Socioeconomic determinants of early childhood development: evidence from Pakistan.

This study investigates the socioeconomic determinants of early childhood development (ECD) in Pakistan by utilizing the data of sixth wave of the Multiple Indicator Cluster Survey (MICS) conducted in the four provinces of the country. The findings of the study reveal that mother's education, father's education, economic status of the household as measured by household's wealth index quintile, region of residence (province), child's gender, disability, nutrition and the practices used by the adult members of the household to discipline child are important determinants of ECD. The study highlights the crucial role of family background and importance of addressing the issue of malnutrition to foster child development.

Socio-economic determinants of child mortality in Pakistan and the moderating role of household's wealth index.

BACKGROUND: Child mortality is an important social indicator that describes the health conditions of a country as well as determines the country's overall socio-economic development. The Government of Pakistan has been struggling to reduce child mortality (67.2 per thousand live births in 2019). Pakistan could not achieve the target set for Millennium Development Goals to reduce child mortality and still working to meet the target set by the Sustainable Development Goals. This study has investigated the socio-economic determinants of child mortality in Pakistan by using household-level data. Socio-economic characteristics related to women (mothers) and households have been considered as possible determinants of child mortality. The moderating role of a household's wealth index on the association between woman's education and child mortality has also been investigated. METHODS: The comprehensive dataset of the Pakistan Demographic and Health Survey 2017-18 has been used to explore the determinants of child mortality by using multivariable logistic regression. The interaction term of women's education and household wealth index has been used to investigate the moderating role of the household's wealth index. RESULTS: The results indicate that the likelihood of child mortality decreases with an increase in women's education, their empowerment, their husband's education, the wealth status of their households, access to clean drinking water, access to toilet facilities, and exposure to mass media. Whereas, an increase in unmet need for family planning increases the likelihood of child mortality. The study also identified the moderating role of a household's wealth index on the association between woman's education and child mortality. CONCLUSIONS: Household wealth status moderates the association between women's education and child mortality. The absolute slope of the curve showing the association of women's education and child mortality is higher (more negative) for richer households than poorer households. It implies that a household's wealth status strengthens the relationship between women's education and child mortality. With the increase in the household's wealth status, the effect of a mother's education on child mortality becomes more pronounced.

Role of husband's attitude towards the usage of contraceptives for unmet need of family planning among married women of reproductive age in Pakistan.

BACKGROUND: Family planning services deliver a wide range of benefits to the well-being of females and the community. It can curtail the risk of maternal and neonatal mortality through the reduction in abortions and pregnancies. The government of Pakistan has been struggling to convince people about the usefulness of family planning programs. However, different factors related to social norms, values, and culture are important to determine the success of these programs. One such factor is the patriarchal structure of Pakistani society where most of the household decisions are made by men. The objective of this research is to examine the role of the husband's attitude towards the usage of contraceptives for the unmet need of family planning (UMNFP) among married women of reproductive age (MWRA) in Pakistan. METHOD: The dataset of Pakistan Demographic and Health Survey 2017-18 is utilized to examine the role of the husband's attitude towards the usage of contraceptives in UMNFP among MWRA in Pakistan. RESULTS: The UMNFP was considerably lower among MWRA between 40 years and above compared to women 15-19 years. The odds of UMNFP were higher among women and men who were educated up to the primary level compared to those with no education. Odds of UMNFP were higher among women from the poor wealth quintile compared to the poorest wealth quintile; similarly, it was significantly lower among women who were from the richer and the richest wealth quintile compared to the poorest wealth quintile. The odds of UMNFP were lower among women who were employed compared to those who were not employed. Lastly, the odds of UMNFP were higher among women whose husbands opposed to using contraceptives, who perceived that there was a religious prohibition for such use and when a decision on the contraception use was solely made by the husband. CONCLUSIONS: Husband's attitude towards the usage of contraceptives is an important predictor of UMNFP. Liaising with the community and religious leaders to persuade people particularly men about the usefulness of family planning programs and encouraging men to understand their women's say in using contraceptives should be encouraged.

Socio-demographic determinants of unmet need for family planning among married women in Pakistan.

