Summary
Objective To find out the relationship between maternal anaemia and perinatal morbidity and mortality.
Method A cohort of 629 pregnant women was studied from October 2001 to October 2002. ...Of these, 313 were anaemic (haemoglobin <11 g/dl in labour and on two previous occasions in current pregnancy). A total of 316 women had haemoglobin >11 g/dl at all times in pregnancy and were labelled as non‐anaemic. Perinatal outcomes included preterm delivery, low birth weight (LBW) at delivery, intrauterine growth restriction, perinatal mortality, APGAR score at 1 and 5 min, intrauterine foetal demise (IUD).
Results The risk of preterm delivery and LBW among exposed group was 4 and 1.9 times higher among anaemic women, respectively. Newborns of anaemic mothers had 1.8 times increased risk of having an APGAR score of <5 at 1 min and the risk of IUD was 3.7 times higher for anaemic women.
Conclusion Low maternal haemoglobin levels are associated with increased risk of preterm delivery, LBW babies, APGAR score <5 at 1 min and IUD.
the purpose of this study was to explore the perceptions and experiences of perinatal women who have availed of midwifery led model of care (MLC) at secondary care settings in Karachi, Pakistan.
a ...qualitative descriptive exploratory approach using semi-structured interviews.
a purposive sample of 10 women who had used MLC was enroled from each site.
content analysis highlighted that ‘women's satisfaction with MLC’ emerged as the main theme and, under this theme, the six categories that emerged were: (1) the admired capability and maturity of midwives, (2) the affordability of midwifery services, (3) a personalised relationship, (4) the empowerment of women to make decisions, (5) presence, and (6) a voiced concern regarding lack of marketing of MLC.
the study findings revealed that women had an overall feeling of satisfaction with the maternity care provided by the midwives. Mostly, women appreciated the midwives' expertise in providing maternity care. Majority of the women acknowledged the continuous presence of the midwives during childbirth and the women shared that they were empowered to make decisions related to their care. Most of the women indicated that marketing for MLC is scarce and insufficient. Majority of the women are even not aware of this model; therefore, it is imperative to create awareness and to provide MLC access to women through robust marketing.
the findings of this study may help to advocate and provide women-friendly maternity care, by giving choice and control to women during childbirth, providing comfort to women by using fewer medical interventions, and promoting normality by attending spontaneous vaginal childbirths.
Objective
Review of obstetric cases admitted to the intensive care unit.
Design
Ten year retrospective review of individual patients' medical records.
Participants
Records of obstetric patients ...admitted from 2005–2014.
Setting
Aga Khan University Hospital Karachi
Main Outcome measures
Diagnosis at the time of admission, associated risk factors, and intervention required aspects of management and rate of mortality.
Findings
A total of 194 obstetric patients were admitted out of which 86.2% of patients had ventilator support. Mortality was not seen to be significantly associated with parity and antenatal/postnatal status. The median age of patients was 34 years, minimum length of stay was 24 hours and maximum stay was 53 days. Sixty one percent of patients were admitted to with organ system failure. The overall mortality rate was 21.64% (42/194). The mortality rate was five times more likely in patients who had gastro-intestinal complication {Odds Ratio=4.87; 95%CI: 1.65-14.36}. The largest group of patients {28.4%} presented with hematological diagnosis.
Conclusion
When the intensive care unit admission became essential, primary diagnosis included: postpartum hemorrhage, hypertensive disorders, sepsis and infectious diseases. An increased vigilance of high-risk pregnant women and a stabilization of their condition before intervention is administered, improves the outcome of these women.
An estimated 276 Pakistani women die for every 100,000 live births; with eclampsia accounting for about 10 % of these deaths. Community health workers contribute to the existing health system in ...Pakistan under the banner of the Lady Health Worker (LHW) Programme and are responsible to provide a comprehensive package of antenatal services. However, there is a need to increase focus on early identification and prompt diagnosis of pre-eclampsia in community settings, since women with mild pre-eclampsia often present without symptoms. This study aims to explore the potential for task-sharing to LHWs for the community-level management of pre-eclampsia and eclampsia in Pakistan.
A qualitative exploratory study was undertaken February-July 2012 in two districts, Hyderabad and Matiari, in the southern province of Sindh, Pakistan. Altogether 33 focus group discussions (FGDs) were conducted and the LHW curriculum and training materials were also reviewed. The data was audio-recorded, then transcribed verbatim for thematic analysis using QSR NVivo-version10.
