Role of antioxidant in recurrent pregnancy losses

Objective: To compare the rate of recurrent abortion in antioxidants supplemented and non-supplemented mothers

Study Design: Randomized control trail, double blind study

Place and Duration of Study: Liaquat University Medical and Health Sciences-Jamshoro [LUMHS], Shaheed Mohtarma Benazir Bhutto Medical University Larkana [SBBMU] hospital and PMC hospital Nawabsha [2012-2014]

Material and Methods: The patients were the mothers who had aborted three consecutive losses continuously. It was multicentre hospitals based study, where cases of recurrent abortion mothers frequently reported and were available. Two techniques were used convenient and snowball to select the patients

Results: A total of 123 cases of recurrent abortion [RA] were recruited and identified for registration [Point Estimate of Incidence] among them n=67 mothers in the active arm and n=56 in placebo arm. The R.A incidence rate was 89 per 1000 mothers at risk in Placebo arm and 149 per 1000 mothers at risk in Active arm. In case of RA the mean age was 30 years in both the arms. Mothers who had suffered recurrent abortion in both arms were mostly illiterate [61%]. The mean duration of marriage in active arm was 16.7 years. Researcher found that most of mothers, 92 [75%] did not become pregnant after taking the prescribed supplementation

Conclusion: The use of antioxidants before conception and during pregnancy significantly improves the chances of live births and outcome in general

Seeking help for abortion: problems in accessibility and quality in family planning services

In Family planning programmes seeking help for abortion has been projected as an indicator of 'unmet needs'. In a situation where terminating pregnancy is illegal and not allowed in religion, it may be a surprise when women seek help for abortion through family planning clinics. This study was conducted on those women to identify the reasons for seeking help so as to determine whether this could be an indication of accessibility and problems in quality of FP care. A total of 93 such women were interviewed. The mean age of women was 29.7 years, 46.2% were illiterate; having a mean gravidity of 5.1. Interestingly, 59.1% were using some contraceptive before getting pregnant; at least half of them were using condoms. Of all the reasons perceived by women for getting pregnant, majority related to having problems with contraceptives usage. Almost half of the women wanted abortion due to reasons related to their or their baby's health and limiting their family's size. More than 1/3rd of women had tried some method for terminating the pregnancy and about a quarter had not even sought a formal permission from their husbands. It can be concluded that seeking help for abortion is not only an indication for 'unmet needs' but also a reflection of the problems related to the practice and quality of FP programmes. It is recommended that scope of FP clinics should be widened to reproductive health centres so as to take care the health of women in toto. There is also an urgent need to address the issue of quality and increase in coverage of family planning services to combat the ever increasing threat for resorting to abortion

Why rickets is still commonly seen in our children: lesson for primary care physicians

Rickets is one of the important micro-nutrient deficiencies still seen by the primary care physicians. A study was conducted to find out the factors associated with rachitic children so as to suggest recommendations for its management and prevention. The clinical diagnosis of the disease was confirmed in 25 children by X-ray. The best indicator of the disease was widening of the wrist [76%] which was later confirmed by wrist x-ray [84%]. Some of the factors associated with rachitic children were compared with 54 normal children by finding out dietary and drug history and sunlight diary besides other basic details by interviewing mothers of both group of children. There was a significant difference in the age of the mother's of rachitic children, the mean age of normal children's mothers being higher. The panty of mothers of normal children was also significantly higher. There was no significant difference in the dietary or medicinal calcium intake of the mothers in both the groups. Rachitic children had been breastfed for a shorter period of lime as compared to controls [P<0.05]. Mean duration being 16.2 months of normal children. There was no significant difference in the birth weight, and calcium intake in the infant of the two groups. A statistically significant difference was noted in the time of the days when sunlight penetrates through the homes

Do workshops make a difference in improving the capability of physicians?

