Aga Khan Development Network

BackgroundIn low- and middle-income countries, maternal, newborn, and child health face significant challenges due to infrastructure limitations, access disparities, and service delivery inefficiencies. The Sehatmandi mobile health (mHealth) app was deployed in 2018 to address these issues across 189 health facilities in Afghanistan's Bamyan and Badakhshan provinces. This app aims to enhance service provision through real-time data monitoring, improved accountability, and performance-based health system strengthening.ObjectiveThis study aims to explore the enablers, challenges, and lessons learned for the sustainability of the Sehatmandi mHealth intervention from the perspective of key stakeholders to inform the future scaling of digital health tools in fragile and resource-constrained settings.MethodsA qualitative study was conducted between June and July 2024 involving 24 in-depth interviews with stakeholders, including health facility managers, administrators, and high-level decision-makers. Participants were selected using stratified purposive sampling to ensure diverse facility representation. Interviews were conducted in person or virtually by using a semistructured guide, recorded, transcribed and translated into English. Thematic content analysis was performed using NVivo version 11 software. Ethics approval was obtained, and informed consent was secured from all the participants.ResultsStakeholders reported that Sehatmandi improved health system responsiveness by enhancing performance monitoring, accountability, timely reporting, and data-driven decision-making. Offline data entry was identified as a critical feature, enabling data collection in remote areas without internet access and ensuring synchronization when connectivity was resumed. However, several barriers affected the long-term sustainability: poor internet connectivity, electricity shortages,inadequate technical support, and high staff turnover, which disrupted functionality and data quality. Training gaps and insufficient supervision further hampered consistent and effective use. Participants emphasized the need for structured capacity building, regular follow-up, and sustainable funding to maintain the intervention. Integration with national health information systems and alignment with broader digital health strategies were also seen as prerequisites for scaling and institutionalization.ConclusionsThe Sehatmandi mHealth intervention demonstrated enhanced performance monitoring and accountability across health care facilities in Afghanistan’s conflict-affected settings. However, for digital health interventions to be sustainable and scalable in low- and middle-income countries, foundational investments in digital infrastructure, continuous training and monitoring, system-level integration, and long-term funding are essential. These findings provide actionable insights for governments, implementers, and donors aiming to strengthen health systems through digital innovation in fragile settings.

Journal clubs (JCs) play an important role in medical education by promoting critical appraisal and evidence-based practice. However, residents often face barriers to effective participation. Some of the issues that are commonly faced include limited time and difficulty understanding complex concepts and statistics. This study was conducted during March-September 2024 and explored the use of a custom-trained Large Language Model (LLM) as a supportive tool for JC preparation and participation among postgraduate dental residents. Using a design-based research approach, researchers implemented the LLM integrated with relevant literature. Six JC sessions were conducted with sixteenresidents across two subspecialties, accompanied by structured observations, feedback forms, and pre-/and post-focus groups with residents and faculty (n=16). Findings revealed that the LLM improved residents' comprehension of complex content, enhanced confidence, and increased engagement during discussions. Residents used the tool for summarizing articles, clarifying statistical methods, and generating discussion points. Fiftythree percent reported a positive experience of using the LLM for JC preparation, Forty-three percentwere neutral, and only one response was negative. However, challenges included the need for precise prompt construction, occasional content inaccuracies, and limited depth in some specialized areas. Faculty observed enhanced participation but stressed the need for critical evaluation of LLM outputs. Both groups identified prompt-writing skills, critical thinking, and AI literacy as key competencies for effective LLM use. LLMs can complement traditional teaching by supporting deeper engagement in JCs. As generative AI evolves, further research should examine its broader implications on learners' cognitive processes, epistemic trust, and educational equity.

Este trabalho apresenta o desenvolvimento inicial de uma bateria virtual em realidade aumentada (RA) utilizando a engine Unity e o dispositivo Meta Quest 3. O projeto tem como objetivo ampliar o instrumento físico, o que na prática, significa permitir uma experiência imersiva de interação musical que mescle real e virtual. Atualmente, o projeto está em fase de protótipo, com implementação das funcionalidades básicas, como a detecção de alguns gestos e o posicionamento livre dos tambores. Espera-se que o sistema contribua para aplicações educacionais e de entretenimento em realidade aumentada, além de servir como base para outros projetos na mesma área.

