Untrained Birth Attendants Research Articles

The birthing experiences of mothers with clinical healthcare professionals and community birth attendants in rural northern Ghana

BackgroundThe use of non-professional birth attendants, such as untrained family members and traditional birth attendants, contributes to birth-related complications such as neonatal and maternal mortality. Strategies such as professionally conducted home births and placement of community health professionals close to homes to ensure easy access to skilled birth attendants aim to reduce complications. However, women in labour continue to access the services of unskilled birth attendants in developing settings. AimTo explore the experiences of women in labour who received care from professional birth attendants and community birth attendants to understand the reasons for continued use of non-professional community birth attendants. MethodsA qualitative approach was used to explore the birthing experiences of nine mothers, aged 20–45 years. In-depth face-to-face interviews were conducted to generate data with the help of an interview guide. A content analysis approach was used to organise and interpret the data. FindingsThe participants reported hostile interactions with professional birth attendants, imposition of birthing positions by professional birth attendants, high cost of birthing services by professional birth attendants, and safety risks with non-professional community birth attendants. ConclusionThere is a need for explicit health financing systems that ensure mothers are aware and adequately prepared for labour-related costs. Mothers wish to receive care from professional birth attendants, but feel compelled by negative experiences to choose family members and non-professional birth attendants instead. The adherence of health professionals to the fundamental principles of ‘Respectful Maternity Care’ could reduce their negative attitudes towards women in labour.

Two level logistic regression analysis of factors influencing skilled birth attendant during delivery among Bangladeshi mothers: A nationally representative sample.

In order to minimize the maternal and child mortality rate, the presence of skilled birth attendants (SBA) during delivery is essential. By 2022, 4th health, population and nutrition sector programme in Bangladesh aims to increase the percentage of deliveries performed by SBA to 65 percent. The objective of the present study was to determine the rate and associated factors of usage SBA among Bangladeshi mothers during their delivery. This study utilized secondary data that was collected by Bangladesh Demographic and Health Survey (BDHS) 2017-18. The usage of SBA was measured by a question to respondent, who assisted during your delivery? It was classified into two classes; (i) skilled birth attendant (qualified doctors, nurses, midwives, or paramedics; family welfare visitors, community skilled birth attendants, and sub-assistant community medical officers) (code 1), and (ii) unskilled birth attendant (untrained traditional birth attendants, trained traditional birth attendants, relatives, friends, or others) (code 0). Two logistic regression model was used to determine the associated factors of SBA after removing the cluster effect of the outcome variable. This study found 53.2% mothers were delivered by SBA in Bangladesh, among them 56.33% and 42.24% mothers were delivered by nurse/midwife/paramedic and doctor respectively. The two level logistic model demonstrated that geographical location (division), type of residence, religion, wealth index, mothers' body mass index, mothers' education level, mothers' occupation, total ever born children, mothers' age at first birth (year), number of ANC visits, husbands' education level and husbands' occupation were significant (p<0.01) predictors of SBA. Mothers' education and wealth index were the most important contributory factors for SBA in Bangladesh. This study revealed that still 46.8% mothers are delivered by unskilled birth attendant, this might be treated of Bangladesh Government to achieve SDGs indicator 3.1.2 by 2030. Counseling could be integrated during ANC to increase awareness, and should ensure for every Bangladeshi mothers visit ANC service during their pregnancy at least 4 times.

