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Tryliskyy Y, Kebkalo A, Tyselskyi V, Owais A, Pournaras DJ. Short-term outcomes of minimally invasive techniques in posterior component separation for ventral hernia repair: a systematic review and meta-analysis. Hernia 2024:10.1007/s10029-024-03030-y. [PMID: 38632220 DOI: 10.1007/s10029-024-03030-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 03/15/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION The objective of this study was to perform a systematic review and meta-analysis to summarize various approaches in performing minimally invasive posterior component separation (MIS PCS) and ascertain their safety and short-term outcomes. METHODS A systematic literature searches of major databases were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to identify studies that provided perioperative characteristics and postoperative outcomes of MIS PCS. Primary outcomes for this study were: surgical site events (SSE), surgical site occurrence requiring procedural intervention (SSOPI), and overall complication rates. A random-effect meta-analysis was conducted which allows computation of 95% CIs using simple approximation and incorporates inverse variance method with logit transformation of proportions. RESULTS There were 14 studies that enrolled 850 participants that were included. The study identified rate of SSE, SSOPI, and overall rate of complications of all MIS TAR modifications to be 13.4%, 5.7%, and 19%, respectively. CONCLUSIONS Our study provides important information on safety and short-term outcomes of MIS PCS. These data can be used as reference when counseling patients, calculating sample size for prospective trials, setting up targets for prospective audit of hernia centers. Standardization of reporting of preoperative characteristics and postoperative outcomes of patients undergoing MIS PCS and strict audit of the procedure through introduction of prospective national and international registries can facilitate improvement of safety of the MIS complex abdominal wall reconstruction, and help in identifying the safest and most cost-effective modification.
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Affiliation(s)
- Y Tryliskyy
- Great Western Hospitals, NHS, Marlborough Road, Swindon, England, SN3 6BB, UK.
- The University of Edinburgh, Edinburgh, UK.
| | - A Kebkalo
- Shupyk National Healthcare University of Ukraine, Kiev, Ukraine
| | - V Tyselskyi
- Shupyk National Healthcare University of Ukraine, Kiev, Ukraine
| | - A Owais
- Great Western Hospitals, NHS, Marlborough Road, Swindon, England, SN3 6BB, UK
| | - D J Pournaras
- Southmead Hospital, North Bristol NHS Trust, Bristol, England, UK
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Carducci B, Dominguez G, Kidd E, Janes K, Owais A, Bhutta ZA. Pivoting school health and nutrition programmes during COVID-19 in low- and middle-income countries: A scoping review. J Glob Health 2024; 14:05006. [PMID: 38236689 PMCID: PMC10795858 DOI: 10.7189/jogh.14.05006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024] Open
Abstract
Background Preventive and promotive interventions delivered by schools can support a healthy lifestyle, positive development, and well-being in children and adolescents. The coronavirus disease 2019 (COVID-19) pandemic presented unique challenges to school health and nutrition programmes due to closures and mobility restrictions. Methods We conducted a scoping review to examine how school health and nutrition programmes pivoted during the COVID-19 pandemic, and to provide summative guidance to stakeholders in strategic immediate and long-term response efforts. We searched MEDLINE, Embase, PsycINFO, and grey literature sources for primary (observational, intervention, and programme evaluations) and secondary (reviews, best practices, and recommendations) studies conducted in low- and middle-income countries from January 2020 to June 2023. Programmes that originated in schools, which included children and adolescents (5-19.9 years) were eligible. Results We included 23 studies in this review. They varied in their adaptation strategy and key programmatic focus, including access to school meals (n = 8), health services, such as immunisations, eye health, and water, sanitation, and hygiene-related activities (n = 4), physical activity curriculum and exercise training (n = 3), mental health counselling and curriculum (n = 3), or were multi-component in nature (n = 5). While school meals, physical activity, and mental health programmes were adapted by out-of-school administration (either in the community, households, or virtually), all health services were suspended indefinitely. Importantly, there was an overwhelming lack of quantitative data regarding modified programme coverage, utilisation, and the impact on children and adolescent health and nutrition. Conclusions We found limited evidence of successful adaptation of school health and nutrition programme implementation during the pandemic, especially from Asia and Africa. While the adoption of the World Health Organization health-promoting school global standards and indicators is necessary at the national and school level, future research must prioritise the development of a school-based comprehensive monitoring and evaluation framework to track key indicators related to both health and nutrition of school-aged children and adolescents.
