Akber, Salima Nazim Meghani
Exploring Community Perceptions, Attitudes And Practices Regarding The Covid-19 Pandemic In Karachi, Pakistan, Anam Shahil Feroz, Naureen Akber Ali, Ridah Feroz, Noshaba Akber, Salima Nazim Meghani
Community Health Sciences
Background: The Government of Pakistan is facing difficulty to contain the surge of COVID-19 due to the country's social, political, economical and cultural context. Experiences from the previous epidemic suggest that community perceptions, social norms and cultural practices can impede COVID-19 containment. To understand social responses towards COVID-19, the study aims to explore the understanding of COVID-19 and the acceptance of control measures among community members.
Methods: We conducted an exploratory qualitative study using a purposive sampling approach, at two communities of Karachi, Pakistan. In-depth interviews were conducted with community members including, young, middle-aged and older adults of both genders. …
Perceptions And Experiences Of Healthcare Providers During Covid-19 Pandemic In Karachi, Pakistan: An Exploratory Qualitative Study, Anam Shahil Feroz, Nousheen Pradhan, Zarak Hussain Ahmed, Mashal Murad Shah, Nargis Asad, Sarah Saleem, Sameen Siddiqi
Perceptions And Experiences Of Healthcare Providers During Covid-19 Pandemic In Karachi, Pakistan: An Exploratory Qualitative Study, Anam Shahil Feroz, Nousheen Pradhan, Zarak Hussain Ahmed, Mashal Murad Shah, Nargis Asad, Sarah Saleem, Sameen Siddiqi
Community Health Sciences
Objective: To explore healthcare provider's perspectives and experiences of the barriers and facilitators to treat and manage COVID-19 cases.
Design and setting: We conducted an exploratory qualitative study using a purposive sampling approach, at a private tertiary care teaching hospital in Karachi, Pakistan. Study data were analysed manually using the conventional content analysis technique.
Participants: Key-informant interviews (KIIs) were conducted with senior management and hospital leadership and in-depth interviews (IDIs) were conducted with front-line healthcare providers.
Results: A total of 31 interviews (KIIs=19; IDIs=12) were conducted, between April and May 2020. Three overarching themes emerged. The first was 'challenges faced …
Application Of The Ultra-Poverty Graduation Model In Understanding Community Health Volunteers’ Preferences For Socio-Economic Empowerment Strategies To Enhance Retention: A Qualitative Study In Kilifi, Kenya, Njeri Nyanja, Nelson Nyamu, Lucy Nyaga, Sophie Chabeda, Adelaide Lusambili, Marleen Temmerman, Michaela Mantel, Anthony Ngugi
Application Of The Ultra-Poverty Graduation Model In Understanding Community Health Volunteers’ Preferences For Socio-Economic Empowerment Strategies To Enhance Retention: A Qualitative Study In Kilifi, Kenya, Njeri Nyanja, Nelson Nyamu, Lucy Nyaga, Sophie Chabeda, Adelaide Lusambili, Marleen Temmerman, Michaela Mantel, Anthony Ngugi
Family Medicine, East Africa
Background: A significant shortage of healthcare workforce exists globally. To achieve Universal Healthcare cover- age, governments need to enhance their community-based health programmes. Community health volunteers (CHVs) are essential personnel in achieving this objective. However, their ability to earn a livelihood is compromised by the voluntary nature of their work; hence, the high attrition rates from community-based health programmes. There is an urgent need to support CHVs become economically self-reliant. We report here on the application of the Ultra-Poverty Graduation (UPG) Model to map CHVs’ preferences for socio-economic empowerment strategies that could enhance their retention in a rural area …
Effectiveness Of Typhoid Conjugate Vaccine Against Culture-Confirmed Salmonella Enterica Serotype Typhi In An Extensively Drug-Resistant Outbreak Setting Of Hyderabad, Pakistan: A Cohort Study, Mohammad Tahir Yousafzai, Sultan Karim, Sonia Qureshi, Abdul Momin Kazi, Hina Memon, Amber Junejo, Zohra Khawaja, Najeeb Ur Rehman, Muhammad Sajid Ansari, Rafey Ali, Heera Mani Lohana, Farah Naz Qamar
Effectiveness Of Typhoid Conjugate Vaccine Against Culture-Confirmed Salmonella Enterica Serotype Typhi In An Extensively Drug-Resistant Outbreak Setting Of Hyderabad, Pakistan: A Cohort Study, Mohammad Tahir Yousafzai, Sultan Karim, Sonia Qureshi, Abdul Momin Kazi, Hina Memon, Amber Junejo, Zohra Khawaja, Najeeb Ur Rehman, Muhammad Sajid Ansari, Rafey Ali, Heera Mani Lohana, Farah Naz Qamar
Department of Paediatrics and Child Health
Background: Salmonella enterica serotype Typhi (S Typhi) is a major public health problem in low-income and middle-income countries. We aimed to investigate the effectiveness and impact of the typhoid conjugate vaccine Typbar-TCV against S Typhi among children in an outbreak setting of extensively drug-resistant (XDR) S Typhi in Pakistan.
