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INTRODUCTION Tobacco taxation remains a poorly used intervention to control tobacco use in many low- and middle-income countries (LMICs) including Pakistan even after two decades of FCTC adoption. This study identifies gaps and implementation challenges in the current Tobacco Taxation and Pricing Policies (TTPP) in Pakistan, and highlights key policy implications and lessons for LMICs to strengthen tobacco control measures. METHODS We used qualitative document analysis to examine the policy documents to assess the TTPP against the WHO Framework Convention on Tobacco Control (FCTC) guidelines for the implementation of Article 6 of the FCTC. In addition, we used secondary data on tobacco tax and prices to assess the impact of TTPP on tobacco affordability in the country. RESULTS Although Pakistan taxes raw tobacco, cigarettes and other tobacco products (cigarillos, cigars, cheroots), the existing TTPP falls below the WHO FCTC requirements of: uniform tax level, simple tax structure and 70% share of excise tax in the price of a product's pack; among others. There are also multiple issues in tobacco tax administration such as lack of monitoring. This is leading to the availability of highly affordable tobacco products in the country. CONCLUSIONS Pakistan does not have a clear strategy on using tobacco taxation and prices as a public health tool in the country. Existing TTPP face dual issues of flawed structure and poor administration translating into highly affordable tobacco products and low revenues in the country. There is a need to introduce multisectoral tobacco control policies in countries like Pakistan in the context of the tobacco sector political economy. [ABSTRACT FROM AUTHOR]

Objective: To determine the knowledge, practices, and preparedness of GHPs for providing tobacco cessation services in public and private hospitals, and to find the factors which impede the provision of tobacco cessation services. Study Design: Cross sectional study. Place and Duration of Study: GHPs in Rawalpindi and Islamabad, from Mar to Aug 2018. Methodology: Semi-structured questionnaire was administered to GHPs worked in public and private hospitals through non probability convenience sampling. Responses were collected on ordinal scale against three main items were knowledge, skills and practice regarding tobacco cessation counseling. Collected data was analyzed through SPSS. Responses were computed in frequency and percentages. Results: The proportions of general healthcare practitioners who got enough training on Tobacco cessation activities during their formal education were (26%). Almost half of the general healthcare practitioners (51.2%) feel confident about their tobacco cessation skills. The proportions of general healthcare practitioners who practice tobacco/smoking cessation activities were (53.2%) who score 21 above and was labeled as they were practicing the tobacco cessation activities on patients who visit them. Conclusion: GHPs have moderate levels of knowledge, and training for tobacco cessation services. However their practices regarding provision of tobacco cessation services is poor. Lack of perceived expertise is the key factor which hinders general healthcare practitioners in providing the tobacco cessation counseling. It is important to invest in training and preparing health care providers for providing effective tobacco cessation services in Pakistan. [ABSTRACT FROM AUTHOR]

Background Pakistan is one of the highest tobacco consuming countries in South Asia and consumption is increasing. To implement equity orientated tobacco control policies, the most vulnerable groups must be identified. We aimed to identify these groups using the Pakistan Demographic and Health Survey (PDHS) 2012–13. Methods Descriptive statistics, univariate and multivariate analyses were used to explore household and participant characteristics associated with smoking inside the home or tobacco smoking, respectively. Survey weights were used to give nationally representative findings. Results Data for 12 931 households, 3132 men and 13 538 women were examined. About 58.3% of surveyed households were smoke-free, 39.1% were exposed to indoor tobacco smoke every day, 2.6% less frequently. Significantly more rural households were exposed to indoor tobacco smoke than urban households (45.2% versus 34.9%). Of men, 28.3% reported smoking compared with 1.3% of women. Smoking prevalence was higher in older age groups. Increasing wealth was associated with lower smoking prevalence and indoor smoking. For men, but not women, increasing education was associated with reduced smoking. Conclusions Inequalities in smoking behaviour impose harm to those who can least afford the financial and health costs. Future tobacco control policies in Pakistan must be sensitive to gender, geography and socio-economic status. [ABSTRACT FROM AUTHOR]

