Acute malnutrition; mid upper arm circumference [MUAC] of children

To determine the frequency of low mid upper arm circumference [MUAC] of children with acute malnutrition. This study was conducted in the department of paediatrics at Liaquat University Hospital Hyderabad from 01-06-2012 to 30-11-2012. All the children with features of malnutrition, of either gender were recruited and evaluated for their mid upper arm circumference which was measured through plastic measuring tape. During six month study period, total 135 children with acute malnutrition were studied for their mid upper arm circumference [MUAC], of which 95[70%] were males and 40[30%] were females. The mean age +/- SD of overall population was 30.24 +/- 10.57 month while the mean age of male children was 32.88 +/- 11.76 and the female child was 31.62 +/- 10.97 months. Regarding the MUAC, was low in 93[68.9%] children with acute malnutrition. The mean age +/- SD of child with low MUAC was 28.99 +/- 12.52 while the mean +/- age of male and female child with low MUAC was 27.63 +/- 10.73 and 29.85 +/- 11.64 respectively. The mean MUAC in children of acute malnutrition with low MUAC was 8.85 +/- 3.93 while it was 8.66 +/- 3.96 and 8.93 +/- 3.31 in male and female child with low MUAC respectively. The present study suggested that MUAC is appropriate and good tool for identifying severe malnutrition in children

Measles vaccine; risk factors for low antibody titers before and after single dose

To determine the rate of sero-conversion after first dose of measles immunization in children less than one year of age and to find out association between seroconversion with nutritional status, URTI, fever and diarrhea. Descriptive cross sectional study of 6 month duration conducted at outpatient department, EPI center LUH Hyderabad. Total 240 children between 9 to 12 months, who came for measles immunization were enrolled. Pre-vaccination blood samples were obtained along with assessment of nutritional status, and current associated illness like pneumonia, diarrhea and fever of each child. The post vaccination samples were taken after 3 months. Measles antibodies were estimated by using ELISA technique and titers were compared with controls supplied by manufacturers. The effectiveness of measles immunization was 87.5%. Statistical analysis proved that association sero-negativity with clinical condition was insignificant [Chi square test, P value > 0.05]. Regarding the pre-vaccinated status 222 [92.5%] were found negative for anti-measles antibodies and 18 [7.5%] were found to be with persistent maternal anti-measles antibodies. Measles immunization produces adequate immunological responses even among malnourished children however a second dose is necessary to increase the efficacy more than 95%

Impact of an IEC [Information, Education and Communication] intervention on key family practices of mothers related to child health in Jamshoro, Sindh

To determine change in practice of mothers having children less than five years of age in five key areas related to child health, growth and development including immunization, feeding during illness, appropriate home treatment for infections and care seeking behavior. This was a community based interventional study of Information, Education and Communication [/EC] intervention in the UC Jamshoro, Taluka Kotri, district Jamshoro of 15 months duration from March 2011 to June 2012. Ninety five mothers having children less than five years of age were selected by systematic random sampling for house hold based survey by questionnaire designed by EPP evaluation and health section of UNICEF during baseline and post-intervention phases. Base line data was collected from the interventional area then health education messages were given through written and pictorial material by LHWs for 9 months. To measure the impact helath education messages, data was again collected by same questionnaire are from the same union council during post-intervention phase. During baseline survey except immunization all other key family practices were poor. After 9 months of intervention of repeated heath education sessions through LHW during their routine visits all practices were improved with statistically significant difference. Regarding the comparison of the results between baseline and post-intervention surveys we found that except immunization which was already better, all those practices which requires mother's knowledge and practice were improved after our intervention with significant P-values. Improving the mother's education level is very important, to empower the first care provider of child in the community. However, in the mean time, health educational messages reteted to the limited number of key family practices should be disseminated

