Search Results (29)

Background: Cholera, caused by Vibrio cholerae, remains endemic in many developing countries, including Pakistan. The extensive use of antibiotics has led to the emergence of antimicrobial resistance in V. cholerae, limiting available treatment options. In this study, we performed molecular characterisation of antibiotic-resistant V. cholerae serotype Ogawa isolates from a recent cholera outbreak in Khyber Pakhtunkhwa, Pakistan. Methodology: Suspected cholera stool samples were collected from hospitalised patients at various district hospitals of Khyber Pakhtunkhwa Province (KPK), Pakistan. The samples were transported to the Public Health Reference Microbiology Laboratory at Khyber Medical University, Peshawar. V. cholerae were identified based on colonial morphology, Gram staining, and biochemical tests using EPI 10E. For serotype identification, monovalent antisera were used. Antibiotic susceptibility testing (AST) was performed using CLSI M45 and EUCAST guidelines. DNA was extracted from pure colonies of multidrug-resistant (MDR) V. cholerae and subjected to whole-genome sequencing (WGS) for genomic characterisation using an Illumina MiSeq platform. Results: Of the 350 active diarrheal cases investigated, 70 were confirmed as V. cholerae. The outbreak was initially reported in Dir and was subsequently followed by a high incidence of cholera in the Peshawar district of KPK. All strains belong to the Ogawa serotype, which shows high antibiotic resistance, particularly to ampicillin (n = 62, 88.57%), Sulfamethoxazole/Trimethoprim (n = 60, 85.71%), Erythromycin (n = 59, 84.29%), and Tetracycline (n = 53, 75.71%). The lowest resistance was against Meropenem (n = 1, 1.4%), followed by amikacin (n = 7, 10.0%) and levofloxacin (n = 13, 18.57%). Furthermore, 34 (48.57%) of the isolates were MDR, while 13 (18.57%) were extensively drug-resistant. Six samples were selected for whole-genome sequencing. The selection of six V. cholerae samples for WGS was based on their drug resistance pattern and origin of isolation. At the genomic level, all sequenced V. cholerae strains harboured multiple antimicrobial resistance determinants. Quinolone resistance was associated with mutations and genes in gyrA, gyrB, parC, and parE; resistance to sulfamethoxazole–trimethoprim with folA, folP, and dfr; tetracycline resistance with tetA and tet35; chloramphenicol resistance with catB and S10p; and aminoglycoside resistance with hns, S12p, and gigB. In addition, β-lactam resistance was linked to the presence of efflux and β-lactamase genes, including blaSHV and mox-3. Mutations were identified in gyrA at positions S83I, S177A, and S202A, and in parC at positions S85L and I231V. Collectively, the presence of these resistance determinants likely enables V. cholerae to survive exposure to high concentrations of multiple antibiotics. Conclusions: Our V. cholerae isolates showed close genetic relatedness to previously sequenced strains from Pakistan (2010 and 2022), as well as to recently reported international strains from the USA, Australia, and China. These findings highlight both the long-term persistence of these lineages within Pakistan and their international dissemination, likely facilitated by globalisation. Full article

Healthcare access is a fundamental human right, yet barriers often negatively impact health, particularly in developing countries like Pakistan, where maternal mortality remains a crisis. This study aimed to identify factors influencing healthcare access barriers among married women aged 15–49 years using spatial analysis. Methods: Data were drawn from the 2017-18 Pakistan Demographic and Health Survey (PDHS), which included an unweighted sample of 8127 women. Healthcare access barriers were identified as the outcome variable. Results: A spatial analysis using ArcGIS 10.7.1 and SaTScan identified clustered distributions, with concentration areas identified in Gilgit Baltistan, Khyber Pakhtunkhwa (KPK), Federally Administered Tribal Areas (FATA), Punjab, and Balochistan. SaTScan highlighted primary clusters in FATA, Southern KPK, Northern Balochistan, and Eastern Punjab. Geographically Weighted Regression identified women who had five or more living children, respondents who did not have four or more antenatal care (ANC) visits, respondents who experienced a lower income (wealth index), respondents who did not participate in decision-making, respondents with a primary education, and respondents who accepted domestic violence as the significant predictors of healthcare access barriers. Conclusions: To improve women’s healthcare access, integrated policy interventions are needed, addressing socioeconomic disparities, strengthening national health policies, empowering women, and expanding healthcare accessibility. Strengthening health insurance and economic empowerment is crucial for achieving Sustainable Development Goals. Full article

