Birth Of Pakistan Research Articles

Perceived Spousal Concordance on Desired Family Size and Birth Intendedness Among Second and Higher-Order Births in Pakistan

Perceived Spousal Concordance on Desired Family Size and Birth Intendedness Among Second and Higher-Order Births in Pakistan

A Cross sectional Study on Nurses Knowledge and Practice of Essential Newborn Care at Tertiary Care Hospitals of Bahawalpur

The newborn survival, growth, and development depend on the knowledge of essential infant care and correct application. The World Health Organization's guideline is crucial, yet the majority of healthcare professionals are unaware of it and do not adhere to it. Four million infants die every year, primarily in developing countries. For every 1,000 live births in Pakistan, there are 40.4 neonatal fatalities. Objectives: To examine nurses understanding and their application of newborn care at Bahawalpur tertiary care hospitals. Methods: At Bahawalpur's tertiary care hospitals, a cross-sectional study was done. Using a random sampling procedure, 280 registered nurses who provide labor and delivery and neonatal care were chosen. Participants were given self-administered questionnaires in order to gather data. Input and analysis of the data were done with SPSS Version 21.0. Frequency and percentages were used to present qualitative characteristics. A P value of 0.05 was employed to evaluate statistical significance. Results: Study participants averaged a 24.28 on a knowledge scale. 53.2 % of respondents had strong knowledge, while 47.8 % had low knowledge, according to the research. 52.1 % of respondents had an excellent level of practice, while 48.9 % had a low level, according to the mean practice score of 33.83. Conclusions: On some crucial aspects of neonatal care, the research population had inadequate knowledge and experience. Therefore, while assigning employees to the delivery room, preference should be given to participants with higher knowledge. Those who perform well should also be commended

Content analysis of Islamiyat (Compulsory) Textbooks of class 5th session 2019-2020 and session 2021-2122(SNC syllabus)

Islamiyat is not a modern concept in Pakistan. It is being taught in Pakistan as compulsory subject for many years after the birth of Pakistan. As a Muslim, it is our religious duty to learn it’s all concepts that’s why the Punjab government has declared it as a separate subject for all schools and the Nazara Quran in the framework of the SNC. It was lacking in all educational policies. Nazara Quran as a compulsory subject will help the students to develop the positive changes as per needs of our religion. Textbooks play an important role in this regard. This study was designed to explore the content analysis of the Islamiyat of class 5th session 2019-2020 and 2021-2022(SNC syllabus). The finding of the study examined those textbooks where significant differences in contents between the two books. Some new things are added and somethings are deleted. Main thing of SNC syllabus Islamiyat book is that Khatamun Nabyeen (S.A.W.) is placed along with our beloved Prophet Hazarat Muhammad (S.A.W) which is the most important addition being follower of the last Prophet (S.A.W). During the content analysis we have fined some similarities between these two books like promoting the Islamic. Booth books have the ability to develop moral values in our students to lead the life according to Islam. These books also promote the concept of unity, brotherhood, punctuality and love with nation and country.

Content analysis of Islamiyat (Compulsory) Textbooks of class 5th session 2019-2020 and session 2021-2122(SNC syllabus)

Islamiyat is not a modern concept in Pakistan. It is being taught in Pakistan as compulsory subject for many years after the birth of Pakistan. As a Muslim, it is our religious duty to learn it’s all concepts that’s why the Punjab government has declared it as a separate subject for all schools and the Nazara Quran in the framework of the SNC. It was lacking in all educational policies. Nazara Quran as a compulsory subject will help the students to develop the positive changes as per needs of our religion. Textbooks play an important role in this regard. This study was designed to explore the content analysis of the Islamiyat of class 5th session 2019-2020 and 2021-2022(SNC syllabus). The finding of the study examined those textbooks where significant differences in contents between the two books. Some new things are added and somethings are deleted. Main thing of SNC syllabus Islamiyat book is that Khatamun Nabyeen (S.A.W.) is placed along with our beloved Prophet Hazarat Muhammad (S.A.W) which is the most important addition being follower of the last Prophet (S.A.W). During the content analysis we have fined some similarities between these two books like promoting the Islamic. Booth books have the ability to develop moral values in our students to lead the life according to Islam. These books also promote the concept of unity, brotherhood, punctuality and love with nation and country.