Methods: This cohort study was done from Feb 21, 2018, to Dec 31, 2019. A census survey of all households located in the Qasimabad and Latifabad subdistricts of Hyderabad, Pakistan, was done at baseline, and 174 005 households were registered in the census. The Typbar-TCV immunisation campaign was initiated at temporary …
Frequency Of Primiparous Mother Initiated Breastfeeding Earlier After Birth And Factors Associated With It In Sindh, Pakistan: A Secondary Analysis, Asma A. Bham, Sucheta Sharma, Akash Sardool, Umer F. Mujahid, Amrat Ayaz, Komal Valliani, Nawaal Maredia
Frequency Of Primiparous Mother Initiated Breastfeeding Earlier After Birth And Factors Associated With It In Sindh, Pakistan: A Secondary Analysis, Asma A. Bham, Sucheta Sharma, Akash Sardool, Umer F. Mujahid, Amrat Ayaz, Komal Valliani, Nawaal Maredia
Community Health Sciences
Background: Initiation of breastfeeding within one hour after delivery plays a vital role in a newborns life by not only increasing their survival rate but also reducing many life-threatening diseases in the newborn. The aim of the study was to determine frequency of early initiation of breastfeeding among primiparous mothers in a rural district of Thatta, Pakistan.
Methods: This study was conducted using survey data extracted from a cross-sectional study conducted in 2019 on prevalence of exclusive breastfeeding and factors associated with it among women in Thatta. The outcome was early initiation of breastfeeding. To determine factors associated with it, …
Longitudinal Association Between Parental-To-Child-Maltreatment And Self-Reported Generalized Anxiety Disorder Symptoms In Pakistani Adolescents, Maryam Pyar Ali Lakhdir, Ghazal Peerwani, Salman Muhammad Soomar, Apsara Ali, Salima Farooq, Naureen Akber Ali, Asif Khaliq, Muhammad Masood Kadir, Syed Iqbal Azam
Longitudinal Association Between Parental-To-Child-Maltreatment And Self-Reported Generalized Anxiety Disorder Symptoms In Pakistani Adolescents, Maryam Pyar Ali Lakhdir, Ghazal Peerwani, Salman Muhammad Soomar, Apsara Ali, Salima Farooq, Naureen Akber Ali, Asif Khaliq, Muhammad Masood Kadir, Syed Iqbal Azam
Community Health Sciences
Background: Parent-to-child maltreatment is considered one of the risk factors for Generalized Anxiety Disorder (GAD) symptoms, but this hypothesis has not been adequately tested in Pakistani settings.
Aim: This study aimed to examine the association between parent-to-child maltreatment and the risk of developing GAD symptoms among adolescents.
