Factors associated with utilization of antenatal care services in Balochistan province of Pakistan: an analysis of the Multiple Indicator Cluster Survey [MICS] 2010

Objective: The study was conducted to identify factors affecting the utilization of Antenatal Care [ANC] in Balochistan Province, Pakistan

Methods: Data on ANC utilization, together with social and economic determinants, were derived from a Multiple Indicator Cluster Survey [MICS] conducted in Balochistan in 2010. The analysis was conducted including 2339 women who gave birth in last two years preceding the survey. The researchers established a model to identify influential factors contributing to the utilization of ANC by logistic regression; model selection was by Akaike Information Criterion [AIC] and Bayesian Information Criterion [BIC]

Results: Household wealth, education, health condition, age at first marriage, number of children and spouse violence justification were found to be significantly associated with ANC coverage. Literate mothers are 2.45 times more likely to have ANC, and women whose newborns showed symptoms of illness at birth that needed hospitalization are 0.47 times less likely to access ANC. Women with an increase in the number of surviving children are 1.07 times less likely to have ANC, and those who think their spouse violence is socially justified are 1.36 times less likely to have ANC. The results draw attention towards evidence based planning of factors associated with utilization of ANC in the Balochistan province

Conclusion: The study reveals that women from high wealth index and having education had more chances to get ANC. Factors like younger age of the women at first marriage, increased number of children, symptoms of any illness to neonates at birth that need hospitalization and women who justify spouse violence had less chances to get ANC. Among components of ANC urine sampling and having tetanus toxoid [TT] in the last pregnancy increased the frequency of visits. ANC from a doctor decreased the number of visits. There is dire need to reduce disparities for wealth index, education and urban/rural living

Expediting support for the pregnant mothers to obtain antenatal care at public health facilities in rural areas of Balochistan province, Pakistan

Objectives: To identify, and compare relative importance of, factors associated with antenatal care [ANC] utilization in rural Balochistan, toward framing a policy to increase such utilization. Methods: This cross sectional study was conducted among 513 pregnant women in Jhal Magsi District, Balochistan, in 2011. A standardized interviewer-administered questionnaire was used. Predisposing, enabling, and reinforcing factors were evaluated with generalized linear models [Poisson distribution and log link]. Results: Prevalence of any ANC was only 14.4%. Predisposing, enabling, and reinforcing factors were all important determinants of ANC utilization. Reinforcing factors were clearly most important, husband's support for ANC was more important than support from other community members. Among predisposing factors, higher income, education, occupation, and better knowledge regarding benefits of ANC were positively and statistically significantly associated with ANC However increased number of children showed negative association. Complications free pregnancy showed positive significant association with ANC at public health facility among enabling factors. Conclusion: It is very important to increase antenatal care utilization in the study area and similar areas. Policy to achieve this should focus on enhancing support from the husband

Insertion of intrauterine contraceptive device [IUCD] at caesarean section after the delivery of placenta: an experience with 60 cases

To access the safety of Intrauterine Contraceptive Device [IUCD] insertion at Caesarean section after placental delivery. Observational analytical study of cohort type. Department of Obstetrics and Gynecology, Bolan Medical Complex Hospital, Quetta, from September 2009 to August 2010. This prospective study was conducted in the department of Obstetrics and Gynecology Quetta from September 2009 to August 2010. Sixty patients who had IUCD inserted at cesarean section were studied and followed for six months. The age ranges from 20-45years. Detailed history of each patient was recorded and thorough physical examination was performed. Patients with findings of any medical disorder were excluded. All analysis and computation including data base were done by SPSS 10. During the study period, a total of sixty women who had IUCD inserted at cesarean section were observed. All the cases were within age group ranging from 20-45 years of age. Out of them 53.3% were between 20 - 30 years, 28% between 31 -40 years, 18.3% belongs to 41-45 years of age. The events that were analyzed during the puerperium were pain, bleeding, infection and expulsion. Considering the postoperative complications, pain was the main complication during the puerperium and it occured in 54% of patients. Endometritis were occurring in 25% of cases and heavy lochia in 21% of cases. The expulsion rate was 8.3%. Women undergoing Cesarean section, who are suitable for using this method, should be given the option of IUCD insertion at the same time

Frequency of primary infertility in woman having fibroid uterus

To ascertain the frequency of primary infertility in women suffering from fibroid uterus. Observational analytical study of cohort type. Department of Obstetrics and Gynecology, Bolan Medical complex Hospital, Quetta, from April 2009 to March 2010. This prospective study was conducted in department of Obstetrics and Gynecology Quetta from April 2009 to March 2010. One hundred patients with fibroid uterus were studied. The age ranges from 20- 50 years. Detailed history were taken. In each patient thorough systemic examination was performed and patient with finding of medical disorder were excluded. All analysis and computation including data base were done by SPSS 10. During the study period, a total of one hundred women presented with fibroid uterus were observed. All the cases were within reproductive age group ranging from 20-50 years of age. Out of them 60% were between 20-30 years, 29% between 31-40 years and 11% belongs to 41-50 years of age. Considering the symptoms, infertility was 14%. According the number of fibroids, in 72% of cases there were multiple fibroids. Single uterine fibroid was seen in 28% of cases. Fibroid is relatively common in the patients in reproductive age and is exclusively responsible for infertility in 10% of cases. This study helps in establishing the relationship between fibroid uterus and primary infertility and by early detection with treatment, reducing the frequency of infertility in women having fibroid uterus

Morbidity and Mortality associated with vaginal hysterectomy

To access the morbidity and mortality of vaginal hysterectomy. Observational analytical study of cohort type. Department of Obstetrics and Gynecology, Bolan Medical Complex Hospital, Quetta, from June 2008 to June 2010. This prospective study was conducted in department of Obstetrics and Gynecology Quetta from June 2008 to June 2010. One hundred twenty five patients undergone vaginal hysterectomy were studied. The age ranges from 25- 65 years. Detailed history were taken. In each patient thorough systemic examination was performed and patient with finding of medical disorder were excluded. All analysis and computation including data base were done by SPSS 10. During the study period, a total of one hundred twenty five women undergone vaginal hysterectomy were observe. All the cases were within age group ranging from 25-65 years of age. Out of them 48% were between 41- 50 years, 27% between 51 -60 years, 9.6% belongs to 25-40 years of age and 15.2% were above the age of 60 years. Considering the commonest indication of vaginal hysterectomy is utero vaginal prolapsed, other important indications were dysfunctional uterine bleeding and uterine myoma. Comprises of the intra-operative and postoperative complications, show hemorrhage was the main complication during the surgery and it is the major cause of postoperative mortality in our study. Vaginal hysterectomy have less morbidity, shorter hospital stay and early resumption of patient of daily activities In our referral area where women's delivered at there home attend by inexperienced DIAS- traditional birth attendants, rapid succession of pregnancy greatly enhance the Perineal tear leads to high ratio if utero vaginal prolapse. Vaginal hysterectomy having less morbidity and mortality, so it is more convenient in our center