Tuesday, March 19, 2019

Pakistan Survey Reveals Positive Trends in Children's Health

The latest national health survey in Pakistan indicates rising immunization rates, growing access to skilled health care and declining child mortality rates. However, the improvements in education and health care indicators in Pakistan are real but slower than in other countries in South Asia region. Pakistan's human development ranking plunged to 150 in 2018, down from 149 in 2017. It is worse than Bangladesh at 136, India at 130 and Nepal at 149. The decade of democracy under Pakistan People's Party and Pakistan Muslim League (Nawaz) has produced the slowest annual human development growth rate in the last 30 years. The fastest growth in Pakistan human development was seen in 2000-2010, a decade dominated by President Musharraf's rule, according to the latest Human Development Report 2018. One of the biggest challenges facing the PTI government led by Prime Minister Imran Khan is to significantly accelerate human development rates in Pakistan.

Pakistan Demographic and Health Survey:

PDHS (Pakistan Demographic and Health Survey) is a nationally-representative household survey that provide data for a wide range of monitoring and impact evaluation indicators in the areas of population, health, and nutrition. It is conducted about every 5 years.

The 2017-18 Pakistan Demographic and Health Survey (2017-18 PDHS) was carried out by the National Institute of Population Studies (NIPS), Islamabad, Pakistan.  It involved 16,240 households.  ICF provided technical assistance through The DHS Program, a project funded by the United States Agency for International Development (USAID) that provides support and technical assistance in the implementation of population and health surveys in countries worldwide.

Declining infant mortality rate:

The infant mortality rate (IMR), defined as the number of deaths in children under 1 year of age per 1000 live births in the same year, is universally regarded as a highly sensitive (proxy) measure of population health.  A declining rate is an indication of improving health. IMR in Pakistan has declined from 86 in 1990-91 to 74 in 2012-13 and 62 in the latest survey in 2017-18.

Pakistan Child Mortality Rates. Source: PDHS 2017-18

During the 5 years immediately preceding the survey, the infant mortality rate (IMR) was 62 deaths per 1,000 live births. The child mortality rate was 13 deaths per 1,000 children surviving to age 12 months, while the overall under-5 mortality rate was 74 deaths per 1,000 live births. Eighty-four percent of all deaths among children under age 5 in Pakistan take place before a child’s first birthday, with 57% occurring during the first month of life (42 deaths per 1,000 live births).

Rising Vaccination Rate:

Vaccines are proven to prevent infectious disease and spread of such disease among children and the larger populations. Polio, measles, diphtheria, pertussis (whooping cough), rubella (German measles), mumps, tetanus, rotavirus and Haemophilus influenzae type b (Hib) can now be prevented by vaccination.

Childhood Vaccination Rate in Pakistan. Source: PDHS

The latest PDHS survey indicates that 66% of the children in Pakistan have received all basic vaccinations, up from 35% in 1990-91 and 55% in 2012-13. Only 4% have had no vaccinations, down from 28% in 1990-91.

Pre-Natal and Delivery Care:

Access to proper medical care and hygiene during delivery can reduce the risk of complications and infections that may lead to death or serious illness for the mother, baby, or both (Van Lerberghe and De Brouwere 2001; WHO 2006). PDHS survey data show that in Pakistan, 69% of the births in the 5 years preceding the survey were delivered by a skilled provider, and 66% were delivered in a health facility.

Pre-Natal and Delivery Care in Pakistan. Source: PDHS

There has been steady improvement of the maternal health care indicator for women receiving ante-natal care (ANC) from a skilled provider, which increased from 26% in 1990-91 to 86% in 2017-18. Similar improvement in the percentage of deliveries at health facilities has been witnessed; these deliveries increased from 13% to 66%. Also, the percentage of births attended by skilled providers increased from 17% to 69% over the same period of time, according to PDHS 2017-18.

Birth Rates Declining:

Pakistan has seen a steady decline in fertility rates over time, from 5.4 births per woman as reported in the 1990-91 PDHS to 3.6 births per woman in the 2017-18 PDHS—a drop of about two births per woman in almost three decades. However, the decline is minimal in the recent period.

Total Fertility Rate (TFR) in Pakistan. Source: PDHS

There has been a consistent decrease in fertility among all age groups over the last four DHS surveys, though the decline is less pronounced recently.

