Estimation of the contribution of private providers in tuberculosis case notification and treatment outcome in Pakistan.

To improve involvement of the private sector in the national tuberculosis (TB) programme in Pakistan various public-private mix projects were set up between 2004 and 2009. A retrospective analysis of data was made to study 6 different public-private mix models for TB control in Pakistan and estimate the contribution of the various private providers to TB case notification and treatment outcome. The number of TB cases notified through the private sector increased significantly from 77 cases in 2004 to 37,656 in 2009. Among the models, the nongovernmental organization model made the greatest contribution to case notification (58.3%), followed by the hospital-based model (18.9%). Treatment success was highest for the district-led model (94.1%) and lowest for the hospital-based model (74.2%). The private sector made an important contribution to the national data through the various public-private mix projects. Issues of sustainability and the lack of treatment supporters are discussed as reasons for lack of success of some projects.

Estimation of the contribution of private providers in tuberculosis case notification and treatment outcome in Pakistan

To improve involvement of the private sector in the national tuberculosis [TB] programme in Pakistan various public-private mix projects were set up between 2004 and 2009. A retrospective analysis of data was made to study 6 different public-private mix models for TB control in Pakistan and estimate the contribution of the various private providers to TB case notification and treatment outcome. The number of TB cases notified through the private sector increased significantly from 77 cases in 2004 to 37 656 in 2009. Among the models, the nongovernmental organization model made the greatest contribution to case notification [58.3%], followed by the hospital-based model [18.9%]. Treatment success was highest for the district-led model [94.1%] and lowest for the hospital-based model [74.2%]. The private sector made an important contribution to the national data through the various public-private mix projects. Issues of sustainability and the lack of treatment supporters are discussed as reasons for lack of success of some projects

Chlorhexidine vaginal and infant wipes to reduce perinatal mortality and morbidity: a randomized controlled trial.

OBJECTIVE: To estimate the effects of chlorhexidine vaginal and baby wipes on fetal and neonatal mortality, respectively, and infection-related morbidity. METHODS: We performed a placebo-controlled, randomized trial of chlorhexidine vaginal and neonatal wipes to reduce neonatal sepsis and mortality in three hospitals in Pakistan. The primary study outcome was a composite of neonatal sepsis or 7-day perinatal mortality. RESULTS: From 2005 to 2008, 5,008 laboring women and their neonates were randomly assigned to receive either chlorhexidine wipes (n=2,505) or wipes with a saline placebo (n=2,503). The primary outcome was similar in the chlorhexidine and control groups (3.1% compared with 3.4%; relative risk 0.91, 95% confidence interval 0.67-1.24) as was the composite rate of neonatal sepsis or 28-day perinatal mortality (3.8% compared with 3.9%, relative risk 0.96, 95% confidence interval 0.73-1.27). At day 7, the chlorhexidine group had a lower rate of neonatal skin infection (3.3% compared with 8.2%, P<.001). With the exception of less frequent 7-day hospitalization in the chlorhexidine group, there were no significant differences in maternal outcomes between the groups. CONCLUSION: Using maternal chlorhexidine vaginal wipes during labor and neonatal chlorhexidine wipes does not reduce maternal and perinatal mortality or neonatal sepsis. The finding of reduced superficial skin infections on day 7 without change in sepsis or mortality suggests that this difference, although statistically significant, may not be of major importance. LEVEL OF EVIDENCE: I.

Drug sensitivity pattern of cholera in children.

OBJECTIVE: To study the drug sensitivity pattern of cholera in children. SETTING: DTU of Civil Hospital, Karachi. PATIENTS AND METHODS: All children age 2 months to 15 years attending Diarrhoea Treatment Unit (DTU) with acute onset of diarrhoea and dehydration were screened for cholera. Stool samples were collected in alkaline peptone and those positive for cholera had their antibiotic sensitivity determined. RESULTS: Of 846 stool specimens, 161 were positive for V. Cholera. All were sensitive to third generation cephalosporins and quinolones, 98-100% to nalidixic acid, 82-86% to chloramphenicol and 67-75% to doxycycline and all were resistant to cotrimaxazole. CONCLUSION: Cholera can be treated with nalidixic acid or chloramphenical in young children while doxycycline for older children. Cotrimoxazole is not effective. Efforts should be done for identification and surveillance of cholera cases, along with change of sensitivity pattern of Vibrio cholera.

