Family Medicine Commons^™

Role Of Complementary And Alternative Medicine In Controlling Dyslipidemia, Waris Qidwai, Firdous Jahan, Kashmira Nanji

Department of Family Medicine

No abstract provided.

Perceived Barriers Among Pregnant Women Towards Cervical Cancer Screening, Visavilwa Vincent Lamuka

Master of Medicine in Family Medicine

Background: Cervical cancer remains the most common cancer in women in Eastern Africa in general and Tanzania in particular. However, to a large extent cervical cancer is preventable by effective screening programmes as has been demonstrated in many developed countries. Developing countries lack formal national screening programmes. Screening is usually mainly done opportunistically. Objective: To assess the perceived barriers to uptake of cervical cancer screening among pregnant women attending antenatal clinics in two hospitals in Dar es Salaam. Methodology: This was a qualitative study, conducted at two hospitals in Dar es salaam, a government facility (Amana District Hospital) and a …

An Assessment Of Whether Medical Doctors Have The Knowledge That Would Enable Them To Competently Deliver Tobacco Cessation Services, Miriam Miima Khamonya

Master of Medicine in Family Medicine

Background: Tobacco use is the leading cause of preventable morbidity and mortality globally. The international community recognizes this epidemic and compelling evidence exists on the significant contribution of the health care provider in propagating the success of tobacco cessation. The World Health Organization highlights minimal implementation of tobacco control policies by Tanzania despite a rise in tobacco use prevalence. Medical doctors’ competence is a reflection on our commitment to tobacco cessation service delivery. Main Objectives: To assess whether medical doctors have the knowledge that would enable them to competently deliver tobacco cessation services. Specific Objectives 1. To assess medical doctors’ …

Understanding The Barriers To Contraceptive Use In Hiv-Positive Women Of Child Bearing Age In Dar-Es-Salaam, Tanzania, Tabitha-Alexandria Njeri Nyanja

Master of Family Medicine

Title: Understanding the barriers to contraceptive use among HIV-positive women of child bearing age in Dar-es-Salaam, Tanzania- a multi-site study Purpose: The purpose of this study was to explore the perceived barriers to contraceptive use and identify the factors that influence contraceptive choice, as well as the relationship of these among HIV-positive women living in an urban population in Dar-es-Salaam Tanzania. Goals and Objectives: To determine the perceived barriers to contraceptive use among HIV-positive women of child-bearing age attending the Care Treatment Centres (CTCs) Tanzania and in the President’s Emergency Plan for AIDS Relief (PEPFAR) supported CTCs within Dar-es-salaam. Methodology: …

Burden Of Epilepsy In Rural Kenya Measured In Disability-Adjusted Life Years, Fredrick Ibinda, Ryan Wagner, Melanie Bertram, Anthony Ngugi, Evasius Bauni, Theo Vos, Josemir Sander, Charles Newton

Family Medicine, East Africa

Objectives: The burden of epilepsy, in terms of both morbidity and mortality, is likely to vary depending on the etiology (primary [genetic/unknown] vs. secondary [structural/metabolic]) and with the use of antiepileptic drugs (AEDs). We estimated the disability-adjusted life years (DALYs) and modeled the remission rates of active convulsive epilepsy (ACE) using epidemiologic data collected over the last decade in rural Kilifi, Kenya.

Methods: We used measures of prevalence, incidence, and mortality to model the remission of epilepsy using disease-modeling software (DisMod II). DALYs were calculated as the sum of Years Lost to Disability (YLD) and Years of Life Lost (YLL) …

Exposure To Multiple Parasites Is Associated With The Prevalence Of Active Convulsive Epilepsy In Sub-Saharan Africa, Gathoni Kamuyu, Christian Bottomley, James Mageto, Brett Lowe, Patricia Wilkins, John C. Noh, Thomas B. Nutman, Anthony Ngugi, Rachael Odhiambo, Ryan Wagner, Angelina Kakooza-Mwesige, Seth Owusu-Agyei, Kenneth Ae-Ngibise, Honorati Masanja, Faith Osier, Peter Odermatt, Charles Newton

Family Medicine, East Africa

Background: Epilepsy is common in developing countries, and it is often associated with parasitic infections. We investigated the relationship between exposure to parasitic infections, particularly multiple infections and active convulsive epilepsy (ACE), in five sites across sub-Saharan Africa.

Methods and Findings: A case-control design that matched on age and location was used. Blood samples were collected from 986 prevalent cases and 1,313 age-matched community controls and tested for presence of antibodies to Onchocerca volvulus, Toxocara canis, Toxoplasma gondii, Plasmodium falciparum, Taenia solium and HIV. Exposure (seropositivity) to Onchocerca volvulus (OR = 1.98; 95%CI: 1.52-2.58, p

Conclusion: This study investigates how …

Premature Mortality In Active Convulsive Epilepsy In Rural Kenya: Causes And Associated Factors, Anthony Ngugi, Christian Bottomley, Gregory Fegan, Eddie Chengo, Rachael Odhiambo, Evasius Bauni, Brian Neville, Immo Kleinschmidt, Josemir W. Sander, Charles R. Newton

Family Medicine, East Africa

Objective: We estimated premature mortality and identified causes of death and associated factors in people with active convulsive epilepsy (ACE) in rural Kenya.