Continuing medical education [CME] activities have been shown to improve the capability and capacity of physicians for appropriate management of their patients. However, doubts have been raised about the role of workshops and seminars. This study is an attempt to find out whether workshops can improve the knowledge [capability] of practicing physician. Participants of 10 randomly selected workshops conducted in whole of Sindh were included for this study. A pre-test followed by post-test methodology used for 214 participants demonstrated that physicians knowledge increased for some of the basic facts after attending the workshop. However, when their knowledge was assessed with some problem-solving approach, no significant [P < 0.05] change could be noted. It is recommended that workshops should be designed and conducted more carefully. Besides, some innovative approaches for CME should be compared with 'workshops' approach to determine their effectiveness

Primary care providers and quality of care for diarrhoeal diseases

Diarrhoeal diseases are still a major cause of death in children in Pakistan. Therefore, it is necessary that they are not only prevented but are also managed properly, therefore, the main responsibility lies with the private primary level health care providers, also known as General Practitioners [GPs]. This study was conducted to find out the quality of care provided by the GPs for managing diarrhoea. 200 GPs working in squatter areas of four districts, were selected. A vignette of simple viral diarrhoea was given to answer the diagnosis, treatment and advice for that case. Expected standards for management were developed and compared with the answers given by the GPs. The results showed that the GPs followed the standards in diagnosis but their treatment and advice was below standard. The prescribing practice for the management of diarrhoea indicated that though most of them suggested ORS, but it was given with some other drugs [mean number of drugs 2.7 +/- 1.2]. Two thirds of the GPs used at least either an antibiotic or a anti-diarrhoeal. ORS alone was used by 38 GPs. The quality of care given by a majority of GPs for managing diarrhoeal diseases is poor. Thus, there is a need to improve their quality by offering some type of continuing medical education. Further research is also needed to understand the influence of the pharma market on the behaviour of the GPs

fourth world people: women residing in squatter settlements of Karachi

Women and children are the most vulnerable groups. Those at greatest risk are pregnant and lactating women, especially those of rural origin and/or residing in squatter areas. A study was done to identify how the place of origin of squatter dwelling women differs in their status and health status of their infants. Four hundred and forty five women were selected from 5 squatter settlements by random selection. They were interviewed and observations of their households were made to assign them a socio-economic score [SES]. Women having [rural origin] scored more Medium [43.7%] and Low [41.4%] SES as compared to [urban origin] who scored High among 55.1% of all urban-origins [P<.05]. [Rural origin] women were also significantly [P<.005] less educated than their [urban] counterparts. Only 53.2% of [rural origin] women had tetanus immunization in their last pregnancy as compared to 61.5% of [urban origin] women. Thirty seven per cent of the infants of [rural origin] women were also malnourished [P<.01]. Careful micro-analysis of women's status has helped us in identifying one of the most vulnerable groups. Detailed anthropological studies are needed into the determinants of poor women's status having rural origin, who can be labelled as the [fourth world people]

Self medication or self care: implication for primary health care strategies

To determine the frequency of self-medication, a cross-sectional study was conducted in a Karachi district by selecting households through systematic random sampling. Health seeking behaviour for childhood illnesses and assessment of the magnitude and reasons for self-medication were done by interviewing mothers/caretakers. Five hundred households were visited, of which 158 fulfilled the criteria of having one sick child in the previous month. Medication without prescription was given to 51.3% children, mostly consisting of unidentified drugs or analgesics/antipyretics. Good past experience [61.3%] with the medicine was the main reason for self-medication. The use of medicines by health professionals was the main reason influencing parents for self-medication to their children. Self-medication is difficult to eliminate, but interventions can be made to discourage use of inappropriate and harmful drugs

Anemia in children: part I Can simple observations by primary care provider help in diagnosis?