Findings from the review of the LHW curriculum and training program describe that in the existing community delivery system, LHWs are responsible for identification of pregnant women, screening women for danger signs and referrals for antenatal care. They are the first point of contact for women in pregnancy and provide nutritional counselling along with distribution of iron and folic acid supplements. Findings from FGDs suggest that LHWs do not carry a blood pressure device or antihypertensive medications; they refer to the nearest public facility in the event of a pregnancy complication. Currently, they provide tetanus toxoid in pregnancy. The health advice provided by lady health workers is highly valued and accepted by pregnant women and their families. Many Supervisors of LHWs recognized the need for increased training regarding pre-eclampsia and eclampsia, with a focus on identifying women at high risk. The entire budget of the existing lady health worker Programme is provided by the Government of Pakistan, indicating a strong support by policy makers and the government for the tasks undertaken by these providers.
There is a potential for training and task-sharing to LHWs for providing comprehensive antenatal care; specifically for the identification and management of pre-eclampsia in Pakistan. However, the implementation needs to be combined with appropriate training, equipment availability and supervision.
ClinicalTrial.gov, NCT01911494.
To explore gender differences in food insecurity (FI) and minimum dietary diversity (MDD) among adolescent girls and boys in a slum community in Karachi, we employed an explanatory sequential mixed ...methods study that included a survey of 391 girls and boys of 10–19 years of age and followed by semi-structured interviews of eight purposely selected food insecure adolescents. Survey data was analyzed by Cox proportional algorithm and adjusted prevalence ratios (APR) with 95% confidence intervals (CI) were estimated for associated factors of FI and thematic analysis was undertaken for qualitative work. Meta inferences for mixed methods study were drawn by joint display analysis of survey results juxtaposed to qualitative findings. Overall, FI among adolescents was prevalent (46.5%) which was not different between boys (52.7%) and girls (47.3%) (APR 0.8, (95% CI 0.6, 1.2); p-value-0.4). MDD (5/10 food groups consumed) was achieved by only 23.0% and it was also not different between boys (25.1%) and girls (20.9%) (p-value-0.3). The survey found no significant difference in FI and MDD between boys and girls however, qualitative findings provided insight into the cultural practices at mealtimes that prefer boys. Qualitative results contrasted the survey results and revealed the increased vulnerability of girls towards FI and low MDD compared to boys due to gender norms.
Congenital obstructing lesions of vagina, hydrometrocolpos, and hematocolpos, present at a variable time during early childhood and adolescence to different medical and surgical specialties. ...Twenty-six cases presenting over an 18-years period (1987-2005) were divided into three groups; Group A: neonates (6), Group B: adolescents (18), and Group C: adults (2). Common presentations in neonates (Group A) were abdominal mass (5), neonatal sepsis (3), and respiratory distress (2); whereas abdominal pain (18), voiding dysfunctions (13), and backache (7) were prevalent in adolescents (Group B). Adults (Group C) presented with inability to consummate and infertility (2). Four patients received erroneous treatment; exploratory laparotomy (1) and appendectomy (3). Urinary symptoms and associated urinary abnormalities were present in more than 50% of cases, especially those with complex anomalies. Management included excision of imperforate hymen (16) and transverse vaginal septum (8) through perineal (20) and abdominoperineal approach (4). Patients with urogenital sinus (1) and cloacal malformation (1) had staged reconstruction at 2.5 years of age following preliminary vesicostomy and colostomy at birth. On follow up (range 1-15 years; mean 7) more than 60% patients have menstrual irregularity (11), endometriosis (5), and infertility (4). In conclusion, rarity and variable presentation of congenital vaginal obstructions can lead to delayed diagnosis and erroneous management. A high index of suspicion and cross-sectional imaging help in early diagnosis and associated renal anomalies. A comprehensive management is imperative to preserve the reproductive potentials, as significant proportion of patients may experience sexual difficulties, menstrual irregularity, and infertility.
241-POS Khowaja, Asif R; Qureshi, Rahat N; Sheikh, Sana ...
