Effect of diabetic counseling based on conversation map as compared to routine counseling on diabetes management self-efficacy and diabetic distress among patients with diabetes in Pakistan: a randomized controlled trial (study protocol).

BACKGROUND: Novel interactive and pictorial health education tool named Diabetes Conversation Map (DCM) might be effective for the improvement of diabetes management self-efficacy (DMSE) and diabetes distress (DD) among diabetic patients in lower middle-income setting. This study protocol will assess the effectiveness of DCM as compared to routine care (RC) to improve DMSE, decrease DD and glycated hemoglobin (HbA1c) among patients with type 2 diabetes (T2DM). METHODS: This will be two arms randomized controlled trial, conducted at national institute of diabetes and endocrinology (NIDE) in Karachi, Pakistan. A sample of 120 T2DM patients of age 30-60 years with suboptimal diabetes control will be screened through eligibility criteria and DD screening tool. Patients who fulfill the eligibility criteria and have diabetes distress will be randomized into interventional and control arm. The intervention arm will receive four education sessions (40 min each) using DCM for 4 weeks duration of enrollment. Controlled arm will receive RC. DMSE and DD will be measured using the validated Likert tools at baseline and after 3 months of enrollment. Latest results of HbA1c will be retrieved from the respective medical record files at baseline and 3 months. Change in DMSE, DD scores and HbA1c levels within groups (pre-post) and between the groups after 3 months of enrollment will be compared. Multivariable linear regression will be conducted to adjust for any potential confounders. DISCUSSION: In a study in UK, 70% of the patients with diabetes reported DCM had helped them in controlling their diabetes and recommended this method to teach other patients with diabetes also. In China, a study found that patients with diabetes who received DCM based education had significantly lower DD and significantly higher diabetes empowerment score after six months of the intervention as compared to the traditional counselling. A cross sectional study conducted in Pakistan also demonstrated that teaching based on DCM was useful in improving the knowledge, attitude and practices of patients with T2DM. Besides, no other study has evaluated the effectiveness of these novel tools for DMSE and diabetes distress DD in well-designed, sufficiently powered clinical trials. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03747471 . Date of registration: Nov 20. 2018. Version and Date of Protocol: Version 1, IRB Approval date 28 June 2018.

Enhancing Smallholder Access to Agricultural Machinery Services: Lessons from Bangladesh.

Resource poor smallholders in developing countries often lack access to capital goods such as farm machinery. Enabling adequate access through machinery services can thereby significantly contribute to food security and farm incomes. At the core of the service provision model is the lead farmer, who makes the initial investment in agricultural machinery, and provides services to others on a fee-for-service basis. Profiling the lead farmers can thereby provide important lessons and scaling implications. The present paper provides a case study of Bangladesh, using primary data to characterise the lead farmers. General education, credit availability and risk taking attitude play significant roles in whether or not a farm household will be a lead farmer in Bangladesh.

Adoption and Impact of the Maize Hybrid on the Livelihood of the Maize Growers: Some Policy Insights from Pakistan.

Despite hybrids being grown on 30-40 percent of the maize area in Pakistan, the retail price of hybrid maize seed is high in Pakistan compared with its neighbors in South Asia and beyond. Hence, this paper analyzes the adoption and impact of hybrid maize on livelihoods using a cross-sectional dataset collected from 822 maize growers in Pakistan. The data were collected from two types of farmers: adopters and nonadopters of hybrid maize, from four major provinces of Pakistan (Punjab, Sindh, KPK, and Balochistan). We use the bivariate probit to analyze the factors influencing the adoption of hybrid maize and the propensity score-matching (PSM) approach to analyze the impact of hybrid maize adoption on livelihood of maize growers, as PSM helps correct sample selection biasedness. The empirical result shows that farm size, farm and household assets, the level of education of farmers, access to market, and social networks positively influence the adoption of hybrid maize in Pakistan. The results from PSM revealed that hybrid maize adopters had higher grain yields in the range of 94-124 kgs per hectare as compared with nonadopters. Similarly household income levels were more in the range of Pakistani rupees 2,176-3,518, while the poverty levels were lower in the range of 2-3 percent for hybrid maize adopters. As hybrid maize adoption has had a positive impact on the livelihood of farmers, policies should aim to scale up the adoption of hybrid maize through enhancing the supply and lowering the seed cost through research and subsidy programs, thereby enabling poor farmers in remote areas to adopt hybrid maize varieties.

