Open Access. Powered by Scholars. Published by Universities.®
- Discipline
-
- Medical Specialties (311)
- Maternal and Child Health (273)
- Obstetrics and Gynecology (160)
- Pediatrics (133)
- Diseases (78)
-
- Community Health and Preventive Medicine (52)
- Nursing (40)
- Social and Behavioral Sciences (28)
- Oncology (25)
- Radiology (21)
- Female Urogenital Diseases and Pregnancy Complications (20)
- Surgery (20)
- Maternal, Child Health and Neonatal Nursing (19)
- Pathology (19)
- Mental and Social Health (17)
- Nutritional and Metabolic Diseases (17)
- Health Services Research (16)
- Life Sciences (16)
- Nursing Midwifery (16)
- Epidemiology (15)
- Infectious Disease (14)
- Patient Safety (11)
- Sociology (11)
- Virus Diseases (10)
- Community Health (9)
- Influenza Virus Vaccines (7)
- Organisms (7)
- Keyword
-
- Pakistan (69)
- Pregnancy (34)
- Maternal health (30)
- Women (23)
- Kenya (21)
-
- Family planning (19)
- Nutrition (18)
- Public health (18)
- COVID-19 (17)
- Breast cancer (14)
- Child health (14)
- Children (12)
- Global health (11)
- Child (10)
- Risk factors (10)
- Depression (9)
- Global network (9)
- Maternal mortality (9)
- Antenatal care (8)
- Developing countries (8)
- Low birth weight (8)
- Maternal (8)
- Neonatal mortality (8)
- Newborn (8)
- Stillbirth (8)
- Systematic review (8)
- Afghanistan (7)
- Africa (7)
- Contraception (7)
- Contraceptives (7)
- Publication Year
- Publication
-
- Community Health Sciences (105)
- Centre of Excellence in Women and Child Health (99)
- Department of Paediatrics and Child Health (76)
- Woman and Child Health (36)
- Department of Obstetrics & Gynaecology (25)
-
- Obstetrics and Gynaecology, East Africa (19)
- School of Nursing & Midwifery (18)
- Department of Pathology and Laboratory Medicine (12)
- Population Health, East Africa (10)
- Department of Biological & Biomedical Sciences (9)
- School of Nursing & Midwifery, East Africa (9)
- Institute for Human Development, East Africa (6)
- Department of Radiology (5)
- IGHD Newsletters Archives (4)
- Institute for Global Health and Development (4)
- Section of General Surgery (4)
- Brain and Mind Institute (3)
- Department of Surgery Docs (3)
- Paediatrics and Child Health, East Africa (3)
- Department for Educational Development (2)
- Department of Anaesthesia (2)
- General Surgery, East Africa (2)
- MSc in Advanced Practice Midwifery (2)
- Medical College Documents (2)
- Pathology, East Africa (2)
- Section of Internal Medicine (2)
- Emergency Medicine, East Africa (1)
- Institute for Educational Development, Karachi (1)
- Internal Medicine, East Africa (1)
- MSc in Advanced Practice Nursing (1)
- Publication Type
Articles 211 - 240 of 472
Full-Text Articles in Women's Health
Risk Of Infection And Transmission Of Sars-Cov-2 Among Children And Adolescents In Households, Communities And Educational Settings: A Systematic Review And Meta-Analysis, Omar Irfan, Jiang Li, Kun Tang, Zhicheng Wang, Zulfiqar Ahmed Bhutta
Risk Of Infection And Transmission Of Sars-Cov-2 Among Children And Adolescents In Households, Communities And Educational Settings: A Systematic Review And Meta-Analysis, Omar Irfan, Jiang Li, Kun Tang, Zhicheng Wang, Zulfiqar Ahmed Bhutta
Woman and Child Health
Background: There is uncertainty with respect to SARS-CoV-2 transmission in children (0-19 years) with controversy on effectiveness of school-closures in controlling the pandemic. It is of equal importance to evaluate the risk of transmission in children who are often asymptomatic or mildly symptomatic carriers that may incidentally transmit SARS-CoV-2 in different settings. We conducted this review to assess transmission and risks for SARS-CoV-2 in children (by age-groups or grades) in community and educational-settings compared to adults.
