Narjis Fatima Hussain

Background: Pakistan is one of only two countries where wild poliovirus type 1 (WPV1) continues to persist. Vaccine refusals challenge efforts to end the virus, especially in high-risk communities. Methods: A qualitative exploratory study took place from September to November 2025 in three High-Risk Union Councils (HRUCs) of Karachi, Pakistan. The study examined reasons for refusing the polio vaccine and identified specific communication and operational strategies to improve vaccine acceptance. A total of 23 in-depth interviews and 10 focus group discussions were conducted with 71 participants, including parents who refuse the vaccine, polio program staff, physicians, and government stakeholders. Data were analyzed using a sequential inductive and deductive thematic approach, mapping findings onto the Socio-Ecological Model (SEM) with NVivo 15 (Lumivero, Denver, CO, USA). Results: Factors influencing polio vaccine refusals were interconnected and spanned multiple levels. At the intrapersonal level, campaign fatigue, a lack of knowledge about poliomyelitis, concerns about side effects, and rumors about infertility were common. Community-level factors included household gatekeepers, local influencers, and digital misinformation. Institutional barriers included weak communication from the frontline, inadequate supervision, workforce shortages, poor tracking of refusals, and limited involvement of physicians. At the policy level, refusals were linked to distrust in governance, poor municipal services, and dissatisfaction with vertical campaign methods. Recommended strategies included integrating polio services with routine immunization and primary healthcare, strengthening counseling by physicians, engaging trusted local influencers and community leaders, expanding targeted social media campaigns to counter misinformation, implementing quick responses to rumors, enhancing workforce capacity, and using data-driven microplanning, including targeted SNIDs and focused interventions in areas with chronic refusals. Conclusions: Polio vaccine refusals are shaped by social, communication, operational, and structural factors. Improving communication and operational guidelines by reducing the number of campaigns, increasing active engagement at the frontline, integrating polio activities into routine health services, and addressing misinformation with a dynamic communication strategy may enhance vaccine acceptance and support polio eradication efforts.

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.

The 2022 floods in Pakistan affected 33 million people and destroyed over 1,400 health facilities, highlighting limited disaster management capaci

Women scientists in low- and middle-income countries continue to face gender-based barriers in accessing higher education, research training, professional development, and leadership opportunities, underscoring the responsibility of higher education institutions, particularly in the Global South, to actively support women’s leadership and mentorship. While online and asynchronous learning environments have expanded globally, limited evidence exists on how Sustainable Development Goals (SDGs)-focused pedagogy can be designed to support women scientists in these contexts. This study examines the collaborative development and evaluation of an online, asynchronous, self-paced SDG course implemented within a broader capacity-strengthening initiative. Using the ADDIE instructional design model and a multidisciplinary co-design process, we analyse how online pedagogical strategies and EdTech tools shaped learner engagement, knowledge acquisition, and perceived relevance. Mixed-methods evaluation included pre-/post-testing, learning analytics of discussion forums, and Student Evaluation of Teaching (SET). Results demonstrate a 9.6% knowledge increase (p<0.005), high engagement across eight discussion boards, and a 68.8% completion rate – substantially higher than typical online learning benchmarks. Findings contribute to scholarship on education for sustainable development by illustrating how gender-responsive, contextually grounded online design can enhance SDG learning and foster communities of practice among women scientists in the Global South.

Introduction: Climate change has led to extreme heat events, disproportionately affecting vulnerable populations. Heat stress during pregnancy is linked to adverse health outcomes, yet the biological mechanisms remain poorly understood. This research study aims to investigate the effect of environmental heat on maternal, fetal and infant health and examine the biological pathways linking heat stress to adverse pregnancy outcomes. Methods and analysis: This prospective cohort study will recruit 6000 pregnant women from three districts in Sindh, Pakistan. Eligible participants ≥18 years old, will have a minimum of five scheduled visits from <14 weeks’ gestation and will be followed up to 12 months postpartum. Primary outcomes include low birth weight and small vulnerable newborns (SVN); secondary outcomes include preterm birth, small for gestational age (SGA), miscarriage, stillbirth, and composite maternal and neonatal morbidity and mortality. Fetal ultrasound scans with Doppler assessments will be performed at each visit to measure fetal growth, uteroplacental and fetoplacental circulation. Each woman’s heat exposure will be measured using wearable sensors and heat strain biomarkers. In a subset of 1000 women, maternal heart rate, skin temperature sleep patterns and physical activity will be monitored throughout pregnancy using wearable devices. Time-varying, distributed lag and non-linear models will examine associations between heat stress indices and pregnancy outcomes. Ethics and dissemination: The study has received ethical approval from the Aga Khan University (AKU) (Ref: 26249) and the Pakistan National Bioethics Committee (Ref: 1065/23/1736). Written informed consent will be obtained from all participants before enrolment. Referral pathways to healthcare facilities will be established to ensure timely management of pregnancy complications. Findings will be disseminated through peer-reviewed publications, scientific conferences, and engagement with policymakers and public health stakeholders to inform climate-resilient maternal health strategies. Results will also be shared with participants and communities through meetings and informal sessions to raise awareness and support evidence-based heat adaptation. Trial registration number: NCT01234567 .

