Role of Parents, Community, and Health Care System in Child Health

Pakistan is a developing country, and the status of children's health is less than satisfactory all over the region. This is evident by the high morbidity and mortality rate of under-five children. The shocking aspect is that the majority of causes are those that can be prevented and treated. Factors contributing to child health are parenting cultural values, physical environment, education, poverty, housing, and health care facilities. All these determinants emphasize that child health is encircled around three essential features of society parents, community, and health services. Focusing on just one will not bring an effective outcome until a collaborative approach is achieved. Here in this article model of child health proposed by the Better Start Child Health and Development Research Group at the University of Adelaide’s School of Population is applied to address child health. Health gives as a rubric of “Five by Five” that is based on the concept that there are five basic domains of child health and each requires a collaborative approach of child, parents, community and health system. Keywords: Child health, health services, Parents, Community DOI: 10.7176/JMPB/62-03 Publication date: December 31st 201

Role of Parents, Community, and Health Care System in Child Health

Pakistan is a developing country, and the status of children's health is less than satisfactory all over the region. This is evident by the high morbidity and mortality rate of under-five children. The shocking aspect is that the majority of causes are those that can be prevented and treated. Factors contributing to child health are parenting cultural values, physical environment, education, poverty, housing, and health care facilities. All these determinants emphasize that child health is encircled around three essential features of society parents, community, and health services. Focusing on just one will not bring an effective outcome until a collaborative approach is achieved. Here in this article model of child health proposed by the Better Start Child Health and Development Research Group at the University of Adelaide’s School of Population is applied to address child health. Health gives as a rubric of “Five by Five” that is based on the concept that there are five basic domains of child health and each requires a collaborative approach of child, parents, community and health system. Keywords: Child health, health services, Parents, Community DOI: 10.7176/JMPB/62-03 Publication date: December 31st 201

Quality of life in children treated for craniopharyngiomas

Craniopharyngiomas are common but complex paediatric brain lesions that present interesting management challenges. Quality of life is an important consideration while choosing management options. In this review, we have discussed the existing literature on various aspects of quality of life in patients treated for craniopharyngioma, assessed by variety of measurement tools

Societal preferences for gender of surgeons: A cross-sectional study in the general population of Pakistan

Background: Sociocultural norms and gender biases may result in surgeon gender preferences among the general public. This study aimed to understand preferences and perceptions related to surgeon gender among the general population in Pakistan, a lower-middle-income country.Methods: A cross-sectional study was conducted by the Aga Khan University, Karachi, among the adult general population in Pakistan. Sequential mixed-mode data collection was performed via online dissemination on social media platforms and in-person surveying at different geographic locations in Karachi.Results: Among 1604 respondents, 50% did not report having surgeon gender preferences in general. Among respondents with gender preferences, there was a highly significant preference for gender concordance across all surgical subspecialties (p Conclusion: While around half of respondents do not have gender preferences, a significant proportion prefers a gender concordant surgeon across subspecialties. In a society where conservative sociocultural norms play a significant role when seeking health care, this makes yet another compelling argument for gender parity in surgery

Radial artery coronary bypass grafting: Surgical outcomes of an unexplored innovation in a developing country

Objective: To explore postoperative outcomes, particularly prolonged length of hospital stay, in radial artery coronary artery bypass graft patients in a tertiary-care setting. Methods: The pilot prospective cohort study was conducted at the Aga Khan University Hospital, Karachi, from September 2019 to September 2020, and comprised adult patients of either gender due to undergo coronary artery bypass grafting for coronary artery disease involving two or more vessels. The subjects were approached for the use of their radial artery as a conduit. Prolonged length of hospital stay was defined as postoperative stay \u3e9 days. Multivariable logistic regression was used to identify independent predictors of the length of hospital stay. Data was analysed using SPSS 21. Results: Of the 97 patients, 84(86.6%) were males. The overall mean age of the sample was 58.33±8.34 years. Mean length of hospital stay was 8.10±2.37 days, and 23(23.7%) patients had prolonged stay. Higher age was a significant predictor of prolonged hospital stay (p\u3c0.05). Besides, 23(23.7%) patients developed acute kidney injury. There was no incidence of wound, infection or deep venous thrombosis, while 1(1.03%) patient had to be reopened due to excessive postoperative bleeding, and it represented the lone mortality. Conclusions: Patient age was found to be a significant predictor of prolonged hospital stay in patients undergoing radial artery coronary artery bypass graft, while almost a quarter of the sample was affected by acute kidney injury

Collision versus loss-of-control motorcycle accidents: Comparing injuries and outcomes

