Effect of lipid-based nutrient supplement - medium quantity on reduction of stunting in children 6-23 Months of age in Sindh, Pakistan: A cluster randomized controlled trial (OR25-06-19)

Objectives: We evaluated the effectiveness of a locally produced lipid-based nutrient supplement - medium-quantity (LNS-MQ) known as Wawamum to prevent stunting in children 6–23 months of age in Thatta and Sujawal districts of Sindh province, Pakistan. Methods: A cluster randomized controlled trial was conducted and a total of 870 children between 6–18 months old were enrolled. Children in the intervention group received 50 grams/day of Wawamum for 6 months, while children in the control group received standard government health services, not including Wawamum. The primary outcome was stunting risk reduction among children 6–23 months of age. Results: Children who received Wawamum were found to have a significantly reduced risk of stunting (RR = 0.91, 95% CI; 0.88– 0.94, P \u3c 0.001) and wasting (RR = 0.78, 95% CI; 0.67–0.92, p0.004) as compared to children who received the standard government health services. A non-significant impact was observed on underweight (RR = 0.94, 95% CI; 0.85–1.04, p-0.241) in the intervention group compared to the control group. Statistically significant reduction in anaemia in the intervention group was also found as compared to the control group (RR = 0.97, 95% CI; 0.94–0.99, p-0.008). The reduction in risk of severe anaemia was even more evident (RR = 0.45, 95% CI; 0.28–0.99, p-0.002) in the intervention group than in the control group. The mean compliance of Wawamum was 60.3% among children. Conclusions: The study confirmed the plausibility of achieving nutrition gains in the short-term with a locally produced LNS-MQ, known as Wawamum, through the primary health care system. The risk of stunting and wasting was reduced by 9% and 22%, respectively. The statistically significant reduction in risk of stunting, wasting and anaemia among children 6–23 months of age showed that an immediate improvement in these nutrition indicators is indeed possible. This approach can be scaled up in similar settings to achieve positive outcomes for nutrition and health. Funding Sources: World Health Organization

Can contracted out health facilities improve access, equity, and quality of maternal and newborn health services? evidence from Pakistan.

BACKGROUND: The case of contracting out government health services to non-governmental organizations (NGOs) has been weak for maternal, newborn, and child health (MNCH) services, with documented gains being mainly in curative services. We present an in-depth assessment of the comparative advantages of contracting out on MNCH access, quality, and equity, using a case study from Pakistan. METHODS: An end-line, cross-sectional assessment was conducted of government facilities contracted out to a large national NGO and government-managed centres serving as controls, in two remote rural districts of Pakistan. Contracting out was specific for augmenting MNCH services but without contractual performance incentives. A household survey, a health facility survey, and focus group discussions with client and spouses were used for assessment. RESULTS: Contracted out facilities had a significantly higher utilization as compared to control facilities for antenatal care, delivery, postnatal care, emergency obstetric care, and neonatal illness. Contracted facilities had comparatively better quality of MNCH services but not in all aspects. Better household practices were also seen in the district where contracting involved administrative control over outreach programs. Contracting was also faced with certain drawbacks. Facility utilization was inequitably higher amongst more educated and affluent clients. Contracted out catchments had higher out-of-pocket expenses on MNCH services, driven by steeper transport costs and user charges for additional diagnostics. Contracting out did not influence higher MNCH service coverage rates across the catchment. Physical distances, inadequate transport, and low demand for facility-based care in non-emergency settings were key client-reported barriers. CONCLUSION: Contracting out MNCH services at government health facilities can improve facility utilization and bring some improvement in quality of services. However, contracting out of health facilities is insufficient to increase service access across the catchment in remote rural contexts and requires accompanying measures for demand enhancement, transportation access, and targeting of the more disadvantaged clientele

Economics of Wheat Production in Mohmand Agency, Khyber Pakhtunkhwa, Pakistan

The central theme of this research endeavour was to compute the cost and net returns of wheat crop. This study has also highlighted the significant variables contributing in wheat productivity. The study universe was two focused villages namely Malok-Korona and Peer-Qila of Ekaghund Tehsil, Mohmand Agency. The proportional allocation sampling technique was used to get the required sample size of 70 respondents. However, 26 respondents from Malok-Korona and 44 respondents from Peer-Qila were interviewed through face to face interview technique. The marked findings of this study divulge that vast majority of the farmers (61.43%) were using certified seed and the study area was predominantly dependent upon rainfall as reported by 60 % of the respondents. It is further revealed that the mean cost of production incurred by the sampled growers was estimated as Rs. 30,000 per acre. Income trend observed by 70 per cent of the respondent through wheat crop was found Rs.40000 per acre. The average income of farmers through wheat crop was Rs.35286 per acre. The estimated results of regression analysis corroborate the expected sign of the majority of coefficient of explanatory variables. Among explanatory variables seed, irrigation and labor days were significant while urea and FYM were found insignificant for crop yield. The study recommends that attempts for awareness, supply of loans, inputs like fertilizer, pesticide, apt agriculture approaches, demonstration plots and training programs should be made available to farmers for higher wheat production in Mohmand Agency

DESIGN AND OPERATION OF MICROGRID

The need for new generation systems has motivated the development of microgrids. This new concept may provide significant benefits such as losses compensation, achieving high degree of efficiency and reliability to the transmission and distribution networks. This novel idea provides more advantages about Microgrids like general structure and different topologies. Also an original methodology for facilitating its design is proposed. Finally Simulink model of Microgrid is designed and then analyzed.Â

DESIGN AND OPERATION OF MICROGRID

The need for new generation systems has motivated the development of microgrids. This new concept may provide significant benefits such as losses compensation, achieving high degree of efficiency and reliability to the transmission and distribution networks. This novel idea provides more advantages about Microgrids like general structure and different topologies. Also an original methodology for facilitating its design is proposed. Finally Simulink model of Microgrid is designed and then analyzed.

Chemical Biology Toolsets for Drug Discovery and Target Identification

Chemical biology is the scientific discipline that deals with the application of chemical techniques and often small molecules produced through synthetic chemistry, to the manipulation and study of biological systems. Its working framework ranges from simple chemical entities to complex drugs by employing the principles of biological origin. This chapter particularly focuses on the principles and working models of chemical biology to discover new drug leads. Drug discovery is an extensive and multifaceted complex process. Chemical biology uses both natural and synthetic compounds with the best therapeutic potential and verifies them by employing the best possible chemical toolsets. Screening of compounds is done by the use of phenotypic as well as the target-based screening to identify and characterize the potent hits. After the identification of target, it is characterized, and validated by extensive testing. The next step is the validation of hits obtained, and lead compounds are tested in clinical trials before introducing them for commercial application