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The Indian subcontinent is highly susceptible to natural disasters. To abate the effect of the disasters, the government emanates institutional mechanisms and strategies for disaster preparedness, mitigation and response. Although there is well-established institutional framework in India for disaster management, there is no study that proposes a disaster supply chain structure under the institutional framework and integrates information and digital technologies (IDT) of industry 4.0 within it. The present study overcomes this research gap. It introduces an IDT structure within the institutional framework of India for multi-agency information sharing, coordination and decision making. It formulates a mathematical model and analyses the impact of IDT on the total response time through three scenarios. The results of scenario analysis reveal the significance of IDT on the disaster supply chains and its capability to handle information delays and IDT failure. The present study can be adopted by disaster management institutions to construct and implement better response practices at the operational, planning and strategic levels. Furthermore, the proposed model in the study can be used for vaccination planning, which includes vaccine distribution, monitoring, regulation and effective implmentation as a response against the current pandemic situation caused due to SARS-CoV-2. [ABSTRACT FROM AUTHOR]

Vaccination against measles still stands as a highly impactful public health strategy for mitigating childhood morbidity and mortality. Relatively poor immunization coverage among children has been observed in low and middle-income countries (LMICs). Our study intended to determine socio-demographic factors associated with the 1st dose of measles vaccination among South Asian (SA) and SubSaharan African (SSA) countries children. This was a cross-sectional study. This study utilized demographic and health survey data from 42 low-and middle-income countries (LMICs) in SA and SSA. The children's dataset yielded 255,775 children between the ages of 12 and 59 months. The independent predictors were determined by using crude and adjusted odds ratios with 95% confidence intervals (CI). The prevalence of first-dose measles-immunized children was 55.5% for the selected LMICs. The multivariable analysis for combined regions (SA and SSA) showed that parents with a higher level of education, rich wealth quintile, mothers with media access, mothers with more than four antenatal care (ANC) visits and baby postnatal check-up (PNC) within two months were significantly associated with the first dose of measles vaccination among children. The first dose measles immunization coverage in the selected LMICs was considerably low. To boost the uptake of childhood measles vaccination, public health interventions particularly need to focus on children born to uneducated parents, poor families, and those who have not used health services (ANC and PNC). Financial funding is crucial for establishing mobile vaccination clinics to improve immunization rates among the impoverished. [ABSTRACT FROM AUTHOR]

How do key players in Bombay's screen industries—producers, directors, writers, and business developers—understand, imagine, and navigate the dizzying new world of streaming platforms in India? Tracking the emergence of symbiotic relationships between new streaming platforms and established media professionals, I discuss how a restructuring of industry dynamics is elemental to the processes of cultural legitimation of new streaming tastes and the reconfigurations of the relationships between texts, industries, and audiences. Through case studies of a few prominent creative professionals associated in various capacities with global and local streaming platforms, I sketch the multiple linkages between contemporary streaming cultures and the structural histories of both film and television in the subcontinent. Ultimately, this article argues that media workers' self-reflexivity and theorizations about the industry-in-digital transit help us not only grasp the heterogeneity of this moment, but also trace notions of value and taste in Bombay's emerging digital media ecologies. [ABSTRACT FROM AUTHOR]

Individuals' coping differs based on sociocultural determinants and the nature of illness. This study developed a coping typology for South Asians with chronic illnesses and differentiated the coping profiles based on sociocultural determinants. Individuals (n = 384) with chronic illness were recruited. The Brief COPE scale was used for data collection and latent profile analysis for typology development. The class differences were examined in terms of age, gender, socioeconomic status, education, type of family, smoking, primary decision maker in the family, type of community, number of years living with chronic illness and type of health care services used. Latent profile analysis supported four class model: Avoider‐Emotion (n = 34, 9%), Problem‐Emotion (n = 128, 33.9%), Problem‐Avoider (n = 55, 14.6%) and Emotion‐Avoider (n = 161, 42.6%) copers. Comparison of classes across chronic illness showed that individuals with chronic respiratory disorders were Emotion‐Avoider and Avoider‐Emotion copers, those with cardiac problems were Problem‐Emotional and Problem‐Avoiders copers, those with renal problems were Emotional‐Avoiders and Problem‐Emotions copers, and individuals with mental health issues were mainly Problem‐Emotional and Emotion‐Avoider copers. These class differences were statistically different (χ2 = 134, df = 18, p <.001). The findings can be useful for developing coping programmes for South Asian populations in low‐ and middle‐income countries and South Asian immigrants. [ABSTRACT FROM AUTHOR]

An examination of the McMahon Line, Radcliffe Line and Durand Line highlights their role as agents shaping regional security complexes in South Asia. By unravelling the intricate interplay of historical and rising populist narratives, evolving power dynamics and intensifying state rivalries surrounding these colonial-era boundaries, a comprehensive analysis of their contemporary security implications is provided. Building on Barry Buzan and Ole Wæver's renowned theoretical framework, it is possible to elucidate the complexities of these boundary disputes while also addressing the inherent challenges in empirically applying such a framework to the nuanced dynamics of South Asia. Overall, a case study analysis of the McMahon, Radcliffe and Durand Lines allows the gap between the conceptual construct of the regional security complex and the intricate realities of regional security to be bridged. [ABSTRACT FROM AUTHOR]

This paper provides a snapshot of educational and economic trends across South Asia with an exploratory and comparative approach. Before COVID-19, South Asia was the world's fastest-growing regional economy, concurrently achieving major strides in poverty reduction and access to education. Despite the region's economic and educational accomplishments, the countries of South Asia fall short of international benchmarks in public education expenditure, resulting in a persistent lag in educational quality that hampers individuals, the workforce, and overall economic productivity. The paper highlights themes in the literature, including context-specific evidence for the various theories of economic growth, the returns to education, and educational inputs (e.g., teachers and private schools) that highlight how spending can be leveraged to increase educational outcomes. In addition, it examines the relationship between education, poverty, and marginalization factors that explain why some populations are deprived of education and its benefits. We provide a broad perspective of the dynamics of the economics of education and the related challenges in this region. This discussion aims to enhance the understanding of the inefficiencies in South Asia's educational systems and, ultimately, in the development of the region's human capacities. [ABSTRACT FROM AUTHOR]

