Helping babies breathe: assessing the effectiveness of simulation-based high-frequency recurring training in a community-based setting of Pakistan.

BACKGROUND: Birth asphyxia is one of the significant causes of neonatal deaths in Pakistan. Poor newborn resuscitation skills of birth attendants are a major cause of neonatal mortality in low resource settings across the globe. This study aimed to evaluate the effectiveness of the Simulation-Based High-Frequency training of the Helping Babies Breathe for Community Midwives (CMW), in district Gujrat, Pakistan. METHOD: A pre-post-test interventional study design was used. The universal sampling technique was employed to recruit 50 deployed CMWs in the entire district of Gujrat. The pre-tested module and tools of Helping Babies Breathe (2nd edition) were used in the intervention. Using the High Frequency training approach, three one-day training sessions were conducted for CMWs at an interval of 2 months. During the 2 months interval, participants were monitored and supported to practice their skills at their birthing centers. Knowledge and skills were assessed before and after each session. The McNemar and Cochran's Q tests were applied for data analysis. Participants' feedback was also obtained at the end of each training, which was analyzed through descriptive statistics. RESULTS: Data from 34 CMWs were analyzed as they completed all three training sessions and assessments. The results were statistically different after each training session for OSCE B (p-value < 0.05). However, for knowledge and OSCE A, significant improvement was observed after training sessions 1 and 2 only. Pairwise comparison showed that pre-assessment at training 1 was significantly different from most of the repeated measures of knowledge, OSCE A, and OSCE B. Moreover, the learners appreciated the overall training in terms of organization, content, material, assessment, and overall competency. Additionally, due to a small sample size of the CMWs, and a short time of the intervention, significant differences in morbidity and mortality outcomes could not be detected. CONCLUSION: The study concluded that a series of training and continuous supportive supervision and facilitation enhances Helping Babies Breathe (HBB) knowledge retention and skills. The study recommends, periodic, structured and precise HBB trainings, with ongoing quality monitoring activities through blended learning modalities would help sustain and scale-up the intervention.

Frequency of Vitamin D deficiency and its association with serum PTH levels in end stage renal disease patients.

OBJECTIVE: To assess the frequency of Vitamin D Deficiency and its association with serum Parathormone (PTH) levels in End stage renal disease patients in a tertiary setup. METHODS: This cross sectional study was conducted in the Department of Nephrology, Liaquat National Hospital from January to December 2016 and comprised patients with End stage renal disease on maintenance haemodialysis. Sample size of 113 at 8% prevalence was calculated inflated to 150. Participants were selected through purposive sampling technique. Numerical variables were expressed as mean ± SD (standard deviation) while categorical variables were expressed as frequency and percentages. To determine association between Vitamin D and serum Parathormone (PTH) levels chi-square test was applied. Association of serum alkaline phosphatase levels with both Vitamin D levels and PTH levels was analyzed using chi-square test. SPSS 20 was used for data analysis. P-value <0.05 was taken as significant. RESULTS: Of the 150 participants, 33 were drop outs, 63(53.8%) were males and 54(46.2%) were females. The overall mean age was 52.47±15.21 years. Of all, hypertension as a comorbidity was present in 64(54.7%), Diabetes mellitus was present in 8(6.8%) and cardiovascular disease in 7(6%). Among the biochemical markers, mean serum vitamin D levels were 18.6±13.6ng/ml, mean Serum PTH levels were 253.8±227.2pg/ml, mean serum alkaline phosphatase levels were 143.7±125.4µg/L, mean serum phosphorus levels were 4.81±3.46mg/dl and mean serum calcium levels were 21.41±114.4mg/dl. Among the study participants, 67(57.3%) were found to be Vitamin D deficient. Both low and normal vitamin D was associated with High PTH (P <0.001) Other significant associations noted were that of High Alkaline Phosphatase with High PTH levels and a normal Vitamin D level (P<0.001). CONCLUSIONS: Our study revealed more than half of our participants were Vitamin D deficient and an association was found between Normal Vitamin D levels and high serum PTH levels with associated high alkaline phosphatase levels.

Post-dialysis effects in patients on haemodialysis.

