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PubMed1996

Mother's health-seeking behaviour and childhood mortality in Pakistan.

"The paper examines the mother's health-seeking behaviour and childhood mortality in Pakistan. This is based on the 1990-91 Pakistan Demographic and Health Survey (PDHS).... It was found that neonatal, infant, and child mortality rate is the highest among children of mothers aged less than 20 years. Infant and child mortality rate is likewise higher among first and higher order births than among births of second or third order. It was further found that mortality declines as the length of the birth interval increases. The results reveal that the education of mother has significant effect on the neonatal, infant and child survival.... Health care factors such as antenatal care, place of delivery, assistance at delivery and immunisation also influenced neonatal, infant and child mortality."

Age Factors↗
PubMed2002

Demographic, socio-economic and environmental determinants of utilisation of antenatal care in a rural setting of Sindh, Pakistan.

OBJECTIVE: Majority of the women in the developing countries are unable receive antenatal care for a variety of reasons. This study determines the factors affecting utilisation of antenatal care by women of a rural area in Sindh, Pakistan. METHODS: A cross-sectional study was conducted during August 1997, in Union Council Jhangara, Sindh, Pakistan. Married women, who had delivered at least one child, were included in the study from each household and systematically 222 eligible women were selected. The effects of demographic, socio-economic and environmental factors on the utilisation of antenatal care, by women during their most recent pregnancy were also studied. Multivariate logistic regression analysis was used to assess independent effect of individual factors. RESULTS: Among the study subjects, 29.3% (65) of the women utilised antenatal care during the last (most recent) pregnancy and out of them 72.3% (47) received it from the government health care provider. Presence of electricity in the house was strongly associated with the utilisation of antenatal care (AOR = 5.3; 95% CI 2.2-12.7). Women whose husbands were in white-collar occupation, were utilizing the antenatal care significantly more (AOR = 2.4; 95% CI 1.2-4.6) compared to women whose husbands were in blue-collar occupations. CONCLUSION: The study shows that social status and economic condition of a woman is an important determinant of utilisation of antenatal care. Therefore, improvement of socioeconomic status is required to increase utilization of antenatal and perinatal care.

Adolescent↗
PubMed2002

Viral hemorrhagic fever in Pakistan: awareness among health care personnel.

OBJECTIVE: To assess the level of knowledge regarding viral hemorrhagic fever (VHF) among healthcare personnel at two largest tertiary care hospitals in Karachi, Pakistan. METHODS: A cross sectional convenience survey was conducted in February 2001 among doctors, nurses, laboratory technicians and janitors/orderlies of Jinnah Postgraduate Medical Centre and Civil Hospital, Karachi. The questionnaire included demographic information with their designation and knowledge level regarding VHF management, spread and prevention. Frequencies of the answers to each question were calculated for all questions and scores were assigned. The frequencies were also calculated on the basis of the designation of the respondent so that each group could be examined separately. RESULTS: A total of 187 healthcare personnel (121 doctors, 31 nurses, 19 laboratory technicians and 16 janitors/orderlies) were interviewed. Forty three percent (81) respondents were males and 57% (106) were females. By designation 90% doctors, 71% nurses, 32% laboratory technicians and 6% janitors knew about VHF. Only 57% doctors (69) knew the common signs and symptoms of VHF. Isolation for affected patients was suggested by 65% nurses and 6% janitors. Knowledge regarding burial procedure of dead patients was low in all groups. CONCLUSION: Differences in knowledge of different groups is obvious but it is essential to raise the knowledge regarding VHF at all levels including the housekeeping staff. There is also a need for continuing medical education (CME) for all health care personnel for the emerging health problems in Pakistan.

Female↗
PubMed1984

Does female education affect fertility behaviour in Pakistan?

The study explores the relationship between female education and fertility in Pakistan and is based on data from the Pakistan Fertility Survey 1975. Only slight differentials were identified between women with no education and those who had primary or less schooling. However, women with more than primary education had notably lower fertility. Also the role of the intermediate variables such as proportions married, length of breastfeeding, and contraceptive use had significant associations with female education.

Age Factors↗
PubMed1992

Factors associated with child mortality in Pakistan and implications for the national health programs.

"This study attempts to establish the levels of infant and child mortality in Pakistan using an indirect estimation technique to analyze data from the 1984-85 Pakistan Contraceptive Prevalence Survey....[Results indicate] that children's survival chances have hardly improved in recent years.... Suggestions are offered on ways to improve the effectiveness of rural health programs."

