{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T22:39:16Z","timestamp":1793659156780,"version":"4.5.1"},"reference-count":16,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2023,12,9]],"date-time":"2023-12-09T00:00:00Z","timestamp":1702080000000},"content-version":"unspecified","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill & Melinda Gates Foundation","doi-asserted-by":"crossref","award":["INV-005776"],"award-info":[{"award-number":["INV-005776"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,11,23]]},"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Pakistan has disproportionately high maternal and neonatal morbidity and mortality. There is a lack of detailed, population-representative data to provide evidence for risk factors, morbidities and mortality among pregnant women and their newborns. The Pregnancy Risk, Infant Surveillance and Measurement Alliance (PRISMA) is a multicountry open cohort that aims to collect high-dimensional, standardised data across five South Asian and African countries for estimating risk and developing innovative strategies to optimise pregnancy outcomes for mothers and their newborns. This study presents the baseline maternal and neonatal characteristics of the Pakistan site occurring prior to the launch of a multisite, harmonised protocol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>PRISMA Pakistan study is being conducted at two periurban field sites in Karachi, Pakistan. These sites have primary healthcare clinics where pregnant women and their newborns are followed during the antenatal, intrapartum and postnatal periods up to 1\u2009year after delivery. All encounters are captured electronically through a custom-built Android application. A total of 3731 pregnant women with a mean age of 26.6\u00b15.8 years at the time of pregnancy with neonatal outcomes between January 2021 and August 2022 serve as a baseline for the PRISMA Pakistan study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings to date<\/jats:title>\n                    <jats:p>In this cohort, live births accounted for the majority of pregnancy outcomes (92%, n=3478), followed by miscarriages\/abortions (5.5%, n=205) and stillbirths (2.6%, n=98). Twenty-two per cent of women (n=786) delivered at home. One out of every four neonates was low birth weight (&lt;2500 g), and one out of every five was preterm (gestational age &lt;37 weeks). The maternal mortality rate was 172\/100 000 pregnancies, the neonatal mortality rate was 52\/1000 live births and the stillbirth rate was 27\/1000 births. The three most common causes of neonatal deaths obtained through verbal autopsy were perinatal asphyxia (39.6%), preterm births (19.8%) and infections (12.6%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Future plans<\/jats:title>\n                    <jats:p>The PRISMA cohort will provide data-driven insights to prioritise and design interventions to improve maternal and neonatal outcomes in low-resource regions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT05904145\">NCT05904145<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-078222","type":"journal-article","created":{"date-parts":[[2023,12,10]],"date-time":"2023-12-10T11:27:14Z","timestamp":1702207634000},"page":"e078222","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Cohort profile: the Pregnancy Risk Infant Surveillance and Measurement Alliance (PRISMA) \u2013 Pakistan"],"prefix":"10.1136","volume":"13","clinical-trial-number":[{"clinical-trial-number":"nct05904145","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct05904145","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4448-0061","authenticated-orcid":false,"given":"Sabahat","family":"Naz","sequence":"first","affiliation":[{"name":"Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Jaffar","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nida","family":"Yazdani","sequence":"additional","affiliation":[{"name":"VITAL Pakistan, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Kashif","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zaid","family":"Hussain","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uzma","family":"Khan","sequence":"additional","affiliation":[{"name":"VITAL Pakistan, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fouzia","family":"Farooq","sequence":"additional","affiliation":[{"name":"Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Imran","family":"Nisar","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5874-4358","authenticated-orcid":false,"given":"Fyezah","family":"Jehan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0439-8293","authenticated-orcid":false,"given":"Zahra","family":"Hoodbhoy","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,12,10]]},"reference":[{"key":"2025121411053104000_13.12.e078222.1","doi-asserted-by":"publisher","DOI":"10.1038\/nrg1919"},{"key":"2025121411053104000_13.12.e078222.2","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyp240"},{"key":"2025121411053104000_13.12.e078222.3","doi-asserted-by":"crossref","unstructured":"Baqui