Methods: The association of none to rare, occasionally, and frequently parent-to-child maltreatment with the incidence of GAD symptoms was investigated in a sample of 800 adolescents aged 11-17 years who were followed for two years. Parent-to-child maltreatment was assessed using ICAST-C (International child abuse screening tool). GAD Symptoms were determined by SCARED (Screen …
Community Health Volunteers Challenges And Preferred Income Generating Activities For Sustainability: A Qualitative Case Study Of Rural Kilifi, Kenya, Adelaide Lusambili, Njeri Nyanja, Sophie Vusha Chabeda, Marleen Temmerman, Lucy Nyaga, Jerim Obure, Anthony Ngugi
Community Health Volunteers Challenges And Preferred Income Generating Activities For Sustainability: A Qualitative Case Study Of Rural Kilifi, Kenya, Adelaide Lusambili, Njeri Nyanja, Sophie Vusha Chabeda, Marleen Temmerman, Lucy Nyaga, Jerim Obure, Anthony Ngugi
Population Health, East Africa
Background: There is a global emphasis on engaging community health volunteers (CHVs) in low- to middle-income countries (LMICs) to reach to the vast underserved populations that live in rural areas. Retention of CHVs in most countries has however been difficult and turnover in many settings has been reported to be high with profound negative effects on continuity of community health services. In rural Kenya, high attrition among CHVs remains a concern. Understanding challenges faced by CHVs in rural settings and how to reduce attrition rates with sustainable income-generating activities (IGAs) is key to informing the implementation of contextual measures that …
Helmet Wearing Saves The Cost Of Motorcycle Head Injuries: A Case Study From Karachi, Pakistan, Asrar Ali, Muhammad Ashar Malik, Uzma Rahim Khan, Umerdad Khudadad, Ahmed Raheem Buksh, Adnan A. Hyder
Helmet Wearing Saves The Cost Of Motorcycle Head Injuries: A Case Study From Karachi, Pakistan, Asrar Ali, Muhammad Ashar Malik, Uzma Rahim Khan, Umerdad Khudadad, Ahmed Raheem Buksh, Adnan A. Hyder
Department of Emergency Medicine
Purpose: To estimate the difference in healthcare cost of head injuries among motorcycle helmet users and non-users.
Methods: Motorcycle crash victims with head injuries that were brought to a public, tertiary care emergency room in Karachi were studied through a descriptive cross-sectional design. A standard questionnaire was used to collect data on demographics, injury pattern, helmeting practice, length of hospital stay, out-of-pocket payments (OOPs), and healthcare service utilization at the facility to estimate total healthcare and other costs applying micro-costing methods during the hospitalization period.
Results: A total of 323 motorcyclists involved in crash were brought to a public tertiary …
Variations In Regulations To Control Standards For Training And Licensing Of Physicians: A Multi-Country Comparison, Wafa Aftab, Mishal Khan, Sonia Rego, Nishant Chavan, Afifah Rahman-Shepherd, Isha Sharma, Shishi Wu, Zahra Zeinali, Rumina Hasan, Sameen Siddiqi
Variations In Regulations To Control Standards For Training And Licensing Of Physicians: A Multi-Country Comparison, Wafa Aftab, Mishal Khan, Sonia Rego, Nishant Chavan, Afifah Rahman-Shepherd, Isha Sharma, Shishi Wu, Zahra Zeinali, Rumina Hasan, Sameen Siddiqi
Community Health Sciences
Background: To strengthen health systems, the shortage of physicians globally needs to be addressed. However, efforts to increase the numbers of physicians must be balanced with controls on medical education imparted and the professionalism of doctors licensed to practise medicine.
Methods: We conducted a multi-country comparison of mandatory regulations and voluntary guidelines to control standards for medical education, clinical training, licensing and re-licensing of doctors. We purposively selected seven case-study countries with differing health systems and income levels: Canada, China, India, Iran, Pakistan, UK and USA. Using an analytical framework to assess regulations at four sequential stages of the medical …
Frequency And Risk Factors Of Non-Alcoholic Fatty Liver Disease In Helicobacter Pylori-Infected Dyspeptic Patients: A Cross-Sectional Study, Basit Siddiqui, Muhammad Kamran, Shiyam Sunder Tikmani, Rabeea Azmat, Zain Mushtaq, Saad Bin Zafar Mahmood, Muhammad Tahir Khan, Javed Yakoob, Zaigham Abbas
Frequency And Risk Factors Of Non-Alcoholic Fatty Liver Disease In Helicobacter Pylori-Infected Dyspeptic Patients: A Cross-Sectional Study, Basit Siddiqui, Muhammad Kamran, Shiyam Sunder Tikmani, Rabeea Azmat, Zain Mushtaq, Saad Bin Zafar Mahmood, Muhammad Tahir Khan, Javed Yakoob, Zaigham Abbas
Section of Gastroenterology
Background: In dyspeptic patients with Helicobacter pylori contributes to non-alcoholic fatty liver disease. However, little evidence available from Pakistan.
