Confusion is the first step towards understanding: Fixing the problems of E-learning in COVID-19 pandemic

Background: The COVID-19 pandemic forced institutions worldwide to adopt online learning, which opened a new era of challenges. Our research was designed to explore the effect of the pandemic on teaching and learning and identify the solutions to the problems based on participants’ perspectives. Methods: A qualitative study of the phenomenological design was conducted at a medical institute in Pakistan. The participants were selected using the purposive sampling technique. Semi-structured interviews were done which were later audio-recorded, transcribed, and subjected to manual thematic analysis. Credibility was ensured by using multiple data collection sources. Results: The 20 participants selected as interviewees were faculty with more than 5 years teaching experience in the medical institute and had gone through online teaching and learning during COVID-19 pandemic.  The thematic analyses of the data generated six themes which were: 1. “I see what you mean”; Re-exploration of educational psychology, 2. Reorganization of curriculum, 3. Mentoring and coaching, 4. Technology: as ubiquities as oxygen, 5. Constructive feedback: a stimulus in pearl formation and 6. Turn the tables: fixing the problem. Conclusion: Online education has emerged as an important mechanism in delivering medical education to undergraduate medical students. Instead of shying away, efforts are needed to restructure the curricula, incorporating various online innovative teaching, and learning tools that are at par with the changing global demands of medical education. Keywords: E-learning, COVID-19, Challenges                                                                                                          

Evaluating motor performance with the Bruininks-Oseretsky test of motor proficiency in impoverished Pakistani children

Objective: To evaluate the sensitivity of the modified Brief Form of Bruininks Oseretsky Test in identifying motor differences secondary to malnutrition and poverty.Methods: This longitudinal cohort study was conducted at Nowshero Feroze, Sindh from 2013 to 2014 and comprised data drawn from children who participated in a randomised controlled trial, that assessed responsive stimulation and nutrition interventions in the first two years of life. Outcome measures included motor development assessed using Brief Form of Bruininks Oseretsky Test, child anthropometry and household economic and demographic information. Data was analysed using SPSS 15 and STATA 12.Results: Of the 1058 children, 570(53%) were boys. Moderate-severe stunting was reported in 171(16.12%) subjects, while moderate-severe underweight was reported in 117(11.1%). Also, 591(56%) subjects belonged to poor families, 343(32%) had illiterate mothers, and 392(37%) were food-insecure. Malnutrition, socio-economic status and maternal literacy were significantly associated with a 6-item motor composite of the Brief Form of Bruininks Oseretsky Test (p\u3c0.05).Conclusions: The 6-item motor composite of the Brief Form of Bruininks Oseretsky Test was found to be a reliable tool to measure motor performance in Pakistani pre-school children

The predictive validity of Bayley Scales of Infant and Toddler Development-III at 2 years for later general abilities: Findings from a rural, disadvantaged cohort in Pakistan

Using data from a rural cohort in Pakistan (N = 1298), the study examined the predictive validity of the Bayley Scales of Infant and Toddler Development (BSID) 3rd edition on later tests of general abilities. The BSID III subscales (cognitive, language and motor) were administered at 2 years; general ability was assessed using the Verbal, Performance and Full-Scale score from the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) III at 4 years, and the Fluid Reasoning Index (FRI) from the Wechsler Intelligence Scale for Children (WISC) V at 8 years. The combined BSID subscales explained 15% of the variation of the WPPSI III full scale, 16% of the Verbal scale, 7% of the Performance scale and 1% of the FRI. BSID III scores at 24 months should be used with caution to predict future intellectual abilities. Copyright: © 2023 Rasheed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.publishedVersio

Global variation of COVID-19 mortality rates in the initial phase

Objective: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused devastation in over 200 countries. Italy, Spain, and the United States (US) were most severely affected by the first wave of the pandemic. The reasons why some countries were more strongly affected than others remain unknown. We identified the most-affected and less-affected countries and states and explored environmental, host, and infrastructure risk factors that may explain differences in the SARS-CoV-2 mortality burden.Methods: We identified the top 10 countries/US states with the highest deaths per population until May 2020. For each of these 10 case countries/states, we identified 6 control countries/states with a similar population size and at least 3 times fewer deaths per population. We extracted data for 30 risk factors from publicly available, trusted sources. We compared case and control countries/states using the non-parametric Wilcoxon rank-sum test, and conducted a secondary cluster analysis to explore the relationship between the number of cases per population and the number of deaths per population using a scalable EM (expectation-maximization) clustering algorithm.Results: Statistically significant differences were found in 16 of 30 investigated risk factors, the most important of which were temperature, neonatal and under-5 mortality rates, the percentage of under-5 deaths due to acute respiratory infections (ARIs) and diarrhea, and tuberculosis incidence (p \u3c 0.05).Conclusion: Countries with a higher burden of baseline pediatric mortality rates, higher pediatric mortality from preventable diseases like diarrhea and ARI, and higher tuberculosis incidence had lower rates of coronavirus disease 2019-associated mortality, supporting the hygiene hypothesis