Public institutions are essential for executing government policies. Citizens' trust in public institutions is a crucial factor to consider when assessing the state of democracy. Working processes, trends, organisational principles, neutrality, approaches and impartiality are also used to assess an institution's trustworthiness. Failing to satisfy any of these indicators can create distrust. Good governance is essential for every country to move forward and attain its development goals. For most countries in South Asia, governance is not in a good condition, with government institutions struggling to perform satisfactorily. In this situation, distrust may be fostered among citizens with limited conviction in democracy and diminish the reliability of public institutions. By taking these issues into account, this article uses secondary literature to evaluate the level of trust in the public institutions of South Asian States with a distinct emphasis on good governance. [ABSTRACT FROM AUTHOR]

Pakistan has the highest rates of consanguinity in the world, with nearly two‐thirds marrying cousins. To understand this pattern, we adopt the theoretical framework of intensive and extensive kinship that allows us to predict correlates of consanguineous marriages and logically connect patterns in Pakistan with those in other regions. Using data from the Punjab Consanguinity Survey, we examine indicators of economic development, fertility, cultural norms, and marriage payments as potential correlates of cousin marriage. Consistent with the intensive kinship framework, we find that number of cousins, parental consanguinity, spousal proximity, and caste or clan endogamy are associated with higher likelihood of consanguinity. In contrast, the likelihood of cousin marriage decreases with extensive kinship indicators including husband's education, co‐education, and large wedding expenditures. For women, cousin marriages are often “marrying down” financially, keeping women's wealth in the family. Comparison of Pakistan to other countries highlights the importance of low levels of literacy and female education, high fertility, and rapid population growth. We conclude that high rates of cousin marriage persist in Pakistan due to slow economic development which maintains motivations for cooperation with kin, and high fertility rates which sustain the large numbers of cousins that enable high levels of consanguinity. [ABSTRACT FROM AUTHOR]

The underground hydrogen storage represents a promising long-term, large-volume solution for hydrogen and hydrogen-methane blends, which is crucial for the anticipated "hydrogen economy" in South Asia. The suitability of any storage location hinges on its capacity and the associated costs of storage. This study provides a comparative analysis of the storage capacities for green hydrogen across fifty-nine porous geological reservoirs in India, Bangladesh, Pakistan, and Sri Lanka— the four major South Asian economies. The levelized cost of hydrogen storage (LCHS) was calculated for pure hydrogen storage in these basins. Additionally, the storage capacities of the five largest basins from India, Bangladesh, and Pakistan were evaluated for hydrogen-methane blends at 25%, 50%, and 75% concentrations. The findings indicate that South Asia's total pure hydrogen storage capacity is 29,799.43 TWh, with India contributing over 75%. Furthermore, hydrogen-methane blends were found to store more energy than pure hydrogen, with a 75% hydrogen blend storing over 65% more energy in the same basin. The primary cost factors for hydrogen storage in South Asia are compressor costs, followed by the costs of working gas and well construction. Under the parameters considered, the LCHS in India, Bangladesh, Pakistan, and Sri Lanka are $2.01, $1.28, $1.2, and $2 per kilogram of injected hydrogen. • 59 porous reservoirs of South Asian countries were evaluated for hydrogen storage. • Pure hydrogen storage capacity of South Asia is 29,799.43 TWh. • Hydrogen-methane blends store more energy than pure hydrogen in the same volume. • In South Asia, compressors have the highest capital cost, and working gas the lowest. • The LCHS: India $2.75/kg, Bangladesh $2.03/kg, Pakistan $1.95/kg, Sri Lanka $2.74/kg. [ABSTRACT FROM AUTHOR]

Introduction: Physiotherapy is a crucial profession of interdisciplinary medical team, in which healthcare professionals need to comprehend the duties of other members in the team to offer a holistic management to the patients. Healthcare professionals who uphold negative beliefs and perceptions about other healthcare professions can be a barrier to 'patient- centered' approach. Nevertheless, there is a paucity of research on knowledge and awareness of physiotherapy by healthcare professionals or students. There has been no study conducted in the Maldives to investigate the knowledge and perception of physiotherapy by healthcare students. Therefore, the aim of the study was to explore the knowledge and perceptions among healthcare science students at The Maldives National University (MNU). Methods: A cross-sectional study was conducted at the Faculty of Health Sciences (FHS), School of Nursing (SN), and School of Medicine (SM). A stratified random sampling method was adopted to recruit the participants. A self-administered questionnaire was used to obtain the data from the participants. The data was analyzed using the SPSS version 25. Results: A total of 318 students from three different schools and faculties of MNU participated in the study. The mean age of the respondents was 23 ± 4, with 89.9% being female. The overall K-score of 12 indicated poor knowledge, whereas the P-score of 10 reflected a positive perception among the participants, with no significant difference observed between genders. The Kruska-Wallis test indicated a significant difference in K-score across courses and years of study enrolled. Conclusion: This study's findings revealed a disparity between healthcare students' positive perception towards physiotherapy and their lack of knowledge regarding the profession, indicating barriers to knowledge acquisition. Significant differences were found between different healthcare courses and years of study. [ABSTRACT FROM AUTHOR]

Young people are increasingly turning away from agriculture in many parts of the global South, even where agriculture remains the backbone of livelihoods and the rural economy. This tendency among rural youth has become a critical research and public concern given that mass youth un (der)employment has emerged as a defining feature in many countries. In this paper, we interrogate and depart from the dominant narrative of the youth‐agriculture disconnect by focussing on socio‐economic conditions that shape diverse patterns of youth livelihood in rural areas. Our empirical evidence draws on ethnographic studies conducted in rural parts of Nepal with in‐depth interviews with young people complemented by key informant interviews with local leaders and community workers who shared their experiences and local narratives of the links among youth, agriculture and migration. Findings show that youth aspiration to leave agriculture is hard to deny, although this is heavily mediated by economic status, caste and gender in rural contexts. Given the chronic livelihood insecurity and the structural barriers rooted in class, caste and gender, we find that youth from underprivileged backgrounds do not have the luxury of considering an ‘exit’ from agriculture despite their mobility aspirations. When a longer‐term livelihood trajectory is considered, youth aspirations to transition out of agriculture show some degree of temporality regardless of their background, suggesting their re‐engagement in agriculture later in their life. [ABSTRACT FROM AUTHOR]

