OBJECTIVE: Biomedical approaches want to change locals\' behaviors without understanding the sociocultural rationales and contextualizing the cultural and structural backdrop of women\'s agency.
OBJECTIVE: This study explored the perceptions and practices of rural mothers about fertility and reproductive health and further examine the lack of preference for contraception and birth spacing in Southern Pakistan.
METHODS: Using purposive sampling we recruited 15 healthcare providers and 20 mothers from Southern Punjab. Key informants and in-depth interviews were used for data collection. We extracted themes and sub themes to analyse qualitative data.
RESULTS: Five major themes identified preventing birth spacing and contraceptive use: (1) cultural barriers (2) economic difficulties and demographic factors; (3) gender-related hurdles; (4) spiritual and religious obstacles, and (5) medico-ethical complications. Nearly, ten sub-themes contributing to these major themes were: custom of girls\' early marriages, in-laws\' permission for contraception, women\'s concern for medical complications and preference for safer methods, misuse of contraceptive methods by the medical community, mothers\' perception of contraception as sinful act and controlling birth is against faith, economic and rural-ethnic factors for high fertility, masculine disapproval of condom use, and wishing to give birth to male children.
METHODS: We advocate for understanding the sociocultural explanations for low contraceptive use and urge practice of more natural methods of birth spacing over commercial solutions. The study suggests socio-economic development of less developed communities and empowerment of poor, illiterate, and rural women along with behavior change communication strategies.

UNASSIGNED: Congenital limb defects (CLD) have a range of phenotypes and can be a substantial cause of disability. The prevalence of CLD in the adult population of Pakistan is not well described.
UNASSIGNED: To investigate the prevalence of CLD and their associated factors in a married female population of the Rahim Yar Khan (RYK) District in Pakistan.
UNASSIGNED: A cross-sectional population-based study was conducted in 4 tehsils of RYK District, and married women and girls from 22 different localities were enrolled by convenience sampling in public places and through door-to-door visits. Data regarding limb phenotype and demographic variables were obtained from participants.
UNASSIGNED: We enrolled 2,204 married women and girls. We found 11 participants with CLD suggesting a prevalence of 4.99/1,000 (proportion: 0.005; 95% confidence interval [CI] <0.001-0.01). Polydactyly was the most frequent (n = 5; prevalence: 2.27/1,000), followed by others in the following sequence: brachydactyly (n = 4; prevalence: 1.81/1,000), camptodactyly (n = 1; prevalence: 0.45/1,000), and oligodactyly (n = 1; prevalence: 0.45/1,000). The odds of occurrence of CLD were higher in individuals originating from Khanpur tehsil (odds ratio [OR] 2.05; 95% CI 0.37-11.27), speaking languages other than Punjabi and Saraiki (OR 2.35; 95% CI 0.24-22.80), belonging to Araien caste (OR 2.35; 95% CI: 0.24-22.80), of a nuclear family (OR 3.35; 95% CI 0.79-16.97), or having parental consanguinity (OR 1.87; 95% CI 0.49-7.06).
UNASSIGNED: Preliminary estimate of CLD prevalence in the married female sample population in RYK appears high compared with estimates from birth defects registries in other countries.

UNASSIGNED: Gastroesophageal reflux disease (GERD) is a highly prevalent gastrointestinal disorder with modifiable risk factors and it is associated with considerable health and economic burden. The current study was conducted to assess the frequency and risk factors related to GERD in the previously unstudied population of Southern Punjab, Pakistan.
UNASSIGNED: A cross-sectional study was conducted for assessing the frequency and risk factors of GERD by using a self-administered questionnaire. The gastroesophageal reflux disease questionnaire (GerdQ) was utilized to detect the presence of the disease.
UNASSIGNED: The study included 308 participants; among them, 55.2% were female and 44.8% were male. The participants diagnosed with GERD (GerdQ score ≥8) were 26.6%. The various risk factors like higher BMI, past disease and smoking history, frequent use of NSAIDs, soft drinks, pickles, and spicy foods were significantly associated with GERD.
UNASSIGNED: The present study showed that GERD is prevalent in Southern Punjab and is associated with various modifiable risk factors. The ascendance of GERD can be prevented by public health education and awareness campaigns.

