Department of Surgery, Baylor College of Medicine
L.E. and Virginia Simmons Fellow in Health and Technology Policy
The Islamic Republic of Pakistan (Pakistan) is the second largest Muslim-majority nation (just behind Indonesia), and with a population of just under 200 million, it’s the fifth most populated country globally. Pakistan’s population is divided into four provinces and three territories (Fig 1). The most populous province is Punjab, which comprises almost one-half of the nation’s population, followed by Sindh, Khyber Pakhtunkhwa (KPK), and Balochistan. The country’s three territories include Gilgit Baltistan, the disputed territory of Azad Jammu and Kashmir, and the Islamabad Capital Territory. About 60% of Pakistanis live in rural areas, and 35% of the population is less than 15 years of age. Before and after its independence in 1947, Pakistan has faced high rates of illiteracy, poverty, malnutrition, and disease, all of which have been perpetuated by political instability and conflict.
Despite these obstacles, the country has made some important strides in improving public health.
Pakistan has made innovations in public health delivery, such as a school-based mental- health program and a community-based perinatal and newborn care program, which have improved population health in Pakistan and the global health community at large. In terms of vaccines, such delivery mechanisms are perhaps most notably demonstrated by the remarkable decrease in the number of diagnosed polio cases in recent years, which has decreased from 306 in 2014 to just 4 in 2018 to date. Moreover, with the assistance of Gavi, the Vaccine Alliance, Pakistan is expanding vaccine coverage targets for its major childhood diseases, including diphtheria, pertussis, tetanus, hepatitis B, and other diseases. However, severe poverty and poverty-related illness remain widespread. According to the Asian Development Bank, approximately 30% of the population was living below Pakistan’s poverty level in 2013, whereas the World Bank estimates that 6.1% (approximately 12 million people) of the country’s population currently lives on less than US$1.90 per day. Accordingly, the nation still suffers from high rates of infant and under-five child mortality, as well as poor maternal health indicators.
In this setting, neglected tropical diseases (NTDs) are widespread, especially among Pakistan’s large rural population but also in many large urban and peri-urban areas. Indeed, an analysis of the Global Burden of Disease (GBD) 2013 study found that Pakistan was one of the top 10 countries in terms of the highest absolute number of NTD cases for 8 of 18 NTDs on which statistics had been gathered. Shown in Table 1 are the latest estimates for either prevalence or incidence of Pakistan’s major NTDs (as well as malaria, for comparison) as determined by the GBD 2016. Overall, ascariasis and other soil-transmitted helminth (STH) infections, as well as dengue and venomous animal contact (snake bite), now represent the most common NTDs, but typhoid and paratyphoid fevers, leishmaniasis, trachoma, and leprosy are also prominent.
Read the full article in PLOS Neglected Tropical Diseases.
