Background. Despite advances in childhood pneumonia management, it remains a major killer of chil... more Background. Despite advances in childhood pneumonia management, it remains a major killer of children worldwide. We sought to estimate global treatment failure rates in children aged 2-59 months with World Health Organization-defined severe pneumonia.
The aim of the study was to investigate the effect of antenatal iron-folic acid (IFA) supplementa... more The aim of the study was to investigate the effect of antenatal iron-folic acid (IFA) supplementation on child stunting in Nepalese children age <2 years. A retrospective cohort study design was used, in which a pooled cohort of 5235 most recent live births 2 years prior to interview from three Nepal Demographic and Health Surveys (2001, 2006 and 2011) was analysed. The primary outcome was stunting in children age <2 years. The main exposure variable was antenatal IFA supplementation. Multivariate Poisson regression analysis was performed. In our sample, 31% and 10% of Nepalese children age <2 years were stunted and severely stunted, respectively. The adjusted relative risk of being stunted was 14% lower in children whose mothers used IFA supplements compared to those whose mothers did not use (aRR = 0.86, 95% CI = 0.77-0.97). Additionally, the adjusted relative risk of being stunted was significantly reduced by 23% when antenatal IFA supplementation was started ≤6 months with ≥90 IFA supplements used during pregnancy (aRR = 0.77, 95% CI = 0.64-0.92). Antenatal IFA supplementation significantly reduced the risk of stunting in Nepalese children age <2 years. The greatest impact on the risk reduction of child stunting was when IFA supplements were started ≤6 months with ≥90 supplements were used.
Several epidemiological studies from low- and middle-income countries have reported a protective ... more Several epidemiological studies from low- and middle-income countries have reported a protective effect of maternal antenatal iron/folic acid (IFA) on childhood mortality. The current study aimed to evaluate the effect of maternal antenatal IFA supplementation on childhood mortality in Pakistan. A propensity score-matched sample of 8,512 infants live-born within the 5 years prior to interview was selected from the pooled data of two Pakistan Demographic and Health Surveys (2006/07 and 2012/13). The primary outcomes were childhood mortality indicators and the main exposure variable was maternal antenatal IFA supplementation. Post-matched analyses used Cox proportional hazards regression and adjusted for 16 potential confounders. Maternal antenatal IFA supplementation significantly reduced the adjusted risk of death on day 0 by 33% [adjusted hazard ratio (aHR)=0.67, 95% confidence interval (95% CI) 0.48-0.94], during the neonatal period by 29% (aHR=0.71, 95% CI 0.57-0.88), and for under-fives by 27% (aHR=0.73, 95% CI 0.60-0.89). When IFA was initiated in the first 4 months of pregnancy, the adjusted risk of neonatal and under-five deaths was significantly reduced by 35 and 33%, respectively. Twenty percent of under-five deaths were attributable to non-initiation of IFA in the first 4 months of pregnancy. With universal initiation of IFA in the first 4 months of pregnancy, 80,300 under-five deaths could be prevented annually in Pakistan. Maternal antenatal IFA supplementation significantly reduced neonatal and under-five deaths in Pakistan. Earlier initiation of supplements in pregnancy was associated with a greater prevention of neonatal and under-five deaths.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2008
Prevalence of wheezing is increasing, bronchodilators are sub-optimally utilized and antibiotics ... more Prevalence of wheezing is increasing, bronchodilators are sub-optimally utilized and antibiotics are over-prescribed. In Thailand, current case management guidelines based on WHO guidelines, recommend two doses of rapid-acting bronchodilator for children with audible wheeze and fast breathing (FB) and/or lower chest indrawing (LCI). To document the response of children with wheeze with FB and/or LCI to up to three doses of bronchodilator therapy and followed children whose FB and LCI disappeared for 7 days. We documented response to up to three dose of inhaled salbutamol in consecutively assessed eligible children 1-59 months of age presenting with auscultatory/audible wheeze and FB [WHO defined non-severe pneumonia (NSP)] and/or LCI [WHO defined severe pneumonia (SP)] at the outpatient department of a referral hospital. Data were collected for up to 7 days in responders to bronchodilator therapy. Of 534 children were screened from November 2001 to February 2003, 263 (49.3%) had whe...
