Digitization can reduce poverty, corruption: Former Estonian President

 By Abdul Qadir Qureshi 

(Pakistan News & Features Services)

“If the willingness is there, states can transform themselves through the use of digital technology, significantly reducing levels of poverty and corruption and simplifying government services that are otherwise bureaucratic and time consuming.” 

This was the core message delivered in a special lecture by Toomas Hendrik Ilves, former president of Estonia (2006-2016). He is recognized for implementing bold and innovative policies that led the Baltic state to becoming a global leader in digital governance, especially in the areas of voting, banking, healthcare, transportation and education. 

The event was hosted by Aga Khan University (AKU) Information and Communications Technology division, led by Chief Information Officer Shaukat Ali Khan, and attended by prominent CIOs from other leading institutions in Pakistan at the as special guests. 

Following his presidency, the Estonian leader has actively worked to advance understanding of how technology can be used to improve lives and create a safer world. He co-chairs the Global Future Council on Blockchain Technology, which examines how blockchain technology can be used to enhance cybersecurity, and recently advised the World Health Organization on technological solutions to address the COVID-19 pandemic. 

President Ilves, who was speaking remotely, shared his experiences spearheading Estonia’s digital transformation. He built on his familiarity with coding to explore innovative solutions to overcome a highly inefficient bureaucracy. Using the example of registering a birth in Estonia, he described a colleague’s frustration at having to manually apply to numerous individual departments to register the birth of a child, a process that took weeks and involved significant frustration. 

Digitization meant that as soon as a child was born, the hospital would enter it into the system, after which it would instantaneously be shared with every other relevant department so records would automatically be updated, expediting the entire process with no involvement from the parent. This ethos to simplify the citizen experience has continued to the point that even to file taxes, citizens usually just verify forms readily filled by the government. Though this process can be quite cumbersome in most countries, it takes mere minutes today for most Estonians. 

Moreover, the former Estonian president emphasized the IT talent existing in Pakistan, highlighting that there were many brilliant Pakistanis working in Estonia’s IT sector. He also suggested building proprietary government systems, and shared that many of Estonia’s systems are open source and can be freely shared for the benefit of other nations. 

Answering questions from the audience as to how a nation with low GDP per capita and limited exposure to computers managed to digitize, President Ilves shared Estonia’s solution of creating computer centres for the public to come and utilize the machines with assistance, so they could engage with the new digital governance systems. He also indicated that the focus of digitization must be on the citizens, and what makes their lives easier, despite how tempting it is to initially pursue projects that make things easier for the government. 

As people notice and feel the benefits of digitization, there is a ‘halo effect’ which leads to greater adoption of other related digital services. Extolling the virtues and necessity of digitization, the President highlighted that Estonia only 30 years ago was a newly independent country with high levels of poverty and corruption. Today, it has a reputation as a digital leader with the most unicorns (companies valued above US$1 billion) per capita in Europe and the sixth lowest corruption levels in the world, a startling achievement. It is a transformation journey upon which any country can embark if the willingness exists. 

The AKU is engaged in its own transformation journey, as it implements a globally leading Electronic Health Records (EHR) system across its hospitals to enhance patient experience, care quality, and research capability. Shaukat Ali Khan thanked President Ilves for sharing his wisdom and experience with the audience, and expressed his gratitude to all the participants, as well as the University of Central Asia (UCA) and the CxO Global Forum, for helping make the event possible.

AKU’s Prof Zulfiqar Bhutta ranked among top global scientists

 By Abdul Qadir Qureshi 

(Pakistan News & Features Services)

Professor Zulfiqar Bhutta of the Aga Khan University (AKU) has been ranked among the top 100 medicine scientists in the first edition of top scientists ranking for medicine published by Research.com, one of the major knowledge centres for medicine research. He is the only scientist from Pakistan and the low- and middle-income countries who made it to the top 100. 

The ranking is based on criteria that considered h-index, which indicates how productive and influential a researcher is, publications and citations. The ranking team examined 166,880 scientists on Google Scholar and Microsoft Academic Graph, and over 65,743 profiles for the discipline of medicine.

“As is the case for other recent recognitions, though a personal recognition, this ranking reflects the achievements of scores of young researchers and faculty members across the world having worked with me on problems of the most marginalized and impoverished women and children in poor communities,” Professor Bhutta commented. 

He is the founding director of the Centre of Excellence in Women and Child Health and the Institute for Global Health and Development at AKU and Co-Director of the SickKids Centre for Global Child Health, Robert Harding Chair in Global Child Health and Policy, and a Senior Scientist in the Child Health Evaluative Sciences programme at The Hospital for Sick Children, Toronto.

“Congratulations to Professor Bhutta and his team for this great achievement. Their relevant research at AKU has changed lives not only in the countries where we seek to serve but also globally,” the AKU President, Sulaiman Shahabuddin, greeted. 

