ORCID Profile
0000-0001-8840-8323
Current Organisation
University of New South Wales
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Publisher: SAGE Publications
Date: 02-2017
Abstract: A higher incidence of neonatal tetanus implies failure of the vaccination program in Pakistan. The objective of this study was to assess knowledge, attitudes and practices related to tetanus toxoid (TT) vaccine in women of childbearing age. We performed a cross-sectional survey in peri-urban Karachi, Pakistan, among women of childbearing age, stratified into three mutually exclusive groups as: married pregnant married non-pregnant and unmarried. Descriptive and inferential analyses were performed to estimate vaccine coverage and knowledge attributes. A total of 450 women participated, of which the largest proportion were married and non-pregnant (n = 185/450, 41%). Over 50% of women (n = 258/450) had not received TT vaccine. Most unmarried women (n = 139, 97%) were unvaccinated. Non-vaccination predictors included: women aged years without any formal education (adjusted odds ratio [OR], 2.1 95% confidence interval [CI], 1.0–4.4), lack of knowledge about free vaccination (adjusted OR, 4.0 95% CI, 1.64–10.20), poor knowledge of tetanus disease/vaccination (adjusted OR, 4.6 95%, 2.2–9.6), living with extended family (adjusted OR, 2.0 95% CI, 1.04–3.96) family non-supporting vaccination (adjusted OR, 5.7 95% CI, 2.3–13.9) and husband/other family member deciding upon issues related to women’s health (adjusted OR, 2.9 95% CI, 1.3–6.6). Low coverage of TT vaccine is largely influenced by poor knowledge, family structure and family decision-making in the local communities of Pakistan.
Publisher: Springer Science and Business Media LLC
Date: 13-01-2020
DOI: 10.1186/S13063-019-3829-Y
Abstract: Acute diarrhoea is a common cause of illness and death among children in low- to middle-income settings. World Health Organization guidelines for the clinical management of acute watery diarrhoea in children focus on oral rehydration, supplemental zinc and feeding advice. Routine use of antibiotics is not recommended except when diarrhoea is bloody or cholera is suspected. Young children who are undernourished or have a dehydrating diarrhoea are more susceptible to death at 90 days after onset of diarrhoea. Given the mortality risk associated with diarrhoea in children with malnutrition or dehydrating diarrhoea, expanding the use of antibiotics for this subset of children could be an important intervention to reduce diarrhoea-associated mortality and morbidity. We designed the Antibiotics for Childhood Diarrhoea (ABCD) trial to test this intervention. ABCD is a double-blind, randomised trial recruiting 11,500 children aged 2–23 months presenting with acute non-bloody diarrhoea who are dehydrated and/or undernourished (i.e. have a high risk for mortality). Enrolled children in Bangladesh, India, Kenya, Malawi, Mali, Pakistan and Tanzania are randomised (1:1) to oral azithromycin 10 mg/kg or placebo once daily for 3 days and followed-up for 180 days. Primary efficacy endpoints are all-cause mortality during the 180 days post-enrolment and change in linear growth 90 days post-enrolment. Expanding the treatment of acute watery diarrhoea in high-risk children to include an antibiotic may offer an opportunity to reduce deaths. These benefits may result from direct antimicrobial effects on pathogens or other incompletely understood mechanisms including improved nutrition, alterations in immune responsiveness or improved enteric function. The expansion of indications for antibiotic use raises concerns about the emergence of antimicrobial resistance both within treated children and the communities in which they live. ABCD will monitor antimicrobial resistance. The ABCD trial has important policy implications. If the trial shows significant benefits of azithromycin use, this may provide evidence to support reconsideration of antibiotic indications in the present World Health Organization diarrhoea management guidelines. Conversely, if there is no evidence of benefit, these results will support the current avoidance of antibiotics except in dysentery or cholera, thereby avoiding inappropriate use of antibiotics and reaffirming the current guidelines. Clinicaltrials.gov, NCT03130114 . Registered on April 26 2017.
Publisher: Elsevier BV
Date: 08-2021
Publisher: Hindawi Limited
Date: 08-09-2012
DOI: 10.5402/2012/540495
Abstract: Objective . The objective of the study was to examine the pattern of low birth weight LBW, maternal complications, and its related factors among Arab women in Qatar. Design . This is a prospective hospital-based study. Setting . The study was carried out in Women’s Hospital, Doha. Subjects and Methods . Pregnant women in their third trimester were identified in the log book of Women’s Hospital and recruited into the study during first week of January 2010 to July 2011. Only 1674 (out of 2238) Arab women (74.7%) consented to participate in this study. Data on clinical and biochemistry parameters were retrieved from medical records. Follow-up data on neonatal outcome was obtained from labor room register. Results . The incidence of LBW ( g) was 6.7% among Arab women during 2010 in Qatar. Distribution of gestational diabetes mellitus (GDM), antepartum hemorrhage (APH), maternal anemia, premature rupture of membrane (PROM), maternal occupation, parity, sheesha smoking, and parental consanguinity were significantly different ( P 0.05 ) between mothers of LBW and normal birth weight NBW (≥2500 g) babies. Multivariable logistic regression analysis revealed that previous LBW, consanguinity, parity, smoking shesha, GDM, APH, anemia, PROM, maternal occupation, and housing condition were significantly associated with LBW adjusting for gestational age. Conclusion . Maternal complications such as GDM, APH, anemia, PROM, and smoking shesha during pregnancy are significantly increasing the risk of LBW outcome. Screening and prompt treatment for maternal complications and health education for smoking cessation during routine antenatal visits will help in substantial reduction of LBW outcome.
Publisher: Mark Allen Group
Date: 02-12-2016
Publisher: Oxford University Press (OUP)
Date: 11-2020
DOI: 10.1093/CID/CIAA1323
Abstract: Clinicians have limited therapeutic options for enteric as a result of increasing antimicrobial resistance, and therefore typhoid vaccination is recommended as a preventive measure. As a part of the Surveillance for Enteric Fever in Asia Project (SEAP), we investigated the extent measured the burden of antimicrobial resistance (AMR) among confirmed enteric fever cases in Bangladesh, Nepal, and Pakistan. From September 2016–September 2019, SEAP recruited study participants of all age groups from its outpatient, inpatient, hospital laboratory, laboratory network, and surgical sites who had a diagnosis of febrile illness that was either suspected or blood culture confirmed for enteric fever. Antimicrobial resistance of isolates was determined by disc diffusion using Clinical and Laboratory Standard Institute cut-off points. We reported the frequency of multidrug resistance (MDR)(resistance to icillin, cotrimoxazole, and chlor henicol), extensive drug resistance (XDR) (MDR plus non-susceptible to fluoroquinolone and any 3rd generation cephalosporins), and fluoroquinolone (FQ) and azithromycin non-susceptibility. We enrolled 8,705 blood culture confirmed enteric fever cases: 4,873 (56%) from Bangladesh, 1,602 (18%) from Nepal and 2,230 (26%) from Pakistan. Of these, 7,591 (87%) were Salmonella Typhi and 1114 (13%) were S. Paratyphi. MDR S. Typhi was identified in 17% (701/4065) of isolates in Bangladesh, and 1% (19/1342) in Nepal. In Pakistan, 16 % (331/2084) of S. Typhi isolates were MDR, and 64% (1319/2074) were XDR. FQ nonsusceptibility among S. Typhi isolates was 98% in Bangladesh, 87% in Nepal, and 95% in Pakistan. Azithromycin non-susceptibility was detected in 77 (2%) in Bangladesh, 9 (.67%) in Nepal and 9 (.59%) isolates in Pakistan. In Pakistan, three (2%) S. Paratyphi isolates were MDR no MDR S. Paratyphi was reported from Bangladesh or Nepal. Although AMR against S. Paratyphi was low across the three countries, there was widespread drug resistance among S. Typhi, including FQ non-susceptibility and the emergence of XDR S. Typhi in Pakistan, limiting treatment options. As typhoid conjugate vaccine (TCV) is rolled out, surveillance should continue to monitor changes in AMR to inform policies and to monitor drug resistance in S. Paratyphi, for which there is no vaccine.
Publisher: The World Academic Publishing
Date: 26-06-2013
DOI: 10.5963/PHF0202003
Publisher: Elsevier BV
Date: 09-2022
Publisher: Hindawi Limited
Date: 2013
DOI: 10.1155/2013/269038
Abstract: Aim . The aim was to compare body mass index (BMI), waist circumference (WC), waist hip ratio (WHR), and waist height ratio (WHtR) to identify the best predictor of metabolic syndrome (MetS) among Qatari adult population. Methods . A cross-sectional survey from April 2011 to December 2012. Data was collected from 1552 participants followed by blood s ling. MetS was defined according to Third Adult Treatment Panel (ATPIII) and International Diabetes Federation (IDF). Receiver operating characteristics (ROC) curve analysis was performed. Results . Among men, WC followed by WHR and WHtR yielded the highest area under the curve (AUC) (0.78 95% CI 0.74–0.82 and 0.75 95% CI 0.71–0.79, resp.). Among women, WC followed by WHtR yielded the highest AUC (0.81 95% CI 0.78–0.85 & 0.79 95% CI 0.76–0.83, resp.). Among men, WC at a cut-off 99.5 cm resulted in the highest Youden index with sensitivity 81.6% and 63.9% specificity. Among women, WC at a cut-off 91 cm resulted in the highest Youden index with the corresponding sensitivity and specificity of 86.5% and 64.7%, respectively. BMI had the lowest sensitivity and specificity in both genders. Conclusion . WC at cut-off 99.5 cm in men and 91 cm in women was the best predictor of MetS in Qatar.
