Objective: To estimate the frequency of severe acute respiratory syndrome coronavirus-2 among pregnant women, the impact in terms of obstetrical and clinical outcomes and vertical transmission to the neonates. Method: The prospective, case-control study was conducted at Zainab Panjwani Memorial Hospital, Karachi, from March to December 2021, and comprised pregnant women regardless of gestational age who exhibited symptoms or had a suspicion of exposure to any confirmed coronavirus disease-2019 individual. They were screened for severe acute respiratory syndrome coronavirus-2 infection using polymerase chain reaction or serology. Those who tested negative were designated as control group A, while who had a positive serology result along with a negative polymerase chain reaction were taken as recovered case group B1, and those who tested positive for polymerase chain reaction were called the positive case group B2. Groups B1 and B2 were followed up till delivery. The clinical presentation of coronavirus disease-2019 infection in pregnancy and its obstetrical and neonatal outcomes was assessed. Products of conception were tested for the detection of the severe acute respiratory syndrome coronavirus-2 genome. The viral genome from group B2 cases was sequenced to confirm vertical transmission. Data was analysed using GraphPad Prism V8. Results: Of the 139 pregnant women, 74(53.2%) were in group A with mean age 25.87±6.90 years, 49(35.3%) were in group B1 with mean age 25.53±7.02 years, and 16(11.5%) were in group B2 with mean age 27.12±5.03 years. The gestational age at which termination of pregnancy occurred was 38.3±1.26 weeks in group B1 and 38.3±1.85 weeks for group B2. There were 96 neonates across the 3 groups. Of the 11(11.45%) neonates in group B2, 1(9.09%) had postnatal transmission of severe acute respiratory syndrome coronavirus-2 and this mother-neonate case was taken as the Indexed case. The severe acute respiratory syndrome coronavirus-2 genome isolated from the neonate showed similar mutations as the viral strain infecting the mother. Conclusion: The risk of vertical transmission was found to be low. The severe acute respiratory syndrome coronavirus-2 genome was the same for both the mother and the neonate. Key Words: SARS-CoV-2, vertical transmission, pregnancy, COVID-19, Pakistan

Objectives: The major challenges of the current century are the rapid changes in the climate, weather conditions and the environment. Governments, individuals, and societies need to work together to tackle the challenges posed to the environment in recent times. The literature highlights the urgent need to act however, little is known about public perception and their responsibilities. This study aimed to explore the public perception of the role of individuals, societies, and states in managing environmental chal-lenges.Methods: In this cross-section study, a well-established English language questionnaire was developed. A total of 1000 questionnaires were distributed, and the response rate was 852 (85.2%). Among 852 partic-ipants, 488 (57.28 %) were males and 364 (42.72%) were females. The survey encompassed students 681 (80%), teachers 85 (10%); government officials 34 (4%), shop owners, merchants 25 (3%), doctors and engi-neers 17 (2%) and housewives 10 (1%). The questionnaires were analyzed, frequencies and percentages were calculated, and a p-value less than 0.05 was considered significant.Results: The results revealed that 621 (72.8%) of the individuals suggested that states adopt sustainable environmental policies; 639 (75%) of the respondents were in favor that individuals personally playing a role in tackling climate change; 699 (82%) agreed that there should be a bottom-up approach while deal-ing with the environmental problems. Moreover, 605 (71%) believed that the young generation is more inclined than the previous generation for global climate action, 542 (63.61 %) were in favor that civil soci-ety galvanized to enshrine environmental protection in the state constitution, and 554 (65%) suggested that national and international efforts cannot make a difference until and unless individuals don't play a role in reducing the environmental pollution. The majority of the respondents were in favor of adopting the constructive approach to managing environmental challenges.Conclusions: These days the environmental issues have become a grave concern. This role cannot be per-formed only by the states, but the role of societies and individuals is also of utmost importance. A large number of people suggested a bottom-up approach required to deal while managing environmental chal-lenges. The importance of individual, societal and collective efforts are essential in managing environ-mental challenges.(c) 2023 The Author(s). Published by Elsevier B.V. on behalf of King Saud University. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

