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KARACHI: Lamenting that the state of maternal and child health in the country remained dismal even after six decades, experts at a seminar have said that success required a holistic approach and concerted efforts aimed at improving access to education and health, ending gender disparity, popularising good quality midwifery and ensuring that people get clean drinking water.

The seminar — The Sustainable Development Goals (SDGs), Pakistan’s Maternal, Child Health and Nutrition Challenges: Issues and Progress — was held at the Aga Khan University (AKU) on Saturday.

The programme was jointly organised by the national ministry of health services, regulations and coordination, the World Health Organisation and AKU.

Pakistan has incorporated 169 targets under the SDGs into long-term planning frameworks such as Vision 2025 and the National Health Vision 2016-2025.

Sharing their insights into factors holding back the country’s progress on these goals, experts pointed out that poor health indicators were intrinsically linked to low education levels and poor environmental conditions people were living in and the state had to work in a holistic manner if real progress was to be made.

Pakistan’s failure in maternal and child health was also rooted in the culture of giving preference to male child, they said.

“Pakistani girls continue to be less likely to receive a full course of vaccinations than boys of the same age. Even though the latest data shows a narrowing of the gender gap in immunisation, the persistence of this inequality for three decades means that young girls and women are more vulnerable to preventable illnesses,” said Dr Zulfiqar A. Bhutta, founding director of the Centre of Excellence in Women and Child Health at AKU.

Worryingly, he observed, there had been an overall decline in demand for treatment of diarrhoea and pneumonia for both sexes over the past three decades with the extent of the drop being much larger for females.

“This means female children are also less likely to receive treatment for these diseases than in the past,” he said, adding that a lack of attention to female health and education both reflected and perpetuated a feudal, patriarchal mindset in society.

One child in three is underweight

In presentations on child malnutrition and stunting, it was stated that though the proportion of children who were underweight had declined slowly in the country, one in three young children continue to have low weight for their age.

The situation, they said, had worsened between 2001 and 2011 with the proportion of children suffering from this chronic form of malnutrition rising from 37 per cent to 44pc.

“The global prevalence of stunting is 25pc whereas in Pakistan it is estimated to be 44pc. Eighty per cent of world’s 165 million stunted children live in just 14 countries, including Pakistan, where 9.6 million children are affected by it. Stunting has long-lasting consequences on cognitive ability, school performance and future earnings,” said Dr Syed Asad Ali, research director and associate professor at the AKU’s department of paediatrics and child health.

Citing some data, he said the prevalence of stunting was highest in the country’s tribal areas followed by Balochistan, Gilgit, Sindh, Khyber Pakhtunkhwa, Punjab and Azad Kashmir. The urban-rural divide mattered little in terms of childhood stunting and wasting, he said.

On why stunting rates had not changed in Pakistan, he said often babies were significantly growth compromised right at birth. In addition, they did not receive adequate quality and quantity of nutrition and suffered from environmental enteropathy as a result of poor diet, frequent infections that led to gut failure.

“Improving breastfeeding practices and mothers’ nutritional status, early detection and treatment of wasting in young children and improving women’s nutritional status is the key to move forward,” he said.

Speakers noted that achieving progress in the health and nutrition indicators laid down in the SDGs required a multisectoral approach with a focus on the underlying determinants of health such as poverty, education, food security, water and sanitation, and population growth.

Published in Dawn, November 19th, 2017