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Background: Because of diverse topographical habitats, the Chenab River wetland harbors a wealth of medicinal and food plant species. This paper presents first quantitative assessment on the ethnobotanical use of plants by the local peoples residing in the Chenab riverine area. Methods: The ethnobotanical data were collected from six parts of the Chenab River wetland: Mandi Bahuddin, Gujranwala, Gujrat, Sargodha, and Sialkot during 2014 to 2015, using semi-structured interviews. Quantitative indices including informant consensus factor (FCI), relative frequency of citation (RFC), relative importance level (RIL), use value (UV), fidelity level (FL), and corrected fidelity level (CFL) were used to analyze the data. Results: On the whole, 129 medicinal plant species belonging to 112 genera of 59 families were reported, with herbs as dominant life forms (51%). Poaceae was the leading family with 13 species, and leaves were the most frequently utilized plant parts (28%). Herbal medicines were mostly used in the form of powder or decoction, and were mainly taken orally. Withania somnifera, Solanum surattense, Solanum nigrum, Azadirachta indica, Ficus benghalensis, Morus nigra, Morus alba, Polygonum plebeium, and Tribulus terrestris were among the highly utilized plant species, with highest UV, RFC, RIL, FL, and CFL values. The reported ailments were grouped into 11 categories based on FCI values, whereas highest FIC was recorded for gastrointestinal diseases and glandular diseases (0.41 and 0.34, respectively). The use report (UR) and frequency of citation (FC) depicted strong positive correlation (r = 0.973; p = 0.01). The value of determination (r2 = 0.95) indicating 95% variation in UR can be explained in terms of the FC. Conclusion: The significant traditional knowledge possessed by local communities depicts their strong relation with phytodiversity. Reported data could be helpful in sustainable use and protection of plant species in the Chenab wetland, with special emphasis on medicinal plants. Furthermore, screening of plant-borne active ingredients and in vivo/in vitro pharmacological activities could be of interest for novel drug synthesis. [ABSTRACT FROM AUTHOR]

Background: Pakistan observes a very high i.e. 37 percent modern contraceptive method related discontinuation rates within 12 months of their initiation. And almost 10 percent of these episodes of discontinuation happened due to the side effects or health concerns experienced by the women. Most importantly, it was noted that more than 12,000 first-level care facilities are located in the rural areas, including rural health centers, basic health units, and family welfare centers, but more than 30% of these facilities are nonfunctional. This paper presents a study protocol and participants' profiling of a prospective cohort follow-up to compare the effectiveness of household based and telephonic approaches in sustaining the use of Long Acting Reversible Contraceptives (LARC) whilst to facilitate lowering method related discontinuation and increasing switching amongst the contraceptive users. Methods: A 12-month multi-centre, non-inferiority prospective user follow-up is employed using three different study categories: a) household based follow-up; b) telephonic follow-up; and c) passive or need-based follow-up along with the hypothetical assumption that the telephonic client follow-up is not inferior to the household based follow-up by continuation rate of LARC and the telephonic follow-up is less-costly than the household based client follow-up. This follow-up will be conducted in 22 health facilities - (16 rural and 6 urban based facilities) in district Chakwal. The first two study categories will receive scheduled but different follow-up from the field workers at 1, 3, 6, 9, and 12 month while the third one i.e. the ‘passive or need-based follow-up' will serve as a control group. Using sampling software PASS 11, it was estimated to have 414 clients in each study category and around 1366 clients will be recruited to account for 10% attrition rate. Discussion: The study will help us to examine a more convenient method of effective follow-up for managing side effects, decreasing method discontinuation and increasing switching amongst users. The study information will also facilitate to develop a robust, effective and efficient mechanism for client follow-up to promote the continuation rates of LARC methods. The follow-up results and lessons learnt will be widely shared with stakeholders for their implementation and streamlining in health system. [ABSTRACT FROM AUTHOR]

Religion and spirituality have been key coping mechanisms of Pakistani Muslims amidst natural calamities such as the COVID-19 pandemic. This study aimed to identify and explore the role of religion and spirituality in the recovery of COVID-19 patients in lower socioeconomics. The data for this qualitative research study were collected from 13 people in Pakistan who survived COVID-19 infection during the wave of the Omicron variant. The participants of this study referenced four key themes about their story of getting infected by COVID-19 and recovering from it and referenced religion and spirituality as an overarching aspect of that story. The patients who recovered believed that COVID-19 was a punishment from God for sinful humanity, which was unavoidable. Amidst such a belief, the studied patients tried to avoid hospitalization but prayed to God for mercy, forgiveness, and help in their recovery. A few who took medical treatment also established and/or strengthened their spiritual connections seeking quick recovery from the infection. The participants of this study believed that their religion or spirituality played a medicinal role in their recovery from COVID-19 infection. [ABSTRACT FROM AUTHOR]

