1.
Comprehensive Retrospective Study Of Dog Bites In Lahore Dr. Shakera Sadiq Gill
by Toraiz Ahmed (2012-VA-902) | Dr. Nusrat Nauman | Dr. Muhammad Hassan Mushtaq | Mr. Tariq Mahmood | Faculty of Veterinary Sciences.
Material type: ; Literary form:
not fiction
Publisher: 2014Dissertation note: Dog may be the best friend of humans but still they are animals and can bite. Despite of domestication dogs show the behavior of their ancestors as their ancestors (wolves) are voracious, strong, cunning, agile, swift and sharp teeth’s (Keuster et al. 2006). In fact dog bites millions of people every year and half of them are children of age from 5 to 9 (Sacks et al. 1996). One out of every five bite case needs medical interventions and treatment (Shuler et al. 2008). Dog bites are the results of attacks of pet or stray dogs on humans. Humans have close association with dogs in their daily life. This association may be as pet dogs or it may be as stray dogs in developing countries (Shuler et al. 2008). Dog bite injuries vary from common injury to severe condition such as rabies. Most of the studies show the association of dog bites with different breeds and considerable debates are also there that which breed is associated more with dog bites (Patrick and O'Rourke 1998). Regardless the breed, some other things are also important, like dog behavior, human behavior, no supervision of dog or carelessness in control and the scenario or conditions under which the dog is living (Cornelissen and Hopster 2010). Breed is rather not an important point to discuss in developing countries like Pakistan. As in developing countries most of the Dog bites occur due to stray dogs. Mostly the injuries are minor but still dog bites are one of the most important problems for society and health administration authorities as dog bites comprises about 90% of total animal bites. About 4.5 million Americans are bitten by dogs every year and about 30,000 of them require procedures of reconstructive surgery (Wilde 1997). Fortunately the fatalities from dog bites are much less. Dog bite cases turn into fatal condition when patient is bitten by potential rabies virus carrier and infection may occur that can be life threatening. Rabies, a viral disease caused by the bite of an infected animal that can cause acute inflammation of brain in warm blooded animals and humans. It is present in more than150 countries of the world (WHO 2005). An estimate shows that 10 thousand deaths occur worldwide due to rabies. Potentially 3 billion people are at threat of rabies in Africa and Asia and out of the total 84% of rabies deaths occur in rural areas. Millions of cases of dog bites cases go unreported throughout the world. This underreporting hides the actual burden of the problem in the community (Turner 1976). In humans dog bite is one of the complex phenomena that may occur by interaction of three elements, animal, scenario and the victim. Figures on dog bites mostly pool out from studies in public health institutions and hospitals (Jacob John 1997). Most of the studies show the scientific analyzed information only on victim while the circumstances and conditions surrounding the incidence of dog bites remain unknown. Important thing is fatalities from dog bites occur only in very small proportion of dog bites (Cleaveland et al. 2002). However treatment expenses and consequences of injuries have turned the issue of dog bite into significant public health importance (Coleman et al. 2004). The other side of coin is that the aggressive behavior development in dogs leads to relinquishment of shelter and euthanasia, which indicate a problem in term of animal safety (Guy et al. 2001). Public health specialists and Epidemiologists focus that fatal and non-fatal dog attacks can be controlled or prevented through effective preventive measures. For effective and suitable preventive measures it is pertinent to start examining the epidemiological data of the respective community. Epidemiological data is require to define the geographically high risk areas, seasonal patterns associated with the dog bites with respect to the victim, and other triggering factors (Sacks et al. 2000). For the sound preventive and control measures epidemiological data is one of the best tools for better decision making in public health issues (CDC 2003). In developing countries like Pakistan epidemiological studies of dog bites are important and are needed on the multi-dimensional aspects as dog bite incidence and other associated risks are much higher and vary according to area of study. These types of multi-dimensional studies may change the preventive strategy plans with their extra efficiency. Normally control and preventive measures are designed to lessen the risk of dog bites and followed by all communities. Possible control and preventive measures are control of free roaming and unrestrained animals, vaccination, breed or type bans, licensing of dogs, extensive media campaigns specially in rural areas, well defined post bite program, investigation of dog bite incidents (Wilson et al. 2003).
Pakistan is among the world highest cases of rabies with about 50 thousand cases per year. Recent estimates show that 570 peoples die annually in Pakistan because of rabies (WHO 1996). In Pakistan people mostly neglect the minor dog bite cases and due to high illiteracy rate large numbers of cases go unreported (Wasay et al. 2008). This is because people suffering from dog bite normally rely on local remedies, such as rubbing red chilies on the wound from the house the dog belongs (in case of pet dog). Rabies virus can be killed upto 65% by washing with soap only (Burki 2008). Vaccination is the ultimate solution for rabies, but very less amount of people knows about the vaccination of dogs. Post exposure treatment is costly in dog bite cases. Cost analysis of post exposure treatment for dog bites shows the actual picture and importance of dog bites in public health sector. Billions of rupees are spent on the vaccines and treatment of dog bites cases (Chulasugandha et al. 2006). A large number of cases report to quacks and go unreported on official database. For the better decision regarding the public health problem the cases must be reported to official database. Weak reporting system is also an important factor in developing countries like Pakistan. As in Pakistan rabies and dog bites are not notifiable disease. No proper surveillance system is there for rabies is at present. Studies and surveys shows that 55% people didn’t even consider dog bites as a predisposing factor for rabies and they even didn’t know that the dog bite can be fatal (Knobel et al. 2005). To prevent and control dog bite it is necessary to have comprehensive epidemiological data that allows the identification of associated risk patterns. Rabies is endemic in Pakistan so this study is aimed to investigate the problem posed by dog bites in Lahore, Pakistan.
Lahore is the second most populated city of Pakistan with population of 5.143 million (according to 1998 census). This study will help the officials of public health in making better decision regarding dog bites. This study is aimed at investigating the problems posed by dog bites in Lahore. Availability: Items available for loan: UVAS Library [Call number: 2202,T] (1).
2.
Status Of Awareness Among Zoo Workers About Zoonotic Diseases
by Tahir Khan (2012-VA-806) | Prof. Dr. Mansur Ud Din Ahmed | Shelly Saima Yaqub | Dr. Shakera Sadiq Gill | Prof. Dr. Aftab Ahmad Anjum.
Material type: ; Literary form:
not fiction
Publisher: 2014Dissertation note: A zoo is a place where wild animals are kept for exhibition purposes to the public.It includes: aquaria, sanctuaries, bird gardens and safari/wildlife parks. These are centers for wild animal’sconservation and for public recreation and education (Cuaron2005). Epidemiologists, wildlife biologists, veterinarians and conservationists used these for research purpose.According to an estimate Pakistan is maintainingapproximately 27 zoos, deer parks, etc.(Walker 2014).
Zoonotic diseases are those which are naturally transmitted from animals to human beings and vice versa. The word Zoonosis is derived from the Greek word zoon (animal) and nosos (disease). The diseases which are transferred from human beings to animals are known as Zooanthroponotic (Greek “Zoon” = animal, “anthrópos” = man, “nosos” = disease) diseases e.g. tuberculosis, measles, giardiasis and amoebiasis. On the other hand the diseases which are transmitted from animals to human beings are known as anthropozoonotic diseases e.g. anthrax, AIDS, psittacosis and rabies (Epstein and Price 2009).
Zoonosis can be classified according to their circulation in the ecosystem. These are either classified as synanthropic zoonosis, with an urban (domestic) cycle in which the source of infection are domestic and synanthropic animals (e.g. cat scratch disease, urban rabies and zoonotic ringworm) or exoanthropic zoonosis, with a sylvatic (feral and wild) cycle in natural foci outside human habitats (e.g. wildlife rabies, arbovirus, lyme disease and tularemia). Some zoonotic diseases can circulate in both urban and natural cycles (e.g. chagas disease and yellow fever).
A review study identified that 1415 species of infectious organism are pathogenic to human beings. This includes 217 viruses and prions, 538 bacteria and rickettsia, 307 fungi, 66 protozoa and 287 helminthes. Out of these, 868 (61%) are zoonotic in nature (Taylor et al. 2001). More than 60% of the emerging human infectious diseases are zoonotic in nature and 70% of their reservoirs are wild animals (Cutler et al. 2010).
The reservoirs of several zoonotic diseases are wild animals whose causative agents are viral, rickettsial, chlamydial, bacterial, parasitic and mycotic(Bengis et al. 2004). Zoonotic diseases like tuberculosis, plague and rabies have badly affected the mankind since ancient times and the reservoirs of all of these are wild animals (Stone et al. 2009). Some zoonotic diseases in human beings are self-limiting whose signs range from few days to a long term illness e.g. gastroenteritis caused byGiardia, Cryptosporidium, and Salmonella species.Some zoonotic diseases may cause abortions (Toxoplasmosis) and fatal encephalitis (Japanese encephalitis). Whereas some zoonotic diseases may causes high mortality e.g. Marburg hemorrhagic fever(MacNeil and Rollin 2012). Zoonotic diseases cause death not only in their natural hosts but also in endangered wild animal species near to extinctione.g. Ebola virus cause high mortality in monkeys (Nunn et al. 2008). It is clear from various studies in different zoos that both anthropozoonotic and zooanthroponotic transmission can occur (Adejinmi and Ayinmode 2008).
Zoonotic agents have potential to be used for bioterrorism. The bioterrorism attack is aimed to cause fear, destabilization, stress, illness and death in people, animals and plants. (Lin 2014). Air, water and food may be the warfare biological vehicles for its spread. During World War 1, anthrax was used as a biological warfare in animal populations. Glanders and typhoid were also used for bioterrorism attack in 1910 and 1970, respectively. Several cases of bioterrorism also occurred in the United States due to anthrax in September and October 2001 (Spencer 2007).
A Zoo worker should haveknowledge of the transmission of the disease to avoid its transmission. The common ways of the transmission are direct mode (ingestion, animal bites, inhalation, needle prick injuries and skin contact) and indirect mode (vector borne, fomite, long distanceand airborne transmission). In zoo management, the role of veterinarians is extremely useful. Their job exposes them to several health-related threats during routine operations. e.g. animal bites, needle prick injuries, back injuries, exposure to anesthetic gases and even mortality in certain cases (Hill et al. 1998; Kabuusu et al. 2010).
The personal protective equipment’s are not used during restraining, treatment, necropsy and cleaning the animal enclosures. It may increases the chances of zoonotic diseases to zoo workers and veterinarians. The disposal of wild animal carcasses, organs, unused food, feces and urine by unscientific methodsenhances the process of pathogens transmission(McLaughlin 2002). Laboratory personnel can also be infected with zoonotic diseases due to lack of good laboratory practices in wildlife disease diagnostic laboratories(Rietschel 1998).
Therefore, prevention and control of zoonosis must be an important part of zoo occupational health and safety measures. Preventive measures can be either general or specifically designed for a particular disease. It is possible to prevent many of the zoonotic diseases by following basic hygiene and sanitation procedures.The present study was conducted to determine knowledge, attitude, practice and experience levels about zoonosis among zoo workers of district Lahore(Lahore Zoo, Jallo Wildlife Park and Lahore Safari Zoo).
Availability: Items available for loan: UVAS Library [Call number: 2229-T] (1).
3.
Epidemiological Investigation And Risk Factor Analysis Of Brucellosis In Large Ruminants And Their Attendants At Govt. Livestock Farms In Punjab
by Muhammad Raashid (2007-VA-496) | Prof. Dr. Mansur-ud-Din Ahmad | Dr. Muhammad Hassan Mushtaq | Dr. Sehrish Firyal.
Material type: ; Literary form:
not fiction
Publisher: 2015Dissertation note: Pakistan has been renowned as an agricultural country. It is rich in livestock sector having fairly large populations of domestic animals. Among these, populations of cattle and buffalo are 38.3 and 33.7 million respectively. The importance of cattle and buffalo cannot be denied at any level as these are the principal farming animals and milk and beef are widely consumed locally in the country. The estimated annual milk production of cattle and buffalo include 17.372 and 30.462 million tonnes respectively and a combined 1.829 million tonnes beef for human consumption during 2012-2013 (Pakistan Economic Survey 2012-2013).
Brucellosis, a worldwide bacterial zoonosis, is one of the most serious diseases causing huge loss to national economy and human beings among developing countries (Wu et al. 2013). The disease is endemic in Middle East, Central Asia, Africa, Mediterranean region and parts of Latin America (Gwida et al. 2010). Brucellae are Gram-negative bacteria, facultative anaerobic and intracellular pathogens. These show a wide range of host specificity. These coccobacilli measure from 0.6 to 1.5 µm long and 0.5 to 0.7 µm wide. Eight species have been identified in the genus Brucella such asBrucella abortus(B. abortus affecting cattle and buffalo), B. melitensis (sheep and goats), B. ovis (sheep), B. suis (swine), B. canis (dog), B. neotomae (desert rats), B. ceti (cetaceans) and B. pinnipedialis (pinnipeds) (Blasco 2010). This wide range of species covers almost all domestic animals however cats have found resistant. Generally it is considered as a reproductive problem in both male and female animals (Ficht 2003).
Brucellosis has been listed as the second most serious zoonotic disease in the world after rabies by OIE (OIE 2009). B. abortus, the primary cause of Brucellosis in large ruminants, (cattle and buffalo), remains not only a significant threat as a source of human illness but also risks economy of the country (Makita et al. 2011). Present estimates of economic loss in meat and milk production resulting from Brucellosis are $800 million annually in the United States(OIE 2009). The incidence of the disease can be correlated to several factors including demographic and geographic factors(Soomro et al. 2014). Seroprevalence of the disease has been reported in different regions of Pakistan and ranges 3.25 to 4.4%(Naeem et al. 1990).
Brucellosis in cattle and buffaloes can be recognized clinically by an abortion usually occurring form 6 months and onwards i.e. last trimester of pregnancy (Soomro et al. 2014). Brucellosis is principally a disease of sexually mature animals as it affects mainly the reproductive system and fertility of the animals. It significantly reduces the survival rate of newborns and also the milk yield (Sikder et al. 2012). Greyish white mucoid or mucopurulent discharges from the vagina, prior to parturition of cow, may show the clinical patterns of disease along withnormal patterns of parturition like swelling of the vulva, relaxation of pelvic ligament, enlargement of udder and discharge from the vulva (Shafee et al. 2012).
Human infections as a result of Brucellosis range more than 500,000 annually round the world (Abo-Shehada and Abu-Halaweh 2011). Brucellosis can cause a wide range of symptoms similar to the flu and may also include fever (39-40°C), night sweats, headache, back pain and physical weakness. Severe form of infection may result in involvement of the central nervous system or the lining of the heart (Soomro et al. 2014). It is one of the principal public health problems for an agricultural country like Pakistan, where majority of the population is engaged in livestock farming (Shafee et al. 2012).
