Extending Transit Facility to India: Implications for Pakistan’s Bilateral Trade with Afghanistan

The paper examines patterns of bilateral trade between Pakistan, India, Afghanistan and CARs. It also investigates whether providing India transit route to Afghanistan has opportunity costs for Pakistan’s trade potential with Afghanistan and CARs. In 2009, Pakistan’s exports to Afghanistan amount to US$ 1.3 billion which make up for 7.8 % of Pakistan’s total exports. For the same year, India’s exports to Afghanistan stand at 471 million dollars which make 0.3 % of India’s total exports. Looking at the product wise composition of Pakistan’s exports to Afghanistan, mineral fuels, oils, distillation products are on the top with share of around 29%. Salt, sulpher, earth, plaster, lime and cement and cereals have a share of around 11 %. While animal, vegetable fats and oils, cleavage products and articles of iron and steel have the share of around 7%. On the other hand, the top five exports of India to Afghanistan are man-made filaments with 42 % share, pharmaceutical products with 11 % share, electric and electronic equipment with 7% share and rubber and articles with 6% share. Clearly there is no overlap between exports of Pakistan and India to Afghanistan. Nonetheless Pakistan has already lost its market share to India in pharmaceuticals. The tariff applied to Pakistan by Afghanistan on pharmaceuticals is 2.50 % while India which enjoys Preferential Trade Agreement with Afghanistan only faces an average tariff of 0.60% on pharmaceuticals. Pharmaceuticals are Pakistan’s top performing exports to CARs with 42.5 % share of total exports to CARs. India also exports pharmaceuticals to CARs but its share in total exports to CARs is only 25.5 %. In Afghanistan, Pakistan has clearly lost its market share to India due to presence of preferential tariffs for India in Afghanistan. If Pakistan provides transit route to India for its exports to Afghanistan, cheaper pharmaceuticals of Indian origin can then be re-exported to CARs capturing Pakistan’s market share in CARs. Much like pharmaceuticals there are other Pakistani products which are likely to lose out to India in Afghanistan and CARs if India is provided transit route to Afghanistan. The Wagah-Peshawar-Torkham route which roughly extends up to 800 km is probably the shortest possible one between India and Afghanistan; which would greatly reduce the logistics cost of shipping goods from India to Afghanistan and beyond. In addition to that, the preferential treatment currently enjoyed by Indian products in Afghanistan under the PTA would further cost Pakistani goods by eroding their competitiveness in the Afghan market. In the absence of a robust mechanism to contain the informal trade, allowing Indian goods a passage through Pakistan’s territory would, in all likelihood, worsen the smuggling situation, something Pakistan can ill afford to accept. Therefore, under the circumstances, there are clear economic disadvantages to Pakistan in extending the transit facility to India without adequate safeguards and preferably a quid pro quo, be it political or economic.International Trade, Transit Trade Agreements, Pakistan, India, Afghanistan, Sectoral Analysis

Factors associated with anemia among women of the reproductive age group in Thatta district: Study protocol

Background: Maternal anemia is a leading public health issue placing pregnant women at higher risk of low birth weight, preterm birth, perinatal mortality, and neonatal mortality. Women in developing countries are at higher risk of anemia which could be either due to micronutrient deficiencies, hemoglobinopathies, infections or other socio-demographic factors. Thus, it is highly essential to explore the factors of anemia among women of the reproductive age group in order to design suitable interventions. The primary objective of this study is to assess the biological and socio-demographic factors that are associated with anemia among the women of the reproductive age group in Thatta district.Methods: An exploratory mixed method study using quantitative and qualitative approaches will be conducted in district Thatta Pakistan from September 2018 to January 2019. In the qualitative phase, data will be collected through focus group discussions and key informant interviews to understand the perceptions of women, their husbands and healthcare providers about anemia. In addition, a quantitative approach using cross-sectional study will be conducted to determine biological and socio-demographic factors associated with anemia. Approximately 150 non-pregnant women and their spouses will be included in the quantitative component of the study. In addition to thematic analysis for the qualitative component, Logistic regression will be done to calculate adjusted Odds ratios with their respective 95% CIs to assess the factors associated with anemia.Discussion: The better understanding of biological, socio-demographic factors and community perceptions of anemia will help us to design strategies and interventions to better address anemia during the reproductive cycle in rural areas of Pakistan. This will help the researchers and policymakers to take the appropriate action accordingly by designing suitable approaches to address the specific type of anemia in the rural population of Pakistan. This will, in turn, reduce the chances of adverse maternal and fetal outcomes associated with anemia

Genetic variability and evolutionary dynamics of atypical Papaya ringspot virus infecting Papaya

