Foundation Community Health Research Articles

Comparison of the accuracy of phone applications with Snellen chart in determining visual acuity

Objective: To correlate the visual acuity assessment as tested by smartphone application with standard Snellen visual acuity. Methodology: A total of 136 individuals were included in this analytical cross-sectional survey conducted at Shifa Foundation Community Health Center, Islamabad between January 2022 and January 2023. Individual’s age ? 18 years were included. Snellen’s visual acuity was assessed using a standard Snellen’s visual acuity chart by the optometrist, while the Paxos checkup by DigiSight technologies was used to assess visual acuity on smart phone using one appropriately color calibrated I-phone 7 device. Both assessments were done in physically separate areas to reduce observation bias. Visual acuity from each assessment was noted in the decimal format. Frequency distribution and Pearson’s correlation was calculated to ascertain the relationship between the two study variables. Results: A total of 88 males and 48 females were included in the study (n=136). The mean age of patients was 29.72±9.0 years. The mean visual acuity of right and left eyes as assessed with Snellen’s chart were 0.88±0.2 and 0.86±0.22, respectively. The mean visual acuity for right and left eyes as assessed by Paxos checkup were 0.84±0.19 and 0.86±0.21, respectively. There was positive correlation was present in both eyes. The Pearson’s correlation for right eyes was r = 0.66 and significant at p = 0.001, while the correlation for left eyes was r = 0.71 and significant at p = 0.001. Conclusions: There is a strong correlation between Snellen’s visual acuity assessment and assessment of visual acuity by the smartphone application. This makes the latter a viable strategy for screening at places where taking a Snellen’s chart might not be feasible.

Screening of Children with Upper Respiratory Tract Infection for Otitis Media with Effusion

Objective: To determine the recurrence rate of Otitis Media with Effusion (OME) among children without hearing loss, in relation to different upper respiratory tract infections.
 Methodology: This cross-sectional study was conducted at the Shifa Foundation Community Health Centre (SFCHC) in Islamabad from February 2020 to February 2021, this study involved otoscopic examinations by a blinded team member. Tympanometry was performed on patients displaying OME signs. Both the examiner and performer were unaware of the child's study status to minimize bias.
 Results: The study included children with a mean age of 7.35 ± 2.30 years, predominantly males (59.4%). Common symptoms were nasal obstruction (98%), mouth breathing (97%), and sore throat (98%). Physical examination revealed no Deviated Nasal Septum (DNS), nasal polyps, or tender sinuses. Mucopurulent nasal discharge (94.1%), adenoid hypertrophy (98%), and congested tonsils (96%) were prevalent. Dull/opaque tympanic membranes were present in 22.8% of children, while 74.3% displayed a light reflex, and 26.7% had a prominent short process of malleus.
 Conclusion: Otitis media with effusion is frequent in children with recurrent upper respiratory tract infections, non-specific ear symptoms, and poor school performance. Although typically benign with a high rate of spontaneous resolution, it often leads to parental anxiety, unnecessary investigations, and sometimes unwarranted medication.
 Key Words: Otitis Media with Effusion, Recurrent Upper Respiratory Tract Infection, Hearing Loss.

Vitamin D deficiency: A risk factor for myopia in children - a cross sectional study in a tertiary care centre.

To study the role of vitamin D deficiency as a risk factor for myopia in children aged 5-15 years. The cross-sectional observational study was conducted from January to September 2019 at the Ophthalmology and Paediatric departments of Shifa Foundation Community Health Centre, Islamabad, Pakista. It comprised patients with suspected / symptomatic vitamin D deficiency who were enrolled from the paediatric outpatient department and referred to the ophthalmology clinics for eye exam. Apart from taking detailed ocular history, slit lamp examination, Snellen's distance visual acuity, auto-refraction to calculate spherical equivalent, and amplitude scan for measuring the axial length were performed. An average of 3 measurements was taken for both refraction and axial length calculation. Myopia was labelled if mean spherical equivalent was ≤0.25 dioptres. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D level < 20ng/ml. Data was analysed using SPSS 23. There were 72 subjects with a mean age of 10.11±2.69 years; 37(51.4%) boys and 35(48.6%) girls. Myopia was seen in 40(55.6%) patients, while 32(44.4%) were emmetropic. The overall mean vitamin D level was 20.25±12.18 ng/ml. There was no significant association between myopia and vitamin D deficiency (p=0.115). Significant associations were found between myopia and relatively older age (p=0.005), higher height (p=0.001), more weight (p=0.001) and higher body mass index value (p=0.008). Low vitamin D levels were not significantly associated with myopia in children aged 5-15 years, but significant associations were found between myopia and relatively older age, and various anthropometric measures.

