High child mortality rate in Thar no new phenomenon, say experts

Published November 24, 2014
A doctor attending to a child from Tharparkar at Civil Hospital Hyderabad.- Online
A doctor attending to a child from Tharparkar at Civil Hospital Hyderabad.- Online

KARACHI: Medical experts based in Tharparkar and Karachi rejected on Sunday what the media had been describing as a continuing humanitarian crisis in Thar due to increasing number of children’s deaths and said the desert region had had the highest under five years mortality rate in Pakistan for the past three decades and there had been no extraordinary change in it so far.

Similar conditions prevailed in other poverty stricken areas of Pakistan including some parts of Karachi, experts pointed out as, according to them, the country has the third highest burden of maternal, fetal and child mortality in the world.

“Thar has the highest under-five mortality rate in Pakistan with 90 to 100 deaths per 1,000 live births. There has been no change in the statistics in three decades,” said Dr Zulfiqar Bhutta, a recipient of the United Nations award on child health and founding director of the Centre of Excellence in Women and Child Health at Aga Khan University.

‘The desert region also has the highest rate of under-five mortality in the country’

Elaborating the issue, he said that the 1.5m population of Tharparkar with a conservative growth rate of 3pc would likely have 45,000 births annually, of which almost 40pc would be low birth weight.

“With an expected neonatal mortality rate of 45-50 per thousand, Tharparkar should have between 4,000 and 4,500 under-five deaths every year, almost half of them newborn infants.

“If the media is reporting 500-800 deaths in four months, this is not unexpected and hence my premise is that this whole focus is on a chronic longstanding issue that is periodically unearthed and highlighted but needs solutions which are long term,” he said.

The region, he pointed out, also had the highest fertility and malnutrition rate in mothers and children for decades but the media reported the issue in a sensationalised way.

Referring to the devastating 2010 floods that forced a huge population living in acute poverty for decades in the interior of Sindh to migrate to Karachi, he said that at that time what the people saw (abject poverty and severe malnourishment in migrant mothers and children) was a chronic problem that remained hidden from public view for a long time.

It needs to be recalled that the media has so far reported 109 deaths in Tharparkar that included 102 children in 52 days.

The deaths are being blamed on the prevailing drought that has led to food shortage and malnutrition, it is said. More than 90 per cent of these deaths involved newborns.

Dr Bhutta, however, believes a number of factors are playing a role in the situation that has been persisting in Thar for ages. They included malnourishment in mothers and children, lack of immunisation and access to antenatal care and health facilities.

“Although appropriate birth-spacing is important for both mother and newborn, it’s common for Thari women to have 10 to 15 children as there is no concept of family planning in that area.

“The basic fault lies with the government that couldn’t take required measures to improve maternal and newborn health over the years,” he said.

Thar, he said, needed more official attention as life in the desert was entirely dependent on seasonal rains which explained why the area suffered from frequent droughts and faced chronic water shortage.

“But in some parts of the world droughts, more severe than what we are experiencing in Thar, are being affectively managed. One case is of California where the government has devised strategies including that of water conservation and livelihood diversification to address the problem,” he said.

Suggesting measures, he said that birth asphyxia, pneumonia, diarrhoea, infection and prematurity were five major killers of under-five children in Pakistan that the government needed to focus upon on a priority basis.

“It should make immediate efforts to scale up immunisation in Thar and bring it to 90 to 100pc, make health facilities functional with trained staff, make available required equipment and medicines and focus on preventive healthcare and delivery of quality primary healthcare. Family planning should be a vital part of this process that should run on sustainable basis.”

Citing AKUH projects in Matiari and Dadu for maternal and newborn health, he said that low-cost efficient interventions reduced child mortality rate by 20pc in Matiari in just one and a half years.

“That was in no way a small achievement if you look at Pakistan’s progress in this field. There has only been a 26pc reduction in 30 years in child mortality in the country,” he said, adding that lessons learnt in these districts could be replicated in other parts of the country.

Sharing similar thoughts, senior obstetrician and founder of Pakistan National Forum on Women Health Dr Shershah Syed said: “If you visit parts of Karachi like Machhar Colony, Chamra Colony and Orangi, you’ll find that a similar number of children dying in these areas and other parts of Pakistan, for instance, Skardu, which I have just visited, that are being reported from Thar.”

Dr Shershah believed that the media hype on Thar could be an attempt to remove the incumbent chief minister.

Newborns, he said, did not die of malnutrition but of bacterial and viral infections that were all very common in Pakistani population. “With the onset of winter, children would now be vulnerable to pneumonia,” he added.

Dr Najma Khoso, the only gynaecologist working in the public sector in Nagarparkar taluka, said that the problem in Thar was related to poverty, lack of medical facilities and education.

Two important reasons for the newborn’s death, she said, were prematurity and neonatal sepsis, that could be addressed to a great extent if the pregnant women received quality antenatal and delivery care.

“85 per cent of our population lives in remote areas, far away from health facilities and by the time a patient reaches a health facility, it’s too late. So, there is a need to expand healthcare system and make already functioning health units efficient,” she said.

Dr Rabia Malik, a gynaecologist working at Mithi Civil Hospital, also stressed the need for antenatal care and family support during pregnancy and said that many mortalities were cases of pre-term and mishandled deliveries.

“Out of 130 delivery cases in a month, 50 involved mishandling by traditional birth attendants and quacks that are operating in large numbers here. Birth in unhygienic conditions is an important reason for newborn infection. Majority of pregnant women in Thar generally have no antenatal care and families take too much time in bringing the patient in critical state to a health facility,” she said.

Faiz Mohammad Junejo, a primary teacher heading and an office-bearer of the Baanhn Beli, a non-governmental organisation operating in Thar, was of the opinion that the deaths reported by media were a reality but they had to do more with government mismanagement than food shortage.

“In the 44 union councils of Thar, there are only two gynaecologists, one of them recently appointed by the government. Illnesses are common as poor people are deprived of access to clean drinking water. Despite the fact that water scarcity has been persisting here for ages, the government has very recently started work on reverse osmosis plants.

“Drought conditions have been prevailing in Thar for the past two years and what could be declared in crisis are the livestock that provide sustenance to villagers,” he said.

Published in Dawn, November 24th, 2014



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