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.

Scientists convinced about coronavirus floating in air as aerosol

By Abdul Qadir Qureshi
(Pakistan News & Features Services)

More than 200 scientists from around the world have challenged the official point of view of regarding the spread of coronavirus (COVID-19) as the pandemic has rocked the whole world by having killed over half a million people. 

The scientists have contended the observations of the World Health Organization (WHO) and the US Centers for Disease Control and Prevention, which has continued to list only a couple of reasons of the transmission of the deadly virus. 

While the two organizations have maintained that inhaling respiratory droplets from an infected person in immediate vicinity or touching a contaminated surface and then eyes, nose or mouth were the two reasons of the contagious disease finding its way into others but the scientists have reckoned that there was growing evidence another way of its transmission. 

These scientists appear convinced on the basis multiple studies which demonstrated that particles known as aerosols, microscopic versions of standard respiratory droplets, can hang in the air for long periods and float dozens of feet, making poorly ventilated rooms, buses and other confined spaces dangerous, even when people stay six feet from one another. 

“We are 100% sure about this,” Lidia Morawska, a professor of atmospheric sciences and environmental engineering at Queensland University of Technology in Brisbane, Australia, asserted. She made the case in an open letter to the WHO accusing the United Nations agency of failing to issue appropriate warnings about the risk. 

A total of 239 researchers from 32 countries have reportedly signed the letter, which was expected to be published next week in a scientific journal. 

In interviews, the experts have pointed out that aerosol transmission appeared to be the only way to explain several super-spreading events like the infection of diners at a restaurant in China who sat at separate tables and of choir members in Washington who took precautions during a rehearsal. 

The WHO officials were reported to have acknowledged that the virus could be transmitted through aerosols but, according to them, it occured only during medical procedures such as intubation that can spew large quantities of the microscopic particles.

WHO issues fresh guidelines, emphasizes on wearing masks for COVID-19 protection

By Syed Sajid Aziz in USA
(Pakistan News & Features Services)

As the entire planet faces the wrath of the coronavirus (COVID-19) pandemic, the World Health Organization (WHO) has issued fresh guidance for the use of masks on the basis of evolving evidence. 

Dr Tedros Adhanom Ghebreyesus, Director General, WHO, shared the new guidance over the weekend, warning the people about the dangers of ignoring the other safety measures while wearing the masks. 

He cautioned the people against developing a false sense of security when they were wearing masks as the protective gear but did not take care of other preventive matters. 

“I cannot say this clearly enough: Masks alone will not protect you from COVID-19. Masks are only a benefit as part of a comprehensive approach,” Dr Ghebreyesus clarified. 

“Masks can be used either for protection of healthy persons (worn to protect oneself when in contact with an infected individual) or for source control (worn by an infected individual to prevent onward transmission). However, the use of a mask alone is insufficient to provide an adequate level of protection or source control, and other personal and community level measures should also be adopted to suppress transmission of respiratory viruses,” the WHO advised. 

In places with widespread transmission, WHO has advised medical masks for all people working in clinical areas of a health facility, not only workers dealing with patients with COVID-19 which meant that when a doctor is doing a ward round on the cardiology or palliative care units even without confirmed COVID-19 patients was advised to wear a medical mask.

In areas with community transmission, people aged 60 years or over, or those with underlying conditions, have been advised to wear a medical mask in situations where physical distancing is not possible. 

The WHO has continued to recommend people, who are sick with symptoms of COVID-19 should remain at home, and should consult their healthcare provider while people confirmed to have COVID-19 should be isolated and cared for in a health facility and their contacts should be quarantined.

Coronavirus Update: Karachi edges past Lahore to be worst affected in Pakistan

By Mukhtar Alam
(Pakistan News & Features Services)

Karachi was reported to have the highest coronavirus case load in the country at 24%, pulling down Lahore to number two at 23%, as the Sindh health authorities confirmed detection of another 371 new cases, with seven relevant deaths, in the megapolis on May 4. 

Only on May 2, according to a report compiled by the World Health Organization (WHO), Lahore topped among the districts of Pakistan for reporting 26% of the country’s total COVID-19 cases, while Karachi was second at 14%. 

