TAHIR ULLAH KHAN
PAEDIATRIC PROBLEMS IN PAKISTAN
Pakistan is placed on 33 position when listed in descending order of under five year mortality rate which is 137 for year 1993. (UNICEF 1995).
The most common causes for under five year mortality rate are
1). Acute respiratory infections(ARI).
2). Diarrhoea.
3). Malnutrition.
4). Other infections.
In the neonatal mortality, the common causes are
Pneumonias
Meningitis
Sepsis from other causes.
Asphyxia
N. Tetanus.
Taking in account the U5MR, all the causes are related to Public Health division.
Diarrhoea
Taking the diarrhoea in slight detail
"In Pakistan 35% of all under five year mortality is due to diarrhoea and dehydration. It kills 250,000 children every year in Pakistan. Every two minutes one Pakistani child is killed by diarrhoea / dehydration. 90% of these deaths are preventable. WHO 1995."
Some of the observations giving a clear picture of the causation of diarrhoea are listed below.
*Diarrhoea is less common in exclusively breast fed children.
*Partially breast fed infants are more protected against diarrhoea as compared to bottle
fed infants.
*Diarrhoea is observed more common in hygienically poor areas especially at the time
when weaning is started.
*Diarrhoea is more in houses with no sanitation.
*It is also very common in peri urban areas.
*Bottle feeding by illiterate parents with poor knowledge of cleanliness and hygiene is the common cause of diarrhoea in infants under four months age.
*With ORT, mortality and complications of diarrhoea have improved.
Other factor observed are
Illiteracy, lack of health orientation, lack of personal hygiene lack of clean water, lack of sanitation, poor economy, uncontrolled and unplanned population rise.
Malnutrition is divided into primary and secondary
general malnutrition 1. marasmus common in younger children
2. P.C.M. common in older age children group.
marasmus is more common in Pakistan. Underfeeding at the time of weaning and diseases is the common cause. Diseases are measles, ARI, Tuberculosis, Chronic diarrhoea and other infections.
Specific deficiencies are
1. Anemia, the most common deficiency disease which has a prevalence of 65% in
preschool children in Pakistan.
2. Rickets.
3. Iodine deficiency (hypo-thyroidism)
4. Vitamin A deficiency.
5. Other mixed vitamin deficiencies.
Factors contributing to these nutrition problems are
1. Lack of knowledge of food and nutrition
2. Poor economy.
3. Poor family health.
Health Programme
Pakistan has three types of health systems for general as well as pediatric population. There are
1. Curative services composed of
B.H.U.(Basic Health Units) for 5,000 to 10,000 population.
R.H.C (Rural Health Centre) for 25,000 to 30,000 population.
Hospital in districts.
Reference hospitals and specialized units.
2. Preventive services.
Immunization (EPI)
ARI control programme
T.B. control Programme
Malaria control Programme
M.C.H. System.
Population Planning
Goitre Prevention Programme. 1995
Polio eradication Programme. (Recent)
3. Promotive Programme.
Clean water Supply
Sanitation facilities.
Nutrition management.
Health Education Programme
Breast feeding promotion programme
as Baby Friendly Hospitals.
Integrated child survival Programme.
Family Health Project (recent)
Polio eradication Programme
In 1994 and in 1995 all the children below five year age were vaccinated and revacinated for polio. In this programme everybody took part including school students, scouts, social workers, teachers. Most of the population was re-vaccinated by O.P.V. Two doses each time.
Integrated child survival Programme
This is also a new programme adopted under the UNICEF in which doctors are invited in groups to a teaching centre for 15 days. They are provided most recent information and management strategies about A.R.I, diarrhoea, vaccination programme, breast feeding.
Baby friendly hospital programme
According to this programme, training to doctors in central as well as in periphery hospitals, regarding the exclusive breast feeding is given. The Hospitals with Pediatric units where promotion of breast feeding is strictly observed are called Baby friendly hospitals. This programme is expected to have good results in the fields of gastro-eutentis (diarrhoea), malnutrition and other infectious diseases in the long run.
Family Health programme
Vast programme of the government in which all respects of family health are touched and it is also an educational programme to promote family Health.
Conclusion
It is observed that the current health programmes are limited. These need to be expanded to cover the whole population especially the population of rural and periurban areas which are most affected by all these pediatric problems.
General knowledge about health, personal hygiene, nutrition and other basic subjects may be provided to most of the people.
Provision of clean water and sanitation is one of the basic needs to decrease mortality and morbidity in general population.
Vaccination programme may be improved to have maximum population vaccinated against the six infectious diseases and T.T vaccination of all women of child bearing age.
To develop the trends of research and studies for public health will be another step for the improvement of social welfare. Cooperative programmes may also help regarding the improvement of health condition in the population
