Rashid Jooma

Intracranial tumors in neonates: a report of seventeen cases

Seventeen patients with intracranial neoplasms that were symptomatic within the first 2 months of life were studied. Macrocrania was the commonest clinical feature, and radiologic studies including computed tomographic examination in five of the patients, showed that the tumors tended to be large, rapidly growing, and located along the neural axis. The outlook was poor, with a high operative and case mortality. The risks of irradiating young infants are discussed, and a conservative surgical approach with careful case selection is advocated.

A successful model of road traffic injury surveillance in a developing country: process and lessons learnt

BackgroundRoad Traffic Injuries (RTIs) are one of the leading causes of death and disability worldwide with 90% of global mortality concentrated in the low and middle income countries. RTI surveillance is recommended to define the burden, identify high risk groups, plan intervention and monitor their impact. Despite its stated importance in the literature, very few examples of sustained surveillance systems are reported from low income countries. This paper shares the experience of setting up an urban RTI surveillance program in the emergency departments of five major hospitals in Karachi, Pakistan.MethodWe describe the process of establishing a surveillance system including assembling a multi-institution research group, developing a data collection methodology, carrying out data collection and analysis and dissemination of information to the relevant stakeholders. In the absence of a road safety agency, the surveillance system required developing individual partnerships with industry, police, city government, media and many other stakeholders. Impact of the surveillance is demonstrated by some initiatives in the local trauma system and improvements in road design to effect hazard reduction.ConclusionWe demonstrated that a functional RTI surveillance program can be established, and effectively managed in a developing country, despite lack of infrastructure and limitation of resources. Data utilization in the absence of well defined road safety infrastructure within the government is a challenge. More effective actions are hampered by the limited capacity in the transport and health sectors to do in-depth analysis through road safety audits and trauma registries.

The Impact of Polio Eradication on Routine Immunization and Primary Health Care: A Mixed-Methods Study

Background.u2003After 2 decades of focused efforts to eradicate polio, the impact of eradication activities on health systems continues to be controversial. This study evaluated the impact of polio eradication activities on routine immunization (RI) and primary healthcare (PHC). Methods.u2003Quantitative analysis assessed the effects of polio eradication campaigns on RI and maternal healthcare coverage. A systematic qualitative analysis in 7 countries in South Asia and sub-Saharan Africa assessed impacts of polio eradication activities on key health system functions, using data from interviews, participant observation, and document review. Results.u2003Our quantitative analysis did not find compelling evidence of widespread and significant effects of polio eradication campaigns, either positive or negative, on measures of RI and maternal healthcare. Our qualitative analysis revealed context-specific positive impacts of polio eradication activities in many of our case studies, particularly disease surveillance and cold chain strengthening. These impacts were dependent on the initiative of policy makers. Negative impacts, including service interruption and public dissatisfaction, were observed primarily in districts with many campaigns per year. Conclusions.u2003Polio eradication activities can provide support for RI and PHC, but many opportunities to do so remain missed. Increased commitment to scaling up best practices could lead to significant positive impacts.

Why We Must Provide Better Support for Pakistan's Female Frontline Health Workers

Svea Closser and Rashid Jooma argue that achieving polio eradication and strengthening Pakistans health system must focus not just on international engagement but also on local partnerships with Lady Health Workers and other ground-level staff. Please see later in the article for the Editors Summary

Clothing-related motorcycle injuries in Pakistan: findings from a surveillance study

This study aims to assess the burden and patterns of clothing-related motorcycle injuries in Karachi, Pakistan. Data were extracted from an ongoing traffic injury surveillance system. In three years (2007–2009), out of 99155 road traffic injury cases there were 986 (0.9%) cases of clothing-related motorcycle injuries. Most cases were females (73.9%) and pillion riders (80.6%). The crashes involving clothing-related injuries were mostly single vehicle (98.5%), and largely resulted in injuries to the external body (60.3%), limbs (51.0%), head (41.5%) and face (35.9%). One-third of injuries were either moderate (26.7%) or severe (10.2%) while 10 (1.01%) deaths were reported. Female gender (11.4%), age ≥ 45 years (19.4%), pillion riding (11.3%) and crashes occurring at intersections (12.3%) were more likely to result in moderate or severe injury as compared to other users (P < 0.001). Injuries due to entanglement of loose fitting clothing in motorcycles are not uncommon in Karachi. Awareness campaigns for prevention of such injuries may involve promotion of appropriate dressing for motorcycle riding including close wrapping of clothes and encouraging installations of covers on the rear wheels and drive chains.

Polio Eradication and Health Systems in Karachi: Vaccine Refusals in Context

ABSTRACT Community and health worker engagement will be key to polio eradication in Karachi, Pakistan. In this study, the authors conducted participant observation, interviews, and a document review in SITE Town, Karachi, an area that in recent years has harbored poliovirus. SITE’s diverse population includes large numbers of internally displaced persons who are disproportionately affected by polio and are more likely than other populations to refuse the polio vaccine. Vaccine acceptance and worker motivation in SITE Town were shaped by the discrepancy in funding and attention for polio eradication campaigns as compared with routine services. Parental vaccine refusals stemmed from a distrust of government and international actors that provided few services but administered polio vaccine door-to-door every month. Addressing this discrepancy could therefore be key to eliminating polio. The authors suggest short-term improvements to routine immunization and sanitation in key polio endemic areas, coupled with a long-term focus on sustainable improvements to routine immunization and broader health services.

