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Iyizoba-Ebozue Z, Fatimilehin A, Kayani M, Khan A, McMahon M, Stewart S, Croney C, Sritharan K, Khan M, Obeid M, Igwebike O, Batool R, A-Hakim R, Aghadiuno T, Ruparel V, O'Reilly K. Unveiling Disparities: Exploring Differential Attainment in Postgraduate Training Within Clinical Oncology. Clin Oncol (R Coll Radiol) 2024; 36:e119-e127. [PMID: 38582627 DOI: 10.1016/j.clon.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/06/2024] [Accepted: 03/15/2024] [Indexed: 04/08/2024]
Abstract
AIMS Differential attainment (DA) in post graduate medical training is a recognised challenge and refers to unexplained variation across groups when split by several protected characteristics. The Royal College of Radiology is committed to fostering diversity, inclusivity, and equality with the goal of narrowing existing gaps and improving training outcomes. MATERIALS AND METHODS This was a mixed methods study aiming to understand the causes of DA with view to helping the RCR develop strategies to address this. A cross-sectional survey was completed by 140 clinical oncology trainees in September 2022. Trainees and trainers (17 and 6 respectively) from across England, Scotland, Wales and Northern Ireland, took part in focus group and interviews from August to December 2022. Quantitative and qualitative data merged and interpreted. RESULT Results showed international medical graduates and trainees from ethnic minority backgrounds were more likely to encounter challenges. The qualitative findings were used to identify three themes through which these problems could be framed. The trainee as a "space invader," the hidden curriculum of clinical oncology training and the process of navigating and tacking the training journey. CONCLUSION Differential attainment is the product of a complex interplay between the trainee, trainer, and the training environment. Therefore, interventions must be tailored to different people and contexts. At a national level, the RCR can adopt general policies to promote this such as mentorship programmes, protected time for supervision and cultural competency training. Efficacy of proposed interventions for trial and their impact on DA should be evaluated to drive evidence-based changes.
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Affiliation(s)
- Z Iyizoba-Ebozue
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK.
| | - A Fatimilehin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - M Kayani
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - A Khan
- Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - M McMahon
- Department of Clinical Oncology, Northern Ireland Cancer Centre, Northern Ireland, UK
| | - S Stewart
- Department of Clinical Oncology, University College London Hospital, London, UK
| | - C Croney
- Department of Clinical Oncology, Northern Ireland Cancer Centre, Northern Ireland, UK
| | - K Sritharan
- Department of Clinical Oncology, University College London Hospital, London, UK
| | - M Khan
- Department of Clinical Oncology, Northern Ireland Cancer Centre, Northern Ireland, UK
| | - M Obeid
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - O Igwebike
- Department of Clinical Oncology, Western Park Cancer Centre, Sheffield, UK
| | - R Batool
- Department of Clinical Oncology, The University Hospital Coventry, West midlands, UK
| | - R A-Hakim
- Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - T Aghadiuno
- Department of Clinical Oncology, Velindre Cancer Centre, Cardiff, Wales, UK
| | - V Ruparel
- Department of Clinical Oncology, Aberdeen Royal Infirmary, Aberdeen, Scotland UK
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Batool R. Contemplating the Human Papillomavirus (HPV) Vaccine Introduction in Pakistan: Is Now the Time? Am J Trop Med Hyg 2024; 110:631-632. [PMID: 38471175 PMCID: PMC10993827 DOI: 10.4269/ajtmh.23-0790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/20/2023] [Indexed: 03/14/2024] Open
Abstract
Human papillomavirus (HPV) vaccine introduction is anticipated in many countries in the coming years. This Perspective addresses the opportunities and challenges of introducing HPV vaccination in Pakistan. A substantial portion of the population within the high-risk age group necessitates the implementation of a robust vaccination strategy. Advocacy, community mobilization, and stakeholder engagement are the key elements for the successful implementation of the vaccination program. However, for long-term control strategies, a multifaceted approach is recommended. This approach should involve integrating HPV vaccination into the national immunization program, improving access to screening methods, and establishing comprehensive and cost-effective programs for preventing cervical cancer.
