Key Clinical Message This case report highlights the importance of considering parasitic infections, particularly Ascaris lumbricoides, as a possible cause of acute pancreatitis in children, especially in endemic regions. Noninvasive imaging techniques, such as ultrasonography, can play a crucial role in the early detection and diagnosis of this unusual presentation. Timely administration of anthelmintic therapy led to the resolution of symptoms and prevented the need for invasive procedures. Healthcare providers should be vigilant about the diverse clinical manifestations of ascariasis, and regular deworming programs and health education are essential in minimizing the burden of this neglected tropical disease among children. Abstract Ascariasis is a common public health problem globally but it is more prevalent in school‐age children and it often goes undiagnosed, leading to severe complications. The purpose of this report is to spread awareness of its unusual presentation and how to judiciously use noninvasive approaches for its diagnosis. We present a case of a 10‐year‐old girl that was presented in pediatric emergency with gradually worsening epigastric pain. Initial lab work‐up showed elevated pancreatic enzymes which lead to the diagnosis of acute pancreatitis. The patient was managed in the line of acute pancreatitis and with further evaluation by imaging techniques such as ultrasound and CT‐scan abdomen, Ascaris lumbricoides (A. lumbricoides) was visualized. She was then treated with prophylactic antibiotics and antiparasitic medications, which resolved her symptoms and the child responded to the treatment. In children, parasites should be considered as a cause of acute pancreatitis by clinicians, especially in low‐income countries, and before performing invasive procedures, noninvasive approaches should be considered as an initial option. This can save the patient from multiple invasive procedure and its severe complications.
Groundwater quality is influenced by urbanization and land use land cover (LULC) changes. This study investigated their impact on groundwater quality in Quetta City, Pakistan, from 2015 to 2021. About 58 groundwater samples from monitoring wells were analyzed using hydrogeochemical and statistical methods. The water quality index (WQI), Wilcox, USSL, and various agricultural indices were employed to assess water quality trends. LULC analysis and NDVI using Sentinel-2 imagery revealed increased urban and agricultural areas and decreased barren land. Rapid urbanization was evident, with the buildup class expanding by 7.50% during this period. NDVI findings emphasized monitoring vegetation health and water quality for environmental assessments. The groundwater in Quetta was primarily classified as Cl–Ca·Mg, Cl–Ca, and Cl–Na according to the Piper diagram, with water-rock interactions and rock weathering evident. Most groundwater samples were suitable for irrigation according to the Wilcox and USSL diagrams. The WQI demonstrated overall safety for human consumption, but declining WQI values in northern parts due to urbanization are concerning. The results also revealed a moderate positive relationship between landcover classes and WQI values. It can be concluded that urbanization and excessive use of pesticides contributed to declining agricultural land quality. The spatial overlay of agricultural indices with landcover class suggested that barren land was most suitable, followed by build-up and agriculture were suitable for drinking and agriculture purposes. Moreover, agricultural indices moderately declined due to excessive fertilizers and pesticides in the agriculture landcover class. Thus, effective water resource management is crucial to address challenges. This comprehensive study serves as a baseline for future research and recommends larger-scale studies to implement efficient management strategies, urbanization planning, and safe irrigation and drinking water practices to prevent groundwater pollution.