Human Development Ranking:

It appears that improvements in education and health care indicators in Pakistan are slower than other countries in South Asia region. Pakistan's human development ranking plunged to 150 in 2018, down from 149 in 2017. It is worse than Bangladesh at 136, India at 130 and Nepal at 149. The decade of democracy under Pakistan People's Party and Pakistan Muslim League (Nawaz) has produced the slowest annual human development growth rate in the last 30 years. The fastest growth in Pakistan human development was seen in 2000-2010, a decade dominated by President Musharraf's rule, according to the latest Human Development Report 2018.

UNDP’s Human Development Index (HDI) represents human progress in one indicator that combines information on people’s health, education and income.

Pakistan's Human Development Growth Rate By Decades. Source: HDR 2018

Pakistan saw average annual HDI (Human Development Index) growth rate of 1.08% in 1990-2000, 1.57% in 2000-2010 and 0.95% in 2010-2017, according to Human Development Indices and Indicators 2018 Statistical Update.  The fastest growth in Pakistan human development was seen in 2000-2010, a decade dominated by President Musharraf's rule, according to the latest Human Development Report 2018.

Child Nutrition in Pakistan. Source: PDHS
Child Nutrition:

PDHS survey shows that the nutritional status of children in Pakistan has improved over the last five years. The percentage of stunted children declined from 45% in 2012-13 to 38% in the 2017-18. A similar downward trend, from 30% to 23%, was observed for underweight children over the same period. Children who are wasted also declined from 11% to 7%. Children who are obese remained at 3% over this period.


There are rising vaccination rates and growing access to skilled health care with declining child mortality in Pakistan, according to the latest national health survey in Pakistan. Neonatal mortality rate is down from 55 to 42 per 1,000 births in the last 5 years.  Vaccination rates are up with 66% of the children in Pakistan having received all basic vaccinations in 2017-18, up from 35% in 1990-91 and 55% in 2012-13. Only 4% have had no vaccinations in 2017-18, down from 28% in 1990-91.   Skilled health care professionals are delivering 69% of children now, up from 48% five years ago. 66% of children are now vaccinated, up from 54% five years earlier. Infant mortality rate (IMR) within first year of birth was recorded at 62 deaths per 1,000 live births, down from 74 in the last survey of 2012-13. Total Fertility Rate (TFR) has declined from 5.4 births per woman 990-91 to 3.6 births per woman in 2017-18.   It appears that improvements in education and health care indicators in Pakistan are slower than other countries in South Asia region. Pakistan's human development ranking plunged to 150 in 2018, down from 149 in 2017. It is worse than Bangladesh at 136, India at 130 and Nepal at 149. The decade of democracy under Pakistan People's Party and Pakistan Muslim League (Nawaz) has produced the slowest annual human development growth rate in the last 30 years. The fastest growth in Pakistan human development was seen in 2000-2010, a decade dominated by President Musharraf's rule, according to the latest Human Development Report 2018. One of the biggest challenges facing the PTI government led by Prime Minister Imran Khan is to significantly accelerate human development rates in Pakistan.

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AZ said...

Its a very mediocre performance, especially when it comes to health metrics like infant mortality, stunted growth, and so on.

Pakistan needs to see significant improvements in these areas and need it FAST.

The only good part is healthy fertility rates that Pakistan has been able to maintain (3.4 children per woman is quite healthy! Pakistan should bring down the TFR gradually to 3 and then 2.5 etc by 2040, and 2.2 by 2050 etc. Sudden drop in TFR is in quick time is disastrous for developing countries like Pakistan. That's why Iran is trying so hard to increase its fertility now after sudden drop of 1990's).

Immunization rates have shown some promise, but the momentum needs to continue there at full speed as well.

nayyer ali said...

Infant mortality of 62 is progress but India is at 31. This is the primary reason why Pakistani life expectancy lags a bit behind India. Getting infant mortality down to 20 should be a screaming priority of the government. TFR also needs to be brought down to under 2.5 so we can slow population growth. Population is on track to hit 300 million, and going much beyond that is not a good idea.
The child mortality in Pakistan (between age 1 and 5) is actually pretty low and a bit better than India.
Getting all those children educated to a decent standard for a modern economy is also a must.

