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A
Stanback J, Qureshi ZP, Sekkade-Kigondu C. "Advance provision of oral contraceptives to family planning clients in Kenya.". 2002. AbstractWebsite

In sub-Saharan Africa, many family planning programmes do not encourage advance provision of oral contraceptives to clients who must wait until menses to initiate pill use. Since some resistance to advance provision of pills is due to provider fears that the practice may be harmful, we conducted a study in Kenya in 1997 to compare pill-taking outcomes between 20 "advance provision" clients and 280 "standard" clients.

Prospective observational study.

Six family planning clinics in Central and Western Kenya.

Women presenting as new clients at MOH family planning clinics.

Researchers used prospective tracking to compare indicators of pill-taking success between non-menstruating clients given pills to carry home for later use and menstruating clients who began pill use immediately.

Pill-taking outcomes such as side effects, compliance, knowledge, satisfaction, and a continuation proxy.

Among clients returning for re-supply, those receiving advance provision of pills did no worse than, and often had superior outcomes to, their counterparts who started taking pills immediately after the clinic visit.

Advance provision of pills, already practiced worldwide, is safe and feasible. Explicit mention should be made of advance provision of pills in national family planning guidance documents and training curricula in Kenya and throughout sub-Saharan Africa.

Gwako G, Qureshi Z, Kudoyi W, Were F. "Antenatal corticosteroid use in preterm birth at Kenyatta National Hospital." J. Obst. Gynae. East Central. Afr. 2013;25(1):3-9 .
Vogel JP, Oladapo OT, Pileggi-Castro C, Adejuyigbe EA, Althabe F, Ariff S, Ayede AI, Baqui AH, Costello A, Chikamata DM, Crowther C, Fawole B, Gibbons L, Jobe AH, Kapasa ML, Kinuthia J, Kriplani A, Kuti O, Neilson J, Patterson J, Piaggio G, Qureshi R, Qureshi Z, Sankar MJ, Stringer JSA, Temmerman M, Yunis K, Bahl R, Gülmezoglu AM. "Antenatal corticosteroids for women at risk of imminent preterm birth in low-resource countries: the case for equipoise and the need for efficacy trials." British Medical Journal Global Health. 2017;2(3). AbstractWebsite

The scientific basis for antenatal corticosteroids (ACS) for women at risk of preterm birth has rapidly changed in recent years. Two landmark trials-the Antenatal Corticosteroid Trial and the Antenatal Late Preterm Steroids Trial-have challenged the long-held assumptions on the comparative health benefits and harms regarding the use of ACS for preterm birth across all levels of care and contexts, including resource-limited settings. Researchers, clinicians, programme managers, policymakers and donors working in low-income and middle-income countries now face challenging questions of whether, where and how ACS can be used to optimise outcomes for both women and preterm newborns. In this article, we briefly present an appraisal of the current evidence around ACS, how these findings informed WHO's current recommendations on ACS use, and the knowledge gaps that have emerged in the light of new trial evidence. Critical considerations in the generalisability of the available evidence demonstrate that a true state of clinical equipoise exists for this treatment option in low-resource settings. An expert group convened by WHO concluded that there is a clear need for more efficacy trials of ACS in these settings to inform clinical practice.

Keywords: antenatal corticosteroids; neonatal mortality; preterm birth.

C
Sanchez JL, Johns MC, Burke RL, Vest KG, Fukuda MM, Yoon IK, Lon C, Quintana M, Schnabel DC, Pimentel G, Mansour M, Tobias S, Montgomery JM, Gray GC, Saylors K, Ndip LM, Lewis S, Blair PJ, Sjoberg PA, Kuschner RA, Russell KL, Blazes DL, Witt CJ, Money NN, Gaydos JC, Pavlin JA, Gibbons RV, Jarman RG, Stoner M, Shrestha SK, Owens AB, Iioshi N, Osuna MA, Martin SK, Gordon SW, Bulimo WD, Waitumbi DJ, Assefa B, Tjaden JA, Earhart KC, Kasper MR, Brice GT, Rogers WO, Kochel T, Laguna-Torres VA, Garcia J, Baker W, Wolfe N, Tamoufe U, Djoko CF, Fair JN, Akoachere JF, Feighner B, Hawksworth A, Myers CA, Courtney WG, Macintosh VA, Gibbons T, Macias EA, Grogl M, O'Neil MT, Lyons AG, Houng HS, Rueda L, Mattero A, Sekonde E, Sang R, Sang W, Palys TJ, Jerke KH, Millard M, Erima B, Mimbe D, Byarugaba D, Wabwire-Mangen F, Shiau D, Wells N, Bacon D, Misinzo G, Kulanga C, Haverkamp G, Kohi YM, Brown ML, Klein TA, Meyers M, Schoepp RJ, Norwood DA, Cooper MJ, Maza JP, Reeves WE, Guan J. "Capacity-building efforts by the AFHSC-GEIS program." BMC Public Health. 2011;11 Suppl 2:S4. AbstractWebsite

Capacity-building initiatives related to public health are defined as developing laboratory infrastructure, strengthening host-country disease surveillance initiatives, transferring technical expertise and training personnel. These initiatives represented a major piece of the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) contributions to worldwide emerging infectious disease (EID) surveillance and response. Capacity-building initiatives were undertaken with over 80 local and regional Ministries of Health, Agriculture and Defense, as well as other government entities and institutions worldwide. The efforts supported at least 52 national influenza centers and other country-specific influenza, regional and U.S.-based EID reference laboratories (44 civilian, eight military) in 46 countries worldwide. Equally important, reference testing, laboratory infrastructure and equipment support was provided to over 500 field sites in 74 countries worldwide from October 2008 to September 2009. These activities allowed countries to better meet the milestones of implementation of the 2005 International Health Regulations and complemented many initiatives undertaken by other U.S. government agencies, such as the U.S. Department of Health and Human Services, the U.S. Agency for International Development and the U.S. Department of State.

Queenan AM, Bush K. "Carbapenemases: the versatile beta-lactamases." Clinical Microbiology Reviews. 2007;20:440-458, table of contents. Abstract

Carbapenemases are beta-lactamases with versatile hydrolytic capacities. They have the ability to hydrolyze penicillins, cephalosporins, monobactams, and carbapenems. Bacteria producing these beta-lactamases may cause serious infections in which the carbapenemase activity renders many beta-lactams ineffective. Carbapenemases are members of the molecular class A, B, and D beta-lactamases. Class A and D enzymes have a serine-based hydrolytic mechanism, while class B enzymes are metallo-beta-lactamases that contain zinc in the active site. The class A carbapenemase group includes members of the SME, IMI, NMC, GES, and KPC families. Of these, the KPC carbapenemases are the most prevalent, found mostly on plasmids in Klebsiella pneumoniae. The class D carbapenemases consist of OXA-type beta-lactamases frequently detected in Acinetobacter baumannii. The metallo-beta-lactamases belong to the IMP, VIM, SPM, GIM, and SIM families and have been detected primarily in Pseudomonas aeruginosa; however, there are increasing numbers of reports worldwide of this group of beta-lactamases in the Enterobacteriaceae. This review updates the characteristics, epidemiology, and detection of the carbapenemases found in pathogenic bacteria.

Qureshi ZP. Case Records and Commentaries.; Submitted.
Bahemuka M, al-Nozha M, Shamena AR, Qaraqish AR, Lambourne A. "Cerebral infarction and left ventricular mass: a clinical and echocardiographic study.". 1988. Abstractcerebral_infarction_and_left_ventricular_mass-a_clinical_and_echocardiographic_study.pdfWebsite

One hundred and two stroke patients were studied. Thirty-three (32 per cent) were hypertensive by the WHO criteria. Eighty-three (83 per cent) had cerebral infarction and three patients suffered from spontaneous intracerebral haemorrhage. The mean left ventricular mass was calculated from echocardiographic measurements and compared with that of controls. Neither cases nor controls had valvular or congenital heart disease, or disease processes that may be associated with myocardial infiltration. Mean left ventricular mass of all cases was significantly greater than that of controls (p less than 0.025) and that of the cases over the age of 50 years was also significantly greater than that of controls of the same age (p less than 0.02). The clinically normotensive cases had greater left ventricular mass than the normotensive controls (p less than 0.02). Meanwhile left ventricular mass in patients aged 50 and under was not significantly different from the appropriate control group (p greater than 0.2). These data indicate that the frequency of arterial hypertension among victims of cerebral infarction is greater than may be ascertained clinically particularly in those over 50.