The Frequency of Maternal Complications after Home Delivered

Objective: To determine the frequency of maternal complications among women delivered at home by Traditional Birth Attended (TBA) Dais presenting at the emergency department of tertiary care hospital. Study Design: Descriptive case series Study setting: The study was conducted at the Emergency Department of Gynecology Unit –III of Liaquat University Hospital, Hyderabad. Study Duration: Six months from 1st May 2018 to 30th November 2018. Methods and Material: A sample of 140 was obtained, participants were selected by using the Non-probability sampling technique and all the women from 20 to 45 years of age either primipara or multiparous who delivered at home by traditional birth attendant (TBA) Dais and presented within 12 hours up to 10 days after delivery at emergency department of Gynecology Unit –III of Liaquat University Hospital, Hyderabad included, after getting informed and written consent from their family members, a questionnaire was used to collect information from the women or her relatives. Data was collected for the complications like post-partum hemorrhage, a retained product of conceptus, perpural sepsis perineal tears injuries. We have used SPSS version 20.0 software for both data entering and analysis. Frequencies and standard deviations were calculated and the chi-square test was used to analyse categorical variables. P values less than 0.05 were considered statistically significant. Result: The total number of women who delivered at home by (TBA’s)/ Dia’s and developed maternal complications presented in the emergency department within 12 hours up to 10 days during the study period was 140. The average age of the patients was SD 29.27±5.21 years. Regarding parity, 58(41.43%) were primigravida and 82(58.57%) multigravida. The postpartum hemorrhage was the commonest maternal complication observed in 62.14% (87/140) cases, retained placental products 27.14% (38/140), purpureal sepsis 7.86% (11/140) and perineal tear injuries 17.14% (24/140). Retained placental product, perianal tear injury and PPH were not statistically significant among different ethnicity while the rate of puerperal sepsis was statistically significant among different ethnicity groups. The frequency of PPH and perianal tear injury was significantly high among those women who had primigravida while the rate of Retained placental products and Puerperal sepsis was high in multigravida but it was not statistically significant. Conclusion: This study concluded that home deliveries conducted by untrained birth attendants were associated with increased maternal morbidity and a high risk of maternal mortality. The postpartum hemorrhage was the most common maternal complication observed in women after home delivery by a Traditional Birth Attended (TBA) Dais.

Knowledge, Beliefs, and Practices around Newborn Resuscitation in Hilly Tribal Homebirth Settings: A Qualitative Observational Study

Objective The study explores home-based newborn resuscitation methods among the Porja hilly tribe in Andhra Pradesh, India. Methods This study was community-based qualitative observational study conducted between October 2021 and March 2022 at 3 intervals. Among the 28 homebirths, 13 were saved with home-based newborn resuscitation methods. The role of traditional birth attendants to save newborn life were found to be highly appreciable. To document its importance, 28 in-depth interviews (IDIs) and two focus group discussions (FGDs) were employed in the study. The participants were 28 mothers of neonates including 13 mothers whose newborns’ first breaths were initiated with different cultural methods and were purposively selected for the IDIs. The data was cross-checked with five untrained traditional birth attendants and 12 elderly female members involved in home deliveries to manage the newborns’ lives. Data collection was carried out using a semi-structured questionnaire on traditional practices, which measured demographic characteristics and women’s perceptions and practices of home-based newborn resuscitation methods. Results The materials used in neonatal awakening were loud sounds with heavy metals, splattering water, thumb pressures on the forehead, chest, and soles region. Four themes were generated: (a) newborn resuscitation is not required on crying neonates, (b) newborn resuscitation is required on noncrying neonates, (c) knowledge of loss of first breath in newborns, (d) post-resuscitation care methods. Conclusion Culture-specified newborn health practices and traditional beliefs still play a crucial role in shaping newborn care practices among hilly tribal communities. The qualitative studies on tribal newborn resuscitation are most important to preserve beneficial traditional methods and preventing harmful practices can help improve the health status of tribal newborn babies, where there are inadequate neonatal services in poor socio-economical resource settings.

An integrative literature review on the impact of COVID-19 on maternal and child health in Africa

Africa has the highest rates of maternal deaths globally which have been linked to poorly functioning health care systems. The pandemic revealed already known weaknesses in the health systems in Africa, such as workforce shortages, lack of equipment and resources. The aim of this paper is to review the published literature on the impact of the COVID-19 pandemic on maternal and child health in Africa. The integrative review process delineated by Whittemore and Knafl (2005) was used to meet the study aims. The literature search of Ovid Medline, CINAHL, PubMed, WHO, Google and Google scholar, Africa journals online, MIDIRS was limited to publications between March 2020 and May 2022. All the studies went through the PRISMA stages, and 179 full text papers screened for eligibility, 36 papers met inclusion criteria. Of the studies, 6 were qualitative, 25 quantitative studies, and 5 mixed methods. Thematic analysis according to the methods of Braun and Clark (2006) were used to synthesize the data. From the search the six themes that emerged include: effects of lockdown measures, COVID concerns and psychological stress, reduced attendance at antenatal care, childhood vaccination, reduced facility-based births, and increase maternal and child mortality. A review of the literature revealed the following policy issues: The need for government to develop robust response mechanism to public health emergencies that negatively affect maternal and child health issues and devise health policies to mitigate negative effects of lockdown. In times of pandemic there is need to maintain special access for both antenatal care and child delivery services and limit a shift to use of untrained birth attendants to reduce maternal and neonatal deaths. These could be achieved by soliciting investments from various sectors to provide high-quality care that ensures sustainability to all layers of the population.