Effectiveness of a youth-led early childhood care and education programme in rural Pakistan: A cluster-randomised controlled trial

Background: The United Nation\u27s Sustainable Development Goals encompass lifelong learning from birth to youth to adulthood (Goal 4) and economic opportunities for young people (Goal 8). The targets include improving access to quality early childhood care and education (ECCE) as well as learning and training opportunities for adolescents and youth. Cross-generational models for young children and youth may offer opportunities to address the interconnections between goals and targets for the next generation. We investigated whether an ECCE programme for young children (3.5-6.5 years) delivered by female youth (18-24 years) in rural Pakistan would be effective on children\u27s school readiness.Methods: In partnership with the National Commission for Human Development in Pakistan, we implemented the \u27Youth Leaders for Early Childhood Assuring Children are Prepared for School\u27 (LEAPS) programme to train female youth to deliver ECCE. The effectiveness of the LEAPS programme on children\u27s school readiness was evaluated in a cluster-randomised controlled trial. We randomly allocated five clusters (villages) to receive the intervention (n = 170 children) and five clusters to control (n = 170 children). Children\u27s school readiness was assessed after nine months of intervention exposure using the International Development and Early Learning Assessment tool. Analyses was by intention-to-treat. The trial is registered with ClinicalTrials.gov, number NCT02645162.Findings: At endline, the intervention group had significantly higher school readiness scores (n = 166, mean percentage score 59.4, 95% CI 52.7 to 66.2) compared with the control group (n = 168, mean percentage score 45.5, 95% CI 38.8 to 52.3). The effect size (Cohen\u27s d) was 0.3.Conclusion: Trained female youth delivered an ECCE programme that was effective in benefitting young children\u27s school readiness. The cross-generational model is a promising approach to support early child development; however, further evaluation of the model is needed to assess the specific benefits to youth including their skills and economic development

Evaluation of a maternal, neonatal and child health intervention package in a rural district of Pakistan: A quasi-experimental study

Background: Pakistan is among the countries which have the highest maternal, neonatal and child mortality rates. Immediate efforts are required to enable Pakistan to achieve the health related sustainable development goals. The continuum of care interventions can substantially reduce the mortality burden, however local evidence to implement them is lacking in Pakistan. We implemented the maternal, neonatal and child health intervention package comprised of health facility strengthening, capacity building, continuum of care interventions and community mobilization and evaluated its effectiveness on maternal, neonatal and child health care practices and neonatal mortality.Methods: The intervention package was delivered through existing public health system in a rural district of Pakistan. We used a quasi-experimental design to assess the impact of interventions. Baseline and end line surveys were conducted and neonatal mortality was considered as the primary outcome measure. Data were analysed using bivariate and difference and difference analysis techniques.Results: We found a reduced risk of neonatal mortality (RR 0.704; 95% CI 0.557-0.889; p=0.0033), in intervention areas compared to control area. For secondary outcomes; including mortality for infants and under five children, antenatal care, skilled birth attendance, institutional deliveries, postnatal care, delayed bathing, inappropriate cord care practices, birth asphyxia, exclusive breastfeeding and immunization a significant difference (p\u3c0.001) was observed in the intervention area compared to control area.Conclusions: This study provides local evidence from Pakistan that effective methods for delivering MNCH interventions within the existing health infrastructure can improve the MNCH outcomes especially in the rural areas

Using “Pub Quiz” to promote participation and active learning in prospective teachers

