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FCDO ODA allocations for 2021/22 were announced on 21 April 2021. Changes to individual programmes are underway. The information on this website may not reflect the latest allocated budgets for this year. This information will be updated in due course.

UK aid from the British people

Pakistan

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Consolidating Democracy in Pakistan

Conflict, Stability and Security Fund

This programme will directly support key components of the UK Government's Pakistan strategy, which aims to help Pakistan to consolidate its democracy and provide effective government, prioritising economic growth and reducing poverty.

Project identifier:

GB-GOV-52-CSSF-08-000001

Start Date:

2017-04-01

Activity Status:

Implementation

Total Budget:

£8,000,000


Rule of Law in Pakistan Programme

Conflict, Stability and Security Fund

This programme will support Pakistan to improve citizens’ trust and public confidence in rule of law, especially among the poorest and most vulnerable, including minorities, women and girls. This is an ODA and non-ODA integrated programme. The spend reported against this programme is the ODA element alone.

Project identifier:

GB-GOV-52-CSSF-08-000002

Start Date:

2017-04-01

Activity Status:

Implementation

Total Budget:

£9,980,000


Darwin Initiative Round 23

Department for Environment, Food, and Rural Affairs

The Darwin Initiative is a UK government grants scheme that helps to protect biodiversity and the natural environment through locally based projects worldwide. The initiative funds projects that help countries rich in biodiversity but poor in financial resources to meet their objectives under one or more of the biodiversity conventions. The objective is to to address threats to biodiversity such as: - habitat loss or degradation - climate change - invasive species - over-exploitation - pollution and eutrophication.

Project identifier:

GB-GOV-7-DAR23

Start Date:

2018-04-01

Activity Status:

Implementation

Total Budget:

£7,619,619


Zephyr Wind Farm

CDC Group plc

Pakistan has an estimated 6,000 megawatt shortfall at peak times and suffers regular power blackouts that affect millions of people and businesses. Much of the country’s current power is supplied by imported heavy fuel oils. Zephyr Power is developing a 50 megawatt wind farm near Karachi to provide a more reliable power source and help reduce the number of blackouts in the region. Our investment will help boost the country's power supply, providing an additional source of clean, renewable energy.

Project identifier:

GB-COH-03877777-F316501

Start Date:

2017-04-03

Activity Status:

Implementation

Total Budget:

£0


Daraz.pk

CDC Group plc

Equity investment supporting growth of an online retailer to buy from local clothing suppliers and to create local logistics jobs.

Project identifier:

GB-COH-03877777-F310801

Start Date:

2015-09-23

Activity Status:

Implementation

Total Budget:

£0


Habib Bank Ltd

CDC Group plc

Equity investment supporting the privatisation of Pakistan’s largest commercial bank, and restarting CDC’s direct investing in the country.

Project identifier:

GB-COH-03877777-F309701

Start Date:

2015-04-08

Activity Status:

Implementation

Total Budget:

£0


Zephyr Power

CDC Group plc

Pakistan has an estimated 6,000 megawatt shortfall at peak times and suffers regular power blackouts that affect millions of people and businesses. Much of the country’s current power is supplied by imported heavy fuel oils. Zephyr Power is developing a 50 megawatt wind farm near Karachi to provide a more reliable power source and help reduce the number of blackouts in the region. Our investment will help boost the country's power supply, providing an additional source of clean, renewable energy.

Project identifier:

GB-COH-03877777-F314401

Start Date:

2017-04-24

Activity Status:

Implementation

Total Budget:

£0


Gulpur Hydropower

CDC Group plc

Debt investment in the construction, operation and maintenance of a 102 MW hydropower plant, to bring down the cost of power and reduce reliance on thermal power.

Project identifier:

GB-COH-03877777-F309901

Start Date:

2015-05-13

Activity Status:

Implementation

Total Budget:

£0


Fleming Fund – Country and Regional Grants and Fellowships Programme

UK - Department of Health (DH)

The Fleming Fund helps low- and middle-income countries to fight antimicrobial resistance. A management agent has been appointed to deliver: country grants 24 low- and middle-income countries, regional grants in West Africa, East and Southern Africa, South Asia and South East Asia, and a global fellowships programme. These initiatives aim to improve laboratory capacity and diagnosis as well as data and surveillance of antimicrobial resistance (AMR).