Riaz Haq said...

Millions of babies are starving in Pakistan despite an abundance of food in the country


According to the International Food Policy Research Institute, a poverty and hunger watchdog, around one in five people in Pakistan are malnourished

And yet, the nation has no shortage of food – US Department of Agriculture data shows Pakistan is projected to export 500,000 tons of wheat from May 2018 until April 2019, and 7.4 million tons of rice in the same period

And yet, the nation has an abundance of food – in fact, according to the US Department of Agriculture, Pakistan is projected to export 500,000 tons of wheat from May 2018 until April 2019, and 7.4 million tons of rice in the same period.
Dawn, the English-language daily newspaper, even reported a potato glut earlier this month.
In Pakistan, women take desperate measures to stop having babies

The issues are socio-economic, experts said – just because goods are available does not mean people can access them.
“There are four key pillars of food security in Pakistan: the first is availability, then accessibility, utilisation and stability,” said Ambreen Fatima, senior research economist at the Applied Economic Research Centre of Karachi University.
In Tharparkar district, where Mithi Civil Hospital is located, all four are lacking, she said.


“This is also linked to inadequate water and sanitation, education and health service delivery, which together with the lack of awareness of appropriate dietary intake contributes to greater food insecurity and malnutrition,” it said.
Tharparkar district is frequently highlighted in Pakistan’s media because of its high rate of child deaths, with politicians blaming the situation on drought – but economists and physicians said that was not the sole explanation.
“Causes of malnutrition are multiple pregnancies, young-aged marriage, iron deficiency in mothers, (lack) of breastfeeding, weak immunisation, and early weaning,” Kumar said.
Pakistan man accused of stabbing woman 23 times gets acquittal overturned
Bearing large numbers of children from a young age takes its toll on women’s health, but also impacts the well-being of the fetus and ability to breastfeed a newborn.
In Pakistan, only 38 per cent of babies are fed breast milk exclusively during their first six months in line with UN recommendations.
This low figure is blamed on local traditions, the heavy workloads of mothers and powerful marketing by the milk industry.
Pakistan’s crackdown on aid agencies may affect 11 million recipients
Many mothers are told to feed their newborns tea, herbs, which can stunt growth. Some are unnecessarily persuaded to use formula instead of breast milk by doctors.
This can introduce health problems if the water use to make it is unclean, or if poor families scrimp on the amount of powder to create the drink.
Sindh’s high number of child deaths are the result of a vicious poverty cycle that begins with malnourished mothers, said Bengali. “An infant is not fed with wheat or solid food.”

Riaz Haq said...

#ImranKhanPrimeMinister performs groundbreaking of #Balochistan #Health Complex, #Quetta-#Zhob Dual Carriageway as part of western alignment of #China-Pakistan Economic Corridor (#CPEC) and New #Gwadar International Airport. #Pakistan https://www.geo.tv/latest/232487-pm-performs-groundbreaking-of-balochistan-health-complex

The premier announced that a cancer institute will be made with the help of Pakistan Army and the provincial government.

Speaking about the Quetta-Zhob Dual Carriageway, the premier said it was a difficult project. "The Quetta-Zhob Dual Carriageway will connect the province to other parts of the country," he said.

"We also needed to pay attention towards the western route," PM Imran said and added that the government wishes to make a railway track from Quetta to Taftan and Railways Minister Sheikh Rashid is making efforts in this regard.

"We need to make a master plan for Quetta," he urged while stating that Pakistani cities are expanding. "As cities expand, people will not be able to receive facilities and will face more difficulties."

PM Imran further said that under CPEC, the western route should have been made first.

The premier also stressed the need for a "strong local government system for Balochistan". "Till local government system is not improved, people's quality of life will not be improved. In Khyber Pakhtunkhwa, we improved the local government system owing to which we emerged successful there for a second time," he added,

"The country also faces water issues for which we are building a dam. We do not want to think about other elections but our country's progress," he asserted. "If Balochistan is focused on then the whole country will progress," he stated.


Gwadar airport, uplift schemes for city
Prime Minister Imran Khan also launched work on New Gwadar International Airport and announced various other development schemes for the city, what he believed would become an engine of growth for Pakistan.