Purpose of review: Child malnutrition in low-and-middle-income countries remains persistently high, driven by converging biological, social, economic, environmental, and conflict-related factors. As progress slows and vulnerabilities intensify, this review synthesises emerging evidence from recent years to identify effective strategies and future directions for reducing undernutrition in resource-constrained settings. Recent findings: Recent literature demonstrates that nutrition-sensitive interventions, including women's empowerment, social protection, WASH, immunisation, kitchen gardens, and biofortification, address key underlying drivers of child malnutrition and contribute to improved growth and dietary diversity. Building on these foundations, nutrition-specific strategies such as antenatal micronutrient supplementation, optimal infant and young child feeding practices, fortified complementary foods, and emerging approaches like microbiota-directed foods and fermentation have shown measurable gains in growth and nutritional status. Across the evidence base, integrated and multisectoral delivery models consistently outperform standalone programs, with particularly strong results when nutrition is combined with health services, social protection, community-based platforms, or climate- and conflict-responsive strategies. Summary: Current evidence underscores a shift toward integrated, layered, and context-responsive programming as the most effective path to reducing child malnutrition. Future research should prioritise implementation models that bridge nutrition-specific and nutrition-sensitive domains, strengthen health and community systems, and adapt to climate and humanitarian pressures.

Introduction: The gender disparities and inequities faced by women in academia are widespread, especially in low- and middle-income countries (LMICs). The scholarly output of women scientists remains significantly lower than that of men due to limited opportunities. This widening gap has significant implications for policy-making and prioritizing agendas. The Supporting Women in Science (SWIS) programme aims to address these barriers by enhancing research capacity among early- and mid-career women scientists from LMIC regions such as South-Central Asia and East Africa, in bespoke areas of health and health-related sustainable development goals (HHSDGs).Methods: The SWIS programme utilizes online and distance learning with a self-paced approach. Applications are accepted on a rolling basis, through a pre-defined eligibility criterion. Phase I involves online self-learning courses covering a core and elective curriculum over 6 months which is then evaluated in Phase II. Eligible candidates then move to Phase III, a mentored fellowship where they develop research proposals and receive funding for research project development, implementation, and evaluation. The rigorous reporting and monitoring mechanisms track compliance and progress. The online format, offered at no cost, enhances program accessibility, particularly in the post-COVID era. Additionally, SWIS prioritizes mentorship by selecting experienced professionals with strong research backgrounds and mentorship skills to guide participants. The programme evaluation will be based on selected success metrics including program completion ratio, funding opportunities availed by the participants, and generated scholarly output and presentations at key events.Discussion and conclusion: Securing grant funding is pivotal for career advancement, yet women applicants face greater challenges as compared to men. The SWIS programme not only equips participants with knowledge and skills but also facilitates practical application through a simulated process, enabling participants to pursue future funding opportunities. Capacity-building initiatives like SWIS are crucial interventions to empower women scientists, foster equitable representation in academia, and create inclusive research environments and the programme acts as a steppingstone for future global leaders.

Objective: COVID-19 has greatly impacted the dental health delivery system while causing an economic crisis globally. This study aims to assess the relationship between virtual consultancy and physical visits during and after the pandemic, and whether monetary concessions can affect the patient’s decision. Materials and methods: A self-administered online questionnaire were distributed to a random sample of 271 participants who were part of a descriptive, cross-sectional, observational study that took place in Karachi, Pakistan. This included demographic data, dental history, and preferences. The socioeconomic status was evaluated using the Modified Kuppuswamy Scale. For statistical analysis, SPSS.24 software was used. A p <0.05 was considered statistically significant. Results: Data was accumulated from 271 participants: Most of them were females (55.7%), had a bachelor’s degree (73.8%), were 21-30 years (61.3%), and belonged to the upper-middle class (36.9%). 50.2% were in favor of a virtual consultation during COVID-19 and when offered a 50% discount, the percentage increased significantly by 8.8%. Alternatively, under post-COVID circumstances, only 31.7% preferred virtual consultation. However, when offered a rebated price, the percentage raised significantly by 11.5%. Chi-square tests identified significant associations between economic considerations (discounts, socioeconomic status) and mode of delivery with a p < 0.001. Conclusion: The findings shed light on the future of the dental care delivery system. When offered monetary incentives, people preferred virtual consultancy over physical visits. This can establish a new criterion for dental care delivery to serve more people and enhance health equity.