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Affiliation(s)
- Rabab Batool
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan; Centre for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Batool R, Qamar ZH, Salam RA, Yousafzai MT, Ashorn P, Qamar FN. Efficacy of typhoid vaccines against culture-confirmed Salmonella Typhi in typhoid endemic countries: a systematic review and meta-analysis. Lancet Glob Health 2024; 12:e589-e598. [PMID: 38485426 DOI: 10.1016/s2214-109x(23)00606-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 03/19/2024]
Abstract
BACKGROUND Typhoid is a serious public health threat in many low-income and middle-income countries. Several vaccines for typhoid have been recommended by WHO for typhoid prevention in endemic countries. This study aimed to review the efficacy of typhoid vaccines against culture-confirmed Salmonella enterica serovar Typhi. METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase for studies published in English between Jan 1, 1986 and Nov 2, 2023. We included randomised controlled trials (RCTs) comparing typhoid vaccines with a placebo or another vaccine. This meta-analysis evaluated the efficacy and safety of several typhoid vaccines, including live attenuated oral Ty21a vaccine, Vi capsular polysaccharide (Vi-PS), Vi polysaccharide conjugated to recombinant Pseudomonas aeruginosa exotoxin A vaccine (Vi-rEPA), and Vi-tetanus toxoid conjugate vaccine (TCV). The certainty of evidence for key outcomes was evaluated using Grading of Recommendations, Assessment, Development, and Evaluations methodology. The outcome of interest was typhoid fever confirmed by the isolation of Salmonella enterica serovar Typhi in blood and adverse events following immunisation. This study is registered with PROSPERO (CRD42021241043). FINDINGS We included 14 RCTs assessing four different vaccines (Ty21a: four trials; Vi-PS: five trials; Vi-rEPA: one trial; TCV: four trials) involving 585 253 participants. All trials were conducted in typhoid endemic countries and the age of participants ranged from 6 months to 50 years. The pooled efficacy against typhoid fever was 45% (95% CI 33-55%; four trials; 247 649 participants; I2 59%; moderate certainty) for Ty21a and 58% (44-69%; five trials; 214 456 participants; I2 34%; moderate certainty) for polysaccharide Vi-PS. The cumulative efficacy of two doses of Vi-rEPA vaccine at 2 years was 91% (88-96%; one trial; 12 008 participants; moderate certainty). The pooled efficacy of a single shot of TCV at 2 years post-immunisation was 83% (77-87%; four trials; 111 130 participants; I2 0%; moderate certainty). All vaccines were safe, with no serious adverse effects reported in the trials. INTERPRETATION The existing data from included trials provide promising results regarding the efficacy and safety of the four recommended typhoid vaccines. TCV and Vi-rEPA were found to have the highest efficacy at 2 years post-immunisation. However, follow-up data for Vi-rEPA are scarce and only TCV is pre-qualified by WHO. Therefore, roll-out of TCV into routine immunisation programmes in typhoid endemic settings is highly recommended. FUNDING There was no funding source for this study.
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Affiliation(s)
- Rabab Batool
- Department of Epidemiology and Biostatistics, Aga Khan University Hospital, Karachi, Pakistan; Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan; Centre for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Zoya Haq Qamar
- Liaquat National Hospital and Medical College, Karachi, Pakistan
| | | | - Mohammad Tahir Yousafzai
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan; The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Per Ashorn
- Centre for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Farah Naz Qamar
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan.
