Predictors of Preterm Neonatal Mortality in India and Pakistan: A Secondary Analysis of Data from PURPOSe Study.

Objective. To create a prediction model for preterm neonatal mortality. Methods. A secondary analysis was conducted using data from a prospective cohort study, the Project to Understand and Research Preterm Pregnancy Outcome South Asia. The Cox proportional hazard model was used and adjusted hazard ratios (AHR) with 95% confidence intervals (95% CI) were reported. Results. Overall, 3446 preterm neonates were included. The mean age of preterm neonates was 0.65 (1.25) hours and 52% were female. The preterm neonatal mortality rate was 23.3%. The maternal factors predicting preterm neonatal death was any antepartum hemorrhage, AHR 1.99 (1.60-2.47), while neonatal predictors were preterm who received positive pressure ventilation AHR 1.30 (1.08-1.57), temperature <35.5°C AHR 1.18 (1.00-1.39), and congenital malformations AHR 3.31 (2.64-4.16). Conclusion. This study identified key maternal and neonatal predictors of preterm neonatal mortality, emphasizing the need for targeted interventions and collaborative public health efforts to address disparities and regional variations.

Assessing the Feasibility of a Multifaceted Intervention Package for Improving Respiratory Health of Textile Workers: Findings From the MultiTex Pilot Study in Karachi, Pakistan.

We piloted the development and implementation of a multifaceted intervention package for improving respiratory health among textile workers using a pre-post design at six mills in Karachi. The intervention, implemented following a baseline survey (n = 498), included health and safety training of workers and managers, promotion of cotton dust control measures, and the provision of facemasks. Follow-up surveys were conducted at 1, 6, and 12 months post-intervention. Knowledge, attitude, and practice (KAP) scores and respiratory symptoms were assessed through a questionnaire and spirometry was conducted. The intervention was provided to 230 workers and led to an improvement in KAP scores that was more likely among workers with a higher educational status, spinners, smokers, those with a permanent employment status, working in morning shifts, and with ⩾5 years of textile experience. We found the intervention acceptable and feasible in these textile mills henceforth, trials are required to determine its effectiveness.

Effect Of Cotton Dust Exposure On Respiratory Health Outcomes Among Textile Workers.

BACKGROUND: Cotton dust is generated during various textile manufacturing processes. Only a few studies from Pakistan assessed cotton dust exposure and explored the relationship of duration of work in the textile industry with respiratory health outcomes. We aimed to assess cotton dust exposure and its association with lung function and respiratory symptoms among textile workers in Pakistan. METHODS: We report findings from the baseline survey of the larger study, MultiTex, among 498 adult male textile workers from six mills conducted between October 2015-March 2016 in Karachi, Pakistan. Data collection included the use of standardized questionnaires; spirometry, and area dust measurements through UCB-PATS. Multivariable logistic and linear regression models were developed to assess the association of risk factors with respiratory symptoms and illnesses. RESULTS: We found the mean age of workers to be 32.5 (±10) years; around 25% were illiterate. The prevalence of COPD, asthma, and byssinosis was 10%, 17%, and 2%, respectively. The median cotton dust exposure was 0.33 mg/m3 (IQR: 0.12-0.76). Increased duration of work among non-smokers was associated with a decline in lung function, FVC (-245 ml; 95% CI: -385.71, -104.89) and FEV1 (-200 ml; 95% CI: -328.71, -841.1). Workers with certain job titles (machine operators, helpers, and jobbers), those with greater duration of work, and higher dust exposure, were more likely to report respiratory symptoms and illnesses. CONCLUSIONS: We report a high prevalence of asthma and COPD and a low prevalence of byssinosis. Cotton dust exposure and duration of employment were associated with respiratory health outcomes. Our findings highlight the need for preventive interventions in the textile industry in Pakistan.

Factors associated with home delivery in rural Sindh, Pakistan: results from the global network birth registry.