Serum vitamin D level in type 2 diabetic patients

To find out serum vitamin D levels in type 2 DM patients in Hyderabad. Cross sectional study. Private clinics, OPDs of government hospitals like Qasimabad, Latifabad and Pretabad. Duration: January to July 2013. Total 550 patients were selected, 450 patients [250 males and 200 females] taken from different OPDs of Hyderabad and towns or Tehsils with diagnosis of type 2 Diabetes mellitus and another 100 patients were taken as control [60 males and 40 females]. The mean age was 45.6 years. The written consent was obtained and demographic features were noted, 3cc of blood was taken for estimation of vitamin D levels. The level of vitamin D was done on an Electrochemiluminescence Immuno Assay [ECLIA] at Diagnostic and Research laboratory Liaquat University of Medical and Health sciences [LUMHS] Jamshoro, Sind. Out of 550, 450 diabetic subjects tested for vitamin D, females were 44.4%and 55.5% were males. The deficiency was seen in 33.7% patients [p <0.04] and Vitamin D insufficiency was observed in20% in both sex. In control group, the deficiency was observed in 23% in females and 20% in males while insufficiency noted in 5% in both sex. The study showed significant decreased levels of vitamin D in type 2 Diabetic subjects than normal individuals. The vitamin D deficiency increased considerably in females with diabetes type 2

Role of rapid diagnostic tests for guiding outpatient treatment of febrile illness in Liaquat university hospital

Objectives: To assess the validity /strength of clinical diagnosis of Malaria on the basis of IMNCI algorithm by slide microscopy [gold standard] and to compare the effectiveness of Rapid Diagnostic Test [RDT ]against slide microscopy

Methods: It is a descriptive cross sectional study of 6 month duration conducted at Pediatric Outpatient Department LUH Hyderabad from June-Dec. 2010. Sample of 400[the minimum required sample was 385 with malaria prevalence 5% [0.05] with margin of error of 3% [0.03, frequency vary from 2-8 % among different studies]] febrile children under 5 years classified as Suspected Clinical Malaria according to algorithm of IMNCI were included; The operational definition for Suspected Clinical Malaria was; fever for more than 2 days with no runny nose, no measel rash and no other cause of fever. Hyderabad was considered as low risk area. Rapid diagnostic test [RDT] and slide microscopy were done, and only confirmed cases were treated according to current guidelines given by National Malaria Program/updated IMNCI

Results: Total 2000 patients under 5 years presented with fever and were evaluated. From 2000 cases 20% [400] were diagnosed as suspected clinical Malaria according to IMNCI algorithm; and only 40 cases [10%] have shown positive results for malaria parasite on slide microscopy and 38 cases on RDT. Regarding the plasmodium species 70% were vivax and 30% were falciparum. As regards the effectiveness, RDT has shown 95% sensitivity for the detection of plasmodium antigens in the febrile clinically suspected cases of malaria

Conclusion: Prompt and accurate diagnosis of malaria is needed for implementation of appropriate treatment to reduce unnecessary anti-malarial prescription. RDT is as effective as slide microscopy for the diagnosis of malaria especially in resource poor countries

Severe acute maternal morbidity [SAMM] in postpartum period requiring tertiary hospital care

Postpartum period is the critically important part of obstetric care but most neglected period for majority of Pakistani women. Only life threatening complications compel them to seek for tertiary hospital care. We describe the nature of these obstetric morbidities in order to help policymakers in improving prevailing situation. To find out the frequency and causes of severe post-partum maternal morbidity requiring tertiary hospital care and to identify the demographic and obstetrical risk factors and adverse fetal outcome in women suffering from obstetric morbidities. This prospective cross-sectional study was carried out in the Department of Gynecology and Obstetrics, Liaquat University Hospital Hyderabad, between April 2008-July 2009. The subjects comprised of all those women who required admission and treatment for various obstetrical reasons during their postpartum period. Women admitted for non-obstetrical reasons were excluded. A structured proforma was used to collect data including demographics, clinical diagnosis, obstetrical history and feto-maternal outcome of index pregnancy, which was then entered and analyzed with SPSS version 11. The frequency of severe postpartum maternal morbidity requiring tertiary hospital care was 4% [125/3292 obstetrical admissions]. The majority of them were young, illiterate, multiparous and half of them were referred from rural areas. Nearly two third of the study population had antenatal visits from health care providers and delivered vaginally at hospital facility by skilled birth attendants. The most common conditions responsible for life threatening complications were postpartum hemorrhage [PPH] [50%], preeclampsia and eclampsia [30%] and puerperal pyrexia 14%. Anemia was associated problem in 100% of cases. Perinatal death rate was 27.2% [34] and maternal mortality rate was 4.8%. PPH, Preeclampsia, sepsis and anemia were important causes of maternal ill health in our population. Perinatal mortality was high