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Affiliation(s)
- Bianca Carducci
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning (PGCRL), Toronto, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Georgia Dominguez
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning (PGCRL), Toronto, Canada
| | - Emily Kidd
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning (PGCRL), Toronto, Canada
| | - Karlie Janes
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning (PGCRL), Toronto, Canada
| | - Aatekah Owais
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning (PGCRL), Toronto, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning (PGCRL), Toronto, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada
- Centre of Excellence in Women, and Child Health, Aga Khan University, Karachi, Pakistan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Harrison L, Padhani Z, Salam R, Oh C, Rahim K, Maqsood M, Ali A, Charbonneau K, Keats EC, Lassi ZS, Imdad A, Owais A, Das J, Bhutta ZA. Dietary Strategies for Complementary Feeding between 6 and 24 Months of Age: The Evidence. Nutrients 2023; 15:3041. [PMID: 37447369 PMCID: PMC10346638 DOI: 10.3390/nu15133041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
Suboptimal complementary feeding practices remain highly prevent. This review aims to comprehensively synthesize new emerging evidence on a set of topics related to the selection and consumption of complementary foods. We synthesized evidence related to five key topics focused on nutritional interventions that target the complementary feeding period, based on four systematic reviews that include updated evidence to February 2022. While there have been many studies examining interventions during the complementary feeding period, there is an overall lack of relevant information through which to draw conclusions on the ideal feeding schedule by food type. Similarly, few studies have examined the effects of animal milk versus infant formula for non-breastfed infants (6-11 months), though those that did found a greater risk of anemia among infants who were provided cow's milk. This review highlights a number of interventions that are successful at improving micronutrient status and anthropometry during the complementary feeding period, including fortified blended foods, locally and commercially produced supplementary foods, and small-quantity lipid-based nutrient supplements. Complementary feeding education for caregivers can also be used to improve nutrition outcomes among infants in both food secure and insecure populations.
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Affiliation(s)
- Leila Harrison
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Zahra Padhani
- Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia
| | - Rehana Salam
- The Daffodil Centre—A Joint Venture of Cancer Council and The University of Sydney, Sydney, NSW 2006, Australia
| | - Christina Oh
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Komal Rahim
- Internal Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Maria Maqsood
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Anna Ali
- Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia
| | - Kimberly Charbonneau
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Emily C. Keats
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Zohra S. Lassi
- Robinson Research Institute, University of Adelaide, Adelaide, SA 5005, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
| | - Aamer Imdad
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Aatekah Owais
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Jai Das
- Division of Women & Child Health, Aga Khan University, Karachi 74800, Pakistan
| | - Zulfiqar A. Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
- Division of Women & Child Health, Aga Khan University, Karachi 74800, Pakistan
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Hess SY, Owais A, Jefferds MED, Young MF, Cahill A, Rogers LM. Accelerating action to reduce anemia: Review of causes and risk factors and related data needs. Ann N Y Acad Sci 2023; 1523:11-23. [PMID: 36987993 PMCID: PMC10918744 DOI: 10.1111/nyas.14985] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Anemia is a major public health concern. Young children, menstruating adolescent girls and women, and pregnant women are among the most vulnerable. Anemia is the consequence of a wide range of causes, including biological, socioeconomic, and ecological risk factors. Primary causes include: iron deficiency; inherited red blood cell disorders; infections, such as soil-transmitted helminthiasis, schistosomiasis, and malaria; gynecological and obstetric conditions; and other chronic diseases that lead to blood loss, decreased erythropoiesis, or destruction of erythrocytes. The most vulnerable population groups in low- and middle-income countries are often at the greatest risk to suffer from several of these causes simultaneously as low socioeconomic status is linked with an increased risk of anemia through multiple pathways. Targeted and effective action is needed to prevent anemia. Understanding the causes and risk factors of anemia for different population subgroups within a country guides the design and implementation of effective strategies to prevent and treat anemia. A coordinated approach across various expert groups and programs could make the best use of existing data or could help to determine when newer and more relevant data may need to be collected, especially in countries with a high anemia burden and limited information on the etiology of anemia.
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Affiliation(s)
- Sonja Y. Hess
- Institute for Global Nutrition and Department of Nutrition, University of California Davis, Davis, California, USA
- Micronutrient Forum, Washington, DC, USA
| | - Aatekah Owais
- Centre for Global Child Health, Hospital for Sick Children on behalf of Exemplars in Global Health, Toronto, Ontario, Canada
| | | | - Melissa F. Young
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Andrew Cahill
- Gates Ventures on behalf of Exemplars in Global Health, Seattle, Washington, USA
| | - Lisa M. Rogers
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
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Owais A, Rizvi A, Jawwad M, Horton S, Das JK, Merritt C, Moreno R, Asfaw AG, Rutter P, Nguyen PH, Menon P, Bhutta ZA. Assessing the hidden burden and costs of COVID-19 pandemic in South Asia: Implications for health and well-being of women, children and adolescents. PLOS Glob Public Health 2023; 3:e0001567. [PMID: 37043496 PMCID: PMC10096516 DOI: 10.1371/journal.pgph.0001567] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 02/27/2023] [Indexed: 04/13/2023]
Abstract
The COVID-19 pandemic has disproportionately affected vulnerable populations. With its intensity expected to be cyclical over the foreseeable future, and much of the impact estimates still modeled, it is imperative that we accurately assess the impact to date, to help with the process of targeted rebuilding of services. We collected data from administrative health information systems in six South Asian countries (Afghanistan, Bangladesh, Nepal, India, Pakistan and Sri Lanka), to determine essential health services coverage disruptions between January-December 2020, and January-June 2021, compared to the same calendar months in 2019, and estimated the impact of this disruption on maternal and child mortality using the Lives Saved Tool. We also modelled impact of prolonged school closures on continued enrollment, as well as potential sequelae for the cohort of girls who have likely dropped out. Coverage of key maternal and child health interventions, including antenatal care and immunizations, decreased by up to 60%, with the largest disruptions observed between April and June 2020. This was followed by a period of recovery from July 2020 to March 2021, but a reversal of most of these gains in April/May 2021, likely due to the delta variant-fueled surge in South Asia at the same time. We estimated that disruption of essential health services between January 2020 and June 2021 potentially resulted in an additional 19,000 maternal and 317,000 child deaths, an increase of 19% and 13% respectively, compared to 2019. Extended school closures likely resulted in 9 million adolescents dropping out permanently, with 40% likely being from poorest households, resulting in decreased lifetime earnings. A projected increase in early marriages for girls who dropped out could result in an additional 500,000 adolescent pregnancies, 153,000 low birthweight births, and 27,000 additional children becoming stunted by age two years. To date, the increase in maternal and child mortality due to health services disruption has likely exceeded the overall number of COVID-19 deaths in South Asia. The indirect effects of the pandemic were disproportionately borne by the most vulnerable populations, and effects are likely to be long-lasting, permanent and in some cases inter-generational, unless policies aimed at alleviating these impacts are instituted at scale and targeted to reach the poorest of the poor. There are also implications for future pandemic preparedness.