Publisher: Elsevier BV
Date: 12-2018
Publisher: Informa UK Limited
Date: 10-2013
DOI: 10.2147/TACG.S49875
Publisher: Elsevier BV
Date: 04-2020
Publisher: Wiley
Date: 31-07-2021
DOI: 10.1111/JVH.13574
Abstract: The World Health Organization 2030 targets for hepatitis C virus (HCV) elimination include diagnosing 90% of people with HCV and treating 80% of people diagnosed with HCV. This systematic review assessed reported data on the HCV care cascade in various countries and populations, with a focus on direct‐acting antiviral (DAA) treatment uptake. Bibliographic databases and conference presentations were searched for studies reporting the HCV care cascade (DAA treatment uptake was a requirement) among the overall population with HCV or sub‐populations at greater risk of HCV. Population‐based studies, with participants representative of a city, province/state or country were eligible. Twenty eligible studies were included, reporting HCV care cascade in 28 populations/sub‐populations from 11 countries. DAA treatment uptake at national levels was reported from Iceland (95%), Egypt (92%), Georgia (79%), Norway (18%) and Sweden (8%), and at sub‐national levels from the Netherlands (52%), Canada (50%), the United States (29%) and Denmark (5%). Among people with HIV‐HCV co‐infection, DAA treatment uptake was 62% in Canada, 44% in the Netherlands, 21% in Switzerland and 18% in the United States. Among people who inject drugs, DAA treatment uptake was 50% in Georgia, 40% in Canada, 37% in Australia and 13% in the United States. Data among people experiencing homelessness were only available from the United States (treatment uptake: 12%–14%). We found no eligible study reporting HCV care cascade data in prisons. Relatively few countries reported HCV care cascade at the national level. DAA treatment uptake was widely varied across populations/sub‐populations, with higher rates reported in recent years.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2019
Publisher: Hindawi Limited
Date: 07-2020
DOI: 10.1111/DTH.13685
Publisher: Walter de Gruyter GmbH
Date: 28-09-2012
Abstract: Objective: To prospectively ascertain Qatar’s national perinatal mortality rate (PMR) during 2011, compare it with recent data from selected high-income countries, and analyze trends in Qatar’s PMR between 1990 and 2011 using historical data. Study design: A national prospective cohort study. Methods: National data on live births, stillbirths, and early neonatal mortality (day 0–6) were collected from all public and private maternity units in Qatar (1 st January–December 31 st 2011) and compared with historical perinatal mortality data (1990–2010) ascertained from the database of maternity and neonatal units of Women’s Hospital and annual reports of Hamad Medical Corporation (HMC). For inter-country comparison, country data were extracted from the World Health Statistics published by WHO in 2011 and from the European Perinatal Health Report published by the Europeristat project in 2008. Results: A total of 20,725 births (20,583 live births plus 142 stillbirths) were recorded during the study period. Qatar’s national PMR during 2011 was 9.55 [early neonatal mortality rate (ENMR) 2.7 and stillbirth rate (SBR) 6.85], which was a significant improvement from a PMR of 13.2 in 1990 [risk ratio (RR) 0.72, 95% confidence interval 0.58–0.89, P=0.002]. This improvement in PMR was more significant in ENMR (P .001) than in SBR (P=0.019). The stillbirths constituted 55% of PMR in 1990, which increased to 71.72% of PMR during 2011. The RR of PMR had a significant downwards trend between 1990 and 2011 (P=0.016). Qatar’s 2011 PMR, SBR, and ENMR are comparable to those of selected high-income counties. Conclusions: Qatar’s PMR, ENMR, and SBR have significantly improved between 1990 and 2011, and are currently comparable to those of selected high-income countries. An in-depth research to assess the correlates and determinants of stillbirth and perinatal mortality in Qatar is indicated.
Publisher: Medknow
Date: 2012
Abstract: The aim of this study was to determine the prevalence and associated risk factors of antepartum hemorrhage (APH) in the third trimester of Arab women residing in Qatar and their neonatal outcome. A prospective hospital-based study was conducted in the Women's Hospital and Maternity Clinics. The study was based on pregnant women in the third trimester from the first week of January 2010 to April 2011. A total of 2,056 pregnant women, who had any kind of maternal complications, were approached and 1,608 women (78.2%) expressed their consent to participate in the study. The questionnaire covered variables related to socio-demographic factors, family history, medical history, maternal complications and neonatal outcome. Multiple logistic regressions were used to describe the association between socio-demographic factors and APH. The overall prevalence of APH among Arab women residing in Qatar was 15.3% with 6.7% among Qatari's and 8.6% among non-Qatari Arab women the difference in ethnicities was not significant. Among maternal socio-demographic characteristics, lower education (primary or below AOR 1.72 95%CI 1.22-2.43, and intermediate education AOR 1.41 95%CI 0.88-2.26 P=0.005) compared to university education was significantly associated with APH. As for maternal biological characteristics, family history of G6PD (AOR 1.87 95% CI 1.18-2.95 P=0.007) and family history of Down's Syndrome (AOR 1.88 95%CI 1.35-2.62 P=<0.001) were significantly associated with APH at the multivariable level family history of hypertension (OR 1.78 95%CI 1.30-2.44 P<0.001) was significant at the univariate level. Neonatal outcomes as a result of APH included increased risk of Apgar score at 1 minutes <7 (AOR 1.44 95%CI 1.12-2.02 P=0.04) and minor congenital anomaly (AOR 2.82 95%CI 1.39-5.71 P=0.004). Qatar has a high prevalence of APH. Poor education, family history of hypertension, G6PD and Down's syndrome were found to be significantly associated with increased risk of APH in Qatar. Neonates of APH are at significantly increased risk of adverse outcome. Thus it is essential that obstetricians are alerted to these risk factors for early detection and to decrease the negative effects of APH.
Publisher: Oxford University Press (OUP)
Date: 05-07-2018
Publisher: TechKnowledge General Trading LLC
Date: 2014
DOI: 10.12816/0006073
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.IJID.2018.12.007
Abstract: To assess the effectiveness of 10-valent pneumococcal conjugate vaccine (PCV10) against invasive pneumococcal disease (IPD) due to vaccine serotypes of Streptococcus pneumoniae post introduction of the vaccine into the routine immunization program in Pakistan. A matched case-control study was conducted at 16 hospitals in Sindh Province, Pakistan. Children aged <5years (eligible to receive PCV10) who presented with radiographically confirmed pneumonia and/or meningitis were enrolled as cases. PCR for the lytA gene was conducted on blood (for radiographic pneumonia) and cerebrospinal fluid (for meningitis) s les to detect S. pneumoniae. The proportion of IPD due to vaccine serotypes (including vaccine-related serogroups) was determined through serial multiplex PCR. For each case, at least five controls were enrolled from children hospitalized at the same institution, matched for age, district, and season. Of 92 IPD patients enrolled during July 2013 to March 2017, 24 (26.0%) had disease caused by vaccine serotypes. Most case (87.5% of 24) and control (66.4% of 134) children had not received any PCV10 doses. The estimated effectiveness of PCV10 against vaccine-type IPD was 72.7% (95% confidence interval (CI) -7.2% to 92.6%) with at least one dose, 78.8% (95% CI -11.9% to 96.0%) for at least two doses, and 81.9% (95% CI -55.7% to 97.9%) for all three doses of vaccine. The vaccine effectiveness point estimates for PCV10 were high and increased with increasing number of doses. However, vaccine effectiveness estimates did not reach statistical significance, possibly due to low power. The findings indicate the likely impact of vaccine in reducing the burden of vaccine-type IPD if vaccine uptake can be improved.
Publisher: Elsevier BV
Date: 08-2022
Publisher: Oxford University Press (OUP)
Date: 06-11-2017
Abstract: We assessed immunity against polioviruses induced with a new Pakistani poliovirus immunization schedule and compared it to alternative poliovirus immunization schedules. Newborns were randomized to undergo vaccination based on 1 of 5 vaccination schedules, with doses administered at birth and at 6, 10, and 14 weeks of age. Arm A received inactivated poliovirus vaccine (IPV) at all time points. Arm B received bivalent oral poliovirus vaccine (bOPV) at all time points. Arms C and D received bOPV at the first 3 time points and bOPV plus IPV at the final time point (the current schedule). Arm E received trivalent OPV (tOPV) at all time points. At 22 weeks of age, all children received 1 challenge dose of tOPV, and children in arm D received 1 additional IPV dose. Sera were analyzed for the presence of poliovirus neutralizing antibodies at birth and 14 and 22 weeks of age. Seroconversion for poliovirus type 1 (PV1) at 22 weeks of age was observed in 80% of in iduals in arm A, 97% in arm B, 94% in arm C, 96% in arm D, and 94% in arm E for PV2, seroconversion frequencies were 84%, 19%, 53%, 49%, and 93%, respectively and for PV3, seroconversion frequencies were 93%, 94%, 98%, 94%, and 85%, respectively. The current immunization schedule in Pakistan induced high seroconversion rates for PV1 and PV3 however, it induced PV2 seroconversion in only half of study subjects. There is a growing cohort of young children in Pakistan who are unprotected against PV2 and this creates an increasing risk of a large-scale outbreak of poliomyelitis caused by circulating vaccine-derived PV2.
