Serial population-based serosurveys for COVID-19 in two neighbourhoods of Karachi, Pakistan

Objective: To determine population-based estimates of COVID-19 in a densely populated urban community of Karachi, Pakistan.Methods: Three cross-sectional surveys were conducted in April, June and August in low- and high-transmission neighborhoods. Participants were randomly selected to provide blood for Elecsys® immunoassay for detection of anti-SARS-CoV-2 antibodies. Bayesian regression model was used to estimate seroprevalence after adjusting for the demographic characteristics of each district RESULTS: We enrolled 3005 participants from 623 households. In Phase 2, adjusted seroprevalence was estimated as 8.7% (95% CI 5.1-13.1) and 15.1% (95% CI 9.4 -21.7) in low and high transmission areas respectively, compared to 0.2% (95% CI 0-0.7) and 0.4% (95% CI 0 - 1.3) in Phase 1. In Phase 3, it was 12.8% (95% CI 8.3 - 17.7) and 21.5% (95% CI 15.6-28) in low and high transmission areas, respectively. CRI was 0.31 (95% CI 0.16-0.47) and 0.41(95% CI 0.28-0.52) in low and high transmission neighborhoods respectively in Phase 2. Similar trends were observed in Phase 3. Only 5.4% of participants who tested positive for COVID-19 were symptomatic. IFR was 1.66%, 0.37% and 0.26% in Phases 1, 2 and 3 respectively.Conclusion: Continuing rounds of seroprevalence studies will help us better understand secular trends and extent of infection during the course of the pandemic

A nationwide virtual research education program for medical students in Pakistan: Methodological framework, feasibility testing, and outcomes

Introduction: Equipping young medical trainees with fundamental research skills can be a promising strategy to address the need for professionals who can understand and responsibly communicate evolving scientific evidence during a pandemic. Despite an ardent interest to partake in research, most educational institutions in Pakistan and other low-middle income countries have not yet adopted a comprehensive strategy for research skills education. The authors aimed to design and assess the feasibility of implementing the first nation-wide virtual research workshop for medical students in Pakistan. Methods: The course Beginners Guide to Research, designed as a nation-wide virtual research workshop series, was conducted for medical students across Pakistan in June 2020. Four interactive live workshops took place online on alternate days from June 22nd, 2020, to June 27th, 2020, each lasting 1-2 h. Outcomes included: (i) reach, (ii) efficacy as indexed by pre-post change in score pertaining to knowledge and application of research and (iii) self-rated perceptions about understanding of research on a Likert scale. Results: 3,862 participants enrolled from 41 cities and 123 institutions. Enrolled participants belonged to the following provinces: Sindh (n = 1,852, 48.0%), Punjab (n = 1,767, 45.8%), Khyber Pakhtunkhwa (n = 109, 2.8%), Azad Jammu and Kashmir (n = 84, 2.2%) Balochistan (n = 42, 1.1%). We also saw a few registrations from international students (n = 8, 0.2%). Mean (SD) age of enrolled medical students was 21.1 (2.1) years, 2,453 (63.5%) participants were female and 2,394 (62.0%) were from private-sector medical colleges. Two thousand ninety-three participants participants filled out all four pre-test and post-test forms. The total median knowledge score improved from 39.7 to 60.3% with the highest improvements in concepts of research bioethics and literature search (p \u3c 0.001) with greater change for females compared to males (+20.6 vs. +16.2%, p \u3c 0.001) and private institutions compared to public ones (+16.2 vs. +22.1%, p \u3c 0.001). Conclusion: The overwhelming enrollment and significant improvement in learning outcomes (\u3e50% of baseline) indicate feasibility of a medical student-led research course during a pandemic, highlighting its role in catering to the research needs in the LMICs

The impact of COVID-19 safety interventions on creating a controlled environment on campus

