Maternal Mortality In Pakistan: Is There Any Metamorphosis Towards Betterment?

BACKGROUND: Every year more than half million mother die due to pregnancy related preventable causes like haemorrhage, hypertensive disorders, sepsis, and obstructed labour and unsafe abortion. Among these deaths 99% occur in developing countries. The study was conducted to assess the maternal death rate and to analyse its trends over a period of 20 years in tertiary care hospital in Sindh Province Pakistan. METHODS: A retrospective analysis of maternal mortality records were carried out for a period of 20 years from 1986-1995 and 2011-2015 at the Department of Obstetrics and gynaecology Liaquat University of Medical and Health Sciences Hyderabad Sindh Pakistan. The record retrieved was categorized into four 5 yearly periods 1986- 1990, 1991-995, 2006-2010 and 2011-2015 for comparison of trends. RESULTS: The cumulative maternal mortality ratio (MMR) was 1521.5 per 100,000 live births. The comparison of first 5 years' period (1986-1990) and last 5 years (2011-2015) showed downward trend in maternal mortality rate from 2368.6-1265.1. Direct causes of death have accounted for 2820 (84.78%) of total maternal death. Sepsis was the major cause of death for first 5 years accounted for 196(35.1%) of maternal death while in the last 5 years' eclampsia causes 284 (27.84%) of direct maternal deaths. CONCLUSIONS: The reduction in the maternal deaths has been very slow. The direct causes were still the main reasons for obstetrical deaths.

Menopausal symptoms: prevalence, severity and correlation with sociodemographic and reproductive characteristics. A cross sectional community based survey from rural Sindh Pakistan.

OBJECTIVE: To determine prevalence and severity of menopausal symptoms and to investigate any correlation of sociodemographic and reproductive characteristics with menopausal symptoms in rural women. METHODS: The cross-sectional study was conducted in 2007-08 in rural Sindh, Pakistan, and comprised women of age 40-70 years who were selected through multistage random sampling. Sociodemographic information was collected on a predesigned proforma. Menopause Rating Scale was used to collect information regarding the prevalence and severity of menopausal symptoms. Multivariate logistic regression was used to adjust prevalence odds ratio for demographic and reproductive characteristics. RESULTS: From among a population of 525,082, the study selected 3062(0.5%) women. The prevalence of menopausal symptoms was mostly higher except bladder problems 1138(37.7%) and dryness of vagina 1008(34%). The frequency of symptoms - all mild in nature - were hot flushes 1287(42%), sleep problems 1251(40.9%), depressive mode 1169(38.2%), physical and mental exertion 1169(38.2%), and muscle and joint pain 861(28.1%). Significant association of the symptoms was found with age, education and menopausal status (p<0.05 each). CONCLUSIONS: The prevalence of most of the menopausal symptoms was high except for bladder problems and dryness of vagina. Majority of the symptoms were categorised as mild.

Age and symptoms at natural menopause: a cross-sectional survey of rural women in Sindh Pakistan.

BACKGROUND: Age at menopause and symptoms vary among populations and societies. Scarce data is available about menopausal age, symptoms and socio-demographic and reproductive factors from rural women of Sindh, Pakistan. The present study was conducted to find out the self reported age at natural menopause, prevalence of menopausal symptoms, and to identify sociodemographic and reproductive factors that may influence the onset of menopause. METHODS: A survey was carried out on women aged 40-70. A multistage random sampling technique was used to retrieve 1,355 women with natural menopause from 10 union councils of district Matiari. These women were further categorised into 3 groups, I, II, and III having menopause for 1-5, 6-10, > 10 years respectively. Pearson's chi-square test was used to analyse the percentage of symptoms distribution. ANOVA was used to analyse the relationship between demographic, reproductive factors and the age at natural menopause. RESULTS: Age at menopause in our subjects was 46.2 +/- 6.4 years. The prevalence of menopausal symptoms ranges from 26 % to 83%. Frequency of somatic, psychological and urogenital symptoms was high in group II. No significant association was found between parity, socioeconomic status and age at natural menopause. CONCLUSION: The results have shown the early age at menopause. The prevalence of menopausal symptoms is high. Results regarding correlation of age at menopause with socio-demographic and reproductive characteristics were different from literature.

Maternal mortality in rural community: a challenge for achieving millennium development goal.