Background: High fertility rates, unwanted pregnancies, low modern contraceptive prevalence and a huge unmet need for contraception adversely affect women's health in Pakistan and this problem is compounded by limited access to reliable information and quality services regarding birth spacing especially in rural and underserved areas. This paper presents a study protocol that describes an evaluation of a demand-side financing (DSF) voucher approach which aims to increase the uptake of modern contraception among women of the lowest two wealth quintiles in Punjab Province, Pakistan. Methods/Design: This study will use quasi-experimental design with control arm and be implemented in: six government clinics from the Population Welfare Department; 24 social franchise facilities branded as 'Suraj' (Sun), led by Marie Stopes Society (a local non-governmental organization); and 12 private sector clinics in Chakwal, Mianwali and Bhakkar districts. The study respondents will be interviewed at baseline and endline subject to voluntary acceptance and medical eligibility. In addition, health service data will record each client visit during the study period. Discussion: The study will examine the impact of vouchers in terms of increasing the uptake of modern contraception by engaging private and public sector service providers (mid-level and medical doctors). If found effective, this approach can be a viable solution to satisfying the current demand and meeting the unmet need for contraception, particularly among the poorest socioeconomic group. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Children and adults involved in carpet weaving are prone to a number of health and safety problems. This paper describes initial impact of an ergonomically designed loom and work place modifications, to encourage young and adult workers to weave carpets and reduce the hazardous child labor in carpet weaving in the province of Punjab, Pakistan. METHODS: A new carpet loom with improved ergonomic and safety features suitable for adult carpet weavers was designed. Model carpet weaving worksites based on the new loom and better work environment were created in 30 villages. The impact of new loom compared with the traditional looms was assessed through structured questionnaires and health examinations after 24 months. RESULTS: Adolescent (15-17 years) and adult (> 17 years) participants included 75 respondents (males 10.7%, n=8; females 89.3%, n=67) operating under the new conditions and 92 respondents (males 12%, n=11; females 88%, n=81) operating under traditional conditions. Results indicated an improvement of health related complaints among those working in the new conditions, most notable were the differences in joint pain (p=0.002) and respiratory health (p=0.02). Improvement of income was also reported by workers at model workplaces. Also, no children below the age of 14 were found to be working at the new looms. CONCLUSIONS: The results indicate that individuals who adopted new looms and workplace interventions reported less joint pain and better respiratory health than those working with traditional looms in a traditional work environment. By reducing the risks in the workplace, this ergonomic intervention has the potential to reduce or eliminate hazardous child labor from carpet weaving. [ABSTRACT FROM AUTHOR]

Women's satisfaction with the quality of care during pregnancy and childbirth can impact their access to and utilization of healthcare services. Since many women live in rural regions in developing nations, it is crucial to secure their access to and use of basic healthcare services to reduce maternal and newborn morbidity and mortality. This cross-sectional study is part of a first-time, sizeable, mixed-method study involving women and midwives' quantitative and qualitative perspectives on the quality of midwifery care in rural Pakistan. The aim was to describe women's satisfaction with the quality of midwifery care during labor and delivery at basic health units in rural Punjab, Pakistan. Simple random sampling was used to select 328 women from 96 basic health units. Data were collected between December 2020-March 2021. The Labor and Delivery Satisfaction Index measured women's satisfaction with childbirth. Data were analyzed using descriptive statistics and presented in frequencies and percentages. Results indicated that the majority, 277 (84.5%), were satisfied with the quality of midwifery care during labor and delivery, whereas the remaining 51 (15.5%) were unsatisfied. Appropriate tools to monitor labor and delivery and non-pharmacological pain management during labor need much improvement. The women must also be treated with respect, given accurate information about their labor status, and given control over it. Midwives and other health service providers and administrators can use the findings of this study to improve services available to rural women. [ABSTRACT FROM AUTHOR]

