Arjumand Rizvi

• MPhil Statistics
• Researcher at Aga Khan University Nairobi

Background Small vulnerable newborn types, defined by combinations of being born too soon or too small, have distinct determinants and health consequences. We aimed to assess the effects of prenatal multiple micronutrient supplementation (MMS) and small-quantity lipid-based nutrient supplementation (SQ-LNS) on small vulnerable newborn types, which...

Background The effects of multiple early adverse psychosocial and biological factors on child development at preschool age in deprived settings are not fully understood. Methods The ‘Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development’ (MAL-ED) project followed childr...

Background Infectious diseases remain the leading cause of death among children younger than 5 years due to disparities in access and acceptance of essential interventions. The Community Mobilisation and Community Incentivisation (CoMIC) trial was designed to evaluate a customised community mobilisation and incentivisation strategy for improving co...

Maternal undernutrition predicts poor birth outcomes. We performed a community-based, open-label, assessor-blinded, randomized controlled trial in Pakistan. Pregnant women (PW) with ultrasound-confirmed gestational age (GA) 8–18·9 weeks, were assigned (1:1:1:1) to one of four groups: control, BEP alone (10·5 g protein, 400 kcal per sachet, two sach...

Approximately five billion people do not have access to necessary surgical treatment globally and up to 85% of children in LMICs are affected with conditions requiring surgical care by the age of 15 years. It is crucial to identify common surgical conditions in children in Pakistan to inform healthcare professionals and policymakers for effective r...

Introduction Undernutrition during pregnancy is linked to adverse pregnancy and birth outcomes and has downstream effects on the growth and development of children. The gut microbiome has a profound influence on the nutritional status of the host. This phenomenon is understudied in settings with a high prevalence of undernutrition, and further inve...

Background Exclusive breastfeeding (EBF) is recommended for the first six months of an infant’s life, but barriers to EBF persist due to socio-cultural, economic and health-related factors. Promoting optimal feeding practices, particularly EBF, in resource-constrained settings is essential for child growth and development. This study examines the a...

Background Zinc deficiency poses significant health risks, particularly in low-income settings. This study aims to evaluate the impact of agronomically zinc biofortified (fermented and non-fermented) and post-harvest wheat flour flatbread on zinc status and metabolic health in adolescents and adult women in rural Pakistan. Methods A four-arm tripl...

Background Maternal undernutrition is a direct risk factor for infant growth faltering. Objectives We evaluated the effect of postnatal balanced energy protein (BEP) supplementation in lactating women and azithromycin (AZ) in infants on infant growth outcomes. Methods A randomized controlled superiority trial of lactating mother–newborn dyads was...

Background Globally, 36.5% of pregnancies are affected by anemia, particularly in low-and middle-income countries, posing significant risks to maternal and perinatal health. In rural Pakistan, 44.3% of pregnant women suffer from iron deficiency, contributing to the high prevalence of anemia. Limited accessibility to antenatal care exacerbates the c...

Approximately five billion people do not have access to necessary surgical treatment globally and up to 85% of children in LMICs are affected with conditions requiring surgical care by the age of 15 years. It is crucial to identify common surgical conditions in children in Pakistan to inform healthcare professionals and policymakers for effective r...

Environmental enteric dysfunction (EED) is a subclinical syndrome of altered small intestinal function postulated to be an important contributor to childhood undernutrition. The role of small intestinal bacterial communities in the pathophysiology of EED is poorly defined due to a paucity of studies where there has been a direct collection of small...

Importance In resource-constrained settings where the neonatal mortality rate (NMR) is high due to preventable causes and health systems are underused, community-based interventions can increase newborn survival by improving health care practices. Objectives To develop and evaluate the effectiveness of a community-based maternal and newborn care s...

Background: Nutritional status critically contributes to maternal and child morbidities and mortality. Undernutrition during pregnancy and preconception is linked to adverse pregnancy and birth outcomes and has downstream effects on the growth and development of children. The gut microbiome has a profound influence on the nutritional status of the...

A.; Mirani, M.; Rahman, A.R.; Khan, Z.A.; Rizvi, A.; Ahmed, I.; et al. The Last Mile-Community Engagement Abstract: Poliomyelitis is a condition of great concern and is endemic in only two countries of the world: Pakistan and Afghanistan. Community mobilization plays a vital role in raising awareness and can help reduce polio vaccine refusals. The...

Introduction: Child stunting remains a public health concern. It is characterized as poor cognitive and physical development in children due to inadequate nutrition during the first 1000 days of life. Across south Asia, Pakistan has the second-highest prevalence of stunting. This study assessed the most recent nationally representative data, the N...