Methods: Data for the review were retrieved from PubMed, EMBASE, Cochrane Library, WHO COVID-19 Database, China National Knowledge Infrastructure (CNKI) Database, WanFang Database, Latin …
Using Amanhi-Act Cohorts For External Validation Of Iowa New-Born Metabolic Profiles Based Models For Postnatal Gestational Age Estimation, Sunil Sazawal, Kelli K. Ryckman, Harshita Mittal, Muhammad Imran Nisar, Usma Mehmood, Amina Barkat, Farah Khalid, Muhammad Ilyas, Ambreen Nizar, Fyezah Jehan
Using Amanhi-Act Cohorts For External Validation Of Iowa New-Born Metabolic Profiles Based Models For Postnatal Gestational Age Estimation, Sunil Sazawal, Kelli K. Ryckman, Harshita Mittal, Muhammad Imran Nisar, Usma Mehmood, Amina Barkat, Farah Khalid, Muhammad Ilyas, Ambreen Nizar, Fyezah Jehan
Department of Paediatrics and Child Health
Background: Globally, 15 million infants are born preterm and another 23.2 million infants are born small for gestational age (SGA). Determining burden of preterm and SGA births, is essential for effective planning, modification of health policies and targeting interventions for reducing these outcomes for which accurate estimation of gestational age (GA) is crucial. Early pregnancy ultrasound measurements, last menstrual period and post-natal neonatal examinations have proven to be not feasible or inaccurate. Proposed algorithms for GA estimation in western populations, based on routine new-born screening, though promising, lack validation in developing country settings. We evaluated the hypothesis that models developed …
Role Of Community Engagement In Maternal Health In Rural Pakistan: Findings From The Clip Randomized Trial, Zahra Hoodbhoy, Sana Sadiq Sheikh, Rahat Qureshi, Javed Memon, Farrukh Raza, Mai-Lei Woo Kinshella, Jeffrey N. Bone, Marianne Vidler, Sumedha Sharma, Zulfiqar Ahmed Bhutta
Role Of Community Engagement In Maternal Health In Rural Pakistan: Findings From The Clip Randomized Trial, Zahra Hoodbhoy, Sana Sadiq Sheikh, Rahat Qureshi, Javed Memon, Farrukh Raza, Mai-Lei Woo Kinshella, Jeffrey N. Bone, Marianne Vidler, Sumedha Sharma, Zulfiqar Ahmed Bhutta
Department of Paediatrics and Child Health
Background: Community-based strategies to promote maternal health can help raise awareness of pregnancy danger signs and preparations for emergencies. The objective of this study was to assess change in birth preparedness and complication readiness (BPCR) and pregnant women's knowledge about pre-eclampsia as part of community engagement (CE) activities in rural Pakistan during the Community Level Interventions for Pre-eclampsia (CLIP) Trial.
Methods: The CLIP Trial was a cluster randomized controlled trial that aimed to reduce maternal and perinatal morbidity and mortality using CE strategies alongside mobile health-supported care by community health care providers. CE activities engaged pregnant women at their homes …
Impact Of Duration Of Antibiotic Prophylaxis On Rates Of Surgical Site Infection (Ssi) In Patients Undergoing Mastectomy Without Immediate Reconstruction, Comparing A Single Prophylactic Dose Versus Continued Antibiotic Prophylaxis Postoperatively: A Multicentre, Double-Blinded Randomised Control Trial Protocol, Abida K. Sattar, Nida Zahid, Hania Shahzad, Rufina Soomro, Omema Saleem, Syed Faisal Mahmood
Impact Of Duration Of Antibiotic Prophylaxis On Rates Of Surgical Site Infection (Ssi) In Patients Undergoing Mastectomy Without Immediate Reconstruction, Comparing A Single Prophylactic Dose Versus Continued Antibiotic Prophylaxis Postoperatively: A Multicentre, Double-Blinded Randomised Control Trial Protocol, Abida K. Sattar, Nida Zahid, Hania Shahzad, Rufina Soomro, Omema Saleem, Syed Faisal Mahmood
Department of Surgery Docs
Introduction: In breast surgeries, prophylactic antibiotics given before the surgical incision as per Joint Commission Surgical Care Improvement Project guidelines have been shown to decrease the rate of postoperative infections. There is, however, no clear consensus on postoperative antibiotic prophylaxis in patients undergoing mastectomy with indwelling drains. This trial protocol proposes to study the difference in rates of surgical site infection (SSI) with or without continuation of postoperative antibiotics in patients undergoing mastectomy without immediate reconstruction and with indwelling drains.
