Methods: FSMS-DI was used to evaluate the context factors, core control and core assurance activities of five powdered beverage manufacturers with different types of FSMS certification. Manufacturer A is not certified with any FSMS, while manufacturers B, C, D and E are complied with MeSTI, GMP, HACCP and ISO 22000, respectively. For MAS, samples were collected from the selected critical sampling locations of two manufacturers who complied FSMS with the least (manufacturer B) and the most stringent (manufacturer E) requirements. The samples consisted of two different types of powdered beverage products were analysed for total plate count (TPC), Salmonella, Escherichia coli, Staphylococcus aureus, yeast and mould count (YMC). Results: The food safety (FS) output of powdered beverages for manufacturer E was better (overall score of 3) than manufacturer B (overall score of 2-3). Manufacturer E was able to achieve their FS objectives. The FSMS activities of manufacturer C, D and E were better (overall score of 2-3) than manufacturer A and B (overall score of 1-2).
Conclusion: The study demonstrated that FSMS-DI and MAS can be used to differentiate the FSMS performance of powdered beverage manufacturers with different types of FSMS certification. Higher scores of FSMS activities obtained by the manufacturer who complied with stringent FSMS certifications contributed to better microbiological safety performance of powdered beverages.
METHODS: Twleve months duration long randomized controlled trial from January to December 2021 will be carried out at Shaikh Zayed Medical Complex (SZMC), Lahore. A total of 440 patients aged 18 years and older diagnosed with hypertension in the last month with non- adherence to antihypertensive therapy <80% of pills used in the last 30 days and have access to a smartphone will be randomized into either the intervention group (n=220) or the control group (n=220). For the intervention arm, a comprehensive intervention, the "Multi-Aid-Package," consisting of seven items: written, voice, and graphics messages, animated video, educational material, and a 24/7 help service, has been designed. Standard care will be provided to the control group. The primary outcome will be improved adherence to antihypertensive medication, while the secondary outcome will be an alteration in systolic blood pressure (SBP). The analysis will be intention to treat.
CONCLUSION: According to this study, if the multifunctional Multi-Aid-Package proves to be a useful mobile health tool for improving hypertension patients' medication adherence, it will also significantly affect systolic blood pressure. In Pakistan and other comparable low- and middle-income countries LMICs, the Multi-Aid-Package ought to be taken into consideration as a means of enhancing adherence to medications among hypertension patients.