Measles Thesis Defense used as preliminary before defense.pptx

This is priliminary ppt about measles thesis defense.

1. Contents: . Introduction Review of the Literature Importance of research Research objectives and research question Material and methods Results Discussion Conclusion Time schedule References

2. Introduction: . Measles is a significant cause of child’s morbidity and mortality, globally. Although, the measles is a vaccine preventable disease, each year its outbreaks occur between February and April of every year, which coincides mostly with the dry and hot season ( Alirol ., et al). Globally, there were about 39.9 million cases of measles were recorded with 777,000 deaths in 2017 (WHO, 2022). Moreover, Africa and Southeast Asia has the highest number (70-84%) of cases of measles and measles-related mortality reported ( Alirol ., et al; WHO, 2022). Afghanistan, with decades of conflict and political instability, is considered a high burden country for measles. This endemic country for measles is significantly on the rise for measles cases and deaths. The most affected provinces, with the highest number of reported cases (confirmed and suspected) are Balkh, Ghazni , Helmand, Kandahar, Kabul, Paktika, and Paktya . The highest rates were observed in Paktya (617 cases per 1000000), Balkh (275 cases per 1000000), Kunduz (204 cases per 1000000) Zabul (168 cases per 1000000), Kandahar (145 cases per 1000000), Logar (127 cases per 1000000) (WHO, 2022).

3. Review of the Literature: . According to the model's estimates, there were approximately 39.9 million measles cases, 777,000 deaths, and 28 million disability-adjusted life years (DALYs) globally in 2000. Notably, 66% of the deaths occurred in eleven countries, namely Afghanistan, Burkina Faso, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Niger, Nigeria, Pakistan, Somalia, and Uganda(Stein et al., 2003). The scholarly works which provide some relevant information about measles in Afghanistan include Nik M. Zafari and others’ article titled Mortality and Morbidity of Measles from 21 March 2021 to 20 March 2022 in Mirwais Regional Hospital Pediatric Department Kandahar Afghanistan, according to the report, hospitalised children had an average measles rate of 11.1%, with 2022 showing a greater prevalence than 2021. Most instances of measles in children between the ages of 1 and 5 years old( Zafari et al., 2022). The article The Trend of Measles in Afghanistan draws attention to the ongoing danger posed by measles, a disease that is extremely infectious and curable through vaccination, especially in impoverished nations. Low vaccination rates in Afghanistan contribute to the disease's recurrent outbreaks, which continue to be a major source of sickness and death, particularly in young children(Nishat et al., 2019).

4. Global prevalence of measles: . According to the model's estimates, there were approximately 39.9 million measles cases, 777,000 deaths, and 28 million disability-adjusted life years (DALYs) globally in 2000 (Stein et al., 2003). Measles is a significant cause of child’s morbidity and mortality, globally. Although, the measles is a vaccine preventable disease, each year its outbreaks occur between February and April of every year, which coincides mostly with the dry and hot season ( Alirol ., et al) Measles mortality was considered within the broader context of global childhood mortality. The World Health Organization (WHO) life table estimations suggest that approximately 10.9 million children under 5 years old died worldwide in 2000(Stein et al., 2003).

5. Measles prevalence in Afghanistan: . The World Health Organization (WHO) has estimated that amid the humanitarian crisis in Afghanistan, weekly notifications of suspected measles cases have been increasing in all provinces since the end of July 2021, with the highest weekly toll observed in the last four weeks in January 2022. The most affected provinces, with the highest number of reported cases (confirmed and suspected) are Balkh, Ghazni , Helmand, Kandahar, Kabul, Paktika, and Paktya . The highest rates were observed in Paktya (617 cases per 1000000), Balkh (275 cases per 1000000), Kunduz (204 cases per 1000000) Zabul (168 cases per 1000000), Kandahar (145 cases per 1000000), Logar (127 cases per 1000000) (WHO, 2022). An article titled Prevalence of pneumonia associated with measles among hospitalized children in Maiwand Teaching Hospital, Kabul, Afghanistan. The study had 557 patients in total, 289 (51.9%) of whom were men and 268 (48.1%) of whom were women. According to the patient's age distribution, 17 (3.1%) were under six months old, 150 (26.7%) were between six and twelve months old, 310 (55.7%) were between thirteen and sixty months old, 68 (12.2%) were between sixty and one hundred twenty months old, and 12 (2.2%) were above one hundred twenty months. In 121 (21.7%) of the cases, some children had pneumonia. (Pour et al., 2023).