OBJECTIVE Environmental pollution has undoubtedly been established as a planetary, intergenerational, and existential threat to global human health and safety. Environmental pollution is adversely affecting the world, mainly the countries where human health is not a priority aspect, and this has been exacerbated due to the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), and pandemic is known as "COVID pandemic". This study investigates the association of environmental pollutants, particulate matter (PM2.5), with SARS-CoV-2 daily cases and deaths in Karachi, Lahore, and Islamabad, Pakistan, presenting the perspectives from the Global South. MATERIALS AND METHODS The day-to-day PM2.5 levels were recorded from the metrological website, Real-Time Air Quality Index-AQI. The corresponding data on the COVID cases and deaths in Karachi, Lahore, and Islamabad were obtained from August 1, 2020, to September 30, 2021, from the Health Ministry and National Command Operations Centre Pakistan. RESULTS The mean values for PM2.5 in Karachi were 110.4±46.2; in Lahore 174.0±83.2; and in Islamabad 107.1±40.0. The COVID-19 mean daily cases in Karachi were 538.9±446.6; Lahore 398.3±403.1; and Islamabad 212.2±187.6; and mean daily deaths in Karachi were 9.2±8.3; Lahore 9.3±9.7; and Islamabad 1.8±1.8. The results further depicted that the SARS-CoV-2 cases were 2.86 times higher in Karachi and 1.4 times higher in Lahore than in Islamabad. Similarly, the SARS-CoV-2 deaths were 3.6 and 2.8 times higher in Karachi and Lahore, respectively, compared to Islamabad. CONCLUSIONS The findings claim that cases and deaths augmented significantly along with PM2.5 levels. These empirical estimates demonstrate an association between PM2.5 and SARS-CoV-2 daily cases and deaths in the cities of the Global South. These findings can contribute to policy-making decisions about addressing air pollutants and climate concerns in developing countries and create an urgency to develop a strategy for minimizing environmental pollution. This study can also steer the actions needed to address the environmental problems in developing countries to improve public health and safety.

Climate change is a reality recognized globally. Although global efforts are accelerating, there are fears in the underdeveloped world regarding the erosion of their sovereignty through climate change action and response mechanisms. Remedial actions taken at various levels are not a compensating reflection of this reality. There is a need to establish a well-thought-out mechanism and support fast-track climate change action and responses. This study, therefore, highlights the impact of climate change action on state sovereignty through in-depth analysis by interviewing climate experts and officials. It reckons that the issue revolves around interference in internal policies through the prism of climate change action incorporating world organisations. It concludes that developing states may have fears regarding the overreach of developed states in their remedial actions, as seen in the Global South and Global North divide. Bibliography Entry Shafi, Khalid Mahmood, Arif Ullah Khan and Rafaqat Islam. 2021. "Climate Change Action and State Sovereignty." Margalla Papers 25 (2): 98-108.

OBJECTIVE:The weather allied conditions have an impact on air, water, soil, food, ecosystem, feelings, behaviors, and pattern of health and disease. The present study aims to investigate the impact of heat and humidity on the daily basis incidence and mortality due to COVID-19 pandemic in European countries.MATERIALS AND METHODS:We selected 10 European countries, Russia, United Kingdom, Spain, Italy, Germany, Turkey, France, Belgium, Netherlands and Belarus. This region has a relatively low temperature and high humidity, and has homogenous European ethnicity with almost similar socioeconomic culture and health care system. The data on COVID-19 pandemic including daily new cases and new deaths were recorded from World Health Organization (WHO). The information on daily temperature and humidity was obtained from world climate web "Time and Date". The daily cases, deaths, temperature and humidity were recorded from the date of appearance of first case of "Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)" in the European region, from Jan 27, 2020 to July 17, 2020.RESULTS:In 10 European countries, (Russia, United Kingdom, Spain, Italy, Germany, Turkey, France, Belgium, Netherlands and Belarus), the daily basis mean temperature from Jan 27, 2020 to July 17, 2020 was 17.07±0.18°C, and humidity was 54.78±0.47%. The overall results revealed a significant inverse correlation between humidity and the number of cases (r= -0.134, p<0.001) and deaths (r= -0.126, p<0.001). Moreover, an increase in temperature was linked with an increase in the number of cases (r=0.062, p=0.013) and deaths (r=0.118, p<0.001). The regression analysis results further revealed that with an increase of 1% humidity the number of cases (β = -15.90, p<0.001) and deaths (β=-1.56, p<0.001) reduced significantly. Whereas, with an increase of 1°C in temperature the number of cases (β = 20.65, p<0.001) and deaths (β = 3.71, p<0.001) increased significantly.CONCLUSIONS:Increase in relative humidity was associated with a decrease in the number of daily cases and deaths, however, a rise in temperature was allied with an upsurge in the number of daily cases and daily deaths due to COVID-19 pandemic in European countries. The study findings on weather events and COVID-19 pandemic have an impact at European regional levels to project the incidence and mortality trends with regional weather events to enhance public health readiness and assist in planning to fight against this pandemic situation.