OBJECTIVES: To asses the Maternal Mortality Ratio and the causes of maternal death over a period of three years in one of the rural district of Sindh Province, Pakistan. METHODS: A retrospective analysis of maternal mortality was carried out for a period of 3 years from 2006 to2008 by reviewing the maternal mortality record and statistics of National Programme for Family Planning and Primary Health Care of District Matiary, Sindh Province Pakistan. The information regarding demographic, reproductive parameters and verbal autopsy questions was collected and analyzed by SPSS V 16. RESULTS: The cumulative MMR was 297/100,000 live births. The direct causes accounted for 58 (80.5%) deaths. The high ratio of maternal mortality was found in women of age 29-39 years and in Para > 4. Thirty five (48.6%) maternal deaths occurred at tertiary care hospitals, while 20 (27.8%) and 16 (22.2%) took place at home and on the way to hospital respectively. CONCLUSION: Maternal Mortality in rural areas of Sindh Province Pakistan is still a challenge for the achievement of the Millennium development Goal (MDG).

Knowledge about AIDS/HIV infection among women attending obstetrics and gynaecology clinic at a university hospital.

OBJECTIVE: To determine the level of awareness about Human Immune-deficiency Virus Infection and Auto Immune Deficiency Syndrome (HIV/AIDS) among women attending obstetrics and gynaecology clinic. METHODS: A descriptive cross-sectional study was conducted in the obstetric and gynaecology clinic at Isra University Hospital Hyderabad Pakistan from April to June 2007. A total of 189 women attending the obstetric and gynaecology clinic between ages 20 and 50 years were included. Informed consent was taken and information was collected by a pre-designed questionnaire to assess the level of awareness about HIV/AIDS. Data analysis was done by computer software, SPSS version 11. RESULTS: Out of the total, 86.8% women had heard about HIV/AIDS. A large majority of women knew that it is transmitted by close sexual relationship, through infected blood, can be transmitted from mother to baby and knew that it is transmitted by reuse of infected needles while only 40.7% knew that it can be transmitted during delivery. The respondents had the knowledge that multiple sexual partners (79.4%), prostitutes and homosexual males (49.7%), drug addicts (49.7%) were high risk groups. Regarding prevention of AIDS, 70.9% mentioned avoiding homosexuality, 58.7% knew the use of condoms and 74.7% women knew that screening of blood in laboratories before transfusion can prevent AIDS. CONCLUSION: The level of awareness regarding HIV/AIDS transmission and prevention was satisfactory among women attending the out-patient department of a gynaecology and obstetrics department. However, number of misconceptions needs to be corrected.

Does clinical experience affect knowledge regarding hepatitis-B among male medical students at a private university?

OBJECTIVE: To assess the knowledge of male medical students about Hepatitis-B in their preclinical and clinical years and to investigate the self reported vaccination status of these students. METHODS: In the year of 2007, 187 male students of Isra University Hyderabad Sindh Pakistan were selected by convenient sampling and surveyed with a self reported questionnaire comprising of questions regarding knowledge about hepatitis B. Data gathered was analyzed by SPSS V. 16. Knowledge between preclinical and clinical students were compared by Pearson's coefficient chi square test, p value < 0.005 was considered significant. RESULTS: Out of 187 students interviewed, 73 (39%) and 114 (61%) were from preclinical and clinical years respectively. Significant difference was found in clinical and preclinical students regarding basic knowledge about hepatitis B. and mode of transmission of disease (P = 0.004) and (P = < 0.001) respectively. CONCLUSION: Significant difference was found in the knowledge of both preclinical and clinical male medical students.

Frequency of menopausal symptoms and their impact on the quality of life of women: a hospital based survey.