Healthy Foods as Proxy for Functional Foods: Consumers' Awareness, Perception, and Demand for Natural Functional Foods in Pakistan.

Using comprehensive primary dataset collected from 400 respondents from all four major provinces of Pakistan, this study assesses consumers' knowledge, awareness, and perception regarding the use of functional foods. The empirical findings show that the majority of the consumers do not have information and knowledge about the functional foods in Pakistan. Hence, the frequency of consumption of functional food was low especially in rural areas. The result revealed that consumers with ill health were more eager to consume functional foods compared to healthier people. Besides health, the level of education and gender (female) of the respondent also play significant role in the acceptability and consumption of the functional foods in Pakistan. Geographically the people in the cities were more aware and willing to pay more for the functional foods as compared to people living in the villages. Majority of the consumers think that consumption of functional foods can help them to maintain good health, hence the policy makers' needs to create more awareness.

Farmers willingness to grow GM food and cash crops: empirical evidence from Pakistan.

Using data collected from 950 farmers in four provinces of Pakistan i.e. Punjab, Sindh, Khyber Pakhtunkhwa (KP) and Balochistan, the current paper analyzes the farmer's willingness to grow genetically modified (GM) food and cash crop. There exists a huge difference in farmers' perception about GM food and cash crops in Pakistan. In Pakistan, over 90 percent of the farmers were aware of the GM cash crop while only few farmers were aware of GM food crops and vegetables. Empirical results show that majority of the farmers were willing to grow GM cash crops but reluctant to grow the GM food crops and vegetables mainly due to the controversy surrounding the GM food crops. The econometric results illustrate the willingness to grow GM food and cash crop is higher among farm households with large land holdings, secured land rights, higher income levels and larger assets ownership. Result also reveals that farm household NGOs membership negatively affects the willingness of the farmers to grow GM food and cash crops. The access to credit and agricultural extension services do not affect farmer's willingness to grow GM food and cash crops in Pakistan.

Impact of climate-change risk-coping strategies on livestock productivity and household welfare: empirical evidence from Pakistan.

Using the primary datasets collected from 700 livestock farmers from all four major provinces of Pakistan and Azad Jammu and Kashmir (AJK) and Gilgit Baltistan, this paper analyzes the impact of climate-change risk coping strategies on household welfare. A Poisson regression model was used to estimate the determinants of the livestock ownership and multivariate probit model to assess the determinants of the measures taken to manage the climatic-risk challenge for livestock. A propensity score matching approach (PSM) was used to assess the impact of the adopted climate-risk management strategies on livestock farmers. Findings indicated that in Pakistan livestock farmers generally adopt four main types of strategies to cope with climate risk: livestock insurance, selling of livestock, allocation of more land area for fodder and migration. The results show that age, education, wealth, access to extension services, and membership in NGOs, influence the livestock farmers' choice of climate-risk-coping mechanisms. The livestock farmers who adopted risk-coping mechanisms generally fared better. Increasing the land area allocated to fodder seems to increase production of milk and butter, resulting in higher income and lower poverty levels. Those who bought insurance had more milk production and a lower poverty level, while those who sold livestock to cope with climate risk decreased production but increased household income and lowered poverty levels. Migration seems to have a negative impact on production and income. Impact assessments confirm that purchasing livestock insurance and increasing fodder areas are more effective compared to the selling of livestock and migration. Agricultural climate policy should focus on creating awareness as well as increasing access to extension services among livestock farmers on climate risk and risk-coping strategies to mitigate the impact on rural livelihoods.