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Benedicto-Matambo P, Avolio LN, Badji H, Batool R, Khanam F, Munga S, Tapia MD, Peñataro Yori P, Awuor AO, Ceesay BE, Cornick J, Cunliffe NA, Garcia Bardales PF, Heaney CD, Hotwani A, Ireen M, Taufiqul Islam M, Jallow O, Kaminski RW, Shapiama Lopez WV, Maiden V, Ikumapayi UN, Nyirenda R, Ochieng JB, Omore R, Paredes Olortegui M, Pavlinac PB, Pisanic N, Qadri F, Qureshi S, Rahman N, Rogawski McQuade ET, Schiaffino F, Secka O, Sonye C, Sultana S, Timite D, Traore A, Yousafzai MT, Taufiqur Rahman Bhuiyan M, Jahangir Hossain M, Jere KC, Kosek MN, Kotloff KL, Qamar FN, Sow SO, Platts-Mills JA. Exploring Natural Immune Responses to Shigella Exposure Using Multiplex Bead Assays on Dried Blood Spots in High-Burden Countries: Protocol From a Multisite Diarrhea Surveillance Study. Open Forum Infect Dis 2024; 11:S58-S64. [PMID: 38532958 PMCID: PMC10962721 DOI: 10.1093/ofid/ofad650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
Background Molecular diagnostics on human fecal samples have identified a larger burden of shigellosis than previously appreciated by culture. Evidence of fold changes in immunoglobulin G (IgG) to conserved and type-specific Shigella antigens could be used to validate the molecular assignment of type-specific Shigella as the etiology of acute diarrhea and support polymerase chain reaction (PCR)-based microbiologic end points for vaccine trials. Methods We will test dried blood spots collected at enrollment and 4 weeks later using bead-based immunoassays for IgG to invasion plasmid antigen B and type-specific lipopolysaccharide O-antigen for Shigella flexneri 1b, 2a, 3a, and 6 and Shigella sonnei in Shigella-positive cases and age-, site-, and season-matched test-negative controls from all sites in the Enterics for Global Health (EFGH) Shigella surveillance study. Fold antibody responses will be compared between culture-positive, culture-negative but PCR-attributable, and PCR-positive but not attributable cases and test-negative controls. Age- and site-specific seroprevalence distributions will be identified, and the association between baseline antibodies and Shigella attribution will be estimated. Conclusions The integration of these assays into the EFGH study will help support PCR-based attribution of acute diarrhea to type-specific Shigella, describe the baseline seroprevalence of conserved and type-specific Shigella antibodies, and support correlates of protection for immunity to Shigella diarrhea. These insights can help support the development and evaluation of Shigella vaccine candidates.
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Affiliation(s)
- Prisca Benedicto-Matambo
- School of Biomedical Sciences and Health Professions, Department of Medical Laboratory Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Department of Clinical Infection, Microbiology and Immunology, Liverpool, UK
| | - Lindsay N Avolio
- Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Henry Badji
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Rabab Batool
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Farhana Khanam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Stephen Munga
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Milagritos D Tapia
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Pablo Peñataro Yori
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Alex O Awuor
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Bubacarr E Ceesay
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Jennifer Cornick
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Department of Clinical Infection, Microbiology and Immunology, Liverpool, UK
| | - Nigel A Cunliffe
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Department of Clinical Infection, Microbiology and Immunology, Liverpool, UK
| | | | - Christopher D Heaney
- Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Aneeta Hotwani
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Mahzabeen Ireen
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md Taufiqul Islam
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Ousman Jallow
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | | | - Victor Maiden
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
| | - Usman Nurudeen Ikumapayi
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Ruth Nyirenda
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
| | - John Benjamin Ochieng
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Richard Omore
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | | | - Patricia B Pavlinac
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Nora Pisanic
- Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Firdausi Qadri
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sonia Qureshi
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Nazia Rahman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Francesca Schiaffino