In the meantime Karachi’s COVID-19 case fatality rate (CFR) decrease to 2.08% on May 4, against the provincial overall CFR of 1.73%, which, according to analysts can be attributed to the considerable increase in the numbers of new testing against the virus in the city. 

According to official data updated on May 4, Karachi reported the biggest increase in the number of confirmed Coronavirus cases in a week as 2,361, about 40% of its total confirmed cases. The average number of new cases per day came as 337 through the week (April 28 to May 4).

The experts reckoned that the manner in which the death toll has increased in the recent days across the province it called for improved, timely and quality interventions in the case of COVID-19 affected population, otherwise the CFR will increase considerably, particularly at a time when peak of the diseases is yet awaited.

A comparative study of the provincial data suggested that corona tests are either not being conducted in almost half of the districts of Sindh or the people tested there are not found having contracted the lethal virus in last couple of days. 

The various districts including Jamshoro, Badin, Naushro Feroz, Thatta, Tando Mohammad Khan, Tando Allahyar, Kasmore, Umerkot, Mirpurkhas, though included in the lists of virus infected districts did not show any new cases. 

The COVID-19 cases update issued by the Sindh health department on May 5 informed that Khairpur reported 20 new cases, followed by Kamber Shahdadkot (9), Ghotki (8), Hyderabad (4), Jacobabad (3), Sujawal (1) and Sanghar (1), in addition to Karachi (371 new cases). 

All the patients having died of COVID-19 during the last 24 hours, ending at 8 am on May 4 belonged to Karachi. They were all males, aged from 43 to 79 years, said an official source, adding that six of them lost their lives in the government hospitals while the seventh one expired at home. 

The latest deaths pushed the COVID-19 death tally to 124 for Karachi (six districts) and 137 for Sindh. Other districts which reported the deaths include Sukkur (5), Hyderabad (3), Shaheed Benazirabad (1), Tando Allahyar (1), Ghotki (1) Matiari (1) and Larkana (1). 

With the addition of 2,571 people who were tested for the virus, the total number of the examined people reached to 66,623 across the province, while the total number people detected positive for COVID-19 came as 7,882; ie the overall provincial infection rate remained 11.83 %. The patients who recovered from the disease numbered 1,629 so far in the province, according to the health department data.

AKU Surgical Conference calls for systemic approach to reduce injury deaths

By Abdul Qadir Qureshi
(Pakistan News & Features Services)

The experts, while speaking at the inaugural session of the 5th AKU Annual Surgical Conference, having the theme Trauma: Striving for Change, reckoned that thousands of injury deaths every year in Pakistan could be averted by taking safety measures on one side and by adopting a systematic approach to improve trauma care on the other side. 

A systematic approach ensures that life-saving interventions are performed in a timely manner and that no life-threatening conditions are missed, the speakers at the event, organized by the Aga Khan University (AKU), noted. 

As per the World Health Organization (WHO) guidelines, such an approach could consist of emergency care in the form of first aid being provided by a trained bystander, who can also call an ambulance, equipped with necessary life support and at least two personnel, one to monitor and manage the patient and the other to drive. Ambulance personnel should be able to communicate to a relevant hospital prior to arrival, if needed. 

During the handover, the ambulance provider should share critical information with hospital personnel, who then triage patients to different areas based on the seriousness of their condition. 

Research from the conference was published in a special supplement of the Journal of the Pakistan Medical Association (PMA). 

During the event, Professor Syed Ather Enam, chair of the Department of Surgery at AKU, referred to a case report of a two and half-year old boy, who sustained three gunshots at point-blank range. 

The child was unresponsive when the terrified family brought him to the emergency department of the Aga Khan University Hospital after trying two nearby hospitals. 

When the patient did not respond to initial resuscitation efforts, a team of paediatric, cardiothoracic and orthopaedic surgery, and paediatric anesthesiology specialists was taken on board and he was moved to the operating room immediately. 

“Today, he is a healthy four-and-a-half-year old schoolgoing child. There could be thousands of people who were not lucky like him. That’s because our hospitals lack multidisciplinary teams of specialists and the emergency care system as a whole is short of fully equipped ambulances and trained bystanders,” Professor Enam said. 