Assessment of infant feeding practices at a tertiary care hospital

To assess the practice and knowledge of mothers regarding breast feeding, complimentary feeding, and to find out socio-economic correlates of feeding practices. A cross sectional survey conducted at paediatric department of Liaquat University Hospital [LUH] from Jan-Dec 2008. During that period 500 mothers with children less than 24 months were included. Infant feeding patterns were assessed in relation to recommendations and household socio-economic factors by an Interview Technique. Out of 500 mothers, 8.4% started exclusive breast feeding [EBF] while Pre-lacteal use was seen in 31.6%. Regarding the duration 52.2% mothers continued breast feeding for 2 years. Median duration of EBF was 3.5 months. It was seen that 60% of the 0-5 month-old infants breastfed 8 or more times per day. However, exclusiveness of breast feeding decreased from 60% at [0-2 months] to 40% [3-5 months]. Majority 64.2% were poor and 61.5% had no education. There is a statistically significant difference in feeding practices of educated and uneducated [P < 0.0001] and also in poor and middle class mothers [P <0.0003]. Regarding, age of their last born babies, 180 babies were under 6 months, and 320 were 6 to 23 months of age. The knowledge about complimentary feeding [CF] was inadequate. Around 21% of 2-3 months old babies received complementary food and 19% of 6-8 month-olds were only breastfed. In 78% mothers CF was advised by family members while in 23% mothers by doctors. Exclusive breastfeeding was not maintained upto recommended age of 6 months. Knowledge about CF was lacking in the mothers. Regarding, mothers' education and socioeconomic conditions, a positive correlation was noted with feeding practices

Etiological spectrum of pancytopenia based on bone marrow examination in children

To determine the spectrum of pancytopenia with its frequency, common clinical presentation and etiology on the basis of bone marrow examination in children from 2 months to 15 years. Observational study. Department of Paediatrics, Liaquat University of Medical and Health Sciences [LUMHS], Jamshoro, from October 2005 to March 2007. All patients aged 2 months to 15 years having pancytopenia were included. Patients beyond this age limits, already diagnosed cases of aplastic anemia and leukemia, clinical suspicion of genetic or constitutional pancytopenia, history of blood transfusion in recent past, and those not willing for either admission or bone marrow examination were excluded. History, physical and systemic examination and hematological parameters at presentation were recorded. Hematological profile included hemoglobin, total and differential leucocyte count, platelet count, reticulocyte count, peripheral smear and bone marrow aspiration/biopsy. During the study period, out of the 7000 admissions in paediatric ward, 250 patients had pancytopenia on their peripheral blood smear [3.57%]. Out of those, 230 patients were finally studied. Cause of pancytopenia was identified in 220 cases on the basis of bone marrow and other supportive investigations, while 10 cases remained undiagnosed. Most common was aplastic anemia [23.9%], megaloblastic anemia [13.04%], leukemia [13.05%], enteric fever [10.8%], malaria [8.69%] and sepsis [8.69%]. Common clinical presentations were pallor, fever, petechial hemorrhages, visceromegaly and bleeding from nose and gastrointestinal tract. Pancytopenia is a common occurrence in paediatric patients. Though acute leukemia and bone marrow failure were the usual causes of pancytopenia, infections and megaloblastic anemia are easily treatable and reversible