Research Highlights

1. Teleglaucoma program receives funding to continue goodwill work in Africa

Glaucoma is the second-leading cause of blindness in East and Sub-Saharan Africa where anyone over the age of 35 can have the eye condition, which can result in blindness if left untreated. Glaucoma is typically caused by a build-up of fluid pressure in the eye that damages the optic nerve leading to permanent loss of side vision and eventually loss of central vision as well. Dr. Karim Damji, a professor in the Department of Ophthalmology with the Faculty of Medicine & Dentistry at the University of Alberta, received CAD$100,000 Grand Challenged grant on Feb. 9th, 2012, for a glaucoma telehealth program which will also be extended in Africa.

The telehealth glaucoma program will go a long way in further developing the program in Kenya and Ethiopia. Dr. Damji and his colleagues helped train Dr. Dan Kiage from the Aga Khan University Hospital in Kenya and Dr. Abeba Giorgis from Addis Ababa University in Ethiopia. These two African specialists will determine whether the patients who tested positive for glaucoma need eye drops, a simple surgery to lower pressure in the eye or a more complex surgery at a major centre. For difficult or unusual cases, the specialists in Africa can consult with Dr. Damji and his team in Canada. The grant money will be used to buy equipment, such as mobile retinal cameras, and train technicians and program managers in Africa about how to obtain basic patient information and take eye images from several thousand people, about 500 of whom are expected to have glaucoma. The program will activity of technicians  who will go from satellite centre to satellite centre dealing with patients.

2. Mild and Moderate Physical Activity is Associated with a Reduced Risk  of AMI- Publication in European Health Journal

Author from AKU: Dr. Romaina Iqbal
Title of the Paper: “Physical activity levels, ownership of goods promoting sedentary behavior and risk of myocardial infarction: Results of the INTERHEART study”
Published in: January 2012
Study Led by: Dr. Khawar Kazmi
Journal: European Heart Journal

The paper summarizes the findings of INTERHEART study which proves that the Individuals who carry out at least 30 minutes of exercise per week have a reduced risk of AMI compared to individuals who do not spend any time in exercise each week.

Pakistan participated in the INTERHEART study and AKU served as the national coordinating center for data with Dr. Khawar Kazmi leading the activity.

Over 100 press releases related to this publication have been published on the world wide web. Some links for those are as follows:

http://www.vancouversun.com/health/Even+minimal+exercise+reduces+heart+attack+risk+study/5976318/story.html

ttp://www.google.com/hostednews/afp/article/ALeqM5jatST6aXv78wm3N2j69qpbJ-upvQ?docId=CNG.6f95bb32214a032dbf51a181cc84a51a.71

Business week Bloomberg Report

3.   Management of Community based Neonatal Pneomonia and Neonatal Umblical Cord Infections​: Publications in Lancet

Author from AKU: Dr. Sajid Soofi
Journal: Lancet
Studies Led by: Professor Zulfiqar Bhutta

Title - Paper-1
"Effectiveness of community case management of severe pneumonia with oral amoxicillin in children aged 2–59 months in Matiari district, rural Pakistan: a cluster-randomised controlled trial."
Published in: January, 2012

Title- Paper-2
"Topical application of chlorhexidine to neonatal umbilical cords for prevention of omphalitis and neonatal mortality in a rural district of Pakistan: a community-based, cluster-randomised trial."
Published in: February, 2012

These papers summarize the findings of two research studies described below

The study of community management of childhood pneumonia (Paper 1), was conducted by the Aga Khan University’s Division of Women and Child Health in collaboration with the Lady Health Workers (LHW) programme of the Government of Pakistan, the Boston University’s Center for Global Health and Development, and the WHO’s Department of Child and Adolescent Health. The trial was carried out in Matiari, a rural district of Pakistan, 250 km north of Karachi with 1,600 villages and an estimated population of 600,000, with high rates of this disease and limited resources. The group looked at the management of severe pneumonia in children (under 5 years)  at their home by LHWs programme versus referral to the nearest health facility - a basic health unit, a rural health centre or even a hospital.  The study found that in only 8 per cent of children treated at home did treatment fail compared to the 13 per cent referred to a health facility.

The second study (Paper 2) targeted the prevention of cord infections and newborn deaths and was conducted in 1,300 villages in the Dadu district of Sindh. Pakistan has one of the highest newborn mortality rates in the world and up to a third are because of serious infections.  Infection risk is greatest in countries where most deliveries take place at home, often attended by unskilled traditional birth attendants (dais) with poor delivery practices like the application of substances such as ash, surma (lead-based concoctions), oil, etc.  The trial was carried out in Dadu, a resource-poor rural district in Sindh, with a population of about 1 million, and an infant mortality rate of 90 per 1,000 live births. The trial enrolled almost 10,000 newborns born at home between January 2008 and June 2009, and evaluated the effectiveness of three interventions. One consisted of birth kits containing 4% chlorhexidine (CHX), to be applied to the cord at birth by dais and once daily by family members for up to 14 days, along with soap and educational messages promoting hand washing.  The second was CHX alone and the third, hand washing only. The fourth group were advised to practice standard dry cord care recommended by WHO. The study showed that cord cleansing with CHX reduced the risk of infection in children by 42% and deaths by 38%. Hand washing promotion alone appeared to have no effect on infection or mortality risk.

Both of these studies have important implications for health policy and practice in Pakistan to reduce newborn and child deaths and could be used to scale up coverage of these interventions in difficult rural settings.”

3.  Cost-Effectiveness of Community-Based Strategies for Blood Pressure Control in a Low-Income Developing Country: Findings From a Cluster-Randomized,Factorial-Controlled Trial - Paper published in Circulation

Untiring efforts of Dr Tazeen Jafar and the Hypertension Study Group resulted in the publication of a paper titled "Cost-Effectiveness of Community-Based Strategies for Blood Pressure Control in a Low-Income Developing Country: Findings From a Cluster-Randomized, Factorial-Controlled Trial" in the September 2011 issue of Circulation.

Hypertension is a diseases carrying the highest  risk to deaths from cardiovascular diseases. Recent reports suggest it to be affecting a third of the population in the South Asian region. Dr Tazeen Jafer and her group have been actively pursuing to assess its real impact on the Pakistani population. Working on a Wellcome Trust sponsored research trial titled "The Control of Blood Pressure and Risk Attenuation (COBRA)," they have been able to successfully identify risk factors. 

The work of Dr Tazeen Jafar and her group has already gained considerable recognition and appreciations. More recently they have also identified the prevention aspect of this problem of huge socioeconomic burden. In this recent paper also, they have identified that cost effective measures such as combined intervention of trained GP and home health education are significantly more effective than no intervention in lowering the BP in the various communities living in Karachi. These findings will be of immense  importance to health policy makers in low and middle income countries.