Risk Factors of Crimean-Congo Hemorrhagic Fever in Sindh Province, Pakistan.

OBJECTIVES: In Sindh Province, Pakistan, confirmed Crimean Congo hemorrhagic fever (CCHF) increased from zero in 2008 to 16 in 2015-2016. To counter this increase, in 2016, we initiated structured CCHF surveillance to improve estimates of risk factors for CCHF in Sindh and to identify potential interventions. METHODS: Beginning in 2016, all referral hospitals in Sindh reported all CCHF cases to surveillance agents. We used laboratory-confirmed cases from CCHF surveillance from 2016 to 2020 to compute incidence rates and in a case-control study to quantify risk factors for CCHF. RESULTS: For the 5 years, CCHF incidence was 4.2 per million for the Sindh capital, Karachi, (68 cases) and 0.4 per million elsewhere. Each year, the onset of new cases peaked during the 13 days during and after the 3-day Eid al Adha festival, when Muslims sacrificed livestock, accounting for 38% of cases. In Karachi, livestock for Eid were purchased at a seasonal livestock market that concentrated up to 700,000 livestock. CCHF cases were most common (44%) among the general population that had visited livestock markets (odds ratio = 102). CONCLUSIONS: Urban CCHF in Sindh province is associated with the general public's exposure to livestock markets in addition to high-risk occupations.

Mid-upper arm circumference only protocol in Pakistan: missed opportunities for children suffering from severe acute malnutrition? A mixed-methods observational study.

OBJECTIVE: We investigated the missed treatment opportunities affecting programmes using mid-upper arm circumference (MUAC) as the sole anthropometric criterion for identification and monitoring of children suffering from severe acute malnutrition (SAM). DESIGN: Alongside MUAC, we assessed weight-for-height Z-score (WHZ) in children screened and treated according to the national MUAC only protocol in Pakistan. Besides, we collected parents' perceptions regarding the treatment received by their children through qualitative interviews. SETTING: Data were collected from October to December 2021 in Tando Allah Yar District, Sindh. SUBJECTS: All children screened in the health facilities (n 8818) and all those discharged as recovered (n 686), throughout the district, contributed to the study. All children screened in the community in the catchment areas of five selected health facilities also contributed (n 8459). Parents of forty-one children randomly selected from these same facilities participated in the interviews. RESULTS: Overall, 80·3 % of the SAM cases identified during community screening and 64·1 % of those identified in the health facilities presented a 'WHZ-only' diagnosis. These figures reached 93·9 % and 84·5 %, respectively, in children aged over 24 months. Among children treated for SAM and discharged as recovered, 25·3 % were still severely wasted according to WHZ. While parents positively appraised the treatment received by their children, they also recommended to extend eligibility to other malnourished children in their neighbourhood. CONCLUSION: In this context, using MUAC as the sole anthropometric criterion for treatment decisions (referral, admission and discharge) resulted in a large number of missed opportunities for children in need of timely and adequate care.

An Investigation of Selected Socio-Demographic Factors with Aplastic Anemia in Pakistan: A Case-Control Study.

INTRODUCTION: In Pakistan, the incidence rate of aplastic anemia is 3.5 cases/million. The associated risk factors are exposure to pesticides, chemicals, and some drugs. The link between aplastic anemia and socio-demographic factors is debatable. PURPOSE: We conducted this study to investigate the role of socio-economic and -demographic factors with aplastic anemia. METHODOLOGY: A total of 191 lab-confirmed incident cases of aplastic anemia were identified from the tertiary hospital of Karachi-Pakistan in between 2015 and 2018. Age and gender-matched 694 controls were randomly selected from the same institute admitted or visited for other non-neoplastic conditions. Socio-demographic and exposure information was gathered using a data collection form. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were computed for selected socio-demographic factors. RESULTS: Among socio-demographic factors, significant associations of aplastic anemia risk emerged for illiteracy (aOR: 2.3; 1.5; 3.5) occupation (any type) (aOR: 2.1; 1.7; 2.5), living in rural environments (aOR: 2.9; 1.9; 4.2). The odds of aplastic anemia increased with the age group 31-50 years (aOR: 1.8; 1.7; 3.5) and >50 years (aOR: 2.5; 2.1; 4.2). We observed no association of income with the risk of aplastic anemia. CONCLUSION: This study highlights the importance of socio-demographic factors as a risk factor for the development of aplastic anemia in the population of Pakistan. In order to reduce disease incidence, health education program and use of personal protective equipment and organization of screening camps in high-risk population is warranted.

Pesticides and Chemicals as Potential Risk Factors of Aplastic Anemia: A Case-Control Study Among a Pakistani Population.

INTRODUCTION: Aplastic anemia is a rare and potentially life-threatening hematological disorder with incidence of 1.4 to 14 cases/million. It is associated with exposures to certain environmental chemicals, drugs and infections. The objective was to investigate the association of illness with family history of aplastic anemia, exposure to pesticides and chemicals. METHODOLOGY: A hospital-based case-control study (191 cases, 696 controls) was conducted from 1st January 2015 to 31st December 2018 in Karachi, Sindh. Cases were patients with diagnosis of aplastic anemia confirmed with bone marrow biopsy. Controls neither had aplastic anemia nor other hematological chronic diseases. An in-person interview was conducted to collect demographic information, family history of aplastic anemia, and history of pesticide and chemical exposure. The adjusted odds ratios (aOR) with 95% confidence intervals (CI) were estimated via SPSS v22. RESULTS: A total of 191 confirmed aplastic anemia cases were selected. Mean age was 29 years (range: 4-69) and predominantly there were males 129 (67.5%). The majority, 84 (44.0%), of the cases were aged 16-30 years. In multivariate analysis models, the significant associations were observed between aplastic anemia with family history of aplastic anemia (aOR=13.3, 95% C.I 3.66-48.50), exposure to pesticides (aOR=2.1, 95% C.I 1.23-3.61) and chemicals (aOR=3.6, 95% C.I 2.06-6.34). CONCLUSION: This study observed a significant association of aplastic anemia with family history of aplastic anemia, exposure to pesticide and insecticide exposure. However, to establish this connection, further longitudinal studies are warranted.

A review of septic induced abortion cases in one year at Khyber Teaching Hospital, Peshawar.

BACKGROUND: Working in a tertiary level hospital we get complicated cases as a result of termination or attempts at termination of unwanted pregnancies. Most of the patients that we get are complicated and need expensive treatments including surgery. This study was conducted to assess the out come of septic induced abortion cases in a year. METHODS: It was conducted at the Department of Obstetrics and Gynaecology, unit B, Khyber Teaching Hospital, Peshawar, from 1.7.01 to 30.6.02. The data of a total of 28 patients admitted as emergency cases with septic induced abortion in above period were collected. History, management given, post operative care, complications and associated morbidity and mortality were taken into account and result compiled. RESULTS: 78.5% patients with unsafe abortions were multi gravida. Termination was attempted at home or other small centers. 57%, had history of surgical interference, 28.5% had used a mechanical device. 78.5% patients needed evacuation and curettage, 42% had laparotomy for visceral injuries. 15% patients had a subtotal hysterectomy. 57% patients had associated complications. 7.5% patients who came with septicemic shock died. CONCLUSION: Septic induced abortion is an important contributor to maternal morbidity and mortality, increasing the burden on not only the patients but health workers and their resources. However, it is preventable, and we suggest commitment to health education, family planning promotion and bringing down the rates of unsafe abortions as solutions to the problems.