Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Bhutta ZA, Hafeez A, Rizvi A, et al. Reproductive, maternal, newborn, and child health in Pakistan: challenges and opportunities. Lancet 2013; published online May 17. http://dx.doi.org/10.1016/S0140-6736(12)61999-0.
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Supplementary appendixThis appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors.
Supplement to: Bhutta ZA, Hafeez A, Rizvi A, et al. Reproductive, maternal, newborn, and child health in Pakistan: challenges and opportunities. Lancet 2013; published online May 17. http://dx.doi.org/10.1016/S0140-6736(12)61999-0.
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Web Appendix Figure 1
Under 5 mortality trends in South Asia (2)
Under 5 Mortality
Afghanistan Bangladesh Bhutan India
Nepal Pakistan Sri Lanka
2
Webappendix Figure 2
Timing of maternal and newborn deaths
(Secondary analysis PDHS data)21
3
Webappendix Figure 3
Correlation between Infant Mortality and Socio-economic status (SES index) in various districts of Pakistan
R Sq Cubic= ‐0.68
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Webappendix Figure 4 Relationship of Skilled Birth attendance by district and Multidimensional Poverty Index in
1993 Polio Eradication Program Multi-donor support
1994 Primary Care Program (LHW Program) Govt of Pakistan
2000 Integrated Management of the Sick Child Initiative
WHO/UNICEF
2007 Maternal, Newborn & Child Health program
Govt of Pakistan (with bilaterals)
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Webappendix Figure 6 Trends in intervention coverage (%) 1990-2006
0
10
20
30
40
50
60
70
80
90
100Coverage in year 1990‐91
Coverage in year 2005‐2006
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Webappendix Figure 7
Place of deaths by cause (secondary analysis) 21
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
In‐transitHomeHospital/Clinic
10
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Webappendix Table 2
Packages of care modeled and evaluated for impact
Packages Interventions included within Packages Periconceptual and post abortion care
Safe abortion services* Post abortion case management * Folic acid supplementation or fortification
Expanded Antenatal Care (ANC) Package
Basic 4 visit ANC** Syphilis detection and treatment MgSO4 management of pre-eclampsia**
Diabetes screening and management* Screening for fetal growth restriction and appropriate
management*
Childbirth & Immediate Newborn Care
Essential care for all women and immediate essential newborn care**
Clean birth practices at home and cord care** Antibiotics for preterm premature rupture of
membranes )pPRoM*) Antenatal corticosteroids for preterm labor* Basic emergency obstetric care (clinic) Comprehensive emergency obstetric care Immediate neonatal assessment and stimulation Neonatal resuscitation** Active management of 3rd stage of labor MgSO4 management of eclampsia** Induction of labour to prevent births at or beyond 41
completed weeks* Postnatal care (including community Newborn Care)
Preventive postnatal care (healthy practices and illness detection) including cord care**
Thermal care including kangaroo mother care Oral antibiotics: case management of severe neonatal
infection** Injectable antibiotics: case management of severe
neonatal infection Full supportive care: case management of severe
neonatal infection**
IMCI and community based child care
Use of improved water source within 30 minutes Use of water connection in the home Improved sanitation - Utilization of latrines or toilets Hand washing with soap**
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Packages Interventions included within Packages Hygienic disposal of children's stools Insecticide treated materials or indoor residual
spraying ORS and zinc for treatment of diarrhea** Antibiotics for dysentery** Case management of pneumonia (oral antibiotics)** Promotion of exclusive breastfeeding till 6 month**
Expanded Nutrition Package
Exclusive breastfeeding till 6 month Calcium supplementation during preconception
period and pregnancy Balanced protein energy supplementation in
pregnancyΩ Multiple micronutrient supplementation** Vitamin A supplementation for children under 5** Preventive Zinc supplementation** Vitamin A for measles treatment Zinc for treatment of diarrhea
*Interventions applied to urban populations of Punjab, Sindh, Baluchistan and KPK ** Interventions tested in Pakistan in effectiveness settings Ω Intervention applied to rural population of all provinces
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Web Appendix Table 3 a
Maternal lives saved by intervention Packages by residence Total