Study Protocol: Validation and Adaptation of community-worker-administered stroke symptom questionnaire in a periurban Pakistani community to determine disease burden.

Background : Stroke is the second leading cause of mortality and the leading cause of disability in the world today. The disease burden is on the rise in developing nations, but there is scarcity of data from these regions to inform policy decisions. Stroke burden can be determined by clinical diagnosis alone in the public health context and is a far more feasible way to assess disease status in low- to middle-income countries like Pakistan. We aim to translate and adapt a validated stroke symptom questionnaire, train community health workers in its administration, and verify it against assessment by two trained neurologists. Methods/Design : This is a prospective study, which we aim to carry out in Ibrahim Hyderi, a periurban slum of Karachi. We translated into Urdu the questionnaire for verifying stroke free status (QVSFS), which is an internationally validated tool to assess the same. Two community health workers (CHW) will be identified and will receive training by neurologists, which will include teaching regarding stroke pathophysiology, symptomatology, and detection. They will be familiarized with the QVSFS, and their questionnaire administration will be assessed through roleplay. We intend to recruit 322 subjects from the same community and the CHWs will gather data on them. The same subjects will later be assessed by two trained neurologists, and the findings collaborated to validate those obtained by the CHWs. Sensitivity, specificity, positive and negative predictive values, and Cohen’s kappa will be determined for the CHW-administered ques tionnaire tested against assessment by two neurologists together and separately for the two CHWs. Data analysis will be done using SPSS version 19.0. Discussion ; The results of this study will determine if and how well CHW-administered questionnaires are at assessing stroke status in a community. This will facilitate use of the same as a practical alternative for stroke surveillance in the countr

Can trained field community workers identify stroke using a stroke symptom questionnaire as well as neurologists? Adaptation and validation of a community worker administered stroke symptom questionnaire in a peri-urban Pakistani community.

Background: Stroke is a leading cause of morbidity and mortality worldwide. There is a paucity of data from South Asia where stroke is highly prevalent. Validated tools administrable by Community Health Workers (CHWs) are required to identify stroke in the community in a resource strapped region such as this. Methods: The study was conducted in a transitional slum in Karachi, Pakistan. Questionnaire for Verifying Stroke-Free Status (QVSFS) was adapted and translated into Urdu. Two CHWs, trained by a neurologist, selected 322 community dwelling subjects using purposive sampling. Each CHW collected data independently which was validated by a vascular neurologist who directly examined each participant. To assess the effect of audit and feedback, data from the final 10% of the subjects was collected following a second training session for the CHWs. Sensitivity, specificity and Cohen’s kappa was determined for the CHW administered questionnaire against neurovascular assessment. Results: Mean age of participants was 56.5 years with 71% of participants being women. The sensitivity and specificity of the questionnaire of detecting stroke was 77.1% (CI: 64.1%–86.9%) and 85.8% (CI: 83.5%–87.5%). The chance corrected agreement using the Cohen’s Kappa statistic was 0.51 (CI: 0.38–0.60). Kappa ranged from 0.37 to 0.58 for each of the seven stroke symptoms. Hemianesthesia (72.9%) and hemiplegia (64.6%) were the most sensitive symptoms. The performance and agreement improved from moderate to substantial after audit and feedback. Conclusion: We found a reasonable sensitivity and specificity and moderate agreement between CHW administered QVSFS and assessment by a vascular neurologist

Classification of adaptation measures and criteria for evaluation Case studies in the Indus River-Basin

This work was carried out by the Himalayan Adaptation, Water and Resilience (HI-AWARE) consortium under the Collaborative Adaptation Research Initiative in Africa and Asia (CARIAA) with financial support from the UK Government’s Department for International Development and the International Development Research Centre, Ottawa, Canada.This working paper is aimed at finding out the climate change adaptations going on across the three HI-AWARE Project Sites in Indus Basin, namely Hunza (High mountains), Soan Basin (Mid hill) and Chaj Doab ( Flood plains). Both autonomous and planned adaptations have been enlisted after thoroughly reviewing published and grey literature. Some focus group discus-sions and key informant interviews were also held in order to know about people experiences, perceptions and existing practices that they are carrying out to sustain their livelihood

Clinical Outcomes Following Bifurcation Techniques for Percutaneous Coronary Intervention

Bifurcation lesions account for 20% of all percutaneous coronary interventions and represent a complex subset which are associated with lower procedural success and higher rates of restenosis [...

