Availability and readiness of primary healthcare facilities for the management of non-communicable diseases in different districts of Punjab, Pakistan.

Introduction: Non-communicable diseases (NCDs) and their effects are rising quickly. NCDs such as cardiovascular illnesses, diabetes, cancer, and chronic lung diseases cause 60% of global deaths; of which, 80% occur in developing countries. In established health systems, primary healthcare handles most of the NCD care. Methodology: This is a mixed-method study conducted to analyze the health service availability and readiness toward NCDs using the SARA tool. It included 25 basic health units (BHUs) of Punjab, which were selected through random sampling. Quantitative data were collected using the SARA tools, while qualitative data were collected through in-depth interviews with healthcare providers working at the BHUs. Results: There was a problem of load shedding of both electricity and water in 52% of the BHUs, which leads to the poor availability of healthcare services. Only eight (32%) out of 25 BHUs provide the diagnosis or management of NCDs. The service availability was the highest for diabetes mellitus (72%), followed by cardiovascular disease (52%) and then chronic respiratory disease (40%). No services were available for cancer at the BHU level. Conclusion: This study raises issues and questions about the primary healthcare system in Punjab in two areas: first, the overall performance system, and second, the readiness of basic healthcare institutions to treat NCDs. The data show that there are many persisting primary healthcare (PHC) deficiencies. The study found a major training and resource deficit (guidelines and promotional materials). Therefore, it is important to include NCD prevention and control training in district training activities. NCDs are underrecognized in primary healthcare (PHC).

Determining critical gaps in implementation of WHO and UNICEF's 7-point plan in diarrhoea control and prevention strategy: A cross sectional study in District Swabi, Pakistan.

OBJECTIVE: To determine the critical gaps in knowledge and practices of mothers/caregivers in the management of diarrhoea in children at home. METHODS: The descriptive cross-sectional study was conducted from September 2019 to August 2020 at primary health centres across Swabi district of the Khyber Pakhtunkhwa province of Pakistan, and comprised mothers/caregivers presenting with children aged <5 years suffering from diarrhoea. Barriers to childhood diarrhoea prevention and control were identified in accordance with the 7-point plan adopted by the federal government in 2009. Data was analysed using SPSS 23. RESULTS: There were 287 mothers with a mean age of 26.8±5.39 years (range: 17-42 years). The mean age of the children was 24.85±12.72 months (range: 2-55 months). Among the mothers, 145 (51.5%) had received no schooling, 83(29%) had primary level schooling, 56(19.5%) secondary level and 3(1%) had received higher-level education. Only 63(22%) were aware of the use of oral rehydration salts and 32(11%) knew about the need of using zinc in diarrhoea. Safe water was available in 14(5%) households. Hand hygiene awareness was low, as 169(59%) mothers were washing hands with soap. Household access to toilet facility was 247(86%). Preventive health services were good with overall breastfeeding practices 204(71%) and children vaccination 244(85%.). CONCLUSIONS: Majority of mothers were found to be well aware of breastfeeding practices and the children had adequate vaccination coverage. There was a wide gap in direct awareness and practices of mothers about sanitation and hygiene and also home-based management of diarrhoeal diseases in children.

A technique for measuring the frictional torque of articular cartilage and replacement biomaterials.

Understanding the tribological behaviour of articular cartilage enables the development of effective replacement biomaterials. This study presents a technique for the investigation of the frictional torque of articular cartilage, for the assessment of replacement biomaterials. A calcium alginate hydrogel was used as the biomaterial for this study. Three different specimen types were examined to include articular cartilage, calcium alginate hydrogel, alone, and in combination with articular cartilage. An axial load, varying from 10 to 100 N, was applied to the specimen and the frictional torque measured whilst an indenter underwent axial rotation from 0° to 2° to 0° for 100 cycles. The resulting frictional torque magnitude was evaluated with a smooth curve fitting function. Linear regression identified a statistically significant relationship between torque magnitude and axial load (p < 0.05) for all specimen variations. From 10 to 100 N of applied load, mean torque magnitude ranged from 0.08±0.010 to 0.11±0.013 N m, 0.08±0.012 to 0.09±0.016 N m and 0.07±0.017 to 0.09±0.020 N m (mean ± standard deviation), for articular cartilage, calcium alginate separately and in combination with articular cartilage, respectively. This study has established a suitable frictional torque testing protocol for potential cartilage replacement biomaterials.

