Ethnic Groups Of Pakistan Research Articles

Morphometric Analysis of the Dimension and Distance to Anatomical Structures From the Mental Foramen Using Cone Beam Computed Tomography.

This study aimed to determine the dimensions and differences in distances from several anatomical structures to the mental foramen (MtF) in Pakistani participants usingcone beam computed tomography (CBCT). For this cross-sectional study, retrospective CBCT data of Pakistani individuals from both genders were assessed using the Mimics software (Materialise NV, Leuven, Belgium). The participants were selected from the Mahajir and Pukhtoon ethnic groups in Pakistan. The dimensions of the MtF, which included vertical and horizontal diameterand area of foramen, were measured. The distance of the foramen to various anatomical structures was measured, which included the alveolar crest, inferior border of the mandible, and anterior mandible. Data were assessed using SPSS version 28 (IBM Corp., Armonk, NY). Statistical analysis was performed using an independent sample t-test and a paired t-test. P-values greater than 0.05 and 0.001 were considered significant. Greater measurements had been recorded for the Pukhtoon ethnicity with respect to the vertical, horizontal, and area of the foramen. In relation to the dimensions, males showed larger measurements than females. MtF's distance to the alveolar crest, inferior border of the mandible, and anterior mandible (p < 0.001) was greater in Pukhtoon ethnicity. Males displayed longer measurements. CBCT proved to be a highly accurate and useful tool for the analysis of the dimensions and distances from the MtF in both ethnicities. The Pukhtoon ethnicity exhibited overall greater measurements with respect to the dimensions, highlighting a significant difference between the two ethnicities. Analysis of MtF distance to various landmarks resulted in longer measurements being observed in males and Pukhtoon ethnicity.

Association of clopidogrel resistance with ethnicity in Pakistan.

Objective: The objective of this study was to assess relationship between clopidogrel resistance and different ethnicities in Pakistan. Study Design: Cross-sectional study. Setting: Army Medical College, National University of Medical Sciences (NUMS), Pakistan. Period: 2015 to 2019. Material &amp; Methods: Included 390 ischemic heart disease (IHD) patients on clopidogrel therapy belonging to different ethnicities in Pakistan. Their platelet aggregation was assessed through light transmission aggregometry and the patients were divided into clopidogrel responder and clopidogrel resistant groups. Chi square analysis was done to assess difference in clopidogrel resistance among different ethnicities. One-way ANOVA was applied to assess difference in mean platelet aggregation among different ethnic groups. Results: This study has demonstrated that there was no significant difference in clopidogrel resistance among ischemic heart disease patients belonging to different ethnic groups of Pakistan, p = 0.566. Mean platelet aggregation of all the ethnic groups was also similar, p = 0.330. Conclusion: There is no association of clopidogrel resistance with ethnicity in Pakistan.

Punjabiyat vs “Punjabistan”: Features of Punjabi Ethnic Nationalism (A Case of Pakistan)

The essay focuses on the specific features of Pakistani punjabiyat, which is interpreted as Punjabi ethnic nationalism. Having analyzed the Pakistani punjabiyat in the perspective of classic theories of ethnic nationalism and South Asian nationalism concepts, the author defines its characteristics and explains the connection between the specific form of Punjabi ethnic nationalism in Pakistan and the process of “punjabization” understood as the overwhelming influence of Punjabis in the country, which has begun since its inception in 1947. Ethnic nationalisms and consequent regional ethnic movements are a typical feature of almost all large ethnic groups in Pakistan. However, Punjabis have not only avoided this behavioral pattern: they commonly renounce their group identity for the sake of the unifying Pakistani ideology (pakistaniyat). Analysis of the specifics of Pakistani punjabiyat leads us to the conclusion that its growth has been slowed down and hindered by the “punjabization”. Punjabiyat as an idea of the Punjabi ethnic identity has lost to “Punjabistan” perceived as the de-facto social, economic and political dominance of Punjabis in the Islamic Republic of Pakistan.