Understanding Perceptions and Practices for Designing an Appropriate Community-Based Kangaroo Mother Care Implementation Package: Qualitative Exploratory Study.

BackgroundLow birth weight (LBW) is a common outcome of preterm birth, which increases the risk of an infant’s morbidity and mortality. Approximately 20 million infants are born with LBW globally per year. Since a significant number of births in Pakistan take place at home, it is important to focus on the use of kangaroo mother care (KMC), the practice of skin-to-skin contact, in communities to prevent neonatal mortality and morbidity.ObjectiveWe employed a formative research approach to understand the context of communities and facilities with regard to neonatal care and KMC practice. The broader aims were to inform the design and delivery of culturally appropriate platforms to introduce KMC in communities, and develop effective recruitment and retention strategies of KMC in rural areas of the Dadu district in the Sindh province of Pakistan.MethodsWe conducted focus group discussions, in-depth interviews, and key informant interviews with families of LBW babies, community members, health care providers, and hospital administrators to identify barriers, enablers, and a knowledge base for KMC interventions.ResultsNewborn care practices in communities were found to be suboptimal. The community was generally unaware of the KMC intervention for the care of LBW babies. However, facility health care providers, the community, and family members were willing to provide KMC to improve outcomes. We found significant support from the community members and health care providers for KMC practices. Mothers were also ready to provide intermittent KMC. The administrative staff at the hospitals accepted the introduction of KMC practices for LBW babies.ConclusionsKMC as a method of treating LBW babies is widely accepted in the community. This formative research provides strategically valuable information that will be helpful for developing effective implementation strategies by identifying common community practices for LBW babies, along with identifying the barriers and enablers to KMC practice.

A CASE REPORT OF TREATMENT COURSE IN A NEGLECTED CLUB FOOT CHILD

Congenital club foot is among the most common developmental deformities in which affected children have abnormal bone arrangement. The worldwide clubfoot prevalence is around 0.6 to 1.5 per 1000 live births and around 1.4-1.5 per 1,000 live births in Pakistan. The need for this case study was to see the effect of Ponseti technique in a neglected clubfoot case where bony surgical procedures are mostly recommended to improve the deformity. After evaluation, the child was diagnosed with right clubfoot deformity. Conservative treatment using Ponseti method was initiated with weekly follow up followed by soft tissue release and post-operative casting. Now the child can bear her weight and walk properly.

Magnitude of Sudden Infants Deaths, maternal mortality and Still Births in Pakistan

SIDS, SIUD, stillbirths and maternal mortality is an alarming condition in low income countries like Pakistan as Pakistan is a country with highest morbidity in such cases all over the world. Although research is ongoing across the globe to reduce the burden of such devastating situation but it continues to rise in Pakistan due to some known and unknown reasons. It is recommended that the pathophysiological basis of the SIDS should be investigated by continued research. To decrease the magnitude of SIDS, SIUD, stillbirths and maternal mortality in Pakistan numerous precautionary measures are required to be taken by NGOs, Government and policy makers. Trained healthcare professionals, midwives, traditional birth attendants should be sent to rural areas to help and increase awareness. A national center should be made on urgent basis to monitor and register such cases, provide health care facilities and guidance, make laws of compulsory investigation and autopsy of sudden death of fetus or infants and implement and enforce these laws. A databank should be made with preserved tissues of such victims for further diagnosis and research. Preventable stillbirths must be avoided by taking necessary measures.

Factors associated with non-utilization of postnatal care among newborns in the first 2 days after birth in Pakistan: a nationwide cross-sectional study

ABSTRACT Background Recent data indicated that approximately four in every ten newborns in Pakistan do not receive postnatal care (PNC) services in the first 48 hours after delivery. Objectives This study aimed to identify factors associated with the non-utilization of PNC for newborns in Pakistan using the 2017–18 Pakistan Demographic and Health Survey (PDHS). Methods This was a cross-sectional analytical study utilizing data from 3887 live-born newborns recorded in the 2017–18 PDHS. Non-utilization of PNC was assessed against a set of independent factors using multilevel logistic regression analysis, and the population attributable risk estimates of factors associated with non-utilization of PNC were also calculated. Results There were 1443 newborns (37%) in Pakistan whose mothers did not utilize PNC check-ups in the first 2 days after delivery. The non-utilization of PNC was largely attributable to newborns delivered at non-health facilities 53% (47% to 59%) and those born to uneducated women 27% (13% to 38%). Adjusted analyses indicated that newborns with higher birth order and with a birth interval of more than 2 years, women who perceived their baby to be small at birth, women with no formal education and those living in regional areas of Khyber Pakhtunkhwa and Federally Administered Tribal Areas were significantly associated with non-utilization of PNC services. Conclusions Tailored health messages by community health workers, including door-to-door visits on utilizing health facilities through pregnancy to the postnatal periods, are needed and should target places of low socioeconomic status, including educationally disadvantaged women from regional areas of Pakistan.