Background and Aims COVID‐19 vaccinations have reduced morbidity and mortality from the disease. Antibodies against severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) have been associated with immune protection. Seroprevalence studies revealed high immunoglobulin G (IgG) antibody levels to SARS‐CoV‐2 in the Pakistani population before vaccinations. We investigated the effect of BBIBP‐CorV vaccination on circulating IgG antibodies and interferon (IFN)‐γ from T cells measured in a cohort of healthy individuals, with respect to age, gender, and history of COVID‐19. Methods The study was conducted between April and October 2021. BBIBP‐CorV vaccinated participants were followed up to 24 weeks. Antibodies to SARS‐CoV‐2 Spike protein and its receptor‐binding domain (RBD) were measured. IFNγ secreted by whole blood stimulation of Spike protein and extended genome antigens was determined. Results Study participants with a history of prior COVID‐19 displayed a higher magnitude of IgG antibodies to Spike and RBD. IgG seropositivity was greater in those with prior COVID‐19, aged 50 years or younger and in females. At 24 weeks after vaccination, 37.4% of participants showed IFN‐γ responses to SARS‐CoV‐2 antigens. T cell IFN‐γ release was higher in those with prior COVID‐19 and those aged 50 years or less. Highest IFN‐γ release was observed to extended genome antigens in individuals both with and without prior COVID‐19. Conclusion We found that IgG seropositivity to both Spike and RBD was affected by prior COVID‐19, age and gender. Importantly, seropositive responses persisted up to 24 weeks after vaccination. Persistence of vaccine induced IgG antibodies may be linked to the high seroprevalence observed earlier in unvaccinated individuals. Increased T cell reactivity to Spike and extended genome antigens reflects cellular activation induced by BBIBP‐CorV. COVID‐19 vaccination may have longer lasting immune responses in populations with a higher seroprevalence. These data inform on vaccination booster policies for high‐risk groups.
Asymptomatic severe hypertension is defined as systolic blood pressure of ≥ 180 mmHg or diastolic blood pressure of ≥ 120 mmHg without signs and symptoms of end-organ damage or dysfunction. Literature shows that around 5% of the patients with severe asymptomatic hypertension had acute hypertension-related end-organ damage. This study aimed to determine the clinical utility of routine investigations and risk factors of end-organ damage in patients presented to the emergency department with asymptomatic severe hypertension. This single-center, cross-sectional study was conducted at the emergency department of the Aga Khan University Hospital, Karachi, Pakistan, from January 2018 to December 2020. All adult patients (age ≥ 18 years) presented to the emergency department with a systolic blood pressure of ≥ 180 or diastolic blood pressure of ≥ 120 mmHg without any signs and symptoms of end-organ damage (e.g., chest pain, unilateral limb or facial weakness, or hemiplegia, altered mental status, shortness of breath, decreased urine output, and sudden-onset of severe headache) were included. Routine investigations were analyzed to detect end-organ damage, including complete blood count, basic metabolic panel, urine detailed report, electrocardiogram, and troponin-I. Multivariable binary logistic regression was applied to identify the risk factors of end-organ damage considering the significant p value of ≤ 0.05. A total of 180 patients were presented to the emergency department with asymptomatic severe hypertension during the study period. Among the total patients, 60 patients (33.3%) had abnormal investigation findings; out of them, new-onset end-organ damage was diagnosed in 15 patients (8.3%). The most common end-organ damage was the kidney (73.3%) followed by the heart (26.6%). The multivariable binary logistic regression showed that age of more than 60 years, past medical history of diabetes, ischemic heart disease, and cerebrovascular accident were significantly associated with a higher risk of end-organ damage (p < 0.05). The study identified a higher prevalence of abnormal routine investigations and acute end-organ damage in emergency department patients with asymptomatic severe hypertension compared to high-income countries and suggested a lower threshold for end-organ damage screening in these patients. The current recommendations of foregoing further workup in patients with asymptomatic severe hypertension may need modification for emergency departments in low-middle-income countries if similar associations are replicated in other settings.
