Recently, the Pakistani press and electronic media have displayed detailed pictures of children who sadly died because of measles, a very infectious disease.
The World Health Organization (WHO) also substantiates the news reports and informed that 306 children died in the country in 2012 due to this infectious disease. A large number of these deaths were reported in December 2012 in Sindh, the second most populated province of Pakistan.
It is all really unfortunate, considering that all these deaths could have been prevented if the Government and the Health Department had properly and timely managed the anti-measles immunization campaign in all parts of the country. In 1990, the Government of Pakistan ratified the UN Convention on the Rights of the Child (CRC) which recognizes that children are vulnerable and therefore require special care and assistance. Article 24 of CRC:
1.States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services.
2. States Parties shall pursue full implementation of this right and, in particular, shall take appropriate measures:
(a) To diminish infant and child mortality;
(b) To ensure the provision of necessary medical assistance and health care to all children with emphasis on the development of primary health care;
(c) To combat disease and malnutrition, including within the framework of primary health care, through, inter alia, the application of readily available technology and through the provision of adequate nutritious foods and clean drinking-water, taking into consideration the dangers and risks of environmental pollution;
(d) To ensure appropriate pre-natal and post-natal health care for mothers;
(e) To ensure that all segments of society, in particular parents and children, are informed, have access to education and are supported in the use of basic knowledge of child health and nutrition, the advantages of breastfeeding, hygiene and environmental sanitation and the prevention of accidents;
(f) To develop preventive health care, guidance for parents and family planning education and services.
3. States Parties shall take all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children.
Health practitioners describe measles as a very contagious viral disease that spreads through the air by breathing, coughing or sneezing. It is highly risky when a child gets exposed to it and has not been vaccinated against the virus. Further diseases and other fatal complications are likely to occur, including pneumonia and encephalitis.
According to the Centers for Disease Control and Prevention, “About one out of 10 children with measles also gets an ear infection, and up to one out of 20 gets pneumonia. About one out of 1,000 gets encephalitis and one or two out of 1,000 die”.
It is a fact that the Pakistani health care management system is sliding in downward track due to lack of direction and resources, and is aggravated by endemic corruption and inefficiency. The situation is compounded with a general lack of awareness about the importance of immunization to prevent diseases such as measles and polio. Additionally, the uncertain situation in many areas of the country and the gruesome attacks on anti-polio health workers have made it difficult to fight against those diseases, which instead have been wiped out not only in developed countries but even in several developing countries.
Dr. Iftikhar Ahmed, an official representative of a health focused NGO, observed that besides polio, a disease which is only present in Afghanistan, Nigeria and Pakistan, measles is the biggest threat to the survival, protection and development of Pakistani children. Dr. Iftikhar Ahmed added that the loss of so many precious lives clearly indicates that the Government Ministries and allied Departments have been failing miserably to administer the measles immunization campaign, especially in the flood affected areas of Sindh province.
It has been reported that most of the children who died in Sindh province were from those areas affected by the super floods in 2010 and 2011. Tufail Khaskheli, an NGO staff member, informed that the survival children in flood affected areas are already at a high stake and added that, “The majority of children’s deaths occurred in poor and displaced families, where availability of adequate and appropriate food is a serious issue.”
Malnourishment among women and children, no matter living in rural or urban areas, is not an unusual phenomenon. The availability of a balanced diet for women and children is an issue of major concern in the country. The lack of healthy food makes the vulnerable groups more prone to health problems and diseases due to their low physical resistance.
It is important to mention that according to a survey conducted by the National Nutritional Survey (NNS) in 2011, almost 58% of Pakistanis are food insecure. A high inflation rate, an increase in food and kitchen item prices and dwindling employment opportunities have further worsened the situation.
Dr. Ali , a public health practitioner working in a national NGO, informed that measles epidemics across the world are mostly seen in areas with low or no uptake of its vaccine at the appropriate age, and the situation is further aggravated by malnourishment and congested living. He added that a closer look at the present surge in measles cases and resulted fatalities in Sindh validates the global findings as mentioned earlier. The province of Sindh witnessed super floods and rain in the last two years, which has entailed death and destruction of immense proportion. The public health expert added that due to limited capacity of the public institutions, the affected population is struggling to bring back a sense of normalcy in their lives. A number of people are still living in the make shift homes with no basic amenities. Generalized malnourish and congested living enhance their vulnerabilities to all sorts of diseases, including measles.
This alarming situation requires immediate action from the Government and health focused organizations to apply plausible strategies and utilize all available resources to protect the exposed children in risky areas. Special effort should be directed not only to ensure the measles vaccination to all children under the age of five, but also to improve their nutritional status. It is a proven fact that the levels of Vitamin A in the body are usually depleted during the measles infection, which leads to respiratory tract infections and diarrhoea, two leading causes of death in children affected by the measles virus. While Vitamin A supplementation is being carried out across the country with the polio campaign, it is worthwhile to remember that this vitamin is abundant in mother’s milk, green leafy vegetables, milk, milk products and yellow fruits. Fish also has very high contents of vitamin A.
Primary health care, if practiced in its true sense, can still provide remedies to a lot of health issues in our country. There is a dire need to understand that the basic purpose of an ideal health care system is to provide services to common and needy people, especially those who have limited or no capacity to access the health services from the private sector.
About the Author: Amir Murtaza is a researcher and can be approached at amirmurtaza@hotmail.com
