Freedom of the Press: The War on Words (1977-1978)

Journalism in Pakistan has passed through successive phases of trials and tribulations. The crises journalism had to undergo since independence had their origin both in the state policies as well as the authoritarianism embedded in the society. The book under review does not claim to divulge into the societal challenges which have emerged more visibly in the last three or four decades, especially, in the context of the spread of religious extremism and ethnic and other types of militancy in the society. Studies need to be done on these aspects as well as the external factors that have had impact on the growth and the content of media. The latter has come in the garb of globalization that has greatly affected the local environment and has come to strongly affect, if not directly dictate, what the media should encompass and present. Leaving the societal and global aspects aside, the role of the state and the successive governments has a lot to offer to be written about by way of what the media has endured in the last seventy plus years. It doesn’t need too much of pondering to conclude that the major pressures over media have come from the governments who, by and large, had been quite at unease with independent flow of information, and criticism of their policies. And, unfortunately, this process had begun right after Independence when newspapers’ and periodicals’ independent voice was tried to be silenced, and they were pressurized to toe the official line with respect to domestic and foreign policies. Pakistan’s independent journey, unfortunately, began with the imposition of black laws which prohibited dissent and curtailed freedom of expression in the strongest possible manner.

Prevalence of Vitamin D Deficiency in Exclusively Breastfed Infants at the Aga Khan University Hospital, Nairobi

Introduction: Vitamin D deficiency in infants is a recognized cause of rickets. In the last few years, evidence has emerged of its association with lower respiratory tract infections, food allergy, type 1 diabetes, schizophrenia and various other extra skeletal health effects. Exclusively breastfed infants are especially vulnerable to vitamin D deficiency due to their dependence on previous trans-placental transfer of vitamin D from the mother, dietary vitamin D from breast milk and cutaneous synthesis of vitamin D on exposure to sunlight. The worldwide epidemic of Vitamin D deficiency in pregnancy and the low content of vitamin D in breast milk underlie the high risk of deficiency in exclusively breastfed infants. Data regarding the magnitude of vitamin D deficiency among exclusively breastfed infants in Kenya is needed to inform policies on supplementation of at risk groups. Objectives: The aim of this study was to determine the prevalence of vitamin D deficiency in exclusively breastfed infants using 25(OH)D and to evaluate the relationship between PTH and 25(OH)D in a population of exclusively breast fed infants. Study Design: This was a cross sectional survey carried out in three to six month old exclusively breastfed infants at the Aga Khan University Hospital, Nairobi. Methods: Ninety-eight infants were enrolled in the study and all had data on their demographics and anthropometric measures recorded. Self-reported data on maternal vitamin D supplementation and sunlight exposure was also collected. A brief physical examination to assess for skeletal signs of rickets was then performed. A blood sample was collected for measurement of serum 25(OH)D, calcium, phosphate and PTH . Prevalence of vitamin D deficiency was analyzed using proportions with 25(OH)D levels below 20ng/ml. PTH, calcium and phosphate levels in the vitamin D deficient and non-deficient groups were compared using analysis of variance(ANOVA). The level of 25(OH)D beyond which there was no PTH elevation was identified by drawing a scatter plot of PTH against vitamin D levels. Tests of association using odds ratio were used to determine the correlation between infant serum vitamin D levels and maternal vitamin D supplementation and sunlight exposure. Skeletal manifestations of vitamin D deficiency in this population were described using bar charts. Results: Prevalence of vitamin D deficiency among exclusively breastfed infants at Aga Khan University Hospital was 23.5% (95% CI 14.9%-32.0%). A further 31.6% were found to have insufficient levels of vitamin D leaving only 44.9% of the population classified as having sufficient levels.