This study explores the role of religion as a state-promoted tool for political assimilation in Pakistan’s border provinces of Khyber Pakhtunkhwa (KP) and Balochistan. The study is based on five phases of fieldwork (2016–2024) combined with a thematic literature review. The research explores how religious strategies were deployed to forge a unified national identity in these regions. The findings reveal significant disparities in the effectiveness of these strategies. In KP, historical factors, cultural alignment, and geopolitical influences—particularly the Afghan conflict—largely facilitated the integration of Pashtun identity into Pakistan’s broader Islamic-national framework. Tools such as madrassa networks, education reforms, religious slogans, and state-backed Islamist parties effectively promoted religious nationalism. In contrast, religious assimilation efforts in Balochistan largely failed due to entrenched ethnic nationalism, economic exclusion, and political marginalization. Attempts to expand madrassas, delegitimize nationalist leaders as “anti-Islamic,” and support religious movements have been met with resistance, deepening distrust between the Baloch population and the state. The study found that religion alone cannot sustain national cohesion, particularly in regions with longstanding grievances and systemic inequalities. This research emphasizes the limitations of top-down, coercive assimilationist policies and underscores the necessity for more inclusive approaches, such as addressing economic disparities, recognizing regional identities, and promoting political participation as essential components for building a sustainable and unified nation. The study provides critical insights for policymakers, advocating for a shift from religious assimilation to strategies that prioritize justice, equity, and cultural accommodation, particularly in KPK and Balochistan. Full article

Organizational change remains a significant challenge in developing countries, often hindered by entrenched bureaucratic cultures and resistance to reform. This study investigates the key determinants of change acceptance among public sector employees in Pakistan, focusing on the Khyber Pakhtunkhwa (KPK) region. Using a survey of 320 public sector workers, this research examines employee attitudes toward organizational change through a multi-conceptual framework that incorporates technical, organizational, and environmental factors. Ten influencing factors were analyzed using Structural Equation Modeling (SEM) in AMOS. The findings reveal a strong positive relationship between nine factors—change management, IT infrastructure, reward systems, technical competency, top management support, legal frameworks, organizational culture, and HRM practices—and employees’ willingness to accept change. This study presents a robust explanatory model with high predictive power for change acceptance. It provides valuable insights into reform dynamics in developing nations and offers practical strategies to guide successful public sector change management initiatives. Full article

Climate-induced migration is increasingly affecting communities, disrupting livelihoods, and intensifying socio-economic inequalities, particularly in disaster-prone regions. Despite the prevalence of recurring flood hazards, there remains limited research on the multi-dimensional impacts of migration particularly in socio-culturally sensitive and resource-constrained settings like Khyber Pakhtunkhwa (KPK), Pakistan. This study seeks to bridge this gap by exploring the post-migration challenges of flood-affected communities in District Nowshera. Using a qualitative methodology, we conducted in-depth interviews with 25 diverse key informants. The study results revealed profound socioeconomic instability, inadequate access to essential services, and cultural disruptions. Key findings include significant challenges such as inadequate housing, the loss of traditional livelihoods, persistent financial hardships, health issues, and the breakdown of social support networks. Moreover, displaced families face marginalization and language barriers, which hinder integration into host communities, amplifying feelings of isolation and identity loss. Environmental degradation in resettlement areas further intensifies these challenges, prolonging poor living conditions and heightened vulnerability. To address these issues, the study recommends community-based interventions such as developing resilient, culturally appropriate housing, implementing targeted skills training programs to restore livelihoods, promoting climate-smart agricultural practices, and enacting inclusive social policies to promote integration and cohesion to address climate-induced migration in disaster-prone regions. Full article