Ulrich W, Soliveres S, Maestre FT, Gotelli NJ, Quero JL, Delgado-Baquerizo M, Bowker MA, Eldridge DJ, Ochoa V, Gozalo B, others. "Climate and soil attributes determine plant species turnover in global drylands." Journal of biogeography. 2014;41:2307-2319. Abstract
n/a
Okusanya BO, Oladapo OT, Long Q, Lumbiganon P, Carroli G, Qureshi Z, Duley L, Souza JP, Gulmezoglu AM. "Clinical pharmacokinetic properties of magnesium sulphate in women with preeclampsia and eclampsia." A systematic Review 2015. 2015. Abstractclinical_pharmacokinetic_properties_of_magnesium_sulphate_in_women_with_pre.pdf

Background
The pharmacokinetic basis of magnesium sulphate (MgSO4) dosing regimens for eclampsia prophylaxis and treatment is not clearly established.
Objectives
To review available data on clinical pharmacokinetic properties of MgSO4 when used for women with pre-eclampsia and/or eclampsia.
Search strategy
MEDLINE, EMBASE, CINAHL, POPLINE, Global Health Library and reference lists of eligible studies.
Selection criteria
All study types investigating pharmacokinetic properties of MgSO4 in women with preeclampsia and/or eclampsia.
Data collection and analysis
Two authors extracted data on basic pharmacokinetic parameters reflecting the different aspects of absorption, bioavailability, distribution and excretion of MgSO4 according to identified dosing regimens.
Main results
Twenty-eight studies investigating pharmacokinetic properties of 17 MgSO4 regimens met our inclusion criteria. Most women (91.5%) in the studies had pre-eclampsia. Baseline serum magnesium concentrations were consistently <1 mmol/l across studies. Intravenous loading dose between 4 and 6 g was associated with a doubling of this baseline concentration half an hour after injection. Maintenance infusion of 1 g/hour consistently produced concentrations well below 2 mmol/l, whereas maintenance infusion at 2 g/hour and the Pritchard intramuscular regimen had higher but inconsistent probability of producing concentrations between 2 and 3 mmol/l. Volume of distribution of magnesium varied (13.65–49.00 l) but the plasma clearance was fairly similar (4.28–5.00 l/hour) across populations.
Conclusion
The profiles of Zuspan and Pritchard regimens indicate that the minimum effective serum magnesium concentration for eclampsia prophylaxis is lower than the generally accepted level. Exposure–response studies to identify effective alternative dosing regimens should target concentrations achievable by these standard regimens.

Quinlan MM, Birungi J, Coulibaly MB, Diabaté A, Facchinelli L, Wolfgang Richard Mukabana, M J. "Containment studies of transgenic mosquitoes in disease endemic countries: The broad concept of facilities readiness." Vector-Borne and Zoonotic Diseases. 2018;18(1):14-20.
D
Osoti A, Gwako GN, Liyayi B, Qureshi ZP. "Distinguishing Intrauterine Fetal Demise versus Abdominal Pregnancy in Low Resource Settings." East African Medical Journal. 2015;92(1). Abstractdistinguishing_intrauterine_fetal_demise_versus_abdominal_pregnancy_in_low_resource_settings.pdf

Diagnosis of abdominal pregnancy always poses a clinical dilemma. Transvaginal ultrasound is the ideal radiological procedure in locating these pregnancies. However in resource limited setting, abdominal and pelvic ultrasounds can be the only available yet unreliable modalities for distinguishing intrauterine versus abdominal pregnancies. We present a case of a 36 year old para 4+0 gravida 5 who presented with fetal demise at 16 weeks of gestation. Multiple abdominal and pelvic ultrasounds showed intra uterine fetal demise for which she underwent induction. The definitive diagnosis of abdominal pregnancy was established using transcervical Foleys catheter aided abdominal-pelvic ultrasound which showed an empty uterus and a gestational sac, placenta and a 16-week fetus with no cardiac activity in the right adnexa/iliac region.

Osoti A, Gwako GN, Liyayi B, Qureshi ZP. "Distinguishing Intrauterine Fetal Demise Versus Abdominal Pregnancy in Low Resource Settings, A Case Report." East African Medical Journal. 2015;92(1). Abstractfull_article.pdf

Diagnosis of abdominal pregnancy always poses a clinical dilemma. Transvaginal ultrasound is the ideal radiological procedure in locating these pregnancies. However in resource limited setting, abdominal and pelvic ultrasounds can be the only available yet unreliable modalities for distinguishing intrauterine versus abdominal pregnancies. We present a case of a 36 year old para 4+0 gravida 5 who presented with fetal demise at 16 weeks of gestation. Multiple abdominal and pelvic ultrasounds showed intra uterine fetal demise for which she underwent induction. The definitive diagnosis of abdominal pregnancy was established using transcervical Foleys catheter aided abdominal-pelvic ultrasound which showed an empty uterus and a gestational sac, placenta and a 16-week fetus with no cardiac activity in the right adnexa/iliac region.

T E, M B, N.W P, S A, J A, G E, S H, C H, R H, O K, J N, D O, E O, N O, M.E.M S, M S, E.-J S, C.-F W, G Y, M Z, Q Z, M.S A-D, K A, G A, D B, D B-G, V B, L.K O,, J.N Kiiru, et al. "Drug discovery and biopiracy of natural products" ." Phytomedicine. 2016;Elsevier(23(2)):166-173.efferth_et_al._2016.pdf
E
Brizuela V, Bonet M, Romero CLT, Abalos E, Baguiya A, Fawole B, Knight M, Lumbiganon P, Minkauskienė M, Nabhan A, Osman NB, Qureshi ZP, Souza JP. "Early evaluation of the ‘STOP SEPSIS!’ WHO Global Maternal Sepsis Awareness Campaign implemented for healthcare providers in 46 low, middle and high-income countries." British Medical Journal . 2020;10(5). AbstractWebsite

Objective To evaluate changes in awareness of maternal sepsis among healthcare providers resulting from the WHO Global Maternal Sepsis Study (GLOSS) awareness campaign.

Design Independent sample precampaign/postcampaign through online and paper-based surveys available for over 30 days before campaign roll-out (pre) and after study data collection (post). Descriptive statistics were used for campaign recognition and exposure, and odds ratio (OR) and percentage change were calculated for differences in awareness, adjusting for confounders using multivariate logistic regression.

Setting and participants Healthcare providers from 398 participating facilities in 46 low, middle and high-income countries.

Intervention An awareness campaign to accompany GLOSS launched 3 weeks prior to data collection and lasting the entire study period (28 November 2017 to 15 January 2018) and beyond.

Main outcome measures Campaign recognition and exposure, and changes in awareness.

Results A total of 2188 surveys were analysed: 1155 at baseline and 1033 at postcampaign. Most survey respondents found the campaign materials helpful (94%), that they helped increase awareness (90%) and that they helped motivate to act differently (88%). There were significant changes with regard to: not having heard of maternal sepsis (−63.4% change, pre-OR/post-OR 0.35, 95% CI 0.18 to 0.68) and perception of confidence in making the right decisions with regard to maternal sepsis identification and management (7.3% change, pre-OR/post-OR 1.44, 95% CI 1.01 to 2.06).

Conclusions Awareness raising campaigns can contribute to an increase in having heard of maternal sepsis and an increase in provider perception of confidence in making correct decisions. Offering the information to make accurate and timely decisions while promoting environments that enable self-confidence and support could improve maternal sepsis identification and management.

