Women's Health Commons^™

What’S Coming For Health Science And Policy In 2018? Global Experts Look Ahead In Their Field, Soumya Swaminathan, Robin S. Room, Louise C. Ivers, Graham Hillis, Rebecca F. Grais, Zulfiqar Ahmed Bhutta, Peter Byass

Department of Paediatrics and Child Health

No abstract provided.

What’S Coming For Health Science And Policy In 2018? Global Experts Look Ahead In Their Field, Soumya Swaminathan, Robin S. Room, Louise C. Ivers, Graham Hillis, Rebecca F. Grais, Zulfiqar Ahmed Bhutta, Peter Byass

Department of Paediatrics and Child Health

No abstract provided.

Influenza Epidemiology And Immunization During Pregnancy: Final Report Of A World Health Organization Working Group, Deshayne B. Fell, Eduardo Azziz-Baumgartner, Michael G. Baker, Maneesh Batra, Julien Beauté, Philippe Beutels, Niranjan Bhat, Zulfiqar Ahmed Bhutta, Cheryl Cohen, Rehana Salam

Department of Paediatrics and Child Health

From 2014 to 2017, the World Health Organization convened a working group to evaluate influenza disease burden and vaccine efficacy to inform estimates of maternal influenza immunization program impact. The group evaluated existing systematic reviews and relevant primary studies, and conducted four new systematic reviews. There was strong evidence that maternal influenza immunization prevented influenza illness in pregnant women and their infants, although data on severe illness prevention were lacking. The limited number of studies reporting influenza incidence in pregnant women and infants under six months had highly variable estimates and underrepresented low- and middle-income countries. The evidence that maternal …

Progress And Priorities For Reproductive, Maternal, Newborn, And Child Health In Kenya: A Countdown To 2015 Country Case Study, Emily C. Keats, Anthony Ngugi, William Macharia, Nadia Akseer, Emma Nelima Khaemba, Zaid Ahmad Bhatti, Arjumand Rizvi, John Tole, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Progress in reproductive, maternal, newborn, and child health (RMNCH) in Kenya has been inconsistent over the past two decades, despite the global push to foster accountability, reduce child mortality, and improve maternal health in an equitable manner. Although several cross-sectional assessments have been done, a systematic analysis of RMNCH in Kenya was needed to better understand the push and pull factors that govern intervention coverage and influence mortality trends. As such, we aimed to determine coverage and impact of key RMNCH interventions between 1990 and 2015.
Methods: We did a comprehensive, systematic assessment of RMNCH in Kenya from 1990 …

How Canada Can Help Global Adolescent Health Mature, Ashley Vandermorris, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: There is an emerging focus on adolescent health within the global health community as we come to recognize that the adolescent years are formative in determining health and health-related behaviours across the life-course. Such attention is not only relevant on the global scale but is imperative in Canada as well.

Main body: This commentary provides a brief review of recent investments targeting global adolescent health and presents five potential avenues for action which emerged out of the recent Canadian Partnership for Women and Children’s Health (CanWaCH) Global Adolescent Health conference. These avenues are: (1) Demand data; (2) Embrace complexity; …

Age And Sex Normalization Of Intestinal Permeability Measures For The Improved Assessment Of Enteropathy In Infancy And Early Childhood: Results From The Mal-Ed Study, Margaret N. Kosek, Gwenyth O. Lee, Richard L. Guerrant, Rashidul Haque, Gagandeep Kang, Tahmeed Ahmed, Pascal Bessong, Syed Asad Ali, Shahida Qureshi, Anita K. M. Zaidi

Department of Paediatrics and Child Health

Objectives: The aim of the study was to describe changes in intestinal permeability in early childhood in diverse epidemiologic settings.
Methods: In a birth cohort study, the lactulose:mannitol (L:M) test was administered to 1980 children at 4 time points in the first 24 months of life in 8 countries. Data from the Brazil site with an incidence of diarrhea similar to that seen in the United States and no growth faltering was used as an internal study reference to derive age- and sex-specific z scores for mannitol and lactulose recoveries and the L:M ratio.
Results: A total of 6602 tests …

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

Department of Paediatrics and Child Health

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

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

Department of Paediatrics and Child Health

No abstract provided.

Diagnostic Methods To Determine Microbiology Of Postpartum Endometritis In South Asia: Laboratory Methods Protocol Used In The Postpartum Sepsis Study: A Prospective Cohort Study, Sadia Shakoor, Megan E. Reller, Amnesty Lefevre, Aneeta Hotwani, Shahida M. Qureshi, Farheen Yousuf, Mohammad Shahidul Islam, Nicholas Connor, Iftekhar Rafiqullah, Fatima Mir

Department of Paediatrics and Child Health

Background: The South Asian region has the second highest risk of maternal death in the world. To prevent maternal deaths due to sepsis and to decrease the maternal mortality ratio as per the World Health Organization Millenium Development Goals, a better understanding of the etiology of endometritis and related sepsis is required. We describe microbiological laboratory methods used in the maternal Postpartum Sepsis Study, which was conducted in Bangladesh and Pakistan, two populous countries in South Asia.
Methods/Design: Postpartum maternal fever in the community was evaluated by a physician and blood and urine were collected for routine analysis and culture. …

