Hamzullah Khan1, Akber Khan Afridi2

Principal author
Dr Hamzullah Khan MBBS,
Khyber Medical College,
Peshawar, Pakistan.
Mobile number: 0092-345-9283415,
Email address: hamzakmc@gmail.com

Co-authors:
Professor Dr Akbar Khan Afridi
Professor and Head Department of Community Medicine,
Khyber Medical College,
Peshawar, Pakistan.

Correspondence to:
Room No 104, Qasim hall hostel,
Khyber Medical College,
Post office: Campus branch,
University of Peshawar,
Postal code: 25120, Peshawar, Pakistan.

 

ABSTRACT Objectives: To determine the demographic variables of the residents of Palosi village near the vicinity of Peshawar. Material and Methods: A descriptive observational survey was conducted from November 2005 to August 2006 in Palosi village near the vicinity of historical city of Peshawar. Relevant information was recorded on a questionnaire prepared in accordance with the objectives of the study. Results: Demographic information of a total of 5820 respondents, 2968 (50.99%) males and 2852 (49.01%) females were collected. Sixty percent of the population was adult, in the age range of 15-59 years and 20% were under five. Only 17.40% had qualified primary education or above. The major source of water supply was tube well (77.60%). Sanitation facilities available in hands were: flushes at home (29.60%), surface 55.8%, and open field 14.6%. Percentage of children fully immunized for polio, tuberculosis, diphtheria, tetanus and measles was 44.46%. Healthcare facilities available to the pregnant ladies were lady doctors 5.62%, trained birth attendant 45.62% and Dai 38.75%. Leading causes of morbidity and mortality were: infectious disease 37.26%, cardiovascular diseases 14.52%, pregnancy related causes and complications 7.12%, injuries 4.56%, neoplasm 3.01%; malnutrition disorders 18.08%, poisoning 0.82% and all other diseases 14.52%. Conclusion: The population of Palosi village comprises adult males and females in their reproductive ages. There is low literacy rate, improper water supply and sanitation facilities. Health care facilities in general and antenatal care to pregnant ladies are not up to the need of the respondents. Immunization coverage is lower because of their social taboos and religious concepts regarding utilization of these services. Key words: Palosi village, demographic variables, factors, Peshawar

According to the National Institute of Population Studies (NIPS), Pakistan's estimated population by year 2002 was 145.5 Million, with world ranking in sixth position. Our growth rate was 2.1% and population density of 166 persons per square kilometer. 32.52% comprised urban and the remaining were rural. The population distribution by age and sex was that 43.4% were in age less than 15 years of age, 53.09% between 15-64 years of age and 3.5% above 64 years of age. Population doubling time was 33 years and male to female ratio by 2002 was 108:100. Dramatic social changes have led to rapid urbanization and the emergence of mega-cities. During 1990-2003, Pakistan sustained its historical lead as the most urbanized nation in South Asia, with city dwellers making up 34% of its population1.

A study indicates that the areas that are backward in terms of economic development are also those with low levels of literacy. Rural areas of the province need the greatest attention. An encouraging sign is the general decline in disparities in literacy levels over time 2. Inadequate water and sanitation services adversely affect the health and socioeconomic development of communities. The Water and Sanitation Extension Programme (WASEP) project, was undertaken in selected villages in northern Pakistan between 1997 and 2001. It concluded that children not living in WASEP villages had a 33% higher adjusted odds ratio for having diarrhoea than children living in WASEP villages 3.

Availability of health care and emergency facilities does matter as it becomes a health emergency if it results in an unexpected risk to the health of people or the physical environment in which they live. In peripheral areas where when the magnitude of such an emergency is so severe that it is beyond the capabilities and resources of the local community to manage, it becomes a disaster 4. Vaccination profile of Pakistan shows that by year 2003, 82% of one-year-old children were immunized for tuberculosis, 67% for DPT3 (Diphtheria, tetanus and pneumonia), 69% for polio, 61% for measles. Data for children immunized for hepatitis B vaccine is not available 5. Gender inequality does matter in our part of the world. The prevalent belief is that in rural Pakistan, parents pay attention to feeding male children at the cost of female children 6.

The present study was also designed to study the demographic variables of the residents of Palosi village near the vicinity of Peshawar city.

A descriptive observational survey was conducted from November 2005 to August 2006 in Palosi village near the vicinity of the historical city of Peshawar.

A total of 500 houses were selected; demographic information was recorded for 5820 respondents; there was on average ten members per house, living in a conjoined family; 2968 (50.99%) males and 2852(49.01%) females.

Relevant information was recorded on a questionnaire prepared in accordance with the objectives of the study. The questionnaire contained information about age, sex, education, water supply, sanitation facilities, health care facilities in common, special care facilities for women in reproductive ages, leading causes of morbidity and mortality in the respondents, social status, cultural taboos, vaccination facilities and its utilization and housing conditions etc.

