KARACHI: Health experts have called maternal wasting — below median weight for height of reference population — in Sindh a bigger emergency than child stunting — below median height for age of reference population — as the former is contributing to stunting and mortality in under-five children.

They said there was a consensus that Pakistan needed a strong political will to uplift health status of mothers and children. A district-wise inter-sectoral strategy backed by adequate funds and trained staff, they added, was required to achieve development goals on maternal and child health.

The experts shared these views at a seminar, titled ‘Reproductive, maternal and child health in Pakistan: priorities for action’, which was organised by the Centre of Excellence in Women and Child Health (CEWCH) of Aga Khan University on Saturday.

“Though Pakistan has been able to reduce maternal mortality over the decades, we are still far away from the millennium development goals on mother and child health. Our progress on child health has been painfully slow and there is only 26pc reduction in under-five child mortality since 1990s,” said Dr Zulfiqar A. Bhutta, founding director of the CEWCH.

Highlighting the causes behind poor maternal and child health status, he said that according to a survey, under-nutrition accounted for 45pc of all under-five deaths. About 45pc children were stunted while wasting prevalence was found to be 10 to 15pc. It was also found that stunting reached its peak level at the age of 24 months, whereas half of stunting took place by the time a child was just six months.

“Very early stunting has to do with mother’s health. That’s the dilemma that we have forgotten the mother. Maternal wasting has been found to be as high as 33pc in some districts of Sindh,” he said, referring to a yet-to-be published report.

He said that poverty was a key factor but maternal and child mortality rates were also high in families considered relatively rich. Poverty, he said, had different dimensions and there was a huge diversity within a province. “We don’t live in one Pakistan but five Pakistan[s]. We have districts where living conditions are comparable to Africa and then there are pockets where people have access to all facilities,” he explained.

He said diarrhoea was another leading cause of neonatal deaths in the country. The disease was effectively controlled by Bangladesh that currently reported negligible deaths from the infection, he added. Sharing findings of AKU projects carried out in the interior of Sindh and Punjab, he said that child mortality and occurrence of diarrhoea could be significantly reduced by cost-efficient interventions. Results of an immunisation project conducted in Bajaur, Karachi and Kashmore, he said, had shown very encouraging results. However, Sindh with many positions vacant in health facilities has the lowest immunisation coverage (urban 29pc, rural 16pc) after Balochistan (16pc) in the country.

Country representative of World Health Organisation Angela Kearney spoke about the global movement on child survival launched in 2012. The focus, she said, would be on 24 countries, including Pakistan, which were accounting for 80pc under-five deaths.

“If we could fix Pakistan, we could fix the world. We also need to understand that the health issue doesn’t stand in isolation but it is interlinked to education especially that of girls, sanitation and family planning services,” she said, adding that honest reporting of data was necessary to have a real change.

Dr Nabeela Ali of the JSI Research Institute, Islamabad, said that the 18th amendment to the Constitution should be taken as an opportunity to perform rather than looked as a ‘divorce’ (between the federal government and the provinces). The federal government had a role to play that was to provide a policy guideline and help the provinces in achieving their targets, she said.

“There are serious gaps and constraints to carry out routine immunisation. Thirty-seven per cent of basic health units in Punjab lack stocks of critical medicines while doctors are posted at only 64pc health facilities. If this is the situation in Punjab, one can imagine the conditions in rest of the country,” she said.

Neonatal mortality, she said, could be significantly reduced if birth spacing of at least two years was promoted in society. There was a need to link health, education and population departments, she said.

Centre to stop vaccines supply in June National Immunization Technical Advisory Group Chairman Dr Tariq Iqbal Bhutta said the federal government’s deadline on the supply of vaccines would end in June. This issue needed to be sorted out as after that period, provinces needed to buy vaccines from their own resources, he added.

Health Director General Dr Asad Hafeez briefed the audience about gaps in maternal, neonatal and child health services and called for a programme review.

Dr Shehla Zaidi, Dr Ali Mir, Dr Ashar Malik, Dr Michel Thieren and Dr Farhat Abbas also spoke.

Published in Dawn, February 22nd, 2015

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