The Utility of the Platelet-Albumin-Bilirubin Score as a Non-invasive Predictor of Esophageal Varices and Variceal Hemorrhage in Patients With Liver Cirrhosis Compared to Child-Turcotte-Pugh and Model of End-Stage Liver Disease-Sodium Scores.

Introduction Research on non-invasive tools for detecting gastro-esophageal varices is underway. We investigated the Platelet-Albumin-Bilirubin (PALBI) score in comparison with the Child-Turcotte-Pugh (CTP) and MELD-Na (MELD-Na) scores in patients with liver cirrhosis. Methods Three hundred and twenty-three patients with liver cirrhosis were studied. The PALBI, CTP and MELD-Na scores were calculated and analyzed for gastroesophageal varices and their characteristics using SPSS version 26 (IBM Corp., Armonk, NY, USA). Results Two hundred and sixty-four patients had esophageal varices and 102 presented with variceal hemorrhage. Mean PALBI, CTP and MELD-Na scores were significantly higher for patients with varices versus without varices (p < 0.05). Unlike the mean MELD-Na score, the mean PALBI and CTP scores were significantly higher in patients with large high-risk varices as compared to patients with small low-risk varices (p < 0.05). The mean CTP scores were significantly higher in patients with variceal hemorrhage than those without hemorrhage (p < 0.05), while the difference between mean PALBI and MELD-Na was insignificant, in this regard. The PALBI score had better sensitivity than the CTP and MELD-Na scores in indicating the presence of varices but was similar to the CTP score in predicting high-risk varices. Conclusion The PALBI score proves to have good utility and efficiency in predicting varices in comparison to CTP and MELD-Na scores. It can determine high-risk stigmata of variceal hemorrhage with similar performance as the CTP Score.

Preparing and Wear-Resisting Property of Al2O3/Cu Composite Material Enhanced Using Novel In Situ Generated Al2O3 Nanoparticles.

Al2O3/Cu composite material (ACCM) are highly suitable for various advanced applications owing to its excellent properties. In the present work, a combination of the solution combustion synthesis and hydrogen reduction method was first employed to prepare Al2O3/Cu composite powder (ACCP), and subsequently ACCM was prepared by employing spark plasma sintering (SPS) technique. The effect of Al2O3 contents and SPS temperatures on the properties (relative density, hardness, friction coefficient, and electrical conductivity, et al.) of ACCM were investigated in detail. The results indicated that ACCM was very dense, and microstructure was consisted of fine Al2O3 particles evenly distributed in the Cu matrix. With the increase of SPS temperature, the relative density and hardness of ACCM had first increased and then decreased. At 775 °C, the relative density and hardness had attained the maximum values of 98.19% and 121.4 HV, respectively. With the increase of Al2O3 content, although the relative density of ACCM had gradually decreased, nevertheless, its friction coefficient had increased. Moreover, with the increase of Al2O3 contents, the hardness of ACCM first increased and then decreased, and reached the maximum value (121.4 HV) with 3 wt.% addition. On the contrary, the wear rate of ACCM had first decreased and then increased with the increase of Al2O3 contents, and attained the minimum (2.32 × 10-5 mm3/(N.m)) with 3 wt.% addition.

Correlates of early initiation of breast feeding and prelacteal feeding: a cross-sectional study in Sindh province of Pakistan.

OBJECTIVES: The objective of this study was to determine the prevalence and correlates of early initiation of breast feeding and prelacteal feeding in highly disadvantaged districts in Pakistan. DESIGN: This cross-sectional study design. SETTINGS: This study was carried out in twelve districts of the Sindh province of Pakistan. PARTICIPANTS: A total of 4800 mothers with children under 2 years, selected through a multistage random sampling method. DATA ANALYSIS: Bivariate association, survival analysis (Kaplan-Meier and Cox proportional hazard techniques), multivariate linear regression and the ordinary least square model were used. RESULTS: The results show that the prevalence of early initiation of breast feeding was 68% and prelacteal feeding was 32%. Adequate treatment, proper guidance at antenatal care visits, postpartum health check, normal birth with skilled birth attendants, institutional birth, skin-to-skin contact at birth and birth size were all associated with early breastfeeding initiation (p<0.001). The odds of early initiation of breast feeding after birth are higher if the respondents received proper guidance (OR 2.05; 95% CI 1.02 to 4.11) or made skin-to-skin contact (OR 10.65; 95% CI 6.82 to 16.65). Bivariate association between the prelacteal feeding and a set of correlates suggests that all variables under study were significantly associated with the outcome variable of interest at a 95% or higher significance level. The factors which significantly reduced the odds of prelacteal feeding were adequate treatment (OR 0.29; 95% CI 0.23 to 0.37) and postpartum health check (OR 0.65; 95% CI 0.53 to 0.80). CONCLUSION: Sudy concludes that the correlates like adequate treatment of mothers during labour, postpartum health check-up, normal birth with skilled birth attendants, institutional births and skin-to-skin contact between mother and the baby determine the early initiation of breast feeding and prelecteal feeding. Early initiation of breast feeding needs to be encouraged, and communities must be educated against the use of prelacteal feeding.

