Browsing by Author "Khowaja, Saira"
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- ItemEngaging the private sector to increase tuberculosis case detection: an impact evaluation study.(2012-07-27) Khan, Aamir J; Khowaja, Saira; Khan, Faisal S; Qazi, Fahad; Lotia, Ismat; Habib, Ali; Mohammed, Shama; Khan, Uzma; Amanullah, Farhana; Hussain, Hamidah; Becerra, Mercedes C; Creswell, Jacob; Keshavjee, SalmaanBACKGROUND In many countries with a high burden of tuberculosis most patients receive treatment in the private sector We evaluated a multifaceted case detection strategy in Karachi Pakistan targeting the private sector METHODS A year long communications campaign advised people with 2 weeks or more of productive cough to seek care at one of 54 private family medical clinics or a private hospital that was also a national tuberculosis programme NTP reporting centre Community laypeople participated as screeners using an interactive algorithm on mobile phones to assess patients and visitors in family clinic waiting areas and the hospital s outpatient department Screeners received cash incentives for case detection Patients with suspected tuberculosis also came directly to the hospital s tuberculosis clinic self referrals or were referred there referrals The primary outcome was the change from 2010 to 2011 in tuberculosis notifications to the NTP in the intervention area compared with that in an adjacent control area FINDINGS Screeners assessed 388 196 individuals at family clinics and 81 700 at Indus Hospital s outpatient department from January December 2011 A total of 2416 tuberculosis cases were detected and notified via the NTP reporting centre at Indus Hospital 603 through family clinics 273 through the outpatient department 1020 from self referrals and 520 from referrals In the intervention area overall tuberculosis case notification to the NTP increased two times from 1569 to 3140 cases from 2010 to 2011 a 2 21 times increase 95 CI 1 93 2 53 relative to the change in number of case notifications in the control area From 2010 to 2011 pulmonary tuberculosis notifications at Indus Hospital increased by 3 77 times for adults and 7 32 times for children INTERPRETATION Novel approaches to tuberculosis case finding involving the private sector and using laypeople mobile phone software and incentives and communication campaigns can substantially increase case notification in dense urban settings FUNDING TB REACH Stop TB Partnership
- ItemAn evaluation of systematic tuberculosis screening at private facilities in Karachi, Pakistan.(2014-04-07) Creswell, Jacob; Khowaja, Saira; Codlin, Andrew; Hashmi, Rabia; Rasheed, Erum; Khan, Mubashir; Durab, Irfan; Mergenthaler, Christina; Hussain, Owais; Khan, Faisal; Khan, Aamir JIn Pakistan like many Asian countries a large proportion of healthcare is provided through the private sector We evaluated a systematic screening strategy to identify people with tuberculosis in private facilities in Karachi and assessed the approaches ability to diagnose patients earlier in their disease progression
- ItemGeographic variation in access to dog-bite care in Pakistan and risk of dog-bite exposure in Karachi: prospective surveillance using a low-cost mobile phone system.(2013-12-18) Zaidi, Syed Mohammad Asad; Labrique, Alain B; Khowaja, Saira; Lotia-Farrukh, Ismat; Irani, Julia; Salahuddin, Naseem; Khan, Aamir JavedBACKGROUND Dog bites and rabies are under reported in developing countries such as Pakistan and there is a poor understanding of the disease burden We prospectively collected data utilizing mobile phones for dog bite and rabies surveillance across nine emergency rooms ER in Pakistan recording patient health seeking behaviors access to care and analyzed spatial distribution of cases from Karachi METHODOLOGY AND PRINCIPAL FINDINGS A total of 6212 dog bite cases were identified over two years starting in February 2009 with largest number reported from Karachi 59 7 followed by Peshawar 13 1 and Hyderabad 11 4 Severity of dog bites was assessed using the WHO classification Forty percent of patients had Category I least severe bites 28 1 had Category II bites and 31 9 had Category III most severe bites Patients visiting a large public hospital ER in Karachi were least likely to seek immediate healthcare at non medical facilities Odds Ratio 0 20 95 CI 0 17 0 23 p valueUnder0 01 and had shorter mean travel time to emergency rooms adjusted for age and gender 32 78 min 95 CI 31 82 33 78 p valueUnder0 01 than patients visiting hospitals in smaller cities Spatial analysis of dog bites in Karachi suggested clustering of cases Moran s I 0 02 p valueUnder0 01 and increased risk of exposure in particular around Korangi and Malir that are adjacent to the city s largest abattoir in Landhi The direct cost of operating the mHealth surveillance system was USD 7 15 per dog bite case reported or approximately USD 44 408 over two years CONCLUSIONS Our findings suggest significant differences in access to care and health seeking behaviors in Pakistan following dog bites The distribution of cases in Karachi was suggestive of clustering of cases that could guide targeted disease control efforts in the city Mobile phone technologies for health mHealth allowed for the operation of a national level disease reporting and surveillance system at a low cost