A , Ahmed P , et al . Development and validation of a simplified algorithm for neonatal gestational age assessment - protocol for the Alliance for maternal newborn health improvement (AMANHI) prospective cohort study. J Glob Health 2017;7. doi:10.7189\/jogh.07.021201","DOI":"10.7189\/jogh.07.021201"},{"key":"2025121411053104000_13.12.e078222.4","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1007\/s10389-019-01175-0","article-title":"Determinants of infant mortality in Pakistan: evidence from Pakistan demographic and health survey 2017\u201318","volume":"29","author":"Patel","year":"2021","journal-title":"J Public Health (Berl)"},{"key":"2025121411053104000_13.12.e078222.5","doi-asserted-by":"crossref","unstructured":"McClure EM , Garces AL , Hibberd PL , et al . The global network maternal newborn health Registry: a multi-country, community-based Registry of pregnancy outcomes. Reprod Health 2020;17.(Suppl 2) doi:10.1186\/s12978-020-01020-8","DOI":"10.1186\/s12978-020-01020-8"},{"key":"2025121411053104000_13.12.e078222.6","doi-asserted-by":"crossref","unstructured":"Naeem K , Ilyas M , Fatima U , et al . Profile: karachi health and demographic surveillance system of pakistan (khdss). OJPHI 2018;10. doi:10.5210\/ojphi.v10i1.8953","DOI":"10.5210\/ojphi.v10i1.8953"},{"key":"2025121411053104000_13.12.e078222.7","unstructured":"GE vivid IQ. 2018. Available: https:\/\/www.probomedical.com\/shop\/ultrasound-systems\/ge\/ge-vivid-iq"},{"key":"2025121411053104000_13.12.e078222.8","unstructured":"Organization WH . WHO recommendations on Antenatal care for a positive pregnancy experience. World Health Organization, 2016."},{"key":"2025121411053104000_13.12.e078222.9","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1002486","article-title":"The WHO 2016 verbal autopsy instrument: an international standard suitable for automated analysis by Interva, Insilicova, and tariff 2.0","volume":"15","author":"Nichols","year":"2018","journal-title":"PLoS Med"},{"key":"2025121411053104000_13.12.e078222.10","unstructured":"Available: https:\/\/smartregister.org\/#:~:text=OpenSRP%20is%20a%20%E2%80%9Cnext%20gen,systems%20like%20DHIS2%20or%20OpenMRS"},{"key":"2025121411053104000_13.12.e078222.11","unstructured":"Momjian B . Postgresql introduction and concepts Bruce Momjian ADDISON. 2001."},{"key":"2025121411053104000_13.12.e078222.12","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1186\/s12884-016-0979-8","article-title":"The timing of Antenatal care initiation and the content of care in Sindh, Pakistan","volume":"16","author":"Agha","year":"2016","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025121411053104000_13.12.e078222.13","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/s12884-016-0829-8","article-title":"Qualitative exploration of facilitating factors and barriers to use of Antenatal care services by pregnant women in urban and rural settings in Pakistan","volume":"16","author":"Nisar","year":"2016","journal-title":"BMC Pregnancy Childbirth"},{"key":"2025121411053104000_13.12.e078222.14","doi-asserted-by":"crossref","unstructured":"Alwan NA , Roderick PJ , Macklon NS . Is timing of the first Antenatal visit associated with adverse birth outcomes? analysis from a population-based birth cohort. The Lancet 2016;388. doi:10.1016\/S0140-6736(16)32254-1","DOI":"10.1016\/S0140-6736(16)32254-1"},{"key":"2025121411053104000_13.12.e078222.15","unstructured":"National Institute of Population Studies (NIPS)[Pakistan] and ICF . Pakistan maternal mortality survey 2019: key indicators report. Islamabad, Pakistan, and Rockville, Maryland, USA NIPS and ICF; 2020."},{"issue":"Suppl 3","key":"2025121411053104000_13.12.e078222.16","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1186\/s12978-020-01023-5","article-title":"Why are the Pakistani maternal, fetal and newborn outcomes so poor compared to other low and middle-income countries?","volume":"17","author":"Aziz","year":"2020","journal-title":"Reprod Health"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-078222","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T19:05:38Z","timestamp":1765739138000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-078222"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12]]},"references-count":16,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,12,10]]},"published-print":{"date-parts":[[2023,12]]}},"alternative-id":["10.1136\/bmjopen-2023-078222"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-078222","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12]]}}}