Professor Bhutta is one of the original members of AKU’s faculty since the establishment of the University. Having begun his career at AKU in 1986, the University provided a foundation for the development of an illustrious career in which he built research programmes on maternal and child health and nutrition with national and global impact, despite the challenges of political turmoil and economic insecurity in Pakistan.

Between 1996 and 2002, Professor Bhutta and his team at the University undertook extensive community outreach and research programme in an urban slum of Karachi and several rural areas of Pakistan, which then expanded to many regions and provinces of Pakistan as well as other low- and middle-income countries.

Over the last two decades, he has closely collaborated with the government of Pakistan to assess effectiveness of health care approaches and innovations in real-world settings through partnering with public sector community health workers. Many of these large community-based cluster randomized trials led by Professor Bhutta have generated findings that changed global policy, most notably the finding that using chlorhexidine for cord care among home births was associated with significant reduction in the risk of neonatal sepsis and death, and that public sector community health workers could successfully work with communities to reach those at greatest risk and reduce perinatal mortality as well as maternal morbidities. 

His work has been the foundation of multiple international guidelines, including changing World Health Organization policy on the treatment of persistent diarrhoea and malnutrition along with establishing lady health workers (LHW) as foundational members of community-based interventions in Pakistan, South Asia and sub-Saharan Africa. His team in Pakistan and Canada has extensively worked on strategies to improve maternal and child health and nutrition in conflict settings and emergencies. Notably his team works with community volunteers and health workers in tribal areas of Pakistan to improve polio and routine immunization coverage. 

Professor Bhutta holds the title of Distinguished University Professor at the AKU which is the highest faculty rank the university can confer as well as an Award of Distinction and Award of Excellence in Research. He has received several international awards and recognition. Recently, he also received the Roux Prize for turning evidence into health impact and the John Dirks Canada Gairdner Global Health Award for outstanding achievements in global health research.

AKU President hosts diplomat dinner

 By Abdul Qadir Qureshi 

(Pakistan News & Features Services)

Sulaiman Shahabuddin, President of the Aga Khan University (AKU), hosted a dinner reception in the honour of diplomats from around the world in Karachi. 

“The AKU’s mission is to improve the quality of life in the developing world and beyond, through world-class teaching, research and healthcare delivery,” the AKU President observed while briefing diplomats on the university's contributions and social impact.

“The AKU educates students for local and global leadership from campuses and teaching hospitals in six countries, including Pakistan, Kenya, Tanzania, Uganda, Afghanistan and the United Kingdom. Being a not-for-profit institution, all revenues generated by the University and its hospitals are invested back in education and research, and in helping patients and improving healthcare,” he stressed. 

Sulaiman Shahabuddin also talked about AKU’s commitment to be carbon neutral by 2030. “The AKU’s first solar power project in Pakistan is a key step forward to realizing our environment and climate ambitions. Using renewable, clean energy brings not only cost savings but benefits people and the planet alike,” he said. 

The dinner was attended by diplomats from France, Japan, Korea, Indonesia, Qatar, the Kingdom of Saudi Arabia, the United Kingdom, the United States of America, Turkey, United Arab Emirates and other countries.

#karachi #karachinews #karachialerts #AllAboutKarachi #karachipakistan #karachieducation #karachi #karachipakistan #KarachiUpdates #karachilatest

WHO designates AKU as collaborating centre

 By Abdul Qadir Qureshi 

(Pakistan News & Features Services)

The World Health Organization (WHO) has opened a collaborating centre on sexual and reproductive health and rights (SRHR) at the Aga Khan University Medical College’s Department of Community Health Sciences (CHS) in Karachi, This is the first such centre specific to SRHR in Pakistan and the fourth in general in the country. 

The partnership incorporates AKU into a network of over 800 WHO collaborating centres in over 80 member states working with the global health body on areas such as nursing, occupational health, communicable diseases, nutrition, mental health, chronic diseases and health technologies. 

Dr Sarah Saleem, a professor of population and reprictive health at AKU, will lead the centre and provide strategic support in implementing WHO's mandated work and programme objectives, and develop and strengthen institutional capacity in the 22 countries and territories within the EMRO (Eastern Mediterranean) region. She is also the principal investigator for the Eastern Mediterranean hub for research capacity strengthening, based within AKU’s CHS Department, which was initiated in 2019 and has trained over 200 participants in sexual and reproductive health research, including gender-based violence. 

“This enables so many people to take their first steps towards quality research, policy and development in SRHR. We are contributing to a cause, a country and a region,” she remarked. 

The collaboration aims to provide technical input and expertise on WHO’s repository of SRHR evidence, guidelines and training resources; to assist WHO in building national and regional capacity on sexual and reproductive health through training on SRHR; and to support WHO in conducting collaborative research, under WHO's leadership, on SRHR at the regional level.  

