Child nutrition

For Pakistan, soil-transmitted helminthiasis (STH) has emerged as a major health issue in recent years. With some 17 million school-aged children at risk, it is among the 10 countries with the largest global burden of intestinal worm infections.

Periodic deworming is a very low-cost yet effective response to the disease, which, if left untreated, can cause anaemia, malnourishment and impaired mental and physical development in children. It will ultimately have adverse effects on their educational outcomes and incomes as adults.

Experts insist that the drug administration against STHs leads to significant improvements in the child's nutrition, cognition, school participation, and future earnings - at a cost of less than Rs82 on average.

Nobel laureate Michael Kremer found that subjecting children to two to three additional years of deworming hikes their food intakes by 14 per cent and income as adults by 13pc. His research in Kenya in the early 2000s showed that deworming can reduce school absenteeism by up to 25pc.

Periodic response.

Waking up to the mounting crisis, the federal government embarked on a pilot project in January 2019 to deworm children in Islamabad. The Federal Ministry of Planning, Development and Special Initiatives is coordinating the Pakistan Deworming Initiative at the national level. Its implementation at the regional and provincial levels is led by provincial health, education and planning departments as well as district administrations.

The Ministry of National Health Services and Regulations is receiving deworming tablets (Mebendazole) from the WHO free of charge,

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effective while technical assistance for the programme is provided by IRD Pakistan, a health delivery and research organisation, Evidence Action, a global non-profit organisation, and the Indus Health & Hospital Network, Karachi, for highquality service delivery. Dubai Cares, which is part of the Mohammed bin Rashid Al Maktoum Global Initiatives, is also chipping in with financial support.

The goals of the deworming programme were set in light of Prime Minister Imran Khan's emphasis, in his first address to the nation, on the growing incidence of stunted growth and malnutrition among Pakistani children. In October 2020, he formed the Pakistan National Nutrition Coordination Council to suggest ways to fight stunting in the country and formulated a comprehensive national strategy for approval by the Council of Common Interests, which has representation of all four provinces.

Deworming is directly aligned with the prime minister's vision as it is a nutrition-sensitive intervention and can help combat malnutrition, especially anaemia, among children. The government has prioritised the inclusion of the initiative in its annual development plans.

The programme is also relevant to the national and provincial multi-sectoral nutrition strategies which highlight the importance of nutrition-sensitive programming in which school-based deworming is one of the proposed interventions for the education department.

During the last year and a half, the government has given a sharper focus to mitigating the devastating impact of the coronavirus pandemic on the country's economic and social development, on top of the tragic loss of human lives. The pandemic has also affected the implementation of other health programmes and services, such as the deworming initiative. Now, with the roll-out of Covid-19 vaccinations, there is a decision to resume efforts to treat school-aged children for intestinal worm infections through mass deworming.

Despite the pandemic-induced challenges, the programme partners have agreed to build the momentum for this important health issue at the national level through a public-awareness campaign. At the same time, mass deworming weeks have been planned for Islamabad Capital Territory and Sindh, KP and Punjab targeting around 15m school-aged children through schools and community platforms. The previous deworming campaign carried out in 2019 and 2020 led to the administration of Mebendazole to over 3m children in schools and seminaries in ICT, KP and Sindh.

A distinctive feature of the initiative is that besides the children enrolled in government and private schools, minors studying in seminaries will also be targeted by the mass deworming drive. Similarly, out-of-school children under the age of five as well as women of reproductive age will be approached through the health sector by mobilising Lady Health Workers and other community health workers.