Early child health in Lahore, Pakistan: I. Study Design

Abstract

In this paper, details are given of a community based follow up study of four areas: a village, a periurban slum, an urban slum and an upper middle class control group living in and around Lahore, Pakistan. The aim was to characterize the determinants of child health in a rapidly urbanizing community. The study was undertaken in two steps. An initial cross-sectional survey collecting socio-economic and demographic background information was carried out between March to August 1984. This was followed by a longitudinal study of 1476 infants representing the outcome of the pregnancies registered continuously between September 1984 to March 1987 among the 3242 families in the study. These infants were followed monthly from birth to 3 years of age and thereafter less frequently. In this communication we describe the study design, the study population, the organization and the research methodology used, including the reasons for drop outs from birth to 24 months of age. The internal consistency of the data is also presented. After the initial examination of the newborns within between 0-7 days of birth, the infants were visited monthly for 24 months making a total of 20911 examinations. At 24 months of age 70% of the infants were still in the study, 11% had died before reaching this age, 13% had moved from the area and 6% had refused to participate in the study. The economic, conditions, social structure, and the quality of life were found, not surprisingly, to vary significantly among the four areas. This community-based project provides new, critical and reliable information for local health planners. The study highlights the importance of the development of a useful model for research collaboration between institutions in developed and developing countries.

Mild intellectual disability in children in Lahore, Pakistan: Aetiology and risk factors

“…The four study areas represented different stages of urbanization: a village, a periurban slum, an urban slum and an upper middle (UM) class group. The socio‐economic background of the population belonging to these areas is described in detail elsewhere (Jalil et al. 1993).…”

“…The contact with these families was made at the private clinics of obstetricians where these mothers came for antenatal check‐ups during the second trimester of their pregnancies. The inclusion criteria for these families were a monthly income more than Rs 5000 (US$166), owning a house with at least three bed rooms, not more than two children, and at least 10 years schooling for both the parents (Jalil et al. 1993).…”

“…Weight at birth was measured to the nearest 100 g with minimal clothing. Length and head circumference were measured to the nearest 1 mm (Jalil et al. 1993).…”

Birth weight predicts response to vaccination in adults born in an urban slum in Lahore, Pakistan

“…However, this is considered unlikely because all of the vaccines were stored in refrigerators at the study site (Department of Social and Preventive Pediatrics), the subjects were brought to the department on the day of vaccinations, and the vaccines were removed immediately before vaccination. The 2 seasons in Lahore are known to have significant effects on the health and growth of young children and may determine the timing of exposure to potentially critical challenges, such as enteric or respiratory viral infections (25,26). It is therefore possible that this seasonal increase in antigenic exposure acts as an adjuvant to the vaccine and primes the immune system, thus increasing the antibody response during the peak months of exposure.…”

Severe mental retardation in 2 to 24‐month‐old children in Lahore, Pakistan: a prospective cohort study

“…These areas represented a natural pathway of migration from villages to the upper-middle class. The socio-economic background of the study population is described in detail elsewhere (11). However, a brief description of the study areas is given below.…”