Background: Adopted in 2015, the sustainable development goals (SDGs) have set specific targets (SDG 3.2) for countries to reduce their neonatal mortality rate (NMR) to below 12 deaths per 1000 live births and under 5 mortality rate (U5MR) to below 25 deaths per 1000 live births by 2030. For Pakistan to achieve these targets, there is a need to me...

Introduction: Anemia remains a global public health problem, especially in developing countries. It affects primarily children under five (CU5), women of reproductive age (WRA), and pregnant women due to their higher need for iron. The most common form of anemia is iron-deficiency anemia (IDA). IDA is estimated to cause half of all anemia cases an...

Introduction: Child stunting remains a public health concern. It is characterized as poor cognitive and physical development in children due to inadequate nutrition during the first 1,000 days of life. Across South Asia, Pakistan has the second-highest prevalence of stunting. This study has assessed the most recent nationally representative data, t...

Objective We examined associations between fat free mass (FFM) and fat mass (FM) accretion during the first 1000 days of life and neurodevelopment in term-born, low-risk infants from Karachi, Pakistan. Design Prospective, observational study nested within the larger Multi-Center Body Composition Reference Study. FFM, FM, and fat% were estimated us...

Aim This study assesses the impact of a community-based intervention package delivered through community lady health workers (LHWs) to improve early postpartum and newborn care practices. Methods A cluster randomized controlled trial was carried out in Sukkur, Sindh Province, Pakistan. We conducted a baseline survey and delivered an enhanced postp...

BACKGROUND Audit and review systems especially with community engagement are key elements in achieving improved health system performance, maternal and perinatal health outcomes. This protocol describes an implementation approach guiding scale-up and presents a proposed mixed-methods evaluation plan. T OBJECTIVE To develop a locally relevant and r...

Background Maternal and newborn mortality in Pakistan remains as a major public health challenge. Pakistan faces significant infrastructure challenges and inadequate access to quality health care, exacerbated by sociocultural factors. Facility-based audit systems coupled with community engagement are key elements in achieving improved health system...

Background: Diarrhoea and acute respiratory infections (ARI) are assumed to be major drivers of growth and likely contribute to environmental enteric dysfunction (EED), which is a precursor to childhood malnutrition. In the present study, we checked the correlation between diarrhoeal/ARI burden and EED using a novel duodenal histological index. M...

Background: We aimed to describe the outcomes of neonates born at or near term to women undergoing elective C-section without prophylactic corticosteroids. Methods: Single-centre retrospective observational study of neonates born between 36+0 and 42+0 weeks. Associations between neonatal complications and maternal and neonatal factors were evaluate...

The COVID-19 pandemic has disproportionately affected vulnerable populations. With its intensity expected to be cyclical over the foreseeable future, and much of the impact estimates still modeled, it is imperative that we accurately assess the impact to date, to help with the process of targeted rebuilding of services. We collected data from admin...

Despite the decline in under-five mortality by over 60% in the last three decades, majority of child mortality is still attributable to communicable and infectious diseases that are not only preventable, but they are also treatable. We evaluated the potential impact of a participatory community engagement and innovative community incentivization (C...

The profile of the intestinal microbiota is known to be altered in malnourished young children in low- and middle-income countries. However, there are limited studies longitudinally evaluating the intestinal microbiota in malnourished young children in resource-limited settings over the first two years of life. In this longitudinal pilot study, we...

Background Socio-economic, nutritional, and infectious factors have been associated with impaired infant growth, but how the presence of these factors during infancy affects growth around 5 years is not well understood. Methods This secondary analysis of the MAL-ED cohort included 277 children from Pakistan for whom socio-demographic, breastfeedin...

Surgical conditions are responsible for up to 15% of total Disability-Adjusted Life Years (DALY) lost globally. Approximately 4.8 billion people have no access to surgical care and this studies aim is to assess the surgical disease burden in children under the age of five years. We used Surgeons OverSeas Assessment of Surgical Need (SOSAS) and Pedi...

Background: Pneumonia is the leading cause of mortality in under-five children and most of these deaths occur in South-East Asia and Africa. Fast breathing pneumonia if not treated can progress to lower chest indrawing pneumonia. Treatment recommendation by the World Health Organization (WHO) for fast-breathing pneumonia includes oral amoxicillin...

Background Artificial Intelligence (AI) holds considerable promise for diagnostics in the field of gastroenterology. This systematic review and meta-analysis aims to assess the diagnostic accuracy of AI models compared with the gold standard of experts and histopathology for the diagnosis of various gastrointestinal (GI) luminal pathologies includi...

