SummaryBackground Newborn deaths account for 57% of deaths in children younger than 5 years in Pakistan. Although a large programme of trained lady health workers (LHWs) exists, the eff ectiveness of this training on newborn outcomes has not been studied. We aimed to evaluate the eff ectiveness of a community-based intervention package, principally delivered through LHWs working with traditional birth attendants and community health committees, for reduction of perinatal and neonatal mortality in a rural district of Pakistan. Interpretation Our results support the scale-up of preventive and promotive maternal and newborn interventions through community health workers and emphasise the need for attention to issues of programme management and coverage for such initiatives to achieve maximum potential. Methods

To determine the prevalence and routes of transmission of hepatitis C virus (HCV) infection in Hafizabad, Pakistan, we collected sera in 1993 from a geographically based random sample of residents, and in 1994 identified 15 HCV-infected individuals (cases) and 67 age and sex matched uninfected individuals (controls). Initially we approached 504 households, and collected serum from a randomly selected household member in 309 (64%). Twenty persons (6·5%) had anti-HCV antibody; 31% percent had hepatitis B core antibodies, and 4·3% had hepatitis B surface antigen. In the case-control study, persons who received more therapeutic injections (categorized as averaging 1, 2–4, 5–9 or >10 injections per year in the previous 10 years) were more likely to be infected with HCV (odds ratio 0, 1·5, 2·5 and 6·9 respectively, P=0·008) compared to persons averaging 0 injections per year. Efforts to limit therapeutic injections to only those that are medically indicated and that use sterile equipment are essential in order to prevent transmission of HCV.

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BackgroundPostpartum anxiety and depression has detrimental effects on the overall mental development of children. This study aims to assess the impact of postpartum anxiety and depression on children’s mental development on all sub-scales in a Pakistani population.MethodsA quasi-experimental study was conducted in two peri-urban communities of Karachi, a mega city of Pakistan, to assess the impact of postpartum anxiety and depression on children’s growth and mental development. A total of 420 women were enrolled, who had given consent out of 651 pregnant women identified, during February 2004 to December 2005. Data for socio-demographic, home environment and family relationship variables were collected between 36 weeks of pregnancy and within 10 days of childbirth. Mother’s levels of anxiety and depression were assessed at 1, 2, 6, 12, 18, 24, and 30 months of childbirth. An indigenous, validated screening instrument- Aga Khan University Anxiety and Depression scale was used and diagnostic confirmation was done through a psychologist’s interview, based on DSM IV criteria. Children’s growth and development was monitored in the same sequence using an Early Childhood Development tool that consists of five subscales; socio emotional, language, cognitive, gross motor and fine motor development. Physical growth was monitored by measuring height and weight of the child. Data was analyzed using SAS 9.2. Multivariable Generalized Estimating Equations (GEE) logistic regression was conducted to identify association of postpartum anxiety and depression with each early childhood development indicator, adjusting for parental and child factors.ResultsA significant association of postpartum anxiety and depression with delayed development on all five subscales of children’s mental development was found in our study. Interestingly, our study found that higher maternal age had adverse effects on child’s emotional whereas positive impact on child’s cognitive development. Children’s stunting had an adverse impact on all five subscales of children’s development. Male children were at higher risk for delayed language and gross motor development relative to female children.ConclusionsOur study found that postpartum anxiety and depression is associated with adverse outcomes regarding children’s mental development on all sub-scales. The impact was accentuated by low family income or child’s increasing age.

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