Khabir Ahmad

Blinding Trachoma: A Disease of Poverty

Trachoma accounts for 15% of blindness worldwide, affecting the worlds poorest communities. How can the disease be controlled?

Prevalence and determinants of blood pressure screening in Pakistan

Objective We analysed data collected during a nationwide cross-sectional household survey to estimate the prevalence of, and to identify factors associated with, blood pressure screening in Pakistan. Design A population-based cross-sectional survey (National Health Survey of Pakistan 1990–1994). Methods During 1990–1994, 18 135 people aged at least 6 months were surveyed across Pakistan. We restricted this analysis to individuals aged 18 years or older (n = 9442). Our primary outcome measure was self-reported blood pressure screening, which was assessed using the question: ‘Have you ever had your blood pressure taken?’ Individuals answering affirmatively or otherwise to this question were categorized as screened or unscreened for high blood pressure. Logistic regression analysis was performed to identify the factors independently associated with the primary outcome. Results Overall, 35.6% [95% confidence interval (CI), 33.9–37.3%] of participants – 41.3% (95% CI, 39.9–42.7%) women versus 29.0% (95% CI, 27.6–30.4%) men – reported ever having had their blood pressure checked. The independent determinants of blood pressure screening identified in the multivariate logistic regression analysis [adjusted odds ratio (95% CI)] included age [26–35 years, 1.58 (1.37–1.81); 36–50 years, 2.18 (1.89–2.51); > 50 years, 2.29 (1.96–2.66)], female sex [2.25 (2.02–2.50)], socio-economic status [lower, 0.54 (0.47–0.63) and middle, 0.70 (0.61–0.80) versus high], province of residence [Punjab, 0.45 (0.39–0.51); Sindh, 0.80 (0.68–0.93); Balochistan, 0.47 (0.39–0.57) versus North West Frontier Province], rural dwelling [0.42 (0.38–0.47)] versus urban dwelling, and educational attainment [less than matriculation, 1.47 (1.27–1.69); matriculation, 1.69 (1.41–2.04); graduation and above, 2.50 (1.81–3.44) versus no education]. Conclusions The rates of blood pressure screening in Pakistan are worryingly low, calling for the establishment of a nationwide programme to improve detection, awareness and treatment of hypertension.

Cataract blindness and visual outcome of cataract surgery in a tribal area in Pakistan

Aim: To estimate the rates of cataract blindness and cataract surgical coverage and to assess the visual outcome of cataract surgery among individuals aged ⩾50 years in Orakzai Agency, Pakistan. Methods: 1600 individuals aged ⩾50 years were selected using probability proportional to size sampling. The main outcome measure was bilateral cataract blindness which was defined as visual acuity of <3/60 in the better eye with best available correction and with obvious central lens opacities/absence of red reflex in both eyes. Results: A total of 1549 people were examined; the coverage rate was 96.8%. Of individuals who were examined, 958 (61.8%) were men. The overall prevalence of bilateral cataract blindness was 4.8% (95% CI: 3.8% to 5.9%). Women had a 2.1-fold greater prevalence of bilateral cataract blindness than men (7.1% (5.0% to 9.2%) v 3.4% (2.3% to 4.6%); p = <0.0001). However, cataract surgical coverage rates were lower for women than men. The overall quality of previous cataract surgery was poor: 43.1% eyes with cataract surgery had VA <6/60. 73.3% people with bilateral cataract blindness reported they could not undergo cataract surgery because they were too poor to afford its cost. Conclusion: The unacceptably high rates of cataract blindness and poor affordability and visual outcome of cataract surgery calls for the establishment, in the agency, of static cataract surgical services that are high quality, affordable, and gender sensitive.

Early experience with intravitreal bevacizumab combined with laser treatment for retinopathy of prematurity.

