The Killer No One Suspects
Written 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.
