Coverage and quality of antenatal care provided at primary health care facilities in the ‘Punjab’ province of ‘Pakistan’

Background: Antenatal care is a very important component of maternal health services. It provides the opportunity to learn about risks associated with pregnancy and guides to plan the place of deliveries thereby preventing maternal and infant morbidity and mortality. In ‘Pakistan’ antenatal services to rural population are being provided through a network of primary health care facilities designated as \u27Basic Health Units and Rural Health Centers. Pakistan is a developing country, consisting of four provinces and federally administered areas. Each province is administratively subdivided in to ‘Divisions’ and ‘Districts’. By population ‘Punjab’ is the largest province of Pakistan having 36 districts. This study was conducted to assess the coverage and quality antenatal care in the primary health care facilities in ‘Punjab’ province of ‘Pakistan’. Methods: Quantitative and Qualitative methods were used to collect data. Using multistage sampling technique nine out of thirty six districts were selected and 19 primary health care facilities of public sector (seventeen Basic Health Units and two Rural Health Centers were randomly selected from each district. Focus group discussions and in-depth interviews were conducted with clients, providers and health managers. Results: The overall enrollment for antenatal checkup was 55.9% and drop out was 32.9% in subsequent visits. The quality of services regarding assessment, treatment and counseling was extremely poor. The reasons for low coverage and quality were the distant location of facilities, deficiency of facility resources, indifferent attitude and non availability of the staff. Moreover, lack of client awareness about importance of antenatal care and self empowerment for decision making to seek care were also responsible for low coverage. Conclusion: The coverage and quality of the antenatal care services in ‘Punjab’ are extremely compromised. Only half of the expected pregnancies are enrolled and out of those 1/3 drop out in follow-up visits

Accessibility of antenatal services at primary healthcare facilities in Punjab, Pakistan

Introduction: Almost one-fifth of the world\\u27s population constitutes women of reproductive age who are repeatedly exposed to pregnancy and childbearing. Many are often at high risk of illness and mortality during pregnancy and require maternal healthcare services for early detection of complications. More than 0.5 million women die every year worldwide due to pregnancy-related complications. Almost 0.03 million of them are in Pakistan. Maternal healthcare in Pakistan is poor and results in high rates of morbidity and mortality. This paper evaluates the accessibility of antenatal care (ANC) services in primary healthcare settings in the Punjab province of Pakistan during the period June 2010-August 2011. Methods: The paper uses a cross-sectional study including mix methods (qualitative and quantitative).Nine districts were included in the project; one from each administrative tier or division. Nineteen health facilities, including two rural health centres (RHCs) and 17 basic health units (BHUs) were randomly selected from each district. The total sample was 171 health facilities. The qualitative assessment was carried out through focus-group discussions (FGDs) and in-depth interviews with clients, providers, and health managers. Results: The reasons for the gaps in service accessibility were the distant location of facilities, a lack of transport, and inconvenient facility working hours. The issues of service accessibility were further exacerbated by socio-cultural factors such as low levels of client awareness, a lack of decision-making by clients, and the influence of spiritual healers and quacks. Health managers further pointed out weak co-ordination between vertical programmes and routine integrated health services, and a lack of human resources in distantly located facilities.Conclusion: In order to increase the accessibility of ANC services, facility working hours must be extended and adjusted according to the convenience of clients in primary healthcare (PHC) facilities. The utilisation of ANC services can also be increased through client awareness and gender empowerment for ANC decision-making

WHAT DIABETICS KNOW ABOUT DIABETES?

Patient’s lack of understanding of disease hinders in proper control of disease thus increasing the morbidity and mortality. Review of the studies done in this region, dose not provide a detail account of patients understanding about the disease. Majority of patients when interviewed in clinics do not know the right answer to cause, level of desired sugar, possible complication. Material and methods: Hospital-based cross-sectional KAP study was conducted on diabetic patients visiting the diabetic clinic in two tertiary care Hospitals and a diabetic poly clinic in different areas of Karachi during the month of September 2012. Results: The mean age was 56 years, with 122 male and 118 female, 40.4 % patients were uneducated, 22.9% metric, 12.9% intermediate and 22.9% were graduate. Considering the knowledge, as to what is diabetes? only 46% answered correctly. What could cause the disease? 35% thought there was no reason for sugar. Regarding most frequent symptom, 27% thought there were no specific symptoms, 24.2% weight loss and 23.8% excessive urine and 21.7% thought not healing of wound was first indicator and 2.1 % thought that increase appetite is the cause. The desired levels of random sugar only 24.2% thought it be around 180 mg /dl while 32.5% had no idea about the value. Desired fasting sugar was correctly known by 34.6% as less than 100 mg/dl and 22.9% as less than 120 mg/dl. , Duration of treatment was believed to be life long treatment by 85%.Oral hypoglycemic were consumed by 68%, 24% were on insulin. And 6% were using both. 75% patients did not do exercise regularly. Regarding the harms created by diabetes, 51.3 % knew that heart or kidneys may get damaged. Regular doctor visits were done by 80% , and 85 % were satisfied with the level of care. The average sugar check cost was less than 100 rupees for 62.1 % . Conclusion: Lack of proper concepts regarding the disease, desired level of sugars, possible complications could be a big hinder in achieving good diabetic control. Thus by addressing the specific deficiencies in the knowledge and practices of patients, a better outcome may be achievable