Land use and land cover (LULC) change, driven by environmental and human activities, significantly impacts ecosystems, climate, biodiversity, and socio-economic systems. This study focuses on Khyber Pakhtunkhwa (KPK), Pakistan, a region with sensitive ecosystems and diverse landscapes, to analyze LULC dynamics and their environmental consequences. Based on Landsat imagery from 2000, 2010, and 2020, we used the Random Forest algorithm on Google Earth Engine (GEE) to classify LULC, and the CA-ANN model to project future scenarios for 2030, 2050, and 2100. Additional simulations were conducted using the MOLUSCE Plugin in QGIS. The results revealed a 138.02% (4071.98 km²) increase in urban areas from 2000 to 2020, marking urbanization as a major driver of LULC change. Urban expansion strongly correlated with land surface temperature (LST) (R² = 0.89), amplifying the urban heat island effect. Rising LST showed negative correlations with the key environmental indices NDVI (−0.88), MNDWI (−0.49), and NDMI (−0.62), signaling declining vegetation cover, water resources, and soil moisture, respectively. Projections for 2100 predict LST rising to 55.3 °C, with NDVI, MNDWI, and NDMI dropping to 0.36, 0.17, and 0.21, respectively. Vegetation health, as indicated by the Leaf Area Index (LAI), also declined, with maximum and minimum values falling from 4.66 and −5.75 in 2000 to 2.16 and −2.55 in 2020, reflecting increased barren land and reduced greenness. The spatial analysis highlights significant transitions from vegetated to barren or urban land, leading to declining moisture levels, water stress, soil erosion, and biodiversity. Projections show continued reductions in forests, vegetation, and agricultural lands, replaced by barren and built-up areas. Declines in key indices such as NDVI, MNDWI, and NDMI indicate deteriorating vegetation, water resources, and soil moisture levels. These findings emphasize the need for sustainable urban planning and environmental management. Expanding urban green spaces, using reflective materials, and preserving vegetation and water resources are vital to mitigating heat island effects and maintaining ecological balance. Anticipated declines in LST, NDVI, MNDWI, NDMI, and LAI stress the urgency for climate adaptation strategies to protect human health, ecosystem services, and economic stability in KPK. Full article

This study maps the rural household vulnerability to flood-induced health risks in flood-affected Khyber Pakhtunkhwa (KPK), Pakistan, focusing on the devastating 2022 flood. Using data from 600 households in the severely impacted districts of Khyber Pakhtunkhwa province (including Charsadda and Nowshera), this research examines the influence of demographic, socioeconomic, and infrastructural factors on household vulnerability. This study assesses household vulnerability to flooding and health issues using logistic regression. The current study findings revealed that female-headed households, those with younger heads, and families with lower educational levels are particularly vulnerable. Income disparities significantly shape coping capacity, with wealthier households more likely to adopt effective risk-mitigation strategies. Proximity to functioning healthcare facilities emerged as a crucial factor in reducing vulnerability, as these households faced fewer health hazards. Conversely, households in areas where health and water infrastructure were damaged experienced higher risks of disease outbreaks, including cholera and malaria, due to water contamination and inadequate sanitation. This study highlights the urgent need for resilient infrastructure, strengthened public health systems, improved health education, and enhanced water and sanitation services to mitigate flood-induced health risks. Policymakers are urged to sustainable development practices by adopting gender-sensitive disaster management strategies, prioritizing educational initiatives, and fostering community support networks to enhance resilience to future flood events in KPK. Full article

