Assessing neo-natal mortality trends in Pakistan: an insight using equity lens

Background Almost 2.5 million neonates died in the first year of life in the year 2017. These account for almost half of the total deaths of children under the age of 5 years. Overall, child mortality has declined over the past two decades. Comparatively, the pace of decline in neonatal mortality has remained much slow. Significant inequalities in health across several dimensions – including wealth, ethnicity, and geography – continue to exist both between and within countries, and these contribute to neonatal mortality. This study aims to quantify the magnitude of inequalities in neonatal mortality trends by wealth quintile and place of residence with province wise segregation. Methods The study was done using raw data from the last three Pakistan Demographic & Health Surveys (2017–18, 2012–13 and 2006–07). The concentration curves were drawn in Microsoft Excel 365 using scatter plot as graph type while the frequencies were calculated using SPSS 24. Results The situation of inequity across provinces and in rural vs urban areas has slightly declined, however, gross inequities continue to exist. Conclusions Presentation of outcomes data, such as neonatal mortality in various wealth quintiles is an effective way to highlight the inequities amongst income groups as it highlights the vulnerable and at-risk groups. In other countries, rural-urban distribution, or ethnic groups may also reflect similar differences and help in identifying high-risk groups.

Variation in Selection Intensities among the Western Coastal Populations of India

Selection is continuously occurring on the living beings and the fittest who are able to reproduce will survive. To measure this selection, the data from 954 women was obtained who belong to different ethnic groups of Gujarat and Maharashtra and various index and components were computed using Crow`s Index and Johnston and Kensinger`s Index. The Crow`s total index value was found to be 0.539. The mortality component was found to be 0.130 and fertility component was found to be 0.363. The contribution of fertility component was greater than the mortality component according to Crow`s Index. Value of total selection index computed using Johnston and Kensinger`s Index is 0.639. The index of selection due to pre‐natal mortality and post‐natal mortality was observed to be 0.064 and 0.130 respectively. Therefore, it is found that among coastal populations of Gujarat and Maharashtra the selection trend is more due to fertility component than mortality component.

Assessing Neo-Natal Mortality Trends in Pakistan: An Insight Using Equity Lens

Background: Almost 2.5 million children died in the first year of life in the year 2017. These account for almost half of the total deaths of children under the age of five years. Overall, child mortality has declined over the past two decades. Comparatively, the pace of decline in neonatal mortality has remained much slow. Significant inequalities in health across a number of dimensions – including wealth, ethnicity, and geography – continue to exist both between and within countries, and these contribute to neonatal mortality. This study aims to quantify the magnitude of inequalities in neonatal mortality trends by wealth quintile and place of residence with province wise segregation. Methods: The study was done using raw data from the last three Pakistan Demographic & Health Surveys (20017-18, 2012-13 and 2006-7). The concentration curves were drawn in Microsoft Excel 365 using scatter plot as graph type while the frequencies were calculated using SPSS 24. Results: The situation of inequity across provinces and in rural vs urban areas has slightly declined, however, gross inequities continue to exist.Conclusions: Presentation of outcomes data, such as neonatal mortality in various wealth quintiles is an effective way to highlight the inequities amongst income groups as it highlights the vulnerable and at-risk groups. In other countries, rural-urban distribution, or ethnic groups may also reflect similar differences and help in identifying high-risk groups.

Assessing Neo-natal mortality trends in Pakistan: An insight using Equity Lens

BackgroundAlmost 2.5 million children died in the first year of life in the year 2017. These account for almost half of the total deaths of children under the age of five years. Overall, child mortality has declined over the past two decades. Comparatively, the pace of decline in neonatal mortality has remained much slow. Significant inequalities in health across a number of dimensions – including wealth, ethnicity, and geography – continue to exist both between and within countries, and these contribute to neonatal mortality. This study aims to quantify the magnitude of inequalities in neonatal mortality trends by wealth quintile and place of residence with province wise segregation. MethodsThe study was done using raw data from the last three Pakistan Demographic & Health Surveys (20017-18, 2012-13 and 2006-7). The concentration curves were drawn in Microsoft Excel 365 using scatter plot as graph type while the frequencies were calculated using SPSS 24. ResultsThe situation of inequity across provinces and in rural vs urban areas has slightly declined, however, gross inequities continue to exist.ConclusionsPresentation of outcomes data, such as neonatal mortality in various wealth quintiles is an effective way to highlight the inequities amongst income groups as it highlights the vulnerable and at-risk groups. In other countries, rural-urban distribution, or ethnic groups may also reflect similar differences and help in identifying high-risk groups.

The Association between Age at Marriage and Child Mortality in Bangladesh

The main objective of this paper is to show the association between age at marriage and the early stage neonatal mortality in Bangladesh. The secondary data has been used for this paper and the data source is Bangladesh Multiple Indicator Cluster Survey. The target group of respondents in this study were the ever married women and who had ever given birth. The total sample size was 44207. In this paper both univariate and bivariate analysis have been used and some graphical representation has also been applied. At bivariate level, to find out the association between dependent variable and independent variables chi square test has been applied. Here dependent variable is considered as early stage neo-natal mortality (child who ever breathed or cried or showed other signs of life-even if he/she lived only a few minutes or hours) which is a binary variable indicating 1 if early stage neo-natal mortality is occurred and 0 if early stage neonatal mortality is not occurred among the respondents. Results show that among the respondents around 16.52 percent experienced very early stage neonatal mortality of their children and this percentage of early stage neonatal mortality for the women who got married at age 18 and above is 22.58 and this figure is 25.96 percent for the women who got married before reaching age 18 and this difference is statistically significant at 5 percent level of significance. So from this study it has been found that age at marriage has a significant role on early stage neonatal mortality in Bangladesh.