6. Conceptual framework: .

7. Importance of research: . Measles is a significant cause of child’s morbidity and mortality, globally. Globally, there were about 39.9 million cases of measles were recorded with 777,000 deaths. Measles is still prevalent in the developing countries and kills thousands of children each year. This preventable disease also leads to a substantial economic burden that further deteriorates developing countries. The actual burden of measles in a country like Afghanistan that is already hard hit by decades of conflict is high. However, this disease is almost neglected. Likewise, the country has witnessed multiple measles outbreak, especially in Eastern and Southern Afghanistan; still, there is very limited data that can estimate the burden on the country level. Hence, we planned this study with the aim of understanding the burden and risk factors for measles in a tertiary care hospital. This study will at least provide a basis for future studies.

8. Research Objectives and Research Question: . Primary objective: The primary aim of this study was to identify the Prevalence of measles in pediatric wards of Mirwais Regional Hospital. Secondary objectives: The secondary aim of this study was to determine the risk factors for measles in pediatric ward of Mirwais Regional Hospital.

9. Research Objectives and Research Question: . Research Question: 1. What is the Prevalence of measles in the pediatric wards of Mirwais Regional Hospital, Kandahar, Afghanistan? 2. What are the risk factors for measles in the pediatric wards of Mirwais Regional Hospital, Kandahar, Afghanistan?

10. Materials and Methods: . Study design: This was a hospital-based cross-sectional study.

11. Materials and Methods – cont … . Study setting: This study was conducted in Mirwais Regional Hospital, a tertiary hospital in southern Afghanistan. Besides, surgery, internal medicine, this tertiary center is considered an important facility for pediatric care. This is public hospital. In pediatric ward, common diseases include, pneumonia, malnutrition, bronchitis and measles. This regional hospital alongside the curative services provides a wide variety of preventive and rehabilitation services.

12. Study population: . This study included all children admitted with the clinical confirmed measles during Jan 2024 – July 2024 Inclusion criteria: We included cases with clinically confirmed measles that were admitted in the pediatric ward of Mirwais Regional hospital from Jan 2024 – July 2024 . Exclusion criteria: We excluded cases of outpatient or patients with incomplete data.

13. Study population: . Confirmed case: All clinically confirmed cases whose caretaker consented to take part in the study were included in the study. Sample Size & Sampling Procedures We included all measles cases admitted during 8 months in the paediatric ward of Mirwais Regional Hospital in Kandahar, Afghanistan

14. Data collection: . Data were collected by the researcher using a Pashto version of the questionnaire that were assessed including information on : Socio-demographic characteristics : Age, sex, father education, mother education, father occupation, and residence. Health related characteristics : Vaccination history, clinical features, laboratory findings, and treatment plan. The outcomes of the study was either complete recovery, complicated or the death of a child. After collection the aforementioned details in a structured form, it will be kept confidential. The principal investigators timely checked the completion of these forms.

15. Data analysis: . The collected data was entered into Microsoft Excel and later transferred into SPSS version 16. We used descriptive statistics such as frequency, mean and standard deviation for descriptive variables. Data was presented with tables and graphs. We further developed frequency tables for risk factors of measles already identified in the literature.

16. Ethical considerations: . The research and ethics committee of Kandahar University approved this study. We got permission of public health directorate and officials in Mirwais Regional Hospital. Consent was taken from all the study participants. The collected and electronic data will be kept confidential and protected in a password-controlled computer, which only the researcher will have access to.

17. Challenges and Strengths: : Challenges The most important challenge was incomplete data in cases files. Many Measles Medical documents was incomplete related Questionary such as parent's education and occupations Strengths This study was first of its kind and was conducted in a large tertiary hospital with clients from southern region of Afghanistan . It will somewhat provide an image of measles in southern Afghanistan. This study will help to develop a base for future cohort and other longitudinal studies.

