Role of vitamin D in reducing number of acute exacerbations in chronic obstructive pulmonary disease [COPD] patients

Background and Objective: Chronic obstructive pulmonary disease [COPD] is characterized by chronic incompletely reversible poor airflow and air trapping and usually this debilitating disorder limits the outside activities of the patients depriving them of sunlight which is a rich source of Vitamin D. The objective of this study was to determine the effect of vitamin D supplementation in reducing number of acute exacerbation in COPD patients

Methods: This randomized control trial was conducted at East Medical Ward Mayo Hospital Lahore from January to December 2015 as exacerbations of COPD are season dependent. Diagnosis was confirmed by performing Pulmonary Function Tests [PFTs]. Basic demographical information was obtained and baseline PFTs of the patient was done. Only Group A patients was treated with oral vitamin D intake of 2000 IU daily for 6 months. Vitamin D level was measured at 0, 2, 4, and 6 months and exacerbation of COPD, FEV1 and FVC was measured weekly. Both the groups were given standard treatment for exacerbation of COPD. Spirometry was repeated at each visit. Blood samples were collected every 2 months for vitamin D. Supplementation was stopped if vitamin D level exceeded 100ng/ml

Results: The mean age of the patients was 46.28 +/- 8.83 years, the male to female ratio was 1.8:1. The mean 25[OH] level at baseline was 24.08 +/- 2.58 and at 6th month was 29.60 +/- 8.74. The mean FVC at baseline was 77.83 +/- 5.49 and at 6th month was 91.34 +/- 5.52. The exacerbation at baseline was present in all 120[100%] patients and at 6th month was reduced to 4[3.3%]

Conclusion: Vitamin D supplementation has significant effect in reducing number of acute exacerbation in COPD patients when it is given for prolonged period

assessment study of maternal mortality ratio databank in five districts of North Western Frontier Province Pakistan

Maternal mortality ratio is an indicator to measure the summary of information about mother and child health. It is estimated that about 500 maternal deaths occur per 100,000 live births each year in Pakistan. It is a well known fact that all health statistics coming out of the developing countries are calculated "guesstimates" some are perhaps more close to the real figures than the others. There is a dire need to help generate information that can be used by health professionals, health care planners and managers to save women's lives by improving the quality of care provided to turn away maternal mortality. The maternal mortality ratio for Pakistan as well as for NWFP is projected as 533 /100,000 live births for the year 1990-91 produced by National Institute of Population Studies, Pakistan. This was a retrospective cross-sectional quantitative study for the period [2001-2002] conducted in five districts of [NWFP] North Western Frontier Province, Pakistan. National HMIS data opened the maternal mortality ratio for; Haripur as 0.168 and 0.173, Mansehra 00 and 00, Battagram 00 and 00, Swat 0.051 and 0.524 and Swabi 00 and 0.968 per/1000 live births, respectively. The small part exercise outcome [the study] endorsed more shadowy side of the actual maternal mortality ratio for the same period in the same districts. In our country there is a urgent need to institute an efficient mode of operation to get accurate maternal mortality database. Verbal Autopsy method is cost effective and feasible approach for implementation in a country like Pakistan

Equity shortfalls and failure of the welfare state: community willingness to pay for health care at government facilities in Jehlum [Pakistan]

The question of willingness to pay is very crucial in planning for services. In Pakistan, the long-term issues of sustainability of health systems particularly, allocation of finances have routinely been addressed by planners with insufficient data and unclear goals. This study was conducted with the objectives to determine the demand for health care services in the community; at first level care facilities and community level and determine the willingness of the community [Willingness to pay] to participate in cost sharing mechanisms for provision of primary health care in fee for service and prepayment mechanisms. A cross sectional stratified household interview survey of 600 households was carried out in urban and rural areas of district Jehlum, to address the financial sustainability of government health care interventions at the community level and to explore the question of willingness to pay for health care and their ability to participate in the cost sharing mechanisms. In response to willingness to pay at a Government facility to obtain health care 437 [72.7%] of the households expressed their willingness to pay for health care. In 72% of the cases, cost was not considered as a barrier in seeking care and only 19% of the cases considered cost as a partial barrier; the rest said that cost prohibited seeking care. A majority across all strata is willing to pay for consultation and medicines at public sector facilities, although the responses from the low income groups exhibit a slight decrease in the willingness to pay. The willingness to pay is marginally affected by income, place of residence and/or cost of the treatment incurred. The findings of this study suggest that the community is willing to pay for health care at the public sector facilities if payment can ensure provision of essential curative services and medications at improved quality levels