Fri. Dec 14th, 2018

The Killer No One Suspects


By Kainat Hasan

As the child mortality rate of under-five year increases, stunting has become a global development priority. With sanitation being one of the leading cause.

Pakistan is one of the ten countries in the world where more than half of the under-five year population suffers from either stunting or wasting. Stunting; is a medical term used for the condition of a child who is too short for his or her age.  If stunting is left untreated, it can lead to irreversible brain and body damage.

Over the past two decades, the Pakistani government has notably recorded significant achievements in combatting polio, increasing routine immunization, and decreasing the number of out of school children. Progress in stunting reduction, however, has presented mixed results. According to the latest available figures by WHO, the under-five stunting rate in the country is as high as 44% and 24% suffer from severe stunting, thus making Pakistan the third largest in the world.

While the consequences of stunting are clear, its causes are more complex. Poor sanitation is one of the major public health concern linked to several health outcomes, including childhood stunting. According to a report by UNICEF, “In 2013, diarrheal diseases were estimated to cause 20% of post neonatal deaths in Pakistan alone.”Pakistan has shown very little progress in terms of water quality despite the number of initiatives taken at federal and provincial levels.

Haseena, a seven-year-old girl who lives in Shantinagar, Karachi, is a victim of stunting. Sadly, her mother Ruksar does not even know what stunting means.  Due to poor sanitation of water in that area, many children suffer and stay ill throughout the year.

During the 3rd Conference of sanitation (PACOSAN), Mr. Javed Jabbar expressed, “We dispose sewerage in to Lake Rivers and sea that is now impacting everyone adversely. The structure of control at grass root level is weak in terms of local government.”

Research during the past years indicates that sanitation could be critical in shaping a child’s height and growth. Water, Sanitation, and Hygiene (WASH) can have a profound effect on health and nutrition.

Apart from Ruksar, Shaji, the area doctor of Shantinagar also is unaware of stunting as a medical issue. Upon asking Shaji about what is the real problem with Haseena, he confidently replied, “her kids are born this way and Haseena has some allergy with un-clean water which gets cured with an injection.”

Sadly, water and sanitation are the most ignored sectors in Pakistan. Adequate sanitation and water quality are important factors in the body’s ability to absorb/retain nutrients.

In 2014, the concern of sanitation and nutrition also moved to the front of the development plan. Sanitation now is a global issue; ending open defecation is near the top of world’s post -2018 goals for sustainable development. The most recent report by World Bank states that “More than 60% of children in Sindh, below five years of age, are feared entering into acute or chorionic malnutrition which then leads to stunting.”

Haseena is Eight – years– old, but, looks like a five – year – old. Ruksar further told us that the area doctor does nothing except giving (takat walay injection) injections for boosting energy. Shajihas been giving these injections to my kids since they were three years old and when the situation used to get worse he would give them a (takat wali drip) drip to boost the energy.

The diseases recurrent diarrhea and intestinal infections which are both linked to poor sanitation have been shown to contribute in child stunting. To eliminate such diseases from the environment, government needs to take quick and strict actions.

Globally, unsafe water, poor sanitation and hygiene cause 860,000 malnutrition deaths. There is prominent inequity between the nutritional indicators of urban and rural populations, and the children from the poorest wealth quintile are faring the worst.

Current recommendations for improved infant and Young Child Nutrition (IYCN) include initiation of breastfeeding until 6 months of age.

“Most of the children diagnosed are under the age of 3, suffering from diarrhea. When asked about their routine from their mothers, many of them were breastfeed until a month after they were born and since are surviving of contaminated water.

If water bases are not secure or are unexpectedly contaminated for any reason, the value of drinking water suffers. We need to stress on the need for sustaining successful intervention through a strong government ownership and a nutrition coalition across all sectors working under a common over-arching framework. Sanitation can add immediate effects on health, which can lead to deaths of an already malnourished child.

Since 2016, Sindh (nutrition only), Already Pakistan has pushed polio occurrence to zero. The country is capable of overcoming stunting through strong leadership and by the actions of state. Pakistan is looking forward to improving breastfeeding rates, decreasing the high use of infant formulas and improving family and community hygiene practices.

With Imran Khan, Pakistan’s newly elected Prime Minister addressing stunting as one of the major issues of Pakistan, the situation needs to gradually improve over the years. Until 2007 more than half of Pakistan’s population did not have access to improved sanitation facilities. By 2015, Pakistan successfully reached its Millennium Development Goal (MDG) for sanitation, with nearly 64% of the population having access to sanitation. Making Pakistan one of the world’s 95 country to attain the MDG for sanitation.

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