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IMPACT: A Structured Human-Centered Design Process for Integrating Community Health Worker Insights Into Program Policy in Pakistan.

BACKGROUND: Community health workers (CHWs), most of whom are women, are the bedrock of primary health care provision in much of the world. CHWs are often employed at the bottom of health hierarchies where they have little voice; in state programs and vertical initiatives, accountability has generally flowed downwards. Yet many programs might function better if CHWs' needs and ideas were considered in program design. METHODS: From 2020-2022, we implemented a human-centered design process called IMPACT with CHWs working on polio vaccination in one district of Pakistan. The name IMPACT draws fr…

From global to local: Developing a context-specific BeSD-HPV tool through cultural and linguistic adaptation in Pakistan.

OBJECTIVES: A key challenge in preventing cervical cancer is the low uptake of the Human Papillomavirus (HPV) vaccine in low and middle-income countries (LMICs). Evidence indicates that, in addition to logistical and structural issues, this is often influenced by sociocultural factors. The objective of this study was to develop a culturally adapted Behavioral and Social Drivers (BeSD) of HPV vaccination framework that is linguistically appropriate, contextually grounded, and culturally sensitive, to evaluate the social, behavioral, and cultural factors influencing HPV vaccination in Pakistan. …

Prevalence and antimicrobial resistance trends of ESKAPEE pathogens in clinical isolates from Hyderabad, Pakistan: a cross-sectional study.

OBJECTIVES: Antimicrobial resistance is a major global health threat that limits treatment options and increases morbidity and mortality. ESKAPEE pathogens are prioritized by the World Health Organization and the Centers for Disease Control and Prevention because of their role in nosocomial infections and their ability to evade antimicrobials. This study aimed to determine the prevalence and antimicrobial resistance patterns of ESKAPEE pathogens in Hyderabad, Pakistan. METHODS: A cross-sectional study was conducted from August 2023 to August 2024 at the University of Sindh. A total of 1072 cl…

Sequence Variation of Epstein-Barr Virus EBNA-1 Gene in Central Nervous System Inflammatory Demyelinating Diseases in Pakistan.

CNS inflammatory demyelinating diseases (CNS-IDDs), including multiple sclerosis and related conditions, have increasingly been associated with Epstein-Barr virus (EBV). However, data on EBV genetic diversity, particularly regarding EBNA-1 gene variants, across different CNS-IDD subtypes in South Asian populations remain limited. This study examined EBV DNA prevalence and EBNA-1 sequence variation in 40 patients with CNS-IDD and 40 healthy controls from Pakistan. EBV DNA was found in 21 of 80 samples (26%), with a significantly higher occurrence in CNS-IDD patients (16/40, 40%) compared to hea…

Understanding barriers to HIV pre-exposure prophylaxis initiation among men who have sex with men in Sindh, Pakistan.

BackgroundPre-exposure prophylaxis (PrEP) is a highly effective intervention to prevent HIV acquisition. Oral PrEP was introduced for men who have sex with men (MSM) in Sindh province of Pakistan in June 2022, yet the uptake remains suboptimal. Here we present an assessment of barriers to PrEP uptake among MSM accessing HIV prevention services in Sindh.MethodsWe conducted a cross-sectional survey among MSM clients attending HIV prevention services from community-based organizations in Sindh province. Those who consented to participate were administered a paper-based questionnaire by providers …

Molecular characterization and drug resistance pattern in pol gene of HIV-1 sub-subtypes circulating in Lahore, Pakistan.

This study aimed to determine sub-subtypes and circulating recombinant forms (CRFs) in Pakistan using the pol gene, identification of amino acid substitutions, structural changes, and drug resistance evaluation in the p66 region of reverse transcriptase. A total of 50 HIV-positive blood samples were collected from Lahore Pakistan, confirmed by Real Time-Polymerase Chain Reaction. The samples were further processed for pol gene amplification followed by nucleotide sequencing through the Sanger method. Out of 50 samples, 26 samples were amplified, and 14 sequences were obtained. The sequences we…

Prevalence of Adverse Childhood Experiences (ACEs) and its association with current mental wellbeing among young adults in Pakistan.

BACKGROUND: Adverse Childhood Experiences (ACEs) are significant stressors that can have lasting effects on an individual's health, especially on mental wellbeing. While ACEs affect up to 91 % of individuals in low- and middle-income countries (LMICs) such as Uganda and India, research in Pakistan remains sparse and underdeveloped, limiting cross-country comparisons. OBJECTIVE: To determine the prevalence of ACEs among young adults aged 18 to 25 in Pakistan and their impact on current mental wellbeing. PARTICIPANTS AND SETTING: Students aged 18-25 years enrolled in grade 13th-16th of selecte…

De Novo bone metastasis in breast cancer: tumor biology and survival outcomes in a retrospective study from Pakistan.