Publisher: Oxford University Press (OUP)
Date: 11-2020
DOI: 10.1093/CID/CIAA1336
Abstract: The objective of this study was to estimate the cost of illness from enteric fever (typhoid and paratyphoid) at selected sites in Pakistan. We implemented a cost-of-illness study in 4 hospitals as part of the Surveillance for Enteric Fever in Asia Project (SEAP) II in Pakistan. From the patient and caregiver perspective, we collected direct medical, nonmedical, and indirect costs per case of enteric fever incurred since illness onset by phone after enrollment and 6 weeks later. From the health care provider perspective, we collected data on quantities and prices of resources used at 3 of the hospitals, to estimate the direct medical economic costs to treat a case of enteric fever. We collected costs in Pakistani rupees and converted them into 2018 US dollars. We multiplied the unit cost per procedure by the frequency of procedures in the surveillance case cohort to calculate the average cost per case. We collected patient and caregiver information for 1029 patients with blood culture–confirmed enteric fever or with a nontraumatic terminal ileal perforation, with a median cost of illness per case of US $196.37 (IQR, US $72.89–496.40). The median direct medical and nonmedical costs represented 8.2% of the annual labor income. From the health care provider perspective, the estimated average direct medical cost per case was US $50.88 at Hospital A, US $52.24 at Hospital B, and US $11.73 at Hospital C. Enteric fever can impose a considerable economic burden in Pakistan. These new estimates of the cost of illness of enteric fever can improve evaluation and modeling of the costs and benefits of enteric fever prevention and control measures, including typhoid conjugate vaccines.
Publisher: Elsevier BV
Date: 08-2023
Publisher: Oxford University Press (OUP)
Date: 29-07-2020
DOI: 10.1093/CID/CIAA367
Abstract: Building on previous multicountry surveillance studies of typhoid and others salmonelloses such as the Diseases of the Most Impoverished program and the Typhoid Surveillance in Africa Project, several ongoing blood culture surveillance studies are generating important data about incidence, severity, transmission, and clinical features of invasive Salmonella infections in sub-Saharan Africa and South Asia. These studies are also characterizing drug resistance patterns in their respective study sites. Each study answers a different set of research questions and employs slightly different methodologies, and the geographies under surveillance differ in size, population density, physician practices, access to healthcare facilities, and access to microbiologically safe water and improved sanitation. These differences in part reflect the heterogeneity of the epidemiology of invasive salmonellosis globally, and thus enable generation of data that are useful to policymakers in decision-making for the introduction of typhoid conjugate vaccines (TCVs). Moreover, each study is evaluating the large-scale deployment of TCVs, and may ultimately be used to assess post-introduction vaccine impact. The data generated by these studies will also be used to refine global disease burden estimates. It is important to ensure that lessons learned from these studies not only inform vaccination policy, but also are incorporated into sustainable, low-cost, integrated vaccine-preventable disease surveillance systems.
Publisher: Elsevier BV
Date: 09-2021
DOI: 10.1016/J.VACCINE.2021.08.051
Abstract: Enteric fever, caused by Salmonella Typhi and S. Paratyphi, is a cause of high morbidity and mortality among children in South Asia. Rising antimicrobial resistance presents an additional challenge. Typhoid Conjugate Vaccines (TCV) are recommended by the World Health Organization for use among people 6 months to 45 years old living in endemic settings. This study aimed to assess the effectiveness of TCV against culture-confirmed S. Typhi in Lyari Town, Karachi, Pakistan. This peri-urban town was one of the worst affected by the outbreak of extensively drug resistant (XDR) typhoid that started in November 2016. A matched case-control study was conducted following a mass immunization c aign with TCV at three key hospitals in Lyari Town Karachi, Pakistan. Children aged 6 months to 15 years presenting with culture-confirmed S. Typhi were enrolled as cases. For each case, at least 1 age-matched hospital control and two age-matched community controls were enrolled. Adjusted odds ratios with 95% confidence intervals (CIs) were calculated using conditional logistic regression. Of 82 typhoid fever patients enrolled from August 2019 through December 2019, 8 (9·8%) had received vaccine for typhoid. Of the 164 community controls and 82 hospital controls enrolled, 38 (23·2%) community controls and 27 (32·9%) hospital controls were vaccinated for typhoid. The age and sex-adjusted vaccine effectiveness was found to be 72% (95% CI: 34% - 88%). The consumption of meals prepared outside home more than once per month (adjusted odds ratio: 3·72, 95% CI: 1·55- 8·94 p-value: 0·003) was associated with the development of culture-confirmed typhoid. A single dose of TCV is effective against culture confirmed typhoid among children aged 6 months to 15 years old in an XDR typhoid outbreak setting of a peri-urban community in Karachi, Pakistan.
Publisher: Elsevier BV
Date: 12-2018
Publisher: International Global Health Society
Date: 29-05-2021
Publisher: Medknow
Date: 2017
Publisher: Springer Science and Business Media LLC
Date: 12-05-2012
Publisher: American Society of Tropical Medicine and Hygiene
Date: 04-05-2022
Abstract: Typhoid fever is endemic in Pakistan, with high annual incidence rates. An outbreak of extensively drug-resistant typhoid fever that first started in the Hyderabad district of Sindh province in November 2016 immediately spread to the whole province. We conducted an age-matched case–control study to assess the risk factors of typhoid fever in an outbreak setting of Lyari Town, Karachi. We enrolled 82 patients with blood culture-confirmed Salmonella typhi between August 2019 to December 2019, 82 age-matched hospital and 164 age-matched community control subjects. In a matched conditional logistic regression model, consumption of meals outside the home more than once per month was associated significantly with developing culture-confirmed typhoid fever compared with no consumption of food outside the home (odds ratio, 4.11). Hygiene of the environment in which food is prepared, practices of adult food handlers, access to clean water, and food legislation play significant roles in the spread of typhoid fever.
Publisher: Oxford University Press (OUP)
Date: 05-07-2023
Abstract: Bacterial pathogens cause substantial diarrhea morbidity and mortality among children living in endemic settings, yet antimicrobial treatment is only recommended for dysentery or suspected cholera. AntiBiotics for Children with severe Diarrhea was a 7-country, placebo-controlled, double-blind efficacy trial of azithromycin in children 2–23 months of age with watery diarrhea accompanied by dehydration or malnutrition. We tested fecal s les for enteric pathogens utilizing quantitative polymerase chain reaction to identify likely and possible bacterial etiologies and employed pathogen-specific cutoffs based on genomic target quantity in previous case-control diarrhea etiology studies to identify likely and possible bacterial etiologies. Among 6692 children, the leading likely etiologies were rotavirus (21.1%), enterotoxigenic Escherichia coli encoding heat-stable toxin (13.3%), Shigella (12.6%), and Cryptosporidium (9.6%). More than one-quarter (1894 [28.3%]) had a likely and 1153 (17.3%) a possible bacterial etiology. Day 3 diarrhea was less common in those randomized to azithromycin versus placebo among children with a likely bacterial etiology (risk difference [RD]likely, −11.6 [95% confidence interval {CI}, −15.6 to −7.6]) and possible bacterial etiology (RDpossible, −8.7 [95% CI, −13.0 to −4.4]) but not in other children (RDunlikely, −0.3% [95% CI, −2.9% to 2.3%]). A similar association was observed for 90-day hospitalization or death (RDlikely, −3.1 [95% CI, −5.3 to −1.0] RDpossible, −2.3 [95% CI, −4.5 to −.01] RDunlikely, −0.6 [95% CI, −1.9 to .6]). The magnitude of risk differences was similar among specific likely bacterial etiologies, including Shigella. Acute watery diarrhea confirmed or presumed to be of bacterial etiology may benefit from azithromycin treatment. NCT03130114.
Publisher: American Society for Microbiology
Date: 07-03-2018
Abstract: Antibiotic resistance is a major problem in Salmonella enterica serovar Typhi, the causative agent of typhoid. Multidrug-resistant (MDR) isolates are prevalent in parts of Asia and Africa and are often associated with the dominant H58 haplotype. Reduced susceptibility to fluoroquinolones is also widespread, and sporadic cases of resistance to third-generation cephalosporins or azithromycin have also been reported. Here, we report the first large-scale emergence and spread of a novel S . Typhi clone harboring resistance to three first-line drugs (chlor henicol, icillin, and trimethoprim-sulfamethoxazole) as well as fluoroquinolones and third-generation cephalosporins in Sindh, Pakistan, which we classify as extensively drug resistant (XDR). Over 300 XDR typhoid cases have emerged in Sindh, Pakistan, since November 2016. Additionally, a single case of travel-associated XDR typhoid has recently been identified in the United Kingdom. Whole-genome sequencing of over 80 of the XDR isolates revealed remarkable genetic clonality and sequence conservation, identified a large number of resistance determinants, and showed that these isolates were of haplotype H58. The XDR S . Typhi clone encodes a chromosomally located resistance region and harbors a plasmid encoding additional resistance elements, including the bla CTX-M-15 extended-spectrum β-lactamase, and carrying the qnrS fluoroquinolone resistance gene. This antibiotic resistance-associated IncY plasmid exhibited high sequence identity to plasmids found in other enteric bacteria isolated from widely distributed geographic locations. This study highlights three concerning problems: the receding antibiotic arsenal for typhoid treatment, the ability of S . Typhi to transform from MDR to XDR in a single step by acquisition of a plasmid, and the ability of XDR clones to spread globally. IMPORTANCE Typhoid fever is a severe disease caused by the Gram-negative bacterium Salmonella enterica serovar Typhi. Antibiotic-resistant S . Typhi strains have become increasingly common. Here, we report the first large-scale emergence and spread of a novel extensively drug-resistant (XDR) S . Typhi clone in Sindh, Pakistan. The XDR S . Typhi is resistant to the majority of drugs available for the treatment of typhoid fever. This study highlights the evolving threat of antibiotic resistance in S . Typhi and the value of antibiotic susceptibility testing and whole-genome sequencing in understanding emerging infectious diseases. We genetically characterized the XDR S . Typhi to investigate the phylogenetic relationship between these isolates and a global collection of S . Typhi isolates and to identify multiple genes linked to antibiotic resistance. This S . Typhi clone harbored a promiscuous antibiotic resistance plasmid previously identified in other enteric bacteria. The increasing antibiotic resistance in S . Typhi observed here adds urgency to the need for typhoid prevention measures.