The AKU’s Annual Surgical Conference brought together national and international experts with expertise in pre-hospital care, mass casualty, rehabilitation, prevention and disaster management. 

“Since blood loss is the leading cause of preventable death following injury, rapid control of bleeding at the scene of an event can be lifesaving, especially if bystanders can step in to help before emergency responders arrive,” Eileen Bulger, a professor of surgery at the University of Washington, remarked. 

On the second day of the conference, the AKU’s upcoming Centre of Excellence for Trauma and Emergencies, and partners will launch a national life-saving initiative focused on bystander training in life support. Emergency care is essential to many targets of the United Nations’ Sustainable Development Goals. Under SDG 3, good health and wellbeing: Post-crash emergency care and rehabilitation has been estimated to play a role in preventing 40 per cent of road traffic deaths. 

"Also, timely emergency care access is critical to effective universal health coverage. Emergency care can also contribute to efforts to achieve targets under 10 more SDGs by addressing non-communicable diseases, obstetric complications, child health issues, and injuries related to disasters and violence,"Hasan Badre Alam, a professor of surgery at the University of Michigan, informed.

The AKU Vice Provost Anjum Halai, Medical College, Dean, Adil Haider, and chair of the event’s organizing committee Hasnain Zafar also spoke at the conference. 

The Annual AKU Surgical Conference, organized by the Department of Surgery at the AKU in Karachi, offered unparalleled hands-on and didactic learning opportunities, timely discourse on the most relevant surgical practices and research and networking with peers. The last year’s conference had focused on the global surgery.

Pakistan’s unusual suicide issues highlighted

By Abdul Qadir Qureshi
(Pakistan News & Features Services)

Married women and single men under the age of 30 in Pakistan are among the groups most likely to commit suicide, according to speakers at a panel session Wellness in the Workplace at Aga Khan University. 

The event was part of a week of sessions and themed activities aimed at spreading awareness of the importance of suicide prevention: the theme for World Mental Health Day 2019. 

The speakers noted that research showed that Pakistan’s highest-risk groups for suicide were different to those in other parts of the world. 

In the West, single men between the age of 50 and 60 are most likely to take their own lives. But in Pakistan, youth of working age, under the age of 30, are most likely to commit suicide which suggested that employers had a role to play in tackling the public health threat of suicide, which claimed about 800,000 lives a year globally, according to data from the World Health Organization (WHO).

According to global figures, one person dies by suicide every 40 seconds with three out of four suicides occurring in low and middle income countries. 

The worthy speakers reckoned that companies needed to establish a culture where people could speak about their challenges and daily stresses without the fear of being judged. 

The forums where employees can openly share their concerns promote wellness in the workplace and reduce the threat of issues such as anxiety and burnout. 

Shagufta Hassan, interim CEO of Aga Khan University Hospital, added that companies should launch professional mentorship programmes so that vulnerable youth had someone they could seek advice from. 

She also highlighted the importance of offices having counselling services where employees facing challenges could access additional help or be referred to professionals. 

Speaking at the event, Atiya Naqvi, a clinical psychologist, noted the importance of friends and family in supporting those going through a difficult time, adding that the mere act of listening to a person’s problems helps reduce anxiety. She also spoke of the need to monitor one’s thought patterns and to communicate one’s concerns with those around them. 

Dr Ayesha Mian, chair of the Department of Psychiatry at AKU, noted that hopelessness and despair are feelings that often exist in people with suicidal ideation. 

She noted that being unable to cope with financial pressures, academic stresses, dysfunctional relationships and bullying were some of the determinants known to lead to passive or active thoughts of suicide. 

“There is a myth that only those patients with mental health disorders will commit suicide. While more often than not, patients who die of suicide have a diagnosed psychiatric illness, there may be those who do not have a mental health disorder. We know that for every one person who takes their life there are ten people actively planning suicide and a 100 with suicidal ideation, which is why prevention efforts are so vital,” Dr Ayesha remarked. 

She also spoke about how compassionate words and actions can help ease feelings of despondency that may lead to pervasive feelings of hopelessness and suicidality in those vulnerable. 