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
- Faculty of Veterinary Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ousman Secka
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Catherine Sonye
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Shazia Sultana
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Drissa Timite
- Centre pour le Développement des Vaccins du Mali, Bamako, Mali
| | - Awa Traore
- Centre pour le Développement des Vaccins du Mali, Bamako, Mali
| | | | - Md Taufiqur Rahman Bhuiyan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - M Jahangir Hossain
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Khuzwayo C Jere
- Malawi Liverpool Wellcome Programme, Blantyre, Malawi
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Department of Clinical Infection, Microbiology and Immunology, Liverpool, UK
- School of Life Sciences & Health Professions, Department of Medical Laboratory Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Margaret N Kosek
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Karen L Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Farah Naz Qamar
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Samba O Sow
- Centre pour le Développement des Vaccins du Mali, Bamako, Mali
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
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Batool R, Yousafzai MT, Qureshi S, Muhammad S, Qazi I, Sadaf T, Ashorn P, Qamar FN. Parental acceptance of typhoid conjugate vaccine for children aged 6 months to 15 years in an outbreak setting of Lyari Town Karachi, Pakistan. Vaccine 2023; 41:5376-5382. [PMID: 37463829 PMCID: PMC10448379 DOI: 10.1016/j.vaccine.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/18/2023] [Accepted: 07/02/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND This study aimed to evaluate the parental acceptance of Typhoid Conjugate Vaccine (TCV) and to determine the predictors of TCV vaccination status among children in an outbreak setting of extensively drug resistant (XDR) typhoid fever in Karachi, Pakistan. METHODS A cross-sectional survey using the WHO recommended rapid vaccine coverage assessment technique was conducted. Out of 11, four union councils (UCs) in Lyari Town were randomly selected. A parent or primary caretaker from the eligible household was interviewed. Data were collected using a locally validated vaccine attitudes scale (VAS). Sum of scores was calculated for VAS. A higher score denoted negative attitudes and perceptions regarding TCV and vice versa. Multivariable logistic regression was performed to determine the predictors of TCV vaccination status. RESULTS Based on the 14-item parental VAS, 78.0 % of the parents had a score between 0 to <40 and 22 % had a score ≥40. VAS score of <40 was significantly associated with higher odds of receiving TCV during the campaign setting (adjusted Odds Ratio (aOR): 1.30; 95 % Confidence Interval (CI): 1.02, 1.66). The odds of receiving TCV vaccination were higher among children whose parents were aware of the ongoing vaccination campaign in the area (aOR: 4.57; 95 % CI: 2.93, 7.12) and expressed willingness to get their child vaccinated against typhoid fever (aOR: 2.54; 95 % CI: 1.82, 3.55). CONCLUSION Parental awareness of the ongoing vaccination campaign, positive perception and attitudes towards vaccine were found to be significantly associated with TCV vaccination among children. Appropriately structured pre-vaccination awareness campaigns focused on childhood vaccination targeted towards parents are necessary to improve parental awareness, attitude and behavior towards vaccination.
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Affiliation(s)
- Rabab Batool
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Stadium Rd, PO Box 3500 Karachi 74800, Pakistan; Centre for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, Tampere 33520, Finland
| | - Mohammad Tahir Yousafzai
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Stadium Rd, PO Box 3500 Karachi 74800, Pakistan; The Kirby Institute, UNSW Sydney, Wallace Wurth Building High Street, UNSW Sydney, Kensington, NSW 2052, Australia
| | - Sonia Qureshi
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Stadium Rd, PO Box 3500 Karachi 74800, Pakistan
| | - Sajid Muhammad
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Stadium Rd, PO Box 3500 Karachi 74800, Pakistan
| | - Ibtisam Qazi
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Stadium Rd, PO Box 3500 Karachi 74800, Pakistan
| | - Tahira Sadaf
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Stadium Rd, PO Box 3500 Karachi 74800, Pakistan
| | - Per Ashorn
- Centre for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, Tampere 33520, Finland
| | - Farah Naz Qamar
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Stadium Rd, PO Box 3500 Karachi 74800, Pakistan.