Background There is limited evidence between contraceptive use, availability of commodities and distance to the facility in developing countries. Distance to the facility is an essential determinant of contraceptive use. Still, women may not seek family planning services from the nearest facility and may be prepared to travel the farthest distance...

statement What is already known about this topic? Infertility has an unequal impact on women and men. Women tend to have marital distress and more negative psychological impact than men. Infertility is ignominy for families of the infertile couple. Constant pressure from families to conceive increases psychological distress in the infertile couple....

Background: In low- and middle-income countries (LMICs), women often use inappropriate materials to manage menstruation, which can threaten their health. Improper practices can also have critical downstream consequences beyond physiologic health, including restricting adolescent girls' access to academic pursuits. Methods: We used cross-sectiona...

(1) Background: To date, there are limited data in low- and middle-income countries (LMICs) that collect, monitor, and evaluate food environments in standardized ways. The development of a pilot survey tool, tailored to LMICs and focused on retail food environments, is necessary for improving public health nutrition. (2) Methods: A novel survey too...

Background Childhood stunting can start in the womb and continue for two years. Therefore, the first 1000 days of life between a woman's pregnancy and her child's 2nd birthday offer a unique window of opportunity to build healthier and more prosperous futures. Therefore, we aimed to assess the effectiveness of nutritional supplementation during the...

Background Surgical conditions are responsible for up to 15% of total DALY lost globally. Worldwide estimates have found that approximately 4.8 billion people have no access to surgical care. Within South Asia, greater than 95% of the population does not have access to care for conditions that require surgical management. Considering that greater t...

Background: Breast cancer is the most common malignancy in women, affecting over 1.5 million women every year, which accounts for the highest number of cancer-related deaths in women globally. Hereditary breast cancer (HBC), an important subset of breast cancer, accounts for 5-10% of total cases. However, in Low Middle-Income Countries (LMICs), th...

Background: Diarrhoea is a leading cause of preventable childhood morbidity and mortality worldwide. Unfortunately, Pakistan has the third-highest burden of diarrhoea-related deaths in children <5 y of age. Therefore we aimed to evaluate factors associated with diarrhoea among Pakistani children. Methods: A retrospective 1:2 matched case-control...

Immunization Coverage Survey 2020 in Super High Risk Union Councils of Pakistan

Background The underperformance of oral vaccines in children of low- and middle-income countries is partly attributable to underlying environmental enteric dysfunction (EED). Methodology We conducted a longitudinal, community-based study to evaluate the association of oral rotavirus vaccine (Rotarix®) seroconversion with growth anthropometrics, EE...

Background: COVID-19 is an infectious disease, categorized as a global pandemic. Daily implications and coping strategies of pregnant women with coronavirus outbreak is currently unknown. This study will assess their knowledge, attitude, and practices (KAP), risk perceptions, anxiety and concerns related to COVID-19.Methods: A hospital-based cross-...

Immunization programs are considered as key to avert vaccine preventable diseases in a country. The Expanded Program on Immunization (EPI) was launched in 1994 in Pakistan, since then it has been delivering extensively to reduce the burden of vaccine preventable disease in the country. To augment further Pakistan started its National Immunization S...

Background: Acute respiratory infection (ARI) accounts for nearly 15% of all childhood mortality in South Asia, with children from rural areas at higher risk due to inaccessibility to healthcare facilities. We therefore aimed to identify risk factors associated with ARI in children under 2 years of age in rural Pakistan. Methods: A retrospective 1:...

The Study of Environmental Enteropathy (EE) and Malnutrition in Pakistan (SEEM) is a community intervention trial designed to understand the pathophysiology of EE and its associated clinical phenotypes in children less than two years of age. Undernutrition is the underlying cause of three million deaths worldwide annually, accounting for 45% of all...

Background: In Pakistan, the prevalence of stunting among children under-five years has remained above WHO critical thresholds (≥30%) over the last two decades. Objective: We hypothesized that an unconditional cash transfer (UCT) combined with lipid-based nutrient supplement (LNS) and/or social and behavior change communication (SBCC) will preve...

PurposeWe compared the impact of management of severe acute malnutrition (SAM) by lady health workers (LHWs) at a community level with the standard CMAM program provided at the health facility.MethodsA two-arm cluster randomised controlled trial was conducted in a rural district in sindh Pakistan. The primary outcome was recovery from SAM and secon...