Shakur H, Roberts I, Fawole B, Chaudhri R, El-Sheikh M, desina Akintan, QURESHI ZAHIDA, Kidanto H, Vwalika B, Abdulkadir A, Etuk S, Noor S, Asonganyi E, Alfirevic Z, Beaumont D, Ronsmans C, Arulkumaran S. "Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial." Lancet. 2017. AbstractWebsite

Summary
Background
Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of
tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration
of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage.
Methods
In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a
clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries.
We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual
care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of
tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box
containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those
assessing outcomes were masked to allocation. We originally planned to enrol 15
000 women with a composite primary
endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became
apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although
tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore
increased the sample size from 15
000 to 20
000 women in order to estimate the effect of tranexamic acid on the risk of
death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with
ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283.
Findings
Between March, 2010, and April, 2016, 20
060
women were enrolled and randomly assigned to receive
tranexamic acid (n=10
051) or placebo (n=10
009), of whom 10
036 and 9985, respectively, were included in the analysis.
Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10
036 patients
vs
191
[1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given
treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group
vs
127 [1·7%] in the placebo group,
RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy
was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group
vs
351 [3·5%] in the placebo
group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy
was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group
vs
546 [5·5%]
in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did
not differ significantly in the tranexamic acid versus placebo group.
Interpretation
Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no
adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as
possible after bleeding onset.
Funding
London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and
Bill & Melinda Gates Foundation.

F
Kivai JM, KAYIMA JK, Were AO, Qureshi Z. "Foetal outcome in women with Pregnacy related Acute Kidney Injury in a referral facilty in Kenya ." IOSR Journal of Dental and Medical Sciences. 2019;18(11):52-56.Website
Qin W, Xuan Y, Liu Y, Jiang T, Yu C. "Functional {Connectivity} {Density} in {Congenitally} and {Late} {Blind} {Subjects}." Cerebral Cortex. 2014:bhu051. AbstractWebsite

Visual deprivation during different developmental periods leads to different structural and functional alterations in the brain; however, the effects of visual deprivation on the spontaneous functional organization of the brain remain largely unknown. In this study, we used voxel-based functional connectivity density (FCD) analyses to investigate the effects of visual deprivation during different developmental periods on the spontaneous functional organization of the brain. Compared with the sighted controls (SC), both the congenitally blind (CB) and the late blind (LB) exhibited decreased short- and long-range FCDs in the primary visual cortex (V1) and decreased long-range FCDs in the primary somatosensory and auditory cortices. Although both the CB and LB exhibited increased short-range FCD in the dorsal visual stream, the CB exhibited greater increases in the short- and long-range FCDs in the ventral visual stream and hippocampal complex compared with the LB. Moreover, the short-range FCD of the left V1 exhibited a significant positive correlation with the duration of blindness in the LB. Our findings suggest that visual deprivation before the developmental sensitive period can induce more extensive brain functional reorganization than does visual deprivation after the sensitive period, which may underlie an enhanced capacity for processing nonvisual information in the CB.

G
Ndungu JR, Amayo A, Qureshi ZP, Kigondu CS. "Gestational Thyrotoxicosis associated with Emesis in early Pregnancy." East. Afr. Med. J. 2009;86(2):55-58.
H
Widmer M, Piaggio G, Nguyen TM, Osoti A, Owa OO, Misra S, Coomarasamy A, Abdel-Aleem H, Mallapur AA, Qureshi Z, Lumbiganon P. "Heat-Stable Carbetocin versus Oxytocin to Prevent Hemorrhage after Vaginal Birth." New England Journal of Medicine. 2018;379(8):743-752. AbstractWebsite

Background: Postpartum hemorrhage is the most common cause of maternal death. Oxytocin is the standard therapy for the prevention of postpartum hemorrhage, but it requires cold storage, which is not available in many countries. In a large trial, we compared a novel formulation of heat-stable carbetocin with oxytocin.

Methods: We enrolled women across 23 sites in 10 countries in a randomized, double-blind, noninferiority trial comparing intramuscular injections of heat-stable carbetocin (at a dose of 100 μg) with oxytocin (at a dose of 10 IU) administered immediately after vaginal birth. Both drugs were kept in cold storage (2 to 8°C) to maintain double-blinding. There were two primary outcomes: the proportion of women with blood loss of at least 500 ml or the use of additional uterotonic agents, and the proportion of women with blood loss of at least 1000 ml. The noninferiority margins for the relative risks of these outcomes were 1.16 and 1.23, respectively.

Results: A total of 29,645 women underwent randomization. The frequency of blood loss of at least 500 ml or the use of additional uterotonic agents was 14.5% in the carbetocin group and 14.4% in the oxytocin group (relative risk, 1.01; 95% confidence interval [CI], 0.95 to 1.06), a finding that was consistent with noninferiority. The frequency of blood loss of at least 1000 ml was 1.51% in the carbetocin group and 1.45% in the oxytocin group (relative risk, 1.04; 95% CI, 0.87 to 1.25), with the confidence interval crossing the margin of noninferiority. The use of additional uterotonic agents, interventions to stop bleeding, and adverse effects did not differ significantly between the two groups.

Conclusions: Heat-stable carbetocin was noninferior to oxytocin for the prevention of blood loss of at least 500 ml or the use of additional uterotonic agents. Noninferiority was not shown for the outcome of blood loss of at least 1000 ml; low event rates for this outcome reduced the power of the trial. (Funded by Merck Sharpe & Dohme; CHAMPION Australian New Zealand Clinical Trials Registry number, ACTRN12614000870651 ; EudraCT number, 2014-004445-26 ; and Clinical Trials Registry-India number, CTRI/2016/05/006969 .).

Delgado-Baquerizo M, Maestre FT, Gallardo A, Eldridge DJ, Soliveres S, Bowker MA, Prado-Comesaña A, Gaitán J, Quero JL, Ochoa V, others. "Human impacts and aridity differentially alter soil N availability in drylands worldwide." Global ecology and biogeography. 2016;25:36-45. Abstract
n/a
I
Mitchell EJ, Benjamin S, Ononge S, Ditai J, QURESHI ZAHIDA, Masood SN, Whitham D, Godolphin PJ, Duley L. "Identifying women giving birth preterm and care at the time of birth: a prospective audit of births at six hospitals in India, Kenya, Pakistan and Uganda." BMC Pregnancy Childbirth . 2020;20(439). AbstractWebsite

Background
Globally, 15 million infants are born preterm each year, and 1 million die due to complications of prematurity. Over 60% of preterm births occur in Sub-Saharan Africa and south Asia. Care at birth for premature infants may be critical for survival and long term outcome. We conducted a prospective audit to assess whether women giving birth preterm could be identified, and to describe cord clamping and neonatal care at hospitals in Africa and south Asia.

Methods
This prospective audit of livebirths was conducted at six hospitals in Uganda, Kenya, India and Pakistan. Births were considered preterm if between 28+ 0 and 33+ 6 weeks gestation and/or the birthweight was 1.00 to 1.99 kg. A pre-specified audit plan was agreed with each hospital. Livebirths before 28 weeks gestation with birthweight less than 1.0 kg were excluded. Data were collected on estimated and actual gestation and birthweight, cord clamping, and neonatal care.

Results
Of 4149 women who gave birth during the audit, data were available for 3687 (90%). As 107 were multiple births, 3781 livebirths were included, of which 257 (7%) were preterm. Antenatal assessment correctly identified 148 infants as ‘preterm’ and 3429 as ‘term’, giving a positive predictive value of 72% and negative predictive value of 97%. For term births, cord clamping was usually later at the two Ugandan hospitals, median time to clamping 50 and 76 s, compared with 23 at Kenyatta (Kenya), 7 at CMC (India) and 12 at FBH/LNH (Pakistan). At the latter two, timing was similar between term and preterm births, and between vaginal and Caesarean births. For all the hospitals, the cord was clamped quickly at Caesarean births, with Mbale (Uganda) having the highest median time to clamping (15 s ‘term’, 19 ‘preterm’). For preterm infants temperature on admission to the neonatal unit was below 35.5 °C for 50%, and 59 (23%) died before hospital discharge.

Conclusions
Antenatal identification of preterm birth was good. Timing of cord clamping varied between hospitals, although at each there was no difference between ‘term’ and ‘preterm’ births. For premature infants hypothermia was common, and mortality before hospital discharge was high.

