The 2022 floods in Khyber Pakhtunkhwa, Pakistan: an assessment of the impacts on the Afghan Refugees

Tuberculosis active case-finding among Afghan refugees in Pakistan: Care cascade, characteristics and treatment outcomes.

Toxoplasmosis is a zoonotic parasitic disease caused by T. gondii, an obligate intracellular apcomplexan zoonotic parasite that is geographically worldwide in distribution. The parasite infects humans and all warm-blooded animals and is highly prevalent in various geographical regions of the world, including Pakistan. The current study addressee prevalence of Toxoplasma infection in women in various geographical regions, mapping of endemic division and t district of Khyber Pakhtunkhwa province through geographical information system (GIS) in order to locate endemic regions, monitor seasonal and annual increase in prevalence of infection in women patients. Setting: Tertiary hospitals and basic health care centers located in 7 divisions and 24 districts of Khyber Pakhtunkhwa (KP) province of Pakistan. During the current study, 3586 women patients from 7 divisions and 24 districts were clinically examined and screened for prevalence of T. gondii infection. Participants were screened for Toxoplasma infection using ICT and latex agglutination test (LAT) as initial screening assay, while iELISA (IgM, IgG) was used as confirmatory assay. Mapping of the studied region was developed by using ArcGIS 10.5. Spatial analyst tools were applied by using Kriging/Co-kriging techniques, followed by IDW (Inverse Distance Weight) techniques. Overall prevalence of T. gondii infection was found in 881 (24.56%) patients. A significant (<0.05) variation was found in prevalence of infection in different divisions and districts of the province. Prevalence of infection was significantly (<0.05) high 129 (30.07%) in Kohat Division, followed by 177 (29.06%), 80 (27.87%), 287 (26.72%), 81 (21.21%), 47 (21.07%), and 80 (13.71%) cases in Hazara Division, D.I Khan Division, Malakand Division, Mardan Division, Bannu Division, and Peshawar Division. Among various districts, a significant variation (<0.05) was found in prevalence of infection. Prevalence of infection was significantly (<0.05) high 49 (44.95%) in district Karak, while low (16 (10.81%) in district Nowshera. No significant (>0.05) seasonal and annual variation was found in prevalence of Toxoplasma infection. LAT, ICT and ELISA assays were evaluated for prevalence of infection, which significantly (<0.05) detected T. gondii antibodies. LAT, ICT and ELISA assays significantly (<0.05) detected infection, while no significant (>0.05) difference was found between positivity of LAT and ICT assays. A significant difference (<0.05) was found in positivity of Toxoplasma-specific (IgM), (IgG) and (IgM, IgG) immunoglobulin by ICT and ELISA assay. The current study provides comprehensive information about geographical distribution, seasonal and annual variation of Toxoplasmosis infection in various regions of Khyber Pakhtunkhwa province of Pakistan. Infection of T. gondii in women shows an alarming situation of disease transmission from infected animals in the studied region, which is not only a serious and potential threat for adverse pregnancy outcomes, but also cause socioeconomic burden and challenges for various public and animal health organizations in Pakistan and across the country.

This study assesses the climate change policy in Khyber Pakhtunkhwa, a province of Pakistan, from the perspective of indigenous communities. The Pakistan federal government directed provinces to develop a climate change policy. To control the worst effects of climate change, the Khyber Pakhtunkhwa (KP) a province of Pakistan developed a climate change policy in 2022. This study examines the perception of indigenous communities residing in merged districts and northern Khyber Pakhtunkhwa, Khyber Pakhtunkhwa, regarding the province's climate change policy. The qualitative research methodology was applied. The primary data were collected through in-depth interviews with the Pashtun, Kalasha, and Khu indigenous communities to understand their perceptions. It is revealed that the climate change policy does not give space to indigenous voices. It is also revealed that the current climate change policy has not been addressing the problems of indigenous communities that arise due to climate change. Climate change policy must be designed in a way that strengthens indigenous resilience and addresses the unique vulnerabilities of indigenous communities. Indigenous perspectives will provide a thorough understanding of the inclusiveness, efficacy, and pliable effects of these policies at the local level.