Project identifier:

GB-GOV-10-FF_MA

Start Date:

2016-10-10

Activity Status:

Implementation

Total Budget:

£258,497,532.75


Applying Astronomy Capability to Map an Invasive Weed: Leveraging Satellite Surveys to Inform ""Famine Weed"" Policy in Pakistan

UK - Department for Business, Energy and Industrial Strategy (BEIS)

It is projected that food demand will more than double by 2050 due to climate changes. The new generation of Earth observation data, including the Sentinel missions, offer the potential to identify and counteract crop yield declines. Astronomers are experts in analysing large multiband imaging surveys by making sense of the plethora of information using smaller targeted observations at high resolution and/or with spectroscopic information. This is exactly the expertise needed to utilise these new Earth observations to address global food security challenges. In this proposal, for the first time, we build crossover capabilities by focussing on a critical threat to two of the four most important crops in Pakistan (>75% of total output). Beyond the specific outputs of this project, this multi-disciplinary collaboration between astronomy, Earth observations and food security will also deliver transformative open-source tools. They will have secondary benefits to the UK in addressing global food security, and could be applied to challenges such as blackgrass in wheat. Furthermore they showcase the huge potential of STFC capabilities to contribute to tackling global challenges. Food security in Pakistan is reliant on its ability to produce wheat and rice. A new invasive species of weed, the ""Famine Weed"" (Parthenium hysterophorus), has been identified as a critical threat to agriculture and human prosperity in the region. Parthenium affects crop yields by as much as 90%, and has serious impacts on human and livestock health, and is therefore this project is of great importance to Pakistan. The University of Manchester and the Centre for Agriculture and Bioscience International (CABI) have joined forces to define a key challenge area for STFC research: the use of astronomy image analysis for mapping Parthenium across Pakistan. With their Islamabad office, CABI have over sixty years of on-the-ground experience in Pakistan and a proven track record of undertaking agricultural research projects in this region. Combined with the world-leading expertise in astronomy image analysis and optical instrumentation engineering at Manchester, we propose a four-stage project to provide detailed mapping of Parthenium in wheat and rice agriculture for the major arable regions of Pakistan. Initially, we will aggregate and preprocess multispectral satellite imagery (WP1) and implement a campaign to collect high quality ground reference data (WP2) which is currently lacking. These will be combined to produce a computing framework for the detection of Parthenium in crops across the country. This will deliver static maps for the current extent of the weed (WP3) as well as a mechanism for future monitoring to be adopted by policy makers (WP4). We also place a strong emphasis on local academic capacity building through employment of local researchers, delivery of technical workshops, data hack challenge events and a researcher exchange program between Manchester and universities in Punjab (WP4). Impact is achieved via three interlinked outcomes: 1) Policy makers become aware of and able to use satellite data for decision-making in agriculture, livestock, and human health; 2) Improved methods allow for automated mapping and monitoring of the distribution of Parthenium in rice and wheat fields; and 3) Pakistani researchers develop strengthened capacities in their fields that contribute to their ongoing work.

Project identifier:

GB-GOV-13-FUND--GCRF-ST_R003009_1

Start Date:

2018-03-01

Activity Status:

Implementation

Total Budget:

£544,281.91


Supervised Treatment in Out-Patients for Schizophrenia (STOPS+)

UK - Department for Business, Energy and Industrial Strategy (BEIS)

Schizophrenia is a severe long-term mental health condition. It causes a range of different psychological symptoms including hallucinations (hearing or seeing things that don't exist), delusions (unusual beliefs not based on reality), muddled thoughts based on hallucinations or delusions and changes in behaviour. Schizophrenia is a common cause of long-term disability in the 15-49-year-old group and whilst effective treatments are available, in developing countries around two thirds of patients receive no treatment. This lack of treatment, commonly known as the 'treatment gap' arises due to factors including poor treatment adherence, a lack of primary care involvement and poor access treatments. We have previously reported a new approach (Supervised Treatment in Out-Patients for Schizophrenia (STOPS)) that resulted in improved treatment adherence and functioning in a resource poor setting in Khyber Pakhtunkhwa (KP), Pakistan. In this study we trained and supported relatives and family members to monitor medication taking, building on the success of a similar approach used for patients with tuberculosis. We now aim to implement and evaluate a 'scaled-up' version of STOPS (STOPS+) which is based on the World Health Organisation mental health guidelines and maintain treatment adherence with the help of family members and text message reminders. We will work with primary care physicians and multipurpose primary are technicians to task shift care, under the supervision of mental health experts. The study has 3 phases: PHASE 1: PRE-IMPLEMENTATION PHASE involving community engagement, modification of STOP to STOPS+ (involving patient, healthcare and wider community partners) and the identification of potential study participants. PHASE 2: IMPLEMENTATION OF STOPS+ IN PRIMARY CARE SETTINGS USING A CLUSTER TRIAL DESIGN to determine the clinical and cost-effectiveness. 24 primary care centres in district Peshawar, KP will be randomised to deliver either STOPS+ or Enhanced Treatment As Usual (ETAU). We will recruit 526 patients (263 in each arm) suffering from Schizophrenia or schizoaffective disorder based on the International Classification of Diseases (ICD)-10 criteria. The outcomes of interest will include Global Assessment of Functioning and adherence to treatment regimen. PHASE 3: EVALUATION OF THE IMPLEMENTATION IN REAL WORLD SETTING will be measured using the standardised World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS), economic evaluation, secondary data from the trial and utilisation of primary health care, and in depth interview study involving all participants. If successful this trial will improve schizophrenia care, improving lives for patients and their families. This work will provide important information for policy makers and set the foundations for reducing disability and improving long term patient outcomes.

