Management In Pakistan Research Articles

Understanding childhood obesity in Pakistan: exploring the knowledge, attitudes, practices of mothers, and influential factors. A cross-sectional study

BackgroundChildhood obesity is a significant public health issue with far-reaching implications. The World Health Organization reported that in 2020, around 38 million children under five were overweight or obese globally, and in 2016, 340 million children and adolescents aged 5–19 were affected. In Pakistan, the situation is alarming; 66.9% of school-going children in Punjab were overweight, and 5.8% were obese in 2022. This study explores mothers’ knowledge, attitudes, and practices regarding childhood obesity in Pakistan and identifies factors contributing to this epidemic. Maternal perspectives are crucial as they significantly influence children’s dietary habits, physical activity, and attitudes toward food and body image.MethodsA cross-sectional study was conducted from November 2023 to January 2024 at four medical centers: Fazaia Ruth Pfau Medical College Hospitals Karachi, Baqai Medical University Karachi, and Nishtar Medical University Multan. The study included 191 mothers with children aged 5 to 15 years. Data were collected using a structured questionnaire on sociodemographic characteristics, knowledge, attitudes, practices, and perceptions of childhood obesity. IBM-SPSS version 26.0 was used for data analysis, employing statistical tests like Kruskal-Wallis, Mann–Whitney U, Spearman, or Kendall Tau correlation to examine associations.ResultsAmong the 191 mothers, 48.7% had education beyond intermediate, and 86.9% were housewives. The children’s BMI distribution showed that 27.7% were obese and 21.5% overweight. Mothers had moderate knowledge (60.5%) about childhood obesity; 75.4% recognized its long-term health risks, and 62.8% associated it with diabetes. Attitudes were generally positive, with a 78.5% average score. Most mothers (73.8%) believed obesity could be controlled and had healthy practices (70.1% average score). However, 96.9% reported witnessing stigmatization of obese children, and 79.6% felt pressured by relatives about their child’s weight.ConclusionThe findings indicate that while Pakistani mothers have moderate knowledge and positive attitudes toward childhood obesity, their practices are influenced by educational and socioeconomic factors. Addressing these disparities, enhancing public health initiatives, and mitigating stigmatization could improve childhood obesity management in Pakistan.

A Relative Analysis of Gardens of Pakistan and UK

Parks play an important role in improving people's quality of life, especially amidst rapid urbanization. This research aims to explore how differences in park design and management affect people's use and perceptions in both countries. The approaches used in this research are qualitative and quantitative. Data were collected through literature review, field observations, and interviews with relevant parties, such as park managers and visitors. The findings show that parks in Pakistan have great cultural significance, often used for social gatherings and recreation, with examples of historical parks such as Shalimar. On the other hand, gardens in the UK offer a diverse range of styles and functions, from formal gardens to natural landscapes, serving as an educational resource for botanical lovers. This analysis provides insights into the unique characteristics of parks in both countries and provides recommendations for park planning and management in Pakistan, taking into account best practices from the UK.

Renal satellite units in Pakistan: Challenges, efforts, and recommendations.

This commentary delves into the complexities surrounding chronic kidney disease management in Pakistan, specifically examining the critical role played by renal satellite units in providing accessible dialysis services. Chronic kidney disease in Pakistan accounts for 3.9% of total deaths, warranting a focused exploration of challenges and potential solutions. RSUs, smaller entities affiliated with main renal units, emerge as key players in addressing issues of geographic accessibility and diminishing travel burdens for chronic kidney disease patients. Challenges such as financial constraints, limited resources, and staff shortages, particularly in rural settings, pose significant hurdles to the effective functioning of RSUs. This commentary emphasizes the importance of clear eligibility criteria, robust vascular access support, regular physician engagement, and the strategic integration of telemedicine. It explores diverse funding models, including government allocations, community contributions, and philanthropic partnerships, as potential solutions to alleviate cost-related concerns. The commentary advocates for a holistic, cost-effective approach to chronic kidney disease care, highlighting the transformative potential of renal satellite units in improving health outcomes across varied settings.