Pregnancy hypertension,
01/2015, Letnik:
5, Številka:
1
Journal Article
Objectives This study aimed to explore community perceptions, and traditional management practices surrounding pre-eclampsia and eclampsia in Pakistan. Background They hypertensive disorders of ...pregnancy are the second leading cause of maternal mortality globally, of which >99% occur in less developed countries. Methods A qualitative study was conducted in Matiari and Hyderabad Sindh, Pakistan from February to July 2012. Altogether 26 focus group discussions were held with women of reproductive age and female decision makers ( N = 173) and male decision makers ( N = 65). The data was transcribed verbatim in Sindhi and Urdu, the data were then analyzed for emerging themes and sub-themes using QSR NVivo-version10. Results High blood pressure in pregnancy was mainly recognized as severe headache, and there was no local name to describe either this condition or the seizures of eclampsia. The majority of participants were aware that a woman can develop hypertension in pregnancy; however, progression of illness from pre-eclampsia to eclampsia was poorly understood. It was widely believed that mental stress and worries in pregnancy cause pre-eclampsia. Hypertension in pregnancy was considered to be dangerous as it could result in death of mother and baby; whereas, very few believed further complications could occur after birth. Seizures during pregnancy were thought to be caused by weakness, anemia, and stress. Many perceived seizures to be a health emergency for both mother and fetus. Self-medication for pre-eclampsia symptoms was common; in addition, some used alternative treatments for pre-eclampsia and eclampsia. Conclusions Community-based participatory health education strategies are recommended to address myths and misperceptions about the hypertensive disorders of pregnancy. These educational initiatives should include information on the presentation, progression, and treatment of pre-eclampsia and eclampsia. Disclosures A.R. Khowaja: None. R.N. Qureshi: None. S. Sheikh: None. S. Zaidi: None. R. Salam: None. D. Sawchuck: None. M. Vidler: None. P. von Dadelszen: None. Z. Bhutta: None.
Precise measurements of activity at a population level are important for monitoring trends and evaluating health promotion strategies. Few studies have assessed the measurement of physical activity ...in developing countries. The aim of this study was to validate the MOSPA (Monica Optional Study of Physical Activity) questionnaire which was developed for the WHO-Monitoring trends and determinants of cardiovasculr disease (MONICA) study sites.
The MOSPA questionnaire assesses energy expendtiture (EE) related to physical activity (employment, household work, transportation, and leisure time) over a one year period. This questionnaire has been described in the manuscript as the long term (LT) questionnaire. An adapted short term (ST) 5 day questionnaire was developed to assess convergent validity. Questionnaire data were compared with physical activity EE estimates from a Caltrac accelerometer and with body composition measures (height, weight and bioelectrical impedance) in 50 women from the Aga Khan University (AKU) hospital antenatal clinics, Pakistan. Other forms of EE i.e. resting EE and thermic effect of food were not assessd in this study.
Subjects were aged 26 +/- 3.8 years and were 16.1 +/- 6.7 weeks pregnant. Their average weight was 58.8 +/- 10.7 Kg. The average EE/day assessed by the Caltrac accelerometer, was 224 kcal and by MOSPA LT questionnaire it was 404 kcal. The questionnaires and Caltrac data were reasonably well correlated: r = 0.51 and r = 0.60 (P < 0.01) for LT and ST questionnaires respectively. Energy expenditure from questionnaire data was not correlated with body composition measures.
The MOSPA questionnaire is useful in assessing physical activity levels in a sedentary population over a one year period.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To understand the level of physical activity in pregnant women and to identify perceived facilitators and barriers faced by them.
This cross-sectional study was conducted from January to June 2016 at ...Aga Khan Maternity and Child Care Centre, Hyderabad, Pakistan, and comprised pregnant women attending the antenatal clinics. They were administered the pregnancy physical activity questionnaire while additional questions were asked to assess perceived barriers and facilitators in pregnancy. SPSS 19 was used for data analysis.
Of the 455 subjects, 179(36%) were physically active. Their median metabolic equivalent of task hours per week was 14.65 (interquartile range=0-105.8). The overall mean age of subjects was 26±4.47 years, while the mean gestational age was 24±10 weeks. Household activity had a strong positive correlation with total activity (p<0.05). Reported barriers included lack of energy and lack of information regarding benefits of physical activity, and facilitators included support from family and affordable facilities in the area of residence.
Majority of the pregnant women failed to meet the daily recommendations for physical activity..
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