COMPARISON OF MICRONIZED PROGESTERONE (CYCLOGEST PESSARY) AND PLACEBO IN PREVENTION OF PRE-TERM BIRTH IN TERTIARY CARE HOSPITAL

Objective: To compare efficacy of micronized per rectal progesterone (cyclogest pessary) and placebo inprevention of preterm birth in tertiary care hospital.
 Study Design: Randomized controlled trial (RCT).
 Place and Duration of Study: Study was conducted at department of gynecology and Obstetrics, CombinedMilitary Hospital Nowshera, Khyber Pakhtunkhwa, from Jan 2018 to Jun 2018.
 Methodology: A sample size of 140 patients was calculated using WHO calculator. Non probability consecutivesampling was used for recruitment of participants. Ethics approval and consent forms were taken. Women weredivided into two groups randomly. Group A was given micronized progesterone (cyclogest pessary) per rectalusage and group B was given placebo. Patients were followed for maternal and neonatal outcomes. Data wasanalyzed using SPSS version 23. Independent t-test was applied. p-value ≤0.05 was considered significant.
 Results: Total 140 patients were included in study. Mean age of women was 29.4 years ± 4.6SD. Patients in micronized progesterone (cyclogest pessary) was more effective in increasing birth weight (p=0.00), Apgar score maintenance at 1st (p=0.00) and 5th minute (p=0.000) and reduction in length of hospital stay (p=0.000) as compared to placebo. Patients were more satisfied with micronized progesterone (cyclogest pessary) per rectal as compared to placebo (p=0.00).
 Conclusion: Preterm birth is remained as significant issue in health care system of Pakistan. However, micronized progesterone (cyclogest pessary) per rectal usage had positive impact in improving maternal and neonatal health outcomes. Effective strategies for prevention of preterm birth in Pakistan are required.

Why are the Pakistani maternal, fetal and newborn outcomes so poor compared to other low and middle-income countries?

BackgroundPakistan has among the poorest pregnancy outcomes worldwide, significantly worse than many other low-resource countries. The reasons for these differences are not clear. In this study, we compared pregnancy outcomes in Pakistan to other low-resource countries and explored factors that might help explain these differences.MethodsThe Global Network (GN) Maternal Newborn Health Registry (MNHR) is a prospective, population-based observational study that includes all pregnant women and their pregnancy outcomes in defined geographic communities in six low-middle income countries (India, Pakistan, Democratic Republic of Congo, Guatemala, Kenya, Zambia). Study staff enroll women in early pregnancy and follow-up soon after delivery and at 42 days to ascertain delivery, neonatal, and maternal outcomes. We analyzed the maternal mortality ratios (MMR), neonatal mortality rates (NMR), stillbirth rates, and potential explanatory factors from 2010 to 2018 across the GN sites.ResultsFrom 2010 to 2018, there were 91,076 births in Pakistan and 456,276 births in the other GN sites combined. The MMR in Pakistan was 319 per 100,000 live births compared to an average of 124 in the other sites, while the Pakistan NMR was 49.4 per 1,000 live births compared to 20.4 in the other sites. The stillbirth rate in Pakistan was 53.5 per 1000 births compared to 23.2 for the other sites. Preterm birth and low birthweight rates were also substantially higher than the other sites combined. Within weight ranges, the Pakistani site generally had significantly higher rates of stillbirth and neonatal mortality than the other sites combined, with differences increasing as birthweights increased. By nearly every measure, medical care for pregnant women and their newborns in the Pakistan sites was worse than at the other sites combined.ConclusionThe Pakistani pregnancy outcomes are much worse than those in the other GN sites. Reasons for these poorer outcomes likely include that the Pakistani sites' reproductive-aged women are largely poorly educated, undernourished, anemic, and deliver a high percentage of preterm and low-birthweight babies in settings of often inadequate maternal and newborn care. By addressing the issues highlighted in this paper there appears to be substantial room for improvements in Pakistan’s pregnancy outcomes.