Publisher: Elsevier BV
Date: 2021
DOI: 10.2139/SSRN.3766233
Publisher: MDPI AG
Date: 08-07-2022
DOI: 10.3390/V14071496
Abstract: This study aimed to identify the factors associated with timely (within four weeks) HCV RNA testing and timely (within six months) DAA initiation following HCV notification in the DAA era. We conducted a cohort study of people with an HCV notification in NSW, Australia. Notifications of positive HCV serology were linked to administrative datasets. Weights were applied to account for spontaneous clearance. Logistic regression analyses were performed. Among 5582 people with an HCV notification during 2016–2017, 3867 (69%) were tested for HCV RNA, including 2770 (50%) who received timely testing. Among an estimated 3925 people with chronic HCV infection, 2372 (60%) initiated DAA therapy, including 1370 (35%) who received timely treatment. Factors associated with timely HCV RNA testing included age (≥30 years), female sex, non-Aboriginal ethnicity, country of birth being Australia, and no history of drug dependence. Factors associated with timely treatment were age (≥30 years), male sex, non-Aboriginal ethnicity, country of birth being Australia, no history of drug dependence, and HCV/HIV co-infection. In the DAA era, 50% of people with an HCV notification did not receive timely HCV RNA testing. Most people with an HCV infection received therapy however, DAA initiation was delayed among many.
Publisher: World Health Organization Regional Office for the Eastern Mediterranean (WHO/EMRO)
Date: 12-2012
Publisher: Oxford University Press (OUP)
Date: 15-08-2020
Abstract: Fractional dose (one-fifth of full intramuscular dose) of inactivated poliovirus vaccine (fIPV) administered intradermally is used as IPV dose-sparing strategy. We compared the rate of decline of poliovirus antibodies (PVA) in recipients of 2 doses of fIPV or IPV. A community-based randomized controlled trial was conducted in Karachi, Pakistan. Children aged 14 weeks were randomized into fIPV or full IPV (study arms A, B) and received 1 vaccine dose at age 14 weeks and 1 at age 9 months. PVAs were measured at age 14, 18 weeks and 10, 21 months. Seroprevalence of poliovirus type 2 antibodies in 170/250 (68%) children after 2 IPV or fIPV doses at age 10 months in A and B reached 100% vs 99% (P = .339), and at 21 months, 86% vs 67% (P = .004). Between age 10 and 21 months antibody log2 titers dropped from ≥ 10.5 to 6.8 in A and from 9.2 to 3.7 in B. There was a significant decline in antibody titers 12 months following the second IPV dose. The slope of decline was similar for full IPV and fIPV recipients. The results provide further evidence that fIPV is a viable option for IPV dose-sparing. NCT03286803.
Publisher: TechKnowledge General Trading LLC
Date: 04-2014
DOI: 10.12816/0006083
Publisher: Elsevier BV
Date: 08-2018
Publisher: Asian Pacific Organization for Cancer Prevention
Date: 30-06-2012
DOI: 10.7314/APJCP.2012.13.6.2547
Abstract: Smoking among university students represents a formidable and global public health challenge. We assessed the associations between socio-demographic, health and wellbeing variables as independent variables, with daily smoking, attempts to quit smoking, and agreement with smoking ban as dependent variables. A s le of 3258 undergraduate students from eleven faculties at Assiut University, Assiut, Egypt, completed a general health questionnaire. Overall daily or occasional smoking in last three months prior to the survey was about 9% (8% occasional and 1% daily smokers), and smoking was generally more prevalent among males (male=17%, female=0.6%, P < 0.001). After adjustment for confounders, not having normal BMI and having a mother who completed at least bachelor's degree education was positively associated with daily smoking, and conversely, no history of illicit drug use was a protective factor. About 76% of smokers had attempted to quit smoking within the last 12 months prior to the survey. Although a large proportion of students agreed/ strongly agreed with the banning of smoking at university altogether (87%), such agreement was less likely among smokers. There is need for implementation of non-smoking policies on university premises, as well as regular up-to-date information on, and the periodic/yearly monitoring of tobacco use by university students employing standardised data collection instruments and reference periods. In addition, it would be valuable to develop c us-based educational/ awareness c aigns designed to counteract tobacco advertisement directed towards young people in Middle East countries. Otherwise, the danger could be that the current relatively low smoking prevalence among university students may escalate in the future.
Publisher: Elsevier BV
Date: 2019
Publisher: Elsevier BV
Date: 07-2021
Publisher: Elsevier BV
Date: 08-2022
DOI: 10.1016/J.VACCINE.2022.06.072
Abstract: Typhoid conjugate vaccine (TCV) has recently been introduced in the expanded program for immunization (EPI) in Pakistan. Before its introduction in routine immunization, a onetime catchup c aign among children 9 months to 15 years old was conducted in November 2019. We performed field evaluation of TCV against culture confirmed Salmonella Typhi (S. Typhi) among 9 months to 15 years old children during the catch up c aign in Karachi and Hyderabad. A rapid assessment of blood culture confirmed S. Typhi was performed. Age eligible cases of culture confirmed S. Typhi were identified from the laboratory networks of Aga Khan University Hospital Karachi and Hyderabad, Kharadar General Hospital Karachi, and Liaqat University of Medical & Health Sciences (LUMHS) Hyderabad. Information on sociodemographic, typhoid vaccination history and antimicrobial resistance was collected using a structured questionnaire. Patient medical records and lab reports were also reviewed to collect information on diagnosis and antimicrobial susceptibility information. Information about the population vaccination coverage during catch-up c aign was obtained from the provincial EPI office. Field performance of TCV in catchup c aign was measured by calculating the effectiveness using rapid screening method which is less resource-intensive technique of calculating vaccine effectiveness (VE). Overall, 968 culture confirmed typhoid cases were enrolled. Among them, 82% (793/968) were from Karachi and 18% (175/968) from Hyderabad. The average age of the participants was 5.68 years, and 54% (523/968) were male. 6% (62/968) of the culture confirmed S. Typhi cases were multidrug resistant (MDR), and 61% (586/968) were extensively drug resistant (XDR). The VE using the TCV coverage data provided by EPI was 98%. TCV is effective against culture confirmed S. Typhi among children aged 9 months to 15 years in the catch-up c aign setting. While typhoid vaccination can significantly decrease the burden of typhoid disease, improvements in sanitation and hygiene are necessary for the prevention of spread of enteric fever. Longer term follow up will be needed to assess the duration of protection and requirement for booster doses of TCV.
Publisher: Oxford University Press (OUP)
Date: 11-2020
DOI: 10.1093/CID/CIAA1309
Abstract: Typhoid fever is caused by Salmonella enterica subspecies enterica serovar Typhi (S. Typhi) and can lead to systemic illness and complications. We aimed to characterize typhoid-related ileal perforation in the context of the population-based Surveillance of Enteric Fever in Asia Project (SEAP) in Bangladesh, Nepal and Pakistan. Between September 2016 and September 2019, all cases of nontraumatic ileal perforation with a clinical diagnosis of typhoid were enrolled from 4 tertiary care hospitals in Karachi, 2 pediatric hospitals in Bangladesh, and 2 hospitals in Nepal. Sociodemographic data were collected from patients or their caregivers, and clinical and outcome data were retrieved from medical records. Tissue s les were collected for histopathology and blood cultures where available. Of the 249 enrolled cases, 2 from Bangladesh, 5 from Nepal and 242 from Pakistan. In Pakistan, most of the cases were in the 0–15 (117/242 48%) and 16–30 (89/242 37%) age groups. In all countries, males were most affected: Pakistan 74.9% (180/242), Nepal 80% (4/5), and Bangladesh 100% (2/2). Blood culture was done on 76 cases 8 (11%) were positive for S. Typhi, and all were extensively drug resistant (XDR) S. Typhi. Tissue cultures was done on 86 patients 3 (3%) were positive for S. Typhi, and all were XDR S. Typhi, out of 86 s les tested for histopathology 4 (5%) revealed ileal perforation with necrosis. Culture or histopathology confirmed total 15 (11%) enteric fever cases with ileal perforation are similar to the clinically diagnosed cases. There were 16/242 (7%) deaths from Pakistan. Cases of ileal perforation who survived were more likely to have sought care before visiting the sentinel hospital (P = .009), visited any hospital for treatment (P = .013) compared to those who survived. Although surveillance differed substantially by country, one reason for the higher number of ileal perforation cases in Pakistan could be the circulation of XDR strain of S. Typhi in Karachi.