Methods and analysis: In this multicentre, double-blinded clinical trial, all patients undergoing mastectomy (without immediate reconstruction) will receive a single …
Management Of Maternal Depression: Qualitative Exploration Of Perceptions Of Healthcare Professionals From A Public Tertiary Care Hospital, Karachi, Pakistan, Makkiya Jawed, Nousheen Pradhan, Rozina Mistry, Amirah Nazir, Sualeha Shekhani, Tazeen Saeed Ali
Management Of Maternal Depression: Qualitative Exploration Of Perceptions Of Healthcare Professionals From A Public Tertiary Care Hospital, Karachi, Pakistan, Makkiya Jawed, Nousheen Pradhan, Rozina Mistry, Amirah Nazir, Sualeha Shekhani, Tazeen Saeed Ali
Community Health Sciences
The lack of implementation and routine screening of management techniques at tertiary care hospitals leads to an increased burden of maternal depression. The consequences are borne emotionally, physically, and mentally by the mother, the child, the overall family, and society. Hence, it is vital to contextualize this mental disorder to design and implement effective healthcare interventions. The study is aimed to assess the knowledge and practices of healthcare professionals, in a tertiary care setting, who deal with depressive symptoms amongst mothers. It gauges whether a psychological screening criterion is being implemented by the clinical staff during prenatal and postnatal visits …
Contextual Challenges In The Implementation Of The Alliance For Maternal And Newborn Health Improvement, Prospective Cohort Study, An Experience From Rural Pakistan, Yaqub Wasan, Shabina Ariff, Amjad Hussain, Sheraz Ahmed, Mansoor A. Abro, Imran Ahmed, Atif Habib, Sajid Bashir Soofi
Contextual Challenges In The Implementation Of The Alliance For Maternal And Newborn Health Improvement, Prospective Cohort Study, An Experience From Rural Pakistan, Yaqub Wasan, Shabina Ariff, Amjad Hussain, Sheraz Ahmed, Mansoor A. Abro, Imran Ahmed, Atif Habib, Sajid Bashir Soofi
Centre of Excellence in Women and Child Health
Introduction: Improving maternal and newborn survival needs robust data on patterns of morbidity and mortality from well-characterized cohorts. It is equally important for researchers to document and understand the contextual challenges of data collection and how they are addressed.
Methods: This was a prospective cohort study implemented from December 2012 to August 2014 in Matiari, Pakistan. A total of 11,315 pregnancies were enrolled. Participants were approached at home for sequential data collection through the standard pretested structured questionnaires. Some indicators were sourced through health facility records. Information on field challenges gathered through field diaries and minutes of meetings with field …
Direct Maternal Morbidity And The Risk Of Pregnancy-Related Deaths, Stillbirths, And Neonatal Deaths In South Asia And Sub-Saharan Africa: A Population-Based Prospective Cohort Study In 8 Countries, Imran Ahmed, Shabina Ariff, Zulfiqar Ahmed Bhutta, Muhammad Ilyas, Fyezah Jehan, Usma Mehmood, Karim Muhammad, Muhammad Imran Nisar, Sajid Bashir Soofi, Yaqub Wasan, Anita K. M. Zaidi
Direct Maternal Morbidity And The Risk Of Pregnancy-Related Deaths, Stillbirths, And Neonatal Deaths In South Asia And Sub-Saharan Africa: A Population-Based Prospective Cohort Study In 8 Countries, Imran Ahmed, Shabina Ariff, Zulfiqar Ahmed Bhutta, Muhammad Ilyas, Fyezah Jehan, Usma Mehmood, Karim Muhammad, Muhammad Imran Nisar, Sajid Bashir Soofi, Yaqub Wasan, Anita K. M. Zaidi
Woman and Child Health
Background: Maternal morbidity occurs several times more frequently than mortality, yet data on morbidity burden and its effect on maternal, foetal, and newborn outcomes are limited in low- and middle-income countries. We aimed to generate prospective, reliable population-based data on the burden of major direct maternal morbidities in the antenatal, intrapartum, and postnatal periods and its association with maternal, foetal, and neonatal death in South Asia and sub-Saharan Africa.
Methods and findings: This is a prospective cohort study, conducted in 9 research sites in 8 countries of South Asia and sub-Saharan Africa. We conducted population-based surveillance of women of reproductive …
Evaluation Of The Feasibility Of The Fast-M Maternal Sepsis Intervention In Pakistan: A Protocol, Sheikh Irfan Ahmed, Raheel Sikandar, Rubina Barolia, Bakhtawar M H. Khowaja, Kashif Ali Memon, James Cheshire, Catherine Dunlop, Arri Coomarasamy, Lumaan Sheikh, David Lissauer
Evaluation Of The Feasibility Of The Fast-M Maternal Sepsis Intervention In Pakistan: A Protocol, Sheikh Irfan Ahmed, Raheel Sikandar, Rubina Barolia, Bakhtawar M H. Khowaja, Kashif Ali Memon, James Cheshire, Catherine Dunlop, Arri Coomarasamy, Lumaan Sheikh, David Lissauer
Department of Obstetrics & Gynaecology
