Three low cost interventions of oral rehydration, breastfeeding and community case management can save the lives of thousands of children under-five suffering from pneumonia and diarrhoea. This was disclosed by speakers at the seminar ‘Diarrhoea and Pneumonia: Global Action Plan and Implications for Pakistan’ held at Aga Khan University. The event was held to locally promote and implement the ‘Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea’ formulated by UNICEF and the World Health Organization earlier this year.
The interventions outlined in GAPPD are based on evidence generated by a special series on preventable deaths by pneumonia and diarrhoea published in The Lancet. The project looked at data from 75 high burden countries and was led by Dr Zulfiqar A. Bhutta, Founding Director of the Centre of Excellence in Women and Child Health, AKU and Dr Jai K Das, Senior Instructor, Division of Women and Child Health, AKU. Other collaborators included John Hopkins University, Sick Kids Toronto, Boston University and WHO.
Even though globally lesser number of children are dying before reaching their fifth birthday, in Pakistan the rate is still 89 deaths per 1,000 live births — much higher than the average global rate two decades ago. To be even able to meet Millennium Development Goal 4, Pakistan would have to slash down the under-five mortality rate by 45 per cent – a humungous and intimidating task to say the least.
Talking about the study findings vis-à-vis Pakistan and the province of Sindh, Dr Bhutta said that official and unofficial data about key indicators for the well-being of children populations are abysmal.
“Despite the obvious difference in population sizes, Sindh along with Punjab has the highest rate of deaths in infants: 81 per 1,000 live births each,” Dr Bhutta revealed. “Unfortunately, Sindh leads other provinces with both the highest number of cases of diarrhoea as well as the highest number of deaths in children under five (101 per 1,000).”
As far as city-wise performance is concerned, the urban areas and semi-urban areas of Karachi, Sukkur, Hyderabad, Khairpur, Ghotki, Larkana and Shikarpur diaplyed relatively better child well-being indicators as compared to the rural and under-developed areas of Badin, Mirpurkhas, Thatta and Jacobabad.
“Socio-economic instabilities and cultural traditions both impound health issues. A woman runs the household but her hands are tied as high rates of female illiteracy prevent women from independently making health decisions, seeking assistance, and stepping out of the household,” he commented.
In this context, he told the audience, it is imperative to widen the community health-worker programmes by improving coordination between various groups working to prevent and treat pneumonia and diarrhoea.
“We have real opportunities to scale-up our efforts,” he said before pointing out, “In Sindh, district governments have launched a unified and concerted effort to revive the health, food, livelihood, shelter, education and WASH sectors. In the latter area, the Pakistan Approach to Total Sanitation (PATS) is to be expanded to more districts, while temporary learning centers have enabled Sindh students to reach schools for the first time.”
Simply implementing interventions, already in place, can make a real difference.
“The 15 proven interventions identified in this series include improved water source, hand washing with soap, hygienic disposal of children’s stools and improved sanitation; vaccines for pneumococcal, Hib and rotavirus; breastfeeding promotion; preventive vitamin A and zinc supplementation; ORS and zinc for the management of diarrhoea; antibiotics for dysentery and case management of neonatal infections and pneumonia,” explained Dr Jai Das.
Addressing the audience at the AKU Auditorium, Mr Inamullah Dharejo, Secretary Health, Sindh commented, “The Sindh Health Policy recognises this as an issue and commits to address rural urban gaps and implement effective intervention packages to reduce the burden of childhood diarrhoea and pneumonia and subsequently child mortality.”
The Federal Secretary, Ministry of Health Services, Regulations and Coordination, Mr Imtiaz Inayat Elahi, in his closing comments stressed the need to “improve coordination between groups working on prevention and treatment of pneumonia and diarrhoea and substantially increase resources for child survival programmes.”
Representatives of UNICEF, Save the Children, Expanded Programme on Immunization, Government of Pakistan, Pakistan Paediatric Association, and health professionals, students and media attended the event.