Publisher: Oxford University Press (OUP)
Date: 11-2020
DOI: 10.1093/CID/CIAA1308
Abstract: The Surveillance for Enteric Fever in Asia Project (SEAP) is a multicenter, multicountry study conducted in Pakistan, Nepal, and Bangladesh. The objectives of the study were to characterize disease incidence among patients with enteric fever. We report the burden of enteric fever at selected sites of Karachi, Pakistan. During September 2016 to September 2019, prospective surveillance was conducted at inpatient, outpatient, surgical departments, and laboratory networks of Aga Khan University Hospital, Kharadar General Hospital, and surgery units of National Institute of Child Health and Jinnah Postgraduate Medical Centre. Socio-demographic, clinical, and laboratory data were obtained from all suspected or confirmed enteric fever cases. Overall, 22% (2230/10 094) of patients enrolled were culture-positive for enteric fever. 94% (2093/2230) of isolates were Salmonella Typhi and 6% (137/2230) were S. Paratyphi. 15% of isolates multi-drug resistant (MDR) to first-line antibiotics and 60% were extensively drug-resistant (XDR), resistant to first-line antibiotics, fluoroquinolones and third generation cephalosporin. Enteric fever cases have increased during the last 3 years with large proportion of drug resistant S. Typhi cases. However, the burden of paratyphoid is still relatively low. Strengthening the existing surveillance system for enteric fever and antimicrobial resistance at the national level is recommended in Pakistan to inform prevention measures. While typhoid vaccination can significantly decrease the burden of typhoid and may also impact antimicrobial resistance, water, sanitation, and hygiene improvement is highly recommended to prevent the spread of enteric fever.
Publisher: Springer Science and Business Media LLC
Date: 12-07-2023
DOI: 10.1186/S12919-023-00265-Y
Abstract: Misinformation regarding COVID-19 pandemic and vaccination is damaging COVID-19 vaccine trust and acceptance in Low- and Middle-Income Countries (LMIC). Identification of misinformation and designing locally acceptable solutions are needed to improve COVID-19 vaccine acceptance. This study aimed to utilize community-led co-design methodology to evaluate misinformation regarding COVID-19 and develop contextual interventions to address misinformation in a marginalized peri urban slum communities of Landhi town Karachi, Pakistan. This study was conducted between January and December 2021, in marginalized peri-urban slum dwellers of Muslimabad Colony, Landhi Town Karachi, Pakistan. We used a community-centred co-design methodology embedded within mixed study design to identify misinformation, co-design, test and implement locally acceptable solutions. The co-design methodology involved five stages of the design thinking model: (1) Empathize, (2) Define, (3) Ideate, (4) Prototype, and (5) Test. The project involved active engagement and participation of wide range of stakeholders and community beneficiaries (end users) including local EPI vaccinators, informal healthcare workers, religious leaders (male and female), schoolteachers (male and female), local government representatives, community leaders, housewives, youth, and general population. To develop a trusting relationship, and understand local culture, values, practices, and traditions, we allowed one month of observation period (observe, engage, watch, and listen) in the beginning, followed by door-to-door survey along with focus group discussions (FGD) and in-depth interviews (IDI) at baseline. Co-design workshops (separate for male and female) were conducted at each stage of co-design methodology to design and test locally acceptable solutions. Community-centred co-design methodology was not only successful in designing, testing, and evaluating locally acceptable solutions but it also actively engaged and empowered the marginalized population living in peri urban slum communities of Karachi, Pakistan.
Publisher: Medknow
Date: 2014
Abstract: Measurement of treatment satisfaction in diabetes is important as it has been shown to be associated with positive outcomes, reduced disease cost and better health. The aim of this study was to assess the relationship between treatment satisfaction of diabetes patients and socioeconomic, clinical, medication adherence and health-related factors in Qatar. This is a cross-sectional study. The survey was carried out in primary health care centers and hospitals from April 2010 to May 2011. Of a total of 3000 diabetic patients, 2582 patients gave their consent to take part in the study, with a response rate of 86.1%. The Diabetes Treatment Satisfaction Questionnaire was used to measure the patient satisfaction. The modified Morisky Medication Adherence was used to measure medication taking behavior. A multivariate stepwise linear regression model was performed to identify factors independently associated with patients' satisfaction instrument. Of the studied patients, majority of the diabetes patients were Qataris (61.2%), married (86.1%), above secondary education (46.9%) and unemployed (28.6%). Diabetes patients who had professional jobs (3.97 ± 0.65 P = 0.009) and those who were staying alone had a significantly higher treatment satisfaction score (4.01 ± 0.64 P = 0.001) compared with the other patients. Patients who were taking tablets were significantly more satisfied with treatment (4.08 ± 0.60 P < 0.001). Diabetes patients of primary health care centers (3.96 vs. 3.80 P < 0.001) were more satisfied with treatment than patients visiting hospitals. Multivariate regression analysis revealed that age of the patient (P < 0.001), expatriates (P = 0.023), patients visiting hospitals (P < 0.001), treatment with insulin (P < 0.001) and any diabetes complications (P < 0.001) were significantly less satisfied with the treatment. The study findings revealed that patient satisfaction was positively associated with sociodemographic variables like high income, employment, married in iduals and those with higher levels of education. We found a lower treatment satisfaction in patients with diabetes-related complications and insulin treatment.
Publisher: Medknow
Date: 2014
Publisher: Oxford University Press (OUP)
Date: 22-11-2019
Abstract: The etiology of intussusception, the leading cause of bowel obstruction in infants, is unknown in most cases. Adenovirus has been associated with intussusception and slightly increased risk of intussusception with rotavirus vaccination has been found. We conducted a case-control study among children & years old in Bangladesh, Nepal, Pakistan, and Vietnam to evaluate infectious etiologies of intussusception before rotavirus vaccine introduction. From 2015 to 2017, we enrolled 1-to-1 matched intussusception cases and hospital controls 249 pairs were included. Stool specimens were tested for 37 infectious agents using TaqMan Array technology. We used conditional logistic regression to estimate odds ratio (OR) and 95% confidence interval (CI) of each pathogen associated with intussusception in a pooled analysis and quantitative subanalyses. Adenovirus (OR, 2.67 95% CI, 1.75–4.36) and human herpes virus 6 (OR, 3.50 95% CI, 1.15–10.63) were detected more frequently in cases than controls. Adenovirus C detection & quantification cycles was associated with intussusception (OR, 18.59 95% CI, 2.45–140.89). Wild-type rotavirus was not associated with intussusception (OR, 1.07 95% CI, 0.52–2.22). In this comprehensive evaluation, adenovirus and HHV-6 were associated with intussusception. Future research is needed to better understand mechanisms leading to intussusception, particularly after rotavirus vaccination.
Publisher: Springer Science and Business Media LLC
Date: 16-06-2020
DOI: 10.1186/S12902-020-00572-X
Abstract: This study aimed to measure the effect of diabetes education using the novel method of “diabetes conversation map (DCM)” as compared to routine counselling (RC) on diabetes management self-efficacy (DMSE) among patients living with type 2 diabetes in Karachi, Pakistan. A parallel arm randomized controlled trial among patients with type 2 diabetes aged 30–60 years, with HbA1c 7%, diagnosed for at least 5 yrs., was conducted at the national institute of diabetes and endocrinology in Karachi, Pakistan. A total 123 type 2 diabetes patients were randomized into DCM ( n = 62) or RC ( n = 61). Four weekly diabetes control sessions of 40 min each using the DCM or RC was provided. DMSE was measured using a validated Urdu language DMSE tool at baseline and after three months of the randomization. Change in DMSE and HbA1c levels within groups (pre-post) and between the groups after 3 months of enrollment was compared. Baseline characteristics except HbA1c were similar between the two arms. After 3 months of enrollment, there was no change in the DMSE score in the RC arm however, significant increase in DMSE score was noted in the DCM arm ( P = 0.001). The average difference (95% confidence interval) in DMSE score between the DCM and RC arm was 33.7(27.3, 40.0 p = 0.001) after 3 months of the enrollment. Difference in HbA1c within groups was not significant. DCM significantly improved DMSE among type 2 diabetes patients in a developing country setting like Pakistan. Healthcare workers caring for type 2 diabetes patients need to be trained on DCM to effectively utilize this novel tool for educating diabetes patients. This trial was prospectively registered. ClinicalTrials.gov Identifier: NCT03747471 . Date of registration: Nov 20. 2018.