Objective: This study was designed to present our early experience with intravitreal bevacizumab combined with laser treatment for retinopathy of prematurity (ROP) at a single institution over a 13-month-period. Methods: A retrospective case series of eight children with ROP who received intravitreal bevacizumab combined with laser treatment between June 2007 and July 2008 were reported. A chart review was conducted to evaluate if stability of the ROP lesion had been achieved. Main information collected included data on demographics, gestational age, birth weight, length of stay in neonatal intensive care unit, and stage of ROP. Results: Fifteen eyes of eight subjects were treated. One eye did not receive any treatment due to complete retinal detachment. The median age at treatment was 8 weeks (range, 6 weeks to 1 year). The most common stage of ROP was 3+. All eyes remained stable at 1 year or later after treatment. Conclusion: Intravitreal bevacizumab in conjunction with laser treatment had promising results at our institution. We recommend prospective, randomized, controlled clinical trials to compare the effect of laser treatment alone, of bevacizumab treatment alone (at different doses), and of combined bevacizumab and laser treatment.

Gendered Disparities in Quality of Cataract Surgery in a Marginalised Population in Pakistan: The Karachi Marine Fishing Communities Eye and General Health Survey

Background Marine fishing communities are among the most marginalised and hard-to-reach groups and have been largely neglected in health research. We examined the quality of cataract surgery and its determinants, with an emphasis on gender, in marine fishing communities in Karachi, Pakistan, using multiple indicators of performance. Methods and Findings The Karachi Marine Fishing Communities Eye and General Health Survey was a door-to-door, cross-sectional study conducted between March 2009 and April 2010 in fishing communities living on 7 islands and in coastal areas in Keamari, Karachi, located on the Arabian Sea. A population-based sample of 638 adults, aged ≥ 50 years, was studied. A total of 145 eyes (of 97 persons) had undergone cataract surgery in this sample. Cataract surgical outcomes assessed included vision (presenting and best-corrected with a reduced logMAR chart), satisfaction with surgery, astigmatism, and pupil shape. Overall, 65.5% of the operated eyes had some form of visual loss (presenting visual acuity [PVA] < 6/12). 55.2%, 29.0%, and 15.9% of these had good, borderline, and poor visual outcomes based on presenting vision; with best correction, these values were: 68.3 %, 18.6%, and 13.1%, respectively. Of 7 covariates evaluated in the multivariable generalized estimating equations (GEE) analyses, gender was the only significant independent predictor of visual outcome. Women’s eyes were nearly 4.38 times more likely to have suboptimal visual outcome (PVA<6/18) compared with men’s eyes (adjusted odds ratio 4.38, 95% CI 1.96-9.79; P<0.001) after adjusting for the effect of household financial status. A higher proportion of women’s than men’s eyes had an irregular pupil (26.5% vs. 14.8%) or severe/very severe astigmatism (27.5% vs. 18.2%). However, these differences did not reach statistical significance. Overall, more than one fourth (44/144) of cataract surgeries resulted in dissatisfaction. The only significant predictor of satisfaction was visual outcome (P <0.001). Conclusions The quality of cataract surgery in this marginalised population, especially among women, falls well below the WHO recommended standards. Gender disparities, in particular, deserve proactive attention in policy, service delivery, research and evaluation.

Trial of antiretroviral for HIV prevention on hold

The Cambodian government has opposed plans by an international team of researchers to assess the role of an oral antiretroviral drug tenofovir in HIV prevention among HIV uninfected sex workers in Cambodia because of concerns over possible harm. On August 13 researchers from the University of California San Francisco (UCSF; USA) the University of New South Wales (UNSW; Australia) and the Cambodian National Center for HIV AIDS Dermatology and STDs (NCHADS) halted preparations for the double-blind placebo-controlled trial after “a verbal directive” from the Cambodian Prime Minister Hun Sen that the trial violated human rights. The trial is on hold pending further communication from Sen’s government according to the US National Institute of Allergy and Infectious Diseases (NIAID) which is funding the study. “It is ultimately the decision of the Cambodian team members and their government whether or not the trial goes forward and we will respect their decision” Mary Fanning of NIAID told TLID. (excerpt)

