Determinants of severe acute malnutrition among children under five years in a rural remote setting: a hospital based study from district Tharparkar-Sindh, Pakistan

Objectives: To understand and catalogue the specific determinants of this alarming rate of malnutrition among children of Tharparkar district, Sindh Pakistan

Methods: This was a hospital based analytical survey. Data was collected through a semi-structured questionnaire by interviewing mothers of the children [age 6-59 months], admitted in the hospital. Following WHO guidelines, weight and length/ height of 105 children were recorded. Study was conducted in District Headquarters Hospital, Tharparkar district of Sindh province

Results: Almost 48% children admitted in the hospital were identified with severe acute malnutrition. More males [55%] were malnourished as compared to females [45%]. Maternal education, household income, family size, breastfeeding, vaccination status, and frequent infections were found to be significantly associated with the severe acute malnutrition

Conclusion: Specific interventions on promoting exclusive breastfeeding, vaccination, and timely health care seeking behaviors would definitely improve the outcomes. Nevertheless, sector wide approaches would be needed on girls' education, poverty, and food security in the district in order to address the issue of malnutrition

Capacity building on health diplomacy: a training experience from Pakistan

Modern-day globalization means that many health issues cannot be resolved by the affected country alone, and this necessitates political consultations, diplomatic negotiations and cross-border solutions. A few examples that require health diplomacy efforts are: halting resentment towards immunization, addressing the burden of noncommunicable diseases, enabling access to drugs and technology, and liberalizing trade to reduce the cost of drugs. The agenda of Sustainable Development Goals [SDGs] demands a concerted effort to achieve the ambitious targets. This article reports the experience of health diplomacy training imparted to mid-level and senior officials in the public as well as private sector in Pakistan. Training was geared to inculcate an understanding of global health diplomacy and governance, and to develop an appreciation of the relationship of global health with other disciplines such as foreign affairs, economics, trade, climate change and human rights. Participants included health professionals, experts from departments other than health, government officials and diplomats. This training was expected to enhance their knowledge of health systems dynamics that are influenced by foreign policy and diplomatic discourses

Frequency of anemia in pregnancy and its association with socio-demographic factors in women visiting a tertiary care hospital in Rawalpindi

Objective: The objective was to find out the frequency of anemia during pregnancy and its association with the different socio-economic factors

Study Design: A descriptive cross-sectional study

Place and Duration of Study: District headquarter hospital Rawalpindi, from September-November 2015

Material and Methods: The pre-diagnosed 196 pregnant anemic women were included in the study. Grand multipara pregnant women, anemia due to bleeding disorders and having chronic illnesses were excluded from the study. The pretested questionnaire along with Pakistan Social Living Standards Measurements [PSLM] prepared poverty score card was used. The study variables age, maternal education, abortions, parity and poverty were studied. The data collected were analyzed through SPSS 20.0 and Chi-square test was used to find out association between demographic variables and severity of anemia at a significance level of p< 0.05

Results: The frequency of anemia in the sample [n=196] observed as mild, moderate and severe +was 34.2% [67], 64.3% [126] and 1.5% [3] respectively. The mean [SD] hemoglobin recorded was 8.9 +/- 0.9g/dl [range=6.2- 10.9g/dl]. The mean [SD] age in the sample was 23.7+/- 4.2 years [range=17-40 years] while 92% [182] of the subjects were below poverty line. Majority of the pregnant anemic women were illiterate constituting 56.6% [111] of the total sample

Conclusion: There was a strong association between poverty, illiteracy, previous history of abortions, age and severity of anemia. Education, poverty, illiteracy, access to fortified sources, iron supplementation, deworming, and access to clean drinking water and sanitation, insecticides infections, inadequate nutrient intake all factors must be improved for success of anemia prevention strategies in developing countries like Pakistan

Contraceptive use and unmet need of family planning among illiterate females of working class in Rawalpindi

