Tando Allahyar Research Articles

Causes of Child Labour in Agriculture in District Tando Allahyar, Sindh, Pakistan within the Framework of the Circular Economy

Causes of Child Labour in Agriculture in District Tando Allahyar, Sindh, Pakistan within the Framework of the Circular Economy

Assessing the Impact of Better Cotton Production Initiatives Taken by Small Farmers in District Tando Allahyar, Sindh, Pakistan within the Context of the Circular Economy

Cotton is an important source of income for small farm holders in India and Pakistan. Production of cotton in Pakistan is lesser than potential due to different socio-economic factors, effective decision-making, lack of proper marketing, high insect/pests attack and less use of fertilizer (Abbas, et al 2017). Present study was carried out to study the impact of Better Cotton (BT) production initiatives taken by small farmers in district Tando Allahyar Sindh Pakistan. Results show that the Farmer Field School (FFS) training in cotton is very beneficial for farmers by creating awareness regarding the proper use of pesticides, fertilizers there by increasing cotton yield and reducing farmer’s exposure to use poisonous pesticides which in turn decrease, human and animal health hazards. Results revealed that average revenue per acre was Rs.93800 while the average cost of production was 38635.81 per acre. Average net income per acre stood at Rs.55165.19 for small farmers who adopted better cotton production initiatives in district Tando Allahyar. Government should arrange such training programs at the national level, take actions against distribution and usage of banned and un-registered pesticides and incorporate the same at policy level.

Coverage and predictors of COVID-19 vaccination in rural districts of Pakistan.

One of the keys to preventing a re-emergence of the COVID-19 pandemic is the attainment and maintenance of high vaccination coverage in urban and rural areas. To estimate the coverage of COVID-19 vaccination in a rural population and identify the determinants of vaccination. A cross-sectional survey was conducted in April 2023 in 5 rural districts of Sindh Province, Pakistan. From each district, 30 clusters (villages) were randomly selected, and 7 households were randomly sampled from each cluster using the 30/7 technique. Household members above 12 years of age were included. Vaccination status was categorized as non-vaccinated, partially vaccinated (either with 1 dose or without booster) and completely vaccinated (2 doses with 1 booster). Adjusted odds ratios with 95% confidence intervals using multinomial logistic regression were computed to determine the factors associated with partial and complete vaccination. Data was analysed using SPSS version 20. Among the 3545 individuals surveyed across 1050 households, 25.9% were not vaccinated, 55.0% were partially vaccinated, and 19.1% were fully vaccinated. Younger age, lack of formal education and residing in flood-affected districts were significantly negatively associated with being vaccinated, while living at <5 km from a vaccination facility was significantly positively associated with partial and complete vaccination. Residents of Dadu (OR=0.03, 95% CI=0.01-0.04), Jamshoro (OR=0.05, 95% CI=0.03-0.08), Hyderabad (OR=0.03, 95% CI=0.02-0.05), and Tando Allahyar (OR=0.09, 95% CI=0.05-0.15) districts were significantly less likely to be completely vaccinated than those in Tharparkar. The most common reasons for not being vaccinated were, the perception that COVID-19 is mild (34.5%), fear of side-effects (22.7%), unavailability of the vaccine (19.8%), and fear of acquiring COVID-19 infection through the vaccine (15.8%). Vaccination coverage was low in some of the districts, particularly the flood-affected districts, mainly due to certain myths. There is a need for community outreaches to debunk myths about COVID-19 vaccination among these rural populations.

Managing Educational Barriers: Innovative Solutions for Female Secondary Education in Pakistan

Education is a fundamental human right and a crucial factor in promoting social and economic development. In Pakistan, female education has been a longstanding issue, with low enrollment rates, high dropout rates, and persistent gender disparities in educational access and outcomes. This research aims to explore the problems and countermeasures of female secondary education in the city district area of Tando Allahyar, Pakistan. The study used quantitative surveys to gather data from female students, teachers, experts, and community members. The results exhibited that poverty, limited access to quality education, and socio-cultural barriers were the main problems faced by female secondary education. Many female students and their families face significant financial challenges, which prevent them from attending school and completing their education. To address these problems, the study concluded that a range of countermeasures, including community engagement and awareness-raising campaigns, targeted investments in infrastructure and resources, and policies that prioritize girls' education and support their access to secondary education. It also concluded that women receive a better education if they are to be included in the productive labor force, which accounts for approximately half of the population. Policy interventions must be tailored to the specific needs of girls and must address the barriers that prevent girls from attending school and completing their secondary education.

