Maternal Mortality Rate in Pakistan

Maternal Mortality Rate in Pakistan Maternal Mortality a Public Health Issue Shahida Abbasi Introduction Maternal mortality refers to when a woman dies during pregnancy or within six weeks after delivery. There are many factors such as biological, socio-economic, cultural and availability of quality Reproductive Health Services (RHS) in the country which contribute to the alarming figure of Maternal Mortality Ratio (MMR). Pregnancy is a normal process in which women experience some physiological changes as it is essential for fetal growth and development. During pregnancy women need healthy diet, antenatal checkup for pregnancy progress and identification of dangers signs and proper treatment. Unfortunately due to certain reasons these needs are not satisfied and resulted in death of the mother. This paper aims to in-depth analysis of the determinants of MM. Significant of the Issue Every year more than 500,000 women die during childbirth or from pregnancy-related causes worldwide. 99% maternal deaths occur in developing country (WHO, 2005) as RHS, and family planning services are not easily accessible and affordable. According to UNDP’s report Roca (2013) Pakistan has highest mortality ratio 260/100,000 per live births in the region. Socio economic determinants Poverty Poverty plays as a barrier to satisfy basic human needs and to access reproductive health services which contribute to maternal mortality. Current global economic crises adversely affected specially marginalized poor women. Escalation in fuel prizes made the food items so expensive that it is beyond the capacity of the poor to buy. Due to inadequate quantity and quality of food intake, the pregnant women suffer with nutritional deficiency anemia. A study conducted by Khan, Fatima, Imran and Khan (2010) in Rawalpindi, to assess the risk factors associated with the nutritional deficiency anaemia revealed that majority of the pregnant women were anaemic due to iron deficiency followed by folate and cobalamin and all these belonged to low socio-economic group. Moreover, these nutritional deficit anemic women are at greater risk of having postpartum hemorrhage and sepsis. Furthermore, cost of RHS such as formal fee, screening, purchasing of medicine and travelling acts as barrier for wome n to obtain care. In case of emergency obstetric complications the cost of treatment goes much high and causes the delay in treatment. A qualitative study by Ronis, Mehboob, Masood, Amjad, Nishtar (2012) revealed that seventy percent of the patients sold their belonging or borrowed money in order to pay for delivery charges. Poverty is a great barrier for pregnant women in approaching family planning and counseling services. National Institute of Population Study (NIPS) [Pakistan] and ICF International. 2013. depicts that in rural areas twenty percent of married women have an unmet contraception needs that increase the chances of unwanted pregnancies leading to abortion. A study conducted by Fawad, Naz, Islam, Zaffar, Abbasi (2011) over the period of 5 years in Abbottabad calculated the MMR 1,057/100,000 live births. All the 78 patients who died belonged to low socioeconomic status and majority of them were illiterate. Female literacy Poverty effects female education as they cannot afford even primary education. These women are not aware of their reproductive health rights and utilization of RHS. According to Lynd, (2007) the literacy rate of youth between the age 15 to 24 years of Pakistans female is (53%) comparatively lower than the boys’ literacy rate (77%) in the same age group. In-fact educated women are more autonomous in decision making and utilization of quality ante natal and perinatal services. It is also illustrated in National Institute of Population Studies (NIPS) [Pakistan] and ICF International. 2013National Institute of Population Study (NIPS) [Pakistan] and ICF International. 