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Affiliation(s)
- Aatekah Owais
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Arjumand Rizvi
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Muhammad Jawwad
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Susan Horton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Jai K Das
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
- Institute of Global Health and Development, The Aga Khan University, South-Central Asia, East Africa & United Kingdom
| | - Catherine Merritt
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Ralfh Moreno
- UNICEF Headquarters, New York, New York, United States of America
| | | | | | | | - Purnima Menon
- International Food Policy Research Institute, Delhi, India
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Institute of Global Health and Development, The Aga Khan University, South-Central Asia, East Africa & United Kingdom
- Center of Excellence in Women and Child Health, The Aga Khan University, South-Central Asia, East Africa & United Kingdom
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Owais A, Wuehler S, Heidkamp R, Mehra V, Neufeld LM, Rogers LM, Saha KK. Critical assessment of the current indicator for antenatal iron‐containing supplementation coverage: Insights from a mixed‐methods study. Maternal & Child Nutrition 2022; 18:e13314. [PMID: 35092159 PMCID: PMC8932708 DOI: 10.1111/mcn.13314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 11/30/2022]
Abstract
Daily consumption of iron‐containing supplements is recommended for all pregnant women but there is no approved global standard indicator for assessing supplementation coverage. Furthermore, the validity of commonly used coverage indicators for iron‐containing supplement consumption is questionable. The WHO–UNICEF Technical Expert Advisory Group on Nutrition Monitoring, and partners, have systematically worked to identify a feasible and valid indicator of iron‐containing supplement coverage for reporting by countries. In 2019, we conducted key informant interviews with respondents in eight countries, fielded an online survey (in three languages using SurveyMonkey) to which 142 nutrition professionals from 52 countries responded, and used Demographic and Health Surveys (DHS) data from four countries to assess determinants of the quality of iron‐containing supplement coverage data. Less than half (45%) of online survey respondents were satisfied with the current methods for collecting iron‐containing supplement coverage data in their context. Recommended changes by study respondents include recall period <5 years, adding questions about counselling, including other beneficiary groups, and assessing supply chain functionality. The DHS analysis suggested an association between time since pregnancy and data quality. Data heaping on multiples of 30 was observed in 40%–75% of data. There is a clear demand for a revised indicator and measurement guidance for coverage of iron‐containing supplementation during pregnancy. Future research should continue the development and validation of a global indicator, to more precisely validate the quality of recall data, including the distinction between distribution and consumption using various question formulations. Health and nutrition professionals have described concerns with current methods for reporting coverage of daily iron‐containing supplementation in pregnant women. The long recall period (5 years) of commonly used iron‐containing supplement consumption indicators calls into question the validity of these indicators. Our study indicates that there is demand for a revised indicator and guidance for data collection.
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Affiliation(s)
- Aatekah Owais
- Nutrition International Ottawa Canada
- Centre for Global Child Health, Research Institute Hospital for Sick Children Toronto Canada
| | | | - Rebecca Heidkamp
- International Health, Bloomberg School of Public Health Johns Hopkins University Baltimore Maryland USA
| | - Vrinda Mehra
- Data and Analytics Section, Division of Data, Analysis, Planning and Monitoring UNICEF New York City New York USA
| | | | - Lisa M. Rogers
- Department of Nutrition and Food Safety World Health Organization Geneva Switzerland
| | - Kuntal Kumar Saha
- Department of Nutrition and Food Safety World Health Organization Geneva Switzerland
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Owais A, Wuehler S, Lee J, Samb O, Thorne-Lyman A, Katz J, Saha K, Heidkamp R. How Can We Improve the Measurement of Iron Folic Acid Coverage Globally? Key Findings from Recent Measurement Research. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa053_083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Daily Iron-Folic Acid (IFA) supplementation is recommended for all pregnant women but there is no global standard coverage indicator. The validity of common IFA consumption indicators is questionable. The WHO UNICEF Technical Expert Advisory Group for Nutrition Monitoring and partners have supported multiple efforts to identify a feasible and valid indicator of IFA coverage for reporting by World Health Assembly member states.
