1. . 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

2. Aim of the study: To investigate the influence/impact of maternal age and other biosocial factors on the hospital newborn’s health, controlling for a range of other variables.

3. 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.

4. 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%

5. Pakistan Vs NWFP & Fed. Adm.Tri.Area (2003)

6. 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*

7. 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).

8. 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

9. 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

10. Maternal Age(<20) 7.5% M. weight (<57kg) 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(<25) 5% Father edu. (illiterate) 38.1% Income (<5000) 69% Cousin marriages 60.1% Introduction of data

11. Diabetes 2.7% Hypertension 18.3% Anaemia 38.9% Mode of del.(other) 33.5% Birth status (other)9.2% Age at marriage (<20) 50.1% Body Mass Index (<19.1) 3.9% Gravida (one) 28.5% Preterm del. (yes) 11.9% Gap (<=2 years) 65% Visits (nil) 31.3% Visits (<=2) 51.6% Gestation (<37wk) 22.5% Birth weight (<2.5 kg) 9.9% length (<45cm) 14.4% h.Circu (<32cm) 14.9% Apgar (<7points) 2.8% and

12. Maternal age & Incidence of Low birth weight

13. Gestation (<37 weeks)

14. Age group and birth-weight

15. Age group, birth-weight and gestation

16. Age group and birth-length

17. Age group, birth-length and gestation

18. Head circumference (<32 cm)

19. Age group, and Head-circumference

20. Age group, birth Head-circum. and gestation

21. Incidence of Apgar score % (<7 points)

22. Age group, and Apgar

23. Age group, Head circumference and gestation

24. Comparison of low birth-weight and head-circumference

25. Maternal age, Apgar & Birth status(still birth etc)

26. Low birth-weight (Area-status)

27. Age group, birth weight and Apgar

28. Age, birth weight and birth status (live, still birth)

29. Linear Regression results

31. Collaboration with Dr. Jose (Uni. De Cantabria Spain)

32. Thank you ?