The commonest and reliable method of diagnosing anaemia is by determining haemoglobin levels, which is an invasive technique. This cross-sectional study aims to detect the validity of diagnosing anaemia by simple non-invasive clinical techniques. This study screened 951 children [6-60 months] residing in a squatter settlement of Karachi. Every child was first labelled anaemic or normal by a clinical scoring system and then his/her haemoglobin was tested by finger prick method on a Hemocue. Mean age was 31.1 +/- 15.3 months [n=945] and median was 32 months. The prevalence of anaemia by Hemocue was 78% [Anaemia=Hb<11gms percent] and by clinical examinations 68%. Conjunctivae alone had the highest sensitivity [74%] and nails alone highest specificity [96%]. Nails alone had the highest positive predictive value and conjunctivae alone highest negative predictive value [43.2%]. Combinations of conjunctivae with either nails, palm or tongue yielded the highest validity. The results indicate that in PHC settings with no laboratory facilities, anaemia can be detected by pallor of conjunctivae associated with pallor of either nails, palm or tongue

Anaemia in children: part II Should primary health care providers prescribe iron supplements by the observation and presence of assumed symptoms?

The dilemma of private practitioners is whether to prescribe or not to prescribe iron supplements on suspicion of anaemia. This cross sectional study was done in an urban squatter settlement with a primary health care centre to assess the significance of symptoms and a history of associated diseases in the diagnosis of anaemia. A total of 321 children were sampled from 1800 children <5 years of age in a population of 11.000, by systematic random sampling. Mothers were asked about the presence of assumed associated symptoms and diseases which were listlessness, irritability, anaemia, pica, poor weight gain, diarrhoea, acute respiratory infection and malaria in last 3 months. There was significant association between anaemia [Hb<11gms percent] and irritability [P<.02], anorexia for solid food [P<.04], pica [P<.001], episode of diarrhoea [P<.001] and poor weight gain [P<.006]. There was no significant association between malaria, cold, cough and anaemia. Children with this symptom complex should receive iron supplements

value of intermittent growth monitoring in primary health care programmes

The objective of growth monitoring is to detect early growth faltering before the child becomes severely malnourished. It has been found in many large projects in the private sector and in Government run Primary Health Care [PHC] programmes that monthly weighing is not feasible which makes it impossible to develop a functional outreach programme on a sustainable basis. This study is an attempt to propose an intermittent growth monitoring which is operationally feasible for large scale PHC programmes in the public sector. A historical prospective study was conducted to find out the correlation of weights of children at different ages with weights at subsequent months. Two hundred and ninety-two growth cards of children were selected from two squatter settlements of Karachi which are having a PHC programme through the Aga Khan University. At six months, about 71% of children were within the normal range, with increasing age from 10% to 39% of these children shifted to grade I Protein Energy Malnutrition [PEM]. When weights of children for each month were correlated with weights at all other months uptil 24 months, it was found that correlation coefficient at 6th and 9th month were significant [P value < 0.001]. Probability of developing malnutrition at different weights and ages were also calculated. The results indicate that malnutrition starts appearing at 6 months and weights at 6 months and to a lesser extent at 9 months are better prognostic indices of future malnutrition. Intermittent weighing of children can help in early identification of "high risk" children who can then be managed and even be prevented from developing future malnutrition

Risk approach for reducing malnutrition in children from a privileged community

Of 279 children, below the age of 5 years, studied from January to March 1984, 30% had some degree of malnutrition. Risk factors like low birth weight, low family income, previous attacks of diarrhoea and absent or inadequate breast feeding were found to have a strong association with malnutrition. In the "Well Baby Clinic", extra attention was given to the children having those risk factors. Nutritional status determined after 2 years showed that though there was no reduction in the overall percentage of malnourished children but the degree of severity of malnutrition definitely decreased

Management of acute respiratory infections[ARI] through primary health care services

Acute Respiratory Infection is one of the three major killers in children. While six million children die of ARI worldwide, in Pakistan 34% of hospital admissions are attributed to ARL This article overviews the role of Primary Health Care in the Management of ARI. It takes into account the level of care required to effectively manage this disease and the corresponding manpower required to do so. It highlights the guidelines and steps for management and relates them to various personnel who can be key decision makers to manage this problem. It pin-points various antimicrobial agents appropriate for different microbes along with the supportive therapy needed to control the disease. It also describes the scheme for the management of patients with different types of cough associated with fever, wheeze and croup