“Talking about suicide doesn’t promote suicide. We often underestimate the importance of listening and acting with compassion even though they help protect against a number of self-harming actions. It is important to listen with sincerity and without fear; if you don’t know what to do, ask the person how would you like me to help,” she advised. 

Over the course of the week, students and staff at the University participated in support group sessions and wellness camps designed to promote mental wellbeing. Students also held a Kindness Walk and organized a Wall of Compassion to showcase the importance of empathy and kindness in preventing harmful thoughts and actions.

Sindh government rolls out typhoid conjugate vaccine

By Abdul Qadir Qureshi
(Pakistan News & Features Services)

The children in the Lyari neighbourhood of Karachi, one of the areas worst-hit by the typhoid outbreak in Sindh, are receiving their first dose of the typhoid conjugate vaccine (TCV), the latest vaccine to be included in Pakistan’s routine immunization programme. 

The staff from Aga Khan University (AKU), working in partnership with the Sindh government, will inoculate over 100,000 infants and children between the ages of six months and 15 years by administering the vaccine at public and private sector schools and hospitals based in one of the city’s most densely populated towns. 

“This is the first step in a mass immunization campaign for Sindh. The vaccine is the most effective way to curb new cases and to protect children from a disease which is becoming increasingly expensive and difficult to treat,” Dr Azra Fazal Pechuho, Sindh Health minister, remarked. 

Pakistan is the first country among low-income nations eligible for funding from GAVI, a global, public-private partnership committed to increasing access to immunization to include TCV in its nationwide schedule of vaccines against 11 preventable diseases. 

The decision is in line with the country’s commitment to end outbreaks of water-borne and communicable diseases in its efforts to meet goal 3 of the Sustainable Development Goals. 

“Deaths and complications from typhoid were rare over the past 15 years but the ongoing outbreak has put an unprecedented number of children at risk,” Farah Qamar, an associate professor in paediatrics and child health at AKU, stated. 

“Efforts are underway to address the root cause of the outbreak failings in our water and sanitation system but in the meantime this vaccine represents the best way to save lives,” she added. 

Researchers from the AKU will analyze the data from the Lyari drive to understand factors determining the acceptability and efficacy of the vaccine which, in turn, will enable its successful rollout across the country from October 2019. 

The World Health Organization (WHO) has disclosed that over 5,000 cases of XDR typhoid have been reported in the province to date. 

The scale of the outbreak led the Sindh government and private sector partners, such as the AKU and the Bill and Melinda Gates Foundation, collaborating to launch an emergency vaccination drive in Hyderabad in January 2018. 

The faculty and staff at the AKU microbiology laboratory first detected the typhoid outbreak in blood culture tests from Hyderabad in October 2016. They collaborated with epidemiologists and infectious disease specialists from the University’s department of paediatrics to bring the matter to the attention of local government, the WHO, the US National Institutes of Health, the Sabin Vaccine Institute and the UK-based Wellcome Sanger Institute. 

Since then, the university’s researchers and its partners have collaborated on a number of studies to understand the genetic make-up of the typhoid strain, to ascertain risk factors for its geographic spread and to assess the safety and efficacy of TCV in an emergency outbreak situation. 

Data and policy implications stemming from these studies were shared with the Drug Regulatory Authority of Pakistan and the federal government’s National Technical Advisory Group. 

This led to a successful application for funding from GAVI and the Bill and Melinda Gates Foundation resulting in the permanent inclusion of TCV in the country’s nationwide immunization programme, a win-win situation for stopping the spread of a preventable disease.

Harmful levels of lead and arsenic in common foods

By Abdul Qadir Qureshi
(Pakistan News & Features Services)

Unusually high levels of lead and arsenic, heavy metals most commonly associated with human poisoning, have been found in common foods. These are the findings of a research study, conducted by the Aga Khan University in collaboration with Japan’s Jichi Medical University, that were presented at a seminar Heavy Metals, Food Safety and Child Development at AKU on December 5.

Lead and arsenic are two chemicals deemed to be of major concern to public health, according to the World Health Organization’s International Programme on Chemical Safety, since both elements have toxic effects that can cause irreversible neurological damage and even trigger a wide range of chronic diseases. 

