Maternal, neonatal and child health in Pakistan: towards the MDGs by moving from desire to reality

Of the 10 million annual deaths of children below five years of age, four million are neonates. Pakistan's neonatal mortality rate of 54/1000 live births, which accounts for 57% of the under-five mortality, the contraceptive prevalence rate stagnating at 30%, the meagre number of deliveries assisted by skilled birth attendants [39%] and the low coverage of cost-effective child survival interventions hamper the achievement of Millennium Development Goals [MDGs] 4 and 5. The Government launched the national maternal, neonatal and child health programme in 2007 to promote access to evidence-based cost-effective interventions; strengthen district health system capacities; empower communities; expand the community midwives' cadre; and promote utilization of essential services. This paper reviews the implementation of the programme and the likelihood of attaining the MDG4 and 5 targets by 2015, and provides strategic directions for scaling-up programme implementation

Acute renal failure: analysis of aetiological factors and outcome

To analyse the causes of acute renal failure [ARF] and management and outcome in these cases. All patients with ARF coming to SlUT between January 1990 and December 1998 were studied. A total of 1716 ARF cases were seen. Of these 43% had medica1, 28%surgical and 17% obstetrical causes. Haemodialysis was required in 88% of patients. Overall mortality was 18%. Causes of ARF in this part of the world is different from the western world. Preventable causes e.g. gastroenteritis, obstetrical haemorrhages, torture induced rhabdomyolysis and malaria, contribute to large percentage of the ARF population

Acute renal failure [ARF] following snake bite: a study of 35 cases

Objectives To study the prevalence, common presentation and factors causing mortality in snake bite induced ARF. Methods From January 1990 to December 1998, a total of 1716 cases of ARF were registered at SlUT [criteria of defining ARF was a rise in creatinine of> 2 mg% and normal size kidneys on ultrasound in a person without any previous systemic illness]. In 35 patients there was a history of snake bite preceeding ARF. Results of laboratory investigations and modalities of renal replacement therapy and outcome were analysed. Results Among 1716 cases of ARF, 764[43.4%] were due to medical causes, 485[28.2%] surgical, 298[17.3%] obstetrical and 169 [9.8%] due to miscellaneous and unknown causes. Thirty five patients, 22 males, 13 females, age range from 6- 65 years from the medical group, developed ARF after snake bite. The most common presentation was anuria and bleeding diathesis. Haemodialysis was started immediately after admission in 31 and peritoneal dialysis in 2 patients and two died before initiation of therapy. Twenty three [66%] patients recovered from renal failure in 2-3 weeks, 6 [17%] required long term dialysis [five of them had cortical necrosis], and 6 [17%] patients expired. Conclusion Bleeding diathesis induced by snake envenomation carries bad prognosis both in terms of mortality and morbidity with irreversible renal failure being the cause. Early initiation of dialysis therapy leads to rapid renal recovery

Acute graft dysfunction due to pyelonephritis, value and safety of graft biopsy

Objectives. To assess the value and safety of graft biopsy in patients who develop graft dysfunction due to pyelonephritis. Methods. Data analysis of all the patients with graft dysfunction and diagnosis of pyelonephritis was made on graft biopsy. During one year period six patients developed graft dysfunction due to pyelonephritis, all of these patients had an episose of acute cellular rejection in early post transplant period and received pulse steroid, while two in addition received ATG. Graft dysfunction when associated with UTI recovered within 4-6 weeks of antibiotic therapy. Graft biopsy is safe and histological diagnosis of pyelonephritis can save a patient from risk of anti rejection therapy given blindly in cases of graft dysfunction