Although the climate has admittedly always been hot and humid in cities like Karachi, increasingly hotter temperatures are exacerbating the impact of heat on informal, precariously employed outdoor workers such as street vendors, guards and rickshaw drivers, who must negotiate their right and access to shade at the everyday scale. Recalling Mike Davis' radical, political claim that shade is an inalienable human right, this paper proposes that few people working in the outdoor spaces of the South Asian city today understand or experience shade in these terms. Rather shade is something that must be claimed, alongside other rights and entitlements. Moreover, shade alone is insufficient as it cannot reduce the exposure of bodies to harmful ambient radiations and overall thermal discomfort. This paper makes three broad propositions for outlining a theory for the social study of shade in the South Asian city. By paying closer attention to the ways that outdoor workers negotiate shade in Karachi, this paper opens up for analysis a wider spectrum of claims-making activity in changing South Asian urban climates. It places workers' search for shade in the broader context of shade policing and urban management aimed at creating spatial as well as social order. Finally, this article emphasises key directions and questions for future research. [ABSTRACT FROM AUTHOR]

Introduction: This study provides an epidemiological description of cancer in the lip, oral cavity, and oropharynx in the South and South‐East Asia region. Methods: The number of new cases and deaths was extracted from the GLOBOCAN 2020 and the CI5 series. We present age‐standardized incidence and mortality rates per 100,000 inhabitants. To assess temporal trends, we estimated the annual percent change. Results: The incidence rates (ASR) for lip and oral cavity cancer in South and South‐East Asia were highest in Taiwan (30.2), Sri Lanka (16.5), India (14.8), and Pakistan (13.2) among males. For oropharyngeal cancer, the highest rates were found in Taiwan (4.7), Bangladesh, Sri Lanka, and India (4.3, 2.9, and 2.6, respectively). Incidence rates were consistently higher in males compared to females. Overall, trends in lip and oral cavity cancer incidence were either stable or decreasing in most of the populations evaluated. In India, an increase in rates among males contrasted with a decline among females over the study period. Conclusion: Incidence and mortality rates of oral cavity cancer in South and South‐East Asia are among the highest globally. Our results suggest an optimistic trend of reduction in oral cavity rates in the region, despite an increase in rates among Indian males. [ABSTRACT FROM AUTHOR]

This study investigates the determinants of quality of life in South Asian countries, focusing on Bangladesh, India, Sri Lanka, Nepal, and Pakistan from 2000 to 2018. Life expectancy is used as the dependent variable, representing life quality. The independent variables include carbon emissions, remittances, information and communication technology, income inequality, government health expenditure, economic development, and food security. Cross‐sectional time series FGLS is the main analytical method, supplemented by Pedroni and Kao cointegration tests and the Drisc/Kraay method. The findings indicate that information and communication technology, remittances, economic progress, and food security positively impact life expectancy, while CO2 emissions, income inequality, and government health expenditures negatively affect it. The study proposes several policy recommendations to improve the quality of life in the South Asian region. [ABSTRACT FROM AUTHOR]

The article explores the global impact of the COVID-19 pandemic, highlighting its severe effects on health systems, economies, and poverty levels. With an estimated 6.9 million deaths worldwide and the deepest recession since World War II, the pandemic had diverse regional impacts. South Asia, for example, experienced varying degrees of health and economic challenges; India faced over 500,000 deaths and a sharp economic downturn, while other nations in the region were less severely affected. The pandemic's relatively brief duration, aided by global responses like lockdowns, social distancing, and rapid vaccine distribution, facilitated a quicker economic recovery, bolstered by unprecedented counter-cyclical policies. The article also examines South Asian case studies, including regional trade integration, the economic benefits of vaccination, and the socio-economic impacts on women in Bangladesh. It further discusses Pakistan's response, Sri Lanka's populist policies, and Indonesia's monetary policy adjustments, offering valuable lessons for managing global health crises and economic downturns. [ABSTRACT FROM AUTHOR]

The study unravels the relationship between trade and connectivity and presents a narrative to re-energise the South Asian regional economic integration in the post-pandemic period. In addition, the study also examines the effect on conflicts and institutional factors in South Asian trade. The study uses the bilateral gravity analysis in 2SLS (Two-Stage Least Squares) framework to address the endogeneity issues. The study finds that South Asia may gain enormously if they reduce the conflicts across the border and secure improvement in both hard and soft infrastructure. Given that the trade is a dynamic concept, connectivity disruption costs cause havoc to the region, which then promotes dis-integration. Facilitating business beyond the border in post-pandemic requires an enhanced trade facilitation and connectivity in the region. The renewed and shared agenda of the South Asian regional cooperation in post-pandemic should, therefore, aim to reduce both intra- and inter- regional trade facilitation gaps as well as to expand the connectivity. The process of South Asian regional integration has to contribute to narrowing the gaps by providing resources for the development of trade infrastructure. Therefore, South Asia has to enhance its own connectivity and trade facilitation arrangement to take forward the agenda of South Asian integration. [ABSTRACT FROM AUTHOR]

This special issue critically examines the interplay between the law and politics of state trans/formation, status precarity and the abuse of law. Globally, governments have exercised state power to undermine citizenship status, democratic well-being and the rule of law. This introduction makes the case for this focus and highlights the range of the special issue's intervention. Firstly, it shows how the contributions in the special issue build upon scholarship that tackles these three values independently and offers a more comprehensive analysis of contemporary challenges of the law and politics of citizenship. It studies the mutual attrition of citizenship, law and democracy by adopting a focus on South and Southeast Asia, especially India, Myanmar and Sri Lanka. Secondly, it emphasises the special issue's methodological contribution by drawing from the theory-generative capacities of focusing on Asia and the Global South more generally. Thirdly, the introduction highlights the cross-cutting substantive contributions of the articles, especially status liminality and statelessness, securitisation and authoritarian politics, bureaucracy and paperwork, and minority and human rights. [ABSTRACT FROM AUTHOR]

Palliative care is a comprehensive approach aimed at improving the quality of life of patients with serious illness and their families. Nevertheless, there exists a dearth of systematically synthesized empirical evidence regarding the key elements that contribute to good home palliative care (HPC) from a familial standpoint in the context of South and Southeast Asia. This paper aims to describe family perspectives on key elements of good home palliative care in both regions. We conducted a scoping review using Arksey and O'Malley's methodological framework. The search was done in 6 electronic databases: PubMed, Ovid MEDLINE, EMBASE, Web of Science, APA PsycINFO, and APA PsycArticles Full Text. Inclusion criteria were (1) exploring family experiences of palliative care, (2) home setting, and (3) South and Southeast Asian countries. Twenty-four studies were included from Bangladesh (n = 1), India (n = 6), Indonesia (n = 7), Malaysia (n = 2), Singapore (n = 2), and Thailand (n = 6). Five key elements of HPC from family perspectives were comprehensive moral and psychological support; religious and spiritual activities with religious figures involvement; empathetic, responsive, and continued home palliative care; adequate access to information and skills training; and facilitation in dealing with systemic barriers. The crucial role of religious and spiritual activities and the need for facilitation in facing systemic barriers were specific to South and Southeast Asia. HPC teams should be able to provide holistic support for patients and their families, which is influential for the quality of care. Improving care on a systemic level in these regions should be a policy priority. [ABSTRACT FROM AUTHOR]

