World Health Organization "School Mental Health Manual"-based training for school teachers in Urban Lahore, Pakistan: study protocol for a randomized controlled trial

Abstract Background The teacher’s role in school mental health initiatives cannot be overemphasized. Despite global evidence of educational interventions in improving teachers’ knowledge and attitudes regarding mental health, this area remains under researched in Pakistan. This paper presents a study protocol of a pilot randomized controlled trial to examine the effectiveness of a teacher training intervention for improving mental health literacy and self-efficacy among school teachers in urban Lahore, Pakistan. Methods The randomized controlled trial will follow the CONSORT guidelines. Participants will be allocated to the Intervention group (receiving the World Health Organization, Eastern Mediterranean Region (WHO-EMRO) School Mental Health Manual-based intervention in three 6-h, face-to-face sessions) or a waitlist control group (not receiving training during the study period). Participants will be teachers of private schools with similar broad demographic characteristics in an inner city area of Lahore. The primary outcome measures for the trial is teachers’ mental health literacy. It will be assessed by using the previously applied (during WHO training of Master Trainers) self-administered questionnaire in both groups pre and post training and at 3 months’ follow-up. Secondary outcomes include: for teachers: Teachers’ self-efficacy (assessed by the Teachers’ Sense of Self Efficacy Scale (TSES) short form.); for students (11–16 years): socio-emotional skills and psychological problems measured by the Strengths and Difficulties Questionnaire (assessed at baseline and 3 months post intervention); for schools: the WHO School Psychosocial Profile Questionnaire (baseline and 3 months post intervention). Discussion Given the high prevalence of child mental health problems, stigma and lack of services, it is important to consider alternate avenues for promoting positive mental health among youth. This pilot study should establish the effectiveness of the WHO-EMRO School Mental Health Manual-based Intervention improving teacher’s mental health literacy and helping them to learn practical steps that can be implemented at low cost in school settings. It will also provide information regarding intervention implementation and sustainability. Trial registration ClinicalTrials.gov, ID: NCT02937714. Registered on 18 October 2016

Validation of verbal autopsy tool for ascertaining the causes of stillbirth

Objective: To assess performance of the WHO revised verbal autopsy tool for ascertaining the causes of still birth in comparison with reference standard cause of death ascertained by standardized clinical and supportive data.Methods: All stillbirths at a tertiary hospital in Karachi, Pakistan were prospectively recruited into study from August 2006- February 2008. The reference standard cause of death was established by two senior obstetricians within 48 hours using the ICD coding system. Verbal autopsy interviews using modified WHO tool were conducted by trained health workers within 2- 6 weeks of still birth and the cause of death was assigned by second panel of obstetricians. The performance was assessed in terms of sensitivity, specificity and Kappa.Results: There were 204 still births. Of these, 80.8% of antepartum and 50.5% of intrapartum deaths were correctly diagnosed by verbal autopsy. Sensitivity of verbal autopsy was highest 68.4%, (95%CI: 46-84.6) for congenital malformation followed by obstetric complication 57.6%, (95%CI: 25-84.2). The specificity for all major causes was greater than 90%. The level of agreement was high (kappa=0.72) for anomalies and moderate (k=0.4) for all major causes of still birth, except asphyxia.Conclusion: Our results suggest that verbal autopsy has reasonable validity in identifying and discriminating between causes of stillbirth in Pakistan. On the basis of these findings, we feel it has a place in resource constrained areas to inform strategic planning and mobilization of resources to attain Millennium Development Goal

Service Discovery for Future Mobile Services

The pervasive computing environment for heterogeneous network is on a continuous rise. The ability to interact and control network devices with different functionalities within office and home environment could be very beneficial to a lot of users. The service discovery in computers and mobile devices enabled them to interact with one another through wireless and heterogeneous wired networks. Services advertise their existence in a dynamic way and devices are designed with this capability to discover these services and its properties automatically. These devices are though based on different technologies but are still able to communicate and discover one another based on existing service discovery architectures. It is notable that a significant number of networked devices are now mobile and these mobile devices make service discovery more challenging.In future mobile multi-domain multi-language environments, a service can be anything and introduced by anybody. Consequently, same or equivalent services may have different names and services with same name or type may be completely different. Existing service discovery systems are incapable of handling these situations. We have implemented a service discovery system which supports semantics to service descriptions. It allows any user to act as a service provider and introduce any service at any time. The service provider can define any service as equivalent to any existing service and in any language as wanted. In addition, it is capable to find services that are not exact matches of the requested ones. More semantics are introduced through attributes like EquivalenceClass, ParentType and Keywords. The test conducted on this system in real time proves that the system is efficient and can be applied in real life

Community engagement and integrated health and polio immunisation campaigns in conflict-affected areas of Pakistan: a cluster randomised controlled trial.