18. Results The Main aim of this study was Assess and determine the risk factors for Measles and the Prevalence of measles in pediatric wards of Mirwais Regional Hospital , A total 422 admitted measles children were included in our study had in under 15 years old children in the. The data start in the below first table:

19. Gender 422 Frequency Percent % Valid Male 205 49 Female 217 51 Total 422 100 Admitting days 422 Frequency Percent % Valid 1 Day 5 1.2 10 Days 3 0.7 11 Days 10 2.4 12 Days 2 0.5 2 Days 24 5.7 3 Days 99 23.5 4 Days 125 29.6 5 Days 72 17.1 6 Days 33 7.8 7 Days 33 7.8 8 Days 12 2.8 9 Days 4 0.9 Total 422 100

20. Admission days Frequency Percentage (%) 1–7 days 8–14 days More than 14 days Total 422 100 Gender Frequency Percentage (%) Male 205 49 Female 217 51 Total 422 100

21. Oxygen saturation Valid Frequency Percent % 91%-100% 203 48 90%-81% 215 51 71%-80% 4 1 Total 422 100 Socio economic status 422 Frequency Percent % Valid Lower 111 26.3 Middle 311 73.7 Total 422 100

22. Breastfeeding   Frequency Percent % Valid Yes 421 99.8 No 1 0.2 Total 422 100

23. Vaccination status from birth dose to 18 th month   Birth 1.5months 2.5months 3.5months 9months 18months Frequency Percent % Frequency Percent % Frequency Percent % Frequency Percent % Frequency Percent % Frequency Percent % Valid Vaccinated 119 28.2 134 31.8 130 30.8 125 29.6 96 22.7 34 8.1 Not Vaccinated 303 71.8 288 68.2 292 69.2 297 70.4 326 77.3 388 91.9 Total 422 100 422 100 422 100 422 100 422 100 422 100 Vaccination status from birth to 18 months

24. Clinical manifestations at admission: Cyanosis Fever Cough Dairrhea Dyspnea Pallor Frequency Percent % Frequency Percent % Frequency Percent % Frequency Percent % Frequency Percent % Frequency Percent % Valid Yes 19 4.5 419 99.3 255 60.4 141 33.4 121 28.7 422 100 No 403 95.5 3 0.7 167 39.6 281 66.6 301 71.3 422 100 Total 422 100 422 100 422 100 422 100 422 100 422 100 Chest indrawing Drowsiness Nasal Flaring Convulsion Wheeze Crepitation Clinical manifestations at admission: Frequency Percent % Frequency Percent % Frequency Percent % Frequency Percent % Frequency Percent % Frequency Percent % Valid Yes 419 99.3 11 2.6 3 0.7 33 7.8 128 30.3 171 40.5 No 3 0.7 411 97.4 419 99.3 389 92.2 294 69.7 251 59.5 Total 422 100 422 100 422 100 422 100 422 100 422 100 Clinical_manifestations_at_admission

25. Chest XRay : Other   Frequency Percent % Valid Null 417 98.8 pneumoni 1 0.2 Pneumoni 4 0.9 Total 422 100 Co-morbidities: Pneumonia   Frequency Percent % Valid Checked 419 99.3 Null 3 0.7 Total 422 100 Co-morbidities: Pneumonia   Frequency Percent % Valid Checked 419 99.3 Null 3 0.7 Total 422 100

26. Vitamin A Used   Frequency Percent % Valid Yes 361 85.5 No 61 14.5 Total 422 100 Other Drugs Used   Frequency Percent % Valid Yes 415 98.3 No 7 1.7 Total 422 100 Antibiotics Used   Frequency Percent % Valid Yes 422 100

27. Outcome   Frequency Percent % Valid Discharged 394 93.4 Self-discharged 19 4.5 Died 9 2.1 Total 422 100

28. Address : City   Frequency Percent % Valid Living in Kandahar city 174 41.2 Living outside the city 248 58.8 Total 422 100

29. Statistics   Case_Code Address : City Address : Province N Valid 422 422 422 Missing Mode 0001 a 2 15 Range 421 1 31 Minimum 1 1 2 Maximum 422 2 33

30. Discussion

31. Conclusion

32. Time schedule: . Activities May, 2023 Jun-Jul, 2023 Aug, 2023 Aug 2023 – Jan 2024 Feb-Mar 2024 Apr 2024 Topic Selection            Final Draft of Proposal            Defense of Proposal            Data Collection            Data Entry and Data Analysis            First Draft of capstone Paper            Submission of capstone Paper            Defense of capstone Paper            Submission of capstone Paper            

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34. Thank You ?