Project identifier:

GB-GOV-13-FUND--GCRF-MR_S00243X_1

Start Date:

2018-08-01

Activity Status:

Implementation

Total Budget:

£430,306.58


Biofortification with Zinc and Iron for Eliminating Deficiency in Pakistan (BiZIFED2)

UK - Department for Business, Energy and Industrial Strategy (BEIS)

Zinc and iron deficiencies are a global public health problem, with the greatest burden occurring in low and middle-income countries. In Pakistan, over 40% of women are zinc deficient and over 20% have iron deficiency anaemia. These micronutrient deficiencies have negative consequences for maternal and child health, and it is imperative that sustainable and cost-effective solutions are found. The project will investigate the potential of biofortification to reduce zinc and iron deficiencies in Pakistan. Biofortification is a process by which the nutritional quality of food crops is improved through conventional plant breeding techniques and addition of nutrient-rich fertilisers. HarvestPlus has developed a variety of wheat with significantly greater zinc and iron concentrations, compared to standard varieties. Wheat is the staple crop in Pakistan and most families consume chapatis (made from wheat flour) with every meal. Therefore, we believe that biofortified flour may benefit communities who cannot afford to consume a diverse range of foods. The project has three main components, to be delivered over two years. The first component is a randomised controlled trial effectiveness study, to assess the impact of consuming biofortified flour on zinc and iron status. The participants will be 500 adolescent girls (aged 10-16 years) and 500 children (aged 1-5 years) living in a low-resource community in North West Pakistan. In phase 1 (months 1-6), the participants and their families will consume their usual locally purchased flour. The cost of the flour will be reimbursed as an incentive to participate in the study. In phase 2 (months 7-12), they will consume either biofortified flour (intervention group) or standard flour (control group), both of which will be grown locally. The participants will be randomly allocated to the intervention or control group and they will not know which flour they are consuming (nor will the research team). A range of biochemical measures will be taken to assess the impact of consuming biofortified flour on zinc and iron status. We will also record the incidence of diarrhoea and upper respiratory tract infections (in children), which are known to be associated with zinc deficiency. The second component focuses on understanding wheat growing conditions in Pakistan, and supporting farmers to improve the yield and grain quality of biofortified wheat. Variations in soil fertility and grain quality will be mapped across Punjab Province, where 80% of Pakistan's wheat is grown. Computer modelling techniques will be used to predict which soil properties (e.g. soil organic matter, fertility) and management options would lead to optimal zinc concentrations in the wheat grain. Cost-benefit analyses will be conducted for different scenarios, such as standard vs. biofortified wheat, addition of zinc fertilisers, improved soil organic inputs etc. The third component focuses on promoting the sustainable production and consumption of biofortified wheat in Pakistan. Mixed methods will be used to explore the views and perspectives of farmers (wheat producers) and community members (wheat flour consumers) to understand what factors influence their decisions to adopt biofortified wheat or not. Participants will be recruited from marginalised communities, who often have the poorest diets and may not access other types of nutrition interventions such as centralised flour fortification. The wheat market system in Pakistan will be mapped through consultations with a range of stakeholders. This information will be used to develop and pilot interventions to promote the sustainable production and consumption of biofortified wheat. As well as intensive communication activities with farmers and consumer, findings will be disseminated to researchers, policy makers, donors, world-wide, through a comprehensive Pathways-to-Impact activities.

Project identifier:

GB-GOV-13-FUND--GCRF-BB_S013989_1

Start Date:

2019-04-01

Activity Status:

Implementation

Total Budget:

£1,463,580.30


GCRF Development Award: Education, Justice and Memory Network

UK - Department for Business, Energy and Industrial Strategy (BEIS)

