BackgroundAntenatal care is a very important component of maternal health services. It provides the opportunity to learn about risks associated with pregnancy and guides to plan the place of deliveries thereby preventing maternal and infant morbidity and mortality. In ‘Pakistan’ antenatal services to rural population are being provided through a network of primary health care facilities designated as 'Basic Health Units and Rural Health Centers. Pakistan is a developing country, consisting of four provinces and federally administered areas. Each province is administratively subdivided in to ‘Divisions’ and ‘Districts’. By population ‘Punjab’ is the largest province of Pakistan having 36 districts. This study was conducted to assess the coverage and quality antenatal care in the primary health care facilities in ‘Punjab’ province of ‘Pakistan’.MethodsQuantitative and Qualitative methods were used to collect data. Using multistage sampling technique nine out of thirty six districts were selected and 19 primary health care facilities of public sector (seventeen Basic Health Units and two Rural Health Centers were randomly selected from each district. Focus group discussions and in-depth interviews were conducted with clients, providers and health managers.ResultsThe overall enrollment for antenatal checkup was 55.9% and drop out was 32.9% in subsequent visits. The quality of services regarding assessment, treatment and counseling was extremely poor. The reasons for low coverage and quality were the distant location of facilities, deficiency of facility resources, indifferent attitude and non availability of the staff. Moreover, lack of client awareness about importance of antenatal care and self empowerment for decision making to seek care were also responsible for low coverage.ConclusionThe coverage and quality of the antenatal care services in ‘Punjab’ are extremely compromised. Only half of the expected pregnancies are enrolled and out of those 1/3 drop out in follow-up visits.

BackgroundThe success of the Global Polio Eradication Initiative was remarkable, but four countries - Afghanistan, Pakistan, India and Nigeria - never interrupted polio transmission. Pakistan reportedly achieved all milestones except interrupting virus transmission. The aim of the study was to establish valid and reliable estimate for: routine oral polio vaccine (OPV) coverage, logistics management and the quality of monitoring systems in health facilities, NIDs OPV coverage, the quality of NIDs service delivery in static centers and mobile teams, and to ultimately provide scientific evidence for tailoring future interventions.MethodsA cross-sectional study using lot quality assessment sampling was conducted in the District Nankana Sahib of Pakistan's Punjab province. Twenty primary health centers and their catchment areas were selected randomly as 'lots'. The study involved the evaluation of 1080 children aged 12-23 months for routine OPV coverage, 20 health centers for logistics management and quality of monitoring systems, 420 households for NIDs OPV coverage, 20 static centers and 20 mobile teams for quality of NIDs service delivery. Study instruments were designed according to WHO guidelines.ResultsFive out of twenty lots were rejected for unacceptably low routine immunization coverage. The validity of coverage was questionable to extent that all lots were rejected. Among the 54.1% who were able to present immunization cards, only 74.0% had valid immunization. Routine coverage was significantly associated with card availability and socioeconomic factors. The main reasons for routine immunization failure were absence of a vaccinator and unawareness of need for immunization. Health workers (96.9%) were a major source of information. All of the 20 lots were rejected for poor compliance in logistics management and quality of monitoring systems. Mean compliance score and compliance percentage for logistics management were 5.4 ± 2.0 (scale 0-9) and 59.4% while those for quality of monitoring systems were 3.3 ± 1.2 (scale 0-6) and 54.2%. The 15 out of 20 lots were rejected for unacceptably low NIDs coverage by finger-mark. All of the 20 lots were rejected for poor NIDs service delivery (mean compliance score = 11.7 ± 2.1 [scale 0-16]; compliance percentage = 72.8%).ConclusionLow coverage, both routine and during NIDs, and poor quality of logistics management, monitoring systems and NIDs service delivery were highlighted as major constraints in polio eradication and these should be considered in prioritizing future strategies.

BackgroundThe success of the Global Polio Eradication Initiative was remarkable, but four countries - Afghanistan, Pakistan, India and Nigeria - never interrupted polio transmission. Pakistan reportedly achieved all milestones except interrupting virus transmission. This paper describes the perceptions of health workers and managers regarding constraints in the Polio Eradication Initiative (PEI) to ultimately provide evidence for designing future interventions.MethodsA qualitative cross-sectional study using focus group discussions and in-depth interviews was conducted in the Nankana Sahib District of Pakistan's Punjab province. Study subjects included staff at all levels in the PEI at district headquarters, in all 4 tehsils (sub-districts) and at 20 randomly selected primary health centers. In total, 4 FGD and 7 interview sessions were conducted and individual session summary notes were prepared and later synthesized, consolidated and subjected to conceptual analysis.ResultsThe main constraints identified in the study were the poor condition of the cold chain in all aspects, poor skills and a lack of authority in resource allocation and human resource management, limited advocacy and communication resources, a lack of skills and training among staff at all levels in the PEI/EPI in almost all aspects of the program, a deficiency of public health professionals, poor health services structure, administrative issues (including ineffective means of performance evaluation, bureaucratic and political influences, problems in vaccination areas and field programs, no birth records at health facilities, and poor linkage between different preventive programs), unreliable reporting and poor monitoring and supervision systems, limited use of local data for interventions, and unclear roles and responsibilities after decentralization.ConclusionThe study highlights various shortcomings and bottlenecks in the PEI, and the barriers identified should be considered in prioritizing future strategies.