Retained Placenta in an Out-of-Hospital Delivery: A Forensics Medicine Case Report

Most maternal deaths are preventable; however, approximately every 2 min woman dies of pregnancy or delivery-related complications. Postpartum hemorrhage (PPH) is among the most common causes of maternal death worldwide and reportedly, 10% of PPHs are a result of retained placenta. Inadequate prevention and response to these potentially fatal complications by untrained and unlicensed birth attendants are also a fundamental factor contributing to the prevalence. As an example of a forensic approach, we present the case of a 25-year-old woman that underwent home delivery without licensed medical supervision. She was dead on arrival, and the cause of death was determined to be retained placenta that led to hemorrhage. The present report includes the autopsy findings, as well as relevant details from the site of delivery. This report intends to highlight the correctable, yet persistent elements of this condition by providing a clear and thorough picture of death due to retained placenta, as well as analysis of the existing concomitant risk factors.

Risk Factors, Indications and Outcome of Emergency Obstetric Hysterectomy: A study performed at Tertiary Care Hospital

Background: Emergency obstetric hysterectomy is the life-saving surgical intervention when all other available measures are unable to control obstetric hemorrhage. In addition to the known indications and risk factors for globally increasing this near miss event, home deliveries by untrained birth attendants is irrefutable cause of obstetric morbidity and mortality Aim: To identify the risk factors and indications for EOH like Pakistan. Study design: Retrospective descriptive study. Settings: OB/GYN department of Lahore General Hospital, PGMI. Duration: Two years, from start of 2020 to the end of 2021. Methodology: All patients having emergency obstetric hysterectomy in Gynae Unit 3, were included in this study. Risk factors and indications for the procedure were recorded. Outcome in the form of morbidity and mortality was reviewed. Results: Out of total 6809 deliveries, 48 patients had EOH and majority were multiparous with age ranging from 20 to 35 years. Complicated home deliveries ending in EOH were 8.32% of the cases. Two third of the patients had one or more previous caesarean sections and 70.8% underwent Caesarean section in the index pregnancy. Most of the women, 81.25%, were un-booked cases. Most common indication for EOH (50%) in our study was uterine atony and 45.81% of the cases had morbidly adherent placenta. Conclusion: Rising trend of caesarian sections leading to placental issues, lack of proper antenatal care and deliveries at inappropriate places are the contributing factors in morbidity and mortality associated with EOH. Keywords: Uterine atony, morbidly adherent placenta, emergency obstetric hysterectomy.

Epidemiological Determinants for Mortality from Neonatal Tetanus in Punjab Province, Pakistan (2020)

Background Neonatal tetanus (NNT) is a vaccine-preventable disease that occurs at higher incidence in resource-poor countries, presumably because of low maternal immunization rates and unhygienic cord care practices. NNT remains an important cause of infant mortality in rural areas of Punjab Province. Objective This study aims to evaluate and determine the risk factors for mortality in NNT cases and to make recommendations for future strategies. Methods A descriptive study was conducted from July 6 to 14, 2021, at Directorate General Health Office Lahore. The surveillance data set for the year 2020 and clinical notes were reviewed and analyzed. Demographic information, clinical presentation progression, and outcomes were evaluated for all investigated cases, and a comparison analysis was performed between those who survived and those who died. Results Of a total of 176 reported cases, 145 (82.3%) were notified from rural areas of Punjab. The mean age was 9 days, 65 (37%) infants were females, and 111 (63%) were males. The overall mortality was 77 (43.6%), while 31 (17.6%) maternal deliveries were conducted by untrained birth attendants. In addition, 119 (67.6%) women received zero tetanus toxoid (TT) shots in their life. Clinical notes revealed that the group that survived had a significantly greater mean body weight on admission, had later onset of disease, was hospitalized early, and received tetanus immunoglobulin (TIG). The children who could not survive had significantly common clinical features, such as generalized rigidity, fever, and respiratory arrest. Conclusions The increased mortality in rural and tribal areas is suggestive of poor TT immunization coverage. Low literacy, poor socioeconomic status of families, lack of awareness regarding antenatal care, and poor hygienic deliveries conducted by untrained persons remain the main risk factors. Improvement in TT coverage, deployment of trained community midwives, and awareness sessions regarding TT vaccination in hard-to-reach areas are recommended.

