Provincial differences in levels, trends, and determinants of childhood immunization in Pakistan

Background: Efforts to improve immunization rates are urgently needed in Pakistan but national statistics mask important local differences in immunization levels and determinants.

Aim: In this study we aimed to determine how similar or different are recent trends and levels of immunization coverage in Pakistan's 4 main provinces [Punjab, Sindh, Khyber Pakhtunkhwa [KPK] and Balochistan], and what factors are associated with complete childhood immunization in each province.

Method: We analysed data from the 2006–07 and 2012–13 Pakistan Demographic and Health Surveys. Trends in immunization coverage among children aged 12–23 months were calculated for each province. Bivariate and multivariate analyses were conducted to identify factors associated with complete immunization.

Results: The proportion of children completely immunized had risen significantly in Punjab but had fallen significantly in Balochistan. Complete coverage ranged from 16.4% in Balochistan to 65.8% in Punjab [2012–13]. Tetanus toxoid injection during pregnancy was a significant predictor of complete immunization everywhere. Other predictors in specific provinces were: urban residence in Balochistan, wealth in Sindh and KPK, mother's education in Punjab and KPK, and distance to the facility in Punjab.

Conclusions: Although some strategies to increase immunization coverage are relevant nationwide, programme managers need to seek solutions specific to provincial trends and predictors. This analysis demonstrates that viewing childhood immunization in Pakistan through a provincial lens can help achieve a deeper understanding of the challenges and potential strategies to boost coverage

Effect of concept maps on knowledge retention in dental students

To determine the effect of Concept Maps on Knowledge Retention in Dental students. Randomized study. study was conducted at the Jinnah Medical and Dental College, Karachi. A randomized controlled trial was conducted on fifty students of BDS first year at the Jinnah Medical and Dental College, Karachi. The students were randomly divided into two groups. Initially the whole class was taught thefirst unit of Biochemistry [Carbohydrates] by the conventional method. It was followed by a Multiple Choice Questions test which established the equivalence in the mean scores of the two groups. The Intervention group now attended a workshop on [Concept Maps]. In the next two units [Proteins and Lipids], the Intervention group made Concept Maps while the Control group continued with the conventional method. Each unit ended with an MCQ test. The score of the Unit test was taken as an indicator of short term retention of knowledge. Two months later, an unscheduled Retest was given consisting of all the MCQ given in the three Unit tests. The difference between the scores of the Unit tests and Retest was taken as an indicator of long term retention of knowledge. The mean scores of the two groups were compared using Independent samples t-test. No significant difference was found in the mean scores of the Intervention and Control groups in the Unit tests. But in the Retest the Intervention group performed significantly better [p < 0.01] than the Control group. Learning through Concept Maps improves long term retention of knowledge

Competency profile of locally manufactured clopidogrel lowplat and foreign manufactured clopidogrel plavix in patients of suspected ischemic heart disease [CLAP-IHD]

The primary objective of this study was to test the hypothesis that the antiplatelet effects of loading dose of locally manufactured clopidogrel Lowplat referred as drug [B] 600 mg [8 tablets] given once is comparable to the antiplatelet effects of loading dose of foreign manufactured clopidogrel Plavix referred as - drug [A] 600 mg [8 tablets] given once in patients with suspected ischemic heart disease. This was a double blind, randomized, cross over, study, to compare the safety and efficacy of study drug [B] versus [A] in adult subjects suffering from suspected ischemic heart disease presented at National Institute of Cardiovascular Disease [NICVD], Karachi. Mean platelet aggregation inhibition by drug [B] was 60.7% [p<0.001], while with drug [A] it was 57.8% [p<0.001], using 20 umol/LADP, which is statistically significant and comparable. Clopidogrel 600 mg as loading dose was well tolerated. Both drugs were equally effective in reducing the platelet aggregation. CLAP-IHD confirmed that drug [B] and [A] are equally effective and comparable antithrombotics in Pakistani population. The cost benefit of drug [B] should be made beneficial to the patients

Competency profile of locally manufactured clopidogrel lowplat and foreign manufactured clopidogrel plavix in patients of suspected ischemic heart disease [CLAP-IHD]