Restoration of degraded land is a significant concern in the 21st century in order to combat the impacts of climate change. For this reason, the provisional government of Khyber Pakhtunkhwa (KPK), Pakistan, initialized a Billion Tree Tsunami Project (BTTP) in 2013 and finished it in 2017. Although a few researchers have investigated the land use transitions under BTTP in the short term by merging all the vegetation types into one, analysis of the long-term benefits of the project and future persistence were missing. Furthermore, the previous studies have not discussed whether the prime objective of the BTTP was achieved. Considering the existing gaps, this research mainly involves analyzing (i) fluctuations in the green fraction by employing a land change modeler (LCM), along with the spatial location of gain-loss and exchange analysis using a high-resolution dataset (GLC30); (ii) forest cover changes under the influence of the BTTP; (iii) impacts of green fraction changes towards land surface temperature (LST) by utilizing the less-explored technique of curve fit linear regression modeling (CFLR); and finally, (iv) assessing the persistence of the NDVI and LST trends by employing the Hurst exponent. Research findings indicate that as an output of BTTP, despite the government’s claim of increasing the forest cover by 2%, a significant gain of grassland (3904.87 km²) was observed at the cost of bare land. In comparison, the overall increase in forest cover was only 0.39%, which does not satisfy the main objective of this project. On the other hand, the CFLRM-based actual contributions of land cover change (LCC) transition to LST indicate a significant decline in LST in the areas with gains in green fraction for both grassland and forest. At the same time, an increase was observed with reverse transitions. Although the results appear positive for climatic impacts in the short term, the HURST model-based persistence analysis revealed that the spatial locations of increasing vegetation and decreasing LST trends fall under the weakly persistent category, therefore these trends may not continue in the near future. Despite some positive impact on LST attributed to the green fraction increase, this project cannot be regarded as a complete success due to its failure to achieve its prime objective. Full article

Numerous investigations on plant ethnomedicinal applications have been conducted; however, knowledge about the medicinal use of wild animals is still limited. This present study is the second on the medicinal and cultural meaning of avian and mammalian species used by the population in the surrounding area of the Ayubia National Park, KPK, Pakistan. Interviews and meetings were compiled from the participants (N = 182) of the study area. The relative frequency of citation, fidelity level, relative popularity level, and rank order priority indices were applied to analyze the information. Overall, 137 species of wild avian and mammalian species were documented. Of these, 18 avian and 14 mammalian species were utilized to treat different diseases. The present research showed noteworthy ethno-ornithological and ethno-mammalogical knowledge of local people and their connection with fauna, which might be useful in the sustainable utilization of the biological diversity of the Ayubia National Park, Khyber Pakhtunkhwa. Furthermore, in vivo and/or in vitro examination of the pharmacological activities of species with the highest fidelity level (FL%) as well as frequency of mention (FM) might be important for investigations on faunal-based new drugs. Full article

Background: Inherited isolated nail clubbing is a very rare Mendelian condition in humans, characterized by enlargement of the terminal segments of fingers and toes with thickened nails. Mutations in two genes have been reported to cause isolated nail clubbing in humans, which are the SLCO2A1 gene and the HPGD gene. Objectives: An extended Pakistani family having two affected siblings born of unaffected consanguineous union was included in the study. Predominant isolated congenital nail clubbing (ICNC) without any other systemic abnormalities was observed, which we aimed to characterize at clinico-genetic level. Methods: Whole exome coupled with Sanger sequencing were employed to uncover the sequence variant as a cause of the disease. Furthermore, protein modeling was carried out to reveal the predicted possible effect of the mutation at the protein level. Results: Whole exome sequencing data analysis revealed a novel biallelic sequence variant (c.155T>A; p.Phe52Tyr) in the SLCO2A1 gene. Further, Sanger sequencing analysis validated and confirmed the segregation of the novel variant in the entire family. Subsequently, protein modeling of the wild-type and mutated SLCO2A1 revealed broad-scale change, which might compromise the proteins’ secondary structure and function. Conclusion: The present study adds another mutation to the SLCO2A1-related pathophysiology. The involvement of SLCO2A1 in the pathogenesis of ICNC may open exciting perceptions of this gene in nail development/morphogenesis. Full article

Global land cover dynamics alter energy, water, and greenhouse gas exchange between land and atmosphere, affecting local to global weather and climate change. Although reforestation can provide localized cooling, ongoing land use land cover (LULC) shifts are expected to exacerbate urban heat island impacts. In this study, we monitored spatiotemporal changes in green cover in response to land use transformation associated with the Khyber Pakhtunkhwa (KPK) provincial government’s Billion Tree Tsunami Project (BTTP) and the Ravi Urban Development Plan (RUDP) initiated by the provincial government of Punjab, both in Pakistan. The land change modeler (LCM) was used to assess the land cover changes and transformations between 2000 and 2020 across Punjab and KPK. Furthermore, a curve fit linear regression model (CFLRM) and sensitivity analysis were employed to analyze the impacts of land cover dynamics on land surface temperature (LST) and carbon emissions (CE). Results indicated a significant increase in green fraction of +5.35% under the BTTP, achieved by utilizing the bare land with an effective transition of 4375.87 km². However, across the Punjab province, an alarming reduction in green fraction cover by −1.77% and increase in artificial surfaces by +1.26% was noted. A significant decrease in mean monthly LST by −4.3 °C was noted in response to the BTTP policy, while an increase of 5.3 °C was observed associated with the RUDP. A substantial increase in LST by 0.17 °C was observed associated with transformation of vegetation to artificial surfaces. An effective decrease in LST by −0.21 °C was observed over the opposite transition. Furthermore, sensitivity analysis suggested that LST fluctuations are affecting the % of CO₂ emission. The current findings can assist policymakers in revisiting their policies to promote ecological conservation and sustainability in urban planning. Full article