Papaya ringspot virus biotype-P is a detrimental pathogen of economically important papaya and cucurbits worldwide. The mutation prone feature of this virus perhaps accounts for its geographical dissemination. In this study, investigations of the atypical PRSV-P strain was conducted based on phylogenetic, recombination and genetic differentiation analyses considering of it’s likely spread across India and Bangladesh. Full length genomic sequences of 38 PRSV isolates and 35 CP gene sequences were subjected to recombination analysis. A total of 61 recombination events were detected in aligned complete PRSV genome sequences. 3 events were detected in complete genome of PRSV strain PK whereas one was in its CP gene sequence. The PRSV-PK appeared to be recombinant of a major parent from Bangladesh. However, the genetic differentiation based on full length genomic sequences revealed less frequent gene flow between virus PRSV-PK and the population from America, India, Colombia, other Asian Countries and Australia. Whereas, frequent gene flow exists between Pakistan and Bangladesh virus populations. These results provided evidence correlating geographical position and genetic distances. We speculate that the genetic variations and evolutionary dynamics of this virus may challenge the resistance developed in papaya against PRSV and give rise to virus lineage because of its atypical emergence where geographic spread is already occurring

Assessment of Parents’ Perceptions of Childhood Immunization: a Cross-Sectional Study from Pakistan

Immunization is one of the most cost-effective public health interventions, with considerable impacts on people’s health. Parents’ perception of their knowledge, attitude, and satisfaction is an important factor, as they may be targeted by interventions for better immunization coverage. Therefore, this study aimed to assess parents’ perceptions in terms of their knowledge, attitude, and satisfaction of the immunization of their children aged less than two years of age, in two cities of Pakistan. A descriptive cross-sectional study was conducted in the vicinity of Rawalpindi and Islamabad from March to August 2019. A semi-structured questionnaire was used for the data collection on a convenient sample of parents. The questionnaire was hand-delivered to the parents by data collectors. Descriptive and inferential statistics were used for data analysis via SPSS version 22. A total of n = 382 respondents were included in the data analysis. Statistically significant differences were found between the parents’ knowledge scores and their education levels and monthly incomes (p < 0.05). Parents with master’s education degrees and low monthly incomes had significantly better knowledge (p < 0.05). Additionally, 96.85% of the respondents believed that child immunization was important. In addition, more than half of the respondents (57.58%) thought that the affordability of vaccines was a principal factor for delays in immunization. Although the parents’ knowledge regarding the immunization of their children was not adequate, they had positive perceptions toward it

Extending Transit Facility to India: Implications for Pakistan’s Bilateral Trade with Afghanistan

The paper examines patterns of bilateral trade between Pakistan, India, Afghanistan and CARs. It also investigates whether providing India transit route to Afghanistan has opportunity costs for Pakistan’s trade potential with Afghanistan and CARs. In 2009, Pakistan’s exports to Afghanistan amount to US$ 1.3 billion which make up for 7.8 % of Pakistan’s total exports. For the same year, India’s exports to Afghanistan stand at 471 million dollars which make 0.3 % of India’s total exports. Looking at the product wise composition of Pakistan’s exports to Afghanistan, mineral fuels, oils, distillation products are on the top with share of around 29%. Salt, sulpher, earth, plaster, lime and cement and cereals have a share of around 11 %. While animal, vegetable fats and oils, cleavage products and articles of iron and steel have the share of around 7%. On the other hand, the top five exports of India to Afghanistan are man-made filaments with 42 % share, pharmaceutical products with 11 % share, electric and electronic equipment with 7% share and rubber and articles with 6% share. Clearly there is no overlap between exports of Pakistan and India to Afghanistan. Nonetheless Pakistan has already lost its market share to India in pharmaceuticals. The tariff applied to Pakistan by Afghanistan on pharmaceuticals is 2.50 % while India which enjoys Preferential Trade Agreement with Afghanistan only faces an average tariff of 0.60% on pharmaceuticals. Pharmaceuticals are Pakistan’s top performing exports to CARs with 42.5 % share of total exports to CARs. India also exports pharmaceuticals to CARs but its share in total exports to CARs is only 25.5 %. In Afghanistan, Pakistan has clearly lost its market share to India due to presence of preferential tariffs for India in Afghanistan. If Pakistan provides transit route to India for its exports to Afghanistan, cheaper pharmaceuticals of Indian origin can then be re-exported to CARs capturing Pakistan’s market share in CARs. Much like pharmaceuticals there are other Pakistani products which are likely to lose out to India in Afghanistan and CARs if India is provided transit route to Afghanistan. The Wagah-Peshawar-Torkham route which roughly extends up to 800 km is probably the shortest possible one between India and Afghanistan; which would greatly reduce the logistics cost of shipping goods from India to Afghanistan and beyond. In addition to that, the preferential treatment currently enjoyed by Indian products in Afghanistan under the PTA would further cost Pakistani goods by eroding their competitiveness in the Afghan market. In the absence of a robust mechanism to contain the informal trade, allowing Indian goods a passage through Pakistan’s territory would, in all likelihood, worsen the smuggling situation, something Pakistan can ill afford to accept. Therefore, under the circumstances, there are clear economic disadvantages to Pakistan in extending the transit facility to India without adequate safeguards and preferably a quid pro quo, be it political or economic