Does Childhood Experience of Interparental Abuse Shape Women's Attitude Toward Intimate Partner Violence in Their Adult Life? Evidence From 31 Developing Countries.

A significant amount of literature exists on the lasting effects of interparental abuse on children's psychological health as adults. However, evidence on how children's childhood experience of interparental violence shapes their attitude toward partner violence in adult intimate relationships is limited. Given the existing evidence that women's acceptance of partner violence as a social norm increases the risk of partner violence, we analyzed the effect of girls' witnessing interparental abuse (where a father is a perpetrator) on their attitude toward partner violence in their intimate relationships as adults. We used data from the Demographic and Health Surveys for 31 low and middle-income countries in Asia and Africa. Aggregating information about women's attitudes toward partner violence into a binary "intimate partner violence acceptance" variable, we found that a woman who witnessed her father beat her mother was 1.62 times more likely to justify partner violence than a woman who did not experience such interparental abuse (adjusted odds ratio [AOR] = 1.62, 95% CI [1.57, 1.66], p < .001). Additionally, using individual components of acceptance as response variables, we found that a woman who witnessed interparental abuse was significantly more likely to justify partner violence if she went out without telling her husband (OR = 1.49, 95% CI [1.45, 1.54], p < .001), neglected children (OR = 1.53, 95% CI [1.49, 1.58], p < .001), argued with the husband (OR = 1.49, 95% CI [1.45, 1.53], p < .001), refused sex with the husband (OR = 1.35, 95% CI [1.31, 1.39], p < .001), or burned food (OR = 1.36, 95% CI [1.31, 1.41], p < .001). This study highlights the need to put in place children-specific social policies to limit the intergenerational transmission of the adverse effects of intimate partner violence.

The Association of Helicobacter pylori With Portal Hypertensive Gastropathy in Patients With and Without Cirrhosis.

INTRODUCTION: Cirrhosis and its associated complication of portal hypertensive gastropathy (PHG), among others, remain a significant cause of death in resource-poor countries with limited capacity for liver transplantation. This research aimed to assess the association of Helicobacter pylori (H. pylori) with portal hypertensive gastropathy and its severity in patients with and without cirrhosis. METHODOLOGY: The study was conducted at a tertiary care hospital in Pakistan from April 2021 to May 2022. Liver cirrhosis was diagnosed by clinical manifestations, ultrasonography, and laboratory investigations. The severity of liver cirrhosis was assessed using the Child-Pugh scoring system. The association of H. pylori with portal hypertensive gastropathy in patients with and without cirrhosis was assessed using the chi-square test. RESULTS: A total of 120 patients participated in the study, of which 40 were without liver cirrhosis, while 80 were with cirrhosis. Among patients with cirrhosis, 24 were in Child-Pugh class A, 26 in class B, and 30 in class C. Of patients with liver cirrhosis who were H. pylori-negative, 37.5% (15/40) had portal hypertensive gastropathy. Of these, 12.5% (5/40) had severe PHG, while 25% (10/40) had mild PHG. Of patients with liver cirrhosis who were H. pylori-positive, 62.5% (25/40) had PHG. Of these, 2.5% (1/40) had severe PHG, while 60% (24/40) had mild PHG. Helicobacter pylori contributed nonsignificantly (p=0.080), showing no association with portal hypertensive gastropathy. CONCLUSION: Helicobacter pylori does not appear to have any significant association to cause or worsen portal hypertensive gastropathy in patients with liver cirrhosis.

Nutritional inequalities among under-five children: a geospatial analysis of hotspots and cold spots in 73 low- and middle-income countries.

