Engaging the private sector to increase tuberculosis case detection: an impact evaluation study.

Khan AJ, Khowaja S, Khan FS, Qazi F, Lotia I, Habib A, Mohammed S, Khan U, Amanullah F, Hussain H, Becerra MC, Creswell J, Keshavjee S.

Abstract: In many countries with a high burden of tuberculosis, most patients receive treatment in the private sector. IRD conducted a study evaluating a multifaceted case-detection strategy in Karachi, Pakistan, targeting the private healthcare sector.

High tuberculosis prevalence in children exposed at home to drug-resistant tuberculosis.

Amanullah F, Ashfaq M, Khowaja S, Parekh A, Salahuddin N, Lotia-Farrukh I, Khan AJ, Becerra MC

Abstract: The purpose of this study was to identify the number of children susceptible to contracting TB from other household members diagnosed with Drug-Resistant TB (DR-TB). IRD implemented a contact investigation protocol in households of DR-TB patients treated at the Indus Hospital, Karachi, between January 2008 and April 2011. Treatment supporters who visited DR-TB patients at home referred all child contacts for baseline evaluation and performed monthly assessments.

Population-level impact of active tuberculosis case finding in an Asian megacity.

Dowdy DW, Lotia I, Azman AS, Creswell J, Sahu S, Khan AJ

Abstract: The potential population-level impact of private-sector initiatives for tuberculosis (TB) case finding in Southeast Asia remains uncertain. In 2011, the Indus Hospital TB Control Program in Karachi, Pakistan, undertook an aggressive case-finding campaign, constructing an age-structured compartmental model of TB in the intervention area. The intervention was modeled as an increase in the rate of formal-sector TB diagnosis and evaluated the potential impact of sustaining this rate for five years.

E-health systems for management of MDR-TB in resource-poor environments: a decade of experience and recommendations for future work.

Fraser HS, Habib A, Goodrich M, Thomas D, Blaya JA, Fils-Aime JR, Jazayeri D, Seaton M, Khan AJ, Choi SS, Kerrison F, Falzon D, Becerra MC

Abstract: Multi-drug resistant TB (MDR-TB) is a complex infectious disease that is a growing threat to global health. It requires lengthy treatment with multiple drugs and specialized laboratory testing. IRD conducted this study to effectively scale up treatment to thousands of patients, identifying the requirement for good information systems to support clinical care, reporting, drug forecasting, supply chain management and monitoring.

Persisting role of healthcare settings in hepatitis C transmission in Pakistan: cause for concern.

Ver Hoeve E, Codlin AJ, Jawed F, Khan AJ, Samad L, Vatcheva KM, Fallon MB, Ali M, Niaz SK, McCormick JB, Fisher-Hoch SP

Abstract: Transmission of hepatitis C (HCV) in Pakistan is a continuing public health problem; 15 years ago it was linked to the practice of reusing therapeutic instruments in healthcare settings. In this paper IRD examines current risk factors for HCV transmission in a hospital population in Karachi, Pakistan.

Infectious diseases in Pakistan: a clear and present danger.

Sultan F, Khan A

Abstract: This paper measures the high prevalence of endemic and infectious diseases in Pakistan and serves as call to action. To improve control of diseases, surveillance, analysis and adequate response are needed. Investments must be made in improving management and enhancing resource allocation. A dire need to better train community health workers and more strongly emphasize, through improved incentives, the importance of rural and public health care.

User engagement with and attitudes towards an interactive SMS reminder system for patients with tuberculosis.

Mohammed S, Siddiqi O, Ali O, Habib A, Haqqi F, Kausar M, Khan AJ

Abstract: IRD conducted a qualitative study to understand user perceptions, acceptability and engagement with an interactive SMS reminder system designed to improve treatment adherence for patients with tuberculosis (TB).

Predictors of delayed culture conversion in patients treated for multidrug-resistant tuberculosis in Pakistan.

Qazi F, Khan U, Khowaja S, Javaid M, Ahmed A, Salahuddin N, Hussain H, Becerra MC, Golub JE, Khan AJ

Abstract: Culture conversion is an interim monitoring tool for treatment of multidrug-resistant tuberculosis (MDR-TB). IRD evaluated the time to and predictors of culture conversion in pulmonary MDR-TB patients enrolled in the community-based MDR-TB management program at the Indus Hospital in Karachi, Pakistan.

