Summary Background COBRA-BPS (Control of Blood Pressure and Risk Attenuation-Bangladesh, Pakistan, Sri Lanka), a multi-component hypertension management programme that is led by community health workers, has been shown to be efficacious at reducing systolic blood pressure in rural communities in Bangladesh, Pakistan, and Sri Lanka. In this study, we aimed to assess the budget required to scale up the programme and the incremental cost-effectiveness ratios. Methods In a cluster-randomised trial of COBRA-BPS, individuals aged 40 years or older with hypertension who lived in 30 rural communities in Bangladesh, Pakistan, and Sri Lanka were deemed eligible for inclusion. Costs were quantified prospectively at baseline and during 2 years of the trial. All costs, including labour, rental, materials and supplies, and contracted services were recorded, stratified by programme activity. Incremental costs of scaling up COBRA-BPS to all eligible adults in areas covered by community health workers were estimated from the health ministry (public payer) perspective. Findings Between April 1, 2016, and Feb 28, 2017, 11 510 individuals were screened and 2645 were enrolled and included in the study. Participants were examined between May 8, 2016, and March 31, 2019. The first-year per-participant costs for COBRA-BPS were US$10·65 for Bangladesh, $10·25 for Pakistan, and $6·42 for Sri Lanka. Per-capita costs were $0·63 for Bangladesh, $0·29 for Pakistan, and $1·03 for Sri Lanka. Incremental cost-effectiveness ratios were $3430 for Bangladesh, $2270 for Pakistan, and $4080 for Sri Lanka, per cardiovascular disability-adjusted life year averted, which showed COBRA-BPS to be cost-effective in all three countries relative to the WHO-CHOICE threshold of three times gross domestic product per capita in each country. Using this threshold, the cost-effectiveness acceptability curves predicted that the probability of COBRA-BPS being cost-effective is 79·3% in Bangladesh, 85·2% in Pakistan, and 99·8% in Sri Lanka. Interpretation The low cost of scale-up and the cost-effectiveness of COBRA-BPS suggest that this programme is a viable strategy for responding to the growing cardiovascular disease epidemic in rural communities in low-income and middle-income countries where community health workers are present, and that it should qualify as a priority intervention across rural settings in south Asia and in other countries with similar demographics and health systems to those examined in this study. Funding The UK Department of Health and Social Care, the UK Department for International Development, the Global Challenges Research Fund, the UK Medical Research Council, Wellcome Trust.
Development of school-based nutrition education programmes and behavior change strategies emphasizing the regular intake of meals and nutrient-rich snacks, and encouraging consumption of easily available and affordable food items such as dried seeds, fruits, vegetables, milk and its derivatives is essential for addressing nutrient deficiencies.
Introduction. Undernutrition in children is a major public health concern in Pakistan. A number of interventions which focused only on providing nutrient supplementation have failed to change child undernutrition status during the last 2 decades. The present study aimed to assess the impact of nutrition education on the nutritional status of children living in resource-limited environments. Methods. Subjects were 586 children from Tando Jam and Quetta, Pakistan, aged from 6 months to 8 years. Children were characterized as mild, moderate, or severely wasted on Z-scores. Anthropometry and 24-hour dietary recall were used for nutritional assessment. Intervention strategy was nutrition counselling targeting mothers. Primary outcome was decrease in the severity of wasting and changes in the feeding practices. Results. Nearly 36% children in Tando Jam and 32% children in Quetta progressed to a normal nutritional status. There was a significant increase in the number of meals taken per day (Tando Jam—P ≤ 0.000/Quetta—P ≤ 0.025). In Tando Jam, significant increase was reported in the intake of high starch food items, vegetables, and fruits (P ≤ 0.000). In Quetta, significant increase was noted in the intake of plant protein (P ≤ 0.005), dairy foods (P ≤ 0.041), and vegetables (P ≤ 0.026). Conclusion. Nutrition education was successful in reducing undernutrition in food insecure households.