Mid-upper arm circumference only protocol in Pakistan: missed opportunities for children suffering from severe acute malnutrition? A mixed-methods observational study.

We investigated the missed treatment opportunities affecting programmes using mid-upper arm circumference (MUAC) as the sole anthropometric criterion for identification and monitoring of children suffering from severe acute malnutrition (SAM). Alongside MUAC, we assessed weight-for-height Z-score (WHZ) in children screened and treated according to the national MUAC only protocol in Pakistan. Besides, we collected parents' perceptions regarding the treatment received by their children through qualitative interviews. Data were collected from October to December 2021 in Tando Allah Yar District, Sindh. All children screened in the health facilities (n 8818) and all those discharged as recovered (n 686), throughout the district, contributed to the study. All children screened in the community in the catchment areas of five selected health facilities also contributed (n 8459). Parents of forty-one children randomly selected from these same facilities participated in the interviews. Overall, 80·3 % of the SAM cases identified during community screening and 64·1 % of those identified in the health facilities presented a 'WHZ-only' diagnosis. These figures reached 93·9 % and 84·5 %, respectively, in children aged over 24 months. Among children treated for SAM and discharged as recovered, 25·3 % were still severely wasted according to WHZ. While parents positively appraised the treatment received by their children, they also recommended to extend eligibility to other malnourished children in their neighbourhood. In this context, using MUAC as the sole anthropometric criterion for treatment decisions (referral, admission and discharge) resulted in a large number of missed opportunities for children in need of timely and adequate care.

Economic Importance of Backyard Poultry in Taluka Jhando Mari, District Tando Allahyar, Sindh

Present study was carried out to observe the economic importance of backyard poultry birds in rural areas of Taluka Jhando Mari district Tando Allahyar during the 2022. Objective: To determine the profitability of backyard poultry production in rural areas of Tando Allahyar. Methods: Our study was divided into two different parts (i) primary and (ii) secondary part. Primary category was based on collection of data by interview from respondents by filling questionnaire. Results: The results revealed that 70% of household poultry kept by female and 30% were males. The cost function was estimated using the OLS method. The model of study suggested that price of egg and price of per bird were recorded statistically significant whereas per bird cost was observed non-significant statistically. It was concluded that high egg producing poultry breeds such RIR, Playmouth, White leghorn must be raised in order to increase the production of household backyard poultry birds. Conclusions: It is also concluded that improvement in rural poultry germplasm will be highly effective in rural poultry production system in future and will be major business for completing the food security and nutritional diet in middle class population of our country. Government of Sindh should also encourage private sector poultry by providing loan and poultry feed on cheapest prices to improve the production of backyard poultry farmers and their livelihood.

Prevalence of Okra Yellow Vein Mosaic Viral Disease and its Correlation with Vector Population in Sindh, Pakistan

Okra (Abelmoschus esculentus (L.) Moench) being an important vegetable crop is widely grown in tropical and subtropical regions of the world. Whitefly (Bemisia tabaci) is not only a major insect pest of okra in Pakistan but also the vector insect of Begomoviruses including okra yellow vein mosaic virus which causes okra yellow vein mosaic viral disease (OYVMVD). Regional monitoring of insect vectors and disease prevalence is being emphasized for proper management, therefore this study was focused on determining the intensity of OYVMVD in the fields and the correlation between the disease and vector population. For this purpose, the virus infection was confirmed with DNA sequencing. The disease and vector population was visually assessed approximately 65-70 days after sowing of okra under field conditions at commercial farmer fields in district viz., Hyderabad, Tando Allahyar, Matiari, and Sanghar of Sindh, Pakistan during the growing season of 2016. Ten okra plants with three replications (N = 30) at ten different locations of each district were assessed. Results of nucleotide alignment of DNA amplified from diseased plants confirmed that yellowing and vein clearing were due to the virus infection. The visual assessment showed that the disease was prevailing throughout all region monitored in this study and the disease was significantly correlated with the vectors population. However, maximum disease incidence and severity were recorded in Tando Allahyar. Therefore, it is recommended to validate various management practices at such high disease risk points for better management

Antimicrobial Sensitivity of Bacterial Pathogens Isolated from Poultry Feed, Water, and Eggshell