The proposed Education, Justice and Memory Network (EdJAM) comes together in order to contribute towards Sustainable Development Goal 4, which aims to ensure inclusive and equitable quality education and to promote lifelong learning opportunities for all. A crucial part of SDG4 is its target 4.7, which specifies the kinds of skills, knowledge and attitudes that education should develop in all learners and includes knowledge and skills to promote a culture of peace and non-violence. Current approaches to teaching about conflict and peace often fall short of meeting this challenge. Peace education often relies on generalised and universal approaches that fall flat for learners since they do not enable connections to past and present injustice or violence that affect daily lives. Formal history education is often a space where violence is perpetuated, for instance when it promotes exclusive group identities; silences cultures and experiences; or legitimises conflict and injustice. Curricula often limit opportunity for students to develop knowledge and understanding of the specific historical, cultural, political and economic roots of the conflicts and violence that affect them, much less the skills to transform these conflicts. Where spaces do exist, teachers often lack training, resources and skills to support dialogue and difficult conversations. Existing research tends to concentrate on textbooks and curricula, meaning there is limited evidence of effective teaching and learning processes in schools and other spaces where learners apprehend the past. However, alternatives exist. Creative and innovative practices, pioneered by teachers, artists, community educators, museum curators, and young people themselves offer engaging ways to connect learning about difficult pasts with skills and commitment to realising better futures. EdJAM works to amplify, connect and share these approaches, drawing on the disciplines and practices of transitional justice, memory studies, history, heritage studies and feminism and working with leading civil society partners in Cambodia, Colombia, Pakistan and Uganda who are doing this pioneering work. This focus enables EdJAM to connect to other SDG challenges, particularly SDG 16 (just, peaceful and inclusive societies) and SDG 17 (global partnerships) and to ensure that learners in our focus countries have a chance to develop the skills and knowledge to build a culture of peace. Our rationale for applying for a Development Award is to support the preparation of the strongest possible Stage 2 proposal for EdJAM. The Development Award : 1) responds to feedback from the Stage 1 application; 2) supports the development of sustainable and equitable partnerships and piloting innovative approaches in Pakistan, where our existing relationships are less developed than in Cambodia, Colombia and Uganda; and 3) enables opportunities for learning and the development processes for safeguarding and risk mitigation and management within EdJAM.

Project identifier:

GB-GOV-13-FUND--GCRF-AH_T005300_1

Start Date:

2019-07-01

Activity Status:

Implementation

Total Budget:

£136,372.44


Children Learning About Second-hand Smoke: Cluster randomised-controlled trial

UK - Department for Business, Energy and Industrial Strategy (BEIS)

Breathing in other people's exhaled smoke is called second-hand smoking. Second-hand smoke (SHS) contains harmful chemicals and is a serious health hazard to non-smokers. SHS is estimated to cost more than 800,000 lives per year, worldwide. Children are worst affected; almost a third of deaths from SHS exposure occur in children. A large proportion of the overall burden of diseases due to SHS in children is due to lung diseases such as asthma and chest infections and lung cancer. SHS exposure can also lead to meningitis in children. Children exposed to SHS are more likely to be hospitalised, fall short of their academic potential and take up smoking themselves as compared to those living in smoke-free environments. Recognising SHS as a public health threat, most countries have introduced bans on smoking in enclosed public spaces, which has significantly reduced adults' exposure to SHS. However, for many children, cars and homes remain the most likely places for them to breathe SHS. The only possible way to protect them from SHS is to make cars and homes completely smoke-free. For the last few years, we have been working with schools, parents and children to develop and test a school-based intervention called, 'Smoke-Free Intervention (SFI). It consists of six teaching lessons delivered by schoolteachers, four fun activities and one educational take home resource. Teaching lessons help to increase pupils' knowledge about the harms caused by breathing second-hand smoke. Fun activities include storytelling, role-playing, quizzes and games. These activities help to motivate children to act and feel confident in talking to adults to persuade them not to smoke inside homes. The take-home resource helps children to show what they have learned in school and to negotiate with their families to ""sign-up"" to a voluntary contract to make their homes smoke-free. The results of this work show that it is possible to encourage children to discuss with their families ways of restricting smoking inside their homes. Our pilot study also showed that it is possible to recruit and retain schools and children and collect the necessary data for such studies. Inspired by our pilot work, we now propose a large study in Bangladesh and Pakistan where SHS is a major public health problem and a priority for policy makers. Through our work in these countries for several years, we have established collaborations with schools, local communities and policy makers. We wish to examine how effective SFI is, in reducing children's exposure to SHS in homes. We are also interested to see if SFI can improve children's lung health, academic performance and general quality of life, and if it can reduce their health service use. To provide accurate answers to these important questions, we will recruit a total of 66 schools and 2,636 children between 9-12 years of age. We will randomly allocate schools to two arms: arm 1 and arm 2. School teachers in arm 1 will receive training and resources on SFI. School teachers will then deliver SFI in classrooms to the children. Those in arm 2, will not deliver anything about SHS to the children. They will receive SFI to deliver only after the completion of the trial. We will also use objective measurements including testing children saliva for cotinine (a chemical compound derived from nicotine) to assess whether our intervention has reduced their SHS exposure. We will also record their respiratory symptoms such as coughing and wheezing and measure their lung functions and quality of life. We will undertake these measurements as described above using internationally agreed standards. During the study, we will repeat these assessments at regular intervals. Using economics, we will also assess whether SFI is value for money. We will run discussion groups with some children to ask about their experience of negotiating a smoke-free home; and interview some parents and teachers to investigate the likely obstacles to implementing SFI.