Objective: The study aims to determine the frequency and risk factors of non-alcoholic fatty liver disease in dyspeptic patients with Helicobacter pylori.
Methods: This cross-sectional study was conducted between 22 November 2016 and 30 June 2018. Adults of age between 18 and 90 years who attended the out-patient department due to abdominal discomfort, pain, fullness, and bloating who underwent upper gastrointestinal tract endoscopy were enrolled after taking informed consent. Patients with celiac disease, inflammatory bowel disease, taking alcohol, pregnant women …
Association Of Ultra-Processed Food Intake With Risk Of Inflammatory Bowel Disease: Prospective Cohort Study, Neeraj Narula, Emily C L. Wong, Mahshid Dehghan, Andrew Mente, Sumathy Rangarajan, Fernando Lanas, Patricio Lopez-Jaramillo, Priyanka Rohatgi, P V M. Lakshmi, Romaina Iqbal
Association Of Ultra-Processed Food Intake With Risk Of Inflammatory Bowel Disease: Prospective Cohort Study, Neeraj Narula, Emily C L. Wong, Mahshid Dehghan, Andrew Mente, Sumathy Rangarajan, Fernando Lanas, Patricio Lopez-Jaramillo, Priyanka Rohatgi, P V M. Lakshmi, Romaina Iqbal
Community Health Sciences
Objective: To evaluate the relation between intake of ultra-processed food and risk of inflammatory bowel disease (IBD).
Design: Prospective cohort study.
Setting: 21 low, middle, and high income countries across seven geographical regions (Europe and North America, South America, Africa, Middle East, south Asia, South East Asia, and China).
Participants: 116 087 adults aged 35-70 years with at least one cycle of follow-up and complete baseline food frequency questionnaire (FFQ) data (country specific validated FFQs were used to document baseline dietary intake). Participants were followed prospectively at least every three years.
Main outcome measures: The main outcome was development of …
Violence And Abuse Among Working Children In Urban And Suburban Areas Of Lower Sindh, Pakistan, Meesha Iqbal, Zafar Fatmi, Kausar S. Khan, Asaad Ahmed Nafees
Violence And Abuse Among Working Children In Urban And Suburban Areas Of Lower Sindh, Pakistan, Meesha Iqbal, Zafar Fatmi, Kausar S. Khan, Asaad Ahmed Nafees
Community Health Sciences
Background: Child labourers are exposed to an insecure environment and higher risk of violence. Violence among child labourers is an under-studied phenomenon which requires contextual assessment.
Aims: We applied Bronfenbrenner's ecological model (micro-, exo- and macro-system) to understand the interplay of individual, community, societal and policy context fuelling violence.
Methods: Focus group discussions and family ethnographies of child-labourers working in common occupational sectors of suburban areas of Sindh were carried out to gain in-depth understanding of their immediate environment and abuse (micro-system). Frequency of emotional, physical and sexual violence (5-14 years; n = 634) was also determined. Indepth interviews with …
Improved First Trimester Maternal Iodine Status With Preconception Supplementation: The Women First Trial, Amy E. Young, Jennifer F. Kemp, Charis Uhlson, Jamie L. Westcott, Sumera Aziz Ali, Sarah Saleem, Ana Garcès, Lester Figueroa, Manjunath S. Somannavar, Shivaprasad S. Goudar
Improved First Trimester Maternal Iodine Status With Preconception Supplementation: The Women First Trial, Amy E. Young, Jennifer F. Kemp, Charis Uhlson, Jamie L. Westcott, Sumera Aziz Ali, Sarah Saleem, Ana Garcès, Lester Figueroa, Manjunath S. Somannavar, Shivaprasad S. Goudar
Community Health Sciences
Maternal iodine (I) status is critical in embryonic and foetal development. We examined the effect of preconception iodine supplementation on maternal iodine status and on birth outcomes. Non-pregnant women in Guatemala, India and Pakistan (n ~ 100 per arm per site) were randomized ≥ 3 months prior to conception to one of three intervention arms: a multimicronutrient-fortified lipid-based nutrient supplement containing 250-μg I per day started immediately after randomization (Arm 1), the same supplement started at ~12 weeks gestation (Arm 2) and no intervention supplement (Arm 3). Urinary I (μg/L) to creatinine (mg/dl) ratios (I/Cr) were determined at 12 weeks …
Cost Estimation Alongside A Multi-Regional, Multi-Country Randomized Trial Of Antenatal Ultrasound In Five Low-And-Middle-Income Countries, B W. Bresnahan, E Vodicka, J B. Babigumira, Ashar Muhammad Malik, F Yego, A Lokangaka, B M. Chitah, Z Bauer, H Chavez, Sarah Saleem
Cost Estimation Alongside A Multi-Regional, Multi-Country Randomized Trial Of Antenatal Ultrasound In Five Low-And-Middle-Income Countries, B W. Bresnahan, E Vodicka, J B. Babigumira, Ashar Muhammad Malik, F Yego, A Lokangaka, B M. Chitah, Z Bauer, H Chavez, Sarah Saleem
Community Health Sciences
Background: Improving maternal health has been a primary goal of international health agencies for many years, with the aim of reducing maternal and child deaths and improving access to antenatal care (ANC) services, particularly in low-and-middle-income countries (LMICs). Health interventions with these aims have received more attention from a clinical effectiveness perspective than for cost impact and economic efficiency.