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Batool R, Qureshi S, Haq Z, Yousafzai MT, Salam RA, Ali R, Sadaf T, Ali M, Qamar FN. Coverage survey of typhoid conjugate vaccine among children aged 6 months to 15 years in an urban slum settlement of Lyari Town Karachi, Pakistan. PLoS One 2023; 18:e0289582. [PMID: 37549155 PMCID: PMC10406246 DOI: 10.1371/journal.pone.0289582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/24/2023] [Indexed: 08/09/2023] Open
Abstract
OBJECTIVE To estimate the coverage rate of typhoid conjugate vaccine (TCV) among children aged 6 months to 15 years in Lyari Town Karachi, Pakistan. METHODS A cross-sectional survey was conducted to estimate the vaccine coverage of Typbar TCV in Lyari Town Karachi utilizing the World Health Organization (WHO) recommended rapid vaccine coverage assessment technique (30 clusters × 7 households). Sampling was powered at town level and multistage cluster sampling was used. Four union councils were randomly selected from a total of 11 and the survey was conducted in those union councils. After consent was obtained, parents of age-eligible children living in the selected union councils were invited to participate in the survey and information was collected on Typbar TCV vaccination status of children aged 6 months to 15 years. RESULTS Overall, 2325 children were included in the survey. The mean age of the participants was 7.60 ± 3.84 years. The ratio of males to females was equal in the survey sample; 1163 (50.02%) were male. In the total target population, 82% children were found to be vaccinated; however, the vaccination status could be verified for 80%. The vaccine coverage of TCV was comparable among the four union councils and the overall coverage of TCV vaccine in Lyari Town was found to be 80%. The coverage was significantly lower in younger children, 5% and 17% among children aged 6 months to < 2 years and 2 years to < 5 years respectively and 78% among children aged 5 years to 15 years. CONCLUSION The overall immunization coverage rate with TCV was found to be satisfactory. Immunization coverage was comparable among both sexes and the selected union councils but it was relatively low among children in younger age groups.
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Affiliation(s)
- Rabab Batool
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
- Center for Child, Adolescent, and Maternal Health, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sonia Qureshi
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Zoya Haq
- Liaqat National Hospital, Karachi, Pakistan
| | - Mohammad Tahir Yousafzai
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Rehana A. Salam
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Rafey Ali
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Tahira Sadaf
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Miqdad Ali
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Farah Naz Qamar
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
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Batool R. A Man Who Died of COVID-19 in Karachi. Am J Trop Med Hyg 2022; 107:10-11. [PMID: 35895376 PMCID: PMC9294712 DOI: 10.4269/ajtmh.22-0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/06/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Rabab Batool
- Aga Khan University, Paediatric Research and Child Health, Karachi, Sind, Pakistan, and Center for Child, Adolescent, and Maternal Health, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Batool R, Qureshi S, Yousafzai MT, Kazi M, Ali M, Qamar FN. Risk Factors Associated with Extensively Drug-Resistant Typhoid in an Outbreak Setting of Lyari Town Karachi, Pakistan. Am J Trop Med Hyg 2022; 106:tpmd211323. [PMID: 35344928 PMCID: PMC9128702 DOI: 10.4269/ajtmh.21-1323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/18/2022] [Indexed: 11/23/2022] Open
Abstract
Typhoid fever is endemic in Pakistan, with high annual incidence rates. An outbreak of extensively drug-resistant typhoid fever that first started in the Hyderabad District, Sindh Province, in November 2016 immediately spread to the entire province. We conducted an age-matched case-control study to assess the risk factors of typhoid fever in an outbreak setting of Lyari Town, Karachi. We enrolled 82 patients with blood culture-confirmed Salmonella typhi between August 2019 to December 2019, and 82 age-matched hospital and 164 age-matched community control subjects. In a matched conditional logistic regression model, consumption of meals outside the home more than once per month was associated significantly with developing culture-confirmed typhoid fever compared with no consumption of food outside the home (odds ratio, 4.11). Hygiene of the environment in which food is prepared, practices of adult food handlers, access to clean water, and food legislation play significant roles in the spread of typhoid fever.