Single image super resolution technique: An extension to true color images

The super-resolution (SR) technique reconstructs a high-resolution image from single or multiple low-resolution images. SR has gained much attention over the past decade, as it has significant applications in our daily life. This paper provides a new technique of a single image super-resolution on true colored images. The key idea is to obtain the super-resolved image from observed low-resolution images. A proposed technique is based on both the wavelet and spatial domain-based algorithms by exploiting the advantages of both of the algorithms. A back projection with an iterative method is implemented to minimize the reconstruction error and for noise removal wavelet-based de-noising method is used. Previously, this technique has been followed for the grayscale images. In this proposed algorithm, the colored images are taken into account for super-resolution. The results of the proposed method have been examined both subjectively by observation of the results visually and objectively by considering the peak signal-to-noise ratio (PSNR) and mean squared error (MSE), which gives significant results and visually better in quality from the bi-cubic interpolation technique

Bone Age practices in infants and older children among practicing radiologists in Pakistan: Developing world perspective

Objective To investigate which bone age assessment techniques are utilized by radiologists in Pakistan to determine skeletal age in three defined age groups: less than one year, one to three years and three to 18 years. We also assessed the perceived confidence in skeletal age assessments made by respondents using their chosen bone age assessment technique, within each defined age group. Materials and methods A cross-sectional survey was conducted among 147 practicing radiologists in Pakistan. A pre-validated survey form was adopted from a similar study conducted amongst members of the Society for Pediatric Radiology. The survey collected demographic information, choice of bone age assessment technique in each age group and confidence of bone age assessments in each age group. Results The hand-wrist method of Greulich and Pyle was used by 87.5% of respondents when assessing bone age in infants (less than one year), followed by Gilsanz-Ratib hand bone age method (7.3%). In children aged one to three years, Greulich and Pyle method was chosen by 85.7% of respondents, followed by Gilsanz-Ratib hand bone age method (6.1%) and the Hoerr, Pyle, Francis\u27 Radiographic Atlas of Skeletal Development of the Foot and Ankle (3.1%). In children, older than three years, the Greulich and Pyle technique was used by 83.7% of respondents. This was followed by Gilsanz-Ratib hand bone age method (5.8%) and the Hoerr, Pyle, Francis\u27 Radiographic Atlas of Skeletal Development of the Foot and Ankle (3.8%). 26.4% were very confident in bone age assessments conducted among infants. In children aged one to three years, 38.1% were very confident . In children, greater than three years, 48.6% were very confident in their chosen technique. Conclusion Greulich and Pyle is the dominant method for bone age assessments in all age groups, however, confidence in its application among infants and young children is low. It is recommended that clear recommendations be developed for bone age assessments in this age group alongside incorporation of indigenous standards of bone age assessments based on a representative sample of healthy native children

Total parotidectomy under local anesthesia: A novel technique

Parotidectomy is a common procedure usually done for a parotid mass necessitating a histological diagnosis. Operation is normally performed under General anesthesia with a nerve stimulator to facilitate facial nerve stimulation. We describe a new technique with reports of three cases, making total parotidectomy under local anesthesia possible. The ascending cervical branch of cervical plexus and the auriculotemporal nerve were anesthetized by bupivacaine 0.25% (2mg/kg) and lignocaine with adrenaline 7 mg/kg. Effective onset of anesthesia was within 15-25 minutes and the operations lasted between 2-3 hours without any complications. This offers advantage in high-risk patients where general anesthesia is contraindicated. The facial nerve can be easily identified with on command movements by the patient rendering the use of nerve stimulator or injection of the dye superfluous. This technique makes total parotidectomy an outpatient procedure and facilitates an early discharge

Vegetation conditions in various plant communities and their performance in district Tharparkar, Sindh, Pakistan