Background: Coronary artery disease (CAD) is the leading cause of cardiovascular mortality (CVD), accounting for 1 in 5 CVD-related deaths. The advent of noninvasive imaging modalities has driven the use of myocardial perfusion imaging (MPI) to improve diagnostic accuracy and clinical outcomes. Objectives: Building on the role of myocardial perfusion imaging (MPI), this meta-analysis assesses the diagnostic accuracy of the Discovery NM 530c CZT SPECT for CAD compared with invasive coronary angiography (ICA ± FFR) and noninvasive modalities, including PET, MRI, and coronary CT angiography. Methodology: We systematically searched six databases, identifying 1,587 studies, with 9 meeting inclusion criteria (510 patients, ≥18 years, known/suspected CAD). NM 530c CZT-SPECT was compared with coronary angiography (±FFR), PET, MRI, or coronary CTA within 90 days. Diagnostic test accuracy was assessed using sensitivity, specificity, predictive values, AUC, and DOR, analyzed in R (Version 2024.12.0+467) using "mada" and related packages. Results: In bivariate analysis, NM 530c CZT-SPECT showed pooled sensitivity of 0.804 (95% CI: 0.751–0.848) and specificity of 0.793 (95% CI: 0.722–0.850) with low heterogeneity (29.8% and 26.2%, respectively). The diagnostic odds ratio (DOR) was 14.19 (95% CI: 8.47–23.77), confirming high diagnostic accuracy. On subgroup analysis, the comparator group had no significant impact on DOR (QM (df = 1) = 0.100, p = 0.752). Against ICA, sensitivity was 0.814 (95% CI: 0.726–0.878) and specificity 0.731 (95% CI: 0.638–0.807) with minimal heterogeneity (2.4%). AUC of 0.84 underscores its clinical reliability. Conclusion: NM 530c CZT-SPECT exhibits high diagnostic accuracy, with consistent sensitivity and modestly lower specificity than other invasive and noninvasive modalities. Its high AUC underscores its reliability for CAD assessment in clinical practice.

Background: Hearing loss is a frequently underdiagnosed condition among children attending Madrasahs, with significant consequences for academic progress and psychosocial development. Conductive hearing loss predominates in such settings, often resulting from preventable factors such as trauma and ear infections, yet systematic data on prevalence and etiology remain scarce in low-resource contexts. Objective: To determine the types, degrees, and causes of hearing loss in male Madrasah students aged 5–16 years in Dera Ghazi Khan, Pakistan, and to identify clinically significant associations between etiological factors and severity of impairment. Methods: In this cross-sectional observational study, 100 male students were selected via purposive sampling from a Madrasah. Each participant underwent otoscopic examination and pure tone audiometry following standard protocols. Hearing loss was categorized by type and severity; etiological data were collected through clinical assessment and structured parent interviews. Statistical analyses included descriptive and inferential statistics, with odds ratios and confidence intervals used to assess associations between trauma and severity of loss. Results: Conductive hearing loss was present in 63% of students, with moderate loss identified in 35%. Trauma accounted for 34.3% of hearing loss cases and was strongly associated with moderate severity (OR: 2.98, 95% CI: 1.32–6.71, p=0.008). Otitis externa (25.4%) and otitis media (11.9%) were also prominent causes. No significant association was found between hearing loss prevalence and duration of Madrasah study. Conclusion: Conductive hearing loss is highly prevalent among Madrasah students, with trauma and preventable infections as leading contributors. Implementation of routine auditory screening, injury prevention, and health education in Madrasahs is warranted to mitigate the burden of hearing impairment.