Water resources in Pakistan: a comprehensive overview and management challenges

ABSTRACT Pakistan has a range of water resources, including many rivers, large glaciers in the Himalayas, and significant underground water reserves, located throughout the country. However, the country faces considerable challenges in effectively managing these water resources. Employing a comprehensive review methodology, this paper examines policy documents and recent scholarly articles to analyze the current obstacles and propose viable solutions for sustainable water management in Pakistan. Significant challenges, including delayed policy implementation, insufficient regulatory enforcement, and inadequate data collection, hinder water resource management. Furthermore, there is a critical gap in integrating climate adaptation measures into water management strategies, which affects the resilience and efficiency of water resource allocation and utilization amid changing environmental conditions. It recommends significant policy changes that include economic measures such as water pricing, advancements in water recycling technologies, and approaches to improve climate resilience. Furthermore, this study proposes a comprehensive framework designed to tackle the complex challenges of water management. It suggests an integrated approach that combines policy, technology, environmental, and economic strategies to promote sustainable and resilient water use.

Evaluating the Effects of Decentralized District-Based Treatment of Drug-Resistant Tuberculosis in Pakistan: An Alternative Model of Care

Background: Pakistan faces a high burden of drug-resistant tuberculosis (DR-TB), with traditional centralized care resulting in delays and poor treatment outcomes. Decentralizing care to district-level hospitals offers a potentially more effective alternative.Objective: This study aimed to evaluate the impact of decentralized DR-TB care on treatment initiation time, patient follow-up, and treatment outcomes.Methods: A descriptive post-intervention study was conducted at a decentralized DR-TB clinic in Sheikhupura, Punjab, between June 2021 and December 2022. Data from 100 patients were retrospectively collected from hospital records and diagnostic labs, including demographic information, treatment compliance, smear and culture conversion rates, and adverse drug reactions. SPSS 25 was used for statistical analysis, including descriptive statistics.Results: The average time from diagnosis to treatment initiation was 14.9 days. Smear conversion by the sixth month was 99%, while culture conversion was 98%. The treatment success rate was 70%, with a 7% loss to follow-up, 2% treatment failure, and 15% mortality.Conclusion: Decentralized DR-TB care significantly reduced delays in treatment initiation and improved patient outcomes. This model is feasible for national implementation with potential to enhance DR-TB management in Pakistan.

Cardiopulmonary Rehabilitation: The Missing Link in Heart Disease Management in Pakistan – Reminder on World Heart Day

Cardiopulmonary Rehabilitation: The Missing Link in Heart Disease Management in Pakistan – Reminder on World Heart Day

Advanced Agricultural Water Management in Pakistan: Integrative Approaches and Cutting-Edge Technologies to Combat Water Scarcity

This article explores the censorious challenge of water scarcity in Pakistan and presents a comprehensive analysis of several strategies and technological metamorphoses aimed at mitigating this issue. By examining precision irrigation, water recycling, desalination technologies, and ecosystem restoration, this article highlights their potential to escalate water use effectiveness and sustainability across key sectors such as agriculture, industry, and domestic use. It also evaluates the role of Integrated Water Resource Management (IWRM) and the National Water Policy, emphasizing the need for coordinated governance, public awareness, and education programs. The findings underline the importance of adopting a multi-sectoral approach, integrating advanced technologies, and fostering collaboration among stakeholders to address the growing water scarcity in Pakistan. The article concludes with recommendations for future research and policy reforms to ensure sustainable water management and long-term water security in the region.

Balancing Costs and Care: Nonoperative Appendicitis Treatment Outcomes in Pakistan.

Dear Respected Editor, In Pakistan, approximately 110,000 cases of appendicitis are reported annually [1], highlighting the condition's prevalence and significance. Traditional management predominantly revolves around widely practiced surgical intervention, such as appendectomy. [2]. Immediate appendectomy has become the standard treatment due to the significant morbidity and mortality difference between perforated and non-perforated acute appendicitis. However, the country's healthcare landscape presents a complex challenge due to varying regional access to medical resources. This variation in healthcare infrastructure exacerbates the difficulty of effectively managing appendicitis and underscores the need for solutions that strike a balance between clinical outcomes and economic considerations. While appendectomy remains a standard surgical procedure, it comes with inherent disadvantages, chief among them being the cost burden it places on patients and healthcare systems [3]. For patients in a low- to middle-income nation like Pakistan, the financial strain associated with surgery—which includes preoperative evaluations, surgical costs, hospital stays, and postoperative care—can be challenging [4]. Furthermore, the ripple effects affect the whole healthcare system, diverting resources that may otherwise be used for other urgent medical needs. A study by Siddiqui et al. emphasizes the need for a comprehensive analysis of economic factors in appendicitis management, particularly in low- and middle-income countries like Pakistan. The challenges in countries such as Pakistan require the exploration of alternative approaches that can optimize clinical outcomes while effectively managing healthcare costs without compromising patient care. [2] The recent study by Lee et al. introduces a promising alternative to conventional appendicitis management [5]. The research focuses on nonoperative treatment approaches, such as antibiotic therapy and observation, which have gained traction for their potential benefits Further, the study shows that the majority of the patients who had nonoperative treatment did not encounter a recurrence of appendicitis and were able to avoid surgical intervention for a period of around 20 years. Furthermore, there is a lack of data indicating any long-term dangers associated with nonoperative care. One of the prominent advantages lies in the reduction of immediate healthcare expenses, which can alleviate the financial burden on both patients and healthcare systems. By presenting evidence on the effectiveness and safety of nonoperative approaches, this study opens avenues for a paradigm shift in appendicitis management in Pakistan. The potential to achieve comparable clinical outcomes while minimizing the economic burden is a compelling proposition that warrants further exploration and consideration within Pakistan's healthcare challenges.