Project identifier:

GB-GOV-13-FUND--GCRF-MR_T004959_1

Start Date:

2019-12-01

Activity Status:

Implementation

Total Budget:

£1,065,494.72


Technology Enhanced Stakeholder Collaboration for Supporting Risk-Sensitive Urban Development [TRANSCEND]

UK - Department for Business, Energy and Industrial Strategy (BEIS)

During the last decade, many initiatives have been undertaken to make progress in disaster risk reduction (DRR) and response. However the progress in disaster risk reduction has been limited by the failure to acknowledge and address the development processes as the root causes of disasters. Previous initiatives have concentrated on reducing existing risks, rather than on how risks are generated and accumulated in the first place through development projects that are taking place as a part of the reconstruction phase after a disaster or in response to the demand of urban sprawl. Furthermore, work on resilience has attracted criticism for its failure to involve vulnerable communities and address the issue of equity and power. As a result, the Sustainable Development Goals which call for ""reduced inequalities"", ""inclusive, safe, resilient and sustainable cities"" and ""partnerships for goals"" and the Sendai Priority 4 that calls for build-back better in recovery, rehabilitation and reconstruction, are hard to achieve due to a lack of research knowledge, current practices and policies. One of the explanations for increasing risks is that the development and disaster risk reduction decision-making processes occur in silos, conducted by different agencies, institutions and other actors with differing priorities, perspectives and time horizons. Therefore, there is an urgent need to transform current development practices that increase or create risks, as well as unfairly distributing risks to vulnerable communities, to a new form of development practice that is equitable and resilient. This project consortium believe such a transformation can be achieved by enabling cross-organisational collaboration, openness, adaptability, learning, impartiality, power sharing and public participation. The project aims to investigate processes, governance structures, policies and technology that can enable a transition towards a more risk-sensitive and transformative urban development approach. More specifically, the project aims to investigate the nature of a sociotechnical system, enabled by a collaborative foresight and consensus building virtual workspace, which can promote collaborative governance approach across relevant organisations and support the transparent and democratic involvement of all the relevant stakeholders (including experts from local authorities, disaster management authorities, developers, poor and vulnerable communities, and humanitarian organisations) to analyse, forecast, visualize and debate disaster-risk trade-offs and to choose development plans that ensure sustainability and equitable resilience, giving considerations to climate change adaptation. The key research questions that the project is aiming to address are: What type of formal and informal collaborative partnerships need to be established to alleviate long-standing tensions between development and DRR and progress towards more risk-sensitive and transformative urban development? What changes are required within the current urban planning process to facilitate risk-sensitive urban development, giving consideration to natural disasters and their impact on the environment, economy and vulnerable communities? What are the type of narratives that need to be developed, presented and discussed to establish a comprehensive understanding of the impact of the proposed developments on the community, economy and environment ? What are the vulnerabilities that need to be considered within the local context? How can we make participatory planning more accessible to a range of communities? Three countries (Pakistan, Sri Lanka, Malaysia) from the Asia-Pacific region have been selected for this research since the Asia-Pacific region continues to be the world's most disaster prone region. These countries are frequently affected by a multitude of natural hazards including floods, landslides, cyclones and droughts.

Project identifier:

GB-GOV-13-FUND--GCRF-ES_T003219_1

Start Date:

2019-11-01

Activity Status:

Implementation

Total Budget:

£481,882.38


Supporting relatives of children with Beta-thalassemia major in Pakistan to make informed decision about cascade screening

UK - Department for Business, Energy and Industrial Strategy (BEIS)