Climate Change Impact on Groundwater-Based Livelihood in Soan River Basin of Pakistan (South Asia) Based on the Perception of Local Farmers

Based on the perceptions of the local farmers, this study aims to assess the effects of socioeconomic factors and climatic change on the groundwater livelihood system, with a particular focus on in situ Persian wheels/dug wells. Farmers’ perceptions of climate change and how it is affecting their way of life in the Soan River Basin have also been evaluated to determine the most appropriate adaptive interventions. Information and literature about dug wells was unavailable, which stressed the need to carry out this survey. A structured close-ended questionnaire was designed and administered with as much quantitative data as possible. Random sampling opted for a 5 km buffer zone across the Soan River and its tributaries. Union councils having more than 50% of their area lying in the buffer zone were surveyed, and data was collected. Fifty UCs fell within this criterion, and six dug wells from each Union Council were surveyed. The results of our survey collecting local farmer’s perceptions determined that about 70% of respondents agreed about climate change in the Soan Basin of Pakistan, and 62% of farmers reported that climate change severely impacted their livelihood by affecting agricultural productivity and water availability. Ninety-two percent reported summer becoming hot, 72% highlighted that winters are becoming less cold, and 96% reported that average annual rainfall has decreased compared to 10 years before. About 72% of respondents indicated that available water in their dug wells had decreased, and 80% of respondents explained that their crop yield had decreased compared to 10 years before. Sixty percent preferred drip and 35% sprinkler irrigation as efficient water management practices to cope with water shortages. Ninety-five percent of farmers were ready to use solar pumps for irrigation to tame high pumping costs. The study recommends integrating solar pumping with drip and sprinkler irrigation systems to enhance farmers’ cropped area and productivity. These vulnerable farmers can enhance their resilience and profitability by adopting high-value agriculture (tunnel farming, off-season vegetables, etc.) instead of conventional crops

Climate change impact on groundwater-based livelihood in Soan River Basin of Pakistan (South Asia) based on the perception of local farmers

Abstract Based on the perceptions of the local farmers, this study aims to assess the effects of socioeconomic factors and climatic change on the groundwater livelihood system, with a particular focus on in situ Persian wheels/dug wells. Farmers’ perceptions of climate change and how it is affecting their way of life in the Soan River Basin have also been evaluated to determine the most appropriate adaptive interventions. Information and literature about dug wells was unavailable, which stressed the need to carry out this survey. A structured close-ended questionnaire was designed and administered with as much quantitative data as possible. Random sampling opted for a 5 km buffer zone across the Soan River and its tributaries. Union councils having more than 50% of their area lying in the buffer zone were surveyed, and data was collected. Fifty UCs fell within this criterion, and six dug wells from each Union Council were surveyed. The results of our survey collecting local farmer’s perceptions determined that about 70% of respondents agreed about climate change in the Soan Basin of Pakistan, and 62% of farmers reported that climate change severely impacted their livelihood by affecting agricultural productivity and water availability. Ninety-two percent reported summer becoming hot, 72% highlighted that winters are becoming less cold, and 96% reported that average annual rainfall has decreased compared to 10 years before. About 72% of respondents indicated that available water in their dug wells had decreased, and 80% of respondents explained that their crop yield had decreased compared to 10 years before. Sixty percent preferred drip and 35% sprinkler irrigation as efficient water management practices to cope with water shortages. Ninety-five percent of farmers were ready to use solar pumps for irrigation to tame high pumping costs. The study recommends integrating solar pumping with drip and sprinkler irrigation systems to enhance farmers’ cropped area and productivity. These vulnerable farmers can enhance their resilience and profitability by adopting high-value agriculture (tunnel farming, off-season vegetables, etc.) instead of conventional crops