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Affiliation(s)
- Rabab Batool
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi City, Sindh, Pakistan
- Center for Child, Adolescent, and Maternal Health, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sonia Qureshi
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi City, Sindh, Pakistan
| | - Mohammad Tahir Yousafzai
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi City, Sindh, Pakistan
| | - Momin Kazi
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi City, Sindh, Pakistan
| | - Miqdad Ali
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi City, Sindh, Pakistan
| | - Farah Naz Qamar
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi City, Sindh, Pakistan
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Batool R, Khan SW, Mohammad Imran, Barry Z, Sheikh Zafar Ali. Culture conversion and six months interim outcomes in retreatment cases of pulmonary MDRTB- a six month interim analysis. J PAK MED ASSOC 2021; 71:2710-2716. [DOI: 10.47391/jpma.1325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background: Multi-Drug Resistant Tuberculosis (MDRTB) is difficult to treat form of TB, retreatment of MDRTB patients is a more difficult area as patients have modified drug resistant patterns, more number of least effective drugs on the regimen and the cure rates are low.
Objectives: The Objectives of this study were to estimate the time to culture conversion and factors associated with failure to culture conversion, six months interim outcomes and associated risk factors with poor interim outcomes in MDRTB patients who had been previously treated with second line drugs.
Methods: The study was Prospective clinical case series study. All bacteriologically confirmed MDRTB retreatment patients enrolled between March-2016 to January-2017 at TB Clinic: The Indus Hospital and seven other Programmatic Management of Drug Resistant Tuberculosis (PMDT) sites (n=266) running under the umbrella of TB Clinic-The Indus Hospital were enrolled into the study.
Results:
Overall, 40.1% of MDR retreatment patients experienced poor interim outcome. Poor interim outcomes were significantly associated with higher number of drugs on the regimen, (OR= 1.27, 95% CI: 1.03-1.58) and high sputum smear grading (OR=4.56, 95% CI: 3.30-18.71). Almost 70.3% patients experienced culture conversion within initial six months of treatment.
Conclusion:
The success rate of retreatment of MDRTB with conventional regimen is unacceptably low.
Key words: Multi-drug Resistant Tuberculosis, Second Line Drugs, Culture Conversion, Interim Outcomes, Sputum Smear Microscopy
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Batool R, Tahir Yousafzai M, Qureshi S, Ali M, Sadaf T, Mehmood J, Ashorn P, Naz Qamar F. Effectiveness of typhoid conjugate vaccine against culture-confirmed typhoid in a peri-urban setting in Karachi: A case-control study. Vaccine 2021; 39:5858-5865. [PMID: 34465474 DOI: 10.1016/j.vaccine.2021.08.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/23/2021] [Accepted: 08/12/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Enteric fever, caused by Salmonella Typhi and S. Paratyphi, is a cause of high morbidity and mortality among children in South Asia. Rising antimicrobial resistance presents an additional challenge. Typhoid Conjugate Vaccines (TCV) are recommended by the World Health Organization for use among people 6 months to 45 years old living in endemic settings. This study aimed to assess the effectiveness of TCV against culture-confirmed S. Typhi in Lyari Town, Karachi, Pakistan. This peri-urban town was one of the worst affected by the outbreak of extensively drug resistant (XDR) typhoid that started in November 2016. METHODS A matched case-control study was conducted following a mass immunization campaign with TCV at three key hospitals in Lyari Town Karachi, Pakistan. Children aged 6 months to 15 years presenting with culture-confirmed S. Typhi were enrolled as cases. For each case, at least 1 age-matched hospital control and two age-matched community controls were enrolled. Adjusted odds ratios with 95% confidence intervals (CIs) were calculated using conditional logistic regression. RESULTS Of 82 typhoid fever patients enrolled from August 2019 through December 2019, 8 (9·8%) had received vaccine for typhoid. Of the 164 community controls and 82 hospital controls enrolled, 38 (23·2%) community controls and 27 (32·9%) hospital controls were vaccinated for typhoid. The age and sex-adjusted vaccine effectiveness was found to be 72% (95% CI: 34% - 88%). The consumption of meals prepared outside home more than once per month (adjusted odds ratio: 3·72, 95% CI: 1·55- 8·94; p-value: 0·003) was associated with the development of culture-confirmed typhoid. CONCLUSION A single dose of TCV is effective against culture confirmed typhoid among children aged 6 months to 15 years old in an XDR typhoid outbreak setting of a peri-urban community in Karachi, Pakistan.