Female medical students were selected and they visited the village and filled out the questionnaire from the female respondents in the home. They collected the relevant information from the elders of the family there. Direct questions were asked and the answers were recorded on the questionnaires.

Inclusion criteria was that information should be obtained from the females only, so that correct information regarding , health care facilities in common, special care facilities for women in reproductive ages, leading causes of morbidity and mortality in the respondents, social status, cultural taboos, vaccination facilities and their utilization could be obtained.

Exclusion criteria were that thyey were not to include male respondents as they are often out of home and cannot give correct information for the above mentioned parameters that were selected to be recorded from all respondents that were interviewed.

Similarly data was collected on the provision of guaranteed consent from the interviewers that the information would not be disclosed to anybody and would be kept secret. Nobody was disturbed regarding getting information outside the residential area.
Finally data was analyzed in percentage values and was tabulated to obtain results for discussion.

1. Age range and Sex wise distribution of population of palosi village: Demographic information of 5820 respondents from 500 houses was collected regarding 2968 (50.99%) males and 2852 (49.01%) females. Sixty percent of the population was adult, in the age range of 15-59 years, 20% were under five and 3.98% were in their sixties or above. (Table 1 and 2).
   
2. Various demographic characteristics of the population: Only 17.40% had qualified primary education or above. Most of the people lived in mud made houses (78.63%). Source of water supply was tube well (77.60%), wells or under surface water (11.60%) etc. Sanitation facilities available to the respondents were: flushes at home (29.60%), surface 55.8%, and open field 14.6%. The majority of the respondents were from the lower social class with income less than 5000/month 53.6 %.(Table No 3).
   
3. Availability of health care facilities to the respondents: Percentage of children fully immunized for polio, tuberculosis, diphtheria, tetanus and measles was 44.46%. Healthcare facilities available to the pregnant ladies on site were lady doctors 5.62%, trained birth attendants 45.62%, Dai 38.75%, and relatives 10% (Table No 4).
   
4. Leading causes of morbidity and mortality in the study population of Palosi village: Distribution of leading causes of morbidity and mortality in the respondents were: infectious disease 37.26%, cardiovascular diseases 14.52%, pregnancy related causes and complications 7.12%, injuries 4.56%, neoplasm 3.01%; malnutrition disorders 18.08%, poisoning 0.82% and all other diseases 14.52% (Table No 5).
   

Pakistan launched one of the first population control programmes in the 1950s, yet has lagged far behind other countries in effectively implementing or developing its understanding of population programmes. A study concluded 7 that the conflicts in these areas are directly related to the larger policy context in which they have evolved, and without addressing the latter, the population programme will remain victim to deep-rooted structural problems. In our study we also observed that the population of the area studies comprises adult males and females in their reproductive ages which signifies a stress on the population growth and increasing population is not less than disaster. Depressive disorders are a serious public health concern in the low- and middle-income countries, predicted to become the most common cause of disability by the year 2020 8.

The present study comprised 2968 (50.99%) males and 2852 (49.01%) females. Findings in the areas like health, education and special services show a wide range of gender disparity. Various studies have shown that gender difference does matter in the delivery of health care services 9-11. In countries with large gender disparities, health status especially in the rural areas, and investments in local communities mitigate the gender bias observed in intra-household resource allocations 12.

Sources of water supply to the respondents were: tube well (77.60%), wells or under surface water (11.60%). The 21st century will open with one of the most fundamental conditions of human development unmet: universal access to basic water services. More than a billion people in the developing world lack safe drinking water 13. Another study reports a reduction in child mortality over the period 1986-96, attributed to clean water supply, good hygienic practices and education 14.

Families should be educated about public health measures such as improved ventilation in houses, hygienic practices, sanitary disposal of wastes after cleaning of the sewers, storage and boiling of water, and home management of diarrhoea. In the present study sanitation facilities available were: flushes at home (29.60%), surface 55.8%, and open field 14.6%. It is of utmost importance to design policies by developing the understanding of behaviours and health care utilization trends especially for sanitation and clean water supply at the district levels and to give enough credence to all the determinants in the background 15-16.

In our study the percentage of children fully immunized for polio, tuberculosis, diphtheria, tetanus and measles was 44.46%.To improve awareness and knowledge of mothers regarding vaccine preventable diseases and the immunization status of children under five, through health education messages, the Aga Khan University survey concluded that the health education messages significantly increased the vaccination status of children under 5 in the intervention area17. Again gender difference does matter. Girls have poorer access to health services than boys: in Bombay boys have immunization rates 16% higher than girls 18.