The primary objective of this study was to test the hypothesis that the antiplatelet effects of loading dose of locally manufactured clopidogrel Lowplat referred as drug [B] 600 mg [8 tablets] given once is comparable to the antiplatelet effects of loading dose of foreign manufactured clopidogrel Plavix referred as drug [A] 600 mg [8 tablets] given once in patients with suspected ischemic heart disease. This was a double blind, randomized, cross over, study, to compare the safety and efficacy of study drug [B] versus [A] in adult subjects suffering from suspected ischemic heart disease presented at National Institute of Cardiovascular Disease [NICVD], Karachi. Mean platelet aggregation inhibition by drug [B] was 60.7% [p<0.001], while with drug [A] it was 57.8% [p<0.001], using 20 micro mol/L ADP, which is statistically significant and comparable. Clopidogrel 600 mg as loading dose was well tolerated. Both drugs were equally effective in reducing the platelet aggregation. CLAP-IHD confirmed that drug [B] and [A] are equally effective and comparable antithrombotics in Pakistani population. The cost benefit of drug [B] should be made beneficial to the patients

Unanticipated hospital admission after andbulatory surgery

The unplanned admission rate is considered to be an important measure of the quality of ambulatory surgical units. The objective of our study was to evaluate the unanticipated hospital admission rate from the Surgical Day Care [SDC] unit of our university affiliated teaching hospital and to analyze the reasons for admission. A review of all unanticipated admissions over a one-year period was done. The admission rate was calculated and the reasons for admission were analysed. The overall admission rate was 4.93%. Most of the admissions were ordered by the surgeons [97%]. The main reasons for admission were patient observation indicated for various reasons [72%] and patient request [18%]. Eighty percent of the admitted patients had received general anaesthesia. Admissions were also related to the male gender [69%], age over 65 years [27%] and surgeries ending in the afternoon [69%]. On analyzing the reasons for admission, a large number of admissions were found to be due to preventable causes. We conclude that proper selection of patients, careful scheduling of lists and education of patients and clinical professionals can help to avoid many unanticipated admissions after day care surgical procedures

Perceptions of students and faculty about conventional learning and community-oriented medical education

To compare the perceptions of the students and faculty to the conventional lecture and practical-based learning [LPBL] with community-oriented-Medical Education [COME]. Design: Descriptive longitudinal study based on evaluations of two different methods. Place and Duration of Study: Dow Medical College, Karachi, March to June 2001. Subjects and All the 364 students who were admitted to Dow Medical College in the year 2001, were taught for eight weeks by the conventional lecture and practical-based learning [LPBL] method. The perceptions of students and 63 faculty members to LPBL was found by a 14-item questionnaire [containing 11 questions on the Likert Scale and 3 open-ended questions]. A four-week field trial of COME was carried out during which all other teaching was suspended. Similar questionnaires about COME were repeated for the 301 students [now present] and 63 faculty members. The responses for each question for the LPBL and COME questionnaires were compared by the Wilcoxon Signed-Rank test. Students and Faculty found COME significantly better [p<0.05] than LPBL in promoting community awareness, empathy, group interaction, life-long self-study skills, clinical relevance and not solely exam-oriented. The students also found it promotional for interest, retention of information, problem solving and communication skills. The faculty felt that clinical skills and research methodologies were learnt better by COME. Both, the students and the faculty found no significant difference by either method in understanding the topic or in the importance of the tutor's expertise. COME was perceived as more resource-intensive in terms of time, teachers and space. It was suggested that core lectures should continue side by side with COME. Both, students and faculty found COME a more clinically and socially relevant way of studying medicine than LPBL

Multiple choice questions as a single tool for assessing retention of knowledge in problem-based learning

To test if traditional multiple-choice-questions [MCQ] can be used in evaluating the retention of knowledge by two methods, problem-based learning [PBL] and lecture-based learning [LBL]. Design: An observational study. Place and Duration of Study: The study was conducted at the Dow Medical College over a period of eight months. Subjects and All 249 second year medical students attending classes were included and taught a topic of biochemistry by the LBL method. Among these students 141 were then taught another topic of biochemistry by a PBL method. A traditional MCQ test was conducted at the conclusion of each topic. Five months later, they were given a specially-designed questionnaire to find their own retention of knowledge by each method. The same two MCQ tests were repeated. Students' self-assessment was compared for both the methods by the Wilcoxon Signed-Rank test for matched samples. Paired t-test for mean MCQ scores was done to compare their scores at 0 and 5 months. No significant difference was found between their mean scores at 0 months by the PBL or LBL methods but after five months, the retest score showed that the material taught by LBL was retained more [though not significantly] than that taught by PBL, although by the students own assessment, retention by PBL was thought to be significantly higher than by LBL [p = 0.001]. There was a discrepancy between the students self-assessment of retention of knowledge and that elicited by the traditional MCQs. Thus, traditional MCQs cannot be used as a sole evaluation tool for retention of knowledge by PBL