Background: Globally 7.6 million children died in 2010 before reaching their fifth birthday and 4... more Background: Globally 7.6 million children died in 2010 before reaching their fifth birthday and 40% of these deaths occur in the neonatal period. Pakistan has the third highest rate of neonatal mortality globally. To implement evidence-based interventions for the reduction of neonatal mortality, it is important to investigate factors associated with neonatal mortality. The aim of the current study was to identify determinants of neonatal mortality in Pakistan.
Journal of the Pakistan Medical Association, Jun 1, 2007
To determine the frequency of metabolic syndrome in both genders, in a limited adult type 2 diabe... more To determine the frequency of metabolic syndrome in both genders, in a limited adult type 2 diabetic population presenting to Pakistan Institute of Medical Sciences, Islamabad. Methods: This was a cross sectional study conducted in a tertiary care teaching hospital. During the six months of study period, 106 adult type2 diabetics were examined and evaluated for the presence of metabolic syndrome according to the ATP-III criteria. Asian standards for the waist circumference were used. Results: Out of 106 patients, 91 (85.8%) had metabolic syndrome of whom 95% were females. Abdominal obesity was present in 91% females and 86% males. Low HDL levels were present in all females and 83% males. Seventy eight percent females and 63% males had elevated levels of triglycerides. Hypertension was present in 68% and 73% females and males respectively. Conclusion: This study showed a very high prevalence of the metabolic syndrome in type2 diabetic population. Females were more affected than males in all respects (JPMA 57:235;2007).
Journal of the College of Physicians and Surgeons Pakistan Jcpsp, Oct 1, 2005
To determine the association of clinical outcome of measles in children with demographic profile ... more To determine the association of clinical outcome of measles in children with demographic profile and complications. Design: A cross-sectional analytical study. Patients and Methods: Detailed history and physical examination of all the hospitalized patients with complications of measles was filled in case report form. Immunization cards were assessed for measles vaccination status. Data was analyzed by using SPSS version 10 software. The clinical outcome of measles was compared with demographic profile and complications by using Chi-square test and p-values were obtained. Results: Two hundred and five hospitalized patients with complications of measles were studied. There were 61.5% males. Mean age was 46.1 months and 57% patients were vaccinated against measles. Malnourished patients were 71.2% and had a longer hospital stay (p=0.010). Pneumonia (40.0%) and diarrhoea (38.5%) were the commonest complications. Seven children died. Mortality was significantly associated with younger age (p=0.04), unvaccinated status (p=0.04) and presence of encephalitis (p=0.00001). Conclusion: The most common complications of measles are pneumonia and diarrhoea with dehydration requiring hospitalization. Malnourished children experience more complications and have longer hospital stay. Mortality is significantly associated with infancy, unvaccinated status and encephalitis. A second dose of measles should be introduced at 15 months of age.
Objectives: To investigate the frequency of endocrine complications among β-thalassemic patients ... more Objectives: To investigate the frequency of endocrine complications among β-thalassemic patients in Pakistan. Materials and Methods: The current cross sectional study was conducted at the Thalassemia Centre, Islamabad, Pakistan between October 2013 and March 2014. We enrolled 96 β-thalassemic patients and blood samples were drawn to determine serum calcium, phosphate, ferritin, parathyroid hormone, free T4, thyroid stimulating hormone, 25-hydroxy vitamin D and random blood sugar levels. Comparison of demographic features and serum ferritin levels between patients with endocrine and without endocrine complication was done using logistic regression analysis and odds ratio (OR), 95% confidence interval (CI) and p-values were reported. The level of significant was considered at 5%. Results: Out of 96, 56 (58.3%) were male patients. The mean (±SD) age and ferritin levels of patients was 13.8 (±3.8) years and 4447 (±2945) ng/mL, respectively. Out of 96, 40 (41.7%) patients had endocrine c...