Brucellosis in humans is a severely debilitating condition that usually requires prolonged treatment involving a combination of strong antibiotics. The treatment results in permanent and disabling sequel, and also in significant medical expenses along with loss of income due to loss of working hours. Brucellosis can be transmitted to humans by ways of inhalation, direct contact with infected animals or contaminated products of conception and ingestion of unpasteurized dairy products and undercooked meat or meat products (Gwida et al. 2010; John et al. 2010). Brucellosis can also be transmitted from infected animals to human beings who are in close contact with animal secretions like infected vaginal secretions, blood, urine, feces, aborted fetus, or those who consume unpasteurized milk or other raw milk products. Shepherds, milkmen, butchers, knackers, veterinary assistants, and abattoir workers are at high risk (Agasthya et al. 2007)
Availability: Items available for loan: UVAS Library [Call number: 2245-T] (1).
4.
Incidence Of Dog Bite Injuries Reported In Tertiary Care Hospitals
by Ambreen Shahzadi (2012-VA-440) | Dr. Mamoona Chaudhry | Dr. Shakera Sadiq Gill | Dr. Muhammad Ijaz.
Material type: ; Literary form:
not fiction
Publisher: 2014Dissertation note: Animal bites people should be considered an important public health problem. Moreover, the number of pets, specifically the dog, is increasing. (Palacio J et al., 2003).Animal bites, particularly dog bites, are a major public health problem throughout the world (Morgan and Palmer, 2007). Animal bites and scratches, even when they are minor, can become infected and spread bacteria to other parts of the body.
Dog attacks, by street or domestic dogs, with injuries from very minor to significant and severe to fatal, are not uncommon. According to WHO report, ten million people are bitten by animals (especially Dogs) around the world, considered for prophylaxis and treatment against rabies and almost (55,000) people die from this disease annually (Mohdjunaid et al., Oct 2012).
6.2 Hypothesis:
The incidence of dog bite injuries is high in densely populated towns of Lahore when compared to less populated towns of Lahore.
6.3 Methodology:
General information about patients and possible causes was collected on a structured questionnaire. All the dog bite victims that were come to emergency ward during three months period were included in the study. Questionnaire include closed questions about the demographics of the victims, circumstances of bite incidents, body parts injured and the degree of injury, type of dog, history of previous bites, the level of knowledge about rabies, post bite home treatment (washing of bite wound etc.) prior to visited the hospital for medical treatment and post exposure treatment at hospital. The densely populated area (ravi town, data ganj bakhsh, shalimar town, samanabad etc) and less populated area (gulberg, azizbhati town, wagah, Allama iqbal town, & nishtar) was be compared.
6.4 Statistical Design
Cumulative incidence was calculated as described by Leon Gordis (2008). Chi square test was applied on the data by using SPSS (version 19.0).
6.5 Results
In this study, cumulative incidence is 4.653 per 1000 popluation, most of the dog bite victims were male 79.9 % as compare to female 20%.5.7% cases visited Mayo Hospital’s emergency department during the study period, 4.5% cases were reported in Services Hospital and 89.9% cases from IPH Lahore. In this the higher percentage was the patients who were illiterate (47%) and very few patients were those who had intermediate and above education (6%). The occupation of the patients who were attended Hospitals, were farmers (31.56%). The 24% patients were those who had bitten once before in previous years. In those 24% patients 19.2 % those who were bitten by dog and 5% were bitten by others (cats, horse, donkeys, etc). Most of the victims were bitten in rural area (65%) and most of the injuries were from stray dogs (65.9%). Most of the victims had provoked bite (74%) and the high frequency were recorded that the cases had type II wound category (deep scratch but no bleeding) 82%. The cases received treatment in different hospitals were RIG (18%), Tetanus toxoid (32%), Antibiotic (78%) and Suturing (7.9%).
Most of the patients were from Ravi town Lahore that is one of the highly densely populated areas of Lahore (38%) and very few cases reported from Nishtar town Lahore (0.5%). The demographic location and the hospitals had no association as the results were insignificant (p-value>0.05). Most of the cases who were bitten by dog and they already bitten by dog in previous years, significant in relation as p-value <0.05. The association between dog status and biting animal was significant, as mostly biting dogs were stray dogs and most of the bite was provoked, there was significant association between biting animal and biting type (p-value<0.05).
Availability: Items available for loan: UVAS Library [Call number: 2285-T] (1).
5.
Prevalence Of Newcastle Disease In Backyard Poultry In District Mardan
by Muhammad Saeed (2013-VA-439) | Dr. Mamoona Chaudhry | Dr. Abdul Sajid | Prof. Dr. Mansur Ud Din Ahmad | Dr. Jawad Nazir.
Material type: ; Format:
print
; Literary form:
not fiction
Publisher: 2015Dissertation note: Newcastle disease (ND) is very important viral diseases of poultry industry in the rural areas of Pakistan It is caused by Avian Paramyxovirus serotype 1 (APMV-1) of the genus Rubulavirus belonging to the family Paramyxoviridae. The outbreaks of ND are usually associated with various factors e.g. confinement of birds, mode of disposal of diseased birds, cadavers and poultry fecal matter; dry seasons in the dry zones just before the rains; wind conditions; short irregular temperature changes and the refilling of farms with chickens from the markets. The present study was conducted in randomly picked 30 clusters in three Union councils of Tehsil Takht Bhai District Mardan to investigate the seroprevalence of Newcastle Disease virus and its potential risk factor in non-vaccinated chicken raised under backyard management system. Serum were observed through Haemagglutination inhibition test for the confirmation of prevalence of Newcastle Disease. 165 were found seropositive and 45 were seronegative (antibody titres of 4 or less) for ND out of 210 sera samples. Overall weighted seroprevalence was found as 76.836%, 95% Cl (66.238-87.433) using R software. This means that NDV was circulating in backyard poultry of district Mardan, while data on risk factor were obtained through a detail predesigned questionnaire from the owner in a face to face interview translated into local language (Pushto) after taking written consent from the owner.
To identify the risk factors for Newcastle Disease seroprevalence, multivariable logistic regression were performed. The result showed that live birds market stall near houses was strongly associated with NDV seroprevalence. Source of water from both type (public water supply and street channels) were also found strongly associated. A strong association was also observed between NDV seroprevalence and water source of street channels. Result also showed that cleaning of backyard premises was a protective factor against NDV with OR < 1. Another
Summary
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strong risk factor was live birds market stall near houses (OR 33.64, 95 % Cl: 6.49-174.28). The largest confidence interval showed less precision which could be due to less no. of samples. The identified estimate of seroprevalence of ND and its associated potential risk factor will be communicated to concerned persons through publication. Availability: Items available for loan: UVAS Library [Call number: 2292-T] (1).
6.
Seroprevalence Of Dengue Fever In Tehsil Jatoi District Muzaffargarh, Punjab
by Muhammad Shahzad Ahmad Khan (2013-VA-848) | Dr. Mamoona Chaudhery | Dr.Tayyaba Ijaz | Dr. Hassan Mushtaq | Dr. Waseem Shahzad.
Material type: ; Literary form:
not fiction
Publisher: 2015Dissertation note: Dengue is caused by single stranded RNA virus that belongs to genus flavivirus and is a mosquito born disease. There are four serotypes of dengue virus DENV-1, DENV-2, DENV-3, and DENV-4. Signs and symptoms of dengue virus are high fever, severe headache, rash, muscle pain, retro-orbital pain and leucopenia. Incubation period is 4-7 days. There are three type of dengue fever named as dengue fever, dengue hemorrhage fever and dengue shock syndrome. More severe form of dengue is dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS).
Hypothesis of this study was that dengue virus is prevalent in Tehsil Jatoi District Muzaffargarh. Data was collected from individual in a face to face interview. Thirty clusters were selected and in each cluster seven (7) elementary unit (individuals) were sampled. A cross-sectional survey was conducted and blood samples were collected from individuals by using aseptic technique. The blood was drawn from the antecubital vein, from elbow or from the back side of a hand. Swab was applied to avoid bleeding.
A total of 210 apparently healthy individuals were sampled from thirsty clusters and serum was observed through ELISA for confirmation of Dengue fever disease. 27 were found positive and 183 were negative for DF out of 210 sera samples.
The data analysis was done by using “R” software. Multivariable logistic regression was conducted to estimate the effect of each explanatory variable on the outcome. Overall weighted seroprevalence was recorded as 13.54 %, (95% CI, 8.144-18.92). This means that DENV was circulating in Tehsil Jatoi district Muzaffargarh, while data on risk factors were obtained through
Summary
54
a detailed predesigned questionnaire from participants in a face to face interview translated into local language (Saraiki) after taking written consent from the individual.
To identify the risk factors for Dengue fever disease seroprevalence, multivariable logistic regression were performed. The result showed that age (OR: 3.084, 95% CI: 1.180-8.061) was risk factors for dengue fever and anti-mosquito spray (OR: 0.349, 95% CI: 0.122-0.997) was protective (OR<1) factor against dengue fever disease. Variable with significant univariable relationship at P < 0.25 were selected for inclusion in the final model
The study had provided successful estimate about the risk factors and seroprevalence of Dengue Fever. The finding of above study will be published. These finding could be utilized by the policy maker to control the epidemic of DF in population. Availability: Items available for loan: (1), UVAS Library [Call number: 2293-T] (1).
7.
A Study On The Incidence Of Zoonotic Tuberculosis To Assess The Associated Risk Factors And Zoonotic Potential Of Bovine Tuberculosis In Lahore
by Syeda Anum Hadi (2013-VA-04) | Dr. Hassan Mushtaq | Dr. Abdul Majeed Akhtar | Professor Dr.Mansur-ud-din Ahmad | Dr. Aamir Gafoor Bajwa.
Material type: ; Format:
print
; Literary form:
not fiction
Publisher: 2015Dissertation note: In the review by O’Reiley and his colleagues, Tuberculosis has been defined as a disease that affects the respiratory system foremost and its route of transmission from one animal species to another is by the airborne route along with consumption of un-pasteurized milk (O'Reilly, 1995) (De la Rua-Domenech, 2006) (Thoen et al. 2006). The review states that Mycobacteriumbovis causes tuberculosis in bovines as well as a number of wild animals such as goats, cats, dogs, pigs, buffalo, badgers, possums, deer, bison and non-human primates but most importantly it causes tuberculosis in humans. This makes the disease of significant public health importance due to its zoonotic nature.
The study was conducted in two of the largest dairy colonies in Lahore- Rakhchandra and Harbanspura dairy colony. 400 dairy animals (lactating) were selected from the target areas. 200 animals per field were chosen through convenience sampling. The research was divided into two parts. Phase 1 was concerned with screening of animals for bovine tuberculosis through performance of comparative intradermal tuberculin test (CIDTT) and followed by culturing of milk samples from animals that came positive. Phase 2 was concerned with testing of all human subjects who were in contact with the positively screened livestock. Since none of the human subjects showed any of the signs for tuberculosis, no testing of the humans could be performed.
The first step to animal testing was concerned with the screening of selected animals with comparative cervical intradermal tuberculin test (CIDTT). This involved the intradermal injection of bovine tuberculin purified protein derivative (PPD) and the subsequent detection of swelling (delayed hypersensitivity) at the site of injection 72 hours later (Anonyms, 2008a). The test was considered positive if the difference between the swellings on the two sites was more than 4mm and it was the mammalian site that showed more swelling. Once the results were read, the dairy farmers were asked a set of questions designed to identify risk-factors for zoonotic tuberculosis. The farmers responded to nearly all the questions that were posed to them.
Milk sample was collected from the animals that tested positive. 50 ml of milk was collected from the positive animals. Once collected, the milk bottles were quickly capped and labeled and put in the ice-box before being transported to Provincial Tuberculosis Reference Laboratory in Lahore. Staining followed by culturing of milk samples for the isolation of Mycobacterium bovis was then proceeded with. For the purpose of culturing two types of media were prepared before-hand-Lowenstein Jensen (LJ) media and LJ-pyruvate media. LJ medium allows the growth of Mycobacterium tuberculosis, whereas LJ with pyruvate medium allows the growth of Mycobacterium bovis.
Petroff’s method was employed for the processing of milk samples which originally is used for sputum processing (Anonyms, 2009). The process was altered to suit our requirements. Once processed 300ul of pipette tips were used to place 100ul of processed sample on pre-marked slides for ziehl-neelson staining and 120ul on pre-made media slants a total of 4 bottles, 2 each of LJ media and LJ pyruvate media for duplication of results and to act as control. The bottles were checked for growth every week on Monday till 8 weeks of time.
At Rakhchandra dairy colony the tuberculin test done on 200 animals revealed only three (3) positive animals. Thus the prevalence of TB in Rakhchandra came out to be 1.5%. Out of 200 animals in Harbanspura dairy colony, six (6) animals showed hypersensitivity reaction and were positive. Prevalence of TB in Harbanspura came out to be 3%. Out of 400 animals tested, 90 were cattle and 310 were buffaloes. Only buffaloes showed hypersensitivity reaction to tuberculin. None of the cows tested came out to be tuberculin positive. In this particular study, the prevalence of TB on the basis of tuberculin test in buffalo was 2.9% where as in cattle it was 0%. When milk was collected and processed from the above mentioned nine (9) animals, the results showed a different picture. None of the cultures showed any signs of growth by 8 weeks of incubation. All nine milk samples after cleaning were stained by ZN staining and observed under microscope for the presence of mycobacterium, none came out positive.
The Basic Health Units (BHU) in each of the colony were contacted and it was found that in the last 10 years less than 10 patients who were suspected to have tuberculosis were referred to District Health Quarter (DHQ).
Even though a higher percentage (44.44%) of farmers in Harbanspura was recorded to have some knowledge about the zoonotic aspect of tuberculosis as compare to those in Rakhchandra (22.22%), yet a higher number of tuberculin positive animals was found in Harbanspura (6 versus 3). The economic status of farmers in Harbanspura was comparatively higher with 33.33% of farmers earning more than 1 lakh rupees per month, whereas in Rakhchandra this figure stood at 27.78%. This might be a mere chance of co-incidence but it also implies the unwillingness of farmers to apply biosecurity measures at their farms. Lack of willingness to take such precautionary steps places the farmers and their animals in great peril, since in the last six months alone 66.67% of the farmers in Harbanspura had purchased at least one animal, which is enough to bring disease in an un-infected herd. Only 27.78% of farmers in Rakhchandra had purchased animals on the other hand. Also only 77.78% of farmers in Harbanspura would clean the dung from the farms twice a day whereas 100% Rakhchandra farmers would cleanup twice a day. The tuberculin positive animals were found to be spending most time of their day in filthy places. Their sheds were not cleaned regularly. Heaps of dung and ground wet with urine was observed on every visit. It exposed animals to numerous infections and 11.11% of animals in Harbanspura and 44.44% of animals in Rakhchandra were suffering from unidentified chronic illnesses. Farmers said that they preferred to sell such animals to butchers (85.8% combined percentage), rather than burying after culling (3.7% combined percentage). Deworming was not considered a mode of disease prevention amongst the farmers since only 22.22% of all farmers bothered to deworm their animals. The animals were seen to not having a score of above 2.5 when their body scoring was done (Scale 1-5). The one blissful factor discovered was the habit of nearly all farmers (92.59%) preferred to boil milk before consumption. Even dairy products were made from boiled milk (81.48%). This single factor could be the reason why the farmers consuming otherwise contaminated milk was still in such a glowing healthy condition.