JM.Kivai, Kayima JK, Were AO, Q.Zahida. "Impact of Pregnancy Related Acute Kidney Injury on foetalsurvival: a single Centre Experience in Kenya." IOSR Journal of Dental and Medical Sciences (IOSR-JDMS). 2019;18(7):13-17. AbstractWebsite

Abstract: Background: Pregnancy related acute kidney injury (PRAKI) is a heterogenous obstetric
complication, which can occur at any stage during pregnancy and in postpartumperiod. It often impacts
negatively on foetaloutcomes.
Objective: To determine impact of PRAKI on foetal outcomes at Kenyatta National Hospital (KNH), Nairobi.
Methods: We carried out a descriptive study on women with viable pregnancies, gestation age equal to, or
above 28 weeks and postpartum women within six weeks after delivery admitted in labour ward or the postnatal
wards at KNH. The study started afterit was approved by the KNH- University of Nairobi Ethics and
Research Committee.Patient management was at the discretion of attending clinician.Data was obtained
fromthe participants and their medical records. Followupwas until dischargeor for a maximum of two weeksfor
those who remained in the wards.
Results: Total participantswere 66 out of2068 admissions. Their mean age was 28years with peak age between
26-30 years.The prevalence of PRAKI was 3.2%. Sixty (91%) participants weredelivered andsix pregnancies
were ongoing past the follow-up period.The average gestation age at birth was 35 weeks. Forty-three (71.7%)
were life infants while 17(28.3%) were fresh still births. Comparing between participant women with PRAKI
and women without PRAKI, the ratio of fresh still births among participants was 1:4 and the ratio of fresh still
births among women without PRAKI was 1 in 23deliveries.
Conclusion: Wetherefore demonstrate that pregnancy related acute kidney injury was associated with a six (6)
fold increase in fresh still births at Kenyatta National Hospital in Kenya.
Key Words: PRAKI, KNH, Preterm births,Fresh still births,Nairobi, Kenya

Kivai JM, KAYIMA JK, Were AO, Qureshi Z. "Impact of Pregnancy Related Acute Kidney Injury on foetalsurvival: a single Centre Experience in Kenya." IOSR Journal of Dental and Medical Sciences. 2019;18(7):13-17.Website
Motomura K, Ganchimeg T, Nagata C, Ota E, Vogel JP, Betran AP, Torloni MR, Jayaratne K, Jwa SC, Mittal S, Recidoro ZD, Matsumoto K, Fujieda M, Nafiou I, Yunis K, QURESHI ZAHIDA, Souza JP, Mori R. "Incidence and outcomes of uterine rupture among women with prior caesarean section: WHO Multicountry Survey on Maternal and Newborn Health." Scientific Reports. 2017;7. AbstractWebsite

Caesarean section (CS) is increasing globally, and women with prior CS are at higher risk of uterine rupture in subsequent pregnancies. However, little is known about the incidence, risk factors, and outcomes of uterine rupture in women with prior CS, especially in developing countries. To investigate this, we conducted a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health, which included data on delivery from 359 facilities in 29 countries. The incidence of uterine rupture among women with at least one prior CS was 0.5% (170/37,366), ranging from 0.2% in high-Human Development Index (HDI) countries to 1.0% in low-HDI countries. Factors significantly associated with uterine rupture included giving birth in medium- or low-HDI countries (adjusted odds ratio [AOR] 2.0 and 3.88, respectively), lower maternal educational level (≤6 years) (AOR 1.71), spontaneous onset of labour (AOR 1.62), and gestational age at birth <37 weeks (AOR 3.52). Women with uterine rupture had significantly higher risk of maternal death (AOR 4.45) and perinatal death (AOR 33.34). Women with prior CS, especially in resource-limited settings, are facing higher risk of uterine rupture and subsequent adverse outcomes. Further studies are needed for prevention/management strategies in these settings.

Use of caesarean section (CS) deliveries has been steadily increasing, from 6.7% in 1990 to 19.1% in 2014 globally1,2. Consequently, the number of deliveries by mothers with prior CS is also on the rise1.

Women with prior CS are at higher risk of uterine rupture. The reported incidence of uterine rupture among women with prior CS ranged from 0.22% to 0.5% in some developed countries3,4,5,6. The risk factors for uterine rupture in women with a history of CS include prior classical incision, labour induction or argumentation, macrosomia, increasing maternal age, post-term delivery, short maternal stature, no prior vaginal delivery, and prior periviable CS4,7,8,9,10,11. Uterine rupture poses considerable risk of adverse maternal and perinatal outcomes. The prevalence of maternal and perinatal complications, such as severe post-hemorrhagic anemia, major puerperal infection, bladder injury, hysterectomy, and perinatal mortality, are significantly higher in women with uterine rupture than women without uterine rupture4,10,12,13.

A World Health Organization (WHO) systematic review to determine the prevalence of uterine rupture worldwide identified uterine rupture as a serious obstetric complication being more prevalent and with more serious consequences in developing countries than in developed countries14. In developing countries, uterine rupture has been reportedly associated with obstructed labour, grand multiparity, injudicious obstetric interventions/manipulations, lack of antenatal care, unbooked status, poor access to emergency obstetric care, and low socioeconomic status rather than prior CS15,16,17,18. However, uterine rupture after prior CS is becoming more common as the availability of CS increases in these settings18. According to a literature review on uterine rupture in developing countries, the proportion of women with prior CS or uterine scar among women who had uterine rupture was up to 64%18. A study in India reported that the incidence of uterine rupture among women with prior CS was 1.69%19. Nevertheless, there are few studies about the incidence, risk factors, and outcomes of uterine rupture among women with prior CS from these settings.

Typically, uterine rupture occurs suddenly and requires immediate critical emergency care for mothers, fetuses, or neonates. The strategies for prevention and management, as well as the quality of affordable care for women at risk of or experiencing uterine rupture, are likely to vary across settings depending on their diagnostic capacity, availability of obstetric interventions, and human and facility resources. Therefore, the findings in developed countries may not be generalizable to low-resource countries and settings. The aim of this analysis was to describe the incidence, risk factors, and maternal and perinatal outcomes of uterine rupture among women with prior CS using data from the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), which was conducted in facilities in 29 countries worldwide from 2010 to 2011.

Sueker J, Blazes DL, Johns MC, Blair PJ, Sjoberg PA, Tjaden JA, Montgomery JM, Pavlin JA, Schnabel DC, Eick AA, Tobias S, Quintana M, Vest KG, Burke RL, Lindler LE, Mansfield JL, Erickson RL, Russell KL, Sanchez JL. "Influenza and respiratory disease surveillance: the US military's global laboratory-based network." Influenza Other Respi Viruses. 2010;4:155-61. Abstract

The US Department of Defense influenza surveillance system now spans nearly 500 sites in 75 countries, including active duty US military and dependent populations as well as host-country civilian and military personnel. This system represents a major part of the US Government's contributions to the World Health Organization's Global Influenza Surveillance Network and addresses Presidential Directive NSTC-7 to expand global surveillance, training, research and response to emerging infectious disease threats. Since 2006, the system has expanded significantly in response to rising pandemic influenza concerns. The expanded system has played a critical role in the detection and monitoring of ongoing H5N1 outbreaks worldwide as well as in the initial detection of, and response to, the current (H1N1) 2009 influenza pandemic. This article describes the system, details its contributions and the critical gaps that it is filling, and discusses future plans.

Abdalla RO, Qureshi MM, Saidi H, Abdallah A. "Introduction of the Canadian CT Head Rule Reduces CT Scan Use in Minor Head Injury." Ann. Afr. Surg.. 2015;12(1):19-21.
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Souza JP, Widmer M, Gülmezoglu AM, Lawrie TA, Adejuyigbe EA, Carroli G, Crowther C, Currie SM, Dowswell T, Hofmeyr J, Lavender T, Lawn J, Mader S, Martinez FE, Mugerwa K, QURESHI ZAHIDA, Silvestre MA, Soltani H, Torloni MR, Tsigas EZ, Vowles Z, Ouedraogo L, Serruya S, Al-Raiby J, Awin N, Obara H, Mathai M, Bahl R, Martines J, Ganatra B, Phillips SJ, Johnson BR, Vogel JP, Oladapo OT, Temmerman M. "Maternal and perinatal health research priorities beyond 2015: an international survey and prioritization exercise." Reprod Health. 2014;11:61. Abstract

Maternal mortality has declined by nearly half since 1990, but over a quarter million women still die every year of causes related to pregnancy and childbirth. Maternal-health related targets are falling short of the 2015 Millennium Development Goals and a post-2015 Development Agenda is emerging. In connection with this, setting global research priorities for the next decade is now required.

