Attitudes of Pakistani men to domestic violence: A study from Karachi, Pakistan

Aim: To explore men\u27s attitudes on wife abuse and examine predictors for the risk of physical abuse in a cohort of Pakistani men. Methods: Men were identified based on convenience sampling from three socioeconomic venues. A total of 176 men (≥18 years) who were married for at least 1 year and lived with their wives during the preceding year were interviewed. Information on demographics, behaviours, and attitudes to wife abuse (verbal and physical) were elicited. Results: The lifetime prevalence of marital physical abuse was 49.4%; slapping, hitting or punching was most often reported (47.7%). Of the men 55% were themselves victims of physical violence during childhood and 65% had, as children, observed their mother being beaten. Almost half of the subjects thought that husbands have a right to hit their wives (46.0%). Significant predictors in the logistic regression analysis included low socioeconomic status (OR 2.6; 95% CI 1.1, 6.1), marriage duration of ≥ 5 years (OR 3.0; 95% CI 1.3,6.9), beaten as a child (OR 4.5; 95% CI 2.1,9.6) and witnessed mother beaten as a child (OR 2.7; 95% CI 1.2,6.0). Study limitations, convenience sampling and small sample size, should be viewed in the context of the rarity of South Asian wife abuse studies. Conclusions: The burden of wife abuse in Pakistani society, the inter-generational cycle of violence perpetuation, men\u27s right to physically abuse their wives, in concert with their felt need of some type of help suggest that interventions should consider preventing child abuse in addition to adopting strategies to prevent spousal abuse

Health service utilization for perceived postpartum morbidity among poor women living in Karachi

To explore traditional beliefs and practices, to assess puerperal morbidity, and to understand care-seeking behaviors, a qualitative and quantitative study was conducted in low socio-economic settlements of Karachi, Pakistan. Five focus group discussions and 15 in-depth interviews were conducted in July and August 2000. 525 Muslim women, who were 6–8 weeks post-partum, were then interviewed at home. Maternal care was relatively good—more than three-quarters of recent mothers sought antenatal care and more than half (267/525) delivered in a hospital or maternity home. Counseling to attend post-partum clinics among facility deliveries was 16% (43/267), of which only 26% (11/43) attended. Practices during the delivery and puerperium, such as massaging the vaginal walls with mustard oil during labor to facilitate delivery and inserting vaginal or rectal herbal pessaries to facilitate ‘shrinkage of the uterus’ and/or ‘strengthening of the backbone’, were pervasive.The core symptoms that are clinically significant during the puerperium are heavy vaginal bleeding and high fever, since they are potentially fatal symptoms if appropriate and timely care is not sought. About half of the study women (53.3%) reported at least one illness symptom, high fever (21.1%), heavy vaginal bleeding (13.9%), and foul smelling vaginal discharge (9.6%). Women did not know the underlying biologic cause of their perceived post-partum morbidity; weakness was frequently mentioned. Women sought care initially from close relatives or traditional healers and if they continued to suffer from their morbidity they finally approached a trained health care (allopathic) provider. The high prevalence of perceived post-partum morbidity illustrates the demand for post-partum community-based health care programs. We suggest promoting maternal health education that encourages women to seek appropriate and timely care by accessing public or private health services

Newborn care practices in low socioeconomic settlements of Karachi, Pakistan

To explore traditional neonatal beliefs and care practices and to assess the predictors for giving prelacteal feeds, a qualitative and quantitative study was conducted in low socioeconomic settlements of Karachi, Pakistan. Five focus group discussions and 15 in-depth semi-structured interviews were conducted in July and August 2000; structured questionnaires were administered to 525 recently delivered women through November.Antenatal care coverage was common; a little over half of the women delivered at home with traditional birth attendants. Among the 387 women who reported at least one antenatal visit, most (78.6%) reported receiving counseling on breastfeeding by their healthcare provider. A significant proportion of women (44.8%) reported giving lacteals; colostrum (41.7%) or animal/formula milk (3.1%), as the first feed. Newborns were bathed immediately (82.1%) after delivery as the vernix was considered ‘dirty looking’ (78.5%), and it was felt it should be removed. To foster muscle relaxation (80.2%) and strengthen the bones (43.0%), daily massage was universally practiced, mustard oil (75.9%) being the most frequently used lubricant.Risky feeding practices such as giving prelacteals (55.0%) or supplementary feeds (71.3%), or delaying first feed (30.9%) were common. During the neonatal period, breast milk was the preferred feed (98.6%); however, honey (28.7%), ghutti (27.8%) and water (11.8%) were also given in order to ‘reduce colic’ or ‘act as a laxative’, which were perceived health benefits mentioned by mothers and traditional birth attendants. Ethnicity and birth attendant at delivery were strong predictors for women who gave prelacteals (after adjusting for education, socioeconomic status and facility delivery). Although administration of colostrum as the first feed was relatively common in this setting, the predominance of other risky traditional newborn care practices stresses the need for promoting health education programs on improving newborn care practices