A method for the assessment of the coefficient of friction of articular cartilage and a replacement biomaterial.

Replacement biomaterials for articular cartilage should encourage a coefficient of friction similar to the natural joint. Whilst the literature has assessed the coefficient of friction of articular cartilage against that of a potential biomaterial, it is unknown what the friction of articular cartilage in sliding against a surface defect, repaired with a biomaterial is. This evaluation is crucial to allow for the development of effective biomaterials to closely have the behaviour of articular cartilage. Thus, the aim of this study was to develop a novel technique for the assessment of the coefficient of friction of replacement biomaterials within articular cartilage, with this original testing configuration. For this study, a biomaterial was induced within an artificial defect perforated on the surface of bovine articular cartilage, whilst the material was assessed in sliding against articular cartilage itself. Calcium alginate was selected as the sample biomaterial for evaluation in this study. The tests were performed in sliding on a pin-on-disc tribometer in Ringer's solution. Two further tests were carried out, one as a benchmark comparison of a cartilage pin against a cartilage plate, as well as a cartilage pin against an aluminium plate. A constant induced stress of 0.06 MPa was applied at a frequency of 1 Hz. For the cartilage-cartilage, cartilage/hydrogel-cartilage and cartilage-aluminium test, the overall median coefficient of friction extracted across six repeats was of 0.36, 0.38 and 0.32, respectively. Statistical insignificance was identified across all three groups tested (p > 0.05). Similarity was observed in the coefficient of friction of cartilage-cartilage and cartilage/hydrogel-cartilage tests, however high-speed data identified the greatest wear for the cartilage/hydrogel-cartilage test.

Effectiveness of a mobile health intervention on infant and young child feeding among children ≤ 24 months of age in rural Islamabad over six months duration.

Background: Childhood development is highly influenced by feeding practices at the infancy and young age of children. Unfortunately, according to the National Nutrition Survey (2011), the prevalence of exclusive breastfeeding in Pakistan was 21% at four months, and 13% at six months of age with 51.3% of mothers initiating semisolid foods to their children at the recommended 6-8 months of age. The latest Pakistan Demographic & Health Survey (PDHS 2018) however; indicates that only 48% of infants are exclusively breastfed which has been improved from 38% as reported in the past five years but still more improvement is anticipated. Methods: A quasi-experimental study design was employed for this post-intervention survey assessing effectiveness of mobile health (mhealth) regarding infant & young child feeding (IYCF) among pregnant and lactating mothers in Tarlai, Islamabad from May to June 2018. A total of 135 mothers who were earlier included in the intervention phase were recruited after obtaining verbal & written consent. The data was entered in EpiData (3.1) and analyzed in SPSS version 21. Results: The mean age of these pregnant and lactating mothers was 30.5 years ± 4.5 SD with the majority of mothers in the age group of 25 to 29 years. After the intervention, the overall knowledge of mothers regarding IYCF nutrition was raised to 69.6% among 94 mothers as compared to 74 (54.8%). Overall attitude regarding IYCF was found to be positive among 86 (63.7%) of the mothers, whereas 88 (65.2%) of the mothers had good IYCF related practices. Conclusion: Our post-intervention survey signifies the effectiveness of mhealth in raising knowledge, attitude, and practices of mothers regarding IYCF in rural Islamabad. However, implementation of mhealth in masses requires future research specifically to address the cost-effectiveness of such interventions in maternal & child health programmes.

Surface damage of bovine articular cartilage-off-bone: the effect of variations in underlying substrate and frequency.