“What a pleasure it is to be in Gwadar. In sha Allah, in coming months, years, Gwadar would be, I see, as engine of growth for Pakistan,” he said addressing the ground breaking ceremony of the airport.

The event was attended by federal ministers, Balochistan chief minister, parliamentarians, Chief of Army Staff General Qamar Javed Bajwa and Chinese Ambassador to Pakistan Yao Jing, besides huge number of Chinese workers and government officials.

The airport was included among Early Harvest High Priority Project of the CPEC in January 2014. The Chinese government would assist Pakistan in construction of the airport under Chinese Grant Assistance.

The project is part of overall infrastructure development of Balochistan.

It would be developed as a green-field facility with all modern facilities for safe operation.

The new Gwadar airport would be able to accommodate large aircraft such as Airbus A380. It would comprise a modern terminal building with cargo terminal having initial handling capacity of 30,000 tons per year.

On this occasion, a memorandum of understanding (MoU) was signed for construction of Pakistan and China Vocational Training Institute and Pak-China Friendship Hospital.

Khan said it was pleasing that the capacity of the hospital in Gwadar would be enhanced and a vocational training institute would also help create employment opportunities.

He announced to launch Insaf Sehat Card to provide health insurance cover worth Rs720,000 to every family.

The premier said previously power was being transmitted from Iran, but now the government had decided to link the area with national grid.

A desalination plant would also be set up in the city and under Clean and Green Pakistan, one million saplings would be planted. Besides, a solid waste management system would also be established to protect the area from pollution, he said.

Riaz Haq said...

#Pakistan to fortify #wheat flour to deal with micronutrient deficiencies that can lead to poor child growth, anemia and many other health issues. #health #vitamins #minerals #nutrition https://www.world-grain.com/articles/12017-flour-fortification-pilot-project-planned-for-pakistan

The National Fortification Alliance of Pakistan (NFA) is partnering with the United Nations World Food Programme (WFP) and the government of Australia to launch a pilot project to fight malnutrition by fortifying wheat flour in Islamabad and Rawalpindi.

As part of the partnership, the WFP will provide technical support and the government of Australia will provide funding for the project, which is focused on providing support to chakkis (small-scale grinders) to mill flour that is rich in micronutrients.

“Given the extent of the consumption of wheat from chakkis, this project will provide a firm basis to reach nutritionally vulnerable populations and provide them with essential nutrients, which is another step WFP is taking to curb malnutrition in Pakistan,” said Finbarr Curran, WFP Country Representative.

According to the WFP, almost half of Pakistan’s population suffers from micronutrient deficiencies that can lead to poor child growth, anemia and many other health issues. Reducing these deficiencies is a high priority for the government of Pakistan, the WFP noted.

The agency noted that Pakistan already has taken steps to fortify wheat flour produced by large-scale mills, and over the next five years the goal is fortify wheat flour produced at all the country’s industrial wheat flour mills.

To achieve the goal, though, the WFP said it must support the output of chakkis. The agency said chakkis produce wheat flour for nearly 70% of the population, and most of these families are the poorest of the poor. This project targets the most vulnerable populations and fulfills the urgent need to assimilate chakkis within a broader national fortification effort.

The pilot project is expected to provide the government with evidence about the potential for the chakki fortification program to prevent micronutrient deficiencies and malnutrition, particularly among the poorest populations. 

Riaz Haq said...

Pakistan’s PK: School Enrollment: Primary: % Gross data was reported at 97.710 % in Dec 2016. This records an increase from the previous number of 92.409 % for Dec 2015. Pakistan’s PK: School Enrollment: Primary: % Gross data is updated yearly, averaging 58.128 % from Dec 1971 to 2016, with 37 observations. The data reached an all-time high of 97.710 % in 2016 and a record low of 49.022 % in 1972. Pakistan’s PK: School Enrollment: Primary: % Gross data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Pakistan – Table PK.World Bank.WDI: Education Statistics. Gross enrollment ratio is the ratio of total enrollment, regardless of age, to the population of the age group that officially corresponds to the level of education shown. Primary education provides children with basic reading, writing, and mathematics skills along with an elementary understanding of such subjects as history, geography, natural science, social science, art, and music.; ; UNESCO Institute for Statistics; Weighted average; Each economy is classified based on the classification of World Bank Group's fiscal year 2018 (July 1, 2017-June 30, 2018).