Depression in Various Ethnic Groups of Pakistan after Primary Percutaneous Coronary Intervention

Background: Depression is very common among individuals recovering from a chronic illness with long-term or recurrent hospitalization. Post-myocardial infarction patients are at risk of developing depression and is considered to be a risk for elevated mortality.&#x0D; Aims and Objective: To determine the frequency of depression among various ethnic groups of patients post primary percutaneous coronary intervention for acute myocardial infarction.&#x0D; Material and Methods: �A cross-sectional study was conducted at the out-patients department of NICVD, Pakistan for a duration of six months from February 2021 to July 2021. Total 256 patients aged between 18 to 85 years, were diagnosed with STEMI, and had undergone PCI were included in the study. Patients with prior diagnosis of CAD or had prior history of psychological problems were excluded from the study. Patients were interviewed for depression by using Beck's depression inventory (BDI). Patients scoring &gt; 10 were labeled as having depression.&#x0D; Results: Out of 256 patients, 122 (48.8%) patients were screened positive for depressive symptoms.� Out of these, about 21.1% had mild depression, 16% had borderline clinical depression, 10.5% had moderate depression, while about 0.8% had severe depression. Age of 71 years and above, female gender, diabetes, hypertension, and sedentary lifestyle were all significantly correlated with increased risk of depression in post-MI patients with BDI scores of 17.64 � 7.9 (&lt;0.0001), 13.54 � 7.53 (0.015), 14.47 � 7.61 (p&lt;0.0001), 13.52 � 6.83 (p&lt;0.0001), and 16.69 � 7.57 (p&lt;0.0001), respectively.&#x0D; Conclusion: After percutaneous coronary intervention for MI, depression was found in almost half of the patients. However, as per our study, the risk for depression is independent of ethnic background.

The Prevalence of Pharmacogenomics Variants and Their Clinical Relevance Among the Pakistani Population.

Background:Pharmacogenomics (PGx), forming the basis of precision medicine, has revolutionized traditional medical practice. Currently, drug responses such as drug efficacy, drug dosage, and drug adverse reactions can be anticipated based on the genetic makeup of the patients. The pharmacogenomic data of Pakistani populations are limited. This study investigates the frequencies of pharmacogenetic variants and their clinical relevance among ethnic groups in Pakistan.Methods:The Pharmacogenomics Knowledge Base (PharmGKB) database was used to extract pharmacogenetic variants that are involved in medical conditions with high (1A + 1B) to moderate (2A + 2B) clinical evidence. Subsequently, the allele frequencies of these variants were searched among multiethnic groups of Pakistan (Balochi, Brahui, Burusho, Hazara, Kalash, Pashtun, Punjabi, and Sindhi) using the 1000 Genomes Project (1KGP) and ALlele FREquency Database (ALFRED). Furthermore, the published Pharmacogenomics literature on the Pakistani population was reviewed in PubMed and Google Scholar.Results:Our search retrieved (n = 29) pharmacogenetic genes and their (n = 44) variants with high to moderate evidence of clinical association. These pharmacogenetic variants correspond to drug-metabolizing enzymes (n = 22), drug-metabolizing transporters (n = 8), and PGx gene regulators, etc. (n = 14). We found 5 pharmacogenetic variants present at >50% among 8 ethnic groups of Pakistan. These pharmacogenetic variants include CYP2B6 (rs2279345, C; 70%-86%), CYP3A5 (rs776746, C; 64%-88%), FLT3 (rs1933437, T; 54%-74%), CETP (rs1532624, A; 50%-70%), and DPP6 (rs6977820, C; 61%-86%) genes that are involved in drug response for acquired immune deficiency syndrome, transplantation, cancer, heart disease, and mental health therapy, respectively.Conclusions:This study highlights the frequency of important clinical pharmacogenetic variants (1A, 1B, 2A, and 2B) among multi-ethnic Pakistani populations. The high prevalence (>50%) of single nucleotide pharmacogenetic variants may contribute to the drug response/diseases outcome. These PGx data could be used as pharmacogenetic markers in the selection of appropriate therapeutic regimens for specific ethnic groups of Pakistan.

