Maternal Neonate and Child Health (MNCH) research in Pakistan: Trend and transition <http://
Pakistan's MNCH (Maternal, Neonatal & Child Health) indicators are showing a slow progress in achieving Millennium Development Goals (MDG) targets. Relevant research is necessary for evidence-based interventions. This paper attempts to identify trends of published work and research in MNCH according to levels of health service delivery and their areas of focus in terms of policy and/or programmatic approach. A total of 342 published papers and documents relevant to MNCH from 1995-2008 were reviewed and categorized according to the level and type of research. Most of the published work specifically focusing on MNCH has been conducted in the tertiary level care facilities (48%) with maximum focus on clinical/diagnostic interventions (52.3%). A surge in publication of MNCH related articles has been observed from the year 2000 onwards. This paper illustrates that most of the research conducted is at tertiary level care facilities with focus on clinical/diagnostic interventions while lesser research was done with focus on policy and strategic planning. Where a number of commendable materials are available on 'policy and strategic planning' but these are not always based on evidence and scientific rigor and on widely disseminated lessons learnt. Thus there is a dire need to carry-out and promote more researches in the area of policy and strategic planning in MNCH.
Available from: PubMed Central
- "Maternal mortality ratio (MMR) during that period was 550/100,000. Currently, Pakistan has an IMR of 78 and CMR of 94 . Pakistan's Millennium Development Goals (MDG) aspire to decrease IMR and CMR to 40 and 45 (MDG4) and MMR to 140 (MDG5) by 2015 . "
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High infant and maternal mortality rates are one of the biggest health issues in Pakistan. Although these rates are given high priority at the national level (Millennium Development Goals 4 and 5, respectively), there has been no significant decrease in them so far. We hypothesize that this lack of success is because the undergraduate curriculum in Pakistan does not match local needs. Currently, the Pakistani medical curriculum deals with issues in maternal and child morbidity and mortality according to Western textbooks. Moreover, these are taught disjointedly through various departments. We undertook curriculum revision to sensitize medical students to maternal and infant mortality issues important in the Pakistani context and educate them about ways to reduce the same through an integrated teaching approach.
The major determinants of infant mortality in underdeveloped countries were identified through a literature review covering international research produced over the last 10 years and the Pakistan Demographic Health Survey 2006-07. An interdisciplinary maternal and child health module team was created by the Medical Education Department at Shifa College of Medicine. The curriculum was developed based on the role of identified determinants in infant and maternal mortality. It was delivered by an integrated team without any subject boundaries. Students' knowledge, skills, and attitudes were assessed by multiple modalities and the module itself by student feedback using questionnaires and focus group discussions.
Assessment and feedback demonstrated that the students had developed a thorough understanding of the complexity of factors that contribute to infant mortality. Students also demonstrated knowledge and skill in counseling, antenatal care, and care of newborns and infants.
A carefully designed integrated curriculum can help sensitize undergraduate medical students and equip them to identify and address complex issues related to maternal and infant mortality in underdeveloped countries.
Available from: Junaid Rafi
Available from: Tuhin Biswas
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ABSTRACT: Abstract: The overall purpose of the study was to identify key health system bottlenecks at the district level in achieving the MNCH (maternal neonatal and child health) related Millennium Development Goals and to cost out the marginal financial resources required to address them in three districts of Bangladesh. The goal was to assist the government in identifying cost-effective interventions in addressing some of the critical health system bottlenecks with particular focus on health equity and the needs of the disadvantaged population. The study, conducted exclusively on the public sector health service providers at the district level, adopted a mixed method approach. Using the Tanahashi model, the quantitative part attempted to identify the extent of the health system bottlenecks on human resources, accessibility, logistics, financing and utilization of services at the selected districts. The qualitative part dealt with the FGDs (focus group discussions) and in-depth interviews conducted on the government health personnel in order to better understand and analyze the bottlenecks. The World Bank developed MBB (marginal budgeting for bottlenecks) tool that was used to estimate the marginal cost of addressing these bottlenecks. The study identified human resource constraints—inadequate numbers, poor expertise, grossly uneven geographical distribution and lack of awareness as the most critical bottleneck affecting health systems at the district level. Inequity in the availability of accessibility to health care services was pronounced and manifested in different dimensions—geographical setup, socioeconomic status and gender. The marginal costs of addressing these bottlenecks are significant in the context of the total health expenditure in Bangladesh. Existing human resource policy needs to be revised to improve the overall quality of services. Allocation of additional resources and interventions should be district specific. Awareness programs need to be strengthened by using effective behavioral change and communication strategies. Moreover, special effort is required to address the equity issue. Key words: Health system, bottlenecks, millennium development goals.
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