This research aims to identify the intricate connections arising from finance and governance to water, food, and energy, utilizing data from 2000 to 2021 for eight South Asian countries. To address cross‐sectional dependence and panel heterogeneity, this study applied an augmented mean group (AMG) approach to discover long‐term connections across the chosen indicators. The estimators' outcome shows interconnectedness across water, food, and energy (WFE) resources, showing that water promotes food and energy, and food promotes water and energy. In contrast, energy fosters food production and reduces water availability. Further, governance positively influences food production (0.434%), water (0.044%), and energy consumption (0.142%). Likewise, finance positively and significantly responds to WFE consumption. Our results highlighted that governance unilaterally influences energy dynamics while bidirectional causal links emerge between finance, food, and energy. The obtained outcomes are re‐validated with feasible generalized least square (FGLS) and Driscoll and Kraay (DK) estimators. Ultimately, our study offers valuable insights for shaping economic, environmental, and food and water security policies in the region and beyond. [ABSTRACT FROM AUTHOR]

South Asian narratives are underrepresented in dance movement psychotherapy academia. Systematically supporting more anecdotal literature on utilising the body's innate wisdom in illness prevention and treatment is essential to support equitable accommodation of oral narratives. In this critical reflection, I have integrated my emerging perspectives as a member of the South Asian diaspora, a clinician who has trained and worked within the medical model and an early career researcher. I present two anecdotal themes and brief case examples relevant to contemplating the value of oral narratives within dance movement psychotherapy. They are: (1) embodied storytelling as a way of building emotional intelligence, and (2) intuition as a way of trusting one's bodily cues in individuals. [ABSTRACT FROM AUTHOR]

This study examines the impact of financial instability (FI) on environmental degradation (ED) along with economic growth (EG), foreign direct investment (FDI), and energy consumption (EC) in five South Asian economies from 1980 to 2021. The study uses a fixed-effect panel model and a two-step system GMM for robust outcomes. The empirical findings demonstrate that FI has a positive and significant effect on ED in South Asian economies. However, the impact of FI on ED varies across South Asian countries. Overall, the impacts of EG, FDI, and EG are positive and significant on ED in South Asia. The effects of EG, FDI, and EG are also heterogeneous for countries in South Asia. However, FDI reduces ED in Pakistan, Bangladesh, and India. Therefore, the study provides several policy recommendations to combat ED in the South Asian region. [ABSTRACT FROM AUTHOR]

The pomfret fish, particularly the black pomfret (Parastromateus niger), serves as a significant economic resource in South Asia, particularly in the coastal regions of Balochistan, Pakistan. This study investigates various biological parameters of Parastromateus niger collected from the Gaddani coastal area of Pakistan, focusing on length-weight relationships, gut fullness, and population demographics. A total of 117 fish specimens were collected, with females dominating the samples. Length and weight data were analyzed separately for males and females, with statistical calculations revealing strong correlations (r2 values ranging from 0.918 to 0.985) between length and weight for both sexes. Gut fullness was categorized into five levels, with the highest percentage observed during July, suggesting potential breeding activity during this period. The zooplanktons were identified as primary dietary components of Parastromateus niger. The study also highlights the importance of regulatory measures to sustainably manage fish populations, especially during breeding seasons, and calls for further research into the intensive culturing and feeding regimes of black pomfret to enhance its production. Overall, these findings contribute to a better understanding of the biological characteristics and potential for aquaculture development of Parastromateus niger in the region. [ABSTRACT FROM AUTHOR]

Approximately one-third of the world’s 169 million migrant workers come from the Asia and Pacific region, primarily working in temporary, low-wage jobs in the Gulf, where they face human and labor rights issues. In 2003, 12 Asian migrant-origin states formed the Colombo Process to address these labor concerns. This article examines and contrasts two major emigrant-origin states’ – India and Bangladesh –behavior in the Colombo Process, a regional consultative process, and other multilateral migration governance fora, focusing on the social construction of skills. Both countries inherited a colonial legal system of emigration regulation which distinguished emigrants into “high-” and “low-skill” categories, which India continues to reproduce, while Bangladesh aims to reformulate their categorization. This article investigates the how, where, and when of the countries’ emigrant categorization processes by tracing the categories’ origins, their reproduction, and reformulation. This article highlights the significant role migrant-origin states play in the politics of skill. [ABSTRACT FROM AUTHOR]