The study allowed us to get a measure of the status of disease in lactating animals and to investigate the conditions that prevail in the two dairy colonies. It showed a difference in the prevalence of disease in Harbanspura and Rakhchandra famous for providing milk to Lahore city. This was scrutinized through a detailed analysis of farmer habits and environment of animals in both the fields. This study would permit upcoming researchers to have an up-to-date status of tuberculosis in the dairy colonies.
Availability: Items available for loan: UVAS Library [Call number: 2321-T] (1).
8.
Seroprevalence Of Brucellosis In Pregnant And Aborted Women Of Rural And Urban Areas In Three Selected Districts Of Punjab Pakistan
by Shakeela Anjum (2006-VA-172) | Dr. Iahtasham khan | Prof. Dr. Abdul shakoor | Prof. Dr. Muhammad Younus.
Material type: ; Literary form:
not fiction
Publisher: 2015Dissertation note: Brucellosis is an important zoonotic disease of animals and human. According to OIE
(Office International des Epizooties), it is the second most important zoonotic disease in the
world after rabies Brucellosis is more common in countries with Poorly standardized animal
and public health programme. Human Brucellosis caused by B. abortus, B. abortus are small,
non-motile, aerobic, facultative intracellular, Gram-negative cocobacilli.
The symptoms of human brucellosis are undulant fever, headache, weakness, body
pain, and sometimes endocarditis, orchitis, or arthritis may develop. Prolonged use of
combination of antibiotics and human vaccine is main control measure strategies for human
brucellosis. This disease is under investigated and hence people are ignorant of this insidious
problem. Serological surveillance is a good and cheap tool to diagnose this problem. There is
also need to know that which diagnostic antigen (Pakistani or French) is more sensitive and
specific from disease eradication and control point of view. Unfortunately annual incidence
of brucellosis in whole Pakistan is unknown but they are expected above 2 per 100,000
people. The hypothesis of present study was that brucellosis is considered to be endemic in
Pakistan but there is no data available about seroprevalence of brucellosis in pregnant,
aborted, rural and urban women with different risk factors in Pakistan.
In present study sero-screening of total 199 serum samples of pregnant and women
presenting with abortions from district Jhang, district Chinoit and district Faisalabad. Test
was performed on 199 samples which showed 40 (20%) positives by RBPT (Pakistan) and 42
(21%) positives by RBPT (France) (Table 4.4). While the indirect modified ELISA showing
5 (2.5%) positive samples. All sera tested positives (5) with modified i-ELIA were also tested
positives with another specific and highly expensive ELISA (Verion Serion) at OIE reference
Summary
41
Laboratory for brucellosis, Germany. Prevalence data was analyzed by chi square test
using SPSS version 20 Software (Apache License, USA) to find out correlation between risk
factors and brucellosis prevalence.
Risk factors such as consumption of raw milk, contact with animals, and symptoms
were significant. In our opinion, indirect modified ELISA is more sensitive than RBPT
(Pakistan) and RBPT (French). RBPT, (Pakistan) can be used for primary screening of
brucellosis cases because of cross reactivity present in RBPT antigen and confirmation must
be made with a more specific and sensitive serological test, such as B. abortus-specific
indirect modified ELISA. The results of present study showed that RBPT, Pakistan antigen
showed almost same sensitivity and specificity as that of RBPT (Pourquier, France) antigen.
Indirect modified ELISA is more specific as compared to RBPT (Pakistan) and RBPT
(French). It is highly suggestive to combine serodiagnostics test with molecular detection
including PCR and Real time PCR to increase the detection rate of brucellosis. Human
ELISA kit is extremely expensive that cannot be afforded in developing countries like
Pakistan to screen the human. PCR technique is highly reliable and less time consuming. It is
highly suggestive to conduct the study on human brucellosis on other districts of south
Punjab as it is believed that brucellosis is endemic due to lack of awareness and vaccination
in these areas. Availability: Items available for loan: UVAS Library [Call number: 2359-T] (1).
9.
Seroprevalence Of Camel Brucellosis In Three Selected Districts Of Punjab, Pakistan
by Sana Fatima (2007-VA-455) | Dr. Iahtasham Khan | Dr. Amar Nasir | Prof. Dr. Muhammad Younus.
Material type: ; Literary form:
not fiction
Publisher: 2015Dissertation note: This is a representative study from Pakistan conducted in three districts of Punjab i.e.,
Jhang, Chiniot and Bhakkar which are rich in livestock population. There is a lot of research
work on livestock and dairy animals but camels are neglected and under-investigated animals.
Nomads mainly depend upon camels for milk, meat, milk byproducts and their earnings. Indeed,
it is a precious animal for them and therefore, to ensure the good health of their animals it is
essential that owners maintain healthy husbandry conditions. Brucellosis is one of the major and
unreported problems amongst the camels of our country. It results in losses to the economics of
the farmers/owners in terms of poor health, abortions, long calving interval, production of weak
offspring’s and poor quality of milk and meat. This disease is under-investigated and hence
people are ignorant of this insidious problem. Serological surveillance is a good and cheaper tool
to diagnose this problem. Determination of the seroprevalence is important to know the load of
disease and pockets of infections in the areas of central Punjab, Pakistan. There is also a need to
know which diagnostic antigen is more sensitive and specific from disease eradication and
control point of view.
A total of 200 camel serum samples were collected from three districts of the Punjab
province and tested by conventional screening test i.e., Rose Bengal Plate Agglutination Test
(RBPT) by using two antigens of different countries origin i.e. RBPT (IDEXX, Pourquier,
France) and RBPT (VRI, Pakistan) and then tested with confirmatory competitive Enzymelinked
Immunosorbent assay (cELISA). The data thus obtained regarding seroprevalence was
analyzed by using Chi-square and logistic regression IBM SPSS Statistics 20 (Apache software
license,USA).
Summary
44
Of the total 200 camels (50 male and 150 female), 5% (10 of 200), 4% (8 of 200) were
seropositive for anti-Brucella antibodies. Different risk factors were also included in study like
origin (nomadic and organized), area, age, gender, season, type of herd, abortion history and
orchitis in male. All of these risk factors were statistically analyzed to reveal the truth about
camel brucellosis. Of the various risk factors studied, the risk factors including camels (cows)
positive history of abortion (45.5%), orchitis (camel bulls) (33.3%), rearing with other ruminants
(9.4%), winter season (11.5%), nomadic production system (2.67-6.67%), and area Jhang (6-
12%) and Chiniot (2-8%) were statistically significant which could be potential source of threat
for humans and other animals. The testing was performed using conventional methods as well as
using cELISA. It is concluded that cELISA is more specific than conventional screening tests but
molecular diagnosis is highly suggestive for future studies. ELISA performed in Pakistan
(cELISA, Svanovir) and the ELISA (iELISA, ID VET Kit, France) performed in OIE reference
lab for brucellosis in Germany showed perfect agreement between them (both tested four camel
sera positive). The current study will help to minimize and eradicate the low prevalence of camel
brucellosis by creating awareness amongst the farmers and through vaccination and herd
immunization of all camel calves at age of 4-8 months. Adopting the policy of testing and culling
of positive reactors will be pivotal to achieve the objectives. Availability: Items available for loan: UVAS Library [Call number: 2361-T] (1).
10.
Poultry Waste Management And Its Impact on Public Health In Lahore, Punjab, Pakistan
by Muhammad Nauman Akhtar (2006-VA-150) | Dr. Hassan Mushtaq | Prof. Dr. Mansur-ud-Din Ahmad | Dr. Muhammad Ijaz.
Material type: ; Literary form:
not fiction
Publisher: 2015Dissertation note: Theses submitted with blank cd. Availability: Items available for loan: UVAS Library [Call number: 2383-T] (1).
11.
Health Education for Adolescents / by W.H.O
by Omran, Abdul Rahim | Al-Hafez, Ghada.
Material type: ; Literary form:
not fiction
Publisher: Cairo : World Health Organization, Regional Office for the Eastern Mediterranean, 2006Availability: Items available for loan: UVAS Library [Call number: 610.71041 Omran 23035 1st 2006 Epidemiology] (1).
12.
Cross Sectional Study Of Newcastle Disease Virus In Wild Captive Peacocks (Pavo Cristatus) In Zoological Gardens Of District Lahore
by Faisal Sher (2007-VA-11) | Dr. Mamoona Chaudhry | Dr. Shakera Sadiq Gill | Dr. Asim Khalid Mehmood.
Material type: ; Literary form:
not fiction
Publisher: 2015Dissertation note: Newcastle disease virus (NDV) is RNA virus.It is the member of avian paramyxovirus type 1 (APMV-1).Its genus is Avulavirus genus. The incubation period ranges from 2-15 days. NDV strains are classified into velogenic, mesogenic and lentogenic categories. Newcastle disease is a virus disease of birds characterized by variable combinations of gastroenteritis respiratory distress and nervous signs.
A cross sectional study was conducted for the duration of 3 months in order to identify the prevalence of Newcastle disease in five zoological gardens of Lahore district. Peacocks were restrained by the trained persons and oropharyngealsamples were collected from apparently healthy Peacocks present in the zoological gardens in Lahore. Sampling of 200Peacocks was done by convenience sampling and stored in freezer at -80°C for further analysis.Virus isolation by egg inoculation was performed to isolate virus and confirmationof (NDV) Newcastle disease virus was done by conducting HI test with specific antisera.Samples were inoculated in 10 days embryonated hen’s eggsand allantoic fluid was collected and tested for haemagglutination (HA) activity. Positive samples were confirmed by haemagglutination inhibition (HI) test.
Frequency distribution through age, sex, breed, origin, date and site of collection were examined by standard statistical methods to determine the prevalence by virus isolation method in that specified population. The data was analyzed by using two way contingency tables with Chi-square test for association. Test was performed to check the association of NDV with age, sex, breeds, origin, and specimen type. The significance level was kept at p<0.05. 2 samples were found positive. Overall prevalence in wild captive peacocks was 1% (95 CI=.1-3.6). 200 samples were screened by spot HA test and 198 samples were found negative in four zoological gardens while 2 samples that were positive found in private zoo samples. Significant association was found between positive samples for NDV and zoological gardens.
Prevalence estimates of (NDV) Newcastle disease virus was generated for Peacock population. Associated factors were identified through this study. Results were shared with international community working for the control and eradication of Newcastle disease.
Availability: Items available for loan: UVAS Library [Call number: 2411-T] (1).
13.
Isolation And Molecular Detection Of Salmonella Species In Milk And Milk Products
by Muhammad Umar Ijaz (2007-VA-040) | Prof. Dr. Mansur-ud-Din-Ahmad | Dr. Muhammad Hassan Mushtaq | Dr. Ali Ahmad Sheikh.
Material type: ; Literary form:
not fiction
Publisher: 2015Dissertation note: Salmonellosis is one of the emerging zoonotic diseases. Human infections result from contaminated raw or undercooked food. Various sources of contamination in milk are dirty udder, unhygienic handling and utensils, dirty hands of milkmen and poor quality water supply at the farm. To ensure food safety there is a dire need for the availability of valid, rapid and accredited diagnostic system. Conventional culture methods for detecting Salmonella spp. in foods needs 4–5 days. The development in molecular techniques made it possible to cut short the procedure.
The present study was conducted with the aim to evaluate the burden of Salmonella spp. in milk and milk products. In total 150 samples were collected, out of which there were 75 milk samples. These samples were collected from farm dairy herds (pooled milk) located in Harbanspura Dairy colony, Lahore. Salmonella was detected in 8 samples (11%) by conventional method.
In addition to milk samples, 75 samples of milk products were also collected from retail shops. These include 50 samples of Yogurt and 25 samples of Yogurt milk. Milk products had 6 positive samples (8%). No sample of Yogurt was detected positive for Salmonella. The reason for this is that Yogurt had only Salmonella if it is present in starter culture. Furthermore yogurt is made after frequent heating. Salmonella is killed by such continuous and vigorous heating. Yogurt milk is prepared from Yogurt along with raw milk in a separate utensil. There are chances of contamination there so it had 6 positive samples. Total 14 (9%) samples were detected in 150 samples by conventional method. It was found that Salmonella was present in raw milk samples and milk products at places where either cleanliness was not proper, milk handling practices
Summary
53
were not up to the mark, udder was not washed before milking or overall management practices were poor.
Positive samples obtained by conventional method were further analyzed by PCR for Salmonella genus confirmation. Out of total 8 positive milk samples by conventional method, 5(62%) were confirmed as Salmonella genus. Similarly from 6 positive samples of milk products by conventional method, only 2(33%) were confirmed as of Salmonella genus. Further PCR was conducted for Salmonella typhimurium detection. Milk samples were containing 3(60%) positive samples while no positive sample was detected in milk products.
On the basis of the results of present study, it is recommended that milk should always be boiled before use. Further Hygienic measures should be adopted during milking. Proper handling of milk and milk products is also important to limit the cross contamination. It is also advised that standards such as pasteurization and HACCP should be introduced to facilitate production of good quality milk. Electronic and print media should also create awareness among people about food safety. Availability: Items available for loan: UVAS Library [Call number: 2408-T] (1).
14.
Essentials of Infectious Disease Epidemiology
by Magnus, Manya.
Material type: ; Literary form:
not fiction
Publisher: Sudbury, Mass. : Jones and Bartlett Pub, 2008Availability: Items available for loan: UVAS Library [Call number: 362.196 Manya 23655 1st 2005 Epidemiology] (1).
15.
Essentials of Biostatistics in Public Health / 2nd ed
by Sullivan, Lisa M | Sullivan, Lisa M.
Edition: 2nd ed.Material type: ; Literary form:
not fiction
Publisher: Sudbury, MA : Jones & Bartlett Learning, c2012Availability: Items available for loan: UVAS Library [Call number: 610.72 Sullivan 31109 2nd 2012 Epidemiology] (2). Checked out (1).
16.
Intermediate Epidemiology : Methods That Matter
by Magnus, Manya.
Edition: 1stMaterial type: ; Literary form:
not fiction
Publisher: USA: Jones & Bartlett Learning; 2016Availability: Items available for loan: UVAS Library [Call number: 362.1072 Magnus 31110 1st 2016 Epidemiology] (1).
17.
Introduction to Research in the Health Sciences
by Polgar, Stephen.
Edition: 6th ed.Material type: ; Literary form:
not fiction
Publisher: USA : Churchill Livingstone, 2013Availability: Items available for loan: UVAS Library [Call number: 613.003 Polgar 31111 6th 2013 Epidemiology] (1).
18.
Family Health
by Dr. Asif Mehmood Jah.
Edition: 1stMaterial type: ; Literary form:
not fiction
Publisher: Lahore: Ilm-o-Irfan; 2004Availability: Items available for loan: UVAS Library [Call number: 341.765 Asif 17488 1st 2004 Urdu.Literature] (1).
