Unmet need for Contraception and unintended Pregnancies among women of reproductive age group: A situation analysis

Each year approximately 210 million pregnancies occur worldwide and more than one-third (75 to 80 million) of these are unintended, more than half of these (46 million) unintended pregnancies undergo unsafe abortions. In Pakistan 16% of the births are reported to be unwanted and if the unwanted fertility is eliminated, total fertility in Pakistan would be 3.1 births per woman. Total demand for family planning in Pakistan is 55%, while the contraceptive prevalence rate is 35% and unmet need for family planning is 20%. Reasons for unmet need and unintended pregnancy include lack of permission, fear of side effects, poor quality and limited access to family planning services. Moreover, non-use of contraceptive methods and method failure are important reasons for unintended pregnancy. Women of reproductive age experience multiple adverse outcomes due to unintended pregnancy. These women neither care for themselves nor for their family and due to such careless behavior the likelihood of maternal and neonatal morbidity and mortality increases. Research on intervention programs for unintended pregnancy needs to be done in future. It is important to focus on how intervention programs should be designed, delivered and examined. Intervention strategies should aim to reduce unintended pregnancy by focusing on all the identified factors so that infant and maternal mortality and morbidity as well as the need for abortion is decreased and the overall well-being of the family is maintained and enhanced. Thus, improved community efforts are required to educate women about family planning as well about the proper use of family planning methods. Improved counseling and proper follow up is required especially of those women who adopt any method. Since improper treatment, incomplete follow up and limited choice of method might lead the women to discontinue the methods, therefore role of quality of care of existing services in improving women’s ability to achieve their desired reproductive goals should be given an attention. In addition to improving the quality of existing family planning services, the focus should be on the follow up of women for assessing the adherence to method and addressing their problems related to any method

Child sexual abuse leads to Psychological disorders: Literature review

This scholarly paper explains the relationship between child sexual abuse and psychological disorders. Childhood sexual abuse (CSA) is a forceful sexual contact with a child who is incapable of consenting. The impact of sexual abuse can range from physical to very severe psychological effects. Psychological disorders caused by child sexual abuse include panic disorder, anxiety, depression, substance abuse, low self-esteem and post-traumatic stress disorder. The phenomenon of child sexual abuse is shaped by some important theories like behavioral, psychodynamic, attachment, cognitive and integrated theory. These theories may help to develop a sound empirical base through which cost effective strategies can be made to prevent child sexual abuse. Although child sexual abuse is considered as an offensive act in Pakistan, but it is usually hidden in our society. Approximately 3,861 and 1,204 child sexual abuse cases were reported in 2012 and 2013 respectively from Pakistan. A series of current cases of child sexual abuse has brought the issue to the limelight. Child sexual abuse affects not only the individual but also the families and societies on large scale. Therefore, an integrated approach focusing on the parents, teachers and medical professionals can be proposed to prevent this issue. Prevention programs such as parenting education, home-visiting programs, public education, and training sessions can be developed. Therefore, it is highly important for the families and communities to work together with the support of stakeholders, so that a voice can be raised against CSA and this will ultimately reduce psychological problems in the society

Infection control in labor and delivery room, learning from the small hospital based project

Background: It has been estimated that around 36% of the neonatal deaths occur due to infection in the lower and middle income countries. Infection control is a more substantial area of concern, particularly in Labor and delivery room. Multiple factors can cause infection in the labor room, therefore it is important to assess various factors of maternal and neonatal infection. Hence we explored multiple factors through this project and developed the action plan to address those factors effectively.Methods: During our Leadership and Management course, we conducted a project in Labor room pertaining to a prevalent issue. The whole process from identification of the issue to the resolution was supposed to be in the light of leadership and management concepts. After a thorough analysis and discussion, an action plan was formulated considering the resources, audience, facilities and time required for implementation and evaluation. Every step was mentioned in the action plan for identification of issue till the evaluation of the project.Findings: Factors of infection were grouped under six broad headings including staff, environment, practices, equipment, factors related to patient and others. These were diagrammatically represented through “Fishbone” Diagram.Conclusion: Infection is a common issue in the hospital setting and we tried to assess the factors of infection in the labor room. We identified multiple factors of infection and tried to address those factors by developing a simple action plan. We found that infection can be controlled by taking very simple precautionary measures without incurring a lot of cost

Exploring the Notion of Technologically Dependent Children: Findings from a Review of the Literature

Background: Literature has highlighted various effects that technologically dependent children have on their parents and the healthcare system. In this review article, we explored the challenges associated with raising such children as well as the impact that they may have on those around them and the healthcare system. Method: We searched databases such as Google Scholar, PubMed, Medline CINHAL Plus, and Science Direct. Scientific papers published in English between 2010 and 2018 pertaining to technology-dependent children were selected for inclusion. We reviewed 13 primary research articles relevant to the topic of interest. Results: The findings revealed that technological dependence alters the lifestyle of both children and their families. The life of these children and their parents is different when compared to those who are not dependent on medical technology since parents and siblings have to plan their daily routines based on the needs of the technology-dependent children. Parents described playing both parenting and nursing roles in taking care of these children and changing their home environment to a ‘mini-hospital’ when it came to providing medical care to these children. The responsibilities associated with the care of ventilator-dependent children changed drastically when the mothers took over from the care-giving nurses. Conclusion: Technological dependence is crucial in shaping the lifestyles and routine activities of families, mainly parents, and siblings of these children. It also has a significant impact on the responsibilities that the family members, especially mothers have to fulfill in providing home-based medical care to their children. Additionally, when nurses were inquired about transitioning care from hospital to homes and preparing mothers for home care, they reported finding it hard to trust the mothers to provide the same level of medical care in the homes as they did in the hospital

