BackgroundIn Pakistan, only 59-73% of children 12-23 months of age are fully immunized. This randomized, controlled trial was conducted to assess the impact of a low-literacy immunization promotion educational intervention for mothers living in low-income communities of Karachi on infant immunization completion rates.MethodsThree hundred and sixty-six mother-infant pairs, with infants aged ≤ 6 weeks, were enrolled and randomized into either the intervention or control arm between August - November 2008. The intervention, administered by trained community health workers, consisted of three targeted pictorial messages regarding vaccines. The control group received general health promotion messages based on Pakistan's Lady Health Worker program curriculum. Assessment of DPT/Hepatitis B vaccine completion (3 doses) was conducted 4-months after enrollment. A Poisson regression model was used to estimate effect of the intervention. The multivariable Poisson regression model included maternal education, paternal occupation, ownership of home, cooking fuel used at home, place of residence, the child's immunization status at enrollment, and mother's perception about the impact of immunization on child's health.ResultsBaseline characteristics among the two groups were similar. At 4 month assessment, among 179 mother-infant pairs in the intervention group, 129 (72.1%) had received all 3 doses of DPT/Hepatitis B vaccine, whereas in the control group 92/178 (51.7%) had received all 3 doses. Multivariable analysis revealed a significant improvement of 39% (adjusted RR = 1.39; 95% CI: 1.06-1.81) in DPT-3/Hepatitis B completion rates in the intervention group.ConclusionA simple educational intervention designed for low-literate populations, improved DPT-3/Hepatitis B vaccine completion rates by 39%. These findings have important implications for improving routine immunization rates in Pakistan.
Leishmaniasis are a group of diseases, endemic in many parts of the world.1,2) Leishmaniasis are mostly prevalent in poor developing countries evident by the growing number of cases seen in AIDS patients 3) and the occurrence of viscerotropic Leishmania tropica disease among Persian Gulf War Participants.2,3) The disease is transmitted by the members of the genus Leishmania which is a protozoal parasite. These parasitic protozoans are digenetic and have two distinct stages in their life cycle. The motile flagellated promastigote stage lives in the alimentary tract of the sand fly vector, while the non-motile amastigote stage resides inside the macrophages of mammalian hosts. 4)Leishmanial infections include three major syndromes: cutaneous, visceral and mucosal leishmaniasis. The basic treatment consists in the administration of sodium stibogluconate (pentostam), meglumine (glucantime) or pentamidine. Common problem with this basic treatment especially in Kalaazar, mucosal leishmaniasis is the developing drug resistance of the parasite.5) In addition, the low efficacy of pentavalent antimony in the treatment of patients coinfected with AIDS is often noticed.6) These problems prompted the development of new anti-leishmanial drugs. [7][8][9][10] Curcumin is a yellow-orange dye derived from the rhizome of the plant Curcuma longa. It has long been used as a naturally occurring medicine for the treatment of inflammatory diseases. Curcumin (difleruloyl methane) is a natural phenolic compound. It is a potent anti-tumor agent having anti-inflammatory and anti-oxidant properties. It induces apoptosis in cancer cells 11,12) and inhibits TPA-induced Protein kinase C (PKC) activity.13) It has also shown anti-bacterial, anti-fungal and anti-trypnosomal activity. 1,14,15) A recent study has also shown action against the promastigote forms of Leishmania major. 16)In this report we evaluated the actions of curcumin against the promastigote forms of different reference and local leishmanial strains in vitro. We also evaluated the activity of curcumin against the axenic amastigote like cells (AALC) of L. major in vitro. MATERIALS AND METHODSParasite Cultures All the promastigote cultures of both the reference and local Pakistani leishmanial strains were maintained in blood agar based bi-phasic Evan's modified Tobie's medium supplemented with RPMI-1640 with 25 mM TES at 25°C. The reference leishmanial strains were obtained from London School of Hygeine and Tropical Medicine. The reference strains of promastigotes that were used include L. major (JISH118), L. tropica (K27) and L. infantum (LEM3437). Local leishmanial strains used in this study include L. major (MHOM/PK/88/DESTO) in the promastigote and AALC stage (see below). Other local strains used in the promastigote stage include L. tropica and L. infantum. The long term continuous culture of axenic amastigote like cells (AALC) of L. major (MHOM/PK/88/DESTO) strain was successfully established. Briefly, AALC cells were obtained from the promastigotes by the gradual adaptation o...