The team is in the process of forming a virtual network of institutions within EMRO to discuss their needs and share knowledge. The team is already developing an open-access SRHR repository housed within the AKU library. This project is led by Dr Peter Gatiti, AKU Associate Vice Provost and University Librarian, and it will serve as a region-specific one-stop rich resource for scientists, researchers and policymakers. 

The WHO collaborating centres are institutions such as research institutes, parts of universities or academies, designated by the director-general to carry out activities in support of the organization's programmes. 

The WHO gains access to top centres worldwide and the institutional capacity to ensure the scientific validity of global health work. Conversely, designation as a WHO collaborating centre provides institutions with enhanced visibility and recognition by national authorities, calling public attention to the health issues on which they work. 

Dr Farina Abrejo, a senior instructor, is the co-principal investigator at the centre. AKU's School of Nursing and Midwifery is also working with the centre, represented by Dr Saleema Gulzar.

Public-private partnership to boost immunization in high-risk Karachi UCs

 By Abdul Qadir Qureshi 

(Pakistan News & Features Services)

Efforts to integrate private providers for boosting routine childhood vaccination in Karachi’s low-income areas are set to receive a much-needed shot in the arm as a memorandum of understanding, signed by the Sindh Department of Health and the Aga Khan University goes into effect. 

The agreement entails integrating local private healthcare providers at the neighbourhood level to plug the gap in the government’s immunization infrastructure and develop sustainable community networks for increasing immunization coverage. 

The project, funded by the Bill and Melinda Gates Foundation, targets hot spots of immunization refusals in eight union councils of Karachi to increase zero dose vaccination provided at birth as well as Penta-3 vaccination in under six-month children which is a marker of complete vaccination in under six-month children. Through the project, immunization services and basic preventive care will be offered at 18 Expanded Programme of Immunization (EPI) centres set up within neighbourhood private provider clinics, NGO clinics and maternity homes. 

Community members in the districts where the project is to be implemented report that private clinics located in the local neighbourhood are the mainstay for their daily illnesses but do not offer immunization services, and while polio teams go from door to door to administer polio drops, the same facility is not available for other childhood vaccines for which families must visit government hospitals located at a considerable distance. 

According to AKU’s senior lead for the project, Professor Shehla Zaidi, AKU with EPI Sindh and other government stakeholders will co-design novel action learning strategies for co-opting private providers for quality assured services including pay for performance, quality accreditation scores and positive behaviour recognition, supported digital communication and community networks. The project will build sustainable links with the Sindh Health Department’s Action Plan for Strengthening Public Private Partnerships 2021-26 and regulatory frameworks towards urban primary health centres. 

Elaborating on the unique challenges of immunization delivery in megacities, Dr Irshad Memon, head of the EPI in Sindh, asserted that immunization rates in Karachi are far lower than in the province’s rural districts. “So far we have struggled to put in place a system to ensure that private providers report immunization volumes, provide free services and deliver quality-assured services. Hence this project fills a key need for technical assistance for effective private engagement for the urban poor. We need sustainable health systems as we don’t want to see super high-risk union councils in five years,” he explained.

AKU initiates first solar power project at campus

 By Abdul Qadir Qureshi

(Pakistan News & Features Services)

As part of its commitment to become carbon neutral by 2030, AKU is investing in solar arrays on its campuses in Karachi. 

Three new solar installations will cut the University’s carbon footprint by more than 365,000 kg per year, the equivalent to 1.5 million kilometers travelled in a medium sized car. Three buildings are being fitted with a 550 kW solar photovoltaic system. 

These include the Sports and Rehabilitation Centre and Utilities Building on the Stadium Road campus, as well as a smaller installation on the Utilities Building in Education City, Karachi. Once all 1021 panels at all three locations have been installed, they are expected to generate nearly 500,000 kWh of carbon neutral electricity per year.

“AKU’s first solar power project in Pakistan is a key step forward to realising our environment and climate ambitions. Using renewable, clean energy brings not only cost savings but benefits people and the planet alikem,” the AKU President, Sulaiman Shahabuddin, remarked at the inauguration of the installation at the Sports Centre. 

Over the last decade, solar power has become one of the cheapest electricity sources, particularly suitable for locations such as Pakistan with a high number of sunny days. Once installed, solar energy requires no inputs, reduces operational costs and can improve the environment for the local community by reducing noise and air pollution.

“We are proud to say that currently, AKU is the only university and only healthcare provider in Pakistan having a publicly committed net zero carbon target. Our goal is to champion good stewardship of the environment: to mitigate the effects of climate change from our activities, and support resilience in the communities we serve,” the AKU President declared.

Indus River threatened by climate change

 By Abdul Qadir Qureshi 

(Pakistan News & Features Services)

Pakistan is fifth on a list of all countries most vulnerable to climate change and rising temperatures are already affecting the Indus River, a lifeline for people across the country, mapped in a moving film Vanishing Wetlands. 

