Zahid Ali Memon

Background Postpartum depression (PPD) is a major global health concern, particularly in low- and middle-income countries such as Pakistan, where prevalence ranges from 28%–63%. PPD affects maternal well-being and mother–child bonding. Perinatal mental health services are limited by stigma, cultural barriers, and a lack of care. Current approaches rely primarily on symptom-based screening and reactive treatment. Therefore, the study aims to develop and validate an AI-based model and digital application to identify pregnant women at risk of perinatal anxiety and PPD and to facilitate timely intervention. Methods This study adopts a three-phase translational research design to develop, validate, and implement an AI-enabled digital application, Sehatmand Maa (Healthy Mother), for early identification and management of PPD in Pakistan. Phase 1, a prospective longitudinal cohort already underway, will enroll 1,581 pregnant women from three Maternal and Child Health facilities in Karachi between April 2024 and December 2026. Participants will be assessed at four time points: two during the prenatal period (T 0 and T 1 ) and two during the postnatal period (T 3 and T 4 ), using clinical and psychosocial measures, including EPDS, PSAS, PSQI, and MSPSS. Phase 2, currently in progress, uses machine-learning algorithms, including CatBoost, to develop and validate separate predictive models for perinatal anxiety and PPD. Phase 3, not yet started, will integrate validated models into Sehatmand Maa and pilot the application across the three facilities to assess feasibility, usability, and integration into routine maternal healthcare. Expected Results The study will generate context-specific evidence on predictors of perinatal anxiety and PPD and establish validated AI-based models for early risk identification. The application is expected to support risk stratification, clinical decision-making, and timely referral of high-risk women. Pilot findings will inform refinement before broader implementation, with the potential to provide a scalable, AI-enabled Tool for maternal mental health care in low-resource settings.

Background: Undernutrition remains a leading driver of child mortality and morbidity in low- and middle-income countries, yet surveillance and case management in Pakistan still rely largely on infrequent surveys and paper-based registers that cannot track nutritional status in real time. The private sector, where most Pakistani households seek care, has been largely excluded from nutrition programming. We describe the development and early implementation of Mazboot Bunyad, a digital nutrition registry embedded within an integrated nutrition–immunization programme at private provider clinics in high-risk, low-income settlements of Karachi. Methods: The Android application and web dashboard used in this implementation study were designed through a participatory process using the AHEAD framework, in consultation with provincial health authorities, immunization staff, and community nutrition worker. The system used QR-linked child records, an embedded digital decision-support system that classified children by mid-upper arm circumference and has automated follow-up reminders. The tool was deployed across 33 clinics, and routinely collected programme data, a preliminary analysis of data from 1 July to 31 December 2024 were retrospectively reviewed. Results: During the period of 6 months, the Mazboot Bunyad application was used to screen and enroll 8,406 children aged 6–59 months. Field teams used the embedded Digital Decision Support System (DDSS) to classify children aged 6–59 months in real-time. Of these, 71.4% were classified as normal, 22.3% as moderately acutely malnourished (MAM), and 6.2% as severely acutely malnourished (SAM). The largest share of enrollments was among children aged 13–24 months (40.5%). Male children represented a slightly larger share of total enrollments (52.2%), but SAM burden was higher among females (7.3%) compared to males (5.3%). Supervisory teams used the dashboard to identify defaulters, monitor stock availability, and follow case recovery timelines. Conclusions: Early implementation of Mazboot Bunyad highlighted opportunities for enhanced nutritional surveillance using real-time tracking, but also challenges such as supply chain gaps that could affect the overall implementation. These offer valuable lessons for scaling digital tools in real world settings across Pakistan and other LMICs.