Publisher: Elsevier BV
Date: 04-2022
Publisher: Pakistan Medical Association
Date: 15-01-2023
DOI: 10.47391/JPMA.5308
Abstract: Objective: To evaluate the perception, knowledge, empowerment and comfort level of critical care staff in relation to the implementation of safety huddles in paediatric intensive care unit of a tertiary care hospital. Method: The descriptive cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from September 2020 to February 2021, and comprised physicians, nurses and paramedics who were part of the safety huddle. Staff perception regarding this activity was evaluated using open-ended questions that were scored on a Likert scale. Data was analysed using STATA 15. Results: Of the 50 participants, 27(54%) were females and 23(46%) were males. Overall, 26(52%) subjects were aged 20-30 years age, while 24(48%) were aged 31-50 years. Of the total, 37(74%) subjects strongly agreed that safety huddle had been routinely held in the unit since initiation 42(84%) felt comfortable sharing their concerns about patient safety and 37(74%) considered the huddles worthwhile. Majority 42(84%) felt more empowered through huddle participation. Moreover, 45(90%) participants strongly agreed that daily huddle helped them in becoming clearer about their responsibilities. For safety risk assessment, 41(82%) participants acknowledged that safety risks had been assessed and modified in routine huddles. Conclusion: Safety huddle was found to be a powerful tool to create a safe environment in a paediatric intensive care unit where all team members can speak up freely about patient safety. Key Words: Safety huddle, Staff perception, Staff empowerment, Patient safety in PICU.
Publisher: Canadian Center of Science and Education
Date: 12-05-2013
Publisher: Medknow
Date: 2017
Publisher: Oxford University Press (OUP)
Date: 27-10-2022
Abstract: The COVID-19-related misinformation and vaccine hesitancy is a widespread global concern and a recognized public health problem in Pakistan. The current research sought to explore the beliefs and experiences with regard to COVID-19, including vaccine hesitancy and acceptance, in a slum of Karachi, Pakistan. This study used an interpretivist epistemological approach for data collection and employed in-depth interviews (IDIs) and focus group discussions (FGDs) to explore the themes of interest. IDIs and FDGs were conducted in the local language (Pashtu) and Urdu, using semi-structured interview guides. A hybrid thematic analysis approach (use of both inductive and deductive coding) was used to analyze the data. We identified two key themes: the first related to vaccine hesitancy and refusal and included the role of personal belief systems, vaccine mistrust and public perceptions in hesitancy the second related to vaccine acceptance and included knowledge and awareness about the vaccine and trusted sources of information. Religious beliefs and cultural norms influenced attitudes toward COVID-19 and vaccination. This study also found that awareness about the COVID-19 vaccine in this s le was influenced by sex, educational status and socioeconomic status. Participants with good health literacy and those from healthcare backgrounds were more likely to share views that indicated vaccine acceptance. The findings of this study are being used to co-design a comprehensive intervention to dispel COVID-19 misinformation and vaccine hesitancy across a range of stakeholders such as youths, community leaders, family members, faith leaders, schools and community-based local organizations in Pakistan.
Publisher: Wiley
Date: 11-01-2023
DOI: 10.1111/JVH.13791
Abstract: The hepatitis C virus (HCV) care cascade characterization is important for monitoring progress towards HCV elimination. This study evaluated HCV care cascade and factors associated with treatment during pre‐DAA (2011–2012 and 2013–2015) and DAA (2016–2018) eras in New South Wales (NSW), Australia. We conducted a cohort study of people with an HCV notification (1993 to 2017) through end 2018, linked to administrative datasets, including HCV treatment and non‐hospital services. Those aged years, died within first 6 months of study period or notification, and who had successful HCV treatment in period before were excluded. Sex‐specific spontaneous viral clearance was incorporated to estimate treatment‐eligible population. The study population in each period were cumulative and brought forward from one period to the next. Among 115,667 people with HCV notification, 87,063 fulfilled eligibility criteria. During 2011 to 2012, 2013 to 2015, and 2016 to 2018, cumulative HCV notifications were 71,677, 77,969, and 80,017 52,016, 56,793, and 57,467 were eligible for treatment 29%, 48%, and 64% confirmed HCV RNA positive and 0.6%, 5%, and 38% initiated HCV treatment, respectively. Birth cohort 1945 to 1964 (vs. ≥1965), males, non‐Aboriginal ethnicity, regional/rural area of residence, and HCV/HIV co‐infection were associated with higher treatment uptake. Incarceration and drug dependence were associated with higher treatment uptake during the DAA era. In Australia, many marginalized populations including those incarcerated and those with drug dependence have equitable treatment uptake in the DAA era. Targeted strategies are required to enhance treatment uptake for females and Aboriginal populations.
Publisher: American Medical Association (AMA)
Date: 16-12-2021
Publisher: Elsevier BV
Date: 08-2018
DOI: 10.1016/J.VACCINE.2018.07.024
Abstract: Global immunization efforts have received a boost through the introduction of several new vaccines. These efforts however, are threatened by sub-optimal vaccine coverage, particularly in countries with large birth cohorts. Pakistan has one of the largest birth cohorts in the world, where coverage of routine vaccination remains persistently inadequate. We undertook this study to ascertain reasons for non-vaccination or incomplete vaccination of children less than two years in 8 districts of southern Pakistan. A cross-sectional survey using WHO recommended rapid coverage assessment technique was conducted in 2014. Using probability proportional to size method, we s led 8400 households with eligible children (aged 4-12 months). Using a structured questionnaire, mothers or other primary caregivers were interviewed to determine vaccination status of an index child. In case of non-vaccination or incomplete vaccination, respondents were asked for reasons leading to low/no vaccine uptake. Based on both vaccination record and recall, only 30.8% of children were fully vaccinated, 46% had an incomplete vaccination status while 23%were non-vaccinated. The most frequently reported reasons for non-vaccination included: mothers/caregivers being unaware of the need for vaccination (35.3%), a fear of side effects (23%), mother/caregiver being too busy (16.6%), distance from vaccination centers (13.8%), and non-availability of either vaccinators or vaccines at vaccination centers (10.7%). Reasons identified for incomplete vaccination were similar, with caregivers being unaware of the need for subsequent doses (27.3%), non-availability of vaccinators or vaccines (17.7%), mother/caregiver being too busy (14.8%), fear of side effects (11.2%), and postponement for another time (8.7%). Various factors result in non-compliance with vaccination schedules and vaccine refusal within the surveyed communities, ranging from lack of knowledge to non-availability of supplies at vaccination centers. These barriers are best addressed through multi-pronged strategies addressing supply gaps, increasing community awareness and enhancing demand for routine vaccination services.
Publisher: Oxford University Press (OUP)
Date: 11-2020
DOI: 10.1093/CID/CIAA1310
Abstract: Implementation of population-based surveys is resource intensive and logistically demanding, especially in areas with rapidly changing demographics and incomplete or no enumeration of the underlying population and their residences. To remove the need for pre-enumeration and to simplify field logistics for the population healthcare utilization survey used for the Surveillance for Enteric Fever in Asia Project in Nepal, we incorporated a geographic information system–based geosurvey and field mapping system into a single-stage cluster s ling approach. A survey was administered to ascertain healthcare-seeking behavior in in iduals with recent suspected enteric fever. Catchment areas were based on residential addresses of enteric fever patients using study facilities clusters were randomly selected from digitally created grids using available satellite images and all households within clusters were offered enrollment. A tablet-compatible geosurvey and mapping system that allowed for data-syncing and use in areas without cellular data was created using the ArcGIS suite of software. Between January 2017 and November 2018, we surveyed 25 521 households in Nepal (16 769 in urban Kathmandu and 8752 in periurban Kavrepalanchok), representing 84 202 in iduals. Overall, the survey participation rate was 90.9%, with geographic heterogeneity in participation rates within each catchment area. Areas with higher average household wealth had lower participation rates. A geographic information system–based geosurvey and field mapping system allowed creation of a virtual household map at the same time as survey administration, enabling a single-stage cluster s ling method to assess healthcare utilization in Nepal for the Surveillance for Enteric Fever in Asia Project . This system removed the need for pre-enumeration of households in s ling areas, simplified logistics and could be replicated in future community surveys.
Publisher: Korea Disease Control and Prevention Agency
Date: 30-04-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2014
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.VACCINE.2018.11.002
Abstract: Intussusception is the invagination of one segment of the bowel into a distal segment, characterized by symptoms of bloody stool, vomiting, and abdominal pain. Previous studies have found regional differences in incidence but the etiology of most intussusception cases is unknown. Rotavirus vaccines were associated with a slightly of increased risk of intussusception in post-licensure evaluations in high- and middle-income countries, but not in low income African countries. To describe the baseline epidemiology of intussusception in young children prior to rotavirus vaccine implementation, active sentinel hospital surveillance for intussusception in children < 2 years of age was conducted in 4 low income Asian countries (Bangladesh, Nepal, Pakistan and Vietnam). Over a 24-month period, 15 sites enrolled 1,415 intussusception cases, of which 70% were enrolled in Vietnam. Overall, 61% of cases were male and 1% (n = 16) died, ranging from 8% in Pakistan to 0% in Vietnam. The median age of cases enrolled ranged from 6 months in Bangladesh and Pakistan to 12 months in Vietnam. The proportion of cases receiving surgical management was 100% in Bangladesh, 88% in Pakistan, 61% in Nepal, and 1% in Vietnam. The high proportion of males and median age of cases around 6 months of age found in this regional surveillance network are consistent with previous descriptions of the epidemiology of intussusception in these countries and elsewhere. Differences in management and the fatality rate of cases between the countries likely reflect differences in access to healthcare and availability of diagnostic modalities. These baseline data will be useful for post-rotavirus vaccine introduction safety monitoring.
