Prevalence and determinants of Caesarean delivery in Punjab, Pakistan.

BACKGROUND: Caesarean section (C-section) is a life-saving obstetric procedure that reduces maternal mortality and improves reproductive health. Although, vaginal delivery is still an important safe and low-cost method of delivery, C-section is sometimes performed when it is not even required, which creates health challenges for pregnant women and their newborn infants. AIMS: To estimate the effect of a set of institutional, demographic, socioeconomic and spatial variables on C-section delivery (n = 2424) in Punjab, Pakistan. METHODS: We used data from the Multiple Indicator Cluster Survey Punjab 2014 and multiple logistic regression analysis. Analysis was carried out using STATA version 12. RESULTS: Higher maternal age at first marriage, higher number of antenatal care visits, and higher wealth quintiles were associated with higher risk of C-section. Women in Punjab were more likely to deliver through C-section in private health facilities and there was no significant difference between urban and rural areas. There was a significant difference in the risk of C-section in different divisions of Punjab, for example, DG Khan and Rawalpindi showed the lowest risk compared with the reference division of Bahawalpur, which is partially explained by the developmental disparities and access to public healthcare facilities. CONCLUSIONS: The government should facilitate access to healthcare facilities in areas that are easily accessible, especially, to rural women.

Correlates of home and hospital delivery in Pakistan.

OBJECTIVE: To identify the socio-economic determinants of home-based and institutional delivery in Pakistan. METHODS: This study has used Pakistan Demographic and Health Survey (PDHS) data collected by the National Institute of Population Studies (NIPS), Islamabad, Pakistan, and Macro International Inc. (now ICF International) Calverton, Maryland, United States. It used three episodes of Pakistan Demographic and Health Survey Data from 1990-91, 2006-07 and 2012-13. Data was analysed using descriptive analysis and odds of delivering at hospital were calculated using logistic regression analysis. RESULTS: Home-based delivery was over 4 times higher in 1990-91 compared with institutional delivery 5,465(85.3%) vs. 852(13.3%), and around 2 times higher in 2006-07 5,900(64.7%) vs. 3,128(34.3%). However, in 2012-13, the share of women delivering at home or health facility was roughly the same, i.e. 6,180(51.6%) at home and 5,773(48.2%) at health facility. CONCLUSIONS: There were wide gaps in the rates of institutional delivery among different subgroups, and they were accentuated by the socio-economic and financial disparities, and high illiteracy rates in the lowest wealth quintiles.

Financing gaps for Pakistan's contraceptive prevalence goals: Analyses using the Guttmacher adding-it-up methodology.

OBJECTIVES: The objective of the paper is to identify levels of and gaps in family planning financing in Pakistan and to assess whether current funding is sufficient to meet national and FP2030 goals to increase contraceptive use to 60% by 2030. STUDY DESIGN: We estimate the cost of family planning services nationally and by province based on the Essential Services Package and WHO/UNFPA cost by applying the existing Guttmacher global Adding-It-Up methodology. Additional data are also analyzed to assess trends in expenditures on family planning between 2017 and 2021. RESULTS: The estimated cost of family planning services provided in Pakistan in 2017 was US$81 million, equivalent to US$0.38 per capita. The estimated gap in costs to provide contraceptive services to the additional 8.6 million women with unmet need for modern contraception was US$93 million. While we found evidence of an upward trend in overall government expenditure on family planning services over the period 2017-21, the pace of increase was slow and uneven across regions. CONCLUSIONS: The evidence highlights the persistent inadequacy of financing for contraceptive services especially if Pakistan intends to achieve its ambitious national and FP2030 goal of increasing contraceptive prevalence to 60% by 2030. IMPLICATIONS: A doubling of current funding for contraceptive services is required in Pakistan. Additional financing needs to be directed towards the poorest women with unmet need to avoid unintended pregnancies and to improve equity in reproductive health outcomes.

Nanobiochar and Copper Oxide Nanoparticles Mixture Synergistically Increases Soil Nutrient Availability and Improves Wheat Production.