Prevalence and risk factors of preterm birth in Pakistan

To find prevalence of preterm birth in Pakistan and to explore its related risk factors. This analytical cross-sectional study was conducted from October 1, 2016, to September 30, 2017, at Hajvery University, Lahore, Pakistan, and data was collected from Obstetrics and Gynaecology departments of various hospitals in four provinces of the country. To find risk factors of preterm birth, data was divided into two groups: Group-1 consisted cases with preterm birth defined as gestational age <37 weeks on ultrasonography; and Group-2 consisted controls with full-term birth defined as gestational age 37-41 weeks. Data was analysed using SPSS 22. There were 1,691 females with mean gestational age of 37.3±2.062 weeks. The prevalence of preterm birth was 366(21.64%). Top 5 major risk factors identified were Placenta Previa (odds ratio: 51.97), maternal thyroid disease (odds ratio: 18.46), being a minority (odds ratio: 7.73), foetal distress (odds ratio: 7.19), and maternal asthma (odds ratio: 6.23). The prevalence of preterm birth was found to be high with several modifiable and controllable risk factors.

Islam in Pakistan: A History by Muhammad Qasim Zaman

Reviewed by: Islam in Pakistan: A History by Muhammad Qasim Zaman Uğur Z. Peçe Islam in Pakistan: A History. By muhammad qasim zaman. Princeton: Princeton University Press, 2018. 432 pp. ISBN 9780691149226. $39.50 (hardcover); $27.95 (paper). What if we organized our personal libraries by the character of books? If the shelves were populated by books with comparable disposition, Muhammad Qasim Zaman's Islam in Pakistan: A History would take its place not too distant from the late Shahab Ahmed's What is Islam? The [End Page 811] Importance of Being Islamic (Princeton: Princeton University Press, 2015). The latter explored "the historical and human phenomenon that is Islam in its plenitude and complexity of meaning" to present a complex story of islams, as opposed to a singular and uniform Islam (p. 5). Rather than purporting to provide an easy answer to the question "What is Islam?" Ahmed approached Islam as a complex constellation of beliefs, philosophies, traditions, and practices. Islam in Pakistan's affinity to Ahmed's tour de force lies not only in its impressive scope but its investigation of the meanings and importance of being Islamic over the course of Pakistan's checkered history without presuming "any sharp distinction between belief and practice, between normative and lived Islam" (p. 2). Zaman's examination of multiple dimensions of Islam in South Asia over the period of almost two centuries within the frame of a single book is an ambitious undertaking, the likes of which only the most competent of scholars perform compellingly. Covering a wide array of topics from Islamic law to education to non-Muslim minorities and to interpretations of jihad, Zaman discusses the modernists, 'ulama, Sufis, and Islamists as the key actors who have shaped state and society in colonial India and Pakistan. Organized thematically, Islam in Pakistan opens with an introduction into Islamic identities in pre-partition South Asia. During the mid-nineteenth century, the deepening penetration of British colonialism in South Asia recast the region, which was home to the largest Muslim population in the world. Perhaps the most formative transformation occurred with Britain's crashing of the Indian Mutiny of 1857, spelling the end of centuries-long Muslim political dominance in India. This proved extremely dislocating for South Asian Muslims as they lost the privileged status of professing the same religion as their rulers whose very existence was widely believed to be indispensable to the implementation of Islamic law. Zaman, however, does not recount a story of Islamic decline in post-Mughal India but a narrative of dynamic adaptability instead. Dislocation brought by the passing of the Mughal rule soon sparked an intellectual vitality among Muslims, both traditionalists and modernists, as they navigated the radically transformed political landscape. And changes in the physical landscape such as the extension of the railway network, helped create a more closely-knit community out of the millions of Muslims scattered across a vast area. From the 1860s through 1940s the length of railroads increased from 1,587 to 40,524 miles, which translated into a sixty-fold surge in the annual number of passengers. In no way did such a dramatic rise in the volume of communications compensate the loss of state power for Indian Muslims, yet it certainly connected them more [End Page 812] firmly as disciples visited, with more ease, their Sufi masters and religious scholars. Following a historical survey of Islam under British colonialism, the book is organized thematically with each chapter examining a major component of Islamic imprint in Pakistan. Chapter 2 investigates the mixed fortunes of Islamic modernism throughout Pakistan's history. Zaman's discussion of the primacy of Islamic modernist ideas in the project for an independent Pakistan as a Muslim state shines light on its founders' objective to prove Islam's compatibility with modernity. The birth of Pakistan, on the other hand, provided the 'ulama with an opportunity to claim leading roles under an Islamic republic, which constitutes one of the main topics in Chapter 3, others being constitution-writing, Islamic legislation, and madrasa reform. The Objectives Resolution, the founding document of Pakistan accepted in 1949, envisioned the new state to be governed in accordance with the idea...