BACKGROUND: Child undernutrition is a severe health problem in the developing world, which affects children's development in the long term. This study analyses the extent and patterns of under-five child undernutrition using Demographic and Health Surveys (DHS) for 73 low- and middle-income countries (LMICs). METHODS: First, we mapped the prevalence of undernutrition in the developing world. Second, using the LISA (a local indicator of spatial association) technique, we analyzed the geographical patterns in undernutrition to highlight the localized hotspots (regions with high undernutrition prevalence surrounded by similar other regions), cold spots (regions with low undernutrition prevalence surrounded by similar other regions), and outliers (regions with high undernutrition surrounded by low undernutrition and vice versa). Third, we used Moran's I to find global patterns in child undernutrition. RESULTS: We find that South Asia has the highest under-five child undernutrition rates. The intra-country nutritional inequalities are highest in Burundi (stunting), Kenya (wasting), and Madagascar (underweight). The local indicator of spatial association (LISA) analysis suggests that South Asia, Middle East and North Africa (MENA) region, and Sub-Saharan Africa are undernutrition hotspots and Europe and Central Asia and Latin America, and the Caribbean are undernutrition cold spots (regions with low undernutrition surrounded by similar other regions). Getis Ord-Gi* estimates generally support LISA analysis. Moran's I and Geary's C gave similar results about the global patterns of undernutrition. Geographically weighted regressions suggest that several socioeconomic indicators significantly explain child undernutrition. CONCLUSIONS: We found a significant within and across country variation in stunting, wasting and underweight rates among the under-five children's population. The geospatial analysis also suggested that stunting, wasting, and underweight patterns exhibit clear regional patterns, underscoring the need for coordinated interventions at the regional level.

Reaction Model and Mechanism of Preparing (Al2O3 + C) Precursor for Carbothermal Synthesis of AlN by a Modified Low Temperature Combustion Synthesis Method.

The preparation of a homogeneous mixture of (Al2O3 + C) precursor is the key step for the successful synthesis of AlN powders by the carbothermal reduction and nitridation method. In the present work, the homogeneous (Al2O3 + C) precursor prepared by a modified low temperature combustion synthesis (MLCS) method by using aluminum nitrate, glucose, and urea as materials exhibited high reaction activity. Furthermore, in order to absolutely control the MLCS process and continuously improve the properties of (Al2O3 + C) precursor, the reaction model of preparing precursors from various molar ratios of urea to aluminum nitrate (U/Al) was investigated by carrying out thermodynamic calculation and by performing experiments in the present work. The whole process was found to involve various phenomena. First, the type and amount of various generated nitrogen-containing gases (N2, NO, N2O, N2O3, N2O4, and NO2) vary with the change of U/Al during combustion process. Second, under the present experimental condition of ignition temperature, the decomposition reaction of aluminum nitrate is more prone to occur than the combustion reaction of urea. Third, the real reaction system with U/Al = 2.5 reaches the highest combustion temperature which is well consistent with the propellant chemical theory. The occurrence of above phenomena was discussed in detail. Moreover, the reaction mechanism of synthesizing precursor from U/Al = 1 with high reaction activity was investigated by using various techniques such as FTIR, XRD, and DTA.

Association of breast feeding and birth interval with child mortality in Pakistan: a cross-sectional study using nationally representative Demographic and Health Survey data.

OBJECTIVES: This study analysed the association between breast feeding (BF) and birth interval (BI) (both succeeding and preceding) with neonatal mortality (NM), infant mortality (IM) and under-5 mortality (U5M). DESIGN: This cross-sectional study used data from the Pakistan Demographic and Health Survey 2017-2018. SETTINGS: All provinces, Islamabad and Federally Administered Tribal Areas were included in the analysis. PARTICIPANTS: A total of 12 769 children born to ever-married multiparous women aged 30-49 years who gave live birth within 5 years preceding the interview. Multiple births are not included. DATA ANALYSIS: Multivariate logistic regression analysis was used. RESULTS: We found that BF was associated with nearly 98% lower risk of NM (OR 0.015; 95% CI: 0.01 to 0.03; p<0.001), 96% lower risk of IM (OR 0.038; 95% CI: 0.02 to 0.06; p<0.001) and 94% lower risk of U5M (OR 0.050; 95% CI: 0.03 to 0.08; p<0.001). Compared with optimal preceding birth interval (PBI) (36+ months), short PBI (<18 months) was associated with around six times higher risk of NM (OR 5.661; 95% CI: 2.78 to 11.53; p<0.001), over five times risk of IM (OR 4.704; 95% CI: 2.70 to 8.19; p<0.001) and over five times risk of U5M (OR 4.745; 95% CI: 2.79 to 8.07; p<0.001). Disaggregating the data by child's gender, place of residence and mother's occupational status showed that being ever breast fed was associated with a smaller risk of NM, IM and U5M in all three disaggregations. However, the risk of smaller PBI <18 months was generally more pronounced in female children (NM and U5M) or when the children lived in rural areas (NM, IM and U5M). PBI <18 months was associated with greater risk of NM and IM, and smaller risk of U5M when mothers did a paid job. CONCLUSION: This study's significance lies in the fact that it has found BF and BI to be consistent protective factors against NM, IM and U5M. Given Pakistan's economic constraints, optimal BF and BI are the most cost-effective interventions to reduce child mortality.