Methods
In 2019 we conducted 1) key informant interviews (KII) in 8 countries 2) an online survey among 58 nutrition professionals from 31 countries 3) cognitive interviews with postpartum women in Senegal, Bangladesh and Nepal and 4) advanced analysis of determinants of IFA data quality across four Demographic and Health Surveys (DHS). Together these methods characterized current challenges and identified ways to improve IFA coverage measurement.
Results
The KII and online surveys reported similar challenges. Less than half (45%) of online survey respondents were satisfied with their current methods for collecting IFA coverage data. Recommended changes include reduced recall period, adding questions about counseling, including other beneficiary groups and assessing supply issues. Cognitive interviews confirmed that women find it difficult to answer questions about numbers of pills consumed. Results from the DHS data quality analysis are forthcoming.
Conclusions
IFA coverage measurement is a global priority and there is clear demand for a revised indicator and guidance for collection in survey and administrative systems. While indicators of IFA delivery are more feasible there are promising ways to improve women's report of amount of IFA consumed.
Funding Sources
Bill & Melinda Gates Foundation.
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Affiliation(s)
| | | | | | - Oumar Samb
- Universite due Quebec en Abitibi-Temiscamingue
| | | | - Joanne Katz
- Johns Hopkins Bloomberg School of Public Health
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Owais A, Suchdev PS, Schwartz B, Kleinbaum DG, Faruque ASG, Das SK, Stein AD. Maternal knowledge and attitudes towards complementary feeding in relation to timing of its initiation in rural Bangladesh. BMC Nutr 2019; 5:7. [PMID: 32153921 PMCID: PMC7050709 DOI: 10.1186/s40795-019-0272-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/21/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Aatekah Owais
- 1Department of Epidemiology, Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, GA USA
| | - Parminder S Suchdev
- 2Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE. Room 7007, Atlanta, GA 30322 USA
| | - Benjamin Schwartz
- 3Los Angeles County Department of Public Health, Los Angeles, CA USA
| | | | - A S G Faruque
- International Center for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Sumon K Das
- International Center for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Aryeh D Stein
- 2Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE. Room 7007, Atlanta, GA 30322 USA.,4Department of Epidemiology, Emory University, Atlanta, GA USA
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Faris M, Hashim M, Owais A, Obaideen A, Alardah L, Jahrami H. Premenstrual syndrome is associated with dietary and lifestyle habits among college students: A cross-sectional study. Journal of Nutrition & Intermediary Metabolism 2017. [DOI: 10.1016/j.jnim.2017.04.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Owais A, Schwartz B, Kleinbaum DG, Suchdev PS, Faruque ASG, Das SK, Rahman S, Stein AD. A Nutrition Education Program in Rural Bangladesh Was Associated with Improved Feeding Practices but Not with Child Growth. J Nutr 2017; 147:948-954. [PMID: 28298543 DOI: 10.3945/jn.116.243956] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/14/2016] [Accepted: 02/17/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Childhood undernutrition is a major public health problem in Bangladesh. Evaluating child nutrition programs is a priority.Objective: The objective of this study was to evaluate a community-based nutrition education program (implemented from 2011 to 2013) aimed at improving infant and young child feeding (IYCF) practices and growth in rural Bangladesh.Methods: A cohort-based evaluation was conducted that included 2400 women (1200 from Karimganj, the intervention subdistrict, and 1200 from Katiadi, the control subdistrict) enrolled at 28-31 wk gestation in 3 waves between January and October 2011. Follow-up occurred at 3, 9, 16, and 24 mo of offspring age. The main outcomes were exclusive breastfeeding (EBF), measured at 3 mo, timing of complementary feeding (CF) initiation and minimum acceptable diet (MAD), measured at 9 mo, and child growth [assessed via length-for-age z score (LAZ) and weight-for-length z score], measured at all follow-ups. The main exposures were subdistrict of residence and wave of enrollment. For IYCF practices as outcome, logistic regressions were used. Generalized estimating equations were used for child growth as outcome.Results: EBF rates at 3 mo remained unchanged between waves 1 and 3 in Karimganj (55.6% compared with 57.3%), but the proportion of infants receiving timely CF initiation and MAD at 9 mo increased significantly (CF: 27.1-54.7%; MAD: 8.4-35.3%). Mean LAZ at 24 mo remained unchanged between waves 1 and 3 in Karimganj (-2.18 compared with -1.98).Conclusions: The program was successful in improving the quality of infant diet at 9 mo and timely CF initiation, but not EBF at 3 mo or LAZ. These findings support the case for implementing simple messages in all programs aimed at improving infant diet, especially in settings in which supplementing overall household diet may not be feasible.