Audiometric Findings in Patients with Age Related Hearing Loss

Aim: To determine the audiometric findings, prevalence of age related hearing loss and association of hearing loss with gender in patients of 60 years and above. Setting and duration of study: This study was conducted in the Department of ENT at Shifa Foundation Community Health Centre (SFCHC), Shifa International hospital, Islamabad, over a period of 5 years from September 2014 to September 2019. Methods: A total of 149 patients were included in the study. All the patients were subjected to audiometry after taking informed written consent. Information regarding the past medical history of all participants regarding ear and hearing disorders and risk factors was taken and recorded. All this information along with demographic information was recorded. Results: The mean age of the participants was 70.72 ± 7.09 years. Most 46 (30.9%) of the patients were between 60 to 65 years old. The proportion of male participants 76 (51%) was slightly higher. In our study sample, 142 (95.3%) of the participants had high-frequency hearing loss, and 129 (86.6%) participants had low-frequency hearing loss. Mostly 62 (41.6%) participants had sloping curve. Most 125 (83.9%) participants were diagnosed with both types of hearing loss. Among male patients flat curve showed a significant (P-value &lt; 0.05) relationship with age and in female patients, flat curve and neither flat curve nor sloping curve showed significant (P-value &lt; 0.05) association with different age brackets. Conclusion: High-frequency hearing loss was the most common type of hearing loss among older patients. Majority of the patients were diagnosed with both types of hearing loss. High-frequency hearing loss was found to be significantly associated with different age brackets. Keywords: Hearing loss, Audiometric findings, High Frequency Hearing Loss,

Results of endoscopic endonasal dacryocystorhinostomy: A prospective cohort study.

To evaluate the success rate of endoscopic endonasal dacryocystorhinostomy. The prospective cohort study was conducted at the Ophthalmology and Otorhinolaryngology departments, Shifa Foundation Community Health Centre, Islamabad, Pakistan, from October 2017 to September 2019, and comprised chronic dacryocystitis patients who underwent endoscopic endonasal dacryocystorhinostomy. Endoscopic dacryocystorhinostomy with or without lacrimal intubation was performed under general anaesthesia. The patients were followed up post-operative at 1 week, 1 month, 6 months and 12 months. Data was analysed using SPSS 20. Of the 47 patients, 41(87.2%) were females. The overall mean age was 40.70±10.84 years (range: 25-66 years). Lacrimal intubation was performed in 31(66%) patients. Surgical success was achieved in 46(97.9%) patients. Of them, 37(78.7%) patients were completely symptom-free, while 9(19.1%) were partially symptomatic and were managed conservatively. Treatment failure requiring repeat surgical procedure was the case with 1(2.1%) patient. Procedure failure was more likely in patients with previous attacks of acute dacryocystitis (p=0.003). Endoscopic dacryocystorhinostomy was found to be a safe procedure with good anatomical and functional outcomes in chronic dacryocystitis patients.

Association of Hypertension with Non-HDL Cholesterol in Patients with Type 2 Diabetes Mellitus.

