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Soil enzymes are considered sensitive indicators of soil management practices. Changes in the soil enzymatic activity in response to conservation agriculture in smallholder rainfed farming systems have not been extensively reported. Therefore, different tillage practices viz. zero tillage (ZT), reduced tillage (RT), and minimum tillage (MT) under fallow-wheat and mungbean-wheat rotations were compared with conventional practices in rainfed Pothwar plateau, Pakistan for C, N, P cycling enzymes. Zero tillage and reduced tillage produced urease activity 312 and 298 µg N g-1 soil 2 h-1, alkaline phosphatise activity 40 and 39 µg p-NP g-1 soil h-1, and dehydrogenase activity 34 and 31 TPF µg g-1 soil 24 h-1 respectively that were higher than minimum tillage and conventional tillage. ZT and RT tillage systems also had higher concentrations of soil organic C, nitrate-N and available-P. Among rotations, mungbean-wheat showed higher activities of the studied enzymes than fallow-wheat. Use of conservation tillage practices especially zero tillage and reduced tillage combined with legume-cereal rotation improves C, N, P cycling enzymes and soil biochemical properties under rainfed conditions of Pakistan. [ABSTRACT FROM AUTHOR]

Conservation tillage and carbon sequestration are critical issues in rain-fed farming areas of Pakistan. Conservation tillage is not extensively used in developing countries on dryland soil where marginal farming is practiced. Therefore, primary purpose of this experiment was to determine the influence of conservation tillage practices on soil organic carbon (SOC), particulate organic matter (POC), mineral associated organic carbon (MOC), microbial biomass carbon (MBC) and dehydrogenase activity (Dha) in loess dry land Pothwar, Punjab, Pakistan. The tillage practices included zero tillage (ZT), minimum tillage (MT), reduced tillage (RT) and conventional tillage (CT) with mouldboardplough as a control in main plot and fallow-wheat (Triticumaestivum L.) and mungbean (Vigna radiate L.) crop rotation in sub plot as a split plot layout. The results indicated that ZT showed higher SOC (7.90 g kg-1), POC (2.35 g kg-1), MOC (5.1 g kg-1), MBC (359.37 μgg-1) and Dha (45.12 TPFμgg-1 dry weight) than CT. Among crop rotation, overall mungbean-wheat showed higher values as compared to fallow-wheat crop. The study indicated that conservation tillage practices with legume crop rotation have potential for improving soil organic carbon storage and hence carbon sequestration in soil. [ABSTRACT FROM AUTHOR]

Water scarcity and land degradation are emerging threats to global food production. The dry land regions of world are affected by climate change to a greater extent and facing food insecurity. The current pattern of food production has been estimated to be inadequate to meet demands of growing population and required around 38% increase to meet world`s food demands by 2025. Food insecurity in erosion hit dry land regions of Pakistan also demands development of resource-efficient cropping systems to meet the food needs of population growing. The research studies involved different cropping patterns such as fallow-wheat, mungbeanwheat, sorghum-wheat, fallow-lentil, mungbean-lentil, sorghum-lentil, fallowbarley, mungbean-barley and sorghumbarley. The organic amendments involved farmyard manure, NPK, poultry manure, compost and inoculation by phosphorus solubilizing microbes. The effect of cropping systems and soil amendments were evaluated at field scale in terms of water use efficiency measured in terms of economic terms. The results of the studies revealed that double cropping (mungbean-lentil and mungbean-barley) was feasible option in the dryland regions of Pakistan if integrated with the use of poultry manure as alternate environmental-friendly strategy to cut down the use of mineral fertilizers and eliminate summer fallowing. [ABSTRACT FROM AUTHOR]

Introduction: Malnutrition and low levels of education continue to be major problems in many developing countries, especially for female children., Methods: In Pakistan, a large-scale school lunch program was implemented in 29 of the poorest rural districts through a public-private partnership. The project provided freshly prepared meals in 4035 government primary girls' schools over a 2 year period. The primary strategy was empowerment of women in the community who volunteered to plan the meals, purchase the food, and cook and serve the meals. The project collected data from growth monitoring, attendance records, pre- and post-intervention community based surveys, focus group discussions, and the use of other ethnographic methods. A study on changes in the levels of malnutrition was based on an analytical sample of 203,116 girls who received at least two sets of body measurements at least 6 months apart., Results: Over the intervention period, wasting declined by almost half and school enrolment increased by 40%. Girls who entered the program early were found to have similar levels of malnutrition to girls who entered late, suggesting that factors external to the program were not associated with the decrease in malnutrition., Conclusion: This study demonstrates the potential success and scalability of school feeding programs in Pakistan. Lessons learned include that synergies are found when working across sectors (health, education, and empowerment) and that there are challenges to intersectoral projects. Globalization may undermine this successful model as Pakistan considers expanded school feeding programs.

