Highlights One out of two children missed routine immunizations during COVID-19 lockdown in Sindh. COVID-19 lockdown disproportionately affected coverage rates across the districts. Drop in the number of immunizations was higher in rural areas followed by urban slums. Expanding pool of un-immunized children is bringing down herd immunity and raising the risk of vaccine-preventable disease outbreaks.

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ObjectivesTo estimate the prevalence of zero dose children (who have not received any dose of pentavalent (diphtheria, tetanus, pertussis, Haemophilus influenzae type B and hepatitis B) vaccine by their first birthday) among those who interacted with the immunisation system in Sindh, Pakistan along with their sociodemographic characteristics and risk factors.Design and participantsWe conducted a descriptive analysis of child-level longitudinal immunisation records of 1 467 975 0–23 months children from the Sindh’s Zindagi Mehfooz (Safe Life) Electronic Immunisation Registry (ZM-EIR), for the birth cohorts of 2017 and 2018.SettingSindh province, Pakistan which has a population of 47.9 million people and an annual birth cohort of 1.7 million.Primary and secondary outcome measuresThe primary outcome measure was zero dose status among enrolled children. Logistic regression was performed to identify the risk factors associated with the zero dose status.ResultsOut of 1 467 975 children enrolled in the ZM-EIR in Sindh, 10.6% (154 881/1 467 975) were zero dose. There were sharp inequities across the 27 districts. Zero dose children had a lower proportion of hospital births (28.5% vs 34.0%; difference 5.5 percentage points (pp) (95% CI 5.26 to 5.74); p<0.001) and higher prevalence from slums (49.5% vs 42.3%; difference 7.2 pp (95% CI 6.93 to 7.46); p<0.001), compared with non-zero dose children. Children residing in urban compared with rural areas were at a higher risk (relative risk (RR): 1.20; p<0.001; 95% CI 1.18 to 1.22), while children with educated compared with uneducated mothers were at a lower risk of being zero dose (RR: 0.47–0.96; p<0.001; 95% CI 0.45 to 0.98).ConclusionsDespite interacting with the immunisation system, 1 out of 10 children enrolled in the ZM-EIR in Sindh were zero dose. It is crucial to monitor the prevalence of zero dose children and investigate their characteristics and risk factors to effectively reach and follow-up with them.

Gender-based inequities in immunization impede the universal coverage of childhood vaccines. Leveraging data from the Government of Sindh’s Electronic Immunization Registry (SEIR), we estimated inequalities in immunization for males and females from the 2019–2022 birth cohorts in Pakistan. We computed male-to-female (M:F) and gender inequality ratios (GIR) Tfor enrollment, vaccine coverage, and timeliness. We also explored the inequities by maternal literacy, geographic location, mode of vaccination delivery, and gender of vaccinators. Between 1 January 2019, and 31 December 2022, 6,235,305 children were enrolled in the SEIR, 52.2% males and 47.8% females. We observed a median M:F ratio of 1.03 at enrollment and at Penta-1, Penta-3, and Measles-1 vaccinations, indicating more males were enrolled in the immunization system than females. Once enrolled, a median GIR of 1.00 indicated similar coverage for females and males over time; however, females experienced a delay in their vaccination timeliness. Low maternal education; residing in remote-rural, rural, and slum regions; and receiving vaccines at fixed sites, as compared to outreach, were associated with fewer females being vaccinated, as compared to males. Our findings suggeste the need to tailor and implement gender-sensitive policies and strategies for improving equity in immunization, especially in vulnerable geographies with persistently high inequalities.

Background: Diabetic nephropathy becomes a disease with a high mortality rate in this modern era of technology. Dialysis in diabetic patients affects kidney functioning is the most common treatment for end-stage renal failure but had different musculoskeletal complications due to bone mineral metabolisms like muscular cramping, atrophy and muscular weakness, restless leg syndrome and limb pain that lowers the quality of life and physical function. Objective: To evaluate the effects of low-impact strengthening exercises on limb pain, strength, glycemic control, hypertension and quality of life of patients with end-stage renal disease. Methods: The randomized controlled study was designed to check the effectiveness of low-impact strengthening exercises on patients involved in the treatment and control group. Using non-probability purposive sampling, data was collected from different hospitals in Faisalabad by providing treatment for six consecutive weeks. Outcomes of measures were pain, strength, glucose level, blood pressure and quality of life which were estimated through the numeric pain rating scale, manual muscle testing, glucometer, sphygmomanometer and kidney disease quality of life questionnaire respectively. Results: Low-impact strengthening exercises in the treatment group showed improvement in muscle strength, blood pressure, glycemic level, pain and quality of life in diabetic patients with end-stage renal disease as compared to the control group. Mean values showed that there was a statistically significant difference in different variables between both groups. Conclusion: It was concluded that there is a statistically significant difference between both groups in the improvement of limb pain and limb muscle strength by low-impact strengthening exercises. These exercises have positive effects on diabetic patients with end-stage renal disease in the treatment group as compared to the control group.