Contraceptive and Abortion-Related Practices Among Females of Lower Income Group in District Lahore

Introduction: Reproductive age females in Pakistan are still having poor access to adequate contraceptive information and difficulty in decision making, resulting in abortions many times.&#x0D; Aims &amp; Objectives: To identify contraceptive and abortion-related practice among married reproductive age females of lower income group in District Lahore.&#x0D; Place and duration of study: Study was conducted in 30 union councils (UCs) of District Lahore, Pakistan in 2011-2016.&#x0D; Material &amp; Methods: A cross sectional descriptive study was carried out on a sample of 210 married females of reproductive age in 30 UCs of District Lahore. 30 UCs were randomly selected out of 150 followed by random selection of one village/ward which was considered as a cluster and 7 females were recruited through convenience sampling in each cluster. Data was collected on contraceptive use, preferences, decision making and abortion-related practice and their associations with socio-demographics of these females.&#x0D; Results: The survey was carried out among 210 females with mean age 29 ± 5.28. 97.6% were Muslims, 23.3% were illiterate and 96.2% were housewives. Per capita per month income was ? PKR 3000 in 99 % of the respondents. 20% females used contraception. 39% women were delivered by untrained birth attendants, 95.7% females breast fed and amongst them only 15.7% fed for two years. 33(15.7%) of respondents had 48 abortions and amongst them 27% got it done by a Dai while female neighbors did it in 4.2% cases so a total of 31.2 % abortions were conducted at home. Place of abortion and delivery was decided by husbands in 87.4% respondents. Lower age and age at marriage were found to be associated with higher contraceptive use and abortions (P&lt;0.001).&#x0D; Conclusion: Contraceptive use is very low and abortion-related practices are poor. Respondent’s age and age at marriage are the determinants showing significant association with contraceptive use and abortion.

Unusual and delayed presentation of chronic uterine inversion in a young woman as a result of negligence by an\xa0untrained birth attendant: a case report

BackgroundUterine inversion is a rare but known complication following parturition and may prove fatal due to neurogenic shock or postpartum hemorrhage if not corrected immediately. The incidence is variable, occurring in 1 in 2000 to 1 in 50,000 deliveries, as reported in the past. Nowadays, the incidence is declining due to better antenatal care and increasing institutional deliveries. However, in a developing country such as India, due to cultural and financial reasons, most of the deliveries are still being conducted by untrained birth attendants (“dais”) who have sparse knowledge of oxytocic drugs. Hence, proper education and training should be imparted to the traditional birth attendants and local village health practitioners about the management of labor, placental delivery, timely diagnosis, and proper management of uterine inversion to avoid this grave complication. We report this case because only a limited number of such cases have been reported so far with delayed presentation of chronic uterine inversion 8 months after delivery as a result of the negligence of an untrained birth attendant.Case presentationWe report a case of a patient with chronic uterine inversion presenting 8 months after childbirth as a result of ignorance at the time of delivery. A 22-year-old P1L1 (Para 1 Live 1) Asian woman of Punjabi ethnicity presented to our institute with a progressively increasing painless vaginal mass along with blood-stained vaginal discharge for the last 6 months and progressive dyspareunia (pain during intercourse) for the last 5 months that had worsened with time. She had experienced a full-term normal vaginal delivery at home 8 months earlier with the assistance of an untrained birth attendant (dai). Her history revealed that she had an unduly prolonged second stage of labor and was given aggressive fundal pressure due to inadequate bearing-down efforts and had collapsed after delivery but was managed conservatively by an untrained birth attendant. A provisional diagnosis of chronic uterine inversion was made on the basis of vaginal findings of a globular mass protruding from the cervix and approaching the vagina with thinning of the cervix around the mass, forming a tight constriction ring, in addition to ultrasound findings. The patient’s condition was corrected surgically using Haultain’s approach. She had a satisfactory outcome and was discharged symptom-free.ConclusionAwareness of this complication with timely diagnosis and prompt management can significantly minimize maternal morbidity and mortality, especially in a low- and middle-income country such as India, where 70–80% of deliveries still occur in a rural setting with untrained birth attendants.