To determine if prolonged active phase of labour is associated with increased risk of uterine scar rupture in labour following previous lower segment caesarean section, a retrospective cohort study (1988-91) was done to analyse active phase partographs of 236 patients undergoing trial of labour following caesarean section, 7 (3%) of whom had scar rupture. After onset of active phase (3 cm cervical dilatation), a 1 cm/h line was used to indicate "alert". A zonal partogram was developed by dividing the active phase partographs into 5 time zones: A (area to the left of "alert" line), B (0-1 h after "alert" line), C (1-2 h after "alert" line), D (2-3 h after "alert" line) and EF (> 3 h after "alert" line). The relative risk of uterine scar rupture was calculated for different partographic time zones. The relative risk of uterine scar rupture was 10.5 (95% confidence interval 1.3-85.5, p = 0.01) at 1 hour after crossing the "alert" line; 8.0 (95% confidence interval 1.6-40.3, p = 0.009) at 2 hours after crossing the "alert" line; and 7.0 (95% confidence interval 1.6-29, p = 0.02) at 3 hours after crossing the "alert" line. In women undergoing trial of labour following caesarean section, prolonged active phase of labour is associated with increased risk of uterine rupture. A zonal partogram may be helpful in assessing this risk in actively labouring women who cross the partographic "alert" line.

Objective: To describe a health priority setting exercise in Pakistan and its relevance to traditional medical care and care providers., Methods: Literature search of local and regional data was performed to identify priority health problems, those with high disease burden and with cost-effective interventions., Results: Major causes of ill-health were communicable (diarrhoea, respiratory infections, childhood immunizable diseases, malaria, tuberculosis) and pregnancy related diseases. Factors that contributed to these disorders included malnutrition, anemia, poor sanitation and water supply, low level of education, high fertility rates and poverty. For these conditions, cost-effective interventions for prevention included environmental control (provision of clean water and sanitation), education programmes, expanded programme of immunization and family planning and those for treatment included case management of diarrhoea, respiratory infections, tuberculosis and complications of pregnancy and childbirth., Conclusion: Priority health problems include factors outside the domain of traditional medical care. Their definition is important for directing policy reform, medical curricula and health research.

To determine, in non-diabetic women, the relationship of abnormal glucose screening test, with the incidence of pre-eclampsia, macrosomia and caesarian delivery, from 1988-92, 5646 consecutive women attending antenatal clinic were screened with a glucose challenge test (GCT) on their first visit (usually at 16-20 weeks); those with risk factors i.e., history of unexplained perinatal loss, macrosomia or family member with diabetes and an initial abnormal screening test were rescreened at 28-32 weeks. In 482 cases the GCT was abnormal (plasma glucose value was > 140 mg% 2 hours after 75 g glucose challenge). Of these, 292 had one or more abnormal critical values at a 75 g-3 hour oral glucose tolerance test (GTT) and they were treated to maintain euglycaemia. The rest (n = 190) had no evidence of glucose intolerance with no abnormal values at the GTT. The subjects were divided into 3 groups based on GCT values; A, randomly selected subjects with a normal GCT (n = 1000); B, those with abnormal GCT but normal GTT (n = 190); and C, those with abnormal GTT (n = 292). The variables studied were age, gravidity, parity, gestational age at delivery, pre-eclampsia, birth-weight and mode of delivery. The incidence of pre-eclampsia and caesarian birth varied, being the lowest in Group A (3.9% and 11.9% respectively) and then rising through group B (6.3% and 16.3% respectively) to the highest in Group C (12.6% and 26.0% respectively; test of linear trend, p < 0.05). For macrosomia, the incidence increased from Group A to B but there was a drop in Group C.(ABSTRACT TRUNCATED AT 250 WORDS)

The prevalence of bacteriuria in Pakistani women and its association with complications of pregnancy was studied. Out of 1579 women, 77 had bacteriuria (4.8%). There was no association of age, gravidity, parity, haemoglobin, pre-eclampsia, mode of delivery, gestational age at delivery, preterm delivery and low birth-weight with presence of bacteriuria. With detection and treatment the pregnancy outcome of women with bacteriuria in pregnancy was the same as that of those without.

Objectives: The Aga Khan University in Karachi has a mission to educate leaders and to contribute to the development of health systems for Pakistan amid challenges of scarcity and complexity., Methods: Its key activities are (1) to design and test urban and rural health system prototypes, (2) to develop faculty in medical and nursing postgraduate community health sciences programs, and (3) to design and implement community-based undergraduate medical and nursing curricula., Results: The university has developed equity-based, cost-effective primary health care prototypes in Karachi slums. With government counterparts it has tested village-, facility-, and district-level interventions in a poor rural district. Federal policymakers have taken models from each for widespread replication. The university is training 49 medical and 19 nursing faculty for postgraduate programs in community health sciences. Most faculty retain institutional leadership positions, including teaching community-based, problem-solving, community health sciences as 20% of the medical and nursing undergraduate curriculum., Conclusions: The mission and experience of the Aga Khan University in population-based health systems design and health sciences education can guide universities in both developing and developed countries.

