KARACHI, Aug 30: Measles and tetanus are still among the major causes of child mortality in the country whereas poliomyelitis is also responsible for a considerable rate of morbidity and long term disability of children.

It is highly unfortunate that in Pakistan, prevention of childhood illness has not been paid due attention as an issue of national importance.

Although the introduction of child survival programmes, immunizations, and oral dehydration therapy has brought about an improvement in child survival rate over the last few decades, the progress has remained much slower than anticipated.

In its review published recently, Unicef concludes on the basis of data that one out 12 infants, born in Pakistan, dies within the first year and 10 per cent of the surviving children do not reach their fifth year of age.

Among the countries of this region also, Pakistan lags behind with regard to the child health.

Many childhood mortal diseases, including measles, tetanus, polio, tuberculosis, diphtheria, pertussuis (whooping cough), etc. are vaccine-preventable.

The National Expanded Programme on Immunization, launched in 1979, was based on the WHO’s initiative as an extension of the Smallpox Eradication Programme-1974 with the objective of bringing down morbidity and mortality rate in children vulnerable to the six diseases.

Over the past two decades, the programme has been implemented vigorously with tall claims and pledges to achieve the goal of eradicating and preventing the diseases as per the set targets.

However, the targets could not be met rendering the programme falling far short of a remarkable success.

The EPI programme was expected to eradicate all the vaccine-preventable diseases gradually and the deadline was initially set at 1990.

In the late 1980s, it was decided to extend the deadline to 2000 and also to focus on the eradication of only three diseases — polio, neonatal tetanus and measles. But by 1990, the EPI programme could achieve the coverage rate of only 80 per cent.

Since then, the EPI programme has faltered and current coverage rates are much lower than the stated target of 90 per cent immunization for all vaccines.

Exclusively polio coverage rates have come close to set target due to extraordinary international and national commitment towards its eradication.

Only 50 to 60 per cent infants are currently immunized against measles and tetanus. Despite intensive supplement activities for polio immunization, the country has not still become polio-free.

Some areas in Pakistan have exceptionally low rates of immunization. According to a survey, less than 30 per cent of children in the age group of 12 to 13 months were immunized against measles in Balochistan. Coverage rate for BCG in the Fata areas is less than 15 per cent.

Vaccines for the six common diseases are available and vaccination programmes against these diseases have been a major factor in reducing morbidity and mortality in children worldwide, according to Dr Tauseef Ahmad Khan and Anita Zaidi of the Department of Paediatrics, Aga Khan University.

The National EPI programme has been plagued by many problems, including lack of government commitment to child health, entire and extreme dependence on external funding for even basic health activities, lack of capacity to manufacture the vaccines locally.