Current Trends in School Management in Pakistan: A Bibliometric Analysis

This research aims to analyze the current trends in management in schools in Karachi. School management is a hot debate these days, and management needs to play an effective role in the sustainability of schools and attaining desired outcomes academically and professionally. For this, bibliometric analysis was done by selecting research papers from Scopus, Elsevier, and Google Scholar. The research articles were chosen using keyword management and trends in Management using inclusion and exclusion criteria. With the help of Google Scholar, 40 research papers were found to be relevant to the selected topic. However, almost 20 papers fulfill the requirements of the main topic. Therefore, 20 papers are included in this review paper. Findings reveal that Management plays an essential role in the progress and achievement of the school. By analyzing students’ performance, principals, as the central part of school administration, can identify areas where improvements are needed. It is recommended that school principals adapt to emerging trends to enhance learners' academic achievement and readiness.

Guiding postmenopausal care for osteoporosis: First evidence-based clinical practice guidelines for Pakistan.

Madam, We would like to address the issue of postmenopausal osteoporosis (PMO) management in Pakistan and advocate for the country-wide dissemination of the recently published Pakistan-specific clinical practice guideline (CPG) "GRADE-Adolopment of Clinical Practice Guideline for Postmenopausal Osteoporosis Management - a Pakistani Context" (1). Osteoporosis poses a significant threat to the health of postmenopausal women. Although osteoporosis prevalence among postmenopausal women ranges from 20% to 49.3% in Pakistan, there is a lack of epidemiological data, diagnostic facilities, and public awareness about bone health. Healthcare providers in Pakistan have thus far struggled with managing osteoporosis effectively because of the absence of local CPGs. The Pakistani PMO guideline, developed by the Aga Khan University aligns the recommendations of the Asia Pacific Consortium on Osteoporosis (2) and the American Association of Clinical Endocrinologists (3). The GRADE-ADOLOPMENT methodology used in developing the guideline provides a systematic support for the recommendations that are evidence based and suitable for adoption in Pakistan's medical settings. The guideline recommends higher doses (2000-4000 IU) of vitamin D in patients with obesity, malabsorption, and old age, considering their increased requirements and suboptimal response to lower doses. It addresses food insecurity and malnutrition, which contribute to vitamin D deficiency and fracture risk. Moreover, the guideline incorporates the surrogate FRAX model created for Pakistan, recommended by the International Osteoporosis Foundation for countries lacking fracture incidence data (4). A management algorithm is proposed, based on intervention thresholds developed for Pakistan for accurate estimation of fracture probability, and to guide clinical practice(5). The primary goal of the guideline is to improve the quality of care by changing the daily practice of physicians in the desired direction. Disseminating and integrating osteoporosis care into the healthcare system is challenging but remains a top priority. The endorsement of the guideline by relevant national societies can play a crucial role in its dissemination. Implementation through their members can help in assessing effectiveness and in shaping clinical practice. The guideline is a critical step in addressing osteoporosis management challenges in Pakistan, but for full impact, widespread dissemination and implementation in clinical practice is required. We implore the medical community, policymakers, and stakeholders to collaborate in this endeavor and work towards improving the management of osteoporosis, to enhance the health outcomes of the Pakistani population. It is essential that healthcare policymakers and practitioners recognize PMO as a significant public health issue and implement the CPG for appropriate practice changes.

