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New Commodities for Management of Pneumonia and Diarrhea Make a Difference

By Fatima Shahryar

Bahawalnagar, Punjab – February 2018: Sitting in her modest courtyard, Kausar pours a mixture of Zinc and low Osmolarity Oral Rehydration Salt (LoORS) into a pot of water boiling in a clay oven. Her one-year-old son Nabeel sits close by, looking frail and unwell. 

“Nabeel has been suffering from diarrhea for the last three days,” says Kausar, a resident of Kot Hamraj, Bahawalnagar District, Punjab. “The frequency of motions had made him very weak. I got worried and rushed him to Irum Naz (a Lady Health Worker in the village). She gave me this new medicine that I fed him in the morning. She also gave me an ORS pack, which I dissolve in water and feed to him all day long. The motions have stopped and he seems to be recovering. My heart is now at peace.”


Kausar, a resident of Kot Hamraj, Bahawalnagar District in Southern Punjab, prepares Oral Rehydration Salt for her one-year-old son Nabeel, who has been suffering from diarrhea.
© UNICEF/PAKISTAN/Sami Malik

Kot Hamraj is a small village located in south east of Punjab. Majority of people in this village depend on cattle farming for their livelihood while others work in the fields. Access to health care is limited; thus, making Irum Naz, the direct point of contact for all health-related issues. 

Irum is a certified “In the past, every time the season changed or there was a disease outbreak, cases of pneumonia and diarrhea in my community would increase rapidly. It was very difficult to manage so many cases at a time,” says LHW Irumgovernment frontline health worker, who provides basic health care and counseling services to the people of her community. She has established a ‘Health House’ in one of the rooms in her own home. Though it has limited facilities, the Health House is a dedicated space for village women and children to visit her and seek medical advice. Irum both advises on general health related issues and provides medicines. For acute or complicated cases, she refers the women and children to higher-level government health care facilities.

“In the past, every time the season changed or there was a disease outbreak, cases of pneumonia and diarrhea in my community would increase rapidly. It was very difficult to manage so many cases at a time,” says Irum Naz. “However, since we have been provided with and trained on the use of the new packing of ORS, amoxicillin and dispersible tablets of Zinc, dosage accuracy has standardized and occurrence of cases has reduced three-fold.”


Irum Naz, the Lady Health Worker in Kot Hamraj, gives Kausar an additional pack of LoORS and Zinc for treatment of diarrhea. Bahawalnagar District, South Punjab.
© UNICEF/PAKISTAN/Sami Malik

Diarrhea and pneumonia are the leading causes of child mortality in Pakistan. Each year, approximately 91,000 children die from pneumonia and another 53,300 die from diarrhea. These diseases can be prevented by simple interventions at the household level, including the use of safe drinking water, handwashing with soap, covering food and dressing children in warm clothing. It is critical that all children suffering from diarrhea and pneumonia receive timely and appropriate treatment.

Amoxicillin syrup remains the prescribed medicine for the treatment of pneumonia at most health care facilities. The prescribed treatment for diarrhea is ORS and zinc syrup. However, ORS requires accuracy in preparation and is therefore often not used correctly; meanwhile zinc syrup is not easily available at local pharmacies.

“It was very difficult to ensure both that mothers are making ORS solution correctly and giving it to the child in accurate amounts and at the appropriate time. In some cases, to save the ORS from wastage, mothers would just prepare it in a glass adding approximate amounts of water and salt, which is incorrect. The size of spoon used for measuring the dosage also varied. This negatively impacted the treatment and recovery of children,” says Irum.

Administration and storage of medicines also remains a challenge for mothers in rural areas. Most medicines require storage in refrigerators, which are simply unaffordable for poorer communities. 

To address these issues and improve child survival in Pakistan, UNICEF, with funding support from the Bill & Melinda Gates Foundation, procured new commodities for management of pneumonia and diarrhea. These include dispersible tablets of amoxicillin (Amoxil DT) for the treatment of pneumonia; and               co-packages of zinc dispersible tablets (Zinc DT) with smaller sachets of LoORS for the treatment of diarrhea. The new gadgets for timely diagnosis of pneumonia and acute respiratory infections (ARI) include pulse oximeters, oxygen and ARI timers that help in getting a correct reading of a child’s breathing rate.


Lady Health visitors at Basic Health Unit, Kot Hamraj, Bahwalnagar District, assess a child for pneumonia diagnosis, using oximeter provided by UNICEF.
© UNICEF/PAKISTAN/Sami Malik

The initiative is being implemented in all 29 districts of Sindh and in five districts of Punjab. Through its own funding, the Government of Punjab is planning to expand the initiative to 10 more districts in the province. With support from the respective health departments, these essential commodities have been made available in all these districts at tertiary, secondary and primary health care facilities.

With limited access to health care in rural areas, most parents tend to go to hospitals located in urban areas. Every time a child does not show signs of improvement after being treated at the local health facility, parents travel long distances taking the child to a district hospital. At the Civil Hospital, Karachi, one of the largest in the city, hundreds of families come in every day from all over Sindh. As a result, it is always overcrowded with patients and their caretakers. While many of them travel back to their respective areas after consultation, several stay on for days and nights for a follow up. Many are seen sleeping in the hospital compound, on the floor and in the open.  

“Due to a high number of patients coming in every day, we have set up a separate clinic for children under five years of age,” says Dr. Ameena Khalid, In-charge of the Children’s Clinic in Civil Hospital. “We have different units where we can treat children depending on the level of care they require. This helps us not only to manage the high influx of patients but also to provide better care.”

“Since the introduction and usage of the new commodities, more mothers are returning to us with evident improvement in their children’s health. With ever increasing demand, we hope that these commodities will soon be available at private pharmacies too. That would improve the health status of children and reduce the price of these medicines considerably.”


Dr. Ameena Khalid, in-charge of under-five children's clinic, at Civil Hospital Karachi, assesses a child for pneumonia diagnosis.
© UNICEF/PAKISTAN/Sami Malik

Emphasizing on the importance of usage of new commodities for pneumonia and diarrhea management, Dr. Kennedy Ongwae, Chief of Health, UNICEF Pakistan believes that “Amoxicillin dispersible tablets, zinc dispersible tablets, loORS, RI timers and oxygen oximeters are evidence based high impact, low cost and lifesaving commodities and devices that, if used at scale, will significantly reduce under-five mortality in Pakistan.” 

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