Elderly patient at mission hospital

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Title
Impact of Maternal Age and Other Biosocial
Factors on Newborn Health at Hospitals in
Peshawar, N-W.F.P Pakistan Sareer
Badshah Director of studies Professor Paulo G.
J. Lisboa School of Computing and Mathematical
Sciences,Liverpool John Moores University,
Liverpool L3 3AF
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Aim of the study

• To investigate the influence/impact of maternal
  age and other biosocial factors on the hospital
  newborns health, controlling for a range of
  other variables.

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Objective of the study

• To assess birth-health, i.e.,
• Weight
• Length
• Head circumference, and
• Apgar (heart rate, respiratory efforts, muscle
  tone, reflex irritability, and colour).
• To examine the effect of maternal age and other
  biosocial factors on birth health.
• To generate yardsticks/parameters and establish
  base statistics, for further comparisons in
  future with national and international studies.
• To identify adverse factors affecting birth
  health, which will inform/help
• Parents
• Husbands
• Doctors
• health department and
• Funding agencies.

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Pakistan Demographic indicators

• Population 138.1 million (2000)
• Urban 37.0
• Pop. Growth 2.4
• Life expectancy at birth 59.6 years
• Fertility rate (births per women) 4.8
• Mortality rate
• Infant 89.8 (per 1,000 live birth)
• Under-5 yrs 126.0 (per 1,000 live birth)
• Maternal 4-7 (per 1,000)
• Education
• Adult literacy rate 45.0
• Male/female 58.9/31.0

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Pakistan Vs NWFP Fed. Adm.Tri.Area (2003)
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Literature review

• Data from Pakistan
• 17 publications
• 13 in Pakistan (using very simple tools)
• 04 others (UK Australia)
• Other than Pakistan
• 14 publications
• India 05
• Nigeria 03
• Bangladesh 02
• Canada 02
• Jordan 01
• Ethiopia 01

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Tools

• Cross-tabulation, percentages, and chi-square 
• (H. Yadav.(1983)., T. O. Lawoyin., et al.
  (1992)., N. Nahar et al.(1998)., B.
  Mondal.(1997). and Sushma Malik.(1997).
•  
• T-test
• (Sami A. Khoury et al.(2000)., Y. Feleke.(1999).,
  and S. A. Taha et al.(1984).
•  
• Odds ratios 
• (Suzanne C. Tough., et al.(2001)., J.C. Grant et
  al.(1997)., and Kwang-sun Lee et al.(1988). 
• Logistic Regression model and the use of -2LL 
• (J. C. Grant et al.(1997). 
• Regression Analyses 
• (E. Karim et al.(1997).

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Data (May-December, 2003)

• Retrospective data collection
  (May-July, 2003)
• Revise questionnaire ethical approval
  (August 6, 2003)
• Prospective data collection (August-December
  2003)
• Retrospective data
• understanding with the staff
• coding
• combination of categories
• introducing medical terminology,
• tools learning/testing

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Prospective data collection

• Total sample 1039 (August-December, 2003)
• Hospitals in Peshawar
• Hayatabad Postgraduate Medical Complex
• Khyber Postgraduate Teaching Hospital
• Lady Reading P. G. Teaching Hospital, and
• Maternity Hospital Peshawar

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Introduction of data

• Maternal Age(lt20) 7.5
• M. weight (lt57kg) 24.7
• Entry in emergency 75
• Employed mothers 5.8
• Afghan refugees 11.8
• Nuclear family 25
• Abortions/Misc. 17
• Other risks 6.1

• Congenital abnormality 4
• M. education (illiterate) 70
• Rural U.Slums 64.8
• Water (fresh) 63.3
• Father age(lt25) 5
• Father edu. (illiterate) 38.1
• Income (lt5000) 69
• Cousin marriages 60.1

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and

• Diabetes 2.7
• Hypertension 18.3
• Anaemia 38.9
• Mode of del.(other) 33.5
• Birth status (other) 9.2
• Age at marriage (lt20) 50.1
• Body Mass Index (lt19.1) 3.9
• Gravida (one) 28.5

• Preterm del. (yes) 11.9
• Gap (lt2 years) 65
• Visits (nil) 31.3
• Visits (lt2) 51.6
• Gestation (lt37wk) 22.5
• Birth weight (lt2.5 kg) 9.9
• length (lt45cm) 14.4
• h.Circu (lt32cm) 14.9
• Apgar (lt7points) 2.8

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Maternal age Incidence of Low birth weight
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Gestation (lt37 weeks)
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Age group and birth-weight



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Age group, birth-weight and gestation
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Age group and birth-length
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Age group, birth-length and gestation
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Head circumference (lt32 cm)
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Age group, and Head-circumference
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Age group, birth Head-circum. and gestation
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Incidence of Apgar score (lt7 points)
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Age group, and Apgar
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Age group, Head circumference and gestation
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Comparison of low birth-weight and
head-circumference
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Maternal age, Apgar Birth status(still birth
etc)
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Low birth-weight (Area-status)
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Age group, birth weight and Apgar
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Age, birth weight and birth status (live, still
birth)
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Linear Regression results
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(No Transcript)
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Collaboration with Dr. Jose (Uni. De Cantabria
Spain)
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Thank you

• ?