Poultry is the most important source of proteins forconsumption. Egg shell and drinking water contributes significantly to the spread of viral, bacterial, and protozoan infections in poultry. A total of 150 samples from poultry feed (feeders n=25, feed bags n=25), water (water tanks n=25, drinkers n=25), and eggshell (n=50) were collected from ten layer farms of district Tando Allahyar. Overall results showed that higher 52% bacterial infection was recorded from the poultry feed, 42% was recorded from water samples while the lowest prevalence recorded from the eggshell 32%. The isolated bacterial species were E. coli, Salmonellatyphi, Shigella sonnei, Klebsiella pneumonia, Proteus mirabilis, and Staphylococcus aureus. In poultry feed, a higher prevalence percentage of E. coli(16%) was recorded, followed by S. sonnei (14%), S.typhi(8%), S. aureus (8%),P. mirabilis (6%), and K. pneumonia (4%). In water, a higher prevalence of E. coli(12%) was recorded, followed by S. aureus (14%),S.typhi(11%), S. sonnei (11%), P. mirabilis (4%), and K. pneumonia (2%). In eggshells, a higher prevalence of E. coli(10%) was recorded followed by S. typhi(6%), S. sonnei (6%), S. aureus (6%), K. pneumonia (2%), and P. mirabilis (2%). E. coli species were susceptible to Tetracycline and Streptomycin. Salmonella typhi was susceptible to Ciprofloxacin and Tetracycline. Shigella sonnei was susceptible to Ciprofloxacin, and Tetracycline.Klebsiella pneumonia was susceptible to Streptomycin and Gentamicin.Proteus mirabilis was susceptible to Streptomycin and Gentamicin.Staphylococcus aureus was sensitive to Gentamicin and Erythromycin. In conclusion higher (52%) bacterial infection was recorded from the poultry feed,(42%) was recorded from water samples and the lowest prevalence was recorded from the eggshell (32%). It is concluded from the present study that bacterial contamination of E. coli, S. typhi, S. sonnei, K. pneumonia, P. mirabilis, S. aureus is common in poultry feed, water, and eggshell.

Understanding Farmers' Knowledge, Attitude, and Practices in Managing Water Quality for Effective Insecticide Performance: A Case Study in Agriculture

Pesticides are frequently used in agriculture to manage pest populations below threshold levels, but their application usually does not get the desired outcome. There are many factors for the low performance of pesticides, with water quality being one of them. Local farmers from Sindh, Pakistan, have little or no knowledge about the role of water quality in the performance of pesticides. Therefore, a survey study was conducted to determine the farmer’s knowledge, attitude, and practice regarding it. Ten villages were selected from the Hyderabad and Tando Allahyar districts, and the information was obtained from five farmers from each village. Descriptive analysis results indicated that most respondents prefer to grow cotton (average 24.07 acres), with the majority being illiterate (54 %), averaging 39.74 years of age and 18.80 years of farming experience. Most farmers (92 %) used groundwater for spray solution, whereas only 3 % tested the water in their fields. The majority (74.51 %) of farmers considered lower-quality pesticides for their poor performance. Therefore, farmers normally apply up to sixteen sprays to control pests. It was also observed that although farmers have knowledge about the role of water quality in the performance of pesticides to get pest control, they lack the attitude and practice in their field. Therefore, it is suggested that awareness should be created among the local farmers regarding water quality to be used in spray solutions to get desired pest control.

Phenotypic diversity of Aseel Chicken in District Tando Allahyar, Sindh, Pakistan

Phenotypic diversity of Aseel Chicken in District Tando Allahyar, Sindh, Pakistan

Spatial Variability Mapping of Selected Soil Properties of District Tando Allahyar, Sindh, Pakistan