Asia↗
PubMed1993

Determinants of marital fertility in Pakistan: an application of the "synthesis framework".

"The present study, in the context of Pakistan, is based on intensive National Population, Labour Force, and Migration Survey data covering 10,000 households [and focuses]...on the determinants of fertility in Pakistan, specifically the determinants of the adoption of deliberate fertility regulation. The role of socio-economic modernisation and cultural factors in the determination of the potential family size and the adoption of deliberate fertility control through a knowledge of fertility regulation have also been explored. The 'Synthesis Framework' of fertility determination, applied to Sri Lanka and Colombia by Easterlin and Crimmins (1982), and with its recent modifications by Ahmed (1987), is the main vehicle for the study."

Asia↗
PubMedDate not supplied

Literacy transition and female nuptiality: implications for fertility in Pakistan.

"This paper is an attempt to examine trends and differentials in education and age at marriage of males and females [in Pakistan] and then relate the two variables to one important aspect of demographic behaviour, namely fertility, and evaluate the implication of these relationships on reduction of fertility in Pakistan." The data are from the 1981 census and the 1979-1980 Population, Labour Force and Migration (PLM) Survey. "Given the limitations of the survey data which pertain to a sample of ever-married women between the ages of 15 and 49 years, the main conclusions of the study are that a rise in female age at marriage and education at secondary and higher levels are important in affecting fertility levels." Policy implications of the findings are discussed. Comments by Akhtar Hasan Khan are included (pp. 601-3).

Asia↗
PubMedDate not supplied

Fertility preferences and contraceptive use in Pakistan.

"The objective of this paper is...to analyse the levels and trends of fertility preferences in Pakistan during the 1975-1980 period and to see if any changes in the preferences have occurred over time even in the absence of the information, education and communication (IE&C) component of the family planning programme. Our hypothesis is that there exists a conscious choice of reproductive goals among married couples and there is no likelihood of any significant change in these expressed choices over time for the last twenty years." The data are from the 1979-1980 Population, Labour Force and Migration (PLM) Survey and the 1975 Pakistan Fertility Survey. "The analysis of data obtained for the two national surveys indicates that the surveys in question are highly consistent with regard to fertility preferences. They also indicate that the magnitude of family size preferences did not change appreciably between the two surveys. Moreover, the period and cumulative fertility behaviour in both the surveys did not record any significant variation.... When contraceptive behaviour was analysed with the reported fertility preferences, it appeared that the women were quite consistent in their stated fertility attitudes." Comments by Khalil A. Siddiqui are included (pp. 617-8).

Asia↗
PubMedDate not supplied

Differences in household characteristics by income distribution in Pakistan.

The authors examine household characteristics by income distribution in Pakistan using data from the 1979 Population, Labour Force and Migration (PLM) Survey. Tabular data, organized by measures of income and expenditure, are presented on average household size, dependency ratios, average number of children and average number of adults, proportion of female household members, labor force participation rates for various ages, and occupational status of heads of households. The authors conclude that "the findings for Pakistan generally are in consonance with those for other Third World countries and confirm that certain characteristics are associated with poverty." Comments by Karol J. Krotki are also included (pp. 668-9).

Adolescent↗
PubMed1992

Marriage delays in Pakistan: analysis of selected view points.

The authors explore reasons for the observed increases in marriage age in Pakistan. "Using anecdotal data from urban Pakistan, an attempt is made in this paper to analyse the perceived reasons that cause delay in marriage as well as some suggestions made by the respondents of this study to overcome the delay if necessary. In [pursuing] this objective, regional and gender variations with regard to reasons and suggestions are discussed."

Asia↗
PubMed2002

Maternal health care in a rural area of Pakistan.

