This document discusses health and nutrition issues in Sindh, Pakistan. It notes that the majority of primary health care facilities in Sindh do not offer 24-hour normal delivery or basic neonatal care services. It also reports that 64% of the population has access to Lady Health Workers but that early marriage before age 18 occurs in 16.3% of women. The document compares Sindh's health indicators to Pakistan's and to targets for the UN's Sustainable Development Goals. It finds that Sindh lags behind on indicators like antenatal care, skilled birth attendance, and child immunization. The document advocates for improving health systems, coordination between agencies, community engagement, and partnerships to address nutrition and maternal

2. Dr. Muhammad Sarwat Mirza
Chief Health and Research Executive
HANDS
Health and Nutrition Issues
in Sindh

3. Contents:
• Health and Nutrition issues in Sindh
• Pakistan commitment for Health indicators related
to Sustainable Development Goals
• Way Forward

4. • 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

5. • 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

6. 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

7. 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

8. 242
210
267 246
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

9. 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%

10. 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 %

11. 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 %

12. Comparison Mortality Status --- Maternal & Children
Indicators MDGs
targets 2015
Pakistan Sindh SDGs 2030
MaternalMortality Ratio
140 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 age
No. 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

13. • 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

14. Thank
You