To determine the association of hypertension with Non-HDL Cholesterol (Non-HDL.C) among patients with type 2 diabetes mellitus. Descriptive study. Shifa Foundation Community Health Centre, Shifa International Hospital, Islamabad, from January to December 2019. This study comprised of 214 patients with type 2 diabetes. Detailed history, examination, anthropometric measurements, fasting lipid profiles and blood glucose levels were recorded for all patients. Non-HDL.C was determined in all patients by subtracting HDL Cholesterol (HDL.C) from total Cholesterol (Total.C). Association of hypertension with Non-HDL.C was analysed using Chi-square Fisher Exact test for qualitative data and post-stratification t-test for quantitative data. Correlation of rising levels of Non-HDL.C with Total.C, LDL.C, Triglycerides, HDL.C and fasting blood sugar was analysed using ANOVA. SPSS version 23 was used for statistical analysis. Non-HDL.C was raised in 169 (78.97%) patients with type 2 diabetes. However, there was no significant difference in the mean Non-HDL.C among patients with hypertension and without hypertension (156.35 +38.52 mg/dl versus 156.81 +45.82 mg/dl; p = 0.936). Furthermore, there was no significant difference in the Total.C, LDL.C, Triglycerides and the number of patients with raised Non-HDL.C among both groups. Increasing values of Non-HDL.C correlated significantly to Total.C, LDL.C and Triglycerides (p <0.001). Hypertension had no significant association with Non-HDL.C in patients with type 2 diabetes. However, the raised level of Non-HDL.C in majority of type 2 diabetic patients in addition to significant correlation with Total.C, LDL.C and Triglycerides necessitates its screening irrespective of the blood pressure status. Key Words: Non-HDL cholesterol, Dyslipidemia, Diabetes, Hypertension.

Treatment for Symptomatic Bacterial Vaginosis: ARandomized Controlled Trial.

To compare the efficacy of multiple doses of vaginal clindamycin with a single oral dose of secnidazole for the treatment of bacterial vaginosis. Double-blinded randomized controlled trial. Shifa Foundation Community Health Center, from March 2012 till February 2015. After obtaining written informed consent, a pelvic examination was performed for the confirmation of symptoms of milky white vaginal discharge on speculum examination, positive Amine test and presence of clue cells on microscopy. Pregnant women, known diabetes or any immunocompromised condition, were excluded. Blinding of the patient, doctor, and the pharmacist was done. Study cohort was then divided into two groups, Group Areceived medicine pack Awhich contained active clindamycin and placebo oral preparation, whereas group B was given pack B which contained active 2-gm secnidazole with placebo vaginal cream. Primary outcome and therapeutic success were defined by correction of two out of three (normal Nugent score, negative Amine test, and no milky white discharge) on day 15. At 15th day of treatment, 96.6% participants in vaginal clindamycin group (Group A), recovered from the bacterial vaginosis; whereas, (group B) 23% patients were cured in oral secnidazole group. Multiple doses of vaginal clindamycin are superior to single dose of oral secnidazole for the treatment of bacterial vaginosis.

Trial of labor after previous cesarean delivery (TOLAC) and association of BMI and previous vaginal delivery with frequency of VBAC

Objectives: To determine the frequency of successful Vaginal Birth after One Cesarean Section in our tertiary care institution and to determine the causes of its failure.Material and Methods: This study was conducted in department of Obstetrics and Gynecology of Shifa International Hospital and Shifa Foundation Community Health Centre Islamabad Pakistan from Feb 2011 to Dec 2014. This study included 592 patients who presented in labor room emergency reception of Obs/Gynae department at term with previous one scar having fulfilled the laid down inclusion criteria for VBAC during ante-natal care. The patients were admitted in hospital and were allowed to proceed for spontaneous labor under vigilant monitoring on complications of trial of scar. Immediate emergency cesarean sections were performed, where indicated.Results: Out of 592 patients 70.7% were delivered vaginally after previous one cesarean section and 29.3% had emergency cesarean section. Leading indications for repeat cesarean section was fetal distress, failure to progress and scar tenderness. No maternal and fetal complication occurred in our study. The success rate of Trial of labor after one previous cesarean delivery was lower in obese (64.38%) as compared to non-obese women (82.06%) (p&lt;0.001). Women with previous successful vaginal delivery had a success rate of 88.2% compared with 62.25% in women without such a history (OR 4.4; 95% CI 2.7-7.2 p &lt;0.001).Conclusion: Vaginal birth after one lower segment cesarean section should be encouraged with vigilant monitoring provided no obstetric contra-indication to vaginal birth exists.Bangladesh Journal of Medical Science Vol.15(4) 2016 p.546-550

Transient Corneal Edema After Phacoemulsification.