We observed that health care facilities in general and antenatal care to pregnant ladies are not up to the need of the respondents. An estimated 400,000 infant and 16,500 maternal deaths occur annually in Pakistan. These translate into an infant mortality rate and maternal mortality ratio that should be unacceptable to any state. Disease states including communicable diseases and reproductive health (RH) problems, which are largely preventable account for over 50% of the disease burden 19. Maternal mortality, infant mortality and neonatal mortality are high in Pakistan where maternal health services depend upon traditional birth attendants (TBAs) 20 and the same belief was observed in the present study as well. The leading causes of morbidity and mortality in our study were communicable infectious diseases and cardiovascular diseases. . Within this context the NGO Heartfile has worked to bring about changes at a health policy and systems level through creation of a policy-level institutional mechanism for systems strengthening and a national health reform agenda based on systems strengthening and an intersectoral approach to health21.

Population of Palosi village comprises adult males and females in their reproductive ages. There is a low literacy rate, improper water supply and sanitation facilities. Health care facilities in general and antenatal care to pregnant ladies are not up to the need of the respondents. Immunization coverage is lower because of their social taboos and religious concepts regarding utilization of these services.

1. National institute of population studies, National institute of population studies Report, 2002. Population characteristics, Islamabad, NIPS, 2002: Annex Table 1.1.
   
2. Husain F, Qasim MA. Inequality in the Literacy Levels in Pakistan. South Asia Economic Journal 2005; 6(2):251-264.
   
3. Nanam D, White F, Azam I, Afsar H. Hozhabri S. Evaluation of a water, sanitation, and hygiene education intervention on diarrhoea in northern Pakistan. Bull World Health Organ. 2003; 81(3):160-5.
   
4. World Health Organization (WHO). WHO action in emergencies and disasters (WHO manual part XV, section 4). Geneva, World Health Organization, 1981.
   
5. United Nation Child Fund (UNICEF) reports 2005. The state of the world children. Childhood under threat. New York, UNICEF, 2005: 104-45.
   
6. Shah SM, Selwyn BJ, Luby S, Rashida A. Prevalence and correlates of stunting among children in rural Pakistan. Pediatrics International,2003; 45 (1): 49-53.
   
7. Shaikh BT, Hatcher J.Complementary and alternative medicine in Pakistan: Prospects and Limitations. Evid. Based Complement. Altern. Med 2005; 2: 139 - 142.
   
8. Mirza I, Jenkins R. (Risk factors, prevalence, and treatment of anxiety and depressive disorders in Pakistan: systematic review. BMJ, 2004; 328:794.
   
9. Baig-Ansari N, Rahbar MH, Bhutta ZA, Badruddin SH. Child's gender and household food insecurity are associated with stunting among young Pakistani children residing in urban squatter settlements. Food Nutr Bull. 2006; 27(2):114-27.
   
10. Jahan F, Qureshi R, Borhany T, Hamza HB. Metabolic syndrome: frequency and gender differences at an out - patient clinic. J Coll Physicians Surg Pak. 2007 Jan;17(1):32-5.
    
11. Ahmad K, Jafar TH, Chaturvedi N. Self-rated health in Pakistan: results of a national health survey. BMC Public Health. 2005; 5(1):51.
    
12. Holms J. Do community factors have a differential impact on the health outcomes of boys and girls? Evidence from rural Pakistan. Health Policy Plan. 2006; 21(3):231-40.
    
13. United Nations (1986). Declaration on the right to development, adopted by General Assembly resolution 41/128, New York, 4December 1986.
    
14. Northrop-Clewes CA, Ahmad N, Paracha PI, Thurnham DI. Impact of health service provision on mothers and infants in a rural village in North West Frontier Province, Pakistan. Public Health Nutr. 1998 ;1:51-9.
    
15. Shaikh BT, Hatcher J. Health seeking behaviour and health service utilization in Pakistan: challenging the policy makers. Public Health (Oxford) 2005; 27:49-54.
    
16. United Nations Development Programme. 2005 Human Development Report. International cooperation at a crossroads: Aid, trade and security in an unequal world. New York: 2005.
    
17. Anjum Q, Omair A, Inam Sn, Ahmed Y, Usman Y, Shaikh S. Improving vaccination status of children under five through health education J Pak Med Assoc, 2004; 54(12): 610-3.
    
18. Carbonu DM, Hashwani S, Badruddin G, Marshall P, Fazal S. All hands against polio. World Health Forum, 1998;19(2):188-91.
    
19. Siddiqi S, Haq IU, Ghaffar A, Akhtar T, Mahaini R. Pakistan's maternal and child health policy: analysis, lessons and the way forward. Health Policy, 2004; 69(1):117-30.
    
20. Fatmi Z, Gulzar AZ, Kazi A. Maternal and newborn care: practices and beliefs of traditional birth attendants in Sindh, Pakistan. East Mediterr Health J. 2005; 11(1-2):226-34.
    
21. Nishtar s. Heartfile's contribution to health systems strengthening in Pakistan.
    East Mediterr Health J. 2006; 12:S38-53.