PURPOSE: Breast cancer is the leading cause of cancer-related deaths among women, with 20-30% of early-stage patients eventually developing metastases, often in bones. Despite the high incidence, risk factors for de novo bone metastasis are understudied in local populations. METHODS: This single-center, retrospective study was conducted at Aga Khan University Hospital, Karachi. Patient demographics, tumor characteristics, and risk factors were assessed. Patients with de novo bone metastasis were compared to non-stage IV cases using binary univariate and multivariate logistic regression, with

Evaluation of genotype matched recombinant DNA vaccine for protection against genotype VII velogenic Newcastle disease virus in Pakistan.

Newcastle disease virus (NDV) remains a major threat to the poultry industry worldwide. Recombinant DNA vaccine against NDV offers a promising solution to current Newcastle disease (ND) challenges. Present study describes the development of a DNA vaccine (rDNA-NDV-F) using the fusion (F) gene from NDV genotype VII strain isolated from Rawalpindi, Pakistan. While conventional NDV vaccines reduce mortality in commercial poultry, they do not provide complete protection or prevent viral shedding. To address this issue, genotype-matched vaccines have been proposed. Here, we developed and evaluated …

Feasibility and Clinical Utility of Low-Field Magnetic Resonance Imaging in Critically Ill Children: An Experience from Pakistan.

BACKGROUND: Low-field portable magnetic resonance imaging (pMRI) systems have been approved for clinical use, but their feasibility, efficacy, and most appropriate clinical application in children are unknown. The objective of this study was to evaluate the diagnostic accuracy of pMRI in detecting acute brain injury (ABI) in critically ill children compared to conventional MRI (cMRI) and or computed tomography (CT). METHODS: This prospective diagnostic accuracy study included children (1 month to < 18 years) admitted between May 2021 and June 2022 who underwent pMRI scans within a 24-h window

Adolescent-Onset Takayasu Arteritis with Vertebral Steal Syndrome and Non-bifurcating Carotid Arteries: A Rare Case from Pakistan.

BACKGROUND: Takayasu arteritis (TA) is a rare chronic vasculitis primarily affecting the aorta and its major branches, often presenting diagnostic challenges due to nonspecific symptoms, particularly in adolescents. This case highlights a rare adolescent-onset TA with unique vascular findings in Pakistan. CASE PRESENTATION: A 17-year-old female presented with a 1-year history of fever, 40 kg weight loss, and vague abdominal discomfort. Physical examination revealed absent left arm pulses, vascular bruits, and asymmetric blood pressure. Laboratory tests showed anemia, elevated inflammatory mar…

Engage less, provide more: Community health workers' perspectives on how to overcome opposition to polio vaccination in Pakistan.

Pakistan has 40 Super High Risk Union Councils (SHRUCs) where polio has been persistently endemic, and community relationships have been a persistent challenge due to campaign fatigue and violent, organised resistance. This study aimed to gather perspectives from frontline workers in these areas to improve community engagement. We conducted participant observation, over 100 interviews, and held Human-centred Design inspired sessions with 171 teams of frontline polio staff from 2020 to 2022 in the SHRUCs of a major city in Pakistan. The results show that frontline polio workers repeatedly visit…

Создание сплоченных общин: использование условных, коллективных и общинных стимулов для изменения социальных норм иммунизации от полиомиелита в Пакистане.

Иммунизация по-прежнему является одной из важнейших стратегий в области здравоохранения, особенно в таких странах, как Пакистан, где, несмотря на глобальные усилия по искоренению полиомиелита, широко распространены заболевания, предотвращаемые с помощью вакцинации. В этом исследовании изучается роль участия общин (ВЭ) и условных стимулов в расширении использования вакцин против полиомиелита в советах Союза высокого риска (СПСВ) Пакистана. В рамках исследовательской и качественной исследовательской работы было проведено исследование с целью оценки воздействия мер, предусматривающих участие насе

Совпадение в аннотации оригинала
Immunization remains a critical public health strategy, particularly in countries like Pakistan where vaccine-preventable diseases are prevalent despite global efforts to eradicate poliomyelitis. This study investigates the role of community engagement (CE) and conditional incentives in increasing polio vaccine uptake in High-Risk Union Councils (HRUCs) of P…

Multi-centre analysis of predictors of death and treatment failure among multi-drug-resistant tuberculosis patients in Pakistan.