Baliraine FN, Bonizzoni M;, Lux, S. A; Mulaa FJ, Osir EO, Quilici, S; Gomulski LM, Gasperi G, Malacrida AR. "Medfly microsatellite markers for species diagnosis and population genetic analysis in three other fruit fly (Diptera: Tephritidae) species."; 2002.
Otieno AC, Quainoo EW, Mwongela S. "Metal Cations for the Determination of Fluorescent Phosphoinositides by Capillary Electrophoresis." Journal of Separation Science . 2008;31:3894-3901.
Wasike C, Ndavi M, Kigondu CS, Wanjala SM, Qureshi ZP. "Motivation for Reacceptance of Intradermal Implants –Norplant on Removal after using for Five Years." J. Obst. Gynae. East Central. Afr. . 2005;18(1):31-45 .
Souza JP, Gülmezoglu AM, Vogel J, Carroli G, Lumbiganon P, QURESHI ZAHIDA. "Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study." Lancet. 2013;381(9879):1747-1755. Abstract

Summary

Background: We report the main findings of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), which aimed to assess the burden of complications related to pregnancy, the coverage of key maternal health interventions, and use of the maternal severity index (MSI) in a global network of health facilities.

Methods: In our cross-sectional study, we included women attending health facilities in Africa, Asia, Latin America, and the Middle East that dealt with at least 1000 childbirths per year and had the capacity to provide caesarean section. We obtained data from analysis of hospital records for all women giving birth and all women who had a severe maternal outcome (SMO; ie, maternal death or maternal near miss). We regarded coverage of key maternal health interventions as the proportion of the target population who received an indicated intervention (eg, the proportion of women with eclampsia who received magnesium sulphate). We used areas under the receiver operator characteristic curves (AUROC) with 95% CI to externally validate a previously reported MSI as an indicator of severity. We assessed the overall performance of care (ie, the ability to produce a positive effect on health outcomes) through standardised mortality ratios.

Results: From May 1, 2010, to Dec 31, 2011, we included 314 623 women attending 357 health facilities in 29 countries (2538 had a maternal near miss and 486 maternal deaths occurred). The mean period of data collection in each health facility was 89 days (SD 21). 23 015 (7•3%) women had potentially life-threatening disorders and 3024 (1•0%) developed an SMO. 808 (26•7%) women with an SMO had post-partum haemorrhage and 784 (25•9%) had preeclampsia or eclampsia. Cardiovascular, respiratory, and coagulation dysfunctions were the most frequent organ dysfunctions in women who had an SMO. Reported mortality in countries with a high or very high maternal mortality ratio was two-to-three-times higher than that expected for the assessed severity despite a high coverage of essential interventions. The MSI had good accuracy for maternal death prediction in women with markers of organ dysfunction (AUROC 0•826 [95% CI 0•802–0•851]).

Interpretation: High coverage of essential interventions did not imply reduced maternal mortality in the health-care facilities we studied. If substantial reductions in maternal mortality are to be achieved, universal coverage of lifesaving interventions need to be matched with comprehensive emergency care and overall improvements in the quality of maternal health care. The MSI could be used to assess the performance of health facilities providing care to women with complications related to pregnancy.

Funding: UNDP–UNFPA–UNICEF–WHO–World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP); WHO; USAID; Ministry of Health, Labour and Welfare of Japan; Gynuity Health Projects.

Souza JP, Gülmezoglu AM, Vogel J, Carroli G, Lumbiganon P, QURESHI ZAHIDA, Costa MJ, Fawole B, Mugerwa Y, Nafiou I, Neves I, Wolomby-Molondo J-J, Bang HT, Cheang K, Chuyun K, Jayaratne K, Jayathilaka CA, Mazhar SB, Mori R, Mustafa ML, Pathak LR, Perera D, Rathavy T, Recidoro Z, Roy M, Ruyan P, Shrestha N, Taneepanichsku S, Tien NV, Ganchimeg T, Wehbe M, Yadamsuren B, Yan W, Yunis K, Bataglia V, Cecatti JG, Hernandez-Prado B, Nardin JM, Narváez A, Ortiz-Panozo E, Pérez-Cuevas R, Valladares E, Zavaleta N, Armson A, Crowther C, Hogue C, Lindmark G, Mittal S, Pattinson R, Stanton ME, Campodonico L, Cuesta C, Giordano D, Intarut N, Laopaiboon M, Bahl R, Martines J, Mathai M, Merialdi M, Say L. "Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): a cross-sectional study." Lancet. 2013;381(9879):1747-55. Abstract

We report the main findings of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), which aimed to assess the burden of complications related to pregnancy, the coverage of key maternal health interventions, and use of the maternal severity index (MSI) in a global network of health facilities.

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Zachariah R, Kumar AMV, Reid AJ, den Bergh VR, Isaakidis P, Draguez B, Delaunois P, Nagaraja SB, Ramsay A, Reeder JC, Denisiuk O, Ali E, Khogali M, Hinderaker SG, Kosgei RJ, van Griensven J, Quaglio GL, Maher D, Billo NE, Terry RF, Harries AD. "Open access for operational research publications from low and middle-income countries: who pays?" Public Health Action . 2014;4(3):141-144.open_acess_for_operations_research_who_pays.pdf
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Santana DS, Silveira C, Costa ML, Souza RT, Surita FG, Souza JP, Mazhar SB, Jayaratne K, QURESHI ZAHIDA, Sousa MH, Vogel JP, Cecatti JG. "Perinatal outcomes in twin pregnancies complicated by maternal morbidity:evidence from the WHO Multicountry Survey on Maternal and Newborn Health." BMC Pregnancy and Childbirth . 2018;18(449). AbstractWebsite

Background: Twin pregnancy was associated with significantly higher rates of adverse neonatal and perinatal outcomes, especially for the second twin. In addition, the maternal complications (potentially life-threatening conditions-PLTC, maternal near miss-MNM, and maternal mortality-MM) are directly related to twin pregnancy and independently associated with adverse perinatal outcome. The objective of the preset study is to evaluate perinatal outcomes associated with twin pregnancies, stratified by severe maternal morbidity and order of birth.

Methods: Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), a cross-sectional study implemented in 29 countries. Data from 8568 twin deliveries were compared with 308,127 singleton deliveries. The occurrence of adverse perinatal outcomes and maternal complications were assessed. Factors independently associated with adverse perinatal outcomes were reported with adjusted PR (Prevalence Ratio) and 95%CI.

Results: The occurrence of severe maternal morbidity and maternal death was significantly higher among twin compared to singleton pregnancies in all regions. Twin deliveries were associated with higher rates of preterm delivery (37.1%), Apgar scores less than 7 at 5th minute (7.8 and 10.1% respectively for first and second twins), low birth weight (53.2% for the first and 61.1% for the second twin), stillbirth (3.6% for the first and 5.7% for the second twin), early neonatal death (3.5% for the first and 5.2% for the second twin), admission to NICU (23.6% for the first and 29.3% for the second twin) and any adverse perinatal outcomes (67% for the first twin and 72.3% for the second). Outcomes were consistently worse for the second twin across all outcomes. Poisson multiple regression analysis identified several factors independently associated with an adverse perinatal outcome, including both maternal complications and twin pregnancy.

Conclusion: Twin pregnancy is significantly associated with severe maternal morbidity and with worse perinatal outcomes, especially for the second twin.

Keywords: Maternal morbidity; Perinatal outcome; Twin pregnancy.

