Strategies to avert preventable mortality among mothers and children in the Eastern Mediterranean Region: new initiatives, new hope

We conducted an assessment of maternal, newborn and child health and progress towards achieving Millennium Development Goals [MDG] 4 and 5 in the Eastern Mediterranean Region [EMR]. We provide recommendations for scaling up and sustaining gains post-2015. Data were obtained from global data repositories. We constructed time trends from 1990 to 2013 and evaluated inequities across the Region. Under-5, neonatal and maternal mortality rates decreased 46%, 35%, and 50% respectively from 1990 to 2013. Pneumonia and diarrhoea accounted for 50% of all post-neonatal deaths; pregnancy- and delivery-related complications were the leading causes of neonatal and maternal deaths. Coverage of maternal, newborn and child health interventions is suboptimal, and poverty, food insecurity and conflict are pervasive across the Region. The EMR has made progress but is unlikely to attain MDG 4 and 5 targets. To sustain and further accelerate gains, the Region must reduce inequities and scale up implementation of recommendations made by the independent Expert Review Group

Self-reported feeding advice by physicians for common childhood lllnesses

A nutritious diet is important for recovery during illnesses. Dietary advice by physicians and consumption of food by the patients are often based upon their hot and cold concepts and beliefs about various foods rather than on scientific basis. To look at the food-advising behaviour of physicians during illnesses and to know the maternal concepts about various foods being hot or cold. A questionnaire was served to the physicians participating in a continuous medical education session held at the Aga Khan University and Hospital, asking them to write the foods they advise or restrict during different illnesses such as fever, jaundice etc. Mothers of sick children suffering from diarrhea and other illnesses were also interviewed to know their concepts about various foods. Six [10%] out of sixty physicians believed in hot and cold concepts of the food. A variety of common foods were either restricted or strongly recommended by 10% to 50% of these physicians without any scientific basis, 23% physicians restricted fatty foods in jaundice, 17% physicians restricted in cough and cold. Although the interviewed mothers believed in hot-cold concepts of food but 55-63% of them were not sure what is meant by hot or cold food. In spite of that 70-80% of these mothers classified chicken, meat, egg, brinjal, masoor and mangoes are hot foods and rice, yogurt, moong, banana and orange as cold foods. Hot-Cold concept of food exists not only in mothers but also in physicians. Proper education regarding food intake is mandatory for both mothers and physicians to ascertain adequate intake of calories during sickness

Lactose intolerance in persistent diarrhea during childhood: the role of a traditional rice-lentil [khitchri] and yogurt diet in nutritional management

Lactose intolerance is frequently encountered in children with persistent diarrhoea [PD]. Selection of an appropriate milk-based formulation is a major management problem in the developing world. In a consecutive series of studies, we evaluated the role of feeding a traditional rice-lentil [khitchri] diet alone [KY] or in combination with either soy formula [KY-Soy] a dilute buffalo milk [KY-B], in children [age 6 months-3 years] with PD. Serial observations of stool output, caloric intake and weight gain of these children over a 14 day period indicated satisfactory tolerance of the KY diet with adequate weight gain. The weight gain and stool output was however higher in lactose intolerant children, with the worst results seen with K-Y and buffalo milk combination. While lactose intolerant children with PD do have higher. rates of therapeutic failure, our data indicates that a traditional diet and yogurt combination can be used satisfactorily for nutritional rehabilitation in over 80% of such children

Pediatric prescribing in Karachi

To assess amount of drug overuse we studied drug prescribing for common childhood problems by 65 general practitioners [GPs] and 29 paediatricians. A total of 2433 encounters between GPs or paediatricians and children under five years of age were observed. The presenting complaints were fever in 18%, cough in 9%, both fever and cough in 21%, vomiting in 20% and diarrhoea in 41% of encounters. Antibacterials were prescribed in 49% of encounters, analgesics and antipyretics in 29%, antiemetics in 8% and injectables in 15%. Antidiarrhoeals were prescribed in 41% encounters with children reported to have diarrhoea. Ampicillin and cotrimoxazole were the two common antibacterials prescribed by both GPs and paediatricians. Antibacterials were prescribed in significantly larger number of encounters with GPs than in those with paediatricians. Mean encounter time of patients with GPs was 3.4 +/- 2.7 minutes and with paediatricians 9.7 +/- 4.1 minutes

Profile and risk factors for congenital heart disease

Congenital heart disease is an important cause of infant mortality and disability. The frequency, spectrum and contributory risk factors for significant cardiovascular malformations among live-births was retrospectively evaluated at the Aga Khan University Hospital. Of a total of 8331 live births between July, 1987 and December, 1992 34 babies were diagnosed to have congenital heart disease in the neonatal period giving a prevalence of 4 per 1000 live births. Ventricular septal defects was the most common [n = 10, 29%] abnormality. Eight cases had associated chromosomal abnormality, the most common being Trisomy 21. Maternal abortions, still-births, consanguinity and diabetes mellitus were not found to be significant risk factors for congenital heart disease in this survey

Down's Syndrome in Pakistan: presentation and prevalence in a defined birth cohort

Evaluation of prevalence of Down's syndrome in a defined birth cohort and relationship to maternal age and clinical presentation. methods: retrospective case - control study in a birth cohort at the Aga-Khan University Hospital from July1987- December 1994. during this period 22 cases of Down's syndrome were delivered at AKUH. The prevalence of Down's syndrome among pakistani babies bron at AKUH was 1 in 550 lives birth. The associaation of Down's syndrome cases with Down's syndrome, 31% were diagnosed in the neonatal period to have congenital heart disease, 13% had musculoskeletal abnormalities and gastrointestinal abnormalities. The prevalence of 1: 550 live births in this birth cohort is comparable to other regional data and highlights the importance of this disorder. There is a continuing need for adopting need for adopting screening techniques for down's syndrome among elderly mothers in our population