Teaching learning process has many things to make it more effective, fruitful and result oriented. Audio visual aids are one of those ingredients. Sufficient Availability and effective usability of AV aids makes teaching learning more effective and objective oriented.The need of the study was to identify the availability and usability of AV aids in the Afghan refugees’ schools in Khyber Pakhtunkhwa. The responses of the female school teachers and male school teachers were used to determine the availability and usability of AV aids in the afghan refugees’ schools.Total 22 afghan refugees’ schools 4 girls and 18 boy’s schools constituted the population of study. The study was delimited to 8 schools from total 22 schools i.e. 4 from boys and 4 from girl’s schools. Thus, 30 afghan school teachers were taken as sample of the study (15 female school teachers from 4 girl’s schools and 15 male school teachers from 4 boy’s schools).One questionnaire was constructed for collection of the information. The data obtained by using the appropriate research tool, questionnaire, was tabulated, analyzed and interpreted by using statistical tools i.e. percentile. It was concluded that AV aids are available in the afghan refugees’ primary schools but modern AV aids are required and teachers of the schools need training and course to the utility of Av aids to the fullest benefit.

Northern Pakistan, Khyber Pakhtunkhwa (KP) is low malaria endemic area characterised by seasonal transmission with predominantly vivax malaria. Migration of high number of Afghan Refugees in 1978 into KP led to concerns for an increase in malaria, as the malaria incidence in this group was reportedly high compared to the local Pakistani population. Considerable progress has been made in controlling malaria through operational research in the camps where the Afghan refugees reside. However, this process requires effective, repeatable active surveillance tools for monitoring malaria control as availability of accurate data is the major challenge at present. The aim of this PhD project was to generate current information on malaria infection rates through parasite prevalence and malaria exposure using antimalarial antibody responses.The project also investigated the risk factors of malaria and heterogeneity in the geographic distribution of malaria in the camps by using GIS data with serological responses and parasite prevalence data. As an ancillary objective the project aimed to determine the prevalence of G6PO deficiency in the study population. A cross-sectional survey was conducted in five Afghan refugee camps of KP between June and September in 2010. Blood samples were obtained on filter paper from 2526 individuals and tested by rapid diagnostic test, paraSite species specific PCR and ElISA for antibody responses to Plasmodium vivax and Plasmodium falciparum. A questionnaire was administered to collect household and individual based information to determine the potential risk factors of malaria. Heterogeneity in malaria was observed between the studied camps based on seroprevalence, which ranged from 17%-45% for P. vivax and 3% to 11% for P. falciparum. Variation in P. vivax infection prevalence was also detected between the camps, which ranged from 0.4-9% (ROT) and 5-15% (peR). Variation in the distribution of malaria was also found within the camp using spatial/GIS data with clear foci of infection identified in 4 of 5 camps. The results showed that as expected parasite based prevalence measures (ROT and peR) are significantly lower than serological measure of exposure. P. falciparum infection prevalence (ROT and PCR) and seroprevalence was found to be extremely low with P. vivax infections predominant. Age seroprevalence changes were more pronounced for P. vivax than P. falciparum and seroconversion rate was strongly associated with parasite rate. Increasing age .and poorly built houses were associated with increasing risk, while staying in the same camp for the last 6 months and using measures to reducing vector biting such as repellents repellent, coils or insecticide spraying were associated with reduce risk of falciparum malaria. The risk of vivax malaria was observed to increase with increasing age, sharing house with cattle and having fever within 24 hours or two weeks and a reduction in the risk was seen in the individuals who reported use of Insecticide treated Bed Nets (ITN) night prior to surveyor used self protection measures from vector. The 563C-T polymorphism of G6PD gene was observed in only 2 unrelated individuals out of 505 individuals tested (O.4%). In conclusion, both parasitological and serological measures were able to detect spatial variation in infection and exposure to malaria at the micro epidemiological level within the camp. This data will help to provide beneficial and up-to-date information to manage control activities in the study area.

Introduction: Consumer preferences play a significant role in determining the choices for purchasing fresh fruits. Consumer interest in fruits is crucial in influencing agricultural production and food policies. Factors like average income per person and the price of fruit have a notable impact on what consumers prefer and, as a result, on the demand for fruit. Objectives: The aim of this study is to examine the patterns of fruit consumption and preferences across the four provinces of Pakistan. Materials &amp; Methods: Data from Household Integrated Economic Survey (HIES) 2018-19 is used for the selected fruits i.e. banana, malta, apple, grapes, watermelon alou bhukhara and dry fruits. The Linear Approximate Almost Ideal Demand System (LA/AIDS) model is used to estimate Marshallian, Hecksian and Expenditure elasticities of demand. Results: The result shows that the expenditure elasticities of all fruits for all provinces is positive and less than unity suggesting they are necessities except for dry fruits (1.2969) in Khyber Pakhtunkhwa, whose expenditure elasticity is greater than unity and considered as luxury in Khyber Pakhtunkhwa. There is no significant difference found by comparing Marshallian own price elasticities for all fruits across provinces of Pakistan. The estimated Marshallian own price elasticities for all fruits are inelastic in all provinces, while in Baluchistan banana (-0.9444) is close to unit elastic and it is inelastic in other three provinces i.e. Punjab, Sindh and Khyber Pakhtunkhwa, which means banana consumption is less in Baluchistan than other three provinces. Conclusion: According to estimates of Marshallian cross price elasticities 21 fruits were found to be complements, only alou bhukhara and dry fruits found to be substitute in Khyber Pakhtunkhwa, while other three provinces all fruits are complements. As most of the own price elasticities of fruits are inelastic for all provinces, any change in own price would result in a massive increase in expenditure on these fruits.