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Affiliation(s)
- Aatekah Owais
- Department of Epidemiology, Rollins School of Public Health and Laney Graduate School
| | | | | | | | | | - Sumon K Das
- International Center for Diarrheal Disease Research, Dhaka, Bangladesh; and
| | | | - Aryeh D Stein
- Department of Epidemiology, and .,Hubert Department of Global Health, Emory University, Atlanta, GA
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Owais A, Schwartz B, Kleinbaum DG, Suchdev PS, Faruque ASG, Das SK, Stein AD. Minimum Acceptable Diet at 9 Months but Not Exclusive Breastfeeding at 3 Months or Timely Complementary Feeding Initiation Is Predictive of Infant Growth in Rural Bangladesh. PLoS One 2016; 11:e0165128. [PMID: 27776161 PMCID: PMC5077142 DOI: 10.1371/journal.pone.0165128] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/06/2016] [Indexed: 11/18/2022] Open
Abstract
The association between suboptimal infant feeding practices and growth faltering is well-established. However, most of this evidence comes from cross-sectional studies. To prospectively assess the association between suboptimal infant feeding practices and growth faltering, we interviewed pregnant women at 28–32 weeks’ gestation and followed-up their offspring at postnatal months 3, 9, 16 and 24 months in rural Bangladesh. Using maternal recall over the past 24 hours, exclusive breastfeeding (EBF) status at 3 months, age at complementary feeding (CF) initiation, and receipt of minimum acceptable diet (MAD; as defined by WHO) at 9 months were assessed. Infant length and weight measurements were used to produce length-for-age (LAZ) and weight-for-length (WLZ) z-scores at each follow-up. Generalized estimating equations were used to estimate associations of LAZ and WLZ with infant feeding practices. All models were adjusted for baseline SES, infant sex, maternal height, age, literacy and parity. Follow-up was completed by 2189, 2074, 1969 and 1885 mother-child dyads at 3, 9, 16 and 24 months, respectively. Stunting prevalence increased from 28% to 57% between infant age 3 and 24 months. EBF at 3 months and age at CF initiation were not associated with linear infant growth, but receipt of MAD at 9 months was. By age 24 months, infants receiving MAD had attained a higher LAZ compared to infants who did not receive MAD (adjusted β = 0.25, 95% CI: 0.13–0.37). Although prevalence of stunting was already high at age 3 months, ensuring infants receive a diverse, high quality diet from 6 months onwards may reduce rates of stunting in the second year of life.
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Affiliation(s)
- Aatekah Owais
- Department of Epidemiology, Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, GA, United States of America
| | - Benjamin Schwartz
- Los Angeles County Department of Public Health, Los Angeles, CA, United States of America
| | - David G. Kleinbaum
- Department of Epidemiology, Emory University, Atlanta, GA, United States of America
| | - Parminder S. Suchdev
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States of America
| | - A. S. G. Faruque
- International Center for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Sumon K. Das
- International Center for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Aryeh D. Stein
- Department of Epidemiology, Emory University, Atlanta, GA, United States of America
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States of America
- * E-mail:
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Thomas JS, Yu EA, Tirmizi N, Owais A, Das SK, Rahman S, Faruque ASG, Schwartz B, Stein AD. Maternal knowledge, attitudes and self-efficacy in relation to intention to exclusively breastfeed among pregnant women in rural Bangladesh. Matern Child Health J 2015; 19:49-57. [PMID: 24752315 DOI: 10.1007/s10995-014-1494-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Achieving optimal exclusive breastfeeding (EBF) remains a challenge. Because intention is a precursor of practice, we examined factors associated with EBF intention during pregnancy in two rural sub-districts of Kishoreganj district, Bangladesh. We studied 2,400 pregnant women in their third trimester (26-32 weeks gestation). We assessed knowledge (6 items, scale range 0-6), attitudes (15 items, scale range 15-75) and self-efficacy (6 items, scale range 6-30) by interview using a standardized questionnaire. 83.9 % of pregnant women reported EBF intention. Mean breastfeeding knowledge was 3.5 (SD 1.3), mean attitude was 55.8 (SD 8.1) and mean self-efficacy was 25.6 (SD 3.4). Knowledge was associated with EBF intention (OR 2.47, 95 % CI 1.74, 3.51), attitudes toward EBF (OR 1.68, 95 % CI 1.31, 2.16) and self-efficacy (OR 1.72, 95 % CI 1.23, 2.40) were independently associated with EBF intention in the model in which all three constructs were entered simultaneously. Receipt of breastfeeding counseling during pregnancy and being literate were each associated with EBF knowledge and EBF intention (all p < 0.05). Increasing maternal knowledge, positive attitudes, and self-efficacy regarding EBF were associated with prenatal EBF intention. These results reinforce the importance of appropriate counseling to increase EBF prevalence .
