Relationship of Family Members’ Support with Practice of Community Midwives in Rural Sindh, Pakistan

Background: Pakistan has one of the highest maternal mortality rates in the world. Community Midwives (CMWs) were introduced in 2006 as a new cadre of birth attendants who would bring midwifery services to rural areas by being based in designated communities. The CMWs face many obstacles and retaining them in practice is a challenge. This study aimed to examine whether there was a relationship between family support and CMWs retention in midwifery practice. We hoped to learn about influences on retention that might improve the Maternal Newborn and Child Health (MNCH) programme. Methods: This was a cross-sectional survey conducted in five districts of rural Sindh, a province in Pakistan. A list of all CMWs who graduated between 2007 and 2012 was obtained from the MNCH programme Sindh. The CMWs were tracked by MCHIP (Maternal Child Health Integrated Program) clinical supervisors posted in the respective districts to gather information about families’ support of CMWs. Findings: Of the 148 CMWs in the MNCH list, 112 (76%) were tracked. Of 112, 44 (39%) CMWs were in active practice while 69 (61%) had completed their training but had not started a practice. Of the 44 practising CMWs, 82% had family members who worked in a health-related field or previously were traditional birth attendants (TBAs). Only 18% of those who established a practice had a family without this profile. Conclusion: These preliminary findings indicate a strong relationship between family engagement in health care work and the capacity of CMWs to establish a midwifery practice. A further comparative analysis of practising and non-practising CMWs is warranted

Understanding psycho-social factors influencing lifestyle of women with a history of gestational diabetes in Pakistan

Lifestyle interventions are proven to be effective in preventing or delaying type 2 diabetes mellitus (T2DM) in high risk individuals, such as women with a history of gestational diabetes mellitus (GDM) referred to henceforth as GDM women. This thesis was designed to address the lack of understanding of factors that affect lifestyle of GDM women in Pakistan and identify suitable approaches for intervention. A series of studies were conducted to develop valid and reliable measures for constructs in the trans-theoretical model (TTM), family support and diet and to test a model for lifestyle change. The study participants were recruited from a tertiary care hospital in Karachi, Pakistan. The qualitative study used in-depth interviews (n=24) and group discussions (n=17) and was analysed thematically. Measures were developed and tested in a cross sectional survey of post-natal women (n=331). Exploratory factor analysis was used to examine the construct validity of measures and Partial least Square (PLS) to predict diet and physical activity of GDM women in Pakistan. The qualitative findings revealed lack of knowledge, social support, cultural expectations and gender role as influencing lifestyle of GDM women. Variables that included TTM constructs (pros and cons, self efficacy and stages of change), family support and selected demographic factors predicted 44 percent of variance in dietary fat intake and 38 percent of physical activity of GDM women. These models explained much less of the variance in non-GDM women. Self-efficacy, cons for change and positive family support were the most significant predicators of dietary behaviour. Self-efficacy and cons for change were significant predictors of physical activity. This study makes an original contribution to the gap in knowledge of factors that affect lifestyle behaviours of GDM women in a South Asian context, and specifically Pakistan. The findings indicate that interventions for GDM women using strategies to improve self efficacy, addressing perceived cons, and using family support would be effective. Culturally specific messages, delivered by a health care provider targeting weight management would be acceptable for GDM women in Pakistan. The findings inform the design of a lifestyle intervention for this target group

Cancer incidence in Khyber Pakhtunkhwa, Pakistan, 2020

Abstract Background To present the population-based cancer statistics for Khyber Pakhtunkhwa (KP), Pakistan, an incidence study was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC) in Lahore, Pakistan, in 2023. Methods Records from various centres on new cancers diagnosed among residents of KP between January and December 2020 were gathered. Both active and passive methods of data collection were applied, and the information was saved in a central repository at SKMCH&RC. The incidence rates were computed by age group and sex and presented per 100,000 population. Results Among children (0–14 years), the Age-Standardised Incidence Rate (ASIR) was 4.0 in girls and 6.1 in boys, and haematologic malignancies were more prevalent; in adolescents (15–19 years), the ASIR was 7.7 in females, 9.4 in males, and bone tumours, haematologic malignancies, and neurological cancers were prominent; in adult females (> / = 20 years), the ASIR was 84.9, and cancers of the breast, digestive system, and reproductive organs were predominant; and adult males, the ASIR was 73.0, and cancers of the gastrointestinal tract, lip/oral cavity/pharynx, prostate, and Non-Hodgkin Lymphoma (NHL) were common. Conclusions It is crucial to investigate the aetiology of these diseases at the community level because dietary elements, infectious diseases, and tobacco use all appear to be significant contributors. Prospective studies could play a key role in highlighting the factors linked to these diseases. Therefore, cancer registration must continue in conjunction with the exploration of risk factors

Barriers and enablers for practicing kangaroo mother care (KMC) in rural Sindh, Pakistan.

