Suchergebnisse

Abstract Background Maternal mortality ratio in Pakistan remains high at 276 per 100000 live births (175 in the urban areas and 319 in rural) with a mother dying as a result of giving birth every 20 minutes. Despite the intervening years since the Safe Motherhood Initiative launch and the Millennium Development Goals (MDGs), there have been few improvements in MDGs 4 and 5 in Pakistan. A key underlying reason is that only 39% of the births are attended by skilled birth attendants. Pakistan, like many other developing countries has been struggling to make improvements in maternal and neonatal health, amongst other measures, which include a nationwide health infrastructure network. Recently, government of Pakistan revised its maternal and newborn health program and introduced a new cadre of community based birth attendants, called community midwives (CMW), trained to conduct home-based deliveries. There is limited research available on field experiences of community midwives as maternal health care providers. Formative research was designed and conducted in a rural district of Pakistan with the objective of exploring role of CMWs as home based skilled service providers and the challenges they face in provision of skilled maternal care. Methods A qualitative research using content analysis was conducted in one rural district (Attock) of Pakistan. Focus group discussions were conducted with CMWs and other community based health workers as LHWs and LHSs, focusing on the role of CMWs in the existing primary health care infrastructure. Results Results of this study reveal that the community midwives are struggling for survival in rural areas as maternal care providers as they are inadequately trained, lack sufficient resources to deliver services in their catchment areas and lack facilitation for integration in district health system. Conclusions CMWs face many challenges in the field related to the communities' attitude and the health system. With adequate training and facilitation by health department, CMWs have potential to play a vital role in reducing burden of maternal morbidity and in achieving significant gains in improving maternal and child health.

Objectives: To observe change in traumatic brain injury (TBI) presentation after enforcement of a motorcycle helmet law and to explore perspectives of stakeholders on road safety measures. Methods: A cross-sectional study was undertaken based on retrospective record review of traffic-related TBI patients, supplemented by a qualitative component. Patient data in periods before and after helmet-law enforcement were stratified by TBI grade. Stakeholders as doctors, motorcyclists, and policemen were interviewed to explore perceptions regarding the observed changes in neurotrauma, helmet-use behaviour and effectiveness of helmet-law enforcement. Setting: Neurosurgery department, public-sector tertiary hospital in Lahore. Results: After the law's enforcement, significant improvement in mean Glasgow Coma Scale (GCS) scores were seen on patient-admission (from 11.15 ± 3.51 to 12.24 ± 3.30). The severity of TBI, proportion of intracranial haemorrhages and other associated head injuries all reduced significantly (p < 0.05). Patient-survival rate increased (74.7% to 82%) and the operative rate reduced from 13.3% to 10.8%. After interviewing stakeholders, the main theme identified was "Enforcement of road safety measures remains partial and inconsistent". Changes in healthcare burden and challenges in implementing legislature were noted. Conclusion: An association between the enforcement of a motorcycle helmet law and a decrease in the severity of traffic-related TBI hospital admissions was observed. Nonetheless, sustained helmet law enforcement remains a challenge in a temperate climate, and children, females and pillion riders are poorly-protected by current road policies.

Objectives: Due to the absence of necessary rules, poor coordination, and various challenges, the pharmacovigilance system of Pakistan is not optimally functional at all levels of the health system. The objective of the study was to assess the stakeholders' perceptions of the current ADR reporting system and to identify the pharmacovigilance policy issues and problems of effective coordination. Methodology: Stakeholders from a broad range of disciplines, academia, regulatory authorities, the pharmaceutical industry, international health organizations, as well as pharmacovigilance experts, and healthcare professionals were included in the study. A total of 25 stakeholders throughout Pakistan were interviewed during exploratory semi-structured interviews. The interviews were recorded digitally, transcribed, coded, compared, and grouped according to their similarity of themes. Participants provided insights into gaps, limitations, and challenges of Pakistan's current ADR reporting system, issues with proposed pharmacovigilance rules, and coordination difficulties. Results: The majority of the participants considered the ADR reporting system in Pakistan to be improving but in a nascent phase. The identified gaps, challenges, limitations of the system, and barriers to reporting were labeled as reasons for limited functioning. Almost all stakeholders were aware of the existence of draft pharmacovigilance rules; however, participants in the industry were familiar with the contents and context of draft pharmacovigilance rules. Bureaucratic red tape and lack of political will appeared to be the top reasons for delaying the approval of the pharmacovigilance rules. Wider consultation, advocacy, and awareness sessions of policymakers and HCPs were suggested for early approval of rules. Participants unanimously agreed that the approval of rules shall improve the quality of life and reduce the economic burden along with morbidity and mortality rates. The need for greater and collaborative coordination among the stakeholders ...