World Health Day 2013: Pakistan Report Card

Years of life lost due to violence have more than doubled (up 109%) in Pakistan since 1990. Violence now ranks 20 among various causes of premature death, up from 34 in 1990. Other major killer diseases which claimed more lives include lifestyle diseases like heart disease (up 103%), cirrhosis (105% up) and diabetes (up 157%).  Overall, age-adjusted death rate in the country has declined from 1,120 per 100,000 in 1990 to 982 per 100,000 now, according to Global Burdens of Disease Study 2010.  More Pakistanis are dying due to rising violence, heart disease and diabetes, partially negating gains made by reducing premature mortality for other factors.
 

Leading Causes of Premature Deaths in Pakistan


Pakistan ranks in the middle among 15 similar countries
compared by the
Global Burden of Disease Study 2010 (GBD 2010).  Other countries in
this group include India, Djibouti, Kyrgyzstan, Laos, Moldova, Mongolia,
Nicaragua, Palestine, Papua New Guinea, Philippines, Solomon Island,
Uzbekistan, Vietnam and Yemen. 




The fact that Pakistan ranks near the middle and outranks India among 15 similar countries in terms of disease burdens is a surprise given the reality that Pakistan spends just $58.27 per person on health (including the gov... , less than half of neighboring India's per capita health spending of $132.20, which includes $38.57 from the government.  Some of the differences in health outcomes may be attributable to nutrition, sanitation and environment.
  




In addition to reducing violent deaths by improving security, Pakistan needs to spend a lot more on health and education to enhance the quality and productivity of its human resources. Looking at examples of nations such as the Asian Tigers which have
achieved great success in the last few decades, the basic ingredient in
each case has been large social sector investments they have made. It
will be extremely difficult for Pakistan to catch up unless similar
investments are made by Pakistani leaders.

Pakistan's HDI grew an average rate of 2.7% per year under President
Musharraf from 2000 to 2007, and then its pace slowed to 0.7% per year
in 2008 to 2012 under elected politicians.  Earlier in 1990s, the increase in Pakistan's HDI was just 9.3% from 1990 to 2000, less than half of the HDI gain of 18.9% on Musharraf's watch from 2000 to 2007.

As Pakistanis prepare to go to the polls on May 11, it is important that
the voters demand an explanation from the incumbent political parties
for their extremely poor performance in the social sector. Without
accountability, these politicians will continue to ignore the badly
needed investments required to develop the nation's human resources for a
better tomorrow. Forcing the political leaders to prioritize social
sector development is the best way to launch Pakistan on a faster
trajectory.

Related Links:

Haq's Musings

Pakistan Human Development: Musharraf Vs Politicians

Pakistan Fares Marginally Better Than India on Health

America Significantly Outweighs Asia

India and Pakistan Suffer Heavy Disease Burdens 

India and Pakistan Off Track, Off Target on Sanitation

Study Finds India's Air Most Toxic

Pak Lady Health Workers "Best in the World"

Infectious Diseases Kill Millions in South Asia

WHO Says Pakistan On Track to be Polio Free













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Comment by Riaz Haq on May 7, 2013 at 10:06am

Here's an NDTV report today:

Of every 100 new-borns that die in the world, 29 are in India. In real, heart-rending numbers that is three lakh babies who die on the day they are born, every year.

Infants fare better even in Pakistan and Bangladesh, says a new report.

Non-governmental organisation Save the Children compared first-day deaths in 186 countries for its "State of World's Mother Report". Luxembourg has the least new-born deaths, India the most, the reports says.

While infant deaths in India have come down by almost half compared to 1990, the rate has been slower than that in, say, Nepal.

The statistics only get worse. More than half the child deaths in India happen in the first month. And India has the biggest disparity between the rich and poor in child deaths.

The country's report card on mother and child health too is abysmal; India is behind Pakistan and Bangladesh on this list.

http://www.ndtv.com/article/india/most-new-born-deaths-in-india-say...

Comment by Riaz Haq on May 7, 2013 at 11:10pm

India leads the world in dengue, reports The Hindu:

Dengue, the world’s most rapidly spreading mosquito-borne viral disease, is taking a far bigger human toll than was believed to be the case. As many as 390 million people across the globe could be falling victim to the virus each year, according to a multinational study published by Nature on Sunday.

India emerges in the analysis as the country with the world’s highest dengue burden, with about 34 per cent of all such cases occurring here.

According to the World Health Organisation (WHO), incidence of dengue has shot up 30 fold in the past 50 years. Its estimate has been that globally there were 50-100 million dengue infections taking place annually.

For their study, Samir Bhatt at the University of Oxford and his colleagues used a map-based approach to model how many dengue cases were occurring in various parts of the world, thereby capturing its global distribution.

They estimated that worldwide, 96 million people suffered each year from ‘apparent infections’ where the disease was severe enough to disrupt an individual’s regular routine. In addition, there were 294 million asymptomatic infections.

