Determining critical gaps in implementation of WHO and UNICEF's 7-point plan in diarrhoea control and prevention strategy: A cross sectional study in District Swabi, Pakistan.

OBJECTIVE: To determine the critical gaps in knowledge and practices of mothers/caregivers in the management of diarrhoea in children at home. METHODS: The descriptive cross-sectional study was conducted from September 2019 to August 2020 at primary health centres across Swabi district of the Khyber Pakhtunkhwa province of Pakistan, and comprised mothers/caregivers presenting with children aged <5 years suffering from diarrhoea. Barriers to childhood diarrhoea prevention and control were identified in accordance with the 7-point plan adopted by the federal government in 2009. Data was analysed using SPSS 23. RESULTS: There were 287 mothers with a mean age of 26.8±5.39 years (range: 17-42 years). The mean age of the children was 24.85±12.72 months (range: 2-55 months). Among the mothers, 145 (51.5%) had received no schooling, 83(29%) had primary level schooling, 56(19.5%) secondary level and 3(1%) had received higher-level education. Only 63(22%) were aware of the use of oral rehydration salts and 32(11%) knew about the need of using zinc in diarrhoea. Safe water was available in 14(5%) households. Hand hygiene awareness was low, as 169(59%) mothers were washing hands with soap. Household access to toilet facility was 247(86%). Preventive health services were good with overall breastfeeding practices 204(71%) and children vaccination 244(85%.). CONCLUSIONS: Majority of mothers were found to be well aware of breastfeeding practices and the children had adequate vaccination coverage. There was a wide gap in direct awareness and practices of mothers about sanitation and hygiene and also home-based management of diarrhoeal diseases in children.

Variation and succession of microbial communities under the conditions of persistent heavy metal and their survival mechanism.

This review summarizes the recent papers published about the microbial communities under the conditions of persistent heavy metals around the world. Many microbial communities' study has demonstrated intense changes in the community composition, and microbial diversity caused by heavy metals, environmental pollution as well as adaptation processes allowing survival of microbes in metal-polluted ecosystems. The effect of heavy metals such as Cu, Pb, Hg, Ni, Cd, Zn, and As on soil microbial communities in mediated soil are reviewed. The different sensitivity measurement, toxicity of metals, relative toxicity is discussed. In recent years, industrial activities have a significant influence on the environment. Especially, heavy metals such as Hg, Cr, Pb, Mn, and As, have induced seriously affected the soil microbial communities, cause diseases and even death of organisms through contaminated soils, although heavy metals in trace amounts are beneficial even significant to organisms. The effect of heavy metals on soil microbial communities is still poorly understood. That how microbial communities respond to environmental changes is a key issue in ecology. In the future further work needed to understand the microbial community under persistent heavy metals, their effects, how to reduce and decrease the microbial diversity, and resistance of specific bacterial species to heavy metals.

Rising HIV seroconversion rates & associated risks among employees of organization 'X': A case control study, Pakistan, 2017.

BACKGROUND AND OBJECTIVES: In 2004 Pakistan escalated from 'low-prevalence' to 'concentrated' phase of HIV epidemic. Despite global decline in HIV incidence since 1997, rate of HIV infections in Pakistan is persistently rising since 1990. Available literature focusses on key populations or localized outbreaks limited by short study duration and regional applicability of results. We studied HIV seroconversion trends over a period of 8 years in a geographically diverse population and evaluated associated risk factors. METHODS: A desk review of HIV surveillance data from 2010 to 2017 was carried out at Armed Forces Institute of Pathology. A case was defined as any adult employed in organization 'X', initially screened for HIV but later seroconverted on ELISA and western blot. Case-control study was conducted on cases diagnosed in 2017. Age and sex matched controls were identified from same population sub-group. Structured telephonic interviews were conducted and statistical analysis done at 5% margin of error. RESULTS: The annual HIV diagnosis rate remained relatively stable till 2015 (< 40 /100,000/yr) after which it rose sharply to 60/100,000/yr in 2016 .Upward trend continued in 2017 to reach 125/100,000/yr (>200% increase from baseline). Acquisition of HIV was significantly associated with commercial sex activities (OR=9; 95% CI: 1.25-395). CONCLUSION: HIV seroconversion rates among employees of organization X have increased significantly in the past two years. Unlike HIV outbreaks previously reported from Pakistan, sexual route seems to be the predominant mode of transmission. Focus is mandated on prevention of sexual transmission of HIV at national level as well for all vulnerable populations.

Fractional-Dose Inactivated Poliovirus Vaccine Campaign - Sindh Province, Pakistan, 2016.

Following the declaration of eradication of wild poliovirus (WPV) type 2 in September 2015, trivalent oral poliovirus vaccine (tOPV) was withdrawn globally to reduce the risk for type 2 vaccine-derived poliovirus (VDPV2) transmission; all countries implemented a synchronized switch to bivalent OPV (type 1 and 3) in April 2016 (1,2). Any isolation of VDPV2 after the switch is to be treated as a potential public health emergency and might indicate the need for supplementary immunization activities (3,4). On August 9, 2016, VDPV2 was isolated from a sewage sample taken from an environmental surveillance site in Hyderabad, Sindh province, Pakistan. Possible vaccination activities in response to VDPV2 isolation include the use of injectable inactivated polio vaccine (IPV), which poses no risk for vaccine-derived poliovirus transmission. Fractional-dose, intradermal IPV (fIPV), one fifth of the standard intramuscular dose, has been developed to more efficiently manage limited IPV supplies. fIPV has been shown in some studies to be noninferior to full-dose IPV (5,6) and was used successfully in response to a similar detection of a single VDPV2 isolate from sewage in India (7). Injectable fIPV was used for response activities in Hyderabad and three neighboring districts. This report describes the findings of an assessment of preparatory activities and subsequent implementation of the fIPV campaign. Despite achieving high coverage (>80%), several operational challenges were noted. The lessons learned from this campaign could help to guide the planning and implementation of future fIPV vaccination activities.