The World Health Organization has designated the control of beta-thalassaemia major in developing countries a priority. Pakistan has a huge economic and welfare burden due to beta-thalassaemia major. To address this burden, the government funded the provincial 'Punjab Thalassaemia Prevention Project' (PTPP). One of the priorities of the PTPP is to facilitate cascade screening, that is, identify and offer carrier testing to biological relatives to enable them to make informed marital and reproductive decisions. However, the uptake of carrier screening by relatives is low and our qualitative research shows that relatives are unlikely to be making informed decision to decline carrier testing. Therefore, the aim of this project is to develop and assess the acceptability of a decision support intervention for relatives (DeSIRe) of children with beta-thalassemia major to facilitate informed decision-making about cascade screening. In this project, we will develop the DeSIRe by working closely with parents and relatives of children with beta-thalassaemia major and health professionals in the PTPP. The DeSIRe will be designed to support informed decision-making about cascade screening. It will include a decision aid for relatives and training for the PTPP professionals responsible for cascade screening (field officers). The DeSIRe will be tested within routine practice by PTPP field officers. We will explore if it is (i) feasible to train PTPP field officers to deliver the DeSIRe, (ii) feasible to deliver the DeSIRe in routine practice and (iii) acceptable to parents and relatives of children with beta-thalassaemia major, and PTPP field officers. We will evaluate the impact of the DeSIRe in a future project (trial) by assessing if relatives are making informed decisions about cascade screening. Furthermore, to support the implementation of the DeSIRe more widely (nationally in Pakistan and in other low-middle-income countries), we will develop a toolkit and make this available via a website linked to the PTPP website. Similar to our previous research in Pakistan, we will use a combination of qualitative and quantitative methods to explore the views of parents and relatives of children with beta-thalassaemia major and PTPP field officers. Also, throughout the project, we will engage in two-way discussions with key stakeholders (e.g. PTPP professionals, policy makers, and representatives of the Thalassaemia Society Pakistan NGO) via 'expert panel' meetings to guide the development of the intervention by reviewing drafts of the DeSIRe produced by the research team.

Project identifier:

GB-GOV-13-FUND--GCRF-MR_T003782_1

Start Date:

2019-11-01

Activity Status:

Implementation

Total Budget:

£127,794.12


Novel inter-disciplinary approaches for identifying and tackling the spread of AntiMicrobial Resistance through Environmental pathways in PAKistan

UK - Department for Business, Energy and Industrial Strategy (BEIS)

Medicine has been transformed by the development of antibiotics, medicines that kill bacteria. These have made deadly bacterial diseases that once killed millions such as tetanus, syphilis, and leprosy, easily treatable. They are given as a preventative measure prior to surgery to prevent infection and they relieve suffering from less dangerous diseases such as strep throat. There is, however, a problem. Bacteria are becoming resistant to antibiotics. This is a result of evolution. The use of antibiotics inevitably selects for bacteria that carry genes that can protect them against these compounds. We call these antibiotic or antibacterial resistance genes (ARGs). Genes are pieces of DNA that make up part of the bacteria's genome or smaller DNA molecules such as plasmids. ARGs provide bacteria with the ability to degrade or excrete antibiotics. They can be exchanged between different species of bacteria allowing these abilities to spread through communities. The use and misuse of antibiotics is accelerating the rate at which ARGs evolve and spread. Using antibiotics to treat non-bacterial infections or to improve the growth rate of livestock results in large amounts of antibiotics entering the environment, this creates a strong selective pressure leading to many resistant bacteria. This resistance can develop in free-living bacteria that perform important functions in ecosystems, e.g. soils or rivers, but then spread to bacteria that cause disease within humans, pathogens. There are pathogens beginning to appear that are resistant to multiple antibiotics, e.g. multidrug-resistant tuberculosis. If this multi-drug resistance spreads further then diseases that are now treatable will become increasingly deadly. This is a potential global public health disaster. The problems caused by antibiotic resistance (ABR) will particularly badly impact Low and Middle Income Countries (LMICs), such as Pakistan, that depend upon cheap antibiotics to treat many infectious diseases. Tragically, it is just these countries, which are likely to have the most problems. This is because antibiotics are easily available without prescription over the counter. People take antibiotics to treat non-bacterial diseases or do not take them for long enough, this allows the resistant bacteria to spread and proliferate. This is compounded by manufacturers of antibiotics releasing wastewater contaminated with antibiotics into the environment, farmers using large quantities of antibiotics in intensive livestock rearing, and the fact that human and animal waste is dumped untreated into water sources. All this pollution results in more resistant bacteria evolving. It is unclear, however, which of these factors are most important to address, in order to prevent the spread of ABR. We have assembled a team of biologists, engineers, social scientists and mathematicians, to better understand ABR in Pakistan and how to combat it. We will conduct a survey of resistance genes across multiple areas within Pakistan, chosen in order to determine what causes them to proliferate and spread, ultimately leading to drug-resistant infections in humans. We will do this by sequencing DNA direct from environmental samples to resolve the genes that are present in the bacteria. We will sample from the environment and from a range of health facilities to reveal how genes are being transmitted from environmental bacteria into pathogens. We will also study the behaviour of people and institutions in Pakistan and determine how that contributes to the scale of the problem. This will allow us to propose ways in which they can reduce the spread of antibiotic resistant genes. These might be changes to how antibiotics are used in health facilities or improved approaches to waste disposal. This will be of great benefit to Pakistan but also - because these genes are capable of spreading between individuals across the world - to other LMICs and us in the UK too.

