Geographic Access to Working Family Planning Centers and Unintended Pregnancies among Married Women: A Community Based Nested Case Control Study

Background: Unintended pregnancies pose substantial risk to mothers and children. In Pakistan, unintended pregnancies account for 46% of all pregnancies. Lack of geographic access to open and well-supplied family planning (FP) centers may be related to the occurrence of such pregnancies, particularly in rural areas. Objective: The objective of this analysis is to determine if geographic access to family planning centers in the Thatta district of Pakistan is related to unintended pregnancy rates among married women. Methods: We conducted a community-based, nested case-control study of 800 pregnant women identified from the database of an active surveillance system, which registers and follows all pregnant women in the catchment area of Thatta district. Women were enrolled during the first trimester;those that reported their pregnancy to be unintended were selected as cases (n = 200), and those whose pregnancies were intended served as controls (n = 600). We defined geographic access as including both the distance of a family planning center from the woman’s home, and availability of personal transportation. Logistic regression was used for analysis. Results: In the multivariate model, neither distance [OR = 1.0;95% CI (0.95 - 1.05)] nor availability of transportation [OR = 1.14;95% CI (0.78 - 1.67)] were significantly associated with unintended pregnancy. In fact, women with unintended pregnancies were more likely to be aware of family planning [OR = 2.21;95% CI (1.23 - 3.97)] and more likely to have been using a contraceptive method before conceiving their index pregnancy [OR = 3.59;95% CI (1.83 - 7.06)]. Other factors related to unintended pregnancy were older maternal age [OR = 1.13;95% CI (1.08 - 1.17)], having already had at least one son [OR = 3.13;95% CI (1.93 - 5.07)];spousal opposition to contraceptive use, [OR = 3.24;95% CI (1.89 - 5.56)] and low spousal education level [OR = 1.85;95% CI (1.08 - 3.18)] as compared to women with intended pregnancy. Conclusion: Lack of geographic access to FP centers is not a risk factor for unintended pregnancy in women from the Thatta district. However, in this population, unintended pregnancies are more common among older women, women having at least one son, and those who have a spouse who does not approve of contraceptive use, and is less educated. Of note, women who reported unintended pregnancy did have knowledge about FP and were more often using contraceptives before they conceived.

Acute Toxicity (Lethal Dose 50 Calculation) of Herbal Drug Somina in Rats and Mice

Somina (herbal preparation) prepared by Hamdard Laboratories (Waqf) Pakistan is a mixture of five different medicinal plants, widely prescribed for the treatment of mental illness. For acute toxicity, the Karber arithmetic method for the calculation of LD50 and Hodge and Sterner toxicity scale was used. In this study, different doses (10, 100, 285, 500, 1000, 5000 and 10,000 mg/kg) of the extract was administered orally to the different groups of rats and mice. Signs of toxicity and possible death of animals were monitored for 24 hrs to calculate the median lethal dose (LD50) of somina. At the end of the study, all the animals in all the dose groups were sacrificed and the internal organ-body was compared with values from the control group. The LD50 was found to be >10,000 mg/kg body weight upon oral administration in mice and rats as no mortality was observed after single dose administration. According to Hodge and Sterner toxicity scale, the obtained value of LD 50 > 10,000 mg/kg classified the Somina as Practically non-toxic herbal medicine.

Paroxetine Augments while Naloxone Abolishes the Analgesic Effect of Paracetamol in Acute Nociceptive Pain in Mice

The mechanism(s) of analgesic action of paracetamol (acetaminophen;N-acetyl-p-aminophenol) remains controversial. Previous studies on rats suggested that the antinociceptive action of paracetamol might involve the central descending inhibitory pain pathways recruiting both a serotoninergic and an opioidergic system. This study explores this issue in mice using paroxetine, the most potent selective serotonin re-uptake inhibitor, and the nonselective opioid pure antagonist naloxone. Animals were divided into two main groups for two separate experiments, each subdivided into 3 subgroups. In both experiments;the first group served as control, the second group received paracetamol (200 mg/kg, i.p). In one experiment, the third group received paroxetine (20 mg/kg p.o for 7 days) before paracetamol. In the other experiment, animals of the third group were pretreated with naloxone (5 mg/kg, i.p) 30 min before paracetamol. The antinociceptive effect of paracetamol was tested using the hot plate test. Paracetamol displayed a significant antinociceptive activity that was augmented by pretreatment with paroxetine as was shown by maintenance of its effect beyond that shown by paracetamol alone. On the other hand, pretreatment with naloxone abolished paracetamol’s antinociceptive activity in the hot-plate test. These results extended the previous observation in rats that the antinociceptive effect of paracetamol involved activation of a central descending pain inhibitory pathway with serotonin and opioidergic peptides being potential mediators recruited.