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2006
In the recent past, there have been reports of rising treatment failure rates for non-severe pneu... more In the recent past, there have been reports of rising treatment failure rates for non-severe pneumonia. It is felt that World Health Organization (WHO) criteria for therapy failure are too sensitive and that many children are unnecessarily classified as failures. We studied alternative, less sensitive therapy failure criteria. In this nested study we followed the clinical course of non-severe pneumonia in children aged 2-59 months using alternative therapy failure criteria. All children received amoxicillin and were followed up on days 3, 5 and 14 after enrollment. On day 3, children were labelled as therapy failure only if their condition had deteriorated. These failure rates were compared with those using WHO definitions. During the study period, 876 children with non-severe pneumonia were followed up until day 14. On day 3, using alternative therapy failure criteria, 31 (3.5%) children were labelled as therapy failure compared to 95 (10.8%) using current WHO criteria. The differe...
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2005
To determine the association of clinical outcome of measles in children with demographic profile ... more To determine the association of clinical outcome of measles in children with demographic profile and complications. A cross-sectional analytical study. Isolation ward, The Children's Hospital, Pakistan Institute of Medical Sciences (PIMS), from January 2003 to August 2004. Detailed history and physical examination of all the hospitalized patients with complications of measles was filled in case report form. Immunization cards were assessed for measles vaccination status. Data was analyzed by using SPSS version 10 software. The clinical outcome of measles was compared with demographic profile and complications by using Chi-square test and p-values were obtained. Two hundred and five hospitalized patients with complications of measles were studied. There were 61.5% males. Mean age was 46.1 months and 57% patients were vaccinated against measles. Malnourished patients were 71.2% and had a longer hospital stay (p=0.010). Pneumonia (40.0%) and diarrhoea (38.5%) were the commonest com...
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2004
Wheeze is a significant problem in children. There is a gradual trend of switching from oral to i... more Wheeze is a significant problem in children. There is a gradual trend of switching from oral to inhaled bronchodilator therapy. No randomised trials have been carried out in the community to compare the clinical outcome of two modes of therapy. If outcome with oral and inhaled bronchodilators is the same in young wheezers in developing countries, it will be easier to manage them. In a randomised multicentre trial, wheezy children aged 1-59 months with fast breathing and/or lower chest indrawing received oral or inhaled salbutamol at home after responding to up to three cycles of inhaled bronchodilators. They were re-assessed on days 3 and 5 for clinical outcome. From May 2001 to August 2002, 780 children were enrolled; 390 each were randomised to oral and inhaled salbutamol. On day 5, 324 (83.1%) children in the oral and 328 (84.1%) in the inhaled group were completely well. There were no differences in clinical outcome of both modes of therapy. The clinical outcome of children aged...
JPMA. The Journal of the Pakistan Medical Association, 2007
To determine the frequency of metabolic syndrome in both genders, in a limited adult type 2 diabe... more To determine the frequency of metabolic syndrome in both genders, in a limited adult type 2 diabetic population presenting to Pakistan Institute of Medical Sciences, Islamabad. This was a cross sectional study conducted in a tertiary care teaching hospital. During the six months of study period, 106 adult type 2 diabetics were examined and evaluated for the presence of metabolic syndrome according to the ATP-III criteria. Asian standards for the waist circumference were used. Out of 106 patients, 91 (85.8%) had metabolic syndrome of whom 95% were females. Abdominal obesity was present in 91% females and 86% males. Low HDL levels were present in all females and 83% males. Seventy eight percent females and 63% males had elevated levels of triglycerides. Hypertension was present in 68% and 73% females and males respectively. This study showed a very high prevalence of the metabolic syndrome in type2 diabetic population. Females were more affected than males in all respects.
In Pakistan, 51% of women are anaemic in pregnancy yet only 44% of women use antenatal iron-folic... more In Pakistan, 51% of women are anaemic in pregnancy yet only 44% of women use antenatal iron-folic acid (IFA) supplements. Little information exits on the perception and barriers to the use of IFA supplements during pregnancy in Pakistan. The aim of the study was to understand women and healthcare providers' perceptions, and to investigate the cultural and behavioural factors influencing the use of antenatal IFA supplements in rural and urban settings of Pakistan. We conducted 10 focus group discussions with mothers, 10 in-depth interviews with currently pregnant women, 6 in-depth interviews with Lady Health Workers and 4 in-depth interviews with doctors providing antenatal care services. The study was conducted in two districts of Pakistan--district Swabi and Islamabad for rural and urban samples, respectively. Data was collected between August and November 2012. The majority of women were aware of the perceived benefits of antenatal IFA supplements. However, the rural women had...