\nBackground: South Asia and Southeast Asia account for more than 40% of the global stroke burden, with differences in stroke risk factors, mortality, and outcomes compared to high-income countries. Sociocultural norms compound the preexisting biological risk differences, resulting in a disproportionate burden of stroke in women in this region. This review summarizes the sex and gender differences across the stroke care continuum in South Asia and Southeast Asia over the past 20 years. Summary: Despite a higher incidence of stroke in men than women in South and Southeast Asia, women have greater stroke severity and poorer outcomes after stroke. Higher levels of premorbid disability and poor physical health at baseline may be contributory. There is a high prevalence of vascular risk factors such as hypertension, dyslipidemia, cardiac sources of embolism, as well as metabolic syndrome and insulin resistance, among the women in this region. Smoking is uncommon among women; however, other forms of smokeless tobacco, such as tobacco leaf and betel nut chewing, are more prevalent, especially in the rural areas in these countries. Women are more likely to have delayed presentations to the hospital due to untimely recognition of stroke symptoms; however, with regards to door-to-needle times or intravenous thrombolysis (IVT) rates, we found equivocal data. Wide gaps exist in stroke awareness and healthcare-seeking behaviors, with women more commonly opting for public hospitals and low-cost wards, more likely to discontinue treatment, and less likely to adhere to poststroke rehabilitation. Key Findings: This review exposes the gender lacunae in stroke service provision across South Asia and Southeast Asia while acknowledging the many knowledge gaps in our understanding. Although the biological risk differences are non-modifiable, educational, policy, and economic measures to mitigate sociocultural barriers are much needed in the region. Sound epidemiological data are needed from more countries to better understand these differences and bridge this gap. It is imperative to advocate and implement policies and programs for stroke care viable for women, cognizant of the gender and cost bias, as well as the interplay of social and cultural structures specific to the regions. In South-and-Southeast Asia, women have greater stroke severity and poorer outcomes after stroke. This is attributable to a higher prevalence of conventional vascular risk factors such as high blood pressure, arrhythmias, and poor lipid regulation as well as hormone related sex-specific factors such as pregnancy, menopause and hormonal replacement therapy which can augment the risk of stroke in women. Women from this region were seen to have similar risk-factor trends with higher frequency of cardiac causes of stroke. Contrary to the rest of the world, tobacco smoking was less common among South-and-Southeast Asian women however, other forms of smokeless tobacco ie consumption of tobacco without burning such as tobacco leaf or betel nut chewing are prevalent especially in countries like Bangladesh and Pakistan. Less frequent forms of stroke like venous strokes are also more common in women in this region. Etiologically, sociocultural practices such as post-partum fluid restriction, dehydration and anemia have been associated although more recently hormonal contraception is also emerging as a cause. Poor awareness, delays in healthcare seeking behaviour, and inadequate availability of stroke services further compounded by disparities augmented by the sociocultural construct of gender, result in wide gaps in stroke care disfavoring women in South-and-Southeast Asia. Future directions to improve equity of care should target improved public awareness of stroke among women, policies cognizant of the existing gender-disparity with the intent of making them viable for women, and equal representation of women in stroke research to better understand gender-based differences in stroke. [ABSTRACT FROM AUTHOR]

Ovid’s Metamorphoses has long served as a window into Greco-Roman culture and mythology. However, the ways in which the Metamorphoses may be shaped by, and in turn shape, the interactions between myths and cultures beyond the Greco-Roman world are underexplored. The Ramayan, a seminal South Asian mythological text, has received less attention in scholarship in the Global North, in part due to the overwhelming focus on the Greco-Roman canon. This article highlights stark narrative parallels between the abduction of Proserpina in the Metamorphoses and the abduction of Sita in the Ramayan. Given that these texts are genetically and geographically distinct, tracing the origin of these parallels remains challenging. Here, I leverage a Jungian analytical framework to propose that “narrative archetypes”—collections of images stored in the collective unconscious which manifest in myths across cultures—may explain why episodic details are conserved between the Metamorphoses and the Ramayan. [ABSTRACT FROM AUTHOR]

This study investigates the burden of COPD attributable to air pollution in South Asia using data from the Global Burden of Disease Study from 1990 to 2019. Method Data for this study were obtained from the Global Burden of Disease Study 2019. The burden was measured in terms of death, disability-adjusted life years (DALYs), and Years of life lost (YLLs). Results Since 1990, several countries in South Asia registered substantial declines in mortality rates attributed to COPD, ranging from −37.47% in Pakistan to −66.25% in Bangladesh. Similar trends were observed for DALYs and YLLs as well, which have potentially contributed to a considerable decrease in mortality rates at the regional level (−43.13%) compared to a 32.59% decline in Low SDI and 56.87% decline globally. Conclusion Despite significant declines since 1990, the burden of COPD attributable to air pollution reductions in the South Asian region’s rates remains alarmingly high. [ABSTRACT FROM AUTHOR]

Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection (PANDAS) occurs in the child and adolescent age group. It is characterised by the acute onset of Obsessive-compulsive Disorders (OCD) and/or tic disorders following an infection with Group A Beta-haemolytic Streptococci (GABHS), but it can also present with a variety of unique clinical manifestations. Despite the high prevalence of streptococcal infections in the Indian subcontinent, very few cases have been reported due to a lack of awareness. Hereby, the authors present a case series of four cases (one female and three males) of PANDAS with rare presenting symptoms, including dissociative (conversion) disorder and hoarding disorder, each with evidence of a preceding streptococcal infection. [ABSTRACT FROM AUTHOR]

Background: Esophageal cancer (EC) remains a significant health challenge in South Asia, with poor prognosis despite advancements in diagnostics and treatment. Identifying and validating prognostic factors is essential for improving patient outcomes. Methods: A prospective study was conducted with 146 biopsy-confirmed EC patients at the Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan. Clinical and laboratory data were collected and analyzed using descriptive statistics, receiver operating characteristic (ROC) analysis, and the Chi-square test. Survival outcomes were assessed using Kaplan–Meier curves, log-rank tests, and Cox proportional hazard models for univariate and multivariate regression analyses, with statistical significance set at p ≤ 0.05. Results: Bivariate analysis showed significant associations of the neutrophil lymphocyte ratio (NLR) (p = 0.017), C-reactive protein to albumin ratio (CAR) (p = 0.033), red cell distribution width to platelet ratio (RPR) (p = 0.020), and systemic immune-Inflammation index (SII) (p = 0.009) with patient survival. Univariate analysis identified tumor length >10 cm (p = 0.016), T4 stage (p = 0.015), metastasis (p < 0.001), surgery not performed (p < 0.001), and SII (p = 0.022) as significant factors for survival, with higher SII linked to poorer overall survival (p = 0.020). Interestingly, in the multivariate model, only metastasis (p < 0.001) and surgery not performed (p = 0.011) remained significant. Conclusions: Immuno-inflammatory markers may be less pertinent prognostic factors for EC in the South Asian population. [ABSTRACT FROM AUTHOR]

Dadu is a traditional board game exclusively played within the Muslim Dawoodi Bohra community in South Asia. Most households have their own hand-stitched cloth board, together with a set of wood-turned playing pieces and cowrie shells for dice. Though formally a two-player game, it is commonly played in large teams during family gatherings. Non-community members rarely take part and the game remains virtually unknown to outsiders. Descriptions of the game are absent from the scholarly literature and it does not find mention in any of the major game encyclopedias. Surviving boards and communal memory trace the game back to the early 20th century, but the hybrid nature of the game and the origin of the Dawoodi Bohra community in Yemen suggest that it may go back several centuries further. The present article uses ludemic theory to analyze the constituent elements of the game and demonstrate their affinity with elements in other games both inside and outside South Asia. The findings are contextualized within the wider history of the Dawoodi Bohra community, suggesting that Dadu may have resulted from the adaptation of a West Asian Tab game to a South Asian single track race game. A detailed set of rules gathered from interviews with members of the Dawoodi Bohra community is appended to the article. [ABSTRACT FROM AUTHOR]