doi: https://doi.org/10.12669/pjms.36.COVID19-S4.2758 How to cite this:Shafi KM, Meo AS, Khalid R. Covid-19: Invisible, Elusive and the Advancing Enemy. Pak J Med Sci. 2020;36(COVID19-S4):COVID19-S138-S139. doi: https://doi.org/10.12669/pjms.36.COVID19-S4.2758 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This article examines the role of UN peacekeepers in creating awareness about the effects of climate change and establishes links with national security policy making process in host nations. A social survey was carried out to determine links between the United Nations Peace Keeping Operations (UNPKOs) and importance of climatic literacy. The data was gathered from 120 UN peacekeepers, 84 per cent of them supported constructive perspective of climatic literacy in maintaining peace and stability in conflict zones. Since the impact of climate change is a wide subject, the scope of this article, therefore, is limited to how the UN peacekeepers can help the host nations through climate literacy campaign. This paper is a contribution to a global awareness campaign as well as source of empirical evidence to enhance capacity of UNPKOs and the host nations to help formulate a sustainable policymaking process to counter the threats of climate change. The article concludes that there is a need to consider climate change as a national and international security threat and, therefore, building capacity of UN peacekeepers through climate literacy program is important.

Introduction: Breastfeeding is a natural way of feeding to a new born baby. World Health Organization launched a Baby Friendly Hospital initiative in 1992, to strengthen maternity practices to support breast-feedings. Currently, about 19250 hospitals world wide have achieved Baby Friendly Status. To evaluate the role of Baby Friendly Hospital Initiative on feeding and weaning practices of mothers in improving health status of children under five years of age Methodology: Cross sectional comparative study was done at baby friendly hospital (BFHI) and non-baby friendly hospital (Non BFHI) Karachi. A total of 784 mothers were selected through convenient sampling and grouped according to place of birth. Results: Feeding practices in BFHI group was better in some respects. Among them 81% mothers did not give any pre-lacteal feeds, 79% mothers reported that their babies were exclusively breast fed up to four months of age and 31% reported that they initiated breast feeding within one hour after the delivery. Conclusions: Baby Friendly Hospital initiative has a beneficial effect on feeding practices of mothers and duration of exclusive breastfeeding. But some areas of optimal breastfeeding practices are not taken care well. Initiation of breastfeeding within ½ to 1 hour needs attention. Key words: Breast feeding, Baby Friendly Hospital Initiative, weaning, exclusive breast feeding

Objective: The aim of the study was to determine the frequency of smear positive malaria and socio-demographic factors of patients visiting the Microscopy center of Civil hospital Khairpur.Methods: A cross-sectional study was conducted January 2016 to April 2016 by using structured questionnaire to assess frequency of smear positive malaria among patients visiting Microscopy center of Civil Hospital Khairpur. About 138 patients who were prescribed Malaria Parasite (MP) Test by the doctors were selected by using consecutive sampling technique and interviewed regarding their socio-demographic characteristics. Data was entered and analyzed by using SPSS version 21.Results: Out of total 138 participants, 55.5% were males, Majority were less than forty years of age with highest range of 25-40 years. Malaria parasite test was found to be positive in 6.5 % participants and the most common identified species was Plasmodium Vivax.Conclusion: This study suggests that Malaria is endemic in certain areas of Khairpur District and Plasmodium Vivax is the most common species affecting the people who visited Microscopy centre for the Malaria Parasite (MP) test. Health education and community participation would be needed to eliminate the Malaria from community.