2013. that the antenatal care is widely received by women with secondary or higher education. Moreover, an international cross sectional study was conducted by Karlsen, et al. (2011) revealed that lower levels of maternal education were associated with higher maternal mortality. This depicts RHS are not being utilize by illiterate women. Cultural Cultural values are deeply rooted specially among poor and illiterate and it has significant impact on women’s health. It is cultural heritage that boys are nourished with rich food as compared to girls beside the fact girls that requirement good quality and quantity of food in order to carry out reproductive responsibilities. Moreover, in conservative families, women mobility is strictly prohibited even to obtain emergency obstetric care. As women are not financially empowered they totally depend on husband regarding their treatment. All the important decisions related to ante natal care, place of delivery and post natal visit are made by the mother in law or husband. Sometime the decisions related to reproductive health issue are made so late that pregnant woman’s condition gets worse. Moreover, women do not have the right to make independent decision for healthy timing and birth spacing which consequently lead to higher fertility one of the contributing factor to inc rease mortality. A qualitative study by Ronis et al., (2012) revealed that cultural norms in Pakistan restrict the women to opt RHS from female doctor only. Therefore their unavailability makes the services inaccessible. Gender Inequality Government has done much to decrease socio-economic gender inequalities on its part. As it is evident in the World Economic Forum’s Global Gender Gap Report by Bekhouch, Hausmann, Tyson, and Zahidi (2013) Pakistan is on ranked 64 out of 136 countries in political empowerment of women. Pakistan had secured the second lowest ranking in the overall measure of gender-based biases. The cultural heritage and ethnic diversity have been playing role in mediating gender inequality. In-fact boys are provided with nutritious food and good quality of schooling as compared to girls. A report by Bekhouch et al. (2013)14 million girls and 18.3 million boys enrolled in basic education in 2006, this depicts the accessibility and affordability of girl’s education. Moreover, gender inequality is also reflected by the accessibility, affordability and acceptability of RHS. According to UNDP’s report Roca (2013) in Pakistan 260 per 100,000 live births, women die due to pregnancy relat ed causes reflects the commitment of the government to provide the RHS to marginalized women. Early marriages Early marriage is one of the customs which is mostly practiced in rural areas. Due to low socio economical resources parents cannot afford required amount of food especially to their daughters therefore, early marriages is considered one of the way to get rid of this burden. Thus early marriage leads to early pregnancy that is one of the factors contribute to MMR. Early marriages consequently lead high parity. The National Institute of Population Study (NIPS) [Pakistan] and ICF International. 2013. report indicated total fertility rate in rural areas is high (4.2) and it is age specific fertility which is strong indication of early childbearing. It is estimated that 30 percent of all marriages fall into the category of child marriage which is more common in interior Sindh (Dawn 2012-01-19). It is well reflected in PDHS 2012-2013, that eight percent of teenage girls became mothers or expecting their first child. According to Roca (2013) Adolescent fertility rate is 28.1per 100,000 liv e birth which depicts the strong evidence of early marriage tradition in Pakistan. High Parity Early marriages consequently lead high parity. The National Institute of Population Study (NIPS) [Pakistan] and ICF International. 2013. indicates the total fertility rate in rural areas is high (4.2) and it is age specific fertility. Every time when a woman gets pregnant, the risk of dying increases. A study conducted by Rahim, Shafqat and Faiz (2011) also revealed that out of 268 deaths 47 percent were having more than five children thus supporting the evidence that maternal mortality is higher in grand multigravidas. These findings are consistent with the study of Fawad et al. (2011) out of 78 maternal deaths 49 patients were multigravida. Skilled Birth Attendant Due to dearth of skilled birth attendants (SBAs) in most of the rural areas deliveries are attended by unskilled traditional birth attendants (TBA) in Pakistan. These TBAs are not competently trained to detect dangers sign during pregnancy and delivery and to refer women for further treatment. The National Institute of Population Study (NIPS) [Pakistan] and ICF International. 