Recently, nanomaterials have received considerable attention in the agricultural sector, due to their distinctive characteristics such as small size, high surface area to volume ratio, and charged surface. These properties allow nanomaterials to be utilized as nanofertilizers, that can improve crop nutrient management and reduce environmental nutrient losses. However, after soil application, metallic nanoparticles have been shown to be toxic to soil biota and their associated ecosystem services. The organic nature of nanobiochar (nanoB) may help to overcome this toxicity while maintaining all the beneficial effects of nanomaterials. We aimed to synthesize nanoB from goat manure and utilize it with CuO nanoparticles (nanoCu) to influence soil microbes, nutrient content, and wheat productivity. An X-ray diffractogram (XRD) confirmed nanoB synthesis (crystal size = 20 nm). The XRD spectrum showed a distinct carbon peak at 2θ = 42.9°. Fourier-transform spectroscopy of nanoB's surface indicated the presence of C=O, C≡N-R, and C=C bonds, and other functional groups. The electron microscopic micrographs of nanoB showed cubical, pentagonal, needle, and spherical shapes. NanoB and nanoCu were applied alone and as a mixture at the rate of 1000 mg kg-1 soil, to pots where wheat crop was grown. NanoCu did not influence any soil or plant parameters except soil Cu content and plant Cu uptake. The soil and wheat Cu content in the nanoCu treatment were 146 and 91% higher, respectively, than in the control. NanoB increased microbial biomass N, mineral N, and plant available P by 57, 28, and 64%, respectively, compared to the control. The mixture of nanoB and nanoCu further increased these parameters, by 61, 18, and 38%, compared to nanoB or nanoCu alone. Consequently, wheat biological, grain yields, and N uptake were 35, 62 and 80% higher in the nanoB+nanoCu treatment compared to the control. NanoB further increased wheat Cu uptake by 37% in the nanoB+nanoCu treatment compared to the nanoCu alone. Hence, nanoB alone, or in a mixture with nanoCu, enhanced soil microbial activity, nutrient content, and wheat production. NanoB also increased wheat Cu uptake when mixed with nanoCu, a micronutrient essential for seed and chlorophyll production. Therefore, a mixture of nanobiochar and nanoCu would be recommended to farmers for improving their clayey loam soil quality and increasing Cu uptake and crop productivity in such agroecosystems.

Zinc Plus Biopolymer Coating Slows Nitrogen Release, Decreases Ammonia Volatilization from Urea and Improves Sunflower Productivity.

Currently, the global agriculture productivity is heavily relied on the use of chemical fertilizers. However, the low nutrient utilization efficiency (NUE) is the main obstacle for attaining higher crop productivity and reducing nutrients losses from these fertilizers to the environment. Coating fertilizer with micronutrients and biopolymer can offer an opportunity to overcome these fertilizers associated problems. Here, we coated urea with zinc sulphate (ZnS) and ZnS plus molasses (ZnSM) to control its N release, decrease the ammonia (NH3) volatilization and improve N utilization efficiency by sunflower. Morphological analysis confirmed a uniform coating layer formation of both formulations on urea granules. A slow release of N from ZnS and ZnSM was observed in water. After soil application, ZnSM decreased the NH3 emission by 38% compared to uncoated urea. Most of the soil parameters did not differ between ZnS and uncoated urea treatment. Microbial biomass N and Zn in ZnSM were 125 and 107% higher than uncoated urea, respectively. Soil mineral N in ZnSM was 21% higher than uncoated urea. Such controlled nutrient availability in the soil resulted in higher sunflower grain yield (53%), N (80%) and Zn (126%) uptakes from ZnSM than uncoated fertilizer. Hence, coating biopolymer with Zn on urea did not only increase the sunflower yield and N utilization efficiency but also meet the micronutrient Zn demand of sunflower. Therefore, coating urea with Zn plus biopolymer is recommended to fertilizer production companies for improving NUE, crop yield and reducing urea N losses to the environment in addition to fulfil crop micronutrient demand.