Tuesday August 09, 2022

Experts call for investment in pneumonia prevention and treatment

November 12, 2017

It only requires six trips to a vaccination centre and your children will be protected from 10 dangerous diseases. Usually, many families miss these trips. It is noted that “from the first to the third vaccines”, trips decrease, and DP3 dropout for polio is very high.

According to Pakistan Demographic and Health Survey (PDHS) 2012-13, in Pakistan the ratio of fully immunised children, i.e. children immunised against all 9 VPDs (Vaccine Preventable Diseases) is 53 per cent, while it is only 29 per cent in Sindh. 

However, Pakistan Social and Living Standards Measurement Survey (PSLM) 2014-12 gives the figures of fully immunised children in Pakistan and Sindh at 82 per cent and 73 per cent respectively.

According to a press report of 2015, Pakistan is still among the top five countries of the world that account for 99 per cent of childhood pneumonia cases. At least 92,000 children die of pneumonia in the country every year, while 52 million cases of the illness are reported every year. This is despite the availability of free pneumonia vaccine in the Expanded Programme on Immunisation. Another micro census 2017 (PCCHI) for immunisation and urban slums puts the number of Zero Dose Children at 45 per cent in Karachi and 16 per cent in Hyderabad.

Every year, World Pneumonia Day is observed on November 12. This year’s theme, “Stop Pneumonia: Invest in Child Health”, calls for investing in pneumonia prevention, treatment and innovation to promote child health. Pneumonia is a form of acute respiratory infection that affects the lungs and the most common symptoms include rapid or difficult breathing, cough, fever, chills, headaches, loss of appetite and wheezing.

Repeated or severe episodes of pneumonia and diarrhea can inhibit a child’s growth and mental development and make a child more susceptible to other disease. Multiple studies identify under-nutrition as a risk factor for diarrhea and pneumonia throughout the world.

According DS Akram, honorary chairperson of Health Education and Literacy Programme, quoting the National Nutrition Survey 2011, wasting (low weight for height) among children is 15 per cent, stunting (low height for age) is 44 per cent and there are 32 per cent children who suffer from under weight.

Dr Agha M Ashfaq, project director of Extended Programme for Immunisation (EPI) Cell, Sindh, while recently explaining the situation regarding EPI to a group of media people, said: “Pakistan where EPI was initiated in 1979-80 has been making steady progress on immunisation. The objectives of EPI were eradication, elimination and reduction in morbidity and mortality caused by Vaccine Preventable Diseases: Covering less than 0-23 months and child bearing age 15-49 years (focusing pregnant women).”

He said that under EPI two types of activities are undertaken one is routine immunisation and the other is accelerated immunisation activity. Polio is an additional activity. Immunisation starts with an at-birth vaccine of childhood tuberculosis, while in the following months pentavalent vaccine which consists of OPV (oral polio), diphtheria, pertusis, tetanus, hepatitis-Bs, H Influenza B vaccines is given, and then pneumococcal (PVC-10), which was started in 2013.  

IPV was added in 2015. The next vaccines are Measles 1 & 2. Rota Virus vaccine will also be added in the EPI programme in December 2017 for childhood diarrhea. Collectively, 9 Antigens in EPI Schedule Plus One Rota Virus in 2017 will become 10 antigens. In Pakistan 6.5 million children are covered through EPI. 

He said the EPI survey coverage of 2014 and 2015 and administrative coverage of 2016 show various figures. PSLM 2015 shows fully immunised children (FIC) at 45 per cent. Similarly, the administrative coverage of Jan-Aug 2017 shows BCG coverage at 90 per cent while for measles 2 the coverage was 56 per cent. Similarly, for IPV the coverage was 53 per cent.

He said there were 1510 EPI centres in Sindh. Besides, vaccines are also administered through outreach centres, which also cover people from encatchment areas.

He said the Government of Sindh had provided Rs6.5 million for strengthening immunisation in the province. “In order to further strengthen the programme, UC-wise vaccinators have been enhanced three per UC for outreach and 01 for each EPI centre (Total EPI 1510), supported by the CM secretariat summary approval for 2119 vaccinators. 

As many as 572 vaccinators’ posts for Karachi will be advertised in the current month. Similarly, performance- based incentive of a Rs4,000 per month cash award will be given to the already working vaccinators. Besides, vaccinators have also been provided 500 motorcycles, and 400 bikes will be provided by WHO and 500 by the fund approved by CM secretariat.

As many as 1317 urban slums of Karachi and Hyderabad will be supported by Health Package that includes Nutrition/ Immunization/ MNCH Services and medical aid through UNICEF support.

He further said 32 high-risk talukas of northern Sindh would be supported by Unicef for M&E services, data management and enhancement of polio & routine immunization activities. Eighteen  cold rooms will be installed in 15 towns, one in Sujawal and two in Provincial EPI Cell (nine installed). Hepatitis B birth dose is being piloted in three districts and two towns of Karachi. Rotavirus introduction in December and Measles SIAs are planned for 2018.

Dr Kausar Fatima, deputy medical superintendent, Sindh Government Children Hospital, North Nazimabad, Karachi, says lack of awareness among mothers is the leading cause of spread of disease. “Mothers pay less attention to immunising their children. They also fail to understand the symptoms of pneumonia and only come to a medical facility when fever is very high and child is severely breathless.”

As for pre-season care, she says that if mothers keep their children covered, especially very young children of three to four months in winters, then illness can be avoided. “We don’t have a habit of wearing masks in case of flue and thus transmit infection to children, who posses very weak immunity. People should also visit hospital with masks,” she says. Dr Kauser terms pneumonia a public health issue, as it can become endemic too.

Awareness about any preventable diseases among the masses can be raised through political leadership too. While we hear a voice or two about immunisation from one political party or the other, none has done a serious campaign on immunisation, as their leading political agenda. 

A review of the manifesto for the 2013 election of major political parties of Pakistan shows that almost all of them have given some plans regarding the health of mothers and children, yet a rigorous campaign on their part is still missing.

The only single party which has carved out a special plan for immunisation is the Pakistan Peoples Party. In their manifesto for the 2013 election, the party has vowed to bring the population growth rate down to 1.6 per cent. Besides, it has also vowed to merge polio eradication, routine vaccination, LHWs, mother and child care, malaria and hepatitis control, and family planning to create a consolidated and coordinated public health programme, providing security for vaccinators. It has also promised to ensure that 100 per cent of infants and children under 5 years are vaccinated and procure WHO-certified vaccines at competitive rates and eradicate polio by 2015.