It has become an established fact that wheneverr students and teachers are involved equally for learning purpose, the use of effective and innovative teaching strategies serve the purpose at its optimal level. Both active learning and classroom participation have been found influential by increasing classroom performance of the students. Having knowledge about the use of multiple teaching strategies and knowing ways to modify applicable strategies in attaining teaching objectives are sensitive, yet crucial to apply in classrooms especially when it is subjected to prospective teachers. The current study was aimed to explore the effect of pub quiz activities on active learning, classroom participation and academic performance of prospective teachers that emphasized the idea of integrating activities in teacher training programs. Sample of the study comprised 22 prospective teachers enrolled in Science course of one year degree program at a public teacher training institute. It was an experimental study that allowed integrating the use of multiple activities during eight weeks of running semester. A five point Likert type scale followed by an open ended questionnaire was used to measure the level of participation and active learning of prospective teachers; whereas their academic performance was measured through taking a test. Data was analyzed by using descriptive statistics and thematic analysis. The results supported the assumption of the study that integration of planned and relevant activities into teaching are not only helpful in pursuit of positively affecting the active learning, classroom participation and academic performance of prospective teachers but also helpfull in breaking the monotony of conventional ways of teaching and learning. The study recommended that adopting flexible use of activities accelerates learning process by ensuring active participation and learning on the part of students

Outcomes of preterm neonates with patent ductus arteriosus: a retrospective review from a tertiary care hospital

The management of patent ductus arteriosus (PDA) in preterm neonates remains controversial. A retrospective review was conducted to determine the outcomes in preterm neonates with PDA. Data of neonates admitted to the Aga Khan University Hospital from January 2012 to December 2016 were retrieved from patient records. Of the 208 neonates included in the study, 143 (68.7%) received no treatment, while 65 (31.2%) underwent pharmacotherapy and/or surgical ligation for PDA closure. PDA closure was spontaneous in 109 (52.4%) neonates. The mean ±SD gestational age (GA) of neonates with spontaneous ductal closure was greater as compared to those who required some form of treatment [33±3.3 vs 29.7±3.1weeks, p=0.001]. Apnoea (OR:4.47; 95% CI:1.21-16.44), sepsis (OR:3.81; 95% CI:1.33-10.87), pulmonary haemorrhage (OR:4.88; 95% CI:1.24-19.19), and lower APGAR (OR:0.69; 95% CI:0.54-0.90) were associated with higher odds of mortality in our cohort. Our findings demonstrate that PDA resolves spontaneously in most preterm neonates and provide evidence that conservative treatment is not associated with mortality. Keywords: Conservative treatment; ligation; mortality; patent ductus arteriosus; premature

Improvement in Neuropathy Specific Quality of Life in Patients with Diabetes after Vitamin D Supplementation

Objective. To assess the effect of vitamin D supplementation on neuropathy specific quality of life (NeuroQoL) in patients with painful diabetic neuropathy. Methods. This prospective, open label study was conducted between June 2012 and April 2013. Patients with symptomatic diabetic neuropathy were given a single dose of 600,000 IU intramuscular vitamin D, and NeuroQol was assessed at baseline and at five follow-up visits every 4 weeks. Results. Of 143 participants, 41.3% were vitamin D deficient (vitamin D < 20 ng/ml). Treatment with vitamin D resulted in a significant increase in 25(OH)D (P<0.0001) and a significant improvement in the NeuroQoL subscale score for emotional distress (P=0.04), with no significant change in the other NeuroQoL domains of painful symptoms and paresthesia, loss of temperature and touch sensation, unsteadiness, limitation in daily activities, and interpersonal problems. There was a significant reduction in patient perception about foot problems on QoL of “quite a lot” (P<0.05) and “very much” (P<0.0001) with a significant reduction in the baseline response of having a “poor” QoL from 5.2% to 0.7% (P<0.0001) and an increase in the response of an “excellent QoL” from 1.5% to 7.4% (P<0.0001). Conclusion. Vitamin D is effective in improving quality of life in patients with painful diabetic neuropathy

Referral profile of developmental disabilities at a tertiary care hospital in a resource-limited country

The burden and the spectrum of neuro-developmental disabilities are well-established in the developed countries, however, they continue to be a challenge in the Low Middle-Income Countries. The aim of this study was to present the referral profile and trends of developmental disabilities in the child development centre of The Agha khan University, from 2012 to 2021. All children (1 month to 18 years), who had undergone diagnostic evaluations for suspected neurodevelopmental disabilities were included. A total of 1340 children were evaluated at the centre. The mean age of the children at the presentation was 5.4 ± 3.0 years. Male to female ratio was 3:1. Autism Spectrum Disorder (ASD) was the most common diagnosis (n=446, 33.3%). This study highlights a considerable burden and an increasing trend of children being referred for suspected developmental disabilities in Pakista