Maternal mortality in Pakistan: Challenges, efforts, and recommendations

Shaeen, Sean Kaisser; Tharwani, Zoaib Habib; Bilal, Wajeeha; Islam, Zarmina; Essar, Mohammad Yasir

doi:10.1016/j.amsu.2022.104380

Cited by 14 publications

(9 citation statements)

References 2 publications

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“…Pakistan is a low-middle-income country with a high perinatal mortality rate of 58.2/1000 births 18 and maternal mortality rate of 186/100,000 live births. 19 There are overwhelming problems in the health system which include lack of clean water, poor sanitation, presence of rampant infectious diseases, and poor access to robust health system. 20 Additionally, many challenges in the implementation of NBS have been identified in our setup of which few are, lack of government support, large numbers of out-of-hospital births, few centers of genetic and metabolic services in Pakistan, 7 , 21 insufficient numbers of trained medical and auxiliary staff, lack of awareness and the high cost of medications and food for special medical purposes (FSMPs).…”

Section: Discussionmentioning

confidence: 99%

Selective screening for inherited metabolic disorders in a tertiary care hospital of Karachi – A retrospective chart review

Kanani,

Shahid,

Sameer

et al. 2023

Pak J Med Sci

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Background & Objective: Selective high-risk screening of children suspected of having inherited metabolic disorders was conducted jointly by Chemical Pathology section and the Pediatric Department of Indus Hospital and Health Network- (IHHN) from October 2020-March 2022. Tandem mass spectrometry (MS) for newborn screening was recently introduced in a local laboratory. We did a selective high screening of children for metabolic disorders by using MS for neonates and other relevant tests for older children in our hospital. The present study was undertaken to get an estimate of the number of metabolic cases screened and identified after inclusion of an extended workup. Methods: This is a retrospective chart review of children who were selectively screened for IMDs. Patients’ records with ages ranging from birth to fourteen years of age were retrieved from the electronic records department of IHHN from October 2020 to March 2022. Records were searched for demographic data, history, signs, symptoms, and lab investigations. All relevant information was recorded on a pre-designed questionnaire. Results: A total of 178 children were screened for inherited metabolic disorders. Majority of the children screened were less than one month of age 96 (54%). Consanguinity was noted in 74 (41.5%) children. Most common symptoms observed were failure to thrive in 77 children (43%), hypoglycemia in 45 children (25%), and feeding difficulty in 36 children (20%). Inherited metabolic disorders were confirmed in 12 children out of which five had congenital adrenal hyperplasia, four had cystic fibrosis and three children had congenital hypothyroidism. Conclusion: In the present study, we were able to screen several children after inclusion of an extended metabolic workup. However, confirmation of many disorders like fatty acid oxidation defects, disorders of carbohydrate metabolism, and sphingolipidosis could not be done due to lack of confirmatory tests. We recommend that confirmatory tests of these disorders be included in local labs. doi: https://doi.org/10.12669/pjms.40.2(ICON).8985 How to cite this: Kanani F, Shahid S, Sameer D, Maqsood S. Selective screening for inherited metabolic disorders in a tertiary care hospital of Karachi – A retrospective chart review. Pak J Med Sci. 2024;40(2):S80-S84. doi: https://doi.org/10.12669/pjms.40.2(ICON).8985 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Discussionmentioning

confidence: 99%

Selective screening for inherited metabolic disorders in a tertiary care hospital of Karachi – A retrospective chart review

Kanani,

Shahid,

Sameer

et al. 2023

Pak J Med Sci

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“…On the supply side, irregular supply of contraceptive methods, poor attitude and competency of healthcare providers and limited coverage and outreach of family planning services, have been reported as significant factors that negate uptake [ 11 – 13 ]. These low rates of uptake, of any type of contraceptive methods, are dangerously manifested in the country’s high fertility rate of 3.56 births per woman, combined with a maternal mortality rate of 186/100,000 livebirths and under-5 mortality rate of 63.3 deaths/ 1000 live births [ 14 , 15 ]. Besides mortality, concomitantly high rates of early marriages of girls before 18 years of age, unintended pregnancies and resulting abortions, estimated at annual rate of 50 per 1000 women [ 16 ] coupled with socio-cultural and patriarchal barriers, present a concerning picture of the sexual and reproductive health and overall well-being of women and young girls in the country.…”

