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Fighting the scourge of pneumonia and diarrhoea in Pakistan

By UNICEF Health Programme

KARACHI / BAHAWALNAGAR, Sindh/Punjab - October 2018: Sitting on a hardwood chair next to a crib, Naseema Bibi keeps a watchful eye on her nine-month-old son, Shahab. 

For the last four days, she had little sleep as she kept watching her  child in the pediatric ward of Karachi’s Civil Hospital. Handwritten on a clipboard chart besides his bed is a diagnosis: pneumonia. 

“Shahab has been suffering from a continuous cough and fever that made him very weak for one week,” Naseema says. “A Lady Health Worker in my village came to see him. She told me to immediately travel to the city and take him to the hospital.”

Naseema Bibi comes from Mubarak, a village populated by fishermen and farmers living in small wooden huts. There are no adequate health facilities to treat children with health complications nearby, which is why Naseema had to take her son to the city.

A vaccinator prepares PCV 10 (vaccine for pneumonia) for a year-and-a-half old infant at a vaccination center in Nankana District, Punjab. © UNICEF/UNI181939/Asad Zaidi

Once in Karachi, the doctors checked the child’s breath counts and determined he had pneumonia. They gave him antibiotics, which have helped him slowly recover, much to the relief of his mother.

Little Shahab is one of 120 million children who develop pneumonia in the world every year. In Pakistan, more than 90,000 children die of this lung infection every year, even though it is treatable.

Pneumonia is a particularly unfair disease, in that it claims the lives of the most impoverished children. Even though the infection can be easily managed with simple and effective interventions, and is rarely life-threatening, it continues to claim the lives of children living in impoverished communities. 

Claiming the lives of the most vulnerable children
Mortality due to childhood pneumonia is strongly linked to poverty-related factors such as undernutrition, lack of safe water and sanitation, indoor air pollution and inadequate access to health care. 

“Most of the vaccines for the treatment of pneumonia must be stored in refrigerators that poor communities cannot afford,” says Ms. Durdana Khalid, who supervises the Lady Health Workers who provide rural communities with health support. 

Another issue is the fact that parents are often unable to detect the danger signs of pneumonia in their children, and that rural communities are often located far from health centres.

UNICEF and the Government of Pakistan have trained community health workers to check on the health of children and to help diagnose and prevent disease like pneumonia. In close cooperation with Pakistan’s Ministry of Health and provincial health authorities, UNICEF has been supporting the fight against under-five child deaths related to both diseases in the provinces of Sindh and Punjab for the past two years. This was made possible thanks to a generous USD 12.6 million grant from the Bill and Melinda Gates Foundation.

The project has helped improve child survival in Pakistan by strengthening diagnosis and treatment processes and ensuring the availability of medical supplies and antibiotics to identify the diseases and treat them. 

Durdana Khalid and the Lady Health Workers she supervises have been trained to accurately detect and treat acute respiratory infections in children. They now have access to the antibiotics and medical supplies they need to timely identify cases of acute respiratory infections and diarrhoea, and can determine whether they should give a child some antibiotics, or refer them to a health centre in case of pneumonia. 

Karachi civil hospital ’s paediatric department now includes a clinic for under-five children, which offers preventive and curative services under the same roof. It also provides weekly sessions on nutrition, WASH and breastfeeding techniques to mothers and Lady Health Workers. 

With the demand increasing, doctors at the hospital expect that soon the new recommended medical supplies needed to treat pneumonia will also be accessible at local pharmacies.

The looming threat of diarrhoea
Pneumonia is not the only danger for impoverished children; diarrhoea is another looming threat.

Living in a rural community often makes life a daily challenge. You need to collect water with a hand pump, knowing that it is not drinkable unless you have the means to purify it. You need to cook on a clay stove where you are exposed to unhealthy smokes and drains, sometimes shared by the whole village. The lack of hygiene often results in young children constantly suffer from stomach pain and diarrhoea.

Such is the case of Muhammad Hazib Ali, a 1.5-year-old baby boy who lives in Toba Qalander Shah, a small village in Punjab’s Bahawalnagar district. He lives with his mother, his father who runs a small samosa stall, and three siblings in a small shack with dirty floors. There is no proper sanitation in the village, where people  often resort to open defecation. 

“Muhammad Hazib started suffering from diarrhea when he was only eight months old,” says Assiya, his mother. “I was very terrified he would die because I had seen other children in my village succumb to it.”

Her little boy kept vomiting, would not drink his milk and became very weak, to the point that he was no longer moving. In the middle of the night, she decided to call the village’s Lady Health Worker, Amna Baji. 

Thanks to the programme, Amna Bibi has been trained to detect the danger signs of diarrhoea in young children. She also knows when to refer severe cases to a health centre located far outside the village, and has taught parents how to use remedies to treat sick children and how to purify water before drinking it.

Thanks to the training and supplies she received under the programme, Amna Bibi knew how to treat the little boy and give him the right medication. 

She provides all children in her community with a combination of zinc and fluid replacement to promote their immunity to diarrhoea and reduce the severity and duration of diarrhoeal episodes. 

In rural settings, a little training and some supplies can make a significant difference. Health authorities say that the programme has helped save many children’s lives in the district of Bahawalnagar -- including that of little Muhammad Hazib, who has recovered and is healthy again.



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