From Pakistan

Raham Niaz

CHILD HEALTH IN PAKISTAN Pakistan is a 7th most populous country in the world having an estimated population of 136 million in 1994. It covers an area of 7,96,095 square kilometers. Population under 16 years is 63.5 millions with annual. No of births as 5461 thousands. Thus having a growth rate of 3.1%. Economy is mostly agricultural based, so 75-80% of population resides in villages and 20 to 25% in cities.
The state of health of Pakistani children is presented under the following headings:
1 . Basic Health Indicators
2 . Educational Status
3.The Health Delivery System
4.Immunization Status
5. Nutritional Status
6 . Common Diseases
BASIC HEALTH INDICATORS

Pakistan is having crude Birth Rate (C.B.R) of 40 while Crude Death Rate (C.D.R) is 1O and a Fertility rate of 6.O. The comparative figure of Japan are C.B.R. 11 ,C.D.R. 8 and fertility rate 1.5.
The infant mortality rate is 80 to 90 while the under five mortality is 140 as compared to Japan which is only 6 . The Gross National Product (G.N.P.) per capita is $ 440 as against $ 34630 of Japan. Poor economics status is the main culprit behind these sad figures. G.N.P per capita growth rate is 6.5% while inflation rate is 7%. Expenditure on health services as % of central Government expenditure is 2%.

EDUCATIoNAL STATUSE
Education of the people of a country contribute a lot to health statistics. The more literate is a community, the better will be their health. At present, the literacy rate is 30% with male to female ratio of 35:6, Percent of children reaching grade 5 is 37%. The correspanding figure of Japan is 100%. Study after study has been shown that education of girls is one of the best investment available to developing countries. It can increase income. It can help free women from subjection. It can lead to better child health and nutrition. It can mean later marriages and lower birth rate.

HEALTH DELIVERY SYSTEM
The health delivery system is divided into primary health care system.
Secondary or District Hospital and tertiary referral hospitals. Primary health care system is composed of Dispensaries, Basic Health Units, Rural Health Centres, Where lady Health Workers, Paramedics and doctors work. Beside these, traditional birth attendants also work.
Most of the B.H.Us and R.H.Cs having qualified doctors and other health workers providing health services, Immunization, Family Planning, ORT Corners etc.

District hospital provide secondary referral facilities. District hospital are having admission facilities and laboratory facilities. District specialist look after the indoor & outdoor patients.
Tertiary referral centers are teaching hospitals attached to different medical colleges.
Population having access to health services is 65% in which 99% is urban and 35% rural. There is on doctor for 2500 persons. One paramedic for 1500 persons and one nurse for 8 hospital beds.
The Government of Pakistan has also started certain projects like Pakistan child survival Pro gramme which aims at reducing the mortality and morbidity in under 5 children. Under the programme doctors and paramedics are trained to diagnose & treat common problems facing Pakistani children like malnutrition . Acute respiratory infections , Diarrhoeal diseases & immunization.

The expanded programme on immunization (E.P.I) was started in 1978 in Pakistan. to prevent the six vaccine preventable diseases. Specific objectives. at that time were
i. Attaining Immunization coverage of 100%
ii. Eradication of Polio by year 2000
iii. Reduction of measles incidence by 95% by 1995.
iv. Reduction of diphtheria , pertussis and T.B. to minimum level.
But unfortunately these goal have not been achieved . The Government is now seriously considering to eradicate polio by 2000. For this 4 polio days has been observed in 1994 & 1995. More than 90% children were given polio drops during this campaign.

RECENT STATITICS :
B.C.G. : 87%
POLIO : 74 %
D.P.T. : 74%
Measles : 65%
T.T. 40%

NUTRITIONAL STATUS
Nutritional status of Pakistani children is very groomy. According to nutritional survey in 1987, the situation is the same as ten years age. The major nutritional problems that are present are protein energy malnutrition (P.E.M), Nutritional anaemia, Iodine dificiency & Vit D dificiency. According. to N.N.S study:
*42% of under 5 children are stunted (Chronic P.E.M)
* Eleven 11% wasted (Acute P.E.M)
* 4% both stunted & wasted
In addition to P.E.M. , micronutrient dificiencies are common.

* The overall prevalence of anaemia having children 7-60 months are is about 65%. Nearly half of these had severe anaemia (Hb<9 Gms)
* Similarly anaemia is a serious problem along pregnant & lactating women, the anaemia rate are 35% for 15-19 years old rising to 66% for women between 45-50 years.
* Iodine difficiency diseases are endemic in northern area of the country & it is estimated that 50 millions people are at risk of iodine dificiency.
In infant & chiIdren , the factor contributing to malnutrition include:
i . Non-exclusive breast feeding.
ii. Inadequate knowledge of good weaning practices.
iii.Recurrent episodes of diarrhoea & resp; infections

In women of child bearing age low nutritional status results from
i. Chronic malnutrition during childhood
ii. Dietary intake that is insufficient to demand the needs of closely spaced pregnancies & Iactation.

COMMON DISEASES
The common diseases in Pakistan as in the other developing countries are Diarrhoeal diseases, Acute respiratory infection, Vaccine preventable diseases, Tuberculosis which is increasing day by day. The diseases causes very high mortality & morbidity in under 5 children. Out of 700,000 deaths annually in under 5 children, 200,000 are due to diarrhoea or complications of it, 1/3 due to acute respiratory infection and the rest due to vaccine preventable diseases and other infections including malaria.

CONCLUSION
Although the health status of children in Pakistan is not very good, it has much room for improvement. We have a lot to learn from Japan to improve child health in Pakistan.
ChiIdren in rich countries do not die from common preventable diseases of childhood. Childlen in poor countries do.
Except in rare and isolated cases measles, diarrhoea, malalia, Pneumonia and malnutlition no longer claim the lives of children in the industrialized countries. But in poor countries, these five conditions kill and account for 2/3 of all under more than 8 millions children a year five deaths.
The industerlized countries like Japan should come forward to help us overcome these problems.

i.National health statistics Government of Pakistan .
ii.National Nutritional Survey (N.N.S) Government of Pakistan.
iii.The Progress of Nations "Unicef 1996"