OBJECTIVE: To assess the post-dialysis effects in normal and diabetic patients on haemodialysis. METHODS: This cross-sectional study was conducted from January to December 2013 at two hospitals in Karachi, and comprised patients receiving dialysis. Participants were selected through purposive sampling technique. SPSS 20 was used for data analysis. RESULTS: Of the 150 subjects, 148(98.8%) were diabetics. Overall, 93(62%) were men and 57(38%) women. Besides, 22(14.7%) participants were having dialysis as a complication of hypertension and 128(85.3%) as a complication of diabetes. Diabetes was a comorbid condition for 148(98.7%) patients, hypertension for 139(92.7%) and cardiac diseases for 40(26.7%). Of the total, 114(76%) subjects were having dialysis thrice a week, 31(20.7%) twice and 5(3.3%) once. Post-dialysis, dizziness was present every time in 25(16.6%) patients, nausea and vomiting in 14(10%), cramps in 22(14.7%), headache in 21(14%), anxiety and depression in 16(10.7%), hunger in 43(28.7%) and itching in 30(20%). CONCLUSIONS: Post-dialysis complications were common in normal and diabetic patients. Nutritional status was found to be poor among long-term dialysis-dependent diabetics.

Midwives' perspectives on perinatal mental health: A qualitative exploratory study in a maternity setting in Karachi, Pakistan.

Women experience perinatal mental health problems (PMHP), such as anxiety and depression antenatally and/or postnatally. Among Asian countries, Pakistan has the highest prevalence of postnatal depression ranging from 28% to 63%. This study aimed to explore midwives' perceptions, understanding, thoughts, and feelings regarding perinatal mental health (PMH), as well as experiences and roles in identifying and managing perinatal women cases suffering from PMHP. A qualitative, descriptive, exploratory design was used. The study was conducted at Koohi Goth Hospital. Purposive sampling was used to recruit practicing midwives holding diplomas in midwifery and public health, and with at least two years of experience. Ten participants were recruited. Data were collected by conducting in-depth interviews using a semi-structured interview guide, translated into Urdu. Interviews were audio recorded. Ethics approval was attained by the institutional Ethical Review Committee. Data analysis was done manually by using the content analysis steps described by Creswell. From the analysis, three themes emerged: 1) Dearth of PMH competencies; 2) Importance of PMH; and 3) Myths related to PMH. PMHP undermine mothers' and infants outcomes, thus, midwives should be competent in assessing and managing symptoms in perinatal women to reduce suffering.

Safe motherhood: A hidden reality in Pakistan.

OBJECTIVE: To explore the perceptions and experiences of healthcare professionals, including female health visitors, female health workers, community midwives, and heads of departments of healthcare facilities, regarding the importance of the Safe Motherhood Initiative (SMI), its pillars, and its foundational principles. DESIGN: Qualitative descriptive exploratory study. SETTING: This study was conducted in healthcare centres in 10 districts in Pakistan: six in Gilgit Baltistan, two in Chitral, and two in Sindh. PARTICIPANTS: Healthcare professionals were recruited using a purposive sampling technique. In total, 14 in-depth interviews were conducted. FINDINGS: The following themes emerged through thematic analysis: (1) health and well-being of mothers and newborns; (2) strengthening the SMI pillars; (3) equity of health services; and (4) effective strategies for behaviour modification. Each theme had two categories. KEY CONCLUSIONS: The health and well-being of mothers and newborns are key indicators; as such, interventions should be made to promote their quality of life. Capacity building and refresher training on antenatal care, childbirth, postnatal care, postabortion care, and family planning can be considered effective to enhance the competencies of healthcare professionals. IMPLICATIONS FOR PRACTICE: The findings of this study suggest that healthcare professionals should receive training to enhance their competencies and provide safe care.

Is HBA1C A True Marker Of Glycaemic Control In Diabetic Patients On Haemodialysis?

BACKGROUND: HbA1c is generally conducted to check blood glucose control in diabetic patients. As reported by several recent studies, HbA1c may not be considered as a reliable assay for monitoring glycaemic status in haemodialysis patients. Multiple factors may result in artificially low HbA1c. We sought to confirm this observation by performing a study in which we saw the agreement between expected HbA1c values as indicated by the mean plasma glucose level and the measured HbA1c values of haemodialysis dependent Diabetic patients. METHODS: This crosssectional study was conducted on 45 patients. Daily three readings of capillary blood glucose were taken for three consecutive days in a week, every two weeks in a month for up to three months. Total 54 capillary blood glucose levels were checked in the duration of three months. Mean blood glucose level was calculated at the end of the study and it is used to calculate the 'expected HbA1c' levels using a formula. At the offset, HbA1c was measured (at 12 weeks) and was compared with the expected HbA1c. RESULTS: On comparing the expected and measured HbA1c levels in 45 patients on haemodialysis. There is a significant difference between the two levels, with reduced levels of measured HbA1c in majority of patients as compared to expected ones. CONCLUSIONS: HbA1c is not a true marker of glucose control in diabetic patients on regular haemodialysis.