To determine the cause of lead and arsenic exposure, the AKU researchers looked at common sources of lead and arsenic exposure including petrol, foods, drinking water, house-dust, respirable dust and soil across urban and rural areas of Pakistan. 

In addition, blood samples from pregnant women, newborns and young children were taken to assess their health risk. Surprisingly, drinking water and surma (kohl) were not the main sources of lead exposure. 

For pregnant women, foods such as potatoes and boiled rice and for children, food and house-dust were found to be the most important contributors of lead exposure. The women and children who took part in the study had blood lead levels significantly higher than the 5 µg/dl (microgrammes per deciliter) used as a reference level for health risk by the US Centers for Disease Control and Prevention (CDC). 

Describing the findings of the study, Dr Ambreen Sahito, research coordinator for the study, stated that more than “60 per cent of newborns and about 90 per cent of children aged 1-3 years had blood lead levels that exceeded CDC guidelines, with grave lifelong consequences. Finding of the research are also relevant to Sustainable Development Goal 3 that calls for efforts to reduce deaths and illnesses caused by exposure to hazardous chemicals.” 

Dr Zafar Fatmi, professor of Community Health Sciences at AKU, revealed that Pakistan’s population has a relatively higher exposure to lead than other countries. “Food contamination can occur during production (farming), processing (in industry or at home) or packaging (if materials are contaminated with lead) and this calls for food processes to be regulated and monitored at each stage. Policymakers will need to pay closer attention to how lead contaminants are entering food chain.” 

He said that the next step was a systematic investigation to reveal at which point in the cycle food is contaminated. Research is also needed into the most commonly contaminated food items, he added. 

Exposure to lead can be limited by simple home activities: hand hygiene, mothers and children washing their hands and washing well, as well as regular wet mopping. Poocha, swabbing, lessens house-dust, containing air pollutants and paint contaminants, reducing lead exposure among children substantially, Dr Shahla Naeem, a member of the AKU research team, remarked 

A second study looking into arsenic exposure had equally surprising findings. It is often thought that drinking water and ‘unsafe’ cookware determines arsenic exposure. 

The researchers looked deeper into the issue by cooking with water that had been boiled and in pans made of four different metals. What they found was that regardless of the type of cookware used, chicken had at least 15 times more arsenic than potatoes and up to 5 times more arsenic than lentils that had been cooked in identical water. 

Explaining the policy implications of the arsenic study, Dr Fatmi, Dr Sahito and Dr Ghani pointed out two areas of concern. “Water standards do need to be considered. The government needs to provide a safe drinking water supply for communities living along the riverbanks as groundwater is a well-known source of arsenic.” 

“Equally important is food standards. We suspect that chicken feed or vaccines given to poultry could be the source of arsenic in meat.” 

It was pointed out that the US Federal Drug Authority has banned an arsenic-based poultry vaccine in April 2015 and regulatory authorities should consider doing the same in Pakistan. However, speakers stressed that the public should not stop eating chicken for fear of arsenic exposure. 

Dr Fatmi said: “While more research is needed on this topic, it’s important to note that people shouldn’t stop eating chicken altogether as it is an important source of protein. For the public, health risks from arsenic exposure are not only determined by the amount of toxins found in food but also by the rate of consumption and the body mass (height and weight) of the consumer.” 

Epigenetic studies are underway, in collaboration with the Japanese that investigate how lead and arsenic exposure affect genes and could potentially lead to chronic diseases. Such research would help understand the long-term impact of heavy metals on public health, speakers added. 

The studies have been funded by Japan’s Ministry Of Health, Labour and Welfare with support from AKU’s University Research Council. Dr Abdul Ghani, Dr Ambreen Sahito and Dr Shahla Naeem from the Aga Khan University’s Community Health Sciences Department and Professor Fujio Kayama from the JICHI Medical University spoke at the event. 

Professor Asad Saeed from Karachi University, Amna Khatoon and Seema Ashraf from the Pakistan Standards and Quality Control Authority, M Yahya from the Sindh Environmental Protection Agency, Professor Masood Kadir from the AKU’s Community Health Sciences Department and Dr Ghazala Rafique from the AKU’s Human Development Programme were also present at the seminar.