OBJECTIVES: To asses the menopause related symptoms and to determine the impact of these symptoms on the quality of life of menopausal women. METHODS: It was a cross sectional hospital based survey conducted at the department of Obstetrics and Gynecology Isra University Hyderabad Sindh Pakistan from November 2007 to August 2008. Two hundred two women of age 40-60 years, who presented in out patient department were included. Women with induced menopause, receiving hormonal treatment, having medical problems like thyroid disorders, diabetes mellitus and hypertension and those who refused to participate were not included. Menopause specific quality of life questionnaire (MENQOL) was used to assess the frequency and severity of symptoms. Mann-Whitney U test and Pearson Co-efficient of correlation was used for statistical analysis. P value < 0.05 was considered significant. RESULTS: Mean age of women was 52.17 +/- 6.019 years. Mean length of time since menopause was 8.39 +/- 6.0 years. Most prevalent symptom within study subjects was body ache 165 (81.7%). Frequencies of some classical symptoms were 134 (66.3%) reported "hot flushes", 139 (68.8%) and 134 (66.3%) reported "lack of energy" and decrease in "physical strengths" respectively. The less frequently reported symptom was increase in facial hair 20 (9.9%). Scores of Physical domain were significantly more in postmenopausal (PM) group P < 0.002 while the scores of psychological domain were significantly high in menopause transition (MT) group P < 0.003. CONCLUSION: Menopause related symptoms had negative affect on the quality of life of postmenopausal women.

Emergency peripartum hysterectomy: frequency, indications and maternal outcome.

BACKGROUND: Emergency Peripartum Hysterectomy (EPH), although rare in modern obstetrics, remains a life saving procedure in cases of severe haemorrhage. The aim of present study was to review the frequency, indication, associated risk factors, maternal morbidity and mortality associated with emergency peripartum hysterectomy in a private sector teaching hospital. METHODS: This was a retrospective review carried out from August 2003 to September 2008. Main outcome measures were frequency, indications, associated risk factors and maternal morbidity and mortality associated with Emergency Peripartum Hysterectomy. RESULTS: The frequency of emergency peripartum hysterectomy over a study period was 0.42%. Mean age and parity of patients was 30.9 +/- 5.0 years and 4.52 +/- 1.8 respectively. The mean gestational age at the time of delivery was 36 +/- 3.4 weeks. Nine (42.9%) patients had previous history of caesarean delivery. Main indication for EPH were rupture uterus 7 (33.3%), uterine atony 6 (28.6%), morbid adherence of placenta 5 (23.8%) and severe bleeding from placental bed in 3 (14.3%) patients. All woman required blood transfusion, 11 (52%) require ICU admission, 81% were anaemic, 3 (14.3%) developed DIC, 4 (19%) pulmonary oedema, febrile illness 6 (28.6%) and wound disruption was seen in 3 (14.3%). The maternal mortality occurred in 4 (19%) cases. CONCLUSION: Frequency of emergency peripartum hysterectomy is high in our set up. High parity, rupture uterus, increase number of caesarean deliveries and abnormal placentation was identified as risk factors for EPH. High frequency of maternal morbidity and mortality was observed in the present study.

Frequency, intensity and impact of premenstrual syndrome in medical students.

OBJECTIVE: To determine the frequency and severity of Premenstrual Syndrome (PMS) in medical college students, evaluate the impact of the condition on the quality of life and find out the associated risk factors. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Isra University Hospital, Hyderabad, Sindh, Pakistan, from August to December 2006. METHODOLOGY: Unmarried medical students aged 18-25 years with regular menstrual period for the last 06 months were recruited by convenience sampling. PMS-related data was collected on daily record of severity of problems (DRSP) for two prospective cycles. Health-related quality of life data was collected on medical outcome study Short Form 36 (Sf - 36) after taking informed consent from participants. Descriptive and inferential analysis was done by two-tailed t-test and multivariate logistic regression analysis. RESULTS: Study participants (n=172) had mean age of 21.2 + 1.9 years. Eighty-nine (51%) girls met the criteria for PMS recording to ICD - 10, among them, 53 (59.5%) had mild PMS, 26 (29.2%) had moderate and 10 (11.2%) had severe PMS. Ten (5.8%) girls were found to have Premenstrual Dysphoric Disorder (PMDD) according to DSM - IV criteria. The order of frequency of symptoms were anger, irritability, anxiety, tiredness, difficult concentration, mood swings and physical symptoms like breast tenderness and general body discomfort with great impairment in social life / activities and work efficiency/productivity. Dysmenorrhea (p=0.003) and family history of premenstrual syndrome (p < 0.001) were significantly associated with premenstrual syndrome on univariate and multivariate analysis. Sf - 36 score on Mental Component Summary (MCS) and Physical Component Summary (PCS) were significantly lower in the affected group. CONCLUSION: Premenstrual syndrome is a common problem in young girls which adversely affects their educational performance and emotional well-being. Strategies should be adopted for detection and management of PMS in young girls.