Introduction: There is a lack of data assessing disease activity in patients with rheumatoid arthritis from Pakistan. We sought to determine the correlation between Disease Activity Score 28 (DAS28) and disease activity parameters and the modified Health Assessment Questionnaire (mHAQ). Secondarily, we evaluated the concordance of acute phase reactants with disease activity. Material and methods: We prospectively studied 132 patients with rheumatoid arthritis (RA) as per the 2010 American College of Rheumatology/European League Against Rheumatism criteria, not in clinical remission. Based on the DAS28 score, the patients were divided into low, moderate, and high activity groups. The patients were also categorized according to the elevation of acute phase reactants to determine concordance and discordance with DAS28-ESR and DAS28-CRP. Descriptive statistics and Pearson's correlation were computed. Results: Complete demographics was available for 132 participants. The mean age was 46.2 ±12.8 years; there were 85.6% (n = 113) females. The mean disease duration was 5.7 ±6.4 years. The (Rephrase as mean ±SD) DAS28 and mHAQ scores were 3.4 ±1.8 and 0.77 ±0.68, respectively. A significant correlation was observed between DAS28 and tender and swollen joint count (r = 0.64; p < 0.001); DAS28 and mHAQ (r = 0.47; p-value < 0.001), DAS28 and patient's global assessment (PGA) (r = 0.45; p-value < 0.001). A weak correlation was observed between mHAQ and CRP and ESR, with r = 0.242 and 0.225, respectively, p-value < 0.001. In comparison, no correlation of DAS28 with the rheumatoid factor (r = -0.035) or ACPA antibody (r = -0.094) was noted. A positive concordance between ESR and CRP was observed in severely active RA. Conclusions: From an outpatient setting in a South Asian country, DAS28-ESR emerged as the preferred choice for an accurate assessment of disease severity in RA when combined with the mHAQ. Acute phase reactants increase positively in concordance with severely active RA, although discordant in low to moderately active disease.
Prevalence of disabilities in Pakistan is 2.4 % (3.2 million), with 7 % population suffering from hearing impairments. This study focuses on many aspects of development including physical development, which have never been studied exclusively in developing countries. This pilot study was aimed to explore play pattern of children with hearing & speech impairments in school settings, Karachi, Pakistan. In this article play behaviors of 53 children with sensory impairments aged 8-12 years were explored. Observations were recorded through semi-structured checklist, using norm-based time sampling procedure, recording various types of behavior in a group play context. Three major play categories were observed and recorded under: a) Social Play; proximity and attentiveness b) Cognitive Play; level of child’s involvement and purpose for engaging in the activity c) Non- Play; marked by absence of focus. Frequently observed play behavior was; group play under cognitive play; games with rules and functional play behavior; engagement of child in physical activities for the enjoyment of physical sensation and in non-play behavior active conversation, rough and tumble play, recorded. Study findings reveal the importance of play as an essential component for healthy child development. Dire need of capacity building of school staff and of caregivers regarding child development and importance of play was felt at larger scale.
The prevalence of micronutrient deficiencies in young children has a profound effect on their immune system, growth and mental development. However, many micronutrients deficiencies in children such as calcium can be prevented. This research has explored the perceptions and practices of mothers, residing in Karachi, regarding milk and milk products (MAMPs) intake in children of age 2-5 years, in order to find out the amount of MAMPs in their diet and the factors affecting such intake. This is a qualitative exploratory study. Semi structured, in-depth interviews were conducted. Eighteen mothers whose children's age were 2-5 years old were purposively recruited from three daycare centers of three different socioeconomic status areas of Karachi. The MAMPs intake of children in three different socioeconomic areas of Karachi was in accordance with 2006's, American Academy of Pediatrics recommendations for requirements, i.e. 2 cups per day of Milk/Dairy for 2-4 years old children. However, the type of MAMPs and children's preferences differs considerably. The most preferred MAMPs among children of age were yogurt and plain milk. The preferences for MAMPs in children were mainly determined by their peers, mother's ethnicity and media advertisements. Most of the mothers did not prefer giving MAMPs in several common childhood illnesses due to prevailing misconceptions. It was also explored that maternal ethnicity plays considerable role in selecting and combining various food items mainly fish with MAMPs. Recognizing the MAMPs intake of children and their mother's perceptions and practices can help researchers to better understand children's preferences for different MAMPs and the factors influencing their intake. Food policies and recommendations related to MAMPs in children can be evaluated for their relevance to children's ecological determinants to address the issues related to growth and development in early ages.
This study aimed to study the manifestation of incivility among students of University of Azad Jammu & Kashmir and further analyze the causes and impact of students’ incivility at campus as it provides a detailed picture of the types and classification of interpersonal conflict situations that arise among students. The study was conducted in one of the oldest and largest university of Azad Jammu & Kashmir. 55 student respondents were selected using purposive sampling technique. Phenomenology as a research method was adopted and data was collected using unstructured and conversational interviews which was later analyzed by making themes. The results obtained from the study have indicated that students differentiate among various uncivil behaviors, from a regular bullying to abusing, to major hand fights. The reasons behind the uncivil behaviors as analyzed by the collected interviews are personal differences, management ignorance and sometimes a latent hate. In addition to this, students who have experienced frequent uncivil behavior at campus has an impact on their academic learning as well as psychological health. The study concludes that majority students who have been part of any kind of incivility at campus are the fresh comers and are enrolled in BS programs. Hence recommends to introduce faculty-led orientation sessions and to increase the faculty civility as teachers can play eminent role in shaping students’ civil behavior. Keywords: uncivil behaviour, incivility, conflict at campus, hate speech
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