Six villages were registered for the experimental purpose/plantation where more than 25,000 plants were planted to develop range forest. These plants were developed at Marvi nursery PARC-Arid Zone Research Institute, Umerkot and some were purchased from private nursery situated at Mirpurkhas. Results revealed that maximum plants mortality rate was found at village Ratnore and lowest mortality of plants was observed at Mithrio Charan. Plants damaged due to unknown reason (natural), termite attack and diseases. In various locations most of plants were affected by termites than others biotic and abiotic factors. The most influenced plant was Prosopis cinerera. Maximum plants survived numbers of grafted ber was found at village Ratnore, the biomass production of green and dry grasses was taken after harvesting. A highest green grass weight 21812.58 kg and dry 3439.83 kg were observed from elephant grass stock and lowest green weight 5001.92 kg from Gatten grass and dry weight 477.57 kg per acre were recorded from Rhode grass 1 (Sabri). Gatten grass and Rhode grass 1 (Sabri) were found lower weight. All these seven grasses showed excellent performance except Elephant grass and Gatten grass. These two grasses needed more water as compared to remaining five species. These grasses when fed by goats their milk production was increased and goats like to feed these grasses. The pictures of these grasses showed their appearance and health irrigated by underground brackish water with more than 2200 ppm

Commonest cancers in Pakistan - findings and histopathological perspective from a premier surgical pathology center in Pakistan.

Abstract CONTEXT: There are no recent authoritative data about incidence and prevalence of various types of cancers in Pakistan. AIM: To determine the frequency of malignant tumors seen in our practice and provide a foundation for building a comprehensive cancer care strategy. MATERIALS AND METHODS: 10,000 successive cases of solid malignant tumors reported in 2014 were included. All cases had formalin fixed, paraffin embedded specimens available and diagnosis was based on histological examination of H and E stained slides plus ancillary studies at the Section of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi. The latest WHO classifications were used along with the latest CAP protocols for reporting and the most updated TNM staging. RESULTS: There were 9,492 (94.9%) primary tumors while 508 (5.1%) were metastatic. Some 5,153 (51.5%) were diagnosed in females and 4,847 (48.5%) in males. The commonest malignant tumors in females were breast (32%), esophagus (7%), lymphomas (6.8%), oral cavity (6.7%) and ovary (4.8%), while in males they were oral cavity (13.9%), lymphomas (12.8%), colorectum (7.9%), stomach (6.9%) and esophagus (6.6%). Malignant tumors were most common in the 5th, 6th and 7th decades. About 8% were seen under 20 years of age. CONCLUSIONS: Oral cavity and gastrointestinal cancers continue to be extremely common in both genders. Breast and esophageal cancers are prevalent in females. Lung and prostate cancer are less common than in the west. Ovarian cancer was very common but cervix cancer was less so

Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial

Background: Intensive antiplatelet therapy with three agents might be more effective than guideline treatment for preventing recurrent events in patients with acute cerebral ischaemia. We aimed to compare the safety and efficacy of intensive antiplatelet therapy (combined aspirin, clopidogrel, and dipyridamole) with that of guideline-based antiplatelet therapy. Methods: We did an international, prospective, randomised, open-label, blinded-endpoint trial in adult participants with ischaemic stroke or transient ischaemic attack (TIA) within 48 h of onset. Participants were assigned in a 1:1 ratio using computer randomisation to receive loading doses and then 30 days of intensive antiplatelet therapy (combined aspirin 75 mg, clopidogrel 75 mg, and dipyridamole 200 mg twice daily) or guideline-based therapy (comprising either clopidogrel alone or combined aspirin and dipyridamole). Randomisation was stratified by country and index event, and minimised with prognostic baseline factors, medication use, time to randomisation, stroke-related factors, and thrombolysis. The ordinal primary outcome was the combined incidence and severity of any recurrent stroke (ischaemic or haemorrhagic; assessed using the modified Rankin Scale) or TIA within 90 days, as assessed by central telephone follow-up with masking to treatment assignment, and analysed by intention to treat. This trial is registered with the ISRCTN registry, number ISRCTN47823388. Findings: 3096 participants (1556 in the intensive antiplatelet therapy group, 1540 in the guideline antiplatelet therapy group) were recruited from 106 hospitals in four countries between April 7, 2009, and March 18, 2016. The trial was stopped early on the recommendation of the data monitoring committee. The incidence and severity of recurrent stroke or TIA did not differ between intensive and guideline therapy (93 [6%] participants vs 105 [7%]; adjusted common odds ratio [cOR] 0·90, 95% CI 0·67–1·20, p=0·47). By contrast, intensive antiplatelet therapy was associated with more, and more severe, bleeding (adjusted cOR 2·54, 95% CI 2·05–3·16, p<0·0001). Interpretation: Among patients with recent cerebral ischaemia, intensive antiplatelet therapy did not reduce the incidence and severity of recurrent stroke or TIA, but did significantly increase the risk of major bleeding. Triple antiplatelet therapy should not be used in routine clinical practice