Preventive Care Services
- Maternal and Child Health Services
- Prevention and management of STIs and RTIs
- Major Micronutrient Deficiencies
Immunization is carried out under Expanded Program on Immunization which is a WHO and UNICEF assisted programme. The objective of the expanded Programme on Immunization (EPI) is to immunize children against vaccine preventable childhood diseases and women against neonatal tetanus. Immunization is done at the health facilities, outreach sites and through mobile teams to provide immunization services for children against Measles, Diphtheria, Tetanus, Polio, Tuberculosis, Pertussis, and Hepatitis-B. In addition to this, mothers of child bearing age receive 5 doses of TT or 2 doses during pregnancy. The current overall coverage in Punjab as per EPI CES for children 12 to 23 months was 77.0% and for mothers against Tetanus, it was 63% respectively73.
Immunization coverage in Pakistan has improved in recent years but remains below the national targets. The programmatic aspects are fully decentralized to the District Governments for reaching the target population with a well-defined package of immunization services. A strategy to expand coverage through private health sector has not yet taken hold.
Maternal and peri-natal conditions account for about 12 percent of the total BOD. This large disease burden is due to several causes. First presently, in the Punjab only 44% of the antenatal care is being provided by a skilled birth attendant and only
about 33% percent of women are assisted by an appropriately trained provider during delivery. Secondly, one-third of births occur less than two years apart, which doubles the mortality risk of newborns as compared to a more normal spacing. Third, about one-third of pregnant women are underweight, which is correlated with low birth weight –a risk factor for the newborn. Basic new born care should also be provided at all levels and comprehensive EMonC should be available at THQ and DHQ hospitals.
The above factors explaining poor reproductive health in Pakistan are in turn largely explained by poor consumer education. There is a massive information deficit concerning reproductive health, and consequence has been the weak demand for family planning services for spacing (although this is changing) and for pre- and post-natal and delivery services by qualified personnel. A second explanation for poor reproductive health in many rural areas is prohibition placed on women seeking care from male providers, in a situation where qualified female providers are often not within reach.
The information deficit and restrictions on women justify government interventions in the reproductive health area. In this intervention, government must also make reliable services available, especially in rural areas, where qualified private providers are generally not present. In addition to front-line services provided by community health workers and staff of first level care facilities, referral services for serious cases (e.g., obstetric emergencies) should be made available at all Tehsil and District Headquarters hospitals.
Stigma associated with sex and STIs/RTIs is a major hindrance to prevention efforts and early treatment, therefore to understand STIs, it is important to take into account social, economic, cultural and other factors that pave the way for the infected organism to enter the human body. Treatment of the infection would cure a single episode of STI, but simultaneously addressing other determinants of STIs empowers the community to lessen the chances of getting infected. STIs are predominantly linked to poverty. Currently there is not enough information available on STIs and on their prevention. There is also a requirement for provision of information and treatment of patients at all levels, according to WHO protocols of Syndromic Case Management.
Current status shows that there is 9.9% and 3.0% deficiency of Vitamin A among mothers and children under five respectively. Iodine deficiency among mothers is 21%, and among school age children 6.6%, Iron deficiency among children below 5 years is 64% and mothers of under 5 years of age is 45%. Currently there are programmes such as fortification of salt for Iodine, vegetable oils for Vitamins A & D, wheat for Iron and folic acid which can reduce these deficiencies at both national and provincial level. There is requirement of developing and launching media campaigns that would bring awareness to the population at large.