Publisher: Public Library of Science (PLoS)
Date: 07-08-2023
DOI: 10.1371/JOURNAL.PONE.0289582
Abstract: To estimate the coverage rate of typhoid conjugate vaccine (TCV) among children aged 6 months to 15 years in Lyari Town Karachi, Pakistan. A cross-sectional survey was conducted to estimate the vaccine coverage of Typbar TCV in Lyari Town Karachi utilizing the World Health Organization (WHO) recommended rapid vaccine coverage assessment technique (30 clusters × 7 households). S ling was powered at town level and multistage cluster s ling was used. Four union councils were randomly selected from a total of 11 and the survey was conducted in those union councils. After consent was obtained, parents of age-eligible children living in the selected union councils were invited to participate in the survey and information was collected on Typbar TCV vaccination status of children aged 6 months to 15 years. Overall, 2325 children were included in the survey. The mean age of the participants was 7.60 ± 3.84 years. The ratio of males to females was equal in the survey s le 1163 (50.02%) were male. In the total target population, 82% children were found to be vaccinated however, the vaccination status could be verified for 80%. The vaccine coverage of TCV was comparable among the four union councils and the overall coverage of TCV vaccine in Lyari Town was found to be 80%. The coverage was significantly lower in younger children, 5% and 17% among children aged 6 months to 2 years and 2 years to 5 years respectively and 78% among children aged 5 years to 15 years. The overall immunization coverage rate with TCV was found to be satisfactory. Immunization coverage was comparable among both sexes and the selected union councils but it was relatively low among children in younger age groups.
Publisher: TechKnowledge General Trading LLC
Date: 2015
DOI: 10.12816/0031228
Publisher: Wiley
Date: 19-09-2012
DOI: 10.1002/AJIM.22117
Abstract: We assessed the frequency and predictors of sharp injuries (SIs) among health care workers (HCWs) at first level care facilities (FLCF) in rural Pakistan. HCWs working at public clinic (PC), privately owned licensed practitioners' clinic (LPC) and non-licensed practitioners' clinic(NLC) were interviewed on universal precautions (UPs) and constructs of health belief model (HBM) to assess their association with SIs through negative-binomial regression. From 365 clinics, 485 HCWs were interviewed. Overall annual rate of SIs was 192/100 HCWs/year 78/100 HCWs among licensed prescribers, 191/100 HCWs among non-licensed prescribers, 248/100 HCWs among qualified assistants, and 321/100 HCWs among non-qualified assistants. Increasing knowledge score about bloodborne pathogens (BBPs) transmission (rate-ratio (RR): 0.93 95%CI: 0.89-0.96), fewer years of work experience, being a non-licensed prescriber (RR: 2.02 95%CI: 1.36-2.98) licensed (RR: 2.86 9%CI: 1.81-4.51) or non-licensed assistant (RR: 2.78 95%CI: 1.72-4.47) compared to a licensed prescriber, perceived barriers (RR: 1.06 95%CI: 1.03-1.08), and compliance with UPs scores (RR: 0.93 95%CI: 0.87-0.97) were significant predictors of SIs. Improved knowledge about BBPs, compliance with UPs and reduced barriers to follow UPs could reduce SIs to HCWs.
Publisher: World Health Organization Regional Office for the Eastern Mediterranean (WHO/EMRO)
Date: 12-2012
Publisher: Hamad bin Khalifa University Press (HBKU Press)
Date: 2013
DOI: 10.5339/QFARF.2013.BIOP-0174
Abstract: Objective: To analyze demographic and socio-economic determinants of neonatal mortality Introduction: Evidence suggests that it is challenging to reduce the infant and under-five mortality without specific focus on neonatal mortality, given that about 43% of under-five deaths and 60% of infant deaths are attributed to neonatal mortality. Hence, key to achieving MDG-4 is the reduction of the global total of 3.82 million neonatal deaths per year, especially the 3 million who pass away in the first week of life (early neonatal period). Socio-economic and demographic variables are generally viewed as important determinants to a range of health outcomes, including neonatal mortality. The current study collected and analyzed the socio-demographic determinants of Qatar's Neonatal Mortality during 2011 about which little is known in the published literature. Methods: A Prospective National Epidemiologic Study was carried out to assess the association between fourteen demographic and socioeconomic variables and neonatal mortality. Data was collected from the 2011 National cohort of 20,583 live births and 102 neonatal deaths and entered in Qatar National Perinatal Registry (Q-Peri-Reg). One fetal variable (gender), three maternal variables (level of education, occupation, age), three paternal variables (level of education, occupation, age), and seven household (family) variables (nationality, consanguinity, family income, house ownership, type of housing, family type, domestic help) were analyzed in a univariate regression model. Results: Less than secondary level of maternal education was associated with two-fold increase in neonatal mortality (OR 2.08, 95% CI 1.23-3.53, p=0.009). The association between the rest of the thirteen variables and neonatal mortality was non-significant. Conclusions: Higher level of maternal education, as compared to lower level of maternal education, is significantly associated with reduced neonatal mortality. Keywords: neonatal mortality, demographic, socio-economic variables, maternal, paternal, household, family
Publisher: Elsevier BV
Date: 08-2017
Publisher: Cold Spring Harbor Laboratory
Date: 21-10-2021
DOI: 10.1101/2021.10.20.21265277
Abstract: The incidence of enteric fever, an invasive bacterial infection caused by typhoidal Salmonellae , is largely unknown in regions lacking blood culture surveillance. New serologic markers have proven accurate in diagnosing enteric fever, but whether they could be used to reliably estimate population-level incidence is unknown. We collected longitudinal blood s les from blood culture-confirmed enteric fever cases enrolled from surveillance studies in Bangladesh, Nepal, Pakistan, and Ghana and conducted cross-sectional serosurveys in the catchment areas of each surveillance site. We used ELISAs to measure quantitative IgA and IgG antibody responses to Hemolysin E (HlyE) and S . Typhi lipopolysaccharide (LPS). We used Bayesian hierarchical models to fit two-phase power-function decay models to the longitudinal antibody responses among enteric fever cases and used the joint distributions of the peak antibody titers and decay rate to estimate population-level incidence rates from cross-sectional serosurveys. The longitudinal antibody kinetics for all antigen-isotypes were similar across countries and did not vary by clinical severity. The seroincidence of typhoidal Salmonella infection among children years ranged between 58.5 per 100 person-years (95% CI: 42.1 - 81.4) in Dhaka, Bangladesh to 6.6 (95% CI: 4.3-9.9) in Kavrepalanchok, Nepal, and followed the same rank order as clinical incidence estimates. The approach described here has the potential to expand the geographic scope of typhoidal Salmonella surveillance and generate incidence estimates that are comparable across geographic regions and time. This work was supported by the Bill and Melinda Gates Foundation (INV-000572). Previous studies have identified serologic responses to two antigens (Hemolysin E [HlyE] and Salmonella lipopolysaccharide [LPS]) as promising diagnostic markers of acute typhoidal Salmonella infection. We reviewed the evidence for seroepidemiology tools for enteric fever available as of November 01, 2021, by searching the National Library of Medicine article database and medRxiv for preprint publications, published in English, using the terms “enteric fever”, “typhoid fever”, “ Salmonella Typhi”, “ Salmonella Paratyphi”, “typhoidal Salmonella ”, “Hemolysin E”, “ Salmonella lipopolysaccharide”, “seroconversion”, “serosurveillance”, “seroepidemiology”, “seroprevalence” and “seropositivity.” We found no studies using HlyE or LPS as markers to measure the incidence or prevalence of enteric fever in a population. Anti-Vi IgG responses were used as a marker of population seroprevalence in cross-sectional studies conducted in South Africa, Fiji, and Nepal, but were not used to calculate population-based incidence estimates. We developed and validated a method to estimate typhoidal Salmonella incidence in cross-sectional population s les using antibody responses measured from dried blood spots. First, using longitudinal dried blood spots collected from over 1400 blood culture-confirmed cases in four countries, we modeled the longitudinal dynamics of antibody responses for up to two years following infection, accounting for heterogeneity in antibody responses and age-dependence. We found that longitudinal antibody responses were highly consistent across four countries on two continents and did not differ by clinical severity. We then used these antibody kinetic parameters to estimate incidence in population-based s les in six communities across the four countries, where concomitant population-based incidence was measured using blood cultures. Seroincidence estimates were much higher than blood-culture-based case estimates across all six sites, suggestive of a high incidence of asymptomatic or unrecognized infections. Still, the rank order of seroincidence and culture-based incidence rates were the same, with the highest rates in Bangladesh and lowest in Ghana. Many at-risk low- and middle-income countries lack data on typhoid incidence needed to inform and evaluate vaccine introduction. Even in countries where incidence estimates are available, data are typically geographically and temporally sparse due to the resources necessary to initiate and sustain blood culture surveillance. We found that typhoidal Salmonella infection incidence can be estimated from community-based serosurveys using dried blood spots, representing an efficient and scalable approach for generating the typhoid burden data needed to inform typhoid control programs in resource-constrained settings.