The Indus River is one of the world’s longest rivers. It flows through parts of China and India, and runs through Pakistan sustaining the livelihoods of millions of people. 

The combined effects of growing pollution, the building of dams, and the permanent melting of glaciers, which provide up to 80 percent of the river’s water during the dry season, are all having an unprecedented impact on the region’s environment, health and quality of life. 

In Vanishing Wetlands, Pakistani filmmaker Abdullah Khan tells the story of farmers dependent on the river and the age-old fishing community, the Mohanas, whose very existence on Lake Manchar is threatened. Along the way, the film profiles the stunning central Indus wetland complex which supports seasonal bird flyways and rare crocodiles and deer species.

“The drastic decrease in visiting migratory birds, the loss of 90 per cent of the hog deer population, almost complete wipe out of mugger crocodiles and threats to the Indus River wetlands is an eye-opener. Equally depressing is to witness the loss of age-old cultures and communities struggling for livelihood,” Abdullah remarked. 

Wetlands is part of Voices from the Roof of the World, a series of 10 environmental documentaries, produced by filmmakers from Pakistan, Kyrgyzstan, Tajikistan and India under a joint initiative by Aga Khan University, Aga Khan Agency for Habitat, Aga Khan Foundation and University of Central Asia. 

The series focuses on the climate crisis in the earth’s highest mountain region from the Pamirs to the Himalayan mountains. Home to 240 million people and countless rare and endangered species, these mountains are also the largest depository of ice outside the polar ice caps, providing water to a quarter of the world's population. 

“With VRW support and tutelage, these filmmakers have captured poignant personal stories of people and cultures threatened by both deluges and desiccation of their environment. They have ventured downstream to document how the melting of the Himalayan glaciers will affect 1.5 billion people living in the threatened fishing and farming communities of South and Central Asia. Others will show how deforestation, air pollution and killer heat waves will make the world’s most densely packed cities unlivable,” Andrew Tkach, Executive Producer of the series, stated. 

“There are many culprits to share the blame for the predicament humanity finds itself in, but with every target we miss to control CO2 emissions, we are squarely painting a target on our own back. It is time to show that even in a world beset by intractable conflicts and it is possible to work across borders and social strata to save our common home. People living in some of the world’s most extreme conditions are fighting this battle every day, it is time we listen and learn from them,” he stressed. 

The VRW series, which will run for at least two seasons, seeks to amplify the voices of those who have borne the greatest burden of climate change.

Pakistan, UK researchers make blood cancer treatment discovery

 By Abdul Qadir Qureshi 

 (Pakistan News & Features Services)

Almost one third people living with an untreatable form of blood cancer can now look forward to the development of new therapies for their disease after researchers discovered a mechanism that makes existing treatments ineffective and how this can be overcome. 

Leukemia is one of the three major types of blood cancer. While most cases of leukemia, including a subtype of the disease, Philadelphia-positive Acute Lymphoblastic Leukemia, Ph+ALL, are treatable, almost one-third of Ph+ALL patients have become impossible to treat due to developing resistance to current treatments. Until now, the mechanism for this type of resistance has remained unknown. 

A recent study in the Neoplasia journal by faculty at Aga Khan University’s Centre for Regenerative Medicine (CRM) and Cardiff University has pinpointed a series of cascading chemical reactions or a signaling pathway that, when targeted, can kill, or suppress the growth of resistant leukemic cancerous cells. 

Cells in our body communicate using chemical signals. These chemical signals, which are proteins or other molecules, are meant to facilitate different functions of cells. These signals usually stop after serving their purpose. If they don’t stop, as it happens in some cases, they can cause serious health problems such as cancer. 

“Our study detected a signaling pathway which is switched on and doesn’t switch off in treatment-resistant Philadelphia-positive Acute Lymphoblastic Leukemia, Ph+ALL,” Dr Afsar Mian, an assistant professor at CRM, remarked adding that blocking this pathway would prevent a protein from activating another protein thereby preventing the development of resistance in cancer cells and ultimately their growth and spread. 

Over the course of his career, he has investigated a number of signaling pathways and his past work and experience led him to partner with a leading researcher in the field, Professor Oliver Ottmann of Cardiff University, United Kingdom, to investigate the AKT/mTOR pathway. In this study, researchers used cell lines from a child and an adult with Ph+ALL. Drug resistance was induced in the child’s sample while the adult’s sample was already resistant to treatment. 

In both cases, they found the AKT/mTOR pathway to be responsible for promoting drug resistance and noticed how a specific chemical compound acted as a ‘brake’ on the functioning of the pathway, halting the growth of cancerous cells.

“The first step to discovering a new cancer drug is to know the mechanisms underlying the development, progression and resistance of a specific cancer. We now hope that our research will help us develop more effective and novel targeted treatments,” Dr Afsar Mian stated.

