Crowding--a risk factor for perinatal mortality?

Crowding is known to be associated with an increased risk of infant and child morbidity and mortality particularly due to infections. We examined the association of crowding with perinatal mortality. Our results indicated a paradoxical relationship with the least crowded households showing the highest perinatal mortality (7.7% as compared to 4.7%). However, further analysis indicated that the observed paradoxical relationship is a spurious one, largely explained by the confounding effect of gravidity

Perceived gynecological morbidity among young ever-married women living in squatter settlements of Karachi, Pakistan

Background: Community-based information on obstetric and gynecological morbidity in developing countries is meager and nearly non-existent in Pakistan.Objectives: To estimate the prevalence of specific gynecological morbidities and investigate the predictors of pelvic inflammatory disease.Methods: Users [404] and non-users [313] of modern contraceptives were identified from eight squatter settlements of Karachi, Pakistan and detailed information on basic demographics, contraceptive use, female mobility, decision-making and gynecological morbidities were elicited.Results: The perceived prevalence of menstrual disorders were 45.3%, uterine prolapse 19.1%, pelvic inflammatory disease 12.8% and urinary tract infection 5.4%. The magnitude of gynecological morbidity was high with about 55% of women reporting at least one gynecological morbidity though fewer [20%] reported at least two gynecological morbidities. Significant predictors of pelvic inflammatory disease were intrauterine contraceptive device users (OR = 3.1; 95% CI 1.7-5.6), age \u3c or = 20 years (OR = 2.3; 95% CI 1.1-4.8) and urban life style (OR = 2.1; 95% CI 1.0-4.6).CONCLUSION: There is an immense burden of reproductive ill-health and a significant association between ever users of intrauterine contraceptive device and pelvic inflammatory disease. We therefore suggest improvement in the quality of reproductive health services generally, but specifically for family planning services

Induced abortions in low socio-economic settlements of Karachi, Pakistan: rates and women\u27s perspectives

Objective: The aim of the study was to determine rates on induced abortions and to identify the perceived and actual reasons for terminating an unplanned pregnancy, health care providers sought, methods used and post-abortion complications.SETTING: Three squatter settlements of Karachi, Pakistan.SUBJECTS: Interviews were conducted on 1,214 ever-married women in the reproductive age group (15-49) with a reproductive history of at least one pregnancy, irrespective of outcome.Methods: A cross-sectional survey from June-August 1997 was conducted in three selected squatter settlements of Karachi.Results: The abortion rate for the past year was 25.5 per 1,000 women of reproductive age group. The post-abortion complication rate reported was 68.5% (61/89), of which fever and heavy vaginal bleeding was the most commonly reported complication (54.1%).CONCLUSION: The results indicate that women are aware of the high mortality and morbidity risk resulting from seeking an unsafe abortion but nevertheless opt for this approach to attain their goal of small family size rather than for a modern method of contraception. Furthermore, healthcare providers, irrespective of legality issues, provide such services due to demand. We suggest that family physicians and other relevant health care providers be trained for post-abortion care including post-abortion family planning counseling with an emphasis on emergency contraceptives

Critical appraisal by reading for medical students--a case study from Pakistan

Doctors read literature to keep abreast of medical advances. A recommendation from the 1993 World Summit for Medical Education is that medical schools should teach medical students to critically appraise scientific reports. The Department of Community Health Sciences of Aga Khan University Medical College teaches basic research methods to medical students. This is now supplemented with Critical Reading . Critical reading was first taught to 67 third year students between October, 1993 and May, 1994. A validity check-list for critical readers was introduced in a two week orientation consisting of three one-hour classroom sessions and four one-hour small group sessions. Thereafter, small groups met monthly to critique clinical epidemiological reports relevant to current organ system teaching. The students reading attitudes and critical appraisal skills were assessed through continuous assessment and a written final examination with questionnaire. All but three students passed the final examination (mean score (74%, standard deviation 12%). Sixty-four of 67 (96%) completed questionnaires. All (73% strongly) agreed that critical reading skills were essential, but only 30% strongly agreed that they had, indeed, mastered the skills. Ninety-seven percent (56% strongly) disagreed that year three was too early to start critical reading. Clinical teaching staff expressed interest in learning these skills. Students benefited from and enjoyed this first critical reading course. It strengthened ties between clinical and community health sciences teaching staff. The critical reading skills of the clinical teaching staff is being addressed in seminars to strengthen institutional research capacity

The quest for small family size among Pakistani women--is voluntary termination of pregnancy a matter of choice or necessity?