Qureshi ZP, Sartor O, Xirasagar S, Liu Y, Bennett CL. "Pharmaceutical fraud and abuse in the United States, 1996-2010.". 2011.
Ogeng’o JA, Obimbo MM, Zhou Y, McMaster MT, Cohen CR, QURESHI ZAHIDA, Ong’ech J, Fisher SJ. "Placental Structure in Preterm Birth Among HIV-Positive Versus HIV-Negative Women in Kenya." J Acquir Immune Defic Syndr . 2019;80(1):94-102. Abstractplacental_structure_in_preterm_birth_among_hiv-positive.pdfWolters Kluwer Health, Inc

Background: Preterm birth (PTB) is a major cause of infant
morbidity and mortality in developing countries. Recent data suggest
that in addition to Human Immunodeficiency Virus (HIV) infection,
use of antiretroviral therapy (ART) increases the risk of PTB. As the
mechanisms remain unexplored, we conducted this study to
determine whether HIV and ART were associated with placental
changes that could contribute to PTB.
Setting: We collected and evaluated placentas from 38 HIVpositive
women on ART and 43 HIV-negative women who had
preterm deliveries in Nairobi, Kenya.
Methods: Anatomical features of the placentas were examined at
gross and microscopic levels. Cases were matched for gestational
age and compared by the investigators who were blinded to maternal
HIV serostatus.
Results: Among preterm placentas, HIV infection was significantly
associated with thrombosis (P = 0.001), infarction (P = 0.032),
anomalies in cord insertion (P = 0.02), gross evidence of membrane
infection (P = 0.043), and reduced placental thickness (P = 0.010).
Overall, preterm placentas in both groups were associated with
immature villi, syncytial knotting, villitis, and deciduitis. Features of
HIV-positive versus HIV-negative placentas included significant
fibrinoid deposition with villus degeneration, syncytiotrophoblast
delamination, red blood cell adhesion, hypervascularity, and reduction
in both surface area and perimeter of the terminal villi.
Conclusions: These results imply that HIV infection and/or ART
are associated with morphological changes in preterm placentas that
contribute to delivery before 37 weeks. Hypervascularity suggests
that the observed pathologies may be attributable, in part, to hypoxia.
Further research to explore potential mechanisms will help elucidate
the pathways that are involved perhaps pointing to interventions for
decreasing the risk of prematurity among HIV-positive women.
Key Words: preterm birth, term birth, placenta, HIV, ART

Baliraine FN, Bonizzoni M, Guglielmino CR, Osir EO, Lux SA, Mulaa FJ, Gomulski LM, Zheng L, Quilici S, Gasperi G, Malacrida AR. "Population genetics of the potentially invasive African fruit fly species, Ceratitis rosa and Ceratitis fasciventris (Diptera: T."; 2004.
Santana DS, Cecatti JG, Surita FG, Silveira C, Costa ML, Souza JP, Mazhar SB, Jayaratne K, QURESHI ZAHIDA, Sousa MH, Vogel JP. "Pregnancy and Severe Maternal Outcomes: The World Health Organization Multicountry Survey on Maternal and Newborn Health." Obstetrics & Gynecology. 2016;127(4):631-641. Abstractpregnancy_and_severe_maternal_outcomes.pdf

OBJECTIVE: To evaluate maternal complications (potentially life-threatening conditions, maternal near miss, and maternal death) that are mutually exclusive and severe maternal outcomes (maternal near miss or maternal death) associated with twin pregnancies.
METHODS: We performed a secondary analysis of a cross-sectional World Health Organization Multicountry Survey, which was implemented in 29 countries. Data from 4,756 twin deliveries were compared with 308,111 singleton deliveries. Factors associated with maternal morbidity and twin pregnancies were reported with adjusted prevalence ratio (95% confidence interval).
RESULTS: Potentially life-threatening conditions, maternal near miss, severe maternal outcomes, and maternal deaths were 2.14 (1.99–2.30), 3.03 (2.39–3.85), 3.19 (2.58–3.94), and 3.97 (2.47–6.38) times higher, respectively, among twin pregnancies. Maternal age older than 20 years, having a partner, multiparity, and elective cesarean delivery were associated with twin pregnancies. Postpartum hemorrhage and chronic hypertension were more frequently associated with severe maternal outcomes among twin pregnancies. Conditions indicating organ dysfunction (maternal near miss) were twofold to fivefold higher for twins. Poisson multiple regression analysis identified several factors independently associated with a severe maternal outcome, but not twin pregnancies.
CONCLUSION: Twin pregnancy is associated with greater severe maternal morbidity and a higher rate of maternal death than singleton pregnancy.

McMenamin PG, Quayle MR, McHenry CR, Adams JW. "The production of anatomical teaching resources using three-dimensional (3D) printing technology." Anatomical Sciences Education. 2014:n/a–n/a. AbstractWebsite

The teaching of anatomy has consistently been the subject of societal controversy, especially in the context of employing cadaveric materials in professional medical and allied health professional training. The reduction in dissection-based teaching in medical and allied health professional training programs has been in part due to the financial considerations involved in maintaining bequest programs, accessing human cadavers and concerns with health and safety considerations for students and staff exposed to formalin-containing embalming fluids. This report details how additive manufacturing or three-dimensional (3D) printing allows the creation of reproductions of prosected human cadaver and other anatomical specimens that obviates many of the above issues. These 3D prints are high resolution, accurate color reproductions of prosections based on data acquired by surface scanning or CT imaging. The application of 3D printing to produce models of negative spaces, contrast CT radiographic data using segmentation software is illustrated. The accuracy of printed specimens is compared with original specimens. This alternative approach to producing anatomically accurate reproductions offers many advantages over plastination as it allows rapid production of multiple copies of any dissected specimen, at any size scale and should be suitable for any teaching facility in any country, thereby avoiding some of the cultural and ethical issues associated with cadaver specimens either in an embalmed or plastinated form. Anat Sci Educ. © 2014 American Association of Anatomists.

Jaldesa GW, Qureshi ZP, Kigondu CS. "Psychosexual problems associated with Female Genital Mutilation (FGM)." J. Obst. Gynae. East Central. Afr. . 2010;22(1):1-6.
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Paesen J, Quintens I, Thoithi G, Roets E, Reybrouck G, Hoogmartens J. "Quantitative analysis of quaternary ammonium antiseptics using thin-layer densitometry." J. Chromatogr. A. 1994;677:377-384.
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Qureshi ZP, Sekadde-Kigondu C, Mutiso SM. "Rapid assement of partograph utilisation in selected maternity units in Kenya.". 2010. Abstract

Prolonged labour causes maternal and perinatal morbidity and mortality. Its sequela include obstructed labour, uterine rupture, maternal exhaustion, postpartum haemorrhage, puerperal sepsis, obstetric fistula, stillbirths, birth asphyxia and neonatal sepsis. These complications can be reduced by using the partograph to assess the progress of labour. The Ministry of Health, Kenya has adopted this tool for labour management in the country and the standardised partograph is recommended for use in all delivery units. Objective: To determine the utilisation of the partograph in the management of labour in selected health facilities in Kenya. Design: A descriptive cross sectional study. Setting: Nine health facilities -ranging from a tertiary hospital to health centre, including public private and faith based facilities in four provinces in Kenya. Results: All facilities apart from Pumwani Maternity Hospital and one health centre were using the partograph. The correct use was low, the knowledge on the use of the tool was average and there was minimal formal training being provided. Staff shortage was listed as the most common cause of not using the tool. Contractions were recorded 30-80%, foetal heart rate 53-90% and cervical dilatation 70-97%. Documentation of state of the liquor, moulding and descent as well as maternal parameters such as pulse, and blood pressure and urinalysis were minimally recorded. Supplies for monitoring labour such as fetoscopes and blood pressure machines were in short supply and sometimes not functional. Overall, the poor usage was contributed to staff shortages, lack of knowledge especially on interpretation of findings, negative attitudes, conflict between providers as to their roles in filling the partograph, and senior staff themselves not acting as role models with regards to the use, advocacy and implementation of the partograph. Conclusion: The partograph was available in most units. However, accurate recording of parameters to monitor the foetus, the mother and progress of labour as recommended was mostly not done. Shortage of staff, lack of knowledge, lack of team work, lack of supplies and negative attitude among healthcare providers were some of the obstacles noted to hamper partograph use.