Gender differences in tuberculosis notification in Pakistan.

Codlin AJ, Khowaja S, Chen Z, Rahbar MH, Qadeer E, Ara I, McCormick JB, Fisher-Hoch SP, Khan AJ

Abstract: Worldwide, the male to female ratio of new smear-positive tuberculosis (TB) cases is approximately two to one. IRD conducted a study closely examines the gender ratio difference in susceptibility for tuberculosis in Pakistan.

WHO guidelines for the programmatic management of drug-resistant tuberculosis: 2011 update.

Falzon D, Jaramillo E, Schünemann HJ, Arentz M, Bauer M, Bayona J, Blanc L, Caminero JA, Daley CL, Duncombe C, Fitzpatrick C, Gebhard A, Getahun H,Henkens M, Holtz TH, Keravec J, Keshavjee S, Khan AJ, Kulier R, Leimane V, Lienhardt C, Lu C, Mariandyshev A, Migliori GB, Mirzayev F, Mitnick CD, Nunn P,Nwagboniwe G, Oxlade O, Palmero D, Pavlinac P, Quelapio MI, Raviglione MC, Rich ML, Royce S, Rüsch-Gerdes S, Salakaia A, Sarin R, Sculier D, Varaine F,Vitoria M, Walson JL, Wares F, Weyer K, White RA, Zignol M.

Abstract: The production of guidelines for the management of drug-resistant tuberculosis (TB) fits the mandate of the World Health Organization (WHO) to support countries in the reinforcement of patient care. WHO commissioned external reviews to summarise evidence on priority questions regarding case-finding, treatment regimens for multidrug-resistant TB (MDR-TB), monitoring the response to MDR-TB treatment, and models of care. Dr. Aamir Khan from the IRD team was part of a multidisciplinary expert panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations.

Extrapulmonary tuberculosis: a retrospective review of 194 cases at a tertiary care hospital in Karachi, Pakistan.

Chandir S1, Hussain H, Salahuddin N, Amir M, Ali F, Lotia I, Khan AJ

Abstract: A retrospective case series study was conducted at Liaquat National Hospital (LNH), the largest private tertiary care hospital in Karachi, Pakistan, describing the types and treatment outcomes of the extra-pulmonary tuberculosis (EPTB) cases in a tertiary care hospital in a high burden tuberculosis country.

Endemic measles in Karachi, Pakistan and validation of IMCI criteria for measles.

Hussain H1, Omer SB, Khan AJ, Bhurgri A, Memon A, Halsey NA

Abstract: IRD conducted this study to estimate the incidence of measles in Karachi, Pakistan and to determine the proportion of children with measles based on the WHO integrated management of childhood illness (IMCI) criteria with a positive IgM for measles or dengue. Patients up to 14 years old were screened for febrile rash illnesses at five Karachi hospitals. Active measles cases were classified as measles, measles with eye and mouth complications, or severe complicated measles using IMCI criteria.

No evidence for prolonged excretion of polioviruses in persons with residual paralytic poliomyelitis in Ethiopia, Pakistan and Guatemala.

Khan AJ, Gebreselassie H, Asturias EJ, Agboatwalla M, Teklehaimanot R, Luby SP, Beyene B, Chezzi C, Asghar H, Moatter T, Torres OR, Kew O, Winkelstein J, Halsey NA

Abstract: Persons who have developed acute flaccid paralysis following infection with wild-type polioviruses or vaccine-associated paralytic poliomyelitis usually excrete polioviruses for only a few weeks. However, some patients with paralytic poliomyelitis have had prolonged excretion of polioviruses for periods of up to 10 years after onset of disease. IRD conducted a study examines patients in Ethiopia, Pakistan and Guatemala with residual paralytic poliomyelitis to determine if they had IgA or IgG deficiency or persistent poliomyelitis excretion at least 1 year after onset of disease.

Regarding “Seroprevalence of the antibody to hepatitis C in select groups in the Punjab region of Pakistan”.

Luby S, Khan AJ, Altaf A, Hutin Y, Aslam M

Abstract: Hepatitis C is on the rise in clinics in Pakistan. To estimate the occurrence of hepatitis C in the region and to create awareness about the disease in the general public, two studies were conducted in Punjab, Pakistan. Before this, no such effort has been made in Pakistan.

Unsafe injections and the transmission of hepatitis B and C in a periurban community in Pakistan.

