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PAKISTAN is a hard place to be a baby. While according to the Pakistan Demographic and Health Survey (PDHS) it brought its under-five mortality rate down from 94 in 1999 to 89 per 1,000 live births in 2013, and by 2016 to 81, in South Asia it still ranks second to Afghanistan which tops the list with 91. India with 48 is followed by Bangladesh 38, Nepal 36, Bhutan 22, Sri Lanka 10 and the Maldives nine.
Pneumonia, diarrhoea and malaria account for almost a third of deaths among under-fives globally. Pneumonia alone accounts for 16 per cent of these deaths. On any given day, it claims the lives of some 2,500 children.
Coupled with the seasonality risk of contracting pneumonia, the deadly virus and bacteria of pneumonia surfaces in an overcrowded environment with indoor air pollution (smoke particles from cooking stoves is a key driver of childhood pneumonia) and affects malnourished and low-immunity children first.
World Pneumonia Day is a reminder to speed up the fight.
Still the world has made significant strides. With better access to antibiotics and improved nutrition, pneumonia deaths have declined. According to WHO, in 2004 pneumonia killed more than two million children globally; in 2015 the number was less than 1m. The vaccines introduced in the early 2000s (they attack 23 of the deadliest forms of the pneumonia bacterium, Streptococcus pneumoniae) have played an important part in fighting the disease.
In Pakistan, there’s little to celebrate. Equated with poverty, the disease remains under the radar of both the state and parents. This World Pneumonia Day (today) is a sombre reminder of the urgent need to reduce health inequality and to ensure no child dies from pneumonia or any vaccine-preventable disease.
The biggest hurdle in Pakistan’s fight against pneumonia is the low routine immunisation (RI) coverage which stands at a dismal 54pc, according to PDHS 2013 (Islamabad 74pc, Punjab 66pc, KP 53pc, Gilgit-Baltistan 47pc, Sindh 29pc and Balochistan 16pc). It may be added that this data is refuted by provinces that insist the RI coverage has vastly improved in the last four years, especially in KP and Punjab.
Pakistan launched the Expanded Programme on Immunisation (EPI)in 1978 with the aim to save children from TB, poliomyelitis, diphtheria, whooping cough, tetanus, hepatitis B, haemophilus influenza type B, pneumonia and measles, and pregnant women from tetanus.
Today, the nine vaccines are administered (a 10th — rotavirus — has been launched in some Punjab districts and is scheduled to be introduced across Pakistan by the end of this year) yet parents do not get their children immunised. The result is that of the over 400,000 under-five deaths, half the number is attributed to these diseases.
With regard to pneumonia, Pakistan is armed with both knowledge and technology. It already has a vaccine against pneumonia. Each of the three doses of the pneumococcus vaccine costs around Rs4,000 if inoculation is administered by a private health provider. However, the government, with support from international donors like WHO, Global Alliance for Vaccines Initiative and the Gates Foundation, provides it for free. Yet children continue to die from this illness. The major reason is that those most at risk — in urban slums, remote areas and migrant communities — are not reached.
A major reason for the lethargy is the two decades of undivided attention and resources spent on the eradication of polio. While the efforts here cannot be emphasised enough, eliminating other childhood diseases is just as important.
Parents used to polio workers arriving at their doorstep expect the same for other illnesses. What needs to be communicated to them is that vaccine vials cannot be taken out from EPI centres where a cold chain is in place, without which the vaccines lose their efficacy.
Apart from bottlenecks in the vaccination programme — insufficient funding, delay in release of funds, weak and ineffective monitoring, reporting and surveillance — there is the political appointment of inept district health officers.
There may not be a magic wand to overcome the plethora of problems that beset Pakistan’s RI, but if Punjab can do it, there is little reason why other provinces cannot.
Pakistan can achieve the Sustainable Development Goal of ending preventable deaths of newborns and under-fives if it sets out to do so. The problems and solutions are all known. All it needs is strong political will at the top and champions from among the elected representatives to take this on as a personal and collective goal.
The key to survival of Pakistani babies is simple and costs nothing. Exclusive breastfeeding up to at least six months (the current rate in the first four months is only 16pc); bringing routine immunisation in every province up to 90pc and improving water and sanitation will not only prevent cases of pneumonia but also help eradicate other diseases.
The writer is a freelance journalist.
zofeen28@hotmail.com
Published in Dawn, November 12th, 2017