To determine the association between pre-operative and intra-operative factors leading to transient corneal edema after phacoemulsification. Cohort study. Department of Ophthalmology, Shifa Foundation Community Health Centre, Islamabad, from October 2011 to September 2012. Patients undergoing phacoemulsification and Intraocular Lens (IOL) implantation were enrolled in the study using consecutive non-probability sampling. Pre-operative risk factors including peripheral corneal degenerations, the type and density of cataract were documented. Surgical risk factors included the incision site, the type of intraocular lens, the phacotechnique and the phacopower time. Postoperatively the patients were assessed for corneal clarity and the degree of striate keratopathy. Statistical analysis was done using SPSS version 17. There were 43% male and 57% female patients (n = 182). Mean age was 58.92 ± 13.00 years (median and mode-60 years). Factors which increased the risk of transient corneal edema after phacoemulsification included hypertension (p = 0.022), dense nuclear cataracts (p=0.006), divide and conquer technique (p = 0.008), duration of phacopower use (p < 0.001) and peripheral corneal degenerations (p < 0.001). Patients with peripheral corneal degenerations and dense nuclear cataracts had significantly higher rates of postoperative corneal edema. Use of phaco-chop technique and less phaco-power time helps in decreasing corneal edema.

High Prevalence of Metabolic Syndrome in Young Hispanic Women: Findings from the National Sister to Sister Campaign

Hispanics are the fastest growing segment of the U.S. population and have a higher prevalence of cardiometabolic risk factors as compared with non-Hispanic whites. Further data suggests that Hispanics have undiagnosed complications of metabolic syndrome, namely diabetes mellitus, at an earlier age. We sought to better understand the epidemiology of metabolic syndrome in Hispanic women using data from a large, community-based health screening program. Using data from the Sister to Sister: The Women's Heart Health Foundation community health fairs from 2008 to 2009 held in 17 U.S. cities, we sought to characterize how cardiometabolic risk profiles vary across age for women by race and ethnicity. Metabolic syndrome was defined using the updated National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines, which included three or more of the following: Waist circumference ≥35 inches, triglycerides ≥150 mg/dL, high-density lipoprotein (HDL) <50 mg/dL, systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥85 mmHg, or a fasting glucose ≥100 mg/dL. A total of 6843 community women were included in the analyses. Metabolic syndrome had a prevalence of 35%. The risk-adjusted odds ratio for metabolic syndrome in Hispanic women versus white women was 1.7 (95% confidence interval, 1.4, 2.0). Dyslipidemia was the strongest predictor of metabolic syndrome among Hispanic women. This disparity appeared most pronounced for younger women. Additional predictors of metabolic syndrome included black race, increasing age, and smoking. In a large, nationally representative sample of women, we found that metabolic syndrome was highly prevalent among young Hispanic women. Efforts specifically targeted to identifying these high-risk women are necessary to prevent the cardiovascular morbidity and mortality associated with metabolic syndrome.

Change in trend of contraceptive uptake — effect of educational leaflets and counseling

Background The study was conducted to determine the impact of counseling and educational leaflets on contraceptive practices of couples. Study Design Randomization of 600 women was done in two groups matched for age, parity and socioeconomic status at the Department of Obstetrics and Gynaecology, Shifa Foundation Community Health Centre, Shifa International Hospital, Islamabad, Pakistan. In Group A, the intervention group was exposed to contraceptive counseling and educational leaflets in the postnatal ward after delivery, whereas in Group B, the nonintervention group was not given any formal contraceptive advice. Later on, both groups were assessed regarding their contraceptive practices. Results At their follow-up visit (8–12 weeks) postpartum, 19 (6.3%) women in the nonintervention group had started contraceptive use, whereas 153 (50.8%) had decided to start contraception in the next 6 months, and 129 (42.8%) women were still undecided. The main contraceptive user was the male partner ( n=117, 38.8%), and the most common method used was coitus interruptus ( n=62, 36.3%). In the intervention group, 170 women (56.9%) had started using contraceptives, whereas 129 (43.1%) had decided to start contraceptive use in the next 6 months. The predominant contraceptive user was the females ( n=212–70.9%), and the most popular method chosen was oral contraceptive pills ( n=111, 37.1%). Conclusion There is a definite increase in contraceptive uptake in women provided with educational leaflets and counseling session with a shift toward use of more reliable contraceptive methods.