19.
Basics in Epidemiology and Biostatistics
by Waqar, H. Kazmi.
Edition: 1st Material type: ; Literary form:
not fiction
Publisher: India; Jaypee Brothers; 2015Availability: Items available for loan: UVAS Library [Call number: 614.4 Waqar 31222 1st 2015 Epidemiology] (1).
20.
An Epidemiological Investigation For The Selection Of Suitable Vaccine Virus Candidate Of Newcastle Disease
by Waqas Shabeer (2013-VA-920) | Dr. MUhammad Hassan Mushtaq | Dr. Muhammad Ali Abdullah Shah | Prof. Dr. Mansur ud Din Ahmed | Dr. Ali Ahmed Shaikh.
Material type: Publisher: 2015Dissertation note: The current study was designed to investigate the risk factors associated with Newcastle disease and characterization and confirmation of Newcastle disease on microbiological and molecular basis. Newcastle disease (ND) is one of the most important viral diseases. It is an acute infectious viral disease of domestic poultry and other species of birds regardless of variation in sex and age. Etiological agents of ND are virulent strains of avian paramyxovirus-1 genus Avulavirus, family Paramyxoviridae and order mononegavirales. The data collection was done on predesigned questionnaire. Newcastle disease virus isolation was done by using the embryonated eggs. Amnion allantoic fluid was harvested and checked for hemaglutinating activity by spot hemaglutinition test and results were recorded. For confirmation of NDV hemaglutinition assay and hemaglutinition inhibition test were used. Further confirmation was done by RT PCR using predesigned primers. Results showed that vaccine used at the most of farms were live attenuated. Most of the farms have no written biosecurity plan. A total of 264 samples were examined 17 samples were the best suspected positive for ND, 10 samples were confirmed on the basis of postmortem lesion, HI and PCR.
Conclusion:-
The study concludes the farm type, dead bird disposal, biosecurity, farm history and vehicles for feed transportation are the risk factors for the outbreak of Newcastle disease. Whereas water quality, farm mangers, litter disposal, vaccine schedule and vaccine type given at farm show no significant association with the spread of disease. The study characterized field isolates on microbiological and molecular basis, submitted to the principle investigator for use in development of multiepitop vaccine. Availability: Items available for loan: UVAS Library [Call number: 2462-T] (1).
21.
Genetic Epidemiology Methods & Applications
by Austin Melissa A.
Edition: 1st edMaterial type: ; Literary form:
not fiction
Publisher: UK: British Library London Publications; 2013Availability: Items available for loan: UVAS Library [Call number: 616.042 Austin 31672 11st 2013 Epidemiology] (1).
22.
Epidemiology Evidence
Material type: ; Format:
print
; Literary form:
not fiction
Availability: Items available for loan: UVAS Library [Call number: 614.5] (1).
23.
Epidemiology Of Bovine Tuberculosis And Its Public Health Significance In Peshawar
by Irfan Khatak (2011-VA-562) | Dr. Muhammad Hassan Mushtaq | Prof. Dr. Umer Sadique | Prof. Dr. Mansur-ud-Din Ahmad | Prof. Dr. Muhammad Sarwar Khan.
Material type: ; Literary form:
not fiction
Publisher: 2016Dissertation note: A cross-sectional study was carried out to determine the prevalence of bovine tuberculosis (bTB)
and associated risk factors in cattle and buffalo in Peshawar, Pakistan. Cattle and buffalo,
randomly selected from all four towns of District Peshawar were screened for bovine
tuberculosis using comparative cervical intradermal tuberculin test (CCIT). For obtaining data on
risk factors, socio-demographic condition, animal characteristics and management, interviewer
administered pretested questionnaire to animal owners. Multivariable logistic regression models
were used to measure association between risk factors and comparative cervical intradermal
tuberculin reactors. A total of 556 cattle and buffalo were screened for bovine tuberculosis. Out
of 556 animals screened, 5.75% (3.9-8.0%) were found positive. The prevalence was higher in
old animals (P= 0.001) as compared to younger animals. Prevalence also varied with source of
animal (either raised on farm or purchased), stay of animals at night (indoor or outdoor) and herd
size. Farmer’s knowledge about transmission of TB from animals to human as well as signs and
symptoms of TB was extremely low. Only 3.6% farmers correctly stated the combination of
three major symptoms of TB. Results of the study call for immediate intervention to control bTB
in animals as well as its transmission to human population. Furthermore, it is suggested to
emphasize on local epidemiology of bTB and husbandry practices of cattle and buffalo during
the control program.
To assess the presence of Mycobacterium bovis (M. bovis) in milk sold at retail shops and find
the knowledge, attitude and practice (KAP) about tuberculosis (TB) in the high risk M. bovis
contaminated milk consumers, milk samples were obtained from 92 milk shops and analysed for
presence of M. bovis. Data on socio-demographic characteristics and KAP about TB was
Summary
152
obtained from 800 M. bovis contaminated milk consumers. Mycobacterium bovis was detected in
8.7% (8/92) milk samples. Although 97.4% of the participants had heard of TB but only 39.6%
knew that cough lasts for more than 3 weeks was one symptom. Only 79.2% have awareness that
TB can be prevented and the most frequently stated (48.4%) method of TB prevention was good
nutrition. Participants believed that TB can be cured by prayers/ eating well (41.8%) and also by
herbal cures/ consulting Hakeem (35.7%). Mean knowledge score for the participants was 12.1±
2.47 out of maximum 22. Mean knowledge score varied significantly with ethnicity, level of
education and residential status (Urban vs rural). Overall knowledge about TB was low.
Therefore community’s health education focused on increasing knowledge of TB must be
initiated.
This part of study was conducted to determine the occurrence of active pulmonary tuberculosis
due to M. bovis in abattoir workers, butchers, livestock farmers and veterinarians and to
document the Knowledge and practices of these professional regarding bTB. The cross sectional
study included 141 abattoir workers, 317 butchers, 50 livestock farmers, 5 veterinary doctors and
3 veterinary assistants. Sputum samples were collected from those respondents who had chronic
cough that last for more than 2 weeks. Four out of 16 suspected abattoir workers and 1 out of 50
livestock farmers were found positive for M. bovis by Polymerase chain reaction analysis.
Duration of work as abattoir worker was found significantly associated (p<0.05) with occurrence
of zoonotic TB. The knowledge of abattoir workers, butchers, livestock farmers and veterinary
assistants regarding transmission of bTB from animal to human and symptoms of TB in human
was very low. Most of these professional did not use protective material/ techniques and are
considered at high risk of acquiring zoonotic tuberculosis. This study declares zoonotic
tuberculosis a critical public health issue especially for professionally exposed groups in
Summary
153
Peshawar, Pakistan and warrant immediate intervention for control of bovine and zoonotic
tuberculosis.
The last part of study aims to determine the proportion of zoonotic TB cases out of overall
human TB patients and school children, drug resistance of M. bovis isolates and knowledge,
attitude and practices about TB. Total 300 human TB patients and 100 school children were
included in the study. Sputum samples were processed by PCR for presence of Mycobacterium
tuberculosis and M. bovis. Sputum samples from TB patients were cultured and M. bovis isolates
were subjected to drug susceptibility testing. Data on knowledge, attitude and practices were
obtained from TB patients by administering pre-tested questionnaire. Among TB patietns 4%
(12/300) were infected with M. bovis. None of the school children was positive for M. bovis.
Residence, occupation, presence of animals at home and sleeping in shed at night was found
significantly associated with occurrence of zoonotic TB. Except one all M. bovis isolates were
resistant to Pyrazinamide. Among other drugs resistance to streptomycin and isoniazid was high.
Low level of knowledge and practices were observed. The study concluded that considering
zoonotic aspect of TB during diagnosis and treatment of TB is necessary and recommends
national survey for true estimation of burden of zoonotic TB in Pakistan. Availability: Items available for loan: UVAS Library [Call number: 2540-T] (1).
24.
Seroprevalence Of Brucellosis In Ruminants At Sale And Purchase Markets And Abattoirs In Three Selected Districts Of Punjab, Pakistan
by Muhammad Tahir (2008-VA-301) | Dr. Iahtasham Khan | Prof. Dr. Muhammad Younus | Dr. Syed Ehtisham-ul-Haque.
Material type: ; Literary form:
not fiction
Publisher: 2016Dissertation note: This is a representative study from Pakistan accompanied in three districts of
Punjab i.e. Jhang, Layyah and Toba Tek Singh which are rich in livestock population.
There is a lot of research work on livestock farms but the sale and purchase markets and
abattoirs are neglected. Pakistan is an agricultural country and livestock contribute a major
share to agriculture in Pakistan GDP and its economy. Sheep, goats, cattle and buffaloes
contribute in the economy of Pakistani people by milk and meat production on majority
basis. Livestock contribution to the agriculture value added is 56.3%, while it contributes
11.9% to the national GDP during 2014-15. More than 8.0 million rural families of the
country are involved in raising livestock. But productivity of livestock is questioned by a
lot of factors. Infectious zoonotic diseases are among these.
Brucellosis is one of the major and unreported problem amongst livestock markets
and abattoirs of our country. It results in losses to the economics of the farmers or owners
in terms of poor health, abortions, long calving interval, production of weak offsprings and
deprived quality of milk and meat. This disease is under investigated and hence people are
unaware of this deceptive problem. Serological surveillance is a good and cheaper tool to
diagnose this problem. Determination of the seroprevalence is important to know the load
of disease and pockets of infections in the area of Punjab, Pakistan. There is also a need to
know which diagnostic antigen is more sensitive and specific from disease eradication and
control point of view.
A total of 300 animals serum samples were collected from three districts of the
Punjab province and tested by conventional screening test i.e. Rose Bengal Plate
Agglutination Test (RBPT) by using two antigens of different countries origin i.e. VRI
(Lahore, Pakistan), IDEXX (Pourquier, France) and ID.vet, France and then tested with
indirect Enzyme-linked Immunosorbent Assay (iELISA). The data thus obtained regarding
seroprevalence was analyzed using Chi-square SPSS version -19 (Nahar et al. 2009).
Of the total 300 animals (77 male and 223 female), 1.3% male and 35.66% female
were seropositive for anti-Brucella antibodies. Different risk factors were also included in
study like sex, area, age, gender, abortion, reproductive problems and also history of orchitis
in male. All of these risk factors were statistically analyzed to reveal the truth about ruminants
brucellosis. Among the various risk factors studied, the risk factors including history of
abortion (16.44%), orchitis (1.3%), retained placenta (26.47%), species cattle (35.55%) and in
Toba Tek Singh (47.36%) were statistically significant which could be potential source of
threat for humans and other animals. The testing was performed using conventional methods
as well as using iELISA. It is concluded that iELISA is more sensitive and specific than
conventional screening tests but molecular diagnosis is highly recommended for future
studies. The current study will help to minimize and eradicate the low prevalence of ruminants
brucellosis by creating awareness between the farmers and through vaccination and herd
immunization. By implementing the policy of testing and culling of positive reactors will be
pivotal to achieve the objectives.
For confirmatory diagnosis all the sera were further tested with iELISA. For this
purpose an exclusive commercially available iELISA Kit (ID.vet, France) was used which
would be able to differentiate anti-Brucella antibodies of B. abortus and B. melitensis and this
iELISA kit would be able to be used for multispecies including cattle, buffaloes, sheep and
goats. Availability: Items available for loan: UVAS Library [Call number: 2556-T] (1).
25.
A Case Control Study On Gestational Diabetes Mellitus In District Lahore
by Shazia Muneer (2014-VA-510) | Prof. Dr. Masur-ud-Din Ahmad | Dr. Muhammad Hassan Mushtaq | Dr. Sana Ullah Iqbal.
Material type: ; Literary form:
not fiction
Publisher: 2016Dissertation note: The present study was designed to identify the association ofvarious risk factors with GDM.The study was consist of cases and controls andconducted for a period of 3 month i.e. February to April 2016. A total sample of 284 comprises of 142 cases and 142 controls were selected fromgynaecological outpatient department, tertiary care hospitalsof district Lahore. The cases matched on the basis of parity with control. The data about demographic and risk factors associated with gestational diabetes were collected through predesigned questionnaires.
The study was completed in a period of three months. The data was analyzed by using SPSS 16.0.The results of this study will be useful for the prevention and control of this disease from fatal outcome.
The results of the study showed the relationship of GDM among cases than controls. It was observed that most of the woman’s were illiterate and housewives. The economic status was found statistically significant in present study. But overall participants werefrom lower middle class families. Present study showed that the woman’s with the age of 29-35, that is high age group and significant association found in the mother age.
Previous history of diabetes mellitus and family history of diabetes mellitus also role plays in raising the prevalence of gestational diabetes mellitus. Gestational diabetes mellitus prevalence was higher in those women who had family history of diabetes. The higher number seen among cases who had diabetes in previous pregnancy, which was significantly higher at(p value= 0.000). It was investigated that diabetes mellitus was more common in high BMI>25kg/m2 so it has strong relationship with high BMI.
Conclusion
This study was designed to identify the risk factors associated with Gestational Diabetes Mellitus. Because the prevalence of Gestational diabetes is increasing with increase the number of women in childbearing age. The timely diagnosis of GDM and identify its risk factors are need of the time to control fetal and maternal complications.
Availability: Items available for loan: UVAS Library [Call number: 2535-T] (1).
26.
Survey To Assess Knowledge About Poultry Disease, Vaccination And Zoonoses In Backyard Poultry Keepers Around Lahore
by Rabia Saleem (2009-VA-460) | Dr. Muhammad Hassan Mushtaq | Dr. Mamoona Chaudhary | Dr. Arfan Ahmad.
Material type: ; Literary form:
not fiction
Publisher: 2016Dissertation note: The term backyard chicken production designates poultry birds which are reared on small scale by a household. In this type of poultry rearing, usually a few birds are kept primarily for family use. The surplus birds and eggs are sold in the village or nearby market and the cash were utilized for fulfilling other needs of the household. This was a common practice in the rural area of all over the Pakistan.
Backyard poultry keepers are not well aware of management practices and poultry diseases. For that purpose nine rural areas were selected from Lahore by convenient sampling method. The households in each of the village were also conveniently select. 200 respondents were interview through a model questionnaire to assess knowledge about poultry diseases, zoonotic diseases and vaccination of poultry in backyard poultry keepers.
After compilation of the research data only 25.00% respondents know about poultry disease and only 48.74% use vaccination and medication for their birds if they got sick otherwise they never vaccinate or medicate.73.73% people do vaccination against New castle disease out of those who use vaccination/treatment but according to data they have no proper knowledge even New castle disease. 55.56% farmer observed diseases and sign and symptoms in their flock from which mites and ticks are 55.56%, respiratory sound and nasal discharge 44.45%, coughing, sneezing and greenish diarrhea 33.34%, swollen joints and ocular discharge 22.23%.Respiratory diseases are prevalent in that area.