Background: Maternal sepsis is a life-threatening condition, defined by organ dysfunction caused by infection during pregnancy, childbirth, and the postpartum period. It is estimated to account for between one-tenth and half (4.7% to 13.7%) of all maternal deaths globally. An international stakeholder group, including the World Health Organization, developed a maternal sepsis management bundle called "FAST-M" for resource-limited settings through a synthesis of evidence and international consensus. The FAST-M treatment bundle consists of five components: Fluids, Antibiotics, Source identification and control, assessment of the need to Transport or Transfer to a higher level of care and ongoing Monitoring (of the …
Uterine Artery Embolization Combined With Methotrexate For Broad Ligament Ectopic Pregnancy In A 30-Year Old Primigravida, Khurram Khaliq Bhinder, Azza Sarfraz, Zouina Sarfraz, Shaista Riaz, Samreen Aslam, Zouina Ameena
Uterine Artery Embolization Combined With Methotrexate For Broad Ligament Ectopic Pregnancy In A 30-Year Old Primigravida, Khurram Khaliq Bhinder, Azza Sarfraz, Zouina Sarfraz, Shaista Riaz, Samreen Aslam, Zouina Ameena
Department of Paediatrics and Child Health
We present the case of 30-year old primigravida female at 11 weeks' gestation who was diagnosed to have ectopic pregnancy on obstetric ultrasound. An MRI pelvis was ordered to assess invasion into the posterior myometrium which confirmed a single right-sided broad ligament-extra uterine pelvic ectopic pregnancy with extrinsic mass effect on the right lower uterine segment without frank myometrial invasion. On an urgent basis, a uterine artery embolization (UAE) was performed by targeting the right femoral artery. Selective catheterization was performed of both uterine arteries and the right side showed a major feeder of the gestational sac. Supplied dose of …
Clinical, Neuroimaging, And Molecular Spectrum Of Tecpr2-Associated Hereditary Sensory And Autonomic Neuropathy With Intellectual Disability, Sonja Neuser, Barbara Brechmann, Gali Heimer, Ines Brösse, Susanna Schubert, Lauren O'Grady, Michael Zech, Siddharth Srivastava, Shahnaz Ibrahim, Fatima Khan
Clinical, Neuroimaging, And Molecular Spectrum Of Tecpr2-Associated Hereditary Sensory And Autonomic Neuropathy With Intellectual Disability, Sonja Neuser, Barbara Brechmann, Gali Heimer, Ines Brösse, Susanna Schubert, Lauren O'Grady, Michael Zech, Siddharth Srivastava, Shahnaz Ibrahim, Fatima Khan
Department of Paediatrics and Child Health
Bi-allelic TECPR2 variants have been associated with a complex syndrome with features of both a neurodevelopmental and neurodegenerative disorder. Here, we provide a comprehensive clinical description and variant interpretation framework for this genetic locus. Through international collaboration, we identified 17 individuals from 15 families with bi-allelic TECPR2-variants. We systemically reviewed clinical and molecular data from this cohort and 11 cases previously reported. Phenotypes were standardized using Human Phenotype Ontology terms. A cross-sectional analysis revealed global developmental delay/intellectual disability, muscular hypotonia, ataxia, hyporeflexia, respiratory infections, and central/nocturnal hypopnea as core manifestations. A review of brain magnetic resonance imaging scans demonstrated a …
Evaluating Motor Performance With The Bruininks-Oseretsky Test Of Motor Proficiency In Impoverished Pakistani Children, Zehra Habib Hasan, Fariha Shaheen, Arjumand Rizvi, Jelena Obradovic, Aisha Khan Yousafzai
Evaluating Motor Performance With The Bruininks-Oseretsky Test Of Motor Proficiency In Impoverished Pakistani Children, Zehra Habib Hasan, Fariha Shaheen, Arjumand Rizvi, Jelena Obradovic, Aisha Khan Yousafzai
Department of Paediatrics and Child Health
Objective: To evaluate the sensitivity of the modified Brief Form of Bruininks Oseretsky Test in identifying motor differences secondary to malnutrition and poverty.
Methods: This longitudinal cohort study was conducted at Nowshero Feroze, Sindh from 2013 to 2014 and comprised data drawn from children who participated in a randomised controlled trial, that assessed responsive stimulation and nutrition interventions in the first two years of life. Outcome measures included motor development assessed using Brief Form of Bruininks Oseretsky Test, child anthropometry and household economic and demographic information. Data was analysed using SPSS 15 and STATA 12.
Results: Of the 1058 children, …
Impact Of Local Terminology On The Design Of A Community-Based Diagnostic And Management Algorithm For Postpartum Sepsis: Findings Of Formative Research, Shabina Ariff, Fatima Mir, Wafa Aftab, Farrukh Raza, Shujaat Zaidi, Sheraz Memon, Amnesty Lefevre, Linda A. Bartlett, Peter Winch, Sajid Bashir Soofi, Zulfiqar Ahmed Bhutta
Impact Of Local Terminology On The Design Of A Community-Based Diagnostic And Management Algorithm For Postpartum Sepsis: Findings Of Formative Research, Shabina Ariff, Fatima Mir, Wafa Aftab, Farrukh Raza, Shujaat Zaidi, Sheraz Memon, Amnesty Lefevre, Linda A. Bartlett, Peter Winch, Sajid Bashir Soofi, Zulfiqar Ahmed Bhutta
Department of Paediatrics and Child Health
Background: Postpartum sepsis is one of the leading causes of maternal mortality and morbidity in developing countries. This formative research elicits local terms used for postpartum illnesses and symptoms of postpartum sepsis with the aim of improving postpartum diagnosis and management in Pakistan.
