KARACHI: Pakistan and Afghanistan may have differences over a host of issues but they stand together when it comes to having the highest fertility rates, newborn mortality rates and lowest vaccination coverage in South Asia, highlights a compendium on health launched on Wednesday at a ceremony in New Delhi by a leading international medical journal.

Titled Health in South Asia, the compilation brings together over 60 authors from across South Asia and other countries to identify health priorities and recommendations for action to improve public health in the fast-growing region of the world.

Prof Zulfiqar A. Bhutta, founding director of the Aga Khan University’s Centre of Excellence in Women and Child Health and Dr Samiran Nundy, dean of the Ganga Ram Institute for Postgraduate Medicine and Research, India have steered the initiative.

The AKU experts, who participated in the discussion with their colleagues in other countries through video link, included Dr Sajid Soofi, Dr Ather Enam, Dr Javaid Khan, Dr Tazeen Jafar and Ashar Malik.

The compilation containing 12 articles shows that fertility rates in South Asia are the highest in Afghanistan followed by Pakistan. For the last 14 years, Pakistan’s fertility rate has not decreased even by one per cent; it was 4.1pc in 2004 and 3.6pc in 2014.

Pakistan, according to the publication, has made the least progress in reducing fertility among adolescent girls.

Newborn mortality rates, it says, continue to be the highest in Pakistan (45.5 deaths per 1,000 live births) and Afghanistan (35.5 deaths per 1,000 live births).

“The main causes of newborn death are fairly consistent across the region, with preterm birth causing about one third of deaths and intra-partum related events; infections, including sepsis and meningitis; and congenital anomalies each contributing about one fifth of deaths,” says an article on maternal health.

Over half (57pc) of deaths among children under five in South Asia occur in the first 28 days of life; this amounts to more than one million newborns dying every year in the region.

High rates of newborn mortality and intra-partum stillbirths, it says, are a major challenge across the region, and are associated with poor quality of care in both community and facility settings. Of the 2.6 million stillbirths that occur globally every year, about 37pc (almost one million) are in South Asia.

Despite progress, current levels of stunting are more than 30pc in most countries in the region, except Sri Lanka (15pc) and the Maldives (20pc). Currently, around a third of children are underweight in most countries except Bhutan (13pc) and the Maldives (18pc). Prevalence of wasting has hardly changed over the decade, and currently ranges from 6pc in Bhutan to 21pc in Sri Lanka.

Since the early 2000s, the prevalence of under-five stunting has dropped by about one third in Afghanistan, Bangladesh, India, Nepal, and the Maldives. Pakistan, however, experienced an increase over this period (from 42pc to 45pc).

On child vaccination, according to the collection, the region has performed well, with about 90pc coverage on average for tetanus, Hib3, measles, and DPT3 (refers to a class of combination vaccines against diphtheria, whooping cough and tetanus).

Country coverage ranges from about 70pc to 100pc, with Afghanistan and Pakistan among the lowest and Sri Lanka consistently the highest.

Other important points

*Literacy of young women (age 15-24 years) is over 85pc in all countries except Pakistan (67pc) and Afghanistan (46pc). Literacy of women (age >15 years) is greater than 90pc in Sri Lanka and in the Maldives 99pc.

*There were 74 wild type polio cases in Pakistan and Afghanistan in 2015, and 33 in 2016. However, unrest in these countries threatens progress in eradication and is a high priority for regional cooperation.

• High out-of-pocket health expenditures annually drag about 4pc of the population into poverty in the three most populous countries of the region: India, Bangladesh, and Pakistan.

*Notwithstanding the limited quality and breadth of data, ischemic heart disease is the leading cause of death in India, Pakistan, Nepal, and Sri Lanka, and stroke is the leading cause in Bangladesh.

*Nearly 30pc of males and only 4pc of females aged 15 or older in South Asian countries smoke with notable variation between countries. In 2010, most of the roughly 170 million adult smokers in South Asia were male and most lived in India. In Bangladesh, Nepal, and Pakistan, most smoked tobacco is in the form of cigarettes.

*There is limited regional capacity to identify, respond to, and mitigate emerging infectious disease threats in South Asia. The main reason seems to be a lack of political will.

*While mechanisms for regional collective conversations do exist, they have not translated into the kind of operational capabilities that the European Centres for Disease Prevention and Control or the European Commission are able to facilitate within the European Union. Moreover, the composition of the World Health Organisation’s South East Asia Regional Office leaves out key countries (Afghanistan and Pakistan) in the region, hindering cooperation at the WHO level.

Professor Bhutta, one of the authors from Pakistan, regrets the fact that while India and Pakistan, both nuclear powers, invest immensely on arms and armaments, millions of people in these countries are deprived of basic facilities and the countries’ human development indices are among the lowest in the world.

According to the analysis, India, Pakistan and Sri Lanka, in South Asia, are the states that spend only 3-4pc of their GDP on health.

Published in Dawn, April 13th, 2017