RESUMEN
Maternal mortality remains a great challenge to health systems in developing countries. Reliable maternal mortality rate in Pakistan is not exactly known. The estimated range of maternal mortality is 190-1700 deaths per 100,000 live births. Our objective was to find out the maternal mortality rate and its main causes in a tertiary care centre in Faisalabad. This is an observational descriptive study. Maternal death which took place in Gynaecology Unit of Allied Hospital/Punjab Medical College Faisalabad from April 2006 to March 2010 were included in this study. Accidental incidental maternal death, patients with medical and gynecological problems and those beyond 42 days post partum were excluded. Total of maternal deaths during these four years was 168 in 24667 births with MMR of 6.81/1000. The common causes of maternal deaths were obstetrical hemorrhage in 58[34.5%], hypertensive disorders in 31[18.45%], puerperal septicemia in 23[13%] and unsafe abortion in 20[11.9%]. Other direct causes were found in 12 [7.1%] patients. One forty eight [88.09%] patients belonged to uneducated class, 110[65.48%] from rural area whereas 95[56.5%] hadn't received any antenatal care. High MMR [Maternal Mortality Rate] can be prevented with timely and proper antenatal and post natal facilities
RESUMEN
Doctor patient relationship is a communication/ interaction between the doctors and patients in terms of good behavior, active listening/ attention and respect. To find out the interaction and communication behavior and attitude of patients towards doctor and vice versa. Both quantitative and qualitative techniques were used through semi structured interviews and observations. Study was done over a month at 2 public sector hospitals [Rawalpindi General Hospital and Pakistan Institute of Medical Sciences, Islamabad] and 2 private hospitals [Maryam Memorial Hospital, Rawalpindi and Shifa International Hospital, Islamabad]. Ten patients and 5 doctors from the gynecology department of each hospital were interviewed over a period of 1 month. Only hospitals with dedicated gynecology department were selected. Patients included both in and out patients who had either visited OPD more than 2 times or were hospitalized for more than 2-3 days. The pre tested qualitative and quantitative questionnaire was used where doctors were asked about the average number of patients they see each day, the time spent to see these cases and the degree of interactive communication between them and their clients. Similarly the patients were asked about their satisfaction with doctors and the time spent to seek medical care. A total of 40 patients and 20 doctors were interviewed. The doctor's workload at public hospitals was much higher than the workload of doctors at private hospitals. The attitude and behavior of the patient towards doctors and vice versa in private hospital was better than that seen in the Public hospital and this non cooperative and less helpful attitude of the doctors was seen maximally in the gynecology department of the public sector hospital. The health care provider's relationship [doctors, nurses and other staff] with the patients was better in private hospitals than in the public sector hospitals. Primary and secondary care health units should be upgraded with manpower and facilities, so that patient's load on tertiary care public sector hospitals is reduced, ultimately resulting in better patient doctor relationships