Healthcare seeking for thalassaemia management among children: a descriptive cross sectional study in Azad Jammu and Kashmir

A wide range of services is required for treating the thalassaemic children. However, in resource constrained settings of a developing country, it is important to understand the problems faced by thalassaemic children and their families prior to proposing any interventions or strategies for the prevention and control of thalassaemia-related morbidities and mortalities. A cross sectional descriptive study was carried out with fifty thalassaemic children [and their families]. These frequently transfused children had been registered with the AJK Central Blood Transfusion Service, district Muzaffarabad. Eighty percent of the thalassaemic children belonged to a poor socio-economic quintile. Only 4% of the parents never faced any difficulty in arranging blood for their children and they represent a well-off class. Forty four percent of the thalassaemic children were not using the chelation therapy because their parents could not afford it. Thirty six percent of the families of thalassaemic children never had heard about the thalassaemia screening test. Thalassaemic children need a standard treatment. However, it is a distant dream for the thalassaemic children of Muzaffarabad, AJK. There is no public or private sector facility specifically providing full range of services to treat thalassaemia. The poverty has compounded the sufferings and imperiled the health seeking behaviours of these children. There is an urgent need to appraise the financing and functioning of the health services so as to provide free or subsidized treatment to thalassaemic children for improving their quality of life

Neonatal deaths in Pakistan: managing the challenge

Every hour 450 neonatal deaths occur worldwide and approximately 4 million babies die during first week of their life. The middle and low income countries bear most of the neonatal mortality where more than half of these deaths occur in households. Pakistan is among six countries which account for 50% of all child deaths worldwide. Most of these deaths occurring in households are preventable. This review attempts to determine gaps either in our health system and practices for neonatal care to present a roadmap for the effective neonatal health programming in resource limited settings. The review methodology used three pronged approach. Firstly, we searched data bases such as PubMed, Cochrane, WHO regional database to catalogue international experiences. Secondly, a detailed document review for sorting the local evidence regarding neonatal health was performed. The third step of the review methodology used open search for indexing the neonatal care specific programmes both in the public and the private health sector. Neonatal death entails a multitude of socio-economic and health system related factors. Health system related factors are substandard care, inadequate training, low staff competence and inefficient resources including equipment and medication while illiteracy, cultural practices and low socio-economic status also contribute to soaring neonatal deaths. The success of community based programmes specific to neonatal health is primarily dependent on socio-economic and political factors, health infrastructure and health system factors. Devising short, medium and long term strategies to bring down high neonatal mortality rates are critically needed at this point in time. Improvements in service delivery of neonatal health specific programmes and capacity development of community health workforce are short and medium term strategies in order to augment home based care. Long term strategies include empowerment of communities and relocation of health budgets towards betterment of primary health care services