Stem cell researchers at the CRM are already in the process of developing new therapies for Ph+ALL. The contributors to the study included Professor El-Nasir Lalani, founding director of CRM and the Khatija and Mohan Manji Dhrolia Endowed Chair in Stem Cell Biology and Regenerative Medicine, and Usva Zafar and Syed Muhammad Areeb Ahmed, research associates at CRM.

Seminar highlights shortage of diabetes specialists in Pakistan

 By Abdul Qadir Qureshi

(Pakistan News & Features Services)

Pakistan has too few diabetes specialists to treat the nearly 19.4 million people suffering from the disease according to the experts who spoke at a seminar at the Aga Khan University (AKU) held to announce the launch of a six-month certificate course in diabetes that seeks to expand access to the knowledge and skills needed to treat and manage the disease. The course, set to begin from January 2021, will offer the most updated and evidence-based knowledge to manage patients.

The country has only one specialist, also known as an endocrinologist, for every 200,000 diabetes patients, according to Pakistan Endocrine Society. Similar shortfalls in training and awareness of diabetes are present at all levels of our healthcare system, speakers added. 

The current deficits in managing the illness, which has no symptoms, mean that many patients often seek care when they are suffering from advanced complications from the disease. 

The new course is part of collaboration between the University, the British Medical Journal and Royal College of Physicians, London, to help doctors across Pakistan improve their theoretical and practical knowledge of the disease. 

It will include modules covering managing diabetes, its complications, lifestyle and obesity management, inpatient diabetes control and how to handle comorbidities in diabetes. The course is open to all registered healthcare professionals who hold an MBBS degree. 

Diabetes not only reduces the quality of life of patients but also puts them at risk of a range of complications such as heart attack, stroke, kidney problems, nerve damage, serious eye problems and even disability. 

A total of 60 percent of non-traumatic lower limb amputations in Pakistan occurred in patients with diabetes. 

“To reduce the burden of complications of diabetes, physicians have to be well-equipped with the knowledge to confidently diagnose the disease and refer for tertiary care in the case of a complication or inability to achieve good control of diabetes,” Professor Najmul Islam, chair, section of endocrinology, department of medicine at AKU, and course director of the diabetes certificate course, remarked. 

The experts at the seminar shared that Pakistan’s healthcare professionals often lack the expertise to manage the disease adding that short courses can bridge the gap and equip clinicians to manage the high burden of diabetes in the country. 

The model of improving knowledge through educational courses for controlling and treating diabetes has proven to be effective worldwide. The studies in United Kingdom have shown that diabetes education in healthcare professionals can help in reducing the amputation rate, a condition that can develop in both type 1 and type 2 patients.

Partnership among physicians, nurses crucial to introduce Advanced Practice Nursing

 By Abdul Qadir Qureshi 

(Pakistan News & Features Services)

Introducing advanced practice nursing, particularly in countries with fragile healthcare systems, will be crucial to meeting the ever-increasing needs of patients and improving health outcomes said experts at a two-day virtual conference organized by the Aga Khan University Schools of Nursing and Midwifery in Pakistan and East Africa. 

The current COVID-19 pandemic has placed nurses in the spotlight and revealed the need for nursing expertise and experience as never before. In 2020, the International Year of the Nurse and the Midwife, governments and healthcare institutions are being called on to support, empower and advance the nursing profession. 

Advanced practice nursing, APN, is one of the most efficient ways of delivering high-quality, affordable and patient-focused care, accessible especially to those vulnerable groups and populations living in the remotest communities where other healthcare professionals may not reach. 

However, developing policies and strategies to support the transition process in order to integrate the APN model into the fabric of healthcare systems in Pakistan, Kenya, Tanzania and Uganda might be challenging and it will require collaborative efforts. 

Dr Rozina Karmaliani and Dr Eunice Ndirangu, Deans of the Schools in Pakistan and East Africa respectively, talked about the support required from the nursing regulatory bodies and government legislatures to build, develop and sustain the role of APNs.

“The government is working on important regulatory reforms for nursing. An important initiative that we will be taking is to improve the quality of nursing education at the graduate level that will consequently lead to better trained nurses from whom APNs will be developed in the future,” Dr Faisal Sultan, Special Assistant to the Prime Minister on National Health Services, Regulation and Coordination, remarked. 

He also highlighted the importance of a multidisciplinary partnership and collaboration amongst healthcare professionals, especially between physicians and nurses, to take this model forward. 

Afshan Nazly, President of the Pakistan Nursing Council, also present at the session, reinforced the need for cooperation and noted that embracing the APN model will be far easier if nurses and physicians work as allies, and if concentrated efforts are made to enhance the capacity and competency of nurses.

“The current Pakistan Nursing Council Act needs amendment and it should include the advanced practice nurses to make this model viable in the country,” she added. 

Global nursing leaders and APN experts from the United States, Canada and Kenya shared their experiences of pioneering this role in their respective regions and in the developing world, and the associated challenges and measures to mitigate issues. 