Section: Introductionmentioning

confidence: 99%

Predictors of voluntary uptake of modern contraceptive methods in rural Sindh, Pakistan

Memon,

Mian,

Ahmed

et al. 2024

PLOS Glob Public Health

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The use of modern contraceptive methods (MCMs) has been stagnant for the last decade in Pakistan. The second most populous province, Sindh reports 25% of MCMs use. Various factors including demographics and health services utilization are associated with the uptake of family planning services. This research aimed to identify and assess specific predictors of MCMs among women aged 15–49 in two districts of Sindh-Matiari and Badin. A cross-sectional household survey was conducted from October 2020- December 2020. In total, 1684 Married Women of Reproductive Age (MWRA) 15–49 years were interviewed. For the selection of eligible respondents, a two-stage stratified cluster sampling strategy was used. Univariate and multivariable logistic regression was used to determine the predictors for the use of MCM. Use of modern methods of contraceptive was 26.1% (n = 441). Statistically significant socio demographic predictors of MCM included: number of children 4 or more (AOR: 5.23; 95%CI: 2.78–9.84), mother having primary education (AOR: 1.73; 95% CI: 1.26–2.36), and husband having middle education (AOR: 1.69; 95% CI: 1.03–2.76). Maternal health services indicators included: postnatal care of mother (AOR: 1.46; 95% CI: 1.09–2.05); women who were visited by Lady Health Workers in their postnatal period and were counselled on family planning (AOR: 1.83; 95% CI: 1.38–2.42). Since the primary purpose of using modern contraceptive methods is for limiting pregnancies, there is a potential to promote awareness about the benefits of birth spacing as part of implementing a more integrated approach to family planning. The integration of family planning services within maternal and newborn child healthcare services effectively promote the voluntary adoption of modern contraceptive methods. The role of Lady Health Workers in family planning counseling and service provision and uptake is important in the context of Sindh and should be fostered further by opportunities for capacity building and their empowerment.

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“…Pakistan is a low-middle-income South Asian country that has high mortality rates among women, especially in rural areas where there are a limited number of reproductive health services, healthcare facilities and trained healthcare providers [19]. Recurrent disasters (earthquakes and glacial lake outburst flooding) are common in the northern mountainous regions of rural Pakistan, resulting in the displaced communities experiencing homelessness and living in cramped living conditions, mainly in tents or shelters that lack basic facilities [20].…”

Section: Introductionmentioning

confidence: 99%

Barriers to Women’s Menstrual Hygiene Practices during Recurrent Disasters and Displacement: A Qualitative Study

Hirani

2024

IJERPH

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Disasters that involve displacement are particularly challenging for managing personal and menstrual hygiene, which can increase the risk of toxic shock syndrome, infections and other health conditions that can endanger women’s lives. This study aimed to examine the menstrual hygiene challenges experienced by internally displaced women affected by recurrent natural disasters and subsequent displacement in the context of a low–middle-income country, i.e., Pakistan. A critical ethnographic study was undertaken in disaster-relief camps in the northern region of Pakistan. Data were collected using multiple methods, including field observations, review of media reports and in-depth interviews with 18 women. The findings suggested that the key barriers to the personal and menstrual hygiene of women during recurrent disasters and displacement in the mountainous rural region of Pakistan include inadequate housing, lack of infrastructure and humanitarian aid, no waste disposal system and lack of women-friendly spaces in disaster-relief camps. Community-based collaboration is necessary for the implementation of effective interventions. A comprehensive menstrual response to promote the health and well-being of women during disasters must include menstruation supplies, supportive facilities (mainly toilets and bathing facilities), supplementary supplies for storing, washing and drying, disposal/waste management facilities, education and culturally appropriate spaces and supplies.

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Maternal mortality in Pakistan: Challenges, efforts, and recommendations

Cited by 14 publications

References 2 publications

Selective screening for inherited metabolic disorders in a tertiary care hospital of Karachi – A retrospective chart review

Selective screening for inherited metabolic disorders in a tertiary care hospital of Karachi – A retrospective chart review

Predictors of voluntary uptake of modern contraceptive methods in rural Sindh, Pakistan

Barriers to Women’s Menstrual Hygiene Practices during Recurrent Disasters and Displacement: A Qualitative Study

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