A Novel Active RFID and TinyML based system for livestock Localization in Pakistan

Localization of livestock is a vital component of good livestock management in Pakistan. This abstract describes a unique method for livestock localization in Pakistan that makes use of Active RFID technology and Tiny Machine Learning (TinyML) approaches. The incorporation of Active RFID technology allows for precise and long-range livestock tracking, while TinyML provides on-device analysis and decision-making. This method has a number of advantages, including high precision, real-time localization, and less reliance on external infrastructure. Accurate triangulation-based localization is obtained by putting Active RFID tags on cattle and carefully positioning Active RFID anchors in specific regions. TinyML integration on resource-constrained microcontrollers within Active RFID tags allows for efficient on-device analysis of Active RFID signals. The suggested system has the potential to significantly improve livestock management practices in Pakistan, including animal tracking and monitoring, behavior analysis, and increased animal welfare. To realize the full potential of this unique Active RFID and TinyML-based livestock localization system in Pakistan, further research should focus on optimizing localization algorithms, enhancing TinyML models, and exploring interaction with upcoming technologies

Extensive Drug-Resistant Typhoid Fever Prevention and Management in Pakistan: A Challenge to Public Health

Typhoid fever is a bacterial infection that largely spreads through contamination in food and water, as well as close contact, and displays many cold-like symptoms in addition to more severe gastrointestinal, muscle, and life-threatening states. The emergence of a new, extensive drug-resistant (XDR) strain in Hyderabad, Pakistan in 2016 resulted in the need for stronger antimicrobials to combat the pathogen. Despite vaccination and contact tracing interventions, the multi-drug resistance and fitness of the H58 strain Salmonella enterica serovar Typhi contributed to rapid spread of typhoid fever in Pakistan. Vaccination is at the forefront of efforts attempting to combat XDR typhoid fever cases in Pakistan, and public education systems and schools should prioritize health classes that pertain to the spread of disease, and what steps individuals can take to be safe, as well as social media infographics circulated through Instagram and Facebook with popular hashtags to reach target audiences. A robust and forward-thinking approach needs to be taken by the Pakistani government to use its budget and international funding in the sectors of health and education to ensure disease prevention.

Impact of Blockchain Technology on Supply Chain Management Efficiency and Transparency in Pakistan


 Abstract
 Purpose: The aim of the study was to influence the impact of blockchain technology on supply chain management efficiency and transparency
 Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries.
 Findings: A study on the impact of blockchain technology on supply chain management in Pakistan revealed significant improvements in efficiency and transparency. Through blockchain integration, supply chain processes experienced reduced delays and increased automation, leading to streamlined operations. Transparency was notably enhanced, with real-time tracking of goods and secure data sharing among stakeholders, mitigating risks of fraud and error. These findings suggest that adopting blockchain technology holds promise for enhancing supply chain management in Pakistan by fostering greater efficiency and transparency.
 Unique Contribution to Theory, Practice and Policy: Diffusion of innovations theory, information processing theory & resource dependency theory may be used to anchor future studies on the impact of block chain technology on supply chain management efficiency and transparency. Encourage supply chain stakeholders to adopt blockchain solutions for enhanced transparency, traceability, and efficiency. Advocate for regulatory frameworks that promote the adoption of blockchain technology in supply chains while addressing concerns related to data privacy, interoperability, and standardization.

Engagement of private health sector in communicable disease and immunization programmes in Pakistan.

In Pakistan, where the burden of communicable diseases remains high, the private sector accounts for 62% of health care provision. To describe the role of the private sector in communicable disease management in Pakistan and inform a more effective engagement towards achieving Universal Health Coverage. We searched the literature and available documents on policies, regulations and experiences in private health sector engagement in Pakistan. We interviewed policy level experts regarding the formulation of national health policies and plans and a sample of private providers using a structured questionnaire to assess their awareness of and engagement in communicable disease programmes. Published reports described initiatives to engage the private sector in improving coverage for a package of care and programme-specific initiatives. Pakistan did not have a national policy for structural engagement, and regulations were limited. Policy level experts interviewed perceived the private sector as market-driven and poorly regulated. Thirty-nine percent of private sector providers interviewed were aware or had been trained in procedures or guidelines, and 23% of them had had their performance monitored by government. We recommend that the Ministry of Health provide overall vision for the operations of the public and private health sectors so that both sectors can complement each other towards the achievement of Universal Health Coverage, including for communicable diseases.