Migration is a universal phenomenon that has presence since human existed on earth. People move from one place to another having a variety of purposes, where the most common and dominant reasons are compulsions and inadequacy of resources to fulfill life needs at the country of origin. The current study is an attempt to understand the phenomenon of migration especially Afghan refugees residing for more than three decades in the KP province of Pakistan. The research work is part of a PhD study on migration and criminality which asserts on the associated parameters with migration that lead to unhealthy activities in the host society. The study is framed under qualitative research design utilizing the qualitative tools for data collection and thematic analysis in three major Divisions i.e. Peshawar, Mardan and Malakand of the province. The central and district jails were selected for identification of respondents and conduction of interviews to dig out the actual facts. The study concludes that unstable socio-political structure of the society diminishes the provision of basic rights to the Afghan refugees where the local masses consider them a threat to their socioeconomic, cultural and political existence. On the contrary, the Afghan refugees become expressive and reactionary and develop feelings of inferiority and deprivation when not given with the expected demands that lead to their mal-integration and mal-social-practices for their survival, integration and settlement.

Community midwives' acceptability in their communities: A qualitative study from two provinces of Pakistan

This thesis examines the pivotal role played by the United Nations High Commissioner for Refugees (UNHCR) in facilitating access to basic education for Afghan refugees residing in Hazara Division Khyber Pakhtunkhwa (KP), Pakistan. As KP hosts a significant Afghan refugee population, ensuring their access to education is paramount. This research investigates the current state of education for Afghan refugees in Hazara Division of KP, with a focus on enrollment rates, school access, and education quality. It assesses the challenges hindering education, including financial, linguistic, and cultural barriers, and evaluates initiatives by the Pakistani government and UNHCR to improve the situation. Through a mixed-method approach, combining qualitative interviews and quantitative surveys, the study provides insights into the impact of education on the refugees' lives and their empowerment prospects. The findings contribute to understanding the effectiveness of UNHCR's efforts and offer recommendations for enhancing education opportunities for Afghan refugees in KP and similar contexts globally.

Dengue Outbreak Response and Control in Khyber Pakhtunkhwa, Pakistan: A Mixed Methods Study

Gender portrayal and the representations of males and females in advertising remains the core interest of researchers from gender studies and communication research. In advertising scholarship, it is often found that there are differences in gender portrayal specifically due to the cultural contexts. In the present study, we explore the gender portrayal in outdoor billboard advertising of two provinces of Pakistan; Punjab and KPK. Theoretically and conceptually, the study takes roots from cultural studies on advertising and social semiotics studies on gender and advertising. We collect data of 360 billboard advertisements from two cities of Punjab and two cities of KPK. We coded 654 units in these 360 billboards according to the conceptual categories of social semiotics. In the present study we found that female models are portrayed more as compare to the male models in outdoor advertising of both provinces; Punjab and KPK. Although, the dominant pattern of gender portrayal in advertisements of KPK is similar to Punjab, however, it is slightly different from Punjab. In KPK, males are also portrayed as submissive. Females are more associated with nurturing roles as compared to Punjab. Hence, it is concluded that in outdoor advertising of Pakistan, females are objectified and they are mostly used for their glamour and beauty. On the contrary, males are portrayed as dominant and in power.

After the Russian invasion in 1979, most of the disturbed Afghans fled their homes. A huge number of refugees rushed to Pakistan, Iran, Tajikistan. Their influx increases infrastructure problems in the targeted countries. According to the United nations available resources, more than 4 million registered Afghan refugees, took shelter in Pakistan. These refugees were given nominated spaces throughout Khyber Pakhtunkhwa &amp; Baluchistan to live there. After the fall of Kabul, refugees remained in Pakistani provinces. During their stay, so many incidents took place in Pakistan. According to the intelligence reports, in many terrorists' activities, Afghan refugees found responsible. The recent attack of Army Public School showed a strong connection between Afghan refugees' involvement in the incident. Pakistani Media also portrayed them with angles.