Reclaiming Pashtun Identity

This essay focuses on the “regime of truth” that has historically been constructed in public education institutions that support the state assimilationist nation-building project which marginalizes Pashtun ethnic identity, culture, history, and political existence. In popular media, Pashtun are also presented as a “suspect community” and “potential terrorists.” In response, some Pashtun have created informal spaces such as study circles, gatherings where they develop alternatives to the official state narrative found in textbooks used in formal education. By focusing on Pashtun history, culture and politics, they consciously and academically resist the image of the Pashtun as “suspect community.” Drawing on what James C. Scott calls “weapons of the weak,” this essay examines the selection and use of these informal spaces as a mode of resistance. The research on which it is based uses anthropological methods, such as participant observation, informal discussions, and unstructured interviews, to examine the construction of narratives that challenge official accounts of Pashtun identity. The essay concludes by comparing these Pashtun informal spaces with different forms of resistance found among other ethnic groups in Pakistan.

Variations in the frequencies of polymorphisms in the CYP2C9 gene in six major ethnicities of Pakistan

Genetic variation in cytochrome P450 (CYP) 2C9 is known to cause significant inter-individual differences in drug response and adverse effects. The frequencies of CYP2C9*2 and CYP2C9*3, both of which are responsible for the low activity of the enzyme, are not known in the Pakistani population. Therefore, we screened various ethnic groups residing in Pakistan for these polymorphisms. A total of 467 healthy human volunteers were recruited from six major ethnicities of Pakistan after written informed consent. Our results indicate that about 20% of the Pakistani population has a genotype containing at least one low activity allele. Ethnic Punjabi and Pathan populations had the highest frequencies of wild type genotypes while Urdu, Seraiki, and Sindhi populations showed higher rates of both low activity genotypes. The Baloch population showed the highest rates of low activity genotypes with less than 50% of the samples showing wild type genotypes, suggesting that more than half of the Baloch population possesses low activity genotypes. The frequencies found in various ethnic groups in Pakistan were comparable with ethnicities in the South Asian region except for the Baloch population. These results suggest that pharmacogenetics screening for low activity genotypes may be a helpful tool for clinicians while prescribing medications metabolized by CYP2C9.

Evaluation of prevalence of different types of cancer and its chemotherapy in various ethnic groups of Pakistan: A retrospective study

The objective of the study was to evaluate different types of cancer and its chemotherapy in various ethnic groups of Pakistan. Ethnic groups includes, Pukhtoons, Punjabis, Sindhis, Muhajirs, Siraikis, Memoons, Hazaras, Hindkos, Baltis, Gilgitis, Kashmiris, and Afghanis. The data was collected from well reputed hospitals located in the different provinces of Pakistan. The collected data was taken from 15 hospitals where around 8500 patients visited during 2010 to 2017. From the visited patients, 8356 were analyzed for their ethnicity, age and sex while, 144 patients (male 77 and female 67) were excluded from analysis due to incomplete information or loss of follow-up. Among 8356 patients, 3762 were male (45%) whereas, 4594 were female (55%). The chemotherapy was carried out as per National Comprehensive Cancer Network guidelines (NCCN- guidelines). The most common five prevalent cancer among these ethnic groups were Head and Neck, Blood, Respiratory, Genito-urinary and Breast cancer. The most common cancer in female was breast cancer while, head and neck cancer was more prevalent in male. It can be concluded that the prevalence of cancer in Pakistan is very alarming, which may be due to lack of awareness, illiteracy, lack of national cancer control programs, and economics issues.