Project identifier:

GB-GOV-13-FUND--GCRF-MR_R015058_1

Start Date:

2017-10-01

Activity Status:

Finalisation

Total Budget:

£80,471.80


Examining the effectiveness and acceptability of the use of bio-fortified crops in alleviating micronutrient deficiencies in Pakistan

UK - Department for Business, Energy and Industrial Strategy (BEIS)

According to the World Health Organisation, dietary zinc deficiency is a global problem affecting 17% of the world's population, with the greatest burden in developing countries. The most recent national survey in Pakistan indicates that over 40% of women are zinc deficient, compared with less than 15% in Europe and North America. The consequences of zinc deficiency are profound and far reaching, ranging from stunted growth and development in children, increased susceptibility to infections in children and adults, and complications during pregnancy and childbirth. This has a negative economic impact on the family, the community and the region. Various strategies to overcome zinc deficiency have been attempted but it is difficult to achieve when large populations are concerned. Dietary zinc supplements are expensive and do not always reach the most vulnerable groups who may live in remote or difficult to reach locations due to poor infrastructure or security problems. In contrast, biofortification of staple foods has potential as a sustainable means of increasing population dietary zinc intake. However to date, few studies have been undertaken to evaluate the efficacy and cultural acceptability of this strategy. One of the key challenges in measuring the effectiveness of such strategies is the lack of a sensitive biomarker of zinc status that is suitable for use in remote settings We have an opportunity to evaluate the potential of a newly developed strain of biofortified wheat, produced by HarvestPlus, as a means of increasing dietary zinc intake in Pakistan. Through a collaboration with a Pakistan based fertilizer company, we will examine the impact of fertilization strategies and soil conditions on the wheat zinc content by of the addition of zinc rich fertilizer to the soil and foliage during the growing season in regions of Pakistan with contrasting soil zinc status. Previous studies have indicated that this new strain of wheat has potential to reach a zinc content that is around 45% higher than the standard varieties. The grain grown in our study will be analysed to measure the zinc content, and also the location of the zinc within the individual grains. A double blind trial will be conducted to examine whether or not consuming the flour made from the high zinc grain has a beneficial impact on the zinc status of zinc deficient women living in a rural community in North West Pakistan. The high zinc grain will be compared with standard grain, both of which will be provided to forty families to consume for eight weeks, with group A (20 families) consuming the high zinc grain, and group B (20 families) consuming the control grain. The families will switch over after eight weeks. To monitor the impact of consuming the flour on zinc status we will use established methods (plasma and hair zinc concentration), and we will also evaluate new indicators of zinc status that have potential for use in population based surveys, including markers of DNA damage and a novel portable laser technique for measuring nail Zn concentration. The success of a biofortification strategy requires that the intervention achieves wide and sustained uptake at production and consumption stages. Therefore, through our extensive and established networks with community leaders and farmers, we will assess the cultural context, traditions, knowledge and attitudes to biofortification in this setting, through focus groups and interviews. A key component of this research is training and capacity building. This is a two-way process by which expertise is shared among the project partners, so that young researchers in Pakistan and in the UK are better equipped to take this important research agenda forward into the future, and to build on the collaborative links generated during this project. The findings of this research will be disseminated to researchers and policy makers word wide.

Project identifier:

GB-GOV-13-FUND--GCRF-BB_P02338X_1

Start Date:

2017-05-01

Activity Status:

Finalisation

Total Budget:

£301,663.95


Pakistan Prevention Programme for Gestational Diabetes Mellitus (PPP-GDM): a feasibility study

UK - Department for Business, Energy and Industrial Strategy (BEIS)

Type 2 diabetes (T2DM) and gestational diabetes mellitus (GDM) are escalating problems worldwide. Depending on the population studied, 1-14% of all pregnancies are complicated by GDM. In Pakistan, we estimate prevalence of GDM is 8% and this has huge financial costs to health care. Further, pregnancies complicated by GDM have increased incidence of fetal, maternal, and childhood long term complications. Therefore, there is an urgent need to implement a coordinated approach to prevent T2DM. It is established that lifestyle modification with weight loss/moderate exercise can reduce T2DM by up to 58% in high risk people. Our research question for the future full randomized trial is 'in women with gestational diabetes mellitus, is a lifestyle intervention programme focusing on physical activity and weight maintenance feasible in a developing country to decrease the risk of diabetes? To inform the design of a larger full trial, we will first undertake a feasibility study to test whether the components of the main study can all work together. Specifically, it is focused on the processes of the main study to ensure the integrity of the study protocol including: - recruitment to study - willingness of participants to be randomised - randomisation process - consent for blood tests - refinement and delivery of the intervention - acceptability and adherence to the intervention - follow-up assessments Achievement of these components will be analysed to inform decisions about progression and the experience accumulated will assist in the refinement of the design of the full trial. In addition, we will estimate the mean and standard deviation of the primary outcome to confirm the trial sample size calculations. Many benefits will arise from this development grant proposal: 1. Academic beneficiaries through publication in peer reviewed journals and presentations at national and international conferences. 2. As there is little research on this topic in low- and middle-income countries (LMICs), we will develop and pilot a novel intervention that will subsequently be tested in a larger trial. This then has potential to be scaled-up in other LMICs. 3. Reducing and/or slowing the rise in diabetes in LMICs is a challenge for all and our developmental proposal will be of interest and use to clinicians and researchers in Pakistan as well as globally. 4. The close collaboration between researchers based at the University of Birmingham, UK and Agha Khan University in Pakistan will further enhanced this international collaboration. 5. This will then lead to increasing research capacity both in the UK and Pakistan. 6. We will also generate data in this in this feasibility and subsequent full trial which will be available for other researchers - though the data collected from the follow-on trial is more likely to be a richer database of qualitative and quantitative material. 7. Prevention of diabetes in women with GDM once the intervention is scale up and fully implemented in Pakistan. 8. Policy makers in Pakistan will have a robust, evidence-based intervention as part of their health plan.

