October 15, 2006	Sunday	Ramazan 21, 1427

KARACHI: The sudden spurt in the HIV/AIDS prevalence rate in Pakistan has stunned the health monitors, compelling them to call for revising the health targets.

According to studies conducted by the National Aids Control Programme (NACP), there are an estimated 74,000 HIV/AIDS cases in Pakistan, and the HIV prevalence rate in Karachi ranges between 23 and 26 per cent.

“The reported level of infection within one high risk group shifts the entire epidemic scenario of the country,” said a UN report, marking completion of the five years of the Millennium Development Goal (2000-2015).

The Ministry of Health does not appear serious about the MDGs.

When contacted, the office of minister health diverted the request to a deputy director-general, Dr Fahim Arshad Malik, who said that the requisite data was at his home.

The scant information he provided was regarding the maternal mortality ratio which currently stands at 350-400 per 100,000 births against an MDG target of 140 per 100,000 deliveries by the end of 2015.

He said the ministry had initiated a programme aimed at encouraging delivery through skilled attendant. The present rate of skilled persons attending deliveries is 20 per cent against a MDG target of 90 per cent.

The under-five mortality rate target by 2015 is 45 per 1,000 births as compared to 65 per 1,000 recorded in 2001. According to the data provided by the ministry, the infant mortality rate at present is 77 deaths per 1,000 births while the MDG target is 40 per 1,000.

The contraceptive prevention rate currently stands at 36 per cent which will be increased to 55 per cent by 2015.

CHILD MORTALITY: Out of each 1,000 live births, 100 children die before the age of five. Despite improvement since the start of the decade (2001-10), progress during the last five years has slowed down as compared to the previous decade. It is attributed to increasing burden of poverty leading to improper care-seeking behaviours, high cost of healthcare services, bad practices due to ignorance, illiteracy, etc.

In poor families of Sindh, 25-30 per cent of babies are born underweight as compared to only 10 per cent in the non-poor families. The government is aggressively pursuing a multi-pronged strategy targeting each of these causes. Among infants, 37 deaths occur out of 1,000 live births. Non-natal deaths account for almost 50 per cent and have remained relatively resistant to change in the last few decades. Causes are same. The other factors include neo-natal tetanus, nutritional, health condition of mothers.

The key challenge to child mortality target is the low access to quality nutrition and poor management of health care and children illnesses.

Another reason is inadequate medical expenses incurred on treatment. According to a World Bank report, in Pakistan the per capita medical expenses on essential health services are just $18 against a standard per capita medical package of $34.

In Karachi’s National Institute of Child Health (NICH), country’s largest hospital for children, the average child mortality rate is four to five per cent per annum. Only last year, 235,000 children were brought to the institute for treatment of various diseases. Most of the deaths among children from one to 12 years of age are due to liver failure, kidney failure, encephalitis and septicaemia. About 1,000 children are brought to the emergency and OPD of the NICH daily while the daily average admission rate is 400.

HIV/AIDS: Statistics provided by the National Aids Control Programme (NACP) on Pakistan basis reveal that infection among identified high-risk group has reached two per cent. The Medium Term Development Framework (MTDF) target for 2009-10 needs to be revised to bring it in conformity with the latest available figures. End of March 2005, 2,515 cases of HIV and 317 cases of AIDS were reported to the National Aids Control Programme (NACP). These cases were based on reports from sentinel centres, a number of cross-sectional studies and a surgery conducted recently. The studies reveal that there are an estimated 74,000 HIV/AIDS cases in Pakistan.

Recently, two studies carried out by the NACP made alarming revelations. The studies revealed that the current prevalence of HIV infection among intravenous drug users (IDUs) in Karachi is 23 per cent — 4.1 per cent among male sex workers (MSs) and two per cent among eunuchs (neutral gender).

The reported level of infection within one high risk group shifts the entire epidemic scenario of the country to a higher stage. Another study piloted in October 2004 in Karachi and Rawalpindi for second generation surveillance (SGS) found the prevalence in the IDUs to have gone up to 26 per cent.

OTHER DISEASES: The percentage of population with access to treatment for malaria rose from 20 per cent in 2001-02 to 30 per cent in 2004-05. The MTDF target is to raise this percentage to 50 by 2009-10, while the MDG target is 75 per cent by 2015.

The percentage of TB cases detected and cured increased from 25pc in 2001-02 to 40 per cent in 2004-05. The MTDF target is to have 80 per cent of TB cases detected and cured by 2009-10, while the MDG target is to have 85pc cases treated by 2015.

MATERNAL HEALTH: Like many developing countries, maternal mortality rate (MMR) is also very high in Pakistan. According to the Planning Commission estimates, MMR had increased from 350 in 2000-01 to 400 per 100,000 live births in 2004-05. The marginal rise in the maternal mortality rate is a matter of concern and the situation demands concrete efforts in order to reverse the trend. The chief causes of maternal mortality rate are haemorrhage infection, eclampsia and obstructed labour. Moreover, the proverbial three delays are also a major contributing factor. These delays are in seeking professional care, logistics problems which delay the delivery of patients in time to the far-off health centres, and lack of adequate human resources and trained personnel at health centres.

The proportion of deliveries attended by skilled personnel has improved from 40 per cent in 2000-01 to 48 per cent in 2004-05, indicating a rise of 8 percentage points over the period. The quality, access and availability of basic and comprehensive obstetrical services and their utilisation is low. The effective way to prevent maternal deaths is to have deliveries — whether they take place at home or any health facility — attended by skilled personnel who can recognise and treat or refer any complications that may arise.