Review article on utilization and perception of health services under Janani Suraksha Yojna among mothers

Janani Suraksha Yojana (JSY) is the name in Hindi language that literally means “maternal protection scheme. Janani Suraksha Yojana (JSY) is a safe motherhood intervention under the National Health Mission (NHM). Earlier it was known as National Rural Health Mission (NRHM) it is being implemented with the objective of reducing maternal and neonatal mortality by promoting institutional delivery among poor pregnant women. The scheme is under implementation in all states and union territories, with a special focus on low performing states. The scheme seeks to reduce maternal and neo-natal mortality by promoting institutional delivery, that is, by providing a cash incentive to mothers who deliver their babies in a health facility. There is also provision for incentives to Accredited Social Health Activists (ASHA) for encouraging mothers to go for institutional delivery. The scheme is fully sponsored by the Central Government and is implemented in all states and Union Territories, with special focus on low performing states like Uttar Pradesh.

Factor X Friuli Coagulation Disorder: Almost 50 Years Later

The story of factor X (FX) Friuli. Factor X Friuli was discovered in 1969 to 1970. However, the story of that disease was an international event since patients with this defect were studied in France and in Italy, and different diagnoses were reached—FVII; FX; combined prothrombin complex; and combined FII, FVII, and FX deficiencies. The diagnostic difficulties were due to the peculiar clotting pattern presented by these patients, namely, prolonged partial thromboplastin time, prolonged prothrombin time but normal Russell viper venom clotting time. Only suitable anti-FX antisera clarified the pattern. Altogether 12 homozygotes and 102 heterozygotes have been followed during 4 decades. Six homozygotes died, 2 of them due to HIV infection and 1 due to hepatitis B liver cirrhosis. The other 3 died of nontransfusion-related morbidity. Bleeding tendency has been moderate in agreement with the extrinsic or intrinsic system assay results—FX level of 4% to 5% is considered normal. Heterozygotes may present occasional bleeding manifestations usually during surgery or delivery. Molecular analysis have shown that the mutation responsible for the defect is a Pro343Ser substitution in exon 8. Chimeric FX Friuli mice have been useful in studying the effect of FX levels on embryonic or natal mortality of these animals. No new homozygote but several heterozygotes have been recently seen. The study of FX Friuli has revolutionized the diagnostic approach to FX deficiencies. The FX should be assayed by all assay systems. The FX Friuli has never been described in any other country, and all patients studied come from the Friuli Meduna River Valley.

Abstract 067: Unexpected Actions of the Endothelial-EP 4 Receptor for PGE 2 to Promote Hypertension

Prostaglandin E2 (PGE 2 ) is a major prostanoid produced by the kidney with vasodilator and natriuretic actions and its actions are mediated by four distinct E-prostanoid (EP) receptor isoforms: EP 1 -EP 4 . The EP 4 receptor (EP 4 R) has multiple actions that could impact blood pressure (BP) by triggering macula densa stimulation of renin, inducing vasodilation, and inhibiting epithelial sodium transport. Accordingly, we examined the role of EP 4 R on BP regulation by generating EP 4 R-deficient mice. Because deletion of EP 4 R in utero causes peri-natal mortality due to persistent patent ductus arteriosus, we carried out conditional deletion using an EP 4 flox/flox mouse line. We first generated mice completely lacking EP 4 R in all tissues (TBKO) using a tamoxifen-inducible transgene driving Cre expression in all tissues. Resting mean arterial pressure (MAP) measured by radiotelemetry tended to be elevated in TBKOs compared to controls (106±2 vs 111±2 mmHg; p=0.06). In addition TBKOs showed exaggerated salt sensitivity and enhanced hypertensive response to chronic Ang II infusion compared to controls (MAP increase: 25±3 vs. 37±2 mmHg; p<0.05). To determine whether altered BP responses in the TBKOs were due to elimination of EP 4 R-depedent actions in vascular smooth muscle cells (VSMCs) or in endothelial cells (ECs), we generated mice lacking EP 4 R in VSMCs (SMKO) or ECs (ECKO) using EP 4 flox/flox and transgenic mice with tamoxifen-inducible expression of Cre limited to VSMCs or ECs. Resting MAP in SMKO mice was significantly reduced compared to controls (109±1 vs. 104±2 mmHg; p<0.05), but salt sensitivity and Ang II-dependent hypertension were unaffected. Although no statistically significant differences in baseline MAP or salt sensitivity were observed between ECKOs and controls, the hypertensive response to AngII infusion was significantly reduced in ECKOs (MAP increase: 31±3 vs 24±2 mmHg; p<0.05). In summary, our work suggests a complex role for PGE 2 acting via its EP 4 R in BP regulation, with a major effect to promote resistance to hypertension, apparent in the TBKOs. However, we have also uncovered an unexpected and opposing effect of EP 4 R in endothelium to promote hypertension.