70.00% people of the study have information about zoonotic diseases while only 26.00 people know about poultry zoonotic diseases. They are not properly educated about poultry zoonotic diseases
This study will help to collect the information about the knowledge of zoonotic disease, poultry disease and vaccination through survey from backyard poultry farmers. Results of the study are helpful to point out the main issue of poultry diseases and mortality. It is a need of hour to properly manage the back yard poultry on an early basis while a timed procedure should be developed to educate the rural farmers. Currently no proper regulatory body is working for the Poultry sector, PPA (Pakistan Poultry Association) working privately without any authoritative power. These points can be easily improved to help the poultry farmers in the sense of developing skillful backyard poultry producers to boost up poultry sector.
Availability: Items available for loan: UVAS Library [Call number: 2577-T] (1).
27.
Seroprevelance And Associated Risk Factors Of Avian Influenza Among Butchers In District Chakwal
by Shumaila Yousaf (2014-VA-513) | Dr. Mamoona Chaudhary | Dr. Muhammad Hassan Mushtaq | Dr. Hamad Rashid.
Material type: ; Literary form:
not fiction
Publisher: 2016Dissertation note: Summary: Availability: Items available for loan: UVAS Library [Call number: 2598-T] (1).
28.
Seropravelance And Assosiated Risk Factor Of Avian Influenza Among Poultry Farm Workers/Handlers In District Lahore And Kasur
by Aneela Ilyas (2014-VA-512) | Dr. Mamoona Chaudhry | Prof. Dr. Mansur-ud-Din Ahmad | Dr. Hamad Bin Rashid.
Material type: ; Literary form:
not fiction
Publisher: 2016Dissertation note: Avian Influenza is one of the most important zoonotic diseases which are a major concern for public health. Avian Influenza Virus (AIV) is a potential source for the emer¬gence of human influenza pandemics (Fouchier et al., 2005; Olsen et al., 2006; Webster et al., 1992). The outbreaks of Avian Influenzas are usually associated with various factors e.g. do not wash hands after handling sick poultry and mortality, do not use of PPE’s (personal protective equipment), no dipping area, eating and drinking during working with poultry, confinement of birds, mode of disposal of infected birds, carcasses and poultry fecal matter; dry seasons in the dry zones just before the rains; wind conditions; short intermittent temperature changes and the restocking of farms with chickens from the markets.
Hypothesis:
Avian Influenza A, H9 virus was prevalent and potential risk factors are associated with AIV disease.
Parameter/Methodology:
A cross sectional survey in poultry farm workers of district Lahore and Kasur would be conducted in order to determine seroprevalence of Avian Influenza. A study population was the apparently healthy poultry farm workers/handlers of District Lahore and Kasur of Province Punjab. Stage one cluster sampling technique was adopted and with the help of formula and 525 blood samples of poultry workers were taken from 38 selected clusters.
Blood sample from apparently healthy poultry workers were collected from brachial veins. Blood (4-5ml) was collected in vacutainers and allowed to clot for separation of serum. Collected sera were stored in freezer at -70°C for further laboratory analysis.
Haemagglutination assay (HA) and Haemagglutination Inhibition (HI) test was applied on samples as per protocol of world health organization (WHO, 2013).
I had to work on H5, H7 and H9 strains according to my topic but due to the non-availability of H5 and H7 live viruses I could not perform lab analysis. So, I worked only on H9 strain of AIV.
Statistical Design:
The proportion estimate with 95% Cl (Confidence Intervals) of the overall seroprevalence would compute by using “R” software. Descriptive analysis was conducted by using SPSS (version 20). Logistic regression (univariable and multivariable) was conduct to estimate the effect of each study variable on the outcome (Hosmer and Lemeshow 2000).
Outcomes:
The current study had provided useful estimates of risk factors related to AIV. The finding of above study will be published. These findings could be utilized by the policy maker to control the epidemics of AIV in population.
Availability: Items available for loan: UVAS Library [Call number: 2585-T] (1).
29.
Seroprevalence Of Brucellosis In Dairy Cattle In Three Selected Districts Of Punjab, Pakistan
by Ahmad Raza (2008-VA-271) | Dr. Iahtasham Khan | Prof. Dr. Muhammad Younus | Dr. Muhammad Faiz Qamar.
Material type: ; Literary form:
not fiction
Publisher: 2016Dissertation note: Brucellosis is an infectious disease of domestic and wild animals with serious
zoonotic implications in humans. The disease in animals causes tremendous economic losses.
Since brucellosis is primarily an animal disease, emphasis should be given to control the
disease in animal populations by adopting well organized control strategies to protect the
public from the risks of acquiring this zoonosis.
A total of 300 blood samples (N=300) were collected randomly from cattle species
with one hundred samples (n=100) from each district of Chiniot, Sargodha and Sahiwal.
Approximately 04 mL of blood was collected and transferred in a blood Vacutainer having
gel containing clot activating factor, stored immediately at 4 °C in an ice box and was
transported to laboratory. The serum samples were screened by RBPT which is screening test
for brucellosis and it was observed that 38 animals were seropositive by RBPT. Then serum
samples were further confirmed by the use of most specific and sensitive serological test
known as ELISA.
Out of 300 samples, 33 animals were confirmed as seropositive by Indirect ELISA.
The overall prevalence in each of this district by RBPT was found to be 12%, 12% and 14 %
in Chiniot, Sargodha and Sahiwal respectively. The overall prevalence in each of this district
by iELISA was found to be 10%, 11% and 12 %.
By RBPT, Seroprevalence in females was 13.57% based on gender, animals having
abortion history had high seroprevalence for brucellosis (30%) than the non-aborted animals
(10.83%) and the animals with history of retained placenta are 19.30%. Seroprevalence of
iELISA based on gender showed 11.79%, cattle having history of abortion 30% and animals having history of retained placenta in cattle (24.57%). The risk factors i.e. sex, abortion,
retained placenta and areas are highly significant. Availability: Items available for loan: UVAS Library [Call number: 2602-T] (1).
30.
Salmonella Contamination In Vegetables Due To Irrigation With Wastewater In Lahore
by Muhammad Shahjahan Zafar (2009-VA-398) | Prof. Dr. Mansur-ud-din Ahmad | Dr. Muhammad Hassan Mushtaq | Ms. Noor-ul-Hudda.
Material type: ; Literary form:
not fiction
Publisher: 2016Dissertation note: Salmonella has been one of the major food-borne pathogens for animals and humans for last many years. Many food borne outbreaks and other sporadic cases occur due to Salmonella in many countries. Foods of animal origin are considered major sources of Salmonella. However, Salmonella infections due to consumption of raw vegetables have occurred numerously in recent past. 30% of sewage water is directly used for irrigation purposes in Pakistan for various crops including vegetables. It may be the cause of Salmonella contamination. Apart from conventional microbiological techniques, nucleic acid amplification technologies have provided the opportunity for rapid detection of Salmonella from various sources, providing better sensitivity and superior specificity, thereby refining the administration of outbreaks by more rapid confirmation.
Untreated wastewater is the major source of Salmonella contamination of vegetables. Vegetable sampling was done from field, wholesale and retail markets of Lahore city and wastewater sampling was done from River Ravi, Lahore Canal and other sources by using aseptic techniques and was transported at 4°C. Salmonella species was isolated by conventional methods and suspected colonies were confirmed by biochemical tests TSI and Urease Test. DNA was extracted through boiling and 10% chelex method. Molecular characterization of isolated strains was done through PCR. Antibiotic resistance of confirmed isolates were also checked.
A total of 320 (Vegetable n=160, Wastewater n=160) samples were taken for present study for screening of salmonella microbial contamination in it. Different types of vegetables including Coriander (n=40), Mint (n=40), Carrot (n=40), Radish (n=40) were used for analysis.
CHAPTER 6
SUMMARY
Summary
46
Wastewater samples were also collected from various sources like River Ravi (n=60), Lahore Branch Canal (n=60) and Kharak Nala (n=40).
Salmonella was found in 4/40 (10%) samples of Coriander, 3/40 (7.5%) of Mint, 5/40 (12.5%) of Carrot, 3/40 (7.5%) of Radish and 33/160 (20.63%) of wastewater samples through PCR detection. Many of the isolates were found multi-drug resistant.
This study revealed the presence of multi-drug resistant Salmonella species in vegetables and wastewater. All the vegetables studied were contaminated with Salmonella. This data was designed to find out the magnitude and real picture of the pathogen. It helped in drawing a relationship between Salmonella contamination of vegetables and irrigation of wastewater. As wastewater is the main reason for bacterial contamination of vegetables, measures should be adopted at governmental level for reduction of this contamination. Water disinfection practices and continuous water supply for irrigation can reduce the bacterial load. Availability: Items available for loan: UVAS Library [Call number: 2624-T] (1).
31.
Essentials Readings in Infectious Diseases: Epidemiology
by Manya, Magnus.
Material type: ; Literary form:
not fiction
Publisher: 2009Availability: No items available Checked out (1).
32.
Biostatistics and Epidemiology
by Sylvia.
Material type: ; Literary form:
not fiction
Publisher: 1990Availability: No items available Checked out (1).
33.
Molecular Epidemiology: Principles and Practice
by Rothman,Nathman | WHO.
Material type: ; Literary form:
not fiction
Publisher: 2011Availability: Items available for loan: UVAS Library [Call number: 614.5 Nathman 28963 2011 Epidemiology] (1).
34.
Prevalence Of Influenza Virus Among Children Of Tehsil Kot Radha Kishen
by Shamsa Rafique | Dr. Mamoona Chaudhry | Prof. Dr. Mansur-ud-Din-Ahmad | Dr. Amir Ghafoor Bajwa.
Material type: ; Literary form:
not fiction
Publisher: 2016Dissertation note: Influenza belongs to orthomyxoviridae with single stranded RNA genome. Influenza has three types namely A, B and C with further subtypes on the basis of hemaglutinin and neuraminidase surface proteins that are H1, H2, H3, N1 and N2. Influenza infection causes headache, muscle ache, runny nose, sneezing and often fever with cough. Nose, lungs and bronchi are affected by it. Human influenza infection usually follows a period of 10-14 days with no residual effects. However, sometimes it may cause serious respiratory illness and rarely involve other body organs. On the other side, newly evolve strains of influenza have little immunity against them so these may cause serious illnesses and even lead to death. Various strains of influenza have caused epidemics, pandemics and zoonotic diseases at different times all over the world. This cross sectional study was conducted to estimate the prevalence rate of influenza in Pakistan. Study period was 12 months. A cross sectional survey of Kot Radha Kishen, district Kasur was undertaken in children less than 15 years from 35 localities. Data was collected through two stage cluster sampling techniques. After a written consent, questionnaires were filled up. Total sample size was 245.
In this study, Child aged less than 5% were 46%, 5-10 year were 40% and 10-15% were 14% including 50.8% female and 49.2%male children. Vaccination was completed in 86.4% and continued in 4.8%. However, 4.4% children were not immunized at all. These families were mostly shifted in that area after migration. During the survey 22% community showed their knowledge about seasonal influenza vaccination while 78% were ignorant of it.
About 40.8% of community kept bird and 51% kept animal at home. Among those children, 33.2% children suffered from influenza like illness within the week of surveillance.
Summary
53
Influenza contact history was positive in 33.2% of these cases. In case of illness 24.4% regularly took medicine from hospital While 34.8% population moved to traditional doctors for medicine and 17.2% took medicine from pharmacies without any doctor’s prescription. Prevalence estimates of human influenza were generated; associated risk factors were identified through this study. Results were shared with international community working for the control and eradication of human influenza Availability: Items available for loan: UVAS Library [Call number: 2634-T] (1).
35.
Evaluation Of Factors For Refusal Of Polio Vaccination During Immunization Campaigns In Aziz Bhatti Town, Lahore
by Fatima Majeed | Dr. Mamoona Chaudhry | Prof. Dr. Mansour-Ud-Din Ahmad.
Material type: ; Literary form:
not fiction
Publisher: 2016Dissertation note: Polio is acute and devastating diseases. It has only human host. Joint efforts of international agencies will be very helpful for achieving the target of Global Polio Eradication. We are still lagging behind, as 3 countries of the world including Pakistan, Afghanistan, and Nigeria are polio endemic countries. In poliomyelitis 90-95 % cases have no symptoms, 4-8 % has minor illness, 1-2 % has meningitis, while paralytic poliomyelitis is seen in only 0.1-0.5 % of cases. Polio virus is member of entero virus subgroup of family Picornaviradae. Picorna viruses are small ether-insensitive with RNA genome. There are 3 polioviruses serotypes (p1, p2, p3).
Unskilled workers, lack of commitment of polio workers, inadequate training, non-professional attitude of polio team and too frequent campaign are common causes for refusal to give polio vaccination to children.
The parents of less than 5 years age children of Aziz Bhatti town, who were approached for the vaccination of polio during immunization campaign, were included in the study. A sample of 260 children‟s was included. The study conducted for a period of one year.
The data was collected from the parents / guardian of the children who were approached for vaccination during the immunization campaign in Aziz Bhatti, town, Lahore. The consent was taken from them
Data was compiled in Excel and entered and analyzed through SPSS. The data was represented through charts, graphs. Rate, ratios and frequencies were calculated. Chi square
69
Summary
test was applied and the test of significance was applied at P values of 0.05. Any value less than 0.05 was considered as significant.
The result of study will be forwarded to health authorities to be used in future to make active measure for successful polio vaccination so that refusal can be brought to zero, and target of polio elimination can be achieved in Pakistan. Availability: Items available for loan: UVAS Library [Call number: 2633-T] (1).
36.
Targeted Survey Of Avian Influenza (H5, H7, H9) In Backyard Poultry In High Risk Area Kasur District
by Shumaila IQbal (2009-VA-83) | Dr. Mamoona Chaudhry | Dr. Muhammad Hassan Mushtaq | Dr. Muhammad Ijaz.
Material type: ; Literary form:
not fiction
Publisher: 2016Dissertation note: Avian Influenza is the most feared disease of poultry and other birds throughout the world. The segmented, negative strand RNA viruses that form the family Orthomyxoviridae are divided into three types of influenza virus, A, B and C. Only influenza A viruses have been reported to cause natural infections of birds. The outbreak can be mitigated by applying biosecurity measures, controlling poultry movement, using inactivated vaccines and initiating an AI surveillance network throughout the country.
A targeted survey was conducted for a period of 3 months in order to determine prevalence of Avian Influenza H5, H7 and H9 in the villages of Kasur district. Two stage cluster sampling without replacement was adopted in this study. Thirty clusters were selected and in each cluster, seven elementary units (chicken) were sampled, i.e. a total of 210 birds. Tracheal swabs were collected from live and apparently healthy backyard birds then swabs were stored properly at 4°C (24-48hours) until processed. Data were collected from the owner in a face to face interview. A detail predesigned questionnaire was filled after taking written consent from the owner. The sample was collected during the survey of backyard poultry in villages of Kasur district was processed for laboratory analysis. Polymerase chain reaction for Avian Influenza virus isolation was conducted to diagnose sample for AIV.