Methods: In this prospective population-based study, people with ACE were identified in a crosssectional survey and followed up regularly for 3 years, during which information on deaths and associated factors was collected. We used a validated verbal autopsy tool to establish putative causes of death. Age-specific rate ratios and standardized mortality ratios were estimated. Poisson regression was used to identify mortality risk factors.

Results: There were 61 deaths among 754 people with ACE, yielding a rate of …

Tobacco Control Efforts In The Gulf Cooperation Council Countries: Achievements And Challenges, S. Hassounah, D. Rawaf, T. Khoja, S. Rawaf, M.S. Hussein, Waris Qidwai, A. Majeed

Department of Family Medicine

This paper reports a review into the current state of tobacco use, governance and national commitment for control, and current intervention frameworks in place to reduce the use of tobacco among the populations of the Gulf Cooperation Council (GCC) member states and Yemen. It further reviews structured policy-oriented interventions (in line with the MPOWER package of 6 evidence-based tobacco control measures) that represent government actions to strengthen, implement and manage tobacco control programmes and to address the growing epidemic of tobacco use. Our findings show that tobacco control in the GCC countries has witness real progress over the past decades. …

Are Physicians More Technical In Their Approach And Less Humane? A Call For Reconsideration, Waris Qidwai

Department of Family Medicine

No abstract provided.

Leadership In Healthcare Is A Neglected Issue: A Call For Action, Waris Qidwai

Department of Family Medicine

Healthcare and medical profession stands at crossroads today. Unprecedented technological advances as a result of ongoing scientific research has revolutionized healthcare around the world. Despite these developments, we are still faced with a huge burden of communicable diseases, an ever rising burden of noncommunicable diseases, coupled with an increasing load of mental health diseases and accidents in healthcare. There are several reasons for our failure to address healthcare issues of our populations, including a desperate need to revamp existing medical and health care related curriculum. In addition to considering curriculum change, perhaps single most needed change we need to address …

Multiple Mini-Interviews (Mmi) And Semistructured Interviews For The Selection Of Family Medicine Residents: A Comparative Analysis, Marie Andrades, Seema Bhanji, Samreen Kausar, Fouad Majeed, Sheilla Pinjani

Department of Family Medicine

Background. Family Medicine Residency Program at the Aga Khan University has applicants for the residency position in excess of the positions offered resulting in formulation of certain selection criteria. The objective of this study was to compare MMI versus semistructured interviews for assessing noncognitive domains in the selection of residents. The secondary objectives were to determine perceptions of the interviewers and candidates for the acceptability and feasibility of MMI as a selection tool.
Methods: The candidates underwent semistructured interviews along with MMI and identical attributes were tested in both. The attributes tested were safe doctor, communication skills, professionalism, problem …

Jfma Street Outreach: A Resident-Run Street Medicine Program A Retrospective Chart Review Examining The Needs Of A Vulnerable Population And Services Provided, Kenneth E. Hemba, Md, Rebecca Simon, Bs, Lara Carson Weinstein, Md

Department of Family & Community Medicine Presentations and Grand Rounds

In Philadelphia it is estimated that over 12,000 people experience homelessness annually, and up to 500 individuals live on the street on any given day.¹

Project HOME coordinates the City of Philadelphia’s outreach effort aimed at forming relationships with unsheltered individuals, identifying their barriers to entering permanent supportive housing and assisting them in overcoming these barriers.

Having identified this population’s need for medical services, in 2007 faculty in Jefferson Family Medicine Associates (JFMA) reached out to Project HOME and extended an ongoing community-academic partnership.

Since then Family Medicine residents and students have been traveling with the outreach team, meeting …

An Interdisciplinary Model To Improve Completion Of Latent Tuberculosis Infection Treatment In The Refugee Population, Christine O'Leary, Pharmd, Marc Altshuler, Md, Kevin Scott, Md, Karen Kitagawa-James, Rn, Bsn, Maria Hervada-Paige, Mss

Department of Family & Community Medicine Presentations and Grand Rounds

Background: Refugees are disproportionately affected by latent tuberculosis infection (LTBI) and active tuberculosis (TB) compared to the general US population. More than 50% of TB cases in the US occur in foreign-born persons. In addition, approximately 80% of TB cases in the US are a result of reactivation of LTBI. Treatment of LTBI is effective to prevent and control TB. Unfortunately, LTBI treatment completion rates in the foreign-born are less than 50%. Methods: After conducting a retrospective chart review to establish baseline rates of treatment completion in our LTBI refugee patients, we implemented a model of prospective chart review, initial …

Adding Obesity To The Problem List Increases The Rate Of Providers Addressing Obesity., Elaine Seaton Banerjee, Angela Gambler, Corey Fogleman

Department of Family & Community Medicine Faculty Papers

BACKGROUND AND OBJECTIVES: Obesity is a common problem that increases risk of many other diseases, from heart disease to cancer. While counseling by a physician increases patient report of weight loss attempts and increased exercise, primary care physicians do not frequently address obesity. The objectives of this study were to determine how often obesity was included on the problem list and whether adding obesity to the problem list affected the rate at which it was addressed in future visits.

