Emergency obstetric care in Punjab, Pakistan: Improvement needed

Ali, Moazzam; Ahmed, Khawaja Masuood; Kuroiwa, Chushi

doi:10.1080/13625180701877712

Cited by 6 publications

(13 citation statements)

References 13 publications

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“…Zimba et al (2012) found that while Malawi has increased the percent of skilled deliveries, the majority of women and newborns with complications still lack access to essential services (37). Ali et al (2005) found the met need for Emergency Obstetric Care (EmOC) was only 9% in Pakistan [38]. A key next step is for countries to focus on and document scale-up so that progress can be measured (39).…”

Section: Resultsmentioning

confidence: 99%

A Regional Multilevel Analysis: Can Skilled Birth Attendants Uniformly Decrease Neonatal Mortality?

Singh

Brodish

Suchindran

2014

Matern Child Health J

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Objective Globally 40% of deaths to children under-five occur in the very first month of life with three-quarters of these deaths occurring during the first week of life. The promotion of delivery with a skilled birth attendant (SBA) is being promoted as a strategy to reduce neonatal mortality. This study explored whether SBAs had a protective effect against neonatal mortality in three different regions of the world. Methods The analysis pooled data from nine diverse countries for which recent Demographic and Health Survey (DHS) data were available. Multilevel logistic regression was used to understand the influence of skilled delivery on two outcomes – neonatal mortality during the first week of life and during the first day of life. Control variables included age, parity, education, wealth, residence (urban/rural), geographic region (Africa, Asia and Latin America/Caribbean), antenatal care (ANC) and tetanus immunization. Results The direction of the effect of skilled delivery on neonatal mortality was dependent on geographic region. While having a SBA at delivery was protective against neonatal mortality in Latin America/Caribbean, in Asia there was only a protective effect for births in the first week of life. In Africa SBAs were associated with higher neonatal mortality for both outcomes, and the same was true for deaths on the first day of life in Asia. Conclusion Many women in Africa and Asia deliver at home unless a complication occurs, and thus skilled birth attendants may be seeing more women with complications than their unskilled counterparts. In addition there are issues with the definition of a SBA with many attendants in both Africa and Asia not actually having the needed training and equipment to prevent neonatal mortality. Considerable investment is needed in terms of training and health infrastructure to enable these providers to save the youngest lives.

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Section: Resultsmentioning

confidence: 99%

A Regional Multilevel Analysis: Can Skilled Birth Attendants Uniformly Decrease Neonatal Mortality?

Singh

Brodish

Suchindran

2014

Matern Child Health J

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“…Notwithstanding a wide network of facilities, a survey of public sector health facilities in Punjab showed that only 13% of facilities designed to provide basic emergency obstetric services were actually doing so [59]. The corresponding rate in North West Frontier Province (NWFP) is 10% [60].…”

Section: Introductionmentioning

confidence: 99%

Addressing disparities in maternal health care in Pakistan: gender, class and exclusion

Mumtaz

Salway

Shanner

et al. 2012

BMC Pregnancy Childbirth

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BackgroundAfter more than two decades of the Safe Motherhood Initiative and Millennium Development Goals aimed at reducing maternal mortality, women continue to die in childbirth at unacceptably high rates in Pakistan. While an extensive literature describes various programmatic strategies, it neglects the rigorous analysis of the reasons these strategies have been unsuccessful, especially for women living at the economic and social margins of society. A critical gap in current knowledge is a detailed understanding of the root causes of disparities in maternal health care, and in particular, how gender and class influence policy formulation and the design and delivery of maternal health care services. Taking Pakistan as a case study, this research builds upon two distinct yet interlinked conceptual approaches to understanding the phenomenon of inequity in access to maternal health care: social exclusion and health systems as social institutions.Methods/DesignThis four year project consists of two interrelated modules that focus on two distinct groups of participants: (1) poor, disadvantaged women and men and (2) policy makers, program managers and health service providers. Module one will employ critical ethnography to understand the key axes of social exclusion as related to gender, class and zaat and how they affect women’s experiences of using maternal health care. Through health care setting observations, interviews and document review, Module two will assess policy design and delivery of maternal health services.DiscussionThis research will provide theoretical advances to enhance understanding of the power dynamics of gender and class that may underlie poor women’s marginalization from health care systems in Pakistan. It will also provide empirical evidence to support formulation of maternal health care policies and health care system practices aimed at reducing disparities in maternal health care in Pakistan. Lastly, it will enhance inter-disciplinary research capacity in the emerging field of social exclusion and maternal health and help reduce social inequities and achieve the Millennium Development Goal No. 5.