The weighted proportion estimate with 95% Cl (confidence intervals) of the overall prevalence was computed by using “R” software. Multivariable logistic regression was conducted to estimate the effect of each study variable on the outcome. Variables with significant univariate relationship at p <0.25 was selected for inclusion in the final model. Odds ratios (ORs) and corresponding 95% Cl (confidence intervals) were calculated (Hosmer and Lemeshow, 2000).
CHAPTER 6
SUMMARY
Discussion
53
The management practice risk scores provide a means to quantify the level of risk to avian influenza across villages. However, the utility of such a measure cannot be assessed until these are related to AI status form clinical tests. Nevertheless it is useful to assess what factors are associated with these scores. In particular, specific profiles of farms can be identified with potential high risk and control resources allocate accordingly. For example, this study has found amongst other things that farms with mixed poultry breeds, which have reported diarrhea, or reported high mortality have high risk scores, and these might be targeted for intervention. Prevalence estimate of Avian Influenza was generated. Potential risk factors associated with this prevalence was identified and will be communicated to concerned persons through publication. The poultry birds reared completely outdoor have more chance to contact with wild birds which increase the occurrence of AIV. A strong association between source of water and AIV was found. Water source can play a vital role in transmission of AIV. Another strong association was found in unethical disposal of dead birds and waste poultry farm near to houses with increase the chances of infection. Presence of live bird market stall and visiting of poultry farm vehicle to villages can increase the chances of AIV infection. Elimination or reduction of above mentioned risk factors, use of disinfectant for cleaning and regular vaccination against AI could significantly improve backyard poultry production system in villages. Availability: Items available for loan: UVAS Library [Call number: 2655-T] (1).
37.
Relationship Of Parent’s Level Of Education And Socio-Demographic Variables With Child’s Immunization Status: A Cross-Sectional Study In The Rural Areas Of District Layyah
by Abida Zahoor (2012-VA-573) | Prof. Dr. Mansur-ud-Din Ahmad | Prof. Dr. Muhammad Athar Khan | Prof. Dr. Masood Rabbani.
Material type: ; Literary form:
not fiction
Publisher: 2015Dissertation note: Immunization is a very important element of public health. It is the process whereby a person is made immune or resistant to an infectious disease, generally by the administration of a vaccine. Vaccines stimulate the body’s own immune system to protect the person against subsequent infections. It prevents against various communicable diseases such as Tuberculosis, Tetanus, Pertussis, Diphtheria, Poliomyelitis, Hepatitis B and Measles.
A cross-sectional study was conducted on 200 parents having at-least one child under five years of age. Data was collected from the rural areas of district Layyah. The purpose of the study was to investigate the relationship between parent’s level of education and child’s immunization status on one hand and the effect of sociodemographic variables on child’s immunization status on the other hand. In this study, it was concluded that there was a significant association between parent’s level of education and the socioeconomic variables with child’s immunization status.
Low rate of parent’s literacy, especially health literacy, poor socioeconomic status, large population size, parent’s refusal, difficulty in accessing immunization services and lack of health facilities were identified as the main barriers to immunization completion. As parent’s level of education is considered to be the corner stone in the progress of modern nation so education is a very important element as educated parents play a significant role in achieving the health of their children. It was concluded that there was a significant association between literacy status of parents, income status of parents and the immunization status of children. The immunization status of children in the rural areas can be improved by higher household income, literacy, better
Summary
41
health knowledge, exposure to media, maternal empowerment and mother’s participation in decision-making process. The policy makers should stress on the education of the people especially female education. Health awareness campaigns should be carried out so that parents can gain the benefits of vaccination.
6.1 Hypothesis
Ho: there is no significant relationship between parent’s level of education and child’s immunization status.
H1: Parent’s level of education has significant relationship on child’s immunization status
6.2 Methodology A cross-sectional study of six months duration from July 2016 to December 2016 was conducted in the rural areas of district Layyah in which parents of children under 5 years of age were interviewed about the immunization status of their children. Convenient sampling technique was used to collect the data. Data was collected from 200 parents living in the rural areas of district Layyah. The collected data was analyzed by using SPSS version 16.0.
6.3 Statistical Design
The dependent variable “child’s vaccination” and independent variables “parent’s educational level, household income, parent’s occupation and family composition” were analyzed by using SPSS version 16 and Microsoft Excel. Data entry and analysis was done on SPSS-16. Chi-square test was used for statistical testing. A p-value of <0.05 was considered significant. Frequencies and percentages of categorical variables were calculated. Cross
Summary
42
tabulations were done among dependent and independent variables. Chi-square test was applied on different sociodemographic factors and child’s immunization status to define the significant associations.
6.4 Study Outcomes It is concluded that there is a significant association between literacy status of parents, income status of parents and the immunization status of children. The major benefit of this study is that, the research findings can be used to assess the relationship of parent’s education with child’s immunization status and to find out those factors which are the main hindrance in child’s vaccination coverage. It will also provide new dimensions for further research related to child immunization and the health managers will find new facts and figures that will help them to make national decisions with the certainty of success. Availability: Items available for loan: UVAS Library [Call number: 2654-T] (1).
38.
Case Control Study Of Brucellosis And Its Associated Risk Factors At Commercial Dairy Farms
by Amna Riaz (2008-VA-257) | Prof. Dr. Mansur Ud Din Ahmad | Dr. Mamoona Chaudhry | Dr. Muhammad Imran Rashid.
Material type: ; Literary form:
not fiction
Publisher: 2016Dissertation note: Brucellosis, is a febrile, zoonotic disease caused by bacteria of genus Brucella. It is a second most important zoonotic disease after rabies. (WHO, OIE, FAO). Brucella is gram negative, aerobic, non-spore forming and non-motile coccobacilli. (Gull and Khan, 2007).The main signs are abortion after fifth month of pregnancy, still births, birth of weak calves, infertility, placentitis in females and in male’s epididymitis and orchitis. Due to its zoonotic nature farm labors, butchers, veterinarians and slaughter house workers are at high risk. Signs in human brucellosis are highly variable i.e., flu, rising and falling of temperature and causes many other complications in the body. (Baba et al.2001; Grillo et al. 2006; Shimol et al. 2012). Standard tests for brucellosis are Rose Bengal Precipitation Test (RBPT), Serum Agglutination Test (SAT) and Complement Fixation Test (CFT) (Memish et al, 2002). Its control is very difficult due to its variable incubation period, long survival time in both extracellular and intracellular environments, asymptomatic stages and resistant to the treatment, co-mingling, increasing population size and nomadism (Rahman et al. 2006).
The case study was conducted on the commercial dairy farms situated in the catchment area of University Diagnostic Laboratory, UVAS Lahore which were located Lahore, Kasur and Sheikhupura districts in Punjab. The data about positive and negative farms was obtained from university diagnostic lab, UVAS, Lahore. A predesigned questionnaire was filled from that farm workers in face to face interview. The sample size was calculated by the formula given by Schlesselman, 1982. The parameters for calculation of the sample size were power of study kept at 80% with 95% confidence interval. Total 90 samples were included (cases= 45, controls=45). Data was analyzed using chi-square. All statistical tests were performed at the significance level of 0.05.
In this study, absence of the calving pens at the farm, feeding and water practices, presence of streams and lakes near the farm and breeding practices show the strong association with this disease,by controlling the above factors and improving management at the farm can low the occurrence and spread of the disease in animals.
Availability: Items available for loan: UVAS Library [Call number: 2664-T] (1).
39.
Epidemiology Of Influenza Virus H5n1 In Islamabad Capital Territory
by Zahida Fatima (2005-VA-246) | Prof. Dr. Muhammad Athar Khan | Dr. Khalid Naeem | Prof. Dr. Mansur Ud Din Ahmad | Prof. Dr. Khushi Muhammad.
Material type: ; Literary form:
not fiction
Publisher: 2016Dissertation note: The poultry sector in Pakistan is the second largest industry that contributes to the national gross domestic products (GDP) and remains a major source of nutrition (protein and energy) for human population in Pakistan. Highly Pathogenic Avian Influenza (HPAI) outbreaks due to H5N1 virus in poultry have been recorded in over 62 countries, indicating the contagious nature of the disease and its potential to infect various avian species. These HPAI outbreaks in poultry have lead to killing/culling of around 120 million birds in various countries. During 2009, the Avian Influenza continues to occur in poultry in China, Hong Kong, India, Egypt, Nepal, Bangladesh and Canada . In Pakistan, an HPAI outbreak due to H7N3 virus was first observed in 1994-95 and those due to H9N2 virus in broiler and layer chickens were recorded between late 1990’s and early 2000. During the period between 2006 and 2008, poultry heavily suffered due to multiple outbreaks caused by H5N1 virus.
The country experienced several and severe HPAI subtype H5N1 outbreaks during 2006-2008 in commercial poultry farms mostly, causing mass economic losses. In Pakistan all the four poultry production system exists being identified by FAO. The present study was conducted in peri-urban areas of ICT Islamabad, capital of Pakistan. The objectives of the present study were to investigate the outbreaks due to HPAIV H5N1 in 2006-2007 in ICT and identify the pattern and trends of these outbreaks. For this purpose descriptive epidemiological study was conducted and data was collected on a predesigned questionnaire regarding farm demography, culling, morbidity and mortality. The result statistical analysis showed a significantly (P< 0.05) higher morbidity, mortality, case fatality and culling rate in layers farms than breeders and broilers respectively. Layers and breeders of old ages were mostly affected with having higher mortality and culling in comparison to younger age layer and breeder commercial farms. The mean morbidity and mortality rates ranged 57–95% and 5-43% correspondingly.
After the HPAIV H5N1 first reported outbreak in Pakistan in 2006 culling strategy was adopted after devastating outbreaks regularly reported from throughout the country. The reasons behind these emerging epidemics were unknown and several hypotheses were given birth after these outbreaks. Knowledge regarding potential risk factors responsible for HPAIV H5N1 epidemics in commercial poultry farms in Pakistan was lacking. Therefore we conducted a longitudinal cross sectional survey (1:1 matched case control study) to identify potential risk factors at farm level responsible for 2006-2007 HPAIV H5N1 infection in poultry in ICT. Information on farm characteristics, biosecurity practices and farm management were collected. Logistic regression model on data was used to unveil the potentially associated risk factors with cases (farms confirmed HPAI H5N1 Positive). Several candidate variables were studied and investigated for association. The results multivariable logistic regression showed that farm location such as in urban area (P<0.05: OR=18.50), wild birds entry (P<0.05: OR= 12.66) and farms situated in highly dense poultry populated area (P<0.05:OR=4.50) were found significantly associated with outbreaks of HPAIV H5N1 infection in commercial poultry farms during 2006-2007 epidemics in the study area.
Live bird markets (LBMs) are essential for poultry marketing in developing countries like Pakistan. One year active disease surveillance for influenza viruses in avian species in LBMs in ICT area was conducted in 2011. LBMs in Pakistan are typically urban that brings together many avian species produced by different suppliers. Which make LBMs in Pakistan a potential source of HPAIV viruses as well as other emerging poultry pathogens i.e. new castle disease virus,infectious bronchitis etc. The results of the present surveillance data showed that seroconversion against H5N1 and H9N2 is present in LBMs bird species which were isolated from different samples like serum, cloacal, nasal samples and organ samples.This indicates the continuous threat of AIV viruses circulating in the live bird markets set up of Pakistan.
Findings of these studies will help to tailor control and prevention measure against devastating outbreaks in future regarding the local circumstances of commercial poultry farms as well as in LBMs. These studies also succeeded to unveil the true reasons behind these devastating outbreaks and their higher impact on poultry industry. Such type of surveillance programs will be useful in future to investigate several emerging diseases and outbreaks in Pakistan and other developing countries. Availability: Items available for loan: UVAS Library [Call number: 2700-T] (1).
40.
Molecular Epidemiology Of Mycobacterium At The Animal Human Interface And Its Co-Morbidity With Diabetes Mellitus
by Zarfishan Tahir (2011-VA-624) | Prof. Dr. Mansur-ud-Din Ahmad | Dr. Abdul Majeed Akhtar | Dr. Muhammad Hassan Mushtaq | Prof. Dr. Tahir Yaqub.
Material type: ; Literary form:
not fiction
Publisher: 2016Dissertation note: Tuberculosis (TB) is a common and fatal infectious disease which has afflicted mankind for several millennia. At the moment, TB is positioned at number five when it comes to the most common causes of fatality worldwide. TB is curable if it is properly diagnosed and treated. In 2015, it was estimated that 1.5 million deaths (an equivalent of 4,000 deaths per day) and 9 million new TB cases have been reported. Diabetes Mellitus is also widely distributed and estimated to affect 366 million people by 2030. The co-morbidity of DM and TB is re-emerging because of the progressive epidemiology of both diseases especially in the developing countries. Endemicity of TB and DM is growing in developing countries because of low socio-economic status and poor living conditions.
In this study, a total of 500 tuberculosis positive patients were selected under TB DOTS program from five tertiary care hospitals of Lahore. Sputum samples were collected from all the enrolled patients and smear microscopy was performed for TB confirmation. Blood samples were collected from the same patients for screening of diabetes mellitus. Sputum samples were also processed for culture and drug sensitivity on LJ medium. Molecular identification by PCR technique was carried out on all positive cultured strains and results were compared with reference strain H37RV. For DNA sequencing, PCR products were sent to Singapore where sequencing was performed by Sanger method.
Data was compiled and variables including gender, age, drug resistance and treatment history and correlation among different variables was analyzed using chi-square test and Fischer’s exact test method at P-value of ≤0.05. SPSS (Statistical Package for Social Sciences, Version 20.0) was used for statistical analysis. The count data was statistically analyzed using
SUMMARY
124
descriptive statistical tools. On screening for fasting blood sugar level, 74 (14.8%) patients were recorded as diabetics as well i.e. blood sugar level ≥ 126 mg/dl. Out of these 74 patients, 22 patients had previous history of diabetes whereas remaining 52 patients were newly diagnosed at the time of screening. The maximum distribution of TB-DM patients was found in age group > 57 years. Mean age of the group without DM was 39 years and with DM was 48 years. Coexistence of DM in TB patients was higher in males (62.2%) as compared to female study subjects. However, the gender difference is statistically non-significant (p value 0.243).
The distribution of education level revealed that out of the total participants, maximum number of patients (n=220) were illiterate and similar trend was observed in diabetic patients with 54 (73%) individuals belonging to the illiterate group of the subjects. There is statistically significant difference between existence of DM and literacy level in tuberculosis patients. Among social and behavioral risk factors in tuberculosis patients, majority of the patients were unemployed (24%) in TB-DM group. Significant correlation p value ≤ 0.05 was found between coexistence of TB-DM and tobacco use. TB cases with diabetes were known to have history of smoking with 73% (n=54) while non-smokers were 27% (n=20).