Health service utilization for perceived postpartum morbidity among poor women living in Karachi

To explore traditional beliefs and practices, to assess puerperal morbidity, and to understand care-seeking behaviors, a qualitative and quantitative study was conducted in low socio-economic settlements of Karachi, Pakistan. Five focus group discussions and 15 in-depth interviews were conducted in July and August 2000. 525 Muslim women, who were 6-8 weeks post-partum, were then interviewed at home. Maternal care was relatively good--more than three-quarters of recent mothers sought antenatal care and more than half (267/525) delivered in a hospital or maternity home. Counseling to attend post-partum clinics among facility deliveries was 16% (43/267), of which only 26% (11/43) attended. Practices during the delivery and puerperium, such as massaging the vaginal walls with mustard oil during labor to facilitate delivery and inserting vaginal or rectal herbal pessaries to facilitate 'shrinkage of the uterus' and/or 'strengthening of the backbone', were pervasive. The core symptoms that are clinically significant during the puerperium are heavy vaginal bleeding and high fever, since they are potentially fatal symptoms if appropriate and timely care is not sought. About half of the study women (53.3%) reported at least one illness symptom, high fever (21.1%), heavy vaginal bleeding (13.9%), and foul smelling vaginal discharge (9.6%). Women did not know the underlying biologic cause of their perceived post-partum morbidity; weakness was frequently mentioned. Women sought care initially from close relatives or traditional healers and if they continued to suffer from their morbidity they finally approached a trained health care (allopathic) provider. The high prevalence of perceived post-partum morbidity illustrates the demand for post-partum community-based health care programs. We suggest promoting maternal health education that encourages women to seek appropriate and timely care by accessing public or private health services.Traditional practices Care-seeking behavior Pakistan Post-partum morbidity Puerperium Socioeconomic status,Karachi

Pakistani obstetricians\u27 recognition of and attitude towards domestic violence screening

Objective: Our study assesses Pakistani obstetricians knowledge of the prevalence of domestic violence in clinical practice and attitudes towards instituting screening protocols during routine antenatal care. Methods: One hundred obstetricians, all Karachi residents, were randomly drawn from a stratified sampling list taken from membership lists. A structured questionnaire assessing prevalence, attitudes, and beliefs on training and domestic violence screening protocols was administered. Results: Nearly 70% of obstetricians reported that more than 30% of Pakistani women are victims of domestic abuse. Sixty-two obstetricians specified that they had identified a physically abused woman within the past year. Almost half of the respondents were favorably inclined to screen patients. Professional, personal and patient-related barriers were identified as the main hurdles preventing instituting screening. Conclusions: The desire for instituting routine screening despite the recognition of major hurdles by Pakistani obstetricians should propel reproductive health stakeholders to raise awareness about appropriately modifying standard antenatal care protocols

Newborn care practices in low socioeconomic settlements of Karachi, Pakistan

To explore traditional neonatal beliefs and care practices and to assess the predictors for giving prelacteal feeds, a qualitative and quantitative study was conducted in low socioeconomic settlements of Karachi, Pakistan. Five focus group discussions and 15 in-depth semi-structured interviews were conducted in July and August 2000; structured questionnaires were administered to 525 recently delivered women through November. Antenatal care coverage was common; a little over half of the women delivered at home with traditional birth attendants. Among the 387 women who reported at least one antenatal visit, most (78.6%) reported receiving counseling on breastfeeding by their healthcare provider. A significant proportion of women (44.8%) reported giving lacteals; colostrum (41.7%) or animal/formula milk (3.1%), as the first feed. Newborns were bathed immediately (82.1%) after delivery as the vernix was considered 'dirty looking' (78.5%), and it was felt it should be removed. To foster muscle relaxation (80.2%) and strengthen the bones (43.0%), daily massage was universally practiced, mustard oil (75.9%) being the most frequently used lubricant. Risky feeding practices such as giving prelacteals (55.0%) or supplementary feeds (71.3%), or delaying first feed (30.9%) were common. During the neonatal period, breast milk was the preferred feed (98.6%); however, honey (28.7%), ghutti (27.8%) and water (11.8%) were also given in order to 'reduce colic' or 'act as a laxative', which were perceived health benefits mentioned by mothers and traditional birth attendants. Ethnicity and birth attendant at delivery were strong predictors for women who gave prelacteals (after adjusting for education, socioeconomic status and facility delivery). Although administration of colostrum as the first feed was relatively common in this setting, the predominance of other risky traditional newborn care practices stresses the need for promoting health education programs on improving newborn care practices.Beliefs Colostrum Pakistan Practices Prelacteals Newborn care