Riaz Haq said...

Every third child is underweight in Pakistan: survey


The National Nutrition Survey 2018-19 has painted a bleak picture of children’s health, stating that “every third child” in the country “is underweight”.

The survey was released on Monday during a ceremony chaired by Adviser to the Prime Minister on Health Dr Zafar Mirza and attended by Health Secretary Zahid Saeed, National AIDS Control Programme Manager Dr Basir Achakzai, Unicef representative and others.

The survey was compiled by experts working under the auspices of the Ministry of Health and Unicef.

The report stated, “Breast-feeding has increased in Khyber-Pakhtunkhwa (K-P), while malnutrition in Balochistan and erstwhile Federally Administered Tribal Areas (Fata).”

It stated, “Every four out of 10 children are malnourished. Over 40% children are affected by malnutrition in which the number of girls is higher than that of boys.”

Giving the break-up of the malnourished children, the report stated, “In the country, 40.9% boys are malnourished, while 39.4% girls are victims of malnutrition and 28% are underweight.

“Over 9% children are overweight. During the last seven years, the number of overweight children has doubled as in 2011 only 5% children were overweight while now the ratio stands at 9.5%. About 50% girls in Pakistan suffer from anemia while 48.4 % children are given mother’s milk. The ratio of children being fed mother’s milk stands at over 60% in K-P.

“In Pakistan, 36.9% of the population face malnutrition. In Balochistan, 50% people are malnourished while in erstwhile Fata the ratio is 54.6%.”

Addressing the ceremony, Health Adviser Dr Zafar Mirza said, “In line with the vision of Prime Minister Imran Khan, the Ministry of Health is taking drastic measures to overcome malnutrition.”
Mirza said, “The data obtained from the survey will help in policy making and devising strategies.”

He said they would join hands with the provinces in taking effective steps in the field of nutrition in light of the data obtained.

“The incumbent government has already decided to tackle the biggest issue – undernourishment, especially in women and children,” said the PM’s aide, adding that the national survey had revealed that 40% children under the age of five were victims of stunting.

Mirza acknowledged the fact that positive signs regarding more women feeding their milk to their newborns were received. “About 10% improvement has been recorded in mothers feeding their children their own milk.”

Mirza said, “The ratio of people consuming clean water has increased, whereas only 21% water has been found fit for consumption.”
He said information and steps regarding women giving birth had improved. “About 63% women come to clinics when they are pregnant, while 68% avail the expertise of experts, which has reduced the ratio of death among newborns,” said Mirza.

About anemia, Mirza said, “Several women and children suffer from this condition. It has been reported that over 50% children suffer from anemia, while 62% lack Vitamin A.”

He said that there had been an increase in the consumption of iodine salt, which “is a positive sign”.


Riaz Haq said...

Can Pakistan's 88% BCG vaccination rate against tuberculosis (TB) help reduce the impact of coronavirus? A New York Institute of Technology study using data from 178 countries has concluded that both the incidence and mortality of COVID-19 are significantly lower in countries with BCG vaccination programs against TB. Will this study help prove Dawn News' alarming forecast of over 2 million
confirmed cases by June 1 and 20 million actual infections wrong?

Scientists have speculated that BCG vaccine may boost the innate immune system not just against TB but also against a variety of other pathogens from invading the body or from establishing an infection. Here are some of the key findings of the study summarized below:

1. Countries that do not have a BCG vaccination policy against TB have seen 10X greater incidence and deaths from Covid-19 than the countries that do, according to a study of data from 178 countries by New York Institute of Technology researchers.

2. BCG, or Bacillus Calmette-Guérin, is a vaccine for tuberculosis (TB). It is administered at birth in many developing countries that have historically suffered from the disease, such as India and Pakistan. Most of the developed nations, including US, Italy and the Netherlands do not have universal TB vaccination programs. Japan is among the few developed OECD nations that still do. The East Asian nation had some of the earlier cases, but the mortality is low despite not having adopted some the more stringent social distancing rules.

3. The study looked at Covid-19 instances and mortality for 15 days between March 9 and 24 in 178 countries and concluded that incidence of Covid-19 was 38.4 per million in countries with BCG vaccination compared to 358.4 per million in the absence of such a program.