BackgroundAs a response to a changing operating environment, healthcare administrators are implementing modern management tools in their organizations. The balanced scorecard (BSC) is considered a viable tool in high-income countries to improve hospital performance. The BSC has not been applied to hospital settings in low-income countries nor has the context for implementation been examined. This study explored contextual perspectives in relation to BSC implementation in a Pakistani hospital.MethodsFour clinical units of this hospital were involved in the BSC implementation based on their willingness to participate. Implementation included sensitization of units towards the BSC, developing specialty specific BSCs and reporting of performance based on the BSC during administrative meetings. Pettigrew and Whipp's context (why), process (how) and content (what) framework of strategic change was used to guide data collection and analysis. Data collection methods included quantitative tools (a validated culture assessment questionnaire) and qualitative approaches including key informant interviews and participant observation.ResultsMethod triangulation provided common and contrasting results between the four units. A participatory culture, supportive leadership, financial and non-financial incentives, the presentation of clear direction by integrating support for the BSC in policies, resources, and routine activities emerged as desirable attributes for BSC implementation. The two units that lagged behind were more involved in direct inpatient care and carried a considerable clinical workload. Role clarification and consensus about the purpose and benefits of the BSC were noted as key strategies for overcoming implementation challenges in two clinical units that were relatively ahead in BSC implementation. It was noted that, rather than seeking to replace existing information systems, initiatives such as the BSC could be readily adopted if they are built on existing infrastructures and data networks.ConclusionVariable levels of the BSC implementation were observed in this study. Those intending to apply the BSC in other hospital settings need to ensure a participatory culture, clear institutional mandate, appropriate leadership support, proper reward and recognition system, and sensitization to BSC benefits.
Measles, despite being vaccine preventable is still a major public health problem in many developing countries. We estimated the proportion of measles susceptible children in Karachi, the largest metropolitan city of Pakistan, one year after the nationwide measles supplementary immunization activity (SIA) of 2007–08. Oral fluid specimens of 504 randomly selected children from Karachi, aged 12–59 months were collected to detect measles IgG antibodies. Measles antibodies were detected in only 55% children. The proportion of children whose families reported receiving a single or two doses of measles vaccine were 78% and 12% respectively. Only 3% of parents reported that their child received measles vaccine through the SIA. Among the reported single dose measles vaccine recipients, 58% had serologic immunity against measles while amongst the reported two dose measles vaccine recipients, 64% had evidence of measles immunity. Urgent strengthening of routine immunization services and high quality mass vaccination campaigns against measles are recommended to achieve measles elimination in Pakistan.
BackgroundIn 2005, Pakistan was first labeled as a country with concentrated epidemic of Human Immunodeficiency Virus (HIV). This was revealed through second generation surveillance conducted by HIV/AIDS Surveillance Project (HASP). While injection drug users (IDUs) were driving the epidemic, subsequent surveys showed that Hijra (transgender) sex workers (HSWs) were emerging as the second most vulnerable group with an average national prevalence of 6.4%. An exceptionally high prevalence (27.6%) was found in Larkana, which is a small town on the right bank of river Indus near the ruins of Mohenjo-Daro in the province of Sindh. This paper presents the risk factors associated with high prevalence of HIV among HSWs in Larkana as compared to other cities of the country.MethodsData were extracted for secondary analysis from 2008 Integrated behavioral and biological survey (IBBS) to compare HSWs living in Larkana with those living in other cities including Karachi and Hyderabad in Sindh; Lahore and Faisalabad in Punjab; and Peshawar in Khyber Pakhtunkhwa provinces. After descriptive analysis, univariate and multivariate analyses were performed to identify risk factors. P value of 0.25 or less was used to include factors in multivariate analysis.ResultsWe compared 199 HSWs from Larkana with 420 HSWs from other cities. The average age of HSWs in Larkana was 26.42 (±5.4) years. Majority were Sindhi speaking (80%), uneducated (68%) and unmarried (97%). In univariate analysis, factors associated with higher prevalence of HIV in Larkana included younger age i.e. 20–24 years (OR: 5.8, CI: 2.809–12.15), being unmarried (OR: 2.4, CI: 1.0–5.7), sex work as the only mode of income (OR: 5.5, CI: 3.70–8.2) and longer duration of being involved in sex work 5–10 years (OR: 3.3, CI: 1.7–6.12). In multivariate logistic regression the HSWs from Larkana were more likely to lack knowledge regarding preventive measures against HIV (OR 11.9, CI: 3.4–41.08) and were more prone to use of alcohol during anal intercourse (OR: 6.3, CI: 2.77–17.797).ConclusionOutreach programs focusing on safer sexual practices and VCT are urgently needed to address the upsurge of HIV among HSWs in Larkana.
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