Prevalence of Preterm Birth in Pakistan: A Systematic Review and Meta-Analysis

Abstract&#x0D; Objective: This study is designed to systematically review the prevalence of preterm birth from previously published studies of Pakistan and to find pooled prevalence from available local data.&#x0D; Methodology: Targeted literature was searched with specific key words such as “preterm birth, prematurity, prevalence and mortality in preterm birth in Pakistan”. Studies with copyright and/or permission issues were excluded. A total of 300 studies were found initially that were somewhat related to the topic, after careful screening only 5 studies met inclusion criteria for cur-rent study. To test the null hypothesis for all studies&#x0D; evaluating effect Cochran's Q was used and P-values with a level of significance of 5%were considered significant.&#x0D; Results: The pooled prevalence of Preterm Birth was found to be 18.89% using fixed effect, 16.81% using random effect and 18.89% using fixed effect heterogeneity. I-squared for each effect model was &gt; 75%. On applying Chi2 test we obtained significant p-value i.e. p-value &lt; 0.01.&#x0D; Conclusion: Through this meta-analysis we found one of the highest pooled prevalence of preterm birth in Pakistan. Reducing preterm birth can result in improvement of overall neonatal health and significantly reduce neonatal mortality in future.

Prevalence of Preterm Birth in Pakistan: A Systematic Review and Meta-Analysis

&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study is designed to systematically review the prevalence of preterm birth from previously published studies of Pakistan and to find pooled prevalence from available local data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methodology:&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;Targeted literature was searched with specific key words such as “preterm birth, prematurity, prevalence and mortality in preterm birth in Pakistan”. Studies with copyright and/or permission issues were excluded. A total of 300 studies were found initially that were somewhat related to the topic, after careful screening only 5 studies met inclusion criteria for current study. To test the null hypothesis for all studies evaluating effect Cochran's &lt;em&gt;Q&lt;/em&gt; was used and P-values with a level of significance of 5%were considered significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;The pooled prevalence of Preterm Birth was found to be 18.89% using fixed effect, 16.81% using random effect and 18.89% using fixed effect heterogeneity. I-squared for each effect model was &amp;gt; 75%. On applying Chi&lt;sup&gt;2&lt;/sup&gt; test we obtained significant p-value i.e. p-value &amp;lt; 0.01.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;Through this meta-analysis we found one of the highest pooled prevalence of preterm birth in Pakistan. Reducing preterm birth can result in improvement of overall neonatal health and significantly reduce neonatal mortality in future.&lt;/p&gt;

Health care provider knowledge and routine management of pre-eclampsia in Pakistan.

BackgroundMaternal mortality ratio is 276 per 100,000 live births in Pakistan. Eclampsia is responsible for one in every ten maternal deaths despite the fact that management of this disease is inexpensive and has been available for decades. Many studies have shown that health care providers in low and middle-income countries have limited training to manage patients with eclampsia. Hence, we aimed to explore the knowledge of different cadres of health care providers regarding aetiology, diagnosis and treatment of pre-eclampsia and eclampsia and current management practices.MethodsWe conducted a mixed method study in the districts of Hyderabad and Matiari in Sindh province, Pakistan. Focus group discussions and interviews were conducted with community health care providers, which included Lady Health Workers and their supervisors; traditional birth attendants and facility care providers. In total seven focus groups and 26 interviews were conducted. NVivo 10 was used for analysis and emerging themes and sub-themes were drawn.ResultsAll participants were providing care for pregnant women for more than a decade except one traditional birth attendant and two doctors. The most common cause of pre-eclampsia mentioned by community health care providers was stress of daily life: the burden of care giving, physical workload, short birth spacing and financial constraints. All health care provider groups except traditional birth attendants correctly identified the signs, symptoms, and complications of pre-eclampsia and eclampsia and were referring such women to tertiary health facilities. Only doctors were aware that magnesium sulphate is recommended for eclampsia management and prevention; however, they expressed fears regarding its use at first and secondary level health facilities.ConclusionThis study found several gaps in knowledge regarding aetiology, diagnosis and treatment of pre-eclampsia among health care providers in Sindh. Findings suggest that lesser knowledge regarding management of pre-eclampsia is due to lack of refresher trainings and written guidelines for management of pre-eclampsia and presentation of fewer pre-eclamptic patients at first and secondary level health care facilities. We suggest to include management of pre-eclampsia in regular trainings of health care providers and to provide management protocols at all health facilities.Trial registration NCT01911494 Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-016-0215-z) contains supplementary material, which is available to authorized users.