Epidemiology of respiratory diseases and associated factors among female textile workers in Pakistan.

Objective. The study aimed to estimate the prevalence of byssinosis and other respiratory symptoms among women textile workers and the associated risk factors in 18 spinning mills of Faisalabad and Lahore districts of Punjab, Pakistan. Method. In this case-control study of 1054 female workers, we used the dose-response function to measure the association between dust level and respiratory disorders in cotton textile workers. Results. Working overtime and long working hours per week are significantly associated with self-reported symptoms of byssinosis. Women's age, marital status and wages were significantly associated with mitigating actions (seeing the doctor), while the education of the women was significantly associated with averting action (use of a mask). Conclusion. Regulating working hours and ensuring employees' compliance with the safety standards are expected to mitigate the health problems of female workers.

Troubling Trade-offs Between Women's Work and Intimate Partner Violence: Evidence From 19 Developing Countries.

The empirical link between women's employment status and their experience of different types of intimate partner violence (IPV) is not very apparent. Using Demographic and Health Surveys (DHS) data from 19 developing countries in South Asia, Sub-Saharan Africa, and the Middle East, we found that working women were significantly more likely to experience IPV than their stay-at-home counterparts. Given the great diversity in women's employment with respect to economic returns and working conditions, we disaggregated women's employment into three categories vis-à-vis agriculture jobs (AJ), blue-collar jobs (BJ), and white-collar jobs (WJ). The disaggregated analysis revealed that women engaged in all three job categories were significantly more likely to experience IPV. After controlling for potential endogeneity of women's employment, we found that women's work increased the risk of less severe physical violence (LSPV) and emotional violence (EV) but reduced the risk of sexual violence (SV). Endogeneity-adjusted disaggregated analysis showed that women engaged in BJ and WJ faced an increased risk of LSPV but reduced risk of SV. In contrast, women undertaking AJ faced a smaller risk of severe physical violence (SPV) and SV. This study contradicts some long-held beliefs that women's work is a sufficient condition for protecting them from IPV. The public policy should not assume that women's earnings automatically protect them against the risk of IPV. While encouraging a greater female labor force participation rate is important in its own right, women's risk of IPV is context-specific.

Microstructure and Properties of Mg-Al-Ca-Mn Alloy with High Ca/Al Ratio Fabricated by Hot Extrusion.

Mg-Al-Ca-Mn alloys with Ca/Al ≥ 1 of AX33, AX44, and AX55 were prepared by combining three processes of water-cooling semi-continuous cast, homogenization heat treatment, and hot extrusion. The as-fabricated alloys translated into composites consisting of α-Mg solid solution + granular Al2Ca. These alloys exhibited some favourable properties such as a tensile strength of 324~350 MPa at room temperature and 187~210 MPa at elevated temperature of 423 K, an ignition temperature of 1292~1344 K, and so on. Variation trend between performance and content of Al and Ca is given in this paper. The result indicated that the emerged second-phase Al2Ca in the alloys was beneficial to the improvement in mechanical properties, heat resistance, flame retardation, and corrosion resistance.

Maternal Correlates of Poliomyelitis Vaccination Uptake: Evidence from Afghanistan, Pakistan, and Nigeria.

Poliomyelitis (polio) is a communicable viral disease that mainly affects under-5 children. This study focuses on the impact of women's empowerment and women's working status on the uptake of polio vaccination of children in polio-endemic countries, including Pakistan and Afghanistan, and Nigeria, the latter of which has recently been declared polio-free. The polio vaccination status can be divided into no vaccination (NV), incomplete vaccination (IV), and complete vaccination. We used data from the most recent Demographic and Health Surveys (DHS) rounds for this manuscript. Multinomial logistic regression-based estimates suggest that mothers' working status, empowerment, age, education, father's education, and household wealth status reduce the risk of NV and IV in the polio-endemic countries (Afghanistan and Pakistan) and Nigeria. In addition, the mothers' working status, empowerment, age, education, and father's education increase the child's healthcare information that helps complete polio vaccination of the child. On the other hand, the children whose mothers work in the agriculture sector or are engaged in a blue-collar job are more likely to remain unvaccinated than women in white-collar jobs. Similarly, mothers engaged in government jobs are more likely to get their children fully vaccinated than unemployed mothers. Thus, as a child's polio vaccination is strongly dependent on a mother's working status and empowerment, the focus of public policy on empowering women and promoting their labor force participation may increase polio vaccination uptake, besides adopting other measures to increase immunization.

