Measuring Child Disability: Piloting a Functional Assessment Tool in Children at the Iganga-Mayuge Health and Demographic Surveillance Site in Uganda

Disability is a dynamic and complex phenomenon. Across the globe, disability is considered a major development priority especially in low-and-middle-income countries (LMICs). Sustainable Development Goal 17 emphasizes the importance of high quality, reliable and timely availability of disability data to monitor the progress of other disability related Sustainable Development Goals (SDGs) on inclusive education (Goal 4), inclusive employment opportunities (Goal 8), social, economic and political inclusion (Goal 10), and accessible cities and public spaces (Goal 11). According to the World Report on Disability reliable data on disability are lacking for most LMICs. Disability among children is even less understood due to lack of standardized and easy-to-use population-based tool. Globally, there are about 93 million (one in 20) disabled children less than 15 years of age living with moderate or severe disability. To address this gap in disability measurement among children, the UNICEF and Washington Group developed a child disability assessment (C-DAS) tool for children 5-17 years of age. This 24-question and 13-domain tool has not been validated in Africa including Uganda where disability among children ranges between 2-13%. This thesis addresses this gap and comprises of three papers. The first paper is titled “Adaptation and validation of a child functional assessment tool at the Iganga-Mayuge Health and Demographic Surveillance Site in Uganda”. It assesses adaptation of the tool for implementation at the Iganga-Mayuge Health and Demographic Surveillance Site in Uganda and presents its psychometric properties. The second paper is titled “Measuring child functioning: assessing correlation and agreement between caregiver and child responses at the Iganga-Mayuge Health and Demographic Surveillance Site in Uganda”. This paper assesses correlation and agreement between responses of child-caregiver pairs. The third paper is titled “Factors associated with child disability at the Iganga-Mayuge Health and Demographic Surveillance Site in Uganda”. It examines disability categories and presents factors associated with disability among children

School-based injury outcomes in children from a low-income setting: results from the pilot injury surveillance in Rawalpindi city, Pakistan

Background School-based injuries account for one in five unintentional childhood injuries. Little is known about the epidemiology of school-based injuries in low-income settings. The objective of our study was to compare emergency department (ED) outcomes of the school-based injuries with respect to age, sex, and injury mechanisms in a Pakistani urban setting. Findings A pilot injury surveillance study was conducted at the EDs of three major tertiary-care hospitals of Rawalpindi city from July 2007 to June 2008 and included children of less than 15 years injured at school. The World Health Organization’s questionnaire for injury surveillance was used. There were 923 school injury cases. Mean age of children involved was 8.3 years (SD ± 3.3) with male female ratio 2.9:1. Most injuries occurred while playing 85.6% (n = 789); of which the most common mechanism was falls (n = 797, 86.4%). Nineteen of twenty cases were directly discharged home from the ED (N = 861). Compared to ED discharged cases, injury characteristics overrepresented in hospital admitted cases (n = 46) were age 10–14 years (65.2% vs. 40.9%, p = 0.005), male (88.6% vs. 25.9%), involved in educational activities (39.1% vs. 5.3%), injured from fire/heat (37.8% vs. 0.6%), had burns (39.5% vs. 0.9%) and head injuries (27.9% vs. 6.4%). Conclusion Falls while playing are the commonest injury mechanism in school-based injuries reported in our ED sample. School officials need to prevent these injuries. Studying injury hazards present in school environment in Pakistan might facilitate developing specific prevention strategies

Types and risk factors of violence experienced by people living with HIV, Pakistan: A cross-sectional study

