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Risk Factors Associated with Birth Asphyxia in Rural District Matiari, Pakistan: A Case Control Study

International Journal of Clinical Medicine 2014年第21期5卷 1430-1441页

作者： Farhana Tabassum Arjumand Rizvi shabina ariff Sajid Soofi Zulfiqar A. Bhutta Department of Pediatrics and Child Health Aga Khan University Karachi Pakistan

Background: During the past two decades there has been a sustained decline in child mortality;however, neonatal mortality has remained stagnant. Each year approximately 4 million babies are born asphyxiated resulting in 2 million neonatal deaths and intrapartum stillbirths. Almost all neonatal deaths occur in developing countries, where the majority is delivered at homes with negligible antenatal care and poor perinatal services. Objectives: To identify socio-demographic and clinical risk factors associated with birth asphyxia in Matiari District of Sindh Province, Pakistan. Method: A matched case control study was conducted in Matiari District with 246 cases and 492 controls. Newborn deaths with birth asphyxia diagnosed through verbal autopsy accreditation during 2005 and 2006 were taken as cases. Controls were the live births during the same period, matched on area of residence, gender and age. Result: The factors found to be associated with birth asphyxia mortality in Matiari District of Sindh Province, Pakistan are maternal education, history of stillbirths, pregnancy complications (including smelly or excessive vaginal discharge and anemia), intrapartum complications (including fever, prolong or difficult labour, breech delivery, cord around child’s neck, premature delivery, large baby size) and failure to establish spontaneous respiration after birth. Conclusion and Recommendation: There is an immediate need to develop strategies for early identification and management of factors associated with birth asphyxia by involving women, families, communities, community health workers, health professionals and policy makers. Community health workers should be trained for emergency obstetric care, basic newborn care including preliminary resuscitation measures to provide skilled birth attendance and encourage early recognition and referral.

关键词： Birth Asphyxia Prolong Labor Antenatal Care

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Contextual Challenges in the Implementation of the Alliance for Maternal and Newborn Health Improvement, Prospective Cohort Study, an Experience from Rural Pakistan

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Open Journal of Preventive Medicine 2021年第7期11卷 334-346页

作者： Yaqub Wasan shabina ariff Amjad Hussain Sheraz Ahmed Mansoor Ali Abro Imran Ahmed Atif Habib Sajid Bashir Soofi Center of Excellence in Women & Child Health Aga Khan University Karachi Pakistan Department of Paediatrics and Child Health Aga Khan University Karachi Pakistan

Introduction: Improving maternal and newborn survival needs robust data on patterns of morbidity and mortality from well-characterized cohorts. It is equally important for researchers to document and understand the contextual challenges of data collection and how they are addressed. Methods: This was a prospective cohort study implemented from December 2012 to August 2014 in Matiari, Pakistan. A total of 11,315 pregnancies were enrolled. Participants were approached at home for sequential data collection through the standard pretested structured questionnaires. Some indicators were sourced through health facility records. Information on field challenges gathered through field diaries and minutes of meetings with field staff. Results: Inaccurate reporting of last menstrual period (LMP) dates caused difficulties in the planning and completion of antenatal data collection visits at scheduled gestational weeks. We documented ultrasound reports wherever available, relied on quickening technique, and implemented a seasonal event calendar to help mothers’ recall their LMP. Health system coordinators of public sector and private healthcare providers were individually approached for maximum data collection. But an unregulated private health system with poor record maintenance and health care providers’ reluctance for cooperation posed a greater challenge in data collection. Conclusions: Within a broader understanding of the health systems and socio-cultural environment, temporal and spatial feasibility of data collection should be considered thoroughly at the early stages of study designing, planning, resource allocation, and implementation. Pre-defined regular and need-based meetings with each tier of data collection teams and study managers help to reinvigorate field execution plans and optimize both quantity and quality of study data.

关键词： Maternal and Newborn Health Research Contextual Challenges Data Collection Field Implementation Lessons Learnt

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Determinants of Health Care Seeking Behaviors in Puerperal Sepsis in Rural Sindh, Pakistan: A Qualitative Study

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Open Journal of Preventive Medicine 2020年第9期10卷 255-266页

作者： shabina ariff Fatima Mir Farhana Tabassum Farrukh Raza Atif Habib Ali Turab Amnesty LeFevre Linda A. Bartlett Sajid Bashir Soofi Zulfiqar A. Bhutta Department of Paediatric and Child Health Aga Khan University Karachi Pakistan Center of Excellence in Women & Child Health Aga Khan University Karachi Pakistan Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA

Background: Puerperal sepsis (PS) is one of the major causes of maternal death, contributing to 26,000 deaths per year in developing countries. Early recognition and treatment are essential to managing PS, but numerous social, cultural and technical barriers prevent or delay access to care and necessary medical attention. Through this qualitative study, we identified barriers to care seeking for puerperal sepsis among recently delivered women in Matiari, Pakistan. Methods: We conducted 20 in-depth interviews among recently delivered women with and without sepsis and their family members in September 2012. Key informant interviews were conducted with 14 healthcare providers and traditional birth attendants. The themes used for content analysis were knowledge of danger signs, factors affecting care seeking and local treatment practices for postpartum sepsis. Results: A total of 34 interviews were conducted. Recently delivered women, their family members and traditional birth attendants were unaware of the word PS or the local translated term for PS. However, they were familiar with most of the individual symptoms associated with PS. Healthcare providers were aware of the condition and the associated symptoms. The healthcare providers’ understanding of the seriousness of PS was directly proportional their age and clinical experience. The most common barriers to care seeking was the division of labor within the household, obtaining permission from the primary decision maker, access to transportation, lack of financial resources and support from family members. Conclusion: To improve maternal care seeking behaviors for PS, interventions focusing on increasing knowledge of PS, addressing gender inequality, implementing an affordable community transport service and enhancing TBA’s knowledge and skills to manage PS need to be implemented.

关键词： Puerperal Sepsis Qualitative Care Seeking Barrier Maternal Health

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