Objective: To determine the vaccination practices of mothers for children less than two years of age admitted with the complain of diarrhoea in the Zainab Panjwani Memorial Hospital, Karachi, Pakistan.Methods: A Cross sectional hospital based study was conducted to determine the vaccination practices of mothers whose children were admitted with the complain of diarrhea in the paediatric ward of Zainab Panjwani Memorial Hospital, Karachi. Study was approved by the Ethical Review Board of Zainab Panjwani Memorial Hospital. After taking verbal consent from mothers or caregivers, the data was collected by using a semi-structured questionnaire. The study was conducted from 1st March to 30th April 2015. About 207 mothers were selected through consecutive sampling from paediatric units of Zainab Panjwani Memorial Hospital. Data was entered and analyzed by using SPSS V.21.Results: Out of 207 children 51% were females, 89% of the children were under 1 year of age. About 90% of the children received BCG and OPV at birth, 82.1 % received Pentavalent1+Hib1+OPV1 at 6 weeks, 75.8% were vaccinated with Pentavalent 2 + Hib2+OPV 2 at 10 weeks. About 66.2% children received Pentavalent 3+Hib3+OPV3 at 14 weeks and 52% of the children were vaccinated with Measles vaccine at 9 months of age. The coverage rate was found low to be 30% at 15 months of age. More than 45% of the mothers reported difficulty in accessing vaccination center as the major reason for not getting their children immunized against EPI ( Expanded Program of Immunization) vaccine preventable diseases.Conclusion: The practices of mothers for immunization at birth, 6 weeks and10 weeks interval were found more than 90% but at 9 months and 15 months the immunization rate for under 2 years of age child was found below 35%. The mothers should be encouraged through awareness campaign for EPI vaccination to completely immunize their children under two years of age.

Objective: To assess the knowledge and practices regarding malaria prevention and control among patients visiting tertiary care hospital of Khairpur.Methods: A hospital-based cross-sectional survey was conducted for the period of three months from October 2015 to January 2016. About 138 adult people who were advised Malarial Parasite test on the basis of clinical manifestations were included in the study by using consecutive sampling technique. A semi-structured questionnaire focused on knowledge, attitude and practices regarding Malaria control and its management. Data was entered and analyzed by SPSS version 21. Frequencies and percentages were calculated. Scoring and grading for knowledge and practices was done.Results: Out of 138 participants 55.5% were males and majority were below 40 years of age. Overall 56% of the respondents had adequate knowledge regarding malaria but only 16% had good practices for malaria control and prevention. About 80% of the respondents knew that fever is the major symptom and malaria is transmitted through the mosquito bite, 47% study participants reported that health workers were the major source of information regarding malaria control and its treatment. About 82% of the respondents reported the use of self-medication. Nearly 50% of the study participants were not using any preventive measure for malaria control and prevention.Conclusion: People living in Khairpur and its peripheral areas had good knowledge regarding malaria symptoms and signs and its mode of transmission but knowledge regarding its control and treatment was inadequate. Hence, adequate knowledge and appropriate practices are necessary to strengthen the Malaria Control Program in interior of Sindh. There is urgent need to develop personal skills and community active participation in reducing the burden of malaria.

