Voice Of Children

Muhammad QasimTuesday, November 12, 2013 
From Print Edition

Rawalpindi

Every 30 seconds, a child somewhere in the world, dies of pneumonia, making it number one global cause of childhood mortality. In Pakistan, an estimated seven million cases of pneumonia occur every year and out of these, as many as 92,000 children die before their fifth birthday due to the infection. At least 85 out of 1,000 children die under the age of five in Pakistan and it is alarming that most of these deaths are unfortunately due to vaccine preventable diseases including pneumonia.

Pneumonia is a form of acute respiratory infection that affects the lungs. It is caused by viruses, bacteria or fungi (germs). The viruses and bacteria that are commonly found in a child’s nose or throat can infect the lungs if they are inhaled. They may also spread via air-borne drops from a cough or sneeze.

Children whose immune systems are compromised are at higher risk of developing pneumonia. Infants and children below two years of age are at higher risk of contracting pneumonia as their immune systems are still developing, said Head of Community Medicine at CMH Lahore Medical College Professor Dr. Muhammad Ashraf Chaudhry while talking to ‘The News’ in connection with World Pneumonia Day being observed on November 12 (today). He said that World Pneumonia Day is observed to raise awareness of pneumonia as a public health issue and help prevent millions of avoidable deaths from the infection that occur each year. “The theme of this year is: “Innovation” highlighting innovative solutions to end childhood pneumonia while at the same time emphasising that there are existing simple interventions that need to reach the most vulnerable children.”

Dr. Ashraf said that pneumonia is preventable and treatable with host of proven interventions, including exclusive breastfeeding infants in their first six months of life, ensuring an environment free of indoor air pollution and promoting frequent hand washing, immunising against leading causes, and ensuring access to medical care and antibiotics when cases do emerge. He said that appropriately treating underlying causes such as malnutrition, and exclusively breast-feeding children for the first six months of their life can decrease the risk of pneumonia.

He believes that a child’s immune system may be weakened by malnutrition or under nourishment, especially in infants who are not exclusively breastfed for the first six months of their life.

He said that more than 50 per cent children under five years of age are malnourished in Pakistan. HIV infections and measles also increase child’s risk of contracting pneumonia. Environmental factors such as indoor air pollution caused by cooking fires and heating with biomass fuels such as wood or dung, a coal, living in crowded homes and parental smoking also increase a child’s susceptibility to pneumonia, he said.

He pointed out that alarmingly Pakistan has the lowest breastfeeding rates in South Asia, 37 per cent. He added that ignoring early signs of pneumonia can be death sentence. The symptoms of pneumonia include: rapid or fast breathing, cough, fever, chills, loss of appetite, wheezing, lower chest wall in drawing; very severely ill infants may be unable to feed or drink and may also experience convulsions, he explained.

Talking of remedies, he said that limiting exposure to smoke from cigarettes or indoor cook stoves and fires can help limit the risk of pneumonia. “Research has shown that hand washing with soap and water can reduce the number of pneumonia -related infections in children under the age of five by more than 50 percent.” Dr. Ashraf added that immunising against pneumococcus, measles and whooping cough is the most effective way to prevent pneumonia. Parents should not be hesitant about taking their children to the nearest health facility for the administration of vaccines that are available free of cost.

To a query, he said that by managing cases of pneumonia in children with antibiotics at community level, pneumonia-related child deaths can be reduced by 70 percent. Lady Health Workers can be trained to assess signs of pneumonia, determine appropriate treatment and guide parents, administer antibiotics and provide home care. They can also refer sick children to a health facility if complications arise, said Dr. Ashraf.

He added that government should also utilize Lady Health Workers to educate mothers to recognize the signs and symptoms of pneumonia. It must also prioritise routine immunisation coverage. When children suffering from pneumonia can be treated promptly and effectively with antibiotics, their chances of survival increase significantly, he said.

He, however, added that overuse of antibiotics should be prevented in order to curb microbial resistance and children with upper respiratory infections mainly cough and colds should not be prescribed unnecessary antibiotics. He suggested that indiscriminate use of cough medicines should be reduced.