Beliefs and Practices During Antenatal and Postnatal Period Among the Host Communities in Cox’s Bazar, Bangladesh

Bangladesh, one of the affected countries with refugee, faces the challenge to provide health care especially maternal care to the host communities. This paper presents maternal care related thoughts and practices in the host communities in Ukhia of Cox’s Bazar. We collected data using mixed method approach including a cross-sectional survey and semi-structure interviews. Using a probability sample, we selected mothers with infants (n=588) living in the host communities of Ukhia sub-district. We also conducted forty-two in-depth semi-structured interviews among the currently pregnant women who had also previously given births (n =21); and recently delivered women (n = 21). The survey found one quarter of the recently delivered women received at least four antenatal care visits and 28 percent women received at least one postnatal care visit. Seventy four percent of deliveries took place at home and 71 percent of the deliveries were assisted by untrained traditional birth attendants. The women mostly relied on their mother in law for information and support. Residents of the host community mainly use cheap, easily accessible informal sectors for seeking care. Cultural beliefs and practices also involved in this behavior, including home delivery without skilled assistance. There is demand of developing behavior change messages to change local resident’s attitude towards antenatal and postnatal care visits and encourage skilled attendance at delivery. Programs in the host communities should also consider interventions to improve social support for key influential persons in the community, particularly mother in law who serve as advisor and decision maker.

Ameliorative Effects of Dried and Germinated Fenugreek Seeds on Kidney Failure Induced by Gentamicin in Male Mice

Bangladesh, one of the affected countries with refugee, faces the challenge to provide health care especially maternal care to the host communities. This paper presents maternal care related thoughts and practices in the host communities in Ukhia of Cox’s Bazar. We collected data using mixed method approach including a cross-sectional survey and semi-structure interviews. Using a probability sample, we selected mothers with infants (n=588) living in the host communities of Ukhia sub-district. We also conducted forty-two in-depth semi-structured interviews among the currently pregnant women who had also previously given births (n =21); and recently delivered women (n = 21). The survey found one quarter of the recently delivered women received at least four antenatal care visits and 28 percent women received at least one postnatal care visit. Seventy four percent of deliveries took place at home and 71 percent of the deliveries were assisted by untrained traditional birth attendants. The women mostly relied on their mother in law for information and support. Residents of the host community mainly use cheap, easily accessible informal sectors for seeking care. Cultural beliefs and practices also involved in this behavior, including home delivery without skilled assistance. There is demand of developing behavior change messages to change local resident’s attitude towards antenatal and postnatal care visits and encourage skilled attendance at delivery. Programs in the host communities should also consider interventions to improve social support for key influential persons in the community, particularly mother in law who serve as advisor and decision maker.

A comparative study of calf muscle circumference with other anthropometry measurement as a measure of low birth weight in neonates

Background: India having 3rd highest incidence of low birth weight (LBW) infants (28%) in the world. Majority of deliveries in our country are conducted at home by untrained traditional birth attendants or relatives, so it is not possible for untrained birth attenders to operate weighing machine in rural areas, therefore to find an alternative method for the estimation of low birth weight we used simple anthropometric indicators like calf circumference which is easily used by rural communities.Methods: It was a Cross-sectional study done at tertiary care center, Udaipur, Rajasthan, India during 1 year period in 2018. 150 neonates without any congenital malformation delivered at hospital irrespective of gestational age were subjected to anthropometric measurements. The different anthropometric measurements like calf circumference, chest circumference were used and data was analyzed by using Receiver Operating Characteristic curve (ROC) to find out the cut-off values with the highest sensitivity and specificity for birth weight &lt;2500gm and &lt;1800gm. For comparison Pearson's Correlation coefficients was used.Results: From different anthropometric measurements, calf circumference of 9.38 cm and 7.90cm had higher sensitivity and specificity in detecting birth weight babies of &lt;2500gm, and &lt;1800gm respectively. The best correlation was observed in calf circumference (r=0.989) and (r=0.990) for identifying babies with birth weight group 1.21-1.80kg and group 1.81-2.50kg.Conclusions: In the absence of a weighing machine, simple measurements like calf circumference is the best indicator in identifying low birth weight babies.

