Are Countries of the Eastern Mediterranean Region on Track towards Meeting the World Health Assembly Target for Anemia? A Review of Evidence.

Anemia is a multifactorial condition, with a complex etiology that involves nutritional and non-nutritional factors. The misconception that iron deficiency is equivalent to anemia may mask the need to address other potential causative factors. This review paper aims to (1) assess the burden of anemia vs. iron deficiency anemia (IDA) amongst women of reproductive age (WRA), pregnant women (PW), and children under five years old (underfive children, U5C) in the Eastern Mediterranean region (EMR); (2) evaluate trends in anemia prevalence and whether countries are on track towards meeting the World Health Assembly (WHA) target for 2025; and (3) characterize anemia reduction efforts and provide a road map for future programs. A search of pertinent literature and databases was conducted. Anemia prevalence in the EMR ranged between 22.6% and 63% amongst PW, 27% and 69.6% amongst WRA, and 23.8% and 83.5% amongst U5C. Data showed that the EMR is not on course towards meeting the WHA target. The contribution of IDA to anemia was found to be less than half. Other potential contributors to anemia in the region were identified, including micronutrient deficiencies, parasitic infestations, and poor sanitation. A framework of action was proposed as a roadmap to meet the targets set by the WHA.

Trans-Fatty Acid (TFA) elimination in Pakistan: A situational analysis.

Recent research studies have highlighted that the consumption of industrially produced trans-fatty acids (TFAs) causes detrimental effects on human health. The World Health Organization (WHO) has recommended the elimination of TFA from diets to reduce the risk of non-communicable diseases (NCDs). In this paper, we use WHO's REPLACE framework for a situation analysis of TFAs in Pakistan's context by reviewing the literature on its dietary and industrial sources along with the legislative and regulatory context surrounding TFA related affairs in Pakistan. To maintain the authenticity of the data and the various actions implemented in Pakistan, we interviewed government officials, experts and researchers engaged in this field. By combining this information with a review of effective policies and best practices applied for TFA elimination around the world, we have prepared recommendations for policymakers in the country. The primary dietary sources of TFA in Pakistan are vanaspati ghee (partially hydrogenated vegetable oil), kinds of margarine, bakery shortenings and fat spreads. Whereas, their main producers are the edible oil, margarine, bakery and confectionary industries. Federal and provincial governments have introduced TFA regulations, but these vary across jurisdictions, complicating enforcement. Lack of credible penalties for violation of regulations, low public awareness and capacity and data gaps among regulators also inhibit TFA elimination. We recommend multi-stakeholder efforts for harmonization of mandatory TFA limits and labeling, replacement of traditional vanaspati ghee, communication efforts for behavioral change, promotion of replacement oils and strengthening regulators' assessment capacities.

Understanding the complexities of prevalence of trans fat and its control in food supply in Pakistan.

Pakistan is among the nations with a high intake of trans-fatty acids (TFAs), a major dietary risk factor of noncommunicable diseases (NCDs). Efforts are underway in the country to eliminate industrially produced TFAs from the food supply in keeping with the priority targets of the World Health Organization (WHO) for 2019-2023. We reviewed the TFA content reported in industrially produced foods and discuss the regulatory landscape for TFAs, to facilitate the required policy changes in Pakistan and ultimately eliminate the TFA burden from industrial food products. The study components include review of published research and product labels as well as review of prevailing food regulations for TFA-related information. A set of recommendations was also prepared to eliminate TFAs from Pakistan after national consultation workshops conducted in year 2019. Vanaspati ghee (partially hydrogenated vegetable oil), bakery shortening, hard margarines, and fat spreads are identified as the major sources of TFAs. Federal and provincial food authorities have recently established the limits for TFAs in few products; however, the TFA regulations are insufficient and not in line with global best practices. This study informs a comprehensive national strategy for TFA elimination based on knowledge of TFA prevalence associated regulatory control. We recommend to (1) promote actions toward replacement of traditional vanaspati ghee/bakery fats with healthier alternatives; (2) develop and implement best regulatory practices in line with WHO recommendations; and (3) amend food labeling laws so that clear information will be provided to inform consumers healthy food choices.

Community management of acute malnutrition (CMAM) programme in Pakistan effectively treats children with uncomplicated severe wasting.