Contaminant transport from solid waste dumps: Implications for environmental degradation with a focus on capital territory regions

Open dumping of Municipal solid waste is the main method of solid waste management in Pakistan. To investigate the impacts of leachate transportation from these waste dumps on groundwater quality, two sites were selected (I-12 in Islamabad and Lohsar in Rawalpindi), water samples were collected from existing wells during summer, winter, and rainy seasons and were analyzed for physiochemical parameters using standard methods. Most groundwater samples showed contamination and values of various parameters exceeded the desired limits set by the World Health Organization (WHO) and the National Standard for Drinking Water Quality (NSDWQ), especially during the rainy season, whereas the least contamination in groundwater samples was observed during the winter season. The results obtained were, pH: 5.75–7.87, Electrical Conductivity (EC): 103–3460 μS cm−1, Total Dissolved Solids (TDS): 436–4425 mg L−1, Total Alkalinity (TA): 190–1330 mg L−1, Total Hardness (TH): 128–676 mg L−1, Chlorides (Cl⁻): 56.7–893.3 mg L−1, Nitrates (NO₃⁻): 7.8–19.9 mg L−1, Dissolved Oxygen (DO): 6.1–20.8 mg L−1, Biological Oxygen Demand (BOD): 1.0–44.0 mg L−1 and Chemical Oxygen Demand (COD): 56–272 mg L−1. The findings suggest that the magnitude of groundwater contamination from leachate transportation is intricately influenced by factors such as leachate composition, seasonal variations and distance from the dumpsite. The contamination level reduced along the distance from the dumps. Except Copper (Cu) and Zinc (Zn), the concentration of all other heavy metals including, Iron (Fe), Chromium (Cr), Nickel (Ni), Lead (Pb), Cadmium (Cd) was found above standard appreciable limits. The t-test showed a significant difference in parameter concentrations for all seasons except for Cd and Zn. The calculation of water quality index through CCME (Canadian Council of Ministers of Environment) model revealed that all the groundwater samples around both the dump sites were of poor and marginal quality. In general, the groundwater quality of both study areas is not suitable for the drinking purpose. The study suggests regular testing and treating groundwater before use, use of engineered landfills, covering landfills with clay and vegetation and use of alternative strategies like composting and recycling for waste management.

Wasting Public Wealth—The Antecedents and practice of Public Land Management in Pakistan 

Wasting Public Wealth—The Antecedents and practice of Public Land Management in Pakistan 

Optimizing PCSK9 Inhibitor Integration for Cardiovascular Disease Management in Pakistan.

Cardiovascular illnesses (CVDs), particularly Coronary Artery Disease (CAD) and Ischemic Heart Disease (IHD), are major global health burdens, with a growing incidence in Pakistan. The development of PCSK9 inhibitors offers encouraging advantages in lowering LDL cholesterol and lowering cardiovascular risk, even though conservative treatments are still essential. However, access to them is severely hampered by their high cost, especially in environments with little resources. The financial limitations and scarcity of healthcare resources while examining the difficulties in obtaining PCSK9 inhibitors in Pakistan is essential. In order to develop solutions for affordability and fair access, it emphasizes the urgent need for multi-stakeholder collaboration, including governmental action, healthcare sector involvement, and pharmaceutical company engagement. It also emphasizes the need for data-specific research and the use of PCSK9 inhibitors in conventional treatment protocols.

Comparison of the Effectiveness of Intra-articular Infiltration of Hyaluronic Acid and Corticosteroids in the Management of Knee Osteoarthritis: A Prospective Comparative Study.