With “large swathes of densely populated regions coinciding with very high suitability for disease transmission,” Asia bore 70 per cent of the apparent infections that took place, the scientists pointed out in the paper.

Africa contributed about 16 per cent of the global dengue infections and the Americas 14 per cent.

“I consider it to be the most comprehensive study of dengue disease burden to date,” said Duane J. Gubler, an internationally known expert on the disease, when asked for his views on the Nature paper.

The study’s estimate of 390 million infections was “much closer to the actual figure than the 50 million WHO is still using,” observed Professor Gubler, who is now with the Duke-NUS Graduate Medical School in Singapore.

“Considering that mosquito control has failed in all dengue-endemic countries, that over half of the world’s population now lives in urban areas, and that dengue is an urban disease, even that number may be too low,” he said in an e-mail.

The study estimated that India had the largest number of dengue cases, with about 33 million apparent and another 100 million asymptomatic infections occurring annually.

However “these are estimates and there are many gaps which we now need to fill,” cautioned Jeremy Farrar, a senior author of the study, in an e-mail. “But it would not surprise me that India was home to the most dengue [patients] globally.”

The model used in the study could help provide a framework to estimate the burden of disease. Inevitably, there were gaps in the data and one needed to extrapolate from other areas. Better data collection should be encouraged so that the estimates were as accurate as possible, said Professor Farrar, who is director of the Wellcome Trust Vietnam Research Programme and Oxford University Clinical Research Unit Hospital for Tropical Diseases in Vietnam.

“We have a tremendous problem of dengue all over India,” said Umesh C. Chaturvedi, agreeing with the finding of the paper. A virologist who has studied the disease, he is a scientific consultant to the Indian Council of Medical Research.

http://www.thehindu.com/sci-tech/health/policy-and-issues/india-lea...

Comment by Riaz Haq on May 10, 2013 at 7:14pm

Here's a story of how Lahore fought dengue outbreak in 2011:

..“No one expected this kind of political commitment,” said Qutbuddin Kakar, who oversees programmes to combat malaria and dengue in Pakistan for the World Health Organization (WHO). “In this part of the world, at least, we had not seen this kind of response before.”

The anticipated 1,000-plus deaths did not occur, and since then, dengue fever cases have dropped - 200 in the province (Punjab) last year, without any reported deaths.

---

The results they collect are processed on site by specially-designed Android based applications on their smartphones, and uploaded to a centralized dengue prevention centre.

There, analysts match the entomological data with reports from hospitals showing where dengue patients are being treated. Based on the findings, a team is sent to fumigate areas where aedes mosquitos seem to be breeding and infecting people, or to identify and remove sources of standing water.

The key season for infections comes with monsoon rains, when the aedes aegyptus and aedes albopictus mosquitoes, which can carry the virus, begin to appear.

Chronology of an outbreak

In August 2011 heavy monsoon rain dumped 13 inches in a week, leaving parts of Lahore with large bodies of standing water, and raising immediate concerns about disease.

By mid-October, the provincial government in Punjab reported that more than 11,000 dengue cases were recorded by the provincial government.

“It was an exponential increase in number, and it really frightened the government,” said Faran Naru, a consultant hired by the provincial government to tackle the problem. “And the issue was resonating in the media... so it created a panic in the public which had to be contained.”

Most people infected with dengue recovered on their own, said Naru, but once media outlets began reporting on the extent of the outbreak, thousands showed up at hospitals and laboratories to get tested.

An initial team of 70 entomologists conducted 12,000 spot-checks to track where aedes mosquitos were present. By mid-October, this data had been mapped, along with the locations of 11,000 reported dengue patients.

The results surprised the scientists. The worst affected areas were some of the wealthiest neighbourhoods of Lahore: Model Town, Race Course, Mozang, and Gulberg.

“I saw that in Model Town there is a big park, and in Race Course there are two of Lahore's biggest parks… and I believe lots of breeding was happening there and mosquitoes were leaving from there and infecting people,” said Naru.

The mosquitoes need fresh water to lay their eggs, and the large puddles in Lahore's biggest public parks proved to be ideal homes.

Another hotspot was the Mozang neighbourhood, home to one of Pakistan's largest graveyards. The 150-acre area was found to be a major breeding ground for mosquitos. Gravediggers had dug large pits to hold water, which they used to soften the dirt when digging.

“It's fresh water,” said Naur, “from the tap, and there were 70 pits, and all of those were infected, full of larvae.”

Back in the hospital, dengue patients were separated into special areas for treatment. The home of each dengue patient was fumigated, along with 12 surrounding houses, three in each direction.

Sanitation workers unclogged sewers and drains in an effort to clear areas of rainwater; and parks, gardens, and cemeteries were also sprayed. Thousands of Mosquitofish and Garden Carp - fish species known to attack mosquito larvae - were also released into ponds and ditch canals.

Within a few weeks, entomologists detected far fewer aedes mosquitoes, and the prevalence of dengue cases rapidly decreased.

http://www.irinnews.org/Report/98010/Marshalling-smartphones-graved...

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