Abstract. Large areas of the province of Punjab, Pakistan are endemic for fascioliasis, resulting in high economic losses due to livestock infection but also affecting humans directly. The prevalence in livestock varies pronouncedly in space and time (1-70%). Climatic factors influencing fascioliasis presence and potential spread were analysed based on data from five meteorological stations during 1990-2010. Variables such as wet days (Mt), water-budget-based system (Wb-bs) indices and the normalized difference vegetation index (NDVI), were obtained and correlated with geographical distribution, seasonality patterns and the two-decade evolution of fascioliasis in livestock throughout the province. The combined approach by these three indices proved to furnish a useful tool to analyse the complex epidemiology that includes (i) sheep-goats and cattlebuffaloes presenting different immunological responses to fasciolids; (ii) overlap of Fasciola hepatica and F. gigantica; (iii) co-existence of highlands and lowlands in the area studied; and (iv) disease transmission following bi-seasonality with one peak related to natural rainfall and another peak related to man-made irrigation. Results suggest a human infection situation of concern and illustrate how climate and anthropogenic environment modifications influence both geographical distribution and seasonality of fascioliasis risks. Increased fascioliasis risk throughout the Punjab plain and its decrease in the northern highlands of the province became evident during the study period. The high risk in the lowlands is worrying given that Punjab province largely consists of low-altitude, highly irrigated plains. The importance of livestock in this province makes it essential to prioritise adequate control measures. An annual treatment scheme to control the disease is recommended to be applied throughout the whole province.

Fascioliasis is an important food-borne parasitic disease caused by the two trematode species, Fasciola hepatica and Fasciola gigantica. The phenotypic features of fasciolid adults and eggs infecting buffaloes inhabiting the Central Punjab area, Pakistan, have been studied to characterize fasciolid populations involved. Morphometric analyses were made with a computer image analysis system (CIAS) applied on the basis of standardized measurements. Since it is the first study of this kind undertaken in Pakistan, the results are compared to pure fasciolid populations: (a) F. hepatica from the European Mediterranean area; and (b) F. gigantica from Burkina Faso; i.e. geographical areas where both species do not co-exist. Only parasites obtained from bovines were used. The multivariate analysis showed that the characteristics, including egg morphometrics, of fasciolids from Central Punjab, Pakistan, are between F. hepatica and F. gigantica standard populations. Similarly, the morphometric measurements of fasciolid eggs from Central Punjab are also between F. hepatica and F. gigantica standard populations. These results demonstrate the existence of fasciolid intermediate forms in endemic areas in Pakistan.

Aim The aim of the study was to define social determinants, causes and trends in child mortality from 1990 to 2013 in Pakistan. Understanding social determinants, causes and temporal trends in child mortality can inform strategies aimed at improving child health in low and middle income countries. Methods We characterised temporal trends and social determinants of child mortality in Pakistan using national demographic health survey data (1990–1991, 2006–2007 and 2012–2013). We analysed national data to generate regional estimates of health programme effectiveness. Results The annual rates of reduction for child mortality between 1990 and 2013 were estimated as follows: neonatal (−0.33% per annum), post‐neonatal (3.13% per annum), infant (0.9% per annum), child (2.47% per annum) and under 5 (1.19% per annum). Bivariate analyses of 2013 data showed that living in Punjab or Balochistan province, belonging to lowest wealth quintile, lack of maternal education, previous birth interval < 2 years, first birth order and below average birth size were associated (p < 0.05) with greater risk of child mortality in Pakistan. Common factors associated with child mortality were fever, diarrhoea and pneumonia, while among stillbirths, intrapartum asphyxia, unexplained antepartum and antepartum maternal disorders were most frequent. Conclusion Child survival strategies should integrate leading biosocial indicators and causes of death. Further research is needed to define the role(s) of social factors in child health and survival. These data should inform the implementation of cost‐effective interventions for child survival and advance targeting of interventions to populations at increased risk of child mortality.

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Background Globally 3 million stillbirths occur per year, and Pakistan is ranked 3 rd among the countries having the highest burden. Despite being a major public health problem, efforts to reduce this figure are insufficient. Objective The aim of the study was to identify and measure the inequalities in stillbirth associated risk factors, causes and fertility risk behaviors. Methods Data were derived from the Pakistan Demographic and Health Surveys (PDHS) 1990–2013. Inequalities on determinants were evaluated using rate differences and rate ratios; time trends computed with annualized reduction rate (ARR). Results Overall ARR determined for stillbirth was −12.52 percent per annum. The high ARR were recorded for mothers age <20, urban areas, educated mothers and for highest wealth quintile. The relative inequalities were most pronounced for wealth quintiles, education and age of mothers. Stillbirth causes were unexplained antepartum (33%), unexplained intrapartum (21%), intrapartum asphyxia (21%) and antepartum maternal disorders (19%). The high fertility risk behavior was found in mothers with age >34 and birth order >3. Conclusion The study concluded that to achieve gain in child survival, there is need to promote antenatal care, birth spacing, and family planning programs in developing countries.

Funding informationQuaid-i-Azam University Primary congenital glaucoma (PCG) causes blindness in early age. It has an autosomal recessive pattern of inheritance, hence is more prevalent in populations with frequent consanguineous marriages that occur in the Pakistani population. Mutations in the CYP1B1 gene are commonly associated with PCG. The aim of the present study was to identify genetic mutations in the CYP1B1 gene in PCG cases belonging to 38 Pakistani families. DNA was extracted using blood samples collected from all enrolled patients, their available unaffected family members and controls. Direct sequencing of the CYP1B1 gene revealed a novel 3' splice acceptor site causative variant segregating in an autosomal recessive manner in a large consanguineous family with four PCG-affected individuals. The novel variant was not detected in 93 ethnically matched controls.Furthermore, four already reported mutations, including p.G61E, p.R355X, p.R368H, and p. R390H were also detected in patients belonging to nine different families. All identified causative variants were evaluated by computational programs, that is, SIFT, PolyPhen-2, and Muta-tionTaster. Pathogenicity of the novel splice site variant identified in this study was analyzed by Human Splicing Finder and MaxEntScan. Ten out of 38 families with PCG had the disease due to CYP1B1 mutations, suggesting CYP1B1 was contributing to PCG in these Pakistani patients.Identification of this novel 3' splice acceptor site variant in intron 2 is the first report for the CYP1B1 gene contributing to genetic heterogeneity of disease. K E Y W O R D S autosomal recessive, CYP1B1, primary congenital glaucoma, splice site variant