Maternal health expenditures and health seeking behavior among lowest wealth quintile of the rural population in an under developed district of the Punjab, Pakistan

Background: Expenditures on maternal health is important factor to determine the health seeking behavior in pregnant women among the lowest economical section of Pakistan. This study was carried out determine the maternal health expenditures and health seeking behavior among lowest wealth quintile of rural Rahim Yar Khan.Methods: Sample Size: For this cross- sectional study, a total of 230 subjects were involved in the study from rural areas of Rahim Yar Khan including Basti Bahishti, Bah-o-Bahar and Chak 83/P. This study was comprised of duration of 06 months from 02/03/2016 to 04/09/2016. The head of Family (Husband) with monthly income less than 15000 Pakistani rupees (PKR) were included and marriage with in last 5 years with at alive delivery. While subjects having income more than 15000 PKR and not willing to participate in study were excluded from the study.Results: People with mean monthly income of PKR. 1176±4109 spent mean amount of PKR. 146442 ± 7747 on their marriages. While the mean expenses on treatment of complication in the last pregnancy were PKR. 35808±6771 and the amount saved for the treatment of complication was PKR. 2750±1157 only. Mean antenatal expenses were PKR. 1807±3335, Mean expenses on delivery were PKR. 7351±855 as compared to the money saved for delivery was PKR. 6115±1460. Mean expenses on complications during delivery were PKR. 1692±523. Mean expenses on postnatal care were PKR.8596±3597 while the mean amount used for treatment of postnatal complications were of PKR. 2451±560. Mean expenses on birth celebrations were of PKR. 7697±832.Conclusions: Present study reveals that there is a high financial cost of maternal health expenditures paid by the lowest wealth quintile in rural areas of Rahim Yar Khan when compared with the income of this quintile. Access of the people to the health sector is still limited due to low income of people, low health education and unavailability of health services in rural areas and even in 2017

Comparison of the Restoration of Breast Feeding after Percutaneous Aspiration vs Incision and Drainage for Management of Breast Abscess

BACKGROUND: Mastitis is not uncommon among lactating woman. This is caused by local inflammation and/or infection of terminal lactiferous ducts. Incision and drainage followed by postoperative antibiotics is the treatment of choice for such abscesses depending on culture and sensitivity. Ultrasound guided needle aspiration is also effective for breast abscesses. OBJECTIVE: To compare the outcome of percutaneous aspiration with incision drainage for management of breast abscess among lactating mothers. METHODOLOGY: This comparative study was carried out at Jinnah Postgraduate Medical Centre, Karachi, Pakistan from August 2015 to August 2016. A total of 90 women with breast abscess were included according to inclusion and exclusion criteria. These women were randomly allocated into two groups. Forty-five in group A, treated with percutaneous aspiration, and 45 patients in group B treated with incision and drainage for breast abscess. Percutaneous aspiration was done after radiological estimation of size, site and shape. After the intervention, all the patients were observed for the outcome parameter i.e. early restoration of breast feeding, as if the mother starts feeding the baby within 24 hours after the procedure All the information was collected on a specially designed Performa. RESULTS: Rate of early restoration of breast feeding was significantly high in group A (percutaneous aspiration) as compared to group B (drainage for breast abscess) [82.2% vs. 57.8%); 0.011]. CONCLUSION: We conclude that percutaneous aspiration of breast abscess is a minimally invasive, simple outpatient procedure without the need of general anesthesia with superior cosmetic results and high satisfaction rate

Maternal health expenditures and health seeking behavior among lowest wealth quintile of the rural population in an under developed district of the Punjab, Pakistan

Background: Expenditures on maternal health is important factor to determine the health seeking behavior in pregnant women among the lowest economical section of Pakistan. This study was carried out determine the maternal health expenditures and health seeking behavior among lowest wealth quintile of rural Rahim Yar Khan.Methods: Sample Size: For this cross- sectional study, a total of 230 subjects were involved in the study from rural areas of Rahim Yar Khan including Basti Bahishti, Bah-o-Bahar and Chak 83/P. This study was comprised of duration of 06 months from 02/03/2016 to 04/09/2016. The head of Family (Husband) with monthly income less than 15000 Pakistani rupees (PKR) were included and marriage with in last 5 years with at alive delivery. While subjects having income more than 15000 PKR and not willing to participate in study were excluded from the study.Results: People with mean monthly income of PKR. 1176±4109 spent mean amount of PKR. 146442 ± 7747 on their marriages. While the mean expenses on treatment of complication in the last pregnancy were PKR. 35808±6771 and the amount saved for the treatment of complication was PKR. 2750±1157 only. Mean antenatal expenses were PKR. 1807±3335, Mean expenses on delivery were PKR. 7351±855 as compared to the money saved for delivery was PKR. 6115±1460. Mean expenses on complications during delivery were PKR. 1692±523. Mean expenses on postnatal care were PKR.8596±3597 while the mean amount used for treatment of postnatal complications were of PKR. 2451±560. Mean expenses on birth celebrations were of PKR. 7697±832.Conclusions: Present study reveals that there is a high financial cost of maternal health expenditures paid by the lowest wealth quintile in rural areas of Rahim Yar Khan when compared with the income of this quintile. Access of the people to the health sector is still limited due to low income of people, low health education and unavailability of health services in rural areas and even in 2017

Duodenal ulcer perforation and its consequences

Duodenal ulcer perforation, a frequent surgical emergency, needs simple closure with indirect Graham’s Omentopexy which is effective with excellent results in majority of cases despite patients’ late presentation. The objective of the study was to determine the frequency of postoperative complications of perforated duodenal ulcer, conducted in the Surgery Department, Jinnah Postgraduate Medical Centre, Karachi, from March 20, 2018 to September 20, 2018. The study was a descriptive case series of 108 patients of both genders with perforated duodenal ulcer > 1 week old with ASA score I & II. Patients with trauma and co-morbidities were excluded. The patients underwent laparotomy and peritoneal toilet, and after noting the site of perforation indirect Graham’s Omentopexy was performed. Complications like duodenal fistula, peritonitis, and paralytic ileus, and patient’s death within 10 days of surgery were noted. ---Continu