Background: Drug-resistant tuberculosis (DR-TB) significantly increases the risk of depression, yet research on mental health in this population remains limited. Aim: This meta-analysis aimed to evaluate the prevalence of depression among multidrug-resistant TB (MDR-TB) patients, emphasizing the necessity for integrated mental health care. Methods: A systematic search across PubMed, Cochrane, EBSCOhost, and Google Scholar identified 536 articles, which were screened for eligibility after removing duplicates. Prevalence data were analyzed using R programming, with back-transformation applied to enhance accuracy. The methodological quality of the included studies was assessed with the JBI Critical Appraisal Checklist, and the study protocol is registered in PROSPERO (CRD42023449156). Results: Ultimately, twelve studies involving 3,258 participants were included in the analysis. The pooled prevalence of depression among MDR-TB patients was found to be 54% (95% CI: 42%-65%). Although substantial heterogeneity was noted (I² = 72%; P < 0.01), excluding one study (Walker et al.) due to high Cook's distance revised the prevalence to 55% (95% CI: 43%-68%), with reduced heterogeneity (I² = 68%; P < 0.01). Subgroup analyses indicated minimal variability among studies using the Hamilton Depression Rating Scale (52%, 95% CI: 40%-64%) and substantial variability among those employing the Patient Health Questionnaire (54%, 95% CI: 30%-79%). Funnel plot analysis and Egger's test revealed no significant publication bias (P = 0.2105). Conclusion: This study highlights a high prevalence of depression among MDR-TB patients, underscoring the urgent need for integrated mental health care strategies tailored for this vulnerable population. Further research is essential to refine these strategies effectively. [ABSTRACT FROM AUTHOR]

Objective: In Pakistan, a predominantly Muslim country, information on the patterning of suicidal thoughts and behaviors, as well as associated public perceptions and opinions, is limited. We sought to advance knowledge on suicide and self-harm in Pakistan with a large, online survey. Method: Leveraging results from a twelve-item online survey (N = 5,157) circulated by the largest English language newspaper in Pakistan, we assessed personal experiences, opinions, and attitudes toward help-seeking in the context of suicide. We calculated proportions with 95% confidence intervals for endorsed responses and implemented binomial generalized linear models with odds ratios to assess differing response tendencies by age, gender, and urban/rural residence. Results: Personal experiences related to suicide and self-harm as well as encounters in social circles were common. Mental illness tended to be recognized as a high likelihood contributor to suicide death over and above nonviolent interpersonal problems. Most considered suicide a way to escape pain, and few considered suicide to be immoral. Barriers to help-seeking included social deterrents, inaccessibility, and unaffordability. Women and youth emerged as higher risk groups, though the status of rural Pakistanis remained unclear. Conclusion: The survey provides a preliminary basis for considering the unique experiences and perspectives of the public in shaping suicide prevention and intervention efforts in Pakistan. HIGHLIGHTS: A voluntary online survey about suicide with over 5,000 responses from a cross-section of Pakistani population Results illuminate popular opinions on suicide risk and mental health treatment Women and youth appear to be especially vulnerable warranting targeted intervention [ABSTRACT FROM AUTHOR]

If anthropology once concerned itself with politics in stateless societies outside Euro-America over and against prevailing Euro-American political theory, today anthropologists see the state at work everywhere. Anthropologists have sought to trouble spatial metaphors of state power that assumed, among other things, its centralization and the unitary character of sovereignty. Locating the state through an attendant question of region, we explore recent literatures on everyday state practices in Central and Eastern Europe and South Asia to show how different regional histories and configurations of knowledge continue to structure our assumptions about the state and its functions as well as the grammar of our descriptions. We suggest that the state could prove to be a useful optic for the study of region, which provides an alternative to an overly rigid local/global dichotomy that continues to shadow our theorizations. [ABSTRACT FROM AUTHOR]

Dethroned: The Downfall of India's Princely States John Zubrzycki. London: C. Hurst & Co., 2023. £25.00. 360 pp. The Return of the Taliban: Afghanistan After the Americans Left Hassan Abbas. New Haven, CT: Yale University Press, 2023. £16.99/$26.00. 320 pp. Sheikh Abdullah: The Caged Lion of Kashmir Chitralekha Zutshi. New Haven, CT: Yale University Press, 2024. £25.00/$35.00. 376 pp. Days of Opportunity: The United States and Afghanistan Before the Soviet Invasion Robert B. Rakove. New York: Columbia University Press, 2023. £30.00/$35.00. 488 pp. Pakistan and American Diplomacy: Insights from 9/11 to the Afghanistan Endgame Ted Craig. Lincoln, NE: Potomac Books, 2024. $34.95. 296 pp. [ABSTRACT FROM AUTHOR]

Adult survivors of childhood sexual abuse (CSA) may experience emotional, social, and psychological difficulties, heightened due to the interpersonal nature of harm. Despite the demonstrated effectiveness of trauma-focused treatments in the West, a culturally specific understanding of the needs of and treatments for survivors in South Asia is still in its infancy. The study aimed to systematically review research findings on the mental health impacts of CSA on adult survivors and current treatment approaches and their efficacy and acceptability in South Asia. Seven databases (Scopus, Ovid, CINAHL, ProQuest, EThOS, Google Scholar, and Dogpile) and five peer-reviewed South Asian journals were searched from inception until March 30, 2023. Searches included participants who were adult survivors of CSA of South Asian origin residing in South Asia. Studies on their mental health, different treatments, and the efficacy and acceptability of these treatments were included. Quality assessment tools were used to appraise the quality of included studies. The results were synthesized narratively. A total of 3,362 records were retrieved, and 24 articles were included in the final review. Twenty studies reported mental health impacts of CSA on adult survivors, four studies reported current treatments offered, and two studies were on recovery. However, no study focused on the efficacy or acceptability of the treatments being delivered. Even though the needs of adult CSA survivors in South Asia have been partly identified, there is very little research into the treatments for them. [ABSTRACT FROM AUTHOR]

