Prevalence and possible factors associated with anaemia, and vitamin B \u3csub\u3e\u3csub\u3e12\u3c/sub\u3e\u3c/sub\u3e and folate deficiencies in women of reproductive age in Pakistan: Analysis of national-level secondary survey data

Objective: To determine the prevalence and possible factors associated with anaemia, and vitamin B12 and folate deficiencies in women of reproductive age (WRA) in Pakistan.Methods: A secondary analysis was conducted on data collected through the large-scale National Nutrition Survey in Pakistan in 2011. Anaemia was defined as haemoglobin levels \u3c12 g/dL, vitamin B12 deficiency as serum vitamin B12 levels of \u3c203 pg/mL (150 pmol/L) and folate deficiency as serum folate levels \u3c4 ng/mL (10 nmol/L).Results: A total of 11751 blood samples were collected and analysed. The prevalence of anaemia, vitamin B12 deficiency and folate deficiency was 50.4%, 52.4% and 50.8%, respectively. After adjustment, the following factors were positively associated with anaemia: living in Sindh province (RR 1.07; 95%CI 1.04 to 1.09)P\u3c0.00, food insecure with moderate hunger (RR 1.03; 95%CI 1.00 to 1.06)P=0.02, four or more pregnancies (RR 1.03; 95%CI 1.01 to 1.05)P\u3c0.00, being underweight (RR 1.03; 95%CI 1.00 to 1.05)P=0.02, being overweight or obese (RR 0.95; 95%CI 0.93 to 0.97)P\u3c0.00 and weekly intake of leafy green vegetables (RR 0.98; 95%CI 0.95 to 1.00)P=0.04. For vitamin B12 deficiency, a positive association was observed with rural population (RR 0.81; 95%CI 0.66 to 1.00)P=0.04, living in Khyber Pakhtunkhwa province (RR 1.25; 95%CI 1.11 to 1.43)P\u3c0.00 and living in Azad Jammu and Kashmir (RR 1.50; 95%CI 1.08 to 2.08)P=0.01. Folate deficiency was negatively associated with daily and weekly intake of eggs (RR 0.89; 95%CI 0.81 to 0.98)P=0.02 and (RR 0.88; 95%CI 0.78 to 0.99)P=0.03.Conclusions: In Pakistan, anaemia, and vitamin B12 and folate deficiencies are a severe public health concern among WRA. Our findings suggest that further research is needed on culturally appropriate short-term and long-term interventions within communities and health facilities to decrease anaemia, and vitamin B12 and folate deficiencies among Pakistani women

Prevalence and possible factors associated with anaemia, and vitamin B 12 and folate deficiencies in women of reproductive age in Pakistan: analysis of national-level secondary survey data

Objective: To determine the prevalence and possible factors associated with anaemia, and vitamin B12 and folate deficiencies in women of reproductive age (WRA) in Pakistan. Methods: A secondary analysis was conducted on data collected through the large-scale National Nutrition Survey in Pakistan in 2011. Anaemia was defined as haemoglobin levels /dL, vitamin B12 deficiency as serum vitamin B12 levels of /mL (150 pmol/L) and folate deficiency as serum folate levels /mL (10 nmol/L). Results: A total of 11 751 blood samples were collected and analysed. The prevalence of anaemia, vitamin B12 deficiency and folate deficiency was 50.4%, 52.4% and 50.8%, respectively. After adjustment, the following factors were positively associated with anaemia: living in Sindh province (RR 1.07; 95% CI 1.04 to 1.09) PConclusions: In Pakistan, anaemia, and vitamin B12 and folate deficiencies are a severe public health concern among WRA. Our findings suggest that further research is needed on culturally appropriate short-term and long-term interventions within communities and health facilities to decrease anaemia, and vitamin B12 and folate deficiencies among Pakistani women

Evaluation of solar disinfection of water intervention delivered through lady health workers in reduction of diarrheal episodes in under five children