Methods: We collected data on resource use and costs as part of a large, multi-country study assessing the use of routine antenatal screening ultrasound (US) with the aim of considering the implications for economic efficiency. We assessed typical antenatal outpatient and …
Chronic Airflow Obstruction And Ambient Particulate Air Pollution, Andre F S. Amaral, Peter G J. Burney, Jaymini Patel, Cosetta Minelli, Filip Mejza, David M. Mannino, Terence A R. Seemungal, Padukudru Anand Mahesh, Li Cher Lo, Asaad Ahmed Nafees
Chronic Airflow Obstruction And Ambient Particulate Air Pollution, Andre F S. Amaral, Peter G J. Burney, Jaymini Patel, Cosetta Minelli, Filip Mejza, David M. Mannino, Terence A R. Seemungal, Padukudru Anand Mahesh, Li Cher Lo, Asaad Ahmed Nafees
Community Health Sciences
Smoking is the most well-established cause of chronic airflow obstruction (CAO) but particulate air pollution and poverty have also been implicated. We regressed sex-specific prevalence of CAO from 41 Burden of Obstructive Lung Disease study sites against smoking prevalence from the same study, the gross national income per capita and the local annual mean level of ambient particulate matter (PM2.5) using negative binomial regression. The prevalence of CAO was not independently associated with PM2.5 but was strongly associated with smoking and was also associated with poverty. Strengthening tobacco control and improved understanding of the link between CAO and poverty should …
Frequency And Determinants Of Vitamin D Deficiency Among Premenopausal And Postmenopausal Women In Karachi Pakistan, Uzma Shamsi, Syed Iqbal Azam, Azra Shamsi, Dua Shamsi, David Callen
Frequency And Determinants Of Vitamin D Deficiency Among Premenopausal And Postmenopausal Women In Karachi Pakistan, Uzma Shamsi, Syed Iqbal Azam, Azra Shamsi, Dua Shamsi, David Callen
Community Health Sciences
Background: Vitamin D deficiency is becoming a serious public health problem, even in sun-drenched cities like Karachi, Pakistan. We investigated the prevalence of vitamin D deficiency and its association with sociodemographic characteristics, anthropometric measures, and lifestyle factors among premenopausal and postmenopausal women (n = 784).
Methods: Face-to-face interviews were conducted to collect information and serum concentrations of 25-hydroxyvitamin D were measured after the interviews.
Results: A total of 57% of women were vitamin D deficient with higher vitamin D deficiency found among premenopausal women (64.7%) compared to postmenopausal women (49%). The median serum concentrations of 25-hydroxyvitamin D (IQR) were 16.7 …
Exploring Equity In Health And Poverty Impacts Of Control Measures For Sars-Cov-2 In Six Countries, Sedona Sweeney, Theo Prudencio Juhani Capeding, Rosalind Eggo, Maryam Huda, Mark Jit, Don Mudzengi, Nichola R. Naylor, Simon Procter, Matthew Quaife, Lela Serebryakova
Exploring Equity In Health And Poverty Impacts Of Control Measures For Sars-Cov-2 In Six Countries, Sedona Sweeney, Theo Prudencio Juhani Capeding, Rosalind Eggo, Maryam Huda, Mark Jit, Don Mudzengi, Nichola R. Naylor, Simon Procter, Matthew Quaife, Lela Serebryakova
Community Health Sciences
Background: Policy makers need to be rapidly informed about the potential equity consequences of different COVID-19 strategies, alongside their broader health and economic impacts. While there are complex models to inform both potential health and macro-economic impact, there are few tools available to rapidly assess potential equity impacts of interventions.
