Ongoing Projects

Ongoing Projects

  • Population based stratagies for effective control of high blood pressure in Pakistan (Project Details)

Dr Tazeen Jafar, Dr Juanita Hatcher, Dr Mehtab Karim, Dr Nish Chaturvedi, Dr Franklin White
Funded by: Wellcome Trust, UK
Amount: US $500,000
Duration: 2003-2006

The study is aimed to assess cost-effective strategies for control of hypertension in Pakistan. The three-year investigator-initiated intervention project will use cluster randomisation and factorial design to assess the effect of  population-based health education by  community health workers on blood pressure levels of population aged five years or over (n=20,000), and cost effective management of blood pressure administered by intensively trained local general practitioners on adults.

  • Hypertension related damage to the microcirculation in South Asians: emergence predictive power and reversibility-an investigator-initiated study (Project Details)

Dr Tazeen Jafar (PI) (Medicine and CHS), Dr Juanita Hatcher (Co-I)
Funding Agency: Wellcome Trust, UK
Amount: US $300,000

The role of the microcirculation is increasingly being recognised in the etiopathogenesis of cardiovascular disease. Delays in this recognition are in part due to the difficulty of studying the microcirculation non-invasively, in large numbers of individuals. Retinal vessels provide an easily accessible "window" to the microcirculation. Abnormalities of the retinal vasculature have been shown to be associated with cardiovascular risk factors and all cause mortality. Non-invasive assessment of the retinal circulation presents a valuable opportunity to study the structure and function of the microvasculature.

Off-springs of patients with hypertension are more likely to have elevated blood pressure, and end organ damage has been shown to manifest during childhood. People of South Asian descent as compared to Caucasians have been shown to be more susceptible to metabolic syndromes predisposing to CVD, and also to end organ damage. The prevalence of hypertension has shown to be very high in Pakistan with one in three persons aged 40 years or over suffering from this disease. Development of non-invasive screening methods for detecting early signs of end organ damage beginning in childhood is of paramount importance for prevention of these dangerous diseases, and for understanding their etiopathogenesis.

This investigator-initiated study being launched by Aga Khan University's (AKU) Clinical Epidemiology Unit (CEU) on 2,400 subjects in 12 low income communities in Karachi is primarily designed to compare geometry of retinal microvasculature of 1) hypertensive vs normotensive adults, 2) children aged 10 to 14 years of hypertensive parent (test group) versus normotensive parent (control group), and, 3) to assess the impact of blood pressure lowering on these changes over 2 years. Retinal photographs would be taken and graded by research team members specially trained in standardised technique at Imperial College London, UK. Primary outcome would be abnormal retinal geometry defined as the composite outcome of a) abnormal arteriolar length: diameter ratios (a measure of relative arteriolar narrowing), b) narrowed branching angles (an indicator of arteriolar rarefaction), or c) disturbed junction exponents (a marker of endothelial dysfunction).

  • Molecular Genetics in Hypertension, Type 2 Diabetes and Coronary Heart Disease in Pakistan

Pakistan Side:
Principal Investigator: Tazeen H. Jafar, MD MPH
Co-Investigator: Philippe Frossard PhD

UK Side:
Principal Investigator: Tim Frayling PhD
Co-Investigators: Marc Caulfield MD, Nish Chaturvedi MD, Andrew Hattersley PhD

Total amount: US $540,000.00 over three years (January 1, 2007 - December 31, 2009)

The Wellcome Trust, UK, has awarded US $540,000 for an investigator-initiated study on "Molecular Genetics in Hypertension, Type 2 Diabetes and Coronary Heart Disease in Pakistan" to Drs Tazeen H Jafar (CHS and Medicine) and Philippe Frossard (BBS) at AKU in collaboration with researchers from University of Exeter and Imperial College London.

The aim of this project is to establish a large study of Pakistan subjects to identify the important genetic factors for hypertension, type 2 diabetes and coronary heart disease.

In addition to studying several polymorphisms, the study would also contribute to capacity building and transfer of technology via training of young researchers from AKU in leading-edge laboratory techniques in the UK (e.g. robotic techniques for DNA analyses), and in genetic epidemiology.

The current award is an excellent example of multidisciplinary research between the Departments of CHS and Biological & Biomedical Sciences, and adds a new dimension to the project, and reflects innovative approaches of collaborative thinking, which would contribute to tackling the enigma of chronic diseases in the Pakistani population.

  • Genetic Architecture of hypertension in a Pakistani population

Dr Philippe Frossard (Department of Biological and Biomedical Sciences) and Dr Tazeen Jafar (CHS)
Collaborators: Dr Franklin White (CHS), Dr Loung Umendani (Biological Sciences)
Funded by: University Research Council, AKU
Amount: US $50,000
Duration: 2002-2004

The study involves determining the association of genetic markers of hypertension and cardiovascular disease in the Pakhtoon population residing in Karachi.