Resistance patterns of diversified phylogroups of Escherichia coli associated with mothers having history of preterm births in Pakistan

Objective: Urinary tract infections (UTIs) are caused by extraintestinal pathogenic Escherichia coli (ExPEC), and are one of the key predictors of preterm births. In the light of this fact, present study was conducted to determine the predominant Escherichia coli (E. coli) phylotypes and their associated antibiotic susceptibility patterns, isolated from pregnant mothers with the history of preterm births.Methods: Forty seven E. coli strains were isolated out of a total of 80 urine samples of pregnant women. The isolates were phylotyped and further screened for the presence of Clonal group A. Moreover, Antimicrobial susceptibility testing and screening for Extended Spectrum Beta Lactamase (ESBL) producing strains were also performed.Results: Among the 47 isolates, phylogroup B2 was found to be highly prevalent (45%), followed by group D (23%), B1 (10.64%), A (6.38%), E (6.38%), cryptic clade I (4.25%) and F (2.13%). Two isolates belonged to CgA and 41 (87.23%) isolates were found to be multidrug-resistant. Out of nine antibiotics tested in the study, the isolates displayed high resistance to Ampicillin (82.6%), Sulphamethoxazole (65.22%), Nalidixic acid (60.87%), Sulphamethoxazole-Trimethoprim, Doxycycline and Erythromycin (56.52% each). In total, 8 (17.02%) of the isolates were found to be ESBL positive.Conclusions: The prevalence of infections caused by virulent and highly drug resistant E. coli isolates constitute a risk of developing preterm birth complications in pregnant women and requires the selection of appropriate antibiotics for the treatment of infections caused during pregnancy.

Stillbirth rates in low-middle income countries 2010 - 2013: a population-based, multi-country study from the Global Network.

BackgroundStillbirth rates remain nearly ten times higher in low-middle income countries (LMIC) than high income countries. In LMIC, where nearly 98% of stillbirths worldwide occur, few population-based studies have documented characteristics or care for mothers with stillbirths. Non-macerated stillbirths, those occurring around delivery, are generally considered preventable with appropriate obstetric care.MethodsWe undertook a prospective, population-based observational study of all pregnant women in defined geographic areas across 7 sites in low-resource settings (Kenya, Zambia, India, Pakistan, Guatemala and Argentina). Staff collected demographic and health care characteristics with outcomes obtained at delivery.ResultsFrom 2010 through 2013, 269,614 enrolled women had 272,089 births, including 7,865 stillbirths. The overall stillbirth rate was 28.9/1000 births, ranging from 13.6/1000 births in Argentina to 56.5/1000 births in Pakistan. Stillbirth rates were stable or declined in 6 of the 7 sites from 2010-2013, only increasing in Pakistan. Less educated, older and women with less access to antenatal care were at increased risk of stillbirth. Furthermore, women not delivered by a skilled attendant were more likely to have a stillbirth (RR 2.8, 95% CI 2.2, 3.5). Compared to live births, stillbirths were more likely to be preterm (RR 12.4, 95% CI 11.2, 13.6). Infants with major congenital anomalies were at increased risk of stillbirth (RR 9.1, 95% CI 7.3, 11.4), as were multiple gestations (RR 2.8, 95% CI 2.4, 3.2) and breech (RR 3.0, 95% CI 2.6, 3.5). Altogether, 67.4% of the stillbirths were non-macerated. 7.6% of women with stillbirths had cesarean sections, with obstructed labor the primary indication (36.9%).ConclusionsStillbirth rates were high, but with reductions in most sites during the study period. Disadvantaged women, those with less antenatal care and those delivered without a skilled birth attendant were at increased risk of delivering a stillbirth. More than two-thirds of all stillbirths were non-macerated, suggesting potentially preventable stillbirth. Additionally, 8% of women with stillbirths were delivered by cesarean section. The relatively high rate of cesarean section among those with stillbirths suggested that this care was too late or not of quality to prevent the stillbirth; however, further research is needed to evaluate the quality of obstetric care, including cesarean section, on stillbirth in these low resource settings.Study registrationClinicaltrials.gov (ID# NCT01073475)

