Medicine and Health Sciences Commons^™

The Causes Of Preterm Neonatal Deaths In India And Pakistan (Purpose): A Prospective Cohort Study, Sangappa M. Dhaded, Sarah Saleem, Shivaprasad S. Goudar, Shiyam Sunder Tikmani, Kay Hwang, Gowdar Guruprasad, Gayathri H. Aradhya, Varun B. Kusagur, Sana Roujani, Sayyeda Reza

Community Health Sciences

Background: Preterm birth remains the major cause of neonatal death worldwide. South Asia contributes disproportionately to deaths among preterm births worldwide, yet few population-based studies have assessed the underlying causes of deaths. Novel evaluations, including histological and bacteriological assessments of placental and fetal tissues, facilitate more precise determination of the underlying causes of preterm deaths. We sought to assess underlying and contributing causes of preterm neonatal deaths in India and Pakistan.
Methods: The project to understand and research preterm pregnancy outcomes and stillbirths in South Asia (PURPOSe) was a prospective cohort study done in three hospitals in Davangere, India, and …

Are Women With Disabilities Less Likely To Utilize Essential Maternal And Reproductive Health Services?-A Secondary Analysis Of Pakistan Demographic Health Survey, Shafaq Mahmood, Waqas Hameed, Sameen Siddiqi

Community Health Sciences

Background: People with disabilities deal with widespread exclusion from healthcare services, including sexual and reproductive health (SRH) rights. Studies analyzing the relationship between disability and key SRH utilization outcomes have often reported mixed findings. In Pakistan, very little to no literature is available on this topic, therefore we aim to determine inequalities in the utilization of essential maternal and reproductive health services between women with and without disabilities in Pakistan.
Methods: This was a secondary analysis of Pakistan Demographic Health Survey 2017-18 performed on a weighted sample of 6,711 women aged 15-49 years with a live birth in the 5 …

The Global Network Socioeconomic Status Index As A Predictor Of Stillbirths, Perinatal Mortality, And Neonatal Mortality In Rural Communities In Low And Lower Middle Income Country Sites Of The Global Network For Women's And Children's Health Research, Archana B. Patel, Carla M. Bann, Cherryl S. Kolhe, Adrien Lokangaka, Antoinette Tshefu, Melissa Bauserman, Lester Figueroa, Nancy F. Krebs, Fabian Esamai, Sarah Saleem

Community Health Sciences

Background: Globally, socioeconomic status (SES) is an important health determinant across a range of health conditions and diseases. However, measuring SES within low- and middle-income countries (LMICs) can be particularly challenging given the variation and diversity of LMIC populations.
Objective: The current study investigates whether maternal SES as assessed by the newly developed Global Network-SES Index is associated with pregnancy outcomes (stillbirths, perinatal mortality, and neonatal mortality) in six LMICs: Democratic Republic of the Congo, Guatemala, India, Kenya, Pakistan, and Zambia.
Methods: The analysis included data from 87,923 women enrolled in the Maternal and Newborn Health Registry of the NICHD-funded …

Factors Associated With Home Delivery In Rural Sindh, Pakistan: Results From The Global Network Birth Registry, Afreen Sadia, Shafaq Mahmood, Farnaz Naqvi, Seemab Naqvi, Zahid Soomro, Sarah Saleem

Community Health Sciences

Background: According to global estimates for 2017, nearly 295,000 maternal deaths occurred worldwide. Thus, approximately 810 women die every day due to pregnancy-related complications. This burden of maternal deaths in LMICs is primarily due to poor healthcare service utilization, as indicated by relatively low rates of institutional deliveries and skilled-birth attendance (SBA). We conducted this study with an aim to assess the factors associated with home delivery and its subsequent effect on the pregnancy outcome in rural Sindh, Pakistan.
Methods: Data for this study were taken from The Global Network's Maternal Newborn Health Registry (MNHR), which is a prospective, population-based …

What Stops Us From Eating: A Qualitative Investigation Of Dietary Barriers During Pregnancy In Punjab, Pakistan, Muhammad Asim, Zarak Hussain Ahmed, Amy R. Nichols, Rachel Rickman, Elena Neiterman, Anita Mahmood, Elizabeth M. Widen

Community Health Sciences

Objective: Adequate dietary intake during pregnancy is vital for the health and nutritional status of both mother and fetus. The nutritional status of reproductive age women in Pakistan is poor, with 14 % being underweight (BMI < 18·5) and 42 % experiencing Fe deficiency anaemia. This may stem from beliefs, practices and other barriers influencing dietary intake. This qualitative study seeks to determine which factors impact dietary intake during pregnancy in rural Punjab.
Design: In-depth interviews and focus group discussions were conducted and then analysed using thematic analysis.
Setting: Three purposively selected rural districts (Sahiwal, Okara and Pakpatan) with the highest prevalence of maternal and child malnutrition in the province of Punjab, Pakistan.
Participants: Mothers with children under age two (n 29) and healthcare providers with at least 5 years of experience working in the district (n …

The Unspoken Grief Of Multiple Stillbirths In Rural Pakistan: An Interpretative Phenomenological Study, Muhammad Asim, Sehrish Karim, Hajra Khwaja, Waqas Hameed, Sarah Saleem

