Impact of maternal respiratory infections on low birth weight - a community based longitudinal study in an urban setting in Pakistan

Background: The health of mothers and their newborns is intricately related. The weight of the infant at birth is a powerful predictor of infant growth and survival, and is considered to be partly dependent on maternal health and nutrition during pregnancy. We conducted a longitudinal study in an urban community within Karachi to determine maternal predictors of newborn birth weight.Methods: Four hundred pregnant women were enrolled in the study during the period 2011-2013. Data related to symptoms of acute respiratory illness (fever, cough, difficulty breathing, runny nose, sore throat, headache, chills, and myalgia/lethargy) in the pregnant women were collected weekly until delivery. Birth weight of the newborn was recorded within 14days of delivery and the weight of \u3c 2.5kg was classified as low birth weight (LBW).Results: A total of 9,853 symptom episodes were recorded of fever, cough, difficulty breathing, runny nose, sore throat, headache, chills, myalgias/lethargy in the enrolled pregnant women during the study. Out of 243 pregnant women whose newborns were weighed within 14days of birth, LBW proportion was 21% (n=53). On multivariate analysis, independent significant risk factors noted for delivering LBW babies were early pregnancy weight of \u3c 57.5kg [odds ratio adjusted (ORadj)=5.1, 95% CI: (1.3, 19.9)] and gestational age [ORadj=0.3, 95% CI (0.2, 0.7) for every one week increase in gestational age]. Among mothers with high socioeconomic status (SES), every 50-unit increase in the number of episodes of respiratory illness/100weeks of pregnancy had a trend of association with an increased risk of delivering LBW infants [ORadj=1.7, 95% CI: (1.0, 3.1)]. However, among mothers belonging to low SES, there was no association of the number of episodes of maternal respiratory illness during pregnancy with infants having LBW [ORadj=0.9, 95% CI: (0.5, 3.5)].CONCLUSIONS: While overall respiratory illnesses during pregnancy did not impact newborn weight in our study, we found this trend in the sub-group of mothers belonging to the higher SES. Whether this is because in mothers belonging to lower SES, the effects of respiratory illnesses were overshadowed by other risk factors associated with poverty need to be further studied

Predictors of diarrheal mortality and patterns of caregiver health seeking behavior in in Karachi, Pakistan

Background: Pakistan is unfortunately among the five countries that contributed to the most deaths due to diarrhea and pneumonia in 2010. To explore factors associated with diarrheal deaths we assessed care-seeking behavior and other predictors of diarrhea-related mortality in children in selected low-income peri-urban communities of Karachi, Pakistan.Methods: A mixed methods study (qualitative and quantitative) using matched case-control design and focus group discussions with parents of children with moderate to severe diarrhea (MSD) was undertaken. Cases were children Demographic, clinical, and care-related behavioral predictors of mortality were assessed. Conditional logistic regression was performed, matched adjusted odds ratios (mOR) are reported.Results: Parents of 77 cases and 154 controls were interviewed. Cases were less likely to receive appropriate care compared to controls (mOR=0.2, 95% confidence interval (CI) 0.05-0.91). Refusal for hospital admission (OR=8.9, 95% CI 2.6-30.8), and delays in reaching the health facility (OR=3.6, 95% CI 1.0-12.9) were significant independent predictors of mortality. We found strong beliefs in traditional and spiritual healing in the population; use of both modern and traditional/spiritual treatments concurrently was common.Conclusion: Appropriate care seeking behavior predicts survival in children with diarrhea in Pakistan. There is a complex belief system relating to traditional and standard therapies. Health education for appropriate health care seeking should be implemented in order to achieve a substantial decline in diarrheal disease mortality in Pakistan

Differences in health care seeking patners for childern less than five years of age who died of severe diarrhea compared to those with non-fatal severe diarrhea in selscted semi Urban areas of Karachi, Pakistan