Background Training nursing students on quality and patient safety (PS) is crucial to ensuring safe healthcare practices given the key role nurses play on the healthcare team. The aim of this study was to evaluate the impact of quality and PS course on the knowledge, and system thinking of students at different stages of the undergraduate nursing course. Methods A 4.5-day quality improvement and PS course was conducted at the Aga Khan University School of Nursing and Midwifery for 146 second- and 139 fourth-year students. Students’ knowledge, self-assessment of knowledge and skills, and system thinking were assessed using pretest and posttest. Results Of the total of 20 points, the course significantly improved students’ knowledge by a mean of 4.91 points for second-year students (95% confidence interval [CI], 4.32–5.51) and 3.46 points for fourth-year students (95% CI, 2.90–4.02) between pretest and posttest. For systems thinking, the Systems Thinking Scale scores increased by 0.41 points (95% CI, 0.29–0.52) for second-year students and 0.33 points (95% CI, 0.22–0.44) for fourth-year students out of the total of 5 points. The self-assessment scores significantly increased on postcourse assessment for second ( P < 0.05) and fourth-year students ( P < 0.001). Positive experience reported by students in the narrative reflections complemented these results. Conclusions There was a significant increase in nursing students’ knowledge, self-efficacy, and system thinking after participating in this short PS course. Replication at a national level may improve safety knowledge and skills among nursing students with subsequent gains in the safety of healthcare delivery in Pakistan.
Background Ongoing high neonatal mortality rates (NMRs) represent a global challenge. In 2021, of the 5 million deaths reported worldwide for children under five years of age, 47% were newborns. Pakistan has one of the five highest national NMRs in the world, with an estimated 39 neonatal deaths per 1,000 live births. Reducing newborn deaths requires sustainable, evidence-based, and cost-effective interventions that can be integrated within existing community healthcare infrastructure across regions with high NMR. Methods This pragmatic, community-based, parallel-arm, open-label, cluster randomized controlled trial aims to estimate the effect of Lady Health Workers (LHWs) providing an integrated newborn care kit (iNCK) with educational instructions to pregnant women in their third trimester, compared to the local standard of care in Gilgit-Baltistan, Pakistan, on neonatal mortality and other newborn and maternal health outcomes. The iNCK contains a clean birth kit, 4% chlorhexidine topical gel, sunflower oil emollient, a ThermoSpot™ temperature monitoring sticker, a fleece blanket, a click-to-heat reusable warmer, three 200 µg misoprostol tablets, and a pictorial instruction guide and diary. LHWs are also provided with a handheld scale to weigh the newborn. The primary study outcome is neonatal mortality, defined as a newborn death in the first 28 days of life. Discussion This study will generate policy-relevant knowledge on the effectiveness of integrating evidence-based maternal and newborn interventions and delivering them directly to pregnant women via existing community health infrastructure, for reducing neonatal mortality and morbidity, in a remote, mountainous area with a high NMR.
Objective Group B streptococcus (GBS) has been associated with adverse pregnancy outcomes, but few prospective studies have assessed its prevalence in low‐ and middle‐income country settings. We sought to evaluate the prevalence of GBS by polymerase chain reaction (PCR) in internal organ tissues and placentas of deceased neonates and stillbirths. Design This was a prospective, observational study. Setting The study was conducted in hospitals in India and Pakistan. Population Pregnant women with stillbirths or preterm births were recruited at delivery, as was a group of women with term, live births, to serve as a control group. Methods A rectovaginal culture was collected from the women in Pakistan to assess GBS carriage. Using PCR, we evaluated GBS in various tissues of stillbirths and deceased neonates and their placentas, as well as the placentas of live‐born preterm and term control infants. Main outcome measures GBS identified by PCR in various tissues and the placentas; rate of stillbirths and 28‐day neonatal deaths. Results The most obvious finding from this series of analyses from India and Pakistan was that no matter the country, the condition of the subject, the tissue studied or the methodology used, the prevalence of GBS was low, generally ranging between 3% and 6%. Among the risk factors evaluated, only GBS positivity in primigravidae was increased. Conclusions GBS diagnosed by PCR was identified in <6% of internal organs of stillbirths and neonatal deaths, and their placentas, and control groups in South Asian sites. This is consistent with other reports from South Asia and is lower than the reported GBS rates from the USA, Europe and Africa.
