Ali Mohammad Mir

Helping rural women in Pakistan to prevent postpartum hemorrhage: A quasi experimental study

BackgroundAccording to the Pakistan Demographic and Health Survey from 2006–2007, the maternal mortality ratio in rural areas is 319 per 100,000 live births. Postpartum hemorrhage is the leading cause of maternal deaths in Pakistan. The objectives of the study were to document the feasibility of distribution of misoprostol tablets by community-based providers mainly traditional birth attendants and acceptability and use of misoprostol by women who gave birth at home.MethodsA quasi-experimental design, comprising intervention and comparison areas, was used to document the acceptability of providing misoprostol tablets to pregnant women to prevent postpartum hemorrhage in the rural community setting in Pakistan. Data were collected using structured questionnaires administered to women before and after delivery at home and their birth attendants.ResultsOut of 770 women who delivered at home, 678 (88%) ingested misoprostol tablets and 647 (84%) ingested the tablets after the birth of the neonate but prior to the delivery of the placenta. The remaining women took misoprostol tablets after delivery of the placenta. Side effects were experienced by 40% of women and were transitory in nature. Among women who delivered at home, 80% said that they would use misoprostol tablets in the future and 74% were willing to purchase them in the future.ConclusionsSelf-administration of misoprostol in the home setting is feasible. Community-based providers, such as traditional birth attendants and community midwives with proper training and counseling, play an important role in reducing postpartum hemorrhage. Proper counseling and information exchange are helpful for introducing new practices in resource-constrained rural communities. Until such a time that skilled birth attendance is made more universally available in the rural setting, alternative strategies, such as training and using the services of traditional birth attendants to provide safe pregnancy care, must be considered.

Sti prevalence and associated factors among urban men in Pakistan

Objectives: To measure the prevalence of selected sexually transmitted infections (STIs) among urban men in Pakistan and identify associated factors. Methods: A cross-sectional survey of 2400 urban men aged 16–45 years was carried out in six cities of Pakistan. Respondents were selected through a multistage systematic sampling design. After obtaining informed consent a structured behavioural questionnaire was administered. Blood and urine samples were also collected and tested for HIV (ELISA), HSV-2 (ELISA) syphilis (RPR and TPHA), chlamydia (PCR) and gonorrhoea (PCR). Results: Of the 2383 respondents whose results were received, 4.4% (n = 106) tested positive for at least one of the five STIs. The prevalence of the individual organisms was as follows: syphilis, 1.3%; HIV, 0.1%; HSV-2, 3.4%; gonorrhoea, 0.8% and chlamydia, no cases. City-wise, the highest prevalence was in Karachi (8.5%) followed by Lahore (5.3%), Faisalabad (4.0%) Quetta (4.3%), Rawalpindi (2.5%) and Peshawar (2.0%). At the univariate and multivariate level, older age, less schooling, and having more than four sexual partners were significantly associated with the presence of an STI. 92% of men who tested positive for any STI were asymptomatic. Conclusions: HIV prevalence in Pakistan remains low, however, the emergence of genital herpes is a matter of concern as it could lead to a future conduit for HIV spread. Health education messages should target less educated segments of society and specifically advocate safe sex practices and early diagnosis.

To serve or to leave: a question faced by public sector healthcare providers in Pakistan

BackgroundThe availability of properly trained and motivated providers is a prerequisite for provision of easily accessible healthcare. Pakistan has been listed by the World Health Organization in its World Health Report 2006 as one of 57 countries with a critical health workforce deficiency. This study examines the factors associated with the willingness of public sector healthcare providers to leave government service and recommends measures that can be adopted to attract and retain staff in the country’s public healthcare system.MethodsA stratified, random sampling methodology was adopted to recruit a nationally representative sample of 1,296 public sector healthcare providers, including paramedics, medical doctors, and specialists. A semi-structured questionnaire was used to interview these providers. Logistic regressions measured the association with determinants of their willingness to leave the public health sector for better prospects elsewhere.ResultsA third of all healthcare providers who were interviewed were of the view that, provided the opportunity, they would leave government service. The odds of willingness to leave service were highest among providers from the region of Azad Jammu and Kashmir (adjusted odds ratio [AOR] = 4.33; 95% CI, 2.49–7.54) followed by the province of Balochistan (AOR = 4.21; 95% CI, 2.41–7.33), and the region of Gilgit Baltistan (AOR = 3.34; 95% CI, 1.67–6.67). Providers who expressed dissatisfaction in the manner their performance was evaluated and those who were dissatisfied with the current salary, each had higher odds of considering leaving government service (AOR = 1.67; 95% CI, 1.18–2.40 and AOR = 2.03; 95% CI, 1.47–2.81, respectively). Providers who reported experiencing interference in their work by influential politicians of the area were more inclined to leave (AOR = 1.44; 95% CI, 1.05–1.98).ConclusionThis study clearly highlights the need to implement more focused strategies in the public healthcare system in Pakistan in order to build sufficient staff motivation and prevent providers from leaving government service. In order to improve coverage of healthcare services in Pakistan, the government will have to introduce more focused interventions to attract and retain healthcare providers, especially in remote and rural areas of the country.