Afghan refugees face persistent poverty, social marginalization, and restricted access to healthcare in Pakistan, making them one of the world's largest and longest-displaced groups. Health disparities have been made worse by decades of instability, especially among marginalized groups living in informal urban settlements and refugee camps. With an emphasis on how income, education, and legal status affect health outcomes and healthcare access, this study explores the socioeconomic determinants and health burdens among Afghan refugees residing in Pakistan. Between January and June 2025, 250 Afghan refugee families (n = 1460 people) in the provinces of Balochistan and Khyber Pakhtunkhwa were surveyed. To guarantee proportionate representation from camp-based and urban populations, stratified random sampling was employed. Data were gathered via structured questionnaires using a cross-sectional methodology, and SPSS v.27 was used for analysis. Multiple logistic regression, chi-square tests, and descriptive statistics were used to find predictors of poor health outcomes. Undocumented status (OR = 3.11, p < 0.001) and low income (OR = 2.34, p < 0.001) were found to be significant risk variables. Results show that poor health outcomes are strongly correlated with socioeconomic deprivation. Reducing health disparities among Afghan refugees in Pakistan requires bolstering social protection systems, livelihood initiatives, and inclusive healthcare access.

BackgroundAsylum seekers and refugees are at great risk for developing mental disorders. Afghan refugees are a particularly vulnerable group with a low average education and mental health literacy level. Traumatic experiences and hardship before and during migration are predictive of mental health problems. However, post-migration living difficulties (PMLDs) also account for a large proportion of mental distress in such populations, which, critically, are not sufficiently considered in treatment protocols and research investigations. Indeed, the evidence base for the treatment of refugees and asylum seekers is sparse and limited mainly to trauma-specific treatments, where refugees may likely suffer from other mental health problems such as depression or anxiety.Methods/designThis trial is the first evaluation of a short-term, transdiagnostic treatment protocol for treatment-seeking Afghan refugees which addresses mental health problems and PMLDs while using an adapted version of the Problem Management Plus (PM+) protocol. Here, we will investigate the efficacy of an intervention manual with a prospective, single-center, randomized, assessor-blind, two-group trial among refugees who are on a waiting list for professional mental health treatment. Furthermore, we will investigate participants’ subjective experiences with the intervention manual via in-depth interviews. One hundred twenty people will be assessed and randomly allocated to either the intervention arm or a treatment-as-usual arm. Clinical psychologists will conduct the treatment, and the sessions will take place with a Dari interpreter. The protocol consists of six 90-min sessions. The primary endpoint is the general symptom distress measure, assessed with the General Health Questionnaire 28 (GHQ-28). Secondary endpoints are the Post-Migration Living Difficulties Checklist (PMLDC), the International Trauma Questionnaire (ITQ), the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF), the Psychological Outcome Profile (PSYCHLOPS), service and health care use (assessed with several items), and the Immigrant Integration Index (IPL-12).DiscussionThis trial may provide substantial evidence for a brief transdiagnostic psychological intervention. Here, we intend to contribute to the treatment of mental health problems among Afghan refugees. The assessment of subjective experience with this treatment manual, as well as the evaluation of its clinical applicability, may optimize treatment acceptance and outcomes across a wide range of mental health problems among refugees.Trial registrationGerman Clinical Trials Register (DRKS) registration number: DRKS00016538. Universal Trial Number: U1111-1226-3285. Registered on January 7, 2019. https://www.drks.de/drks_web/setLocale_EN.do

Floods due to “blocking event” in the jet stream during 2010 caused intense rainfall and flash floods in northern Pakistan which resulted to riverine flooding in southern Pakistan. In the beginning of July 2010, changes in summer monsoon rainfall patterns caused the most severe flooding in Pakistan history. Process control charts suggest that monsoon pattern was not normal which made one-fifth of the country to be inundated. In this study, our main concern was to check the upward shifts (floods) in the rainfall pattern of all provinces of Pakistan. Results indicate that there was significant and sudden shift in the rainfall pattern of monsoon in 2010 which might be due to prolong “blocking event” in the jet stream. In late July, rainwater from the highlands entered major rivers which affected nearby areas of the Indus River. More than 250 mm of rain fell over a 36-h period in late July. Abeyant policies by the Pakistan Irrigation Department (PID) caused destruction in Jacobabad which was not a normal Indus waterway. The first week of August marked the worst week of extreme flooding in southern Pakistan. Flood simulation overylay technique showed the affected areas of the country in comparison with normal waterways by using vector and raster data images.