THE figures for stunting are alarming worldwide, but more so in Pakistan. Where globally roughly 25pc of children under the age of five have stunted growth, 44pc of the children in Pakistan suffer from this problem. With the third highest percentage of stunted children in the world and a burgeoning young population, this translates to almost 10 million Pakistani children who have experienced malnutrition in utero or during early childhood.
To put the problem into perspective, stunting hinders the health and growth of children and is associated with suboptimal brain development, poor cognition, reduced lean body mass and lower productivity, amongst other problems. It also causes a number of children’s deaths every year. As a result, there has been some focus on nutrition-specific programmes by international agencies and the government.
At the same time, the government of Pakistan has also shown resolve in providing access to sanitation and raising awareness about the need for sanitation, to the extent that the proportion of the population that does not have sustainable access to basic sanitation went down from 76pc in 1990 to 36pc in 2015. However, the need for a more holistic approach to nutrition, health, water and sanitation remains.
Pakistan allocates seven times more funds to health than it does to water and sanitation, while diseases linked to open defecation and inadequate sanitation facilities cause one death every five minutes, mostly that of children. Horrifyingly enough, water sampling in various parts of the country has shown the presence of bacteriological contamination, including fecal coliform (the infamous E. coli bacteria), in excess of the standard set by the World Health Organisation, which is indicative of the possible presence of etiologic agents of other waterborne bacterial infectious diseases.
Across the developing world, the pollution of municipal water by human and animal sources is a major threat to public health. In Pakistan, the quality of drinking water is extremely poor. The Pakistan Council of Research in Water Resources (PCRWR) has monitored the drinking water quality of 23 major cities, revealing that water resources contain bacteriological contamination, arsenic, nitrate and fluoride.
The water samples collected from 23 surface water bodies were all contaminated by bacteria and had higher values of turbidity, total dissolved solids, nitrate and lead. Results of the rural water quality monitoring of 48 tehsils out of 64 to be monitored showed that 80-85pc of the water samples are bacteriologically unsafe for drinking.
With the population set to reach 300 million by 2050, the negative impact of human activity on water has even more dire implications. Millions already have no access to safe drinking water while even greater numbers have no access to sanitation facilities. Bacteriological contamination of drinking water remains one of the major problems in the country in rural as well as urban areas, due to leakage of pipes, pollution from sewerage, biofilm formation in the distribution system, intermittent water supply, and human activities (a euphemism for open defecation).
The government of Punjab allocated Rs400m to make 3,600 villages open defecation free, while the Sindh government started open defecation-free programmes in three districts, scaling the programmes up to 13 districts. Similarly, Azad Kashmir, Khyber Pakhtunkhwa and other areas have also initiated programmes in selected villages.
The federal government formed a policy in 2006 in order to overcome open defecation and the provinces adopted the same policy, but the villages gained very little out of it. The 18th Amendment to the Constitution shifted the mandate for sanitation to the provinces, but without the federal government to oversee, guide and monitor efforts, improvements will be slow. Now, under the Vision 2025 programme, the current federal government has set a goal to achieve 90pc improved sanitation which has revived the hope for putting an end to open defecation.
According to a recent Unicef report on improved access to sanitation (2012-2015), the remaining 25 million people (or 13pc of the population) still practising open defecation in Pakistan are for the most part living in poor rural homes and insecure urban informal settlements, making them the most difficult to reach. Both cultural norms and poverty — a lack of knowledge of ramifications and access to adequate physical structures and waste disposal mechanisms — cause the problem to persist.
Many common illnesses — including those causing diarrhoea, a leading cause of death in infants — spread due to open defecation. Safe disposal of excreta, isolation of excreta carried by flies and other insects, and prevention of fecal contamination of water will reduce the spread of diseases. A significant proportion of these infections can be prevented through integrated programmes involving the provision of sanitation, water, and the promotion of hygiene practices, but mass awareness and equally coherent coordination are critically important in bringing about a solution to stunting and sanitation — the two faces of one problem.
The writer is a development consultant.
Published in Dawn, April 10th, 2016