Spatial variability mapping of soil properties is essential to understand the differences among soils found in a geographical region for their better management. This study aimed at spatial variability mapping of selected soil properties of district Tando Allahyar, Sindh which is one of the most important districts of Sindh province. The results revealed that majority of soils (35.6%) had loamy slightly medium-textured type, including 30.8% silt loam, 3.8% loam and 1.0% silt, followed by clayey, fine-textured heavy type (27.9%), including 18.3% clay, 6.7% silty clay and 2.9% sandy clay. Soils with sandy, coarse-textured light type were 20.2%, including 16.3% sandy loam and 1.9% loamy sand and sand each. Soils with loamy, moderately medium-textured type were 16.3%, including 9.6% clay loam and 6.7% sandy clay loam, while silty clay loam soil texture was total missing. The EC ranged from 0.14 to 4.44 dS m-1 (mean: 0.69 dS m-1, mode: 0.42 dS m-1). Majority (91%) of soils had low (46%) to medium (45) level of salinity. Soil pH ranged from 6.2 to 8.6 (mean: 7.7, mode: 8.3). Majority of soils (84%) had either slightly (24%), medium (22%) or strongly alkaline (38%) soil pH. Interestingly, some soils (13%) had slightly acidic pH. Organic matter ranged from 0.10 to 1.6% (mean: 0.64%, mode: 0.17%). Majority (84%) of soils were deficient in organic matter. Soil ABDTPA-P ranged from 1.2 to 18.8 mg kg-1 (mean: 5.38 mg kg-1, mode: 2.4 mg kg-1). More than half (55%) of the soils had low P, while soils with marginal (14%) or adequate (31%) P were also present. Soil ABDTPA-K ranged from 31 to 376 mg kg-1 (mean: 154 mg kg-1, mode: 230 mg kg-1). Majority of soils (62%) had adequate K, while soils with marginal (28%) or low (11%) K were also found. Spatial variability mapping revealed the dominance of loam, sandy clay loam, sandy loam, silty clay and clay loam textures, medium &gt; low and high &gt; salinity, slightly to medium alkaline soils &gt; strongly alkaline soils, low organic matter content, medium to adequate &gt; low soil P, and adequate soil K. The spatial variation found in various soil properties of district Tando Allahyar, Sindh must be taken in mind while deciding about their site-specific management, using the recently developed maps.

Estimation of metal and metalloid in crude oil of newly developed oil field after acid digestion/extraction methods using different devices

BackgroundThe contamination of the environment by metals and metalloids occurs due to oil exploration, owing to combustion via automobiles or different industrial activities. MethodsThe crude oil obtained from two newly developed oil fields in Tando Allahyar, Pakistan, were analyzed for the physical characteristics of crude oil. Moreover, arsenic (As) and cadmium (Cd) concentrations in crude oil were measured by three digestion/extraction methods, conventional acid digestion (CAD), microwave-assisted acid digestion (MAD), and ultrasonic-assisted extraction (UAE). The inductively coupled plasma emission spectrometry was applied to determined the As and Cd in digests and extracts of crude oil samples. The standard addition method was applied to evaluate the accuracy of all three methodologies at two concentration levels of As and Cd in a composite crude oil sample. ResultsUnder the optimum operating conditions, the limits of detection obtained from the standard addition curves were lower in the MAD method, whereas higher value was observed for the CAD method. The LOD for As obtained after MAD, CAD, and UAE were observed as (0.072, 0.083, and 0.078) and Cd (0.062, 0.087, and 0.092) µg L−1, respectively. The respective recoveries of As and Cd obtained with MAD were optimum as compared to those obtained by CAD and UAE. However, the recovery of As was lower from the conventional heating system as compared to UAE. ConclusionThe UAE method was easy, efficient, and environmental friendly. The results obtained are comparable with conventional acid heating systems and about 1% lower than those values obtained by MAD. However, the difference in% recoveries between the three digestion/extraction methods of both elements was insignificant (p>0.05).

Prospects and Constraints of Onion Production and Marketing: A Case Study of District Tando Allahyar, Sindh-Pakistan

This study aimed to identify the existing onion production practices and constraints at smallholder farms and profitability of onion in the Tando Allahyar district of Sindh during the year 2018-19. The primary data were collected from 24 randomly chosen onion-producing farmers in village Ibrahim Shah using a pre-tested systematic questionnaire. Descriptive statistics were used to evaluate percentages, frequency, and mean, while the benefit-cost analysis (BCA) method was used to determine onion growers' profitability. Results of the study revealed that the overall average total cost and gross revenue of onion production were (Rs. 115120/acre, Rs. 154875/acre) respectively. The benefit-cost ratio was found to be 1.52 for (variable costs) and 1.35 for (total cost), indicating that onion cultivation benefits farmers in the Tando Allahyar district. The most common and local onion variety grown was Nasarpuri, which was cultivated by 87 % of farmers, along with Hazari and Phulkara. However, the farmers were reluctant to use hybrid seeds due to their inability to withstand high temperatures. The main production constraints for onion growers were high input prices, particularly seed costs, and high labour charges for hoeing and weeding. Similarly, low product prices and high transportation costs were major marketing constraints. Due to a lack of technical expertise with current technology, such as a shortage of cold storage and skilled labor, the marketing of excess produce throughout the year was a significant problem for onion growers. It is therefore suggested that a comprehensive marketing capacity building and Global GAP will improve the quality, productivity and profitability of the farmers and open the channel of export for Pakistan.