4. The death rate was 4.28 per million in countries with BCG programs compared to 40 per million in countries without such a program. Out of the 178 countries studied, 21 had no vaccination program, while the status was unclear in 26 countries. The latter group was treated as not having a policy for the purpose of this study.


Riaz Haq said...

India, Pakistan tackle backslide in child immunizations


While India and Pakistan topped the list of countries that saw the greatest increase in children not receiving a first dose of DTP between 2019 and 2020, they were also quick to bounce back.

Pakistan now figures among countries that successfully fought back declines to return to pre-pandemic levels of coverage "thanks to high-level government commitment and significant catch-up immunization efforts", UNICEF/WHO said.

In India, progress towards reducing the number of zero-dose children was impacted by the pandemic and the number of children who did not receive the first dose of the DTP vaccine was estimated to have increased to three million in 2020, up from 1.4 million in 2019, according to Mainak Chatterjee, health specialist at UNICEF India.

"Despite having the largest birth cohort in the world, India was able to prevent a further backslide through special drives such as the Intensified Mission Indradhanush, which enabled the country to bring down zero-dose to 2.7 million in 2021," Chatterjee told SciDev.Net.

Riaz Haq said...

Lancet Study: Non-infectious diseases cause early death in Pakistan


Pakistan has considerable control over infectious diseases but now struggles against cardiovascular diseases, diabetes and cancer as causes of early deaths, according to a new study published Thursday.

The Lancet Global Health, a prestigious British-based medical journal, reported that five non-communicable diseases — ischaemic heart disease, stroke, congenital defects, cirrhosis, and chronic kidney disease — were among the 10 leading causes of early deaths in the impoverished Islamic nation.

However, the journal said some of Pakistan’s work has resulted in an increase in life expectancy from 61.1 years to 65.9 over the past three decades. The change is due, it said, “to the reduction in communicable, maternal, neonatal, and nutritional diseases.” That’s still 7.6 years lower than the global average life expectancy, which increased over 30 years by 8% in women and 7% in men.

The study says “despite periods of political and economic turbulence since 1990, Pakistan has made positive strides in improving overall health outcomes at the population level and continues to seek innovative solutions to challenging health and health policy problems.”

The study, which was based on Pakistan’s health data from 1990 to 2019, has warned that non-communicable diseases will be the leading causes of death in Pakistan by 2040.

It said Pakistan will also continue to face infectious diseases.

“Pakistan urgently needs a single national nutrition policy, especially as climate change and the increased severity of drought, flood, and pestilence threatens food security,” said Dr. Zainab Samad, Professor and Chair of the Department of Medicine at Aga Khan University, one of the authors of the report.

“What these findings tell us is that Pakistan’s baseline before being hit by extreme flooding was already at some of the lowest levels around the globe,” said Dr. Ali Mokdad, Professor of Health Metrics Sciences at IHME. “Pakistan is in critical need of a more equitable investment in its health system and policy interventions to save lives and improve people’s health.”

The study said with a population approaching 225 million, “Pakistan is prone to the calamitous effects of climate change and natural disasters, including the 2005 Kashmir earthquake and catastrophic floods in 2010 and 2022, all of which have impacted major health policies and reform.”

It said the country’s major health challenges were compounded by the ongoing COVID-19 pandemic and last summer’s devastating flooding that killed 1,739 people and affected 33 million.

Researchers ask Pakistan to “address the burden of infectious disease and curb rising rates of non-communicable diseases.” Such priorities, they wrote, will help Pakistan move toward universal health coverage.”

The journal, considered one of the most prestigious scientific publications in the world, reported on Pakistan’s fragile healthcare system with the Institute for Health Metrics and Evaluation at the University of Washington’s School of Medicine. The study was a collaboration with a Karachi-based prestigious Aga Khan University and Pakistan’s health ministry.

The study also mentioned increasing pollution as one of the leading contributors to the overall disease burden in recent years. Pakistan’s cultural capital of Lahore was in the grip of smog on Thursday, causing respiratory diseases and infection in the eyes. Usually in winter, a thick cloud of smog envelops Lahore, which in 2021 earned it the title of the world’s most polluted city.