Methods: We created an economic model to simulate the impact of lockdown measures in Pakistan, Georgia, Chile, UK, the Philippines and South Africa. We consider impact of lockdown in terms of ability to socially distance, and income loss during lockdown, and tested the impact of assumptions on social protection coverage …
Exploring Willingness To Pay For Health Insurance And Preferences For A Benefits Package From The Perspective Of Women From Low-Income Households Of Karachi, Pakistan, Shifa Salman Habib, Shehla Zaidi
Exploring Willingness To Pay For Health Insurance And Preferences For A Benefits Package From The Perspective Of Women From Low-Income Households Of Karachi, Pakistan, Shifa Salman Habib, Shehla Zaidi
Community Health Sciences
Background: Achieving universal health coverage (UHC) and reduction in out of pocket (OOP) expenditures on health, is a critical target of the Sustainable Development Goals (SDG). In low-middle income countries, micro-health insurance (MHI) schemes have emerged as a useful financing tool for laying grounds for Universal Health Coverage. The aim of this study was to provide evidence for designing a feasible health insurance scheme targeted at urban poor, by exploring preferences for an insurance benefits package and co-payments among women from low-income households in Karachi, Pakistan.
Methods: This was a descriptive cross-sectional study, conducted using household surveys between July-August 2015. …
Gestational Weight Gain In 4 Low- And Middle-Income Countries And Associations With Birth Outcomes: A Secondary Analysis Of The Women First Trial, Melissa S. Bauserman, Carla M. Bann, K Michael Hambidge, Ana L. Garces, Lester Figueroa, Jamie L. Westcott, Jackie K. Patterson, Elizabeth M. Mcclure, Sumera Ali Aziz, Sarah Saleem
Gestational Weight Gain In 4 Low- And Middle-Income Countries And Associations With Birth Outcomes: A Secondary Analysis Of The Women First Trial, Melissa S. Bauserman, Carla M. Bann, K Michael Hambidge, Ana L. Garces, Lester Figueroa, Jamie L. Westcott, Jackie K. Patterson, Elizabeth M. Mcclure, Sumera Ali Aziz, Sarah Saleem
Community Health Sciences
Background: Adequate gestational weight gain (GWG) is essential for healthy fetal growth. However, in low- and middle-income countries, where malnutrition is prevalent, little information is available about GWG and how it might be modified by nutritional status and interventions.
Objective: We describe GWG and its associations with fetal growth and birth outcomes. We also examined the extent to which prepregnancy BMI, and preconception and early weight gain modify GWG, and its effects on fetal growth.
Methods: This was a secondary analysis of the Women First Trial, including 2331 women within the Democratic Republic of Congo (DRC), Guatemala, India, and Pakistan, …
Adolescent Undernutrition In South Asia: A Scoping Review, Sara Estecha Querol, Paramjit Gill, Romaina Iqbal, Maartje Kletter, Neslihan Ozdemir, Lena Al-Khudairy
Adolescent Undernutrition In South Asia: A Scoping Review, Sara Estecha Querol, Paramjit Gill, Romaina Iqbal, Maartje Kletter, Neslihan Ozdemir, Lena Al-Khudairy
Community Health Sciences
Undernutrition is a growing public health challenge affecting growth and development during adolescence in many low- and middle-income countries. This scoping review maps the evidence on adolescent undernutrition (stunting, thinness and micronutrient deficiencies) in South Asia and highlights gaps in knowledge. Using Arksey and O'Malley's framework and the Joanna Briggs Institute Reviewers' Manual, the search included electronic bibliographic databases (Medline (OVID), Embase, Cochrane Library, Web of Science, CINAHL, PsycInfo, and Scopus) as well as various grey literature sources published up to March 2019. In total, 131 publications met the inclusion criteria of this review. All the included evidence used quantitative …
Smokeless Tobacco Initiation, Use And Cessation In South Asia: A Qualitative Assessment, Faraz Siddiqui, Ray Croucher Ray Croucher, Fayaz Ahmad, Zarak Hussain Ahmed, Roshani Babu, Linda Bauld, Fariza Fieroze, Rumana Huque, Maira Mubashir, Narjis Rizvi
Smokeless Tobacco Initiation, Use And Cessation In South Asia: A Qualitative Assessment, Faraz Siddiqui, Ray Croucher Ray Croucher, Fayaz Ahmad, Zarak Hussain Ahmed, Roshani Babu, Linda Bauld, Fariza Fieroze, Rumana Huque, Maira Mubashir, Narjis Rizvi
Community Health Sciences
Introduction: Smokeless tobacco (ST) is a significant South Asian public health problem. This paper reports a qualitative study of a sample of South Asian ST users.
