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 combating 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
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. Shaji has 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
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
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
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.