Objective: Motorcycles are a common mode of transport, especially in low-middle-income countries like Pakistan. The pattern and severity of injuries in motorcycle trauma depends on the mechanism of accident, which may be classified as collision accidents (CAs) or loss-of-control accidents (LOCAs). In this study, we aimed to investigate patterns of trauma due to motorcycle CAs and LOCAs, with a focus on injuries, management, complications, and outcomes.Methods: A retrospective cohort study was conducted at the Aga Khan University Hospital (AKUH), Pakistan (a level 1 trauma facility), enrolling all patients presenting with motorcycle trauma between January 2018 and March 2019.Results: The most common sites of major injury were the lower limb (40.9%), head and neck (38.1%), and upper limb (27.5%). A significantly higher percentage of CA victims had head and neck injuries (43.4% vs. 30.5%), abdominal injuries (5.5% vs. 1.1%), pelvic fracture (5.9% vs. 0%), and polytrauma (22.8% vs. 11.1%). Compared to LOCA victims, CA victims had a significantly higher incidence of acute kidney injury (AKI; 25.7% vs. 15.8%; P \u3c .011), longer hospital lengths of stay (LOSs; 3 [2-6] days vs. 2.5 [2-4] days; P = .019), and long-term disability (P = .002). When adjusted for age and gender on multivariable logistic regression with mechanism of accident as the dependent variable, CA was significantly associated with male gender (odds ratio [OR] = 2.045, 95% confidence interval [CI] [1.038-4.026]), abdominal injury (OR = 5.748, 95% CI [1.285-25.702]), head and neck injury (OR = 1.492, 95% CI [1.007-2.211]), polytrauma (OR = 2.368, 95% CI [1.383-4.055]), AKI (OR = 1.937, 95% CI [1.183-3.171]), and LOS (OR = 1.041, 95% CI [1.004-1.079]).Conclusions: Though both motorcycle CAs and LOCAs stress trauma systems in developing countries, the dynamics of CAs mean that they result in worse injuries and outcomes. Specific measures to reduce CAs and LOCAs are urgently indicated in developing countries to reduce the burden of morbidity and mortality of motorcycle accidents

Management of breast intraductal papilloma diagnosed on core needle biopsy: Excision or follow-up?

Introduction: Management of intraductal papillomas (IDPs) diagnosed on core needle biopsy (CNB) remains controversial. We report our experience of IDPs identified on CNB, our institutional rates of upgradation to atypia/malignancy as well as radiologic/pathologic features that may allow selection for surgery as well as those for safe observation. Methods: The study is a retrospective review of patient records from 2012 to 2019, at a tertiary care hospital in Pakistan. Data was analyzed using Statistical Package for Social Sciences (SPSS), version 21.0 (IBM Corp., Armonk, NY). Associations between various patient factors were assessed using Pearson’s chi-square test. Results: This study included a total of 55 female patients with IDPs, with a mean age of 54.67 ± 15.57 years. On CNB, 69.1% (n = 38) of patients had IDP without atypia while 30.9% (n = 17) had IDP with atypia, with single IDPs being the most common lesions on excisional biopsy. Overall, of all CNB-diagnosed IDPs, only 4/55 (7.3%) demonstrated upgradation (3/4 to DCIS, 1/4 showed atypia) on excisional biopsy, and all these upgraded cases had failed to demonstrate atypia on initial CNB. Conclusion: CNB-identified cases of IDPs are rarely upgraded on excision and thus routine excision in all cases may be unnecessary. Appropriate patient selection based on radiology-pathology findings should be done. Those with suspicious findings on imaging as well as those that demonstrate atypia on CNB must be excised

Patterns of traumatic injuries and outcomes to motorcyclists in a developing country: A cross-sectional study