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Affiliation(s)
- Joan S Thomas
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Room 7007, Atlanta, GA, 30322, USA
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Owais A, Kleinbaum D, Suchdev P, Faruque AS, Das S, Stein A. Maternal knowledge and attitudes in relation to complementary feeding initiation in rural Bangladesh. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.898.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | - Sumon Das
- Centre for Nutrition & Food Securityicddr, bBangladesh
| | - Aryeh Stein
- Dept. of Epidemiology Emory UniversityUnited States
- Hubert Dept. of Global Health Emory UniversityUnited States
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Owais A, Faruque ASG, Das SK, Ahmed S, Rahman S, Stein AD. Maternal and antenatal risk factors for stillbirths and neonatal mortality in rural Bangladesh: a case-control study. PLoS One 2013; 8:e80164. [PMID: 24244638 PMCID: PMC3820579 DOI: 10.1371/journal.pone.0080164] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 09/29/2013] [Indexed: 11/18/2022] Open
Abstract
Objective To identify maternal and antenatal factors associated with stillbirths and neonatal deaths in rural Bangladesh. Study Design A prospective cohort study is being conducted to evaluate a maternal and child nutrition program in rural Bangladesh. Cases were all stillbirths and neonatal deaths that occurred in the cohort between March 7, 2011 and December 30, 2011. Verbal autopsies were used to determine cause of death. For each case, four controls were randomly selected from cohort members alive at age 3-months. Multivariable logistic regression was used to identify factors associated with these deaths. Results Overall, 112 adverse pregnancy outcomes (44 stillbirths, 19/1,000 births; 68 neonatal deaths, 29/1,000 live births) were reported. Of the stillbirths 25 (56.8%) were fresh. The main causes of neonatal death were birth asphyxia (35%), sepsis (28%) and preterm birth (19%). History of bleeding during pregnancy was the strongest risk factor for stillbirths (adjusted odds ratio 22.4 [95% confidence interval 2.5, 197.5]) and neonatal deaths (adjusted odds ratio 19.6 [95% confidence interval 2.1, 178.8]). Adequate maternal nutrition was associated with decreased risk of neonatal death (adjusted odds ratio 0.4 [95% confidence interval 0.2, 0.8]). Conclusions Identifying high-risk pregnancies during gestation and ensuring adequate antenatal and obstetric care needs to be a priority for any community-based maternal and child health program in similar settings.
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Affiliation(s)
- Aatekah Owais
- Department of Epidemiology, Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, Georgia, United States of America
| | | | - Sumon K. Das
- International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shahnawaz Ahmed
- International Center for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Aryeh D. Stein
- Hubert Department of Global Health, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
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Patel A, Roston A, Owais A, Roston A, Keith L, Stern L. Immediate postabortion IUD placement for women with unknown STI status in a high-risk population: what's the dilemma? Contraception 2013. [DOI: 10.1016/j.contraception.2013.05.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Owais A, Khowaja AR, Ali SA, Zaidi AKM. Pakistan's expanded programme on immunization: an overview in the context of polio eradication and strategies for improving coverage. Vaccine 2013; 31:3313-9. [PMID: 23707167 DOI: 10.1016/j.vaccine.2013.05.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 05/02/2013] [Accepted: 05/07/2013] [Indexed: 11/26/2022]
Abstract
Since its inception in 1978, Pakistan's Expanded Programme on Immunization (EPI) has contributed significantly towards child health and survival in Pakistan. However, the WHO-estimated immunization coverage of 88% for 3 doses of Diptheria-Tetanus-Pertussis vaccine in Pakistan is likely an over-estimate. Many goals, such as polio, measles and neonatal tetanus elimination have not been met. Pakistan reported more cases of poliomyelits in 2011 than any other country globally, threatening the Global Polio Eradication Initiative. Although the number of polio cases decreased to 58 in 2012 through better organized supplementary immunization campaigns, country-wide measles outbreaks with over 15,000 cases and several hundred deaths in 2012-13 underscore sub-optimal EPI performance in delivering routine immunizations. There are striking inequities in immunization coverage between different parts of the country. Barriers to universal immunization coverage include programmatic dysfunction at lower tiers of the program, socioeconomic inequities in access to services, low population demand, poor security, and social resistance to vaccines among population sub-groups. Recent conflicts and large-scale natural disasters have severely stressed the already constrained resources of the national EPI. Immunization programs remain low priority for provincial and many district governments in the country. The recent decision to devolve the national health ministry to the provinces has had immediate adverse consequences. Mitigation strategies aimed at rapidly improving routine immunization coverage should include improving the infrastructure and management capacity for vaccine delivery at district levels and increasing the demand for vaccines at the population level. Accurate vaccine coverage estimates at district/sub-district level and local accountability of district government officials are critical to improving performance and eradicating polio in Pakistan.
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Affiliation(s)
- Aatekah Owais
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
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Abstract
Karachi is the only mega city in the world with persistent poliovirus transmission. We determined routine childhood immunization rates in Karachi and identified predictors of vaccine completion. A population-based cross-sectional survey was conducted in Karachi between August and September 2008. Data on demographics, socioeconomic, and DTP3 vaccination status in children 12 to 23 months old were collected. Logistic regression was used to identify predictors of vaccination completion. Overall, 1401 participants were approached; 1391 consented to participate. Of these, 1038 (75%) were completely vaccinated. Punjabi families had the highest DTP3 coverage (82%), followed by Urdu-speaking families (79%). Pashtun (67%) and Bengali (48%) families had the lowest vaccine coverage. Children of mothers with ≥12 years of schooling (OR = 25.4; 95% CI = 5.7-113.1) were most likely to be vaccinated. A quarter of study participants were unvaccinated. Targeted strategies for boosting DTP3 rates in communities with low immunization coverage are essential for polio eradication in Karachi.