Methods: We conducted 34 in-depth interviews with recently delivered women (RDW), traditional birth attendants (TBAs), healthcare providers and family members of RDW from rural Sindh to explore local Sindhi terms used to describe postpartum sepsis and related symptoms. During interviews, all participants were asked to orally free list common symptoms of postpartum illnesses; those who were aware …
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 …
Workplace Mistreatment And Mental Health In Female Surgeons In Pakistan, Mahim Malik, Hina Inam, Russell S. Martins, Mahin B N. Janjua, Nida Zahid, Sadaf Khan, Abida K. Sattar, Shaista Khan, Adil H. Haider, Ather Enam
Workplace Mistreatment And Mental Health In Female Surgeons In Pakistan, Mahim Malik, Hina Inam, Russell S. Martins, Mahin B N. Janjua, Nida Zahid, Sadaf Khan, Abida K. Sattar, Shaista Khan, Adil H. Haider, Ather Enam
Section of Cardiothoracic Surgery
Background: Despite workplace mistreatment, which includes harassment, bullying and gender discrimination(GD)/bias, being serious problems for female surgeons, there are limited data from lower-middle-income countries like Pakistan. This study explored harassment and GD/bias experienced by female surgeons in Pakistan, and the effects of these experiences on mental health and well-being.
Methods: A nationwide survey was conducted between July and September 2019 in collaboration with the Association of Women Surgeons of Pakistan, an organization consisting of female surgeons and trainees in Pakistan. An anonymous online survey was emailed directly, disseminated via social media platforms (such as Facebook, Twitter and Instagram), and sent …
Predictors Of Iron Consumption For At Least 90 Days During Pregnancy: Findings From National Demographic Health Survey, Pakistan (2017-2018), Sumera Aziz Ali, Savera Aziz Ali, Shama Razzaq, Nayab Khowaja, Sarah Gutkind, Fazal Ur Rehman, Nadir Suhail
Predictors Of Iron Consumption For At Least 90 Days During Pregnancy: Findings From National Demographic Health Survey, Pakistan (2017-2018), Sumera Aziz Ali, Savera Aziz Ali, Shama Razzaq, Nayab Khowaja, Sarah Gutkind, Fazal Ur Rehman, Nadir Suhail
Section of Internal Medicine
Background: Iron supplementation is considered an imperative strategy for anemia prevention and control during pregnancy in Pakistan. Although there is some evidence on the predictors of iron deficiency anemia among Pakistani women, there is a very limited understanding of factors associated with iron consumption among Pakistani pregnant women. Thus, this study aimed to investigate the predictors of iron consumption for at least ≥90 days during pregnancy in Pakistan.
Methods: We analyzed dataset from the nationally representative Pakistan Demographic Health Survey 2017-2018. The primary outcome of the current study was the consumption of iron supplementation for ≥90 days during the pregnancy …
Randomised Trials At The Level Of The Individual, Jay J H. Park, Nathan Ford, Denis Xavier, Per Ashorn, Rebecca F. Grais, Zulfiqar Ahmed Bhutta, Herman Goossens, Kristian Thorlund, Maria Eugenia Socias, Edward J. Mills
Randomised Trials At The Level Of The Individual, Jay J H. Park, Nathan Ford, Denis Xavier, Per Ashorn, Rebecca F. Grais, Zulfiqar Ahmed Bhutta, Herman Goossens, Kristian Thorlund, Maria Eugenia Socias, Edward J. Mills
Centre of Excellence in Women and Child Health
In global health research, short-term, small-scale clinical trials with fixed, two-arm trial designs that generally do not allow for major changes throughout the trial are the most common study design. Building on the introductory paper of this Series, this paper discusses data-driven approaches to clinical trial research across several adaptive trial designs, as well as the master protocol framework that can help to harmonise clinical trial research efforts in global health research. We provide a general framework for more efficient trial research, and we discuss the importance of considering different study designs in the planning stage with statistical simulations. We …
Economic And Cost-Effectiveness Analysis Of The Community-Level Interventions For Pre-Eclampsia (Clip) Trials In India, Pakistan And Mozambique, Jeffrey N. Bone, Asif R. Khowaja, Marianne Vidler, Beth A. Payne, Mrutyunjaya B. Bellad, Shivaprasad S. Goudar, Ashalata A. Mallapur, Khatia Munguambe, Rahat Qureshi, Zulfiqar Ahmed Bhutta
Economic And Cost-Effectiveness Analysis Of The Community-Level Interventions For Pre-Eclampsia (Clip) Trials In India, Pakistan And Mozambique, Jeffrey N. Bone, Asif R. Khowaja, Marianne Vidler, Beth A. Payne, Mrutyunjaya B. Bellad, Shivaprasad S. Goudar, Ashalata A. Mallapur, Khatia Munguambe, Rahat Qureshi, Zulfiqar Ahmed Bhutta
Woman and Child Health
Background: The Community-Level Interventions for Pre-eclampsia (CLIP) trials (NCT01911494) in India, Pakistan and Mozambique (February 2014-2017) involved community engagement and task sharing with community health workers for triage and initial treatment of pregnancy hypertension. Maternal and perinatal mortality was less frequent among women who received ≥8 CLIP contacts. The aim of this analysis was to assess the incremental costs and cost-effectiveness of the CLIP intervention overall in comparison to standard of care, and by PIERS (Pre-eclampsia Integrated Estimate of RiSk) On the Move (POM) mobile health application visit frequency.
