DEPARTMENT SOCIAL & PREVENTIVE PAEDIATRIC
Dr. Rifat Nisar Ashraf MBBS, DCH, DPH, M.Med. Sci, Ph.D Professor of Preventive Paediatrics

Brief History & Introduction

In 1964 the Prof SMK Wasti, of the Department of Paediatrics, King Edward Medical College started a community outreach health programme for the urban slums of Lahore. Dr Fehmida Jalil, the then registrar was made responsible for this programme. Mrs Saadat a public health nurse was appointed to assist Dr Jalil in this activity. The families living in Gawalmandi were registered with the department. They were visited by the doctor-nurse team for health promotion activities, and the mothers and children came to the PHC clinic established in the department for their health problems, where a family folder was maintained for each family. The data collected during this period was of such high quality, that it was used by Dr Jalil to write her MD thesis. This was the beginning of the section of Social and Preventive Paediatrics, this later became a unit and in 1984 a professorial chair was created and a department of Social and Preventive Paediatrics was established. This was the first department of Social and Preventive Paediatrics in south-east Asia. Prof Fehmida Jalil was appointed the first Professor of Social and Preventive Paediatrics, King Edward Medical College.

The Department of Social and Preventive Paediatrics established research collaborations with various international universities (especially Swedish and British), and international agencies like WHO and UNICEF. These research collaborations resulted in more than a hundred research papers and reports published in the local and international journals. The data generated for these collaborative research projects was used by the local and international research scholars for their Masters and PhD thesis. Four local researchers and
four international students were awarded Ph.Ds by Swedish and British universities and about 8 researchers received their Masters degree. It would be fair to say that this department started a new trend in paediatrics research especially community based research in Pakistan. This department also pioneered the immunization and use of ORS in diahorrea in the country in the late 70s. And later took active part in the implementation of the national EPI and ORT programmes through involvement in the trainings, monitoring and evaluations.

The current head of the department Dr. Rifat Nisar Ashraf was appointed the Professor at the retirement of Prof Jalil, in 1993. She is continuing in the tradition of Prof. Jalil. She is the provincial coordinator of the Community Oriented Medical Education Programme in King Edward Medical College (now University), and Punjab. She has contributed actively to the Baby Friendly Hospital Initiative in the country.

The functions of the Department of Social and Preventive Paediatrics are comprehensive health care service (preventive, promotive, curative and rehabilitative) to the children and families in the community, teaching and training of undergraduate and post graduate medical students, and research.

The department is currently providing services to the urban population of Gwalmandi (1000 househols), and rural populations of five villages i.e. Halloki, Sadhoki, Karole, Arazi Janjua and Inoo Bhatian (2500 household). Of these the health programmes in Gwalmandi, Sadhoki, and Halloki are run by the resources (both human and monitory) of KEMU and Mayo Hospital and the rest are supported by Human Development Foundation (an NGO run by North American Pakistani doctors) and the technical support of KEMU. The population who benefits from these outreach activities is approximately 50,000. This is a registered population; the new families are enrolled by periodic surveys.

Services: The out reach services that are provided to the population are: care of the newborn, growth monitoring, immunization, health promotion and health education, breastfeeding promotion, and promotion of complementary feeding. There are four fixed PHC clinics which provide care to the people of the villages and two mobile clinics are held by rotation alternately in the smaller villages once a week. The clinics are conducted by the doctors and LHVs, the local LHWs working in the area facilitate the work and hence strengthen the linkage between the National Health Programme and the local health system run in the public sector. The department has therefore developed partnerships between the public sectors (tertiary care and primary care), and public private partnerships (KEMU and HDF)

Sitting (L –R): Dr. Muhammad Sharif, Dr. Mjad Majeed, Prof. Rifat Nisar Ashraf, Dr. Munir Saleemi, Ms. Tayyaba Ansari
Standing(L-R):Mrs. Asia (H.W), Mrs. Fakkhra (H.W), Dr. Azhar Ayaz, Dr. Abdul Malik, Dr. Asif Mirani, yasir Hassan (Biostat), Mrs. Saleem Akhtar (LHV), Ms. Munaza (HW), Mrs Haseeb bano(LHV).