Our Multidrug-resistant tuberculosis poses a significant global health challenge, particularly in low- and middle-income countries where access to diagnostic and treatment services is limited. Our multi-centre retrospective cohort study attempts to evaluate treatment outcomes and predictors of death or failure among 546 multi-drug-resistant tuberculosis patients, treated at eight specialised units between January 2017 and August 2018, with follow-up until June 2020. Overall, 69% achieved successful outcomes and 22.2% died. Significant predictors of death included older age, weight <40 kg, prio

Genomic reconstruction of Bacillus anthracis from complex environmental samples enables high-throughput identification and lineage assignment in Pakistan.

Bacillus anthracis, the causative agent of anthrax, is a highly virulent zoonotic pathogen primarily affecting domesticated and wild herbivores. Human exposure to B. anthracis is primarily through contact with infected animals or contaminated animal products. In Pakistan, where livestock vaccines are largely unavailable and infected carcasses are often disposed of improperly, the risk to humans, wildlife and livestock is significant. Currently, the diagnosis of anthrax infections and outbreak tracing necessitates the isolation and culturing of B. anthracis, a process that requires BSL-3 facili…

Cultural Persistence of Tahnik Practice (Use of Honey) Despite Infant Botulism Risk: A Community-Based Study in Pakistan.

PURPOSE: Infant botulism is an uncommon but serious condition arising from honey containing spores of Clostridium botulinum. Despite this we … ger were recruited into this descriptive cross-sectional survey through a questionnaire in Karachi, Pakistan. Maternal awareness of infant botulism, prevalence of tahnik practice, and factors affecting tahnik practice were assessed. FINDINGS: A total of 94.75% of subjects had never heard of botulism, and none linked it with C. botulinum. Despite risks, 54 …

Incidence of colistin heteroresistance among carbapenem-resistant Acinetobacter baumannii clinical isolates in a tertiary care hospital in Pakistan.

PURPOSE: The emergence of colistin-resistant and heteroresistant strains of carbapenem-resistant Acinetobacter baumannii (CRAB) complicates treatment and exacerbates the global health crisis of drug-resistant bacteria. This study aims to investigate the incidence and clinical implications of colistin heteroresistance in carbapenem-resistant Acinetobacter baumannii isolates from a tertiary hospital in Pakistan. MATERIALS AND METHODS: A total of 130 CRAB isolates were collected from December 2022 to December 2023. Colistin susceptibility was assessed using broth microdilution, and heteroresista…

Molecular prevalence, phylogeny and hematological impact of Toxoplasma gondii and Plasmodium spp. in common quails from Punjab, Pakistan.

This study investigates the molecular prevalence and phylogenetic characteristics of two prominent blood-borne pathogens, Toxoplasma gondii (T. gondii) and Plasmodium spp., in common quails (Coturnix coturnix) sampled from both wild (N = 236) and farmed (N = 197) populations across four districts (Layyah, Dera Ghazi Khan, Lahore, and Multan) in Punjab, Pakistan, during the hunting seasons from 2021 to 2023. Additionally, the impact of these pathogens on the complete blood count (CBC) of the hosts is examined. Out of 433 quails tested, 25 (5.8%) exhibited amplification of the internal transcrib…

Where Do We Stand in Blood Transfusion Practices: Insights From the First Clinical Audit From Khyber Pakhtunkhwa, Pakistan.

Objective To evaluate the appropriateness of packed red blood cell (PRBC) transfusions across different departments of a tertiary care hospital. Methods This audit included 632 patients admitted to the major departments of Hayatabad Medical Complex, Peshawar, Pakistan, who received one or more PRBC transfusions from November 2023 till July 2024. Six categories were defined who had different characteristics and thresholds for PRBC transfusion according to the Association for the Advancement of Blood & Biotherapies Red Blood Cell Transfusion International Guidelines. The appropriateness of PRBC …

UNRAVELLING ATRIAL FIBRILLATION AETIOLOGY AND ANTICOAGULATION TRENDS IN STROKE. WHERE DO WE STAND? A STUDY FROM NORTHERN PAKISTAN.

BACKGROUND: Atrial Fibrillation is a heart arrhythmia causing stroke and associated with many modifiable risk factors. A number of strokes can be prevented by identifying these risk factors and adopting primary prevention and anticoagulation. METHODS: This Cross-Sectional observational study on 160 stroke patients; identified frequency and risk factors of Atrial Fibrillation and their prior anticoagulation status. Correlation of risk factors associated with Atrial Fibrillation in stroke was done through Chi Square test. RESULTS: Among 160 patients, 72 (45%) were males and 88 (55%) females. M