On sputum smear microscopy frequency of 3+ results showing high bacterial load, was profoundly higher i.e. 67.6% in diabetic tuberculosis patients as compared to non-diabetics which was 4.9% only. Total culture yield was 363 out of 500 sputum samples. There were 193 samples that were sensitive to all drugs, 9.4% were MDR strains (resistant to Isoniazid and Rifampicin). MDR-TB is significantly higher in TB-DM patients i.e. 13.5% as compared to 8.7% in TB only patients.
In our study, DNA sequence data for drug resistance was studied by the sequence of rpoB gene of the wild type MTB strain. Sequencing results showed mutations at various spots of rpoB gene.
SUMMARY
125
Most common mutational sites identified were at codon 531, 526 and 516 with frequency of 70%, 15% and 7.5%, respectively. Moreover, mutation sites at 512 and 574 codon had also been reported. In this study, predominantly two phylogenetic variants were identified. Majority of the isolated strains were Central Asia Strain (CAS) with a prevalence of 88.2% and rest were Beijing strain. However, attempts to find zoonosis could not be established. A total of 900 raw milk samples were also screened for M. bovis and no positive sample could be detected.
The present study emphasizes the importance of screening for DM in TB patients, which had not been done in routine. This practice may prove to be helpful in reducing the disease burden of TB patients as well as DM patients. Thus it is recommended that the screening for DM should be implemented in TB/DOTS clinics.
Emergence of Multi drug resistant Mycobacterium tuberculosis is also a serious challenge for clinicians. A very large financial implication in terms of treatment, duration of chemotherapy and spread of MDR TB strains is being faced. Treating MDR TB is more complicated than treating drug sensitive TB. Patients with MDR TB require longer, much more costly treatment and experience higher mortality rates. Such a long time to initiate the treatment is not affordable, thus there is a dire need for some rapid technique like molecular based diagnostics for MDR detection, which can provide quick results and making it possible to start treatment at earlier to minimize transmission, morbidity and mortality. Availability: Items available for loan: UVAS Library [Call number: 2710-T] (1).
41.
A Case Control Study Of Risk Factors Of Periodonitis In Pregnant Women In District Faisalabad
by Sehar Yousaf (2014-VA-539) | Prof. Dr. Mansur-ud-Din Ahmad | DR. MamoonaChaudhry | Dr. Muhammad Nasir.
Material type: ; Literary form:
not fiction
Publisher: 2016Dissertation note: Good oral health is the indicator of good general health of an individual. Poor oral hygiene is the most important factor to cause dental diseases. Severe form of gingivitis called periodontitis. Periodontal disease affects the gum and jaw bone.
If periodontitis is not treated in the early stages it become worse due to increased production of clavicular fluid, which contains inflammatory mediators and bacterial flora that can damages the periodontium. Gingival health is compromised during pregnancy due to hormonal changes. This is called pregnancy gingivitis which is initial stage of periodontitis.
A matched case control study was conducted to identify the risk factors of periodontitis during pregnancy. Study duration was three months and it was conducted in tertiary care hospitals of Faisalabad (Madina teaching hospital, D.H.Q, Allied hospital).Cases were matched on the bases of month of pregnancy and number of pregnancy with control.
Study sample was 282 (141 cases and 141 controls). Data were collected through questionnaire which comprises of two sections one is demographic data and one is questions related risk factors.
Data was entered on SPSS software value was less than 0.05 and confidence interval was 95%. Multi logistic regression test was applied to identify the potential risk factors of periodontitis. Results have been shown the different risk factors which are capable of cause periodontitis.
The most significant risk factors e.g. family history, systemic illness in which diabetes and hypertension were most common, poor eating habits due to lack of knowledge about oral health were common. Results have been shared with health authorities of concerned hospitals. Results cannot be generalized on the whole population due to its less sample size.
Availability: Items available for loan: UVAS Library [Call number: 2695-T] (1).
42.
Prevalence Of Campylobacteriosis Among Diarrheic Children And Its Associated Risk Factors
by Zahra Aziz Butt (2014-VA-985) | Dr. Muhammad Hassan Mushtaq | Prof. Dr. Mansur-ud-Din Ahmad | Miss Noor-ul-Hudda.
Material type: ; Literary form:
not fiction
Publisher: 2016Dissertation note: Campylobacteriosis is an acute gastroenteritis characterized by diarrhea (which could be
bloody), fever and abdominal cramps. Campylobacter is becoming a leading cause of bacterial
diarrheal disease worldwide. Campylobacter is a food born pathogen that can transmit to
children through unhygienic practices by mother during feeding, through contact with pets, or
consumption of raw milk, milk products, vegetables, undercooked poultry meat and
contaminated water. It can leads to fetal outcome in children. Post infection complications can
lead to reactive arthritis, irritable bowel syndrome and Guillain Barre Syndrome (GBS). So the
study was design to measure the prevalence and associated risk factors of Campylobacteriosis
among children suffering from acute diarrhea in a tertiary care hospital in Lahore.
A total of 41 stool samples were collected through systematic random sampling from
children having complaint of acute diarrhea visiting a tertiary care hospital (MAYO Hospital) in
Lahore. The samples were transported within 6 hours of collection and cultured on modified
charcoal cefparazone deoxycholate agar and incubated at 42ᴼC for 42 hours for isolation of
Campylobacter. Then the samples were purified and various biochemical tests as catalase,3.5%
NaCl stress, and 1% glycine stress were performed. Out of 41 samples 7 showed no growth on
charcoal agar. Out of 34 samples that showed growth on charcoal agar 14 were positive
biochemically. So the prevalence was found to be 34%.
Data was analyzed by using SPSS 16.0 version. Descriptive statistics was applied to
check the frequencies of different risk factors. Risk factors like sociodemographics and other risk
factors related to hygiene as house member suffering from diarrhea, playing of child in muddy
areas, use of raw milk, bottle feeding, use of common latrines, washing of latrines, presence of
Summary
49
pets in house, access of pets to kitchen, restaurant eating and travelling to any other area were
studied. Chi square test was applied to check the association of different risk factors with
Campylobacteriosis. Three factors as washing of hands by mother before preparing food,
frequency of washing of latrines and consumption of food from restaurant before onset of illness
were found to be associated with the Campylobacteriosis.
Campylobacteriosis is an important disease of children which is underestimated in
Pakistan due to deficient knowledge in subject and financial constraints. Adequate awareness of
hand washing, good hygiene, proper cooking of food and boiling of drinking water can be
important in preventing infection. Careful attention should be given on the disease and further
studies should be conducted about the disease to study upcoming status of the disease . Availability: Items available for loan: UVAS Library [Call number: 2734-T] (1).
43.
Application Of Euroscore To Predict Risk Of Mortality After Coronary Artery Bypass Grafting In Pakistani Population
by Ali Naeem (2014-VA-780) | Dr. Muhammad Hassan Mushtaq | Dr. Ammar Hameed Khan | Dr. Mamoona Chaudhry | Dr. Muhammad Nasir.
Material type: ; Literary form:
not fiction
Publisher: 2016Dissertation note: Coronary artery bypass surgery has become the standard of care for advanced coronary artery disease. It is one of the most audited and closely monitored operations in the history of surgery. Morbidity and mortality associated with this operation is also very closely monitored by surgeons, hospitals, professional bodies and governments at large. Based on the preoperative clinical information available about patients preparing to undergo coronary artery bypass surgery various predictive models for assessment of mortality risk have been developed over the last two decades in various regions across the world. Euro SCORE is one such predictive model which can accurately predict the risk of mortality for large groups of patients for the population in which it was developed. A large number of Pakistanis and nationals from South East Asian countries reside in different European countries and form part of the population on which this score has been developed and validated. We intend to find out the predictive accuracy of this model in our patients living in Pakistan.
Euro SCORE accurately predicts operative mortality in patients from Pakistani population.
This study will be conducted at the Department of Cardiac Surgery Shalamar Hospital Lahore. One hundred consecutive patients admitted to hospital for coronary artery bypass surgery will be enrolled in study. A total of 18 variables as included in EuroSCORE (Appendix 1) will be collected and entered into database. The expected mortality risk will be calculated by the EuroSCORE Calculator software (http://www.euroscore.org/). Actual or observed mortality and morbidity will also be recorded.
Statistical analysis will be performed using SPSS version16. Continuous numerical data will be presented as mean ± Standard deviation, the Student t test will be used to compare means of normally distributed data. The qualitative data will be analyzed using chi square test. The relationship of the observed and the expected rates of mortality will be assessed using ROC curves for the accuracy of prediction of the Euro-SCORE.
This study will indicate how accurately Euro SCORE can predict the risk of mortality after coronary artery bypass grafting in our population and more over it may indicate other patient related variables that can contribute to operative mortality other than Euro SCORE.
Availability: Items available for loan: UVAS Library [Call number: 2713-T] (1).
44.
Prevalence And Associated Risk Factors Of Needle Stick Injuries Among Health Care Workers In Government Tertiary Care Hospitals Of Lahore
by Gurdeep Singh (2014-VA-957) | Dr. Mamoona Chaudhry | Dr. Muhammad Hassan Mushtaq | Dr. Ali Ahmad sheikh.
Material type: ; Literary form:
not fiction
Publisher: 2016Dissertation note: In present study, seventy six percent (n=228) of respondents were involved in
sharp injuries and twenty four percent (n=72) were not involved. This study concluded there
was high occurrence of needle stick sharps injuries among healthcare workers in tertiary care
hospitals of Lahore. There are several risks associated with handling healthcare sharps
among healthcare workers which include, needle prick that could be contributed to cases of
occupational infections such as HIV/AIDS. Majority of reported cases were due to following
reasons , inadequate supply of barrier products ,unsafe practice such as recapping of needle
In paramedical staff due to failure in standard guide lines to handle medical sharps and lack
of reporting of sharps incidents and very lower ratio utilization of post exposure
prophylaxis. It was observed that risks of needle stick injuries were reduced with the
experience. Those who have work experience of 5 years or less had higher ratio of sharp
injuries than those who had work experience five to eight years. Respondents with nursing
profession and laboratory technicians were at high risk; their exposure to handle sharps is
greater and due to failure in precautionary measure risk of needle stick injuries in this
category is higher compared to other. While Females were at high exposure risk of sharp
injuries at tertiary care hospitals than male. Respondents with education level of diploma
were more exposed to needle stick injuries as compared with degree holders in paramedical
staff. It was observed that shift of eight hour work is absolute and healthcare workers were
normal with it. If work load increased and time was exceeded then it was difficult to manage
such injuries .while training on infection control and prevention has no effect in government
hospitals of Lahore to decrease the risk of sharps injury among healthcare workers.
Several recommendations which need to be implemented at the hospitals were
identified as discussed below. and special attention need to be given to nurses , cleaners ,
the critical care section and the department of medicines There is need of fully trained
Summary
38
health care workers in critical care units , medical and surgical ward Momentary to
developed infection control department in every government and private hospital of Lahore
and give them special training about the handling of medical sharps. adequate supply of
barrier products (gloves, masks, lab coats etc) Check and balance on proper use of barrier
product , there is need of timely collection of used medical sharps in puncture proof
containers such as safety boxes that should be ¾ full when emptying .Need of safe
transportation in a covered vehicle for incarnation .Administration of hospital need to
developed polices for reporting of needle stick injuries by designing a log form that capture
information on demographic data of the employee. Data and time of injury, type of sharp,
procedure involved, part of body involved where it occurred. So it’s important to analyzed
enter data in an order to understand root cause. It’s important to conduct surveillance and
prevent further injury. Infection control department should need to check post-exposure
prophylaxis status in health care workers go through counseling and are followed up to
enhance post exposure prophylaxis in health care workers it’s not up to individual effort it’s
a team work by involving administration and health care workers.. In government hospitals of
Lahore there is many factors which contribute to needle stick injuries it might be reduced by
strengthening of reporting system is necessary. The responsibility of government is to
strengthen the check and balance on use of barrier products (gloves, pads, lab coats etc.) and
create awareness on standard guidelines on handling of medical sharps. Thus rate of needle
stick injuries could be reduced to acceptable level. Availability: Items available for loan: UVAS Library [Call number: 2748-T] (1).
45.
Burden Of Respiratory Illness Related To Influenza Among Oupatient And Inpatients Healthcare Facility Centers District Sheikhupura
by Ayesha Mukhtar (2014-VA-1052) | Dr. Mamoona Chaudhry | Prof. Dr. Mansur-ud-din Ahmad | Dr. Shafqat Fatima Rehmani.
Material type: ; Literary form:
not fiction
Publisher: 2017Dissertation note: Influenza is a highly contagious, acute illness in humans. Influenza viruses have negative-sense RNA genomes and are placed in the Orthomyxoviridae family grouped into three types A, B and C on the basis of the internal nucleocapsid or the matrix protein. Droplet and airborne are the most common modes of transmission. In Humans infection appears to be direct or indirect exposure to infected person or infected live or dead poultry or contaminated environments.Globally the annual attack rate with influenza viruses ranges between 5 to10% in adults and 20- 30 % in children. The WHO estimates that 3-5 million cases of severe influenza illness occur every year resulting in 250,000 to 500,000 deaths worldwide, with most influenza deaths occurring among adults over 65 years of age.
Influenza is the cause of outpatient visits and inpatient hospitalization among population of District Sheikhupura.
A prospective study for duration of 3 months (September to october) was performed in Tehsil Muridke District Sheikhupra. Population of Tehsil Muridke is 4, 52,009. We selected Tehsil headquarter hospital randomly as sentinel sites .Our Target population was cases of ILI and SARI. All cases of influenza like illness (ILI) or severe acute respiratory illness (SARI) who meets the inclusion & exclusion criteria was enrolled. Data was obtained by the face to face interview. A detail investigation form was filled after taking written consent form. Throat swab was collected from patient. The sample was stored at -70°C for further laboratory procedure. We will use Reverse transcriptase polymerase chain reaction (RT-PCR) for detection of type of the influenza virus. RT-PCR allows viral template RNA to be reversed transcribed producing complementary DNA (cDNA) which can then be amplified and detected. So in our Study we used RT-PCR for influenza virus detection.
Data analyzed by using SPSS software with 95% confidence interval. Chi-square test used to measure the association of risk factors (age, sex, occupation, exposure, healthcare worker, travelling etc) and the rate of morbidity and mortality was calculated by using standard formulae.
We identified ILI and SARI cases associated with outpatients and inpatients & also provided data to identify and monitor groups at high risk for influenza and will measure trends in morbidity and mortality attributable to influenza.
Availability: Items available for loan: UVAS Library [Call number: 2805-T] (1).
46.
Cross Sectional Survey Of Avian Infleunza In Poultry Butchers Of Sentinel Live Bird Markets In Lahore District
by Gul Naz Namat (2014-VA-1120) | Dr. MamoonaChaudhary | Dr. Hassan Mushtaq | Dr. Shafqat Fatima Rehmani.
Material type: ; Literary form:
not fiction
Publisher: 2017Dissertation note: 6.1 Background:
Influenza is a highly contagious, acute illness in humans. Influenza viruses have negative-sense RNA genomes and are placed in the Orthomyxoviridae family grouped into three types A, B and C on the basis of the internal nucleocapsid or the matrix protein. Droplet and airborne are the most common modes of transmission. In Humans infection appears to be direct or indirect exposure to infected live or dead poultry or contaminated environments, such as live bird markets.