Severe wasting is the most widespread form of severe acute malnutrition, affecting an estimated 17 million children globally. This analysis assesses the effectiveness of Pakistan's community management of acute malnutrition (CMAM) programme. We conducted a retrospective case series analysis of 32,458 children aged 6-59 months who were admitted to the programme with a mid-upper arm circumference (MUAC) < 115 mm (January 1-December 31, 2014). We found that at admission, 59.6% of the children were girls and 87.4% were in the age group 6-23 months old. While in the programme, 120 children (0.4%) died, 3,456 (10.6%) defaulted, and 28,882 (89.0%) were discharged after a mean length of stay of 69.3 ± 25.7 days. Children's mean weight gain while in the programme was 3.2 ± 2.7 g/kg body weight/day. At discharge, 28,499 children (98.7% of discharged) had recovered (MUAC ≥ 125 mm). The odds of death were significantly higher among children with weight-for-height (WHZ) < -3 and/or height-for-age (HAZ) < -2 at admission. The odds of recovery on the basis of MUAC ≥125 mm were higher among children with HAZ ≥ -2 at admission. The odds of recovery on the basis of WHZ ≥ -2 were significantly higher among children with WHZ ≥ -3 and/or HAZ < -2 at admission. Pakistan's CMAM programme is effective in achieving good survival and recovery rates. Population-level impact could be increased by giving priority to children 6-23 months old and children with multiple anthropometric failure and by scaling up CMAM in the provinces and areas where the risk, prevalence, and/or burden of severe acute malnutrition is highest.

Determinants of contraceptives use amongst youth: an exploratory study with family planning service providers in Karachi Pakistan.

INTRODUCTION: In Pakistan, Contraceptive Prevalence Rate (CPR) among married female youth is 17.4% and even lower in rural and slum areas leading to rapid population growth on one hand and poor health consequences on the other. The study was conducted to explore family planning service providers' perceptions regarding use of different contraceptive methods and to identify factors that are influencing their use amongst currently married youth aged 18-24 years in slum areas of Karachi. METHOD: Qualitative exploratory study design was adopted and a total of ten in-depth interviews were conducted with family planning service providers of the area. For content analysis coding of transcribed interviews was done and then categories were made and furthermore themes were derived. RESULTS: Our findings revealed that family planning service providers perceived that there is low use of contraceptive methods amongst youth of study area and low usage could be due to side effects; myths and misconceptions; lack of proper knowledge about different contraceptives; unmet needs of contraceptives; socio-cultural and religious factors about different contraceptive methods and family planning service providers own biases against or for use of contraceptive methods amongst youth in the study area. However better education of youth and family planning service providers' improved knowledge about counseling and use of contraceptive methods was perceived to be associated with improved use of family planning methods amongst youth of the study area. CONCLUSION: Exaggerated side effects and socio-cultural factors could be important influences leading to low use of family planning methods amongst youth of Karachi. Some policy initiatives are the training of lady health Workers, lady health visitors, physicians and staff of the pharmacies for counseling youth in the correct use of family planning methods.

Myths and fallacies about male contraceptive methods: a qualitative study amongst married youth in slums of Karachi, Pakistan.

Pakistan presently has one of the largest cohorts of young people in its history, with around 36 million people between the ages of 15 and 24 years. One of the main reasons for high population growth in Pakistan is almost stagnant contraceptive prevalence rate of 30% nationally and 17.4% amongst youth. The study was conducted to explore the perceptions regarding myths and fallacies related to male contraceptive methods among married youth aged 18-24 year in Karachi, Pakistan. Qualitative exploratory study design was adopted and a total of eight Focus Group Discussions (FGDs) were conducted. Study was conducted in two Union Councils of Korangi Town in the squatter settlement of Karachi, Pakistan from July to September 2010. Thematic analysis was done manually. General, physical, sexual, psychological, socio-cultural and religious were the common categories which lead to myths and fallacies related to condoms use and vasectomy among the married youth. The foremost myth amongst male and female youth was that use of both condoms and vasectomy cause impotence in males. Additionally, condoms were thought to cause infections, backache and headache in males. Some youth of the area think that vasectomy is meant for prisoners only. In conclusion our findings suggest that the potential reasons behind low use of male contraceptive methods among youth of squatter settlement of Karachi were myths and fallacies about male contraceptive methods. There are some important policy implications like counseling of the couple through peers and well trained family planning service providers to address these myths and misconceptions from the minds of youth.

Parallel NGO networks for HIV control: risks and opportunities for NGO contracting.

Policy measures for preventive and promotive services are increasingly reliant on contracting of NGOs. Contracting is a neo-liberal response relying on open market competition for service delivery tenders. In contracting of health services a common assumption is a monolithic NGO market. A case study of HIV control in Pakistan shows that in reality the NGO market comprises of parallel NGO networks having widely different service packages, approaches and agendas. These parallel networks had evolved over time due to vertical policy agendas. Contracting of NGOs for provision of HIV services was faced with uneven capacities and turf rivalries across both NGO networks. At the same time contracting helped NGO providers belonging to different clusters to move towards standardized service delivery for HIV prevention. Market based measures such as contracting need to be accompanied with wider policy measures that facilitate in bringing NGOs groups to a shared understanding of health issues and responses.