ABSTRACT
BACKGROUND: We aimed to assess the feasibility of using community-based informants' networks to identify maternal deaths that were followed up through verbal autopsies (MADE-IN MADE-FOR technique) to estimate maternal mortality in a rural district in Pakistan. METHODS: We used 4 community networks to identify deaths in women of reproductive age in the past 2 years in Chakwal district, Pakistan. The deaths recorded by the informants were followed up through verbal autopsies. RESULTS: In total 1,143 Lady Health Workers (government employees who provide primary health care), 1577 religious leaders, 20 female lady councilors (elected representatives), and 130 nikah registrars (persons who register marriages) identified 2001 deaths in women of reproductive age. 1424 deaths were followed up with verbal autopsies conducted with the relatives of the deceased. 169 pregnancy-related deaths were identified from all reported deaths. Through the capture-recapture technique probability of capturing pregnancy-related deaths by LHWs was 0.73 and for religious leaders 0.49. Maternal mortality in Chakwal district was estimated at 309 per 100,000 live births. CONCLUSION: It is feasible and economical to use community informants to identify recent deaths in women of reproductive age and, if followed up through verbal autopsies, obviate the need for conducting large scale surveys.
Subject(s)
Pregnancy Complications/mortality , Adolescent , Adult , Cause of Death , Child , Community Health Workers/economics , Community Health Workers/statistics & numerical data , Community Networks/economics , Community Networks/statistics & numerical data , Costs and Cost Analysis , Data Collection/economics , Data Collection/methods , Feasibility Studies , Female , Humans , Maternal Mortality , Middle Aged , Pakistan/epidemiology , Patient Acceptance of Health Care/statistics & numerical data , Pregnancy , Pregnancy Complications/economics , Rural Health/economics , Rural Health/statistics & numerical data , Young AdultABSTRACT
OBJECTIVE: To evaluate the outcome of totally extra-peritoneal laparoscopic hernioplasty in terms of hospital stay, operative time and complications. METHODS: The prospective descriptive study was carried out at the Department of Surgery, Unit-I, Chandka Medical College Teaching Hospital, Larkana, Pakistan, from September 2008 to June 2010. A total of 141 male patients above 12 years of age with reducible primary and secondary, unilateral and bilateral, direct and indirect inguinal hernia underwent total extra-peritoneal hernia repair. All the relevant details of each patient were noted and subsequently analysed statistically. RESULTS: Overall, 100 (71%) patients had unilateral inguinal hernia and 41 (29%) had bilateral inguinal hernia. The mean age of the patients was 51+/-14 years. The mean operation duration was 70+/-19 minutes. Bilateral repairs took 20 minutes more than unilateral repairs (80 versus 59 minutes). However, the mean operative time for the last 55 (30%) cases decreased to 55+/-10 minutes. One (0.7%) patient had conversion to open surgery and 10 (7.1%) had minor complications; mostly scrotum seroma, that were resolved. Recurrences occurred in 2 (1.4%) cases; 1 in recurrent hernia, and 1 in bilateral direct hernia. However, no hernia recurrence was present in the last 81 (59%) patients. The mean hospital stay was 1.4+/-0.6 days. CONCLUSION: Laparoscopic hernia repair is difficult to learn and perform, but has advantages of less post-operative pain, early recovery with minimal hospital stay, low post-operative complications and recurrence.