Chief Guest, Dr Afaf Meleis, Professor of Nursing and Sociology and Dean Emerita, University of Pennsylvania drew on her considerable years of nursing.

“From my own experience in leading APN programmes and witnessing APNs in action in different parts of the world, I want to offer you three principles vital in planning and effective utilization of APNs in healthcare: Integration of a collaborative healthcare model, of evidence-based training for APNs, of clarity of role and competencies for smooth functioning; the potential of Innovation and problem-solving skills in advanced nursing practice and Influence and impact that APNs can create in health outcomes.” Dr Maria W. O’Rourke, Clinical Professor of Nursing at the University of California San Francisco, the keynote speaker identified and shared an APN implementation framework from a more universal perspective.

“Health and illness are a complex, multifaceted experiences and to meet those needs, we need people with specialised knowledge, skills and especially, the ones who are accessible in both rural and urban settings,” Dr O’Rourke elaborated.

The University Hospital’s leadership, including Dean Medical College Dr Adil Haider and Interim CEO, AKUH, Shagufta Hassan supported this initiative and shared willingness to facilitate the integration of APNs at the AKUH. 

Dr Elissa Ladd from the International Council of Nursing’s Advanced Practice Nursing Network pointed out that hundreds of millions of people around the world are able to access quality, safe and affordable healthcare services as nurses make the largest group of healthcare providers, particularly in the primary care setting. 

“In this context, it is not surprising that an investment made on the nursing workforce can yield significant improvement in patient care outcomes,” she added. 

The event also commemorated SONAM’s 40 years in Pakistan and 20 years in East Africa. Six APN competency-building workshops were offered online and attended by nurses and midwives from Afghanistan, Canada, Kenya, Pakistan, Tanzania, UAE, Uganda, USA and the UK.

PASNO conducts study of brain tumors

By Abdul Qadir Qureshi
(Pakistan News & Features Services)

Brain tumors have one of the lowest survival rates of all types of cancer in Pakistan yet there is little research into the prevalence of the disease, success of different treatment options and ways to improve patient outcomes, the speakers at the inaugural symposium of the Pakistan Society of Neuro-oncology (PASNO) noted at the Aga Khan University (AKU) noted.

The members of PASNO, a multidisciplinary platform spanning researchers, surgeons, oncologists, allied health professionals and basic scientists in the field of neuro-oncology, discussed preliminary findings of a nationwide study that will gather data from close to 50 collaborating centers and will eventually include the treatment history of up to 10,000 patients. 

Preliminary findings from the study suggested that Pakistan doesn’t have as many high-grade tumors as the developed world. However, patients of brain cancer tend to be of a younger age than in the West.

“Neuro-oncology has been largely ignored as a specialty in Pakistan. As a result, not only do our patients continue to receive delayed or suboptimal care, but the skills of our teams remains deficient. Although the data being collected is only a fraction of what will be achieved in the next several months, besides several interesting demographic features it is becoming obvious that a large number of brain tumor patients are receiving fragmented care in Pakistan. This study will help us understand the true burden of brain cancer in Pakistan,” Professor Syed Ather Enam, a neurosurgeon who chairs the department of surgery at AKU and is the founding president of PASNO, observed.

He stressed that a large number of brain tumor patients require a combination of surgery, radiotherapy and chemotherapy. While these different modalities of treatment can be carried out at different centers, it all needs to be orchestrated from one hub to obtain the best results, he added. PASNO is the first venture of its kind in Pakistan.

It aims to bring all specialists involved in the management of neuro-oncology to a common platform to improve not just the care of patients but also improve education, training and research in the field. Such societies are now common in developed countries where they have been shown to improve the overall care of patients. 

New developments in the field were also discussed at the meeting including precision medicine, molecular diagnosis, state of the art operative techniques and technologies, and the potential of artificial intelligence to improve the diagnosis of brain tumors. 

At present, neuro-oncologists have to conduct a series of tests and processes in addition to interpreting MRIs, or scans of the brain, to decide on whether to operate on a patient. Artificial intelligence could uncover hidden information in MRI scans, which are often missed by professionals, and help determine which patients really need surgery, the speakers added. 

The participants in the inaugural session of the seminar had the unique opportunity of hearing the perspective of brain tumor patients and caregivers. One such patient, Yasser Latif Hamdani, underwent awake brain tumor surgery in 2017 and then in 2020. After the first surgery, he went on to study at Harvard University and to publish a biography on Quaid-e-Azam Muhammad Ali Jinnah. 

The speakers reckoned that platforms like PASNO are coming up in other parts of the world and play a key role in bringing together experts from various cancer specialties to ensure the patient receives comprehensive and optimum care. 

During the inaugural ceremony, PASNO received endorsements from many neuro-oncology societies across the world, including the Society of Neuro-oncology from North America, the European Association of Neuro-oncology, the Asian Society of Neuro-oncology, the World Federation of Neuro-oncology and the International Stereotactic Radiosurgery Society. Over 50 speakers from 13 countries participated in the three-day virtual symposium.