B ACKGROUND Improving survival from childhood diarrhea still remains a challenge for most developing countries. Despite reductions in overall number of deaths due to diarrhea, there is insufficient progress in countries like Pakistan and children less than five years of age continue to die of diarrhea each year in many low income countries. Prevention of diarrhea in these settings requires both effective prevention and management strategies and methods to change behavior to improve access to care. It is therefore imperative to study health care seeking behavior patterns and their impact for addressing better future strategies. Hence we proposed to see the differences in health care seeking patterns for children less than five year of age who died of severe diarrhea compared to those with non-fatal severe diarrhea METHODS This was a mixed method study including a matched case-control study done at selected semi-urban communities of Karachi and focus group discussions using qualitative methods. Cases were identified from the ongoing surveillance system which captured diarrheal deaths and included children 0-59 months old who had died after developing severe diarrhea. Their age and neighborhood matched controls included children 0-59 months with severe diarrhea who survived after a severe diarrhea episode. The caretakers were interviewed through a questionnaire to inquire about patterns of health care seeking behavior. Analysis was done using statistical analysis system (SAS) version 9.1 and also on statistical package for social scientist (SPSS) version 11.5. Conditional logistic regression was performed to identify factors associated with severe diarrhea mortality in children less than five year of age. RESULTS Seventy four cases of fatal diarrhea and 148 matched controls with non-fatal diarrhea were included in the study. The results of the multivariable model showed that the odds of having appropriate care were 80% less in children with severe fatal diarrhea than in children with severe non-fatal diarrhea after matching for age and neighborhood. (MORadi = 0.20, 95% CI: 0.05, 0.90). Time (one hour or more) taken to reach health facility (MORadi = 5.0 95% CI 1.3, 19.1), and refusal to comply with advice for hospital admission (MORadi = 18.2 95% CI 4.0, 82.41) were also found to be associated with death in children with severe diarrhea. Other factors associated with fatal diarrhea in children were; having blood in stools (MORadi = 10.7 95% CI 2.2, 52.6), no boiling of drinking water (MORadi = 7.6 95% CI 2.5, 23.5) and use of public place as source of drinking water (MORadj = 12.6 95% CI 1.8, 86.6). Another factor of home care feeding which was independently associated with diarrheal mortality in children showed that children with fatal severe diarrhea were more likely to be given nothing to drink (crude MOR= 5.4 95%CI 1.4, 21.7) and nothing to eat (crude MOR= 2.9 95%CI 0.9, 9.3) compared to being given usual or more than usual to drink and eat, however this became insignificant in the final multivariable model. Additional findings from the qualitative study showed switching and simultaneous treatment from traditional, spiritual and modern healers by the caretakers of children 0-59 months with severe diarrhea were common rather than following the advice of one provider. Moreover limited decision making power of mothers, lack of belief in oneself for taking care of the child, inadequate knowledge of prevention of diarrhea illness, lack of awareness about water boiling, self treating child at home resulting in delay in seeking formal care and misconceptions regarding ORS were factors associated more commonly with caretakers of children with severe fatal diarrhea than nonfatal diarrhea. CONCLUSION The results of the study show that lack of appropriate care seeking, refusal to admit the child in hospital and delays in time to reach the health facility are significant determinants of diarrheal deaths among children with severe diarrhea. Other factors associated with fatal diarrhea in children were not boiling drinking water, use of public sources of drinking water and presence of blood in stools of the child. Caretakers from these low-income areas showed switching and simultaneous treatment from traditional, spiritual and modern healers, lack of belief in oneself and blamed their inadequate knowledge for their child death. Social marketing through health education promotion campaigns at the community level and mass media campaigns for oral rehydration therapy and for importance of seeking appropriate care should be implemented in order to achieve a substantial decline in diarrheal disease mortality in Pakistan

Incidence of Typhoid Bacteremia in Infants and Young Children in Southern Coastal Pakistan

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 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 consent, and inoculated in BACTEC Peds Plus bottles (Becton Dickinson, Sparks, MD) and processed per manufacturer\u27s 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 (95% confidence interval, 193.8-876.5) per 100,000 child years. The overall incidence rate of typhoid for children (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

Routine EPI coverage: subdistrict inequalities and reasons for immunization failure in a rural setting in Pakistan