Objective: To determine the frequency of contraceptive use among illiterate employed females and to determine the frequency and causes of unmet need of family planning

Study Design: Descriptive cross sectional study

Place and Duration of Study: Rawalpindi city from Jun to Nov 2015

Material and Methods: Three hundred and sixty six illiterate and employed married women in the reproductive age group were approached using non probability purposive sampling. They were interviewed by the researchers through a pretested questionnaire. SPSS version 20 was used for data entry and analysis

Results: Frequency of respondents using contraception was found to be 56%, 48.9% for the modern and 7.1% for traditional methods. Unmet need of contraception was 17.6%. The main causes of unmet need were unwillingness of husband and fear of side effect. Un met need was found to be significantly lower in the couples where spouses mutually discussed the family planning, where females were high earners, or where women were having their own business while no significant association of unmet need was found with family type

Conclusion: Although there is high unmet need of family planning and low contraceptive prevalence rate [CPR] among illiterate working women, having a paid job seems to improve female's control on family planning issues when compared to CPR of illiterate women in general

Comparison of diagnostic accuracy of non-invasive tests for helicobacter pylori infection in children

To compare urea breath and stool antigen in children, with hisotological diagnosis for helicobacter pylori [H.pylori] infection. Cross-sectional study. From June 2005 to December 2005 carried out at KRL Hospital, Islamabad and Children Hospital, PIMS, Islamabad. Children between 3 and 15 years of age reporting in pediatric outpatient department with upper gastrointestinal symptoms were included. All the participating children underwent an upper gastrointestinal endoscopy and 3 tests namely: histopathological identification of H.pylori [the traditional gold standard], urea breath test and stool antigen test were carried out on each child. The sensitivity, specificity, and positive predictive values were calculated for each noninvasive test used in the study. A total of 54 patients completed the study with a mean age of 8.2 years. On histological examination, 725 [39] were positive for H.pylori infection. On gross endoscopic examination, only 9 patients had signs of gastritis as compared to 39 histological positives. The sensitivity, specificity and positive predictive value of stool antigen test were: 77%, 73% and 89% respectively whereas the same for urea breath test: 79%, 80% and 91% respectively. Both the noninvasive tests were found to be sensitive and specific as compared with histological identification, for the diagnosis of H.pylori in our pediatric population. The accuracy of urea breath test was better than the stool antigen test but later was easier to perform and could fulfill the criteria for a rapid bedside diagnostic test

Serum zinc levels and effects of oral supplementation in pregnant women

To evalmicroate the effects of oral zinc smicropplementation on the sermicrom zinc levels of pregnant women. Experimental [domicroble blinded randomized controlled trial]. PIMS and KRL Hospital, Islamabad, and commmicronity in tehsil Kahmicrota from April 2003 to April 2004. Pregnant women of 10 to 16 weeks gestation were invited to enter the stmicrody on their booking visit. A sample size of 125 in each gromicrop was calcmicrolated. After taking an informed consent, they were assigned to control or test gromicrop by simple random sampling techniqmicroe. A detailed qmicroestionnaire was filled-microp by trained staff and initial evalmicroation along with sermicrom zinc samples was collected. The smicrobjects were given either zinc smicrolphate powder, eqmicroivalent to 20 mg elemental zinc, or were given placebo treatment along with romicrotine smicropplements. These patients were followed microp thromicroghomicrot the pregnancy by health care providers and their compliance was monitored. At delivery, sermicrom samples were again collected for zinc estimation. The data was entered on compmicroter, cleaned and analyzed. Paired t-test was microsed for comparison of means. The data of 242 smicrobjects was analyzed at the end of the stmicrody. The mean age of the stmicrody participants was 25.7 +/- 4.8 years [range 16 to 40]. Both the gromicrops were similar in other demographic variables as socioeconomic statmicros, edmicrocation, BMI, height and weight. One-third of the patients had sermicrom zinc levels below 64microg/dl at the start of the stmicrody. A 128 pairs of pre and post-sermicrom zinc levels were analyzed in the two gromicrops [64 pairs in each gromicrop] to compare the means. The zinc smicropplemented women showed a mean increase of 14.7 microg/dl [95% CI 5-23] [P=0.002]. On the other hand the non-smicropplemented gromicrop showed an actmicroal decrease in the sermicrom zinc level which, however, did not reach statistical significance [P=0.47]. Oral zinc smicropplementation of pregnant women with 20 mg elemental zinc was effective in raising the sermicrom levels of zinc. It is smicroggested that smicropplementation trials with larger dose of zinc shomicrold be carried omicrot