Understanding of frequency, severity, damages and adaptation costs of climate extremes is crucial to manage their aftermath. Evaluation of PRECIS RCM modelled data under IPCC scenarios in Southern Punjab reveals that monthly mean temperature is 30°C under A2 scenario, 2.4°C higher than A1B which is 27.6°C in defined time lapses. Monthly mean precipitation under A2 scenario ranges from 12 to 15mm and for A1B scenario it ranges from 15 to 19mm. Frequency modelling of floods and droughts via poisson distribution shows increasing trend in upcoming decades posing serious impacts on agriculture and livestock, food security, water resources, public health and economic status. Cumulative loss projected for frequent floods without adaptation will be in the range of USD 66.8-79.3 billion in time lapse of 40years from 2010 base case. Drought damage function @ 18% for A2 scenario and @ 13.5% for A1B scenario was calculated; drought losses on agriculture and livestock sectors were modelled. Cumulative loss projected for frequent droughts without adaptation under A2 scenario will be in the range of USD 7.5-8.5 billion while under A1B scenario it will be in the range of USD 3.5-4.2 billion for time lapse of 60years from base case 1998-2002. Severity analysis of extreme events shows that situation get worse if adaptations are not only included in the policy but also in the integrated development framework with required allocation of funds. This evaluation also highlights the result of cost benefit analysis, benefits of the adaptation options (mean & worst case) for floods and droughts in Southern Punjab. Additionally the research highlights the role of integrated extreme events impact assessment methodology in performing the vulnerability assessments and to support the adaptation decisions. This paper is an effort to highlight importance of bottom up approaches to deal with climate change.

BACKGROUND: Rahim Yar Khan (RYK) District is a multi-ethnic assemblage of both ancient and migrated communities in Southern Punjab, Pakistan. There is a paucity of knowledge on the bio-demographic structure of this endogamous population.
METHODS: We have carried out a cross-sectional epidemiological study in RYK District and recruited 2174 random Muslim married females. Detailed account of marital union types, level of consanguinity, and subject\'s fertility, was taken.
RESULTS: The analyses of these data revealed that consanguineous unions (CU) were 58.46 %, rendering an inbreeding coefficient (IC-F) = 0.0355. The CU were observed to be significantly higher in subjects originating from rural areas, speaking Saraiki language, illiterate or having a religious/Madarsa education only, and belonging to nuclear family type. The rate of consanguinity was also higher in subjects whose husbands were engaged in unskilled manual or skilled manual jobs, and had consanguinity in the parental generation. Multivariate logistic regression analyses revealed that variables like Saraiki language, illiteracy, reciprocal marriages, and parental consanguinity, were the significant predictors of CU in the subject. Among the first cousin unions (which constituted 52 % of all marriages), parallel-cousin and patrilineal unions were in the majority (54 and 57 %, respectively), and father\'s brother\'s daughter type had the highest representation (31 %). The analyses further demonstrated that fertility and mean live-births were significantly higher in women who had CU compared to the non-consanguineous (NCU) group (p < 0.006); and significantly higher number of sons per women were born to the mothers who had CU compared with the NCU sample (p = 0.0002). However, there were no differences in the CU and NCU samples with respect to pre- or post-natal mortalities and child morbidities.
CONCLUSIONS: The scientific findings in RYK District are distinct from the observations in other Pakistani populations and clue to a unique nature of this population. This study presents a comprehensive account of consanguinity and IC-F in RYK District and would be helpful in getting an insight into the structure of this population.

BACKGROUND: Indigenous plants have played a key role in the treatment of human diseases. This study was aimed to report the indigenous medicinal plants from Bahawalnagar district of Southern Punjab, Pakistan to document the important medicinal plants and herbal preparations.
METHODS: Rapid appraisal approach (RAA) involved direct interaction with local people and observations during the field visits; was used to collect data during March to June and August to December 2012.
CONCLUSIONS: A total of 63 plants were reported to be effective for ailments treatment in the local healthcare system of the study area, belonging to 56 genera and 34 families. Among families Fabaceae was the predominant by contributing 09 species.
CONCLUSIONS: Plants knowledge is not uniformly distributed among the 488 informants interviewed by mean of questionnaire.

BACKGROUND: Cancer pattern varies in different regions and depends on race, lifestyle and diet. There is a lack of definitive information regarding hospital-based cancer profile in Southern Punjab, which is a cotton growing area. Excess of toxins in the macro-environment is thought to be the reason for the high incidence of cancer in this area.
OBJECTIVE: To generate data on the magnitude and pattern of cancer cases reporting in the medical college hospital and to plan activities for prevention of cancer in the field practice area.
METHODS: A five year record-based retrospective study from 1(st)January 2007 to 31(st)December 2011.
METHODS: All cancer cases who reported either for diagnosis or for treatment (radiotherapy/chemotherapy/surgery) were included in the study. These confirmed cases of cancer were classified according to the International classification of Disease (ICD-10) given by WHO.
METHODS: Descriptive statistics, percentages.
RESULTS: Out of a total of 1328 cancer cases, females accounted for 809 (60.9%) and males for 519 (39.1%) cases. Male to female ratio was 1:1.55. The maximum number of patients were seen in 35-64 yr age group (63.5%). Top five leading sites of cancer in males were lung (9.6%), myeloid leukemia (8.3%), prostate (6.8%), mouth (6.1%) and gall bladder (6.0%); and in females were breast (35.7%), cervix (19.1%), esophagus (5.1%), myeloid leukemia (4.7%) and gall bladder (3.9%). Our figures have been compared with the national data from NCRP.
CONCLUSIONS: Population-based epidemiological studies are required to find out the disease burden & its cause in this region.