{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:09:43Z","timestamp":1772168983844,"version":"3.50.1"},"reference-count":16,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2019,6,24]],"date-time":"2019-06-24T00:00:00Z","timestamp":1561334400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns4:p>\n                    <ns4:bold>Background:<\/ns4:bold>\n                    In recent years, M\u00e9decins Sans Fronti\u00e8res has observed high mortality rates among hospitalized infants in Pakistan. We describe the clinical characteristics of the infants admitted between 2013 and 2016 in order to acquire a better understanding on the risk factors for mortality.\u00a0\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Methods:<\/ns4:bold>\n                    We analyzed routinely collected medical data from infants (&lt;7 months) admitted in Chaman and Dera Murad Jamali (DMJ) hospitals. The association between clinical characteristics and mortality was estimated using Poisson regression.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Results:<\/ns4:bold>\n                    Between 2013 and 2016, 5,214 children were admitted (male\/female ratio: 1.60) and 1,178 (23%) died. Days since admission was associated with a higher risk of mortality and decreased with each extra day of admission after seven days. The first 48 hours of admission was strongly associated with a higher risk of mortality. A primary diagnosis of tetanus, necrotizing enterocolitis, prematurity, sepsis and hypoxic-ischemic encephalopathy were strongly associated with higher rates of mortality. We observed an annual peak in the mortality rate in September.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Conclusions:<\/ns4:bold>\n                    The first days of admission are critical for infant survival. Furthermore, the found male\/female ratio was exceedingly higher than the national ratio of Pakistan. The observed seasonality in mortality rate by week has not been previously reported. It is fully recommended to do further in-depth research on male\/female ratio differences and the reasons behind the annual peaks in mortality rate by week.\n                  <\/ns4:p>","DOI":"10.12688\/f1000research.19547.1","type":"journal-article","created":{"date-parts":[[2019,6,24]],"date-time":"2019-06-24T05:45:06Z","timestamp":1561355106000},"page":"954","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Risks and seasonal pattern for mortality among hospitalized infants in a conflict-affected area of Pakistan, 2013-2016. A retrospective chart review."],"prefix":"10.12688","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7643-7888","authenticated-orcid":false,"given":"Babette","family":"van Deursen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2013-8405","authenticated-orcid":false,"given":"Annick","family":"Lenglet","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cono","family":"Ariti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1296-3416","authenticated-orcid":false,"given":"Barkat","family":"Hussain","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaap","family":"Karsten","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harriet","family":"Roggeveen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Debbie","family":"Price","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jena","family":"Fernhout","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Abdi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8845-3447","authenticated-orcid":false,"given":"Antonio Isidro","family":"Carrion Martin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2019,6,24]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"371-86","DOI":"10.1053\/j.semperi.2010.09.011","article-title":"3.6 million neonatal deaths--what is progressing and what is not?","volume":"34","author":"J Lawn","year":"2010","journal-title":"Semin Perinatol."},{"key":"ref-2","first-page":"72","article-title":"The Millennium Development Goals Report.","year":"2015","journal-title":"United Nations."},{"key":"ref-3","first-page":"392","article-title":"Pakistan Demographic and Health Survey 2012-13","year":"2013"},{"key":"ref-4","first-page":"100","article-title":"International Activity Report 2015","year":"2016"},{"key":"ref-5","article-title":"PAKISTAN\u2019S BALOCH INSURGENCY: History, Conflict Drivers, and Regional Implications.","author":"M Kupecz","year":"2012","journal-title":"Int Aff Rev."},{"key":"ref-6","doi-asserted-by":"publisher","article-title":"Stata Statistical Software: Release 14. 2015","year":"2015","DOI":"10.2307\/2234838"},{"key":"ref-7","doi-asserted-by":"publisher","first-page":"875-8","DOI":"10.1097\/00003246-199605000-00024","article-title":"Risk factors for nosocomial infection in critically ill children: A prospective cohort study.","volume":"24","author":"N Singh-Naz","year":"1996","journal-title":"Crit Care Med."},{"key":"ref-8","doi-asserted-by":"publisher","first-page":"1173-79","DOI":"10.1097\/00003246-200004000-00043","article-title":"Relationship of illness severity and length of stay to functional outcomes in the pediatric intensive care unit: a multi-institutional study.","volume":"28","author":"D Fiser","year":"2000","journal-title":"Crit Care Med."},{"key":"ref-9","doi-asserted-by":"publisher","first-page":"49-54","DOI":"10.1093\/pubmed\/fdh207","article-title":"Health seeking behaviour and health service utilization in Pakistan: Challenging the policy makers.","volume":"27","author":"B Shaikh","year":"2005","journal-title":"J Public Health (Oxf)."},{"key":"ref-10","doi-asserted-by":"publisher","first-page":"31408","DOI":"10.3402\/gha.v9.31408","article-title":"Strategies for improving health care seeking for maternal and newborn illnesses in low- and middle-income countries: A systematic review and meta-analysis.","volume":"9","author":"Z Lassi","year":"2016","journal-title":"Glob Health Action."