Uncovering the rural-urban gap in determinants of infant mortality in Punjab-Pakistan.

OBJECTIVE: The main objective of this research is to observe the various socio-economic, demographic, health-seeking, and environmental factors influencing infant mortality and the rural-urban division in Punjab, Pakistan. METHODS: The study used the data of 38,405 households from the Multiple Indicator Cluster Survey that was conducted by the Bureau of Statistics Punjab during 2017-18. This survey assessed 125 indicators i.e., health, education, etc. created by UNICEF to assess the well-being of mothers and children in Punjab, Pakistan. RESULTS AND CONCLUSION: The mother, the child, and the family are the three main risk factors for infant death, according to our research in Pakistan. The socioeconomic position of the household, social practices, environment, and usage of medical services are the key factors that help in reducing infant death. Women's education, birth spacing, and household economic position all played a significant role in the decline in infant mortality. The health of infants born in rural Punjab is at risk due to a large rural-urban gap in the determinants of infant mortality. Uncovering and addressing this disparity has become a pressing health priority in Pakistan.

Pathway analysis of food security by employing climate change, water, and agriculture nexus in Pakistan: partial least square structural equation modeling.

Increasing population and augmented demand for food have put burden on water resources, crops, and livestock for future sustainability. Pakistan is facing difficulties of water shortage, low crops and livestock productivity, meagre livelihood, and intensive food insecurity. Hence, this study was conducted in Pakistan to explore the nexus of climate change, irrigation water, agriculture, rural livelihoods, and food security. The study is based on primary data of 1080 farmers gathered from 12 districts of the rice-wheat and cotton-wheat cropping systems. A partial least square structural equation modeling (PLS-SEM) was used to compute the nexus. Findings of path analysis indicated that climate change had a significant negative impact on irrigation water, crops, livestock, rural livelihood, and food security in both cropping systems. There was positive relationship between surface water and crops. In addition, groundwater and crops were also positively and significantly correlated. The impact of crop was positive and significant on rural livelihood and food security. Furthermore, rural livelihood and food security were positively and significantly influenced by livestock. Moreover, there was positive relationship between rural livelihood and food security. The cotton-wheat cropping system was more affected by climatic and natural hazards than rice-wheat cropping system. Interconnectivity among nexus components and their contribution to rural livelihood and food security indicate that government, policymakers, and other concerned stakeholders should effectively improve food security policies under climatic and natural hazards. Moreover, it helps in examining adverse impacts of hazards induced by climate change on nexus components, leading to the designing and adoption of sustainable climate change policies. The study's originality lies in its ability to provide a inclusive and integrated pathway of the interconnections and interdependencies among these variables, identifying key drivers of food insecurity in Pakistan. Moreover, outcome of the study has policy implications for developing sustainable policies and strategies to improve sustainable food security in the country.

Do farmers' risk perception, adaptation strategies, and their determinants benefit towards climate change? Implications for agriculture sector of Punjab, Pakistan.

Due to global and regional climatic dynamics for a couple of decades, agricultural productivity, rural livelihood, and food security have been badly affected in Pakistan. This study was conducted in Punjab, Pakistan, to explore the farmers' understanding of the impacts of climate change, adaptation strategies, determinants, and benefits on agriculture using data from 1080 respondents. Perceived risks by the farmers in the rice-wheat cropping system and the cotton-wheat cropping system were weed infestation, seed rate augmented, low-quality seeds, infestation of crop diseases and pests, change of cropping pattern, increase of input use, decrease of cropping intensity and productivity, decreasing soil fertility, increasing irrigation frequency, and increase of harvesting time. To alleviate the adverse influences of climate change, the adaptation strategies used by farmers were management of crop and variety, soil and irrigation water, diversification of agriculture production systems and livelihood sources, management of fertilizer and farm operations time, spatial adaptation, access to risk reduction measures and financial assets, adoption of new technologies, institutional support, and indigenous knowledge. Moreover, the results of Binary Logistic Regression indicate that adaptation strategies are affected by different factors like age, education, household family size, off-farm income, remittances, credit access, information on climatic and natural hazards, information on weather forecasting, land acreage, the experience of growing crops and rearing of livestock, tenancy status, tube well ownership, livestock inventory, access to market information, agricultural extension services, and distance from agricultural input/output market. There is a significant difference between adapters and nonadapters. The risk management system may be created to protect crops against failures caused by extreme weather events. There is a need to develop crop varieties that are both high yielding and resistant to climate change. Moreover, cropping patterns should be revised to combat the effects of climate change. To enhance farmers' standard of living, it is necessary to provide adequate extension services and a more significant number of investment facilities. These measures will assist farmers in maintaining their standard of living and food security over the long term to adapt to the effects of climate change based on various cropping zones.