BACKGROUND: Changes in bone mineral density have been implicated with the onset of osteoarthritis, but its role in inducing failure of articular cartilage mechanically is unclear. This study aimed to determine the effect of substrate density, as the underlying bone, on the surface damage of cartilage-off-bone, at frequencies associated with gait, and above. METHODS: Bovine articular cartilage samples were tested off-bone to assess induced damage with an indenter under a compressive sinusoidal load range of 5-50 N at frequencies of 1, 10 and 50 Hz, corresponding to normal and above normal gait respectively, for up to 10,000 cycles. Cartilage samples were tested on four underlying substrates with densities of 0.1556, 0.3222, 0.5667 and 0.6000 g/cm3. India ink was applied to identify damage as cracks, measured across their length using ImageJ software. Linear regression was performed to identify if statistical significance existed between substrate density, and surface damage of articular cartilage-off-bone, at all three frequencies investigated (p < 0.05). RESULTS: Surface damage significantly increased (p < 0.05) with substrate density at 10 Hz of applied frequency. Crack length at this frequency reached the maximum of 10.95 ± 9.12 mm (mean ± standard deviation), across all four substrates tested. Frequencies applied at 1 and 50 Hz failed to show a significant increase (p > 0.05) in surface damage with an increase in substrate density, at which the maximum mean crack length were 3.01 ± 3.41 mm and 5.65 ± 6.54 mm, respectively. Crack formation at all frequencies tended to form at the periphery of the cartilage specimen, with multiple straight-line cracking observed at 10 Hz, in comparison to single straight-line configurations produced at 1 and 50 Hz. CONCLUSIONS: The effect of substrate density on the surface damage of articular cartilage-off-bone is multi-factorial, with an above-normal gait frequency. At 1 Hz cartilage damage is not associated with substrate density, however at 10 Hz, it is. This study has implications on the effects of the factors that contribute to the onset of osteoarthritis.

OBSERVANCE OF WHO TEN STEPS TOWARDS SUCCESSFUL BREASTFEEDING; A SURVEY FROM POSTPARTUM MOTHERS.

BACKGROUND: Breastfeeding is a physiological phenomenon; nonetheless, this act is a learned behaviour that requires continuous active support to make it successful. This study determines the frequency of mothers practicing successful breastfeeding according to the WHO ten steps at tertiary care hospital. METHODS: A descriptive cross sectional study was conducted in the Obstetrics department of Military Hospital, Rawalpindi over six month duration from July to December 2014. Booked mothers aged 15-49 years, having given birth to healthy, singleton baby were included in the study. Questions were asked after taking written informed consent from the mothers after delivery. Data was entered and analysed on SPSS version 20. RESULTS: Out of 148 mothers, 35 (23.7%) mothers were following successful breastfeeding, i.e., knew 7 or more steps. A total of 100 (67.6%) mothers received support for breastfeeding by healthcare staff during their stay in hospital while 19 (12.8%) mothers started breastfeeding within one hour. About 71% had started formula milk along with breastfeeding. About 127 (85.8%) reported that they fed their children on demand and 144 (97.3%) did not use dummies. Statistically significant difference was observed as housewife mothers gave no top feed (p = 0.005) and multiparous mothers started breastfeeding within one hour of delivery (p = 0.04). CONCLUSION: The steps to achieve successful breastfeeding are followed to a small extent among mothers. Delayed initiation of breastfeeding and increasing trend towards use of formula feed was observed. Employed, primiparous mothers are the most sensitive group to be focused during antenatal period.

Effects of male literacy on family size: A cross sectional study conducted in Chakwal city.

OBJECTIVE: To determine the effects of male education on family size, the desired family size, knowledge and use of contraception and opinion about female education. METHODS: The cross-sectional study was carried out in Chakwal city, Punjab, Pakistan, from June to October 2009. A pre-tested questionnaire was used for data collection. The respondents were males and data on their demographics, age at marriage, actual and desired family size, knowledge about methods of contraception, and opinion about female education was collected. SPSS 15 was used for statistical analysis. RESULTS: Out of the 178 respondents, 52(29.2%) were illiterate and 126(70.8%) were educated. Among the educated, 97(77%) were in favour of small families compared to only 10(19.2%) of the uneducated males (p< 0.001). Besides, 118 (93.6%) educated males were aware of any method of contraception. The most important source of awareness was television 45(37.8%) followed by lady health visitors 40(33.9%). Among the respondents, 38(21.3%) were not using any contraceptive method because they considered it unIslamic, 16(9.1%) had fear of side effects, 57(32.0%) were desirous of large families, while 67(37.6%) had other reasons, like trying to conceive. Among the uneducated males, 17(32.7%) didn't discuss any family planning issue with their wives compared to 14(11.3%) of educated males (p< 0.001). CONCLUSIONS: Educational status of the males had an effect on the desired family size, contraceptive use and views in favour of female education.