Khan AJ1, Luby SP, Fikree F, Karim A, Obaid S, Dellawala S, Mirza S, Malik T, Fisher-Hoch S, McCormick JB

Abstract: Following reports of frequent deaths associated with jaundice and chronic liver disease among adults in a periurban community of Karachi, Pakistan, an investigation was conducted to evaluate the relationship between injections and viral hepatitis infections, to identify the reasons why patients received frequent injections, and to observe the injection practices employed in clinics.

Household members of hepatitis C virus-infected people in Hafizabad, Pakistan: infection by injections from health care providers.

Pasha O, Luby SP, Khan AJ, Shah SA, McCormick JB, Fisher-Hoch SP

Abstract: Household members of people with hepatitis C are at increased risk of HCV infection. The prevalence and routes of transmission of HCV to household members in Hafizabad, Pakistan were investigated. Household members of 24 index cases were given a risk factor questionnaire, tested for HCV infection, and the risk factors between the infected and uninfected were compared.

HIV antibody seroprevalence and associated risk factors in sex workers, drug users, and prisoners in Sindh, Pakistan.

Baqi S, Nabi N, Hasan SN, Khan AJ, Pasha O, Kayani N, Haque RA, Haq-IU, Khurshid M, Fisher-Hoch S, Luby SP, McCormick JB

Abstract: IRD conducted this study to determine prevalence of HIV infection and risk behaviors in commercial sex workers (CSWs), drug users, and prisoners in Sindh, Pakistan.

The relationship between therapeutic injections and high prevalence of hepatitis C infection in Hafizabad, Pakistan.

P. Luby, K. Qamruddin, A. A. Shah, A. Omair, O. Pahsa, A. J. Khan, J. B. McCormick, F. Hoodbhouy, and S. Fisher-Hoch

Abstract: This study aims to determine the prevalence and routes of transmission of hepatitis C virus (HCV) infection in Hafizabad, Pakistan.

An evaluation of systematic tuberculosis screening at private facilities in Karachi, Pakistan.

Creswell J, Khowaja S, Codlin A, Hashmi R, Rasheed E, Khan M, Durab I, Mergenthaler C, Hussain O, Khan F, Khan AJ

Abstract: In Pakistan, like many Asian countries, a large proportion of healthcare is provided through the private sector. IRD implemented a systematic screening strategy to identify people with tuberculosis in private facilities in Karachi and assessed the approaches’ ability to diagnose patients earlier in their disease progression.

The burden of non-communicable disease in transition communities in an Asian megacity: baseline findings from a cohort study in Karachi, Pakistan.

Khan FS, Lotia-Farrukh I, Khan AJ, Siddiqui ST, Sajun SZ, Malik AA, Burfat A, Arshad MH, Codlin AJ, Reininger BM, McCormick JB, Afridi N, Fisher-Hoch SP

Abstract:The demographic transition in South Asia coupled with unplanned urbanization and lifestyle changes are increasing the burden of non-communicable disease (NCD) where infectious diseases are still highly prevalent. IRD designed and executed a unique ‘Framingham-like’ Pakistan cohort with the objective of measuring the prevalence and risk factors for hypertension, obesity, diabetes, coronary artery disease and hepatitis B and C infection in a multi-ethnic, middle to low income population of Karachi, Pakistan.

The cost of treatment for child pneumonias and meningitis in the Northern Areas of Pakistan.

Hussain H, Waters H, Omer SB, Khan A, Baig IY, Mistry R, Halsey N

Abstract: Pneumonia, meningitis, and sepsis place a significant economic burden on health care systems, particularly in developing countries. IRD conducted a study that estimates treatment costs for these diseases in health facilities in the Northern Areas of Pakistan.

Geographic Variation in Access to Dog-Bite Care in Pakistan and Risk of Dog-Bite Exposure in Karachi: Prospective Surveillance Using a Low-Cost Mobile Phone System

Syed Mohammad Asad Zaidi, Alain B. Labrique, Saira Khowaja, Ismat Lotia-Farrukh, Julia Irani, Naseem Salahuddin, Aamir Javed Khan

Abstract: Dog-bites and rabies are under-reported in developing countries such as Pakistan and there is a poor understanding of the disease burden. IRD prospectively collected data utilizing mobile phones for dog-bite and rabies surveillance across nine emergency rooms (ER) in Pakistan, recording patient health-seeking behaviors, access to care and analyzed spatial distribution of cases from Karachi.