Pakistan has an annual deforestation rate of 4.6% which is the second highest in Asia. It has been described by the Food and Agriculture Organization (FAO) that the deforestation rate increased from 1.8–2.2% within two decades (1980–2000 and 2000–2010). KPK (Khyber Pakhtunkhwa), Pakistan’s northwestern province, holds 31% of the country’s total forest resources, the majority of which are natural forests. The Malam Jabba region, known for its agro-forestry practices, has undergone significant changes in its agricultural, forestry, and urban development. Agricultural and built-up land increased by 77.6% in the last four decades, and significant changes in land cover especially loss in forest, woodland, and agricultural land were observed due to flood disasters since 1980. For assessing and interpreting land-cover dynamics, particularly for changes in natural resources such as evergreen forest cover, remote sensing images are valuable assets. This study proposes a framework to assess the changes in vegetation cover in the Malam Jabba region during the past four decades with Landsat time series data. The random forest classifier (RF) was used to analyze the forest, woodland, and other land cover changes over the past four decades. Landsat MMS, TM, ETM+, and OLI satellite images were used as inputs for the random forest (RF) classifier. The vegetation cover change for each period was calculated from the pixels using vegetation indices such as NDVI, SAVI, and VCI. The results show that Malam Jabba’s total forest land area in 1980 was about 236 km² and shrank to 152 km² by 2020. The overall loss rate of evergreen forests was 35.3 percent. The mean forest cover loss rate occurred at 2.1 km²/year from 1980 to 2020. The area of woodland forest decreased by 87 km² (25.43 percent) between 1980 and 2020. Other landcover increased by 121% and covered a total area of 178 km². The overall accuracy was about 94% and the value of the kappa coefficient was 0.92 for the change in forest and woodland cover. In conclusion, this study can be beneficial to researchers and decision makers who are enthusiastic about using remote sensing for monitoring and planning the development of LULC at the regional and global scales. Full article

A substantial drop in atmospheric visibility or visual range (VR) is documented in several parts of the world. We examined the long-term spatiotemporal variability in ground-based VR data for ten airports in Pakistan from 1980 to 2020. Average VR time series analysis was performed using nonparametric tests of Mann–Kendall (MK), Modified Mann–Kendall (MMK), Sen’s Slope (SS), and Sequential Mann–Kendall (SMK), followed by spatiotemporal mapping. Bad VR (<5 km) conditions prevailed over more than 60% of the study period. Noticeably, VR was better during 1991–2000 due to the high average annual rainfall (905 mm) during the 1990s. Plain areas such as Faisalabad experienced the greatest number of bad VR days with hourly (92.85%), daily (95.35%), monthly (90.97%), and seasonal (90.97%) measurements, followed by Sialkot and Multan. The VR of lowlands in central, southern, and eastern Punjab and northern, central, and eastern Sindh showed decreasing trends. In contrast, the VR in coastal areas of south and southwestern Sindh, in the western highlands, and parts of Khyber Pakhtunkhwa (KPK) province, have indicated positive trends. The results of this study will support policymakers in catering to the issue of declining VR in the region by supporting and developing strategies to limit the factor associated with VR. Full article