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Affiliation(s)
- Rabab Batool
- Department of Pediatrics and Child Health, Aga Khan University Hospital, National Stadium Rd, Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan; Adolescent, and Maternal Health, Faculty of Medicine and Health Technology, Tampere University, Kalevantie 4, 33100 Tampere, Finland.
| | - Mohammad Tahir Yousafzai
- Department of Pediatrics and Child Health, Aga Khan University Hospital, National Stadium Rd, Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan; Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, High Street, Kensington, NSW 2052, Australia.
| | - Sonia Qureshi
- Department of Pediatrics and Child Health, Aga Khan University Hospital, National Stadium Rd, Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan.
| | - Miqdad Ali
- Department of Pediatrics and Child Health, Aga Khan University Hospital, National Stadium Rd, Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan.
| | - Tahira Sadaf
- Department of Pediatrics and Child Health, Aga Khan University Hospital, National Stadium Rd, Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan.
| | - Junaid Mehmood
- Department of Pediatrics and Child Health, Aga Khan University Hospital, National Stadium Rd, Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan.
| | - Per Ashorn
- Adolescent, and Maternal Health, Faculty of Medicine and Health Technology, Tampere University, Kalevantie 4, 33100 Tampere, Finland; Department of Paediatrics, Tampere University Hospital, Kalevantie 4, 33100 Tampere, Finland.
| | - Farah Naz Qamar
- Department of Pediatrics and Child Health, Aga Khan University Hospital, National Stadium Rd, Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan.
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Affiliation(s)
- Rabab Batool
- Paediatric Research and Child Health, Aga Khan University, Karachi, Pakistan
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Batool R, Khan SW, Imran M, Barry Z, Ali SZ. Treatment outcomes of the drug resistant tuberculosis cases previously exposed to second line anti Tuberculosis drugs in Pakistan: A multi-center cross-sectional study. J PAK MED ASSOC 2019; 69:4-10. [PMID: 30623904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To determine the treatment outcomes of the drug-resistant tuberculosis patients who were previously exposed to second line drugs. METHODS The retrospective study was conducted at eight Programmatic Management of Drug Resistant Tuberculosis (PMDT) sites in Sindh and Balochistan. Data of patients who were previously exposed to second line drugs and re-enrolled in the drug-resistant tuberculosis register at PMDT sites in Sindh and Balochistan between 2008 and 2016 was included for analysis. Data of those still under treatment or transferred to another treatment site was excluded. Association was explored between treatment outcomes and other independent variables, while in order to identify the risk factors associated with poor treatment outcomes univariate and multivariate logistic regression was used. RESULTS Overall, there were 3645 patients and 288(8%) were previously exposed to second line drugs. Of them, 95(33%) were excluded, and the final sample stood at 193; 99(51.3%) males and 94(48.7%) females. The median age of the sample was 29 years (inter-quartile range: 22-41 years). The mean duration of treatment was 20}11.14 months. Overall success rate of the re-treatment of previously treated patients was 105(54.4%). Observed relapse rate was 9(4.7%).. CONCLUSIONS The success rate for re-treatment drug-resistant tuberculosis patients was found to be unacceptably low. New drugs and novel regimens should be made widely available.