Helmets and traffic injury outcomes: Findings from a setting lacking legislation on proper wearing and quality assessment

Abstract Objective: We assessed the effectiveness of helmet wearing for improving traffic injury outcomes in a setting lacking legislations on proper wearing and quality assessment of helmets. Methods: The study included motorcycle riders from Karachi, Pakistan, who were involved in a road traffic crash between 1 January 2007 and 30 September 2013. We estimated likelihoods of death and severe injury in riders wearing helmets compared to those not wearing them. Results: Only 6% (n = 6,092) of the 109 210 riders wore helmets. Helmet wearing was about 1% in pillion riders, women, and children. About 2% of riders died (n = 1,949) and 15% (n = 16,051) were hospitalized. About a third of riders (n = 37,439, 34%) suffered from head injuries, 30% (n = 33,130) had facial injuries, 46% (n = 50,264) had extremity injuries, and 61% (n = 67,094) had external body injuries. Those wearing helmets were less likely to die (adjusted odds ratio [aOR] = 0.37, 95% confidence interval [CI] = 0.28–0.50) or sustain a severe head injury (aOR = 0.70, 95% CI = 0.55–0.89) than others. The preventive effects however disappeared in high-impact collisions, e.g. heavy vehicles, head-on. Conclusion: Helmets effectively reduced the likelihood of deaths and serious head injuries in the injured motorcyclists in Pakistan. Improving legislation and enforcement could help further prevent deaths and serious head injuries in Pakistan and similar settings.

666 Human cost of “motorcycle mass transit”: report of 9,000 fatalities from Urban road injury surveillance in a developing country

Background Many of the burgeoning megacities in developing countries have witnessed poorly planned urban sprawls. The absence of a coherent mass public transport system encourages the acquisition of inexpensive motorcycles for commuting and this has distorted the traffic mix. In Karachi the proportion of motorcycles on the road has risen from 34% of registered vehicles to 55% over the past decade. We have sought to assess the impact of this on road use fatalities by analysis of data captured by ongoing road traffic injury surveillance based in 5 city hospitals. Methods The recorded road-use deaths were those dying within 30 days of being admitted to hospital and included cases brought dead to the EDs or the mortuaries of the hospitals. The case information included gender, age, number of vehicles involved in the crash, road-user type (motorcycle rider or pillion rider), helmet use and injury scoring. Results During 8 years, 2007–2014, motorcycle occupants accounted for 3901 of the 9192 fatalities and over the study period these increased from 36% to 53% of the recorded road deaths (p < 0.001). 69% of them were aged 35 years or less. Though most motorcycle collisions resulting in death involved heavy commercial vehicles, 185 fatalities resulted from motorcycle to motorcycle collisions. Of the 3253 pedestrian fatalities recorded, a motorcycle had struck 19% of them. Of the 2179 instances where a cause could be ascribed to the motorcycle fatality, over speeding was reported in over 50% and the top 6 roads for motorcyclist fatalities were signal-free corridors. Conclusions An escalating socio-economic tragedy is being played out in the urban centres of many developing countries by the juxtaposition of poor public transport and availability of inexpensive motorcycles. Our study suggests that while the implementation of mass transit schemes are awaited, strategies that segregate traffic and reduce speeds should be prioritised along with strict enforcement of helmet laws.

878 Surveillance in the service of safety

Background It has been recommended that the newly motorizing countries establish road injury surveillance to define the burden, identify high risk groups, plan intervention and monitor their impact. Despite its stated importance in the literature, very few examples of sustained surveillance systems are reported from low income countries. We present the results of an urban road injury surveillance program that has been running for the past 8 years in the emergency departments of five major hospitals in Karachi, Pakistan. Methods We describe the process of establishing the road injury surveillance system incorporating a multi-institution research group including physicians and transportation engineers. Data was collected from 5 hospitals with details of the injury, severity scoring and information of the circumstances of the crash. Crash site visits supplemented this data and the results were disseminated to municipal authorities along with low cost engineering solutions to rectify hazards in the road network. The impact of these interventions were monitored in the surveillance. Results In the 8 years between 2007 and 2014, 262,269 road injury victims were registered. Though 76% of the injuries were categorised as “minor”, 20% led to hospital admission and in 3% deaths occurred. The information on location of crashes and site visits led to an extensive catalogue of road network hazards and their rectification led to demonstrated reductions in crash frequency. Data was also used for safety advocacy in groups found to be vulnerable in the surveillance, such as motorcyclists, road sweepers and school going pedestrians. Conclusions We demonstrate that a functional road injury surveillance program can be established and effectively managed in a developing country. The data collected and analysed from the victim’s perspective can be a potent tool for effecting safety education and hazard rectification.

Political determinants of Health: Lessons for Pakistan

There is much concern about the capacity of the health system of Pakistan to meet its goals and obligations. Historically, the political thrust has been absent from the health policy formulation and this is reflected in the low and stagnant public allocations to health. Successive political leaderships have averred from considering healthcare is a common good rather than a market commodity and health has not been recognized as a constitutional right. Over 120 of world’s nation states have accepted health as a constitutional right but the 1973 Constitution of Pakistan does not mandate health or education as a fundamental right and the recently adopted 18th constitutional amendment missed the opportunity to extend access to primary health care as an obligation of the State. It is argued in this communication that missing from the calculations of policy formulation and agenda setting is the political benefits of providing health and other social services to underserved populations. Across the developing world, many examples are presented of governments undertaking progressive health reforms that bring services where none existed and subsequently reaping electoral benefit. The political determinant of healthcare will be realized when the political leaders of poorly performing countries can be convinced that embracing distributive policies and successfully bringing healthcare to the poor can be major factors in their re-elections.