Background: The mountainous territory of Kohistan shelters diverse food plant species and is considered one of the important hotspots of local plant knowledge. In the era of globalization and food commodification, wild food plants (WFPs) play an important role in supporting local food systems and related local knowledge is one of the important pillars of food sustainability across the region. Since the area is populated by different cultural groups and each culture has retained particular knowledge on the local plant species, therefore, to make a cross-culturally comparison, the study was planned to record and compare the local plants knowledge among three linguistic groups viz Gujjar, Kohistani and Shina in order to not only protect the local knowledge but to determine the food cultural adaptations among these groups looking through the lens of their food ethnobotanies. Methods: Field ethnobotanical survey was carried out in 2020–2021 to gather the data on wild food plants. We used semi-structured interviews. Use reports were counted, and the results were visualized through Venn diagrams. Results: In total, 64 plant species belonging to 45 botanical families were documented. Among these Ajuga integrifolia, Barbarea verna, Clematis grata, Impatiens edgeworthii, Ranunculus laetus (vegetables), Parrotiopsis jacquemontiana (fruit), Indigofera tinctoria (flower), Juniperus excelsa, Primula elliptica, P. macrophylla (flavoring agent), Leontopodium himalayanum (Chewing gum), and Juniperus excelsa (snuff) were reported for the first time. The highest use reports (≥ 90) were recorded for Mentha longifolia, Amaranthus hybridus, Quercus semecarpifolia, Solanum miniatum, Oxalis corniculata, Ficus palmata, and Urtica dioica. Maximum number of wild food plant species (WFPs) were reported by Kohistani, followed by Shinaki and Gujjari linguistic groups. The percentage overlap of traditional knowledge on WFPs was highest among Kohistani and Shinaki (56.0%), followed by Shinaki and Gujjars (17.0%), and Kohistani and Gujjars (15.0%). Kohistani and Shinaki groups exhibited maximum homogeneity in traditional knowledge. However, Gujjars had more knowledge on WFPs compared to Kohistani and Shinaki. In addition, some dairy products viz. Bhorus, Bagora, Bak, Cholam, Kacha, Gurloo and Poyeen were reported also reported that are consumed orally and used in traditional cuisines. Conclusions: The study indicates that Kohistan is one of the important spots of biocultural diversity and could be recognized as biocultural refugia. WFPs have been an integral part of the traditional food systems among the studied groups, particularly the Gujjars have reported more distinct plant uses which could be referred to their distinctive ecological experiences among others. However, social change is one of the challenges that might lead to the erosion of local plant knowledge. Moreover, intercultural negotiations among the studied groups are also a matter of concern which could homogenize the local knowledge among them. Therefore, we suggest solid policy measures to protect the local knowledge and celebrate diversity across this mountain territory. [ABSTRACT FROM AUTHOR]

(1) Background: Patients' satisfaction is based on the perceived health care services of individuals and is influenced by the level of care provided by the health care system. It is often based on the patients' expectations of care and self-assessment of their experiences. The success of the Directly Observed Treatment Strategy (DOTS) also depends on the quality of health care provided at the Tuberculosis (TB) centers, which can be evaluated by satisfaction levels of the patients. (2) Methods: A tuberculosis facility-based cross-sectional study was carried out in Khyber Pakhtunkhwa province in Pakistan. A mixed-method approach was adopted for data collection. An interviewer-administered questionnaire was used for quantitative data collection from 269 patients who were registered at 11 TB centers and private clinics. Qualitative data were collected through 20 in-depth interviews, 15 key informant interviews, and a focus-group discussion. Binary logistic regression was employed for analysis of the data. (3) Results: More than half of the respondents (63.94%) were satisfied with the DOTS strategy. A high percentage of patients were dissatisfied with the availability of safe water, waiting space for patients, waiting time, privacy, and the processing of appointments. Results from the binary logistic regression showed that gender (AOR = 2.21, CI 1.07–4.58, p = 0.033), marital status (AOR = 3.12, CI 1.45–6.73, p = 0.004), employment status (AOR = 5.22, CI 2.44–1.21, p = 0.000), home ownership (AOR = 3.82, CI 1.94–7.54, p = 0.000), literacy (AOR = 2.17, CI 1.11–4.25, p = 0.023), households' main occupation (AOR = 4.42, CI 1.12–17.38, p = 0.033), and level of income (AOR = 2.39, CI 1.13–5.04, p = 0.023) were the significant factors affecting satisfaction levels of the patients. (4) Conclusion: There are a number of areas that need improvement for successful TB eradication. Significant work is required to improve the quality of TB care in these specific areas from the patients' perspective. For instance, female health workers' involvement in the DOTS program can solve the problems of female respondents in rural areas. Improving the infrastructure facilities at the TB centers, allocation of doctors and nurses at the rural health centers would result in positive outcomes of the DOTS in Pakistan as well as in other developing countries. [ABSTRACT FROM AUTHOR]

