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.