Qureshi ZP, Sekadde-Kigondu C, Mutiso SM. "Rapid assement of partograph utilisation in selected maternity units in Kenya.". 2010. Abstract

Prolonged labour causes maternal and perinatal morbidity and mortality. Its sequela include obstructed labour, uterine rupture, maternal exhaustion, postpartum haemorrhage, puerperal sepsis, obstetric fistula, stillbirths, birth asphyxia and neonatal sepsis. These complications can be reduced by using the partograph to assess the progress of labour. The Ministry of Health, Kenya has adopted this tool for labour management in the country and the standardised partograph is recommended for use in all delivery units. Objective: To determine the utilisation of the partograph in the management of labour in selected health facilities in Kenya. Design: A descriptive cross sectional study. Setting: Nine health facilities -ranging from a tertiary hospital to health centre, including public private and faith based facilities in four provinces in Kenya. Results: All facilities apart from Pumwani Maternity Hospital and one health centre were using the partograph. The correct use was low, the knowledge on the use of the tool was average and there was minimal formal training being provided. Staff shortage was listed as the most common cause of not using the tool. Contractions were recorded 30-80%, foetal heart rate 53-90% and cervical dilatation 70-97%. Documentation of state of the liquor, moulding and descent as well as maternal parameters such as pulse, and blood pressure and urinalysis were minimally recorded. Supplies for monitoring labour such as fetoscopes and blood pressure machines were in short supply and sometimes not functional. Overall, the poor usage was contributed to staff shortages, lack of knowledge especially on interpretation of findings, negative attitudes, conflict between providers as to their roles in filling the partograph, and senior staff themselves not acting as role models with regards to the use, advocacy and implementation of the partograph. Conclusion: The partograph was available in most units. However, accurate recording of parameters to monitor the foetus, the mother and progress of labour as recommended was mostly not done. Shortage of staff, lack of knowledge, lack of team work, lack of supplies and negative attitude among healthcare providers were some of the obstacles noted to hamper partograph use.

Zhou X, An J, Wu X, Lu R, Huang Q, Xie R, Jiang L, Qu J. "Relative axial myopia induced by prolonged light exposure in {C}57BL/6 mice." Photochemistry and photobiology. 2010;86:131-137. Abstract

Ambient lighting is essential for ocular development in many species, however, disruption in diurnal lighting cycle can affect the development in refraction and axial growth of the eye. This study investigated the effects of prolonged daily lighting on refraction and various optical components of the eye by raising C57BL/6 mice under three different light/dark cycles (18/6, 12/12 and 6/18). Egr-1 mRNA expression, apoptosis and histology of the retina and size of the scleral fibrils were evaluated in these three lighting cycles. Results showed that there was a trend of myopic development, increasing vitreous chamber depth and thinning of the retina in eyes from 6/18 to 18/6 groups. Retinal Egr-1 mRNA expression and diameter of scleral fibrils were reduced with the prolongation of daily lighting from 6/18 to 18/6. However, retinal apoptosis was not detected in all the groups. These results suggest that prolonged lighting can induce axial myopia in inbred mice. This model, which uses mice with similar genetic backgrounds, provides an alternative to the currently available models and therefore is useful for evaluation of refractive errors caused by changes in environmental illumination.

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QURESHI ZAHIDA, KIGONDU-SEKADDE C. "Sekkade -Kigondu C, Qureshi Z P, Karanja JG, Jaldesa GW, Kaihura DMM Abstracts of Research in Gynaecology and Family Planning by Department of Obstetrics and Gynaecology 1971 - 1995. Published 1996.". 1996. AbstractWebsite

PIP: In November and December, 1993, a self-administered questionnaire was distributed to men in the town of Machakos and to nonmedical hospital workers of Machakos General Hospital. The purpose of the study was to assess their knowledge about and attitude towards vasectomy. The majority of men were in the age group of 30-44 years and were married; the hospital group was more educated. The town men perceived the pill to be the best contraceptive method for women in contrast to the hospital group who gave more importance to bilateral tubal ligation. The hospital group also perceived vasectomy as the best method for men. Overall, 53.2% men were aware of the correct procedure of vasectomy, but only 24% had correct knowledge of how the procedure affects masculinity. The knowledge of the procedure among hospital workers was not very different from that of the town group. Recommendations were made to increase information and education to all groups of people through various media. author's modified

Chantada GL, Qaddoumi I, Canturk S, Khetan V, Ma Z, Kimani K, Yeniad B, Sultan I, Sitorus RS, Tacyildiz N, Abramson DH. "Strategies to Manage Retinoplastoma in Developing Countries.". 2011. Abstract

Survival of retinoblastoma is >90% in developed countries but there are significant differences with developing countries in stage at presentation, available treatment options, family compliance, and survival. In low-income countries (LICs), children present with advanced disease, and the reasons are socioeconomic and cultural. In middle-income countries (MICs), survival rates are better (>70%), but there is a high prevalence of microscopically disseminated extraocular disease. Programs for eye preservation have been developed, but toxicity-related mortality is higher. Although effective treatment of microscopically extraocular disease improved the outcome, worldwide survival will be increased only by earlier diagnosis and better treatment adherence.

Muthini, D., Nzuma, M.J., Qaim, M. "Subsistence Production, Markets, and Dietary Diversity in the Kenyan Small Farm Sector." Food Policy. 2020;DOI: 10.1016/j.foodpol.2020.101956.
Demmler K. M, Klasen S, Nzuma, M.J., Qaim, M. "Supermarket purchase contributes to nutrition-related non-communicable diseases in urban Kenya." PLoS ONE. 2017;12(9):1-18.
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Chen B, Restaino J, Norris L, Xirasagar S, Qureshi ZP, McKoy JM, Lopez IS, Trenery A, Murday A, Kahn A, Mattison DR, Ray P, Sartor O, Bennett CL. "A tale of two citizens: a State Attorney General and a hematologist facilitate translation of research into US Food and Drug Administration actions--a SONAR report.". 2012. Abstract

Pharmaceutical safety is a public health issue. In 2005, the Connecticut Attorney General (AG) raised concerns over adverse drug reactions in off-label settings, noting that thalidomide was approved to treat a rare illness, but more than 90% of its use was off label. A hematologist had reported thalidomide with doxorubicin or dexamethasone was associated with venous thromboembolism (VTE) rates of 25%. We review US Food and Drug Administration (FDA) and manufacturer responses to a citizen petition filed to address these thalidomide safety issues. Case study. The AG petitioned the FDA requesting thalidomide-related safety actions. Coincidentally, the manufacturer submitted a supplemental New Drug Approval (sNDA), requesting approval to treat multiple myeloma with thalidomide-dexamethasone. FDA safety officers reviewed the petition and the literature and noted that VTE risks with thalidomide were not appropriately addressed in the existing package insert. In the sNDA application, the manufacturer reported thalidomide-associated toxicities for multiple myeloma were primarily somnolence and neurotoxicity, and a proposed package insert did not focus on VTE risks. In October, the FDA informed the Oncology Drug Division that VTE risks with thalidomide were poorly addressed in the existing label. After reviewing this memorandum, an Oncology Drug Division reviewer informed the manufacturer that approval of the sNDA would be delayed until several thalidomide-associated VTE safety actions, including revisions of the package insert, were implemented. The manufacturer and FDA agreed on these actions, and the sNDA was approved. New approaches addressing off-label safety are needed. The conditions that facilitated the successful response to this citizen petition are uncommon.

Otto JL, Baliga P, Sanchez JL, Johns MC, Gray GC, Grieco J, Lescano AG, Mothershead JL, Wagar EJ, Blazes DL, Achila R, Baker W, Blair P, Brown M, Bulimo W, Byarugaba D, Coldren R, Cooper M, Ducatez M, Espinosa B, Ewings P, Guerrero A, Hawksworth T, Jackson C, Klena JD, Kraus S, Macintosh V, Mansour M, Maupin G, Maza J, Montgomery J, Ndip L, Pavlin J, Quintana M, Richard W, Rosenau D, Saeed T, Sinclair L, Smith I, Smith J, Styles T, Talaat M, Tobias S, Vettori J, Villinski J, Wabwire-Mangen F. "Training initiatives within the AFHSC-Global Emerging Infections Surveillance and Response System: support for IHR (2005)." BMC Public Health. 2011;11 Suppl 2:S5. AbstractWebsite

Training is a key component of building capacity for public health surveillance and response, but has often been difficult to quantify. During fiscal 2009, the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) supported 18 partner organizations in conducting 123 training initiatives in 40 countries for 3,130 U.S. military, civilian and host-country personnel. The training assisted with supporting compliance with International Health Regulations, IHR (2005). Training activities in pandemic preparedness, outbreak investigation and response, emerging infectious disease (EID) surveillance and pathogen diagnostic techniques were expanded significantly. By engaging local health and other government officials and civilian institutions, the U.S. military's role as a key stakeholder in global public health has been strengthened and has contributed to EID-related surveillance, research and capacity-building initiatives specified elsewhere in this issue. Public health and emerging infections surveillance training accomplished by AFHSC-GEIS and its Department of Defense (DoD) partners during fiscal 2009 will be tabulated and described.

