Demographic, socio-economic and environmental determinants of utilisation of antenatal care in a rural setting of Sindh, Pakistan

Objective: Majority of the women in the developing countries are unable receive antenatal care for a variety of reasons. This study determines the factors affecting utilisation of antenatal care by women of a rural area in Sindh, Pakistan.Methods: A cross-sectional study was conducted during August 1997, in Union Council Jhangara, Sindh, Pakistan. Married women, who had delivered at least one child, were included in the study from each household and systematically 222 eligible women were selected. The effects of demographic, socio-economic and environmental factors on the utilisation of antenatal care, by women during their most recent pregnancy were also studied. Multivariate logistic regression analysis was used to assess independent effect of individual factors.Results: Among the study subjects, 29.3% (65) of the women utilised antenatal care during the last (most recent) pregnancy and out of them 72.3% (47) received it from the government health care provider. Presence of electricity in the house was strongly associated with the utilisation of antenatal care (AOR = 5.3; 95% CI 2.2-12.7). Women whose husbands were in white-collar occupation, were utilizing the antenatal care significantly more (AOR = 2.4; 95% CI 1.2-4.6) compared to women whose husbands were in blue-collar occupations.CONCLUSION: The study shows that social status and economic condition of a woman is an important determinant of utilisation of antenatal care. Therefore, improvement of socioeconomic status is required to increase utilization of antenatal and perinatal care

Maternal and newborn care: Practices and beliefs of traditional birth attendants in Sindh, Pakistan

Maternal mortality, infant mortality and neonatal mortality are high in Pakistan where maternal health services depend upon traditional birth attendants (TBAs). We examined the practices of TBAs in Dadu district in rural Sindh from September to November 1998 by interviewing and hosting focus group discussions with 17 TBAs. Health care personnel and other important members of the community were also interviewed. TBAs worked in areas demarcated by extended families, ethnicity or geographical access and a system of seniority was observed. Only one TBA was formally trained and antenatal and postnatal care concepts, cleanliness and equipment were inadequate. Communities trusted the TBAs and remunerated them according to factors particular to each birth. TBAs need training and to be linked with the formal health sector to effect change and to decrease maternal and neonatal mortality

Knowledge about hepatitis B and C among patients attending family medicine clinics in Karachi

Knowledge about hepatitis B and C was assessed in a cross-sectional study of 300 adults aged 18 or older attending family medicine clinics at The Aga Khan University Hospital, Karachi. Most knew that hepatitis B and C are viral diseases that primarily affect the liver, but knowledge about risk factors for disease transmission was poor. Approximately 70% knew that hepatitis B is vaccine preventable; 60% had the misconception that hepatitis C is also vaccine preventable. The majority incorrectly believed that people with hepatitis B or C should follow the diet \u27parhaiz\u27. Generally women knew more than men about the diseases. This study suggests that health education about these infections should be provided to the public. Family physicians can play an important role in educating people about the prevention of these diseases

An Optical Characterization of the Effect of High-Pressure Hydrodynamic Cavitation on Diesel

Most modern high-pressure common rail diesel fuel injection systems employ an internal pressure equalization system in order to provide the force necessary to support needle lift, enabling precise control of the injected fuel mass. This results in the return of a substantial proportion of the high-pressure diesel back to the fuel tank. The diesel fuel flow occurring in the injector spill passages is expected to be a cavitating flow, which is known to promote fuel ageing. The cavitation of diesel promotes nano-particle formation through induced pyrolysis and oxidation, which may result in deposit formation in the vehicle fuel system. A purpose-built high-pressure cavitation flow rig has been employed to investigate the stability of unadditised crude-oil derived diesel and a paraffin-blend model diesel, which were subjected to continuous hydrodynamic cavitation flow across a single-hole research diesel nozzle. Continuous in-situ spectral optical extinction (405 nm) has been employed to identify, determine and measure variations in fuel composition as a function of the cavitation duration. The results of two high-pressure diesel cavitation experiments are reported. The first dealt with the effect of injection pressure on the rate of induced variation in chemical composition of diesel, and concluded that faster degradation of the fuel occurred at higher pressure. The second experiment involved an investigation into the variation in composition occurring in diesel fuel and the paraffin-blend model diesel, subjected to cavitating flow over a longer duration. Observed differences suggest that the high-pressure cavitation resulted in hydrodynamic sono-chemical destruction of aromatics in the diesel, which is believed to lead to carbonaceous nano-particle formation

Burden and associated factors for caregivers of the elderly in a developing country

The elderly population in South Asia is growing. In Pakistan trained caregivers are scarce and culturally not acceptable. This study assessed the level of stress experienced by caregivers of the elderly and determined the association of care giving burden with different characteristics of the elderly. A cross-sectional, questionnaire based study was conducted using nonprobability purposive sampling. All consenting participants aged 60 years and above needing help with at least one activity of daily living or two instrumental activities of daily living were included. 350 participants were assessed for perceived care giver burden. Care providers were mostly female (68.9%). Half (50.3%) of the caregivers had a positive score on a perceived care burden scale. Financial impact had a strong correlation (0.79) with perceived caregiver burden. Higher dependency levels of a physical and cognitive nature posed greater burden on caregivers. Behavioural issues of the elderly such as verbal abuse and difficulty sleeping were predictors of a higher caregiver burden. Caregiver burden is a significant issue for those caring for elderly family members in Karachi, Pakistan

