Delivering reproductive health services through non-state providers in Pakistan: Understanding the value for money of different approaches

Sophie Witter - orcid: 0000-0002-7656-6188 https://orcid.org/0000-0002-7656-6188Background - Delivering Reproductive Health Results(DRHR) programme used social franchising (SF) and social marketing (SM) approaches to increase the supply of high quality family planning services in underserved areas of Pakistan. We assessed the costs, cost-efficiency and cost-effectiveness of DRHR to understand the value for money of these approaches.Methods - Financial and economic programme costs were calculated. Costs to individual users were captured in a pre-post survey. The cost per couple years of protection (CYP) and cost per new user were estimated as indicators of cost efficiency. For the cost-effectiveness analysis we estimated the cost per clinical outcome averted and the cost per disability-adjusted life year (DALY) averted.Results - Approximately £20 million were spent through the DRHR programme between July 2012 and September 2015 on commodities and services representing nearly four million CYPs. Based on programme data, the cumulative cost-efficiency of the entire DRHR programme was £4.8 per CYP. DRHR activities would avert one DALY at the cost of £20. Financial access indicators generally improved in programme areas, but the magnitude of progress varies across indicators.Conclusions - The SF and SM approaches adopted in DRHR appear to be cost effective relative to comparable reproductive health programmes. This paper adds to the limited evidence on the cost-effectiveness of different models of reproductive health care provision in low- and middle-income settings. Further studies are needed to nuance the understanding of the determinants of impact and value for money of SF and SM.This study was funded by UKaid from the UK government. However, the views expressed do not necessarily reflect the UK government’s official policies.3 [33]pubpu

Isolation of bacterial fish pathogen Aeromonas hydrophila and therapeutic effects of medicinal plants on its invasion

Aeromonas hydrophila, a bacterial pathogen,  was isolated form Pangasius hypophthalmus. For pathogenicity test, different doses were injected intramuscularly in Barbonymus gonionotus. Crude extracts were prepared from various parts Azadirachta indica, Curcuma longa, C. zedoaria, and Callotropis gigentia and applied to B. gonionotus for 7 days. Bath treatment was done up to their tolerance level and well ventilation was confirmed for aeration and 50% water was exchanged daily. Minimum inhibitory dose was detected as 7 mg/ml. High inhibitory effect was observed in case of A. indica and mixed extract of A. indica and C. gigentia. Both A. indica and C. gigentia showed the best result with 90-95% recovery of infected fish at a dose of 7 mg/l. C. zedoaria showed moderate to weak effect with 50-60% recovery at the same dose. The present study showed that medicinal plants would be an effective control measure against A. hydrophila

Role of Surgical Feeding Gastrostomy in Patients Requiring Prolonged Nutrition in a Neurosurgical Department

Objective: To build up the nutritional status of the neurosurgical patients with an easy and practical way. Patients and Methods: This prospective study was conducted in Neurosurgery department of Pakistan Institute of Medical Sciences Islamabad in a six months’ time. In total thirty adult patients of either gender with H/O road traffic accident with severe head injury and GCS less than 8/15, persistent vegetative state, brain tumor patients who had developed lower cranial nerve palsies were included in the study. 28 for two way Foleys catheter was used in feeding gastrostomy. Results: Thirty patients, with the median age of 35 years (range, 18-55 years) underwent feeding gastrostomy. Before the gastrostomy tube insertion, 18 patients had enteral nutrition by a nasogastric tube and 10 had parenteral nutrition (PN), with a median duration of 14.5 (range, 4-60) and 12 (range, 7-25) days, respectively. Two patients accidentally pulled out the gastrostomy tubes 10 and 11 days after insertion. Buried bumper syndrome developed in 1 patient. Two patients died 8 and 34 days after the procedure in the neurosurgical ICU. Twenty-eight patients were discharged from the hospital while being fed via the gastrostomy tubes. In 11 patients who were able to resume oral feeding, the tube was removed, with a median interval of 62 (range, 25-150) days. There was no Procedure-related mortality. Conclusion: An improvised method of nutritional support according to our circumstances. This study can be extended to other surgical and medical patients who need nutritional support for longer period of time.&nbsp

Therapeutic performances of some selected aqua drugs

This study was carried out at the Disease Laboratory of the Faculty of Fisheries, Bangladesh Agricultural University, Mymensingh, Bangladesh to verify the therapeutic performances of six commercial aqua drugs; three doses were selected as less than recommended, recommended and more than recommended to assess their performances. Before starting therapeutic experimental nine climbing perch (Anabas testudineus) and six stinging catfish (Heteropneustes fossilis) were confirmed as diseased ones by their clinical signs. The backswimmers (Notonecta glauca) were collected from faculty of fisheries pond and fish louses (Argulus sp.) were collected from tilapia fishes. Effective doses and their performances were determined on the basis of desired water quality change and clinical signs. It was found that all the drugs performed better at more than recommended doses as follows Aqua Ox performed better at the rate of 0.2 mg/l, GR Plus, 0.0005 ml/l, ID Plus (5%), 0.00026 ml/l; Active Blue, 0.0002 ml/l; Hashpoka Killer, 0.0001 ml/l; and Para Control, 0.001 ml/l. So these doses were suggested as recommended doses

