INTERNATIONAL JOURNAL OF ENDORSING HEALTH SCIENCE RESEARCH

Volume 4            Issue 4            December 2016

A Verbal/Social Autopsy (VASA) Child Mortality Inquiry to Investigate Under-Five Mortality Determinants in Slums of Karachi, Pakistan: A Mix Methods Interventional Study

Muhammad Bilal Siddiqui1,4, Chiu Wan Ng2, Wah Yun Low3, Shershah Syed4,5, Sadaf Ahmed4,5, Shamoon Noushad4,5, Alvira Ali4, Kisa Fatima5 & Maria Mirza5

  1. Hamdard University, Department of Community Health Sciences, Karachi, Pakistan.
  2. Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia.
  3. Health Research Development Unit, Faculty of Medicine, University of Malaya.
  4. Child Registry of Pakistan (CROP)
  5. Health Advocacy Council for Women and Children (HACWC)

Corresponding Author: drbilals@gmail.com

Abstract

Background Pakistan stands along top ten countries responsible for two-third of global child mortality burden. To improve Child Mortality (CM) estimates in Pakistan, there is an exigent need to understand the in-depth reasoning behind mortalities. In Pakistan, the data on cause-of-death (CoD) for a large number of child mortalities in Pakistan is either not available or not suitable for use. Pakistan uses an alternative technique called Verbal autopsy (VA). Since VA only determines the biological cause of death (BCoD), and does not capture multitude of other modifiable social, cultural and health system determinants, it has a limited importance. Such non-biological determinants are captured by another technique i.e. Social Autopsy (SA). Objective By integrating VA with SA, extended set of mortality related determinants will be explored, in addition to strengthening death notification coverage and assigning CoD in such missed out mortalities. Method Under the working group of Health Advocacy Council for Women and Children (HACWC) in collaboration with Child Registry of Pakistan (CROP), mixed method (QUAN-QUAL) interventional study will be carried out in urban-slums of Karachi city using VASA-integrated under-five mortality investigative technique. Parents of dead children will be interviewed. Second stage of study will be followed by qualitative interviews with different cadres of stakeholders. Expected Outcomes By focusing the specific determinants related to case-management and care-seeking process (identified by The Pathway to Survival Framework-TPtoSF) an in-depth understanding of related determinants can be achieved, which will help in crafting potential interventions required to limit the barriers that increase the chances of CM in developing nations.

downloaddownload-full-paper

Surgical Closure of ASD’s and Concomitant Procedures Needed in Adults: A 3-Year Cardiac Centre Experience

Ahson Memon, Azeem Khan, Ghufranullah Khan, Junaid Ansari,

Khalid Rasheed, Adeel Hussain & Imran Ali

Tabba Heart Institute, Karachi

Corresponding Author: ahson@aeirc-edu.com

Abstract

Objective The study aims to evaluate the surgical closure of Atrial Septal Defect (ASD) and concomitant surgical procedures needed at Cardiac Care Centre.  Introduction An ASD is a hole of variable size in the atrial septum. A patent foramen ovale that is functionally closed by overlapping of limbic tissue superiorly and the valve of the fossa oval inferiorly (in response to the normal left-to-right atrial pressure gradient) is excluded. ASDs generally permit left-to-right shunting at the atrial level. Partial anomalous pulmonary venous connection (PAPVC) is a condition in which some but not all pulmonary veins connect to the right atrium or its tributaries, rather than to the left atrium. Methodology A prospective cohort study was done at Tabba heart institute. 115 consecutive patients were reviewed and investigated. All the patients with surgical closure of ASD and concomitant surgical procedures who returned for follow-up from June 2011 to May 2016 in the study were included as population sample. Results Total ASD repair only patients were 80 and patients who needed concomitant procedures too were 35. The size of the defect ranged from 3mm to 58mm, with a mean of 26.96±11.02mm. The relative frequencies of different ASDs were secundum 57 (80.2%), primum 4 (5.6%), and sinus venosus 10 (14.08%). Major post-operative complications by Age group and by procedure were evaluated and presented. Conclusion It was concluded from our results that surgical repair of atrial septal defects and its variants is associated with very low morbidity in different age groups due to its excellent results.

 downloaddownload-full-paper

Assessment of Gestational Diabetes Mellitus Risk Factors in Local Population

Javeria Saeed1, GhazalaYasmeen1, Anjumara Hasan2 & Ahmed Raheem Bakhsh3

  1. University of Karachi, Pakistan.
  2. Hamdard Medical University, Karachi, Pakistan.
  3. Aga Khan University Hospital, Karachi, Pakistan.