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“…The national cesarean rate in the rural population is reported as very low, 0.51%, and only 9.1% of the pregnant females have accessibility to emergency obstetric care. [34] In another study the overall cesarean rate in Pakistan's rural population was 9 per 100,1000 and in the developed countries the rate is 236 per 100,000 population. The rate of cesarean section is variable in developing and developed countries.…”

Section: Discussionmentioning

confidence: 97%

“…The crude birth rate is 30 per 100 and maternal mortality rate 500 per 100,000. [22,23,34] The rural communities do not have access to the minimal quality surgical care and cannot afford it either. [1,3,4] On paper the state has a system in place including basic health units (5171) and maternal and child centres (852) to provide primary healthcare services.…”

Section: Discussionmentioning

confidence: 99%

“…Rural health units (551) are supposed to provide secondary health facilities including emergency surgical and obstetric care but unfortunately there is a very unreliable mechanism of implementation and monitoring system. [2,4,34] In 1983 a survey of 19 districts of Pakistan was conducted to assess the healthcare system in the rural areas including infrastructure, spectrum of surgeries and the number of qualified surgeons. The study showed an overall rate of surgery of 124 per 100,000 population and the commonest surgeries were gastrointestinal (38%), obstetric (30%), orthopedic (13%) and urological (19%).…”

Section: Discussionmentioning

confidence: 99%

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Experience of developing rural surgical care in a remote mountainous region of Pakistan: Challenges and opportunities

Alvi

2011

Ann Trop Med Public Health

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Background: Pakistan is one of the most populated countries with a population of 160 million; 67% are rural population but all the tertiary care facilities are concentrated in large cities. The Northern Areas is the most remote region with difficult terrain, harsh weather conditions and the tertiary care hospital at a distance of 600 km with traveling time of 16 h. The Aga Khan Medical Centre, Singul (AKMCS) is a secondary healthcare facility in Ghizer district with a population of 132,000. AKMCS was established in 1992 to provide emergency and common elective surgical care. It has strengthened the primary health service through training, education and referral mechanism. It also provided an opportunity for family physicians to be trained in common surgical operations with special emphasis on emergency obstetric care. In addition it offers elective rotations for the residents and medical students to see the spectrum of diseases and to understand the concept of optimal care with limited resources. Methods and Results: The clinical data was collected prospectively using international classification of diseases ICD -9 coding and the database was developed on a desktop computer. Information about the operative procedures and outcome was separately collected on an Excel worksheet. The data from January 1998 to December 2001 were retrieved and descriptive analysis was done on epi info-6. Thirty-one thousand seven hundred and eighty-two patients were seen during this period, 53% were medical, 24% surgical, 16% obstetric and 7% with psychiatric illness. Out of 1990 surgical operations 32% were general surgery, 31% orthopedic, 21% pediatric, 12% obstetric and 4% urological cases; 42% of operations were done under general anesthesia, 22% spinal, 9% intravenous (IV) ketamine, 6% IV sedation and 21% under local anesthesia. Six hundred and sixty-two were done in the main operation room including general surgery 337, obstetric 132, urological 67, pediatric 66 and orthopedic 66 cases; 64% of cases in the main operation room were done under general and 22% under spinal anesthesia. The commonest surgeries were exploratory laparotomy, caesarian sections, open prostatectomy, urological stone surgeries, appendectomy, hernia repairs and surgery for osteomyelitis. There were 21 surgical mortalities including six operative deaths, 15 non-operative deaths and 89% of the mortalities were unavoidable. The crude in-hospital mortality decreased significantly from 5.5% in 1992 to 1.1% in 2001 and the contributing factors were improved structure and process of care. Conclusion: The impact of a secondary care rural medical centre (AKMC) is very obvious from the clinical audit including accessibility, sustainability and quality of care. This could be a model of care in rural Pakistan where accessibility, affordability and quality of care is lacking.

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Emergency obstetric care in Punjab, Pakistan: Improvement needed

Cited by 6 publications

References 13 publications

A Regional Multilevel Analysis: Can Skilled Birth Attendants Uniformly Decrease Neonatal Mortality?

A Regional Multilevel Analysis: Can Skilled Birth Attendants Uniformly Decrease Neonatal Mortality?

Addressing disparities in maternal health care in Pakistan: gender, class and exclusion

Experience of developing rural surgical care in a remote mountainous region of Pakistan: Challenges and opportunities

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