Therapeutic performances of some selected aqua drugs

This study was carried out at the Disease Laboratory of the Faculty of Fisheries, Bangladesh Agricultural University, Mymensingh, Bangladesh to verify the therapeutic performances of six commercial aqua drugs; three doses were selected as less than recommended, recommended and more than recommended to assess their performances. Before starting therapeutic experimental nine climbing perch (Anabas testudineus) and six stinging catfish (Heteropneustes fossilis) were confirmed as diseased ones by their clinical signs. The backswimmers (Notonecta glauca) were collected from faculty of fisheries pond and fish louses (Argulus sp.) were collected from tilapia fishes. Effective doses and their performances were determined on the basis of desired water quality change and clinical signs. It was found that all the drugs performed better at more than recommended doses as follows Aqua Ox performed better at the rate of 0.2 mg/l, GR Plus, 0.0005 ml/l, ID Plus (5%), 0.00026 ml/l; Active Blue, 0.0002 ml/l; Hashpoka Killer, 0.0001 ml/l; and Para Control, 0.001 ml/l. So these doses were suggested as recommended doses

Zinc nutrition application augments morpho-physiological attributes, productivity and grain zinc bioavailability of Paddy Rice

Zinc (Zn) deficiency is the most important micronutrient disorders affecting plants and human health. Present study evaluated the potential of various Zn application methods in improving the performance of selected rice genotypes and Zn bioavailability in grains. Pre-selected Zn application methods through pot experiments were validated in the field. Harvested grains were fed to albino rats for Zn bioavailability. Results revealed that soil + foliar application of Zn was effective in improving the seedling growth of rice genotypes by modulating the agronomic, water related and biochemical attributes. The rats gained more body weight fed with rice genotype Accession-164 (high Zn accumulator) compared with the minimum for Super Basmati (low Zn accumulator) feed. In crux, soil application of Zn at 15 kg ha-1 followed by foliar application of 0.25% ZnSO4.7H2O solution at tillering and heading stages produced the highest grain yield (26.25%, 29.11%) with maximum bioavailable Zn (21.02%, 22.50%) during both years, respectively, in the grains for combating malnutrition in the tested rats

Influenza in Outpatient ILI Case-Patients in National Hospital-Based Surveillance, Bangladesh, 2007–2008

Recent population-based estimates in a Dhaka low-income community suggest that influenza was prevalent among children. To explore the epidemiology and seasonality of influenza throughout the country and among all age groups, we established nationally representative hospital-based surveillance necessary to guide influenza prevention and control efforts.We conducted influenza-like illness and severe acute respiratory illness sentinel surveillance in 12 hospitals across Bangladesh during May 2007–December 2008. We collected specimens from 3,699 patients, 385 (10%) which were influenza positive by real time RT-PCR. Among the sample-positive patients, 192 (51%) were type A and 188 (49%) were type B. Hemagglutinin subtyping of type A viruses detected 137 (71%) A/H1 and 55 (29%) A/H3, but no A/H5 or other novel influenza strains. The frequency of influenza cases was highest among children aged under 5 years (44%), while the proportions of laboratory confirmed cases was highest among participants aged 11–15 (18%). We applied kriging, a geo-statistical technique, to explore the spatial and temporal spread of influenza and found that, during 2008, influenza was first identified in large port cities and then gradually spread to other parts of the country. We identified a distinct influenza peak during the rainy season (May–September).Our surveillance data confirms that influenza is prevalent throughout Bangladesh, affecting a wide range of ages and causing considerable morbidity and hospital care. A unimodal influenza seasonality may allow Bangladesh to time annual influenza prevention messages and vaccination campaigns to reduce the national influenza burden. To scale-up such national interventions, we need to quantify the national rates of influenza and the economic burden associated with this disease through further studies

Incidence of Respiratory Virus-Associated Pneumonia in Urban Poor Young Children of Dhaka, Bangladesh, 2009–2011

Pneumonia is the leading cause of childhood death in Bangladesh. We conducted a longitudinal study to estimate the incidence of virus-associated pneumonia in children aged <2 years in a low-income urban community in Dhaka, Bangladesh.We followed a cohort of children for two years. We collected nasal washes when children presented with respiratory symptoms. Study physicians diagnosed children with cough and age-specific tachypnea and positive lung findings as pneumonia case-patients. We tested respiratory samples for respiratory syncytial virus (RSV), rhinoviruses, human metapneumovirus (HMPV), influenza viruses, human parainfluenza viruses (HPIV 1, 2, 3), and adenoviruses using real-time reverse transcription polymerase chain reaction assays.Between April 2009-March 2011, we followed 515 children for 730 child-years. We identified a total of 378 pneumonia episodes, 77% of the episodes were associated with a respiratory viral pathogen. The overall incidence of pneumonia associated with a respiratory virus infection was 40/100 child-years. The annual incidence of pneumonia/100 child-years associated with a specific respiratory virus in children aged < 2 years was 12.5 for RSV, 6 for rhinoviruses, 6 for HMPV, 4 for influenza viruses, 3 for HPIV and 2 for adenoviruses.Young children in Dhaka are at high risk of childhood pneumonia and the majority of these episodes are associated with viral pathogens. Developing effective low-cost strategies for prevention are a high priority

Avian Influenza Virus A (H5N1), Detected through Routine Surveillance, in Child, Bangladesh

We identified avian influenza virus A (H5N1) infection in a child in Bangladesh in 2008 by routine influenza surveillance. The virus was of the same clade and phylogenetic subgroup as that circulating among poultry during the period. This case illustrates the value of routine surveillance for detection of novel influenza virus