95% COVID-19 patients asymptomatic: Study

By Abdul Qadir Qureshi
(Pakistan News & Features Services)

More than 9 out of 10 people infected with coronavirus (COVID-19) experience have had no symptoms of the disease, a new study, carried out by the Aga Khan University (AKU) researchers, revealed.

Karachi has the most COVID-19 cases in Pakistan and the study saw AKU faculty investigate COVID-19’s prevalence in parts of the city with high and low rates of transmission in the community in April and June 2020. 

They found out that 95 percent of those who tested positive for COVID-19 through blood tests, which register the presence of antibodies to fight the disease, reported feeling no symptoms of the illness such as a cough, fever or sore throat. In other words, they were asymptomatic. 

The proportion of asymptomatic cases in Pakistan is much higher than the developed world. Since asymptomatic people do not seek hospital treatment this may help explain why Pakistan’s hospitals have not been under the same strain as in Spain and the UK, according to researchers. 

The results also indicated that children and adolescents are just as likely to catch the disease as adults. Men and women face the same risk of being infected. 

The study also confirmed a sharp rise in COVID-19 cases between April and June this year from 0.2 per cent to 8.7 per cent in low community transmission areas such as Ibrahim Hyderi, and from 0.4 per cent to 15.1 percent in high community transmission sites like Safoora Goth, Faisal Cantonment, Pehlwan Goth and Dalmia/Shanti Nagar.

These results were in line with the federal government’s national seroprevalence study where antibody testing found that overall, 11 percent of Pakistanis had contracted the disease.

“The sharp increase in antibody levels in an area with low reported cases indicates that the virus continues to spread unchecked in populations where testing rates are sub-optimal,” Dr Imran Nisar, an assistant professor at AKU and co-investigator on the study, remarked.

Over 2,000 participants were engaged in the first two phases of the study. The researchers are currently undertaking a third serosurvey and plan to do a fourth in September 2020. These surveys will show the impact of easing lockdowns around Eid-ul-Azha and the impact of the Muharram processions on the coronavirus transmission rate in communities.

"Antibody testing or seroprevalence provides a true picture of the burden of COVID-19 as they capture asymptomatic cases who represent silent carriers of the disease. Understanding how, when and in what types of settings, COVID-19 spreads is critical to developing effective public health and infection prevention measures to break chains of transmission,” Dr Fyezah Jehan, an associate professor at AKU and co-investigator on the study, explained.

AKU’s Dr Nadia Ansari and Dr Mashal Amin as well as US-based international collaborators Dr Bailey Fosdick and Dr Daniel Barremore also contributed to the study.

Ways to tackle maternal death highlighted

By Abdul Qadir Qureshi
(Pakistan News & Features Services)

A study by Aga Khan University (AKU) researchers has suggested ways to reduce the burden of a leading cause of maternal death and disease in Pakistan, pre-eclampsia, a pregnancy-related disorder linked to high blood pressure.

Up to a quarter of all deaths of pregnant women in the country are caused by high blood pressure. Yet, there is little awareness among the public and some healthcare providers of the importance of monitoring blood pressure as part of antenatal care practices. 

“There is no word for pre-eclampsia in prominent regional languages like Sindhi. Unlike other childbirth complications, signs of pre-eclampsia cannot be identified easily which limits the chances of early detection and leaves many pregnant women vulnerable to its dangerous complications,” Dr Rahat Qureshi, the study’s co-principal investigator in Pakistan and an associate professor at the AKU, remarked. 

The findings of the CLIP, Community-Level Interventions for Pre-eclampsia, Pakistan study published in The Lancet suggested that community health workers could play an important role in tackling delays in triaging women, providing initial treatment and in ensuring transport to a health facility. 

The study saw lady health workers (LHWs) in Matiari and Hyderabad visit over 35,000 women over a three-year period.

LHWs asked mothers in the intervention arm about a variety of symptoms related to pre-eclampsia and also measured their blood pressure and oxygen saturation levels on the spot.

This information was then entered into a smartphone-based mobile health application allowing a quick assessment of the risk of severe pre-eclampsia.

If warnings signs were noted, LHWs were trained to provide prompt treatment by providing anti-hypertensive tablets and/or by administering magnesium sulfate. They also created awareness about antenatal care seeking and birth preparedness during pregnancy and referred at-risk mothers to nearby hospitals.

The trial demonstrated that the LHWs could use technology to provide accurate referral advice to communities within their homes.

The analysis showed that when there were enough LHWs to provide care there were fewer deaths of mothers, fewer stillbirths and fewer deaths of newborns.

The number of LHWs should be sufficient to ensure at least 8 antenatal care visits to help reduce the risk of adverse pregnancy outcomes, the researchers added.