BackgroundMore than 2.5 million newborns die each year, accounting for 47% of children dying worldwide before their age of five years. Complications of preterm birth are the leading cause of death among newborns. Pakistan is amongst the top ten countries with highest preterm birth rate per 1000 live births. Globally, Every Newborn Action Plan (ENAP) has emphasized on Kangaroo Mother Care (KMC) as an essential component of neonatal health initiatives.Materials and methodsWe conducted this qualitative study with 12 in-depth interviews (IDIs) and 14 focus group discussion (FGD) sessions, in two health facilities of Sindh, Pakistan during October-December 2016, to understand the key barriers and enablers to a mother's ability to practice KMC and the feasibility of implementing and improving these practices.ResultsThe findings revealed that community stakeholders were generally aware of health issues especially related to maternal and neonatal health. Both the health care providers and managers were supportive of implementing KMC in their respective health facilities as well as for continuous use of KMC at household level. In order to initiate KMC at facility level, study respondents emphasized on ensuring availability of equipment, supplies, water-sanitation facility, modified patient ward (e.g., curtain, separate room) and quality of services as well as training of health providers as critical prerequisites. Also in order to continue practicing KMC at household level, engaging the community and establishing functional referral linkage between community and facilities were focused issues in facility and community level FGDs and IDIs.ConclusionThe study participants considered it feasible to initiate KMC practice at health facility and to continue practicing at home after returning from facility. Ensuring facility readiness to initiate KMC, improving capacity of health providers both at facility and community levels, coupled with focusing on community mobilization strategy, targeting specific audiences, may help policy makers and program planners to initiate KMC at health facility and keep KMC practice continued at household level

Quality of labor and birth care in Sindh Province, Pakistan: Findings from direct observations at health facilities.

This study presents data from the first observation of labor, childbirth and immediate newborn care in a clinical setting in Sindh, the second most populous province of Pakistan. Trained midwives observed 310 births at 126 district level referral facilities and primary health care facilities in 10 districts of Sindh where the USAID-funded Maternal Child Health Integrated Program (MCHIP) was implemented. The facility participation rate was 78%. The findings show that monitoring vital signs during the initial examination was conducted for less than one-in-ten women. Infection prevention practices were only observed for one-in-four women. Modesty was preserved for less than half of women. In spite of an absence of monitoring during the first and second stages of labor, providers augmented labor with oxytocin in two-thirds of births. To prevent post-partum hemorrhage, oxytocin was administered within a minute of birth in 51% of cases. Immediate drying of the baby was nearly universal and eight out of ten babies were wrapped in a dry towel. Newborn vital signs and the baby's weight were taken in one-in-ten cases. Breastfeeding was initiated during the first hour of birth in 18% of cases. A support-person was present during labor and birth for 90% of women. While quality of care is poor across all facilities, the provision of care at district-level referral facilities was even lower quality than at primary health care facilities. This is because dais or assistants without formal training provided labor, birth, and newborn care for 40% of deliveries during night shifts at referral facilities. This study found many examples of suboptimal practice by skilled birth attendants across all levels of health facilities. There remains an urgent need to improve quality of service provision among skilled birth attendants in Pakistan

Factors associated with the use of antenatal care in Sindh province, Pakistan:A population-based study

BACKGROUND: Antenatal care (ANC) is critical to decrease maternal and neonatal mortality. However, little is known about the utilization of ANC services in Pakistan. This study assessed the utilization of ANC in Sindh province, Pakistan, and identified the factors that affect its use. METHODS: We analysed a subset of data from Maternal and Child Health (MCH) Program Indicator Surveys conducted in Sindh province, Pakistan in 2013 and 2014. Respondents included 10,200 women who had given birth in the past two years. The outcome measure was making at least four ANC visits. Logistic regression models were used to identify demographic, socioeconomic, characteristics of ANC, and informational factors associated with ANC use. RESULTS: Most women (83.5%) received one or more ANC, mostly by doctors (95%), but only 57.3% of them made the recommended four or more visits, and just 53.7% received their initial ANC care during the first trimester. Making four or more ANC visits was associated with: fewer household occupants (odds ratio [OR] = 0.98; 95% confidence interval [CI] = [0.97, 0.99]), large city residence (OR = 1.92; 95% CI = [1.57, 2.35]), higher women's education (OR = 1.70; 95% CI = [1.33, 2.15]), greater household wealth (OR = 5.66; 95% CI = [4.22, 7.60]), and receiving MCH information from lady health worker (OR = 1.17; 95% CI = [1.00, 1.37]), mother-in-law (OR = 1.17; 95% CI = [1.01, 1.36]), other relatives/friends (OR = 1.19; 95% CI = [1.03, 1.38]), or nurse/midwife (OR = 1.31; 95% CI = [1.06, 1.61]). CONCLUSIONS: This study demonstrates that both socioeconomic factors and health information sources are associated with women's use of ANC. Therefore, programs should target socially disadvantaged and vulnerable groups, particularly rural, less educated, and poor women, to improve utilization of ANC. In addition, strategies to increase exposure to MCH information sources should be a priority in Sindh, Pakistan