Publisher: Elsevier BV
Date: 2021
DOI: 10.2139/SSRN.3866551
Publisher: Oxford University Press (OUP)
Date: 10-10-2018
Publisher: El Mednifico Journal
Date: 29-10-2013
DOI: 10.18035/EMJ.V1I3.49
Publisher: Public Library of Science (PLoS)
Date: 15-10-2020
Publisher: Medknow
Date: 2014
Abstract: There is strong evidence in the literature that there is an association between ABO blood group and certain diseases. The aim of this study was to investigate any association between the ABO blood groups and diabetes mellitus (DM) in Qatar. This was a sex-matched case-control study. This study was carried out in the diabetic outpatient clinics and blood bank of the Hamad Medical Corporation (HMC) from April 2011 to December 2012. The study included 1633 diabetic patients and 1650 nondiabetic apparently healthy controls. A total of 2148 adult patients above 18 years of age were selected consecutively from the diabetic clinics of the hospitals and 1633 patients gave consent to take part in this study, thus giving a response rate of 76%. A total of 2150 nondiabetic healthy adults above 18 years of age were recruited from the blood bank and 1650 in iduals agreed to take part in this study, giving a response rate of 76.7%. Blood group of the recruited subjects was taken from the database of the Blood Bank, Central laboratory, HMC. The data revealed that the blood group B was significantly more common in diabetic patients as compared with healthy population (25.7% vs. 20.4% P < 0.001). Blood group O was significantly less common in diabetic patients compared with nondiabetics (38.5% vs. 45.4% P < 0.001). Among diabetic men, the frequency of only blood group B was significantly higher, while on the contrary among diabetic women the frequency of both A and B (29.7% vs. 24.8% P = 0.03 and 25.5% vs. 20% P < 0.009, respectively) were significantly higher as compared with nondiabetic healthy population. The findings in this study suggest that ABO antigens are associated with DM. DM is more common in in iduals with blood group B.
Publisher: Elsevier BV
Date: 04-2020
Publisher: Oxford University Press (OUP)
Date: 27-07-2018
Publisher: Elsevier BV
Date: 05-2017
Publisher: Oxford University Press (OUP)
Date: 15-02-2019
DOI: 10.1093/CID/CIY877
Publisher: Elsevier BV
Date: 07-2022
Publisher: World Health Organization Regional Office for the Eastern Mediterranean (WHO/EMRO)
Date: 06-2013
Publisher: Elsevier BV
Date: 03-2018
Publisher: Oxford University Press (OUP)
Date: 11-2020
DOI: 10.1093/CID/CIAA1321
Abstract: Characterizing healthcare-seeking patterns for acute febrile illness is critical for generating population-based enteric fever incidence estimates from facility-based surveillance data. We used a hybrid model in the Surveillance for Enteric Fever in Asia Project (SEAP) to assess incidence of enteric fever at 6 study hospitals in 3 countries. We recruited in iduals presenting to the hospitals and obtained blood cultures to evaluate for enteric fever. For this analysis, we undertook cluster random household surveys in Dhaka, Bangladesh (2 sites) Karachi, Pakistan Kathmandu, Nepal and Kavrepalanchok, Nepal between January 2017 and February 2019, to ascertain care-seeking behavior for in iduals with 1) fever for ≥3 consecutive days within the past 8 weeks or 2) fever resulting in hospitalization within the past year. We also collected data about disease severity and household demographics and assets. We used mixed-effect multivariable logistic regression models to identify determinants of healthcare seeking at study hospitals and determinants of culture-confirmed enteric fever. We enrolled 31 841 households (53 926 children) in Bangladesh, 25 510 households (84 196 children and adults) in Nepal, and 21 310 households (108 031 children and adults) in Pakistan. Children & years were most likely to be taken to the study hospitals for febrile illness at all sites. Household wealth was positively correlated with healthcare seeking in 4 of 5 study sites, and at least one marker of disease severity was positively associated with healthcare seeking in 3 of 5 catchment areas. Wealth and disease severity were variably predictive of blood culture-confirmed enteric fever. Age, household wealth, and disease severity are important determinants of healthcare seeking for acute febrile illness and enteric fever risk in these communities, and should be incorporated into estimation models for enteric fever incidence.
Publisher: Oxford University Press (OUP)
Date: 11-2020
DOI: 10.1093/CID/CIAA1320
Abstract: Enteric fever can lead to prolonged hospital stays, clinical complications, and death. The Surveillance for Enteric Fever in Asia Project (SEAP), a prospective surveillance study, characterized the burden of enteric fever, including illness severity, in selected settings in Bangladesh, Nepal, and Pakistan. We assessed disease severity, including hospitalization, clinical complications, and death among SEAP participants. We analyzed clinical and laboratory data from blood culture–confirmed enteric fever cases enrolled in SEAP hospitals and associated network laboratories from September 2016 to September 2019. We used hospitalization and duration of hospital stay as proxies for severity. We conducted a follow-up interview 6 weeks after enrollment to ascertain final outcomes. Of the 8705 blood culture-confirmed enteric fever cases enrolled, we identified 6 deaths (case-fatality ratio, .07% 95% CI, .01–.13%), 2 from Nepal, 4 from Pakistan, and none from Bangladesh. Overall, 1.7% (90/5205) of patients recruited from SEAP hospitals experienced a clinical complication (Bangladesh, 0.6% [18/3032] Nepal, 2.3% [12/531] Pakistan, 3.7% [60/1642]). The most identified complications were hepatitis (n = 36), septic shock (n = 22), and pulmonary complications neumonia (n = 13). Across countries, 32% (2804/8669) of patients with hospitalization data available were hospitalized (Bangladesh, 27% [1295/4868] Nepal, 29% [455/1595] Pakistan, 48% [1054/2206]), with a median hospital stay of 5 days (IQR, 3–7). While defined clinical complications and deaths were uncommon at the SEAP sites, the high proportion of hospitalizations and prolonged hospital stays highlight illness severity and the need for enteric fever control measures, including the use of typhoid conjugate vaccines.
Publisher: Springer Science and Business Media LLC
Date: 08-07-2019
Publisher: MDPI AG
Date: 19-11-2020
Abstract: The emergence and spread of extensively drug-resistant (XDR) typhoid in Karachi, Pakistan led to an outbreak response in Lyari Town, Karachi utilizing a mass immunization c aign with typhoid conjugate vaccine (TCV), Typbar TCV®. The mass immunization c aign, targeted Lyari Town, Karachi, one of the worst affected towns during the XDR typhoid outbreak. Here we describe the strategies used to improve acceptance and coverage of Typbar TCV in Lyari Town, Karachi. The mass immunization c aign with Typbar TCV was started as a school- and hospital-based vaccination c aign targeting children between the age of 6 months to 15 years old. A dose of 0.5 mL Typbar TCV was administered intramuscularly. A mobile vaccination c aign was added to cope with high absenteeism and non-response from parents in schools and to cover children out of school. Different strategies were found to be effective in increasing the vaccination coverage and in tackling vaccine hesitancy. Community engagement was the most successful strategy to overcome refusals and helped to gain trust in the newly introduced vaccine. Community announcements and playing typhoid jingles helped to increase awareness regarding the ongoing typhoid outbreak. Mop-up activity in schools was helpful in increasing coverage. Networking with locally active groups, clubs and community workers were found to be the key factors in decreasing refusals.
Publisher: BMJ
Date: 07-2021
DOI: 10.1136/BMJOPEN-2020-045904
Abstract: Children with primary immunodeficiency disorders (PID) are more susceptible to developing viral infections and are at a substantially increased risk of developing paralytic poliomyelitis. Such children, if given oral polio vaccines tend to excrete poliovirus chronically that may lead to the propagation of highly ergent vaccine-derived poliovirus (VDPV). Consequently, they may act as a reservoir for the community by introducing an altered virus potentially imposing a risk to global polio eradication. However, the risks of chronic and prolonged excretion are not well characterised in the study context. This study seeks to establish a pilot surveillance system for successful identification and monitoring of VDPV excretion among children with PID. It will assess whether the Jeffrey Modell warning signs of PID can be used as an appropriate screening tool for PID in Pakistan. In this pilot surveillance, recruitment of PID cases is currently done at participating hospitals in Pakistan. Potential children are screened and tested against the Jeffrey Modell Foundation (JMF) warning signs for immunodeficiency and their stool is collected to test for poliovirus excretion. Cases excreting poliovirus are followed until the two consecutive negative stool s les are obtained over a period of 6 months. The data will be analysed to calculate hospital-based proportions of total Immunodeficiency-related vaccine-derived poliovirus (iVDPV) cases over a 2-year period and to determine the sensitivity and specificity of the JMF signs. This protocol was reviewed and approved by the WHO (WHO Reference-2018/811124-0), Aga Khan University (AKU ERC-2018-0380-1029) and National Bioethics Committee (Ref No. 4-87 NBC-308-Y2). The results will be published in an open access peer-reviewed scientific journal and presented to the iVDPV Working Group members, policy-makers, paediatric consultants and fellow researchers with the same domain interest. It may be presented in scientific conferences and seminars in the form of oral or poster presentations.
Publisher: Elsevier BV
Date: 12-2020
Publisher: Baishideng Publishing Group Inc.
Date: 2013
DOI: 10.4239/WJD.V4.I2.40
Start Date: 2021
End Date: 2021
Funder: Sabin Vaccine Institute
View Funded ActivityStart Date: 2020
End Date: 2023
Funder: GAVI Alliance
View Funded ActivityStart Date: 2018
End Date: 2020
Funder: World Health Organization
View Funded Activity