This study is necessitated by the high rate of infant mortality in South Asia (SA) and Sub-Saharan Africa (SSA) and the need to enhance the chances of these regions achieving SGD 3. The endemic nature of infant mortality in these regions constitutes a threat to attaining the 2030 sustainable development goal (SDG) 3 target. This study examined whether carbon emission matters and how other socioeconomic factors militate against the attainment of the infant mortality target in SA and SSA for the period 1981-2019. The study analyzed annual panel series using the robust least squares estimator. The result revealed that carbon emission per capita is the most critical impediment to attaining the SDG 3 target (25 infant mortality rate per 1000 in 2030) in SA and SSA. Fortunately, an increment in per capita income would be the strategic action to attaining the infant mortality target in these regions, and it is imperative to promote maternal education through improvement in female school enrollment rates. While the South Asian economies could afford to rely on foreign direct investment (FDI) inflows in addition to the aforementioned strategies, the SSA countries should not strongly depend on FDI to address the menace of infant mortality, rather improved social spending that is devoid of corruption and other systemic encumbrances would be more productive in arresting infant mortality in this region. Also, policymakers in Sub-Saharan African economies are encouraged to rely less on FDI and are strongly advised to improve government social spending and to implement pollution abatement policies and environmental regulations in line with international treaties and best practices. [ABSTRACT FROM AUTHOR]

This paper examines the involvement of members of South Asian communities in cricket (in Bradford and Leeds, UK). The England and Wales Cricket Board (ECB) identified that despite the high level of interest in cricket within these communities, relatively few were participating in opportunities provided through ECB structures; instead, they were engaged in various forms of 'informal' cricket. Using data from a small-scale survey and group interviews, this paper speaks to issues of diversity and equality utilizing Rowe's theory of sporting capital framed with insights from Critical Race Theory (CRT). We argue that Rowe's model should be refined by incorporating the concepts of cultural competence and cultural wealth. Doing this can safeguard against deficit models of capital that stress what people lack rather than what they possess. This provides the sporting establishment with better insight to how their sport is perceived and engaged with by those outside the mainstream. [ABSTRACT FROM AUTHOR]

The Azadirachta indica, normally known as the Neem tree, is a remarkable plant with a rich history of medicinal and healing properties. This evergreen tree, native to the Indian subcontinent, is renowned globally for its adaptability and ability to address various health issues. This bio-analytical study aims to identify and structurally elucidate the major phytoconstituents present in the hydroalcoholic extract of the Neem plant. In this phyto-analysis, the phytoconstituents from the Neem plant were isolated using column chromatography and their structural elucidation was accomplished using spectral analysis. Two major isolate, Nimoid and Nimbine were identified and structurally elucidated from A. indica by spectral analysis (I.R., NMR and mass spectroscopy). Neem plant traditionally use for skin conditions, infected burns, and septic sores. These medicinal properties are outcome of major phytoconstituents Nimoid and Nimbine. [ABSTRACT FROM AUTHOR]

The Amaranthus viridis, normally known as the green amaranth, is a remarkable leaf with a rich history of medicinal and healing properties. This evergreen leaf, native to the Indian subcontinent, is renowned globally for its adaptability and ability to address various health issues. This bioanalytical study aims to identify and structurally elucidate the major phytoconstituents present in the Ethanolic extract of the Amaranthus viridis. In this phyto-analysis, the phytoconstituents from the Amaranthus viridis plant were isolated using column chromatography, and their structural elucidation was accomplished using spectral analysis. Two major isolate, Squalene and Trilinolein were identified and structurally elucidated from Amaranthus viridis, by spectral analysis (I.R., NMR and mass spectroscopy). This two major phytoconstituents are cause of A. viridis pharmacological activities like antibacterial, anti-inflammatory and immunomodulatory property. Squalene can use effectively as a potential antioxidant and emollient and Trilinolein can use potential medicine for arrhythmias and thrombogenicity. [ABSTRACT FROM AUTHOR]

Known by its common name, Syzygium aromaticum (Clove plant) this leaf is a fascinating one with a long history of therapeutic and medicinal uses. This evergreen leaf, which is indigenous to the Indian subcontinent is well known around the world for its versatility and capacity to treat a wide range of illnesses. The primary goal of this bioanalytical investigation is to identify and structurally clarify the principal phytoconstituents found in the Syzygium aromaticum ethanolic extract. In this phyto-analysis, spectral analysis was used to clarify the structure of the phytoconstituents that were extracted from the Syzygium aromaticum plant using column chromatography. Using spectrum analysis (I.R., NMR and mass spectroscopy), two significant isolates from Ocimum tenuiflorum, Eugenol and Gallic acid were found and their structures clarified. [ABSTRACT FROM AUTHOR]

Notopterus notopterus (Pallas) is a freshwater fish widely distributed on the Indian subcontinent and frequently harvested by fishermen. The present study aimed to assess the effect of photoperiod on gonad maturation in female N. notopterus to evaluate its potential as a tool to manipulate reproduction under artificial conditions. Fish were exposed to different photoperiods in five treatments, as follows: the control group (10 hr light and 14 hr dark (10L:14D), 24 hr continuous light (24L:00D), 18 hr light and 6 hr dark (18L:06D), 24 hr continuous dark (00L:24D) and 6 hr light and 18 hr dark (6L:18D). The highest mean gonadosomatic index (GSI) were observed under 24 hours of continuous dark treatment (3.07±0.2, p<0.001), suggesting an enhancement of gonadal growth with increased vitellogenic activity. On the other hand, the same parameter was minimal in the fish with a 24-hour continuous light period (0.62±0.02). The hepatosomatic index (HSI) studies indicated that there is an increase in HSI during longer periods of light exposure (1.022±0.082, p< 0.001) and a decrease during shorter periods of light exposure (0.51±0.01). The decrease of HSI in longer periods of darkness exposure may be related to the hepatic involvement in gonadal growth and maturity. Therefore, it was concluded that prolonged darkness is useful to accelerate gonadal growth and maturity in N. notopterus. [ABSTRACT FROM AUTHOR]

In the present study, we investigated comparative biochemical and enzymatic parameters among dung beetles from three different species: Tiniocellus spinipes (Tribe: Oniticellini), Onthophagus sagittarius (Tribe: Onthophagini) and Onitis subopacus (Tribe: Onitini), widely distributed in the Indian subcontinent. Our results reveal distinct biochemical and enzymatic profiles across these species, potentially reflecting their varied ecological roles and physiological adaptations. Specifically, Onthophagus sagittarius exhibited higher assimilation rates of both glucose and triglycerides compared to the other species, indicating a more efficient metabolic capacity. Tiniocellus spinipes showed moderate assimilation rates, but demonstrated significant superoxide dismutase activity, suggesting a robust antioxidant defense mechanism. Onitis subopacus, while displaying the highest catalase activity, exhibited the lowest assimilation rates of glucose and triglycerides, possibly indicating a different metabolic strategy or ecological niche. These findings provide valuable insights for conservation strategies and future research on the ecological roles of these species within their habitats. [ABSTRACT FROM AUTHOR]