Methods: Included were all women enrolled in the three …
A Clinical Audit Of Management Of Third And Fourth Degree Perineal Tears, Saida Abrar, Raheela Mohsin Rizvi, Urooj Kashif
A Clinical Audit Of Management Of Third And Fourth Degree Perineal Tears, Saida Abrar, Raheela Mohsin Rizvi, Urooj Kashif
Department of Obstetrics & Gynaecology
Objective: To perform a clinical audit of the practices related to the management of third and fourth degree perineal tears.
Methods: The retrorspective study was conducted in 2019 at the Aga Khan University Hospital, Karachi, and comprised medical records from January 2008 to December 2018 of women having singleton term vaginal delivery and sustaining obstetric anal sphincter injuries. The change in practices regarding tear management was compared with a previous audit done at the same institution in 2008. Data was analysed using SPSS 20.
Results: Of the 25,370 deliveries, 142(0.56%) sustained obstetric anal sphincter injuries. There was a significant increase …
The Role And Challenges Of Cluster Randomised Trials For Global Health, Louis Dron, Monica Taljaard, Yin Bun Cheung, Rebecca Grais, Nathan Ford, Kristian Thorlund, Fyezah Jehan, Etheldreda Nakimuli-Mpungu, Denis Xavier, Zulfiqar Ahmed Bhutta, Jay J H. Park, Edward J. Mills
The Role And Challenges Of Cluster Randomised Trials For Global Health, Louis Dron, Monica Taljaard, Yin Bun Cheung, Rebecca Grais, Nathan Ford, Kristian Thorlund, Fyezah Jehan, Etheldreda Nakimuli-Mpungu, Denis Xavier, Zulfiqar Ahmed Bhutta, Jay J H. Park, Edward J. Mills
Department of Paediatrics and Child Health
Evaluating whether an intervention works when trialled in groups of individuals can pose complex challenges for clinical research. Cluster randomised controlled trials involve the random allocation of groups or clusters of individuals to receive an intervention, and they are commonly used in global health research. In this paper, we describe the potential reasons for the increasing popularity of cluster trials in low-income and middle-income countries. We also draw on key areas of global health research for an assessment of common trial planning practices, and we address their methodological shortcomings and pitfalls. Lastly, we discuss alternative approaches for population-level intervention trials …
Determinants Of Short Birth Intervals Among Married Women: A Cross-Sectional Study In Karachi, Pakistan, Sidrah Nausheen, Maria Asif Bhura, Kristy Hackett, Imtiaz Hussain, Zainab Shaikh, Arjumand Rizvi, Uzair Ansari, David Canning, Iqbal Shah, Sajid Bashir Soofi
Determinants Of Short Birth Intervals Among Married Women: A Cross-Sectional Study In Karachi, Pakistan, Sidrah Nausheen, Maria Asif Bhura, Kristy Hackett, Imtiaz Hussain, Zainab Shaikh, Arjumand Rizvi, Uzair Ansari, David Canning, Iqbal Shah, Sajid Bashir Soofi
Department of Obstetrics & Gynaecology
Introduction: Birth spacing is a critical pathway to improving reproductive health. WHO recommends a minimum of 33-month interval between two consecutive births to reduce maternal, perinatal, infant morbidity and mortality. Our study evaluated factors associated with short birth intervals (SBIs) of less than 33 months between two consecutive births, in Karachi, Pakistan.
