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- Sundar Tikmani, Shiyam, et al.
(author)
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Diagnostic accuracy of foot length measurement for identification of preterm newborn in rural Sindh, Pakistan
- 2024
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In: BMJ Paediatrics Open. - : BMJ Publishing Group Ltd. - 2399-9772. ; 8:1
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Journal article (peer-reviewed)abstract
- Introduction Assessing gestational age accurately is crucial for saving preterm newborns. In low and middle-income countries, such as Pakistan, where access to antenatal ultrasonography (A-USG) is limited, alternative methods are needed. This study evaluated the diagnostic accuracy of foot length (FL) measurement for identifying preterm newborns in rural Pakistan using A-USG as the reference standard.Methods A test validation study was conducted between January and June 2023 in rural Sindh, Pakistan, within the catchment area of the Global Network for Maternal Newborn Health Registry, Thatta. Singleton newborns whose mothers had an A-USG before 20 weeks of gestation were enrolled. A research assistant measured FL three times using a rigid transparent plastic ruler within 48 hours of birth and the average FL was reported. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) and likelihood ratios were calculated. The optimal FL cut-off for the identification of preterm newborns was determined using the Youden Index.Results A total of 336 newborns were included in the final analysis, of whom 75 (22.3%) were born before 37 weeks of gestation. The median gestational age of the newborns was 38.2 weeks, and the median FL was 7.9 cm. The area under the curve was 97.6%. The optimal FL cut-off for identifying preterm newborns was considered as ≤7.6 cm with a sensitivity of 90.8%, specificity of 96.0%, PPV of 86.7% and NPV of 97.3%. A lower cut-off of ≤7.5 cm had a sensitivity of 95.4%, specificity of 84.0%, PPV of 63.1% and NPV of 98.5%.Conclusion In conclusion, this study highlights the utility of FL measurement for identifying preterm newborns in rural settings where A-USG is unavailable before 20 weeks of gestation. Optimal cut-offs of ≤7.6 and ≤7.5 cm provide a simple, cost-effective and reliable tool for clinicians and frontline healthcare providers in rural areas, respectively.
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| 2. |
- Sunder Tikmani, Shiyam, et al.
(author)
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Exploring gestational age, and birth weight assessment in Thatta district, Sindh, Pakistan : Healthcare providers' knowledge, practices, perceived barriers, and the potential of a mobile app for identifying preterm and low birth weight
- 2024
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 19:4
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Journal article (peer-reviewed)abstract
- IntroductionReliable methods for identifying prematurity and low birth weight (LBW) are crucial to ending preventable deaths in newborns. This study explored healthcare providers’ (HCPs) knowledge, practice, perceived barriers in assessing gestational age and birth weight and their referral methods for preterm and LBW infants. The study additionally assessed the potential of using a mobile app for the identification and referral decision of preterm and LBW.MethodsThis qualitative descriptive study was conducted in Thatta District, Sindh, Pakistan. Participants, including doctors, nurses, lady health visitors, and midwives, were purposefully selected from a district headquarter hospital, and private providers in the catchment area of Global Network’s Maternal and Newborn Health Registry (MNHR). Interviews were conducted using an interview guide after obtaining written informed consent. Audio recordings of the interviews were transcribed and analyzed using NVIVO® software with an inductive approach.ResultsThe HCPs had extensive knowledge about antenatal and postnatal methods for assessing gestational age. They expressed a preference for antenatal ultrasound due to the perceived accuracy, though accept practical barriers including workload, machine malfunctions, and cost. Postnatal assessment using the Ballard score was only undertaken sparingly due to insufficient training and subjectivity. All HCPs preferred electronic weighing scales for birth weight Barriers encountered included weighing scale calibration and battery issues. There was variation in the definition of prematurity and LBW, leading to delays in referral. Limited resources, inadequate education, and negative parent past experiences were barriers to referral. Foot length measurements were not currently being used. While mobile apps are felt to have potential, unreliable electricity supply and internet connectivity are barriers.ConclusionThe HCPs in this study were knowledgeable in terms of potential tools, but acknowledged the logistical and parental barriers to implementation.