Extending Transit Facility to India: Implications for Pakistan’s Bilateral Trade with Afghanistan

The paper examines patterns of bilateral trade between Pakistan, India, Afghanistan and CARs. It also investigates whether providing India transit route to Afghanistan has opportunity costs for Pakistan’s trade potential with Afghanistan and CARs. In 2009, Pakistan’s exports to Afghanistan amount to US$ 1.3 billion which make up for 7.8 % of Pakistan’s total exports. For the same year, India’s exports to Afghanistan stand at 471 million dollars which make 0.3 % of India’s total exports. Looking at the product wise composition of Pakistan’s exports to Afghanistan, mineral fuels, oils, distillation products are on the top with share of around 29%. Salt, sulpher, earth, plaster, lime and cement and cereals have a share of around 11 %. While animal, vegetable fats and oils, cleavage products and articles of iron and steel have the share of around 7%. On the other hand, the top five exports of India to Afghanistan are man-made filaments with 42 % share, pharmaceutical products with 11 % share, electric and electronic equipment with 7% share and rubber and articles with 6% share. Clearly there is no overlap between exports of Pakistan and India to Afghanistan. Nonetheless Pakistan has already lost its market share to India in pharmaceuticals. The tariff applied to Pakistan by Afghanistan on pharmaceuticals is 2.50 % while India which enjoys Preferential Trade Agreement with Afghanistan only faces an average tariff of 0.60% on pharmaceuticals. Pharmaceuticals are Pakistan’s top performing exports to CARs with 42.5 % share of total exports to CARs. India also exports pharmaceuticals to CARs but its share in total exports to CARs is only 25.5 %. In Afghanistan, Pakistan has clearly lost its market share to India due to presence of preferential tariffs for India in Afghanistan. If Pakistan provides transit route to India for its exports to Afghanistan, cheaper pharmaceuticals of Indian origin can then be re-exported to CARs capturing Pakistan’s market share in CARs. Much like pharmaceuticals there are other Pakistani products which are likely to lose out to India in Afghanistan and CARs if India is provided transit route to Afghanistan. The Wagah-Peshawar-Torkham route which roughly extends up to 800 km is probably the shortest possible one between India and Afghanistan; which would greatly reduce the logistics cost of shipping goods from India to Afghanistan and beyond. In addition to that, the preferential treatment currently enjoyed by Indian products in Afghanistan under the PTA would further cost Pakistani goods by eroding their competitiveness in the Afghan market. In the absence of a robust mechanism to contain the informal trade, allowing Indian goods a passage through Pakistan’s territory would, in all likelihood, worsen the smuggling situation, something Pakistan can ill afford to accept. Therefore, under the circumstances, there are clear economic disadvantages to Pakistan in extending the transit facility to India without adequate safeguards and preferably a quid pro quo, be it political or economic

Perceptions of health professionals regarding minimally invasive tissue sampling (MITS) to identify the cause of death in stillbirths and neonates: Results from a qualitative study

Background: Pakistan is considered to be one of the riskiest places in the world for childbirth as measured by its high stillbirth and neonatal mortality rates. Complete diagnostic autopsy remains the gold standard to determine the cause of death (CoD); however, it is not routinely implemented due to religious objections, sociocultural beliefs, limited resources and low demand from physicians and families. Recently, minimally invasive tissue sampling (MITS) using needle biopsies of multiple tissues to obtain tissue for histological examination and organism identification with PCR has been developed and promoted to determine CoD in low-resource areas. To ensure successful implementation of MITS, it is important to understand health professionals\u27 attitudes and perceptions related to MITS.Methods: A qualitative study was conducted at the National Institute of Child Health (NICH), Karachi, Pakistan. Focus group discussions (FGDs) and Key-informant interviews (KIIs) were conducted with health professionals including doctors, nurses, trainees, clinicians, bioethics experts and public health experts to explore their perceptions and views on acceptability of MITS. Data were analyzed using NVivo 10 software.Results: A total of 12 interviews (FGDs = 4; KIIs = 8) were conducted. Four overarching themes were identified: (I) acceptability of MITS; (II) perceived benefits of the MITS procedure; (III) factors facilitating the implementation of MITS; and (IV) health system requirements for implementing the MITS procedure. Generally, MITS was considered as a positive development for the health system. Diagnostic accuracy and identification of less common causes of death were highlighted as two main benefits of the MITS procedure. The study highlighted a number of facilitators for the acceptability of MITS including effective counseling, building trust with parents, fast procedure time, and approaching families within a few hours of death. In addition, lack of skilled staff, poorly equipped healthcare facilities and the potential high cost to conduct MITS were identified as challenges for the implementation of MITS.Conclusions: This formative research provided a unique opportunity to explore health professionals\u27 views and attitudes towards the MITS procedure. Such insights are crucial to ensure successful implementation and integration of a new technique into the existing health system. The research identified the factors influencing the acceptability of MITS among health professionals in Pakistan. The study also informed factors that could help facilitate the implementation of the MITS procedures in the context of Pakistan and similar settings

