Are self reported morbidities deceptive in measuring socio-economic inequalities.

Background & objectives: The ambiguity and variability in existing literature on the magnitude of socio-economic inequality in self-reported morbidities makes it difficult to set priorities in health policy. This study examined three critical research questions: first, how far self-reporting affects measuring socio-economic inequalities in case of obstetric morbidities. Second, does using simple bivariate variations mislead in estimating socio-economic differentials in prevalence of obstetric morbidities? Finally, whether use of sophisticated regression based decomposition results can overcome such problems. Methods: The data from National Family Health Survey (NFHS-3; 2005-06) were used, and analyzed by statistical tools such as bivariate estimates and regression based decomposition analysis. Results: Bivariate results revealed that self-reported obstetric morbidity data were misleading in measurement of socio-economic differentials, as these failed to show existing socio-economic variations in obstetric morbidities by socio-economic standing of women. However, decomposition analysis showed that the prevalence of obstetric complications was greater among socioeconomically disadvantaged groups. Interpretation & conclusions: Based on our findings on measurement of socio-economic inequality in self-reported obstetric morbidity, we conclude that the use of regression based inequality decomposition estimates not only overcomes the problems of measuring socio-economic inequality based on self-reported morbidities, but also increases the validity of such measures.

Maternal and fetal outcome in undiagnosed and diagnosed singleton breech presentation at term

To find out the maternal and fetal outcome in undiagnosed and diagnosed singleton breech presentation at term. This study was conducted at Lady Reading Hospital, Peshawar from 1st July 2000 to 30th June 2001 on patients presenting with singleton term breech. Multiple pregnancy and preterm breech were excluded. Information regarding,age, address, parity, gestational age, physical and vaginal examination, ultrasound findings, mode of delivery, any specific procedures performed including external cephalic version [ECV] was collected. Demographic variables and obstetrical outcome were observed in diagnosed and undiagnosed breech cases.Diagnosed breech cases were diagnosed antenatally and proper management plan decided, while undiagnosed breech cases were unbooked who came to hospital for 1st time in labour. Out of 203 cases, 163 [80.29%] patients presented with undiagnosed breech and 40[19.71%] had been diagnosed in antenatal clinic. Out of 163 undiagnosed cases, 137 [84.1%] had successful vaginal breech delivery [VBD], 22 [13.5%] cases had caesarean section [CS], three [1.8%] had subtotal hysterectomy for rupture uterus and 1 [0.6%] with successful ECV had normal vaginal delivery [NVD]. Among 40 diagnosed cases, 8[20%] had successful VBD, 22 [55%] had CS and 10 [25%] had successful ECV followed by NVD. There was no statistical significant difference in short term neonatal outcome, neonatal morbidity and mortality among both groups. Maternal morbidity was lower in vaginally delivered undiagnosed breech cases than in those delivered by caesarean section.In diagnosed group maternal morbidity was the same regardless of mode of delivery. Good prenatal care is essential to reduce undiagnosed breech cases at term. ECVreduces the incidence of Breech Presentation at delivery. In selected cases VBD is a safe option