Intravascular imaging (IVI) namely intravascular ultrasound (IVUS) and optical coherence tomography (OCT), presents as a promising imaging modality for drug eluting stent (DES) implantation compared to the gold-standard conventional two-dimensional angiography. IVI provides detailed information of vessel lumen, lesion length, and degree of calcification. For this purpose, we conducted a meta-analysis by pooling recently conducted randomized control trials (RCTs) to compare IVI with angiography for DES implantation. Scopus and MEDLINE were searched till May 2023 for RCTs comparing IVI with traditional angiography-guided stent implantation in coronary artery disease patients undergoing percutaneous coronary intervention. The primary outcome of interest was target-lesion revascularization (TLR). Secondary outcomes included target vessel revascularization (TVR), all-cause mortality, and major adverse cardiovascular events (MACE). A random-effects meta-analysis with meta-regression was performed to derive risk ratios with corresponding 95% CIs from dichotomous data. 14 RCTs with a total of 8,946 CAD patients (IVI 4,751 vs. angiography 4,195; mean age 61.7 years), and a median follow-up of 15 months (12-24.3) were included. IVI was associated with significantly reduced TLR (RR 0.63 [0.49, 0.79]) vs. conventional angiography. Similarly, TVR incidence (RR 0.66 [0.53, 0.83]), and MACE (RR 0.69 [0.58, 0.78]) were also significantly decreased with IVI vs. conventional angiography for PCI. However, no significant difference was observed in all-cause mortality between the two imaging modalities (RR 0.85 [0.63, 1.15]). Meta-regression analysis showed no significant impact of follow-up duration, baseline comorbidities such as hypertension, smoking status, previous MI, and stent length on TLR incidence. IVI was associated with improved clinical outcomes in terms of reduced TLR, TVR, and MACE incidence when compared with traditional angiography in CAD patients for stent implantation.
Objectives: Disclosure of bad news is distressing for patients and family members. Our aim was to assess patients' perceptions and preferences regarding bad news in the health setting. Methods: Cross-sectional, multi-centered study supported by an external grant in 15 Government and Private Hospitals across Pakistan. A sample size of 1673 patients and family members was used. Ethics permission/consent was taken from each participating hospital and participant. Responses were compared across provinces, gender, age, education and income. Results: >80% patients preferred their relatives to know the diagnosis first and they wanted the news to be disclosed to them by doctors. Significant association between education level, income and preference for wanting to know the diagnosis was found. Reasons for wanting to know the diagnosis included treatment, prognosis and prevention options whereas reasons for not wanting to know included fear of emotions and God's will. Conclusion: The majority of Pakistani patients want to be informed and want the family to know first. Preferences for disclosure vary across, age, education and income level. Innovation: First countrywide study on this topic. Identifies need for culturally sensitive guidelines that include the family's role in disclosure of bad news.
Introduction: Surgical site infections (SSIs) are among the the most common postoperative complications, despite being highly preventable. Multiple studies have explored the incidence and risk factors of SSIs globally. However, nationally representative data capable of informing evidence-based guidelines remain limited in Pakistan. Hence, the aim of this study is to identify the incidence and risk factors of developing SSIs following surgery and to explore existing SSI prevention practices in Pakistan. Methods and analysis: This study is a multicentre, prospective cohort study across various sites in Pakistan. All consecutive adult patients undergoing inpatient elective surgery in a 1 month patient recruitment window from one or more of the nine eligible subspecialties will be included in the study. Patients with preoperative infections, emergency surgeries or intraoperative mortality are to be excluded. The following surgical subspecialties are included: breast surgery, cardiac surgery, colorectal surgery, cranial surgery, general surgery, obstetrics and gynaecology, orthopaedics surgery, spine surgery and vascular surgery. Each mini-team of up to three collaborators can select one of the nine subspecialties and a 1 month patient recruitment window from 20 September 2022 to 31 March 2023. Multiple mini-teams from the same sites can recruit patients across the same subspecialty in distinct patient recruitment windows. Additionally, multiple mini-teams from the same sites can recruit patients across different subspecialties in the same or distinct patient recruitment windows. The primary outcome is 30 day SSIs. Secondary outcomes include 30 day antibiotic-resistant SSIs, organ-space infections, other healthcare associated infections, reinterventions and all-cause mortality. Ethics and dissemination: Approval was received by the Aga Khan University (AKU) Ethics Review Committee (ERC) and the National Bioethics Committee (NBC) Pakistan. The results from this study will be disseminated by the steering committee in journal publications, conference presentations and on other academic platforms. Evidence-based guidelines that result from these data will be disseminated to all surgical care providers in Pakistan through national networks. Keywords: epidemiology; infection control; surgery.