Background Knee osteoarthritis (KOA) is a chronic and progressive disease of the knee joint characterized by articular cartilage destruction. It is the most common cause of knee disability and pain globally. Various treatments are used for the management of KOA; however, the role of intra-articular injections in KOA management in Pakistan remains understudied. Therefore, this study aims to evaluate the effectiveness of intra-articular injections of hyaluronic acid (HA) and corticosteroids in the management of KOA. Methodology This randomized, prospective, comparative study was conducted among 88 patients diagnosed with KOA in the outpatient department clinic of orthopedics in Benazir Bhutto Hospital, Rawalpindi, from January 2022 to January 2023. For patient enrolment, structured inclusion and exclusion criteria and a simple random sampling technique were used. Before data collection, ethical approval and informed consent were obtained. Data collection was done via a self-structured and interview-based proforma. Data analysis was performed through descriptive statistics and independent t-tests using SPSS version 25 (IBM Corp., Armonk, NY, USA). Results KOA was more prevalent in women (60, 68.18%) than men (28, 31.82%). The means for study variables such as age, Visual Analog Scale (VAS) score, and Western Ontario and McMaster Universities (WOMAC) score were 58.08 ± 7.89 years, 7.66 ± 1.8, and 71.86 ± 8.90, respectively. The incidences of right-sided and left-sided KOA were 57 (64.77%) and 31 (35.23%), respectively. Likewise, the frequency of grade II KOA was 55 (62.50%), while the frequency of grade III KOA was 33 (37.50%). Differences in the mean scores of both VAS and WOMAC between study groups were statistically significant at the second-week, sixth-week, and third-month follow-up visits. However, the mean scores of VAS and WOMAC were lower in group B than in group A at the second-week follow-up visit, whereas the scores were lower in group A compared to group B after the sixth week and third month of intra-articular injections. Conclusions Intra-articular injections of both HA and corticosteroids were adequately effective in the management of KOA-associated pain and functional restrictions; nevertheless, the benefits of corticosteroids were acute and short-term, whereas the outcomes of HA were gradual and long-term.

Botanical biopesticides have an influence on tomato quality through pest control and are cost-effective for farmers in developing countries.

Synthetic insecticides heavily applied to manage agricultural pests are highly hazardous to the environment and non-target organisms. Their overuse through repeated treatments in smallholder farming communities is frequent. Botanical biopesticides are ideal for sustainable pest management in agricultural environments by keeping synthetic insecticide use at a minimum. Here we evaluated a locally prepared neem seed extract (NSE) alongside emamectin benzoate against both lepidopteran pests Helicoverpa armigera (Hübner) and Spodoptera exigua (Hübner) on tomato Lycopersicon esculentum Mill under natural field conditions in Pakistan. We compared pest severity, fruit injury, quality, marketability, and cost:benefit ratio (CBR) between treatments. The concentration of azadirachtin A in the NSE was 26.5 ppm. NSE at 2% (20 mL/L) and the emamectin benzoate at the recommended field rate in Pakistan were sprayed weekly throughout the fruiting stage. The pest larvae were significantly more abundant on fruits than on flowers and leaves. Fruit injury and losses were significantly more important in untreated control compared to NSE and emamectin benzoate treatments. NSE efficacy varied with respect to the cultivars used and the seasons. Cultivar Eden harboured more pests than Adventa, and emamectin benzoate suppressed more pest individuals than NSE. Both the insecticidal treatments were comparable in terms of marketable yield productions as well as unmarketable, uninjured, and recovered fruit yields. NSE generated a higher CBR (1: 9.26) than emamectin benzoate (1: 3.23). NSE suppressed pests by acting as an antifeedant, similar to its synthetic counterpart. Smallholder growers can thus use NSE as a cost-effective solution in tomato pest management in Pakistan.

Assessing the impact of future climate scenarios on crop water requirements and agricultural water supply across different climatic zones of Pakistan

This study investigates the potential impacts of future climate change on crop water requirements (CWR) in different climatic zones of Pakistan and the subsequent implications for agricultural water demand and supply. Using the latest CMIP6 climate projections, we focused on Rabi and Kharif crop seasons, which are crucial for the growth of major crops in Pakistan. An empirical climate-crop and a hydrological model based on the Budyko theory were modified and forced to project future CWR changes and the potential widening of the water demand-supply gap until 2,100. Our results indicate a significant rise in mean annual CWR across all zones and emissions scenarios, with increasing rates at 2.30–2.57 mm/yr under SSP585 and 1.0–1.26 mm/yr under SSP245. Both Rabi and Kharif seasons show rising CWR, notably more under SSP585 (Kharif: 8%–14%, Rabi: 12%–15%) than SSP245 (Kharif: 4%–7%, Rabi: 6%–8%). The demand-supply gap is expected to grow notably, with arid and semi-arid zones being the most affected. Compared to 2015–2025, by 2091–2,100, the gap increased by 7%–15% (SSP245) and 15%–28% (SSP585) for Kharif and 7%–13% (SSP245) and 13%–32% (SSP585) for Rabi. To address these challenges, we recommend strategies like enhancing irrigation efficiency, adjusting crop patterns, and developing heat-resilient crops. Our insights aim to inform policy decisions on agriculture and water management in Pakistan under future climate change.