Upping primary healthcare

November 20, 2022

The absence of a structured primary care system has contributed significantly to inadequate provision of child healthcare

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hildren are a vulnerable population. They need to be looked after in many ways and cannot make decisions for themselves. In low middle-income countries, healthcare systems are fragile and access to healthcare is limited. Healthcare provision to children is often inadequate. According to the UNICEF, Pakistan’s under-five mortality rate is 65.2 percent. Moreover, 62.56 percent of the Pakistani population resides in a rural setup, where provision of essential medical facilities is insufficient. On top of that, Pakistan’s literacy rate has not risen above 60 percent for a number of years. The sheer absence of a structured primary care system has resulted in inadequate awareness and signposting of unschooled people. The task of promoting and maintaining healthy lifestyle is therefore severely compromised.

As per figures from 2021, the under 15 population in Pakistan is 34.63 percent. In the absence of comprehensive digitalised data collection the implementation of various services, such as neonatal screening, country cannot be assured. A study conducted on 770 neonates in tertiary care hospitals in Lahore concluded that the rate of congenital hypothyroidism was significantly higher than other countries. This warrants nationwide screening for congenital hypothyroidism (CH) to ensure that cases are diagnosed early and treated. Such measures will reduce the development of complications affecting physical development and neurological functions due to CH.

40-70 percent of Pakistani children under five years of age have iron deficiency anaemia (IDA). This not only hampers their physical growth/ development but also impairs cognition. IDA can be managed through counselling regarding diet, use of iron supplements and prevention of parasitic infections.

Identification of Inherited disorders like genetic or metabolic conditions (for example: sickle cell disease, thalassemia, phenylketonuria (PKU), Wilson’s disease, glycogen storage disorders etc) remains abysmal due to non-availability or limited resources or services. With no national data/ disease registry and lack of timely diagnosis of such disorders, significantly high morbidity and mortality is seen among paediatric population.

40-70 percent of Pakistani children under five years of age have iron deficiency anaemia (IDA). This not only hampers their physical growth/ development but also impairs cognition.

In terms of vaccine preventable diseases, an expanded programme of immunisations exists. However, eradication of measles and polio has not been achieved yet. Sadly, Pakistan continues to be on the list of countries with high numbers of unvaccinated or under vaccinated children. Low socioeconomic position of families coupled with high illiteracy rates in the population has been associated with higher unvaccinated children.

Mental health among children and adolescents is another need to be addressed. Communications and regular meeting of parents with school teachers, primary care physicians and specialists must take place to effectively deal with this growing problem. Counselling and discussion forums (face to face or online) must be provided to parents, children and carers.

Various local studies have highlighted data on prevalence and incidence of infectious diseases like hepatitis B, C and HIV among children in Pakistan. Both vertical transmissions (i.e., from mother to child) or horizontal transmissions (i.e., exposure to infected blood) have been reported. Use of contaminated needles as part of therapeutic use of injections or drip sets, unsterilised surgical or dental instruments or use of unsterilised razors at barbers’ shops have been reported as leading causes of spread of these infections.

The solution to deal with the aforementioned challenging situations is to establish a robust primary care system. Steps must be taken to train primary care physicians and other members of primary healthcare teams like vaccinators, nurses and lady health visitors to deal with current disease burden effectively. Health and education departments must give priority to mental health education and nutrition education in schools. Mental health counsellors, psychologists and nutritionists must be placed in institutions to deal with emerging issues. It is crucial that our policy makers and stakeholders recognise that use of unsafe injections is a country wide issue and must be resolved immediately. Investing in children’s health is productive in the long run. There are economic benefits too to adequate nutrition and timely immunisation.

The writer is an assistant professor in family medicine atthe University ofHealth Sciences, Lahore

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