Background Balochistan is the largest province of Pakistan by area, and the least developed. It suffers from several political, tribal and border conflicts. The distances to health facilities for the catchment population are long with limited accessibility. Immunization is one of the most cost-effective interventions to prevent deaths from vaccine preventable diseases (VPDs), especially in children. While Pakistan has an overall routine immunization coverage of 66 per cent for fully immunized children (FIC), coverage in the province of Balochistan is much lower at 29 per cent. This study aimed to assess the feasibility of introducing mHealth intervention using an artificial intelligence (AI) platform based on SMS (short-message service) and Interactive Voice Response (IVRs) to remind and persuade parents to get their children vaccinated. Methods We employed a mixed study design using both quantitative and qualitative approaches. Baseline data were collected from 1,600 eligible mothers/parents within the catchment areas of 75 basic health units (BHUs) in Quetta (provincial capital of Balochistan province), and the automated platform was instituted with SMS and IVRs from EPI (Expanded Programme on Immunization) Quetta. Daily reminders and IVRs were sent to the cell numbers in the database/records. Responses were noted on the AI platform. After a period of about two months, an end line survey of 1,203 participants was undertaken with a loss of 397 (25%) participants due to seasonal migration to warmer cities in Sindh province. For the qualitative part, three key informant interviews (KII) were conducted; two KIIs with Lady Health Supervisors and one KII with the WHO staff responsible for routine immunization. There were also three focus group discussions (FGDs). Results We found that the intervention was feasible as well as acceptable both at the community and programme management levels. The baseline indicators of immunization coverage improved significantly on end line survey (95% confidence interval, CI = 0.208-0.269; P<0.001). Conclusions Our study demonstrates the potential for mHealth and AI to improve childhood immunization and addresses equity in the least developed areas of this country. The replication of the strategy in subnational immunization programmes could decrease morbidity and mortality due to VPDs.
The Zhob Ophiolite is divided into three detached blocks including the Omzha block. The Omzha block is mapped and divided into lithological units such as ultramafic rock, mafic-felsic rock, and volcanic–volcaniclastic–pelagic rocks. These units are quite deformed and mixed up and are associated with one another by thrust faults. Petrography and geochemistry divide them into gabbro, diorite, plagiogranite, pheno-tephrite and trachy-andesite basalt, trachy basalt, chert, limestone, and mudstone. The ultramafic rocks are dominantly serpentinized harzburgite, dunite, and a minor lherzolite. Petrography of peridotite shows that it may be depleted in nature and may have residual after processes such as partial melting and the melt-rock reaction of a lherzolitic source. The gabbroic rocks are less well-developed and highly deformed. They are cross-cut by diorite, plagiogranite and anorthosite’ intrusions. The gabbro may be the plutonic section of Omzha block’ crust while the intermediate-felsic igneous rocks may have formed by the anataxis of crustal gabbro. The volcanic–volcaniclastic–pelagic rocks unit may be corrected with Bagh complex found underneath the Muslim Bagh Ophiolite. The metamorphic sole rocks of Omzha block are highly deformed and dismembered are comprising of metamorphic facies such as amphibolite, quartz-mica schist, and greenschist.
Zhob Ophiolite complex is composed of three detached blocks named Omzha, Ali Khanzai and Naweoba blocks. The crustal plutonic section of the Naweoba block is mapped and divided into gabbro and granite. Based on petrographical studies, the gabbros fell in the domain of gabbro, gabbronorite, and hornblende gabbro while granitic rocks fell in the vicinity of quartz-rich granitic rocks, granodiorite, plagiogranite and tonalite. Gabbroic rocks cover the maximum area of the crustal plutonic section and are usually medium-grained while at many places the grain size is quite large to be seen with naked eyes. Minerlogically gabbroic rocks consist of orthopyroxene, clinopyroxene, amphibole and plagioclase. These rocks maybe the fragments of main crustal plutonic section of the Zhob ophiolite. The granitic rocks having mafic minerals dominted in the eastern portion, while the felsic minerals dominted ones are in the west. The eastern side of the granitic body is compact and massive compared to western portion which is quite altered and shattered. Granitic rocks are composed of plagioclase, alkali feldspar and quartz where rutile and Cr-spinel exist in trace amounts. The gabbros of Naweoba block may have formed in a magma chamber as a result of fractional crystallization. While the granites maybe a late magmatic differentiate from the same magma chamber. The close correlation of gabbroic and granitic rocks of Naweoba block with Muslim Bagh, Khanozai and Bela ophiolites suggests their formation in supra subduction zone setting.
The Quetta and surrounding areas are part of the collision zone between the Indian and Eurasian plates, named as Kirthar and Sulaiman Fold-Thrust belts. The collision is accommodated by folding, thrusting and the Nushki-Chaman Transform Fault System. Detailed high-resolution (scale 1:50,000) mapping and structural analyses were carried out using modern remote-sensing techniques of the ArcGIS to understand mutual relationships of the structural patterns and geometries, and the regional and local stress patterns in the study area. Fieldwork was carried out to acquire the stratigraphic, structural and geomorphological data, using topographic maps and satellite images as base maps in order to plot additional information and further incorporate them in the GIS-based map. Balanced structural cross-sections were also prepared along the selected lines using ArcGIS techniques. Based on new mapping, the understudy area has been subdivided into five distinct structural domains. These domains are classified as; Domain I: broad syncline intervened by a narrow anticline; Domain II: upright folds and thrusts; Domain III: tight, over-turned thrust zone; Domain IV: flysch and molasse successions of Paleocene-Holocene age; and Domain V: suture belt (ophiolites) and associated mélanges and sediments.
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