Characteristics of pipe corrosion scales in untreated water distribution system and effect on water quality in Peshawar, Pakistan.

This study investigated the characteristics of iron corrosion scales in pipes at tube well, overhead tank, and consumers' end in older untreated water distribution system in Peshawar city, Pakistan. Effect of water quality conditions on corrosion scales and that of scales on drinking water quality in such systems was also assessed by undertaking a comparison with new piped distribution systems. The scales were analyzed for chemical composition and morphology using X-ray diffraction (XRD), inductively coupled plasma (ICP), and a scanning electron microscope (SEM), while water quality was examined for physicochemical and biological characteristics. The main crystalline phases of corrosion scales were goethite, magnetite, siderite, and quartz. From tube well to consumers' end, goethite increased from 36 up to 48%, quartz declined from 22 to 15%, while magnetite fluctuated and siderite disappeared. Elemental composition of scales showed the deposition of Zn, Al, Mn, Cr, Pb, Cu, As, and Cd with Zn (13.9 g/kg) and Al (3.6 g/kg) in highest proportion. The SEM analysis illustrated the presence of microbial communities indicating the formation of biofilms in the corrosion scales. The significant difference (P < 0.05) in levels of dissolved oxygen (DO), Cl-, SiO44-, electrical conductivity (EC), SO42-, NO3-, alkalinity, hardness, and trace metals between old (DS-O) and new piped systems indicated their role in corrosion scale formation/destabilization and the effect of scale dissolution on water quality. In DS-O, EC, Cu, and Mn were significantly higher (P < 0.05), whereas turbidity, EC, DO, and SiO44- significantly increased from source to consumers' end implying a higher dissolution of scales and lowered corrosion rates in DS-O to utilize SiO44- and DO for iron oxidation.

Compliance to timely vaccination in an Expanded Program on Immunization center of Pakistan.

The importance of childhood immunization in prevention of highly fatal diseases and disability cannot be overemphasized. Pakistan has a national Expanded Program on Immunization but the compliance is far below the international benchmark for achieving a herd immunity. Monitoring the compliance to timely receipt of vaccinations is crucial to establishing and preventing disease and disability associated risk in children. There is little or no evidence that reports the timeliness of the vaccinations according to the EPI schedule in Peshawar. The primary objective of the study was to evaluate rate of Fully Immunized Children and to report compliance to the timeliness of vaccine specific schedule during the study period in the EPI center in the capital city of Peshawar, Khyber Pakhtunkhwa province of Pakistan. We collected consecutive retrospective data of the infants enrolled from June 2014 to December 2015 in one EPI center for our study. Out of the total 157 (n) children, fully immunized children (FIC) were 62 (39.5%) and only 19 (12.1%) were FIC with timely visits. Dropouts increased with successive vaccinations with highest for Measles 1 (42%). On-time vaccinations decreased over time, while the proportion of children receiving vaccination outside the ideal window period reaches as high as 46%. The study reports a low compliance to EPI schedule, and also highlights that immunization coverage is not a good indicator of age appropriate vaccinations.

Prevalence of selected pharmaceuticals in surface water receiving untreated sewage in northwest Pakistan.

This study investigated the occurrence of four non-steroidal anti-inflammatory drugs (NSAIDs) and four benzodiazepines/anti-depressants (ADs) in municipal wastewater in Mardan city, Pakistan, and in River Kabul and River Indus receiving untreated sewage. Liquid chromatography with a triple quadrupole tandem mass spectrometry (LC-MS/MS) was used for the analysis of paracetamol, diclofenac, ibuprofen, and codeine (NSAIDs) and diazepam, bromazepam, lorazepam, and temazepam (ADs). Except codeine and lorazepam, all the target compounds were observed in sewage and surface water in various concentrations. In sewage, paracetamol was found at the higher end (32.4 µg/L) of the reported ranges in literature for other countries. Results of river samples showed that the target compounds were usually lower in concentration than the respective EC50 values for aquatic organisms. However, the levels for paracetamol and ibuprofen were critical depicting the consequence of untreated disposal. Environmental risk assessment by estimating the risk quotient (RQ) as the ratio of measured environmental concentration and predicted no-effect concentration showed medium to high (RQ > 1 and 0.1 < RQ < 1) risk from paracetamol and ibuprofen to aquatic organisms in River Kabul and Kalpani stream, Pakistan.

Introducing a structured prescription form improves the quality of handwritten prescriptions in limited resource setting of developing countries.

INTRODUCTION: Incomplete or illegible prescriptions can lead to serious errors in administration of the prescribed medication, which can become hazardous. OBJECTIVE: Our aim is to determine if a structured prescription form can improve the quality of handwritten prescription in terms of completeness and legibility. METHODS: We conducted a prospective, non-randomized, time series study of quality of written prescriptions of general practitioners at a tertiary teaching hospital in Peshawar, Pakistan. The study involved an intervention, composed of the introduction of a pre-printed structured prescription form. The data were collected within 4 weeks including a 2-week pre-intervention phase and 2-week post-intervention phase. Completeness, quality of prescriptions and legibility were compared before and after the intervention of the pre-printed structured prescription form. RESULTS: A total of 463 prescriptions were obtained (260 in the pre-intervention phase and 203 in the post-intervention phase). Between pre-intervention phase and post-intervention phase, the Pakistan Medical and Dental Council registration number presence in prescriptions improved from 73.1% to 100% (P < 0.0005). The presence of prescriber's signature improved from 92.7% to 99% (P = 0.001). Drug duration was not missing in 99.5% in post-intervention phase as compared with 90.4% in pre-intervention phase (P < 0.0005). Prescriptions with no legibility problems improved from 76.2% to 94.1% (P < 0.0005). Although not statistically significant, prescriptions in which drug dosage was not missing improved from 85% to 90.6% (P = 0.07). LIMITATIONS: We have a limited single-center study. A larger study in multiple settings is needed to develop adequate evidence for such interventions. Subjective nature of prescription legibility can also be considered as a limitation. CONCLUSION: Structuring a prescription form alone may improve certain aspects of quality of written prescription in terms of completeness and legibility.