Community Health Sciences

Background: Pakistan has the highest rate of stillbirth (30.6 stillbirths per 1000 total births) as compared to other South Asian countries. The psychological impact of stillbirths on bereaved women is well documented; however, there is a dearth of literature on lived experiences of women with multiple stillbirths in Pakistan.
Objective: The purpose of this research is to understand the lived experiences of women who had multiple stillbirths in Thatta, Pakistan.
Methods: An interpretative phenomenological study was conducted in district Thatta with eight women who experienced more than one stillbirth. A semi-structured in-depth interview guide was used for data collection. The …

Knowledge, Attitude And Practices Of Pregnant Women Related To Covid-19 Infection: A Cross-Sectional Survey In Seven Countries From The Global Network For Women's And Children's Health, Farnaz Naqvi, Seemab Naqvi, Sk Masum Billah, Sarah Saleem, Elizabeth Fogleman, Nalini Peres Da-Silva, Lester Figueroa, Manolo Mazariegos, Ana L. Garces, Sana Yousaf

Community Health Sciences

Objective: We sought to understand knowledge, attitudes and practices (KAP) regarding COVID-19 in pregnant women in seven low and middle-income countries (LMIC).
Design: Population-based prospective, observational study.
Settings: Study sites in DRC, Kenya, Zambia, Bangladesh, India (two sites), Pakistan and Guatemala.
Population and sample: Pregnant women in the Global Network's Maternal and Neonatal Health Registry (MNHR).
Methods: A KAP questionnaire was administered in face-to-face interviews with pregnant women from September 2020 through October 2021 in the MNHR.
Main outcome measures: KAP regarding COVID-19 during pregnancy.
Results: In all, 25 260 women completed the survey. Overall, 56.8% of women named ≥3 …

Quality Of Care Assessment For Small And Sick Newborns And Young Infants In Pakistan: Findings From A Cross-Sectional Study, Nousheen Pradhan, Sumera Aziz Ali, Sana Roujani, Ammarah Ali, Syed Shujaat Hussain, Samia Rizwan, Shabina Ariff, Sarah Saleem, Sameen Siddiqi

Community Health Sciences

Introduction: Pakistan is facing a challenging situation in terms of high newborn mortality rate. Securing pregnancy and delivery care may not bring a substantial reduction in neonatal mortality, unless coupled with the provision of quality inpatient care for small and sick newborns and young infants (NYIs). We undertook this study to assess the availability and quality of newborn care services provided and the readiness of inpatient care for NYIs in Pakistan.
Methods: We conducted a cross-sectional study across Pakistan from February to June 2019, using a purposive sample of 61% (23) of the 38 sick newborn care units at public …

Exploring Digital Health Interventions For Pregnant Women At High Risk For Pre-Eclampsia And Eclampsia In Low-Income And-Middle-Income Countries: A Scoping Review, Anam Shahil Feroz, Noreen Afzal, Emily Seto

Community Health Sciences

Objective: To explore digital health interventions that have been used to support pregnant women at high risk for pre-eclampsia/eclampsia (HRPE/E) in low-income and middle-income countries (LMICs).
Design: Scoping review.
Data source: EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL were searched between 1 January 2000 and 20 October 2020.
Eligibility criteria: The review included original research studies that were published in English, involved pregnant women at HRPE/E and implemented digital health interventions for PE/E in LMICs.
Data extraction and synthesis: Two reviewers independently completed the data extraction for each of the 19 final …

Do Empowered Women Receive Better Quality Antenatal Care In Pakistan? An Analysis Of Demographic And Health Survey Data, Muhammad Asim, Waqas Hameed, Sarah Saleem

Community Health Sciences

Introduction: Quality antenatal care is a window of opportunity for improving maternal and neonatal outcomes. Numerous studies have shown a positive effect of women empowerment on improved coverage of maternal and reproductive health services, including antenatal care (ANC). However, there is scarce evidence on the association between women's empowerment and improved ANC services both in terms of coverage and quality. Addressing this gap, this paper examines the relationship between multi-dimensional measures of women empowerment on utilization of quality ANC (service coverage and consultation) in Pakistan.
Methods: We used Pakistan Demographic and Health Survey 2017-18 (PDHS) data which comprises of 6,602 …

School-Based Interventions To Promote Personal And Environmental Hygiene Practices Among Children In Pakistan: Protocol For A Mixed Methods Study, Nousheen Pradhan, Waliyah Mughis, Tazeen S. Ali, Maleeha Naseem, Rozina Karmaliani Professor

Community Health Sciences

Background: Poor personal hygiene and inadequate sanitation practices among young children leads to communicable diseases. There remains a gap in the holistic assessment of school children's hygiene literacy, practices and effectiveness of school-based hygiene interventions in Pakistan. Therefore, a school-based intervention protocol has been designed to promote personal and environmental hygiene practices for primary school children. Towards improving children's hygiene behaviors, the study will also focus on enhancing mothers' hygiene knowledge and practices.
Methods: Using quasi-experimental design with mixed methods data collection approaches, this study will be conducted in schools located in an urban squatter settlements in Pakistan. To assess …