Adherence of private practitioners with the National Tuberculosis Treatment guidelines in Pakistan: a survey report

In Pakistan, over 80% of the patients suffering from TB consult a private practitioner for the initial evaluation. A cross-sectional survey was conducted in seven thickly populated urban communities of Rawalpindi district to evaluate the adherence of private practitioners with TB treatment guidelines as laid down by National Tuberculosis Control Programme [NTP] in Pakistan. The data was collected over 30 days. A young lean man was simulated to act as a TB patient and was provided with a chest X-ray suggestive of TB and two Acid-Fast Bacilli [AFB] positive sputum reports. Only those prescriptions were included for analysis which either had recognized the patient having TB or had any TB drug written in the prescription. A total of 77 practitioners were visited. Prescriptions of 53 general practitioners fulfilled the inclusion criteria and were analyzed. Only 2 [3.7%] prescriptions out of 53 met the required standard for TB patients as laid down by NTP. Eighty three% [n = 44] favored a combination drug for the treatment while the rest preferred individual preparations. The study reflects the lack of knowledge about standardized TB treatment protocols amongst the private practitioners in Pakistan. Public Private Partnerships between government public health departments and non-governmental organizations working in public health can be a valuable tool in generating mass awareness campaigns

Control of burkholderia [pseudomonas] bacteraemia in the intensive care and paediatric units

Investigation and control of nosocomial bacteraemia caused by Burkholderia [Pseudomonas] cepacia in the Intensive Care and Paediatric Units of a general care hospital. Design: A cross-sectional analytical study. Place and Duration of Study: Departments of Pathology, Intensive Care and Paediatrics, Kahota Research Laboratory Hospital, Islamabad from January 1998 to June 2002. Subjects and Blood cultures from patients admitted to Intensive Care Unit and Paediatric Ward were inoculated into brain heart infusion broth and incubated for upto 10 days. Any Gram-negative rods isolated were characterized by API-20E. Environmental samples were inoculated on blood and MacConkey's agars and isolates, if any, were identified as above. Intensive intervention in the form of hand washing, strict adherence to aseptic practices and standard sterilization techniques were adopted and then cultures were again carried out with similar methodology. Cultures yielded 58 strains of Burkholderia cepacia, 52 from blood cultures and 6 from hospital environment, including 1 from the washbasin of the ICU. Thirty- four of these were isolated before intervention measures were adopted, mainly during 1998. Findings suggested a strong probability of nosocomial transmission, with washbasin as the common source. After a lapse of about a year, B. cepacia infection re-emerged in a sporadic form but remaining confined to paediatric unit. Only 18 isolates were yielded over the next two and-a-half years. The intervention measures for Burkholderia bacteraemia within the hospital, proved effective in stopping the nosocomial transmission leading to disappearance of B. cepacia from blood cultures. We emphasize the crucial role of hand hygienic practices in the hospital setting, especially in critical care units

