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Karachi, Pakistan

Site Institution: Aga Khan University
U.S. Institution: Yale University
Research Areas: Vaccine Trials, Pediatric Diseases

Site Description:
The Aga Khan University is a private, non-profit international university established in 1980. The flagship campus is in Karachi, Pakistan, with other institutes and programs in East Africa, London, and Afghanistan. AKU is a teaching hospital that provides a broad range of secondary and tertiary care to patients in the 500-bed facility. Clinical diagnostics laboratories are certified by the Joint Commission for International Accreditation and the College of American Pathologists. The clinical laboratories within the campus are located near the hospital space, where research subjects are seen in outpatient clinics, emergency rooms or inpatient units, to facilitate easy transport of samples. Clinical laboratories provide quality service to patients and doctors all over the country. The clinical laboratories have several regional stat labs, and over 250 network of collection points all over the country.

The Department of Pediatrics and Child Health of The Aga Khan University, Karachi established a Health and Demographic Surveillance System (HDSS) in 4 low-income areas (Rehri Goth, Ibrahim Hyderi, Bhains Colony, Ali Akbar Shah) and has been running Primary Healthcare Centers (staffed with physicians, lady health visitors, & community health workers) for several years. Surveillance is conducted on married women of reproductive age. Currently, information is updated every two months by CHWs. AKU have a history of successful collaboration with these communities. Moreover, in preparation for the RSV Mortality surveillance study, we have engaged with the community and conducted in-depth interviews with religious leaders, those in charge of burial, caregivers and elders in the family to establish methods to recruit parents of deceased infants with minimal discomfort. We have established relationships with the community leaders and religious leaders in the target population to facilitate the process of obtaining information regarding infant death. We have a formal partnership established with the community at the Union Council level of government. This partnership includes a signed Memorandum of Understanding (MOU) which established community designated primary health care (PHC) units from which our in-country partner (AKU) provides free healthcare services for children under 5 years of age. The MOU also established a community advisory board that is responsible for the hiring of Community Health Workers (CHW) and other AKU staff from within the community as well as being responsible for other community level logistics.

Other features of this site include:

  • AKU have established a PHC unit at each of the study sites, which provide treatment, medicines and health services for children under five years of age for free. In addition, almost all the community health workers (females with at least a middle school education level) are trained and hired from within the catchment area of the study sites. As part of community outreach services, household surveillance is conducted. The pregnant women surveillance system provides multivitamins and supplements to the pregnant women and the newborn surveillance team conducts well baby visits. Routine immunization administration and health education services are provided at all HCUs and dedicated community outreach locations. Our focus (among other studies) has been conducting mortality studies (community-based) from deceased infants under 6 months of age, from whom nasopharyngeal swabs and lung/thorax MITS have been collected.

Recent projects include:

  • COVID-19, Burial Site Surveillance to Measure Excess Mortality- Pakistan: This is an ongoing research project in which Dr. Abdul Momin Kazi and his team is exploring and analyzing the mortality surveillance data for examining disease outcomes based on age, gender and cause of death classification. This study will describe trends in mortality data in the most populated city of an LMIC (Karachi, Pakistan), obtained from all major graveyards of the city.
  • Supplement Study: Estimating COVID-19 prevalence among the deceased in Karachi, Pakistan: prospective post-mortem surveillance study (Dry Nasal Swab Study): In this proposed study, we are estimating COVID-19 prevalence among the deceased in an urban slum population in Karachi, Pakistan. Further we are also evaluating the performance and stability of polyester nasal swabs stored in dry collection tubes as an alternative specimen collection option for molecular testing of SARS-CoV-2 and other respiratory viral antigen testing.
  • Profile of social mixing patterns in Pakistan: This first multi-site study will be undertaken with the overall goal to use standardized methods to collect social contact data from urban and rural populations in Pakistan using standardized social contact diaries and using wearable proximity sensing devices. Special focus is being given to study the social interactions of infants less than six months of age. We will use standardized social contact diaries to characterize the patterns of social contacts and mixing across the age range in urban and rural LMIC settings. The results from this study will allow parameterizing models for infectious disease transmission and control in LMICs such as Pakistan.
  • Child Health and Mortality Prevention Surveillance (CHAMPS) Network Pakistan Site: The Child Health and Mortality Prevention Surveillance (CHAMPS) study will collect robust and standardized longitudinal data with the overarching objective of understanding and tracking the preventable causes of childhood death in Pakistan. The resulting data will provide evidence needed to support the goal of significantly reducing child deaths in a low constraint setting like Pakistan.