Future in danger

July 14, 2017

Every year about 400,000 infants die during the first year of their life. One in 10 children dies before reaching the age of five and one among 30 just after they are born. Child mortality in Pakistan is a major cause of concern. The collection of new-born and child health care statistics in the country is a faulty exercise and mortality rates for children at all ages are very high. According to the 2014 State of Children in Pakistan report, one in every 14 Pakistani children (7.1%) die before their first birthday, and one in every 11 (9.1%) do not survive to their fifth birthday. Pakistan has long suffered from a high infant mortality rate and is making very slow progress towards improving the health of the child and mother. Although there is a consistent decrease in child mortality rate since the last two decades, Pakistan still has the lowest reduction rate of child mortality in Asia. The child mortality rates for Pakistan are amongst the highest in the world. It is believed that malnutrition alone causes 50% of infant deaths. There are a lot of factors that have led to these dangerous numbers.

According to researchers from the Johns Hopkins Bloomberg School of Public Health, “the main causes of death for children under five, are diarrhoea, pneumonia, measles, malaria, HIV/AIDS, and the underlying cause of malnutrition. Asphyxia, preterm delivery, sepsis, and tetanus are chief causes of deaths among infants and new-borns”. The most common and lethal diseases in Pakistan include acute respiratory tract infection, viral hepatitis, malaria, diarrhoea, dysentery, scabies, goitre, hepatitis and tuberculosis. Among the victims of acute respiratory tract infection, the most vulnerable are children whose immune systems have been weakened by malnutrition.

Poor social conditions and lack of interest of the responsible authorities is causing the increased spread of these diseases. Many of these illnesses spread due to pollution and mismanagement of administrative services; for instance, diarrhoea spreads due to drinking contaminated water and malaria occurs due to a bite from a mosquito which is born in stagnant water. A well-managed water and sewerage system can be helpful in reducing the amplification of such diseases. The main reason for rising child mortality in Pakistan is a lack of child healthcare facilities, especially in rural areas, where a majority of the population lives. Low state spending on healthcare, abject poverty, low literacy, lack of skilled birth attendants, widespread communicable diseases, insufficient emergency child health services in government-run district and rural hospitals are amongst other major reasons behind growing diseases in children. A number of pregnant women lose their child before reaching the hospital. There should be proper awareness among people in rural areas and good public transport facilities are mandatory to avoid losses. Healthcare is every child’s right, but problems like a lack of quality infrastructure, shortage of experienced medical functionaries and non-access to basic medicines and medical facilities deny this intrinsic right to many of Pakistan’s children on a daily basis. Thousands of children in Pakistan die every year from preventable diseases. Due to inadequate intake of essential nutrients, malnourished children experience several problems, including delays in development, weight-loss and other illnesses. Lack of access to clean water and sanitation facilities has a wide range of impact on children’s health and the current status of sanitation and poor hygiene practices has led to significant public costs, such as premature deaths, economic and financial costs due to diseases attributable to poor sanitation, environmental costs, and other welfare costs. In young children, undernourishment can greatly compromise the immune system, making them highly susceptible to infectious diseases. Besides this, it causes severe growth implications and cognitive implications like memory deficiency, low intelligence quotient (IQ) scores, impaired school performance, and learning disabilities. Underprivileged children are at a higher risk for various short-term and long-term complications as they experience several macronutrient and micronutrient deficiencies since the time of birth. In fact, it is before birth that many children and their mothers face complications due to undernourishment.

Rural healthcare lacks in quality, affordability, and accessibility for several reasons. Childhood diseases have been a major concern throughout Pakistan. Immunisation of children is an indispensable element of primary healthcare. Routine immunisation coverage rates in Pakistan remain significantly below desired rates of 90%. Medical reports reveal that one child dies every minute from the diseases mentioned above. Illnesses related to diarrhoea are the fourth biggest cause of child deaths in Pakistan and with the introduction of the Rotavirus vaccine in routine immunisation across the country, the lives of 29,000 children in Pakistan could be saved each year and a large number of children under five can be protected against Rotavirus infections. There is a fundamental need to ensure the provision of the quality immunisation services that promote, protect and preserve the children of Pakistan against the vaccine preventable diseases.

The situation of child health in the country is abysmal and among the most important national issues that needs serious attention. Major factors which are a playing role in death of children should be improved like education of the mother, removing gender inequality and proper secondary as well as tertiary care. A holistic approach is needed to improve children and new-born health, mainly by improving and upgrading facilities at district hospitals. In order to save the lives of children, paediatric institutes should be opened in all districts of Pakistan where emergency services along with trained child-disease experts should be made available all the time. Along with this, there should be a proper gap between births so proper dietary care could be taken of one child. There should be a nationwide training programme for doctors of Pakistan to make them aware of how to handle pregnancy cases in order to reduce infant mortality rate. Since Neonatal Mortality Rate (NMR) constitutes about half of under five deaths in the country, any initiative to reduce NMR would in turn help in decreasing under five mortality rate and improve child health status.

We all can strive to play a role for the betterment of our children without considering the volume of the struggles. Small efforts can bring giant changes. Indeed, there are examples that can motivate us towards sincerely serving humanity. In the districts of Sindh, a welfare programme for mother and child health facilitating vaccinators in the shape of providing petrol for their motorbikes in order to help them performing smooth field activities. Such intentions surely show us a way forward.