OBJECTIVE: The need for effective strategies for delivery of healthcare to rural women is paramount and requires a study of maternal perceptions and experiences of the healthcare system. METHOD: This article describes knowledge, attitudes and practices regarding obstetric healthcare in a rural area of Pakistan. This is a cross sectional survey of a rural area of district Hyderabad, Pakistan. A multistage sample of 1,150 households was drawn from a population of 247,257 living in 30,653 households. Structured KAP questionnaires regarding maternal health were administered to male and female respondents in study household. RESULTS: A total of 1,178 married women and 1,146 married men were interviewed. The mean age of female respondents was 29 +/- 6 years. At the time of the interview 20% women were pregnant. Sixty-one percent women received antenatal care during their last pregnancy. The most frequent antenatal care providers were female doctors (55%). Majority (67%) of women had delivered at home with the assistance of traditional birth attendants (TBAs). Overall less than 40% of respondents could correctly identify signs of obstetric complications. Thirty-eight percent women experienced obstetric complications during their last pregnancy. Estimated annual maternal mortality ratio (MMR) was 689/100,000 live births. CONCLUSION: Women have inadequate access to obstetric care due to limited healthcare options and poor knowledge of obstetric complications. This can be corrected by improving services and increasing overall maternal health awareness in the community.

Adolescent↗
PubMed2002

The obesity pandemic--implications for Pakistan.

BACKGROUND: Adverse health outcomes are associated with overweight and obesity. In February 2000, the WHO Regional Office for the Western Pacific, the International Association for the Study of Obesity and the International Obesity Task Force published provisional recommendations for adults for the Asia-Pacific region: overweight at Body Mass Index (BMI) > or = 23 and obesity at BMI > or = 25. METHODS: Data from the National Health Survey of Pakistan, 1990-94 were reanalyzed using BMI cut-offs recommended for Asians to reassess prevalence of overweight and obesity in the adult Pakistani population. RESULTS: Prevalence of obesity (BMI > or = 25) in 25-44 year olds in rural areas was 9% for men and 14% for women; in urban areas, prevalence was 22% and 37% for men and women, respectively. For 45-64 year olds, prevalence was 11% for men and 19% for women in rural areas, and 23% and 40% in urban areas for men and women, respectively. Obesity prevalence was directly associated with SES, regardless of residence. CONCLUSION: In South Asia, including Pakistan, social and environmental changes are occurring rapidly, with increasing urbanization, changing lifestyles, higher energy density of diets, and reduced physical activity. The coexistence of underweight in early life with obesity in adults may presage both a higher prevalence and incidence for noncommunicable diseases (NCDs) such as hypertension and diabetes. Use of BMI > or = 23 for overweight, and BMI > or = 25 for obesity, may provide a more accurate determination of the health of Pakistanis, especially in those with more than one risk factor for NCDs.

Adult↗
PubMed2002

Seroprevalence of hepatitis B, C and HIV in blood donors in northern Pakistan.

OBJECTIVE: To study the seroprevalence and trends of Hepatitis B, C and HIV sero markers in healthy blood donors of Northern Pakistan. SUBJECTS AND METHODS: Blood donated by healthy donors from both Armed Forces and civilian population, collected from Jan 1996 to Dec 2000 were tested by Enzyme Linked Immunoassay at Armed Forces Institute of Transfusion Rawalpindi, Pakistan. Demographic data of these donors was also studied. RESULTS: Of 103858 blood donors, 3.3% (95% CI 3.20%-3.41%) were HBsAg, 4.0% (95% CI 3.91%-4.11%) were anti HCV and 0.007% anti HIV positive. Their average was 28 years. HBsAg positive donors were a decade younger than anti HCV positive donors. Pattern in Armed Forces and civilians donors was similar but there was significant reduction in the prevalence of HBsAg carriage in all blood donors. CONCLUSION: This study supports the changing trends in HBV/HCV seroprevalence in blood donors and a low prevalence of HIV in Pakistani population.

Adolescent↗
PubMed2002

Prevalence of depression in patients with coronary artery disease in a tertiary care hospital in Pakistan.

OBJECTIVE: To determine the prevalence of depression in patients with coronary artery disease (CAD) in a tertiary care hospital setting in Pakistan. METHODS: One hundred and fifty four patients of CAD (115 males and 39 females) were randomly selected from the outpatient department and wards of the National Institute of Cardiovascular Diseases, Karachi and were scored for depression via the Hospital Anxiety and Depression Scale. Basic demographic data and disease variables were also collected. RESULTS: The point prevalence of depression in the sample was 37% (31.3% males and 53.8% females). Female sex, income level below Rs. 5000 per month, low education level, outpatient, single earning family member and hypertension were few variables associated positively with depression (p < 0.05). Only one patient was receiving treatment for depression by his cardiologist. CONCLUSION: Depression is prevalent in CAD patients in Pakistan. Economic conditions may pose an additional threat on these patients. Treating physicians (especially cardiologists) need to be aware of this co-morbidity so as to be able to diagnose and adequately manage such patients.