Background Vitamin D deficiency during pregnancy is a public health problem in Pakistan and is prevalent among most women of reproductive age in the country. Vitamin D supplementation during pregnancy is suggested to prevent adverse pregnancy outcomes and vitamin D deficiency in both the mother and her newborn. Methods We conducted a double-blinde...

Objective: To examine the prevalence and predictors of family planning (FP) know-do gaps among married women of reproductive age (MWRA) in low socio-economic urban areas of Karachi, Pakistan. Design: This was a cross-sectional survey of randomly selected 7288 MWRA (16-49 years) to identify predictors of the know-do gap in FP using a logistic reg...

Background Pneumonia is a leading cause of death among children under 5 specifically in South Asia and sub-Saharan Africa. Hypoxaemia is a life-threatening complication among children under 5 with pneumonia. Hypoxaemia increases risk of mortality by 4.3 times in children with pneumonia than those without hypoxaemia. Prevalence of hypoxaemia varies...

Stunting predominantly occurs during the first 1000 days of life and continues to the age of five years. We will aim to assess the effectiveness of specialized nutritious foods (SNF)and social and behavior change communication (SBCC) strategies during the first 1000 days of life to prevent stunting among children in two rural districts of Badakhsha...

Objective Nutrition societies recommend using standardised parenteral nutrition (SPN) solutions. We designed evidence-based SPN formulations for neonates admitted to our neonatal intensive care unit (NICU) and evaluated their outcomes. Design This was a quality improvement initiative. Data were collected retrospectively before and after the interv...

The Study of Environmental Enteropathy (EE) and Malnutrition in Pakistan (SEEM) is a community intervention trial designed to understand the pathophysiology of EE and its associated clinical phenotypes in children less than two years of age. Undernutrition is the underlying cause of three million deaths annually, accounting for 45% of all deaths am...

Introduction: Birth spacing is a critical pathway to improving reproductive health. WHO recommends a minimum of 33-month interval between two consecutive births to reduce maternal, perinatal, infant morbidity and mortality. Our study evaluated factors associated with short birth intervals (SBIs) of less than 33 months between two consecutive birth...

Objective: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused devastation in over 200 countries. Italy, Spain, and the United States (US) were most severely affected by the first wave of the pandemic. The reasons why some countries were more strongly affected than others remain unknown. We identified the most-affected and less...

Objectives To evaluate the usefulness of transcutaneous bilirubin (TcBR) nomogram in high-risk neonates and to identify the validity of TcBR and total serum bilirubin (TsBR) in both low and high-risk neonates to guide management in under-resourced settings. Methodology A cross-sectional study was conducted at the well-baby nursery of a tertiary car...

Purpose: We aimed to assess the effectiveness of wheat soya blend plus (WSBP) provided during pregnancy and lactation on weight gain during pregnancy, reduction of low birthweight (LBW), and improvement in nutritional status in infants at 6 months of age in Thatta and Sujawal districts of Sindh, Pakistan. Methods: A cluster randomized-controlled...

Objective To determine population-based estimates of COVID-19 in a densely populated urban community of Karachi, Pakistan. Methods Three cross-sectional surveys were conducted in April, June and August in low- and high-transmission neighborhoods. Participants were randomly selected to provide blood for Elecsys® immunoassay for detection of anti-SA...

Background Neonatal mortality due to preterm birth and low birthweight remains a significant challenge in Pakistan. Kangaroo mother care (KMC) is a unique, low-cost intervention proven to reduce neonatal mortality and morbidity and increase exclusive breastfeeding rates. However, KMC has not been attempted in community settings in Pakistan. We aim...

BACKGROUND Neonatal mortality due to preterm birth and low birthweight remains a significant challenge in Pakistan. Kangaroo mother care (KMC) is a unique, low-cost intervention proven to reduce neonatal mortality and morbidity and increase exclusive breastfeeding rates. However, KMC has not been attempted in community settings in Pakistan. We aim...

Objective: To evaluate the utility of a Transcutaneous Bilirubin nomogram in high risk neonates and to evaluate the validity of Transcutaneous Bilirubin and Total serum bilirubin in both low and high-risk neonates. Study Design: Cross-sectional study. Place and Duration of Study: Postnatal Ward, Aga Khan University Hospital, Karachi, from May to...

Objective: To evaluate the sensitivity of the modified Brief Form of Bruininks Oseretsky Test in identifying motor differences secondary to malnutrition and poverty. Methods: This longitudinal cohort study was conducted at Nowshero Feroze, Sindh from 2013 to 2014 and comprised data drawn from children who participated in a randomised controlled...