Aim: To (i) assess the prevalence, incidence, and burden of severe periodontitis and edentulism in 2021, and (ii) forecast their rates in 2050. Methods: Prevalence, incidence, and Years Lived with Disability (YLDs) for severe periodontitis and edentulism in 2021 were gathered globally, covering 204 countries, seven super regions, and 21 regions from the Global Burden of Disease (GBD) 2021 study. Prevalence, incidence, and YLDs due to periodontitis and edentulism to 2050 were projected using mixed‐effects models with the socio‐demographic index as the main covariate. Results: In 2021, over 1 billion people were affected by severe periodontitis (1066.95 million; 95% UI: 896.55–1234.84), with a global age‐standardized prevalence of 12.50% (10.53–14.49). South Asia had the highest prevalence rate, at 17.57% (14.73; 20.14). Edentulism affected 353 million people globally (300.60–416.20), resulting in an age‐standardized prevalence of 4.11% (3.50; 4.83). The highest edentulism prevalence was found in Latin America and the Caribbean, at 7.39% (6.44; 8.39). By 2050, more than 1.5 billion people (+44.32%) are projected to have severe periodontitis, and over 660 million (+84.40%) to be edentulous. In the same year, 19.67% (130.23 million) of the edentulous people worldwide will be located in China. Severe periodontitis is expected to move up one position, and edentulism nine positions, among the most impactful Level 4 diseases/conditions affecting YLDs worldwide by 2050. Conclusion: Severe periodontitis and edentulism remain major public health challenges in 2021, with the number of affected individuals projected to rise significantly in the coming decades. [ABSTRACT FROM AUTHOR]

Background: Patient and public involvement and engagement (PPIE) in clinical trials is increasingly recognized as vital for ensuring research relevance and accessibility. Despite its proven benefits, PPIE remains limited, particularly in low- and middle-income countries, and more examples of effective strategies for involvement are needed. This commentary outlines the establishment of a PPIE group for clinical trials in a lower-middle-income country setting with limited research infrastructure. Main Body: We established Pakistan's first ever PPIE group for clinical trials within a new clinical trials unit at Ziauddin University in Karachi. The objectives of our project were focused on group formation, redesign of informed consent documents for trials, and dissemination of trial results to the public. Recruitment strategies involved referrals from clinicians and existing collaborators as well as engagement at public events, distribution of advertising leaflets and social media posts. Ten potential members were selected based on motivation, commitment and ability to contribute critically, with six members continuing their involvement long-term. An existing tool designed to establish the access needs of public partners was adapted to our project to help us document and account for members' expectations and support requirements. The process of using the tool enabled deep engagement, clarified roles, and fostered trust between coordinators and group members. Patient and public members gained confidence about the legitimacy of the project and felt more comfortable participating in the first group meeting. Lessons learned emphasize the importance of wide-ranging engagement efforts and transparent discussions about expectations to build effective collaborative relationships. Conclusion: Our experience demonstrates the feasibility of establishing a PPIE group for clinical trials in Pakistan and highlights strong public interest for research involvement. The use of a formal tool to document needs, prior experiences and expectations encouraged relationship-building and helped coordinators make relevant accommodations for members. This account contributes to the growing body of literature on effective PPIE practices, emphasizing the value of tailored support and transparent communication in facilitating meaningful public involvement in clinical trials. Plain English summary: Working together with patients and members of the public has the potential of making clinical trials better, more person-centered and relevant. Unfortunately, partnerships between trial researchers and the public are still uncommon. It is not known what the best ways are to involve the public in clinical trials, especially when it comes to non-Western populations. We set up the first-ever patient and public involvement and engagement group to support clinical trials in Pakistan. In this commentary, we share our initial experiences of successfully establishing the group and the two main lessons we learned. Ten group members were identified by widely advertising our project to doctors, community organizations, patients and their carers at our hospital. Before the first group meeting, two coordinators met with each potential member to discuss and document their interests, expectations and needs. Both researchers and group members felt that these discussions were a good use of their time and helped make the project a success. The first main lesson learned from our experience was that enough time, funding, staff and resources are needed to identify members and build meaningful collaborative partnerships. The second main lesson learned was that honest discussions are needed at the very beginning of a collaboration about expectations. Our experience shows that involving patients and members of the public in clinical trials in Pakistan is possible and we hope it inspires and helps other researchers in their patient and public engagement efforts. [ABSTRACT FROM AUTHOR]

Background and context: Providing care to the elderly is an emerging area of interest due to the increase in elderly population not only in the developed world but also in low and middle income countries. In Pakistan a country with an overall population of over 200 million, the elderly population amounts to 11.3 million. Caregiving of the elderly tends to occur within the kinship motivated by sociocultural norms as well as absence of government support facilities. While quantitative literature exists in Pakistan describing the "caregiver's burden," an in-depth analysis into the experiences of familial caregivers is missing. Methods: The research used qualitative methods with the aim to explore the lived experiences of 7 daughters and 3 daughters-in-law, living in Karachi, Pakistan providing care to the elderly requiring assistance in at least two tasks of daily living. Results: Five themes were developed inductively through the phenomenological method. All participants were Muslim and belonged to the upper economic strata of the society. Findings reveal that obligations to care are dominant in kinship circles particularly among women. Participants highlighted the importance of elderly in the Pakistani society, especially due to the religious lens that considers them as blessings. Daughter caregivers spoke about caregiving of their parents as a form of role reversal, emphasizing also upon the life-long emotional bond that served as a strong motivator. On the other hand, for daughter-in-law caregivers, motivations to care also stemmed from social expectations and kinship obligations. All participants reported multiple difficulties during the caregiving experience, despite existence of paid formal help, with respect to balancing multiple role demands and the nature of caregiving that requires constant effort. Results also illustrate that despite the desire to care for the elderly within a collectivist and patrilocal society, participants experienced multiple physical and emotional effects. However, a few also reported an increase in self-mastery and self-worth. Conclusion: This study reveals that despite increasing urbanization and more women working outside the home, providing care to the elderly appears to be centered within the kinship circle. The research makes important contributions to the ageing literature in Pakistan with relevance to other South Asian contexts. [ABSTRACT FROM AUTHOR]