Hospital and community validation of a screening instrument for detection of neurodisability in Indian children aged 6 months to 2 years.

OBJECTIVE: To develop and validate a screening instrument for neurological disorders in children aged 6 months to 2 years in the community. METHODS: A comprehensive parent-administered instrument was developed to screen for hearing, vision, seizures, motor deficits and development in Indian children aged 6-24 months. This was tested for reliability and validated in the hospital setting by comparing with pre-decided gold standards. It was then used in a community survey in a two-phase design in which all screen positives and a random sample of screen negatives were validated. RESULT: The screening instrument had overall sensitivity, specificity and positive predictive values of 95.8, 68.1 and 76.1%, respectively, in the hospital setting. In the field setting, these figures changed to 95.4, 51.8 and 20.6%, respectively. The reasons for this are discussed. CONCLUSION: Community surveys must use a two-phase design to get the true prevalence. A falsely high prevalence will be computed if only a single-phase design or hospital validation is used.

Verbal autopsy of maternal deaths in two districts of Pakistan--filling information gaps.

In Pakistan, the vital registration system is weak, and population-based data on the maternal mortality ratio are limited. This study was carried out to collect information on maternal deaths from different existing sources during the current year-2007 (prospective) and the past two years--2005 and 2006-(retrospective), identify gaps in information, and critically analyze maternal deaths at the community and health-facility levels in two districts in Pakistan. The verbal autopsy questionnaire was administered to households where a maternal death had occurred. No single source had complete data on maternal deaths. Risk factors identified among 128 deceased women were low socioeconomic status, illiteracy, low-earning jobs, parity, and bad obstetric history. These were similar to the findings of earlier studies. Half of the women did seek antenatal care, 34% having made more than four visits. Of the 104 women who died during or after delivery, 38% had delivered in a private facility and 18% in a government facility. The quality of services in both private and public sectors was inadequate. Sixty-nine percent of deaths occurred in the postpartum period, and 51% took place within 24 hours of delivery. The study identified gaps in reporting of maternal deaths and also provided profile of the dead women and the causes of death.

Effect of fiber bread on the management of diabetes mellitus.

OBJECTIVE: To evaluate the effects of soluble fiber rich bread on lowering blood glucose, blood pressure and blood lipid levels. DESIGN: An interventional study. PLACE AND DURATION OF STUDY: The study was undertaken at Medical Unit III, Jinnah Postgraduate Medical Centre, Karachi. Duration of the project was one year (1997-1998). SUBJECTS AND METHODS: Twenty stable diabetics of both genders were included in this study. They were provided with this bread (test diet) to replace their usual breakfast bread and chapati for lunch and dinner. The intakes of other foods as well as medications were unchanged. Anthropometric measurements, fasting and 2 hours postprandial blood sugar, fasting serum cholesterol and triglyceride levels were recorded before and after 4 weeks of intervention. Blood sugar and blood pressure were checked every week. Quality of life was assessed subjectively with the help of questionnaire, which were asked before and after the end of the intervention. RESULTS: Glycemic control, both fasting and postprandial, improved significantly during intervention. Satisfactory reduction of blood pressure as well as serum cholesterol and triglyceride level was also observed in these cases. The medicines reduced significantly and quality of life improved in all subjects. None of these subjects complained any gastrointestinal discomfort during their consumption of this bread for 4 weeks. CONCLUSION: The use of soluble fiber rich bread helps to control blood sugar, the hyperlipidemia, and blood pressure which are elevated in poorly controlled diabetics. Thus, integrated improvement will improve the quality of life, reduce the cost of drugs as well as help to avoid harmful effect of drugs.

Longitudinal growth patterns of Pakistani infants in a clinic based growth promotion program.

OBJECTIVE: To describe the operation of growth monitoring and promotion (GMP) clinic and longitudinal growth patterns of children. DESIGN: Prospective observation and intervention. SETTING: Outpatient department of a teaching hospital. METHODS: Less than 6 months old infants were registered at GMP clinic and followed for up to two years of age. Mothers were provided information, education and counselling about healthy growth of their infants. The outcome measure was change in weight after follow-up. RESULTS: We enrolled a cohort of 553 children in the first 6 months of life, of which 318 were males. Mean follow up period was 15.7 (SD+/-6.4) months. At enrollment 207 were underweight [weight-for-age Z score (WAZ<-2], of which 153 were from low-income families. The children from poorer families also gained weight regularly, although it was less than the higher income families. Of 346 infants with normal weight at registration, 305 maintained their weight gain by last follow-up visit. Of 207 underweight infants at enrollment 128 improved their weight gain by the last follow-up visit. Overall 433 infants followed-up at our GMP clinic either maintained or improved their weight gain. CONCLUSIONS: Children at risk of undernutrition should be identified at an early age and through effective interaction between health workers and the family, their growth can be improved. Children of poor families can also benefit from this activity, provided a comprehensive approach is made available.

Frequency of hepatitis C in obstetric cases.

OBJECTIVE: To compare the frequency of antihepatitis C virus (HCV) after single blood transfusion, multiple blood transfusion and in non-transfused obstetric cases. DESIGN: A comparative descriptive study. PLACE AND DURATION OF STUDY: The Department of Obstetric and Gynaecology, Jinnah Postgraduate Medical Centre, during the period of one-year from January 2002 to December 2002. PATIENTS AND METHODS: Patients included in the study after single transfusion were 38, after multiple transfusion 39, and controls 120. History of patients regarding all the relevant information and clinical examination were recorded on a specially-designed and coded proforma. Anti-HCV was detected by Roche HCV EIA 2nd generation kit method in all cases and controls. Descriptive statistics and frequency of anti HCV in each group was calculated using SPSS version 10. RESULTS: Frequency of anti-HCV among patients with single blood transfusion was 13.2% (5), with multiple transfusion was 15.4% (6) and 6.6% (8) in non-transfused subjects. CONCLUSION: Anti-HCV frequency after one pint blood was almost same (13.2%) as after multiple transfusion (15.4%). This positively provided a firm argument for the necessity of a nationwide blood donor screening for anti-HCV by most sensitive immunoassay. Equally important was the need for clear cut indication for single blood transfusion.

Risk factors for gall bladder cancer in Karachi.

BACKGROUND: Frequency of gallbladder cancer in Karachi has been reported to be 8% and that from other parts of Pakistan varies between 6-7%. This is very high as compared with the Western studies. With this in mind a case control study was designed to identity risk factors responsible for gallbladder cancer. METHODS: This case control study included 107 histologically proven cases of gall bladder cancer from Jinnah Postgraduate Medical Center, Civil Hospital and two private hospitals of Karachi. Age and sex matched controls were of two types. Those with and without cholelithiasis screened sonographically. Demographic, socio-economic factors, life-style, dietary habits and dietary intake were recorded on a proforma. The cases and controls were compared for various factors using odds Ratio. RESULTS: Among 107 cancer cases 27 were males and 80 females (M:F = 1:3). Mean age of males was 59 years (range 35-82 years) and females 53 years (range 31-70 years). One hundred and five (98%) had associated choleliathiasis. Important risk factors appeared to be gallstones, high parity, young age at first delivery, low fiber and Vitamin A intake (p < 0.01), high fat intake (p < 0.01), prolonged fasting hours/habit of missing dinner (OR:6.8), using repeatedly boiled or improperly stored ghee or oil (OR:2.6). CONCLUSIONS: According to this case-control study major risk factors for gall bladder cancer were gallstones, dietary malpractices and poorly balanced diet. Poorly stored/processed food acts as a promoter in the presence of gall stones and may favour cancer development.