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Tuesday March 19, 2024

No progress on Pakistan’s high diarrhoea, stunting incidence, regrets World Bank

By Jamila Achakzai
November 14, 2018

Islamabad: Though Pakistan has made significant progress on reducing poverty, improving dietary diversity and reducing open defecation in the recent years, the critical markers of child health – rates of diarrhoea and stunting – still do not show any real improvement, declares a World Bank report launched at a hotel here on Tuesday.

The report titled 'when water becomes a hazard: the state of water supply, sanitation, and poverty in Pakistan and its impact on child stunting' warned that the alarming state of water supply and sanitation in Pakistan was creating major health hazards for the entire population with young children being at risk in particular.

According to it, bacterial contamination of surface and groundwater is on the rise in the country due to a lack of treatment of human waste. "The rural areas, where the majority of poor households reside, are the worst affected. Contamination levels are much higher in poorer and more rural districts and there is virtually no treatment of water at the household level.

"Fecal waste is also finding its way into the surface soil and into the water used for crop irrigation. This contaminates food supplies, which find their way into urban centres posing health hazards for millions of city dwellers."

The report declared young children the most vulnerable to diarrhoea and growth faltering due to environmental enteropathy, which, it said, limits the absorption of nutrients even during periods when the child shows no signs of diarrhoea—eventually leading to stunting.

Given the gravity of the problem and the levels of investment required, the report recommended a targeted and multi-tiered approach. "Investments in fecal waste management systems as well as in the provision of safe drinking water need to begin on an urgent basis but these will take time to reach scale.

"In the meantime, there are a number of relatively low-cost interventions that can be started immediately and at scale, to protect young children. These include efforts to encourage the point of use treatment of water and community and neighbourhood-based interventions to contain exposure to fecal waste so that the oral-fecal route for the transmission of disease can be weakened if not broken," it said.

Dr Ghazala Mansuri, one of the report authors, claimed that there were huge disparities across the country in the quality of water and sanitation infrastructure. "Rural areas across Pakistan have seen little or no investment in publicly provided piped drinking water, sewer connections or the treatment of human waste," she said.

Dr Mansuri, however, said even the most developed urban areas were not immune. "Untreated wastewater is mixed with ground and surface water to irrigate crops, so these pathogens also find their way to urban households. The key issue is that in such a context no one is protected," he said. Another report author, Farhan Sami, strongly felt that targeting available resources to the poorest and least well-served districts would not only maximise the direct impact of public spending, it would also reduce the negative spillovers created by poor quality sanitation and water to neighbouring non-poor areas creating a virtuous win-win cycle for all.

"Pakistan’s long-term aim must be adequate and safe piped water supply with metering and realistic tariffs. To accomplish this, we will need to safely move fecal waste away from human settlements and treat it adequately," he said.