6.2 Hypothesis:
Avian influenza virus is prevalent in poultry butchers working in live bird markets with domestic and pet, wild, exotic birds.
6.3 Parameter/Methodology:
A cross sectional survey of poultry butchers in Lahore was conducted in order to determine seroprevalence of avian influenza Disease. A target population was the poultry butchers/retailers in the District Lahore. A study population was the apparently healthy butchers in Lahore. A sample of 300 butchers was collected. Blood sample from apparently healthy butchers was collected from brachial veins as described in WHO (2010). Three ml blood was collected in the syringe and was allowed to clot to separate serum. Collected sera was stored in freezer at -70°C for further laboratory analysis. Data was gathered by simple random sampling technique. A total of 300 samples were collected. Haemagglutinationinhibition (HI) test applied to detect antibodies sensitivity. The test was followed as described by WHO (2013).
6.4 Statistical Design:
The weighted proportion estimate with 95% Cl (confidence intervals) of the overall seroprevalence was computed by using R-software. Logistic regression was conducted to estimate the effect of each study variable on the outcome.
6.5 Outcomes:
Out of 300 blood samples of butchers of sentinel live bird markets, 171 blood samples are sero positive for H9 virus after HI Testing. The sero prevalence of H9 virus in butchers of live bird markets is found to be 57 %. The results of H5 and H7 are found to be negative.
In univariable analysis, following risk factors which were significant as per criteria of selection in current study (p-value < 0.25); Education, Age, Smoking, Sticks smoke/day, Years of smoking, Having chronic disease, Birds sold/day, Keep birds at home, Access of stray dogs, Access of stray cats, Wash instruments after slaughtering, Do not clean cutting boards, Wearing of aprons.Multivariate analysis determined one factor i-e having birds other than broiler as significant factor having p-value < 0.001.
Availability: Items available for loan: UVAS Library [Call number: 2804-T] (1).
47.
Active Surveillance Of Avian Influenza In Sentinel Live Bird Markets Of District Rawalpindi
by Muhammad Asif (2015-VA-435) | Dr. Mamoona Chaudhary | Prof. Dr. Mansur-ud-din Ahmed | Dr. Hamad Bin Rashid.
Material type: ; Literary form:
not fiction
Publisher: 2017Dissertation note: Influenza is a highly contagious, acute illness in humans. Influenza viruses have negative-sense RNA genomes and are placed in the Orthomyxoviridae family grouped into three types A, B and C on the basis of the internal nucleocapsid or the matrix protein. Droplet and airborne are the most common modes of transmission. In Humans infection appears to be direct or indirect exposure to infected live or dead poultry or contaminated environments, such as live bird markets. The outbreak can be subsided by applying biosecurity measures, controlling poultry movement, using inactivated vaccines and initiating an Avian Influenza surveillance network throughout the country.
Avian influenza virus is prevalent in live birds markets of poultry in district Rawalpindi.A survey was conducted for a period of 6 months in order to determine prevalence and trends of Avian Influenza H9 in the live birds markets of district Rawalpindi. A total of 355 samples were required to estimate retail shop level prevalence of avian influenza. Using systematic sampling method 14 butchers will be enrolled from 2 sentinel live bird market and they were visited weekly to collect samples for a period of 6 months. In each week 14 pooled samples from 70 birds (a pool of 5 swab samples and 2 serum samples from each shop was collected) was collected from both sentinel sites. Tracheal/oropharyngeal swabs will be collected from live and apparently healthy poultry birds then stored properly at 4°C (24-48hours) until processed. Data was collected from the shopkeeper in a face to face interview. A detail predesigned questionnaires were filled after taking written consent from the owner. The sample collected during the survey live birds markets of Rawalpindi district were processed for laboratory analysis. Real time RT-PCR and HA and HI tests for avian Influenza virus were conducted to diagnose sample for AIV.
The proportion estimate with 95% C.I (confidence intervals) of the overall prevalence was computed by using R software. Pattern of influenza infection in live bird markets were estimated with reference to space and time. Descriptive analysis was conducted (i.e. mean, proportion) to answer four epidemiological W’s i.e. what, who, when and where.
In present study, sero-positivity against H9 AIV was determined in district Rawalpindi. Haemagglutination (HA) assay was performed and HA titer of 1:256 was calculated, the dilutions of 8HAU was 1:32.Serum samples (n=784) were tested by HI. Out of these 784, 306 sera samples were positive (HI titer>1:8) from 2 preselected sentinel markets and 14 poultry shops, while 478 were negative (HI titer <1:8) for AI. The highest antibody titer was 1:64.
The period sero-prevalence was 39.03% (95% CI: 35.41- 42.44).Results showed thatnumber of positive was high in the month ofOctober and November then slight decreased in the month of December, January and February after that it again increased in the month of March, April and May.During the study a week with one positive result was considered positive and a week was declared negative when all samples were negative. Results showed that minimum 4 and maximum 22 weeks remained positive sample results.Fourteen shops were followed up for 28 weeks and from each shop the study 56 sera samples were collected throughout the study. In 14 shops, highest prevalence was 48.21% and lowest was 28. 57%
It is concluded that avian influenza is circulating in Live Bird Markets in district Rawalpindi. This process shared that this market could perpetuate and transmit avian Influenza to Human. So these markets are the hot spot of avian influenza infection.
Availability: Items available for loan: UVAS Library [Call number: 2798-T] (1).
48.
Study On Sero Prevalance Of Hepatitis C For Predisposition Of Diabetes In Pregnant Women From Low Economic Status Famlies
by Waseela ashraf (2015-VA-445) | Dr.Muhammad Hassan mushtaq | Mr.Ubaid ur rehman zia | Mr.Muhammad asad ali.
Material type: Publisher: 2017Dissertation note: This cross sectional study is design to rule out the effect of seroprevalence of HCV infection in causing diabetes in pregnant women and also in aim of identifying potential risk factors associated with HCV infection cause in pregnant women. A total of 550 pregnant women were participated in this study.We made two groups of pregnant women to rule out the association between seroprevalence of HCV and diabetes. One group consisted of 275 women who were anti- HCV negative and second group consisted of 275 women who were anti-HCV positive.
A blood sample was drawnin a gel vial for testing of anti HCV and a fluoride oxalate vial was used to draw blood for random plasma glucose levels testing among pregnant women.
ELISA was performed to confirm the seroprevalence of HCV infection and diabetes status was confirmed by testing blood glucose levels in pregnant women by hexokinase method. Data was gathered and analyzed on SPSS version 20.0 software. A Chi square test was used to know the relationship between diabetes and anti HCV. This test was also used to find outlink between anti HCV and other variables collected.
Most of the women in both groups did not know about their diabetic status. HCV positive group was presented with strong family history of diabetes. From the data it was suggested that possible risk factors for causing HCV infection among pregnant women were surgical procedure, blood transfusion and history of syringe use. Ear/nose piercing, history of dental, dilatation and curettage procedure and accidents were statistically not significantly associated in causing HCV infection. It was also found that number of abortions were high in HCV infected group (p-value=0.046).
No association was found between seroprevalence of HCV infection and diabetes among pregnant women (p value= 0.96). Therefore our hypothesis is rejected on the basis of this study results.
The most frequent age group was 18-27years of women found for pregnancy. Therefore in this age group our study results found that HCV infection prevalence was high. This group was found to be very prone in catching viral infection. S/CO ratios were also found to be too high in this age group due to the fact thatin this age groupHCV infection prevalence was high.
Also there is a strong association of blood pressure and HCV infection. Blood pressure found to be varying in HCV infected group.
Recommendations for further Research
According to several studies there was a strong true association between hepatitis C virus infection and diabetes. But our study results were not correlated. It may be due to the lack of confirmatory tests for both diseases which we did not perform.Following recommendations are offered for related research.
1. ELISA is commonly used as initial screening method for HCV antibody in serum. This method does not differentiate between acute, active or resolved infection. In this study we usedELISA for presence of antibody in serum but presence of antibody in serum is not a confirmation of active viremia in patient. The active viremia further can only be confirmed by PCR. It also tells us the true presence of virus in infected patient.So PCR is the confirmatory test of hepatitis C virus infection and it should be used for diagnosis and true presence of virus in body.
2. Random plasma glucose is a screening method for predicting gestational diabetes. Further confirmatory tests are required for diagnosis of gestational diabetes. Confirmatory test for diagnosis of gestational diabetes is oral glucose tolerance test (OGTT).
3. Age and body mass index are confounders in relating the association of diabetes and hepatitis C infection. High BMI and older age are risk factor in causing diabetes.
Availability: Items available for loan: UVAS Library [Call number: 2865-T] (1).
49.
Cross Sectional Study To Identify Risk Factors Of Appendicular Bone Fractures In Canine And Felines At Pet Clinics In District Lahore
by Mudassar Aziz (2015-VA-805) | Dr. Muhammad Hassan Mushtaq | Prof. Dr. Mansur-ud-Din Ahmad.
Material type: Publisher: 2017Dissertation note: With increasing trend in pet animal’s ownership, bone fractures constitute a major
problem including those caused by traumatic injuries. Orthopedic diseases are common in canine
and felines especially those caused by traumatic injuries. Appendicular fractures affecting femur
and tibia were most common in canine and felines. Forelimb fracture is particularly challenging
in orthopedic surgery as dogs bear most of their weight with the thoracic limbs. Pectoral limb
fractures were due to high energy trauma and therefore can result in both lives threatening
injuries, severe and permanent disability. Understanding the different types of fracture will be
helpful to develop improved techniques of fracture fixation in dogs. Young dogs above one and a
half month to six months are most commonly affected. Therefore management of pet’s
environment by the owner can play an important role in the preventing traumatic injuries in pets.
Recording the occurrence and pattern of appendicular bone fractures in canine and felines to
determine the principal causes is important for their management and control. Fractures in
animal bones have not received the required attention and there are few publications that deal
specifically with their epidemiology. Appendicular bone fractures due to trauma were most
common in canines and felines.
All canine and felines with appendicular bone fractured coming to pet clinics during 4
months and their owners willing to participate were enrolled in the study irrespective of age,
breed, and geography. Pet owners not willing to participate were excluded from the study. Data
about age, sex, breed; clinical signs, radiography report and other risk factors were obtained from
the pet owners on a pre-designed close ended questionnaire. Radiographs of the fractured area
were taken for confirmation of fracture. A cross-sectional study was conducted to classify
different types of fractures and to identify the risk factors associated with appendicular fractures
Summary
59
in canine and felines. The study was conducted for four months. The samples consisted of those
canine and felines brought to the selected three pet clinics with fracture during the study period.
Cases were confirmed after taking their radiographs.
The data were analyzed by using SPSS version 20.0.The dependent variable
“appendicular bone fracture” and independent variables “owner’s education, profession, monthly
income, pet sex, pet breed, weight and physical condition” were analyzed by using SPSS version
20.0. Data entry and analysis was done in SPSS 20.0. Chi-square test was used for statistical
testing.
A p-value of <0.05 was considered significant. Frequencies and percentages of
categorical variables were calculated. Cross tabulations were done among dependent and
independent variables. Chi square test was applied to different risk factors associated with
appendicular bone fracture in canines and felines status to define the significant associations.
The present study collected descriptive epidemiological data on appendicular bone
fractures in canine and felines important for control and prevention of fractures. Also, risk
factors associated with appendicular bone fractures in canine and felines were evaluated that
would be helpful in controlling in future such as accidents and falls.
Conclusion
The current study was conducted at three different pet clinics in District Lahore
namely Pet center UVAS, Dr. Asim Pet clinic Faisal town Lahore, Dr. Zia Pet Hospital DHA
Phase-I Lahore, to evaluate the risk factors leading to the appendicular bone fracture in canine
and felines so that these factors can be identified and possible strategies are taken to avoid bone
fractures in canine and felines. The chi-square test result identified the following 10 factors
strongly associated with the appendicular bone fractures in canine and felines during the study
period, which is
Summary
60
1) Owner’s education.
2) The physical condition of the pet.
3) Taking pet daily for outside walk.
4) Wandering habits of pet.
5) The habit of traveling with pets.
6) Not giving balanced diet daily to the pet.
7) Early weaning within two weeks after birth.
8) Aggressive behavior of the pet.
9) Road accidents.
10) Falling from a height. Availability: Items available for loan: UVAS Library [Call number: 2864-T] (1).
50.
Descriptive Epidemiology And Risk Factors Of Antenatal Depression Among Women Visiting Tertiary Care Hospital In Lahore
by Gulshan Umbreen (2015-VA-415) | Prof. Dr. Mansur Ud Din Ahmad | Dr. Mamoona Chaudhry | Dr. Muhammad Nasir.
Material type: ; Literary form:
not fiction
Publisher: 2017Dissertation note: Mental health is an important but neglected component of reproductive health. Mental health problems among women of reproductive age group (15–45 yrs.) contributes to 7% of Global Burden of Diseases of women of all ages. During pregnancy prevalence of depression ranges from 4% to 20%. Women with perinatal depression experience full-blown major depression during pregnancy or after delivery (postpartum depression). The feelings of extreme sadness, anxiety, and exhaustion that accompany perinatal depression may produce or create difficulties to perform daily care activities for themselves and for their babies. Several risk factors predispose to depression during pregnancy are poor antenatal care, economic deprivation, previous history of psychiatric disorders, previous events during pregnancy like previous abortions, and modes of previous delivery like past instrumental or operative delivery age, marital status, gravidity, whether pregnancy was planned. Antenatal depression was the strongest indicator of postnatal depression. A hospital based cross sectional survey for duration of 4 months (December 2016 to March 2017) was performed in Lady Aitchison hospital Lahore. Pregnant women who visited to the obstetrics and gynecology departments for routine prenatal or perinatal care. Woman belongs to lower middle class was included and women with physical disabilities such as deafness and dumbness as well as those with a history of or ongoing mental illness/retardation was excluded in this study. Sampling was done by using convenience sampling technique and sample size was 300. Information regarding risk factors of antenatal depression was collected by using structured questionnaire and a screening tool, Edinburgh postnatal Depression Scale to assess depression after taking written consent. Data was obtained by face to face interview. Data was analyzed by using SPSS software with 95% confidence
85
interval. Descriptive analysis was conducted in terms of who, when and where. Frequency distribution and graphs were be made. Chi- Square test was applied to see the association of risk factors. Depression and various risk factors have been identified among pregnant woman. Association found among various risk factors like age, education of woman and husband, occupation of husband, Husband income, Family type, number of persons living in home, number of children’s, number of daughters, trimester of pregnancy, mode of delivery, pregnancy status, fear from childbirth, Bitter experience/Complication in current /previous Pregnancy and Family Support. Through assessment provide an opportunity in need of intervention to safeguard the well-being of mother and baby and reduce the impact of antenatal depression on the mother, her baby, and her family. Availability: Items available for loan: UVAS Library [Call number: 2903-T] (1).