Effect of continued professional development on clinical performance in a public sector health care setting.

OBJECTIVE: To determine the effectiveness of intervention by education of doctors in improving the referral rate and quality in a public-sector healthcare setting. METHODS: The quasi-experimental study was conducted from March to September 2012 at PNS Rahat Hospital in naval sailors' residential estate, Karsaz, Karachi. Two awareness sessions were held three months apart by a gynaecologist and a paediatrician. The sessions were aimed at communicating the consultant practice to female general practitioners employed at the two family welfare centres. Pre- and post-intervention data was collected manually from the record registers at the two centers as well as gynaecology and paediatrics outpatient clinics. RESULTS: The study comprised 10 female GPs. In paediatric clinic, there was 47% (118 post intervention/ 187 pre intervention) reduction in referrals for acute gastroenteritis and fever of unknown origin (32 post intervention/75 pre intervention). In gynaecology, 30% (50 post intervention/61 pre intervention) reduction was seen in referrals for severe anaemia in 2nd and 3rd trimesters of pregnancy, and an increase in referrals (35 post intervention/19 pre intervention) for high-risk cases indicating better counselling and case identification. Improved standard of counselling was also reflected by 31% reduced referrals (40 post intervention/ 58 pre intervention) for hyper-emesis gravidarum during the first trimester. The difference in referrals was not statistically significant (p>0.05) for paediatrics, but it was highly significant (p<0.001) for gynaecology. CONCLUSIONS: Healthcare system can function optimally with focus on referral standards and by improving the communication between the primary care physicians and consultants.

Perceptions of undergraduate medical students regarding case based learning and tutorial format.

OBJECTIVE: To evaluate the perception of medical students regarding tutorial and case-based learning formats. METHODS: The within stage mixed model research was conducted at the Army Medical College, National University of Sciences and Technology, Islamabad, Pakistan, from April 2012 to March 2013, and comprised medical students of 4th year. Data-collection tool was a self-developed questionnaire, and it was statistically analysed using SPSS 16. RESULTS: Of the 144 students, 86(60%) were males. The overall age range was 21.5-23.4 years. Case-based learning method had significantly higher scores compared to tutorial method for learning process (p<0.001), for behavioural influence of facilitators (p<0.001), for group dynamics (p<0.001), and for learning environment (p<0.001). For open-ended questions regarding like or dislike of the two methods, majority named some faculty members as their role models and appreciated their support in better and in-depth learning through case-based learning format. CONCLUSIONS: Case-based learning format was significantly more appreciated and favoured as a learning strategy by students.

Proportion of exposure of passive smoking in teenage group and symptoms precipitated after exposure to second hand smoke.

Exposure of passive smoking and second hand smoke (SHS) exposure in teenage group results in precipitation of several symptoms. Five hundred teenagers between ages of 13 - 19 studying in Army Public School and College Westridge, Rawalpindi, were selected for descriptive cross-sectional study from September 2012 till February 2013. Out of the total 500, 279 (55.8%) were exposed to passive smoking while 221 (44.2%) were not exposed to passive smoking. Out of the exposed 279 (55.8%) students, males were 132 (47.3%) and females were 147 (52.7%) with mean age of 15.06 ± 1.805 years. After exposure to SHS, multiple responses were observed. Statistical significant association was found between symptoms precipitation and exposure to SHS. Nose irritation was present in 84, while 195 did not complain of it (p = 0.002). Allergic symptoms were precipitated with SHS in 42, while not in 21 students (p < 0.001). Asthma attack was precipitated in 38, while 241 did not experience precipitation of asthma attack (p < 0.001). More cough was present in 168, while not in 111 students (p = 0.037). Nausea was present in 41, while not in 238 (p < 0.001). Nose irritation was seen in 84 and not in 195 students (p = 0.002). More than half of the teenagers had exposure to passive smoking. Statistical significant association was found between passive smoking exposure and precipitation of symptoms.

Frequency of co-existence of dengue and malaria in patients presenting with acute febrile illness.

OBJECTIVE: To find out the frequency of co-existence of malaria and dengue fever in patients presenting with acute febrile illness. METHODS: The descriptive cross-sectional study was conducted at the Military Hospital Rawalpindi from June to November 2012. A total of 500 patients with complaint of acute febrile illness were selected after applying the inclusion and exclusion criteria. Preliminary data was collected on a pretested proforma. Blood samples of patients were tested for dengue serology and malaria parasite. Results were entered in respective proforma. Co-existence was considered present when a patient had both dengue serology and malaria parasite slide positive. SPSS 20 v was used for data analysis. RESULT: Of the total, 349 (69.8%) were males and 151 (30.2%) females. Dengue serology was positive in 16 (3.2%); 81(16.2%) had malaria parasite slide positive; 403 (80.4%) had none of the two findings. Co-existence of both dengue and malaria was nil among the whole sample. In males, 67 (13.4%) had malaria, while 11 (2.2%) had dengue. In females, 14 (2.8%) had malaria, while 5 (1%) suffered from dengue fever. CONCLUSION: Co-existence of dengue and malaria was zero per cent in 500 patients visiting Military Hospital Rawalpindi. More studies shall be conducted to find out whether the reason of having zero per cent co-existence is that dengue or/and malaria epidemic did not occur in 2012 or whether there are some other factors involved.