KARACHI: Deaths of children in drought-hit Thar, over two dozens new polio cases and a number of deaths from Congo-Crimean Haemorrhage Fever (CCHF), Ebola, Naegleria fowleri (brain-eating amoeba) and dengue overshadowed the remarkable legislation done by the Sindh Assembly in the health sector in the year 2014.

However, none of the several landmark healthcare bills could be implemented because of red tape.

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The provincial government allocated Rs13 billion for annual development budget of the Sindh health department, claiming that health services had been substantially improved. But complaints about ghost doctors and paramedics were rampant across the province with most health facilities in rural areas continued to be victim of neglect.PAM is defined in medical literature as a rare but typically fatal infection caused by Naegleria fowleri (an amoeba found in rivers, lakes, springs, drinking water networks and poorly chlorinated swimming pools).

About the drought situation in Thar, Sindh government reports state that 311 children aged up to five years died between December 2013 and November 2014. But independent groups and individuals put it more than double to the official figure.

Officially, the main causes of death of the children were birth asphyxia, pre-term, low birth weight, respiratory distress syndrome, pneumonia, delivery of babies through traditional birth attendants that caused neonatal sepsis and diarrhoea.

Health officials say 118 children of those who died were newborn babies (one day old), 82 were between two days and one month, 28 children aged between 45 days and 90 days and 29 children were between eight months and one year.

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The reports say the Thar communities, particularly women, lack awareness of health concerns aimed at ensuring safety of their lives.

Polio

In sharp contrast to the claims of the Sindh government, which right after winning the May 2013 general elections promised to make Sindh polio-free province, the province saw the number of polio victims triple within the couple of years. The rise in number of polio cases caused the authorities to announce ‘polio emergency’ in the province.

As the curtains drawn down on 2014, Sindh contributed 29 out of around 300 polio cases reported at the national level. Karachi remained the worst city with 23 cases, while two cases were recorded from Sanghar and one each case was reported from Dadu, Badin, Shikarpur and Larkana districts.

In Sindh, the disease had crippled 10 children in 2013, four in 2012 and as many as 33 children in 2011. The surge in number of polio cases were again witnessed in 2014 when 29 cases were recorded.

Security remained a major issue in carrying out effective polio vaccination drives. The worst and only violent attack on volunteers was reported on Jan 21 in which two women and a man were gunned down in Qayyumabad.

The attack prompted the government to restrict volunteers’ movement until they were provided better security cover by the police. For host of reasons, including limited resources and manpower with the police, volunteers never fully covered all targeted areas in any campaign, making it hard to inoculate children across the metropolis.

The total number of polio cases in Pakistan rose more than three times of 93 cases which had been recorded in 2013. The figure was 58 in 2012.

In all, 775 polio cases have been detected during the past 18 years in Sindh.

The authorities are more concerned for Karachi, particularly Gadap and Baldia towns, where positive samples are still surfacing. Eleven union councils where all the 23 cases in Karachi were detected last year were finally marked by the relevant authorities for targeted immunisation campaigns.

Naegleria fowleri

Last year death toll from a deadly waterborne infection, primary amoebic meningoencephalitis (PAM), shot to 14 — all time high since the lethal germ began attacking residents of Karachi in 2012.

The cases in the city stood at three in 2013.

Ineffective chlorination of tap water was blamed for the threat posed to a large population by the Naegleria fowleri that claimed at least 10 lives in 2012.

Experts suggest that the government ensure supply of chlorinated water supply for domestic use, make water filter plants functional and ensure quality of water in swimming pools.

Dengue

After record cases documented because of dengue infection, the health department dismantled the dengue surveillance cell with the promise to replace it with a much more effective body.

However, no body was witnessed to take responsibility of informing public and media about its hazards and exact figures.

Independent sources said around 2,000 dengue cases were recorded in 2014 with around 20 deaths. Some officials said the number of deaths were less than 15.

The year, however, still proved better than 2013 when it was in the grip of dengue infection until the year end with half a dozen patients suffering from dengue. In 2013, more than 6,000 confirmed cases of dengue patients were reported, making it the year with most confirmed cases.

Congo fever

Congo-Crimean Haemorrhage Fever (CCHF) surged in the city with the total number of cases last year rising to 16, which happened to be the 15-year high.

Of the 16 patients, six patients including a woman died.

A 55-year-old woman was the oldest and a four-year-old boy the youngest victim of the disease.

Barring five, all the victims were young aging between four years and 27 years – seven of them were 20 years or less.

Officials said the most number of CCHF cases in Karachi were recorded in 2014 since the beginning of the new millennium. But they said the health department had not preserved the records on a scientific ground which could be compared with previous years toll.

Ebola virus

Ebola virus, which wreaked havoc on West Africa last year with hundreds of deaths, scared Sindh also where isolation wards in government hospitals were arranged while special kits and training were given to health officials by the World Health Organisation.

Authorities at the Karachi airport found a Pakistani passenger arriving from Liberia carrying Ebola symptoms. But he remained under treatment and observation at the Jinnah Postgraduate Medical Centre during which he was tested negative for Ebola and subsequently discharged from the hospital.

Malaria

Given the authorities’ immense concentration on tackling dengue fever, they even used the manpower and equipment meant to combat malarial threat for prevention of dengue.

A director of its vertical programme was transferred from Hyderabad to Karachi besides the resources diverted to Karachi. Officials said because of little attention given to malaria, which affects most of Sindh’s rural districts, it afflicted the populations almost double to what it averagely does previously.

Legislation

The province, however, saw remarkable legislation in 2014 when the Sindh Assembly passed over a dozen landmark bills.

Most prominent of them was the Sindh Healthcare Comm­ission Bill. Being the first provincial assembly in the country to have passed the bill, Sindh set a precedent for others to follow.

However, despite several months after the bills were signed into law, they were still waiting for proper enforcement. Strict procedures and manpower were needed to get them practised to gain what they were actually aimed at.

The bills included The Postgraduate College of Medical Sciences Sindh Bill, Sindh Allopathic System (Prevention of Misuse) Bill, Sindh Physiotherapy Council Bill, Sindh Pharmacy Council Bill, Sindh Nursing Council Bill, Sindh Epidemic Disease Bill 2014, Sindh Eye Surgery (Ban) Bill 2014, Sindh Tuberculosis Notification Bill 2014 and The National Institute of Cardiovascular Diseases (Sindh Administration) Bill 2014.

A bill relating to the provincial medical and dental council was handed to the health standing committee after it attracted huge opposition from medical fraternity.

Some significant bills of 2013, which were yet to be implemented, included Sindh HIV and Aids Control Treatment and Protection Bill, 2013, The Sindh Newborn Screening Bill, 2013 and The Sindh Prevention and Control of Thalassemia Bill, 2013.

Published in Dawn, January 12th, 2015

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