Background: In Pakistan, data are lacking on the violence experienced by people living with HIV.Aims: This study determined the prevalence and risk factors of violence (physical, psychological and sexual) in people living with HIV in Karachi, Pakistan.Methods: This was a cross-sectional study in 2016 of people living with HIV attending clinics of Bridge Consultants Foundation, a community-based care provider. Date were collected using an interview-based questionnaire. Multivariate logistic regression analysis was done to assess the risk factors for violence with adjusted odds ratios (aOR) and 95% confidence intervals (CI) presented.Results: The sample included 250 people living with HIV; 183 were men, 60 were women and 7 were transgender. The mean (standard deviation) age of the participants was 30 (6.5) years. The prevalence rates of psychological, sexual and physical violence were 79.6%, 74.8% and 64.4%, respectively. More women experienced physical violence than men (76.2% versus 60.7%). Psychological violence was associated with injecting drug use (aOR = 2.64, 95% CI: 1.27-5.50) and being married (aOR = 0.46, 95% CI: 0.24-0.90). Marriage (aOR = 2.30, 95% CI: 1.27-4.16) and having an HIV-positive partner (aOR = 2.07, 95% CI: 1.09-3.92) were risk factors for sexual violence. Physical violence was associated with young age (aOR = 0.95; 95% CI: 0.91-0.99) and having an HIV-positive partner (aOR = 2.17, 95% CI: 1.10-4.26).Conclusion: Violence is an important public health problem affecting people living with HIV in Pakistan. This issue needs to be addressed by the government and nongovernmental organizations

Applying quality improvement methods to neglected conditions: Development of the South Asia Burn Registry (SABR)

Objective: South Asia has the highest mortality rate from burns in the world. Application of quality improvement methods to burn care can help identify health system gaps. Our overall aim is to introduce a sustainable hospital-based burn registry for resource-constrained settings to assess health outcomes of burn injury patients presenting to dedicated burn injury centers in South Asia.Results: The South Asia Burn Registry (SABR) is implemented through collaborative approach in selected burn centers in Bangladesh and Pakistan. Th registry collects data on burn injury events, the care provided, and the functional status of patients at discharge from burn centers. It covers the entire spectrum of care provision for burn injury patients from the actual event through their discharge from the healthcare system. SABR investigates locally relevant contextual factors associated with burn injury and health-system requirements for burn patients receiving emergency and inpatient care in resource-constrained settings. It also explores factors associated with burn injury and care provision. SABR will inform better prevention and management efforts in South Asia and help to address healthcare needs of burn injury patients

Understanding unintentional childhood home injuries: pilot surveillance data from Karachi, Pakistan

<p>Abstract</p> <p>Background</p> <p>Childhood injuries, an important public health issue, globally affects more than 95% of children living in low-and middle-income countries. The objective of this study is to describe the epidemiology of childhood unintentional injuries in Karachi, Pakistan with a specific focus on those occurring within the home environment.</p> <p>Methods</p> <p>This was a secondary analysis of a childhood unintentional injury surveillance database setup in the emergency department of the Aga Khan Hospital, Karachi, Pakistan for 3 months. The data was collected by interviewing caretakers of children under 12 years of age presenting with an unintentional injury to the emergency departments of the four major tertiary care hospitals of Karachi, Pakistan.</p> <p>Results</p> <p>The surveillance included 566 injured children of which 409 (72%) injuries had taken place at/around home. Of 409 children, 66% were males and mostly between 5 and 11 years of age. Injuries commonly occurred during play time (51%). Fall (59%), dog bites (11%) and burns (9%) were the commonest mechanisms of injury. The majority of the children (78%) were directly discharged from the emergency room with predicted short term disability (42%). There were 2 deaths in the emergency department both due to falls.</p> <p>Conclusion</p> <p>Childhood injury surveillance system provides valuable in-depth information on child injuries. The majority of these unintentional childhood injuries occur at home; with falls, dog bites and burns being the most common types of unintentional childhood home injuries. Specific surveillance systems for child injuries can provide new and valuable information for countries like Pakistan.</p

Intubation in emergency department of a tertiary care hospital in a low-income

Objective: To study the indications, method, success rate and complications of intubation at the Emergency Department of a private, tertiary care hospital in Karachi, Pakistan.Methods: The case series involved 278 patients above 14 years of age who underwent emergency intubation at the Emergency Department of Aga Khan University Hospital, Karachi between 1998 and 2003. Descriptive statistics were used to compare rapid sequence intubation with crash intubation. The level of significance was p\u3c0.05.Results: Of the total 278 intubations performed, 37 (13.3%) had to be left out for incomplete information. The study population remaining for inferential analysis comprised of 241 patients. Of the total 278 patients, 174 (63%) were males. Rapid sequence intubation was the commonest type (n=185, 67%) of intubation and was performed mostly by anaesthetists (n=236, 85%). Cardiogenic pulmonary oedema and head injury were commonly seen in these patients. The success on first attempt of intubation was 98% (n=181) in rapid sequence intubation, and 85% (n=48) in crash intubation. Overall, 15 (5.3%) complications were seen in these intubations.Conclusion: Study showed a satisfactory success rate in both rapid sequence and crash intubations