Hard ticks are blood-sucking ectoparasites infesting all types of domestic ruminants throughout the world and serve as vectors in the dissemination of a wide variety of pathogens. Sheep and goat farming is a vital economic source for resource-poor farming communities in the Khyber Pakhtunkhwa (KPK) province of Pakistan. Aim: The aim of present study is to study the epidemiological profile of ticks in various agro-climatic zones of KPK. Materials and Methods: A total of 1500 (882 sheep and 618 goats) of all age groups and sexes were examined for the presence of ticks belonging to six districts in four agro-climatic zones of KPK province, Pakistan. Non-probability sampling was undertaken based on animal hosts’ selection, collection of hard ticks, and epidemiological parameters. Ticks collected from sheep and goats were identified phenotypically using standard keys. Results: The results revealed that Rhipicephalus microplus (36.2%) was the predominant tick species followed by Hyalomma anatolicum (25.2%), Hyalomma trancatum (18.1%), Hyalomma aegyptium (11.3%), Hyalomma asiaticum (6.9%), and Haemephysalis bispinosa (2.4%). Different epidemiological parameters showed that weather, humidity, and host age negatively affect (p < 0.05) tick load while temperatures (Minimum and Maximum), sunshine (hrs), and precipitation positively affected (p < 0.05) tick load. Host sex only showed a positive association with tick load (p > 0.05). The highest value of tick diversity index (H) 0.36748 was noted for Hyalomma anatolicum as this tick species was commonly distributed in three agro-climatic zones except in the Suleiman Piedmont zone, while Haemaphysalis bispinosa has the lowest diversity index (0.0334) as it was only found in the Central Valley Plains zone of KPK. The Shannon diversity index of tick diversity was highest at Barikot while the lowest index value was at Kabal (2.407). Similarly, a higher Simpson’s diversity index was at Barikot (0.9554) and the lowest hard index was noted at Takht bai (2.874). The dominance index showed that the tick species were more dominant at Takht bai (0.1251), while the lowest dominance was at Barikot (0.04465). Conclusions: It has been concluded that tick diversity and distribution, abundance, reproduction, development, and survival depend on prevailing climatic conditions. The present study would not only help to identify the tick species but also facilitate in devising effective control measures to minimize the transmission pathogens in sheep and goats being reared in the various agro-climatic zones of KPK province, Pakistan. Full article

Self-medication is an important issue, especially in developing countries. Self-medication is the concept in which individuals use medicine to ease and manage their minor illnesses. The current survey was designed to conduct interviews at different universities based on the availability of the students from August 2021 to October 2021 in Hazara region of Khyber Pakhtunkhwa (KPK), Pakistan. Overall, 1250 questionnaires were distributed to students from various departments. Students of microbiology (n = 305, 24.4%) and agriculture 236 (n = 18.8%) were the most elevated members in this study, while other participants were from medical lab technology (n = 118, 9.4%), chemistry (n = 103, 8.2%), food science (n = 92, 7.3%), business administration (n = 83, 6.6%), sociology (n = 78, 6.2%), math/physics (n = 6, 14.8%), Pak study (n = 58, 4.6%), English (n = 47, 3.7%), and psychology (n = 19, 1.5%). Students working towards their Bachelor numbered (n = 913, 73.0%), Master (minor) numbered (n = 80, 6.4%), Master (major) numbered (n = 221, 17.6%), and Doctorate numbered (n = 36, 2.8%). The age group of participants was majorly 20–25 years (61.0%), while others belonged to the age groups 25–30 years (20.6%), 30–35 years (9.8%), and 35–40 years (8.4%). The mean and standard deviation of daily practices of self-medication were observed (M = 416.667, SD = 1,026,108.667) and p = 0.002. The mean and standard deviation of daily practices of antibiotic knowledge was (M = 431.5, SD = 1,615,917) and p = 0.002. Antimicrobial agents were leading over others with 631 (50.4%), followed by anti-inflammatory with 331 (26.4%), multivitamins with 142 (11.3%), gynecological purpose with 59 (4.7%), and analgesic with 72 (5.7%), while the lowest frequency rate was observed against herbal remedies with 15 (1.2%). The results of the current study concluded that students practiced self-medication for reasons such as convenience to obtain these medications from cheap sources and to avoid the fee of a physician. They searched for the medicine on social media platforms and purchased it blindly from the pharmacy without any prescription from a physician. Full article