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PUlei AN, Shatry NA, Sura MK, Njoroge MW, Kibii DK, Mwaniki DK, Teko HP, Maranga O, Ogutu O, Vogel JP, Qureshi Z. "Updating of a clinical protocol for the prevention and management of postpartum haemorrhage at Kenyatta National Hospital, Nairobi, Kenya." East African Medical Journal. 2018;95(2). AbstractWebsite

Background: Postpartum haemorrhage (PPH) affects 6% of births and accounts for almost 30% of maternal deaths. The use of clinical protocols for preventing and treating PPH is recommended by WHO. Protocols should be evidence-based, regularly updated, widely available and routinely adhered to.
Broad Objective: To update the Kenyatta National Hospital (KNH) PPH prevention and management protocol based on latest recommendations, and ensure its dissemination and use by providers.
Materials and Methods: A literature search identified selected PPH-related guidelines which were assessed using the AGREE-II tool for guideline quality. A matrix was created to compare recommendations across guidelines. Recommendations included in the KNH protocol were based on agreement across guidelines, guideline quality, publication year, and contextual factors in our setting. To aid implementation, an updated KNH protocol document, a clinical algorithm and a PPH management checklist were developed. These were reviewed and accepted as best practice by KNH and University of Nairobi.
Results: Six PPH-related guidelines were used (WHO, FIGO, RCOG, ACOG, FOGSI, and the Kenya National Guidelines for Quality Obstetrics and Perinatal care). The KNH protocol covers PPH prevention, including: active management of third stage, oxytocin after vaginal or caesarean delivery, other drugs for prevention (when oxytocin is not available), controlled cord traction and delayed cord clamping. It also covers PPH management (supportive and definitive measures).
Conclusion: An updated PPH prevention and management protocol for KNH was developed. Implementation and adherence will help standardize PPH-related care and improve health outcomes for women.

Latif KA, Freire AX, Kitabchi AE, Umpierrez GE, Qureshi N. "The use of alkali therapy in severe diabetic ketoacidosis." Diabetes Care. 2002;25:2113-2114. Abstract
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Vogel JP, Souza JP, Gülmezoglu MA, Mori R, Lumbiganon P, QURESHI ZAHIDA, Carroli G, Laopaiboon M, Fawole B, Ganchimeg T, Zhang J, Torloni MR, Bohren M, Temmerman M. "Use of antenatal corticosteroids and tocolytic drugs in preterm births in 29 countries: an analysis of the WHO Multicountry Survey on Maternal and Newborn Health." Lancet. 2014;384(9957):1869-77. Abstract

Despite the global burden of morbidity and mortality associated with preterm birth, little evidence is available for use of antenatal corticosteroids and tocolytic drugs in preterm births in low-income and middle-income countries. We analysed data from the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS) to assess coverage for these interventions in preterm deliveries.

Muhula S, Opanga Y, Kuyo M, Qureshi Z, Memiah P, M N. "Use of performance dashboards in health care project management: a case of an international health development organization in Kenya." Africa Health Agenda International Journal. 2018;1(3). AbstractWebsite

In this paper we document the use of dashboards in health care project management in an international health non-governmental organization. All projects at the organization monitor output performance on specific indicators against set targets and report these as project outputs performance report every month. In addition, projects prepare quality improvement report, compliance report and financial report. The four reports are then used to generate the monthly integrated performance monitoring and management dashboard which is shared with all staff and used by project managers and programme directors to review projects performance in the 4 parameters of measure and then used to provide appropriate technical support. We conducted a client satisfaction survey among staff to assess their levels of satisfaction with the dashboard and it came out that staff consider the dashboard as a “must have” monthly project management tool as it results in timely measurement of projects’ financial performance, programmatic performance, quality of service performance and compliance performance at a glance without the need to go through detailed reports. Programme directors and project managers use the dashboard to quickly identify hotspots, detect outliers in indicators of measure in a project and use this to deeply analyse possible causes of poor performance in projects for targeted technical assistance.

Vogel JP, Betrán AP, Vindevoghel N, Souza JP, M. R. Torloni ZJ, Tuncalp O, Mori R, Morisaki N, Ortiz-Panozo E, Hernandez B, Pérez-Cuevas R, Qureshi Z, Gülmezoglu AM, Temmerman M. "Use of the Robson classification to assess caesarean section trends in 21 countries." A secondary analysis of two WHO multicountry surveys Lancet Glob Health, 2015.. 2015. Abstract

Background
Rates of caesarean section surgery are rising worldwide, but the determinants of this increase, especially in low-income and middle-income countries, are controversial. In this study, we aimed to analyse the contribution of specific obstetric populations to changes in caesarean section rates, by using the Robson classification in two WHO multicountry surveys of deliveries in health-care facilities. The Robson system classifies all deliveries into one of ten groups on the basis of five parameters: obstetric history, onset of labour, fetal lie, number of neonates, and gestational age.
Methods
We studied deliveries in 287 facilities in 21 countries that were included in both the WHO Global Survey of Maternal and Perinatal Health (WHOGS; 2004–08) and the WHO Multi-Country Survey of Maternal and Newborn Health (WHOMCS; 2010–11). We used the data from these surveys to establish the average annual percentage change (AAPC) in caesarean section rates per country. Countries were stratified according to Human Development Index (HDI) group (very high/high, medium, or low) and the Robson criteria were applied to both datasets. We report the relative size of each Robson group, the caesarean section rate in each Robson group, and the absolute and relative contributions made by each to the overall caesarean section rate.
Findings
The caesarean section rate increased overall between the two surveys (from 26·4% in the WHOGS to 31·2% in the WHOMCS, p=0·003) and in all countries except Japan. Use of obstetric interventions (induction, prelabour caesarean section, and overall caesarean section) increased over time. Caesarean section rates increased across most Robson groups in all HDI categories. Use of induction and prelabour caesarean section increased in very high/high and low HDI countries, and the caesarean section rate after induction in multiparous women increased significantly across all HDI groups. The proportion of women who had previously had a caesarean section increased in moderate and low HDI countries, as did the caesarean section rate in these women.
Interpretation
Use of the Robson criteria allows standardised comparisons of data across countries and timepoints and identifies the subpopulations driving changes in caesarean section rates. Women who have previously had a caesarean section are an increasingly important determinant of overall caesarean section rates in countries with a moderate or low HDI. Strategies to reduce the frequency of the procedure should include avoidance of medically unnecessary primary caesarean section. Improved case selection for induction and prelabour caesarean section could also reduce caesarean section rates.
Funding
None.

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Zheng JW, Qiu WL, Zhang ZY, Lin GC, Zhu HG. "[{Anatomical} and histologic study of the cervical vessels in goats]." Shanghai kou qiang yi xue = Shanghai journal of stomatology. 2000;9:39-41. Abstract

OBJECTIVE:To investigate the normal anatomic relations and histologic features of the cervical arteries and veins of goat, with the aim of providing a basis for resection and reconstruction of the common carotid artery.MATERIALS AND METHODS: Surgical dissection was performed on 15 healthy adult goats under general anaesthesia. The external diameters of the common carotid artery (CCA) and external jugular vein(EJV) were measured at their midpoints. 1 cm of the CCA and EJV was subject to light microscopic examination. Direct carotid angiography was performed on 2 selected goats to observe the course and branches of the carotid artery and normal blood flow mapping of the CCA was recorded using Laser Doppler Flowmeter. RESULTS:The average external diameter of the EJV was 5.4 mm for the left side and 5.3 mm for the right side. The average external diameter of the CCA was 3.8 mm for the left side and 3.6 mm for the right side. Histologic examinations found that the media of the carotid artery had 10-15 layers of smooth muscles. The EJV had valvulae, its wall was thin, only 1-2 layers of smooth muscle were contained in its medium. CONCLUSION:The CCA and EJV of the goat had a longer course in the neck, and a larger diameter (3-5 mm). Their histologic structures were similar to that of the human being, which makes it advantageous to be more often used as an animal model in experimental surgery.

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