Acceptability of GM foods among Pakistani consumers.

In Pakistan majority of the consumers do not have information about genetically modified (GM) foods. In developing countries particularly in Pakistan few studies have focused on consumers' acceptability about GM foods. Using comprehensive primary dataset collected from 320 consumers in 2013 from Pakistan, this study analyzes the determinants of consumers' acceptability of GM foods. The data was analyzed by employing the bivariate probit model and censored least absolute deviation (CLAD) models. The empirical results indicated that urban consumers are more aware of GM foods compared to rural consumers. The acceptance of GM foods was more among females' consumers as compared to male consumers. In addition, the older consumers were more willing to accept GM food compared to young consumers. The acceptability of GM foods was also higher among wealthier households. Low price is the key factor leading to the acceptability of GM foods. The acceptability of the GM foods also reduces the risks among Pakistani consumers.

Impact of gender participation in non-farming activities on household income and poverty levels in Pakistan.

BACKGROUND: In the rural areas of Pakistan, the majority of farm households have small landholdings of less than 2 hectares. Both male and females are engaged in farming and non-farming activities. However, in Pakistan the gender-wise participation in farming activities is not much documented. OBJECTIVES: The main objective of the current study is to estimate the impact of male and female participation in non-farming activities on a household's income level and poverty status in Pakistan. METHODS: The current study is based on a cross-sectional data set collected from 325 households through a purposive random sampling technique. A detailed comprehensive questionnaire was prepared for data collection. The data were analyzed by employing the propensity score matching approach. RESULTS: The empirical results indicate that both male and female participation in non-farming activities has a positive impact on household welfare in Pakistan by raising income levels and thus contributing to poverty reduction. However, the impact is greater when the males of a household take part in these activities rather than the females. CONCLUSIONS: In the past only a few studies have focused on gender-based participation in non-farming activities. The non-farming sector is an important one in rural areas, especially in developing countries like Pakistan. More opportunities need to be created for both men and women in rural areas of Pakistan to find off-farm work, in order to increase household income and reduce poverty levels.

Demographic and Clinicopathologic features of membranous glomerulonephritis.

OBJECTIVE: To determine the frequency of membranous glomerulonephritis(MGN) in the renal biopsy specimens. To observe the presenting features and the demographics to determine association, if any, between MGN and hepatitis B in these patients. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: The section of histopathology, The Aga Khan University Hospital, Karachi over a period of three years (May 1999-April 2002). SUBJECTS AND METHODS: All consecutive percutaneous renal biopsy specimens received during the study period were included. A total of 1590 renal biopsy specimens were evaluated. All cases where a definitive diagnosis of MGN (stage II to IV) was made on light and/or immunofluorescence studies were included in the results. Twenty-eight cases were excluded owing to inadequate material. Cases with a presumptive diagnosis and those in stage I of MGN were also excluded. Laboratory investigations carried out include urine examination, blood urea nitrogen. (BUN), serum creatinine, 24 hours urinary protein, Hepatitis B sAg, serological tests for hepatitis C virus, ANA, dsDNA, etc. Clinical features and results of laboratory analysis were recorded along with light microscopic features and statistical analysis was carried out. RESULTS: Out of 1562 renal biopsy specimens, 835(53.4%) cases showed primary glomerular pathology. 741(47.4% of the total) cases presented with nephrotic syndrome. Out of these in 176 cases (23.75%), findings were those of membranous glomerulonephritis followed by amyloidosis and focal segmental glomerulosclerosis. Among the cases with MGN, 23(13%) cases were those of secondary MGN whereas 87% were grouped under primary MGN. The male to female ratio was 2.2:1. Mean age at presentation was 29 years, median 29 years and a mode of 30 years. Nineteen cases (1.07%) were seen in children of 14 years old or less. CONCLUSION: The frequency of MGN was much higher in our study subjects as compared to most other regional studies. No significant association with hepatitis B was seen with only 4 out of 89 cases showing positivity for HBsAg. The pattern of disease corresponds more to that seen in the west.