Dichromacy: Color Vision Impairment and Consanguinity in Heterogenous Population of Pakistan

Abstract:&#x0D; Background and Objectives: Dichromacy, an X-linked recessive disorder is identified worldwide, more in males than females. In European Caucasians, its incidence is 8% in males and 0.5% in females. In India, it is 8.73% in males and 1.69% in females, and in Iran, it is 8.18% in males and 0.43% in females. Population based epidemiological data about dichromacy in different ethnic groups in Pakistan is not available. The aim of this study was to find out the population prevalence of inherited red-green dichromacy in a heterogenous population of the district of Chiniot, Punjab, Pakistan, and to determine the impact of consanguinity and ethnicity.&#x0D; Methods: In this cross-sectional study, boys and girls of the higher secondary schools were examined in the three tehsils of district Chiniot. Pseudoisochromatic Ishihara Test has been employed for detection of dichromacy in the study population. The sample size was calculated statistically as 260, which was expanded to 705 and divided by population density of the three tehsils.&#x0D; Results: Screening of 359 males and 346 females revealed 19 (5.29%) dichromat males and only 2 (0.58%) females. The study population belonged to 23 castes / isonym groups. The consanguinity found in the district of Chiniot is 84.82% and in the dichromat families, it is 85.71%, of which 52.37% are first cousin.&#x0D; Interpretation &amp; Conclusion: The study has shown that the incidence of dichromacy could be reduced through genetic counseling

Genetic Polymorphism of CYP2C19 in Pakistani Population.

CYP2C19 polymorphism is associated with pretreatment drug response prediction, metabolism, and disposition. Pakistan consists of a population comprising of various ethnic groups residing in different regions of the country each claiming diverse ethnic origins. The identification of CYP450 genotypic composition of these populations is therefore necessary to avoid adverse drug reactions in these individuals. The main objective of the study was to investigate the prevalence of CYP2C19*2 and CYP2C19*17 alleles in these ethnic groups. The study was conducted on one thousand and twenty-eight (n = 1028) healthy volunteers from nine ethnic groups of Pakistan namely Brusho (n = 28), Hazara (n = 102), Kalash (n = 64), Pathan (n = 170), Punjabi (n = 218), Saraiki (n = 59), Brahui (n = 118), Parsi (n = 90), and Sindhi (n = 179). DNA was extracted from leukocytes and analyzed by allele specific amplification polymerase chain reaction (ASA-PCR). Multi allelic polymorphism of CYP2C19 led to four distinct phenotypes identified as extensive metabolizer (EM), poor metabolizer (PM), intermediate metabolizer (IM), and ultra-rapid metabolizer (UM). Over all, the percentage of predicted poor metabolizer allele was 29.0% compared to UM allele (23.70%). Among the studied groups, Saraiki and Brahui showed highest percentage of PM allele (40%, 36%) whereas Parsi and Hazara had highest percentage of UM allele (37% and 30% respectively). In conclusion, the high allele frequency of PM (CYP2C19*2 and *17) in Pakistani population led to the recommendation of a pre-treatment test to monitor drug response and dosage (personalized medicine) to avoid post-treatment adverse drug reactions.

The Variation in Anaemic Parameters in the Ethnic Groups of Pakistan

The Variation in Anaemic Parameters in the Ethnic Groups of Pakistan

Language shift or maintenance

Abstract Pakistan is a multilingual country with six major and over 59 minor languages. However, the languages used by the domains of power, (government, corporate sector, media and education), are English and Urdu. Compared to the other regional languages in Pakistan, the Sindhi language has a more emancipated position in the state-run schools and some other domains. The present study seeks to explore the extent to which the use of Sindhi language has been shifted or maintained, and to survey the patterns of language use in certain domains through Fishman’s domain concept for the determination of language shift within the community concerned. A mixed method data collection including questionnaires and in-depth interviews was conducted to find out whether Sindhis in the Sind province of Pakistan maintain their heritage language in specific domains and to ascertain the impact of Pakistan’s language policy on Sindhi language. The results show that Sindhis in Sindh province fully maintain their language and behold sentimental affiliation with it as part of their cultural identity. The Sindhis have successfully uplifted and maintained their language in education and other vital domains. The Sindhi community enjoys a higher ethno-linguistic vitality than the other ethnic groups in Pakistan.