Chloroquine resistant malaria in children.

Malaria remains a major cause of childhood morbidity and mortality. The changing susceptibility of Malaria parasites to drugs means that it is no longer possible to make global generalization about its chemotherapy. This study was conducted in District Hospital, Mirpurkhas, Sindh. Over sixteen months period four hundred and six patients had slide documented malarial parasites. Sixty-five percent had plasmodium falciparum, 33% plasmodium vivax and 2% had both. Approximately, 81% responded to chloroquine while 19% were non-responders. Chloroquine non-responders were treated with halofantrine or sulfadoxine--pyrimethamine combination. P. falciparum being the dominant species and its emergence of resistance to Chloroquine, in life threatening and serious forms of malaria should be treated with parenteral quinine. Antimalarials other than Chloroquine should be reserved for non-responders. Therefore, rational use of drugs is essential.

Cefixime: an oral option for the treatment of multidrug-resistant enteric fever in children.

BACKGROUND: Enteric fever is a serious public health problem in Pakistan, where multidrug-resistant salmonellosis causes enteric fever with increased morbidity and mortality. Costly parenteral therapy and lack of an established safety profile for the use of quinolones in children necessitate evaluation of an oral treatment option. This study is meant to assess the efficacy, safety, and cost effectiveness of an oral third-generation cephalosporin (cefixime) in the treatment of multidrug-resistant enteric fever. METHODS: Between November 1993 and October 1994, 85 patients, 15 years of age or less, with culture-proven enteric fever were randomly assigned to two groups. Group A (n = 41) received cefixime at a dosage of 10 mg/kg to 12 mg/kg per day in two divided doses. Group B (n = 44) received chloramphenicol at a dosage of 100 mg/kg daily in four divided doses. Both groups were treated for 2 weeks. RESULTS: In group A, 95% (39/41) of the patients receiving cefixime responded favorably, whereas in group B, 30% (14/45) responded to chloramphenicol. The 31 patients not cured in group B were then successfully treated with cefixime. Overall, cefixime was well tolerated. Subsequent antibiogram data showed an overall multidrug-resistance rate of 78% (66/85). CONCLUSIONS: Cefixime is a safe, effective, and cheaper oral option for the treatment of multidrug-resistant enteric fever. Further studies are needed, however, to validate this observation.

Anterolateral decompression for traumatic spinal cord compression.

Nine patients with traumatic fractures of dorsolumbar spine leading to pain and neurological deficit are presented. All had radiological evidence of spinal cord or quada equina compression, with either monoparesis, paraparesis or sphincter dysfunction alone. All patients underwent anterolateral decompression through a transpleural or retroperitoneal approach. Seven patients had bone grafting and spinal stabilization with Webb-Morley system. Two patients had decompression only. The results were favourable. This approach is safe and effective and allows early mobilization and functional recovery.

Group B streptococcal osteomyelitis and septic arthritis. Its occurrence in infants less than 2 months old.

Nine infants less than 2 months of age with group B streptococcal (GBS) osteomyelitis or septic arthritis, or both, were seen from January 1975 through January 1978. The infants had local joint signs, usually in the absence of systemic signs. The bones and joints involved were equally distributed between proximal humerus and proximal and distal femur. An infant had involvement of the talus. Treatment consisted of two to three weeks of parenteral antibiotics, arthrotomy in infants with arthritis, and bone decompression in infants with osteomyelitis. Clinical follow-up showed normal growth and function of the affected joint. Of the organisms, five were typed: four were type III and one was type Ib. Group B streptococcal osteomyelitis and/or septic arthritis was the second most common late-onset GSB infection, being surpassed only by meningitis.