Project identifier:

GB-GOV-13-FUND--GCRF-MR_M022048_1

Start Date:

2015-09-01

Activity Status:

Finalisation

Total Budget:

£136,103.38


Multicenter RCT to evaluate the clinical and cost-effectiveness of a culturally adapted therapy (C-MAP) in patients with a history of self-harm

UK - Department for Business, Energy and Industrial Strategy (BEIS)

Suicide is a serious global public health issue ranked amongst the leading causes of death in many countries. The worldwide rates of suicide have increased by 60% in the last 45 years, and the 1.8% total global burden of disease attributed to suicide in 1998 is expected to increase to 2.4% by 2020. The WHO Mental Health Action Plan 2013-2020 and all the member states have committed to work towards the global target of a 10% reduction in the suicide rate by 2020. WHO's Mental Health Gap Action Programme includes suicide as one of the priority conditions and the recent WHO report ""Preventing suicide: a global imperative"" calls for suicide prevention to be a high priority on the global public health agenda. More than 800 000 people across the world die due to suicide each year and for each suicide there are more than 20 people attempting suicide. Each suicide takes the life of the individual and has a tremendous effect on friends, family and the wider community. Up to 75% of all suicides occur in in low- and middle-income countries where resources and services are limited for treatment and support for people who need. There is a clear gap in the robust evaluation of culturally appropriate suicide prevention strategies in low and middle income countries. Individuals who have a history of self-harm are at much higher risk of dying by suicide than individuals who do not have such a history. The WHO recommends that offering them appropriate treatment should be a key component of all suicide prevention strategies. There are in excess of 100,000 acts of self-harm carried out in Pakistan annually. The aim of the proposed trial is to evaluate the clinical and cost-effectiveness of a culturally adapted psychological therapy (C-MAP) in patients with a history of self-harm. We carried out a study in Karachi to determine the effectiveness of a 6-8 session CBT-based intervention (C-MAP) in people who had recently self-harmed. The assessments were carried out at baseline, 3 & 6 months. There was a significant reduction from baseline in suicidal ideation, severity of depression and hopelessness in the intervention group compared to the Treatment as Usual (TAU) group at each follow up assessment. The findings from this work have highlighted the applicability of such an intervention to health services in Pakistan for patients who present after a self-harm episode. The proposed research will be conducted in Karachi, Lahore, Rawalpindi, Quetta and Peshawar. Participants will be randomized either to the Intervention (C-MAP) or TAU. The existing culturally adapted intervention (C-MAP) includes an evaluation of the self-harm episode, crisis skills, problem solving and basic cognitive techniques to manage emotions, negative thinking and relapse prevention strategies. The intervention will be delivered in six sessions over 12 weeks. Assessments will be conducted at baseline and at 3 months (end of intervention) 6 months and 12 months after randomisation. The outcome measures will include questionnaires to measure the repetition of self-harm, severity of suicidal ideation; depression; hopelessness; quality of life and coping resources. In addition, qualitative interviews and focus groups will provide rich information regarding the experiences of participants and therapists, which will inform the development of more effective and sensitive services for self-harm management. TAU will be standard routine care delivered by local medical, psychiatric and primary care services according to their clinical judgement. A record will be kept of any treatment received by each participant. This trial will provide detailed clinical and cost-effectiveness analyses for the management of self-harm which will inform future research and national clinical practice guidelines. We have established contacts with the ministry of health and once the trial is completed we will enter discussions to present the results to them and attempt to influence policy change.

Project identifier:

GB-GOV-13-FUND--GCRF-MR_N006062_1

Start Date:

2015-11-01

Activity Status:

Finalisation

Total Budget:

£750,145.04




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