Problems in Mitochondrial DNA forensics: while interpreting length heteroplasmy conundrum of various Sindhi and Baluchi ethnic groups of Pakistan

The insight heterodox genetics of mtDNA infer new perspectives at the level of human mitochondrial control region heteroplasmy, which is substantial in evolutionary as well as forensic interpretation. The main goal of this study is to interrogate the recurrence and resolve the ambiguity of blurry spectrum of heteroplasmy in the human mtDNA control region of 50 Baluchi and 116 Sindhi unrelated individuals. Sanger sequencing was employed classically, that was further investigated by minisequencing. Only 20% Baluchi and 25.8% Sindhi were homoplasmic, whereas rest of 80% Baluchi and 74.1% Sindhi exhibited at least one heteroplasmy within the specimen. In total, 166 individuals have length heteroplasmy (LH) found at positions 16189, 303–315, 568–573, and 514–524, whilst point mutation heteroplasmy (PMH) was detected at positions 73, 16093, 16189, and 16234, respectively. Overall LH was observed albeit high frequency in Sindhi ethnic group (82%) rather than Baluchi’s (37%), whereas PMH accumulation was relatively extensive (24%) in Baluchi’s than Sindhi’s (11.2%). The obtained results ascertained that growing knowledge of heteroplasmy assisted to develop consciences in the forensic community that heteroplasmy plays a pivotal role in the legal interpretation on a regular basis and knowledge of its biological underpinnings has a vital niche in the forensic science. Limited studies have focused on heteroplasmy, yet scientific attention should be given, in order to determine its magnitude in different ethnic boundaries.

Prenatal screening for β-thalassemia major reveals new and rare mutations in the Pakistani population

β-Thalassemia is the most common genetic disorder in Pakistan, where more than 6000 affected children are born annually, and the carrier population is around 10 million. The objective was to study β-globin gene mutations in chorionic villous biopsy samples. Prenatal screening of 383 pregnant women between 2003 and 2010 was carried out using a panel of 13 mutation primers and amplification refractory mutations system (ARMS)-PCR. In addition, DNA sequencing was used to confirm uncharacterized mutations and in some cases fetal disease status was confirmed by linkage analysis. Families enrolled in this study represented major ethnic groups in Pakistan. Of the 13 mutations tested, three mutations accounted 71% of the total, including IVS1-5(G-C)[HBB:c.92+5G>C], codon 8/9(+G) [HBB:c.27_28insG] and del 619[NG_000007.3:g71609-72227del619]. Mutations in four uncharacterized samples were later confirmed by DNA sequencing as -88(C-T)[HBB:c.-138C>G], -90(C-T)[HBB:c.-140C>T] and codon 59(+T)[HBB:c.178_179insT]. To our knowledge, this is the first report of these mutations in Pakistan. Moreover, 19.2% fetal samples were normal and 52.3% heterozygous, whereas 26.4% were affected with thalassemia major. IVS1-5:IVS1-5 was the most common genotype in fetal samples. Prenatal diagnosis of β-thalassemia using ARMS PCR is an efficient approach for reducing the burden of this disease in Pakistan. In addition, rare mutations reported in this study should be incorporated in the diagnostic strategy.