Frequency of Various Hemoglobinopathies

Objective: To see the pattern of hemoglobinopathies in the blood samples, received for Hb electrophoresis. Introduction: Hemoglobinopathy is a kind of genetic defect that results in abnormal structure of one of the globin chains of the hemoglobin molecule. Approximately 250 million people (4.5% of the world population) carry potentially pathological haemoglobinopathy gene. Some of the hemoglobinopathies are due to the production of abnormal hemoglobin proteins. Other types of hemoglobinopathies result from reduced production of hemoglobin proteins that otherwise are normal. We attempted to see the pattern of various hemoglobinopahies in the blood samples of the patients referred to our center for Hb electrophoresis. Setting: Diagnostic & Research Lab of Liaquat University of medical & health sciences, Jamshoro, Pakistan. Methodology: In this retrospective study, we included all the consecutive cases from July 2012 to June 2013, referred to Diagnostic & Research Lab, for Hb electrophoresis. Hemoglobin electrophoresis was performed by HPLC Variant II Bio-Rad. Results: A total of 10,000 samples were received during the study period. 15% (1,500/10,000) subjects had confirmed haemoglobinopathies. Of them 43.2 %( 661/1530) were males & 56.7 %( 869/1530) were females. The most predominant was thalassemia trait 8.5% (850/10,000)followed by thalassemia major 3.25 %( 325/10,000), HbD 1.19% (119/10,000), HbS 1.26 %(126/10,000), HbE 0.8% (80/10,000). Conclusion: This study shows that, prevalence of hemoglobinopathies is not uncommon in our population, Therefore, early detection and characterization of haemoglobinopathies is necessary to reduce the burden of affected births in Pakistan.

Frequency of haemoglobinopathies: a single-centre, cross-sectional study from Islamabad, Pakistan

Thalassaemia is the most frequent hereditary disorder in Pakistan, with an estimated 8-10 million carriers. This single-centre study reported the frequency of haemoglobinopathies among 504 consecutive cases visiting Islamabad Diagnostic Centre for haemoglobin electrophoresis from July 2010 to February 2011. Haemoglobin electrophoresis was performed on cellulose acetate membrane, followed by staining and densitometric scanning of bands. A total of 143 (28.4%) subjects had haemoglobinopathies. The most predominant was thalassaemia trait (25.6%), followed by thalassaemia major (1.4%) and HbS or HbD (1.4%). The gene frequencies for thalassaemia trait and major were 0.256 and 0.0139 respectively. The study provides support for continuing efforts towards early detection and characterization of haemoglobinopathies to control the affected births in Pakistan.

Neonatal Death in Low- to Middle-Income Countries: A Global Network Study

To determine population-based neonatal mortality rates in low- and middle-income countries and to examine gestational age, birth weight, and timing of death to assess the potentially preventable neonatal deaths. A prospective observational study was conducted in communities in five low-income countries (Kenya, Zambia, Guatemala, India, and Pakistan) and one middle-income country (Argentina). Over a 2-year period, all pregnant women in the study communities were enrolled by trained study staff and their infants followed to 28 days of age. Between October 2009 and March 2011, 153,728 babies were delivered and followed through day 28. Neonatal death rates ranged from 41 per 1000 births in Pakistan to 8 per 1000 in Argentina; 54% of the neonatal deaths were >37 weeks and 46% weighed 2500 g or more. Half the deaths occurred within 24 hours of delivery. In our population-based low- and middle-income country registries, the majority of neonatal deaths occurred in babies >37 weeks' gestation and almost half weighed at least 2500 g. Most deaths occurred shortly after birth. With access to better medical care and hospitalization, especially in the intrapartum and early neonatal period, many of these neonatal deaths might be prevented.