Objective: To present the socio-biologic predictors of induced abortion among married women residing in low income squatter settlements of Karachi, Pakistan.Methods: A cross-sectional survey was conducted in three squatter settlements of Karachi from June to August 1997. Interviews were conducted on 1,214 married women assessing past pregnancy history, literacy and employment status of self and spouse and specifically probing for past history of seeking an induced abortion.Results: Fifty women reported an induced abortion during last three years prior to survey. Of these, forty percent (20/50) of abortion seekers were using some method of family planning before conceiving the index pregnancy. Post abortion family planning method use was adopted by 50% (25/50) of the abortion seekers. The most parsimonious multivariate logistic regression model included grand-multigravidity (OR 2.6 CI, 1.3 - 5.2), literate status of the woman (OR 1.9 CI, 1.0 - 3.4) and the 26-35 age group (OR 3.0 CI, 1.4 - 6.6).CONCLUSIONS: Unplanned/mistimed pregnancies generally result from high unmet need and ineffective use of contraceptives and culminate through induced abortions. We propose that improvement in the quality of family planning counseling should be targeted to effective use of a method, back-up support in case of method failure and the health consequences of unsafe abortions

An epidemiologic study of cystitis among Muslim women attending an out-patients clinic in Karachi

Cystitis is considered to be one of the most common infections afflicting women of all age groups. It has been suggested that personal hygiene customs may influence the prevalence of cystitis. In this study, 130 women of child bearing age attending the out-patients clinic were interviewed in order to determine the frequency of cystitis and its associated risk factors including personal hygiene practices. Twenty seven percent of the women reported suffering from cystitis atleast once in the past, comparable to reported studies from the United States but higher than reported from other Muslim countries. Sixty-three percent of women reported their first episode during pregnancy and a significant relationship was observed between parity and cystitis (p value \u3c 0.000). However, personal hygiene practices following micturition or sexual intercourse bore no significant association with cystitis. Cystitis, commonly reported among Pakistani married women, occurs primarily during pregnancy. Preventive measures during pregnancy are suggested

A rapid community based health evaluation of pregnant women in low socioeconomic settlements of Karachi

A rapid nutritional and health evaluation of a random sample of 163 pregnant women was conducted in low socioeconomic settlements of Karachi, with the objective of determining the morbidity and nutritional status of pregnant women. These data are expected to be used in an ongoing community-based antenatal care programme. Twenty-nine percent of women reported fever, 14 percent diarrhoea and 33 percent respiratory infections in the previous week. Mean weight was 54.8 (+/- 10.6) kg, mean height was 151.6 (+/- 6.0) cm and mean midarm circumference was 25.6 (+/- 3.2) cm. The mean uterine height at gestational ages 8 months and over was 32.1 (+/- 10.2) cm which is below the 10th percentile. These results suggest a chronic, mildly malnourished population with a high rate of infections. Specifically, we suggest that maternal height and uterine height be used to assess women at high risk for low birthweight

Scaling Up a Strengthened Youth-Friendly Service Delivery Model to Include Long-Acting Reversible Contraceptives in Ethiopia: A Mixed Methods Retrospective Assessment

Background: Donor funded projects are small scale and time limited, with gains that soon dissipate when donor funds end. This paper presents findings that sought to understand successes, challenges and barriers that influence the scaling up and sustainability of a tested, strengthened youth-friendly service (YFS) delivery model providing an expanded contraceptive method choice in one location – the YFS unit – with additional units in Amhara and Tigray, Ethiopia.Methods: This retrospective mixed methods study included interviews with key informants (KIs) (qualitative arm) and analysis of family planning (FP) uptake statistics extracted from the sampled health facilities (quantitative arm). A multi-stage convenience purposive sampling technique was adopted to randomly select 8 health facilities aligned with respective woredas, zones and regional health bureaus (RHBs). A semi-structured interview guide soliciting information on 6 scaling-up elements (stakeholder engagement, roles and responsibility, policy environment, financial resources, quality of voluntary FP services and data availability and use) guided the interviews. Fifty-six KI interviews were conducted with policy-makers, program managers, and clinic staff. Recurring themes were triangulated across administrative levels and implementing partners. Relevant FP data (acceptor status, age and method uptake) were extracted from the 8 sampled health facilities for a thirteen-month period. Qualitative findings triangulated with FP service statistics assessed the influence of the 6 scaling-up elements with trends in long-acting reversible contraceptive (LARC) uptake before and after training.Results: Our findings depict that respondents were knowledgeable and supportive of an expanded method mix. Statistically significant increases in long-acting contraceptive uptake were noted at 2 of the 8 health centers. Fidelity to the tested model was operationally constrained; respondents frequently mentioned trained staff absences and turnover as obstacles in offering quality FP services. Conclusion: Despite conducive policy environment, supportive stakeholders, favorable environment, and financial support for trainings, statistically significant increases in LARC uptake occurred at only 2 of the 8 health centers; indicating the influence of weak health systems, poor quality of voluntary FP services and a ceiling effect. Scale-up processes must consider potential bottlenecks of weak health systems and availability of financial resources by addressing these as crucial elements in any systematic scale-up framework