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Grant administration plays a pivotal role in the success of research and academic endeavors. However, in Pakistan, academic institutions often face challenges in this domain, primarily due to a lack of specialized training and infrastructure. This research paper presents the outcomes of a comprehensive capacity-strengthening workshop, hosted in two cities, aimed at improving grant administration skills in Pakistani academic institutions. A pre and post-survey analysis was conducted to assess participants' knowledge and experience. A pre-survey method was used to develop the learning objectives and content for the workshop, whereas the post-survey tool was used to assess the immediate effect of a two-day capacity-strengthening workshop on participants' knowledge of grants. Response rates for Karachi participants were 86% pre and 87% post, while for Islamabad participants, they were 63% pre and 57% post. Notably, participants in Islamabad, where infrastructure and support services are often less advanced, exhibited significant improvement in their understanding of grant administration processes. Factors contributing to the workshop's success included its dynamic content, interactive learning methods, and an inclusive learning environment. The outcomes of this research provide insights into the effectiveness of tailored capacity-strengthening programs in addressing the unique needs of diverse academic institutions. In addition, it highlights the potential of collaborative learning, where participants from various backgrounds come together to enhance their collective knowledge. This initiative underscores the importance of enhancing grant administration skills to foster a more robust research ecosystem in Pakistan.

IntroductionThe Control of Blood Pressure and Risk Attenuation-Bangladesh, Pakistan, Sri Lanka (COBRA-BPS) programme is a community-based initiative for managing hypertension in rural South Asia. Previous analyses found the intervention more effective but too costly to be considered cost-effective, using a gross domestic product-based threshold cost-effectiveness threshold that overlooked Pakistan’s constrained healthcare resources. Additionally, key benefits, such as avoided cardiovascular events and associated cost savings, were not considered. This study evaluates the long-term cost-effectiveness of the COBRA-BPS programme compared with the standard of care (SoC) in Pakistan.MethodsA Markov model was used to estimate long-term costs and health outcomes, measured in life years and disability-adjusted life years (DALYs). Cost-effectiveness was assessed using incremental cost-effectiveness ratios (ICERs) and net monetary benefit statistics. Thresholds of US$183 (based on Pakistan’s marginal productivity of public health expenditure), US$500 and US$1000 per DALY averted were applied. Sensitivity analyses were conducted to assess robustness.ResultsBased on the pooled results, the COBRA-BPS programme incurred higher costs than SoC, with an incremental cost of US$105 and an incremental gain of 0.41 DALYs averted over individuals’ lifetimes, resulting in an ICER of US$252 per DALY averted.ConclusionCOBRA-BPS effectively reduces cardiovascular events but has marginal cost-effectiveness when evaluated against the US$183 per DALY threshold. However, it becomes cost-effective at higher thresholds. Compared with previous analyses, our study found a significantly lower cost per DALY averted, driven by substantial downstream cost savings from avoided cardiovascular events.

Vectorcardiography (VCG) enables measurement of voltages and directions of resultant spatial vectors in the heart that are altered by myocardial ischemia. To validate the ability of VCG to detect electrophysiological effects of regional myocardial ischemia and identify blood vessels that obstruct blood flow significantly, VCG records of 37 patients who presented with unstable symptoms of ischemia requiring coronary angiography (CA) were processed and analyzed. The difference in magnitude and direction of electrical vectors were measured before and after percutaneous coronary intervention (PCI) to study the significance of changes after revascularization. Bio amplifiers recorded 3 simultaneous orthogonal lead ECG signals with low-pass frequency of 150 Hz without electronic filtration. The analogue signals were digitized and recorded for analysis. The numerical output was processed by algorithms to calculate and display the state of vectors. 36 of 37 patients showed congruence between VCG and CA results: 34 of the 36 showed changes in electrical vectors and insufficient blood supply. 2 showed no changes in electrical vectors and non-obstructive arteries on CA. 1 patient had ischemia detected by VCG, but CA was negative. Blood vessels that were opened with PCI corresponded with regions of myocardial ischemia and expected coronary blood supply on VCG interpretation.

