Background Pakistan is among those countries where the number of caesarean section births has increased unusually in the past two decades. Therefore, the aim of the present study is to analyse the trend of caesarean section deliveries among child-bearing women (aged 15–49 years) in Pakistan and to identify maternal socio-demographic factors and pregnancy-related variables associated with the change in caesarean deliveries from 1990 to 2018. Methods Secondary data from Pakistan Demographic and Health Surveys (1990–2018) were analysed. The analysis of data was confined to child-bearing mothers. Sample sizes were 4029, 5721, 7461 and 8287 for the time periods of 1990–91, 2006–07, 2012–13 and 2017–18, respectively. Socio-demographic information of the mothers and pregnancy-related variables were taken as independent variables for the present study. The association between independent variables and caesarean deliveries was measured in terms of unadjusted odds ratios (OR) and adjusted OR (AOR). Results The percentages of the mothers who had at least one delivery during the 5 years prior to each survey who had caesarean deliveries increased continuously from 3.2% in 1990–91 to 19.6% in 2017–18. Results indicate that mothers over 24 years of age, located in Punjab, from the richest socio-economic class and living in urban areas were more likely to have delivered by caesarean section. Mothers with a first child in birth order and who had five and more children, as well as mothers who had more antenatal care visits and delivered babies in private hospitals showed a higher probability of caesarean section births. Conclusions The findings of the present study confirm the gradual upsurge in the percentage of mothers delivering by caesarean section during the past two decades in Pakistan. Against this backdrop, some measures need to be taken by health departments to regulate the number of caesarean deliveries. Awareness among women about pregnancy complications and elaborated details by gynaecologists about the medically indicated reasons for caesarean delivery are a few important steps in Pakistan that can help in reducing caesarean deliveries which are not medically indicated.

Background: Pakistan is among those countries where the number of caesarean section births has increased unusually in the past two decades. Therefore, the aim of the present study is to analyse the trend of caesarean section deliveries among child-bearing women (aged 15–49 years) in Pakistan and to identify maternal socio-demographic factors and pregnancy-related variables associated with the change in caesarean deliveries from 1990 to 2018.Methods: Secondary data from Pakistan Demographic and Health Surveys (1990–2018) were analysed. The analysis of data was confined to child-bearing mothers. Sample sizes were 4,029, 5,721, 7,461 and 8,287 for the time periods of 1990–91, 2006–07, 2012–13 and 2017–18, respectively. Socio-demographic information of the mothers and pregnancy-related variables were taken as independent variables for the present study. The association between independent variables and caesarean deliveries was measured in terms of unadjusted odds ratios (OR) and adjusted OR (AOR).Results: The percentages of the mothers who had at least one delivery during the five years prior to each survey who had caesarean deliveries increased continuously from 3.2 % in 1990–91 to 19.6 % in 2017–18. Results indicate that mothers over 24 years of age, located in Punjab, from the richest socio-economic class and living in urban areas were more likely to have delivered by caesarean section. Mothers with a first child in birth order and who had five and more children, as well as mothers who had more antenatal care visits and delivered babies in private hospitals showed a higher probability of caesarean section births.Conclusions: The findings of the present study confirm the gradual upsurge in the percentage of mothers delivering by caesarean section during the past two decades in Pakistan. Against this backdrop, some measures need to be taken by health departments to regulate the number of caesarean deliveries. Awareness among women about pregnancy complications and elaborated details by gynaecologists about the medically indicated reasons for caesarean delivery are a few important steps in Pakistan that can help in reducing caesarean deliveries which are not medically indicated.