In addition to the above mentioned services the department is responsible for a six bedded ward for management ant rehabilitation of severely malnourished children. The department also provides community based rehabilitative services to the handicapped children (LEKOTEK, which means a toy library in Swedish). The toys are lent to the mothers to use for stimulating the handicapped children, after the mothers are trained in using them. The person responsible for LEKOTEK is a trained child care worker. The department is also a reference centre lactation problems. A birth spacing motivator from the Population Planning Department provides services to mothers visiting the department, and also the mothers who are accompanying their sick children admitted in the Paediatrics wards of the Mayo Hospital. Health education sessions with the mothers with children in the neonatology section and diarrhoea wards of the Paediatrics Department are also conducted thrice a week by the health educator of the department.

Teaching and Training: The teaching and training programmes include structured programmes for under graduate students in their 3rd, 4th and final year MBBS class, this also includes one week of community based learning activities for the fourth year class.
Two courses are conducted annually for the Diploma in Child Health students of Post graduate Medical Institute, Lahore and Shiekh Zayad Hospital, Lahore. In addition the department also holds classes at the request of the nursing school Mayo hospital, The School of Physiotherapy, Mayo Hospital for topics related to public Health.
A number of students from various institutions have chosen this department for their electives from time to time; these include medical students from international universities (USA, Sweden, British, Norway), Aga Khan University, College of Home Economics, Social Sciences Departments of the Punjab University and Government College University.

The faculty takes part in facilitating research methodology training workshops conducted in the University, and also informally guiding the postgraduate students in development of their research protocols and report writing. The faculty of also contributes to the child health programmes at the national and provincial levels by virtue of being on various technical advisory groups and research committees. They also contribute by arranging and facilitating their training courses e.g. for Ministry of Health, Save the Newborn Lives, National Infant Feeding Board and National Breastfeeding Steering Committee etc.

The head of the department in her role of coordinator COME has actively contributed to the development of the COME curriculum, organization of training workshops in orientation to COME, curriculum development, tutor training and problem based learning not only for the faculty of KEMU but for other medical institutions in Lahore and other provinces.

Research: A number of research projects have been undertaken by the department these research projects have resulted in publishing of more than a 100 research papers in indexed journals, scientific presentations at the national and international conferences and reports.

Staff: The department is currently headed by a professor the other two faculty positions i.e. of associate professor and assistant professor are vacant (the post of Assistant professor has been advertised and hopefully will be filled in the next few weeks). There is a registrar, and one medical officer (four posts of medical officers are vacant waiting appointments), one APMO (appointed by KEMU), two public health nurses, two child care workers (one post is vacant), two CDC supervisors, one vaccinator, three nurses (six posts need to be filled)

Physical Facilities: The department is housed in the Paediatrics Specialty Block. One and a half flour is designated for the department. One third of the building where the department is to be housed is functional; the rest will become functional within the next six months as the construction work is in progress. Currently the department has an air-conditioned class-room for about 30 students; this is equipped with a white board, an overhead projector. A smaller room which is used as a departmental library is also used for small group teaching, this is also equipped with a white board, overhead projector. A small room for a mini-meeting for about six persons is also available. A computer lab with 4 functional computers along with printers is available for researchers and staff of the department. The primary health care clinic in the hospital has a room attached for EPI activities and a room for counseling the mother. The clinic for rehabilitation of the handicapped is presently also used as a lactation clinic when required.

Annual targets, regarding functions and data regarding output during the year ending 31st December 2005

Services: Services: The services provided by the department are community based (75%) and hospital based (25%). The community based PHC clinics in the field areas were functional. The services rendered were as follows: patients seen in the clinics (6577), health education sessions in Mayo Hospital ( 96), vaccination shots given (26732), Polio days celebrated (6 rounds), severely malnourished children treated (70 ), growth monitoring (679), handicapped children seen (150), lactation management (238 mothers). The community based activity was as follows: patients in the PHC clinics (2683) households visited for child care by the teams of health care providers (12000), antenatal care (480), the number of newborns examined at birth (300 ), vaccination shots given (10000), growth monitoring (800), community promotion sessions (60).

