Rabia Zuberi

Background: Anemia is a major public health issue, particularly among women of reproductive age (WRA) in low- and middle-income countries (LMICs). Pakistan’s National Nutrition Survey (NNS) 2011 showed a high prevalence of vitamin B₁₂ (B₁₂) and folate deficiency among WRA, necessitating further investigation in subsequent surveys. Methods: Blood samples from 31,828 WRA (15–49 years old) were collected using a stratified multi-stage sampling technique in NNS-2018. We conducted a secondary analysis using population-weighted logistic regression to assess the association of potential factors with B₁₂ and folate deficiency. B₁₂ (n = 4442) and folate (n = 12,662) samples were measured using an electrochemiluminescence immunoassay and a Centers for Disease Control and Prevention, USA (CDC)-approved microbiologic assay, respectively. Results: Folate deficiency was present in 44.7% WRA, and 20.2% had B₁₂ deficiency. Provincial distribution was associated with folate deficiency, i.e., Sindh (OR = 1.140, 95% CI 1.018, 1.285), Baluchistan (OR = 1.237, 95% CI 1.052, 1.453), and Islamabad (OR = 1.524, 95% CI 1.109, 2.092), while B₁₂ deficiency was prevalent in Islamabad (OR = 1.673, 95% CI 1.122, 2.497), Gilgit Baltistan (OR = 2.472, 95% CI 1.197, 5.106), and newly merged districts of KPK (OR = 1.584, 95% CI 0.977, 2.570). Rural residence (OR = 1.407, 95% CI 1.125, 1.760), obesity (OR = 1.649, 95% CI 1.282, 2.122), and overweight (OR = 1.560, 95% CI 1.262, 1.928) were associated with B₁₂ deficiency. Conclusions: Our results show regional and demographic differences in the prevalence of folate and B₁₂ deficiencies among WRA. This underscores the need for targeted nutritional interventions and further longitudinal studies to identify potentially associated factors.

Background According to the World Health Organization (WHO), worldwide anemia prevalence in children of 6–59 months is 40% [1]. Though iron deficiency is recognized as a significant cause of anemia, vitamin B₁₂ (B₁₂) and folate deficiencies are also important causes. The previous Pakistan National Nutrition Survey (NNS) 2011 showed a high prevalence among women of reproductive age (WRA), which necessitated further investigation in follow-up surveys among children. Methods We performed a secondary analysis of the National Nutrition Survey (NNS) 2018–2019. Blood samples were obtained from 31,828 children (< 5 years), with a subsample analyzed for B₁₂ (n=2693) and folate (n=6690) deficiency. B₁₂ was assessed by electrochemiluminescence immunoassay, and folate by CDC’s microbiologic assay. Logistic regressions were applied to determine factors associated with deficiency. Results 35.1%, while 24.8% of children showed folate and B₁₂ deficiency, respectively. Higher odds of folate and B₁₂ deficiency were observed in Khyber Pakhtunkhwa, OR = 1.424 (95% CI 1.157, 1.752), and newly merged districts of Khyber Pakhtunkhwa, OR = 11.257 (95% CI 2.291, 55.314), respectively. Additionally, mother’s education was associated with B₁₂ deficiency i.e. uneducated OR = 2.017, (95% CI 1.229, 3.308), primary OR = 2.361 (95% CI 1.359, 4.103) and middle OR = 2.108 (95% CI 1.144, 3.882) while underweight was associated with folate deficiency only, OR = 1.181 (95% CI 1.016, 1.371). Conclusion This analysis highlights a considerable burden of folate (35.1%) and vitamin B₁₂ (24.8%) deficiencies among Pakistani children under five years of age, with regional disparities. Socioeconomic and nutritional factors, particularly maternal education and child undernutrition, further influence the risk of deficiency. These results emphasize the need for region-specific nutrition interventions, maternal education programs, and strengthened food fortification strategies.