Objective: To determine the association of sleep wake pattern with cognitive performance and academic achievement in young adults. Methods: It was a cross sectional study conducted in March 2019 after approval from the Institutional Review Board & Ethics Committee of the study setting on February 28, 2019. Total sample of the study was 189 calculated by using Rao software. Inclusion criteria was healthy young adults of age 18 to 24 years from Doctor of Physical Therapy department of Shifa Tameer-e-Millat University, Dar-ul-Shifa campus, Islamabad. Exclusion criteria included all those students who were married, diagnosed psychological disorder and were taking any sedatives. Data was collected through three questionnaires named Pittsburgh Sleep Quality Index (PSQI), Morningness-Eveningness Questionnaire (MEQ) and Montreal Cognitive Assessment (MOCA) in addition to inquiry regarding GPA of latest exam. Results: A total sample was 236 students with a mean age of 20.94±1.58 years with range 18-24 years. The sample comprised of males n=24 (10.2%) and females n=212(89.8%). Mean GPA was 3.10±0.53. MOCA showed that 70(29.66%) students had mild cognitive impairment, 166(70.34%) were students with normal cognition. The results obtained by applying independent T-test showed a significant difference of cognition between high and low achievers (P value: 0.029<0.05. Students who scored high were definite morning types. Conclusion: There is a significant association between cognitive performance and academic achievement with high achievers being definite morning types. Keywords: Cognition, Sleep, Academic success, Young adult.

Aim: To explore the lived experiences of patients suffering from chronic kidney disease (CKD)to understand how the physical and psychological challenges associated with the disease influenced their life and what role did resilience play to cope up with the physical and psychological challenges. Method: The present study is qualitative in nature and used the phenomenological research design to study the lived experiences of CKD patients. Thirty seven participants were selected through purposive sampling from the nephrology departments of three government hospitals of Lahore which included Jinnah Hospital, Sheikh Zayed Hospital and General Hospital. Data was collected through in-depth interviews. Results: The study revealed that resilience is a major factor which helps to cope up with the physical and psychological challenges associated with CKD by reducing stress, developing a positive self-image, encouraging to fight back, finding alternative treatment options and increasing the will power of CKD patients. Practical implications: Findings of the present study will be helpful for the health care professionals and clinical psychologists to develop strategies and training programs which can increase resilience among patients. Training the patients and care givers regarding how to fight with CKD will lead to an improvement in their quality of life. Conclusion: Resilience enables CKD patients to have a self-worth and brings them back to life by motivating them to participate in the normal activities of life. On the basis of these results, it is expected that this factor can be helpful for the health care professionals, caregivers and patients themselves in order to minimize the negative impacts of the disease through counseling. Keywords: Chronic kidney disease, Resilience, Physical challenges, Psychological challenges

Background Pakistan is amongst those countries where the number of caesarean section births has unusually increased in the past two decades. Therefore, the aim of the present study is to analyse the trend of caesarean section deliveries among child-bearing women (aged 15–49 years) in Pakistan and to identify maternal socio-demographic factors and pregnancy related variables associated with the change in caesarean deliveries from 1990 to 2018.Methods Secondary data from Pakistan Demographic and Health Surveys (1990–2018) were analysed. The analysis of data was confined to the child-bearing mothers. Sample sizes were 4,029, 5,721, 7,461 and 8,287 for the time period of 1990–91, 2006–07, 2012–13, and 2017–18, respectively. For the present study, socio-demographic information of the mothers and pregnancy related variables were taken as independent variables. The association between independent variables and caesarean deliveries was measured in terms of unadjusted odds ratios (OR) and adjusted odds ratios (AOR).Results Out of the mothers who had at least one delivery during the five years prior to each survey, the percentages of the mothers who had caesarean deliveries increased continuously from 3.2% in 1990–91 to 19.6% in 2017–18. Results indicate that mothers above 24 years of age, located in Punjab, from the richest socio-economic class, and living in urban areas were more likely to have delivered by caesarean section. Mothers with first child in birth order and who had five and above children, as well as mothers who had more antenatal care visits and delivered babies in private hospitals showed a higher probability for caesarean section births.Conclusions The findings of the present study confirm the gradual upsurge in the percentage of mothers delivering through caesarean section during the past two decades in Pakistan. In this backdrop, some measures need to be taken by health departments to regulate the number of caesarean deliveries. Awareness among women about pregnancy complications and elaborated details by gynaecologists about the medically indicated reasons of caesarean delivery are a few important steps that can help in reducing not medically indicated caesarean deliveries in Pakistan.