Assessment of Parents’ Perceptions of Childhood Immunization: A Cross-Sectional Study from Pakistan

Immunization is one of the most cost-effective public health interventions, with considerable impacts on people’s health. Parents’ perception of their knowledge, attitude, and satisfaction is an important factor, as they may be targeted by interventions for better immunization coverage. Therefore, this study aimed to assess parents’ perceptions in terms of their knowledge, attitude, and satisfaction of the immunization of their children aged less than two years of age, in two cities of Pakistan. A descriptive cross-sectional study was conducted in the vicinity of Rawalpindi and Islamabad from March to August 2019. A semi-structured questionnaire was used for the data collection on a convenient sample of parents. The questionnaire was hand-delivered to the parents by data collectors. Descriptive and inferential statistics were used for data analysis via SPSS version 22. A total of n = 382 respondents were included in the data analysis. Statistically significant differences were found between the parents’ knowledge scores and their education levels and monthly incomes (p < 0.05). Parents with master’s education degrees and low monthly incomes had significantly better knowledge (p < 0.05). Additionally, 96.85% of the respondents believed that child immunization was important. In addition, more than half of the respondents (57.58%) thought that the affordability of vaccines was a principal factor for delays in immunization. Although the parents’ knowledge regarding the immunization of their children was not adequate, they had positive perceptions toward it

Perceptions of women, their husbands and healthcare providers about anemia in rural Pakistan: Findings from a qualitative exploratory study

Background: In Pakistan, there is a dearth of literature on the perceptions of anemia among women of reproductive age (WRA). This study was undertaken to explore the perceptions of women, their husbands, and healthcare providers about anemia, its possible causes, and how anemia impacts maternal and child health in Thatta, Pakistan.Methods: A qualitative study was conducted in Thatta, Pakistan from September to December 2018. Using a pre-tested semi-structured interview (SSI), we collected data to understand their definitions of anemia through ten focus group discussions (FGDs) with women and their partners and ten primary informant interviews (KIIs) with healthcare providers. We identified six major themes: (I) Knowledge and awareness of anemia, (II) Causes and consequences of Anemia, (III) Dietary practices, (IV) Knowledge and practices regarding the use of iron-folic acid supplements, (V) Factors influencing prevention and control of anemia and (VI) Women\u27s health behavior. We analyzed the data through thematic analysis using NVivo 10 software.Results: Most community members were not aware of the term anemia but described anemia as a condition characterized by \u27blood deficiency\u27 in the body. All study participants perceived anemia as an important health problem tending to cause adverse outcomes among WRA and their children. Study participants perceived gutka (chewable tobacco) consumption as an important cause of anemia. Healthcare providers identified short inter-pregnancy intervals, lack of family planning, poor health-seeking behavior, and consumption of unhealthy food as causes of anemia in the district. Consumption of unhealthy food might not be related to related to a poorer knowledge of iron-deficient foods, but economic constraints. This was further endorsed by the healthcare providers who mentioned that most women were too poor to afford iron-rich foods. All men and women were generally well versed with the sources of good nutrition to be consumed by WRA to prevent anemia.Conclusion: The findings suggest that the government should plan to develop strategies for poverty-stricken and vulnerable rural women and plan health awareness programs to improve dietary practices, compliance with supplements, and health-seeking behavior among women of reproductive age. There is a need to develop effective counseling strategies and context-specific health education sessions to improve the health-seeking behavior of women and men in the Thatta district of Pakistan. Besides, there is need to address social determinants of health such as poverty that pushes women of poorer socioeconomic strata to eat less nutritious foods and have more anaemia. Therefore, a comprehensive and robust strategic plan need to be adopted by government that focuses not only on the awareness programs, but also aim to reduce inequities that lead to pregnant women eat iron-poor foods, which, in turn, forces them to become anemic