ABSTRACT
To determine association of risk factors with hepatitis B surface antigen positivity in pregnant women. Case control study. Two years from 2004 to 2006 at Agha Khan University Hospital. A total of 210 subjects including 35 cases and 175 controls were enrolled into study. A detailed history from study subjects was recorded on a performa during antenatal visits. Univariate and multivariate analysis was done using SPSS package. A significant association was observed for the history of at least four injections for minor illnesses in past one year [adjusted odds ratio [AOR] = 5.5; 95% confidence interval [CI]: 1.6, 18.1] and history of blood transfusion [AOR= 6.025; 95% CI: 2.1, 17.1], with HBsAg status of pregnant women. We recommend interventions to improve injection safety and to discourage unnecessary therapeutic injections. There is also urgent need for strict enforcement of regulations for safe blood transfusion. Further research is required to estimate proportion and to evaluate reasons for unnecessary injections in women of reproductive age
ABSTRACT
To determine whether dissemination of explicit guidelines, developed in consensus with stakeholders, for the processes of induction of labour [IOL], results in reduction of variability in clinical practice. Design: A prospective behaviour modification interventional study. Place and Duration of Study: The study was conducted in the department of Obstetrics and Gynaecology at the Aga Khan University, Karachi, between January 1 and August 31, 2002. Subjects and In a total of 142 conveniently sampled women, undergoing IOL, pre-identified quality assessment indicators were measured. After collection of data from initial 71-women [pre-intervention group] mutually agreed guidelines for clinical practice were disseminated, over a period of time, among consultants, residents and nurses. These indicators were again measured in subsequent 71 women [post-intervention group] to evaluate magnitude of residual non-conformities in these processes. Following behaviour modification interventions, nonconformities in consultants and residents-dependent processes like timely review of patients by consultants [72 vs 1.4%, p value <0.0001], documentation of indication for IOL [66.2 vs 16.9%, p value <0.0001], method of induction for IOL [56.3 vs 28.2%, p value 0.0001], and calculation of Bishop score before IOL [38.0 vs 4.2%, p value <0.0001] were significantly reduced. Dissemination of explicit guidelines developed in consensus with stakeholders significantly reduces variability in clinical practice. Our model can be used for improving quality of care in other areas of obstetric health care