Molecular Epidemiology of β-Thalassemia in Pakistan: Far Reaching Implications

Abstract 5309 Introduction:β -Thalassaemia, an autosomal recessive hemoglobinopathy, is one of the commonest genetically transmitted disorders throughout the world. Collective measures including carrier identification, genetic counseling and prenatal diagnosis are required for preventing β -thalassemia. To achieve this objective, Identification of the spectrum of genetic mutations, especially for various ethnic backgrounds in Pakistan, since the country is a High Burdon Country. Therefore, we designed a cross sectional study to identify the frequency of various gene mutations in different ethnic groups of Pakistan. Methodology:Over a period of five years, venous blood samples were collected from 466 individuals belonging to different ethnic groups residing in Karachi, having at least one affected family member known to have β-thalassemia major/ HbE- β-thalassemia/ HbE homozygotes/ β-thalassemia trait. Chorionic villus sampling at 11 to 15 weeks gestational age for 143 couples referred by thalassemia clinics as also used to obtain allele information. In all, 648 mutated alleles were identified. The diagnosis of β-thalassemia trait, β-thalassemia major and Hb E thalassemia were established from clinical data, hematological indices and hemoglobin electrophoresis by cellulose acetate method. DNA was extracted from whole blood for detection of mutations. Primers were designed for simultaneous detection of the following previously described mutations in a single reaction: IVS 1–5 (G-C), Fr 8–9, IVS 1-1 (G-T), Cd-30 (G-C), Cd-5 (−CT), Del 619bp, Cd-15 (G-A), Fr 41–42, Fr 16 (−C) and Cap +1 (A-C) along with two Hb variants: HbS and HbE. Results:The genetic heterogeneity in Karachi is reflected by the identification of all the common β-thalassemia alleles and two Hb variants but following eight mutations were more common: IVS 1–5 (G-C), Fr 8–9, Del 619 bp, IVS 1-1 (G-T), Fr 41–42, Cd-30 (G-C), Cd-5 (−CT) and Cd-15 (G-A), accounting for 93.9% of the β-thalassemia alleles. However, the distribution was uneven.Although IVS 1–5 (G-C) was the most common mutation (40.89% of the sample), its frequency varied from 20% in the immigrant (from India) population to 76.9% in the Balochis. The second most frequent mutation was Fr 8–9, constituting 15.7% of the allele pool. Fr 8–9 was the most common mutation in the Pathans (31.3%) as it was in people of Saraikee origin (47%). Discussion:IVSI-5 (G-C),(40.89%), Fr8-9(15.7%), & IVSI-I(G-T),(8.17%), were the most common genetic mutations identified in Pakistan. Knowledge of the predominant mutation in a given ethnic group will not only help in developing a short panel of (population-specific) primers of mutations thereby providing a cost-effective method for prenatal diagnosis and also help the clinicians for genetic counseling and pregnancy termination. Disclosures:No relevant conflicts of interest to declare.

Characterization of Y-Chromosomal Short Tandem Repeat Markers in Pakistani Populations

The Y chromosome microsatellite markers have been extensively used for population genetic studies and in individual identification and paternity testing in forensic medicine. In the present study, we report the data of five male-specific, polymorphic microsatellites in 740 unrelated male individuals from 12 different ethnic groups of Pakistan. The overall diversities of these individual loci in Pakistan ranged from 0.236 to 0.799. The total haplotypes identified were 152, and of these, 70 different haplotypes were present in only single individuals. Two haplotypes were found more frequently, 9_8_17_11_24 (13.5%) and 9_8_17_11_25 (8.6%), showing population-specific clustering in the Mohanna and the Brahui, respectively. An overall haplotype diversity of 0.965 in Pakistan suggested a high power of discrimination for these loci. Few populations, particularly the Mohanna and the Balti, showed lower haplotype diversity values for these loci (0.662 and 0.758, respectively). This set of microsatellite loci reported in the study can be used for population genetics and forensic medicine analysis. This study also demonstrates the importance of studying haplotype distribution pattern in population genetics.

VNTR Polymorphism of the DRD4 Locus in Different Pakistani Ethnic Groups

The present study was designed to investigate the dopamine receptor D4 (DRD4) locus variable number of tandem repeat (VNTR) allelic distribution in different Pakistani ethnic groups. DNA samples from nine different ethnic groups of Pakistan were analyzed. Greek and Somali samples were included as representatives of the European and African populations, respectively. Pakistani, Greek, and Somali populations were also compared to the published data on different world populations. The allelic distribution revealed that the four-repeat allele was the most common allele in all the Pakistani ethnic groups as is in different other world populations, followed by the seven- and two-repeat alleles. To study the evolutionary relationship of the Pakistani ethnic groups among themselves and with a few other world populations, multidimensional scaling based on the allelic frequencies of the DRD4 VNTR was obtained. This analysis grouped most of the Pakistani ethnic groups together and closer to the European and Middle Eastern populations, except for the Mohanna from Sindh, who grouped with the African populations. In addition, the Somali and the Greek samples analyzed in this study grouped closer to the previous data obtained on the African and European populations, respectively.