Background: Solar Water Disinfection (SODIS) is a simple, inexpensive and sustainable means of daily household treatment for drinking and storage of water. Globally, over a billion people lack access to safe drinking water. As many as half million under five children die annually due to diarrheal illnesses. Most of these deaths are concentrated in Africa and South Asia. Unsafe water is one of the most critical risk factors for diarrhoea. Systematic reviews indicate that interventions to improve the microbial quality of drinking water in households are effective at reducing diarrhoea illnesses and thereby contribute significantly in reducing deaths due to communicable diseases in children under 5 years. We evaluated the impact of the SODIS intervention on health outcomes and diarrheal episodes in two districts of Punjab province in Pakistan. Methods: A cross-sectional survey was undertaken to assess the impact of solar water disinfection (SODIS) program in two districts of Punjab province, Pakistan. The program was implemented by the Ministry of Health from April 2010- May 2011 in Faisalabad district. We selected Toba Tek Singh as a comparison district for the survey.Results: Analysis with regression models revealed that children had a lower risk of contracting diarrhoea when they consumed high percentages of safe drinks (SODIS), lived in households with good hygiene, washed hands, and belonged to the richest quintile. Diarrhoea prevalence was 10.1 episodes per child per year in the non-intervention area compared to 5.6 episodes per child per year (\u3c 0.0001) in the intervention area. Similarly the proportion of children with dysentery reported in the intervention was half compared to non-intervention area (6.1% vs. 13.9%). SODIS method for purifying drinking water is acceptable and effective in the developing countries. It should be a part of preventive strategies at health system level to control diarrheal illnesses and reduce under five mortalit

Burden and predictors of undernourishment among married women of reproductive age: a cross-sectional study in Dadu and Jacobabad districts of the Province Sindh, Pakistan

Objective: To assess the nourishment level of married women of reproductive age in a two rural setting. Method: The cross-sectional study was based on secondary data of the Impact Assessment Survey 2019, which was conducted by the People’s Primary Health Care Initiative from January to May, 2019, in Dadu and Jacobabad districts of the province of Sindh, Pakistan. Nutritional status of married women of reproductive age was analysed using mid-upper arm circumference; <23cm being indicative of under-nourishment, and <21cm of severe under-nourishment. Predicting factors were identified using multivariate logistic regression. Data was analysed using STATA 15. Results: Of 10,388 subjects, 5,138(49.5%) were from Dadu and 5,250(50.5%) from Jacobabad. The overall mean age was 32.9+8.1 with 4,739(45.6%) aged 25-35 years. Overall, 2,336(22.5%) subjects were undernourished and 609(5.9%) were severely undernourished. Age, education, socio-economic status and parity were significant predictors of the nourishment status (p0.05). Conclusion: Overall nutrition status of the married women of reproductive age in the two rural districts of Sindh was less than satisfactory. Key Words: Undernourishment, Underweight, Mid-upper arm circumference, Women of reproductive age, Pakistan. Continues..

Knowledge and perceptions of polio and polio immunization in polio high-risk areas of Pakistan

Pakistan and Afghanistan remain the only countries where polio is endemic, and Pakistan reports the most cases in the world. Although the rate is lower than in previous years, the situation remains alarming. We conducted a mixed methods study in high-risk areas of Pakistan to identify knowledge, attitudes, and practices of target populations about polio vaccine and its eradication, and to estimate coverage of routine immunization and oral polio vaccine. We surveyed 10,685 households in Karachi, 2522 in Pishin, and 2005 in Bajaur. Some knowledge of polio is universal, but important misconceptions persist. The findings of this study carry strategic importance for program direction and implementation

Seroprevalence of anti-polio antibodies in children from polio high-risk areas of Pakistan: a cross-sectional survey 2015–2016