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| 3. |
- Tikmani Sunder, Shiyam, et al.
(author)
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Assessing the diagnostic accuracy of postnatal clinical scoring methods and foot length measurement for estimating gestational age and birthweight of newborns in low- and middle-income countries : a systematic review and meta-analysis
- 2024
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In: BMJ Paediatrics Open. - : BMJ Publishing Group Ltd. - 2399-9772. ; 8:1, s. 1-16
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Journal article (peer-reviewed)abstract
- Background This study aimed to update systematic reviews and meta-analyses on the diagnostic accuracy of postnatal clinical scoring (PCS) methods and foot length (FL) measurement for assessing gestational age (GA) and birth weight in low-income and middle-income countries (LMICs). In addition, the quality of reference standards, including antenatal ultrasound (A-US), last menstrual period (LMP), PCS and newborn weighing scales, was also evaluated. Methods Studies from LMICs published between January 2000 and February 2024 were searched, using databases such as PubMed, Web of Science, Cochrane Library, CINAHL and Scopus. Studies that compared PCS and/or FL with LMP and/or A-US to estimate GA or used calibrated newborn weighing scales for birthweight estimation were included. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-II tool and evaluated the quality of the reference standards. When sufficient data were available, pooled estimates were calculated using random-effects models. Results A total of 50 studies were included. A-US was a reasonable tool for GA assessment if conducted by physicians using fetal biometry and the Hadlock method for GA estimation. LMP was reasonable when women had regular cycles, knew their LMP, were not using contraceptives and LMP data were collected by healthcare providers. When A-US was used as the reference standard, PCS methods estimated GA with a precision of +/- 2.8 to +/- 3.2 weeks. FL measurement <7.5 cm showed a pooled sensitivity of 76.2% and specificity of 36.6% for identifying preterm birth. FL measurement <= 7.6 cm had a pooled sensitivity of 78.6% and specificity of 65.7% for identifying low birth weight (LBW). High heterogeneity across studies was observed. Conclusion This systematic review and meta-analysis highlights significant variability and methodological inconsistencies in using PCS methods and FL measurement for estimating GA and LBW in LMICs. The observed high heterogeneity across studies suggests a cautious interpretation of the results. PROSPERO registration number CRD42020209455.
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| 4. |
- Urooj, Faiza, et al.
(author)
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Socio-demographic characteristics of children and young people with primary brain tumours : comparison between a public and private sector tertiary hospital in Karachi, Pakistan
- 2024
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In: JOURNAL OF PAKISTAN MEDICAL ASSOCIATION. - : Pakistan Medical Association. - 0030-9982. ; 74:2, s. 366-369
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Journal article (peer-reviewed)abstract
- Primary brain tumours (PBTs) are the commonest solid tumours in children and young people (CYP). A study was conducted at a private and a public sector hospital in Karachi, Pakistan, to determine the socio-demographic and tumour -related characteristics of CYP with PBTs between those presenting to the public and private hospitals. A total of 49 patients were included. The commonest PBT was pilocytic astrocytoma (29%). There were no differences in tumour -related characteristics between the two groups. However, parents of CYP with PBTs presenting to the public sector hospital were significantly less educated and had lower household incomes. No significant differences in age, gender, educational status, and ethnicity of CYP with PBTs were observed. Since CYP with PBTs presenting at the public sector hospital were from significantly lower socioeconomic backgrounds and their parents were less educated, it suggests socio-economic disparities in PBT care for CYPs in Karachi, Pakistan.
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| 5. |
- Connelly, Sean, V, et al.
