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© 2006 POPULATION REFERENCE BUREAU Presentation by Dr. Fariyal Fikree of the Population Reference Bureau, November 1, 2007 Pakistans Health Status: Past, Current and Future
© 2006 POPULATION REFERENCE BUREAU Burden of Disease Disease Conditions % total deaths % total DALYs Communicable, maternal, and perinatal conditions Diarrheal diseases Respiratory infections Maternal conditions Perinatal conditions Low birthweight Nutritional deficiencies Non-Communicable Diseases Cancers Diabetes mellitus Neuropsychiatry Cardio-vascular diseases Injuries Source: Mathers, Lopez & Murray, Burden of Disease Volume, 2006.
© 2006 POPULATION REFERENCE BUREAU Age Pyramid ,093,285 Ages ,127,740 Ages 15-49
© 2006 POPULATION REFERENCE BUREAU Age Pyramid – ,386,844 Ages ,998,903 Ages 15-49
© 2006 POPULATION REFERENCE BUREAU Family Planning Trends: Source:Pakistan Demographic & Health Survey ( ) Pakistan Demographic & Health Survey ( Family Planning Total Fertility Rate Urban Rural Contraceptive Prevalence Rate (%) Ever Used Currently Using Method Used (%) Female sterilization Condom Oral Pills Injectables Others
© 2006 POPULATION REFERENCE BUREAU Child Health Trends: At 12 months (BCG, measles and three doses of DPT and polio) 2.Birth to 5 years to a health provider or facility Source:Pakistan Demographic & Health Survey ( ) Pakistan Demographic & Health Survey ( ) Child Health Neonatal Mortality Rate Infant Mortality Rate Immunization Status Health Seeking Behavior 2 Acute Respiratory Infections Fever Diarrhea
© 2006 POPULATION REFERENCE BUREAU Maternal Health Trends: At least once by a health professional 2.Various sources (WHO, National Institute Population Studies) Source:Pakistan Demographic & Health Survey ( ) Pakistan Demographic & Health Survey ( Maternal Health Tetanus Toxoid Immunization Antenatal care visit Delivery at a Health Facility Postnatal Care-21.7 Maternal Mortality Ratio
© 2006 POPULATION REFERENCE BUREAU Age Pyramid ,914,726 Ages ,872,637 Ages 35-74
© 2006 POPULATION REFERENCE BUREAU Age Pyramid ,481,889 Ages ,383,943 Ages 35-74
© 2006 POPULATION REFERENCE BUREAU Imploding Health Care Needs: Non- Communicable Diseases and Injuries Very high mortality - a quarter of total deaths Rapidly rising morbidity: One in three adults over the age of 45 suffers from hypertension Prevalence of diabetes – 10% Tobacco Consumption – 40% of men; 12.5% women Cancers: Breast, lung and oral cavity Hospital visits: 25% are related to injuries
© 2006 POPULATION REFERENCE BUREAU Health Delivery System Integrated Rural Health Complex Basic Health Units Rural Health Centers District Headquarters Hospital Tertiary Hospitals Population Served Referral Centers 100,000 – 300,000 25,000 – 50, 000 5,000 – 10,000 Health Care Providers Specialists, Doctors, Nurses, Paramedical Staff Doctors, Nurses, Paramedical Staff Paramedical Staff
© 2006 POPULATION REFERENCE BUREAU Meeting United Nations Standards for Safe Motherhood ; Multan District, United Nations Process Indicator Recommended Level Multan District 1 Multan District 2 Availability of Emergency Obstetric Care Comprehensive Facility (One) 3 34 Basic Facility (Four) 3 80 Proportion of all births in Emergency Obstetric facilities> 15%5.50%10.30% Met need100%14.90%23.30% Cesarean deliveries as a proportion of all births5-15%0.08%2.40% Case fatality rate<1%50%13.50% 1.Excludes tertiary hospital 2.Includes tertiary hospital 3.Per 500,000 population Fikree FF, Mir AM and ul-Haq I. She may reach a facility but will still die! An analysis of quality of public sector maternal health services, District Multan, Pakistan. Journal of Pakistan Medical Association 2006; 56(4):
© 2006 POPULATION REFERENCE BUREAU Health Systems Constraints: Infrastructure and Resources Infrastructure: Physical buildings Water, electricity and disposal/incineration Human Resources: Skilled Health Care Providers Training institutions Retention Equipment & Supplies: At Basic Facilities Secondary Level Facilities
© 2006 POPULATION REFERENCE BUREAU Conclusions High and growing burden of disease Inadequate Health Care Services to meet current and future growing demands Broader Question: Where to focus attention/investment? Social Needs – education, health, employment, justice
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