Methods: We used data from a cross-sectional study among married women of reproductive age (MWRA) who had at least one live birth in the 6 years preceding the survey (N=2394). Information regarding their sociodemographic characteristics, reproductive history, fertility preferences, family planning history and a 6-year reproductive calendar were …
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, …
Are Underprivileged And Less Empowered Women Deprived Of Respectful Maternity Care: Inequities In Childbirth Experiences In Public Health Facilities In Pakistan, Waqas Hameed, Mudassir Uddin, Bilal Iqbal Avan
Are Underprivileged And Less Empowered Women Deprived Of Respectful Maternity Care: Inequities In Childbirth Experiences In Public Health Facilities In Pakistan, Waqas Hameed, Mudassir Uddin, Bilal Iqbal Avan
Community Health Sciences
Background: Attainment of healthcare in respectful and dignified manner is a fundamental right for every woman regardless of the individual status. However, social exclusion, poor psychosocial support, and demeaning care during childbirth at health facilities are common worldwide, particularly in low- and middle-income countries. We concurrently examined how women with varying socio-demographic characteristics are treated during childbirth, the effect of women's empowerment on mistreatment, and health services factors that contribute to mistreatment in secondary-level public health facilities in Pakistan.
Methods: A cross-sectional survey was conducted during August-November 2016 among 783 women who gave birth in six secondary-care public health facilities …
Fears And Barriers: Problems In Breast Cancer Diagnosis And Treatment In Pakistan, Sidra Saeed, Muhammad Asim, Malik Muhammad Sohail
Fears And Barriers: Problems In Breast Cancer Diagnosis And Treatment In Pakistan, Sidra Saeed, Muhammad Asim, Malik Muhammad Sohail
Community Health Sciences
Background: Women in Pakistan lack appropriate awareness about diagnosis and treatment for breast cancer due to a range of multifaceted barriers. There is a dearth of literature examining the socio-cultural factors that inhibit women from breast cancer screening, diagnosis and treatment in Punjab, Pakistan. Addressing this gap, this qualitative study sought to identify and explore the barriers that hinder women from seeking timely screening and treatment.
Methods: In this process 45 women (age = 18-50 years) with breast cancer were purposively sampled and interviewed from the Punjab Institute of Nuclear Medicine (PINUM) hospital, Faisalabad, Pakistan.
Results: An inductive approach was …
Multiple-Micronutrient Supplementation In Pregnant Adolescents In Low- And Middle-Income Countries: A Systematic Review And A Meta-Analysis Of Individual Participant Data, Emily C. Keats, Nadia Akseer, Pravheen Thurairajah, Simon Cousens, Zulfiqar Ahmed Bhutta, Global Young Women’S Nutrition Investigators’ Group
Multiple-Micronutrient Supplementation In Pregnant Adolescents In Low- And Middle-Income Countries: A Systematic Review And A Meta-Analysis Of Individual Participant Data, Emily C. Keats, Nadia Akseer, Pravheen Thurairajah, Simon Cousens, Zulfiqar Ahmed Bhutta, Global Young Women’S Nutrition Investigators’ Group
Woman and Child Health
Context: Approximately 7.3 million births occur annually among adolescents in low- and middle-income countries. Pregnant adolescents constitute a nutritionally vulnerable group that could benefit from intervention to mitigate the mortality and adverse birth outcomes associated with adolescent pregnancy.
Objective: The aim of this systematic review and meta-analysis was to assess the following: (1) the effect of multiple-micronutrient (MMN) supplementation vs iron and folic acid (IFA) supplementation among adolescents on maternal morbidity, birth outcomes, and mortality outcomes, (2) the effects of MMN supplementation in adolescents compared with the effects in adult women, and (3) the effect modification, if any, of MMN …
Concordance Between Clinical And Pathological Response Assessment After Neo-Adjuvant Chemotherapy In Patients With Invasive Lobular Carcinoma, Aisha Shaikh, Muhammad Usman Tariq, Shaista Khan, Romana Idress, Lubna Mushtaque Vohra, Saira Fatima Shaikh, Hira Waheed
Concordance Between Clinical And Pathological Response Assessment After Neo-Adjuvant Chemotherapy In Patients With Invasive Lobular Carcinoma, Aisha Shaikh, Muhammad Usman Tariq, Shaista Khan, Romana Idress, Lubna Mushtaque Vohra, Saira Fatima Shaikh, Hira Waheed
Department of Surgery Docs
Background: Neo-adjuvant chemotherapy (NAC) is frequently administered in breast carcinoma patients. The clinical response to NAC guides further treatment. The pathological response is not only an independent prognostic factor, but it also guides further treatment and prognosis.