(author)
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Strong isolation by distance and evidence of population microstructure reflect ongoing Plasmodium falciparum transmission in Zanzibar
- 2024
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In: eLIFE. - : eLife Sciences Publications Ltd. - 2050-084X. ; 12
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Journal article (peer-reviewed)abstract
- Background: The Zanzibar archipelago of Tanzania has become a low-transmission area for Plasmodium falciparum. Despite being considered an area of pre-elimination for years, achieving elimination has been difficult, likely due to a combination of imported infections from mainland Tanzania and continued local transmission. Methods: To shed light on these sources of transmission, we applied highly multiplexed genotyping utilizing molecular inversion probes to characterize the genetic relatedness of 282 P. falciparum isolates collected across Zanzibar and in Bagamoyo district on the coastal mainland from 2016 to 2018. Results: Overall, parasite populations on the coastal mainland and Zanzibar archipelago remain highly related. However, parasite isolates from Zanzibar exhibit population microstructure due to the rapid decay of parasite relatedness over very short distances. This, along with highly related pairs within shehias, suggests ongoing low-level local transmission. We also identified highly related parasites across shehias that reflect human mobility on the main island of Unguja and identified a cluster of highly related parasites, suggestive of an outbreak, in the Micheweni district on Pemba island. Parasites in asymptomatic infections demonstrated higher complexity of infection than those in symptomatic infections, but have similar core genomes. Conclusions: Our data support importation as a main source of genetic diversity and contribution to the parasite population in Zanzibar, but they also show local outbreak clusters where targeted interventions are essential to block local transmission. These results highlight the need for preventive measures against imported malaria and enhanced control measures in areas that remain receptive to malaria reemergence due to susceptible hosts and competent vectors.
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| 6. |
- Lundin, Johan, et al.
(author)
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Diagnosis of soil-transmitted helminth infections with digital mobile microscopy and artificial intelligence in a resource-limited setting
- 2024
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In: PLoS Neglected Tropical Diseases. - : Public Library of Science (PLoS). - 1935-2727 .- 1935-2735. ; 18:4
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Journal article (peer-reviewed)abstract
- Background: Infections caused by soil-transmitted helminths (STHs) are the most prevalent neglected tropical diseases and result in a major disease burden in low- and middle-income countries, especially in school-aged children. Improved diagnostic methods, especially for light intensity infections, are needed for efficient, control and elimination of STHs as a public health problem, as well as STH management. Image-based artificial intelligence (AI) has shown promise for STH detection in digitized stool samples. However, the diagnostic accuracy of AI-based analysis of entire microscope slides, so called whole-slide images (WSI), has previously not been evaluated on a sample-level in primary healthcare settings in STH endemic countries.Methodology/Principal findings: Stool samples (n = 1,335) were collected during 2020 from children attending primary schools in Kwale County, Kenya, prepared according to the Kato-Katz method at a local primary healthcare laboratory and digitized with a portable whole-slide microscopy scanner and uploaded via mobile networks to a cloud environment. The digital samples of adequate quality (n = 1,180) were split into a training (n = 388) and test set (n = 792) and a deep-learning system (DLS) developed for detection of STHs. The DLS findings were compared with expert manual microscopy and additional visual assessment of the digital samples in slides with discordant results between the methods. Manual microscopy detected 15 (1.9%) Ascaris lumbricoides, 172 (21.7%) Tricuris trichiura and 140 (17.7%) hookworm (Ancylostoma duodenale or Necator americanus) infections in the test set. Importantly, more than 90% of all STH positive cases represented light intensity infections. With manual microscopy as the reference standard, the sensitivity of the DLS as the index test for detection of A. lumbricoides, T. trichiura and hookworm was 80%, 92% and 76%, respectively. The corresponding specificity was 98%, 90% and 95%. Notably, in 79 samples (10%) classified as negative by manual microscopy for a specific species, STH eggs were detected by the DLS and confirmed correct by visual inspection of the digital samples.Conclusions/Significance: Analysis of digitally scanned stool samples with the DLS provided high diagnostic accuracy for detection of STHs. Importantly, a substantial number of light intensity infections were missed by manual microscopy but detected by the DLS. Thus, analysis of WSIs with image-based AI may provide a future tool for improved detection of STHs in a primary healthcare setting, which in turn could facilitate monitoring and evaluation of control programs.
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