Objectives: During COVID-19 the re-opening of educational institutes was frequently debated, however with the decline in the number of COVID-19 cases, The Aga Khan University (AKU) in Karachi, Pakistan opened its campus for medical and nursing students after more than 6 months of closure. To ensure gradual resumption of activities on-campus, a combination of interventions was diligently deployed to minimize student infection rates. Scarce literature exists on students' perceptions regarding decisions implemented by university leadership. The aim of the study was to determine the efficacy of these interventions. Methods: We conducted a convergent, parallel, mixed-methods observational study targeting medical and nursing students. An online questionnaire was disseminated to elicit students' degree of (dis)agreement on a four-point Likert scale. Focused group discussions (FGDs) were conducted to comprehend reasons for (dis)agreement. Results: Total of 183 students responded to questionnaire (59.0% nursing, 67.8% female), 11 FGDs were conducted with 85 students. Interventions with highest agreement were mandatory face masks policy (94.54%), weekly mandated COVID-testing (92.35%) and students' Academic Bubble (91.26%); highest disagreement was for Sehat Check application (41.53%); and stay strong campaign (40.44%). Four themes emerged from FGDs: Effective safety interventions, Safety interventions with limited effectiveness, Utility of Sehat Check Application and Future recommendations for informing policy. Conclusion: It is paramount to seek student-feedback at forefront of university re-opening strategy. Clear communication channels are as important as an administrative response system's robustness. Bidirectional communication channels are fundamental and requisite during ever-changing policies and regulations. Engaging student representatives in decision making or implementation processes (such as “pilot” before “roll-out”) would allow any potential issues to be managed early on. Gather real-time anonymous feedback and identify key areas that need further promulgation and those that need to be replaced with more effective ones

Serial population-based serosurveys for COVID-19 in two neighbourhoods of Karachi, Pakistan

Objective: To determine population-based estimates of coronavirus disease 2019 (COVID-19) in a densely populated urban community of Karachi, Pakistan. Methods: Three cross-sectional surveys were conducted in April, June and August 2020 in low- and high-transmission neighbourhoods. Participants were selected at random to provide blood for Elecsys immunoassay for detection of anti-severe acute respiratory syndrome coronavirus-2 antibodies. A Bayesian regression model was used to estimate seroprevalence after adjusting for the demographic characteristics of each district. Results: In total, 3005 participants from 623 households were enrolled in this study. In Phase 2, adjusted seroprevalence was estimated as 8.7% [95% confidence interval (CI) 5.1-13.1] and 15.1% (95% CI 9.4-21.7) in low- and high-transmission areas, respectively, compared with 0.2% (95% CI 0-0.7) and 0.4% (95% CI 0-1.3) in Phase 1. In Phase 3, it was 12.8% (95% CI 8.3-17.7) and 21.5% (95% CI 15.6-28) in low- and high-transmission areas, respectively. The conditional risk of infection was 0.31 (95% CI 0.16-0.47) and 0.41 (95% CI 0.28-0.52) in low- and high-transmission neighbourhoods, respectively, in Phase 2. Similar trends were observed in Phase 3. Only 5.4% of participants who tested positive for COVID-19 were symptomatic. The infection fatality rate was 1.66%, 0.37% and 0.26% in Phases 1, 2 and 3, respectively. Conclusion: Continuing rounds of seroprevalence studies will help to improve understanding of secular trends and the extent of infection during the course of the pandemic. &nbsp;</p

Evaluation of the resources and inequities among pediatric critical care facilities in Pakistan

Objectives: To evaluate nationwide pediatric critical care facilities and resources in Pakistan. Design: Cross-sectional observational study. Setting: Accredited pediatric training facilities in Pakistan. Patients: None. Interventions: None. Measurements and main results: A survey was conducted using the Partners in Health 4S (space, staff, stuff, systems) framework, via email or telephone correspondence. We used a scoring system in which each item in our checklist was given a score of 1, if available. Total scores were added up for each component. Additionally, we stratified and analyzed the data between the public and private healthcare sectors. Out of 114 hospitals (accredited for pediatric training), 76 (67%) responded. Fifty-three (70%) of these hospitals had a PICU, with a total of 667 specialized beds and 217 mechanical ventilators. There were 38 (72%) public hospitals and 15 (28%) private hospitals. There were 20 trained intensivists in 16 of 53 PICUs (30%), while 25 of 53 PICUs (47%) had a nurse-patient ratio less than 1:3. Overall, private hospitals were better resourced in many domains of our four Partners in Health framework. The Stuff component scored more than the other three components using analysis of variance testing (p = 0.003). On cluster analysis, private hospitals ranked higher in Space and Stuff, along with the overall scoring. Conclusions: There is a general lack of resources, seen disproportionately in the public sector. The scarcity of qualified intensivists and nursing staff poses a challenge to Pakistan\u27s PICU infrastructur