Background. Despite advances in childhood pneumonia management, it remains a major killer of chil... more Background. Despite advances in childhood pneumonia management, it remains a major killer of children worldwide. We sought to estimate global treatment failure rates in children aged 2-59 months with World Health Organization-defined severe pneumonia.
The aim of the study was to investigate the effect of antenatal iron-folic acid (IFA) supplementa... more The aim of the study was to investigate the effect of antenatal iron-folic acid (IFA) supplementation on child stunting in Nepalese children age <2 years. A retrospective cohort study design was used, in which a pooled cohort of 5235 most recent live births 2 years prior to interview from three Nepal Demographic and Health Surveys (2001, 2006 and 2011) was analysed. The primary outcome was stunting in children age <2 years. The main exposure variable was antenatal IFA supplementation. Multivariate Poisson regression analysis was performed. In our sample, 31% and 10% of Nepalese children age <2 years were stunted and severely stunted, respectively. The adjusted relative risk of being stunted was 14% lower in children whose mothers used IFA supplements compared to those whose mothers did not use (aRR = 0.86, 95% CI = 0.77-0.97). Additionally, the adjusted relative risk of being stunted was significantly reduced by 23% when antenatal IFA supplementation was started ≤6 months with ≥90 IFA supplements used during pregnancy (aRR = 0.77, 95% CI = 0.64-0.92). Antenatal IFA supplementation significantly reduced the risk of stunting in Nepalese children age <2 years. The greatest impact on the risk reduction of child stunting was when IFA supplements were started ≤6 months with ≥90 supplements were used.
Several epidemiological studies from low- and middle-income countries have reported a protective ... more Several epidemiological studies from low- and middle-income countries have reported a protective effect of maternal antenatal iron/folic acid (IFA) on childhood mortality. The current study aimed to evaluate the effect of maternal antenatal IFA supplementation on childhood mortality in Pakistan. A propensity score-matched sample of 8,512 infants live-born within the 5 years prior to interview was selected from the pooled data of two Pakistan Demographic and Health Surveys (2006/07 and 2012/13). The primary outcomes were childhood mortality indicators and the main exposure variable was maternal antenatal IFA supplementation. Post-matched analyses used Cox proportional hazards regression and adjusted for 16 potential confounders. Maternal antenatal IFA supplementation significantly reduced the adjusted risk of death on day 0 by 33% [adjusted hazard ratio (aHR)=0.67, 95% confidence interval (95% CI) 0.48-0.94], during the neonatal period by 29% (aHR=0.71, 95% CI 0.57-0.88), and for under-fives by 27% (aHR=0.73, 95% CI 0.60-0.89). When IFA was initiated in the first 4 months of pregnancy, the adjusted risk of neonatal and under-five deaths was significantly reduced by 35 and 33%, respectively. Twenty percent of under-five deaths were attributable to non-initiation of IFA in the first 4 months of pregnancy. With universal initiation of IFA in the first 4 months of pregnancy, 80,300 under-five deaths could be prevented annually in Pakistan. Maternal antenatal IFA supplementation significantly reduced neonatal and under-five deaths in Pakistan. Earlier initiation of supplements in pregnancy was associated with a greater prevention of neonatal and under-five deaths.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2008
Prevalence of wheezing is increasing, bronchodilators are sub-optimally utilized and antibiotics ... more Prevalence of wheezing is increasing, bronchodilators are sub-optimally utilized and antibiotics are over-prescribed. In Thailand, current case management guidelines based on WHO guidelines, recommend two doses of rapid-acting bronchodilator for children with audible wheeze and fast breathing (FB) and/or lower chest indrawing (LCI). To document the response of children with wheeze with FB and/or LCI to up to three doses of bronchodilator therapy and followed children whose FB and LCI disappeared for 7 days. We documented response to up to three dose of inhaled salbutamol in consecutively assessed eligible children 1-59 months of age presenting with auscultatory/audible wheeze and FB [WHO defined non-severe pneumonia (NSP)] and/or LCI [WHO defined severe pneumonia (SP)] at the outpatient department of a referral hospital. Data were collected for up to 7 days in responders to bronchodilator therapy. Of 534 children were screened from November 2001 to February 2003, 263 (49.3%) had whe...