Objectives: This study was conducted to determine if thalassemia patients were getting quality care in Rawalpindi and Islamabad, Pakistan, as per international standards and to identify determinants for better quality of thalassemia care.Design: A cross sectional study was conducted using interview based structured questionnaire, which was developed using standards of thalassemia care used by International Thalassemia Foundation.Setting: Five healthcare facilities catering to the needs of thalassemia patients in Rawalpindi and Islamabad, Pakistan.Participants: Data were collected from 315 thalassemia patients from May to August, 2016.Main Outcome Measure: Survey data on quality indicators.Results: Results showed that almost half of thalassemia patients (48.5%) were getting poor quality of care. On average patients were getting only 63.93% of possible quality care for the disease. The most deficient quality area was management of complications where patients were getting only 49.1% of possible care. Better quality of care was likely to be received by those patients who were educated, patients with educated fathers, those visiting private facilities and those who were visiting facilities in Islamabad. Those with concomitant diseases were also likely to receive better care.Conclusion: Quality of care provided to thalassemia patients was well below the international standards for the care of thalassemia. There is a need to take urgent action to improve quality of care in the country. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to report the vision-related quality of life (QoL) in Pakistani subjects with early or moderate glaucoma., Methods: This case control study was conducted at Al-Shifa Trust Eye Hospital, Pakistan, from 1 January 2014 to 31 December 2015. All the patients having early or moderate glaucoma, with a disease duration of at least 6 mo, and presenting during the study period, were included. Subjects in the control group were recruited from the hospital volunteer staff, spouses and friends of patients. QoL assessment was done using the NEIVFQ25 questionnaire translated into the Urdu language. A two-tailed t-test was used to test the significance of difference between the mean QoL scores and a p-value of ≤0.05 was considered significant. Multiple linear regression was carried out to assess the predictors of QoL scores., Results: A total of 698 participants were enrolled, including 247 cases and 451 controls. The mean QoL score was higher in controls 81.31 (mean=81.31, SD=26.33) than in cases (mean=53.89, SD=30.32), p<0.001. The lowest NEIVFQ-25 scores for glaucoma patients were for mental health (mean=23.88, SD=28.80) followed by general vision (mean=27.73, SD=29.74). The difference in all the mean subscale scores of two groups was statistically significant (p<0.001)., Conclusion: QoL scores are significantly reduced in Pakistani glaucoma patients with early and moderate glaucoma, with more pronounced effect on mental health and general vision.

Background: Disrespectful and abusive practices at health facilities during childbirth discourage many women to seek care at facilities. This may lead to maternal morbidity and mortalities. Despite severe impacts, such practices remain hidden and are rarely reported in developing countries., Objectives: The study was carried out to assess the prevalence and determinants of the disrespect and abuse (D & A) during child birth in rural Gujrat, Pakistan., Methods: A cross sectional household based study was conducted in tehsil Kharian of district Gujrat. Data was collected using an interview based questionnaire from the women who had a live birth within the previous two months (n = 360). The D & A scale was based on standard Maternal and Child Health Integrated Programme indicators. Multiple logistic regression was used to find out the determinants of reported D & A., Results: Almost all women experienced D & A (99.7%) during childbirth according to objective assessment "experienced D & A". However, only 27.2% reported subjective experience of D & A "reported D & A". The main determinant of reported D & A was facility based childbirth (OR = 13.49; 10.10-100.16) and lower socio economic strata (OR = 2.89; 1.63-5.11). The risk of reporting D & A was twice in public health facilities as compared to private. Women who had reported D & A were more likely to opt for changing the place of childbirth for next time (OR = 4.37, 95% CI = 2.41-7.90)., Conclusion: D & A during childbirth is highly prevalent and under-recognized in Pakistan. High prevalence at facilities and particularly at public facilities can be a reason for underutilization of this sector for childbirth. Maternal health policies in Pakistan need to be revised based on the charter of respectful maternity care., Competing Interests: The authors have declared that no competing interests exist.

Background: Smoking is highly prevalent in Pakistan claiming the lives of over 100,000 individuals every year. A significant proportion of smokers (24.7%) make an attempt to quit each year but 97.4% fail to quit successfully. Little is known about the reasons for, and experiences of, failed quit attempts. This study was carried out to explore the experiences of young male smokers in quitting smoking in the twin cities of Pakistan METHOD: A qualitative study was carried out using a phenomenological approach in Rawalpindi and Islamabad. A total of 11 participants were interviewed. All study participants were male and had made at least one quit attempt. Study participants were a mix of smokers who failed to quit smoking, intermittent smokers and successful quitters. Streubert's (1991) method of phenomenology was followed during data analysis., Results: The experiences of smokers while smoking "the smoking phase" have major effects on their journey towards quitting smoking. The smoking phase consists of three major stages: contact with initial smoking stimuli, the journey from first puff to enjoying smoking and then finally smoking becoming part of life. However, the journey towards quitting smoking is not as simple as the journey towards becoming a smoker. Instead, smokers get trapped in three overlapping cycles of smoking and quit attempts: smoking & forced quitting, smoking & intentional quitting, and smoking & intermittent smoking before successful quitting. Breaking the cycle is not easy in the presence of trapping factors (addiction, high availability, easy affordability, conducive social setup and low perceived risks of smoking). Three factors play a major role in breaking these cycles which are strong will power, continuous peer support and avoidance of smokers' company., Conclusion: A young smoker, during his experience of quitting smoking gets entrapped in several overlapping cycles of smoking & quit attempts before successful quitting. There are known entrapping factors as well as factors which help in breaking these cycles. Targeted interventions are needed to facilitate smoking cessation among young smokers in Pakistan.