2013. indicated that 67% of rural women received antenatal health care, while 41% women were assisted for deliver by SBAs. The reasons for less utilization of antenatal and delivery services are dearth of SBAs, geographical hindrance and long distance from health facility. Medical causes Obstructed labor, antepartum postpartum hemorrhage, sepsis and eclampsia are obstetric emergencies which need timely intervention. Mortality due to these cases can be prevented by proper antenatal care and detections of life threatening signs and timely referral to comprehensive emergency maternal obstetric neonatal care (EmOC) services. A retrospective, analytic study to analyze direct causes of maternal mortality over a period of seven years was conducted by Rahim et al. (2011) identified hemorrhage a leading cause followed by pregnancy induced hypertension, ruptured uterus and septicemia. A study conducted by Fawad et al. (2011) revealed that eclampsia was the leading cause of maternal deaths followed by sepsis and hemorrhage. Perhaps these precious lives could have been saved if the antenatal and natal services were provided or utilized. These studies calculated MMR 1311/100,000 and 1,057/100,000 live births live birth respectively a big figure as compared to UNDP’s report by Roca (2013) reported MMR 260/100,000 live birth. Abortion Abortion is one of the most important direct medical causes of maternal mortality, accounts for 12-40 % of overall global maternal deaths (WHO, 1994; According to a study conducted by Sathar, Singh, and Fikree (2007) an estimated 890,000 induced abortions are performed annually in Pakistan and 6 to 13% deaths occurred due to complications of abortion like hemorrhage, sepsis and visceral injuries (Jafarey, 2002). A descriptive observational study conducted by Shaikh, Razia, Abbassi, Rizwan and Abbasi (2010) revealed that 230 women were admitted with complications of unsafe abortion over period of one year. These complications include bleeding, uterine perforation, and gastro intestinal injury due to the procedure. Of these 12% women died as they developed septicemia. Deaths due to abortion can be prevented if the safe abortion care services are available by the skilled birth attendants at the door step. Poor Reproductive Health Services: It is quite encouraging that we have good health system that includes basic health unit (BHU), Rural Health Center (RHC) and Tertiary unit. Even though RHS services are available free of charges, BHU and RHC services are underutilized because of long distances to access. Moreover, poor referral system causes a delay in getting access and treatment. According Ali, Bhatti and Kuroiwa (2012) majority of the hospitals were lacking EmOC services and most referral hospitals equipped with EmOC were inaccessible. As in most of the rural areas broken roads and unavailability of proper ambulance services hinder the transfer of women in time. A cross-sectional survey on emergency obstetric care services facilities conducted by Ali et al. (2012) revealed that more than 50 percent of the public health facilities were lacking female doctor to provide Emoc services, thus creating a barrier for women to opt reproductive health services. Summary of analysis Maternal mortality is a public health issue that should be stem out. There are many factors which contribute to MM, and poverty is worse determinant that prevents female to receive education, have nutritious food and get access for reproductive health treatment. Reducing inequity and promoting female education is one of the key strategies to empower women and to bring their status equal to man. MM due to obstetric emergencies can be prevented by strengthening existing health facilities and increasing female skill birth attendants Recommendation Government and NGOs should have one focused agenda to invest in female education as this is their fundamental right. Empowering women with education consequently will improve their socio economic status and will reduce the gender inequity as well. Incentive should be provided to poor women who attend antenatal services in order to eliminate costs issue. Food supplement and medicine for correction of anemia should be free available to pregnant women. All the stake holders should collaborate in ensuring family planning and counseling services as to reduce unintended pregnancies which leads to induces abortions. Reproductive health services including Post Abortion Care (PAC) and family