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1. Reducing the affordability of tobacco products in Pakistan : a political economy analysis

Author

Masud, Haleema

Subjects
HV Social pathology. Social and public welfare, RA Public aspects of medicine, RC Internal medicine
Abstract

Background Tobacco taxation is one of the most effective yet underused intervention to control tobacco use globally. Several LMICs including Pakistan have failed over the years to implement effective taxation measures for tobacco products to control its use and reduce harms. One of the reasons for this underutilisation is the poorly understood political economy of tobacco taxation in the LMICs context. This thesis aims to present a political economy analysis for introducing tobacco taxation and pricing policy (TTPP) reforms in Pakistan to achieve public health objectives. Methods A mixed-methods approach was used as follows: 1) a qualitative documents analysis of the regulatory framework for tobacco taxation, 2) econometric analysis to estimate the price elasticity and building econometric simulation models to predict fiscal and public health outcomes, 3) qualitative study based on in-depth interviews with key stakeholders in TTPP arena, and 4) a mixed methods analytical integration to ascertain policy, practice and research implications. Results Study component 1 highlighted that Pakistan does not have a clear strategy on using tobacco taxation 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. Study component 2 found negative price elasticity estimates for Pakistani adults (n=7831), indicating an increase in the price will decrease consumption. It was found that an increase in the price of low-priced cigarettes would have a greater impact on smoking prevalence and daily consumption by smokers. Study component 3 predicted positive fiscal and public health outcomes for a 10% annual increase in taxation even in expanding illicit market activity. Study component 4 identified the position-power dynamics of key stakeholders and revealed the key facilitators and challenges for introducing TTPP reforms in the country. Mixed methods analytical integration found the best-fit taxation policy considering the political economy scenario in the country will be a long-term commitment to slowly and regularly increase excise duty on tobacco products along with control of illicit market activity. Conclusions The findings provide a detailed understanding of the political economy of tobacco taxation in Pakistan, which can be used for designing future policies.

Published
2021

14. INCIDENCE OF MICRO DETACHMENTS AFTER SUCCESSFUL SCLERAL BUCKLING SURGERY FOR MACULA-OFF RETINAL DETACHMENTS.

Author

Syed, Abdullah Naeem, Batool, Isra, Masud, Haleema, and Qureshi, Nadeem

Subjects
RETINAL surgery, RETINAL detachment, MECHANICAL buckling, OPTICAL coherence tomography, VISUAL acuity
Abstract

Objective: To determine the incidence of micro detachments and change in mean height of persistent sub-retinal fluid (SRF) in eyes that underwent successful scleral buckling surgery for macula-off rhegmatogenous retinal detachment (RRD). Study Design: Prospective cohort study. Place and Duration of Study: Retina Department, Al Shifa Trust Eye Hospital Rawalpindi, from Jan 2016 to Dec 2016. Methodology: Thirty two patients that underwent successful scleral buckling surgery for macula-off RD were included in the study. Pre-operative assessment including retinal examination by slit-lamp bio microscopy was carried out before surgery. Post-operative assessment included best corrected visual acuity (BCVA) with a Snellen chart and optical coherence tomography (OCT) by OCT Spectralis, Heidelberg Engineering. The post-operative assessment was performed at 1 week, 1 month, 3 months and 6 months after surgery. Results: The incidence of micro detachments was 31.25% (10 patients) as detected by presence of sub-retinal fluid on optical coherence tomography at one week postoperative and 9.38% (3 patients) at six months after surgery while the base population was considered to be 32. The mean height of persistent sub-retinal fluid decreased significantly at all 4 time-points after the surgery. Mean height of SRF at 1 week, 1 month, 3 months and 6 months after surgery was 357.42 ± 114.25μm, 303.67 ± 107.57μm, 267.36 ± 106.79μm and 240.45 ± 19.77μm respectively. Conclusion: Incidence of micro detachments decreased significantly after scleral buckling surgery up to a period of 6 months with only a small fraction of patients having persistent sub-retinal fluid after 6 months of surgery. [ABSTRACT FROM AUTHOR]

Published
2020

19. Rapid detection of Mycobacterium tuberculosis and rifampicin resistance in extrapulmonary tuberculosis and sputum smear-negative pulmonary suspects using Xpert MTB/RIF

Author

Ullah, Irfan, primary, Javaid, Arshad, additional, Masud, Haleema, additional, Ali, Mazhar, additional, Basit, Anila, additional, Ahmad, Waqas, additional, Younis, Faisal, additional, Yasmin, Rehana, additional, Khan, Afsar, additional, Jabbar, Abdul, additional, Husain, Masroor, additional, and Butt, Zahid Ahmad, additional

Published
2017
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20. PREPAREDNESS OF GENERAL HEALTHCARE PRACTITIONERS IN ‘TOBACCO CESSATION COUNSELING/TREATMENT’ IN TWIN CITIES -A CROSS-SECTIONAL STUDY.

Author

Saeed, Ifrah, Masud, Haleema, Pervaiz, Farrah, Azam, Naila, Niazi, Zubair Khan, Zill-e-Huma, Khan, Farah, and Hammed, Attiya

Subjects
*GENERAL practitioners, *TOBACCO, *THERAPEUTICS, *CROSS-sectional method, *PREPAREDNESS
Abstract

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]

Published
2019

22. Reducing the affordability of tobacco products in Pakistan : a political economy analysis

Author

Masud, Haleema

Subjects
HV, RA, RC
Abstract

Background \ud \ud Tobacco taxation is one of the most effective yet underused intervention to control tobacco use globally. Several LMICs including Pakistan have failed over the years to implement effective taxation measures for tobacco products to control its use and reduce harms. One of the reasons for this underutilisation is the poorly understood political economy of tobacco taxation in the LMICs context. This thesis aims to present a political economy analysis for introducing tobacco taxation and pricing policy (TTPP) reforms in Pakistan to achieve public health objectives. \ud \ud Methods \ud \ud A mixed-methods approach was used as follows: 1) a qualitative documents analysis of the regulatory framework for tobacco taxation, 2) econometric analysis to estimate the price elasticity and building econometric simulation models to predict fiscal and public health outcomes, 3) qualitative study based on in-depth interviews with key stakeholders in TTPP arena, and 4) a mixed methods analytical integration to ascertain policy, practice and research implications. \ud \ud Results \ud \ud Study component 1 highlighted that Pakistan does not have a clear strategy on using tobacco taxation 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. Study component 2 found negative price elasticity estimates for Pakistani adults (n=7831), indicating an increase in the price will decrease consumption. It was found that an increase in the price of low-priced cigarettes would have a greater impact on smoking prevalence and daily consumption by smokers. Study component 3 predicted positive fiscal and public health outcomes for a 10% annual increase in taxation even in expanding illicit market activity. Study component 4 identified the position-power dynamics of key stakeholders and revealed the key facilitators and challenges for introducing TTPP reforms in the country. Mixed methods analytical integration found the best-fit taxation policy considering the political economy scenario in the country will be a long-term commitment to slowly and regularly increase excise duty on tobacco products along with control of illicit market activity. \ud \ud Conclusions \ud \ud The findings provide a detailed understanding of the political economy of tobacco taxation in Pakistan, which can be used for designing future policies.\ud

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