Corresponding author: jvsaeed@gmail.com

Abstract

Background The gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Risk management of GDM should be done at first prenatal visit. As it is the most common metabolic complication of pregnancy, the present study was focused on finding out the risk factors of GDM in local population. Method We evaluated the risk factors of GDM in 200 females who were randomly tested for GDM with 75 g Oral glucose tolerance test (OGTT) at 24–28th weeks of pregnancy. A detailed questionnaire was administered in this cross sectional study. Results The most commonly observed risk factor was family history DM,117 patients (p<0.001and odd ratio as 40.4 [17.4 to 93.6]), obesity,113 patients (P< 0.001, odd ratio as 4.5[2.2 to 9.2]), pregnancy related stress in109 (P< 0.001, odd ratio as 4.8[2.4 to 9.5]), anemia in 88 females (P=0.003, odd ratio as 3.5[1.5 to 8.0]), history of abortions,76 (P< 0.001), odd ratio as 2.9[1.59 to 5.34]). Furthermore, stress, hypertension, lack of exercise were significantly associated risk factors of GDM. Only 93 females who had fatigue during pregnancy (P=0.718 and odd ratio as 0.88[0.45 to 1.71]) had association with development of GDM that was statistically insignificant. Conclusion The most commonly occurring risk factor of GDM in our population were obesity, family history of diabetes, stress, hypertension and lack of exercise. Unusual association was observed between iron deficiency anemia and GDM.

downloaddownload-full-paper

Prevalence of Depressive Symptoms Among Entrance Test Applicants of Mirpurkhas

Aatir H. Rajput1, Sana Ayesha2 & Saher Rafique3

  1. LUMHS Research Forum
  2. Liaquat University Hospital, Hyderabad
  3. Liaquat University of Medical & Health Sciences, Jamshoro
    Corresponding Author: rajput@gmail.com

Abstract

Background The interest of the scientific community regarding depression in students is rather new. However, case reports dating back to the seventeenth century do exist. In that era, the belief prevailed that depression rarely existed (if at all) among students but the belief is now being challenged. Our research takes the belief one step further and hypothesizes that depression is most often high during tests & exams and the highest when they are preparing for & about to appear in entrance tests. Objective Entrance tests are, without doubt, the most crucial career defining periods of a student’s life. This study aims to test this hypothesis and figure out whether the belief, that depressive symptoms are intensified during the period of entrance tests, holds truth. Methodology A cross-sectional, observational study was conducted in Mirpurkhas district. A data sample of 222 entrance test students was chosen via purposive sampling. Data was collected through a self-administered structured questionnaire (which included the Hamilton stress scale) from May to July 2014. The data was analyzed using SPSS v.16.0. Results The mean stress score of the entrance test applicants was 21.56, which indicate moderate severity. The mean stress score of females (22.43) was higher than that of males (20.82) showing that females are more severely affected. A significant proportion of applicants admitted that they consciously experienced depressive mood. The applicants also complained of other general depressive symptoms like loss of appetite, general aches, weight loss, anxiety and agitation. Health worries were also common among the entrance test applicants. Conclusions On the basis of our data we conclude that depression is common and wide array of general depressive symptoms are aggravated in entrance test applicants. This issue needs immediate attention and steps must be taken to pre-empt the future adverse health problems that can stem from this condition.

 downloaddownload-full-paper

An Epidemiological Study: Assessment of Symptomatic Osteoarthritis and its Management in General Population of Karachi with Joint Pain

Aisal Khan, Syed Muhammad Mustahsan, Quratulain Eraj, Hina Parvez, Ayesha Anwar, Munazza Ali, Sameen Iqbal, Urooj Fatima, Aiman Warsi, Tayyabah Moeen, Sundas Dastagir, Fateeha Tariq, Rehan Shamim & Hafiza Fatima Aziz