Aging people in Pakistan are a growing population who face a shortage of old age home facilities. There is critical need to develop state-run old age homes for poor older people but to plan them while identifying protective factors for life satisfaction in currently housed residents. Our sample consists of 139 aging residents from six public sector old age homes across four cities. The qualitative results highlight barriers to life satisfaction and coping strategies of the aging population. Bivariate regression results show that aging residents have higher odds for life satisfaction when they are content with: (i) quality of life overall (AOR 5.99; 95% CI: 2.38–7.06); (ii) health (AOR 2.50; 95% CI: 1.02–4.14); (iii) finances (AOR 1.98; 95% CI: 0.67–3.72); (iv) religious and spiritual associations (AOR 1.90; 95% CI: 0.81–2.45); and (v) opportunities for learning (AOR 1.02; 95% CI: 0.42–2.41). We conclude with four salient social policy recommendations to improve life satisfaction for older populations living in old age homes. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the challenges and patterns of seeking primary health care services in slums of Karachi, where about 60% of the population lives in various informal settlements. We surveyed 8 largest slums of the metropolitan, and analyzed the data both descriptively and inferentially to evaluate the factors associated with health care seeking behavior. Significantly positive association of quality health care seeking behavior and various socioeconomic indicators were found. In addition, substantial insights about the conditions of slum dwellers and health challenges of the population, such as low immunization and low vaccinations, among others, were reported. Thus, the role of policymakers is emphasized to strategize for the inclusion of these people in national health plans and to develop health infrastructure near these communities. Furthermore, there is a strong need to increase awareness of the population about hygiene practices, importance of immunization, and importance of utilizing appropriate health care services. [ABSTRACT FROM AUTHOR]

Commonalities abound varied health challenges confronting Pakistan and India. Some of these warrant joint collaborative solutions. This study presents existing health collaborations by mapping out active connections between the countries, through a literature review and clinical and public health professionals’ interviews. It reveals that a diversity of practices exist beyond the usual notions of ‘collaboration’ usually depicted in the literature. Outcomes from such initiatives included enhanced learning and exchanges of information and research across various communities and contexts. In various adoptions of the term, contextualisation within and between countries and amongst particular communities is cited as important. Travel and mobility restriction emerged as one key issue that hampers and discourages collaborations. Key lessons conveyed by the participants included an enabling environment, missing on both sides of the border. Opportunities and recommendations are presented to address the obstacles that discourage cross-border dialogue and to enhance collaborations between the two countries. [ABSTRACT FROM AUTHOR]

Background: Mazri palm (Nannorrhops ritchiana (Griff) Aitch.) is a member of the family Arecaceae, native to Pakistan, Iran, Afghanistan, Oman, and Saudi Arabia. In Pakistan, it is used since long time for various purposes. This species plays a significant cultural and economic role in the daily lives of many rural areas in Pakistan and adjacent countries. However, the handcrafted products made up of this palm are often mainly known by specific local communities rather than by a broader range of people. Methods: Eighty-six structured and semi-structured interviews were conducted from Mazri growing areas, villages, and markets of urban centers during the fieldwork that was conducted in diverse regions of Pakistan. Interviewees included 27 Mazri farmers, 17 locals retaining Traditional Knowledge in handcrafting Mazri palm (12 were men and 5 were women), 23 handicrafts experts (21 were men and 2 were women), and 19 sellers. The age of the informants ranged from 14 to 83 years. Study participants shared detailed information about various traditional utilizations of the Mazri palm. Results: Mature leaves of Mazri palm are used to produce mats, baskets, hand fans, hats, cages, hot pots, salt pots, brooms, etc. in the sudy area. Hot pots, salt pots, mats, baskets, and ropes represent highly used items. The mats are used for various purposes like drying grains, performing prayers, sitting, and sleeping. As a whole, 39 different kinds of handcrafted products from the leaves were found. Our findings revealed also that other parts of the plant, ie. petioles, fruits, and bark, have been used, although more rarely, by the locals. The palm uses differ accordingly to the different cultural areas of Pakisitan, thus demonstrating that local cultural heritage significantly informs Traditional Knowledge and practices related to the use of Mazri palm. The findings suggest also that this plant represents a crucial resource for the livelihood of the local communities in dry areas of the western borders of Pakistan, starting right from the coastal areas of Baluchistan up to District Bajaur in the North, where other farming activities there are difficult due to drought conditions. Conclusions: Traditional Knowledge about the sustainable utilization of Mazri palm is eroded in Pakistan among the younger generations due to rapid globalization and industrialization processes and appropriate strategies for revitalizing this heritage in a sustainable way should be urgently fostered. [ABSTRACT FROM AUTHOR]