The value of intermittent growth monitoring in primary health care programmes

The objective of growth monitoring is to detect early growth faltering before the child becomes severely malnourished. It has been found in many large projects in the private sector and in Government run Primary Health Care (PHC) programmes that monthly weighing is not feasible which makes it impossible to develop a functional outreach programme on a sustainable basis. This study is an attempt to propose an intermittent growth monitoring which is operationally feasible for large scale PHC programmes in the public sector. A historical prospective study was conducted to find out the correlation of weights of children at different ages with weights at subsequent months. Two hundred and ninety-two growth cards of children were selected from two squatter settlements of Karachi which are having a PHC programme through the Aga Khan University. At six months, about 71% of children were within the normal range, with increasing age from 10% to 39% of these children shifted to grade I Protein Energy Malnutrition (PEM). When weights of children for each month were correlated with weights at all other months up to 24 months, it was found that correlation coefficient at 6th and 9th month were significant (P value \u3c 0.001). Probability of developing malnutrition at different weights and ages were also calculated. The results indicate that malnutrition starts appearing at 6 months and weights at 6 months and to a lesser extent at 9 months are better prognostic indices of future malnutrition. Intermittent weighing of children can help in early identification of high risk children who can then be managed and even be prevented from developing future malnutrition

Causes of reproductive age mortality in low socioeconomic settlements of Karachi

The Maternal and Infant Mortality Survey (MIMS) was conducted in eight squatter settlements of Karachi. The female mortality rate was 151.0 per 100,000 women aged 10-49 years and the maternal mortality ratio was 281 per 100,000 livebirths. The leading causes of deaths among women were complications of pregnancy (28.1%), infectious diseases (24.8%), cardiovascular diseases (20.7%), neoplasia (10.7%) and trauma (10.7%). Hemorrhage (47.1% of all maternal deaths), tuberculosis (40.0% of all infectious disease deaths), oropharyngeal cancer (23.1% of all neoplastic deaths), and burns (61.5% of all trauma deaths) were among the major causes identified. Maternal deaths were associated with young age and nulliparity (p-value \u3c 0.01), and a higher proportion occurred in the hospital or on the way to the hospital as compared to non-maternal deaths

Risk factors for intrauterine growth retardation: results of a community-based study from Karachi

There is a serious lack of community-based information on low birthweight or intrauterine growth retardation from Pakistan. A community based prospective study was conducted in four squatter settlements of Karachi, to examine the prevalence and risk factors for adverse pregnancy outcome. This paper reports on the prevalence and risk factors for intrauterine growth retardation (age) among 755 singleton births. The incidence of intrauterine growth retardation was 25.4% (192 intrauterine growth retarded and 563 appropriate for gestational age). Major socioeconomic risk factors identified were low maternal education (RR = 1.4, 95% CI = 1.0,2.1) and poor housing material (RR = 1.7, 95% CI = 1.0,3.0). Among the significant biologic factors, primiparity (RR = 1.9, 95% CI = 1.4,2.7), consanguinity (RR = 1.4, 95% CI = 1.4,2.7), consanguinity (RR = 1.4, 95% CI = 1.1,1.8), short birth to CI = 1.1,2.1), short stature (RR = 2.2, 95% CI = 1.6,3.0), low maternal weight (RR = 2.0, 95% CI = 1.6,2.5) and non-vegetarian diet (RR = 2.3, 95% CI = 1.3,4.2) were especially important. Investigations to assess the adverse mortality and morbidity effects of intrauterine growth retardation are ongoing

Maternal mortality in different Pakistani sites: ratios, clinical causes and determinants

Background: Population-based estimates of maternal mortality from Pakistan are inadequate to define the magnitude of the problem or provide information on clinical causes and determinants.Methods: Surveys were conducted in selected clusters in Karachi, Balochistan and North West Frontier Province from 1989-1992. Pre-coded questionnaires were administered to 38,563 households to ascertain household characteristics, complete pregnancy histories and deaths of household members in the five years preceding the survey. Verbal autopsy questionnaires were then conducted to establish cause of death to women in the reproductive age group. Descriptive, bivariate and multivariable analyses were carried out to determine the association between the background variables, biological and women\u27s status indicators and maternal mortality using a nested case-control design.Results: Overall, the estimated maternal mortality ratio combining the data from the different sites was 433 per 100,000 livebirths. The estimated maternal mortality ratios per 100,000 livebirths ranged from a low of 281 in Karachi to a high of 673 in Khuzdar [Balochistan]. Hemorrhage (52.9%), puerperal sepsis (16.3%) and eclampsia (14.4%) were the leading causes for direct maternal deaths. Logistic regression identified the important risk factors as poor housing construction material (OR = 2.1; 95% CI = 1.3,3.2), distance of 40 or more miles from nearest hospital (OR = 1.3; 95% CI = 0.9,1.8), grandmultigravidity (OR = 1.6; 95% CI = 1.1,2.4) and prior fetal losses (OR = 5.3; 95% CI = 3.8,7.4).CONCLUSION: Focusing on special groups of pregnant women with targeted programs such as training, monitoring and supervision of birth attendants for the provision of oxytocics, will go a long way in decreasing the proportion of maternal deaths attributed to direct, avoidable causes