Neonatal Mortality and Prevalence of Practices for Newborn Care in a Squatter Settlement of Karachi, Pakistan: A Cross-Sectional Study

Background: During the past two decades there has been a sustained decline in child and infant mortality, however neonatal mortality has remained relatively unchanged. Almost all neonatal deaths (99%) occur in developing countries, where the majority are delivered at homes. Evidence suggests that these deaths could be prevented by simple, inexpensive practices and interventions during the pregnancy, delivery and postnatal period. In Pakistan over the last decade extensive efforts have been made by the international donors and government to implement these practices. However, limited attempts have been made to explore if these efforts have made a difference at the grass root level. This study assessed the burden of neonatal mortality and prevalence of practices for newborn care in a squatter settlement of Karachi, Pakistan.Methodology/Principal Findings: A community based cross-sectional study was performed. A pre-tested structured questionnaire was administered to 565 women who had recently delivered. Information was collected on neonatal morbidity, mortality and practices of women regarding care during pregnancy, child birth and for newborn, till 28th day of birth. Although 70% of women mentioned receiving antenatal care by a skilled provider, only 54.5% had four or more visits. Tetanus toxoid was received by 79% of women while only 56% delivered at a health care facility by a skilled attendant. Newborn care practices like bathing the baby immediately after birth (56%), giving pre-lacteals (79.5%), late initiation of breast feeding (80.3%), application of substances on umbilical cord (58%) and body massage (89%) were common. Most neonates (81.1%) received BCG injection and polio drops after birth. Neonatal mortality rate was 27/1000 live births with the majority of deaths occurring during the first three days of life.Conclusion: Even after years of efforts by government and nongovernmental sector to reduce newborn morbidity and mortality, inadequate antenatal care, home deliveries and unhealthy newborn care practices are highly prevalent. This leads us to important questions of why practices and behaviors have not changed. Who is responsible and what strategies are needed to bring this change

Prevalence of adverse neonatal events and their association with neonatal health care practices of mothers in squatter settlements of Karachi, Pakistan

During past few decades there has been considerable emphasis on reducing child mortality largely through immunization and oral dehydration. This resulted in sustained decline in infant mortality; however neonatal mortality has remained relatively unchanged. Worldwide neonatal mortality is estimated to be 4 million annually, of which 99% are in developing countries, where most of newborns are delivered at home and die without reaching health care facility. There is a huge gap in reliable information on the magnitude and factors associated with neonatal mortality and morbidity in communities. This study aimed to estimate the prevalence of adverse neonatal events and neonatal health care practices of mothers in squatter settlements of Karachi, Pakistan. It also sought to assess the association of adverse neonatal events with neonatal health care practices of mothers. A cross-sectional study was conducted from August 2006 to November 2006 in Azam Basti and near by areas. Data was collected from recently delivered women between 28 and 33 days post delivery. A structured questionnaire was used to obtain information on 565 women in the study area. Data was analyzed using appropriate descriptive analysis and multiple logistic regression analysis. Prevalence of adverse neonatal events was 5.3% (95 %CI:3.5%,7.1%).Neonatal mortality rate was estimated to be 27/1000 live births. Most of neonatal adverse events (90%) were observed during the first week of birth. Of these 45% were seen on first day of life. Receiving antenatal care from a skilled provider was common (72.4%) although only half of women received four visits from skilled provider. Although tetanus toxoid immunization coverage during pregnancy was common, iron and appropriate folic acid use was reported by only 23% and 16% of women. About 56% of deliveries were conducted in health care facility. Among women whose neonate had an adverse event about 73% received appropriate antenatal care and 77% were born in health care facility. A high prevalence of unhealthy newborn care practices were seen in the study area. About 56% of the newborns were bathed immediately after birth. Although majority of the women (97%) reported breast feeding the newborns, unhealthy practices like giving prelacteals (80%) and delaying first feed (80%) were common. Fifty eight percent of women applied some substance on the umbilical cord; ointment (33%) was the most commonly reported substance followed by ghee (27%), coconut oil (19%), mustard oil (9.5%) and others. Massage to the baby was universally practiced; mustard oil (73%) being most frequently used. Majority of neonates (81%) received immunization injection and polio drops after birth. Results indicated that women whose neonate had an adverse event were 4.8 times (CI:2.2,10.3) more likely to have illness during pregnancy than women whose neonate were healthy. We found reduced risk of 0.45(CI:0.27,0.75) per 5 years increase in maternal age. We also found a reduced risk of adverse events in those who belonged to lower (OR: 0.22,CI:0.07, 0.75) and middle (OR:0.36,CI:0.13, 0.95) SES. Neonatal mortality is high considering the easy availability of health care facilities in Karachi. Illness of women during pregnancy is significantly associated with adverse neonatal events. Therefore there is a need to provide continuum of care which should include care during antenatal, natal and post natal period. Unhealthy neonatal health care practices are highly prevalent in the study area. Behavioral change communication strategies are required to educate the mothers and TBAs about healthy newborn care practices

Percentage distribution of postnatal newborn care practices.

<p>*Most of these babies died within first three days of life.</p><p>#These babies were ill at birth and did not receive immunization, application.</p><p>on cord or neonatal massage.</p

Demographic and reproductive characteristics of the study population (n = 565).

<p>Demographic and reproductive characteristics of the study population (n = 565).</p

Percentage distribution of Natal care practices.

<p>*Properly covered: Newborn covered from head to toe when handed over to mother.</p

Description of neonatal morbidity and mortality.

<p>Description of neonatal morbidity and mortality.</p

Percentage distribution of Antenatal Care practices.

<p>*Appropriate antenatal care: a woman having ≥4 visits from a skilled provider.</p

Experimental and Computational Analysis of MnO2@V2C-MXene for Enhanced Energy Storage

Herein, we studied the novel and emerging group of 2D materials namely MXene along with its nanocomposites. This work entails detailed experimental as well as computational study of the electrochemical behavior of vanadium carbide (V2CTx) MXene and MnO2-V2C nanocomposite with varying percentages of MnO2. A specific capacitance of 551.8 F/g was achieved for MnO2-V2C nanocomposite in 1 M KOH electrolyte solution, which is more than two times higher than the gravimetric capacitance of 196.5 F/g obtained for V2C. The cyclic stability achieved for the MnO2- V2C nanocomposite resulted in a retentivity of 96.5% until 5000 cycles. The c-lattice parameter achieved for MXene is 22.6 Å, which was 13.01 Å for MAX phase. The nanocomposite resulted in a c-lattice parameter of 27.2 Å, which showed that the spatial distance between the MXene layers was efficiently obtained. The method of wet etching was used for the preparation of pristine MXene and the liquid phase precipitation method was opted for the synthesis of the MnO2-V2C nanocomposite. Density functional theory calculation was exercised so as to complement the experimental results and to understand the microscopic details, such as structure stability and electronic structure. The current report presents a comprehensive experimental and computational study on 2D MXenes for future energy storage application