Background: Pakistan is one of the 3 remaining wild poliovirus endemic countries. We collected sera from children to assess the prevalence of poliovirus antibodies in selected high-risk areas for poliovirus transmission. Methods: Children in 2 age groups (6–11 and 36–48 months) were randomly selected between November 2015 and March 2016 in 6 areas of Pakistan (Sindh Province: Karachi and Kashmore; Khyber Pakhtunkhwa Province: Peshawar, Bannu and Nowshera; Punjab Province: Faisalabad). After obtaining informed consent, basic demographic and vaccination history data were collected, 1 peripheral venipuncture was obtained, and assays to detect poliovirus (PV)–neutralizing antibodies were performed. Results: A total of 1301 children were enrolled and had peripheral blood drawn that analyzed. Study subjects were evenly distributed among survey sites and age groups. Anti-polio seroprevalence differed significantly among geographic areas (P \u3c 0.001); in the 6–11 months group, it ranged between 89% and 98%, 58% and 95%, and 74% and 96% for PV serotypes 1, 2 and 3, respectively; in 36–48 months group, it ranged between 99% and 100%, 95% and 100%, and 92% and 100% for PV 1, 2, and 3, respectively. Having received inactivate poliovirus vaccine, malnourishment (stunting) and educational level of parents were found to be associated with presence of anti-polio antibodies. Conclusion: The polio eradication program achieved overall high serologic protection; however, immunity gaps in young children in the high polio risk areas remain. These gaps enable sustained circulation of wild poliovirus type 1, and pose risk for emergence of vaccine-derived polioviruses. Focusing on the lowest socioeconomic strata of society, where malnutrition is most prevalent, could accelerate poliovirus eradication

Determinants of infant and young child feeding practices by mothers in two rural districts of Sindh, Pakistan: a cross-sectional survey

Abstract Background Infant and young child feeding (IYCF) practices during the first two years of life are important for the growth and development of a child. The aim of this study was to assess IYCF practices and its associated factors in two rural districts of Pakistan. Methods A cross-sectional study was conducted in two rural districts of Sindh province, Pakistan as part of a stunting prevention project between May and August 2014. A standard questionnaire on IYCF practices recommended by World Health Organization was used to collect information from 2013 mothers who had a child aged between 0 and 23 months. Results Only 49% of mothers initiated breastfeeding within one hour of birth. Thirty-seven percent of mothers exclusively breastfed their infants for six months. Seventy-percent mothers introduced complementary feeding at 6–8 months of age. Eighty-two percent of mothers continued breastfeeding for at least one year and 75% for at least two years of age. IYCF practices were not significantly different for boys and girls in the study area. Being an employed mother (AOR 2.14; 95% CI 1.02, 4.51) was positively associated with the early initiation of breastfeeding. Children who were born at a health facility (AOR 0.65; 95% CI 0.50, 0.84) and were aged six to eleven months (AOR 0.70; 95% CI 0.54, 0.90) were less likely to be have an early initiation of breastfeeding. Mothers aged 25 to 29 years (AOR 1.83; 95% CI 1.05, 3.18), being literate (AOR 1.79; 95% CI 1.15, 2.78), and higher income (AOR 10.6; 95% CI 4.40, 25.30) were more likely to have an improved dietary diversity. Being an employed mother (AOR 2.18; 95% CI 1.77, 4.03) and higher income were more likely to have minimum acceptable diet (AOR 9.7; 95% CI 4.33, 21.71). Conclusion IYCF practices were below the acceptable level and associated with maternal age, maternal illiteracy, unemployment, and poor household wealth status. Emphasis should be given to improve maternal literacy and reduction in poverty to improve IYCF practices

Formative research and development of an evidence-based communication strategy: the introduction of Vi typhoid fever vaccine among school-aged children in Karachi, Pakistan

The authors conducted formative research (a) to identify stakeholders\u27 concerns related to typhoid fever and the need for disease information and (b) to develop a communication strategy to inform stakeholders and address their concerns and motivate for support of a school-based vaccination program in Pakistan. Data were collected during interactive and semi-structured focus group discussions and interviews, followed by a qualitative analysis and multidisciplinary consultative process to identify an effective social mobilization strategy comprised of relevant media channels and messages. The authors conducted 14 focus group discussions with the parents of school-aged children and their teachers, and 13 individual interviews with school, religious, and political leaders. Parents thought that typhoid fever was a dangerous disease, but were unsure of their children\u27s risk. They were interested in vaccination and were comfortable with a school-based vaccination if conducted under the supervision of trained and qualified staff. Teachers and leaders needed information on typhoid fever, the vaccine, procedures, and sponsors of the vaccination program. Meetings were considered the best form of information dissemination, followed by printed materials and mass media. This study shows how qualitative research findings can be translated into an effective social mobilization and communication approach. The findings of the research indicated the importance of increasing awareness of typhoid fever and the benefits of vaccination against the disease. Identification and dissemination of relevant, community-based disease and vaccination information will increase demand and use of vaccination