The findings also supported the World Health Organization’s recommendation of the benefits of regular antenatal visits to lower the risk of pregnancy-related complications.

The researchers noted that improvements were needed in the quality of care offered at facilities and the availability of key commodities in order to reduce the incidence of women dying during their pregnancy or immediately after giving birth.

“The findings of the CLIP Pakistan study once again reinforce the need to work on multiple fronts to address the burden of maternal and newborn mortality. Addressing this challenge through well-trained LHWs linked to quality care in our referral facilities is critically important in our quest to reduce preventable maternal and newborn deaths,” AKU’s Professor Zulfiqar A Bhutta, a co-principal investigator of the Pakistan study, observed.

The objectives of the study were in line with global efforts to achieve targets under goal 3 of the sustainable development goals, ensure healthy lives and promote well-being for all at all ages, which calls for special efforts to reduce preventable deaths of mothers and newborns by 2030.

Dr Sana Sadiq Sheikh and Dr Zahra Hoodbhoy were co-investigators on the CLIP Pakistan study. The Pakistan study was conducted in partnership with researchers from the University of British Columbia, King’s College London and the Centre for Global Child Health at the Hospital For Sick Children in Toronto. The global CLIP study spanned over 70,000 women in Pakistan, India and Mozambique.

Study finds casual attitude of Pakistanis towards COVID-19

By Abdul Qadir Qureshi
(Pakistan News & Features Services) 

One in six Pakistani adults believed that they and their families were safe from COVID-19 even if they didn’t take any preventive measures, according to a study conducted by Aga Khan University (AKU) and The Chinese University of Hong Kong (CUHK). 

The Pakistani researchers conducted an online survey of 1,406 adults across Pakistan over the first two weeks of May 2020 and compared the results with a similar study in Hong Kong. Hong Kong is widely regarded as a COVID-19 containment success story. It has seen just 2,770 cases and 22 deaths in 6 months despite being a part of China and never imposing a lockdown.

In contrast, data collected in May 2020 showed Pakistan’s rate of infections per 100,000 people at 137 against Hong Kong’s 33 while Pakistan’s fatality rate per 100,000 was also three times higher at 21 despite imposing wide-ranging lockdowns across the country.

“Comparing risk perceptions, anxiety levels and community response to COVID-19 in Pakistan and Hong Kong can help assess whether Pakistan is prepared to take the strict preventive measures needed to control the spread of the disease,” the researchers from AKU’s department of community health sciences felt. 

The study found that the Pakistanis were less concerned about COVID-19’s complications and felt they were more likely to survive the virus than those surveyed in Hong Kong. Only 41 percent, of Pakistanis rated COVID-19 symptoms as being very severe or severe compared to 97 percent of respondents in Hong Kong. 

Similarly, nearly seven out of ten Pakistanis, or 68 percent, believed they had a high or very high chance of surviving the disease against just 36 per cent of respondents from Hong Kong. Such perceptions about the risk of contracting COVID-19 and its complications contributes to preventive behaviour such as wearing face masks, which are almost universally worn in Hong Kong. 

The Pakistanis were also less likely to seek out information on preventive measures and how to detect COVID-19 symptoms than their counterparts in Hong Kong. 

“The casual attitude of literate Pakistanis to preventive measures and the risk of contracting the disease is concerning. We need to be more cautious and attentive to preventive measures especially during the Eid holidays so that we can continue to contain the disease,” Professor Fauziah Rabbani, the study’s principal investigator and associate vice provost for research at the AKU, stated.

Compared to Hong Kong, Pakistan is much more trusting of its government. Nearly eight out of ten Pakistanis, or 79 percent, rate government information as being very reliable compared with just 16 per cent of people in Hong Kong. 

“In Hong Kong citizens took charge of the pandemic as they didn’t trust the government. The Pakistanis are fortunate to have proactive government campaigns about mask use and physical distancing but remain reluctant to follow these measures,” she added. 

The researchers also analysed the data by gender to assess differing perceptions about COVID-19 between Pakistani men and women. In general, Pakistani men had a lower risk perception of COVID-19 compared to women. Despite a government-imposed lockdown only 71 percent of men avoided going out in contrast to 87 percent of women. 

Moreover, 62 percent of women reported experiencing symptoms of anxiety compared to 50 percent of men. Men in Pakistan preferred to acquire information about the pandemic from their family and friends while women in the country viewed information from doctors as being more reliable. 

The researchers noted that in both countries, seven out of 10 citizens were reluctant to go to hospitals or clinics. They called on Pakistanis with non-communicable diseases such as diabetes and cardiac diseases, maternal as well as child health issues to continue seeking care whilst adopting preventive measures at hospitals and clinics. 

Dr Adeel Abid, Dr Hania Shahzad, Dr Hyder Ali Khan, Dr Suneel Piryani and Dr Areeba Raza Khan from the AKU were also associated in the study.