BackgroundThere are two types of barriers to the utilisation of maternal health and antenatal care (ANC) services, including the supply-side barriers operating at the health facility level and demand-side, affecting the utilisation ANC services by pregnant women. The purpose of the study was to assess the essential resources required for the provision of ANC services in primary healthcare facilities in Punjab, Pakistan.MethodsA cross-sectional facility assessment was conducted in primary healthcare facilities across Punjab. A multi-stage sampling was used to randomly select nine districts from three stratifications and 19 primary healthcare facilities in the public sector (17 Basic Health Units (BHUs) and two Rural Health Centres (RHCs)) from each district. A total of 171 health facilities were included. Data on infrastructure and availability of equipment, essential supplies, medicines, treatment protocols, and infection control items was collected through pre-tested, semi-structured questionnaires. Univariate analysis was carried out to describe the frequency and percentages of facilities across three ratings (good, average, and poor) by type of facility.ResultsOverall, 28% of facilities had poor infrastructure and the availability of equipment was poor in 16% of the health facilities. Essential supply items, such as urine strips for albumin, blood sugar testing strips, and haemoglobin reagents, were particularly poorly stocked. However, infrastructure and the availability of equipment and supplies were generally better in RHCs compared to BHUs.ConclusionHealth facilities lacked the resources required to provide quality ANC services, particularly in terms of infrastructure, equipment, supply items, and medicines. The availability of these resources needs to be urgently addressed.

Objectives: To determine fetomaternal outcome in patients undergoing planned vaginal breech delivery at term. Methods:It was a descriptive cross sectional study conducted at Lady Aitchison hospital, Lahore for one and a half year from July 2012 to December 2013. All patients presenting with term breech presentation were included. Fetomaternal outcome in terms of successful vaginal delivery, maternal complications of operative delivery, PPH, wound infection and fetal complications of apgar score of less than five minutes, nursery admission, trauma during delivery (bone fracture, intra cranial hemorrhage) and perinatal mortality was studied.Results: 375 patients delivered as breech presentation during the study period. Out of 375 patients, 155 patients were selected for vaginal birth. Out of these, 65% had successful vaginal delivery, rest had emergency caesarean section due to fetal distress, cord prolapse, dysfunctional labour. 6.4% patients had wound infection and 3.2% had PPH. Booking status was significantly important in patients who had successful vaginal delivery as 80% were booked (p = 0.001). There was no maternal mortality in these patients. Perinatal outcome was good in 87% of patients. 20 fetuses had Apgar score less than 7/min and required nursery admission. Two babies expired due to birth asphyxia and rest were discharged home in satisfactory condition. Conclusion: Although delivery of breech remains a dilemma, the plan of delivery should be individualized. Proper selection of cases with proper antenatal and intrapartum care can result in successful breech vaginal delivery without compromising feto maternal wellbeing and curtailing the percentage of caesarean being done for this malpresentation.

Introduction: Hepatocellular carcinoma (HCC) is the commonest primary malignant cancer of the liver in the world.Characteristics of our population suffering from HCC are not known, this study aims to present epidemiological, clinical and laboratorycharacteristics of HCC patients..Design: A retrospective study. Setting: At Jinnah hospital, Lahore. Period: 36 months. Material & m e t h o dsHCC was diagnosed according to the guide lines given by EASL-2000. The data was later analyzed by SPSS13. Results. A total of 34 patientswere included in the study. Majority patients were male 21(80%) and belonged to urban setting (21). Pain abdomen 21(61.8%) and Ascites22(64.7%) were the commonest presentations. 15(44%) patients were suffering from HCV and 12 (35.3%) were negative for both HCV & HBV,while 9 out of these were also not alcoholic. Most of the patients had symptoms present for 1 -6 (76%) months and majority presented in eitherstage III or IV (91 %), none of the patient presented in stage I. Most the patients 25(73.5%) had tumor size larger than 5 cm at presentation andsimilarly 20 (59%) had more than one lesions at presentation, stage of tumor was positively associated (p <0.02) with number of tumor lesions.Conclusion. HCC does occur in a cirrhotic background but a good number of patients were not cirrhotic and need to be investigated furtherfor other possible dietary risk factors. Pain and abdominal distension in a cirrhotic patient should be addressed to immediately so as to diagnoseHCC at an earlier stage.

Aim: Prevalence and determining factors of refractive errors among the medical students in FMU, Faisalabad. Methodology: Cross-sectional quantitative study conducted in Faisalabad Medical University from 01-03-2020 to 15-12-2020 after approval from institutional review committee. All students of MBBS in FMU were included in this study. A structured questionnaire was used to collect the required quantitative information. SPSS version 26 was used for analysis. Results: Prevalence of refractive error is 49%. Females were 59% and males were 41%. More students i.e. 85.2% were suffering from myopia. In our study, usage of electronic devices i.e. mobile phones especially was one of the risk factors in developing refractive errors. 20.6% students having refractive error said that they use mobile phone for 4 hours, 30.2% having refractive error said that they watch TV for one hour, 23.3% having refractive error said that they play video games for one hour. For the correction of the refractive error, 184 students i.e. 97.4% used spectacles whereas only 5 (2.6%) students used contact lenses. It is observed in this study that contact lenses were only used by those students having refractive error <1.5. Conclusion: Refractive errors were a significant cause of visual impairment among medical students. The prolonged use of electronic devices especially mobile phones should be discouraged. Keywords: Refractive errors, myopia, electronic devices, mobile phone