Pneumonia control and other child health interventions must be accelerated to meet Millennium Development Goal 4 that is reducing under-five mortality by two-thirds by 2015, concluded Dr. Ashraf.

Islamabad

The Child Right Movement (CRM) Pakistan on Tuesday launched a postcard campaign for the enactment of pending child rights related legislation at the federal level.

Under this campaign, 5,000 postcards from across the country will be sent to Prime Minister of Pakistan Mian Muhammad Nawaz Sharif by children, parents, teachers, members of civil society and others urging him to play his role for the enactment of all pending legislation related to child rights including the National Commission on the Rights of Children (NCRC) Bill, the Child Protection (Criminal Law) Amendment Bill 2013, the Prohibition of Corporal Punishment Bill 2013, the Charter of Child Rights Bill and the Child Marriage Restraint (amendment) Bill 2010.

Addressing a press conference at the launch, CRM representatives said legislation on child rights issues has not gained due consideration of the Parliament at the federal level despite several commitments at the national and international level by the consecutive governments. The UN Committee on the Rights of the Child while considering Pakistan’s Periodic Reports in 2003 and 2009 repeatedly raised its concerns and recommended to enact pending legislation related to child rights with no results so far. The names of the panellists included Arshad Mehmood from Save the Children, Saleem Malik from Baidari, Kausar Bano from Right to Play, Habiba Salman from Sahil. The CRM is a coalition of more than 100 civil society organisations working for the protection and promotion of child rights across Pakistan.

In Pakistan, over the years legislation on child rights issues has not received due consideration and commitment by the policy makers and one of the biggest reasons for this disparity is the absence of National Commission on the Rights of Children (NCRC) to act as a central, independent and effective child rights body to ensure monitoring and implementation of the minimum child rights standards across the country; to respond to the child rights violation cases effectively in a timely manner; and to exercise pressure for filling legislative gaps. The Bill on the NCRC has been pending since 2001. Despite the fact that 2013 was declared as “The Year of the Rights of the Child” by the then Prime Minister on Universal Children’s Day, November 20, 2012. CRM members lamented that no significant steps have been taken during the year for the promotion and protection of child rights at the policy and legislation level.

The previous National Assembly passed the Prohibition of Corporal Punishment Bill 2013 in the session on the last day of its tenure. However, the Bill lapsed as it was not passed by the Senate of Pakistan and the National Assembly was dissolved. Similarly, the Child Protection (Criminal Law) Amendment Bill 2013 was approved by the previous Cabinet in its last meeting without any further progress, shared members of the CRM Pakistan. The CRM announced a sustained campaign for the enactment of child rights related Bills and urged the media and civil society of Pakistan for their support to gather maximum signatures to convince the policy makers to enact the pending bills and make Pakistan a safer and protected place for our children. The CRM Pakistan members said that it was important to support the campaign for the enactment of the pending legislation keeping in mind the state of child rights in the country. They shared that there are more than 20.5 million children out of school and of these 10.2 million are engaged in child labour where they are exploited, abused, tortured and killed. The Global Slavery Index 2013 reveals millions of modern slave children in Pakistan. Unfortunately, crimes against children are increasing rapidly. In 2009, 2010, 2011 and 2012, the reported cases of child sexual abuse were 2012, 2595, 2303 and 2788 respectively.

Though the ICT Right to Free and Compulsory Education Act was passed in 2012 by the both houses of the parliament yet the law is not enforceable in the ICT as rules have not been notified for the enforcement and implementation of the law in letter and spirit.

Karachi

Prof Aisha Mehnaz, an eminent pediatrician and chairperson of the Department of Pediatrics, Dow University of Health Sciences and Civil Hospital, Karachi, has voiced concern over increasing levels of malnutrition in Pakistan.

The News conducted an interview with her on Saturday about the likely impact of the rising inflation and the withdrawal of subsidies on the vast majority of the people of Pakistan, particularly the poorest of the poor. Excerpts follow:

Q: Given the fact that 30 percent of Pakistan’s population is condemned to live below the poverty line and inflation is at the highest ebb, how can the common man combat malnutrition?