Implementation of the Henry J. Kaiser Family Foundation's Community Health Promotion Grant Program: A Process Evaluation

The Community Health Promotion Grants Program, sponsored by the Henry J. Kaiser Family Foundation, represents a major health initiative that established 11 community health promotion projects. Successful implementation was characterized by several critical factors: (1) intervention activities; (2) community activation; (3) success in obtaining external funding; and (4) institutionalization. Analysis of the program was based on data from several sources: program reports, key informant surveys, and a community coalition survey. Results indicate that school-based programs focusing on adolescent health problems were the most successful in reaching the populations they were targeting. The majority of the programs were able to attract external funding, thereby adding to their initial resource base. The programs were less successful in generating health promotion activities and in achieving meaningful institutionalization in their communities.

Conference Report: Community-Based Health Promotion—State of the Art and Recommendations for the Future

The evaluators of the Henry J. Kaiser Family Foundation Community Health Promotion Grants Program in the West and the Foundation brought together 21 researchers, funders, and community organizers with a variety of perspectives on community-based health promotion to share what has been learned to date and how that knowledge should be applied in the future. The two-day conference was divided into three sessions, covering conceptual, implementation, and evaluation issues. Specific topics were selected by the organizers with input from participants. Two papers were presented in each session, followed by comments from discussants and a general discussion involving the entire group. The dominant theme of the conference was the relationship between communities and outside institutions, focusing on problems with the current state of relations and how they might be improved in the future. All viewed building partnerships between communities and institutions as a desirable goal; however, the challenges involved in building effective partnerships are considerable and require a substantial investment to make them work. Recommendations that emerged from the discussions included explicitly acknowledging the diverse interests of the parties in community-based programs at the earliest stages of program planning; making a concerted effort to bridge the cultural gaps that exist among the parties; structuring funding to allow enough lead time for partnerships to develop or using social reconnaissance to identify strong existing partnerships; and integrating the evaluation more closely into the process of program development.

Evaluating the Usefulness for School Principals of Feedback Reports From a School-Based Adolescent Health Survey

Researchers doing school surveys of adolescent health behavior frequently provide feedback reports to the schools summarizing the survey results, but it is not generally known how useful this information is for the recipients. The authors conducted a survey of 43 high school principals in 11 communities about the usefulness of feedback reports generated from data collected as part of the evaluation of the Henry J. Kaiser Family Foundation's Community Health Promotion Grants Program. The results of the survey suggest that principals found the reports to be extremely valuable: The reports were distributed widely among staff, parents, and school boards, and were put to use in a variety of ways, including planning, needs assessment, and evaluation. Furthermore, many principals said that without the promise of feedback they would not have participated in the survey. These results suggest that this information, if properly presented, can be very useful to schools as they design and implement adolescent health programs.

Evaluating Community-Based Nutrition-Programs: Comparing Grocery Store and Individual-Level Survey Measures of Program Impact

Background. This paper examines whether an "environmental indicator"-a survey of grocery store product displays-can provide a realistic alternative to individual-level telephone surveys for the evaluation of community-based nutrition programs. Methods. Telephone and grocery store measures were used separately to evaluate three community-level dietary interventions that were part of the Kaiser Family Foundation Community Health Promotion Grants Program (CHPGP). Both surveys were conducted in the three intervention and seven control communities at three points in time: 1988, 1990, and 1992. The grocery store survey recorded the relative availability of low-fat and high-fiber products and the amount of store-provided health-education information. Self-reported dietary intake of residents was obtained in the same communities using a telephone survey. Results. In the one community in which the intervention seemed to have contributed to reduced fat consumption, the grocery store and telephone surveys showed very similar relative changes for the only variable they had in common, low-fat milk consumption. In another community, bath survey approaches indicated that there was no change or perhaps a slight worsening in the treatment relative to the controls. The third community produced the only contradictory results: the telephone survey suggested no change or perhaps a worsening, while the grocery store results were generally positive, though not statistically significant. Conclusion. These results, combined with the much lower cost of the grocery store survey, justify further pursuit of environmental indicators as an evaluation tool.