Teaching children road safety through storybooks: an approach to child health literacy in Pakistan

Background: Road traffic injuries (RTIs) commonly affect the younger population in low- and-middle-income countries. School children may be educated about road safety using storybooks with colorful pictures, which tends to increase the child’s interest in the text. Therefore, this study assessed the use of bilingual pictorial storybooks to improve RTI prevention knowledge among school children.Methods: This pretest-posttest study was conducted in eight public and nine private schools of Karachi, Pakistan, between February to May 2015. Children in grades four and five were enrolled at baseline (n = 410). The intervention was an interactive discussion about RTI prevention using a bilingual (Urdu and English) pictorial storybook. A baseline test was conducted to assess children’s pre-existing knowledge about RTI prevention followed by administration of the intervention. Two posttests were conducted: first immediately after the intervention, and second after 2 months. Test scores were analyzed using McNemar test and paired sample t-test. Results: There were 57% girls and 55% public school students; age range 8–16 years. Compared to the overall baseline score (5.1 ± 1.4), the number of correct answers increased in both subsequent tests (5.9 ± 1.2 and 6.1 ± 1.1 respectively, p-value \u3c 0.001). Statistically significant improvement in mean scores was observed based on gender, grades and school type over time (p-value \u3c 0.001).Conclusion: Discussions using bilingual pictorial storybooks helped primary school children in Pakistan grasp knowledge of RTI prevention. RTI education sessions may be incorporated into school curricula using storybooks as teaching tools. Potential exists to create similar models for other developing countries by translating the storybooks into local languages

794 Evaluating disability in adult burn injury patients treated at a tertiary-care burn unit in Karachi, Pakistan: a longitudinal study using who disability assessment schedule II

Abstract Background Disability after burn injury is not assessed in the context of Pakistan. This study assesses disability among adult burn injury patients presenting to a burn unit in Karachi, Pakistan. Methods This longitudinal study was conducted at a burn centre is Karachi, Pakistan. Adult patients(\u3e18 years) who were discharge after 24-hour admission were enrolled from August 2014–March 2015. Baseline assessment before discharge and follow-up at 2,6 and 12 weeks after discharge via telephone was done using 12-item WHODAS 2.0 (5 -point likert-scale; 1 = none; 2 = mild; 3 = moderate; 4 = severe; and 5 = extreme) related to cognition, mobility, self-care, getting along, life activities and participation. The score range was 12–60 with higher score being worse. Ethical approval was taken from collaborating and participating sites. Results Of the 59 eligible patients, 53 completed all follow-ups. There were 69.8% males. Mean age of all patients was 36.8 ± 14.0 years, 71.7% were married and 17.0% had no/informal education. About half the patients were breadwinners. More than half of burn incidents occurred at home. Flame burns (50.9%) and scalds (17%) were the most common type of burns. The average surface area burnt was 43.0 ± 14.2%. The mean-scores for all patients at baseline, 2-week, 6-week and 12-week were 13.9 ± 4.9, 35.3 ± 13.8, 26.8 ± 11.9 and 20.1 ± 9.1, respectively. The mean-scores for males were lower than that of females for the four assessments (Males: 13.5 ± 1.8, 34.2 ± 14.1, 25.3 ± 10.7, 19.2 ± 8.4 and females: 16.1 ± 8.5, 37.3 ± 13.3, 30.5 ± 14.4, 22.1 ± 10.6). The two-week score was higher for those with \u3e15% burn(36.7 ± 13.9) compared to those with ≤15% burn(34.6 ± 14.2) while the score were similar at 12-week follow-up. Conclusions This analysis shows that the burn injury patients tend to recover from their injury over a period of 12 weeks after discharge. Future work should focus on larger group of patients and long term follow-up at one and two years after burn injury