Dynamics of Post-Injection Fuel Flow in Mini-Sac Diesel Injectors Part 1: Admission of 1 External Gases and Implications for Deposit Formation

Samples of unadditized, middle distillate diesel fuel were injected through real-size optically accessible mini-sac diesel injectors into ambient air at common rail pressures of 250 bar and 350 bar respectively. High-resolution images of white light scattered from the internal mini-sac and nozzle flow were captured on a high-speed monochrome video camera. Following the end of each injection, the momentum-driven evacuation of fuel liquid from the mini-sac and nozzle holes resulted in the formation of a vapour cloud and bubbles in the mini-sac, and vapour capsules in the nozzle holes. This permitted external gas to gain entrance to the nozzle holes. The diesel fuel in the mini-sac was observed to rotate with large initial vorticity, which decayed until the fuel became stationary. The diesel fuel remaining in the nozzle holes was observed to move inwards towards the mini-sac or outwards towards the nozzle exit in concert with the rotational flow in the mini-sac. The mini-sac bubbles’ internal pressure differences revealed that the bubbles must have contained previously dissolved oxygen and nitrogen. Under diesel engine operating conditions, this multi-phase mixture would be highly reactive and could initiate local pyrolysis and/or oxidation reactions. Finally, the dynamical behaviour of the diesel fuel in the nozzle holes would support the admission of external hot combustion gases into the nozzle holes, establishing the conditions for oxidation/pyrolysis reactions with surrounding liquid fuel films

An Investigation into the Effect of Hydrodynamic Cavitation on Diesel using Optical Extinction

A conventional diesel and paraffinic-rich model diesel fuel were subjected to sustained cavitation in a custom-built high-pressure recirculation flow rig. Changes to the spectral extinction coefficient at 405 nm were measured using a simple optical arrangement. The spectral extinction coefficient at 405 nm for the conventional diesel sample was observed to increase to a maximum value and then asymptotically decrease to a steady-state value, while that for the paraffinic-rich model diesel was observed to progressively decrease. It is suggested that this is caused by the sonochemical pyrolysis of mono-aromatics to form primary soot-like carbonaceous particles, which then coagulate to form larger particles, which are then trapped by the filter, leading to a steady-state spectral absorbance

COVID-19 and Mental Health of Primary Healthcare Workers (PHCWS): lessons from a large-scale inquiry in Sindh and Punjab Provinces of Pakistan.

Research and Policy brief: Hameed W, Avan BI, Khan B, Fatmi Z, Feroz AS, Jafri SH, Wassan MA, Siddiqi S. COVID-19 and Mental Health of Primary Healthcare Workers (PHCWS): lessons from a large-scale inquiry in Sindh and Punjab Provinces of Pakistan. 2022, Aga Khan University

Birthing practices of traditional birth attendants in South Asia in the context of training programmes

Traditional Birth Attendants (TBA) training has been an important component of public health policy interventions to improve maternal and child health in developing countries since the 1970s. More recently, since the 1990s, the TBA training strategy has been increasingly seen as irrelevant, ineffective or, on the whole, a failure due to evidence that the maternal mortality rate (MMR) in developing countries had not reduced. Although, worldwide data show that, by choice or out of necessity, 47 percent of births in the developing world are assisted by TBAs and/or family members, funding for TBA training has been reduced and moved to providing skilled birth attendants for all births. Any shift in policy needs to be supported by appropriate evidence on TBA roles in providing maternal and infant health care service and effectiveness of the training programmes. This article reviews literature on the characteristics and role of TBAs in South Asia with an emphasis on India. The aim was to assess the contribution of TBAs in providing maternal and infant health care service at different stages of pregnancy and after-delivery and birthing practices adopted in home births. The review of role revealed that apart from TBAs, there are various other people in the community also involved in making decisions about the welfare and health of the birthing mother and new born baby. However, TBAs have changing, localised but nonetheless significant roles in delivery, postnatal and infant care in India. Certain traditional birthing practices such as bathing babies immediately after birth, not weighing babies after birth and not feeding with colostrum are adopted in home births as well as health institutions in India. There is therefore a thin precarious balance between the application of biomedical and traditional knowledge. Customary rituals and perceptions essentially affect practices in home and institutional births and hence training of TBAs need to be implemented in conjunction with community awareness programmes

COVID-19 and Mental Health of Secondary-Level and Tertiary-Level Healthcare Workers: lessons from a large-scale inquiry in Sindh and Punjab Provinces of Pakistan.

Research and Policy brief: Hameed W, Avan BI, Khan B, Fatmi Z, Feroz AS, Jafri SH, Wassan MA, Siddiqi S. COVID19 and Mental Health of Secondary-Level and Tertiary-Level Healthcare Workers: lessons from a large-scale inquiry in Sindh and Punjab Provinces of Pakistan. 2022, Aga Khan University