BACKGROUND: Pakistan faces huge challenges in eradicating polio due to widespread poliovirus transmission and security challenges. Innovative interventions are urgently needed to strengthen community buy-in, to increase the coverage of oral polio vaccine (OPV) and other routine immunisations, and to enhance immunity through the introduction of inactivated polio vaccine (IPV) in combination with OPV. We aimed to evaluate the acceptability and effect on immunisation coverage of an integrated strategy for community engagement and maternal and child health immunisation campaigns in insecure and conflict-affected polio-endemic districts of Pakistan. METHODS: We did a community-based three-arm cluster randomised trial in healthy children aged 1 month to 5 years that resided within the study sites in three districts of Pakistan at high risk of polio. Clusters were randomly assigned by a computer algorithm using restricted randomisation in blocks of 20 by an external statistician (1:1:1) to receive routine polio programme activities (control, arm A), additional interventions with community outreach and mobilisation using an enhanced communication package and provision of short-term preventive maternal and child health services and routine immunisation (health camps), including OPV (arm B), or all interventions of arm B with additional provision of IPV delivered at the maternal and child health camps (arm C). An independent team conducted surveys at baseline, endline, and after each round of supplementary immunisation activity for acceptability and effect. The primary outcome measures for the study were coverage of OPV, IPV, and routine extended programme on immunisation vaccines and changes in the proportion of unvaccinated and fully vaccinated children. This trial is registered with ClinicalTrials.gov, number NCT01908114. FINDINGS: Between June 4, 2013, and May 31, 2014, 387 clusters were randomised (131 to arm A, 127 to arm B, and 129 to arm C). At baseline, 28 760 children younger than 5 years were recorded in arm A, 30 098 in arm B, and 29 126 in arm C. 359 clusters remained in the trial until the end (116 in arm A, 120 in arm B, and 123 in arm C; with 23 334 children younger than 5 years in arm A, 26 110 in arm B, and 25 745 in arm C). The estimated OPV coverage was 75% in arm A compared with 82% in arm B (difference vs arm A 6·6%; 95% CI 4·8-8·3) and 84% in arm C (8·5%, 6·8-10·1; overall p<0·0001). The mean proportion of routine vaccine doses received by children younger than 24 months of age was 43% in arm A, 52% in arm B (9%, 7-11) and 54% in arm C (11%, 9-13; overall p<0·0001). No serious adverse events requiring hospitalisation were reported after immunisation. INTERPRETATION: Despite the challenges associated with the polio end-game in high-risk, conflict-affected areas of Pakistan, a strategy of community mobilisation and targeted community-based health and immunisation camps during polio immunisation campaigns was successful in increasing vaccine coverage, including polio vaccine coverage. FUNDING: Bill & Melinda Gates Foundation

Clinical Characteristics and Cross Analysis of HIV and HCV Co-Infection in Faisalabad Region

About 150 and about 35 million human beings are infected with HCV (hepatitis C virus) as well as HIV (human immunodeficiency virus) respectively. The increasing stress of HIV/HCV coinfection is supposed to infect five to seven million individuals globally due to their coinciding approaches of procurement. Co-infection of HCV/HIV in patients caused them to suffer from more liver-associated mortality and anguish. This paper aims to investigate the spread rate of the HIV and HCV coinfection in District Faisalabad. In this paper, blood samples of patients are evaluated and tested for anti-HIV/HCV antibodies employing the ICT (immune chromatography technique) for HIV/HCV confections. The six out 30 confirmed patients (real-time PCR) for HIV infection who also have HCV infection were analyzed for additional provisional clinical examination. In these patients, the hemoglobin (17.38±0.159 per dL), ALT (77 uL-1) and Hematocrit (50.60±0.255%) levels increased significantly than standard reference values. On the body, these facts could be developed due to HIV/HCV co-infection burden. An inverse relation has been demonstrated by these coinfected patients in the levels of hemoglobin as well as in platelets. With the usages of better supplements/nutrients, the above differential values can be improved and ultimately beneficial for the survival of the infected individuals. The Current paper could be convenient for appropriate perpetuation of HIV/HCV co-infected patients under related treatment