Pulmonary artery sling is a rare congenital vascular anomaly in which the left pulmonary artery arises from the posterior aspect of right pulmonary artery and courses to the left behind the tracheal bifurcation and in front of the esophagus to reach the left lung hilum and forms a sling around the trachea. We are reporting a case of a two-month-old infant with biliary atresia referred for screening echocardiogram before surgical procedure. The patient had no history of respiratory distress or dysphagia. Echocardiography revealed aberrant left pulmonary artery arising from the right pulmonary artery with no pulmonary stenosis probably pulmonary artery sling. Diagnosis was confirmed on cardiac computed tomography angiography. On minor class of risk stratification patient was allowed to proceed for surgical procedure for biliary atresia as standard risk of anesthesia.
Introduction: Muco-epidermoid carcinomas are primarily the subtypes of salivary gland tumors that can rarely originate within the respiratory tract. Our case highlights the occurrence of an unusual, localized, endo-bronchial muco-epidermoid cancer. We aim to strengthen the evidence of occurrence of this distinct variety of lung cancer in our country as little is known about this rare subclass of lung cancer. Case presentation: We report a case of a 22-year-old female patient, belonging to Karachi, Pakistan, who presented with respiratory symptoms and upon work-up, was diagnosed with a low-grade, localized muco-epidermoid carcinoma of the lung. She underwent surgical resection successfully and was advised to get evaluated for adjuvant radiotherapy. Clinical discussion: Localized low-grade MEC respond well to surgical resection in contrast to high-grade MEC which is associated with poor prognosis thus requiring adjuvant radiotherapy to improve survival outcomes. Conclusion: Lung cancers can be unusually of muco-epidermoid origin. It has been uncommonly found in the world including Pakistan. Special attention with validated data is therefore needed, for developing guidelines for the optimal management of such neoplasms.
The current research paper aimed to investigate the current research practices in Higher Education Institutions (HEIs) in Khyber PakhtunKhwa (KP). The study was Mixed Methods Research (MMR) and thereby convergent Parallel design was used. A sample 254 participants were taken out of 695 individuals through Yamane’s (Yamane, 1967) formula. A self-developed questionnaire, checklist and semi-structure interview were developed. Analysis of variance (ANOVA) was used as inferential statistics to analysis the quantitative data while thematic analysis was used to analyze the qualitative data. The result of study indicates that collaborative research environment in the HEIs. HEC approved supervisors available in the institutions. Thesis evaluation process found transparent but lengthy. The study found that paper publication is one of the difficult tasks for the teachers and students.