© 2011 APJPH.High vaccine coverage at the district level may not translate with the same vigor to subdistrict levels; therefore, it is important to understand coverage inequalities. This study underscored vaccine coverage inequalities at subdistrict levels and explored reasons for immunization failure in a high-performing rural district of Pakistan. Parents of children aged 12 to 23 months were randomly selected and interviewed for child\u27s vaccination history through a cross-sectional survey in 2008. Using secondary data (GIS maps and population census), coverage was plotted in respect to sociodemographic and presence of lady health workers. The proportion of children fully immunized was found notably low (75%) than officially reported (85%). Coverage inequalities were observed at subdistrict levels, ranging from 58% to 85% in rural to urban areas and from 60% to 80% in lower to higher income quintiles. Distance to immunization facility, parental unawareness, and wrong ideas about vaccination were statistically significant for immunization failure. Focus of immunization microplans at the subdistrict level are needed to achieve universal immunization goals

Incidence of pneumonia, bacteremia, and invasive pneumococcal disease in Pakistani children

Objective: To determine the incidence of pneumonia, bacteremia, and invasive pneumococcal disease (IPD) in Pakistani children \u3c 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 \u3c 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 \u3c 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

Zinc and Potassium Fertilizer Synergizes Plant Nutrient Availability and Affects Growth, Yield, and Quality of Wheat Genotypes

The growth and productivity of wheat crops depend on the availability of essential nutrients such as zinc (Zn) and potassium (K2O), which play critical roles in the plant’s physiological and biochemical processes. This study aimed to investigate the synergizing effect of zinc and potassium fertilizers on uptake of both the nutrients, growth, yield, and quality of the Hashim-08 cultivar and local landrace, during the 2019–2020 growing season in Dera Ismail Khan, Pakistan. The experiment was designed using a split plot pattern in a randomized complete pattern, with main plots for the wheat cultivars and subplots for the fertilizer treatments. Results indicated that both cultivars responded positively to the fertilizer treatments, with the local landrace exhibiting maximum plant height and biological yield, and improved Hashim-08, showing increased agronomic parameters, including the number of tillers and grains and spike length. Application of Zn and K2O fertilizers significantly enhanced agronomic parameters, such as the number of grains per plant, spike length, thousand-grain weight, grain yield, harvest index, Zn uptake of grain, dry gluten content, and grain moisture content, while crude protein and grain potassium remained relatively unchanged. The soil’s Zn and K content dynamics were found to vary among treatments. In conclusion, the combined application of Zn and K2O fertilizers proved beneficial in improving the growth, yield, and quality of wheat crops, with the local landrace exhibiting lower grain yield but greater Zn uptake through fertilizer application. The study’s findings highlight that the local landrace showed good response to the growth and qualitative parameter when compared with the Hashim-08 cultivar. Additionally, the combined application of Zn and K showed a positive relation in terms of nutrient uptake and soil Zn and K content

Analysis and characterization of opto-electronic properties of iron oxide (Fe2O3) with transition metals (Co, Ni) for the use in the photodetector application

There are several uses for ultraviolet photodetectors, including in the scientific, military, and industrial sectors. In this sense, UV photodetectors must have high responsiveness, be insensitive to visible light, and be inexpensive to produce. For this purpose, we report the development of Co and Ni based iron oxide nanoparticles via the cost effective low temperature sol–gel auto-combustion process. XRD study approves the cubic crystal structure of iron oxide (Fe2O3) with predominant orientation along (311) direction. A sharp and strong peak is obtained at 583 cm−1 and 594 cm−1 for both samples in FT-IR spectra assigned to metal oxide Fe–O network system which approves the formation of iron oxide. Raman spectroscopy analysis reveals the presence of two A1g and five Eg phonon modes in the case of both samples. Absorption study exhibits the strong absorption peaks for the iron oxide sample doped with cobalt and nickel, while poor absorption was noticed from the pure iron oxide nanoparticles. The large and low energy band gap values are found to be 2.77 eV and 1.68 eV for pure Fe2O3 and cobalt and nickel doped Fe2O3 nanoparticles, respectively. Stone and cloud-like shape morphology was observed from SEM analysis. The EDX spectra reveal the presence of essential elements, like Fe and O in the case of pure iron oxide while Fe, O, Co and Ni in the case of transition metals doped iron oxide nanoparticles. The photoluminescence (PL) spectroscopy technique was recorded the luminescent properties which reveals the decrease in PL intensity that confirms the decline in electron–hole recombination. Therefore, I–V characterization analysis reveals that electrical conductivity increases with the addition of metals due to decrease in electron–hole recombination with the co-doping of metals. These modified opto-electronic properties of the developed Fe2O3 by metals co-doping make it suitable candidate for the use in photodetector application