Objectives: This study aimed to identify research priorities for maternal and infant nutrition in the context of climate change in Sindh, Pakistan, using an eco-social framework to examine structural, environmental and gendered inequalities. Setting: The study was conducted from March to May 2024 in Sindh province of Pakistan. Survey respondents were drawn from across Sindh province, while the priority-setting workshop and a focus group discussion were conducted with both male and female participants in Karachi and Matiari District, respectively. Participants: In total, 127 participants were engaged, including community members, doctors, female health workers, nurses, nutritionists, climate experts, advocates and researchers from across Sindh province of Pakistan. Results: Among survey respondents, 89% expressed extreme or very high concern about the impact of climate change on maternal and infant nutritional health. Across the survey and workshop, ‘lack of awareness of proper nutrition’ emerged as the top nutritional priority, while ‘dehydration, weakness and exhaustion’ ranked highest among maternal health concerns. Infant health priorities differed slightly: survey respondents prioritised ‘heat exposure and low birth weight’, whereas workshop participants highlighted ‘heat waves and infant hospital admissions’. Participants also identified climate-resilient nutritional interventions and addressing the nutritional needs of pregnant women as critical research priorities. Focus group findings from Matiari District highlighted structural drivers of vulnerability, including flood-related displacement, disrupted agriculture, gendered labour burdens and limited social protection. Conclusion: Awareness and concerns about the increasing impacts of climate change and associated extreme weather events, including floods, extreme heat and changing weather patterns affecting food production, are increasing. However, understanding how these intersect with the everyday realities of affected people, places and communities remains significant for developing meaningful and equitable responses.

Purpose: This study explored how adolescent mothers in Pakistan experience the transition to motherhood and the mental health challenges that arise during this period. Methods: A focused ethnographic study was conducted with 25 adolescent mothers in Matiari, Sindh. Data were collected through semi‑structured interviews, participant observations, and artifact elicitation. Meleis’ Transition Theory informed the study focus and development of the interview guide. Reflexive thematic analysis guided interpretation, informed by an intersectional lens. Findings: Five themes described mothers’ experiences: early educational disruption and redirected aspirations; continuous caregiving with uneven support; barriers to maternal healthcare access; emotional distress and psychological strain; and identity transformation. These intersecting challenges contributed to significant mental health strain and highlighted persistent gaps in access to supportive, adolescent-responsive maternal care. Conclusions: Adolescent mothers navigate motherhood with substantial emotional and practical burdens yet demonstrate meaningful resilience. Findings highlight the need for adolescent‑responsive mental health support, accessible care, routine and confidential distress screening, referral pathways, and supportive educational and community‑based interventions tailored to underserved rural settings.

Pakistan has hosted Afghan refugees for more than four decades, in one of the world's most protracted displacements of people. Afghan refugees receive health services through United Nations High Commissioner for Refugees (UNHCR) and non‐governmental organisation (NGO) supported programmes alongside public sector facilities at every tier. They remain excluded from key national health protection programmes such as the Sehat Sahulat Programme. Understanding the system‐level enablers and barriers is essential for advancing equitable and sustainable healthcare for refugees and host populations. An exploratory qualitative case study was conducted using 30 key informant interviews and three participatory Group Model Building (GMB) workshops across Khyber Pakhtunkhwa, Sindh, and Islamabad Capital Territory. Data were thematically analysed using a Health System Resilience and Refugee Response Framework. Findings reveal a mixed picture of resilience and fragility. Refugees with Proof of Registration and Afghan Citizen Cards reported using primary care on a par with residents, while high reported immunisation coverage was widely perceived to have reduced polio risk among Afghan refugee children since around 2014, in line with national data showing a sharp decline in wild poliovirus cases over this period. While essential health services are being provided to refugees in the camps, they continue to face critical shortages, including frequent stock‐outs of medicines, limited diagnostic capacity, too few trained female healthcare providers, and fragmented referral pathways. Financing remains heavily donor‐dependent, with refugees excluded from the Sehat Sahulat Programme, the National Health Insurance programme. Governance challenges, including overlapping mandates, poor coordination, and a lack of refugee‐specific data, undermine efficiency and planning. Despite these challenges, community health workers and shared health initiatives fostered social cohesion and equitable treatment in public sector health facilities. Our study demonstrates that inclusive health services can be delivered in Pakistan at scale but cannot be sustained and scaled without broader health system strengthening reforms. The inclusive and resilient refugee health services require embedding refugee health into national strategies, ensuring predictable financing, stronger coordination mechanisms, and integrating refugee data into health management information systems. These findings offer lessons for other host countries managing protracted refugee crises that create substantial challenges for national health‐system financing, workforce, and service delivery.