Exploring the perceptions, practices and challenges to maternal and newborn health care among the underprivileged teagarden community in Bangladesh: a qualitative study

Poor health care-seeking behaviour, access to services and availability of service delivery have implications for the health of the community. This study explored the perceptions, practices and challenges related to maternal and neonatal care in the teagarden community in Bangladesh. The study also identified service gaps and problems prevalent in teagarden health facilities. A qualitative study was conducted in five teagardens in the Moulvibazar district of Bangladesh. Six focus group discussions (FGDs) were completed with individuals from the teagarden community, and twelve in-depth interviews (IDIs) were performed with health facility staff working in those teagarden facilities. Misconceptions and harmful traditional practices were found to exist among the families in the teagardens, restricting them from accessing quality health care. Pregnant women are not aware of antenatal care, and deliveries are being conducted at home by untrained birth attendants. Unhygienic and harmful postnatal practices are used. Teagarden health facilities are not well equipped or prepared to provide good care. Inequities exist within the teagarden communities, with unregistered workers having even poorer access to care. Improvement of the quality of maternal health care for this marginalised community is needed to progress maternal health.

Obstetrics Factors Related with Pelvic Inflammatory Disease Patients

Background: Pelvic Inflammatory disease is a very common gynaecological condition among the women.&#x0D; Objectives: The purpose of the present study was to see the obstetrics factors related with the pelvic inflammatory disease.&#x0D; Methodology: This cross-sectional study was carried out in the Department of Obstetrics and Gynaecology at Dhaka Medical College Hospital, Dhaka, Bangladesh from November 2001 to April 2002 during the period of six (06) months and December 2002 to February 2003 for three (03) months with the total duration of nine (09) months. Women in child bearing age who were suffering from chronic pelvic inflammatory disease (PID) attended at the OPD of gynecology Department at Dhaka Medical College Hospital, Dhaka, Bangladesh were selected as study population. Relevant data from each patient were recorded in a questionnaire.&#x0D; Result: A total number of 150 cases were studied. Out of 146 patients 75.3% were delivered at home, 8.2% at hospital and 16.4% cases had their deliveries at home and at hospital also. Out of 146 patients 63.0% were delivered by untrained birth attendants at home and 36.99% were delivered by trained birth attendants. Out of 146 patients 54.1% had history of puerperal sepsis. However, the rest of the 67(45.9%) cases were normal puerperium. In this study 84.0% patients had history of MR, 18 percent had spontaneous abortion and 4.7 percent had induced abortion. Out of these 115 patients with history of pregnancy termination, 47.3% patients had history of pelvic infection following that event. Also, 2.7% gave history of ectopic pregnancy.&#x0D; Conclusion: In conclusion most of the PID patients are delivered at home with untrained birth attendants with the history of puerperal sepsis&#x0D; Journal of Science Foundation 2018;16(2):65-69

The nature of language problem in Bangladeshi children with cerebral palsy: an observation using neurolinguistic approach

Cerebral palsy (CP) is the leading cause of childhood disability affecting function and development. The objective of the study was to look into the language problems in Bangladeshi children with CP on the basis of neurolinguistic approach and was conducted during the period of April 2014 to December 2014 at the Department of Linguistics, University of Dhaka among children aged between 3 to 18 years. In the study, a total of 10 children with CP were enrolled purposively from two tertiary care hospitals in Dhaka (Children Development Centre of Sir Salimullah Medical College and Mitford Hospital and National Institute of Mental Health). The mean±SD age was 8.9±4.8 years. Male was predominant (60.0%). History of prolonged labour was 100%, and home attended by untrained birth attendants in 70.0%. The 90.0% of the children understood simple meaningful sentences using two words. The children were unable to understand complex sentences. The 80.0% children did not want to play or make friendship with other children; 40.0% did not understand others’ speech, 50.0% did not express their own speech, and 10.0% did not understand &amp; express their own speech. All the children had deep thong articulation changed to mono thong in case of semi vowel articulation. In case of history of delayed crying at birth, phoneme omission occurred when the children tried to articulate any word. To the best of knowledge, this was the first study done on the neurolinguistic approach in Bengali children, but the limitation of the study were that it was with small sample size, city based and short duration. Therefore, generalization of the results would be difficult. Further studies using larger sample would be better to visualize the extent of the issue in order to insert the children with CP in their social context and to give them quality of life.Mediscope Vol. 5, No. 1: Jan 2018, Page 22-27

Clinical Profile of Pelvic Inflammatory Disease (PID).