Implication of soluble transferrin receptor and ferritin ratio in gestational diabetes

Ferritin provides a good estimate of body iron stores, but loses its significance during systemic inflammation, a defining feature of insulin resistance (IR). On the other hand, serum transferrin receptor protein (sTfR) represents true iron load of body. This study attempts to identify the utility of sTfR/ferritin index in gestational diabetes mellitus (GDM). Eighty-eight pregnant females were recruited and divided into group A (norm-glycemic pregnant) and group B (GDM) according to the IADPSG criteria. Insulin, hemoglobin, serum iron, ferritin, sTfR, and CRP levels were determined. However, HbA1c and sTfR/ferritin ratio were calculated by formulas. Mann Whitney U and Spearman’s rank correlation were used, where p \u3c 0.05 was considered significant. Results showed no difference between the groups in terms of age, weight, and BMI. IR was significantly high in GDM as compared to non-GDM subjects (p \u3c 0.001), however, the insulin levels were found to be low in GDM group. Hemoglobin was comparatively lower in GDM females (p = 0.212). Serum levels of sTfR, ferritin, and hs-CRP were found to be higher in GDM as compared to non-GDM (p = 0.774, p = 0.201, and p = 0.267, respectively). The sTfR/ferritin ratio was lower in the GDM as compared to the healthy controls (p = 0.326). Furthermore, the correlation between sTfR/ferritin ratio and insulin resistance was slightly negative (r = −0.301, p = 0.347). These results suggest that sTfR may be used for the estimation of accurate iron status in the body during gestational diabetes. However, longitudinal studies are required to propose the utility and a cutoff value for this biomarker

641: Resources and inequities among pediatric critical care facilities in Pakistan

Introduction: With persistent population growth and the need to rapidly provide healthcare coverage in Pakistan, the need to enhance the critical care capacity may also have increased. This study aims to evaluate the current landscape of pediatric critical care facilities in Pakistan.Methods: We conducted a nationwide cross-sectional survey. Our survey tool was modified from a previously used innovative tool, based on the Partners In Health 4S (Space, Staff, Stuff, Systems) framework. The tool was administered via email and or telephonic correspondence. All facilities accredited for pediatric training were selected for this survey. We stratified and analyzed the data between the public and private healthcare sectors of Pakistan using Fisher’s exact test and Chi-square analysis. We employed a scoring system in which each of the items of our capacity assessment checklist were given a score of 1, if definitively available. We added the score for each component and used a weighted index to score each denominator out of 25.Results: A total of 114 hospitals were identified and approached in this study, of which 76(66.7%) responded. 53(69.7%) of these hospitals had a Pediatric Intensive Care Unit (PICU) with 667 beds and 50 mechanical ventilators. 32(60.3%) PICUs were in Punjab and only 1(1.9%) in Baluchistan indicating vast geographical disparities. 44 (83.0%) PICUs were present in metropolitan areas as compared to 8(17.0%) PICUs in rural/peri-urban areas. There were 38(71.7%) public hospitals whereas there were 15(28.3%) private hospitals overall. Trained intensivists were present in 16(30.2%) PICUs while 25(47.2%) PICUs had an optimal nurse ratio (≥1:3). Private hospitals were better resourced in many domains of our 4 components. The Stuff component scored more than the other three components using ANOVA testing (p-value=0.003). On cluster analysis, public hospitals ranked higher than private ones in Space and Stuff, along with the overall clusters.Conclusions: Our study shows that PICU is progressing is Pakistan but highlighted the deficiencies in the pediatric critical care infrastructure in Pakistan. There is a general lack of resources that is disproportionately seen in the public sector. A lack of qualified intensivists and nursing staff poses a challenge to PICUs