ISLAMABAD, Dec 4: Pakistan ranks eighth in the world for the number of child deaths with 478,000 under five deaths every year. Almost two-thirds of these deaths, (mostly due to newborn causes) are related to care of mothers during pregnancy, delivery and during post-natal period.

A combination of low birth weight, under-nutrition, respiratory infection, diarrhea and anemia are the prime causes of this high mortality and morbidity rates among Pakistani children. Apart from the burden of neonatal causes, pneumonia and diarrhea (22 per cent) are the main killers of children under the age of five years.

Compelling evidence-based analysis shows that hygiene and sanitation are among the most cost-effective public health interventions to reduce childhood mortality. Access to a toilet alone can reduce diarrhea deaths by over 30 per cent and hand washing by more than 40 per cent.

The link between sanitation and health is not just theoretical. To acknowledge the impact of hygiene and sanitation practices on incidence of pneumonia and diarrhea, Child Health and Sanitation Week was observed in six districts (three in Punjab, one each in the NWFP, Sindh and Balochistan) in months of April and October 2008 with support from Unicef Pakistan.

The campaign, launched at national and provincial levels reaching a total of 11 million people (around two million households) proved that pneumonia and diarrhea, both of which have seasonal occurrence can benefit from focused mass awareness campaigns.

Public messages on television, radio and press accompanied by a display of banners and mosque announcements and special sermons by religious leaders that “practicing cleanliness is half of the Islamic belief”, contributed a great deal to public knowledge. Lady health workers, community volunteers and municipal corporations undertook an enhanced sanitation drive to reinforce health and hygiene messages.

The results of a pre and post survey assessment, to gauge the coverage of vaccination and de-worming and increase in knowledge about the key messages showed as much as 10 to 30 per cent increase in children (0-23 months) starting immunisation. Children (2-5 years) who had received de-worming tablet increased from 24 per cent to 87 per cent. While 20 to 25 per cent increase in awareness of mothers who could tell correctly how to prepare ORS at home, mothers who could tell correctly when is hand washing necessary (after going to toilet, before preparing food, before eating, before feeding a child) and who could tell the importance of boiling water for purification.

In short, the whole process of child health and sanitation week was an affirmation for the need to link concepts of hygiene and sanitation with child health and well-being. This set of core interventions for child survival can be delivered during child health and sanitation weeks twice a year at a very low cost.

Together these interventions are likely to contribute significantly to reduction in infant and under child mortality rates.

Pakistan is not on track for achieving millennium development goals 4 and 5, and need some extraordinary efforts to achieve its targets. The initiative needs to be scaled up and national programmes through lady health workers and civil society organisations working on maternal and child health with a combined effort can make a difference in saving the lives of thousands of Pakistani children and their mothers.