METHODS: We conducted an initial assessment, followed by a randomized controlled trial of patient records at a family medicine residency office. …

Generating Hypotheses About Care Needs Of High Utilizers: Lessons From Patient Interviews., Dawn B Mautner, Hauchie Pang, Jeffrey C Brenner, Judy A Shea, Kennen S Gross, Rosemary Frasso, Carolyn C Cannuscio

Department of Family & Community Medicine Faculty Papers

Informed by a largely secondary and quantitative literature, efforts to improve care and outcomes for complex patients with high levels of emergency and hospital-based health care utilization have offered mixed results. This qualitative study identifies psychosocial factors and life experiences described by these patients that may be important to their care needs. Semi-structured interviews were conducted with 19 patients of the Camden Coalition of Healthcare Providers' Care Management Team. Investigators coded transcripts using a priori and inductively-derived codes, then identified 3 key themes: (1) Early-life instability and traumas, including parental loss, unstable or violent relationships, and transiency, informed many participants' …

Impact Of Postpartum Anxiety And Depression On Child’S Mental Development From Two Peri-Urban Communities Of Karachi, Pakistan: A Quasi-Experimental Study, Niloufer Sultan Ali, Sadia Mahmud, Asia Khan, Badar Sabir Ali

Department of Family Medicine

Background

Postpartum anxiety and depression has detrimental effects on the overall mental development of children. This study aims to assess the impact of postpartum anxiety and depression on children’s mental development on all sub-scales in a Pakistani population.

Methods

A quasi-experimental study was conducted in two peri-urban communities of Karachi, a mega city of Pakistan, to assess the impact of postpartum anxiety and depression on children’s growth and mental development. A total of 420 women were enrolled, who had given consent out of 651 pregnant women identified, during February 2004 to December 2005. Data for socio-demographic, home environment and family …

Improvement In Access And Equity For Maternal And Neonatal Health Services: Comparative Advantages Of Contracted-Out Versus Non-Contracted-Out Facilities, Shehla Zaidi, Fauziah Rabbani, Iqbal Azam Syed, Atif Riaz, Peter Hatcher, Gul Nawaz Khan Nawaz Khan, Nousheen Pradhan, Hassan Fazli, Shiraz Shaikh, Yasmeen Khan, Syeda Nida Naim, Unaib Rabbani

Community Health Sciences

No abstract provided.

Illuminating The Dark Side--Vitamin D Status In Different Localities Of Karachi, Romaina Iqbal, Lena Jafri, Ali Haroon, Aysha Habib Khan

Department of Medicine

This study was conducted to determine the association between place of residence (grouped into neighbourhoods), and 25-hydroxy D (25[OH]D) levels of individuals of Karachi. Addresses of 4788 individuals tested for 25[OH]D at the clinical laboratory of the Aga Khan University (AKU), Karachi, from January 2007 to June 2008 were reviewed. The neighbourhoods were categorized into ten, based on locality attributes. A high overall prevalence (74%) of vitamin D deficiency (VDD) was observed. There was a significant difference (p-value < 0.01) between mean log 25[OH]D levels amongst neighbourhoods grouped according to distinct housing structure attributes and localities. A high frequency of VDD in all the studied localities of an urban city warrant dietary vitamin D supplementation and food fortification.

Self-Perceived Health Among School Going Adolescents In Pakistan: Influence Of Individual, Parental And Life Style Factors?, Asad Ali Khan Afridi, Komal Motwani, Saleem Khawaja, Adeel Khoja, Zafar Fatmi, Iqbal Azam Syed, Muhammad Masood Kadir

Department of Medicine

BACKGROUND: Adolescents are at substantial risk of acquiring behaviors which might influence their health status. This study was aimed to assess the proportion of school going adolescents (both males and females) with poor self-perceived health and its associated factors.

METHODOLOGY: A cross-sectional study was conducted in three major cities of Pakistan i.e. Karachi, Lahore and Quetta. From each city, six (6) secondary schools were randomly selected (3 public and 3 private). Pre-tested, self-administered questionnaire was distributed to students. Binary logistic regression analysis was conducted to determine independent factors associated with poor self-perceived health.

RESULTS: Approximately 29% adolescents (119/414) reported poor …

Unintentional Childhood Poisoning, Epidemiology And Strategies For The Prevention And Policy Change In Pakistan, Omer Ul Hassan, Hasana Qadri, Umer Mir, Bilal Ahmed

Department of Medicine

Poisoning is the fifth leading cause of unintentional injuries among young children. Agents most commonly ingested by young children include medicines, cleaning substances, hydrocarbons, pesticides and cosmetics. Children with less educated fathers, living in more crowded conditions and from lower income families are more predisposed to unintentional poisoning. Unsafe storage of medicines, chemicals and other hazardous substances is one of the leading reasons for childhood poisoning. Knowledge of parents and caregivers about prevention of poisoning may be the basis to prevent subsequent injuries. This paper is a review of the epidemiology of unintentional poisonings among young children (less than five …