The Emerging Concept of Community Development Parks (CDP): An Evaluation of Rashidabad CDP

The concept of "Science Parks" is a well-known concept, whereas the phrase "Community Development Parks" is embryonic, even though there is a need to consider these as equally important. The Community Development Parks form social transformation matrices, encouraging the social inclusion of community groups by offering an environment conducive to common identity formation. This study aims to assess the overall performance of a Community Development Park titled, Rashidabad in Tando Allahyar, initiated by Rashid Memorial Welfare Organization (RMWO). This Community Development Park not only createsrural-urban interaction, thereby generating positive externalities for adjoining areas, but it also provides health, education, and employment opportunities. The current study delineates motivational channels that explain the initiation of this Community Development Park. The results of the study show that Rashidabad has proved to be exemplary in uplifting education and health facilities for the local community, besides contributing to social inclusion.

INCOME ELASTICITY OF HOUSEHOLD’S HEALTH AND WELLNESS IN RURAL PAKISTAN

This study investigates the income elasticity of health in rural areas of Pakistan. It was conducted during 2019-20 to find out the responsiveness of health expenses proportionate to the earnings of rural people of the country. Multistage sampling technique was used for data collection from 180 respondents from two districts, i.e., Toba Tek Singh district from Punjab province and Tando Allahyar district from Sindh province. The respondents were categorized into three income groups – low, medium, and high – and were interviewed to find out that what portion of income of each group is being directly or indirectly on their health and wellness. The findings show that the low, medium, and high-income groups were spending about 17.7, 7.7 and 4.2 percent of their income on health and wellness, respectively. Further, it was observed that with the increase of income, the low income group will spend another 8.8 percent on health as compared to the medium, and high-income groups, who will lower the expenses on health by 0.6 and 0.09 percent, respectively. Due to large family size i.e., 9.7 persons per family, most of them were unable to fulfill the basic nutritional requirements in daily food. Moreover, in case of emergency, low-income group either uses home-made medicines (totkas) or pays visits to the unauthorized doctors called hakeem. While medium and high-income groups prefer to visit the private hospitals, due to insufficient healthcare facilities at the public hospitals.

Barriers to Access of Healthcare Services for Rural Women-Applying Gender Lens on TB in a Rural District of Sindh, Pakistan.

Background: Women in the rural districts of Pakistan face numerous barriers to healthcare, rendering gender-responsive health programming important, including for the disease of tuberculosis (TB). This study was conducted to assess the general understanding of TB and for women’s access to healthcare, as a first step towards implementation of a gender responsive TB program in Tando Allahyar, a rural district of Pakistan. Methods: A total of 36 participants were interviewed for the study. The focus group discussion guide comprised of questions on: (1) family/household dynamics, (2) community norms, (3) healthcare systems, (4) women’s access to healthcare, (5) TB Awareness, and (6) women’s access to TB Care. Results: Limited autonomy in household financial decision-making, disapproval of unassisted travel, long travel time, lack of prioritization of spending on women’s health and inadequate presence of female health providers, were identified as barriers to access healthcare for women, which is even higher in younger women. Facilitators to access of TB care included a reported lack of TB-related stigma, moderate knowledge about TB disease, and broad understanding of tuberculosis as a curable disease. Other suggested facilitators include health facilities closer to the villages and the availability of higher quality services. Conclusion: Significant barriers are faced by women in accessing TB care in rural districts of Pakistan. Program implementers in high burden countries should shift towards improved gender-responsive TB programming.

A CROSS-SECTIONAL SCREENING SURVEY ON THE SEROPREVALENCE OF HEPATITIS B AND HEPATITIS C AMONGST THE GENERAL POPULATION OF RURAL DISTRICTS OF SINDH, PAKISTAN.