Impact of high-risk fertility behaviours on underfive mortality in Asia and Africa: evidence from Demographic and Health Surveys.

BACKGROUND: Maternal age < 18 or > 34 years, short inter-pregnancy birth interval, and higher birth order are considered to be high-risk fertility behaviours (HRFB). Underfive mortality being disproportionately concentrated in Asia and Africa, this study analyses the association between HRFB and underfive mortality in selected Asian and African countries. METHODS: This study used Integrated Public Microdata Series-Demographic and Health Surveys (IPUMS-DHS) data from 32 countries in sub-Saharan Africa, Middle East, North Africa and South Asia from 1986 to 2017 (N = 1,467,728). Previous evidence hints at four markers of HRFB: women's age at birth of index child < 18 or > 34 years, preceding birth interval < 24 months and child's birth order > 3. Using logistic regression, we analysed change in the odds of underfive mortality as a result of i) exposure to HRFB individually, ii) exposure to any single HRFB risk factor, iii) exposure to multiple HRFB risk factors, and iv) exposure to specific combinations of HRFB risk factors. RESULTS: Mother's age at birth of index child < 18 years and preceding birth interval (PBI) < 24 months were significant risk factors of underfive mortality, while a child's birth order > 3 was a protective factor. Presence of any single HRFB was associated with 7% higher risk of underfive mortality (OR 1.07; 95% CI 1.04-1.09). Presence of multiple HRFBs was associated with 39% higher risk of underfive mortality (OR 1.39; 95% CI 1.36-1.43). Some specific combinations of HRFB such as maternal age < 18 years and preceding birth interval < 24 month significantly increased the odds of underfive mortality (OR 2.07; 95% CI 1.88-2.28). CONCLUSION: Maternal age < 18 years and short preceding birth interval significantly increase the risk of underfive mortality. This highlights the need for an effective legislation to curb child marriages and increased public investment in reproductive healthcare with a focus on higher contraceptive use for optimal birth spacing.

Is Attitudinal Acceptance of Violence a Risk Factor? An Analysis of Domestic Violence Against Women in Pakistan.

Violence against women (VAW) is a grave problem in Pakistan, and women from all socioeconomic groups are vulnerable to domestic violence in varying degrees. It is argued that patriarchal definition of gender roles may reinforce the internalized inferiority of women. So, it may not be a mere coincidence that a large number of women in Pakistan justify VAW for various reasons. The objectives of this article are threefold: (a) to identify the drivers of VAW, (b) to see if women's attitudinal acceptance of violence is causally linked with observed violence against women, and (c) to see if attitudinal acceptance of violence mediates between the socioeconomic status of women and observed violence. We used data from the Pakistan Demographic and Health Survey (PDHS) 2012-13. The sample consisted of 3,265 ever married women aged between 15 and 49 years who were interviewed for domestic violence. We used multivariate logit regression analysis to identify the drivers of VAW and used the Karlson-Holm-Breen (KHB) method for mediation analysis. We found that women's attitudinal acceptance of violence, their childhood experience of violence in their parental household, the education of both husband and wife, and some occupation types significantly predicted their experience of spousal violence. In addition, we found that women's attitudinal acceptance of violence mediated the relationships between socioeconomic factors (education and wealth status) and VAW. The significance of the study lies in the fact that it highlights the need to modify the perceptions of violence through change in educational policy. Among multiple other factors, an increase in the economic status of women is an effective hedge against the risk of spousal violence.

Women's choice of delivery site and the surge in private facility-based deliveries in Pakistan: A 28-year trend analysis.