A: Pakistan is the 6th most populous country in the world with a population of over 178 million and has some of the worst health indicators in the world. Fifty percent of its population comprises children, and 31 percent of them are under five years.

Ninety-four out of 1,000 children do not reach their 5th birthday and 78 out of 1,000 do not complete even the first year of life.

Pakistan has one of the highest levels of under nutrition and malnutrition in the world. In Pakistan, 30.3 percent of children under five years are underweight, 40.9 percent are stunted, 16.8 percent are severely wasted and 62 percent are anaemic.

The super floods of 2010 and 2011 have further worsened the situation. Our nutritional programmes have failed to address the problem because the root causes of poverty, illiteracy and socioeconomic deprivation have been largely ignored .The common man lacks the knowledge to combat malnutrition. Though the rapidly deteriorating economic condition is much to blame, in my opinion it is the poverty of knowledge regarding food and its nutritive value that is the main cause. Very few people have the knowledge that food grain available at home such as rice and lentils, if cooked with plenty of oil with addition of vegetables such as spinach and potato etc. can become a very wholesome and balance diet. Fruits such as dates and bananas are not only rich in energy but are a good source of vitamins and minerals such as potassium, thus a very healthy food for those living in warm climates such as ours.

Q: Please enlighten The News on the importance of breastfeeding and injurious effects of bottle feed.

A: Breast milk is the inherent birthright of every child. Mothers who deny breastfeeding are violating the rights of the child as well as God’s command. In the Holy Quran it is clearly stated that babies should be giving mother’s milk till two years of life. Breast milk is species’ specific, i.e. human milk is good for human child and cow’s milk for calves.

This is because of the fact that human child is in the process of maturation even after birth and his systems such as renal system is still immature. Giving whole cow’s milk will place an electrolyte load on yet immature kidney of babies. Unlike human child, cow’s young one begins to graze soon after birth and their renal system is mature. Mother’s milk is thus tailor-made to the species of its own kind. Besides providing nutrition, human milk has anti-infective properties by virtue of which babies are protected from infections. Breast milk is the first vaccine a baby needs to be given even before the BCG and polio vaccine.

Regarding bottle feeding a number of studies have shown a direct correlation of bottle feeding with diseases such as diarrhea, ear infection, asthma and allergies.

A recent study published in a reputable journal has shown that children who are breastfed have a much higher IQ level compared with children who were given animal milk or were bottle-fed. This shows a direct effect on brain growth and intellectual performance in children fed on human milk.

Q: Ninety percent of diseases are waterborne. Given the fact that most of Pakistan’s population is condemned to drink contaminated water, what steps should be adopted to make water safe?

A: It does not need very sophisticated means to purify water. Simply boiling the water, particularly, the drinking water and hand-washing, observing all the essential steps of hand-washing will decrease the waterborne diseases considerably. The government should also ensure water purification and decontamination of water supplied to the population. Vaccines against some waterborne infections such as typhoid and rotavirus are available and these should be included in the EPI programme of Pakistan and particularly be given to children.

Q: Health and education has always been a low priority in Pakistan. Given the fact that health budget is minuscule, how can we meet challenges in the domain of health and education?

A: Unless health and education is given priority, we cannot imagine a healthy and educated Pakistan. If the government is not willing to take a positive step, then philanthropist and non-governmental organisations (NGOs) should play a proactive role. This does not mean that the state will be exempted from this. Thus the onus will still lie with the government.

Q: Don’t you agree that participatory development can help meet the abovementioned challenges, especially when we are forced to withdraw subsidies?

A: I think to some extent it will; at least, it will be a good beginning.

Rawalpindi

According to estimates, nearly 50 million people in Pakistan are suffering from iodine deficiency while 70 per cent of the total population in the country is at risk of Iodine Deficiency Disorders.

Studies reveal that more than five million children born every year in Pakistan are unprotected against brain damage while 36 per cent mothers and 23 per cent pre-school children are suffering from iodine deficiency in Pakistan. Pakistan is rated 6th among the countries where iodine deficiency is a serious health problem.