Background: Globally 7.6 million children died in 2010 before reaching their fifth birthday and 4... more Background: Globally 7.6 million children died in 2010 before reaching their fifth birthday and 40% of these deaths occur in the neonatal period. Pakistan has the third highest rate of neonatal mortality globally. To implement evidence-based interventions for the reduction of neonatal mortality, it is important to investigate factors associated with neonatal mortality. The aim of the current study was to identify determinants of neonatal mortality in Pakistan.
Journal of the Pakistan Medical Association, Jun 1, 2007
To determine the frequency of metabolic syndrome in both genders, in a limited adult type 2 diabe... more To determine the frequency of metabolic syndrome in both genders, in a limited adult type 2 diabetic population presenting to Pakistan Institute of Medical Sciences, Islamabad. Methods: This was a cross sectional study conducted in a tertiary care teaching hospital. During the six months of study period, 106 adult type2 diabetics were examined and evaluated for the presence of metabolic syndrome according to the ATP-III criteria. Asian standards for the waist circumference were used. Results: Out of 106 patients, 91 (85.8%) had metabolic syndrome of whom 95% were females. Abdominal obesity was present in 91% females and 86% males. Low HDL levels were present in all females and 83% males. Seventy eight percent females and 63% males had elevated levels of triglycerides. Hypertension was present in 68% and 73% females and males respectively. Conclusion: This study showed a very high prevalence of the metabolic syndrome in type2 diabetic population. Females were more affected than males in all respects (JPMA 57:235;2007).
Journal of the College of Physicians and Surgeons Pakistan Jcpsp, Oct 1, 2005
To determine the association of clinical outcome of measles in children with demographic profile ... more To determine the association of clinical outcome of measles in children with demographic profile and complications. Design: A cross-sectional analytical study. Patients and Methods: Detailed history and physical examination of all the hospitalized patients with complications of measles was filled in case report form. Immunization cards were assessed for measles vaccination status. Data was analyzed by using SPSS version 10 software. The clinical outcome of measles was compared with demographic profile and complications by using Chi-square test and p-values were obtained. Results: Two hundred and five hospitalized patients with complications of measles were studied. There were 61.5% males. Mean age was 46.1 months and 57% patients were vaccinated against measles. Malnourished patients were 71.2% and had a longer hospital stay (p=0.010). Pneumonia (40.0%) and diarrhoea (38.5%) were the commonest complications. Seven children died. Mortality was significantly associated with younger age (p=0.04), unvaccinated status (p=0.04) and presence of encephalitis (p=0.00001). Conclusion: The most common complications of measles are pneumonia and diarrhoea with dehydration requiring hospitalization. Malnourished children experience more complications and have longer hospital stay. Mortality is significantly associated with infancy, unvaccinated status and encephalitis. A second dose of measles should be introduced at 15 months of age.
Objectives: To investigate the frequency of endocrine complications among β-thalassemic patients ... more Objectives: To investigate the frequency of endocrine complications among β-thalassemic patients in Pakistan. Materials and Methods: The current cross sectional study was conducted at the Thalassemia Centre, Islamabad, Pakistan between October 2013 and March 2014. We enrolled 96 β-thalassemic patients and blood samples were drawn to determine serum calcium, phosphate, ferritin, parathyroid hormone, free T4, thyroid stimulating hormone, 25-hydroxy vitamin D and random blood sugar levels. Comparison of demographic features and serum ferritin levels between patients with endocrine and without endocrine complication was done using logistic regression analysis and odds ratio (OR), 95% confidence interval (CI) and p-values were reported. The level of significant was considered at 5%. Results: Out of 96, 56 (58.3%) were male patients. The mean (±SD) age and ferritin levels of patients was 13.8 (±3.8) years and 4447 (±2945) ng/mL, respectively. Out of 96, 40 (41.7%) patients had endocrine c...