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Batool R, Salahuddin H, Mahmood T, Ismail M. Study of anticancer and antibacterial activities of Foeniculum vulgare, Justicia adhatoda and Urtica dioica as natural curatives. ACTA ACUST UNITED AC 2017; 63:109-114. [PMID: 28980930 DOI: 10.14715/cmb/2017.63.9.19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Indexed: 11/18/2022]
Abstract
High-throughput technologies, such as synthetic biology and genomics have paved new paths for discovery and utility of medicinally beneficial plants. Bioactive molecules isolated from different plants have significantly higher biological activities. The present study was done to analyze antibacterial potential of some medicinal plants against multi drug resistant (MDR) pathogens and anticancer effect against MCF-7 cell line. Methanolic and ethanolic extracts were tested for their antibacterial activity by disc diffusion method against six MDR bacterial strains and for cytotoxicity evaluation by MTT assay. Ethanolic extracts of the three tested plants exhibited growth inhibitory effect against Klebsiella pneumonia, Serratia marcescens and Methicillin-resistant S. aureus. Pseudomonas aeruginosa was more resistant to all extracts as its growth was least inhibited by the extracts of all tested plants. Ethanol extract of Foeniculum vulgare exhibited significant inhibition of cancer cells proliferation. Methanol extract of Justicia adhatoda also showed considerable inhibition of cancer cells. Future studies must converge on detailed investigation of modes of action of extracts of tested plants.
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Affiliation(s)
- R Batool
- Department of Plant Sciences, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad- 45320, Pakistan
| | - H Salahuddin
- Department of Plant Sciences, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad- 45320, Pakistan
| | - T Mahmood
- Department of Plant Sciences, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad- 45320, Pakistan
| | - M Ismail
- Institute of Biomedical and Genetic Engineering, Islamabad, Pakistan
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Salahuddin H, Mansoor Q, Batool R, Farooqi AA, Mahmood T, Ismail M. Anticancer activity of Cynodon dactylon and Oxalis corniculata on Hep2 cell line. Cell Mol Biol (Noisy-le-grand) 2016; 62:60-63. [PMID: 27188871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 04/28/2016] [Indexed: 06/05/2023]
Abstract
Bioactive chemicals isolated from plants have attracted considerable attention over the years and overwhelmingly increasing laboratory findings are emphasizing on tumor suppressing properties of these natural agents in genetically and chemically induced animal carcinogenesis models. We studied in vitro anticancer activity of organic extracts of Cynodon dactylon and Oxalis corniculata on Hep2 cell line and it was compared with normal human corneal epithelial cells (HCEC) by using MTT assay. Real Time PCR was conducted for p53 and PTEN genes in treated cancer cell line. DNA fragmentation assay was also carried out to note DNA damaging effects of the extracts. The minimally effective concentration of ethanolic extract of Cynodon dactylon and methanolic extract of Oxalis corniculata that was nontoxic to HCEC but toxic to Hep2 was recorded (IC50) at a concentration of 0.042mg/ml (49.48 % cell death) and 0.048mg/ml (47.93% cell death) respectively, which was comparable to the positive control. Our results indicated dose dependent increase in cell death. P53 and PTEN did not show significant increase in treated cell line. Moreover, DNA damaging effects were also not detected in treated cancer cell line. Anticancer activity of these plants on the cancer cell line showed the presence of anticancer components which should be characterized to be used as anticancer therapy.
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Affiliation(s)
- H Salahuddin
- Institute of Biomedical and Genetic Engineering Islamabad Pakistan
| | - Q Mansoor
- Institute of Biomedical and Genetic Engineering Islamabad Pakistan
| | - R Batool
- Quaid-e-Azam University Department of Plant Sciences Islamabad Pakistan
| | - A A Farooqi
- Institute of Biomedical and Genetic Engineering Islamabad Pakistan
| | - T Mahmood
- Quaid-e-Azam University Department of Plant Sciences Islamabad Pakistan
| | - M Ismail
- Institute of Biomedical and Genetic Engineering Islamabad Pakistan
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Batool R, Hasnain S. Phytostimulatory effects of chromium reducing ochrobactrum intermedium and Pseudomonas aeruginosa on Triticum aestivum Growth. N Biotechnol 2009. [DOI: 10.1016/j.nbt.2009.06.887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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