Breast Cancer in Pakistan: Identifying Local Beliefs and Knowledge

Sughra Raza, MD, Sana Z. Sajun, BS, Christopher C. Selhorst, MD

Abstract: The aim of this study was to assess the attitudes of women and general practitioners (GPs) living in Karachi, Pakistan, regarding breast cancer, mammographic screening, and local barriers to breast health care.

Cost-effectiveness of the Ponseti method for treatment of clubfoot in Pakistan.

Hussain H, Burfat AM, Samad L, Jawed F, Chinoy MA, Khan MA

Abstract:Clubfoot is disabling, with an incidence of 0.9/1,000 live births to 7/1,000 live births. It affects mobility, productivity, and quality of life. Patients are treated surgically or non-surgically using the Ponseti method. IRD estimated the cost per patient treated with both methods and the cost-effectiveness of these methods in Pakistan.

Understanding the knowledge and perceptions about clubfoot in Karachi, Pakistan: a qualitative exploration.

Burfat A, Mohammed S, Siddiqi O, Samad L, Khan MA, Chinoy MA

Abstract: This paper explores local knowledge and perceptions about clubfoot in the Indus Hospital’s catchment population in Karachi, Pakistan. Data was collected through seven focus group discussions with community members, Lady Health Workers, nine in-depth interviews with parents of children with treated or untreated clubfoot and one interview with an adult with untreated clubfoot.

Effect of food coupon incentives on timely completion of DTP immunization series in children from a low-income area in Karachi, Pakistan: a longitudinal intervention study.

Chandir S, Khan AJ, Hussain H, Usman HR, Khowaja S, Halsey NA, Omer SB

Abstract:IRD conducted a that study introduced food/medicine vouchers as an incentive to mothers of infants visiting Expanded Program on Immunization (EPI) centers in a low socio-economic area. The timely completion of diphtheria, tetanus and pertussis vaccines combined (DTP) series immunization rates between intervention and control cohorts were compared.

Evaluation of blood bank practices in Karachi, Pakistan, and the government’s response.

Luby S, Khanani R, Zia M, Vellani Z, Ali M, Qureshi AH, Khan AJ, Abdul Mujeeb S, Shah SA, Fisher-Hoch S

Abstract:National legislation in Pakistan regulating blood banks has been introduced several times, but has never been passed. To support provincial-level efforts to develop legislation a study was conducted to evaluate blood-banking practices in Karachi, Pakistan, to identify areas that could be improved.

Coverage, timeliness, and determinants of immunization completion in Pakistan: evidence from the Demographic and Health Survey (2006-07).

Zaidi SM, Khowaja S, Kumar Dharma V, Khan AJ, Chandir S

Abstract: Immunization coverage data and determinants for completion are not well described for Pakistan. IRD conducted a study determines immunization coverage rates and timeliness based on the 2006-07 Pakistan Demographic and Health Survey (DHS) and identifies determinants for completion of immunizations.

Equitable access to comprehensive surgical care: the potential of indigenous private philanthropy in low-income settings.

Samad L, Iqbal M, Tariq A, Shahzad W, Khan AJ

Abstract: Equitable access to surgical care is necessary for improving global health. This study reports on the performance, financial sustainability, and policy impact of a free-of-cost multispecialty surgical delivery program in Karachi, Pakistan built upon local private philanthropy.

Community-based assessment of surgical symptoms in a low-income urban population.

Samad L, Jawed F, Sajun SZ, Baig-Ansari N, Lotia-Farrukh I, Khan FS, Khan AJ, Fisher-Hoch SP

Abstract: The global burden of surgical disease has not been well quantified, but is potentially immense. Given the enormity of the problem and the relative paucity of data, definition and monitoring of surgical burden of disease is an essential step in confronting the problem. This study aimed to estimate the prevalence of non-acute surgical disease symptoms in a low-income population.

Barriers to accessing surgical care: a cross-sectional survey conducted at a tertiary care hospital in Karachi, Pakistan.

Samad L, Jawed F, Sajun SZ, Arshad MH, Baig-Ansari N

Abstract: The need for surgical care far exceeds available facilities, especially in low income and poor countries. Limited data are available to help us understand the extent and nature of barriers that limit access to surgical care, particularly in the Asian subcontinent. The aim of this study was to understand factors that influence access to surgical care in a low-income urban population.