An overview of diarrhea among infants and under-five in Punjab-Pakistan.

BACKGROUND: Diarrhea, pneumonia, malnutrition, tuberculosis, measles, and fever are the leading causes of mortality in children under five-years of age (0-59 months), whereas diarrhea alone is the world's second-biggest cause of mortality in this population. This study is particularly important for Pakistan as it focuses on one of the main causes of infant mortality, diarrhea, which is a major challenge for Pakistan to achieve the Sustainable Development Goals to reduce infant mortality to 12/1000 live births by 2030. AIM: This study was planned to investigate the various household, parental, environmental, and child-related factors causing diarrheal diseases in children aged 0-59 months in Punjab Pakistan. METHODS: The study used the data of 38,405 households from the Multiple Indicator Cluster Survey (MICS) 2017-18, directed by the Punjab Bureau of Statistics. Comprehensive descriptive statistics, i.e., cross-tabulations and logistic regression were used for the detailed analysis. FINDINGS: The results showed that infants are more probable to get diarrhea than older children. A wide range of influences were found to affect the probability of a child getting diarrhea, including child-specific, mother-specific and environment-specific ones. One prominent finding was that, at the mother level, the education of the mother played a significant role in reducing diarrhea among children under five-years of age (0-59 months). DISCUSSION: The results of the study contribute to the literature by highlighting that it is an interplay of factors that result in diarrhea. Hence, improving the source of drinking water, e.g., tap water and bottled water, can decrease the occurrence of diarrhea, especially in poor households. It was also revealed that households with a toilet facility of flush have less probability of their children being diagnosed with diarrhea than toilet facilities in open drains and fields. On the child level, results suggested that birth order matters as well, with the firstborn child having a lower probability of contracting diarrhea than siblings born after. APPLICATION TO PRACTICE: Interventions targeting infants and mothers of infants aimed at reducing diarrhea are expected to be very effective to reduce child mortality, one of the main child health challenges faced by Pakistan.

Modelling wellbeing of farmers by using nexus of climate change risk perception, adaptation strategies, and their drivers on irrigation water in Pakistan.

This study aimed to determine the farmers' perceived impact of climate change on irrigation water and the adaptation measure adopted to mitigate its adverse effects. A binary logistic regression model was used to identified factors affecting the selection of adaptation measures. Partial Least Square-Structural Equation Modelling (PLS-SEM) was employed to compute the benefits of adaptation strategies. The study was conducted in two major cropping systems, i.e., the Cotton Wheat Cropping System (CWCS) and Rice Wheat Cropping System (RWCS) of Punjab, Pakistan, using primary data of 1080 farmers collected through a multistage sampling technique. Due to climate change there was deterioration in surface water and groundwater quality in CWCS than in RWCS. The farmer uses different adaptation strategies like water harvesting, crop diversification, increasing use of irrigation, laser land leveling to save water, making ridges, building a water harvesting scheme, changing irrigation time, high-efficiency irrigation system and water-saving technologies. Adaptation strategies used by farmer were affected by different socioeconomic, demographic and agronomic factors. Results of the binary logistic regression showed that age, farming experience, education, household size, farm size, tenancy status of owner, access to farm credit, information on weather forecasting, soil quality, tube well ownership, remittances, off-farm income, agricultural extension services provided for irrigation water, and information on climatic and natural hazards played a significant role in the selection of adaptation strategies for irrigation water. Results of PLS-SEM showed that adaptation strategies mitigate the adverse effects of climate change on irrigation water. Farmers' awareness regarding the impact of climatic variability on irrigation water should be enhanced. Availability of credit to farmers should be improved on easy terms to facilitate the adoption of interventions for better irrigation water management. It is high time for policymakers to design effective, affordable, and workable policies to mitigate climate change vulnerabilities against irrigation water to improve the wellbeing of the farmers.

Health issues of internally displaced persons in Pakistan: preparation for disasters in future.

Army action against terrorism in Pakistan led to the largest human migration in this century. About 3.4 million people (internally displaced persons, IDPs) were displaced. The authors visited all major camps and some houses in Mardan area and interviewed IDPs and doctors at these camps and areas to identify medical needs and current state of provision of medical care. This disaster largely represented displacement of millions of people (IDPs) including women and children to a new weather and environment in overcrowded refugee camps and houses. Influx of large number of displaced people created excessive burden for already deprived local health services. The medical issues and requirements for these IDPs living in camps were totally different from a disaster like earthquake. Global response to this disaster was slow and less effective. The need for a WHO coordination center for creating quick and urgent response for such kind of disasters in future is emphasized in this article.