Pelvic inflammatory disease is an important and major health problem in Bangladesh. This study was undertaken to find out the common clinical presentation of pelvic inflammatory disease in relation to reproductive health of women in our country. This study has been carried out at the outpatient department of Obstetrics and Gynaecology, Sher- EBangla Medical College Hospital, Barisal, during period from January 2010 to December 2010. In this descriptive type of cross sectional study, total number of 150 patients suffering from PID were selected. Details history and thorough clinical examination was performed with the aim of find out clinical presentation of PID. Related investigations were done. This study shows that 54% belongs to age group 26-35 years, 90% patients were married and 4% were separated, 90% were house wifes, 60% patients were from lower socio-economic status. All patients complained lower abdominal pain, 60% had vaginal discharge, 80% patients delivered solely at home and 73.33% were delivered by untrained birth attendants at home. Pelvic inflammatory disease is detrimental to reproductive health and makes the women cripple physically, mentally and socially. So appropriate measures e.g. better obstetric and delivery care, family planning care, safe way of pregnancy termination; health education etc. should be made for our women.Faridpur Med. Coll. J. Jan 2017;12(1): 25-30

Maternal health care seeking behavior: the case of Haor (wetland) in Bangladesh.

BackgroundThe state of maternal healthcare (MHC) in Bangladesh is a grave concern especially in the remote haor areas. In this study, we aimed to determine the factors affecting the utilization of MHC services in the haor areas, to discover mothers’ knowledge of MHC, and explore their attitudes toward MHC as well as practices in seeking MHC services.MethodIn this cross-sectional survey (n = 400), we randomly selected mothers (aged 15–49 years) from haor areas of the Habiganj district of Bangladesh. The study participants’ socio demographic information as well as the extent of their knowledge about MHC, their attitudes, and practices in seeking MHC services were ascertained. The degree of association between the respondents’ socio-demographic characteristics and their health-seeking behavior (before, during, and after childbirth) was assessed by the odds ratio (OR) with 95 % confidence intervals (CI) estimated from the bivariate and multivariable logistic regression analyses.ResultsThe mean age of the study participants was 27.26 years. Respondents had an average of 2.64 children, and 88.6 % had at best a primary education or less. Among the study participants, 61 % of mothers had no knowledge about the availability of MHC in the study area, and only 36 % received any antenatal care (ANC). Also, 47 % sought ANC from government healthcare institutions. Irrespective of complications and potential danger signs, 95 % of births were delivered at home with the assistance of untrained birth attendants. Only 19.75 % of mothers and 12.3 % of infants received postnatal care (PNC). Moreover, mothers who had a secondary or tertiary education level had a higher likelihood of receiving ANC (OR: 3.48, 95 % C.I: 1.49–7.63) compared to mothers with no education. Also, mothers aged 25 years or older were less likely (OR: 0.24, 95 % C.I: 0.06–0.095) to give birth in a health facility than mothers who were younger than 25. The low utilization of MHC services can be attributed to many factors such as a lack of communication, a lack of knowledge about MHC services, low income, decision making, and the lack of a companion with whom to visit health services.ConclusionTo improve MHC utilization, to reach national targets and to save the lives of mothers and newborns, boat or ship-based special healthcare and educational programs should be implemented in the haor areas.

Surgical complications of abortions at periphery

Objectives: To study the patients presented with catastrophic abdominal misadventure due to abortion performed by untrained birth attendants to get rid of unwanted fetus by un-indicated procedures in unfavorable circumstances. Design: Observational case series. Place and Duration of Study: Surgical Unit I, Sh. Zayed Hospital, Rahim Yar Khan from July, 2001 to August, 2004. Patients and Methods: Forty patients from different age groups presented with this killer problem. Majority was concealing it. They were resuscitated, operated and managed postoperatively. Results: These patients presented late, suffered financial loss, morbidity and significant mortality. Conclusion: Unplanned abortions are catastrophic. Education of masses in regard to birth control is mandatory.

Neonatal tetanus: Case series

Neonatal tetanus occurs in developing countries, particularly those with the least developed health infrastructure. It usually occurs through infection of the unhealed umbilical stump, particularly when the stump is cut with a nonsterile instrument. World Health Organization defines it as an illness in a child who has the normal ability to suck in the first 2 days of life, but who loses the ability between 3 and 28 days of life and becomes rigid and has spasms. The overall incidence of tetanus is reducing globally and is rare in developed nations. We describe four cases of neonatal tetanus with regard to demography, clinical profile, and outcome. From them, 3 newborns were delivered at home by untrained birth attendants. All the mothers were from lower socio-economic class, illiterate and were below 25 years of age. Common symptoms were unable to feed, difficulty in respiration, episodes of spasms, and convulsions. Mortality was 50%.