Background Kyrgyzstan has made considerable progress in reducing child mortality compared with other countries in the region, despite a comparatively low economic standing. However, maternal mortality is still high. Given the availability of an established birth registration system, we aimed to comprehensively assess the trends and determinants of...

Background: Exclusive breastfeeding is essential for the first 6 months of life. In Pakistan, the proportion of children under age 6 months who are exclusively breastfed is only 38 percent making it urgent to explore interventions to address the low rates. Research Aim: To investigate the influence of breastfeeding promotion package on breastfeedin...

Background In low- and middle-income countries, women often use inappropriate materials to manage menstruation, which can pose a hazard to their health. Inappropriate menstrual hygiene management (MHM) can also have important downstream consequences beyond physiologic health, including the restriction of adolescent girls’ access to academic pursuit...

Culture-independent diagnostics have revealed a larger burden of Shigella among children in low-resource settings than previously recognized. We further characterized the epidemiology of Shigella in the first two years of life in a multisite birth cohort. We tested 41,405 diarrheal and monthly non-diarrheal stools from 1,715 children for Shigella b...

Introduction: Birth spacing is a critical pathway to improving reproductive health. The World Health Organization recommends a minimum of 33-month interval between two consecutive births to reduce maternal, perinatal, and infant morbidity and mortality. Our study evaluated factors associated with short birth intervals (SBIs) of less than 33 months...

Background Chronic childhood malnutrition, or stunting, remains a persistent barrier to achieve optimal cognitive development, child growth and ability to reach full potential. Almost half of children under-five years of age are stunted in the province of Sindh, Pakistan. Objective The primary objective of this study was to test the hypothesis tha...

Serial household antibody sero-surveys informs the pandemic where testing is non-uniform. Young populations with intergenerational co-residence may have different transmission dynamics. We conducted two serial cross-sectional surveys in April and June 2020 in low- and high-transmission neighborhoods of Karachi, Pakistan, using random sampling. Symp...

(1) Background: Little is known on impacts of ready-to-use therapeutic food (RUTF) treatment on lipid metabolism in children with severe acute malnutrition (SAM). (2) Methods: We analyzed glycerophospholipid fatty acids (FA) and polar lipids in plasma of 41 Pakistani children with SAM before and after 3 months of RUTF treatment using gas chromatogr...

Vitamin D deficiency during pregnancy is a public health problem in Pakistan, and prevalent among most women of reproductive age in the country. Vitamin D supplementation during pregnancy is suggested to prevent adverse pregnancy outcomes and prevent vitamin D deficiency in both the mother and her newborn. However, there remains uncertainty surroun...

The Aga Khan University (AKU) conducted a five-arm cluster randomized controlled trial to examine the effectiveness and cost-effectiveness of specialized nutritious foods (SNF), unconditional cash transfers delivered to the regular Benazir Income Support Programme (BISP) beneficiaries and social and behavioral change communication (SBCC) to prevent...

BACKGROUND World Health Organization (WHO) recommends oral amoxicillin in fast breathing pneumonia while recent trial evidence indicates that non-treatment might be non-inferior. METHODS A double blind randomized parallel placebo-controlled non-inferiority trial was conducted in slums of Karachi, Pakistan. Children 2-59 months at primary health ca...

Objectives Amphotericin-B (d-AmB) has a broader anti-fungal spectrum and is used for neonatal invasive-fungal-infections especially invasive candidiasis (IC). Nephrotoxicity is a known adverse effect of d-AmB therapy. The renal protective effect of fluid and electrolyte management has been established among d-AmB treated adults; in this study, the...

Introduction: Since decades, the health system of Afghanistan has been in disarray due to ongoing conflict. We aimed to explore the direct effects of conflict on provision of reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH&N) services and describe the contextual factors influencing these services. Method: We co...

Introduction: In conflict affected countries, healthcare delivery remains a huge concern. Pakistan is one country engulfed with conflict spanning various areas and time spans. We aimed to explore the effect of conflict on provision of reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH&N) services and describe the co...

Aim: To assess factors associated with the timing of puberty onset (Tanner Stage Breast 2/Genitals 2) among adolescents living in an urban slum in Karachi, Pakistan. Methods: Girls enrolled at 8-10 years (n = 1009) and boys 9-11 years (n = 863) were followed every six months from 2006 to 2010. Parametric survival analysis for interval censored d...

Objective Central line associated bloodstream infection (CLABSI) is an important cause of morbidity and mortality in the neonatal intensive care unit (NICU). We designed a CLABSI Prevention Package (CPP) to decrease NICU CLABSI rates, using evidence-proven interventions. Design This was a quality improvement (QI) project. Data collection was divid...