Background: Anemia is a severe public health issue, particularly among women of reproductive age (WRA) in low-and middle-income countries. Pakistan National Nutrition Survey (NNS) 2011 showed a high prevalence of B12 and folate deficiency in WRA, necessitating further investigation in follow-up surveys. Methods: Using a stratified multi-stage sampling technique, we conducted a secondary analysis of the National Nutrition Survey (NNS) 2018–2019. Blood samples were collected from 31,828 WRA (15–49 years old), and a subsample was examined for folate (n=12662) and B12 deficiencies (n=4442). B12 and folate levels were measured using Electrochemiluminescence immunoassay and a CDC-approved microbiologic assay, respectively. The association of factors was analyzed using logistic regression. Results: 44.7% and 20.2% WRA had folate and B12 deficiency, respectively. Provincial distribution was associated with folate deficiency i.e., Sindh OR=1.140 (95% CI 1.018, 1.285), Baluchistan OR = 1.237 (95% CI 1.052, 1.453), Islamabad OR = 1.524 (95% CI 1.109, 2.092). In comparison, B12 deficiency was prevalent in Islamabad, OR = 1.673 (95% CI 1.122, 2.497), Gilgit Baltistan, OR = 2.472 (95% CI 1.197, 5.106), and the tribal districts of KPK, OR = 1.584 (95% CI 0.977, 2.570). Rural residence OR=1.407 (95% CI 1.125, 1.760), being obese OR=1.649 (95% CI 1.282, 2.122), and being overweight OR=1.560 (95% CI 1.262, 1.928) were also associated with B12 deficiency. Conclusion: Study revealed that nearly half of women were affected by folate deficiency and one in five by B12 deficiency. The findings highlight significant regional disparities and stronger vulnerability among women in rural areas and those with higher body mass indices. These results emphasize the need for targeted nutritional interventions, improved dietary diversity, and public health strategies.

Understanding factors associated with protective immunity against emerging viral infections is crucial for global health. Pakistan reported its first COVID-19 case on 26 February 2020, but experienced relatively low COVID-19-related morbidity and mortality between 2020 and 2022. The underlying reasons for this remain unclear, and our research aims to shed light on this crucial issue. We conducted a serial population-based serosurvey over 16 months (rounds 1-4, July 2020 to November 2021) across households in urban (Karachi) and rural (Matiari) Sindh, sampling 1100 households and 3900 individuals. We measured antibodies in sera and tested a subset of respiratory samples for COVID-19 using polymerase chain reaction (PCR) and antigen tests, also measuring haemoglobin (Hb), C-reactive protein (CRP), vitamin D, and zinc in round 1. Participants showed 23% (95% confidence interval (CI) = 21.9-24.5) antibody seroprevalence in round 1, increasing across rounds 2-4 to 29% (95% CI = 27.4-30.6), 49% (95% CI = 47.2-50.9), and 79% (95% CI = 77.4-80.8), respectively. Urban residents had 2.6 times (95% CI = 1.9-3.6) higher odds of seropositivity than rural residents. Seropositivity did not differ between genders. Individuals aged 20-49 years had 7.5 (95% CI = 4.6-12.4) times higher odds of seropositivity compared to children aged 0-4 years. Most participants had no symptoms associated with COVID-19, with no reported mortality. Vitamin D deficiency was linked to seroprevalence. COVID-19 was confirmed in 1.8% of individuals tested via RT-PCR and antigen tests. The data suggests a steady increase in humoral immunity in Pakistan, likely due to increased transmission and associated asymptomatic disease. Overall, this reflects the longitudinal trend of protection against severe acute respiratory syndrome coronavirus 2, leading to the relatively low morbidity and mortality observed in the population.

Background: Understanding factors associated with protective immunity against emerging viral infections is crucial for global health. Pakistan reported its first COVID-19 case on February 26, 2020, but compared to other countries, it experienced relatively low COVID-19-related morbidity and mortality between 2020 and 2022. The underlying reasons remain unclear. Our research aims to shed light on this crucial issue. Methods: We conducted serial household surveys over 16 months (Rounds 1-4, July 2020 - November 2021) in urban (Karachi) and rural (Matiari) Sindh, sampling 1100 households and 3900 individuals. Our comprehensive approach included measuring antibodies in sera, testing a subset of respiratory samples for COVID-19 using RT-PCR and antigen tests, and measuring Hemoglobin, CRP, Vitamin D, and zinc in Round 1. Results Participants showed 23% (95% CI 21.9-24.5) antibody seroprevalence in round 1, increasing across rounds to 29% (95% CI 27.4-30.6), 49% (95% CI 47.2-50.9) and 79% (95% CI 77.4-80.8). Urban residents had 2.6 times (95% CI 1.9-3.6) higher odds of seropositivity than rural residents. Seropositivity did not differ between genders. Individuals aged 20-49 had 7.5 (95% CI 4.6-12.4) times higher odds of seropositivity compared to children aged 0-4. Most participants were asymptomatic, with no reported mortality. Vitamin D deficiency was linked to seroprevalence. COVID-19 was confirmed in 1.8% of individuals via RT-PCR and antigen tests. Conclusions: The data suggests a steady increase in humoral immunity in Pakistan, likely due to increased transmission and potential cross-protective immunity, which may be associated with asymptomatic disease, leading to the reduction of morbidity and mortality observed.