  • Chronic Kidney Disease in the Pakistani Population-Estimation of Glomerular Filtration Rate (GFR)

Principal investigator: Dr Tazeen H. Jafar (Medicine/CHS)
Co-Investigator: Juanita Hatcher
Funding Agency: NIH Forgarty Grant
Amount: US $110,000
Duration: Three years (2007-2010)

The Indo-Asian developing countries are facing an epidemic of chronic diseases including hypertension, diabetes and chronic kidney disease (CKD). Diagnosis of early CKD is essential for institution of effective and timely prevention of its complications; costly late stage treatment for end stage renal disease is currently an unfeasible option in these populations. GFR estimates of kidney function provide a common reference standard for all people and are therefore readily applicable by physicians and understood by patients. However, the existing GFR equations yield widely discrepant results in the Indo Asian population, and none of the currently available estimating equations have been validated in this population.

The study would be performed on 650 adult subjects from the general population in Karachi. A new GFR equation specific to a Pakistani population would be developed and validated using the gold standard of measured insulin GFR. The performance of the new equation will be compared to the existing ones developed in other populations.

The project is likely to contribute significantly to moving the field of kidney disease forward, and its results are likely to have far reaching implications for understanding of CKD and, ultimately, its prevention in Indo-Pakistani populations worldwide.

  • Perinatal Infections and Pregnancy Outcome in Pakistan: A Collaborative Research Project in Partnership with the University of Alabama, USA

PI Robert  L. Goldenberg, MD, Obgyn, UAB
SFI  Dr Saeed Akhtar, CHS AKU
Co Investigators: Dr Imtiaz Jehan and Dr Rozina Karmaliani, CHS, AKU
Funding Agency: NIH
Amount:  US $1.6 million (2000-2005)

Among the most disturbing differences in health outcomes between the developed and the developing countries are those related to pregnancy and birth outcomes. While in developed countries, less than 1 in 10,000 women die during pregnancy and childbirth, in some developing countries 1 in 100 women succumb to premature death due to complications during pregnancy and childbirth (UNICEF 2000). Official maternal mortality ratio for Pakistan is reported as 340 per 100,000 live births and perinatal  mortality rate of 54 per 1000 live births, with a still birth to early neonatal mortality ratio of 1:1.  About 77 % of deliveries in Pakistan take place at home mostly attended by untrained traditional birth attendants (TBAs). Postpartum hemorrhage, eclampsia, and sepsis are the most common causes of maternal mortality, whereas prematurity, asphyxia and infections for early neonatal mortality.  It is important to better understand factors leading to perinatal mortality and morbidity in Pakistan to ensure appropriate interventions. Based on available information, sepsis is a major cause of maternal mortality. Community based studies point to sepsis as a cause to maternal death in about 12% cases whereas hospital based studies attribute 21% maternal deaths to sepsis.  In Pakistan there is dearth of community-based data on genital tract infections and other risk factors associated with pregnancy and childbirth. This proposed study is a response to this critical gap in information.

This pregnancy outcome study is primarily focused on contribution of perinatal infections to adverse birth outcomes to mother and baby.  The primary objective of the study is to determine the association between bacterial vaginosis in pregnant women at 20-26 weeks gestation with adverse pregnancy outcomes (i.e. perinatal mortality, neonatal mortality, LBW, SPTD, PROM, histological chorioamnionitis).  Moreover, as part of the secondary objectives, the study aims to determine the prevalence of  various genital tract infections ( bacterial vaginosis, Neisseria gonorrhoeae, Treponema pallidum, Chlamydia trachomatis, and Trichomonas vaginalis)  among pregnant women (20-26 weeks gestation) from selected urban communities.  And to determine general health, dental and nutritional status, psycho-social and exposure to violence in pregnant Pakistani women and to relate these characteristics to pregnancy outcome.

  • International Maternal and Child Health Research Training Grant

PI  Dr Sten Vermund, SOPH, UAB
SFI  Dr Imtiaz Jehan, CHS AKU
Funding Agency: Fogarty International
Amount: US $1 million (2000-2005)

The purpose of this training grant is to strengthen and sustain a health research system in Pakistan through training and capacity building of young scientists in Pakistan to contribute to maternal and child health research efforts. To this effect, we have designed a training programme addressing factors appropriate to Pakistan that contribute to poor pregnancy outcomes and the poor health status of mothers and children in Pakistan. This training programme is intended to be multidisciplinary and to include both biomedical, socio-cultural and behavioral research issues.  Multiple training models and opportunity would be utilised that are available in Pakistan and at UAB.  The trainees would be able to conduct high quality research and in addition to their professional and scholarly development contribute to advance existing research evidence and ultimately overall improvement in health.