BACKGROUND: According to global estimates for 2017, nearly 295,000 maternal deaths occurred worldwide. Thus, approximately 810 women die every day due to pregnancy-related complications. This burden of maternal deaths in LMICs is primarily due to poor healthcare service utilization, as indicated by relatively low rates of institutional deliveries and skilled-birth attendance (SBA). We conducted this study with an aim to assess the factors associated with home delivery and its subsequent effect on the pregnancy outcome in rural Sindh, Pakistan. METHODS: Data for this study were taken from The Global Network's Maternal Newborn Health Registry (MNHR), which is a prospective, population-based observational cohort study. Registry data for 2018-2019 for District Thatta, Pakistan was retrieved for the analysis. Multivariable logistic regression models were used to determine the effect of each independent variable on the place of delivery by including all predictors and covariates. Results of the regression analyses are presented with crude odds ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals (CIs). RESULTS: A total of 4649 women were included in the study, of these, 1286 (27.7%) women had delivered at home. Of those who delivered at home, a larger proportion was illiterate (90%), had a BMI of less than 18.5 kg/m2 (26.0%), had parity of 3 or more (48.1%), and had a history of pregnancy loss as compared to women who had institutional delivery. In addition, two-thirds of women (63.4%) who had delivered at home had less than 4 ANC visits, whereas 15.6% did not receive any ANC. On multivariable logistic regression we found that home delivery was significantly associated with being illiterate (aOR = 1.60; [95% CI: 1.34, 2.04]), having high parity (aOR = 1.91; [95% CI: 1.58, 2.32]), and no ANC visit (aOR = 14.8; [95% CI: 10.2, 21.5]). CONCLUSIONS: More than a quarter of our study sample women delivered at home. These women were illiterate, multiparous, and did not receive antenatal care during pregnancy. It is essential to conduct extensive educational interventions for the women and their family members regarding the potential benefits of delivering in a safe and skilled environment. Moreover, the provision of comprehensive and quality antenatal care should be ensured as it improves the mothers' health-seeking behavior and helps them make informed decisions about their health and well-being.

Exploring healthcare providers' perceptions of mental health amid COVID-19 pandemic in obstetrics and gynaecology department of a tertiary care public sector hospital of Karachi, Pakistan: an exploratory qualitative study protocol.

INTRODUCTION: In the wake of the unprecedented public health challenge of the COVID-19 pandemic, it is highly significant to recognise the mental health impact of this mounting threat on healthcare providers (HCPs) working in the obstetrics and gynaecology department. Experience from epidemics and emerging literature around COVID-19 show that the unparalleled amount of stress that HCPs are dealing with is linked with the increased burden of mental health conditions. We aim to conduct an exploratory qualitative descriptive study to assess HCPs' perceptions of mental health amid the COVID-19 pandemic in the obstetrics and gynaecology department of a public sector tertiary care hospital of Karachi, Pakistan. METHODS AND ANALYSIS: This study will use a qualitative descriptive approach where approximately 20-25 HCPs from the obstetrics and gynaecology department will be recruited using a purposive sampling approach. Data will be collected through semistructured interviews and it will be analysed thematically using NVivo V.12 Plus software. ETHICS AND DISSEMINATION: Ethical approval for this study has been obtained from the Institutional Review Board Committee of Jinnah Postgraduate Medical Center hospital. The study results will be disseminated to the scientific community and the HCPs participating in the study. The findings will help us to explore the doctor's perceptions of mental health during the current pandemic of COVID-19 and its impact on their daily lives and mental well-being.

Characterization of the Effect of Drug-Drug Interaction on Protein Binding in Concurrent Administration of Sulfamethoxazol and Diclofenac Sodium Using Bovine Serum Albumin.

Purpose: This project was aimed to determine the effect of concurrent administration of sulfamethoxazole and diclofenac sodium. Methods: Equilibrium dialysis method was adopted to study different protein binding aspects of sulfamethoxazole and diclofenac sodium. Results: Sulfamethoxazole showed two types of association constants; high affinity constant 29.0±0.20×106 M-1 with lower number of binding sites of 0.7±1 and low affinity constant 1.13±0.20×106 M-1 with higher number of binding sites of 3.45±1 at pH 7.4 and 40 °C temperature. Diclofenac sodium showed high affinity constant 33.66±0.20×106 M-1 with lower number of binding sites of 1.01±1 and low affinity constant 1.72±0.20×106 M-1 with higher number of binding sites of 6.40±1 at the same condition. Site specific probe displacement data implied that site-I, warfarin sodium site, was the high affinity site, while site-II, diazepam site, was the low affinity site for these drugs. During concurrent administration, sulfamethoxazole increased the free concentration of diclofenac sodium from 17.5±0.14% to 70.0±0.014% in absence and from 22.5±0.07% to 83.0±0.014% in presence of site-I specific probe. Diclofenac sodium also increased the free concentration of sulfamethoxazole from 2.8±0.07% to 52.0±0.14% and from 8.5±0.014% to 64.4±0.07% in absence and presence of site-I specific probe respectively. Conclusion: The study revealed that the concurrent administration of sulfamethoxazole and diclofenac sodium may result drug concentration alteration in blood.