Incidence of infection in peripheral intravenous cannulas

To evaluate the incidence of infection in the peripheral intravascular devices of hospital. Design: An exploratory study conducted prospectively. Place and Duration of Study: It was conducted at KRL General Hospital, Islamabad over a period of six months. Subjects and Intravenous cannula tips from 69 hospitalized patients selected at random with age range from newborn to 70 years were immediately cultured on blood agar and MacConkey's media and classified according to API 20E scheme by a trained pathologist. Blood cultures could be obtained in 33 [47.8%] patients only. Chi square test was used for statistical analysis. Out of the 69 cannula cultures 40.57% showed positive isolates. The most common organism isolated was Staphylococcus aureus [11.59%] followed by Coagulase negative staphylococcus [CONS] 8.69%, bacillus species 8.69% and Burkholdaria cepacia 4.34%. Among 33[47.8%] patients from whom blood cultures were obtained, only 5 [15.1%] showed positive growth. The use of cannula for > 72 hours but < 5 days was not associated with a significantly higher number of positive cultures [P value > 0.1]. Similarly, use of antibiotics did not decrease the infection rate in cannulas as compared to cannulas used for other purposes [P value > 0.1]. Intravascular devices could be an important portal of entry for nosocomial infection if appropriate care is not observed during the procedure. A single cannula can be used up to five days without any hazard of infection. Awareness and advantages of aseptic techniques should be promoted regarding the potential complications of intravascular devices among all health workers

audit of pediatric upper gastrointestinal endoscopies

One hundred upper gastrointestinal endoscopies were performed in 90 children [age ranging from 2 months to 12 years, Mean: 7 years 2 months] over a period of 18 months, by the pediatricians, at the adult endoscopy unit of KRL Hospital, Islamabad. We used an Olympus GIF N30 fibreoptic endoscope with an external diameter of 5mm. Fifty-four% of our patients were female where as the major indications were recurrent upper abdominal pain [n=36], chronic diarrhoea [n=28], short stature/failure to thrive [n=13], portal hypertension [n=5], and GI bleeding [n=3] and other [n=12]. Sixty-three endoscopies were carried out under general anaesthesia, 9 patients needed mild sedation and the rest of the 28 children did not need any sedation or anaesthesia. No complications were observed during or after the procedure. In total 67 antral biopsies, 60 duodenal biopsies and 5 sclerotherapies were performed. The histological diagnosis were gastritis [64%] of antral biopsies, coeliac disease [55%] and duodenitis [16.6%] incase of duodenal biopsies. Pediatric GI endoscopy is invaluable and can be successfully. Performed by pediatricians, in an adult endoscopy unit, at centers where separate pediatric setups are not available

Massive foetomaternal haemorrhage resulting in severe neonatal anaemia

A case of massive foetomaternal haemorrhage [FMH] is presented which resulted in diminished foetal movements and severe neonatal anaemia. An emergency caesarian section was performed in a 37 weeks pregnant woman with poor foetal activity and non-reactive foetal heart rate of unexplained etiology. A baby boy with severe anaemia [Hb 5.7 g/dl] having no signs of haemolysis was delivered. The blood film of the baby showed normoblastaemia and reticulocytosis. Kliehaur test on mother revealed 4% foetal red cells, confirming massive FMH. The baby required repeated packed red cell transfusions during his stay in the hospital. He was discharged symptom free with a Hb of 13.4 g/dl. In this case the baby had a good clinical course. Early diagnosis and prompt intervention are mandatory in cases of massive FMH for good prognosis

Blood lead levels in preschool children in Rawalpindi

Blood lead levels were determined in preschool children residing in Urban areas of Rawalpindi city. Of 92 [50 males and 42 females] children aged one to 5 years were included in the study. Blood lead levels ranged from 7 ug/dl to 34 ug/dI [mean 18.8 ug/dI]. The mean lead levels were slightly higher in males [20.3 ug/dI] than in females [17.2 ug/dl] and over 90% children had lead levels above the acceptable limit of 10 ug/dl. Use of leaded petrol, contaminated surma, leaded paints and pica in children are common in our country and may lead to increased lead levels and appropriate measures should be taken to control this trend