Objectives: The aim of our study was to find the degree of concordance between clinical and pathological response assessments after NAC in Invasive lobular Carcinoma (ILC) cases by using World Health Organization (WHO) criteria and different pathological systems, respectively. We also tried to identify any useful parameter of clinical assessment that could better correlate with pathologic assessment and provide a better estimation of …
Delivering Nutrition Interventions To Women And Children In Conflict Settings: A Systematic Review, Shailja Shah, Zahra Ali Padhani, Daina Als, Mariella Munyuzangabo, Michelle F. Gaffey, Wardah Ahmed, Fahad J. Siddiqui, Sarah Meteke, Jai K. Das, Zulfiqar Ahmed Bhutta
Delivering Nutrition Interventions To Women And Children In Conflict Settings: A Systematic Review, Shailja Shah, Zahra Ali Padhani, Daina Als, Mariella Munyuzangabo, Michelle F. Gaffey, Wardah Ahmed, Fahad J. Siddiqui, Sarah Meteke, Jai K. Das, Zulfiqar Ahmed Bhutta
Woman and Child Health
Background: Low/middle-income countries (LMICs) face triple burden of malnutrition associated with infectious diseases, and non-communicable diseases. This review aims to synthesise the available data on the delivery, coverage, and effectiveness of the nutrition programmes for conflict affected women and children living in LMICs.
Methods: We searched MEDLINE, Embase, CINAHL, and PsycINFO databases and grey literature using terms related to conflict, population, and nutrition. We searched studies on women and children receiving nutrition-specific interventions during or within five years of a conflict in LMICs. We extracted information on population, intervention, and delivery characteristics, as well as delivery barriers and facilitators. Data …
Feasibility, Usability And Acceptability Of Paediatric Lung Ultrasound Among Healthcare Providers And Caregivers For The Diagnosis Of Childhood Pneumonia In Resource-Constrained Settings: A Qualitative Study, Atif Riaz, Olga Cambaco, Laura Elizabeth Ellington, Jennifer L. Lenahan, Khatia Munguambe, Usma Mehmood, Sana Qaisar, Benazir Baloch, Muhammad Imran Nisar, Fyezah Jehan
Feasibility, Usability And Acceptability Of Paediatric Lung Ultrasound Among Healthcare Providers And Caregivers For The Diagnosis Of Childhood Pneumonia In Resource-Constrained Settings: A Qualitative Study, Atif Riaz, Olga Cambaco, Laura Elizabeth Ellington, Jennifer L. Lenahan, Khatia Munguambe, Usma Mehmood, Sana Qaisar, Benazir Baloch, Muhammad Imran Nisar, Fyezah Jehan
Department of Paediatrics and Child Health
Objectives: Paediatric pneumonia burden and mortality are highest in low-income and middle-income countries (LMIC). Paediatric lung ultrasound (LUS) has emerged as a promising diagnostic tool for pneumonia in LMIC. Despite a growing evidence base for LUS use in paediatric pneumonia diagnosis, little is known about its potential for successful implementation in LMIC. Our objectives were to evaluate the feasibility, usability and acceptability of LUS in the diagnosis of paediatric pneumonia.
Design: Prospective qualitative study using semistructured interviews SETTING: Two referral hospitals in Mozambique and Pakistan PARTICIPANTS: A total of 21 healthcare providers (HCPs) and 20 caregivers were enrolled.
Results: HCPs …
Heterogeneous Contributions Of Change In Population Distribution Of Body Mass Index To Change In Obesity And Underweight, Ncd Risk Factor Collaboration (Ncd-Risc), Maria Lc Iurilli, Bin Zhou, James E. Bennett, Rodrigo M. Carrillo-Larco, Marisa K. Sophiea, Andrea Rodriguez-Martinez, Honor Bixby, Bethlehem D. Solomon, Zulfiqar Ahmed Bhutta
Heterogeneous Contributions Of Change In Population Distribution Of Body Mass Index To Change In Obesity And Underweight, Ncd Risk Factor Collaboration (Ncd-Risc), Maria Lc Iurilli, Bin Zhou, James E. Bennett, Rodrigo M. Carrillo-Larco, Marisa K. Sophiea, Andrea Rodriguez-Martinez, Honor Bixby, Bethlehem D. Solomon, Zulfiqar Ahmed Bhutta
Woman and Child Health
From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape …
Development And Feasibility Testing Of A Play-Based Psychosocial Intervention For Reduced Patient Stress In A Pediatric Care Setting: Experiences From Pakistan, Muneera A. Rasheed, Vardah Bharuchi, Waliyah Mughis, Ayesha Hussain
Development And Feasibility Testing Of A Play-Based Psychosocial Intervention For Reduced Patient Stress In A Pediatric Care Setting: Experiences From Pakistan, Muneera A. Rasheed, Vardah Bharuchi, Waliyah Mughis, Ayesha Hussain
Department of Paediatrics and Child Health
Background: Hospitalization can be a source of great stress for children and their families. In high-income countries, there are specialized staff to help children cope using different techniques including play. However, it is a major challenge in low and middle-income countries (LMIC) due to financial constraints and untrained human resource. The objective of study was to develop and test the feasibility and acceptance of a psychology trainee-delivered model postulated on employing play as a means of enhancing child-parent interactions leading to reduced stress during hospitalization.
Methods: This study was conducted in the paediatric ward of a tertiary care private hospital …