  • A Collaborative Capacity Development Training in Clinical Epidemiology and Related Discipline

PI Dr Imtiaz Jehan, Assistant Professor and Co Director CEU, AKU
Main Collaborator : Prof Cynthia Cordero, CEU University of Philippine Manila
Funding Agency INCLEN Trust International
Amount US $20,000 (2004-2005)

The goal of the project is to design and conduct a cost effective, innovative and workable capacity development strategy involving various levels networking arrangement within the INCLEN Trust. In phase-1 of the project, with our partners in Philippine-CLEN, we will review the existing resources (faculty, courses, long distance learning resources etc.) available in the network. This will provide an opportunity to map INCLEN's existing strength and resources as well as to identify areas that require improvement. In Phase-2 of the project, in keeping with CEU-AKU's training needs as pilot site, we will design a cost effective, sustainable training course and strategy from the available resources During this process we will also identify other partners from the region with shared objectives ( need) on whom the common strategy / arrangement can be applied. The project will provide support and strengthen CEU- AKU as a resource in clinical epidemiology and related disciplines in Pakistan, through required skill enhancement and training of its core faculty as local master trainers. This would also be enriching and supplementing the Clinical Scholar's Program of CEU-AKU. By attracting other interested clinicians and scientist in these training courses. we hope to broaden the base of trained people and to promote clinical epidemiology and related disciplines in Pakistan. This is in line with AKUs vision of research capacity building, fostering a research conducive environment and evidence based health care.

MSc Thesis Projects

  • A cross sectional survey to estimate the prevalence and to identify the risk factors associated with unipolar major depression and dementia among above 40 years old population of Karachi, Pakistan.

Student: Faiza Habib
Primary supervisor: Dr Tazeen Jafar
Co-investigators/collaborators:  Dr Saeed Akhtar, Dr Juanita Hatcher, Dr Murad Musa Khan, Dr Saad Shafqat
Total funding: US $31,616
Duration: 2003-2005
Funding agency: Wellcome Trust, UK

  • Knowledge, Perceptions and Health Care Seeking Behavior in Older and Younger Patients with Myocardial Infarction in Karachi

Student: Muhammad Saleem
Primary supervisor: Dr Tazeen Jafar
Co-investigators: Dr Juanita Hatcher, Dr Faheem Jafary,  Dr Nish Chaturvedi, Dr Syed Ishtiaq Rasool
Total funding: US $25,709
Duration: 2003-2005
Funding agency: Wellcome Trust, UK

The aim of the study is to compare the knowledge base about heart disease among young and older adult patients with AMI in Karachi; estimate the duration between onset of symptoms of AMI in young adults and hospital admission in Karachi and compare it with a similar older population; and investigate the differences between young and old patients in terms of the various factors that lead to delay in early seeking health care facility after the attack of AMI.

  • Comparison of Population Screening Tools for Coronary Artery Disease with Thallium- 201 Scintigrapghy in adult population in Karachi

Student: Dr Shazia Shehzad Abbas
Primary supervisor:  Dr Tazeen Jafar
Co-Supervisor: Dr Juanita Hatcher
Total funding: Rs 4,727,400
Duration: 30 months
Funding agency: Wellcome Trust, UK

This is a population based cross-sectional study to compare the screening tools for Coronary Artery Disease in adult population in Karachi.

  • Relationship between Salt and Blood Pressure in South Asian Population in Pakistan

Student: Dr Saleem Jessani
Primary Supervisor: Dr Tazeen Jafar
Funding agency: Wellcome Trust, UK

The objective of this study is to explore the relationship of dietary salt intake with blood pressure in the population of Karachi, Pakistan.

  • Impact of Special GP training on Adherence to Antihypertensive Medication: A Cluster Randomised Controlled Trial

Student: Dr Nudrat Qureshi
Primary Supervisor: Dr Tazeen Jafar
Funding agency: URC, Wellcome Trust, UK and Aaredx, Switzerland

The objective of this study was to determine the impact of special general practitioner (GP) training in management of hypertension (special care) on adherence to antihypertensive medication versus usual care provided by GPs in the community.

  • Prevalence of chronic kidney disease and associated risk factors in hypertensive patients

Student: Dr Muslima Ejaz
Primary Supervisor: Dr Tazeen Jafar

The aim of the study is to detect sub-clinical CKD in hypertensive patients at community level and to identify associated risk factors.

Students' Projects

  • Evaluation of inhalational anaesthesia induction in children using sevoflurance with or without nitrous oxide guided with Bispectral Index monitoring.

Student: Dr Anwar Huda
Programme: MCR
Primary Supervisor: Dr Tazeen Jafar

  • Prevalence and Determinants of Childhood Obesity in School Going children in Karachi.

Student: Dr Azra Rizwan
Programme: MCR
Primary Supervisor: Dr Tazeen Jafar

  • Exercise Intervention in Female School Children; effect on blood pressure, BMI and Maths Scores.

Student: Dr Aysha Almas
Programme: MCR
Primary Supervisor: Dr Tazeen Jafar

  • A randomised clinical trail to compare a low carbohydrate with a low fat low calorie diet, to achieve weight loss over one year, in obese Pakistani adults.

Student: Dr Sadia Arshad
Programm​e: MCR
Primary Supervisor: Dr Tazeen Jafar

  • Validating anthropometry for assessment of body fat composition in 5 - 10 year old children using DEXA as gold standard.

Student: Dr Zainab Hussain
Programme: MCR
Primary Supervisor: Dr Tazeen Jafar​