Molecular Characterization of α‐Thalassemia in Pakistan

Common α‐thalassemia (thal) rearrangements were studied in a normal random population and in six ethnic groups of Pakistan. Analyses of 204 individuals from the normal population revealed the presence of only the −α3.7 allele with an overall frequency of 8.3%. Ethnic differences were statistically significant for Pashtoon vs. Balochi (p < 0.0005) and Pashtoon vs. Sindhi (p < 0.002). Two hundred and eighty‐five thalassemia patients were also studied to identify rare α‐thal alleles. In this group, 24.6% of the patients had one or two α genes deleted. Two rare alleles in the Pakistani population, −α4.2 (0.2%) and αααanti 3.7 (0.9%), were identified in these patients. The −α4.2 allele was found only in Sindhis, while αααanti 3.7 was present in Punjabis, Sindhis and Balochis. Five patients with triplicated α genes were homozygous for either the β+ or the β0 genotype.

Molecular Characterization of β-Thalassemia in Pakistan

β-Thalassemia is one of the most common inherited hemoglobin disorders in Pakistan. The carrier frequency is estimated to be 5.4%. To determine the spectrum of β-globin gene defects causing β-thalassemia, we have analyzed a representative sample of 602 alleles from six ethnic groups in Pakistan; 99.2% alleles were characterized, while 0.8% remained unidentified. The spectrum of mutations is heterogeneous and we have found 19 different mutations in all ethnic groups. The four most common mutations, IVS-I-5 (G→C) (37.7%), codons 8/9 (+G) (21.1%), the 619 bp deletion (12.4%), and IVS-I-1 (G→T) (9.5%), account for 80.7% of the alleles. There are differences between the ethnic groups and also between provinces. In the four provinces of Pakistan, the IVS-I-5 (G→C) mutation is more prevalent in Sindh and Balochistan, bordering India in the south and Iran in the southwest, while the codons 8/9 (+G) mutation is more common in the Punjab and the North West Frontier Province, bordering India in the northeast and Afghanistan, respectively. The 619 bp deletion is high (46%) in Gujratis and Memons residing in the Province of Sindh, neighboring the Indian Gujrat

Pneumonia perceptions and management: An ethnographic study in urban squatter settlements of Karachi, Pakistan

Childhood pneumonia continues to be the second highest contributor to childhood morbidity and mortality in all ethnic groups in Pakistan. Information on community perceptions and management is largely limited to the Punjabi populace. In this study, ethno-specific illness terminologies, recognition and severity indicators and resort to treatment options for childhood pneumonia are explored among the two main ethnic groups in Sindh. Results are based on focus group discussions with 90 caretakers and 16 case history interviews. The findings indicate that pneumonia recognition is almost universal. The main recognition and severity indicator was pasli chalna (chest indrawing) followed by signs and symptoms relating to the quality of breathing and presence of high fever, lethargy and anorexia. Recognition of rapid breathing was low and mostly associated with fever. Exposure to thand (cold) through a variety of mechanisms was perceived to be the dominant causal model. The concept of contagion was virtually non-existent. Despite this, belief in efficacy of allopathic care was very high. Most caretakers reported seeking outside care within one to three days of the onset of symptoms. However, unrealistic expectations of cure often led to change in physicians and treatment regimen, if no improvement was observed by the second day. On the other hand, the quality of care provided by the physicians (both licensed and unlicensed) left much to be desired. Female autonomy and mobility did not appear to be a major constraint in seeking outside care other than for hospitalisation. Implications of these findings for the national acute respiratory infections control programme and future research are discussed