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Owais A, Sultana S, Stein AD, Bashir NH, Awaldad R, Zaidi AKM. Why do families of sick newborns accept hospital care? A community-based cohort study in Karachi, Pakistan. J Perinatol 2011; 31:586-92. [PMID: 21273989 PMCID: PMC3152606 DOI: 10.1038/jp.2010.191] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Sick young infants are at high risk of mortality in developing countries, but families often decline hospital referral. Our objective was to identify the predictors of acceptance of referral for hospital care among families of severely ill newborns and infants <59 days old in three low-income communities of Karachi, Pakistan. STUDY DESIGN A cohort of 541 newborns and infants referred from home by community health workers conducting household surveillance, and diagnosed with a serious illness at local community clinics between 1 January and 31 December 2007, was followed-up within 1 month of referral to the public hospital. RESULT Only 24% of families accepted hospital referral. Major reasons for refusal were financial difficulties (67%) and father/elder denying permission (65%). Religious/cultural beliefs were cited by 20% of families. Referral acceptance was higher with recognition of severity of the illness by mother (odds ratio=12.7; 95% confidence interval=4.6 to 35.2), family's ability to speak the dominant language at hospital (odds ratio=2.0; 95% confidence interval=1.3-3.1), presence of grunting in the infant (odds ratio=3.3; 95% confidence interval=1.2-9.0) and infant temperature <35.5 °C (odds ratio=4.1; 95% confidence interval=2.3 to 7.4). No gender differential was observed. CONCLUSION Refusal of hospital referral for sick young infants is very common. Interventions that encourage appropriate care seeking, as well as community-based management of young infant illnesses when referral is not feasible are needed to improve neonatal survival in low-income countries.
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Affiliation(s)
- Aatekah Owais
- Department of Paediatrics and Child Health. Aga Khan University, Karachi, Pakistan
| | - Shazia Sultana
- Department of Paediatrics and Child Health. Aga Khan University, Karachi, Pakistan
| | - Aryeh D. Stein
- Hubert Department of Global Health, Emory University, Atlanta, GA, United States
| | - Nasira H. Bashir
- Department of Paediatrics and Child Health. Aga Khan University, Karachi, Pakistan
| | - Razia Awaldad
- Department of Paediatrics and Child Health. Aga Khan University, Karachi, Pakistan
| | - Anita K M Zaidi
- Department of Paediatrics and Child Health. Aga Khan University, Karachi, Pakistan
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Owais A, Hanif B, Siddiqui AR, Agha A, Zaidi AKM. Does improving maternal knowledge of vaccines impact infant immunization rates? A community-based randomized-controlled trial in Karachi, Pakistan. BMC Public Health 2011; 11:239. [PMID: 21496343 PMCID: PMC3094245 DOI: 10.1186/1471-2458-11-239] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 04/17/2011] [Indexed: 11/17/2022] Open
Abstract
Background In 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. Methods Three 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. Results Baseline 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. Conclusion A 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.
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Affiliation(s)
- Aatekah Owais
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
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Abstract
AIM The aim of this study was to systematically review the literature on the influence of enhanced recovery after surgery (ERAS) protocols and health related quality of life (HQoL) and patient satisfaction. METHOD A systematic review of the literature from January 1990 to February 2009 was undertaken. Studies were included if they compared HQoL and/or patient satisfaction after ERAS and conventional surgery (CS). Jadad score was used to evaluate the studies. Results were divided into immediate (first week), early (second to third week) and late (more than 30 days after surgery) post-operative phases. A meta-analysis was not possible due to the heterogeneity of the studies. RESULTS Ten publications were included in the final analysis. In the first week after surgery, two non-randomised trials found reduced fatigue and another 2 non-randomised studies found reduced pain with ERAS. One randomised study found increased emotional distress on SF36 in ERAS patients. At two to three weeks after surgery, none of the multidimensional HQoL measures showed any differences. Increased fatigue was reported with CS in 2 studies. Limitations in activities of daily living were more marked after CS in one study. Beyond 30 days after surgery, none of the HQoL measures showed any differences. Only one non-randomised study compared patient satisfaction after ERAS and CS and no difference was found. CONCLUSION There is no evidence that ERAS adversely affect HQoL or patient satisfaction. Certain aspects of HQoL such as pain and fatigue may improve with ERAS. Further research is required, especially in the early post-operative period.