Background Noncommunicable diseases (NCDs) are a growing health challenge in low- and middle-income countries (LMICs), including Pakistan. Adolescence is a critical period for shaping lifelong behaviors, yet school-based health education remains limited, and inconsistently implemented. Digital health interventions offer scalable opportunities, but their feasibility, sustainability, and cultural acceptability in LMIC school settings remain underexplored. Objective This study examined barriers and facilitators to delivering the School eHealth Education Program Pakistan (eSHEPP) and explored stakeholder perceptions of its design, delivery, and content for adolescent NCD prevention. Methods An exploratory qualitative design was applied in public secondary and higher secondary schools using purposive sampling. Data were collected through four Focus Group Discussions (FGDs) with students and teachers ( N  = 36) and 11 Key Informant Interviews (KIIs) with parents and administrators. KII and FGD guides were based on the Technology Acceptance Model and the Task–Technology Fit framework. Transcripts were thematically analyzed in NVivo v14 using a hybrid deductive–inductive approach. Credibility was supported through intercoder reliability (κ = 0.71) and stakeholder validation. Results Major barriers included infrastructure gaps such as unreliable internet, electricity shortages, and lack of multimedia resources. However, students’ digital familiarity and widespread mobile access were strong facilitators. Parents, teachers, and administrators endorsed eSHEPP, noting students’ enthusiasm and the spillover of health knowledge to families. Stakeholders recommended a bilingual (Urdu/English), offline-accessible app with intuitive navigation, privacy safeguards, and interactive tools such as quizzes and rewards. Short Urdu videos with English subtitles, relatable scenarios, and student involvement were considered most engaging. Cultural sensitivities around mental health, gender norms, and substance use require careful framing. Sustainability was viewed as dependent on curriculum integration, teacher training, and institutional support. Conclusions eSHEPP shows strong potential as a culturally sensitive, scalable, and pedagogically sound model for adolescent health promotion in LMIC schools. Addressing infrastructural gaps, ensuring policy integration, and promoting digital equity will be critical for long-term impact.

IntroductionClimate change has led to extreme heat events, disproportionately affecting vulnerable populations. Heat stress during pregnancy is linked to adverse health outcomes, yet the biological mechanisms remain poorly understood. This research study aims to investigate the effect of environmental heat on maternal, fetal and infant health and examine the biological pathways linking heat stress to adverse pregnancy outcomes.Methods and analysisThis prospective cohort study will recruit 6000 pregnant women from three districts in Sindh, Pakistan. Eligible participants ≥18 years old, will have a minimum of five scheduled visits from <14 weeks’ gestation and will be followed up to 12 months postpartum. Primary outcomes include low birth weight and small vulnerable newborns (SVN); secondary outcomes include preterm birth, small for gestational age (SGA), miscarriage, stillbirth, and composite maternal and neonatal morbidity and mortality. Fetal ultrasound scans with Doppler assessments will be performed at each visit to measure fetal growth, uteroplacental and fetoplacental circulation. Each woman’s heat exposure will be measured using wearable sensors and heat strain biomarkers. In a subset of 1000 women, maternal heart rate, skin temperature sleep patterns and physical activity will be monitored throughout pregnancy using wearable devices. Time-varying, distributed lag and non-linear models will examine associations between heat stress indices and pregnancy outcomes.Ethics and disseminationThe study has received ethical approval from the Aga Khan University (AKU) (Ref: 26249) and the Pakistan National Bioethics Committee (Ref: 1065/23/1736). Written informed consent will be obtained from all participants before enrolment. Referral pathways to healthcare facilities will be established to ensure timely management of pregnancy complications. Findings will be disseminated through peer-reviewed publications, scientific conferences, and engagement with policymakers and public health stakeholders to inform climate-resilient maternal health strategies. Results will also be shared with participants and communities through meetings and informal sessions to raise awareness and support evidence-based heat adaptation.Trial registration numberNCT01234567.