Objective: Motorcyclists are frequently involved in road traffic accidents and may suffer polytraumatic injuries, contributing a substantial burden on healthcare systems particularly in lower-middle-income countries. This study aimed to describe patterns of injury, in-hospital course, and outcomes of road accident trauma in motorcyclists, including polytrauma, at a Trauma Facility in Pakistan.Methods: A retrospective review was conducted by using relevant trauma codes to extract data from records for all victims presenting with motorcycle trauma between January 2018 and June 2019, to a tertiary care hospital in Pakistan. Data collected included victim characteristics, mechanism of accident, patterns of traumatic injury, management, in-hospital complications, and outcomes. Polytrauma was defined as traumatic injuries in two or more anatomic regions with abbreviated injury scale (AIS) ≥ 3. Multivariable logistic regression, adjusted for age, gender, and mechanism of accident, was performed to identify in-hospital complications and outcomes associated with polytrauma.Results: A total of 514 victims, 90.9% male and 39.5% aged between 18-30 years, were included in this study. The victim was the motorcycle driver in 94.6% of cases. The most common mechanism of accident was motorcycle vs. other motor vehicle (56.2%). Patients were mostly admitted under the services of Orthopedic Surgery (50.8%) and Neurosurgery (30%), with common sites of injury being the lower extremity (42.6%), head (38.1%), and upper extremity (26.8%). Polytrauma occurred in 19.5% of victims. Patients were managed surgically in 77.3% of cases, with the most common procedure being open reduction of fractures (48.1%). Blood transfusion was required in 4.1% of patients. The commonest in-hospital complication was acute kidney injury (23.7%). The median length of stay was 3 days, and 4.1% of patients expired in the hospital. Polytrauma was significantly associated with the need for blood transfusion (2.642 [1.053-6.630]), AKI (2.212 [1.339-3.652]) and hospital length of stay (1.059 [1.025-1.094]), but not with mortality.Conclusion: Although orthopedic injuries occur most frequently in motorcycle trauma, polytrauma necessitating multi-disciplinary management and complicating hospital stay is also common. Understanding patterns of injuries and management in motorcycle trauma will enable trauma teams in a developing country like Pakistan to devise evidence-based management protocols, especially for cases of polytrauma

The need for transgender healthcare medical education in a developing country

Purpose: The single most significant barrier to healthcare for people who identify as transgender is poor access to healthcare providers trained in trans-health. Despite this, trans-health education is far from being a routine component of the undergraduate medical curriculum in developing countries like Pakistan. This study aimed to assess knowledge and attitudes regarding people who identify as transgender, as well as the perceived need for trans-health in the curriculum, amongst medical students in Pakistan.Materials and methods: A cross-sectional study using a self-designed questionnaire was carried out amongst undergraduate medical students at the Aga Khan University. Stratified random sampling was used, whereby students were stratified based on their current year of medical education.Results: A total of 249 students were included in this survey. The majority (61%) had poor overall knowledge, with a significantly higher percentage of pre-clinical students (79.6%) having poor knowledge regarding differences in transgender health needs compared to clinical students (60.3%; p = 0.001). Most students acknowledged that individuals who identified as transgender faced a lack of access to healthcare (78.3%), were poorly integrated into society (92.0%) and were treated differently in a clinical setting (58.6%). Many students were unsure of how to address (49.8%) and clinically examine (38.2%) patients identifying as transgender. However, most students demonstrated good (49.4%) or fair (45.0%) attitudes towards individuals who identified as transgender, and the majority reported a high (54.6%) or moderate (42.2%) perceived need for the inclusion of trans-health in the medical curriculum.Conclusion: Despite deficiencies in trans-health education in the medical school curriculum, positive attitudes and a high perceived need among students lay the foundation for developing a medical curriculum that gives due priority to trans-health. In developing countries, this can help bridge disparities in healthcare provision to people who identify as transgender

Cultural barriers for women in surgery: How thick is the glass ceiling? An analysis from a low middle-income country

Background: This study aimed to highlight cultural barriers faced by surgeons pursuing a surgical career faced by surgeons at a tertiary care hospital in Pakistan. As more females opt for a surgical career, barriers faced by female surgeons are becoming increasingly evident, many of which are rooted in cultural norms. In Pakistan, a predominantly Muslim-majority, low middle-income country, certain societal expectations add additionally complexity and challenges to existing cultural barriers.Methods: A cross-sectional survey was administered via e-mail to the full-time faculty and trainees in the Department of Surgery at the Aga Khan University Hospital, Karachi, Pakistan, from July 2019 to November 2019.Results: In total, 100 participants were included in this study, with the majority being residents (55.6%) and consultants (33.3%). 71.9% of female surgeons felt that cultural barriers towards a surgical career existed for their gender, as compared to 25.4% of male surgeons (p \u3c 0.001). 40.6% of females reported having been discouraged by family/close friends from pursuing surgery, as compared to only 9.0% of males (p \u3c 0.001). Moreover, a greater percentage of females surgeons were responsible for household cooking, cleaning and laundry, as compared to male surgeons (all p \u3c 0.001). Lastly, 71.4% of female surgeons felt that having children had hindered their surgical career, as compared to 4.8% of males (p \u3c 0001).Conclusion: Our study shows that significant cultural barriers exist for females pursuing a surgical career in our setting. Findings such as these emphasize the need for policy makers to work towards overcoming cultural barriers