BACKGROUND Digital health interventions (DHIs) are increasingly being integrated into immunization programs to address persistent challenges such as low vaccine coverage, poor schedule adherence, and rising vaccine hesitancy. However, the evidence on the effectiveness, implementation barriers, and stakeholder-specific outcomes of these interventions remains fragmented. This scoping review aimed to map the types of digital tools used in immunization programs globally, assess their impact on key outcomes coverage, adherence, knowledge, and hesitancy and identify common implementation barriers and enablers. OBJECTIVE This scoping review aimed to map the types of digital tools used in immunization programs globally, assess their impact on key outcomes coverage, adherence, knowledge, and hesitancy and identify common implementation barriers and enablers. METHODS Following the Arksey and O’Malley framework, refined by Levac et al., and guided by the Joanna Briggs Institute (JBI) and PRISMA-ScR guidelines, we conducted a comprehensive literature search across seven electronic databases and grey literature sources covering studies published from January 2005 to March 2025. Eligibility criteria included studies focusing on digital health interventions for immunization across all populations and settings, published in English, including randomized controlled trials, quasi-experimental, mixed-methods studies, and systematic reviews. Eligible studies included randomized controlled trials, quasi-experimental studies, mixed-methods designs, and systematic reviews. Study selection was conducted through title/abstract and full-text screening. Data were charted by digital tool type, stakeholder group, immunization domain, outcomes, and implementation context, using a standardized data charting form RESULTS Fifty-three studies met the inclusion criteria. SMS reminders were the most frequently used and consistently effective tools, especially in low- and middle-income countries (LMICs), showing improvements in vaccine uptake and schedule adherence. Electronic Immunization Registries (EIRs), AI chatbots, gamified applications, and decision aids demonstrated varied impact on data quality, knowledge, and vaccine confidence. Implementation success was supported by health system integration, localized messaging, and community trust, while barriers included low digital literacy, infrastructure gaps, and mistrust. CONCLUSIONS Digital tools hold significant promise for enhancing immunization programs, particularly when tailored to local contexts and integrated into existing health systems. Further research should prioritize cost-effectiveness, equity, and long-term impact. These findings provide a comprehensive mapping of existing evidence to inform policy, practice, and future research in digital immunization strategies CLINICALTRIAL -

Family planning (FP) is a critical component of reproductive health, enabling individuals to plan the number and timing of children through various contraceptive methods. We outline the conceptual framework and country case study methodology used by the Exemplars in Family Planning (EFP) project. This was based on the wider Exemplars in Global Health programme, which uses mixed-methods to examine determinants of FP progress in countries that exceed expectations for health outcomes. The EFP project integrates findings from case studies on six such countries, including quantitative analyses of trends and drivers of modern contraceptive prevalence, systematic reviews, policy, programme and financing assessments, and qualitative data collection with policymakers, providers and community actors. Data triangulation across these methods, complemented by consortium input and country workshops, enabled robust validation of findings and identification of cross-cutting themes. This approach produced a nuanced understanding of FP progress by capturing interactions between government programmes (demand and supply), service delivery mechanisms, subnational contexts and individual determinants. Quantitative decomposition and trend analyses quantified the contributions of population characteristics, behavioural factors and interventions, while qualitative and stakeholder data contextualised these findings within local sociocultural, health system and policy environments. This multicountry, mixed-methods analysis led by local researchers and supported by a global consortium enhanced methodological rigour, contextualised findings and enabled cross-country learning on FP progress. It identified key cross-cutting drivers and offers evidence-informed guidance to improve contraceptive uptake and demand satisified, while highlighting the need for context-specific interventions and further longitudinal, multicountry research.

Introduction: Expanding access to voluntary family planning is a global health priority, yet progress has been uneven across low-income and middle-income countries. Despite being a fragile state with historically high fertility and limited health resources, Sierra Leone has achieved one of the fastest increases in modern contraceptive prevalence in sub-Saharan Africa. This study explores the drivers of this progress through a mixed-methods case study. Methods: We analysed national-level data from urban and rural settings, and engaged diverse stakeholders including family planning professionals, healthcare providers, community leaders and service users. Quantitative data were drawn from Demographic and Health Surveys (DHS 2008, 2013 and 2019), and United Nations (UN) Population Division estimates (1990–2022). Qualitative insights were obtained through 33 key informant interviews and 12 focus group discussions. A systematic review of peer-reviewed articles, policies and programme documents was conducted to assess the broader implementation context. Results: Between 2008 and 2019, modern contraceptive prevalence among women aged 15–49 rose from 8.2% to 23.9% (+15.7 percentage points). Among married women, gains were larger in those aged 15–24 years (+12.6) than in women aged 25–49 years (+10.0). Unmarried women maintained substantially higher use, with gains of +19.5 and +16.9 points, respectively. Key drivers included expanded knowledge, higher education, delayed marriage and outreach by fieldworkers. Political commitment—particularly integration into the Free Health Care Initiative (FHCI)—together with women’s empowerment policies, donor and non-governmental organisation (NGO) support, media and community engagement improved access, awareness and autonomy. Conclusions: Sierra Leone’s progress demonstrates the importance of holistic approaches combining political commitment, external financing, cross-sector partnerships and community engagement. Government leadership was most evident in integrating family planning into the Free Health Care Initiative, while educational and gender-sensitive strategies proved particularly effective. These drivers consolidated gains and offer lessons for fragile, high-fertility settings.

