Dr. Muhammad Sarwat MirzaChief Health and Research Executive

HANDS

Health and Nutrition Issuesin Sindh

Contents:• Health and Nutrition issues in Sindh• Pakistan commitment for Health indicators related

to Sustainable Development Goals• Way Forward

• Sindh with population of about 41.5 million

• Majority of the Primary Health Care Facilities not offering 24 hour normal delivery/basic neonatal care services

• There is in general shortage of female staff at Primary and Secondary Health Facility Level

• LHW coverage is 64 %• Early marriages of women (before 18 years of age) =

16.3 %

Health Scenario in Sindh

• Behaviors of communities have improved through consistent health education

• Care seeking for diarrhea improved to 69 %• Care seeking for ARI improved to 75.4 %• Improved drinking water at source is 90 % • Sixty-three percent people are suffering from food security,

according to the National Nutrition Survey of 2011.• 38 percent people live below the poverty line. That means that

nearly one third households can’t earn even $1.25 per day per all family members.

• Children age 6-23 months got food from 4 or more groups = 14.7%• HHs consuming iodized salt = 36 %

Source: MICS Sindh 2014/ NNS 2011

Health Scenario in Sindh

Vicious Cycle Health --- Nutrition

Five million pregnancies

Five million pregnancies

Under nutrition and Anemia during Pregnancy

No antenatal care

• Maternal Mortality• Low birth weight

Under nourished and stunted children

Frequent pregnancies

• Malnourished adolescent• Early marriages

Pregnancy and Outcomes in Sindh

Five million pregnancies

Five million pregnanciesFive million pregnancies

1,245,000 pregnancies Annually

1,150,000 births annually

>3400 Maternal deaths annually due to

complications during pregnancy and delivery

Nearly 500 deaths from Unsafe abortions

> 20000 faced complications after

unsafe abortions

242 210267 246

637

855

15-19 20-24 25-29 30-34 35-39 40-44

Maternal Mortality can drop dramatically by stopping pregnancies after 35

Maternal Mortality Ratio by Age

1990-91 and 2006-07 PDHS

Comparison Maternal Health Status

Indicators MDGs targets 2015

Pakistan Sindh SDGs 2030

Antenatal care visits (4 or more) 90 % 73% 41% 100%

Deliveries conducted by Skilled Birth Attendants >90% 52% 65.7% 100%

Institutional Deliveries 64 %Public Health Facilities 16 %

Private Health Facilities 48 %Total Fertility Rate (TFR)

2.1 3.8 4.0 1.9

Contraceptive Prevalence Rate (CPR) 55% 35.4% 29% 55%

Comparison Children Health Status

Indicators MDGs targets 2015 Pakistan Sindh SDGs 2030

Low birth weight 27.8% 30 % <10%

Under nourished Children <20% 31.5% 42 % <20%

urban 32 %rural 50 %

Stunting among children under 5 years of age 43.7% 48 % <10%

urban 37 %rural 57 %

Breast Feeding Early initiation

20.7 %

Exclusive Breast feeding 28.9 %

Extended BF up to 24 months

48.9 %

Comparison Children Health Status

Indicators MDGs targets 2015 Pakistan Sindh SDGs 2030

BCG coverage 76.3 %

Pentavalent third dose 52.7 %

Proportion of under 1 year children immunized against Measles >90% 81% 38% >90%

Proportion of Fully immunized children (age 12-23 months)

>90% 82% 53% >90%

Neonatal tetanus protection (TT vaccination of Mothers) 54.1 %

Comparison Mortality Status --- Maternal & Children

Indicators MDGs targets 2015

Pakistan Sindh SDGs 2030

Maternal Mortality Ratio140 per

100000 live births

276 per 100000 live

births

276 per 100000 live

births

<70 per 100000 live

births

Children mortality under 5 years of ageNo. of deaths per 1000 live births

52 89 104 25

Neonatal mortality No. of deaths per 1000 live births 20 55 59 12

Infant mortality No. of deaths per 1000 live births 40 74 82 <20

• Improvement in health delivery system • Improvement in coordination between Population

Welfare and Health Department at Provincial and District level

• Inclusion of Birth spacing / FP services in MNCH program

• Strengthening partnership with Civil Society organizations and Community organizations

• Engaging communities in sustained behavior change, monitoring, accountability and voice generation

Way Forward

Thank You