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Affiliation(s)
- S Khan
- The Combined Gastroenterology Research Unit, Scarborough Hospital, Scarborough, UK
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Owais A, Sultana S, Zaman U, Rizvi A, Zaidi AKM. Incidence of typhoid bacteremia in infants and young children in southern coastal Pakistan. Pediatr Infect Dis J 2010; 29:1035-9. [PMID: 21046701 PMCID: PMC3073093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
INTRODUCTION The burden of typhoid fever in preschool children is not well recognized. The purpose of this study was to estimate the incidence of typhoid bacteremia in Pakistani children <5 years of age, with a focus on children younger than 2 years of age. This will help to inform prevention policies in highly endemic countries. METHODS Household surveillance from February 1, 2007 to May 12, 2008, was carried out by community health workers in 2 low-income, coastal communities of Karachi. Workers referred each sick child <5 years old to the local clinic. Blood for culture was obtained from those who gave consent, and inoculated in BACTEC Peds Plus bottles (Becton Dickinson, Sparks, MD) and processed per manufacturer's guidelines. RESULTS Overall, 5570 children contributed 3949 observation years. Blood culture was obtained from 1165 cases, yielding 36 pathogens. Salmonella Typhi was isolated in 16 cases, Salmonella Paratyphi A in 2 cases, and Salmonella Paratyphi B in 1 case. The incidence of typhoid bacteremia in children <2 years of age was 443.1 (95% confidence interval, 193.8-876.5) per 100,000 child years. The overall incidence rate of typhoid for children <5 years was 405.1 (95% confidence interval, 239.8-643.9) per 100,000 child years. CONCLUSION Typhoid is a common and significant cause of morbidity among young children in Pakistan, including children less than 2 years of age. Vaccines that provide protection to preschool children should be included in typhoid control efforts.
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Affiliation(s)
- Aatekah Owais
- Department of Paediatrics and Child Health. Aga Khan University, Karachi, Pakistan
| | - Shazia Sultana
- Department of Paediatrics and Child Health. Aga Khan University, Karachi, Pakistan
| | - Umber Zaman
- Department of Paediatrics and Child Health. Aga Khan University, Karachi, Pakistan
| | - Arjumand Rizvi
- Department of Paediatrics and Child Health. Aga Khan University, Karachi, Pakistan
| | - Anita K M Zaidi
- Department of Paediatrics and Child Health. Aga Khan University, Karachi, Pakistan
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Owais A, Tikmani SS, Sultana S, Zaman U, Ahmed I, Allana S, Zaidi AKM. Incidence of pneumonia, bacteremia, and invasive pneumococcal disease in Pakistani children. Trop Med Int Health 2010; 15:1029-36. [PMID: 20636300 DOI: 10.1111/j.1365-3156.2010.02591.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the incidence of pneumonia, bacteremia, and invasive pneumococcal disease (IPD) in Pakistani children <5 years old. METHODS Household surveillance from 1st February 2007 to 12th May 2008 was conducted in two low-income, coastal communities of Karachi. Community health workers referred each sick child <5 years old to the local clinic. Blood culture was obtained whenever possible from children meeting inclusion criteria. RESULTS Overall, 5570 children contributed 3949 observation years. There were 1039 clinical cases of pneumonia, of which 54 were severe pneumonia and four cases of very severe disease according to WHO criteria. The overall pneumonia incidence was 0.26 (95% CI: 0.25-0.28) episodes per child-year. A pathogen was isolated from the blood of 29 (2.8%) pneumonia cases. Bacteremia incidence was 912 (95% CI: 648-1248) episodes per 100,000 child-years with a case fatality rate of 8%. The detected IPD incidence was 25 (95% CI: 1-125) episodes per 100,000 child-years. The under-five mortality rate was 55 per 1000 live births, with pneumonia causing 12 (22%) deaths among children <5 years old. CONCLUSION Clinical pneumonia is common in Pakistani children, with one in four deaths attributable to the disease. Bacteremia occurs at a high rate but surveillance for pneumococcus underestimates the burden of IPD.
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Affiliation(s)
- Aatekah Owais
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
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Owais A, Sharif K, Rehman A, Nunn T. Asymmetric odontoid process following high-speed road traffic accident. Emerg Med J 2009; 26:218. [PMID: 19234020 DOI: 10.1136/emj.2008.059907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- A Owais
- FTSTA Surgery, Scarborough Hospital, Scarborough, Yorks, UK
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Thaver D, Zaidi AKM, Owais A, Haider BA, Bhutta ZA. The effect of community health educational interventions on newborn survival in developing countries. Cochrane Database of Systematic Reviews 2009. [DOI: 10.1002/14651858.cd007647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Durrane Thaver
- The Aga Khan University Hospital; Department of Paediatrics & Child Health; Stadium Road PO Box 3500 Karachi Pakistan 74800
| | - Anita KM Zaidi
- The Aga Khan University Hospital; Department of Paediatrics & Child Health; Stadium Road PO Box 3500 Karachi Pakistan 74800
| | - Aatekah Owais
- The Aga Khan University Hospital; Paediatrics; Stadium Road PO Box 3500 Karachi Pakistan 74800
| | - Batool A Haider
- The Aga Khan University Hospital; Department of Paediatrics & Child Health; Stadium Road PO Box 3500 Karachi Pakistan 74800
| | - Zulfiqar A Bhutta
- The Aga Khan University Hospital; Department of Paediatrics & Child Health; Stadium Road PO Box 3500 Karachi Pakistan 74800
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Owais A, Alhadethi S, Davies J, Aldoori MI. MRSA Contamination. Ann R Coll Surg Engl 2007; 89:553. [PMID: 17688735 PMCID: PMC2048633 DOI: 10.1308/003588407x202218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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