Introduction: Exclusive breast feeding is the key strategy for the development and growth of a child. Inadequate,partial or complementary feeding practices in the initial six months may lead to detrimental effects on the health,amongst them diarrhea has been recognized as the major consequences of it. Diarrheal diseases accounts forapproximately 1.34 million deaths globally and act as a second leading cause of mortality among children. Theproposed study was undertaken to determine the breastfeeding practices among children less than 2 years ofage suffering from diarrhea, seeking care at tertiary care Hospital of Karachi.Methodology: A Cross sectional hospital based study was conducted and data were collected by using semistructured questionnaire after taking consent from mothers. The study was conducted from 1st October to 5thNovember 2013. About 207 mothers were selected through Purposive sampling from all three pediatric units ofCivil Hospital Karachi as well as pediatric emergency and pediatrics out-patient departments of Civil Hospital,Karachi. Results: Out of 207 patients, study results showed children breastfed within one hour after birth were43.5% (90), within 6 hours were 19.3%(40), within 24 hours were14.5%(30), after 24 hours were19.3%(40) andpatients who were not breastfed at all about were 3.4%(7). Patients who were exclusively breastfed up to 6months were 36. 2% (75) and about 58% (120) children were given pre-lacteal feed other breast milk.Conclusion: This study concluded that awareness and knowledge regarding breastfeeding is appropriate amongmothers and care givers but the practices of exclusive breastfeeding are not satisfactory.Key words: breastfeeding, pre-lacteal feed, complementary feeding, vaccination, diarrhea.

Background: In Pakistan, poor infant and young child feeding practices are contributing to the burden of infectious diseases and malnutrition. Objective: This study aimed to estimate the determinants of selected feeding practices and key indicators of breastfeeding in Pakistan. Materials and Methods: Total 5718 children aged 0 to 23 months from the Pakistan Demographic and Health Survey of 2006-2007 were included. WHO recommended infant and young child feeding indicators were estimated, and selected feeding indicators were examined against a set of individual-, household-, and community-level variables using univariate and multivariate analyses. Results: Only 26.3% of mothers initiated breastfeeding within the first hour after birth, 97.6% had ever breastfed, 92.5% were currently breastfeeding, and 62.7% were currently bottle feeding. Bottle feeding rates were higher among infants whose mothers partner had worked (OR = 1.66), had ever been employed (OR = 1.17), birth order > 5 (OR = 1.25) and in the Richest wealth quintiles (OR for the richest = 2.34). The likelihood of not initiating breastfeeding within first hour after birth was higher for mothers those who were not visited to the antenatal clinic (OR = 1.54), no post natal visits (OR = 1.45), working mother (OR = 1.76), delivery at facility based centre (OR = 1.95), richer households (OR = 1.77), birth order > 5 (OR = 1.67), and formally married women (OR = 2.31). Conclusions: Breastfeeding practice indicators suggest that there is need for promotion of correct/recommended breastfeeding practices in the community. Breast feeding promotion should targeted those women who have younger age and working in the urban areas.

Background: Pakistan holds rank 8 th among the world countries in which high prevalence of tuberculosis (TB) is present. There is evidenced that up to 30% of close contacts of TB patients become infected and at least half of them progress to active disease. The aim of this study was to screen active contacts of sputum positive pulmonary TB (SS +ve PTB) among household contacts (HHCs) of TB patients in Karachi, Pakistan. Materials and Methods: Cross-sectional study, which was conducted at chest clinics of Karachi. Total 750 HHCs were screened out of which 135 diagnosed smear positive TB patients was registered as index cases (ICs) from July 2012 till March 2013. Logistic regression analysis was carried out to estimate the odds ratio (OR) of different associated factors. Results: Prevalence among males (6.1%) compared with female (5.6%). The crude OR for age less than 15 years was 0.28 (95% confidence interval (CI) 0.14-0.55). Eighty-eight HHCs (11.73%) were found to have SS +ve TB. Disease frequency was significantly higher in HHCs who were smokers (adjusted OR 36.41; 95% CI 12.07, 109.79), had age less than 12 years (adjusted OR 3.63; 95% CI 1.68, 7.86), and who lived in houses less than 80 square yards (adjusted OR 3.77; 95% CI 1.27, 6.05). Conclusion: The IC with positive sputum smear constitutes great risk for TB infection and disease in HHC. There is needed for contact tracing strategy in the high-risk population.