Although according to National Nutrition Survey (NNS) 2011, 79 per cent people in Punjab province are consuming iodised salt as compared to 17 per cent in 2001, still it is low when compared with countries with similar socio-economic conditions like Nepal where 98 per cent of the total population consumes iodised salt.

Professor and Head of Community Medicine at CMH Lahore Medical College Professor Dr Muhammad Ashraf Chaudhry expressed this while talking to ‘The News’ in connection with Global Iodine Deficiency Disorder Day being observed on October 23. He said that Iodine is essential for the normal growth, development and well being of all humans. The whole spectrum of health consequences casually linked to iodine deficiency is collectively known as Iodine Deficiency Disorders (IDDs). IDD is most commonly seen among poor, pregnant women and preschool children. Groups most susceptible to iodine deficiency include children below two years of age, he said.

Dr. Ashraf explained that the Global Iodine Deficiency Disorder Day is an awareness campaign to educate the people on how hard the effects of iodine deficiency can fall on you if you are not careful enough. Though IDD has lowered in number over the years due to iodisation of salt and awareness programs, even today one sixth of the world population is still under the risk of the disorder, he said.

He said that the effects of IDD on the baby in the mother’s womb are in the form of congenital abnormalities (defects by birth), early deaths, brain damage, cretinism and deafness; effects on the child and adolescent are goitre (enlargement of thyroid gland), impaired mental function, stunted physical growth, short stature and diminished school performance; whereas effects of iodine deficiency on women are in the from of decreased fertility, spontaneous abortions and still births in pregnant women.

To a query, Dr. Ashraf said that Iodine deficiency can result in loss of 15 IQ points. “The main factor responsible for iodine deficiency is a low dietary supply of iodine.”Talking of remedies, he said that to prevent iodine deficiency, it is very important to educate people about the Iodine Deficiency Disorders that they and their children might get if not careful about their diet and nutrition. The addition of small amount of iodine to table salt in the form of potassium iodate at very little cost can help prevent the incidence of this serious disorder, he said.

He added that seafood is also a known source of iodine. Other sources of iodine are bread, grains, green vegetables, drinking water, milk (especially cow milk) and eggs. Daily requirement of iodine for adults is placed at 150 micrograms per day or 5 gram (1 teaspoonful) of iodized salt per day. The most viable option is having Universal Salt Iodization (USI) of edible salt across the country, he said.

He said that for children up to six months, iodine supplementation should be given through breast milk. This implies that the child is exclusively breastfed and the lactating mother should receive iodine supplementation, said Dr. Ashraf.

He said that there are specific situations, such as emergencies, among displaced people and geographically remote areas, where iodized salt may not be accessible. In these specific situations, increasing iodine intake should be provided in the form of iodine supplements for pregnant and lactating women, and a supplement or complimentary food fortified with iodine for children 6-23 months of age, he said.

He added that there is a dire need to create mass awareness on this issue and mount advocacy for promotion of IDDs legislation and monitoring of the enforcement of Universal Salt Iodisation at production, retail and community levels in order to combat iodine deficiency in the country. Trainings and capacity building of salt processors at the district level is also required.

However, concerted efforts of civil society organizations including health professionals, teachers, religious leaders, social workers, salt producers, processors and policy makers are required in partnership to overcome this challenge, said Dr. Ashraf.

He said that medial community can play a vital role in advocacy for the usage of iodized salt at the gross-root level. Medical professionals can make people aware of the consequences of iodine deficiency and dispel any myths, disbeliefs or misconceptions associated with the use of iodised salt, he said.

He suggested that new plans to strengthen salt iodization that include increasing political commitment and advocacy are strongly needed. The hospitals and nursing units should take part in the awareness program which can reduce disorders and retardation. Awareness programs, talk shows and photo exhibits can all help in reducing the Iodine Deficiency Disorder in the country, concluded Dr. Ashraf.

LONDON: British Prime Minister David Cameron says the UK is proud it helped send tens of thousands of Pakistani children to schools.

Speaking to members of the Muslim Community at an Eid Millan party at Ten Downing Street, he said that the children would spend a better life with the help of UK.

He said Eid-ul-Azha teaches people to become merciful while Islam teaches generosity. The prime minister said that British Muslims were an asset of the country.