Teaching and training: All the targets for the under graduate teaching were met. Two courses of one month each were conducted for the Diploma in Child Health students. Two workshops sponsored by the Ministry of Health and WHO for training of tutors were conducted in KEMC. A course was conducted for training of trainers for the PAIMAN project of Government of Pakistan, for saving newborn lives; this was sponsored by the Save the Children, USA. Two courses were conducted for training master trainers in lactation management with 24 participants in each course. This was sponsored by the Ministry of Health.

Faculty Members

Sr.No. Name Designation Qualification
1 Dr. Rifat Nisar Ashraf Professor MBBS, DCH, DPH, M.Med. Sci,, Ph.D
1 Dr. Munir Akhtar Saleemi APMO MBBS, DCH, FCPS, M. Med. Sci
2 Dr. Amjad Majeed Registrar MBBS
3 Dr. Azhar Ayaz MO MBBS, MPH
4 Dr. Muhammad Sharif APMO MBBS
5 Mrs. Tayyaba Ansari Health Educator M.Sc Clinical Psychology

List of teaching programmes run in the department:

1. Undergraduate medical students rotate through the department for clinical community based learning activities in the 3rd and 4th year MBBS. In the Final year MBBS there are lectures in Preventive Paediatrics.
2. MD Preventive Paediatrics
3. Post-graduate teaching: four weeks course in Preventive Paediatrics for students of Diploma in Child Health
4. Lactation Management and Counseling Course sponsored by the Ministry of Health, Nutrition Wing for district trainers

List of postgraduate candidates in the department:

• Dr Amjad Majeed MD Preventive Paediatrics
• Dr Ayaz Azhar Khan MD Preventive Paediatrics
• Dr Humaira Zareen MD Preventive Paediatrics

Teaching Programs

Postgraduate Programs

i) M.D
ii) Diploma in child Health

Undergraduate Programs

i) MBBS
ii) Nursing
iii) Physiotherapy

Research Projects

1. Promotion of child health survival through home care- integrated international for improvement in neonatal and infant health.
2. Food induced stimulation of antisecretory factor in maternal milk may prevent mastitis in lactating mothers.

Research projects of the department in 2005 and 2006

• The study “Food induced stimulation of anti-secretory factor in maternal milk may prevent mastitis in lactating mothers” was planned and implemented. More then 2/3rd of the data collection is completed.
• Evaluation of the Nutritional Counseling component of the “Integrated Management of Childhood illness” package in Lahore Pakistan (sponsored by WHO, in report writing stage).

• The effect of poverty, early life malnutrition, and infections on adult and mortality: long-term follow-up of a 1964-78 birth cohort from a slum in Lahore, Pakistan. (Sponsored by Swedish Universities, in report writing stage)

• Food induced stimulation of anti-secretory factor in maternal milk may prevent mastitis in lactating mothers (SAREC sponsored). At the completion of data collection, samples will be sent to Sweden for analysis of anti-secretory factor, statistical analysis will be done locally and report will be finalized.

• Promotion of child survival through home care - integrated interventions for improvement in neonatal and infant feeding, care, development and family response to needs in illness and health (WHO sponsored). To be implemented in April 2006.

• Health appraisal of rural school children in Lahore, Pakistan (ongoing)

Paper Published in 2005

1. Feeding patterns, diarrhoeal illness and linear growth in 0-24 old children . Saleemi MA, Zaman S, Akhter HZ, Jalil F, Ashraf RN, Hanson LA, Mellander L. Journal of Tropical Peadiatrics, 2005.
2. Cytokines in the placenta of Pakistani newborns with and without intrauterine growth retardation Sylvie Amu, Mirijana Han-Zuric, Aisha Malik, Rifat Nisar Ashraf, Shakila Zaman et al, in Paediatrics Research, 2005.

Facilities Available.

• Class room
• Computer Lab
• Meeting room
• Skills Lab.