Methods: Interviews, using a piloted topic guide, with 33 consenting, urban dwelling adult ST users explored their ST initiation, continued use and cessation attempts. Framework data analysis was used to analyse country specific data before a thematic cross-country synthesis was completed.
Results: Participants reported long term ST use and high dependency. All reported strong cessation motivation and multiple failed attempts because of ease of purchasing ST, tobacco dependency and lack of institutional support.
Conclusions: …
Performance And Determinants Of Serum Creatinine And Cystatin C-Based Gfr Estimating Equations In South Asians, Yeli Wang, Andrew S. Levey, Lesley A. Inker, Saleem Jessani, Rasool Bux, Zainab Samad, Ali Raza Khan, Amy B. Karger, John C. Allen, Tazeen H. Jafar
Performance And Determinants Of Serum Creatinine And Cystatin C-Based Gfr Estimating Equations In South Asians, Yeli Wang, Andrew S. Levey, Lesley A. Inker, Saleem Jessani, Rasool Bux, Zainab Samad, Ali Raza Khan, Amy B. Karger, John C. Allen, Tazeen H. Jafar
Community Health Sciences
Introduction: The creatinine-based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (eGFR) equation was calibrated for the general Pakistan population (eGFRcr-PK) to eliminate bias and improve accuracy. Cystatin C-based CKD-EPI equations (eGFRcys and eGFRcr-cys) have not been assessed in this population, and non-GFR determinants of cystatin C are unknown.
Methods: We assessed eGFRcys, eGFRcr-cys, and non-GFR determinants of cystatin C in a cross-sectional study of 557 participants (≥40 years of age) from Pakistan. We compared bias (median difference in measured GFR [mGFR] and eGFR), precision (interquartile range [IQR] of differences), accuracy (percentage of eGFR within 30% of mGFR), …
Cardiopulmonary Resuscitation (Cpr) Training Strategies In The Times Of Covid-19: A Systematic Literature Review Comparing Different Training Methodologies, Daniyal Mansoor Ali, Butool Hisam, Natasha Shaukat, Mirza Noor Ali Baig, Marcus Eng Hock Ong, Jonathan L. Epstein, Eric Goralnick, Paul D. Kivela, Bryan Mcnally, Junaid Razzak
Cardiopulmonary Resuscitation (Cpr) Training Strategies In The Times Of Covid-19: A Systematic Literature Review Comparing Different Training Methodologies, Daniyal Mansoor Ali, Butool Hisam, Natasha Shaukat, Mirza Noor Ali Baig, Marcus Eng Hock Ong, Jonathan L. Epstein, Eric Goralnick, Paul D. Kivela, Bryan Mcnally, Junaid Razzak
Department of Emergency Medicine
Background: Traditional, instructor led, in-person training of CPR skills has become more challenging due to COVID-19 pandemic. We compared the learning outcomes of standard in-person CPR training (ST) with alternative methods of training such as hybrid or online-only training (AT) on CPR performance, quality, and knowledge among laypersons with no previous CPR training.
Methods: We searched PubMed and Google Scholar for relevant articles from January 1995 to May 2020. Covidence was used to review articles by two independent researchers. Effective Public Health Practice Project (EPHPP) Quality Assessment Tool was used to assess quality of the manuscripts.
Results: Of the 978 …