planning services should be made available, accessible and affordable within community settings. Civil society, educationist and health professionals should raise the awareness regarding Child Marriage Restraint Act 1929 and its reinforcement, as child marriage is widely practiced in some parts of the country. It is imperative to strengthen existing health care facilities in order to provide emergency obstetric care. More skilled birth attendants should be trained and deployed who will provide twenty four hours services and make timely referral in case of emergency obstetric care. Health professionals should focus on research as suggested by Travis, et al., (2004) that identification of common national and international barriers in several studies will guide the policy makers and donors to pay attention. References Ali, M., Bhatti, M. A., Kuroiwa, C. (2008). Challenges in access to and utilization of reproductive health care in Pakistan.Journal of Ayub Medical College Abbottabad,20(4), 3-7. Bekhouch, Y., Hausmann, R., Tyson, L. D., Zahidi, S. (2013, September). The global gender gap report 2013. Geneva Switzerland World Economic Forum 2013. Dawn (2012, January 19). Child marriage behind high mortality rate. Dawn. [Punjab]. Retrieved from:http://www.dawn.com/news/689119/childmarriage- behind-high-maternal-mortality-rate. Fawad, A., Naz, H., Islam, A., Zaffar, S., Abbasi, A. U. N. (2011). Maternal mortality in a tertiary care hospital. Journal of Ayub Medical College Abbottabad, 23(1), 92-5. Jafarey, S. N. (2002). Maternal mortality in Pakistancompilation of available data. J Pak Med Assoc, 52(12), 539-44. Karlsen, S., Say, L., Souza, J. P., Hogue, C. J., Calles, D. L., GÃ ¼lmezoglu, A. M., Raine, R. (2011). The relationship between maternal education and mortality among women giving birth in health care institutions: Analysis of the cross sectional WHO Global Survey on Maternal and Perinatal Health. BMC Public Health, 11(1), 606. Khan, D. A., Fatima, S., Imran, R., Khan, F. A. (2010). Iron, folate and cobalamin deficiency in anaemic pregnant females in tertiary care centre at Rawalpindi.J Ayub Med Coll Abbottabad,22(1), 17-21. Lynd, D. (2007). The Education System in Pakistan.Retrieved June,30, 2012. National Institute of Population Study (NIPS) [Pakistan] and ICF International. 2013. Pakistan Demographic and Health Survey (2012-13). Islamabad, Pakistan, and Cleverton, Maryland, USA: NIPS and ICF InternationalNational Institute of Population Studies (NIPS) [Pakistan] and ICF International. 2013.National Institute of Population Studies (NIPS) [Pakistan] and ICF International. 2013. Pakistan Demographic and Health Survey 2012-13. Islamabad, Pakistan, and Calverton, Maryland, USA: NIPS and ICF International.National Institute of Population Studies (NIPS) [Pakistan] and ICF International. 2013. Pakistan Demographic and Health Survey 2012-13. Islamabad, Pakistan, and Calverton, Maryland, USA: NIPS and ICF International. Rahim, R., Shafqat, T., Faiz, N. R. (2011). An analysis of direct causes of maternal mortality.Journal of Postgraduate Medical Institute (Peshawar-Pakistan),20(1). Roca, T. (2013). Human development Report 2013. The Rise of the South, Human Progress in a Diverse World.Afrique contemporaine, (2), 164-166. Ronis, K. A., Mehboob, G., Masood, M., Amjad, S., Nishtar, S. The Voice of Women. Sathar, Z. A., Singh, S., Fikree, F. F. (2007). Estimating the incidence of abortion in Pakistan. Studies in Family Planning, 38(1), 11-22. Shaikh, Z., Abbassi, R. M., Rizwan, N., Abbasi, S. (2010). Morbidity and mortality due to unsafe abortion in Pakistan.International Journal of Gynecology Obstetrics,110(1), 47-49. Travis, P., Bennett, S., Haines, A., Pang, T., Bhutta, Z., Hyder, A. A., Evans, T. (2004). Overcoming health-systems constraints to achieve the Millennium Development Goals. The Lancet, 364(9437), 900-906. WHO. World Health Report–2005. Make every mother and child count. Geneva: WHO; 2005.(2012, 19 January). National Institute of Population Studies (NIPS) [Pakistan] and ICF International. 2013. Pakistan Demographic and Health Survey 2012-13. Islamabad, Pakistan, and Calverton, Maryland, USA: NIPS and ICF International.National Institute of Population Studies (NIPS) [Pakistan] and ICF International. 2013. Pakistan Demographic and Health Survey 2012-13. Islamabad, Pakistan, and Calverton, Maryland, USA: NIPS and ICF International.