Viral hepatitis is a global phenomenon, with the disease burden varying on a daily basis. Amongst chronic infections, hepatitis B virus and hepatitis C virus (HCV) are egregiously linked to severe health-related complications, with a worldwide prevalence of 248 million and 71 million respectively. Amongst the developing world, a hand full of countries are exhibiting a gross decline in chronic viral infection prevalence, like Bangladesh. While countries such as India have a consistent prevalence, Pakistan bears one of the largest proportions of chronic viral hepatitis globally with increasing trends shown year-by-year. Various old literature texts have stated an approximate national prevalence rate around 2.6% and 5.3% of hepatitis B and C respectively. The objective of this study was to determine the current seroprevalence rates of chronic viral hepatitis amongst the general population of rural Sindh using a screening program to determine the current disease burden. An observational, cross-sectional survey based on a screening program was conducted in 5 districts with a combined population of over 6.5 million. The screening was carried out via the administration of various camps with the assistance of local social workers and welfare organizations. A total of 24,322 individuals met the inclusion criteria and were screened through (HBsAg/HCV) rapid test cassette (WC) Imu-Med one-step diagnostic test. Hepatitis B was found positive in 964 (3.96%) individuals including 421 (43.67%) males and 543 (56.32%) females, while hepatitis C was positive in 2872 (11.80%) individuals including 1474 (51.32%) males and 1398 (48.67%) females. The prevalence amongst the districts varied between 0.97% and 9.06% for hepatitis B, and 1.61% and 29.50% for hepatitis C, respectively. Umerkot was found to be the most prevalent district amongst rural Sindh, while Badin had the least number of seropositive people. The second most prevalent district of the study population was found to be Tando Allahyar followed by Mirpur Khas. The combined seroprevalence of 15.76% was calculated for hepatitis B and C together amongst the five studied districts of rural and peri-urban Sindh. The alarmingly high prevalence rates revealed in our study warrant the urgent need to generate multiple effective strategies in the region to enhance awareness amongst the general population regarding screening, prevention, and prompt treatment of the disease.

Pollen analysis: using mellissopalynology to determine the bee-foraged sources from Tando Allah Yar and Tando Muhammad Khan, agriculturally, two important districts of Sindh, Pakistan

Pollen analysis: using mellissopalynology to determine the bee-foraged sources from Tando Allah Yar and Tando Muhammad Khan, agriculturally, two important districts of Sindh, Pakistan

The Intensity of Tomato Post-Harvest Rot in the Surroundings of Tandojam

Tandojam is one of the main tomatoes producing city in Pakistan. Several tones of tomatoes are produced in the Tandojam each year. The main objective of the study was to estimate the intensity of tomato post-harvest rot in the vicinity of Tandjam, so curative strategies can be explored. A survey was conducted in the surrounding of Tandojam viz; Tando Allahyar, Sultanabad Vegetable Market, Tandojam city, Tando Qaiser, Bahawal Zaur, and Hyderabad Vegetable Market. A total of 20 tomato growers/farmers, 30 brokers, and 23 small shopkeepers were interviewed based on the proforma developed in the current study. The fruit rot infection among all 20 different fields ranged from 5 to 65% with 31.85% infected fruits by Alternaria. At Sultanabad and Hyderabad vegetable markets infection was ranged from 20 to 60% and 10 to 70%, respectively, with mean percentages 37 and 38.5% infected by Alternaria sp. Infection in small shops was ranged from 16.67 to 60% in Tandojam city and 16.67 to 53.33% in Tando Qaiser. The overall comparison revealed 30 percent infected fruit by Alternaria under field conditions, 36 percent at the vegetable market, and 43 percent at small shops level. Controlling tomato rots is a big challenge as the intensity of this disease is unknown in different regions. This research has significantly contributed to estimating the intensity of this disease.

Reuse of syringes for therapeutic injections in Pakistan: rethinking determinants.

Frequent reuse of syringes during medical injections is fuelling epidemics of human immunodeficiency virus and hepatitis C virus infections in many low- and middle-income countries including Pakistan. To explore specific factors related to syringe reuse during therapeutic injections. We randomly surveyed 319 healthcare providers from 2 socioeconomically diverse districts in Pakistan, along with 625 of their patients. Providers see 12-25 patients per day, and provide 7-14 therapeutic injections or intravenous drips. Comparing daily stocks with injections provided, we estimated that 38% of providers (Rawalpindi: 14%, Tando Allah Yar: 44%) likely reuse syringes 2 or 3 times. Rural location and longer duration of practice predict a higher likelihood of reuse. Physicians and non-physicians were equally likely to reuse. Most patients were unaware when a syringe had been reused. High rate of syringe reuse is driven by high injection demand by patients, to which providers comply. Patients are generally unaware of the harm of injections with syringe reuse or that reuse happens. Our findings suggest that patient focused approaches may help reduce syringe reuse.