BackgroundThere is an increasing number of urgently ill and injured children being seen in emergency departments (ED) of developing countries. The pediatric disease burden in EDs across Pakistan is generally unknown. Our main objective was to determine the spectrum of disease and injury among children seen in EDs in Pakistan through a nationwide ED-based surveillance system.MethodsThrough the Pakistan National Emergency Department Surveillance (Pak-NEDS), data were collected from November 2010 to March 2011 in seven major tertiary care centers representing all provinces of Pakistan. These included five public and two private hospitals, with a collective annual census of over one million ED encounters.ResultsOf 25,052 children registered in Pak-NEDS (10% of all patients seen): 61% were male, 13% under 5 years, while almost 65% were between 10 to < 16 years. The majority (90%) were seen in public hospital EDs. About half the patients were discharged from the EDs, 9% admitted to hospitals and only 1.3% died in the EDs. Injury (39%) was the most common presenting complaint, followed by fever/malaise (19%) and gastrointestinal symptoms (18%). Injury was more likely in males vs. females (43% vs. 33%; p < 0.001), with a peak presentation in the 5-12 year age group (45%).ConclusionsPediatric patients constitute a smaller proportion among general ED users in Pakistan. Injury is the most common presenting complaint for children seen in the ED. These data will help in resource allocation for cost effective pediatric ED service delivery systems. Prospective longer duration surveillance is needed in more representative pediatric EDs across Pakistan.

BACKGROUND: Motor vehicles crashes (MVCs) are the leading cause of injury related morbidity and mortality in developed countries. Recent evidence proves that properly used child seat belts can dramatically reduce the risk of severe and life-threatening injury from MVCs. There are rarities of thought and inspiration regarding the use of child seat belts in our society and region, therefore we lack of data regarding factors and paucity of usage of child seat belts in motor vehicles. This study aimed to assess the knowledge and attitudes of child seat belt usage among the educated population in Karachi, Pakistan. METHODS:Altogether 304 employees were investigated. They were employees of Aga Khan University who were using their cars and having children younger than 10 years old. A cross sectional observational study was designed, and a 36-item questionnaire in English was used to collect data on participants' demographic details, designation, educational level, economic status, validity of driving license, number of children and cars, availability of adult seat belts and child seat belts along with their functionality, awareness, knowledge and attitude toward its use, and reason of not using these devices. SPSS version 20 for Windows was used to analyze the data and the Chi-square test was used. RESULTS:Totally 290 participants were recruited with a response rate of 72% (212). Of 212 participants, 126 (59%) were male. 154 (72.6%) participants had valid driver licenses, and 154 (72.6%) had adult seat belts in their vehicles. Only 32 (15%) reported regular use of adult seat belts. Although 168 (79.2%) participants had some knowledge about child restrains (CRs), only 65 (22%) had CRs in their cars. Eighty-two (38.7%) participants got the knowledge about CRs and seat belts from media. Mothers were more concerned about the use of CRs than fathers. Only 14 (6.6%) parents were found to use both adult and child seat belts all the time. Of the 157 parents who did not us use CRs, 42 considered unnecessary, 35 lacked relevant knowledge. But 15 parents used CR against their children's wills. CONCLUSIONS:The pattern of CR usage among the employees at Aga Khan University, Karachi is dictated by the unavailability of CR, followed by ignorance, inconvenience, and nonacceptance by their children. The important issue of CR has consistently been ignored over the years and it has never gained enough popularity in Pakistan.

Introduction: Seizures are one of the most common presentation in children requiring urgent care in Emergency Departments. This study was conducted to determine the clinical profile, management and spectrum of patients presenting to Emergency department in a low middle income country. Methods: This was an observational cross-sectional study carried out in tertiary care hospital. Data was collected on a predesigned questionnaire from June 2018–May 2019. Qualitative variables like gender and type of seizure were expressed as percentages and frequencies. Quantitative variables like age, levels of sodium, potassium and calcium were expressed as median, interquartile ranges and Wilcoxon Rank Sum test was used. Results: The prevalence of seizures amongst children presenting to pediatric emergency room was found to be 9.36 per 1000 children. A total of 186 patients presented to pediatric emergency department with seizures. There were 58.1% boys and 41.9% females. The median age of children presented with seizure was 26 months. The most common type of seizure noticed by eye witness were grandmal 95 (51.1%), simple partial 6 (3.3%), complex 1 (0.5%). Hyponatremia was the most commonly reported abnormality 54.2%. Febrile Convulsion were reported in 46.8%, 24.7% were known epileptic, 9.1% had an infective source, 5.4% metabolic & 2.7% had afebrile seizures. Conclusion: Seizure was one of the commonest neurological condition occurring predominantly in males. Febrile seizures usually do not require hospitalization. Emergency Department care was needed in majority of children and 45.7% were discharged directly from Emergency Room. Highlights:

Background Appropriate and timely provision of pre-hospital care is critical for improving outcomes to injury and trauma. Pre-hospital providers in Pakistan as in most low and middle income countries do not receive standardised training in evidence-based acute paediatric care. Aims/Objectives/Purpose Develop an Acute Paediatrics and Injury Care (APIC) course tailored to the local context and pilot test the course in ambulance providers in Karachi, Pakistan. Methods APIC, a combination didactic and practical exercise-based course, was developed using validated international course materials and modifying them to the local context in collaboration with local paediatric and emergency providers. The course was piloted in 24 ambulance providers who were asked to complete pre and post-course knowledge assessments and a 3 month follow up knowledge retention test. Results/Outcome Upon course completion, students exhibited a statistically significant knowledge gain (57.9% in the pre-test to 73.9% in the post-test, p=<0.001). Of the 19 students completing the knowledge retention test, students exhibited statistically significant gain in knowledge in the area of airway management/respiratory distress (56% to 74%, p=0.027), and a trend towards increased knowledge in shock (42% to 68%, p=0.06), fluid administration (74% to 95%, p=0.13) and trauma resuscitation (74% to 84%, p=1.0). Significance/Contribution to the Field The APIC course provided ambulance providers in Pakistan with important knowledge gains in paediatric-specific emergency care, particularly in the area of airway management and respiratory distress. Further studies are needed for expansion to a wider audience and to assess the impact of such courses on actual outcomes of paediatric illness, injuries and trauma.

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