Pattern of Presentation of Spinal Dysraphism: A Study of 72 Patients in Hayatabad Medical Complex Peshawar, Pakistan

Objective:&nbsp;&nbsp;To review the pattern of presentation and current understanding of patients with spinal dysraphism in our local population. Material and Methods:&nbsp;&nbsp;Cases of spinal dysraphism of any gender and age were admitted via OPD, emergency or referred from another department were included in the study. Information on demographics, developmental history, presenting symptoms , presence/absence of back swelling, hairy patches, a nevus, dimple, an appendage/ skin tag, lower limb function, sensory/ motor deficit, bowel and bladder dysfunction were recorded. MRI spine was done in all patients to know the exact diagnosis. Results:&nbsp;&nbsp;Out of 72 cases, 52 (72.2%) presented with spina bifida Aperta (spina bifida cystica) while 20 (27.7%) with spina bifida occulta. Total 53 (73.6%) patients presented at the age of 0 – 1 years. 41 (56.9%) of the patient presented with visible sac, 35 (48.6%) swelling over the back, in 5 (6.9%) of patient have hairy patch and dermal sinus each, while 28 (38.8%) patients have neurological deficit. Most common type of spinal dysraphism was myelomeningocele 45 (62.5%). Postoperative course of patients with spinal dysraphism was found to be uneventful in 56 (77.7%), wound infection was seen in 11 (15.2%), deterioration of neurological status in 3 (4.16%) of cases. Conclusion:&nbsp;&nbsp;Spinal dysraphism is not an uncommon condition in our local population its clinical presentation and features are in line with internationally reported literature. Our population is least aware of the adverse neurological outcomes of the condition and face difficulties to access the adequate healthcare for spinal dysraphism

Modeling and Analysis of Cooperative Packet Recovery Protocol

Real-time audio/video transmission through Internet media is an important part of communication. Due to bandwidth limitations and a noisy environment, delivery of multimedia content to a remote location is not 100% guaranteed. These limitations are the basic cause of missing packets which affect the Quality of Service (QoS). A protocol for the recovery of lost packets is described in [Maxemchuk, Nicholas F., K. Padmanabhan, and S. Lo. 'A cooperative packet recovery protocol for multicast video.' Network Protocols, 1997. Proc. of 1997 International Conference on. IEEE]. This protocol claims significant improvement in QoS. We formally specify the protocol in a network of timed automata. By model-checking (A mathematical technique), we find that packet recovery is not always there. In this article, We report such scenarios of malfunctioning in the protocol when the size of multimedia contents is known (e.g., live video/audio broadcasting) and middle-level servers have different rates of data sending and receiving. We formulate the effect of inter-packet delay and transmission speed difference on a buffer.</p

Risk factors associated with typhoid fever in children aged 2-16 years in Karachi, Pakistan

We analysed the data from the control group in a typhoid vaccine trial in Karachi to assess the differences in individual-, household-and cluster-level characteristics for developing typhoid fever. The annual incidence of typhoid in children aged 2-16 years in the control arm of the vaccine trial was 151/100 000 population. After adjustment, the risk of typhoid was lower with increasing age [risk ratio (RR) 0.89, 95% confidence interval (CI) 0.83-0.95], was higher with an increase in population density (RR 1.13, 95% CI 1.05-1.21) and was lower in the households using a safe drinking-water source (RR 0.63, 95% CI 0.41-0.99). Typhoid fever affects younger children living in areas of high population density and lack of access to safe water in Pakistan. A combination of environmental and biological interventions is required to prevent the continued epidemiological and economic impact of typhoid fever in high-risk areas of Pakistan