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

Department of Paediatrics and Child Health

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

Diagnosis And Management Of Preeclampsia In Community Settings In Low And Middle-Income Countries, Rehana A. Salam, Jai K. Das, Anum Ali, Soumyadeep Bhaumik, Zohra S. Lassi

Department of Paediatrics and Child Health

Hypertensive disorders of pregnancy contribute significantly to maternal mortality and morbidity. Preeclampsia belongs to the spectrum of hypertensive disorders of pregnancy and if undiagnosed and/or untreated leads to fatal consequences for both the mother and the baby. Early detection and prevention of preeclampsia is limited by uncertainty in the knowledge about its etiopathogenesis. While much work has been done in establishing clinical guidelines for management of preeclampsia in the hospital or tertiary care settings, there is considerable lack of work in the domain of evidence-based guidelines for screening, identification and management of preeclampsia at the community-level. The article reviews these …

Risk Factors Associated With Birth Asphyxia In Rural District Matiari, Pakistan: A Case Control Study, Farhana Tabassum, Arjumand Rizvi, Shabina Ariff, Sajid Bashir Soofi, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: During the past two decades there has been a sustained decline in child mortality; however, neonatal mortality has remained stagnant. Each year approximately 4 million babies are born asphyxiated resulting in 2 million neonatal deaths and intrapartum stillbirths. Almost all neonatal deaths occur in developing countries, where the majority is delivered at homes with negligible antenatal care and poor perinatal services.
Objectives: To identify socio-demographic and clinical risk factors associated with birth asphyxia in Matiari District of Sindh Province, Pakistan.
Method: A matched case control study was conducted in Matiari District with 246 cases and 492 controls. Newborn deaths …

Approaches To Improve Quality Of Care (Qoc) For Women And Newborns: Conclusions, Evidence Gaps And Research Priorities, Zulfiqar Ahmed Bhutta, Rehana A. Salam, Zohra S. Lassi, Anne Austin, Ana Langer

Department of Paediatrics and Child Health

Despite progress in recent years, an estimated 273,500 women died as a result of maternal causes in 2010. The burden of these deaths is disproportionately bourne by women who reside in low income countries or belong to the poorest sectors of the population of middle or high income ones, and it is particularly acute in regions where access to and utilization of facility-based services for childbirth and newborn care is lowest. Evidence has shown that poor quality of facility-based care for these women and newborns is one of the major contributing factors for their elevated rates of morbidity and mortality. …

Immune Responses To Vi Capsular Polysaccharide Typhoid Vaccine In Children 2 To 16 Years Old In Karachi, Pakistan, And Kolkata, India, R. Leon Ochiai, M. Imran Khan, Sajid B. Soofi, Dipika Sur, Suman Kanungo, Young Ae You, Atif Habib, Shah Muhammad Sahito, Byomkesh Manna, Camilo J. Acosta, Mohammad Ali, Sujit K. Bhattacharya, Zulfiqar A. Bhutta, John D. Clemens

Department of Paediatrics and Child Health

The geometric mean concentration (GMC) and the proportion maintaining a protective level (150 enzyme-linked immunosorbent assay (ELISA) units [ELU]/ml) 2 years following a single dose of 25 μg of injectable Vi capsular polysaccharide typhoid vaccine was measured against that of the control hepatitis A vaccine in children 2 to 16 years old in cluster randomized trials in Karachi and Kolkata. The GMC for the Vi group (1,428 ELU/ml) was statistically significantly different from the GMC of the control hepatitis A vaccine group (86 ELU/ml) after 6 weeks. A total of 117 children (95.1%) in the Vi group and 9 (7.5%) …

Global Epidemiology Of Invasive Meningococcal Disease, Rabab Z. Jafri, Syed Asad Ali, Nancy E. Messonnier, Carol Tevi-Benissan, David Durrheim, Juhani Eskola, Florence Fermon, Keith P. Klugman, Mary Ramsay, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Neisseria meningitidis is one of the leading causes of bacterial meningitis globally and can also cause sepsis, pneumonia, and other manifestations. In countries with high endemic rates, the disease burden places an immense strain on the public health system. The worldwide epidemiology of invasive meningococcal disease (IMD) varies markedly by region and over time. This review summarizes the burden of IMD in different countries and identifies the highest-incidence countries where routine preventive programs against Neisseria meningitidis would be most beneficial in providing protection. Available epidemiological data from the past 20years in World Health Organization and European Centre for Disease Prevention …

Chloramphenicol Therapy Of Typhoid Fever, Z A. Bhutta, S H. Naqvi, S Durrani, A Suria

Department of Paediatrics and Child Health

In a prospective study we compared two different dosage regimens of IV chloramphenicol succinate (100 mg/kg/day and 75 mg/kg/day) in children with culture proven typhoid. Trough and peak blood samples, obtained at 48 hrs, were analysed for free chloramphenicol by high pressure liquid chromatography (HPLC). Although the mean trough (8.8 +/- 7.7 versus 5.4 +/- 2.6 mcg/ml) and peak (19.9 +/- 12.2 versus 15.4 +/- 6.1 mcg/ml) chloramphenicol concentrations were comparable in both groups, a significantly wider range was found in the group receiving 100 mg/kg/day. Potentially toxic levels (greater than 30 mcg/ml) developed in two patients with liver dysfunction. …