Background Childhood obesity and hypertension are growing concerns globally, especially in developing countries. This study investigated the association between overall and central obesity at baseline, and prehypertension or hypertension at follow-up among preadolescent school children in urban Karachi, Pakistan. Methods This is a sub study with cohort design embedded within a feasibility trial on School Health Education Program in Pakistan (SHEPP) in preadolescents aged 6–11 years, attending two private schools conducted from 2017 to 2019. Hypertension or prehypertension at follow-up were the outcomes and obesity or central obesity at baseline were the exposure variables. Hypertension was defined as systolic blood pressure and/or diastolic blood pressure ≥ 95th percentile for age, sex, and height. Obesity was defined as body mass index for-age and sex ≥ 95th percentile, whereas central obesity was determined by waist circumference measurements ≥ 85th percentile of age, sex, and height specific cut-offs. Logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) to identify risk factors for hypertension and prehypertension. Results Analysis was conducted for 908 participants, evenly distributed with 454 boys and 454 girls. Hypertension was observed in 19.8% of the preadolescents, with rates of 18.5% in boys and 21.0% in girls. Prehypertension was found in 16.8% of preadolescents, with 18% among boys and 16% among girls. Additionally, 12.8% of preadolescents were classified as obese and 29.8% had central obesity. Obesity at baseline was associated with hypertension at followup (OR 8.7, 95% CI 3.5, 20.4) in the final model after adjusting for age, gender, physical activity, sedentary behavior, fruits, vegetable intake and hypertension at baseline. Central obesity at baseline also yielded high odds, with prehypertension (OR 1.9, 95% CI 1.4, 2.8) and hypertension (OR 2.7, 95% CI 1.9, 3.9) at follow up in the final model. Conclusion This study highlights a concerning prevalence of hypertension and prehypertension among preadolescent school-going children. Obesity and central obesity at baseline emerged as significant predictive factors for hypertension or prehypertension at followup within this cohort. The findings emphasize the urgency of implementing comprehensive school health education programs aimed at early detection and effective management of hypertension during childhood and adolescence in school settings.

Background: Tobacco consumption poses a significant challenge to global health and contributes to the increase in noncommunicable diseases and premature deaths. Aim: To investigate the potential impact of a 70% tobacco tax on consumption and government revenue in Pakistan. Methods: We analysed secondary data from 2011 to 2022 (after imposition of a 70% excise tax) from the Pakistan Bureau of Statistics, Pakistan Social and Living Standard Survey, financial yearbooks and Federal Board of Revenue reports for tobacco consumption and government revenue. Variables included tobacco price inflation, per capita income, cigarette price, federal excise duty, and government revenue. Results: The higher taxes reduced tobacco production by PKR 3.72 billion (≈US $ 13.4 million). Price elasticity analysis indicated an inelastic demand for cigarettes, mostly among the rural populations. Imposition of excise duty of 70% of the retail price caused a decrease in government revenue by PKR 390 million (≈US$1.4 million). Conclusion: Implementing 70% taxation on tobacco products is beneficial, however, to fully realize its benefit, there is a need for strict regulation on brand shifting and illegal trade.

ObjectivesData on postdischarge care for stroke and myocardial infarction (MI) patients remain limited. Logistical barriers, including fragmented communication and poor coordination between patients and physicians, contribute to suboptimal outcomes and hinder secondary prevention. Mobile health (mHealth) offers a promising strategy to support continuity of care. We aimed to synthesise existing literature and evaluate mHealth interventions for postdischarge MI and stroke care.DesignThis scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guideline.Data sourcesPubMed, CINAHIL, Scopus and Cochrane were searched from 26 July 2016 to 5 July 2024.Eligibility criteriaThis scoping review included randomised controlled trials and observational studies published in peer-reviewed journals that evaluated mHealth interventions for postdischarge care in MI and stroke. Studies reporting outcomes such as mortality, functional capacity, readmissions or adverse events were included.Data extraction and synthesisTwo authors independently extracted and summarised the data. Subsequently, methodological quality was independently assessed by two other authors using the Joanna Briggs Institute checklist.ResultsWe identified 31 eligible studies, with 14 631 participants and 59.9 mean years old. Most participants were male. Among these, three (%) originated from low-middle income, seven (%) from upper-middle income and 21 (%) from high-income countries. Overall, we identified 17 studies using mobile apps: eight as a single intervention, and nine combined with remote sensors, seven with SMS, three studies used web-based platforms, two used phone calls, one study combined SMS and phone calls and another used remote sensors only. Multimodal telerehabilitation reported better outcomes compared with single-mode mHealth interventions. Most studies assessed functional capacity (26 studies) and quality of life (21 studies).ConclusionThis review highlighted increased mHealth uptake among postdischarge MI and stroke patients, including significant underrepresentation of female participants, scarce studies from low-middle-income countries or rural areas and limited reporting of hard clinical endpoints. While mHealth showed positive outcomes across most studies, it further highlights contextual factors that account for digital disparity and the need to prioritise inclusive, user-centred designs and integrate objective measurement tools on future trials and policy frameworks.