Dow University of Health Sciences, Sindh Medical College Campus

Corresponding Author: mustu198@gmail.com

Abstract

Object: To determine the frequency of symptomatic osteoarthritis in general population of Karachi presenting with joint pain. Introduction: People easily get tired due to heavy duty occupations to keep pace with the society. Arthralgia commonly called as “Joint pain” is one of the most frequently observed complain, especially in individuals aged 50 above. Methods: A cross-sectional study was conducted at Jinnah Postgraduate Medical Centre (JPMC) from 1st November 2013 to 25th November 2013. The data was collected from 316 patients presenting to the department of rheumatology and orthopedics with joint pain. A structured questionnaire was designed based on the clinical symptomatology of osteoarthritis. It was administered to the participants aged above 18 yrs. old. 17.7% of males and 82.3% of females participated in the study. Result: Out of 316 patients with joint pain, 71.2% (n=225) were diagnosed osteoarthritis on the basis of symptoms present with a high prevalence in females than males. The most common joints to be involved in osteoarthritis were found to be knee joint (90.2%) and hip joint (55.7%). The majority of the patients (n=109) had an X-ray of their joint and n=125 was getting analgesics as an effective therapy for osteoarthritis. Conclusion: The frequency of osteoarthritis is increasing in Karachi with globalization due to high level occupational stress along with recreational activity stress and other contributive factors. Female predominance as compare to that of man is quite alarming that needs to be controlled for maintaining future quality of life and providing ease for daily activities.

 downloaddownload-full-paper

Relationship of Physical stress and hypertension among Cardiovascular Disease Patients

Safdar Ali1, Hamza Akhter1, Kisa Fatima Altaf3, Shamoon Noushad3, Naila Asghar4&

Syed Saad Ahmed4,5 & Sadaf Ahmed2,3

  1. Shaheed Mohtarma Benazir Bhutto Medical College Lyari
  2. University of Karachi
  3. Advance Educational Institute and Research Centre
  4. Dow Medical College
  5. Sindh Govt. Hospital North Karachi

Corresponding Author: drhamzakk@gmail.com

Abstract

Objective The aim of the study is to find out amount of physical stress among cardiovascular disease (CVD) patients and its relation with hypertension. Background Physical stress is defined as a pressure – force and strain a state of physical mental tension. Stress is among the mental factors that has for some time been recorded among the potential. Furthermore, essential hazard variables of hypertension and coronary illness. Methodology A cross-sectional study was conducted in the patients of department of Cardiology at tertiary hospitals, Karachi, from January 2014 to December 2014. Sadaf stress scale (SSS) 2.0 was used to find out the physical stress. Results It showed physical stress among CVD patients about n=39 (43.3%) have moderate physical stress. which was decreased over time after 5 year of illness as compared to the patient who have disease for less than 5 years. While systolic blood pressure among subjects with severe physical stress showed an average systolic B.P. of 147mmhg, moderate have 146mmhg and patients with mild physical stress have 135mmhg. Conclusion This report concluded moderate physical stress among CVD patients which was decrease over time due different coping mechanism and blood pressures are directly related to severity of physical stress mainly systolic which lead to hypertension.

 downloaddownload-full-paper

Morbidity and Mortality in Methanol Poisoning: An Observational Study Conducted in Karachi

Ruhksana Sattar, M Omer Sultan, Muhammad Inam Khan, Sham Kumar, Aasima Omer & Amna

Jinnah Postgraduate Medical Centre, Karachi

Corresponding Author: M Omer Sultan

Abstract

Background Alcohol poisoning is a serious issue in both the developed and developing countries. Illicit alcohol is commonly called as moonshine or bootleg whereas in Pakistan it is ordinarily known as tharra, kuppi, desi sharab, or daroo. This alcohol is mainly prepared by fermenting the mash of sugar cane pulp in a clay pot up to near 100% alcohol, however, it may contain impurities and many toxic materials. The awareness and basic knowledge of methanol poisoning is quite scarce in our society due to the cultural aspects. The goal of our study is to identify the clinical factors associated with the alcohol poisoning along with the frequency of mortality. Methodology A cross sectional has been conducted on the patients who were admitted in the National Poison Control Centre, Jinnah Postgraduate Medical Centre, Karachi. The patients who presented in a critical condition afterwards the alcohol consumption were included in the study from the year 2011 to 2015. Result The inclusion criteria conscripted a total of 188 patients in the study amongst which majority was observed during a single outbreak in the month of September 2011. The results of the study recorded mortality in 38.83% of the study group while 35.64% indicated survival with sequelae. On the other hand, 25.53% of the patients were discharged with recovery. Conclusion Morbidity in the cases of methanol poisoning tends to be crucial and high along with an eminent rate of mortality. Sequelae from methanol poisoning predominantly involves the visual disturbances including the blindness.

 downloaddownload-full-paper

downloadVolume 4 Issue 4