Do communities differ in health behaviors?

Communities differ in the prevalence of various health behaviors, but it is not known to what extent these differences are due to “different types” of people living in them. We used data from the evaluation of the Henry J Kaiser Family Foundation Community Health Promotion Grant Program to study individual-level and community-level variation in health behaviors for 15 communities. Our results show (1) there was significant variation among these communities in prevalences of smoking, consumption of alcohol and dietary fat, and use of seatbelts; (2) these differences persisted after control for demographic, health status, and other health behavioral characteristics of the people in the communities; (3) the community effect on a particular person's behavior, as represented by R2, was very small (less than I%); and (4) the adjusted differences in prevalences among communities were potentially large (for example, a 7 percentage point difference in the probability of smoking). Unique features of communities may influence health behaviors. These findings affirm the potential importance of contextual effects on individual health behavior and thus support the theory that changing the community environment may offer effective ways to change individual health behavior.

Assessment of Community-Level Influences on Individuals’ Attitudes About Cigarette Smoking, Alcohol Use, and Consumption of Dietary Fat

A basic premise of community-based health promotion is that enduring changes in health behaviors are facilitated by changing community norms or the standards of acceptable behavior in the community. We examine whether community-level influences on individuals' normative attitudes can be related to cigarette smoking, alcohol consumption, and dietary fat intake. We conducted a random-digit dialing survey of 8,849 adults in 15 communities in the western United States as part of the evaluation of the Henry J. Kaiser Family Foundation Community Health Promotion Grant Program. We found independent associations among attitudes for tobacco, alcohol, and diet and both individual-level and community-level characteristics. A significant community effect on attitudes remained even when we controlled for individual demographics and health behaviors, as well as for the overall prevalence of the target health behavior in the community. The specific community characteristics that account for this effect were not clear in our analyses, suggesting that influential characteristics vary from community to community.

An Empirical Exploration of a Conceptual Model for Community-Based Health-Promotion

Community-based approaches to health promotion and disease prevention are often based on underlying theoretical models of behavior change, but evaluations of these programs have not attempted to assess empirically the validity of these models. This article uses data from the Henry J. Kaiser Family Foundation Community Health Promotion Grants Program (CHPGP) evaluation to examine a conceptual model which guided the program evaluation. The model posits relationships among six theoretical constructs: community activation, program activity, norms, environment, role models, and health behaviors. Correlational analyses using two waves of survey data were used to examine whether the hypothesized relationships were actually present. Positive cross-sectional associations between the constructs at each point in time were found but the associations between changes in the constructs over time were weak. The stability of these cross-sectional patterns suggests that there may be forces leading communities to have an underlying "consistency" with respect to community norms, the environment, health behaviors and perhaps other community characteristics. If so, effective community-based programs may need to target a wide range of community characteristics rather than to focus narrowly on a single dimension.

The evaluation of the Henry J. Kaiser family foundation's community health promotion grant program: Design

The Kaiser Family Foundation's Community Health Promotion Grant Program (CHPGP) provides funding and technical assistance in support of community-based efforts to prevent major health problems. The first phase of the program was implemented in 11 communities in the western United States. This paper describes the evaluation design of the CHPGP in the West, the methods of data collection, and the baseline comparability of intervention and control communities. Major features of the evaluation design include: (1) the randomization of qualified communities making application into funded and unfunded comparison groups; (2) a second set of matched control communities for some intervention sites; (3) data gathering through repeated surveys of community residents (probability samples of adults and adolescents) and institutions (health-related organizations and randomly sampled grocery stores and restaurants); and (4) the use of secondary data to monitor health events. Selected baseline data show that intervention and control communities differ in racial/ethnic composition, but relevant health behaviors and ratings of community activation for health promotion appear comparable.