BackgroundThis review aims to describe existing evidence on the state of hypertension in Pakistan, including the prevalence, associated risk factors, preventive strategies, and challenges in the management of hypertension.MethodsA comprehensive literature search was conducted electronically using PubMed and Google Scholar. Using specific screening methodology, 55 articles were selected to be included.ResultsWe found from this extensive review that several small studies report high prevalence of hypertension but there is a lack of population based prevalence of hypertension in Pakistan. Lifestyle risk factors such as obesity, unhealthy diet, decreased physical activity, low socioeconomic status, and lack of access to care were the main associated factors with hypertension. Lack of blood pressure monitoring practices and medication non-adherence were also linked to uncontrolled hypertension in Pakistan and were more evident in primary care setups. The evidence presented is essential for delineating the burden of the disease, hence allowing for better management of this underserved population.ConclusionThere is a need for updated surveys to depict the true prevalence and management of hypertension in Pakistan. Cost-effective implementation strategies and policies at the national level are needed for both prevention and control of hypertension.

Background Non-communicable diseases (NCDs) pose a significant health threat, particularly among adolescents in low- and middle-income countries (LMICs) such as Pakistan. Unhealthy habits, including poor diet, physical inactivity, and substance use, often begin in childhood. These behaviors not only increase the risk of NCDs later in life but can also cause serious health problems during adolescence or early adulthood. This protocol aims to assess the feasibility and potential efficacy of the School eHealth Education Program Pakistan (eSHEPP) in improving the knowledge, attitudes, and practices (KAP) of school students in Karachi regarding NCDs and their risk factors. Methods and analysis A sequential mixed-methods design will be used, combining qualitative and quantitative approaches. In Phase 1, focus group discussions (FGDs) and interviews with stakeholders will identify barriers and facilitators to implementation, as well as gather perspectives on the eHealth application’s design and content. In Phase 2, a pilot cluster randomized controlled trial (cRCT) will assess the program’s feasibility and potential efficacy in improving participants’ KAP regarding NCDs. In Phase 3, FGDs with intervention participants will explore the program’s usability, acceptance, and task–technology fit. Participants The study will engage a diverse group of stakeholders across three phases. Phase 1 will involve four FGDs, two with students and two with teachers (eight participants per FGD), and ten key informant interviews (five with parents and five with school administrators). In Phase 2, 272 secondary and higher secondary school students aged 13–18 years will be recruited from selected schools in Karachi. Phase 3 will include two FGDs with students (eight participants per FGD). Written assents and consents will be obtained from all participants. Intervention The eSHEPP will deliver digital health education via an interactive eHealth application to raise awareness about NCDs and their risk factors among adolescents. Students in the intervention group will attend health-promoting sessions in the classroom for over two months, while the control group will receive no intervention and continue with the routine teaching schedule. Outcomes Phase 1 will identify barriers and facilitators to implementing the eSHEPP in secondary and higher secondary schools and explore stakeholders’ perceptions of its design and content. Phase 2 will assess feasibility, defined as achieving recruitment, retention, and treatment fidelity rates above 70%, and potential efficacy, indicated by a ≥ 25% improvement in KAP after two months. Phase 3 will evaluate the program’s acceptability, perceived usefulness, and task–technology fit to determine how well it meets students’ needs and expectations in the school setting. Ethics and dissemination Ethical approval has been obtained from the Aga Khan University Ethical Review Committee (Ref: 2023-9277-27367) and the National Bioethics Committee Pakistan (Ref: 4–87/NBCR-1089/23/1896). Findings will be disseminated through peer-reviewed journals and national and international conferences. Trial registration number NCT06674798. Strengths and limitations of this study The sequential mixed-methods design will enhance understanding and credibility of the eSHEPP through data triangulation. The pilot cRCT will rigorously evaluate the program while controlling for confounders, strengthening internal validity. Diverse stakeholder perspectives will enrich the data by highlighting barriers, facilitators, and potential efficacy. Findings may not be generalizable to educational settings or cultural contexts beyond Karachi, Pakistan. The small number of clusters ( N  = 4) limits statistical power; therefore, analyses are exploratory, and results should be interpreted with caution.