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2006
In the recent past, there have been reports of rising treatment failure rates for non-severe pneu... more In the recent past, there have been reports of rising treatment failure rates for non-severe pneumonia. It is felt that World Health Organization (WHO) criteria for therapy failure are too sensitive and that many children are unnecessarily classified as failures. We studied alternative, less sensitive therapy failure criteria. In this nested study we followed the clinical course of non-severe pneumonia in children aged 2-59 months using alternative therapy failure criteria. All children received amoxicillin and were followed up on days 3, 5 and 14 after enrollment. On day 3, children were labelled as therapy failure only if their condition had deteriorated. These failure rates were compared with those using WHO definitions. During the study period, 876 children with non-severe pneumonia were followed up until day 14. On day 3, using alternative therapy failure criteria, 31 (3.5%) children were labelled as therapy failure compared to 95 (10.8%) using current WHO criteria. The differe...
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2005
To determine the association of clinical outcome of measles in children with demographic profile ... more To determine the association of clinical outcome of measles in children with demographic profile and complications. A cross-sectional analytical study. Isolation ward, The Children's Hospital, Pakistan Institute of Medical Sciences (PIMS), from January 2003 to August 2004. Detailed history and physical examination of all the hospitalized patients with complications of measles was filled in case report form. Immunization cards were assessed for measles vaccination status. Data was analyzed by using SPSS version 10 software. The clinical outcome of measles was compared with demographic profile and complications by using Chi-square test and p-values were obtained. Two hundred and five hospitalized patients with complications of measles were studied. There were 61.5% males. Mean age was 46.1 months and 57% patients were vaccinated against measles. Malnourished patients were 71.2% and had a longer hospital stay (p=0.010). Pneumonia (40.0%) and diarrhoea (38.5%) were the commonest com...
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2004
Wheeze is a significant problem in children. There is a gradual trend of switching from oral to i... more Wheeze is a significant problem in children. There is a gradual trend of switching from oral to inhaled bronchodilator therapy. No randomised trials have been carried out in the community to compare the clinical outcome of two modes of therapy. If outcome with oral and inhaled bronchodilators is the same in young wheezers in developing countries, it will be easier to manage them. In a randomised multicentre trial, wheezy children aged 1-59 months with fast breathing and/or lower chest indrawing received oral or inhaled salbutamol at home after responding to up to three cycles of inhaled bronchodilators. They were re-assessed on days 3 and 5 for clinical outcome. From May 2001 to August 2002, 780 children were enrolled; 390 each were randomised to oral and inhaled salbutamol. On day 5, 324 (83.1%) children in the oral and 328 (84.1%) in the inhaled group were completely well. There were no differences in clinical outcome of both modes of therapy. The clinical outcome of children aged...
JPMA. The Journal of the Pakistan Medical Association, 2007
To determine the frequency of metabolic syndrome in both genders, in a limited adult type 2 diabe... more To determine the frequency of metabolic syndrome in both genders, in a limited adult type 2 diabetic population presenting to Pakistan Institute of Medical Sciences, Islamabad. This was a cross sectional study conducted in a tertiary care teaching hospital. During the six months of study period, 106 adult type 2 diabetics were examined and evaluated for the presence of metabolic syndrome according to the ATP-III criteria. Asian standards for the waist circumference were used. Out of 106 patients, 91 (85.8%) had metabolic syndrome of whom 95% were females. Abdominal obesity was present in 91% females and 86% males. Low HDL levels were present in all females and 83% males. Seventy eight percent females and 63% males had elevated levels of triglycerides. Hypertension was present in 68% and 73% females and males respectively. This study showed a very high prevalence of the metabolic syndrome in type2 diabetic population. Females were more affected than males in all respects.
In Pakistan, 51% of women are anaemic in pregnancy yet only 44% of women use antenatal iron-folic... more In Pakistan, 51% of women are anaemic in pregnancy yet only 44% of women use antenatal iron-folic acid (IFA) supplements. Little information exits on the perception and barriers to the use of IFA supplements during pregnancy in Pakistan. The aim of the study was to understand women and healthcare providers' perceptions, and to investigate the cultural and behavioural factors influencing the use of antenatal IFA supplements in rural and urban settings of Pakistan. We conducted 10 focus group discussions with mothers, 10 in-depth interviews with currently pregnant women, 6 in-depth interviews with Lady Health Workers and 4 in-depth interviews with doctors providing antenatal care services. The study was conducted in two districts of Pakistan--district Swabi and Islamabad for rural and urban samples, respectively. Data was collected between August and November 2012. The majority of women were aware of the perceived benefits of antenatal IFA supplements. However, the rural women had...
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