Sports Tourism In Post Conflict Peace Building: Evidence From Swat, Pakistan

Taliban uprising in Swat followed by military operations and floods severely damaged the tourism industry of Swat. Skiing festival in Malamjabba and Aman Festival in Kalam were instrumental in bringing tourists back to Swat in post conflict scenario. The study focused on the contribution of Skiing at MalamJabba in revival of tourism and post conflict peace building. Mixed method approach was used to collect data from fifty respondents that included tourists, tourism service providers and representatives of relevant stake holders from government and private organizations. Questionnairs followed by in depth interviews were used to collect the data. Findings of the study indicated that skiing played a very important role in the revival of tourism. Most of the tourist whose primary motivation was skiing at Malamjabbaalso visited or had intentions to visit other areas of Swat. Local communities are engaged in the industry at different levels constituting about 91 percent of the total labor force. Winter sports and increasing range of tourism products means increasing tourist season in the area that provides sustainable source of livelihoods for local community. Engagement of youth in sports and income generating activities provides an important tool for the peace building in the area

National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma

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Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Impact of Covid-19 on informal employment: A case study of women domestic workers in Khyber Pakhtunkhwa, Pakistan

COVID-19 indiscriminately impacted all the segments of the global society. Due to the unstructured job market, women in the informal sector were at high risk to experience the adverse effects of the pandemic. This paper aims to explore the impact of COVID-19 on women domestic workers and their families. Semi structured interviews conducted with fifty-four women domestic workers in three districts of Khyber Pakhtunkhwa, Pakistan were analyzed in five themes: disruption caused by lockdown, loss of livelihood, economic hardships, social support mechanism, and challenges faced during the pandemic. The study underlines that the pandemic left severe impacts on access to basic services, employment, food security at household level and pattern of expenditures. The plummeting economic activities led to sudden drops in earnings that forced families to sell their assets and incur debts. Respondents lamented over the social support system and considered it a necessary but not sufficient condition for uplifting the lives of the poor. Strains in marital relationships led to stress, anxiety and domestic violence among families. The utmost concern was the restoration of economic activities and urgent policy interventions to strengthen social safety measures for the vulnerable segments of society

Descriptive statistics of demographic details.

Descriptive statistics of demographic details.</p

Details of respondents.

Details of respondents.</p

Demographic details of respondents.

Demographic details of respondents.</p

Verbal informed consent form for participant and demographic details of respondents in three Districts.

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