BackgroundWorld Health Organization recommends a standard daily oral dose of iron and folic acid (IFA) supplements throughout pregnancy to begin as early as possible. The aim of the present study was to determine the prevalence of use of antenatal IFA supplements, and the socio-demographic factors associated with the non-use of antenatal IFA supplements from 14 selected districts in Pakistan.MethodsData was derived from a cross sectional household survey conducted in 14 project districts across Pakistan. Trained female field workers conducted interviews with married women of reproductive age from December 2011 to March 2012. Women with the most recent live births in the preceding five years of the survey were selected for this study. Data was analysed by using STATA 13 and adjusted for the cluster sampling design. Multivariate logistic regression models were constructed to identify the independent factors associated with the non-use of antenatal IFA supplements.ResultsOf 6,266 women interviewed, 2,400 (38.3%, 95% CI, 36.6%, 40.1%) reported taking IFA supplements during their last pregnancy. Among IFA users, the most common source of supplements was doctors (49.4%) followed by community health workers (40.3%). The mean (±SE) number of supplements used was 76.9 (±51.6), and the mean (±SE) month of pregnancy at initiation of supplementation was 5.3 (±1.7) months. Socio-demographic factors significantly associated with the non-use of antenatal IFA supplements were living in Dera Ghazi Khan district (AdjOR: 1.72), maternal age 45 years and above (AdjOR: 1.97), no maternal education (AdjOR: 2.36), no paternal education (AdjOR: 1.58), belonging to the lowest household wealth index quartile (AdjOR: 1.47), and no use of antenatal care (ANC) services (AdjOR: 13.39).ConclusionsThe coverage of antenatal IFA supplements is very low in the surveyed districts of Pakistan, and the lack of parental education, older aged women, belonging to poorest households, residence in Dera Ghazi Khan district and no use of ANC services were all significantly associated with non-use of these supplements. These findings highlight the urgent need to develop interventions targeting all pregnant women by improving ANC coverage to increase the use of antenatal IFA supplements in Pakistan.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2393-14-305) contains supplementary material, which is available to authorized users.

Leadership is about knowledge, skills, and abilities for transformation. It is also increasingly about worldviews or visions of life—beliefs, values, and principles. But worldviews are also ways of life, for beliefs direct us, values guide us, and principles motivate us to certain kinds of action and behavior.How, then, do worldviews have an impact on leadership for transformation? If worldviews are glasses or filters by which we view the world, mental models of the bigger picture, frameworks by which we make sense of the world, and narratives by which we orient our lives, then how do they influence human thoughts, ideas, and behaviors when it comes to transformative leadership?This was the subject matter of an International Leadership Association Conference panel discussion held in November 2009 in Prague, entitled Leadership for Transformation: The Impact of Worldviews. It is also the subject matter of this issue's symposium, in which we bring you the four papers and the response presented at the conference. Members of the panel were characterized by gender, disciplinary, religious, and global diversity.Nathan Harter, organizational leadership professor at Purdue University in the United States, begins the discussion with some preliminary remarks about worldviews. Ali Mohammed Mir, medical doctor and director of programs of Population Council, Pakistan, speaks of leadership from an Islamic perspective. Michael Jones, accomplished composer, pianist, and leadership educator, writer, and speaker from Orillia, Canada, reflects on how a “marriage of mythos and logos” can transform leadership today. Lisa Ncube, originally from Zimbabwe and currently assistant professor of organizational leadership at Purdue University, speaks about Ubuntu as an alternative leadership philosophy emerging from Africa. John Valk, associate professor of worldview studies at Renaissance College, University of New Brunswick, Canada, speaks of leadership for transformation from a Christian worldview perspective. Jonathan Reams, associate professor in the Department of Education at the Norwegian University of Science and Technology in Trondheim, responds to all of the papers and opens a venue for further discussion.We hope that you will find this symposium engaging. We hope it will give food for thought and that it might stimulate further thinking regarding the role worldviews play in leadership for transformation.

BackgroundAccording to the Pakistan Demographic and Health Survey from 2006–2007, the maternal mortality ratio in rural areas is 319 per 100,000 live births. Postpartum hemorrhage is the leading cause of maternal deaths in Pakistan. The objectives of the study were to document the feasibility of distribution of misoprostol tablets by community-based providers mainly traditional birth attendants and acceptability and use of misoprostol by women who gave birth at home.MethodsA quasi-experimental design, comprising intervention and comparison areas, was used to document the acceptability of providing misoprostol tablets to pregnant women to prevent postpartum hemorrhage in the rural community setting in Pakistan. Data were collected using structured questionnaires administered to women before and after delivery at home and their birth attendants.ResultsOut of 770 women who delivered at home, 678 (88%) ingested misoprostol tablets and 647 (84%) ingested the tablets after the birth of the neonate but prior to the delivery of the placenta. The remaining women took misoprostol tablets after delivery of the placenta. Side effects were experienced by 40% of women and were transitory in nature. Among women who delivered at home, 80% said that they would use misoprostol tablets in the future and 74% were willing to purchase them in the future.ConclusionsSelf-administration of misoprostol in the home setting is feasible. Community-based providers, such as traditional birth attendants and community midwives with proper training and counseling, play an important role in reducing postpartum hemorrhage. Proper counseling and information exchange are helpful for introducing new practices in resource-constrained rural communities. Until such a time that skilled birth attendance is made more universally available in the rural setting, alternative strategies, such as training and using the services of traditional birth attendants to provide safe pregnancy care, must be considered.

Background. We aimed to assess the feasibility of using community-based informants' networks to identify maternal deaths that were followed up through verbal autopsies (MADE-IN MADE-FOR technique) to estimate maternal mortality in a rural district in Pakistan. Methods. We used 4 community networks to identify deaths in women of reproductive age in the past 2 years in Chakwal district, Pakistan. The deaths recorded by the informants were followed up through verbal autopsies. Results. In total 1,143 Lady Health Workers (government employees who provide primary health care), 1577 religious leaders, 20 female lady councilors (elected representatives), and 130 nikah registrars (persons who register marriages) identified 2001 deaths in women of reproductive age. 1424 deaths were followed up with verbal autopsies conducted with the relatives of the deceased. 169 pregnancy-related deaths were identified from all reported deaths. Through the capture-recapture technique probability of capturing pregnancy-related deaths by LHWs was 0.73 and for religious leaders 0.49. Maternal mortality in Chakwal district was estimated at 309 per 100,000 live births. Conclusion. It is feasible and economical to use community informants to identify recent deaths in women of reproductive age and, if followed up through verbal autopsies, obviate the need for conducting large scale surveys.

Training health care providers and medical college faculty about the supportive nature of Islam toward family planning principles addressed their misconceptions and enhanced their level of comfort in providing family planning services and teaching the subject.