Adult↗
PubMed2003

Aetiology of shigellosis in northern Pakistan.

People of northern Pakistan face health hazards because of poor sanitation practices. Bacterial gastrointestinal infections are very common, and sometimes outbreaks occur. The present study was aimed at evaluating and analyzing infestation of Shigella spp. in patients with suspected gastroenteritis and ascertaining the status of antibiotic therapy. Five hundred and eighty-five faecal samples of patients with suspected gastroenteritis, referred to the District Headquarter Hospital Gilgit, were investigated for common enteropathogenic bacteria from July 1997 to September 1999. Seventy-seven (13.2%) of the faecal specimens were infected with different strains of Shigella spp., 61% of which were Shigella dysenteriae, 15.6% were S. flexneri, and 23.4% were Shigella sp. All Shigella strains were sensitive to ceftriaxone, cefotaxime, ciprofloxacin, and enoxacin. Sixty-one percent of the strains were resistant to both ampicillin and chloramphenicol, and 3.9% to ampicillin and nalidixic acid, while 10.4% were resistant to ampicillin alone and 14.3% to chloramphenicol only. Only 10.4% of the strains were sensitive to all the antibiotics tested. Sixty strains of Shigella spp. were processed for isolation of plasmids, and 58 (97%) of these antibiotic-resistant bacteria harboured at least one plasmid. The number of plasmids varied from 1 to 9. Escherichia coli C600 were transformed with the isolated plasmids. Transformants, containing 23-kb plasmid, resisted growth in media containing antibiotics, thereby indicating that antibiotic resistance is plasmid-borne. Based on the findings of the study, it is concluded that the infestation of Shigella spp. is high in northern Pakistan, the aetiological agents are highly resistant to chloramphenicol and ampicillin, and the antibiotic resistance is mediated by the 23-kb plasmid.

Adolescent↗
PubMed2003

Evaluation of a water, sanitation, and hygiene education intervention on diarrhoea in northern Pakistan.

OBJECTIVE: Inadequate water and sanitation services adversely affect the health and socioeconomic development of communities. The Water and Sanitation Extension Programme (WASEP) project, undertaken in selected villages in northern Pakistan between 1997 and 2001, was designed to deliver an integrated package of activities to improve potable water supply at village and household levels, sanitation facilities and their use, and awareness and practices about hygiene behaviour. METHODS: A case-control study was conducted during July-September 2001 to evaluate whether, after selected confounders were controlled for, children aged <6 years with diarrhoea were more or less likely to reside in villages that participated in the project than in villages that did not participate. Descriptive and logistic regression analyses were performed. FINDINGS: Children not living in WASEP villages had a 33% higher adjusted odds ratio for having diarrhoea than children living in WASEP villages (adjusted odds ratio, 1.331; P<0.049). Boys had 25% lower odds of having diarrhoea than girls (adjusted odds ratio, 0.748; P<0.049). A 2.6% decrease was found in the odds of diarrhoea for every yearly increase in the mother's age (adjusted odds ratio, 0.974; P<0.044) and a 1.4% decrease for every monthly increase in the child's age (adjusted odds ratio, 0.986; P<0.001). CONCLUSIONS: The findings in this study may help refine the approach to future water, sanitation, and hygiene initiatives in northern Pakistan. The integrated approach taken by WASEP, which incorporates engineering solutions with appropriate education to maximize facility usage and improve hygiene practices, is a useful example of how desired health benefits can be obtained from projects of this type.

Adolescent↗
PubMed2003

Progress toward poliomyelitis eradication--Afghanistan and Pakistan, January 2002-May 2003.

Since 1988, when the World Health Assembly resolved to eradicate poliomyelitis worldwide, the number of countries in which polio is endemic has decreased from 127 to seven, including Afghanistan and Pakistan. These two countries are considered one epidemiologic block because of their geographic proximity, frequent cross-border population movement, and the presence of genetically similar wild poliovirus (WPV) lineages. Although polio remains endemic in both countries, progress in interrupting poliovirus transmission has been substantial. This report describes intensified polio eradication activities in Afghanistan and Pakistan during January 2002-May 2003, summarizes progress made, and highlights the remaining challenges to interrupting poliovirus transmission.

Afghanistan↗