Background Gender disparities in various fields, including medicine, are a well-known issue, and the field of gastroenterology is no exception. In Pakistan, there is a lack of representation of women in gastroenterology societies, which can contribute to this disparity. Therefore, this study aimed to evaluate the representation of women in the Pakistan Society of Gastroenterology and Hepatology (PSG), the Pakistan Society for the Study of Liver Diseases (PSSLD), and the Pakistan Society of Hepatology (PSH) from 2018 to 2022. Methods To conduct the study, the annual scientific program brochures of the societies were reviewed from 2018-2022, and the PSG conference 2023 was also included. And the gender of plenary speakers, panelists, moderators, and session speakers was assessed using Google search. The total representation of each group was calculated for each year. Results The results showed that the proportion of female moderators, chairpersons, and speakers was low in PSSLD (IDDF2023-ABS-0043 Figure 6. PSSLD results) in the past 5 years. However, there was an improvement in the total proportion of female representation in 2022, while it decreased in PSH (IDDF2023-ABS-0043 Figure 5. PSH results). The percentage of female speakers varied from year to year, with a similar range in both conferences (IDDF2023-ABS-0043 Figure 1. Overall female representation, IDDF2023-ABS-0043 Figure 2. PSG conference female representation, IDDF2023-ABS-0043 Figure 3. PSG results). At the PSG conference (IDDF2023-ABS-0043 Figure 4. Conference female representation), the lowest representation of women was observed in 2019 and 2020, with no female moderators and low numbers of female chairpersons and speakers. However, there was an increase in female representation in 2023, with 32% of the moderators, 6% of the chairpersons, and 12% of the speakers being female. Conclusions The findings of this study highlight the gender disparity in gastroenterology societies in Pakistan and underscore the need for greater inclusivity of women in these societies. Encouraging greater representation of women can support career development, promotion, mentorship, and role modeling for the next generation of gastroenterologists. Moreover, it can foster a diverse and inclusive environment that can lead to better patient outcomes, research, and clinical practice. Therefore, it is essential to address this issue and work towards achieving greater gender equality in gastroenterology societies in Pakistan. • Download figure • Open in new tab • Download powerpoint Abstract IDDF2023-ABS-0043 Figure 1 Overall female representation • Download figure • Open in new tab • Download powerpoint Abstract IDDF2023-ABS-0043 Figure 2 PSG conference female representation • Download figure • Open in new tab • Download powerpoint Abstract IDDF2023-ABS-0043 Figure 3 PSG results • Download figure • Open in new tab • Download powerpoint Abstract IDDF2023-ABS-0043 Figure 4 Conference female representation • Download figure • Open in new tab • Download powerpoint Abstract IDDF2023-ABS-0043 Figure 5 PSH results • Download figure • Open in new tab • Download powerpoint Abstract IDDF2023-ABS-0043 Figure 6 PSSLD results
Introduction: Systematic collection and analysis of surgical outcomes data is a cornerstone of surgical quality improvement. Unfortunately, there remains a dearth of surgical outcomes data from low- and middle-income countries (LMICs). To improve surgical outcomes in LMICs, it is essential to have the ability to collect, analyze, and report risk-adjusted postoperative morbidity and mortality data. This study aimed to review the barriers and challenges to developing perioperative registries in LMIC settings. Methods: We conducted a scoping review of all published literature on barriers to conducting surgical outcomes research in LMICs using PubMed, Embase, Scopus, and GoogleScholar. Keywords included 'surgery', 'outcomes research', 'registries', 'barriers', and synonymous Medical Subject Headings derivatives. Articles found were subsequently reference-mined. All relevant original research and reviews published between 2000 and 2021 were included. The performance of routine information system management framework was used to organize identified barriers into technical, organizational, or behavioral factors. Results: Twelve articles were identified in our search. Ten articles focused specifically on the creation, success, and obstacles faced during the implementation of trauma registries. Technical factors reported by 50% of the articles included limited access to a digital platform for data entry, lack of standardization of forms, and complexity of said forms. 91.7% articles mentioned organizational factors, including the availability of resources, financial constraints, human resources, and lack of consistent electricity. Behavioral factors highlighted by 66.6% of the studies included lack of team commitment, job constraints, and clinical burden, which contributed to poor compliance and dwindling data collection over time. Conclusions: There is a paucity of published literature on barriers to developing and maintaining perioperative registries in LMICs. There is an immediate need to study and understand barriers and facilitators to the continuous collection of surgical outcomes in LMICs.