BACKGROUND: Family planning is considered as an effective tool to control population and to bring improvement in maternal and child health. The Government of Pakistan has been continuously struggling to improve the availability of family planning services. However, like many other developing countries of the world, unmet need for family planning still exists in the country. According to Pakistan Demographic and Health Survey 2012-13, the prevalence of unmet need for family planning is 21% in the country. The objective of this study is to investigate the determinants of unmet need for family planning among married women in Pakistan. METHODS: Secondary data of Pakistan Demographic and Health Survey 2012-13 has been used to analyze the determinants of unmet need for family planning through Binary and Multinomial Logistic regressions. RESULTS: Outcomes of the study show that the likelihood of unmet need for family planning among married women in Pakistan goes on to decrease with an increase in their age and education. The likelihood of unmet need for family planning decreases with the increase in wealth status of women's household, number of living children and husband's education. Similarly, the women residing in rural areas are more likely to have unmet need for family planning as compared with women living in urban areas. The women who lack mass media exposure, who are not employed and who have fear of side effects for using contraceptives are more likely to have unmet need for family planning. CONCLUSIONS: Fear of side effects for using contraceptives has been identified as the major cause of unmet need for family planning in Pakistan. The Government of Pakistan has been putting a lot of efforts to convince people about the usefulness of population control programs. A huge media campaign has been launched to persuade people about the benefits of birth control. But the efforts of the government do not seem to be very much effective to clear the perception of people about side effects of contraceptive use. Hence, fear of side effects still remains one of the most important reason behind unmet need for family planning.

Is it Ethnic Fractionalization or Social Exclusion, Which Affects Social Cohesion?

The theory about missing links of economic growth often lags behind the empirical estimations of such links. A consensus has emerged that ethnic fractionalization has a negative impact on growth, also when controlled for income inequality. Often, although implicitly, the assumed channel is social cohesion. We analyse the effect of fractionalization on social cohesion with a different inequality measure, namely a social measure of inequality: the Inclusion of Minorities Index. Our results indicate that it is social exclusion, which reduces social cohesion, rather than diversity as such. We conclude that future studies of social cohesion and its relation to growth may benefit from using measures of social exclusion next to ethnic diversity.

Reconstruction of complex chest wall defects by using polypropylene mesh and a pedicled latissimus dorsi flap: a 6-year experience.

BACKGROUND: Reconstruction of full thickness defects of the chest wall is controversial and presents a complicated treatment scenario for thoracic and reconstructive plastic surgeons. It requires close cooperation between the cardiothoracic and reconstructive surgeons to achieve an optimal outcome and reduce the incidence of complications. OBJECTIVE: The purpose of this study is to evaluate our results in patients who underwent prosthetic bony reconstruction with polypropylene mesh and pedicle latissimus dorsi flap after chest wall resection. The principles of chest wall reconstruction include: wide excision of primary chest wall tumour with macroscopically healthy margins, wound excision and debridement of necrotic devitalised and irradiated tissues, control of infection and local wound care. STUDY DESIGN: This is a descriptive study. It includes 20 patients who underwent chest wall resection due to various causes and followed by reconstruction with polypropylene mesh along with pedicled latissimus dorsi flap. PLACE AND DURATION OF STUDY: The study was conducted at the Department of Plastic and Reconstructive Surgery, Federal Postgraduate Medical Institute, Sheikh Zayed Hospital Lahore, over a period of 6 years from August 1999 to August 2005. PATIENTS AND METHODS: This study included 20 patients who underwent chest wall reconstruction using polypropylene mesh and pedicled latissimus dorsi flap from August 1999 to August 2005. Patient demographic data including age, sex, pathological diagnosis, extent and type of resection, size of defect, and outcome were recorded. All patients were followed up in our outpatients department for 1 year. RESULTS: There was a total of 20 patients, 16 males and four females. The average age was 54 years (range 44-64 years). The indications for resection were primary chest wall tumours in 13 (65%) patients, local recurrence from breast tumours in one (5%) patient, post median sternotomy in three (15%) patients and radionecrosis in three (15%) patients. Ribs along with a part of sternum were resected in 14 (70%) patients, ribs along with clavicle in two (10%) patients and ribs only in four (20%) patients. The average area of chest wall defect after resection was 16.5 x 13 cm. In all patients, skeletal defect was reconstructed with polypropylene mesh. Soft tissue coverage was provided with a pedicled latissimus dorsi flap in all cases. Three patients with a chest wall tumour developed a recurrence within 6 months. Among these three, one patient died within 8 months of follow up due to myocardial infarction. CONCLUSION: Chest wall resection and reconstruction with synthetic polypropylene mesh and local muscle flaps can be performed as a safe, effective one-stage surgical procedure for a variety of major chest wall defects.