Introduction: While many countries achieved notable gains in contraceptive use levels after the 1994 International Conference on Population and Development which redefined family planning (FP) as a human right, there was a long period of 15 years when contraceptive use levels did not receive due attention. It was only later that its subsequent inclusion in the Sustainable Development Goals and the 2012 London Summit on FP renewed global commitment and a focus towards FP. This paper aims to select countries that identify as ‘exemplar’ low-middle-income countries that have achieved exceptional progress in FP. Examining these outliers can uncover actionable drivers of success to accelerate progress in other countries that have not achieved as much success and are still experiencing stagnation in contraceptive prevalence rates. Methods: We selected exemplar countries based on exceptional performance across the outcome indicators of modern contraceptive prevalence and demand satisfied for modern methods, using a recent time frame post 2000 when focus on improving FP returned to the field. A selection approach was applied across various time periods to assess change in modern contraceptive prevalence rates (mCPR) and demand satisfied as the dependent variables. The Human Development Index for 2015 was used as a predictor of contraceptive use on a pooled sample of 130 countries. Results: The countries, defined by our criteria of residuals falling much higher than expected levels of predicted mCPR at a high level of significance, fell in the African continent. The countries selected in the first round were Senegal, Malawi, Kenya based on deviation from the predicted pattern at 5% significance level. In the second round, Sierra Leone from the African region, Lao People's Democratic Republic from Asia and Bolivia from Latin America, were added, on relaxing the level of significance, but still using the same approach. This was to have comparators in different regions. Conclusions: Our methodology, using a time lag analysis to build in an element of causation, offers a novel approach to selecting exemplar countries in family planning, based on the Human Development Index as a control metric.

Background: Senegal has made significant progress in family planning (FP), with the modern contraceptive prevalence rate (mCPR) increasing from 12% in 2010 to 26% in 2023, along with a sharp decline in unmet need. Once among West Africa’s lowest performers, Senegal now stands out for its advancements in FP access and equity. Objectives: This study examines the main factors driving Senegal’s FP progress—including policy leadership, financing mechanisms and community engagement—while identifying ongoing challenges and lessons for policy and practice. Methods: We employed a mixed-methods approach, combining trend and decomposition analyses with a review of FP policies, financing and programmes, guided by the WHO’s health system building blocks. Qualitative data were collected from interviews and focus groups with policymakers, providers, community leaders and users across various regions. Results: Senegal’s early gains in FP were driven by strong political leadership, task-shifting, community-based service delivery and supply chain improvements. Social mobilisation campaigns, including Moytou Nef and engagement with religious leaders and men, promoted supportive norms and increased demand. These efforts improved method availability, reduced stockouts and expanded access. Decomposition analysis identified FP knowledge (35%), education (18%) and facility access (16%), particularly among young women, as the main drivers of performance. Broader shifts in gender norms, women’s empowerment and male involvement also supported uptake. Since 2017, mCPR has plateaued, with persistent gaps among adolescents, unmarried women and rural populations due to stigma, provider bias, limited youth-friendly services and donor dependence. These findings highlight the need for targeted, equity-focused interventions to sustain and expand Senegal’s FP achievements. Conclusion: Senegal’s FP progress demonstrates how strategic governance, service innovation, and community engagement can increase contraceptive use. To sustain and build on these achievements, renewed investment is necessary in youth-focused services, domestic funding, and equity-centered strategies that are integral to larger health and development plans.