To assess the safety and effect of epidural analgesia on the course of labour and delivery in Pakistani women, a retrospective case control study was conducted from November, 1986 to November, 1991 (5 years) at the Aga Khan University Medical Centre, Karachi. All patients (n = 64) who received epidural analgesia for labour (cases) were compared with randomly selected patients (n = 18) who did not receive epidural analgesia during labour (controls). The cases and controls were matched for age, height, body mass index, parity, use of oxytocin, presentation and weight of the foetus. There was no significant difference (P > 0.05) between the two groups in duration of labour, caesarean section rate and foetal apgar scores at 1 and 5 minutes after birth. The incidence of malposition of foetal vertex at delivery and that of instrumental (forceps) deliveries was significantly higher (P < 0.05 and < 0.01 respectively) in the epidural group as compared to controls. The incidence of complications was low and the acceptance and tolerance of epidural analgesia was good in our patients.

A systematic cervical cancer screening program was initiated in January 1987 at The Aga Khan University Medical Center, Karachi, Pakistan. The 8,784 cervical smears obtained in 3 subsequent years from 8,412 consecutive women attending the gynecology and antenatal clinics were reviewed. "Positive" smears were found in 111 (1.3%) patients; 107 (1.27%) smears showed squamous epithelial dysplasia and 4 smears showed adenocarcinoma. The highest incidence of abnormal smears was found in the 45-54 years age group. Colposcopy and biopsy was performed on all patients with "positive" smears except on those with atypical or mildly dysplastic ones, in whom only the persistence of the abnormality on repeated smears was considered an indication for tissue evaluation. The histopathologic diagnosis of these biopsy specimens revealed cervical intra-epithelial neoplasia in 60 patients and invasive cervical cancer in 6 patients.

Hysterectomy in Pakistan, like in other parts of the world is considered to be overused in a number of cases. As a part of a quality assurance process at the Aga Khan University Medical Centre, Karachi, 376 hysterectomies performed between January, 1987 and December, 1989 were retrospectively analysed and the results are presented. In 250 (66.5%) cases, where pathology was expected to be found, the hysterectomy was considered justified if the preoperative diagnosis was verified by the pathology report of if significant alternate pathology was present. In 126 (33.5%) cases, where no pathology was expected to be found 'validation criteria' were used to ascertain justification of the procedure. The results showed justification rates of 83% for recurrent uterine bleeding, 85% for adenomyosis, 90% for adnexal masses and endometrial carcinoma, 95% for fibroids, 97% for pelvic relaxation and 100% each for pregnancy catastrophe, endometriosis, chronic pelvic inflammatory disease and premalignant disease of uterus and cervix. In general 92.0% of all hysterectomies in this series were justified.

In order to determine the prevalence of glucose intolerance in pregnancy, 1267 consecutive women attending the antenatal clinic of the Aga Khan University Medical Centre were subjected to a 75 g glucose challenge followed 2 hr later by plasma glucose determination irrespective of gestation on the first antenatal visit. The test was repeated at 28-32 weeks of gestation if the patients had an abnormal initial screen at less than 28 weeks gestation and a normal glucose tolerance test on diagnostic follow-up and for those who had a risk factor for gestational diabetes and a normal initial screen at less than 28 weeks gestation. The glucose challenge test was abnormal (2 hr plasma glucose greater than 140 mg%) in 8.6% of the screened population. Follow-up oral glucose tolerance test on these patients revealed a prevalence of 3.2% of gestational diabetes and 1.9% of impaired glucose tolerance test based on the modified O'Sullivan criteria. Improvement in cost effectiveness of screening programmes was adjudged possible by avoiding glucose tolerance tests in patients with 2 hr plasma glucose value of greater than 170 mg% after a 75 g oral glucose challenge for screening.

As part of a quality assurance programme at the Aga Khan University Medical Centre, Karachi, Pakistan, all hysterectomy specimens were reviewed from January 1986 to December 1989. Adenomyosis was found in 237 of the 419 (56.5%) specimens studied. Of these 237 patients, 232 (97.9%) were parous and 196 (82.8%) were in the fourth and fifth decades of life. This high prevalence in parous women aged 40-59 years was significant. Fibroids, cervicitis, and endometrial hyperplasia were the most common associated diagnoses. Of all the associations studied, only endometrial hyperplasia was significantly more prevalent in the group with adenomyosis. Adenomyosis was stated as an indication for surgery in 69 patients and was confirmed by histopathology in 49 (71%). Preoperative suspicion of adenomyosis was present in 49 (20.6%) patients of all those ultimately found to have the disease. There is a high prevalence of adenomyosis in the population studied, which indicates that the condition may have been underdiagnosed in the past, especially as it is difficult to diagnose without surgery and hysterectomy is currently the only treatment.