High-dose vitamin D3 in the treatment of severe acute malnutrition: a multicenter double-blind randomized controlled trial.

Background: Vitamin D deficiency is common in children with severe acute malnutrition, in whom it is associated with severe wasting. Ready-to-use therapeutic food (the standard treatment) contains modest amounts of vitamin D that do not reliably correct deficiency. Objective: The aim of this study was to determine whether high-dose oral vitamin D3 enhances weight gain and development in children with uncomplicated severe acute malnutrition. Design: We conducted a randomized placebo-controlled trial of high-dose vitamin D3 supplementation in children aged 6-58 mo with uncomplicated severe acute malnutrition in Pakistan. Participants were randomly assigned to receive 2 oral doses of 200,000 IU vitamin D3 or placebo at 2 and 4 wk after starting ready-to-use therapeutic food. The primary outcome was the proportion of participants gaining >15% of baseline weight at 8 wk after starting ready-to-use therapeutic food (the end of the study). Secondary outcomes were mean weight-for-height or -length z score and the proportion of participants with delayed development at the end of the study (assessed with the Denver Development Screening Tool II), adjusted for baseline values. Results: Of the 194 randomly assigned children who started the study, 185 completed the follow-up and were included in the analysis (93 assigned to intervention, 92 to control). High-dose vitamin D3 did not influence the proportion of children gaining >15% of baseline weight at the end of the study (RR: 1.04; 95% CI: 0.94,1.15, P = 0.47), but it did increase the weight-for-height or -length z score (adjusted mean difference: 1.07; 95% CI: 0.49,1.65, P < 0.001) and reduce the proportion of participants with delayed global development [adjusted RR (aRR): 0.49; 95% CI: 0.31, 0.77, P = 0.002], delayed gross motor development (aRR: 0.29; 95% CI: 0.13, 0.64, P = 0.002), delayed fine motor development (aRR: 0.59; 95% CI: 0.38, 0.91, P = 0.018), and delayed language development (aRR: 0.57; 95% CI: 0.34, 0.96, P = 0.036). Conclusions: High-dose vitamin D3 improved the mean weight-for-height or -length z score and developmental indexes in children receiving standard therapy for uncomplicated severe acute malnutrition in Pakistan. This trial was registered at clinicaltrials.gov as NCT03170479.

The association of intimate partner violence with unintended pregnancy and pregnancy loss in Pakistan.

OBJECTIVE: To determine if intimate partner violence (IPV) was associated with unintended pregnancy and pregnancy loss among married women in Pakistan. METHODS: A retrospective analysis was conducted using nationally representative cross-sectional secondary data from women of reproductive age who were currently married and had participated in the domestic violence module of the 2012-13 Pakistan Demographic and Heath Survey. Unintended pregnancy and pregnancy loss were defined as any mistimed or unwanted pregnancy, and any pregnancy that resulted in spontaneous abortion, induced abortion, or stillbirth, respectively. Associations with IPV were assessed by calculating adjusted odds ratios using logistic regression models. RESULTS: Data from 3518 individuals were included. Pregnancy loss had been experienced by 1282 (36.4%) participants and unintended pregnancy was reported by 391 (19.5%) of 2005 individuals this information was available for. In total, 1335 (37.9%) participants reported having ever experienced any form of IPV, including 919 (26.1%), 1112 (31.6%), and 697 (19.8%) participants who had experienced physical, emotional, and both emotional and physical IPV. Significant associations were observed between participants experiencing either physical or emotional IPV, emotional IPV, and both emotional and physical IPV, and unintended pregnancy (P=0.017, P<0.001, and P=0.011, respectively) and pregnancy loss (P=0.002, P=0.005, and P<0.001, respectively). CONCLUSIONS: There is an urgent need to develop preventive strategies to reduce intramarital IPV and its associated poor health outcomes.

Harnessing information technology to improve women's health information: evidence from Pakistan.

BACKGROUND: More than half of Pakistani women are illiterate, marginalized, and experience myriad health problems. These women are also disadvantaged in terms of their restricted mobility and limited access to public space. Nonetheless, user-friendly information and communication technologies (ICTs) have opened up new opportunities to provide them with information that is essential for their health and well-being. METHODS: We established an Information and Communication Centre (ICC) in a village in Sialkot (Pakistan) on a pilot basis in 2009. The basic philosophy of the ICC was to provide women with health-related information by exposing them to modern sources of information on their doorstep. By design, the ICC was a community-based and community-managed institution where women could access information through online (e.g., internet, mobile phone etc.) and offline (e.g., CDs, TV etc.) resources. The ICC was managed by a group of local volunteer women who had the capacity and skills to use the devices and tools of modern ICTs. RESULTS: We noted an overwhelming participation and interest from local women in the activities of the ICC. The women wanted to receive information on a wide range of issues, from family planning, antenatal care, and childcare to garbage disposal and prevention of domestic violence. Overall, the ICC was successful in initiating a meaningful "information dialogue" at community level, where much-needed information was retrieved, negotiated, mediated, and disseminated through intimate and trusted relations. CONCLUSION: We conclude that ICTs have the capacity to cross the barriers of illiteracy and can reach out to disadvantaged women living under a conservative patriarchal regime.

Intimate partner violence and its association with women's reproductive health in Pakistan.

OBJECTIVE: To determine the prevalence of intimate partner violence in Pakistan and its association with reproductive health outcomes. METHODS: A cross-sectional survey was conducted in 8 hospitals in Lahore and Sialkot between October 2008 and January 2009. Information from randomly selected ever-married women of reproductive age was collected via a structured interview. Psychologic, physical, and sexual violence was categorized as "no" or "severe" violence. Associations between reproductive health outcomes and violence were assessed by multivariate logistic regression. RESULTS: Among 373 women interviewed, 75.9% reported severe psychologic, 34.6% reported severe sexual, and 31.9% reported severe physical violence at least once in marital life. Women who experienced severe physical violence were more likely to have their husband's noncooperation in using contraceptives (adjusted odds ratio [AOR], 3.31; 95% confidence interval [CI], 1.93-5.68), poor prenatal care (AOR, 2.11; 95% CI, 1.23-3.69), unplanned pregnancies (AOR, 2.29; 95% CI, 1.39-3.76), and poor self-reported reproductive health (AOR, 2.95; 95% CI, 1.71-4.91) as compared with non-abused women. Similar associations existed for other types of violence. CONCLUSION: The results highlight the magnitude of violence and its association with reproductive health of women. Urgent action is needed to mitigate the violence and its consequential damage to health.

Intimate partner violence against women and its related immigration stressors in Pakistani immigrant families in Germany.

This paper addresses the issue of intimate partner violence against women and its related immigration stressors in Pakistani immigrant families in Germany. Drawing on 32 in-depth interviews with Pakistani women in three cities in Germany, we found that psychological violence was the commonly reported violence among the study participants. The data showed that the process of immigration exacerbated tensions between spouses because of various immigration stressors such as threats to cultural identity, children's socialization, and social isolation. In order to cope with the stressful spousal relations, women applied various indigenous strategies, but avoided seeking help from the host country's formal care-providing institutions. This study also debunks some stereotypes and popular media clichés about the "victimhood of women from conservative developing countries" and provides an understanding of the issue of intimate partner violence within an immigration context. Further research with a larger sample will be helpful to understand immigration-induced stress and intimate partner violence in immigrant families.