},{"key":"ref-11","doi-asserted-by":"publisher","first-page":"153-187","DOI":"10.1080\/00220380412331293807","article-title":"Why is Son preference so persistent in East and South Asia? a cross-country study of China, India and the Republic of Korea.","volume":"40","author":"M Gupta","year":"2003","journal-title":"J Dev Stud."},{"key":"ref-12","doi-asserted-by":"publisher","first-page":"130-8","DOI":"10.2471\/blt.08.050963","article-title":"Neonatal mortality, risk factors and causes: A prospective population-based cohort study in urban Pakistan.","volume":"87","author":"I Jehan","year":"2009","journal-title":"Bull World Health Organ."},{"key":"ref-13","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1186\/1471-2393-14-310","article-title":"Seasonality of birth outcomes in rural Sarlahi District, Nepal: a population-based prospective cohort.","volume":"14","author":"M Hughes","year":"2014","journal-title":"BMC Pregnancy Childbirth."},{"key":"ref-14","doi-asserted-by":"publisher","first-page":"814-23","DOI":"10.1093\/ije\/27.5.814","article-title":"Seasonal patterns of deaths in Matlab, Bangladesh.","volume":"27","author":"S Becker","year":"1998","journal-title":"Int J Epidemiol."},{"key":"ref-15","first-page":"147-152","article-title":"Epidemiology of Plasmodium Species and Prevalence of Malaria on the Basis of Age, Sex, Area, Seasonality and Clinical Manifestation in the Population of District Lower Dir, Khyber Pakhtunkhwa, Pakistan.","volume":"10","author":"J Zeb","year":"2015","journal-title":"World J Zool."},{"key":"ref-16","first-page":"a11","article-title":"Dengue outbreak 2013: Clinical profile of patients presenting at DHQ Burner and THQ Shangla, Khyber Pakhtunkhwa, Pakistan.","volume":"3","author":"J Khan","year":"2015","journal-title":"Immun Dis."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/8-954\/v1\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/8-954\/v1\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/8-954\/v1\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,2,12]],"date-time":"2020-02-12T12:00:25Z","timestamp":1581508825000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/8-954\/v1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6,24]]},"references-count":16,"URL":"https:\/\/doi.org\/10.12688\/f1000research.19547.1","relation":{"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.21431.r51353","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.21431.r50282","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.21431.r51351","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.21431.r51351","asserted-by":"object"},{"id-type":"doi","id":"10.5256\/f1000research.21431.r50282","asserted-by":"object"},{"id-type":"doi","id":"10.5256\/f1000research.21431.r51353","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,6,24]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/8-954\/v1#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.21431.r50282, Babar Tasneem Shaikh, Health Services Academy, Islamabad, Pakistan, 08 Jul 2019, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/8-954\/v1#referee-response-50282","order":0,"name":"referee-response-50282","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Babette van Deursen<\/b>; \n<i>Posted: 15 Jul 2019<\/i>; Dear Mr Shaikh,&nbsp;Thank you for your revision of our article and your very useful comments. We believe that they have helped us to improve our paper.&nbsp;To start with your comment on the PDHS 2017-2018, we would like to clarify that we were not aware of the new version when we submitted this manuscript. When we were drafting the manuscript last year, it was not published yet. So, your suggestion is highly pertinent and helpful. We think it is indeed better to use the newest results instead of the PDHS of 2013. We have amended accordingly. However, we still think our manuscript is not redundant since the PDHS does not include data on seasonality patterns in mortality, nor on time to death from admission. So our manuscript provides extra information on these two topics.&nbsp;Regarding your point about describing the activities of MSF, we agree that it would be very interesting to elaborate more on this. Unfortunately it would be very difficult now for us to get these details as this was not included in our original request to the MSF research committee and to the team on the ground.&nbsp;We believe that your comments and suggestions have helped us to improve the context information and the discussion of our results. We very much appreciate your time and comments.&nbsp;Many thanks.&nbsp;Yours sincerely,Babette van Deursen\n<b>Adjustments:<\/b>  Introduction:  We can use the new data from PDHS 2017-2018 instead of the old PDHS 2013 on the mortality numbers.   Discussion:  New ratio male\/female ratio for under-five 1.02 (PDHS 2017-2018).&nbsp; Small difference between female\/male treatment seeking behavior, especially for fever. However, these small differences do not fully explain our found difference in health seeking behavior between boys and girls.","URL":"https:\/\/f1000research.com\/articles\/8-954\/v1#referee-comment-4753","order":1,"name":"referee-comment-4753","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.21431.r51351, Eva Leidman, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA, 26 Jul 2019, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/8-954\/v1#referee-response-51351","order":2,"name":"referee-response-51351","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.21431.r51353, Sharif Ismail, Department of Primary Care and Public Health, Imperial College London, London, UK, 06 Sep 2019, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/8-954\/v1#referee-response-51353","order":3,"name":"referee-response-51353","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}