Low self-esteem leads to depression among elderly: Case study of nursing home

Background: Self-esteem is defined as “how we value our self”; it affects our trust and relationships in every part of life. Person with low self-esteem may feel powerless and incompetent about himself/herself. Moreover, low self-esteem operates as a risk factor for depression, which is most common disorder among elderly people both in developed and developing countries, causing multiple behavioral changes as well as may increase the chances of depression and suicide among the elderly people. Objective: The objective of this case study was to understand the problems faced by elderly people in the nursing home and to relate the self-esteem with depression among them.Methods: A face to face in-depth interview was conducted with a 70-year-old female living in the nursing room. Her perceptions for life were explored through a questionnaire.Findings of case study: It was observed that old lady was unable to express herself and was reluctant in sharing her views with interviewer. According to her, she was introverted and was unable to interact socially with other people because of physical disability. She used to feel unworthy and always used to think that she cannot do anything and was not encouraged by her colleagues and always been criticized by others. She was found to be depressed and had no meaning to life. Conclusion: It can be concluded that depression is one of the common problems among geriatric population, attributed to low self-esteem. Based on the personal observation during the interview, it is recommended that such clients should be encouraged, educated and counseled appropriately to enhance their trust and confidence. There should be some mechanism by which a space can be provided to them to interact with people outside their limited circle and to share their problems with their colleagues and relatives if possible. This may enhance their self-esteem and may decrease the chances of depression among elderly

Ozone depletion, a big threat to climate change: What can be done?

Ozone in the stratosphere is very important as it acts as a safeguard for the earth and protects life from harmful ultraviolet radiations coming from the sun. Depletion of stratospheric ozone, resulting from atmospheric pollution has led to increased ultraviolet radiation at the earth’s surface as well as spectral shifts to the more biologically damaging shorter wavelengths. A decrease in the concentration of stratospheric ozone enhances the solar ultraviolet (UV) radiation, which is harmful to the growth of the plant and various other metabolic processes of the organisms and might cause changes in pigment concentrations, nucleic acids, and proteins. Multiple causes of ozone depletion have been identified in the literature review, but the findings are not synthesized at one place. Thus, the purpose of this paper was to review the causes of ozone depletion and to propose the interventions to address this problem in order to avoid the climate change and its associated outcomes

Predictors of Modern Contraceptive Usage among Women in Rural Pakistan: Physical Access to Services Stills a Major Barrier

Background: The predictors of contraceptive use may vary in urban and rural areas. Studies have largely focused on the factors predicting contraceptive usage in urban areas. We studied the predictors of contraceptives in one of the rural districts of Pakistan.Methods: A nested case-control design was used on The Global Network’s Maternal Newborn Health Registry (MNHR) in district Thatta Pakistan between June 2011 to July 2012. Pregnant women before their index pregnancy, who did not use (n = 200 cases) and those used any modern contraceptive method (n = 600 controls), were compared. Logistic regression was used to as certain independent factors associated with non-use of modern contraceptives.Results: Increasing maternal age (AOR = 1.1, 95 % CI = 1.03 - 1.11 per year increase in age), women’s educational level (AOR for secondary education = 2.8, 95 % CI = 1.58 - 5.01 and AOR for higher education = 2.0, 95% CI = 1.04 - 3.95), high socioeconomic status (AOR = 1.9, 95 % CI = 1.05 - 3.56) and unintended pregnancy (AOR   1.9, 95 % CI = 1.29 - 3.02) were significantly associated with the utilization of modern contraceptive methods. While distance from the family planning centers was inversely related (AOR = 0.9, 95% CI = 0.87 - 0.98 per kilometers).Conclusion: Maternal age, women’s education, socioeconomic status, the intention of a woman for pregnancy and distance were independent predictors for contraceptive use in district Thatta. Besides addressing known socio-demographic differential, access to family planning services to the women of reproductive age, particularly for younger age, poor and less educated women is essential to improve contraceptive prevalence. Furthermore, intention of pregnancy affect the use of contraceptive which has not been studied previously

Unintended Pregnancies among Married Women in Sindh Pakistan: Role of Lady Health Workers

Background: Unintended pregnancies, which pose substantial risks to both mothers and children, account for 24% of all pregnancies in Pakistan. Door to door visits and service provision by lady health workers (LHWs) may be related to the reduction of such pregnancies, particularly in rural areas. This study aimed to determine the association of knowledge about Lady Health Visitors (LHWs) and door to door visits by LHWs with unintended pregnancies among rural women.Methods: We conducted a community-based, nested case-control study of 800 pregnant women, identified from the database of an active surveillance mechanism, which registers and follows all pregnant women in the catchment area. Women who were enrolled during the first trimester and reported their pregnancy to be unintended were selected as cases from the database (n=200). Women whose pregnancies were intended served as controls (n=600). Logistic regression was used for analysis.Results: Knowledge about LHWs and door to door visits by LHWs had no significant association with unintended pregnancies OR=1.11(95%CI: 0.74-1.66) and OR=1.03 (95%CI: 0.67-1.58) respectively. Other factors associated with unintended pregnancy were higher knowledge and use of family planning, maternal age, having at least one son, spousal opposition to family planning and limited spousal education.Conclusion: Results suggest that Family planning strategies need to target old aged women and address the role of men in addition to improving coverage and quality of Family planning services