Camp Wahanowin Swot

Internal Analysis: Strengths: †¢Facilities: High end facilities which accommodate up to 450 campers at one time, located on a 150 acre plot of land with water access not too far from many of the clienteles homes while remaining in a secluded area. †¢Partnerships: Keeping a close relationship with their â€Å"sister camp,† Green Acres Day Camp allows them to offer accommodations to day campers and spread their name to the day campers segment at the same time. Their partnership with the Toronto District School Board and their music program, Music by the Lake, brings revenue and word-of-mouth advertising to the camp. Management: Wahanowin has a strong management team coming from a variety of backgrounds, the university credentials of the team along with the range of skills and work experience are a big strength for the camps team. †¢Customers: Wahanowin has customers that not only come from within the GTA area, but also internationally from USA, Mexico, Israel, Fra nce, and England, providing a large clientele basis for the camp. Weaknesses: †¢Competitors: There is many other residential summer camps within a two hour drive from Wahanowin that offer different adventures luring customers away.There are also day camps which are less expensive but also offer some of the same activities and experiences which are increasing in popularity. Not to mention that there is a larger opportunity for children to travel in the summer now instead of going to camp. †¢Finance: Most of Wahanowin’s financing has come from the retained earnings of the company which are produced from the previous year’s profits. Not having any outside investors could be seen as a weakness to Wahanowins financial future. External Analysis: Opportunities: Natural: The summers are naturally getting longer and longer in North America as time goes by which provides more time for residential camping. Camp Wahanowin can capitalize on this opportunity by extending t heir summer camp season and bringing in more revenue for a longer period of time. †¢Technological: As society become more dependable on technology and the internet it becomes a more useful marketing tactic. Since today’s generation of children have grown up with technology and spend copious amounts of time on social media and other web pages, this would be an excellent opportunity to market to the children. Threats: Economically: The market for camps in Southern Ontario is actually quite saturated which makes it difficult for Wahanowin to capture the market share that they desire. Furthermore the recession of 2008 also pushed some of the higher income families out of the higher tax bracket which shrunk the potential market for these camps. †¢Social: Some social factors such as the increasing desire to travel over the summer have affected the market for residential summer camps. Other social factors such as the increasing amount of â€Å"helicopter† parents wh ich over-protect their children and forbid them from taking part in these experiences. Cultural: As the GTA (Wahanowin’s main client pool) is becoming more multi-cultural the cultures could begin to group together and form camps specific to each culture or religion (such as Jewish camps), leaving open camps such as Wahanowin on the backburner. http://wahanowin. com/facilities http://wahanowin. com/chronology http://wahanowin. com/staff http://www. livescience. com/7124-study-summer-longer. html http://www. ourkids. net/overnight-camps-s-ontario. php http://www. time. com/time/magazine/article/0,9171,1940697,00. html

Ideas, Formulas and Shortcuts for Best Personal Essay Samples

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Essay on Sample and Design Critique - 1124 Words

Sample and Design Critique The purpose of this paper is to critique the design, sample and ethical issues used in the selected research studies. The article â€Å"The Experience of Patients Undergoing Awake Craniotomy† is a qualitative study. The overall purpose of the study is as Palese, Skrap, Fachin, Visioli, and Zannini, (2008) states, â€Å"Although different techniques are used, very little has been documented about how the patients feels, what they think about, or how they approach this type of surgery with anesthetic† (p.166). On the other hand, the article â€Å"The effects of Crossed Leg on Blood Pressure Measurement† is a quantitative study. This study’s objective was â€Å"to determine if crossing of a leg at the knee during blood pressure†¦show more content†¦Their responses were then measured and trends were generalized on a chart shown in the article. The study did not include a control group so the data is purely descriptive. This is opposed to comparative method as used in the quantitative study. An example of this would have been if a control group was undergoing conventional surgery by using anesthesia. Sample Methodology In the qualitative study the sample methodology used was convenience sampling. The sample size of the study was eleven women and ten men for a total of twenty-one patients. The ages ranged from twenty to sixty-three years. Even though this study involved a procedure not commonly performed the sample size was of an appropriate amount with almost even distribution of gender. Twelve participants had mapping done on the language area and nine had mapping done the movement area of the brain. â€Å"The inclusion criteria were patients (a) with a brain neoplasm who were awaiting surgery under local anesthesia, (b) who were older than 18 years, (c) without language or cognitive disabilities, and (d) who were ready to collaborate and accept an interview† (Palese et al., 2008, p.167). 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