Quality Of Life Of Road Traffic Injury Survivors Aged 15-44 Years Suffered From Moderate And Severe Head Injuries In Karachi, Pakistan, S A. Abbasi, Tazeen Saeed Ali, Shafquat Rozi, Uzma Rahim Khan, Rashid Jooma

Community Health Sciences

Background: Most of Road traffic injuries are predicted to be the third leading contributor to the global burden of disease by 2020 and patients end up into head injuries which leave devastating impacts on individual and society. Quality of Life After Brain Injury (QOLIBRI) is a specific tool that measures quality of life in head injury patients.
Methods: This was a cross sectional study among 300 patients aged 15-45 years, attended emergency department of the Aga khan University Hospital. Structured questionnaire included demography, injury details, QOLIBRI, GOSE and WHO Disability Assessment Scale (WHODAS 12 items). Severity of injury was determined …

Out-Of-School Children: Examining The Reasons In Semi- Urban Setting In Pakistan, Nousheen Pradhan, Tanzil Jamali, Shireen Shehzad Bhamani, Tazeen Saeed Ali, Rozina Karmaliani

Community Health Sciences

Globally, 57 million primary age children remain out-of-school. In South Asia, Pakistan has the highest (34%) out-of-primary school age children. This paper highlights the proportion of out-of-school children with reasons and children’s educational attainment in the semi-urban community of Pakistan. A cross-sectional survey was conducted by using systematic sampling in a semi-urban town in Karachi, Pakistan. Chi-square was used to describe the difference in the educational achievements with age and gender of the children with p-value < 0.05, considered as significant. Among 254 surveyed households, 22.9% of the children (age 3-15 years) were found out-of-school, with no significant gender difference among boys (11.6%) and girls (11.1 %). A large group of young children (3-6 years of age) were found out-of-school with boys 71.6% (n=68) and girls 67.03% (n=61). Children’s lack of interest in education was the major (42%) reason, followed by high school expenses (23%). Children’s educational attainment was significantly (p<0.000) related to age and gender. At the local community level, teachers and Taluka Education Officers have a pivotal role to play towards increasing primary school enrollment and mobilizing the resources to overcome financial hardships faced by the parents for their children’s education in early years. Nousheen Akber Pradhan is a Senior Instructor at the Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan

Measuring Socio-Economic Status Of An Urban Squatter Settlement In Pakistan Using Wami Index, Nousheen Pradhan, Tazeen Saeed Ali, Fauzia Basaria Hasnani, Shireen Shehzad Bhamani, Rozina Karmaliani

Community Health Sciences

Objective: To determine the socio-economic status of a peri-urban community.
Methods: The cross-sectional study was conducted at Deh Chuhar village, Gaddap Town, Karachi from December 2015 to February 2016. The Water/Sanitation, Assets, Maternal Education and Income Index was used. All variables were given a score on the scale of 0-8. The resulting index was illustrated in the form of quintiles.
Results: : A total of 254 households were surveyed. Total population was 2117 with mean number of household members being 8±4. Mean index score was 0.39±0.14 and the median score was 0.375. Percentile distribution of the score indicated that 152(60%) …

Barriers Or Gaps In Implementation Of Misoprostol Use For Post-Abortion Care And Post-Partum Hemorrhage Prevention In Developing Countries: A Systematic Review, Amirali Samnani, Narjis Rizvi, Tazeen Ali, Farina Abrejo

Community Health Sciences

Background: Around 303,000 maternal deaths occur every year; most of these are preventable (World Health Organization), ICD-10: International classification of diseases and related health problems, 10th revision. Volume 2: Instruction manual, 2010). Ninety-nine percent of these maternal deaths occur in developing countries. PPH contributed 35 % (35%) of total maternal. Several interventions being done to reduce the number of maternal deaths. It has been noted that a simple low cost intervention of providing misoprostol timely could prevent these deaths.
Objectives: The objectives of this systematic review was to identify barriers/gaps in the implementation of misoprostol use for prevention of …

Schools Of Public Health In Low And Middle-Income Countries: An Imperative Investment For Improving The Health Of Populations?, Fauziah Rabbani, Leah Shipton, Franklin White, Iman Nuwayhid, Leslie London, Abdul Ghaffar, Bui Thi Thu Ha, Rajiv Rimal, Anwar Islam, Amirhossein Takian, Samuel Wong, Shehla Zaidi, Kausar S. Khan, Rozina Karmaliani, Imran Naeem Abbasi, Farhat Abbas

Community Health Sciences

BACKGROUND:

Public health has multicultural origins. By the close of the nineteenth century, Schools of Public Health (SPHs) began to emerge in western countries in response to major contemporary public health challenges. The Flexner Report (1910) emphasized the centrality of preventive medicine, sanitation, and public health measures in health professional education. The Alma Ata Declaration on Primary Health Care (PHC) in 1978 was a critical milestone, especially for low and middle-income countries (LMICs), conceptualizing a close working relationship between PHC and public health measures. The Commission on Social Determinants of Health (2005-2008) strengthened the case for SPHs in LMICs as …