Need improvement in healthcare via demand side financing in Pakistan

Objective: To see the effect of maternal mortality rate and life expectancy on the death rate via demand side financing intervention in Pakistan

Study Design: Time Series Experimental Study

Place and Duration of Study: The study was conducted in IBM, UET,Lahore during August to September, 2015

Materials and Methods: This was a time series experimental study where time series data from World Bank Indicators [WBI] from 2000 to 2013 was used to see the effect of maternal mortality rate and life expectancy on the death rate. Dependent variable is death rate in the country and independent variables are maternal mortality rate and life expectancy of the country of Pakistan. I have applied regression through Eviews software to see the effect and results are significant

Results: There is a positive significant effect of MMR on the death rate and negative significant effect of LE on the death rate. MMR has significant positive impact on the death rate its P value is .0004 and Life expectancy has negative significant impact on the death rate its P value is .0000

There is no multicol linearity as Durbin Watson value is 1.785 which is near 2.There is no heteroscedasticity as R-Squared value is .99 almost 1

Conclusion: It is essential to decrease the death rate by providing healthcare facilities; although government allocate budget to healthcare and trying to facilitate especially poor via providing free medicines and many other healthcare incentives [Primary and Secondary healthcare] which somehow affect the death rate. However healthcare needs more funds to increase the usage of accessible and timely healthcare facilities to people. This can be possible via acquiring fund to facilitate poor through a proper system i.e Demand side financing

Frequency of diabetic retinopathy in hypertensive diabetic patients in a tertiary care hospital of Peshawar, Pakistan

Background: Diabetic retinopathy is a common microvascular complication of both type 1 and type 2 diabetes mellitus. If left untreated, it can progress to serious visual disability. Coexistence of hypertension with diabetes has been described as another risk factor adding to the problem. We designed this study to assess the occurrence of diabetic retinopathy in hypertensive diabetic patients of this region and to compare it with normotensive diabetic patients. Methods: This cross-sectional study was carried out on 200 previously diagnosed diabetic patients. Apart from routine examination and investigations, retinopathy and blood pressure assessment of each patient was done using standard techniques. Hypertensive diabetic subjects [Group-I, n=107] were compared with non-hypertensive diabetics [Group-II, n=93] for the presence of retinopathy. Results: Retinopathy and hypertension were observed in 51% and 53.5% of the total diabetic patients respectively. Hypertensive diabetic patients had significantly higher percentage of retinopathy compared to non-hypertensive diabetic patients [58 vs 43%; p<0.05]. Conclusion: Retinopathy and hypertension are highly prevalent in our diabetic patients. The proportion of retinopathy is significantly more in hypertensive as compared to normotensive diabetics. Keywords: Diabetes Mellitus, Diabetic Retinopathy, Hypertension, Prevalence, Tertiary care

Recurrent abdominal pain in children

To determine the causes of recurrent abdominal pain [RAP] in children and suggest general management guidelines. It is a descriptive observational study conducted from August 2000 to July 2003.One hundred fifty two children of 2- 15-Years age with recurrent abdominal pain were enrolled in this study. A pre-designed proforma was filled and investigations like Complete Blood Count [CBC], urine and fresh stool analysis was performed in all cases. Patients presenting with upper abdominal pain with or without dyspeptic symptoms were evaluated for H. Pylon by serology. Helicobacter pylon antibody serology [value >50 i.u Elisa method] positive patients were offered endoscopy examination and endoscopic antral biopsies were done. Other tests like x-ray chest and or abdomen, barium meal study, ultrasonography of abdomen, EEG examination and tuberculin test were done as indicated. Patients were followed at 2-week interval for three months and specific treatment prescribed as per etiology identified. Out of 152 children, a female to male ratio was 2:1, age range was 2-15 years and mean age was 8.9 years. Mean duration of symptoms was 16 months. Patients presented with epigastric localization of pain 65%, 25% presented with 'whole' abdominal pain while 5% patients presented with pain in loins and 5% had pain in tower abdomen. Protozoal infections which included giardiasis and amoebiasis [33%] were the commonest association followed by Helicobacter pylon [31%]. Endoscopy was performed in 15 cases; biopsy was positive for H.Pylori in all [100%] cases. Thirteen percent had worms in addition to giardia and entamoeba histolytica and 10% had gastro-esophageal reflux. Among other causes urinary tract infection was 5%, constipation was 3% a peptic ulcer diseases was 02%. Abdominal epilepsy, abdominal migraine, cholilithiasis, ovarian cyst, ulcerative colitis and gastnic-trichobizoar all were less than 1%. Recurrent abdominal pain is frequent and challenging pediatric problem. High index of suspicion and careful thorough clinical evaluation supported by stepwise laboratory work-up according to it's clinical presentation and consideration of common treatable causes will be a cost effective approach. Balanced diet with higher fiber content, environmental cleanliness, better quality of water and good personal hygiene practices can reduce common infections with causative factors

Factors causing non-breastfeeding in children under six months of age in district Nowshera, Pakistan

In developing countries bottle feeding has emerged a big public health problem while in developed countries the trend is opposite. Prevalence of breast feeding in Pakistan is 90-98% but in some subgroups of population it is as low as 60-80%. The objectives of the study were to determine the causes of non breast feeding in children less than six months of age in district Nowshera, and assess practice of starting first breast feeding to the newborn. A cross sectional study was conducted in ten union councils of district Nowshera. A total of 305 children under six month age were selected by simple random method. Data was collected on pre-designed questionnaire and analysed by descriptive statistics. The study included 198 children from rural and 107 from urban areas. Mothers/guardians of 71.8% children were uneducated. Causes of non breast feeding included perception of mothers of having insufficient milk [45.9%], working mothers [18.4%], mothers with chronic diseases [13.1%], children with congenital or acquired diseases [17%], mothers having next pregnancy [3.61%] whose mothers have been died [0.98%] and twin babies [0.98%]. On the other hand, 61% babies started breast feeding on first day, 19% on second, 10.8% on third and 3.9% after third day while 5.2% babies got no breast feeding at all. Main causes of non-breastfeeding in less than six month age are perception of having insufficient milk, working women and twin babies