Implementation of Competency based medical education (CBME) requires an organized and structured set of interrelated competencies known as a competency framework. Integration of competencies across residency educational programmes and meaningful competency-based clinical supervision is found to be lacking. Study conducted at Aga Khan University tested a five-dimensional model which can be used for competency based clinical supervision in health professionals at postgraduate medical education level. It investigated various factors, including faculty development through clinical supervisor self-assessment of competencies and resident evaluation to propose a Competency/Outcome-based Model of Clinical Supervision along with its working model.
Gamma-aminobutyric acid (GABA) is a non-protein amino acid known for its role in the nervous system of animals. However, research has also revealed its presence and function in plants recently. In plants, GABA is a signal molecule involved in multiple physiological processes, including stress response, growth, and development. This review aims to present a thorough summary of the current knowledge regarding the role of GABA in plants. We begin by discussing the biosynthesis and transport of GABA in plants, followed by a detailed examination of its signaling mechanisms. Additionally, we explore GABA's potential roles in various plant physiological processes, such as abiotic stress response, and its potential application in horticultural plants. Finally, we highlight current challenges and future directions for research in this area. Overall, this review offers a comprehensive understanding of the significance of GABA in plants and its potential implications for plant physiology and crop improvement.
Purpose of Review South Asia has around 1/6th of the current global population. Epidemiological studies suggest that South Asians living in South Asia and diaspora are at an increased risk of premature atherosclerotic cardiovascular diseases (ASCVDs). This is due to an interplay of genetic, acquired, and environmental risk factors. Due to its increasing share of the global population, clinicians need to know the reasons for this early predisposition, and strategies for early identification and mitigation. Recent Findings South Asians have earlier onset of cardiometabolic risk factors such as insulin resistance, hypertension, and central adiposity. This increased risk is seen in both native South Asians and the diaspora. Summary South Asians have earlier onset of ASCVD due to an earlier onset of cardiometabolic risk factors. Health promotion and early identification of these risk factors are essential to mitigate this ongoing crisis.
Objective: To examine prevalence of novel newborn types among 541 285 live births in 23 countries from 2000 to 2021. Design: Descriptive multi-country secondary data analysis. Setting: Subnational, population-based birth cohort studies (n = 45) in 23 low- and middle-income countries (LMICs) spanning 2000-2021. Population: Liveborn infants. Methods: Subnational, population-based studies with high-quality birth outcome data from LMICs were invited to join the Vulnerable Newborn Measurement Collaboration. We defined distinct newborn types using gestational age (preterm [PT], term [T]), birthweight for gestational age using INTERGROWTH-21st standards (small for gestational age [SGA], appropriate for gestational age [AGA] or large for gestational age [LGA]), and birthweight (low birthweight, LBW [<2500 g], nonLBW) as ten types (using all three outcomes), six types (by excluding the birthweight categorisation), and four types (by collapsing the AGA and LGA categories). We defined small types as those with at least one classification of LBW, PT or SGA. We presented study characteristics, participant characteristics, data missingness, and prevalence of newborn types by region and study. Results: Among 541 285 live births, 476 939 (88.1%) had non-missing and plausible values for gestational age, birthweight and sex required to construct the newborn types. The median prevalences of ten types across studies were T+AGA+nonLBW (58.0%), T+LGA+nonLBW (3.3%), T+AGA+LBW (0.5%), T+SGA+nonLBW (14.2%), T+SGA+LBW (7.1%), PT+LGA+nonLBW (1.6%), PT+LGA+LBW (0.2%), PT+AGA+nonLBW (3.7%), PT+AGA+LBW (3.6%) and PT+SGA+LBW (1.0%). The median prevalence of small types (six types, 37.6%) varied across studies and within regions and was higher in Southern Asia (52.4%) than in Sub-Saharan Africa (34.9%). Conclusions: Further investigation is needed to describe the mortality risks associated with newborn types and understand the implications of this framework for local targeting of interventions to prevent adverse pregnancy outcomes in LMICs.
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