Mammals, being social creatures communicate through a variety of signal cues, thus it is vital to understand how wild carnivores create and maintain connections with their neighbors for their survival. However, observing elusive species in their natural habitats poses significant challenges leading to scarcities of data. In this study, we aimed to provide a detailed long-term observation of snow leopards in the northern region of Pakistan, hence we utilized data from 136 camera traps between 2018 and 2023 in order to investigate the territorial marking behavior of snow leopards in Baltistan. We documented 813 sightings of snow leopards with 103 videos showing territorial marking behavior from 40 sightings during snow presence and 63 on snow-free days. Nine unique communication behaviors were identified during the presence or absence of snow cover. We observed that snow leopard marking behavior occurred more often at night in the absence of snow and less often during the day in the presence of snow. The marking activities were higher during the crepuscular period in the presence of snow and showed a preference for marking activities in open areas over mixed herbaceous and shrub habitats. Olfaction and scraping were observed more frequently in open areas while fecal deposition was found in herbaceous and shrub habitats. Scraping and urine spraying were associated with cliffs, rocky outcrops and boulders in open areas. In conclusion, our findings discovered new insights into the marking patterns of snow leopards during both day and night, having taken into consideration the influence of snow conditions. Moreover, the identified marking locations hold significant potential as powerful assets for wildlife preservation initiatives.

SUMMARYBACKGROUNDPakistan ranks fourth globally in terms of high drug-resistant TB (DR-TB) burden, with approximately one-third of cases resistant to fluoroquinolones. Bedaquiline, pretomanid, linezolid and moxifloxacin (BPaLM/BPaL) offers an opportunity for most DR-TB patients to benefit from a shorter, all-oral, well-tolerated and more effective treatment.METHODSWe conducted a retrospective cohort study to pilot the BPaLM/BPaL regimen at four selected sites in two provinces of Pakistan, i.e. Punjab and Khyber Pakhtunkhwa. Data were extracted and analysed using electronic medical records from the program. Descriptive statistics, survival analysis and binary logistic regression analysis were employed.RESULTSA total of 116 patients took treatment between October 2022 and February 2023. The treatment success rate was 96%, with 3% deaths and <1% loss to follow-up. Patients typically completed treatment in 26.2–26.7 weeks for BPaLM and BPaL, respectively. No serious adverse events were observed. The most common side effects included QTcF prolongation (BPaLM: 55%, BPaL: 84%), haematological events (BPaLM: 32%, BPaL: 34%), and gastrointestinal problems (BPaLM: 36%, BPaL: 25%).CONCLUSIONThe BPaLM/BPaL regimens for DR-TB are highly effective with minimal adverse events and feasible to implement in routine program circumstances.

Surgery in the pediatric age group entails a significant amount of anxiety for parents. Due to anxiety, parents are unable to take care of their children, which could affect the child's well-being and contributes to poor outcomes. The primary objective of this study is to determine the frequency of preoperative anxiety in parents before the surgery of their children. It is a cross-sectional descriptive study that included either parent of 147 children of American Society of Anaesthesiology (ASA) I & II, aged 1-12 years undergoing tonsillectomy over the period of 1 year. Each parent's demographic data were recorded and requested to answer a proforma containing the Amsterdam Preoperative Anxiety Information Scale (APAIS) for assessing anxiety on a 5-point Likert scale. Median interquartile range (IQR), and frequency (%) were used to report the normal, skewed, and categorical variables. APAIS anxiety and information scores were compared by using either the Mann-Whitney U-test or the Kruskal-Wallis test. Furthermore, anxiety scores were grouped (present/absent) with a cut-off score of 11 for the presence of anxiety, and multivariate logistic regression was performed to explore the relationship between potential risk factors and the parent's anxiety. Overall, anxiety was present in 59 (40.1%) respondents with 20 (33.9%) being fathers and 39 (66.1%) mothers. The median (IQR) for APAIS anxiety and information score were 9 ± 5 and 5 ± 2, respectively. Higher median anxiety scores were observed statistically significant in children under 5 years old, mother respondents, mothers aged 35 or younger, fathers under 40, and mothers with graduate or higher education (p < 0.05). Father respondents (AOR = 0.3, 95% CI = 0.1-0.8, p = 0.01), and mother's education less than graduation (AOR = 0.2, 95% CI = 0.1-0.6, p = 0.006) were also found to be statistically significant predictors. There is a significant prevalence of anxiety in parents of children who underwent surgery under general anaesthesia, and mothers have showed significantly higher anxiety levels than fathers.