Vaccination halts meningitis outbreak in Burkina Faso

An outbreak of W135-meningitis in Burkina Faso has been successfully contained because of readily available stocks of a newly developed vaccine WHO announced last week. “We have just vaccinated around 135 000 people against Neisseria meningitidis serogroups W135 A and C in Burkina Faso’s Nanoro district. The W135 meningitis outbreak there appeared recently in the middle of another meningitis outbreak caused by serogroup A” WHO’s spokesperson Dick Thompson explains. Because of lack of a multivalent conjugate meningococcal vaccine which provides long-term protection but will not reach the market for 4 years mass immunisation with the new trivalent meningitis vaccine offers the only hope to limit the spread of meningitis outbreaks in Africa. (excerpt)

Experts call for surveillance of drug-resistant typhoid at a global level

S African President Thabo Mbeki hinted strongly that his government will expand its test progamme of antiretroviral drugs for HIV-positive pregnant mothers in his state-of-the-nation address in parliament in Cape Town on Feb 8. But he stopped short of announcing a full roll out of nevirapine to all HIV-positive pregnant women. Mbeki said that “continuing work will be done to monitor the efficacy of antiretroviral interventions against mother-to-child transmission in the sites already operational and any new ones that may be decided upon”. He added that the government would “intensify the campaign against AIDS . . . and other communicable diseases” and called for the focus to remain on “a massive prevention campaign”. In his speech, Mbeki also praised drug companies for responding “very positively” to discussions on new ways of making drugs more affordable and to strengthening the health infrastructure. Paediatrician Glenda Gray (Chris Hani Baragwanath Hospital, Soweto, Johannesburg), who together with her colleague, obstetrician James McIntyre, was awarded the 2002 Nelson Mandela Award for Health and Human Rights on Feb 7, said that compared with his opening address to parliament last year, Mbeki’s 2002 speech was more positive about AIDS. She told The Lancet that progress has been made, as last year Mbeki was not even prepared to talk about HIV/AIDS without grouping it together with other infectious diseases, such as cholera and malaria. However, Gray felt that Mbeki had missed an opportunity to announce a total shift in the government’s policy on vertical transmission of HIV. Gray and McIntyre were awarded the annual Henry J Kaiser Family Foundation’s award for “cutting edge” research into mother-to-child transmission. They cofounded the Perinatal HIV Research Unit at the Chris Hani Baragwanath Hospital, where trials into the efficacy of drugs to prevent vertical transmission of HIV have been done. Gray said that in just 3 months, the number of Soweto clinics where HIV-infected mothers can get nevirapine has grown from three to 11—“a clear example of how easy it is to roll out these programmes”. The government has been under intense pressure to provide antiretroviral drugs to HIV-positive pregnant mothers, and even Mandela has entered the fray. At the award ceremony, on the eve of Mbeki’s address, Mandela said the importance of preventing vertical transmission was “beyond argument or doubt” in fighting HIV/AIDS.

Measles epidemic sweeps through Afghanistan

This article reports that the measles epidemic continues to spread in at least 7 of the war-ravaged Afghanistans 30 provinces. The WHO estimated that the case-fatality rate has reached 8-13%. This was further exacerbated by a lack of the most basic health service, which led to thousands of children malnourished and nonimmunized. In Badakhshan province, the districts of Darwaz, Shegnan, Kishem, Khawhan, Kalafgan, Chal and Ishkamish were areas affected by the epidemic. On the other hand, in Samangan province the scene was worst in the district of Darra Souf. Likewise, in the western province of Afghanistan districts of Tolak and Kush Rabat Sango, child death due to measles were also reported. In response, the Global Alliance for Vaccines and Immunization announced that 25 million children would benefit from a donation of US

UN study expresses concern over national antiabortion policies

350 million annually.