OBJECTIVE: This paper aims at estimating the long-term trends of facility-based and home-based deliveries and identifies the factors associated with the choice of delivery site. STUDY DESIGN: Secondary analysis evaluating the trends in the choice of the delivery site by women of reproductive age using Pakistan Demographic and Health Surveys from 1990-91 to 2017-18. MAIN OUTCOME MEASURES: The main outcome measure of this study is the choice of delivery site. METHOD: This study used data from four waves of Pakistan Demographic and Health Surveys (DHS) corresponding with 1990-91, 2006, 2012-13 and 2017-18. Logistic regression was used for empirical analysis. RESULTS: The odds of home delivery significantly came down in 2017-18 relative to 1990-91 (OR = 0.09; 95% CI:0.08-0.12; P < 0.001), growth in the likelihood of institutional delivery shows wide disparities. While the odds of delivery at the public health facility nearly doubled from 1990 to 91 to 2017-18 (OR = 2.12; 95% CI:1.70-2.65; P < 0.001), the odds of delivery at the private health facilities in the same period increased nearly eight times (OR = 7.78; 95% CI:6.45-9.38; P < 0.001). CONCLUSION: Results suggest an investment gap in public health facilities and an inequitable health care system in Pakistan.

Correlates of C-section in Punjab: a disaggregated analysis at the level of rural-urban residential status and place of delivery.

The World Health Organization-recommended rate of delivery by Caesarean section (C-Section) is 10-15% of all live births, but in Punjab, the largest province of Pakistan, this rate was 23% in 2014. The perception is that an inadequate public health sector forces women toward the private sector where C-Section is routinely conducted without valid medical reasons, posing risks to women's health and incurring catastrophic out-of-pocket expenditures. This study identified the correlates of C-section delivery and whether they differed by the urban/rural residence of women and place of delivery (public vs. private). Using multivariate logistic regression analyses of data from the Multiple Indicators Cluster Survey (MICS) collected from June-October, 2014 for all women who gave birth in the prior two years (N = 10,558), we found that rich women were statistically no different from poor women in their odds of delivery by C-section in the generally more expensive private health facilities (adjusted odds ratio [aOR] 1.23; 95% confidence interval [CI] 0.88-1.71); rich women were more likely to deliver by C-section in the less expensive public health facilities (aOR 2.03; 95% CI 1.13-3.63). This paradox may reflect the inefficiency of the health system and suggests limited affordable alternatives for poor women in the public sector.

Prevalence and determinants of Caesarean delivery in Punjab, Pakistan.

BACKGROUND: Caesarean section (C-section) is a life-saving obstetric procedure that reduces maternal mortality and improves reproductive health. Although, vaginal delivery is still an important safe and low-cost method of delivery, C-section is sometimes performed when it is not even required, which creates health challenges for pregnant women and their newborn infants. AIMS: To estimate the effect of a set of institutional, demographic, socioeconomic and spatial variables on C-section delivery (n = 2424) in Punjab, Pakistan. METHODS: We used data from the Multiple Indicator Cluster Survey Punjab 2014 and multiple logistic regression analysis. Analysis was carried out using STATA version 12. RESULTS: Higher maternal age at first marriage, higher number of antenatal care visits, and higher wealth quintiles were associated with higher risk of C-section. Women in Punjab were more likely to deliver through C-section in private health facilities and there was no significant difference between urban and rural areas. There was a significant difference in the risk of C-section in different divisions of Punjab, for example, DG Khan and Rawalpindi showed the lowest risk compared with the reference division of Bahawalpur, which is partially explained by the developmental disparities and access to public healthcare facilities. CONCLUSIONS: The government should facilitate access to healthcare facilities in areas that are easily accessible, especially, to rural women.

Correlates of home and hospital delivery in Pakistan.

OBJECTIVE: To identify the socio-economic determinants of home-based and institutional delivery in Pakistan. METHODS: This study has used Pakistan Demographic and Health Survey (PDHS) data collected by the National Institute of Population Studies (NIPS), Islamabad, Pakistan, and Macro International Inc. (now ICF International) Calverton, Maryland, United States. It used three episodes of Pakistan Demographic and Health Survey Data from 1990-91, 2006-07 and 2012-13. Data was analysed using descriptive analysis and odds of delivering at hospital were calculated using logistic regression analysis. RESULTS: Home-based delivery was over 4 times higher in 1990-91 compared with institutional delivery 5,465(85.3%) vs. 852(13.3%), and around 2 times higher in 2006-07 5,900(64.7%) vs. 3,128(34.3%). However, in 2012-13, the share of women delivering at home or health facility was roughly the same, i.e. 6,180(51.6%) at home and 5,773(48.2%) at health facility. CONCLUSIONS: There were wide gaps in the rates of institutional delivery among different subgroups, and they were accentuated by the socio-economic and financial disparities, and high illiteracy rates in the lowest wealth quintiles.