A randomized trial of misoprostol compared with manual vacuum aspiration for incomplete abortion

Objective: To compare the safety, efficacy, and acceptability of misoprostol and manual vacuum aspiration for the treatment of incomplete abortion in a hospital setting in Kampala, Uganda. Methods: Three hundred seventeen women with clinically diagnosed incomplete first-trimester abortions were randomized to treatment with either manual vacuum aspiration or 600 μg misoprostol orally to complete their abortions. All women received antibiotics posttreatment and were followed up 1-2 weeks later. Results: Regardless of treatment allocation, nearly all women in this study successfully completed their abortions with either oral misoprostol or manual vacuum aspiration (96.3% versus 91.5%, relative risk 1.05, 95% confidence interval 0.98-1.14). Complications were less frequenl in those receiving misoprostol than those having manual vacuum aspiration (0.9% versus 9.8%, relative risk 0.1, 95% confidence interval 0.01-0.78). In the 6 hours after treatment, women using misoprostol reported heavier bleeding but lower levels of pain than those treated with manual vacuum aspiration. Rates of acceptability were similarly high among women in the 2 treatment groups, with 94.2% and 94.7% of women reporling that their treatment was satisfactory or very satisfactory in the misoprostol and manual vacuum aspiration groups, respectively. Conclusion: For treatment of first-trimester uncomplicated incomplete abortion, both manual vacuum aspiration and 600 jug oral misoprostol are safe, effective, and acceptable treatments. Based on availability of each method and the wishes of individual women, either option may be presented to women for the treatment of incomplete abortion

Is home-based administration of prostaglandin safe and feasible for medical abortion? Results from a multisite study in Vietnam

Objectives: To study the efficacy and acceptability of a simplified medical abortion regimen in Vietnam. Design: Open-label study. Setting: One peri-urban and three urban hospitals and four urban maternal-child health family planning clinics located in Northern, Central and Southern Vietnam. Sample: A total of 1601 women seeking abortion services from January 2001 to December 2001. Methods: Consenting women presenting for abortion services with gestations less than 56 days LMP who met the inclusion criteria were given 200 mg mifepristone and offered the choice of either home or clinic administration of 400 μg oral misoprostol two days later. Main outcome measure: Complete abortion rate of 89.2% (n = 1395), with 1.5% (n = 24) of the women lost to follow up. The majority of women (\u3e 90%) reported that their medical abortion experience was either \u27very satisfactory\u27 or \u27satisfactory\u27. Results: There was a strong preference for home administration of misoprostol, with more than four-fifths of the study population selecting to administer the prostaglandin at home. Location of misoprostol administration did not affect efficacy rate. Regardless of location selected, women expressed a high degree of satisfaction with the medical abortion experience. Conclusions: Medical abortion with the option of home administration of misoprostol is safe and feasible for introduction into the Vietnamese healthcare system

A systematic review of the relationship between blood loss and clinical signs.

INTRODUCTION: This systematic review examines the relationship between blood loss and clinical signs and explores its use to trigger clinical interventions in the management of obstetric haemorrhage. METHODS: A systematic review of the literature was carried out using a comprehensive search strategy to identify studies presenting data on the relationship of clinical signs & symptoms and blood loss. Methodological quality was assessed using the STROBE checklist and the general guidelines of MOOSE. RESULTS: 30 studies were included and five were performed in women with pregnancy-related haemorrhage (other studies were carried in non-obstetric populations). Heart rate (HR), systolic blood pressure (SBP) and shock index were the parameters most frequently studied. An association between blood loss and HR changes was observed in 22 out of 24 studies, and between blood loss and SBP was observed in 17 out of 23 studies. An association was found in all papers reporting on the relationship of shock index and blood loss. Seven studies have used Receiver Operating Characteristic Curves to determine the accuracy of clinical signs in predicting blood loss. In those studies the AUC ranged from 0.56 to 0.74 for HR, from 0.56 to 0.79 for SBP and from 0.77 to 0.84 for shock index. In some studies, HR, SBP and shock index were associated with increased mortality. CONCLUSION: We found a substantial variability in the relationship between blood loss and clinical signs, making it difficult to establish specific cut-off points for clinical signs that could be used as triggers for clinical interventions. However, the shock index can be an accurate indicator of compensatory changes in the cardiovascular system due to blood loss. Considering that most of the evidence included in this systematic review is derived from studies in non-obstetric populations, further research on the use of the shock index in obstetric populations is needed